Lori A. Francis’s research while affiliated with Pennsylvania State University and other places

Racialized stress disproportionately impacts Black individuals and confers increased risk for psychological distress and executive dysfunction. However, there is little evidence on psychological distress’ association with cognitive flexibility (CF), an executive function theorized to be a neurocognitive resilience factor, as it is shown to reflect the ability to adapt thoughts/behaviors to changing environmental stimuli. As such, we aimed to examine the relation between racialized stress and psychological distress and the potential buffering effects of CF. Data were drawn from The Family Life Project and included 372 Black mothers from rural households experiencing poverty. Mothers completed a battery of questionnaires to assess sociodemographics, experiences with racialized stress (RRSE), psychological distress (CES-D), and their cognitive flexibility (WCST-64). Results evidenced a significant association between psychological distress and racialized stress, such that mothers who reported higher racialized stress reported higher psychological distress; this relation remained significant after controlling for a host of sociodemographic risk factors. CF did not emerge as a significant moderator of the relation between psychological distress and racialized stress. Findings highlight the potential deleterious effects of racialized stress on psychological distress. There may be unique facets of racialized stress that differentially impact the risk for psychological distress, and CF potentially buffers this relation. Further investigations are needed to understand the underlying mechanisms that may confer resilience to psychological distress amongst Black mothers.

Objective The current study tested whether participating in a family‐focused preventive intervention designed to promote toddlers' self‐regulation improves parental resilience among families living in poverty. Background Family‐focused preventive interventions can help strengthen family functioning, but it is unclear how parents apply what they have learned to new child‐rearing challenges. Method Two hundred and forty‐two families with toddlers (37% White, 25% Black, 19% Latino, 17% multiracial, 2% Asian; median income = $1,555 per month) enrolled in Early Head Start were randomly assigned to the Recipe 4 Success preventive intervention or usual practice home visits. Parents reported on parental resilience, which included aspects of social problem‐solving, personal control, engagement coping, and self‐regulation, assessed 18 months after the end of the intervention. Results A structural equations model revealed that parents in the intervention group, compared to parents in the control group, reported greater parental resilience and used more competent strategies to address child‐rearing challenges (β = .33, p = .03). Subgroup analyses indicated that the intervention effects were similar across families with different demographic characteristics. Conclusion This study demonstrates how a family‐focused preventive intervention designed to improve parents' skills in one specific domain at one point in their toddlers' development can have positive ripple effects, enhancing parental resilience in the future. Implications These findings reinforce the potential widespread value of providing rigorous, evidence‐based family‐focused preventive interventions during early childhood.

Obesity in children remains a major public health problem, with the current prevalence in youth ages 2–19 years estimated to be 19.7%. Despite progress in identifying risk factors, current models do not accurately predict development of obesity in early childhood. There is also substantial individual variability in response to a given intervention that is not well understood. On April 29–30, 2021, the National Institutes of Health convened a virtual workshop on “Understanding Risk and Causal Mechanisms for Developing Obesity in Infants and Young Children.” The workshop brought together scientists from diverse disciplines to discuss (1) what is known regarding epidemiology and underlying biological and behavioral mechanisms for rapid weight gain and development of obesity and (2) what new approaches can improve risk prediction and gain novel insights into causes of obesity in early life. Participants identified gaps and opportunities for future research to advance understanding of risk and underlying mechanisms for development of obesity in early life. It was emphasized that future studies will require multi‐disciplinary efforts across basic, behavioral, and clinical sciences. An exposome framework is needed to elucidate how behavioral, biological, and environmental risk factors interact. Use of novel statistical methods may provide greater insights into causal mechanisms.

The Recipe 4 Success preventive intervention targeted multiple factors critical to the health and well‐being of toddlers living in poverty. This randomized controlled trial, which was embedded within Early Head Start home visits for 12 weeks, included 242 racially and ethnically diverse families (51% girls; toddler mean age = 2.58 years; data collected 2016–2019). Compared to parents in usual practice home visits, parents in Recipe 4 Success displayed greater sensitive scaffolding of toddlers' learning and more responsive food parenting practices (Cohen's d = .21–.30). Toddlers in Recipe 4 Success exhibited greater self‐regulation and had healthier eating habits (Cohen's d = |.16–.35|). Results highlight the value of Recipe 4 Success in promoting parent and toddler behavior change that could have life‐long benefits.

Background/aims: Preventing the development of childhood obesity requires multilevel, multicomponent, comprehensive approaches. Study designs often do not allow for systematic evaluation of the efficacy of individual intervention components before the intervention is fully tested. As such, childhood obesity prevention programs may contain a mix of effective and ineffective components. This article describes the design and rationale of a childhood obesity preventive intervention developed using the multiphase optimization strategy, an engineering-inspired framework for optimizing behavioral interventions. Using a series of randomized experiments, the objective of the study was to systematically test, select, and refine candidate components to build an optimized childhood obesity preventive intervention to be evaluated in a subsequent randomized controlled trial. Methods: A 24 full factorial design was used to test the individual and combined effects of four candidate intervention components intended to reduce the risk for childhood obesity. These components were designed with a focus on (a) improving children's healthy eating behaviors and nutrition knowledge, (b) increasing physical activity and reducing sedentary activity in the childcare setting, (c) improving children's behavioral self-regulation, and (d) providing parental web-based education to address child target outcomes. The components were tested with approximately 1400 preschool children, ages 3-5 years in center-based childcare programs in Pennsylvania, the majority of which served predominantly Head-Start eligible households. Primary child outcomes included healthy eating knowledge, physical and sedentary activity, and behavioral self-regulation. Secondary outcomes included children's body mass index and appetitive traits related to appetite regulation. Results: Four intervention components were developed, including three classroom curricula designed to increase preschool children's nutrition knowledge, physical activity, and behavioral, emotional, and eating regulation. A web-based parent education component included 18 lessons designed to improve parenting practices and home environments that would bolster the effects of the classroom curricula. A plan for analyzing the specific contribution of each component to a larger intervention was developed and is described. The efficacy of the four components can be evaluated to determine the extent to which they, individually and in combination, produce detectable changes in childhood obesity risk factors. The resulting optimized intervention should later be evaluated in a randomized controlled trial, which may provide new information on promising targets for obesity prevention in young children. Conclusion: This research project highlights the ways in which an innovative approach to the design and initial evaluation of preventive interventions may increase the likelihood of long-term success. The lessons from this research project have implications for childhood obesity research as well as other preventive interventions that include multiple components, each targeting unique contributors to a multifaceted problem.

Associations between parents’ self-rated mental health status and children’s (0–17 years) unmet health care needs were examined in the 2019–20 National Survey of Children’s Health. Compared to parents with excellent/very good mental health, parents with poor/fair mental health were more likely to report children as having unmet health care needs, more missed school days due to illness/injury, and poor/fair general health. Problems paying for health care, transportation or childcare, lack of parenting support, parenting stress and parents’ own physical health problems were identified as barriers. Parents with poor mental health may benefit from programs that provide parenting support.

A free and charitable clinic successfully designed and implemented mass COVID-19 vaccination clinics in a semirural area in Central Pennsylvania. A total of 172 clinics were offered, approximately 500 volunteers were mobilized, and approximately 45,000 vaccine doses were administered. Partnering with local schools, universities, and recreation centers to offer mass vaccination clinics made it possible to expand the clinic's reach beyond its own patients. Findings provide evidence for the capacity of small community clinics to respond to major public health emergencies, such as a pandemic.

Eating in the absence of hunger (EAH) has been identified as a behavioral phenotype for obesity. Few studies have reported on objective measures of EAH in adolescents, and fewer yet have objectively measured EAH in a naturalistic, home setting. The purpose of this paper was to examine relations between objective, adolescent-report and parent-report measures of EAH, and to examine variation by sex and race. Participants included 295 predominantly low-income and rural adolescents (mean age = 14.2 ± 0.6 years) and their parents, drawn from the Family Life Project. An EAH task was administered in the home following an ad-libitum meal and compulsory milkshake; EAH was also reported on a web-based survey (both adolescent and parent reports) and adolescents’ BMIz was calculated from height and weight, measured in the home or self-reported on the web survey. A high degree of variability in EAH intake was observed (range = 8–741 kcals). Parent and adolescent reports of EAH were weakly correlated and unrelated to observed EAH consumption; only adolescent reports of EAH were related to their BMIz. Several relations varied by sex and race. Positive associations between reported and observed EAH was only observed in girls, and positive associations between observed EAH and BMI was only observed in boys and in white adolescents. Overall EAH consumption was significantly greater in boys and in white adolescents. These findings suggest that EAH can be measured in adolescents in the home. In this sample of youth experiencing rural poverty, this home-based measure appears most valid for white adolescent girls.