Early intervention of multiple home visits to prevent childhood obesity in a disadvantaged population: a home-based randomised controlled trial (Healthy Beginnings Trial)

Background  

Studies have shown that a proportion of children as young as two years are already overweight. This indicates that obesity prevention programs that commence as early as possible and are family-focused are needed. This Healthy Beginnings Trial aims to determine the efficacy of a community-based randomized controlled trial (RCT) of a home visiting intervention in preventing the early onset of childhood overweight and obesity. The intervention will be conducted over the first two years of life to increase healthy feeding behaviours and physical activity, decrease physical inactivity, enhance parent-child interaction, and hence reduce overweight and obesity among children at 2 and 5 years of age in the most socially and economically disadvantaged areas of Sydney, Australia.     

Parents' dietary patterns are significantly correlated: findings from the Melbourne Infant Feeding Activity and Nutrition Trial Program

The objectives of the present study were to identify dietary patterns independently in first-time mothers and fathers, and to examine whether these patterns were correlated within families. Dietary intakes were collected at baseline in the Melbourne Infant Feeding Activity and Nutrition Trial Program using a validated FFQ in 454 pairs of first-time mothers and fathers. Education level was reported in associated questionnaires. Principal components analyses included frequencies of fifty-five food groups and were performed independently in mothers and fathers. Spearman's correlation coefficients were used to assess associations between dietary pattern scores. A total of four dietary patterns were identified in mothers and fathers. Of these, three dietary patterns had similar characteristics between these two populations, namely 'Fruits and vegetables', 'High-energy snack and processed foods', 'High-fat foods' in mothers; and 'Fruits', 'High-energy snack and processed foods', 'High-fat foods' in fathers. The following two additional patterns were identified: 'Cereals and sweet foods' in mothers and 'Potatoes and vegetables' in fathers. Patterns incorporating healthier food items were found to be positively associated with parent education. An inverse association with education was found for the 'High-fat foods' and 'High-energy snack and processed foods' dietary patterns. Qualitatively similar patterns between corresponding mothers and fathers were the most strongly correlated (ρ?=?0·34-0·45, P?相似文献   

CHILE: Outcomes of a group randomized controlled trial of an intervention to prevent obesity in preschool Hispanic and American Indian children

ObjectiveWe examined the outcomes of the Child Health Initiative for Lifelong Eating and Exercise (CHILE) study, a group randomized controlled trial to design, implement, and test the efficacy of a trans-community intervention to prevent obesity in children enrolled in Head Start centers in rural American Indian and Hispanic communities in New Mexico.MethodsCHILE was a 5-year evidence-based intervention that used a socioecological approach to improving dietary intake and increasing physical activity of 1898 children. The intervention included a classroom curriculum, teacher and food service training, family engagement, grocery store participation, and healthcare provider support. Height and weight measurements were obtained four times (fall of 2008, spring and fall of 2009, and spring of 2010), and body mass index (BMI) z-scores in the intervention and comparison groups were compared.ResultsAt baseline, demographic characteristics in the comparison and intervention groups were similar, and 33% of all the children assessed were obese or overweight. At the end of the intervention, there was no significant difference between the two groups in BMI z-scores.ConclusionsObesity prevention research among Hispanic and AI preschool children in rural communities is challenging and complex. Although the CHILE intervention was implemented successfully, changes in overweight and obesity may take longer than 2 years to achieve.     

Prevention through Activity in Kindergarten Trial (PAKT): A cluster randomised controlled trial to assess the effects of an activity intervention in preschool children

Background  

Physical activity and motor skills acquisition are of high importance for health-related prevention and a normal development in childhood. However, few intervention studies exist in preschool children focussing on an increase in physical activity and motor skills. Proof of positive effects is available but not consistent.     

Workplace exercise intervention to prevent depression: A pilot randomized controlled trial

ObjectiveThis study evaluates whether it is feasible to deliver an exercise program to inactive employees with minimal symptoms of depression, and the size of effects on the mental and physical health of employees.MethodIn the fall of 2008, 30 white-collar employees with minimal symptoms of depression (5 ≤ PHQ-9 ≤ 9) were randomly assigned to a 10-week in-company fitness program with two supervised training sessions per week or to a control group. Demographics, depression scores, and exercise behavior were determined by questionnaire, physical health variables were measured and company records were checked to calculate sickness absence data. Participants were measured at baseline and 10 weeks after (post-test).ResultsANCOVA showed that the difference between the groups on the average change in depression from baseline to post-test approached significance. Eighty-six percent of the participants in the exercise group were below the cut-off point for experiencing minimal symptoms of depression, compared with 31% of the control participants. Most physical measures improved significantly from baseline to post-test in the exercise group compared to the control group. The difference between the groups on average change in sickness absence was not significant.ConclusionsThis intervention was feasible and shows that exercise can reduce the risk of depression in employees with sedentary jobs, an inactive lifestyle, and a high-risk of depression. A large randomized controlled trial with a long-term follow-up is needed to establish the effectiveness and cost-effectiveness of exercise in the prevention of depression in a workplace setting.     

Physical activity to prevent obesity in young children: cluster randomised controlled trial

Physical activity to prevent obesity in young children: cluster randomised controlled trial . Reilly , J. J. , Kelly , L. , Montgomery , C. , Williamson , A. , Fisher , A. , McColl , J. H. , Lo Conte , R. , Paton , J. Y. & Grant , S. ( 2006 ) British Medical Journal , 333 , 1041 DOI: 10.1136/bmj.38979.623773.55.     

Universal parenting programme to prevent early childhood behavioural problems: cluster randomized trial

Universal parenting programme to prevent early childhood behavioural problems: cluster randomized trial .
Hiscock H. , Bayer J.K. , Price A. , Ukuomunne O.C. , Rogers S. , Wake M ( 2008 ) BMJ , 336 , 318 – 321 .
DOI: 10.1136/bmj.39451.609676.AE.     

Effects of early childhood intervention on fertility and maternal employment: Evidence from a randomized controlled trial

This paper presents the results of a randomized study of a home visiting program implemented in Germany for low-income, first-time mothers. Besides improving child health and development, a major goal of the program is to improve the participants’ economic self-sufficiency and family planning. I use administrative data from the German social security system and detailed telephone surveys to examine the effects of the intervention on maternal employment, welfare benefits, household composition, well-being, and fertility behavior. The study reveals that the intervention decreased maternal employment by 9.3 percentage points and increased subsequent births by 6.4 percentage points, in part through a reduction in abortions.     

ENTREN-F family-system based intervention for managing childhood obesity: Study protocol for a randomized controlled trial at primary care

BackgroundPediatric obesity is a primary public health concern, and designing effective programs for managing it is of the utmost importance. The objective of this study was to describe the protocol study of a three-arm, parallel, randomized controlled trial aimed at assessing the efficacy of a family-system-based intervention (“ENTREN-F” program) for managing childhood obesity, compared to the “ENTREN” program (no “F” - without specific family-system-based workshop) and a control group (behavioral monitoring).Methods/designThe ENTREN-F program was a multicomponent family-system-based intervention carried out by a multidisciplinary team in the primary health care setting. The program targeted children between 8 and 12 years with overweight and obesity (P ≥ 85th). Parents were actively involved in the process. The contents were designed using the Cognitive Behavioral Therapy (CBT) principles. The program comprised individual behavioral monitoring, a healthy habits workshop for children and their parents, a CBT workshop for children, and a family-system-based workshop for parents, enhancing parental management skills plus family functioning. The trial’s primary outcomes included changes in child body mass index (BMI) z-scores, child’s psychological well-being, and family functioning over six months. Secondary outcomes included changes in eating behavior, physical activity, self-esteem, parental distress, parental feeding practices, and parental modeling.DiscussionTo our knowledge, this is one of the few randomized controlled trials to assess the efficacy of a multicomponent program that considers health from a comprehensive perspective, trying to improve children’s psychological well-being and family functioning besides weight loss. This study, therefore, addresses a gap in the literature. If found to be efficacious, it suggests a new potential health service for translation into National Primary Health Care services in Spain, one of the ten countries with the highest prevalence of obesity in Europe.     

Addressing logistical barriers to childhood vaccination using an automated reminder system and online resource intervention: A randomized controlled trial

BackgroundAs the rates of vaccination decline in children with logistical barriers to vaccination, new strategies to increase vaccination are needed. The goal of this study was to develop and evaluate the effectiveness of the Vaccines For Babies (VFB) intervention, an automated reminder system with online resources to address logistical barriers to vaccination in caregivers of children enrolled in an integrated healthcare system. Effectiveness was evaluated in a randomized controlled trial.MethodsQualitative interviews were conducted with parents of children less than two years old to identify logistical barriers to vaccination that were used to develop the VFB intervention. VFB included automated reminders to schedule the 6- and 12-month vaccine visit linking caregivers to resources to address logistic barriers, sent to the preferred mode of outreach (text, email, and/or phone). Parents of children between 3 and 10 months of age with indicators of logistical barriers to vaccination were randomized to receive VFB or usual well child care (UC). The primary outcome was percentage of days undervaccinated at 2 years of life. A difference in differences analysis was conducted.ResultsQualitative interviews with 6 parents of children less than 2 years of age identified transportation, scheduling challenges, and knowledge of vaccine timing as logistical barriers to vaccination. We enrolled 250 participants in the trial, 45% were loss to follow-up. There were no significant differences in vaccination uptake between those enrolled in UC or the VFB intervention (0.51%, p = 0.86). In Medicaid enrolled participants, there was a modest decrease in percentage of days undervaccinated in the VFB intervention compared to UC (6.3%, p = 0.07).ConclusionAutomated Reminders and with links to heath system resources was not shown to increase infant vaccination uptake demonstrating additional resources are needed to address the needs of caregivers experiencing logistical barriers to vaccination.     

Infant well-being at 2 years of age in the Growth Restriction Intervention Trial (GRIT): multicentred randomized controlled trial

Infant well-being at 2 years of age in the Growth Restriction Intervention Trial (GRIT): multicentred randomized controlled trial . The GRIT study group ( 2004 ) Lancet , 364 , 513 – 520 .     

Increasing community capacity to prevent childhood obesity: challenges,lessons learned and results from the Romp &; Chomp intervention

Background  

Obesity is a major public health issue; however, only limited evidence is available about effective ways to prevent obesity, particularly in early childhood. Romp & Chomp was a community-wide obesity prevention intervention conducted in Geelong Australia with a target group of 12,000 children aged 0-5 years. The intervention had an environmental and capacity building focus and we have recently demonstrated that the prevalence of overweight/obesity was lower in intervention children, post-intervention. Capacity building is defined as the development of knowledge, skills, commitment, structures, systems and leadership to enable effective health promotion and the aim of this study was to determine if the capacity of the Geelong community, represented by key stakeholder organisations, to support healthy eating and physical activity for young children was increased after Romp & Chomp.     

The dose of behavioral interventions to prevent and treat childhood obesity: a systematic review and meta-regression

Background

A better understanding of the optimal “dose” of behavioral interventions to affect change in weight-related outcomes is a critical topic for childhood obesity intervention research. The objective of this review was to quantify the relationship between dose and outcome in behavioral trials targeting childhood obesity to guide future intervention development.

Methods

A systematic review and meta-regression included randomized controlled trials published between 1990 and June 2017 that tested a behavioral intervention for obesity among children 2–18 years old. Searches were conducted among PubMed (Web-based), Cumulative Index to Nursing and Allied Health Literature (EBSCO platform), PsycINFO (Ovid platform) and EMBASE (Ovid Platform). Two coders independently reviewed and abstracted each included study. Dose was extracted as intended intervention duration, number of sessions, and length of sessions. Standardized effect sizes were calculated from change in weight-related outcome (e.g., BMI-Z score).

Results

Of the 258 studies identified, 133 had sufficient data to be included in the meta-regression. Average intended total contact (# sessions x length of sessions) was 27.7 (SD 32.2) hours and average duration was 26.0 (SD 23.4) weeks. When controlling for study covariates, a random-effects meta-regression revealed no significant association between contact hours, intended duration or their interaction and effect size.

Conclusions

This systematic review identified wide variation in the dose of behavioral interventions to prevent and treat pediatric obesity, but was unable to detect a clear relationship between dose and weight-related outcomes. There is insufficient evidence to provide quantitative guidance for future intervention development. One limitation of this review was the ability to uniformly quantify dose due to a wide range of reporting strategies. Future trials should report dose intended, delivered, and received to facilitate quantitative evaluation of optimal dose.

Trial registrations

The protocol was registered on PROSPERO (Registration #CRD42016036124).

     

The NOURISH randomised control trial: Positive feeding practices and food preferences in early childhood - a primary prevention program for childhood obesity

Background  

Primary prevention of childhood overweight is an international priority. In Australia 20-25% of 2-8 year olds are already overweight. These children are at substantially increased the risk of becoming overweight adults, with attendant increased risk of morbidity and mortality. Early feeding practices determine infant exposure to food (type, amount, frequency) and include responses (eg coercion) to infant feeding behaviour (eg. food refusal). There is correlational evidence linking parenting style and early feeding practices to child eating behaviour and weight status. A focus on early feeding is consistent with the national focus on early childhood as the foundation for life-long health and well being. The NOURISH trial aims to implement and evaluate a community-based intervention to promote early feeding practices that will foster healthy food preferences and intake and preserve the innate capacity to self-regulate food intake in young children.     

A randomised controlled trial of a school-based intervention to prevent tobacco use among children and adolescents in Italy

Aim

A randomised field trial was conducted to evaluate a school-based programme to prevent tobacco use in children and adolescents.

Subject and methods

The trial included 534 children and 308 adolescents who were randomly selected to receive or not to receive the prevention programme. The prevention programme included: (a) health facts and the effect of smoking, (b) analysis of the mechanisms underlying intiation of smoking and (c) refusal skills training to deal with the social pressures to smoke. A questionnaire was administered before the intervention programme and 2 years later.

Results

The prevalence rates of smoking in both groups of children and adolescents were increased at the end of the study. Anyway, the difference of smoking prevalence between the intervention and control groups was statistically significant only for the children’s group (from 18.3 to 18.8% for the intervention group and from 17.8 to 26.9% in the control group) (p?=?0.035). As regards reasons that induced the start of smoking, there was a significant increase of the issue “because smokers are fools” (p?=?0.004 for children; p?<?0.001 for adolescents) and “because smokers are irresponsible” (p?≤?0.001 for both children and adolescents) in the experimental groups.

Conclusion

The results suggest that a school-based intervention programme addressing tobacco use among children and adolescents, based on the development of cognitive and behavioural aspects, can be effective. After 1 year of intervention, smoking prevalence was significantly lower in children belonging to the intervention group than in children not randomised to intervention. Targeting young children before they begin to smoke can be a successful way of prevention.