Progress 08/15/06 to 08/14/11
Outputs
OUTPUTS: The objectives were to compare three interventions delivered to families of WIC participants on improvments in diet, physical activity, and weight status. Participants were randomized into experimental or placebo intervention. The experimental interventions were: 1) maternal diet and physical activity and 2) parenting, limit setting, and child development strategies. The placebo intervention focused on toddler safety. The interventions, based on social cognitive theory, including goal setting, outcome expectancies, and self efficacy, were conducted over 12 weeks. We successfully recruited 277 participants. They participated in a Post Intervention Follow-Up, following the intervention, followed by a Delayed Follow-Up (3-5 outstanding participants). Delayed Follow-Up rate exceeds 78%, and 86% participated in at least one follow-up. EVENTS (for space limited to 2011) Black, M.M. Pediatric obesity prevention: Responsibilities for families and communities. Maryland Chapter, American Academy of Pediatrics. Symposium on Obesity Prevention and Treatment. Baltimore, December 2010. Black, M.M. Pediatric obesity prevention: Challenges and successes. Cornell University, Ithaca, NY, February 21, 2011. Black, M.M. Making the link between early life nutrition, early childhood development (ECD), cognition, and later life health outcomes. The World Bank, Washington, DC. March 1, 2011. Black, M.M. Common feeding and behavior problems in the toddler years. International Scientific Symposium, Prague, Czech Republic, March 18, 2011. Black, M.M. Preventing rapid weight gain and obesity during infancy and toddlerhood. International Scientific Symposium, Prague, Czech Republic, March 19, 2011. Black, M.M. Interventions to prevent failure-to-thrive and obesity: Commonalities. Columbia University, Grand Rounds, Department of Pediatrics, New York, NY, April 15, 2011. Black MM, Aboud FE. Theoretical basis of responsive feeding. Experimental Biology, Washington, DC, April 22, 2011. Black, MM. A Lifespan Approach to Maternal and Child Nutrition: Strategies to Promote Healthy Growth & Development. Building Interdisciplinary Research Careers in Women's Health Annual Seminar (BIRCWH), Baltimore, MD, May 10, 2011 Black MM. Toddler obesity prevention: Healthy lifestyle behavior from the beginning. Pediatric Obesity Symposium. Children's National Medical Center, Washington, DC, May 18, 2011. Black MM. Obesity prevention for infants and toddlers: Healthy lifestyle behavior for families. University of Maryland Extension. Working Forum for Parent-Child Feeding Interactions in Obesity Prevention: Advancing Research and Practice, Annapolis, MD, June 2, 2011. Black MM. Getting started: Intervention research with infants and toddlers. NICHD Summer Institute on Applied Research in Child and Adolescent Development. Rockville, MD, June 19-21, 2011. Black MM. Healthy habits build healthy children and families. University of Maryland School of Social Work, Baltimore, MD, September 30, 2011 PARTICIPANTS: Partner organizations included Maryland WIC. Individuals include: PI: Maureen Black; Co-investigators: Kristen Hurley, Erin Hager, Laura Caulfield, Joel Gittelsohn; Project Coordinator: Adrienne McGill, Laura Latta, Falguni Patel; Health Educators: Krystal Hodge, Emma Rixmann; Data Coordinator: Raquel Arbaiza; Data Analyst: Yan Wang TARGET AUDIENCES: Audiences included WIC directors and personnel and broader professional audiences. We reached through professional publications and through presentations at local and national meetings Audiences also included policy makers and the lay public. We reached them throu Op-Eds and commentaries in the local newspaper and local talks. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.
Impacts
Change in knowledge We developed and validated a Toddler Silhouette Scale that can be used to assess caregiver's perceptions of and satisfactions with their toddler's body sixe Using the Toddler Silhouette Scale, we found that parents of toddlers did not recognize overweight/obese toddlers as being overweight/obese. They were much more likely to recognize underweight toddlers. Parents of overweight/obese toddlers were highly satisfied with their toddler's body size. Parents of underweight toddlers were not satisfied. Parents prefer their toddler to be overweight/obese. Preliminary findings from the analysis for the randomized controlled trial of parenting intervention are that toddlers in the parenting and maternal groups are more likely to consume fruit and more physically active (based on accelerometer) than toddlers in the placebo group. Mothers in the intervention groups are more likely to consure total vegetables, green vegetables, and fruit than mothers in the placebo group. Differences in weight status are in the expected direction, but do not reach significance.
Publications
- Hurley KM, Black MM. Low maternal iron intake is characterized by maternal depression and iron-poor diets among offspring. Oral Presentation at the 7th Annual Interdisciplinary Women Health Research Symposium (2010).
- Latta LW, Hager ER, Kim E, Caulfield LE, Black MM. Measurements and Predictors of Physical Activity Among Toddlers. Poster at the American Society for Nutrition at Experimental Biology (2011)
- Hager ER, Hurley KM, Latta L, Caulfield L, Black MM. Using Ecological Momentary Assessment (EMA) to evaluate dietary patterns of low-income adult women in real-time. Oral Presentation at the American Society for Nutrition at Experimental Biology (2011)
- Pepper MR, Hurley KM, Caulfield LE, Latta L, Hager ER, Candelaria M, Wang Y, Black MM. Validity of the Toddler Feeding Style Questionnaire. Oral Presentation at the American Society for Nutrition at Experimental Biology (2011)
- Candelaria MA, Quigg AM, Hager E, Latta L, Black M. Food Insecurity During Toddlerhood: Links With Maternal Depression, and Parent and Child Competence. Poster at APA August, 2011.
- Black, M, Wang Y, Hurley K, Hager E, Latta L. Toddler obesity may be linked to parenting practices and maternal lifestyle. Presentation at The Obesity Society October 2011.
- Hager ER, Hurley KM, Latta L, Candelaria M, Kim, E, Wang Y, Black M. Factors Associated with Low-Income Mothers Accuracy and Satisfaction with Toddler Body Size. Poster at The Obesity Society Meeting (2010).
- Hager E, McGill A, Black MM. (2010). Development and validation of a toddler silhouette scale. Obesity, 18, 397-401
- Hager ER, Candelaria M, Latta L, Hurley KM, Wang Y, Caulfield LE, Black MM (2012). Maternal perception of toddler body size and satisfaction differ by toddler weight status. Archives of Pediatric and Adolescent Medicine.
- McGill A, Hager ER, Black MM. (2007). Development and Validation of a Toddler Silhouette Scale. The Obesity Society Meeting.
- Hager ER, Merry B, Wadler L, Black MM. (2009). Novel Approaches to Assessing Physical Activity Among Toddlers. Oral Presentation at the International Conference on Diet and Physical Activity Methodology.
- Tilton N, Quigg A, Candelaria M, Scaletti L, Lennon K, Porter P, Black M. Interaction between maternal age and depression is associated with household food insecurity: Cross-sectional analyses among two samples of low-income families with infants and toddlers. Oral Presentation at APHA October 2011.
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Progress 08/15/06 to 08/14/07
Outputs
OUTPUTS: We focused on three primary activities: 1. Formative Research: a) We conducted formative interviews with WIC staff members and WIC participants to address conceptual and logistical issues of the evaluation and intervention; b) Mothers recommended adding home visits to the evaluation protocol to observe mealtime behavior. We amended the IRB for the University of Maryland and State of Maryland to include home visits; c) We developed brochures and hand-outs for participants on local resources. 2. Evaluation: a) We finalized the study measures and instruments, tested them, and entered them into Quality Data Systems (QDS), a computerized data entry system in which participants hear questions on headsets, read them on the screen, and respond with a mouse; b) Body size perception: We developed a toddler silhouette scale and conducted validation studies among medical personnel; c) Physical activity: To evaluate toddler physical activity, we use an electronic monitoring assessment
(EMA) delivered via a PDA (Personal Data Assistant). Mothers have the device for several days and are queried multiple times/day regarding their toddler's activities. We included EMA testing as part of our formative research and found that mothers were receptive and able to complete the questions regarding their and their toddler's activity; d) Dietary data: The evaluation team has received detailed training in the AMPM 24-hour diet recall from USDA staff in Beltsville; e) All the evaluations were pilot tested with mothers and their toddlers and protocols for the evaluations were written. The evaluations take place in two phases: Weighing and measuring are done at the WIC Clinic, accelerometers are placed on the ankle and mothers are given a PDA. The home visit is conducted one week later, accelerometers are removed, 24-hour diet recall is done, and a videotape is made of a meal. 3. Intervention: a) We manualized the three intervention curricula (Maternal Nutrition Education and
Physical Activity, Parenting/Toddler, & Safety), trained the Health Educators, and conducted pilot interventions. Health Educators participated in train-the-trainer sessions delivered by experts in the field on the intervention topics. Information about the study was put on our division's website which can be found at: http://medschool.umaryland.edu/growth. We presented information about the project to several professional groups: a) Health Commissioner, Anne Arundel County, Maryland; b) Maryland State WIC Advisory Board; c) Department of Pediatrics, University of Maryland, Grand Rounds; d) Center for Infant Studies, Department of Psychiatry, University of Maryland; e) Maryland State WIC Nutritionists, annual meeting. We provided training to several graduate and undergraduate students who have done internships on the project. The toddler silhouette scale is designed to be a new product. We have spent the year developing the silhouettes and collecting data on the reliability and
validity of the scale. We hold monthly meeting of the entire research team. Minutes are prepared and distributed. We discuss the ongoing activities of the project, along with plans for papers and scientific presentations.
PARTICIPANTS: Individuals: 1) PI: Maureen Black, Ph.D- provided overall direction of the study and expertise on the development of evaluations and curricula, made critical decisions on the protocol and study design; 2) Co-Investigators: Laura E. Caulfield, Ph.D- provided expertise on the development of measures for and collection of anthropometric data, feeding styles, and dietary data; Joel Gittelsohn, Ph.D- provided guidance for the formative research efforts; 3) Project Coordinator: Adrienne McGill, MHS- Assisted in the development of the intervention curricula and evaluation protocols, oversaw the daily functioning of the study staff, recruited, trained and hired research staff, finalized study logistics; 4) Data Collection Manager: Raquel Arbaiza,MA- Oversaw development of the data collection protocols, supervised data management efforts, trained data collection staff on measures, recruited pilot participants, conducted formative research and pilot evaluations; 5) Data
Collector/ Recruiter: Animari Fermaint- recruited formative research and pilot participants, assisted with pilot evaluations, entered measures into the QDS data system, helped create databases; 6) Research Assistant: Jacqueline Hurtt-recruited participants; 7) Health Educator: Janelle Maddox- assisted with curricula development, received training on lesson plans; 8) Health Educator: Margaret Wrobleski, RD, MPH- assisted with curricula development, specifically the maternal nutrition and physical activity lesson plans, received training on lesson plans; 9) Post-doctoral fellow: Kristen Hurley, Ph.D., MPH- assisted with the measurement of feeding styles, coordinated and supervised the USDA 24-hour dietary recall training and pilot data collection. Partner Organizations: 1) Johns Hopkins University Injury Prevention Center (provided expertise on child safety curriculum); 2) Maryland Poison Center, Maryland Kids in Safety Seats, the Anne Arundel County Fire Department (these organizations
developed lesson plans for the child safety curriculum); 3) Maryland WIC program (our community partner for recruiting participants and running the study); 4) Random House publishers (donated children's books for participants' toddlers); Estee Lauder (donated gifts for participants); 5-a-day program (donated brochures to the study); Wal-Mart (financial support); Safeway and Super Fresh (donated gift cards). Training or professional development: 1) We had 3 interns in the first year (2 undergraduates and 1 graduate student); 2) Data collection staff attended an extensive training at the USDA on administering the AMPM 24-hour dietary recall; the data collectors were also trained in anthropometric measures and attended a QDS software training; in addition, the health educators attended train-the-trainer sessions as noted above.
TARGET AUDIENCES: The community served by the Toddler Overweight Prevention Study (Tips on Parenting Study) is the WIC (Women, Infants and Children Supplemental Food Program) program in Anne Arundel County, MD. All of the study participants in the formative research efforts and piloting were low-income WIC mothers and their young children. The mothers and children who participated in the project were from diverse racial and ethnic backgrounds including African-American, Caucasian and Hispanic families. The efforts completed in the first year of the study include participating in a WIC community outreach event and developing three theory-based curricula: a maternal nutrition education and physical activity curriculum, a parenting curriculum and a child safety curriculum.
PROJECT MODIFICATIONS: None
Impacts
Curricula- The three curricula that were developed for the interventions increased the knowledge of life skills for the pilot participants in the areas of nutrition, physical activity, parenting and child safety. In addition, the health educators' knowledge has increased with train-the-trainer sessions facilitated by community organizations and individuals who are experts in the curricula subject area. This training has increased the self-efficacy of the health educator so that they feel confident in delivering the lesson plans. Data collection- The data collectors have increased their knowledge and skills of administering the USDA's 24-hour dietary recall program, programming and utilizing the QDS system, using PDA (Personal Data Assistants) systems and accelerometers. The data collectors are using novel technologies such as PDAs to collect physical activity data. The data collection team is also using newly developed methods such as the Toddler Silhouette Scale to
collect and record data.
Publications
- 1. An abstract on the validity of the Toddler Silhouette Scale was accepted for presentation at The Obesity Society annual meeting in New Orleans, October 2007.
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