ABSTRACT: Parents of infants and toddlers with cystic fibrosis (CF) report problematic mealtime behaviors. Controlled studies that examine parent and child mealtime behaviors in infants and toddlers with CF using objective, observational procedures are needed to augment parent report findings and identify targets for effective interventions. We examined four hypotheses: 1) Parents of young children with CF would engage in more mealtime management behaviors to encourage eating than parents of control children. 2) Infants and toddlers with CF would engage in more problematic mealtime behaviors than control children. 3) Infants and toddlers with CF and their parents would demonstrate a greater frequency of behaviors incompatible with eating in the second half of the meal compared to the first half. 4) During slow meals, infants and toddlers would display a higher rate of mealtime behavior problems than during fast meals.
Thirty-four infants and toddlers with CF (M age = 18.3 +/- 7.9 months) and a matched community sample of same age peers participated. Videotaped mealtimes were coded using the Dyadic Interaction Nomenclature for Eating (DINE).
Parents of children with CF gave a higher rate and frequency of commands to eat than controls. All children displayed similar rates and frequencies of mealtime behaviors incompatible with eating. As the meal progressed, all children, regardless of illness status, displayed a greater frequency of behaviors incompatible with eating.
Direct observation of mealtime behaviors indicates that parents of infants and toddlers with CF engage in more mealtime management behaviors than parents of controls and that young children exhibit more behaviors incompatible with eating as the meal progresses. These findings highlight modifiable targets for behavioral and nutrition interventions that can be specifically designed for families of infants and toddlers with CF.
Journal of Cystic Fibrosis 10/2005; 4(3):175-82. · 3.19 Impact Factor
ABSTRACT: Parent and child mealtime behaviors in school-age children with cystic fibrosis (CF; n = 28) and children without CF (n = 28) were examined during dinner meals by using multivariate analysis of variance. Parents of children with CF were found to differ from comparison parents in the frequency and rate of child management strategies. No differences were found in child behaviors. As the meal progressed, children displayed an increase in behaviors incompatible with eating, and parents increased behaviors to encourage eating. Slow eaters (> 20 min) with CF consumed more calories at the dinner meal than fast eaters (< 20 min) but did not achieve a higher daily caloric intake. Interventions targeting improvement of parent- child interactions during the mealtime are needed to achieve optimal dietary intake.
Health Psychology 05/2005; 24(3):274-80. · 3.87 Impact Factor
ABSTRACT: Infants and toddlers with cystic fibrosis (CF) are at risk for poor growth. Controlled behavioral assessment studies have not focused on this population. This study compared calorie intake, percentage of Recommended Daily Allowance (RDA) per day and per kilogram, and percentage of calories from fat, protein, and carbohydrates between infants and toddlers with CF and healthy peers. Also, eating behaviors, such as meal duration, bites and sips per minute, percentage of meal spent eating, children's problematic eating behaviors, and parents' perceptions of mealtime behaviors were compared between infants and toddlers with CF and controls. Five hypotheses were tested. 1) Infants and toddlers with CF would be comparable to controls on the number of calories consumed per day and the percentage of calories from fat. 2) Infants and toddlers with CF would not meet the CF dietary guidelines for the percentage of RDA for calories or the percentage of calories from fat. 3) Infants and toddlers with CF would have longer meal durations than healthy peers, but would not differ on the pace of eating, the number of calories consumed during the meal, or the percentage of time spent eating during the meal. 4) Parents of infants and toddlers with CF would perceive more problematic mealtime behavior than controls. 5) Parents' perceptions of children's mealtime behavior would positively correlate with meal duration and negatively correlate with the number of calories consumed during the meal.
A 2-group comparison study.
A clinical sample of 35 infants and toddlers with CF (M = 18.6; standard deviation = 8.1 months; range = 7-35 months) and a community sample of 34 healthy peers matched for age, gender, socioeconomic status, and number of parents and siblings present during mealtimes.
Children's calorie intake was measured using 3-day diet diaries. The 2 groups did not differ on the total number of calories consumed per day, the percentage of calories derived from fat, or the percentage of RDA consumed per day. Infants and toddlers with CF were not meeting the CF dietary recommendations of 120% to 150% RDA for energy with 40% of calories coming from fat. Using the Dyadic Interaction Nomenclature for Eating, a behavioral coding system, videotaped recordings of children's dinner meals were scored for meal duration, number of bites and sips per minute, number of calories per bite or sip, and the percentage of 10-second intervals with bites and sips. The CF sample had significantly longer mealtimes (20.2 minutes) than the control group (16.4 minutes), but did not differ on calories consumed at the meal, bites and sips per minute, calories per bite and sip, or time spent eating during the meal. On the Behavioral Pediatrics Feeding Assessment Scale, a measure of parental perceptions of mealtime behavior that was completed by a subset of families (39 families), parents of infants and toddlers with CF endorsed a greater number of mealtime behaviors as problems and a higher occurrence of problems than did parents of controls. Examples of these behaviors for the CF sample included problems with their child's willingness to try new foods (48%), eat vegetables (48%), and observations that their child has a poor appetite (32%) and would rather drink than eat (32%). Parents of children with CF chose a greater number of mealtime strategies and feelings as problems and reported more frequently using problematic strategies at mealtimes than did parents of controls. Examples of problematic strategies and feelings for parents of infants and toddlers with CF included feeling anxious/frustrated when feeding their children (37%), not feeling confident that their child eats enough (32%), and using coaxing to get their child to take a bite (26%). For the entire sample, a positive correlation of 0.29 was found between the number of mealtime behavior problems reported by parents and meal duration, suggesting the co-occurrence of problematic mealtime behavior with longer meal duration. No relationship was found between the number of child mealtime behavior problems reported by parents and the number of calories consumed during the filmed meal. For the CF sample, a correlation of -0.26 between children's weight percentile for age and the filmed meal duration was found, suggesting a tendency for meal duration to increase as children's weight for age decreases. Post-hoc analyses were conducted comparing infants and toddlers with previously reported samples of preschool and school-aged children on meal duration. Results demonstrated that in each group, children with CF had longer meals than age-matched controls.
Our findings reveal significant deficits in achieving dietary recommendations for many families of infants and toddlers with CF. Only 11% of infants and toddlers with CF met the CF dietary recommendation of at least 120% of the RDA/day for energy. In addition, infants and toddlers were found to derive only 34% of their daily calories from fat, compared with the recommended 40% needed for a moderate to high fat diet. These results underscore the need for intervention in families of infants and toddlers with CF, who in addition to being at increased risk for malnutrition, may also experience a hastening in the decline of their pulmonary status because of poor nutritional status. Currently, there is limited programmatic research on nutritional and feeding interventions for toddlers and infants with CF. One study, which used a hospital-based behavioral education program to increase the caloric intake of 3 children (ages 10-20 months) who were below the fifth percentile for weight for length, found at least a 54% increase in calories for each child after treatment. Similarly, preliminary findings of 2 parent-based interventions, a nutrition education curriculum and a nutrition education plus behavior parent-training curriculum, found a 22% and 32% increase in daily calories, respectively, at treatment completion. A large-scale clinical trial is needed to evaluate the efficacy of any nutritional intervention before widespread dissemination. Additional assessment-focused research is also needed to identify patients' who may be at greatest risk for malnutrition and to guide the development of interventions to treat them.
PEDIATRICS 06/2002; 109(5):E75-5. · 4.47 Impact Factor
ABSTRACT: To determine the efficacy of community-based, culturally tailored exercise intervention on the moderate and vigorous physical activity and physiologic outcomes of low-income Latino women (Latinas).
A randomized trial contrasted safety education to an aerobic dance intervention.
Interventions were held in a "store-front" exercise site near a community clinic.
Sedentary low-income Latinas (N = 151; 18-55 years; 70% overweight/obese) were recruited. Retention was 91% for follow-up measures.
Three sessions per week of supervised aerobic dance were provided for 6 months. Controls attended 18 safety education sessions over 6 months.
Physical activity and aerobic fitness (VO2max) were primary outcomes.
Participants in the exercise group reported more vigorous exercise (p < .001) and walking (p = .005) at post-test than controls. Aerobic dance and unsupervised activity resulted in a five-fold greater increase in relative VO2max compared with controls (p < .001). Although exercise and fitness decreased at follow-up, vigorous exercise (p = .001) and relative VO2max (p < .001) remained higher in the exercise group, suggesting maintenance at 1 year. CONDUSION:. Culturally tailored aerobic dance can increase vigorous physical activity, possibly generalizing to walking, and the combination can improve cardiorespiratory fitness in low-income, overweight, sedentary Latinas.
American journal of health promotion: AJHP 22(3):155-63. · 2.37 Impact Factor
ABSTRACT: To explore the feasibility of engaging community businesses in human immunodeficiency virus (HIV) prevention.
Randomly selected business owners/managers were asked to display discreetly wrapped condoms and brochures, both of which were provided free-of-charge for 3 months. Assessments were conducted at baseline, mid-program, and post-program. Customer feedback was obtained through an online survey.
Participants were selected from a San Diego, California neighborhood with a high rate of acquired immune deficiency syndrome.
Fifty-one business owners/managers who represented 10 retail categories, and 52 customers.
Participation rates, descriptive characteristics, number of condoms and brochures distributed, customer feedback, business owners'/managers' program satisfaction, and business owners'/managers' willingness to provide future support for HIV prevention were measured.
Kruskal-Wallis, Mann-Whitney U, Fisher's exact, and McNemar's tests were used to analyze data.
The 20 business owners/managers (39%) who agreed to distribute condoms and brochures reported fewer years in business and more employees than those who agreed only to distribute brochures (20%) or who refused to participate (41%; p < .05). Bars were the easiest of ten retail categories to recruit. Businesses with more employees and customers distributed more condoms and brochures (p < .05). More than 90% of customers supported distributing condoms and brochures in businesses, and 96% of business owners/managers described their program experience as positive.
Businesses are willing to distribute condoms and brochures to prevent HIV. Policies to increase business participation in HIV prevention should be developed and tested.
American journal of health promotion: AJHP 24(5):347-53. · 2.37 Impact Factor