Both researchers and primary care providers vary in their methods for assessing weight status in infants. The purpose of the present investigation was to compare standing-height-derived to recumbent-length-derived weight-for-length standardized (WLZ) scores, using the WHO growth curves, in a convenience sample of infants who visited the lab at 18 and 21 months of age. Fifty-eight primarily White, middle class infants (25 girls) from a semi-rural region of southern Appalachia visited the lab at 18 months, with 45 infants returning 3 months later. We found that recumbent-length-derived WLZ scores were significantly higher at 18 months than corresponding standing-height-derived WLZ scores. We also found that recumbent-length-derived WLZ scores, but not those derived from standing height measures, decreased significantly from 18 to 21 months. Although these differential results are attributable to the WHO database data entry syntax, which automatically corrects standing height measurements by adding 0.7cm, they suggest that researchers proceed cautiously when using standing-height derived measures when calculating infant BMI z-scores. Our results suggest that for practical purposes, standing height measurements may be preferred, so long as they are entered into the WHO database as recumbent length measurements. We also encourage basic science infancy researchers to include BMI assessments as part of their routine assessment protocols, to serve as potential outcome measures for other basic science variables of theoretical interest.

Inappropriate weight gain during pregnancy is a widespread problem associated with adverse maternal and newborn outcomes. This study’s objective was to examine the impact of gestational weight gain (GWG) above and below the Institute of Medicine (IOM) guidelines on pregnancy, delivery, and newborn outcomes in a rural population. Women were recruited at the first prenatal visit, and data was collected through research interviews and examination of prenatal and delivery medical records. Prepregnancy weight and weight at delivery were obtained, and the final sample (n=913) was restricted to women with singleton pregnancies. Participants were categorized by prepregnancy body mass index (BMI) and GWG above, within, or below IOM guidelines based on gestational length. After controlling for pregnancy smoking, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to identify significant outcomes associated with high or low weight gain, with normal GWG as the control. Of the 913 participants, 208 (22.8%) had inadequate GWG, 255 (27.9%) gained within the recommended range, and 450 (49.3%) gained more than recommended. Inadequate GWG was associated with delivery before 39 weeks, oxygen administration to the infant, admission to the neonatal intensive care unit (NICU), and a hospital stay longer than seven days. Excess GWG was associated with preeclampsia, pregnancy-induced hypertension (PIH), gestational diabetes mellitus, cesarean delivery, labor longer than 12 hours, macrosomia, and large-for-gestational-age (LGA) infants. GWG outside IOM guidelines was prevalent in the sample and associated with numerous adverse outcomes, suggesting a need for increased awareness and improved management of GWG in this population.

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School-based efforts to promote physical activity and healthier eating are a potentially effective approach to decreasing child obesity in rural populations. This article describes follow-up data on student activity and eating behaviors 4 years after implementation of the Winning with Wellness obesity prevention initiative. This project was based on the Centers for Disease Control and Prevention's coordinated school health model and used a community-based participatory research approach to address health behaviors in rural Appalachian elementary students. Results suggest significant increases in daily pedometer steps and healthier food selections by students as well as teacher support for continued health promotion efforts.

The American Psychological Association (APA) Working Group’s Proactive Approach and Pedagogical Statement represent good first steps in helping graduate programs manage threats to professional training imposed by “conscience clause legislation.” But much heavier lifting is needed if the discipline hopes to fend off far greater threats to its legitimacy imposed by anti-intellectualism broadly. I suggest that this objective can be accomplished through establishing statewide psychology collaboratives comprising health service psychology (HSP) and non-HSP psychologists, jointly mobilized by APA and the Association for Psychological Science, who should work with state legislatures, through existing infrastructures found in state psychological associations, to implement wholesale foundational changes in psychology education from elementary school through graduate school, through political reformation and the branding of psychology.

Birth order effects have been the subject of considerable research in the developmental literature. One aim of the present investigation was to explore links between temperament and birth order. Temperament should be linked to birth order. Because infant temperament is related to maternal stress during pregnancy (Huizink et al, 2002), and because mothers caring for children while pregnant presumably experience more stress, laterborn children could have different temperamental profiles than earlier-born children. Research has also shown reliable links between birth order and vocabulary size in infancy; with second born children demonstrating significantly larger vocabularies at 21 months (Oshima-Takane et al., 1996). However, to our knowledge, no studies have investigated the relationship between birth order and gestural productivity. Because gestural production is linked to language development (Iverson & Goldin-Meadow, 2005), it stands to reason that birth order should also be linked to gestural production. Thus, our second aim was to evaluate the relationship between birth order and gestural production. Eighty-three children (32 girls) visited the lab at M = 15.45 months (SD = 1.92 months). Caregivers completed the Infant Behavioral Questionnaire-Revised (IBQ-R), the MacArthur-Bates Communicative Development Inventory: Words and Gestures (MCDIWG), and a demographic questionnaire assessing family size and birth order. The IBQ-R produced three overarching superdimensions: surgency, negative affectivity, and effortful control. Gestural productivity was derived from the MCDI-WG. In line with our first aim, we evaluated correlations between infant temperament and birth order. These analyses revealed a significant and positive relationship between later-born status and temperamental negative affectivity (r = .27, p = .03), indicating that later-born children were rated by mothers as temperamentally more negative in affective expression. Neither other temperament superdimension was related to birth order. Follow-up analyses revealed that sadness was the only subdimension of negative affectivity to be associated with later-born status (r = .31, p < .01). To investigate whether birth order was related to gestural production, we analyzed correlations between birth order and the MCDI-WG categories of "performing actions with objects" and "imitation". Positive and significant associations between birth order and both gestural production measures were found (performing actions with objects, r = .30, p = .03; and imitation, r = .35, p < .01). Although these results were in line with our expectations, they remain to be supported by replication. In the meantime, these results suggest interesting findings for both temperament and language researchers. First, later born children appear more at risk for temperamental difficulty. The source of this risk could include heightened maternal prenatal stress during pregnancy. But the source could also be postnatal, perhaps exacerbated by later-borns spending proportionally less time with caregivers, or more time sharing with siblings. Secondly, the gestural production results suggest that later born children are at a particular advantage. This advantage may be due to the fact that later born children, by virtue of their larger families, have more mode.

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Childhood obesity has been an increasing problem in the United States, especially in rural areas. Effective prevention approaches are needed. This article describes the development, implementation, effectiveness, feasibility, and sustainability of a school-based obesity prevention pilot project, Winning with Wellness. The program was based on the coordinated school health model and included a community-based participatory research approach aimed at promoting healthy eating and physical activity in a rural Appalachian elementary school. Findings from this preliminary project revealed improvements in nutrition offerings and increased physical activity during the school day. In addition, the program was found to be acceptable to teachers, successfully implemented utilizing both existing and newly developed resources, and sustainable as evidenced in continued practice and expansion to other area schools.

Objectives: Breast-feeding rates in rural and southeastern regions of the United States are lower than national rates and Healthy People 2020 targets. The objectives of this study were to understand current breast-feeding knowledge, attitudes, and beliefs among rural southern Appalachian adolescents and to explore whether a high school educational intervention designed to address the five tenets (knowledge, attitudes, intentions, perceived behavioral control, and subjective norms) of the theory of planned behavior may be effective in increasing future rates of breast-feeding in this population. Methods: An educational session including an interactive game was developed and administered to occupational health science students during a single class period in two county high schools. A presurvey and a postsurvey administered 2 weeks after the intervention were completed by students. Pre- and postsurveys were analyzed using paired ttests and Cohen d and potential differences based on sex and grade were explored. Results: Both pre- and postsurveys were completed by 107 students (78%). Knowledge, attitudes about breast-feeding benefits, subjective norms, and intentions significantly improved following the intervention. Baseline knowledge and attitudes about breast-feeding benefits for mothers were low and demonstrated the greatest improvement. Conclusions: Offering breast-feeding education based on the theory of planned behavior in a single high school class session was effective in improving student knowledge, attitudes, and beliefs about breast-feeding and intention to breast-feed.