[Show abstract][Hide abstract] ABSTRACT: Physical and psychological changes that occur during pregnancy present a unique challenge for women's physical activity. Using a theory-based prospective design, this study examines the effects of pregnant women's (a) physical activity cognitions (self-efficacy, outcome expectancy, and safety beliefs) and (b) online self-regulation activities (goal-setting and self-monitoring) on subsequent changes in their physical activity intentions and behavior during pregnancy and immediately postpartum. The authors used data from three panel surveys administered to pregnant women enrolled in a web-based intervention to promote healthy pregnancy and postpartum weight, as well as log data on their use of self-regulatory features on the intervention website. Perceived self-efficacy and perceived safety of physical activity in pregnancy enhanced subsequent intentions to be physically active. Repeated goal-setting and monitoring of those goals helped to maintain positive intentions during pregnancy, but only repeated self-monitoring transferred positive intentions into actual behavior. Theoretically, this study offers a better understanding of the roles of self-regulation activities in the processes of goal-striving. The authors also discuss practical implications for encouraging physical activity among pregnant and early postpartum women.
Journal of Health Communication 07/2015; 20(10):1-10. DOI:10.1080/10810730.2015.1018639 · 1.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND
For rural adolescents, schools are among the few places where environmental interventions can promote health outside of the home. The goal of this study was to assess the nutrition and physical activity (N&PA) environments of schools attended by a birth cohort and examine the association with change in body mass index (BMI) from sixth to eighth grade.METHODS
Using data from adolescents of a rural New York State birth cohort (N = 281), we used linear mixed models to identify N&PA environments associated with change in BMI. We also examined family income trajectory as a potential modifier to consider how the association between school environment and change in BMI might differ depending on income.RESULTSWe found considerable heterogeneity in environments within and between schools. Among students with low-income trajectories, reductions in BMI z-scores were associated with school environments that promote better physical education (PE) and general (non-PE, non-sport) physical activity. Schools with better sports environments were associated with reductions in BMI for some students, but not lower-income students.CONCLUSIONS
School environments may have differing effects on students depending on their socioeconomic status. Strategies are needed to identify and address barriers that impair low-income students' access to health-promoting school resources.
Journal of School Health 02/2015; 85(2). DOI:10.1111/josh.12227 · 1.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
Gaining more weight during pregnancy than is recommended by the Institute of Medicine is prevalent and contributes to the development of obesity in women. This article describes the development and use of e-Moms of Rochester (e-Moms Roc), an electronic intervention (e-intervention), to address this health issue in a socioeconomically diverse sample of pregnant women.
Materials and methods:
Formative research in the form of intercept interviews, in-depth interviews, and focus groups was conducted to inform the design of the e-intervention. The Web site continuously tracked each participant's use of e-intervention features.
An e-intervention, including Web site and mobile phone components, was developed and implemented in a randomized control trial. Formative research informed the design. Participants in all arms accessed blogs, local resources, articles, frequently asked questions, and events. Participants in the intervention arms also accessed the weight gain tracker and diet and physical activity goal-setting tools. Overall, 80% of women logged into the Web site and used a tool or feature at least twice. Among those in the intervention arm, 70% used the weight gain tracker, but only 40% used the diet and physical activity goal-setting tools.
To maximize and sustain potential usage of e-Moms Roc over time, the e-intervention included customized reminders, tailored content, and community features such as blogs and resources. Usage was comparable to those in other weight studies with young adults and higher than reported in a published study with pregnant women. This e-intervention specifically designed for pregnant women was used by the majority of women.
Telemedicine and e-Health 10/2014; 20(12). DOI:10.1089/tmj.2013.0354 · 1.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Excessive gestational weight gain may lead to long-term increases in maternal body weight and associated health risks. The purpose of this study was to examine the relationship between maternal body weight and weight-related self-efficacy from early pregnancy to 2 years post-partum. Women with live, singleton term infants from a population-based cohort study were included (n = 595). Healthy eating self-efficacy and weight control self-efficacy were assessed prenatally and at 1 year and 2 years post-partum. Body weight was measured at early pregnancy, before delivery, and 6 weeks, 1 year and 2 years post-partum. Behavioural (smoking, breastfeeding) and sociodemographic (age, education, marital status, income) covariates were assessed by medical record review and baseline questionnaires. Multi-level linear regression models were used to examine the longitudinal associations of self-efficacy measures with body weight. Approximately half of the sample (57%) returned to early pregnancy weight at some point by 2 years post-partum, and 9% became overweight or obese at 2 years post-partum. Body weight over time was inversely related to healthy eating (β = −0.57, P = 0.02) and weight control (β = −0.99, P < 0.001) self-efficacy in the model controlling for both self-efficacy measures as well as time and behavioural and sociodemographic covariates. Weight-related self-efficacy may be an important target for interventions to reduce excessive gestational weight gain and post-partum weight gain.
Maternal and Child Nutrition 10/2014; DOI:10.1111/mcn.12149 · 3.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examined psychosocial and sociodemographic factors associated with pregnant women's use of Web-based tools to set and monitor personal goals for healthy diet and physical activity. These tools were made available to women participating in a randomized trial testing a Web-based intervention to promote appropriate gestational weight gain. We used data from a baseline survey of pregnant women assigned to the intervention group and log data on women's use of various intervention features (N = 873). Women who believed that appropriate gestational weight gain would lead to healthy outcomes for their child were more likely to engage in online goal-setting and self-monitoring. Less positive outcome expectancy beliefs about the relationship between their own weight and baby's health partially explains why some at risk subpopulations (e.g., African-American women) were less likely to utilize online self-regulatory tools. This study specifies key psychosocial and motivational factors that guide the construction and monitoring of goals among pregnant women. These findings offer guidance for the design of interventions to promote self-regulatory techniques by identifying groups for whom those features are most likely to be useful, as well as psychological determinants of their use.
Health Communication 09/2014; 30(9):1-11. DOI:10.1080/10410236.2014.905900 · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Young adulthood has been identified as a high-risk period for the development of obesity but few interventions have been tested in this population. One way to escalate our learning about effective interventions is to test a number of interventions simultaneously as a consortium of research trials. This paper describes the Early Adult Reduction of weight through LifestYle intervention (EARLY) trials. Seven research sites were funded to conduct intervention trials, agreeing to test similar primary outcomes and cooperating to use a set of common measurement tools. The EARLY consortium was able to work cooperatively using an executive committee, a steering committee, workgroups and subcommittees to help direct the common work and implement a set of common protocol and measurement tools for seven independent but coordinated weight-related intervention trials. Using a consortium of studies to help young adults reach or maintain a healthy weight will result in increased efficiency and speed in understanding the most effective intervention strategies.
Translational Behavioral Medicine 09/2014; 4(3):304-13. DOI:10.1007/s13142-014-0252-5
[Show abstract][Hide abstract] ABSTRACT: Online interventions have emerged as a popular strategy to promote healthy behaviors. Currently, there is little agreement about how to capture online intervention engagement. It is also uncertain who engages with weight-related online interventions and how engagement differs by demographic and weight characteristics.
Journal of Medical Internet Research 08/2014; 16(8):e194. DOI:10.2196/jmir.3483 · 3.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The association between socioecological factors and poor health outcomes for low-income women and their children has been the focus of disparities research for several decades. This research compares the socioecological conditions among low-income women from pregnancy to post-partum and highlights the factors that make weight management increasingly difficult after delivery. As part of the formative research for an online health intervention, group and individual interviews were conducted with low-income pregnant and post-partum women. Five pregnancy group interviews (n = 15 women), five post-partum group interviews (n = 23 women) and seven individual interviews with a total of 45 participants were conducted in Rochester, New York. All interviews were audio-recorded. The constant comparative method was used to code interview notes and identify emergent themes. Subjects faced many challenges that affected their attitudes, beliefs and their ability to maintain or improve healthy weight behaviours. These included unemployment, relationship issues, minimal social support, lack of education, limited health care access, pre-existing medical conditions and neighbourhood disadvantage. Compared with pregnant women, post-partum women faced additional difficulties, such as child illnesses and custody issues. The most striking differences between pregnancy and post-partum related to the family's medical problems and greater environmental constraints. Many factors detracted from women's capacity to engage in healthy weight behaviours post-partum, including challenges present prior to delivery, challenges present prior to delivery that worsen after delivery, and new challenges that begin after delivery. These additional post-partum challenges need to be considered in designing programmes, policies and interventions that promote healthy weight.
Maternal and Child Nutrition 08/2014; DOI:10.1111/mcn.12135 · 3.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
An emerging body of research suggests the trajectory of a family’s income affects children’s health and development more profoundly than the often-measured income at a single time point. The purpose of this study was to examine the associations between changes in family income status, early-life risk factors, and body mass index (BMI) z-score trajectory from age 2 to 15 years.
This longitudinal study employed a birth cohort (n = 595) located in a rural region of New York State. Data were collected through an audit of medical records and mailed questionnaires. Family low-income and BMI z-score trajectories were identified using latent-class modeling techniques that group children based on similar trends across time. We examined five early-life risk factors in relation to income and BMI z-score trajectories: maternal overweight/obesity, maternal gestational weight gain, maternal smoking during pregnancy, breastfeeding duration, and early-life weight gain trajectory. We used multinomial logistic regression models to estimate the odds of being in a BMI z-score trajectory group based on income trajectory and early-life risk factors.
Children who remain low-income throughout childhood were more likely to maintain overweight (AOR = 2.55, 95% CI = 1.03, 5.42) and children who moved into low-income during childhood were more likely to be obese (AOR = 2.36, 95% CI = 1.12, 5.93) compared to children who were never low-income. Maternal overweight/obesity was significantly associated with a child become obese (AOR = 8.31, 95% CI = 3.80, 18.20), become overweight (AOR = 2.37, 95% CI = 1.34, 4.22), and stay overweight (AOR = 1.79, 95% CI = 1.02, 3.14). Excessive gestational weight gain was associated with increased likelihood of a child becoming overweight trajectory (AOR = 2.01, 95% CI = 1.01, 4.00).
Our findings further supports the growing evidence that there are several preventable early-life risk factors that could be targeted for intervention. This study provides new evidence that remaining in low-income and moving into low-income increases risk for adolescent overweight and obesity.
BMC Public Health 05/2014; 14(1):417. DOI:10.1186/1471-2458-14-417 · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We examine how social support (perceived support and support from a spouse, or committed partner) may influence pregnant women's information seeking behaviors on a pregnancy website. We assess information seeking behavior among participants in a trial testing the effectiveness of a web-based intervention for appropriate gestational weight gain. Participants were pregnant women (N = 1,329) recruited from clinics and private practices in one county in the Northeast United States. We used logistic regression models to estimate the likelihood of viewing articles, blogs, frequently asked questions (FAQs), and resources on the website as a function of perceived social support, and support from a spouse or relationship partner. All models included socio-demographic controls (income, education, number of adults and children living at home, home Internet use, and race/ethnicity). Compared to single women, women who were married or in a committed relationship were more likely to information seek online by viewing articles (OR 1.95, 95 % CI [1.26-3.03]), FAQs (OR 1.64 [1.00-2.67]), and blogs (OR 1.88 [1.24-2.85]). Women who felt loved and valued (affective support) were more likely to seek information by viewing articles on the website (OR 1.19 [1.00-1.42]). While the Internet provides a space for people who have less social support to access health information, findings from this study suggest that for pregnant women, women who already had social support were most likely to seek information online. This finding has important implications for designing online systems and content to encourage pregnant women with fewer support resources to engage with content.
Maternal and Child Health Journal 03/2014; 18(9). DOI:10.1007/s10995-014-1471-6 · 2.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This article investigates the impact of community-based interventions developed by the Healthy Start Partnership (HSP) to promote healthy body weights in families. Intercept surveys were conducted to monitor community exposure. A nonconcurrent, no treatment control design was used to assess population-level weight outcomes. Control (n = 219) and intervention (n = 276) cohorts of pregnant women were recruited and followed until 6 months postpartum. Data were collected through 2 self-administered questionnaires and medical record audits. Results indicate community residents were exposed to interventions. However, little evidence of positive effects of interventions on weight outcomes was found for mothers or infants.
Family & community health 01/2014; 37(1):74-85. DOI:10.1097/FCH.0000000000000016 · 0.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Online interventions have emerged as a popular strategy to promote healthy behaviors. However, there is little agreement about how best to measure involvement in the intervention and what demographic characteristics might be associated with involvement. The objectives of this study were to: 1) identify patterns of website usage in an online intervention to reduce pregnancy weight gain and 2) determine if demographic characteristics differed across these patterns.
Methods: We report on a cohort of racially and socioeconomically diverse pregnant women ages 18-35 enrolled in a randomized controlled trial to prevent excessive gestational weight gain. Women were randomized to receive: website access with articles, resources, and blogs (control, n=557) or the same website with an additional weight tracker and goal setting tools (intervention, n=1112). Latent-class analysis was used to identify patterns of usage and chi-squared analysis was used to examine associations with demographic characteristics including: income, BMI, race, and age.
Results: Four distinct patterns of usage emerged in our intervention and control arms: non-users (21% and 18%, respectively); minimal users (34% and 34%); viewers-of-content (34% and 34%); and super-users (11% and 14%). Overall patterns of website usage were similar between the intervention and control website, but the demographics of those patterns varied. For instance, among super-users there were a higher proportion of overweight/obese women in the intervention arm compared to the control arm (p=0.09).
Discussion: These emergent patterns illuminate how website features cluster among a diverse study population and could guide the development of future interventions.
141st APHA Annual Meeting and Exposition 2013; 11/2013
[Show abstract][Hide abstract] ABSTRACT: Background: Optimal breastfeeding behavior tends to cluster with other behaviors that are protective against the development of obesity making it very challenging to determine its true benefit. Our objective was to determine if longer breastfeeding duration was protective against rising growth trajectories by comparing its effects in children with different risk for obesity. Methods: This study utilized longitudinal data from a birth cohort in rural upstate New York (n=595). The outcome, weight-for-length z-score trajectory from birth to 2 years, was classified using latent-class modeling, that grouped children based on similar growth trajectories. Four trajectories emerged: high-rising, low-rising, mid-stable, and low-stable. An early-life risk index for obesity, classified into 3 levels (low, medium, high), included maternal BMI category, gestational weight gain, smoking during pregnancy, maternal education, and stress at 1 year post-partum. Logistic regression analysis was performed to investigate whether breastfeeding duration (<2 months, 2-4 months, >4 months) moderated the association between early-life obesity risk and infant growth trajectory. Results: Infants at high-risk for obesity who were breastfed for <2 months were more likely to be in a rising growth trajectory (p < 0.05 for both low-rising and high-rising) compared to infants who were breastfed for longer durations. Infants at medium-risk for obesity who were breastfed for <2 months were more likely to be in the high-rising growth trajectory (P <0.01). Conclusion: Short breastfeeding duration, especially for infants at higher risk for obesity, is associated with accelerated growth from birth to 2 years.
141st APHA Annual Meeting and Exposition 2013; 11/2013
[Show abstract][Hide abstract] ABSTRACT: Food stores within a large area of rural upstate New York (N = 870) were surveyed using the Nutrition Environment Measurement Survey for Stores. Food environments within 5 miles of the women's homes were characterized by (1) the proximity and (2) density of each store type and (3) the average Healthy Food Availability Index (HFAI) score. Logistic regression analyses predicted the risk of being overweight, obese, and overweight or obese (combined) by food environment characteristics. Greater access to food stores and greater availability of healthy food were associated with increased risk of overweight and obesity.
Journal of Hunger & Environmental Nutrition 10/2013; 8(4). DOI:10.1080/19320248.2013.816994
[Show abstract][Hide abstract] ABSTRACT: The absence of school meals on the weekend might adversely affect children's weekend eating and have implications for their health. We used one weekday and one weekend day of dietary recall data for 2376 schoolchildren in the National Health and Nutrition Examination Survey (NHANES, 2003–2008) to estimate the prevalence of low energy intake and low diet quality and to examine their associations with financial and food resources. Low energy intake was equally prevalent on weekdays and weekend days (13.6% and 14.9%), as was low dietary quality (16.9% and 21.4%), and both were unrelated to measures of financial and food resources. Dietary recall data provided no evidence that a lack of school meals on the weekend was adversely related to dietary intake among school children.
Journal of Hunger & Environmental Nutrition 10/2013; 8(4). DOI:10.1080/19320248.2013.845869
[Show abstract][Hide abstract] ABSTRACT: Prior research has shown positive associations between participation in school meals and some dietary measures, but the evidence is equivocal. Few prior studies have used methodological approaches that address underlying differences in food preferences and health beliefs between school meals participants and nonparticipants, resulting in the potential for selection bias to influence results. This study estimated relationships among school meals participation and weekday energy intake and dietary quality, controlling for weekend dietary intake as a proxy for food preferences and health beliefs. Further, this paper explored how family income moderated these relationships. NHANES data (2003-2008) were analyzed for children aged 6-17 y with reliable dietary recalls for one weekday and one weekend day (n = 2376). Using multivariate linear regression models, we examined weekday-weekend differences in energy intake as a percentage of the estimated energy requirement (%EER) and differences in Healthy Eating Index-2005 (HEI) scores for breakfast and lunch and for the entire day. Overall, school meals participants and nonparticipants had equivalent %EERs and total HEI scores, but participants scored higher for milk and lower for saturated fat and sodium after adjustment for weekend eating. Family income moderated the relationship between school meals participation and HEI. Low-income children who ate school breakfast and lunch had significantly higher total HEI, and total grain, and meat and beans component scores. Conversely, higher income participants had significantly lower scores for total grains, whole grains, and saturated fat. Changes to the content of school meals may differentially affect weekday dietary intake of low-income and higher income participants.
Journal of Nutrition 03/2013; 143(5). DOI:10.3945/jn.112.170548 · 3.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Few lifestyle interventions have successfully prevented excessive gestational weight gain. Understanding the program processes through which successful interventions achieve outcomes is important for the design of effective programs. The objective of this study was to evaluate the effect of the quantity and quality of participation in a healthy lifestyle intervention on risk of excessive gestational weight gain.
Pregnant women (N = 179) received five newsletters about weight, nutrition, and exercise plus postcards on which they were asked to set related goals and return to investigators. The quantity of participation (dose) was defined as low for returning few or some vs. high for many postcards (N = 89, 49.7%). Quality of participation was low for setting few vs. high for some or many appropriate goals (N = 92, 51.4%). Fisher's exact tests and multivariate logistic regression were used to analyze the effect of participation variables on the proportion with excessive weight gain. Quantity and quality of participation alone were each not significantly associated with excessive gestational weight gain, while quality of participation among those with high-levels of participation approached significance (p = 0.07). The odds of gaining excessively was decreased when women had both a high quantity and quality of participation (OR = 0.04, 95% CI = 0.005, 0.30).
Both quantity and quality of participation are important program process measures in evaluations of lifestyle interventions to promote healthy weight gain during pregnancy.
International Journal of Behavioral Nutrition and Physical Activity 02/2013; 10(1):23. DOI:10.1186/1479-5868-10-23 · 4.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Nutritionists have been criticized for taking diet out of the context of lifestyle in their professional practice. Eat Well, Eat Local, Eat Together (Eat3) aimed to combine objectives related to nutrition and health with the social and ecological aspects of eating in an educational campaign. The multicomponent campaign was developed by the Healthy Start Partnership Coordinating Committee, a group of health and nutrition professionals from 6 rural counties in New York State, with Cornell University faculty serving as conveners. In 2009, with funding from Cornell Cooperative Extension, well over 10 000 individuals from 20 counties were reached. Self-reported behaviors on campaign themes shifted significantly (P 3.
Journal of Hunger & Environmental Nutrition 01/2013; 8(1). DOI:10.1080/19320248.2012.761573