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Objectives: This study examined the relation of multiple aspects of the home food environment to dietary intake and body weight among overweight and obese children in southern Appalachia. Methods: The study used baseline data from a cluster-randomized controlled trial, Parent-Led Activity and Nutrition for Healthy Living, evaluating a parent-mediated approach to treating child overweight and obesity in the primary care setting in southern Appalachia. Sixty-seven children ages 5 to 11 years were recruited from four primary care clinics. Multiple linear regression was used to estimate the relation between multiple aspects of the home food environment to dietary intake (fruit and vegetable intake, fat and sweets intake), and standardized body mass index (zBMI), adjusted for baseline family characteristics (education, smoking status during the past month, BMI) and child characteristics (sex, age, Medicaid/TennCare). Results: Findings showed greater parental restriction and pressure in feeding were associated with greater fruit and vegetable intake in children (β = 0.33, β = 0.30, respectively; both P < 0.05). The availability of chips and sweets in a child’s home and parental inappropriate modeling of eating were associated with an increased risk for consumption of fats and sweets by children (β = 0.47, β = 0.54, respectively; both P < 0.01). Parental monitoring of the child’s eating was associated with a reduced risk for fat and sweets intake (β = −0.24; P < 0.01). Finally, parental responsibility for feeding the child was associated with lower zBMI (β = −0.20; P < 0.05). Conclusions: The home food environment, including food availability and parenting behaviors, was associated with overweight and obese children’s dietary intake and weight. This study adds to evidence suggesting that programs aimed at improving overweight and obese children’s eating patterns may target both aspects of the physical home environment and parental behaviors surrounding eating.

Background: Professional guidelines recommend that all adolescents receive annual preventive visits including psychosocial and behavioral screening, and anticipatory guidance and counseling for health risk behaviors. Youth with special health care needs (YSHCN) experience many health-related disparities yet little is known about receipt of such counseling this population. Objective: We characterized adolescents’ receipt of recommended healthcare provider-delivered counseling and assessed differences between youth with and without special health care needs. Design/Methods: We used data from a 2016 school-based survey of adolescents ages 16-18 in rural South Central Appalachia Tennessee (n=403). About one-quarter (23%) were categorized as YSHCN. A greater proportion of YSHCN were female (68% vs. 49%), non-Hispanic white (96% vs. 83%), or had seen a doctor or other healthcare provider in the past year (97% vs. 83%) (all p<.05). Adolescents reported on their discussions with a healthcare provider about ten different recommended topics across four areas: weight/physical activity; mental health; substance use; and protective factors (i.e., friends, school). We assessed differences in individual topics discussed by YSHCN status using chi-square analyses and multivariable logistic regression. Results: Overall, only half (50%) of adolescents reported talking with their healthcare provider about any of the assessed topics. As shown in Figure 1, receipt of counseling varied by YSHCN status with a greater proportion of YSHCN reporting having discussed most of the assessed topics with a healthcare provider compared to other youth. In multivariable models controlling for adolescents’ sex, age, race/ethnicity, SES, use of health services, and quality of a relationship with their healthcare provider, YSHCN had greater odds than other youth of discussing topics related to weight/physical activity (OR=4.08, 95% CI: 2.35-7.07); mental health (OR=2.50, 95%CI: 1.46-4.31); protective factors (OR=2.32, 95% CI: 1.29-4.18); but not substance use (p>.05). Conclusion(s): This study provides novel data on receipt of healthcare provider-delivered counseling about important health risk and promotion topics. Findings suggest that YSHCN are more likely than other youth to receive counseling about most topics, even when controlling for their increased receipt of preventive care. However, findings also highlight suboptimal provision of anticipatory guidance to all youth, and point to the need to increase delivery of adolescent preventive servcies.

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It is currently estimated that over one-third of children aged 6-11 years in the United States are overweight or obese with some of the highest rates documented in Southern Appalachia. Primary care providers are uniquely positioned to intervene, however, lack of time as well as training and confidence in using behavioral techniques have been cited as barriers. Recommended strategies include use of a multidisciplinary team approach, family-centered communication, behavioral strategies, and care delivery following the chronic care model, including enhancement of parent self-management. The purpose of this study was to develop and evaluate a parent-mediated approach utilizing physician’s brief motivational interviewing and parent group sessions to treat child overweight and obesity in the primary care setting in Southern Appalachia. The current study enrolled 67 children (5-11 years) with BMI≥85th percentile and a parent/primary caregiver from four primary care practices in Southern Appalachia. The two participating Pediatric practices and two Family Medicine practices were randomized to intervention or usual care control groups. Providers in the intervention group were trained to deliver two individual visits, using brief motivational interviewing and following the AAP 15-minutes obesity prevention protocol, and four group visits using the NIH We Can! Curriculum with parents over an 8-10 week period. Trained study staff also completed four phone calls using brief motivational interviewing with parents following each group visit. Child weight and height and parent surveys were collected for both intervention and control groups at baseline, three, and six months. Additionally, parents in the intervention group completed We Can! surveys at baseline and following the fourth group session. An analysis of covariance (ANCOVA) was performed to test for the effect of treatment on zBMI at three and six months post-intervention. We Can! survey results were analyzed using paired t-tests. Data on 53 (82%) and 46 (69%) of participants was available at 3 and 6 months, respectively. While the point estimate of the treatment effect was in the expected direction, the effect of treatment assignment did not have a statistically significant effect on the zBMI at either three or six months. However, significant (p This study provides preliminary data on the use of a combination of individual and group visits with parents to treat overweight and obesity in children in primary care.

As part of a cluster randomized controlled trial of a parent-mediated approach to treating overweight and obese children ages 5-11 years in Southern Appalachia, feedback on use of the NIH We Can! curriculum for parent group visit sessions in primary care was obtained from parents and providers in two intervention clinics. Parents/caregivers of 28 children in two primary care clinics were randomized to the intervention group to participate in four on-site 1.5 hour group sessions held every other week during an 8-10 week period. Five primary care providers (PCPs) in the two clinics were trained to lead the group sessions using the NIH We Can! online training and an additional 1-hour face-to-face training conducted by the project team. The Project Coordinator and one project team clinician (Pediatrician, Pediatric Psychologist, or Registered Dietician (RD)) was present during each group visit to answer any questions about the study protocol, behavior (Pediatric Psychologist) or nutrition/eating (RD). The Project Coordinator or RD called each parent during the week following each group visit to discuss the family’s progress and answer questions. Written feedback surveys were completed by parents and focus groups were conducted with providers following the last group session. Provider focus groups were recorded and later transcribed and coded to indentify themes. Among 22 (79%) parents/caregivers who completed group sessions and a feedback survey, 91% agreed/strongly agreed that “this program was very useful to me as a parent.” In addition, 95% said that they would “recommend We Can! to a friend” citing benefiting from information received from healthcare providers and parents as well as the opportunity for “fellowship” with other parents. All five PCPs led at least 1 or 2 group sessions and participated in focus groups. Most PCPs agreed that the We Can! leader’s guide and training prepared them to lead the group sessions. All providers reported that preparation time to lead a session (15-90 minutes) was reasonable. On average, providers perceived the group sessions to be moderately effective in promoting healthier eating, physical activity, and reducing screen time in their patients. Some providers were interested in continuing to offer a monthly group session for long-term support. These findings suggest parent and healthcare provider acceptability of using NIH We Can! parent group sessions to treat child overweight in primary care.