Shannon E. Whaley

Characterizing interactions between anxious mothers and their children.

The present study assessed interactions between anxious mothers and their children, using observational techniques to elucidate potential mechanisms of anxiety transmission. Results revealed that anxious mothers were less warm and positive in their interactions with their children, less granting of autonomy, and more critical and catastrophizing in comparison with normal control mothers. Maternal anxiety status appeared to be the primary predictor of maternal warmth during interactions. Child anxiety status was most predictive of maternal granting of autonomy behavior. Maternal behaviors exhibited during interactions were the most salient predictors of child anxiety, contributing more than maternal psychopathology or ongoing strain to the development of child anxiety. Interventions focusing on family interactions that take into account the contributions of both members of the dyad may be more effective in curbing transmission than interventions that solely address maternal or child symptomatology.

Interactions between mothers and children: impacts of maternal and child anxiety.

This study, an expansion of an earlier study of parenting behaviors of anxious mothers, examined the relationship of both mother and child anxiety disorders to mother behavior in parent--child interactions. Participants were 68 mother--child dyads with children ranging in age from 7 to 15 years. Mothers and children completed diagnostic evaluations and engaged in conversational tasks; behaviors were rated by coders who were blind to diagnosis. Mothers of anxious children, regardless of their own anxiety, were less warm (p <.05) toward their children. They also granted less autonomy (p <.01). There was an interaction between mother and child anxiety in predicting maternal catastrophizing (p <.01), with anxious mothers and nonanxious mothers of anxious children likely to catastrophize. Theoretical and research implications are discussed.

Animal Source Foods Improve Dietary Quality, Micronutrient Status, Growth and Cognitive Function in Kenyan School Children: Background, Study Design and Baseline Findings

A previous longitudinal three-country study in Egypt, Kenya and Mexico found significant positive associations between intake of animal source foods (ASF) and growth, cognitive development and physical activity. To test for a causal relationship, a controlled school feeding intervention study was designed to test the hypotheses that ASF would improve micronutrient status, growth and cognitive function in Kenyan primary school children. Twelve rural Kenyan schools with 554 children were randomized to four feeding interventions using a local vegetable stew as the vehicle. The groups were designated as Meat, Milk, Energy and Control, who received no feedings. Feeding was carried out on school days for seven terms during 21 mo. Preintervention baseline measures included nutritional status, home food intake, anthropometry, biochemical measures of micronutrient status, malaria, intestinal parasites, health status and cognitive and behavioral measures. The measurements of each child were repeated at intervals over 2 y. Baseline data revealed stunting and underweight in approximately 30% of children and widespread inadequate intakes and/or biochemical evidence of micronutrient deficiencies, particularly of iron, zinc, vitamins A and B-12, riboflavin and calcium. Little or no ASF were eaten and fat intake was low. Malaria was present in 31% of children, and hookworm, amebiasis and giardia were widely prevalent. The outcomes measured were rates of change or increase during the intervention in cognitive function, growth, physical activity and behavior and micronutrient status. Hierarchical linear random effects modeling was used for analysis of outcomes.

Brief Intervention for Alcohol Use by Pregnant Women

OBJECTIVES We examined the efficacy of brief intervention as a technique to help pregnant women achieve abstinence from alcohol. A second aim was to assess newborn outcomes as a function of brief intervention. METHODS Two hundred fifty-five pregnant women who were participants in the Public Health Foundation Enterprises Management Solutions Special Supplemental Nutrition Program for Women, Infants, and Children and who reported drinking alcohol were assigned to an assessment-only or a brief intervention condition and followed to their third trimester of pregnancy. Brief intervention consisted of 10- to 15-minute sessions of counseling by a nutritionist, who used a scripted manual to guide the intervention. Newborn outcomes of gestation, birth-weight, birth length, and viability were assessed. RESULTS Women in the brief intervention condition were 5 times more likely to report abstinence after intervention compared with women in the assessment-only condition. Newborns whose mothers received brief intervention had higher birthweights and birth lengths, and fetal mortality rates were 3 times lower (0.9%) compared with newborns in the assessment-only (2.9%) condition. CONCLUSIONS The success of brief intervention conducted in a community setting by nonmedical professionals has significant implications for national public health policies.

The Impact of Dietary Intervention on the Cognitive Development of Kenyan School Children

Previous observational studies in developing countries have suggested that diet quality, particularly increased animal source food (ASF) consumption, is positively associated with child cognitive development. This report presents findings from a study in rural Kenya, designed to test the impact of three different diets on the cognitive development of school children. Twelve schools with a total of 555 Standard 1 children (equivalent to U.S. Grade 1) were randomized to one of four feeding interventions: Meat, Milk, Energy or Control (no feeding). Feeding continued for seven school terms (21 mo), and cognitive tests were administered before the commencement of feeding and during every other term of feeding. Hierarchical linear random effects models and associated methods were used to examine the effects of treatment group on changes in cognitive performance over time. Analyses revealed that children receiving supplemental food with meat significantly outperformed all other children on the Ravens Progressive Matrices. Children supplemented with meat, and children supplemented with energy, outperformed children in the Control group on tests of arithmetic ability. There were no group differences on tests of verbal comprehension. Results suggest that supplementation with animal source food has positive effects on Kenyan childrens cognitive performance. However, these effects are not equivalent across all domains of cognitive functioning, nor did different forms of animal source foods produce the same beneficial effects. Implications of these findings for supplementation programs in developing countries are discussed.

Revised WIC food package improves diets of WIC families.

OBJECTIVE To explore the impact of the new Special Supplemental Nutrition Program for Women, Infants and Children (WIC) food package on WIC participant consumption of fruit, vegetables, whole-grain food, and lower-fat milk. DESIGN Telephone surveys of cross-sectional samples of California WIC families before and after the changes to the food package. PARTICIPANTS Random samples of pregnant or postpartum women and/or caregivers of children enrolled in WIC: 3,004 in September, 2009; 2,996 in March, 2010. MAIN OUTCOME MEASURES Consumption of fruit, vegetables, whole-grain food, and lower-fat milk. ANALYSIS Comparisons of outcome variables were made by examining the differences by time point, adjusted for sociodemographic variables, using ANOVA (for means) or logistic regression (for percentages). RESULTS Following the changes to the WIC food package, consumption of whole-grain food increased by 17.3 percentage points, a 51% increase over baseline. Caregivers and children who usually consumed whole milk decreased by 15.7 and 19.7 percentage points, respectively, a 60%-63% reduction over baseline. Accompanying increases in lower-fat milk consumption were demonstrated. Small but significant increases in consumption of fruits and vegetables were also observed. CONCLUSIONS AND IMPLICATIONS Federal policy changes to the WIC program had the intended effect of increasing consumption of the prescribed food items.

Favorable Impact of Nutrition Education on California WIC Families

OBJECTIVE To explore the impact of coordinated statewide nutrition education on Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) family behavior regarding fruits and vegetables, whole grains, and lower-fat milk. DESIGN Survey of different cross-sectional samples of WIC families before and after education. SETTING Intervention delivered at all WIC sites in California from April-September 2009. PARTICIPANTS Random samples of pregnant or postpartum women and/or caregivers of children enrolled in WIC: 3,015 before and 3,004 after coordinated nutrition education. INTERVENTION Education directed at families to eat more, and a greater variety of, fruits and vegetables; eat more whole grains; and drink lower-fat milk instead of whole milk. MAIN OUTCOME MEASURES Data collected by phone interview of women and caregivers on recognition of education messages, intention to consume, and change in family consumption of target food items. ANALYSIS Means and frequencies computed. Chi-square and t tests used to compare responses before and after education and for Spanish and English subgroups. RESULTS Following nutrition education, women and caregivers reported increased recognition of education messages, positive movement in stage of change for target food items, increased family consumption of fruits and whole grains, and replacement of whole milk with lower-fat milk. Impacts were similar for Spanish and English speakers. CONCLUSIONS AND IMPLICATIONS Coordinated nutrition education in WIC can significantly influence consumption toward more healthful food choices.

Effects of breastfeeding and low sugar-sweetened beverage intake on obesity prevalence in Hispanic toddlers

BACKGROUND Few studies have examined the independent and additive effects of breastfeeding (BF) and sugar-sweetened beverage (SSB) intake in early life on overweight and obesity prevalence. OBJECTIVE The objective was to assess the effects of BF and SSB intake on the prevalence of overweight and obesity in Hispanic toddlers. DESIGN Nutrition data were collected via phone surveys with caregivers of 1483 Hispanic children (2-4 y of age) from the Los Angeles County Women, Infants, and Children (WIC) program. BF history at 2-4 y of age was categorized as follows: no BF, >1 wk to <6 mo BF, 6 to <12 mo BF, and ≥12 mo BF. SSB intake at 2-4 y of age was categorized as follows: high SSB (≥2 SSBs/d), mid SSB (1 SSB/d), and no SSB. The height and weight of the children were measured by WIC staff and stored in the Integrated Statewide Information System. Binary logistic regressions assessed the effects of BF and SSB categories on overweight and obesity prevalence. RESULTS In comparison with the no-BF participants, the odds of obesity were lower in the ≥12-mo-BF participants (OR: 0.55; 95% CI: 0.37, 0.83; P = 0.004). In comparison with high-SSB participants, the odds of obesity were lower in the no-SSB participants (OR: 0.69; 95% CI: 0.47, 1.00; P = 0.047). In comparison with the combined no-BF/high-SSB participants, the odds of obesity were lower in the ≥12-mo BF/no-SSB participants (OR: 0.39; 95% CI: 0.19, 0.80; P = 0.01). CONCLUSION The results suggest that BF for ≥1 y and low SSB intake during the toddler years can have profound effects on reducing the prevalence of obesity in Hispanic toddlers.

Dietary micronutrients are associated with higher cognitive function gains among primary school children in rural Kenya.

With the exception of iodine and Fe, there is still very limited information on the effect of micronutrients on cognitive function, especially among school-age children. The present analysis evaluates the relationship between dietary Fe, Zn and B vitamins (B12, B6, folate and riboflavin) and gains in cognitive test scores among school children in rural Kenya. Data for the present study were obtained from The Child Nutrition Kenya Project, a 2-year longitudinal, randomised controlled feeding intervention study using animal source foods. Dietary nutrient values were based on monthly and bimonthly 24 h recall data collected during the study period. In longitudinal regression analyses, available Fe, available Zn, vitamin B12 and riboflavin showed significant relationships with improved cognitive test scores, after controlling for confounders such as energy intake, school, socio-economic status and morbidity. Available Fe intake was associated with significantly higher gains in Ravens Coloured Progressive Matrices test scores over time. Available Zn intake was associated with significantly higher gains in digit span-total test scores over time, while vitamin B12 and riboflavin intakes were each associated with significantly higher gains in digit span-forward test scores over time. This analysis demonstrates the influence of improved dietary micronutrient status on school childrens cognitive function.

Participation in the Child and Adult Care Food Program Is Associated with More Nutritious Foods and Beverages in Child Care

BACKGROUND Nearly two million California children regularly spend time in child care. Surprisingly little is known about the nutrition environments of these settings. The aim of this study was to compare foods and beverages served to 2- to 5-year-olds by type of child care and participation in the federally funded Child and Adult Care Food Program (CACFP). METHODS A statewide survey of child care providers (n = 429) was administered. Licensed child care was divided into six categories: Head Start centers, state preschools, centers that participate in CACFP, non-CACFP centers, homes that participate in CACFP, and non-CACFP homes. RESULTS CACFP sites in general, and Head Start centers in particular, served more fruits, vegetables, milk, and meat/meat alternatives, and fewer sweetened beverages and other sweets and snack-type items than non-CACFP sites. Reported barriers to providing nutritious foods included high food costs and lack of training. CONCLUSIONS CACFP participation may be one means by which reimbursement for food can be increased and food offerings improved. Further research should investigate whether promoting CACFP participation can be used to provide healthier nutrition environments in child care and prevent obesity in young children.