Rebecca Kehm

The Role of Family and Community Involvement in the Development and Implementation of School Nutrition and Physical Activity Policy

BACKGROUND Although there are several evidence-based recommendations directed at improving nutrition and physical activity standards in schools, these guidelines have not been uniformly adopted throughout the United States. Consequently, research is needed to identify facilitators promoting schools to implement these recommendations. Therefore, this study analyzed the 2008 School Health Profiles Principal Survey (Profiles) to explore the role of family and community involvement in school nutrition and physical activity standards. METHODS Survey data on nutrition and physical activity policies, as well as family and community involvement, were available for 28 states, representing 6732 secondary schools. One-factor analysis of variance (ANOVA), 2-sample t-tests, Pearsons chi-square tests, and multiple logistic and linear regression models were employed in this analysis. RESULTS Family and community involvement were associated with schools more frequently utilizing healthy eating strategies and offering students healthier food options. Further, involvement was associated with greater support for physical education staff and more intramural sports opportunities for students. CONCLUSIONS Though family and community involvement have the potential to have a positive influence on school nutrition and physical activity policies and practices, involvement remains low in schools. Increased efforts are needed to encourage collaboration among schools, families, and communities to ensure the highest health standards for all students.

Taking Steps Together: A Family- and Community-Based Obesity Intervention for Urban, Multiethnic Children.

Objectives. Successful childhood obesity intervention models that build sustainable behavioral change are needed, particularly in low-income, ethnic minority communities disparately affected by this problem. Method. Families were referred to Taking Steps Together (TST) by their primary care provider if at least one child had a body mass index ≥85%. The TST intervention comprised 16 weekly 2-hour classes including educational activities, group cooking/eating, and physical activities for parents and children. TST’s approach emphasized building self-efficacy, targeting both children and parents for healthy change, and fostering intrinsic motivation for healthier living. Pre–post intervention data were collected on health-related behaviors using a survey, and trained staff measured weight and height. Results. Adults (n = 33) and children (n = 62) were largely Hispanic/Latino and low-income. Adults and children significantly increased their fruit and vegetable consumption and weekly physical activity, and adults significantly decreased sugared beverage consumption and screen time. No change in body mass index was observed for adults or children. Conclusions. This family-focused childhood obesity intervention integrated evidence-based principles with a nonprescriptive approach and produced significant improvements in key healthy behaviors for both adults and children.

Where We Used to Live: Validating Retrospective Measures of Childhood Neighborhood Context for Life Course Epidemiologic Studies

Early life exposures influence numerous social determinants of health, as distal causes or confounders of later health outcomes. Although a growing literature is documenting how early life socioeconomic position affects later life health, few epidemiologic studies have tested measures for operationalizing early life neighborhood context, or examined their effects on later life health. In the Life-course Influences on Fetal Environments (LIFE) Study, a retrospective cohort study among Black women in Southfield, Michigan (71% response rate), we tested the validity and reliability of retrospectively-reported survey-based subjective measures of early life neighborhood context(N=693). We compared 3 subjective childhood neighborhood measures (disorder, informal social control, victimization), with 3 objective childhood neighborhood measures derived from 4 decades of historical census tract data 1970-2000, linked through geocoded residential histories (tract % poverty, tract % black, tract deprivation score derived from principal components analysis), as well as with 2 subjective neighborhood measures in adulthood. Our results documented that internal consistency reliability was high for the subjective childhood neighborhood scales (Cronbach’s α =0.89, 0.93). Comparison of subjective with objective childhood neighborhood measures found moderate associations in hypothesized directions. Associations with objective variables were strongest for neighborhood disorder (rhos=.40), as opposed to with social control or victimization. Associations between subjective neighborhood context in childhood versus adulthood were moderate and stronger for residentially-stable populations. We lastly formally tested for, but found little evidence of, recall bias of the retrospective subjective reports of childhood context. These results provide evidence that retrospective reports of subjective neighborhood context may be a cost-effective, valid, and reliable method to operationalize early life context for health studies.

Increasing fruit and vegetable consumption and offerings to Somali children: the FAV-S pilot study.

Objective: To determine the feasibility, acceptability, and impact of a parent-centered intervention to increase fruit and vegetable servings and consumption among Somali children living in the United States. Design: Pilot intervention that included Somali community health workers who organized groups of 3 or 4 women to participate in 2 initial educational sessions, including topics of health and nutrition, serving size, and label reading. A third session taught interactive cooking to increase skills in preparing fruits and vegetables and increasing the numbers of vegetables included in traditional Somali dishes. The final session was a trip to the grocery store to identify fruits and vegetables, determine ripeness, and explore frozen and canned fruits and vegetables for halal, low-sodium, and low-sugar products. Surveys were completed pre- and post-intervention. Setting: Study participants were recruited from a large housing complex in Minneapolis, Minnesota, with a high population of Somali immigrants. Participants: Somali women (N = 25) with children aged 3 to 10 years. Results: The intervention was feasible and well accepted. In comparing pre- and post-intervention surveys, mothers reported providing their children significantly more frequent servings of fruits and vegetables at dinner, lunch, snack, and breakfast (vegetable only). There was a statistically significant increase in parent-reported intake of fruits and vegetables for themselves and their children. Conclusion: The FAV-S study was feasible and acceptable, and it demonstrated potential for increasing fruit and vegetable servings and consumption among Somali children. A larger-scale randomized trial is needed to assess the impact of this intervention.

Life-course Social Mobility and Reduced Risk of Adverse Birth Outcomes

INTRODUCTION Higher adult socioeconomic position (SEP) is associated with better birth outcomes. However, few studies incorporate life-course or intergenerational SEP, which may inform etiology and targeted prevention efforts. This study tested whether life-course social mobility from childhood was associated with lower risk of adverse birth outcomes. METHODS Data were from the Life-course Influences of Fetal Environments (LIFE) retrospective cohort study among black women, 2009-2011, in metropolitan Detroit, MI. This study (analyzed in 2014-2016) examined whether social mobility was associated with two primary birth outcomes: small for gestational age (SGA) and preterm birth (PTB). Childhood and adulthood SEP were measured by survey in adulthood, for two constructs, measured ordinally: educational attainment and perceived financial sufficiency (subjective income/wealth). Social mobility was calculated as the difference of adulthood minus childhood SEP. RESULTS In covariate-adjusted Poisson regression models, 1-SD improved educational social mobility from childhood to adulthood was protective for SGA (adjusted risk ratio=0.76; 95% CI=0.64, 0.91); this association remained after adjusting for financial mobility. Upward financial social mobility from early childhood was marginally protective for SGA (adjusted risk ratio=0.85; 95% CI=0.72, 1.02), but became nonsignificant after controlling educational mobility. There were no overall associations of social mobility with PTB or low birth weight, although sensitivity analyses identified that improved financial mobility was associated with 16% marginally lower risk of spontaneous PTB and 28% marginally lower risk of low birth weight among upwardly mobile/stable women only. CONCLUSIONS Improved life-course social mobility is associated with reduced risk for SGA and spontaneous PTB among black women.

Socioeconomic Status and Childhood Cancer Incidence: A Population-Based Multilevel Analysis

Abstract The etiology of childhood cancers remains largely unknown, especially regarding environmental and behavioral risk factors. Unpacking the association between socioeconomic status (SES) and incidence may offer insight into such etiology. We tested associations between SES and childhood cancer incidence in a population‐based case‐cohort study (source cohort: Minnesota birth registry, 1989‐2014). Cases, ages 0‐14 years, were linked from the Minnesota Cancer Surveillance System to birth records through probabilistic record linkage. Controls were 4:1 frequency matched on birth year (2,947 cases and 11,907 controls). We tested associations of individual‐level (maternal education) and neighborhood‐level (census tract composite index) SES using logistic mixed models. In crude models, maternal education was positively associated with incidence of acute lymphoblastic leukemia (odds ratio (OR) = 1.10, 95% confidence interval (CI): 1.02, 1.19), central nervous system tumors (OR = 1.12, 95% CI: 1.04, 1.21), and neuroblastoma (OR = 1.15, 95% CI: 1.02, 1.30). Adjustment for established risk factors—including race/ethnicity, maternal age, and birth weight—substantially attenuated these positive associations. Similar patterns were observed for neighborhood‐level SES. Conversely, higher maternal education was inversely associated with hepatoblastoma incidence (adjusted OR = 0.70, 95% CI: 0.51, 0.98). Overall, beyond the social patterning of established demographic and pregnancy‐related exposures, SES is not strongly associated with childhood cancer incidence.

The FAV-S Pilot Study: Increasing Self-Efficacy and Fruit and Vegetable Intake Among Somali Women and Children

The 2012 FAV-S pilot study was developed as a dietary intervention program for low-income Somali mothers grounded in the health belief model. The intervention was geared toward increasing fruit and vegetable intake among participants’ children. The purpose of this analysis was to determine the impact of the FAV-S program on participants’ (1) self-efficacy in ability to serve more fruits and vegetables, (2) knowledge and beliefs about healthy eating, and (3) perceived barriers to accessing healthy foods. Furthermore, this study assessed change in fruit and vegetable intake among participants and their children. The intervention consisted of two small group education sessions addressing nutrition, serving size, and label reading; a cooking session incorporating fruits and vegetables into traditional Somali dishes; and a grocery store session demonstrating best purchasing practices. Self-efficacy, knowledge and beliefs, and perceived barriers were assessed via surveys administered verbally in Somali pre- and postintervention. Paired t tests were used to compare pre- and postintervention survey responses. Twenty-five women participated in the pilot study; mean age was 43.6 years (SD = 12.4). Self-efficacy significantly increased among participants postintervention (p = .01), though there were no significant changes in knowledge and beliefs or perceived barriers. Following intervention, daily servings of fruits and vegetables significantly increased among both women and children (p = .01 to p < .01). Findings suggest that a multistage, culturally tailored, approach is effective at increasing self-efficacy and fruit and vegetable intake in the Somali community. Continued and expanded research is needed to further develop culturally focused dietary interventions.

A Comparison of the Vending Environment Among Three Rural Subtypes of Secondary Schools

ABSTRACT The purpose of this study was to further explore the rural school food environment. This study assessed trends in prevalence of vending machines and vending items within and between Minnesota schools located in 3 rural subtypes: town/rural fringe, town/rural distant, and remote rural. Generalized estimating equation models were employed to analyze data from the 2006 through 2012 School Health Profiles Principal’s Surveys (Profiles). All 3 rural subtypes had a statistically significant decrease in the prevalence of low nutrient energy dense (LNED) vending items between 2006 and 2012, with the exception of sports drinks. However, different vending practices were observed between rural subtypes, with town/rural fringe schools providing more LNED vending options and experiencing less positive change over time compared to town/rural distant and remote rural schools. Differences in vending machine practices emerge when rural schools are subtyped.

Does Socioeconomic Status Account for Racial and Ethnic Disparities in Childhood Cancer Survival?: Mediation of Childhood Cancer Survival

For many childhood cancers, survival is lower among non‐Hispanic blacks and Hispanics in comparison with non‐Hispanic whites, and this may be attributed to underlying socioeconomic factors. However, prior childhood cancer survival studies have not formally tested for mediation by socioeconomic status (SES). This study applied mediation methods to quantify the role of SES in racial/ethnic differences in childhood cancer survival.

Do pregnancy characteristics contribute to rising childhood cancer incidence rates in the United States

Since 1975, childhood cancer incidence rates have gradually increased in the United States; however, few studies have conducted analyses across time to unpack this temporal rise. The aim of this study was to test the hypothesis that increasing cancer incidence rates are due to secular trends in pregnancy characteristics that are established risk factors for childhood cancer incidence including older maternal age, higher birthweight, and lower birth order. We also considered temporal trends in sociodemographic characteristics including race/ethnicity and poverty.