Background: Efforts to prevent the development of overweight and obesity have increasingly focuse... more Background: Efforts to prevent the development of overweight and obesity have increasingly focused early in the life course as we recognise that both metabolic and behavioural patterns are often established within the first few years of life. Randomised controlled trials (RCTs) of interventions are even more powerful when, with forethought, they are synthesised into an individual patient data (IPD) prospective meta-analysis (PMA). An IPD PMA is a unique research design where several trials are identified for inclusion in an analysis before any of the individual trial results become known and the data are provided for each randomised patient. This methodology minimises the publication and selection bias often associated with a retrospective meta-analysis by allowing hypotheses, analysis methods and selection criteria to be specified a priori.
Abstract Background Inadequate fruit and vegetable consumption in childhood increases the risk of... more Abstract Background Inadequate fruit and vegetable consumption in childhood increases the risk of developing chronic disease. Despite this, a substantial proportion of children in developed nations, including Australia, do not consume sufficient quantities of fruits and vegetables. Parents are influential in the development of dietary habits of young children but often lack the necessary knowledge and skills to promote healthy eating in their children. The aim of this study is to assess the efficacy of a telephone-based intervention for parents to increase the fruit and vegetable consumption of their 3- to 5-year-old children. Methods/Design The study, conducted in the Hunter region of New South Wales, Australia, employs a cluster randomised controlled trial design. Two hundred parents from 15 randomly selected preschools will be randomised to receive the intervention, which consists of print resources and four weekly 30-minute telephone support calls delivered by trained telephone ...
Intervention programs to prevent childhood obesity are more likely to be successful when mothers ... more Intervention programs to prevent childhood obesity are more likely to be successful when mothers are involved and engaged. Yet programs that involve mothers do not often employ process evaluation to identify aspects of the intervention that participants enjoyed or viewed as useful. The aims of this study were to describe how participants of the Melbourne InFANT Program-an early childhood obesity prevention intervention-engaged in the program and perceived its usefulness. Process evaluation data were collected at multiple time points during and after the intervention, using mixed methods drawing upon both quantitative and qualitative data. Results from short surveys (n = 271) and interview transcripts (n = 26) revealed that the Melbourne InFANT Program was perceived as useful and relevant by most (82-93%) participants. The formats through which the knowledge and skills were delivered were considered concise and effective, and aspects considered particularly useful included group sess...
Findings from research that has assessed the influence of dietary factors on child obesity have b... more Findings from research that has assessed the influence of dietary factors on child obesity have been equivocal. In the present study, we aimed to test the hypothesis that a positive change in diet quality is associated with favourable changes in BMI z-scores (zBMI) in schoolchildren from low socio-economic backgrounds and to examine whether this effect is modified by BMI category at baseline. The present study utilised data from a subsample (n 216) of the Resilience for Eating and Activity Despite Inequality study, a longitudinal cohort study with data collected in 2007-8 (T1) and 2010-11 (T2) in socio-economically disadvantaged women and children (5-12 years at T1). Dietary data were collected using a FFQ and diet quality index (DQI) scores derived at both time points. The objective measures of weight, height and physical activity (accelerometers) were included. The other variables were reported in the questionnaires. We examined the association between change in DQI and change in ...
Food preferences are important determinants of children's food intakes. Parental feeding beha... more Food preferences are important determinants of children's food intakes. Parental feeding behaviours have a significant influence on the development of children's food preferences. The aim of the present study was to describe the ways in which parents attempt to influence their children's food preferences. Parents of 2-5 year old children participated in semi-structured qualitative interviews, which were transcribed and content analysed using a thematic coding manual. The parents described the ways in which they tried to influence the foods their child liked and disliked. Participants (N=57) were separated into three separate groups based on an a priori study measuring food preferences and food neophobia: those who either had children with healthy food preferences (i.e. closely aligned with dietary guidelines) (N=20), or unhealthy food preferences (i.e. not closely aligned with dietary guidelines) (N=18), or high levels of food neophobia (N=19). The parents used many, div...
Abstract Dietary intake and food habits are important contributors to the obesity epidemic. They ... more Abstract Dietary intake and food habits are important contributors to the obesity epidemic. They are highly modifiable components of energy balance and are usually targeted in both obesity prevention and treatment programs. However, measurement of total diet creates challenges and can convey a large burden in terms of cost, technical expertise, impact on respondents and time. It is not surprising therefore that comprehensive reports of dietary intake in children are uncommon and, when reported, have limitations. The aim of this paper is to guide researchers and practitioners in selecting the most appropriate dietary assessment method for situations involving children and adolescents. This paper presents a summary of the issues to consider when choosing a method, a description of some of the more commonly used dietary assessment methods for young people and a series of case-studies to illustrate the range of circumstances faced when measuring dietary intake. We recommend that researchers consider the specific components of dietary intake addressed in their research and practice, and whether diet should be reported comprehensively or as targeted components. Other considerations include age, cognitive ability, weight status, physical activity level, respondent burden, and reliability and validity in the context of program goals and research questions. A checklist for selecting the appropriate dietary methodology is provided. This guide aims to facilitate the reporting of dietary intake and food habits in the context of obesity using valid and reliable measures, thus contributing to the evidence-base for nutrition policies and programs relating to obesity.
Prevention of childhood obesity is an international public health priority given the significant ... more Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies that governments, communities and families can implement to prevent obesity, and promote health, has been accumulating but remains unclear. This review primarily aims to update the previous Cochrane review of childhood obesity prevention research and determine the effectiveness of evaluated interventions intended to prevent obesity in children, assessed by change in Body Mass Index (BMI). Secondary aims were to examine the characteristics of the programs and strategies to answer the questions "What works for whom, why and for what cost?" The searches were re-run in CENTRAL, MEDLINE, EMBASE, PsychINFO and CINAHL in March 2010 and searched relevant websites. Non-English language papers were included and experts were contacted. The review includes data from childhood obesity prevention studies that used a controlled study design (with or without randomisation). Studies were included if they evaluated interventions, policies or programs in place for twelve weeks or more. If studies were randomised at a cluster level, 6 clusters were required. Two review authors independently extracted data and assessed the risk of bias of included studies. Data was extracted on intervention implementation, cost, equity and outcomes. Outcome measures were grouped according to whether they measured adiposity, physical activity (PA)-related behaviours or diet-related behaviours. Adverse outcomes were recorded. A meta-analysis was conducted using available BMI or standardised BMI (zBMI) score data with subgroup analysis by age group (0-5, 6-12, 13-18 years, corresponding to stages of developmental and childhood settings). This review includes 55 studies (an additional 36 studies found for this update). The majority of studies targeted children aged 6-12 years. The meta-analysis included 37 studies of 27,946 children and demonstrated that programmes were effective at reducing adiposity, although not all individual interventions were effective, and there was a high level of observed heterogeneity (I(2)=82%). Overall, children in the intervention group had a standardised mean difference in adiposity (measured as BMI or zBMI) of -0.15kg/m(2) (95% confidence interval (CI): -0.21 to -0.09). Intervention effects by age subgroups were -0.26kg/m(2) (95% CI:-0.53 to 0.00) (0-5 years), -0.15kg/m(2) (95% CI -0.23 to -0.08) (6-12 years), and -0.09kg/m(2) (95% CI -0.20 to 0.03) (13-18 years). Heterogeneity was apparent in all three age groups and could not explained by randomisation status or the type, duration or setting of the intervention. Only eight studies reported on adverse effects and no evidence of adverse outcomes such as unhealthy dieting practices, increased prevalence of underweight or body image sensitivities was found. Interventions did not appear to increase health inequalities although this was examined in fewer studies. We found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeted to children aged six to 12 years. However, given the unexplained heterogeneity and the likelihood of small study bias, these findings must be interpreted cautiously. A broad range of programme components were used in these studies and whilst it is not possible to distinguish which of these components contributed…
Objective. To assess the effectiveness of the Melbourne Infant Feeding, Activity and Nutrition Tr... more Objective. To assess the effectiveness of the Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) Program according to maternal education and age.
Background: Children from disadvantaged families including those from low socioeconomic backgroun... more Background: Children from disadvantaged families including those from low socioeconomic backgrounds and Indigenous families have higher rates of obesity, making early intervention a priority. The aim of this study was to systematically review the literature to examine the effectiveness of interventions to prevent obesity or improve obesity related behaviours in children 0-5 years from socioeconomically disadvantaged or Indigenous families. Methods: Searches of major electronic databases identified articles published from 1993-2013 targeting feeding practices, anthropometric, diet, activity or sedentary behaviour outcomes. This was supplemented with snowballing from existing reviews and primary studies. Data extraction was undertaken by one author and cross checked by another. Quality assessments included both internal and external validity.
Although mothers of young children frequently experience negative affect, little is known about t... more Although mothers of young children frequently experience negative affect, little is known about the association between these symptoms and their children's eating behaviors. We aimed to test a model in which maternal negative affect would be related to maternal emotional eating which in turn would be associated with child emotional eating through maternal feeding practices (emotional and instrumental feeding) in a cross-sectional sample of mothers and their children. A sample of 306 mothers (mean age = 35.0 years, SD = 0.46) of 2-year-old children completed a survey assessing symptoms of depression, anxiety and stress, maternal emotional eating, maternal feeding practices, and child emotional eating. Maternal symptoms of depression, anxiety, and stress were correlated with maternal emotional eating (p < .001), and child emotional eating (p < .05). The initial model proposed was not a good fit to the data. Modification indices indicated that the model would be improved if a direct pathway was added between maternal and child emotional eating. As this model was theoretically plausible these changes were made. The resulting model proved a good fit to the data, χ2 = 17.36, p = .098, and explained 29% of the variance in child emotional eating. High levels of negative affect and associated emotional eating in mothers may contribute to the use of instrumental and emotional feeding practices. Our findings suggested that maternal negative affect has an indirect effect on children's emotional eating, primarily through mothers' own emotional eating and feeding her child to regulate the child's emotions.
Objective: To examine the potential efficacy of a brief telephone-based parental intervention in ... more Objective: To examine the potential efficacy of a brief telephone-based parental intervention in increasing fruit and vegetable consumption in children aged 3-5 years and to examine the feasibility of intervention delivery and acceptability to parents. Design: A pre-post study design with no comparison group. Telephone surveys were conducted approximately 1 week before and following intervention delivery. Setting: Participants were recruited through pre-schools in the Hunter region, New South Wales, Australia. Subjects: Thirty-four parents of 3-5-year-olds received four 30-min interventional telephone calls over 4 weeks administered by trained telephone interviewers. The scripted support calls focused on fruit and vegetable availability and accessibility within the home, parental role modelling of fruit and vegetable consumption and on implementing supportive family eating routines. Results: Following the intervention, the frequency and variety of fruit and vegetable consumption increased (P 5 0?027), as measured by a subscale of the children's dietary questionnaire. The intervention was feasible to be delivered to parents, as all participants who started the intervention completed all four calls, and all aspects of the interventional calls, including the number, length, content, format and relevance, were considered acceptable by more than 90 % of parents. Conclusions: A brief telephone-based parental intervention to encourage fruit and vegetable consumption in pre-school-aged children may be effective, feasible and acceptable. Further investigation is warranted in a randomised controlled trial.
Parents have a major influence on young children's diets, food choices and habit formation. 1 How... more Parents have a major influence on young children's diets, food choices and habit formation. 1 However, research concerning parental influence on children's diets is limited. Qualitative 2 research informs quantitative research with a narrative of 'what works', and is a valuable tool 3 to inform intervention design and practice. This paper presents a systematic review of 4 qualitative research with parents of preschool children and their influence on their child's 5 diet. Nine studies were identified. Findings highlight the need to promote culturally tailored 6 programs to combat specific cultural differences such as attitudes, perceptions and concerns, 7 address common barriers to providing healthy foods and challenges faced by lower income 8 families, the use of food to shape a child's behaviour , that children will grow out of excess 9 weight, common misconceptions such as a heavier child is healthier and depriving a child's 10 food request could result in starvation. Research on parental understanding of healthy diets 11 and feeding practices is lacking. Further insights into how to positively influence children's 12 diets will come from research examining parent feeding practices and nutrition knowledge. 13 14
International Journal of Behavioral Nutrition and Physical Activity, 2014
Background: To investigate the effect of an early childhood obesity prevention intervention, inco... more Background: To investigate the effect of an early childhood obesity prevention intervention, incorporating a parent modelling component, on fathers' obesity risk-related behaviours. Methods: Cluster randomized-controlled trial in the setting of pre-existing first-time parents groups organised by Maternal and Child Health Nurses in Victoria, Australia. Participants were 460 first-time fathers mean age = 34.2 (s.d.4.90) years. Dietary pattern scores of fathers were derived using principal component analysis, total physical activity and total television viewing time were assessed at baseline (infant aged three to four months) and after 15 months. Results: No significant beneficial intervention effect was observed on fathers' dietary pattern scores, total physical activity or total television viewing time. Conclusion: Despite a strong focus on parent modelling (targeting parents own diet, physical activity and television viewing behaviours), and beneficial impact on mothers' obesity risk behaviours, this intervention, with mothers as the point of contact, had no effect on fathers' obesity risk-related behaviours. Based on the established links between children's obesity risk-related behaviors and that of their fathers, a need exists for research testing the effectiveness of interventions with a stronger engagement of fathers.
Multiple factors combine to support a compelling case for interventions that target the developme... more Multiple factors combine to support a compelling case for interventions that target the development of obesity-promoting behaviours (poor diet, low physical activity and high sedentary behaviour) from their inception. These factors include the rapidly increasing prevalence of fatness throughout childhood, the instigation of obesity-promoting behaviours in infancy, and the tracking of these behaviours from childhood through to adolescence and adulthood. The Infant Feeding Activity and Nutrition Trial (INFANT) aims to determine the effectiveness of an early childhood obesity prevention intervention delivered to first-time parents. The intervention, conducted with parents over the infant's first 18 months of life, will use existing social networks (first-time parent's groups) and an anticipatory guidance framework focusing on parenting skills which support the development of positive diet and physical activity behaviours, and reduced sedentary behaviours in infancy.
Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30-5... more Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30-50% reported in early pregnancy. Maternal adiposity is a costly challenge for Australian obstetric care, with associated serious maternal and neonatal complications. Excess gestational weight gain is an important predictor of offspring adiposity into adulthood and higher maternal weight later in life. Current public health and perinatal care approaches in Australia do not adequately address excess perinatal maternal weight or gestational weight gain. This paper argues that the failure of primary health-care providers to offer systematic advice and support regarding women's weight and related lifestyle behaviours in child-bearing years is an outstanding 'missed opportunity' for prevention of inter-generational overweight and obesity. Barriers to action could be addressed through greater attention to: clinical guidelines for maternal weight management for the perinatal period, training and support of maternal health-care providers to develop skills and confidence in raising weight issues with women, a variety of weight management programs provided by state maternal health services, and clear referral pathways to them. Attention is also required to service systems that clearly define roles in maternal weight management and ensure consistency and continuity of support across the perinatal period.
Cameron: Clustering of obesity-related behaviours 2 Abstract Purpose To examine the clustering an... more Cameron: Clustering of obesity-related behaviours 2 Abstract Purpose To examine the clustering and patterns of obesity-related behaviours in children and their mothers and the concordance between mother and child pairs.
Keywords: BRCA1, BRCA2, psychological distress, breast cancer, peer support, RCT Running head: Pe... more Keywords: BRCA1, BRCA2, psychological distress, breast cancer, peer support, RCT Running head: Peer support for women with mutations in the BRCA genes Word count: 2999 words (excluding references and acknowledgements) Financial Disclosure: No Financial disclosures to report for any author 4 Abstract Purpose: To assess the effectiveness of a telephone-based peer-delivered intervention, in reducing distress among women with a BRCA1 or BRCA2 gene mutation. The intervention involved trained peer volunteers contacting women multiple times over a four-month period to provide informational, emotional and practical support. Methods: 337 participants completed the baseline questionnaire and those reporting interest in talking to other mutation carriers were randomized to either usual care (UCG) (n = 102) or the intervention (n = 105) (IG). Participants and researchers were not blinded to group allocation. Two follow-up questionnaires were completed: i) at the end of the intervention (four months after randomization, Time 2) and ii) two months later (Time 3). Outcomes included breast cancer distress (primary outcome), unmet information needs, cognitive appraisals about mutation testing and feelings of isolation.
Background: Efforts to prevent the development of overweight and obesity have increasingly focuse... more Background: Efforts to prevent the development of overweight and obesity have increasingly focused early in the life course as we recognise that both metabolic and behavioural patterns are often established within the first few years of life. Randomised controlled trials (RCTs) of interventions are even more powerful when, with forethought, they are synthesised into an individual patient data (IPD) prospective meta-analysis (PMA). An IPD PMA is a unique research design where several trials are identified for inclusion in an analysis before any of the individual trial results become known and the data are provided for each randomised patient. This methodology minimises the publication and selection bias often associated with a retrospective meta-analysis by allowing hypotheses, analysis methods and selection criteria to be specified a priori.
Abstract Background Inadequate fruit and vegetable consumption in childhood increases the risk of... more Abstract Background Inadequate fruit and vegetable consumption in childhood increases the risk of developing chronic disease. Despite this, a substantial proportion of children in developed nations, including Australia, do not consume sufficient quantities of fruits and vegetables. Parents are influential in the development of dietary habits of young children but often lack the necessary knowledge and skills to promote healthy eating in their children. The aim of this study is to assess the efficacy of a telephone-based intervention for parents to increase the fruit and vegetable consumption of their 3- to 5-year-old children. Methods/Design The study, conducted in the Hunter region of New South Wales, Australia, employs a cluster randomised controlled trial design. Two hundred parents from 15 randomly selected preschools will be randomised to receive the intervention, which consists of print resources and four weekly 30-minute telephone support calls delivered by trained telephone ...
Intervention programs to prevent childhood obesity are more likely to be successful when mothers ... more Intervention programs to prevent childhood obesity are more likely to be successful when mothers are involved and engaged. Yet programs that involve mothers do not often employ process evaluation to identify aspects of the intervention that participants enjoyed or viewed as useful. The aims of this study were to describe how participants of the Melbourne InFANT Program-an early childhood obesity prevention intervention-engaged in the program and perceived its usefulness. Process evaluation data were collected at multiple time points during and after the intervention, using mixed methods drawing upon both quantitative and qualitative data. Results from short surveys (n = 271) and interview transcripts (n = 26) revealed that the Melbourne InFANT Program was perceived as useful and relevant by most (82-93%) participants. The formats through which the knowledge and skills were delivered were considered concise and effective, and aspects considered particularly useful included group sess...
Findings from research that has assessed the influence of dietary factors on child obesity have b... more Findings from research that has assessed the influence of dietary factors on child obesity have been equivocal. In the present study, we aimed to test the hypothesis that a positive change in diet quality is associated with favourable changes in BMI z-scores (zBMI) in schoolchildren from low socio-economic backgrounds and to examine whether this effect is modified by BMI category at baseline. The present study utilised data from a subsample (n 216) of the Resilience for Eating and Activity Despite Inequality study, a longitudinal cohort study with data collected in 2007-8 (T1) and 2010-11 (T2) in socio-economically disadvantaged women and children (5-12 years at T1). Dietary data were collected using a FFQ and diet quality index (DQI) scores derived at both time points. The objective measures of weight, height and physical activity (accelerometers) were included. The other variables were reported in the questionnaires. We examined the association between change in DQI and change in ...
Food preferences are important determinants of children's food intakes. Parental feeding beha... more Food preferences are important determinants of children's food intakes. Parental feeding behaviours have a significant influence on the development of children's food preferences. The aim of the present study was to describe the ways in which parents attempt to influence their children's food preferences. Parents of 2-5 year old children participated in semi-structured qualitative interviews, which were transcribed and content analysed using a thematic coding manual. The parents described the ways in which they tried to influence the foods their child liked and disliked. Participants (N=57) were separated into three separate groups based on an a priori study measuring food preferences and food neophobia: those who either had children with healthy food preferences (i.e. closely aligned with dietary guidelines) (N=20), or unhealthy food preferences (i.e. not closely aligned with dietary guidelines) (N=18), or high levels of food neophobia (N=19). The parents used many, div...
Abstract Dietary intake and food habits are important contributors to the obesity epidemic. They ... more Abstract Dietary intake and food habits are important contributors to the obesity epidemic. They are highly modifiable components of energy balance and are usually targeted in both obesity prevention and treatment programs. However, measurement of total diet creates challenges and can convey a large burden in terms of cost, technical expertise, impact on respondents and time. It is not surprising therefore that comprehensive reports of dietary intake in children are uncommon and, when reported, have limitations. The aim of this paper is to guide researchers and practitioners in selecting the most appropriate dietary assessment method for situations involving children and adolescents. This paper presents a summary of the issues to consider when choosing a method, a description of some of the more commonly used dietary assessment methods for young people and a series of case-studies to illustrate the range of circumstances faced when measuring dietary intake. We recommend that researchers consider the specific components of dietary intake addressed in their research and practice, and whether diet should be reported comprehensively or as targeted components. Other considerations include age, cognitive ability, weight status, physical activity level, respondent burden, and reliability and validity in the context of program goals and research questions. A checklist for selecting the appropriate dietary methodology is provided. This guide aims to facilitate the reporting of dietary intake and food habits in the context of obesity using valid and reliable measures, thus contributing to the evidence-base for nutrition policies and programs relating to obesity.
Prevention of childhood obesity is an international public health priority given the significant ... more Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies that governments, communities and families can implement to prevent obesity, and promote health, has been accumulating but remains unclear. This review primarily aims to update the previous Cochrane review of childhood obesity prevention research and determine the effectiveness of evaluated interventions intended to prevent obesity in children, assessed by change in Body Mass Index (BMI). Secondary aims were to examine the characteristics of the programs and strategies to answer the questions "What works for whom, why and for what cost?" The searches were re-run in CENTRAL, MEDLINE, EMBASE, PsychINFO and CINAHL in March 2010 and searched relevant websites. Non-English language papers were included and experts were contacted. The review includes data from childhood obesity prevention studies that used a controlled study design (with or without randomisation). Studies were included if they evaluated interventions, policies or programs in place for twelve weeks or more. If studies were randomised at a cluster level, 6 clusters were required. Two review authors independently extracted data and assessed the risk of bias of included studies. Data was extracted on intervention implementation, cost, equity and outcomes. Outcome measures were grouped according to whether they measured adiposity, physical activity (PA)-related behaviours or diet-related behaviours. Adverse outcomes were recorded. A meta-analysis was conducted using available BMI or standardised BMI (zBMI) score data with subgroup analysis by age group (0-5, 6-12, 13-18 years, corresponding to stages of developmental and childhood settings). This review includes 55 studies (an additional 36 studies found for this update). The majority of studies targeted children aged 6-12 years. The meta-analysis included 37 studies of 27,946 children and demonstrated that programmes were effective at reducing adiposity, although not all individual interventions were effective, and there was a high level of observed heterogeneity (I(2)=82%). Overall, children in the intervention group had a standardised mean difference in adiposity (measured as BMI or zBMI) of -0.15kg/m(2) (95% confidence interval (CI): -0.21 to -0.09). Intervention effects by age subgroups were -0.26kg/m(2) (95% CI:-0.53 to 0.00) (0-5 years), -0.15kg/m(2) (95% CI -0.23 to -0.08) (6-12 years), and -0.09kg/m(2) (95% CI -0.20 to 0.03) (13-18 years). Heterogeneity was apparent in all three age groups and could not explained by randomisation status or the type, duration or setting of the intervention. Only eight studies reported on adverse effects and no evidence of adverse outcomes such as unhealthy dieting practices, increased prevalence of underweight or body image sensitivities was found. Interventions did not appear to increase health inequalities although this was examined in fewer studies. We found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeted to children aged six to 12 years. However, given the unexplained heterogeneity and the likelihood of small study bias, these findings must be interpreted cautiously. A broad range of programme components were used in these studies and whilst it is not possible to distinguish which of these components contributed…
Objective. To assess the effectiveness of the Melbourne Infant Feeding, Activity and Nutrition Tr... more Objective. To assess the effectiveness of the Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) Program according to maternal education and age.
Background: Children from disadvantaged families including those from low socioeconomic backgroun... more Background: Children from disadvantaged families including those from low socioeconomic backgrounds and Indigenous families have higher rates of obesity, making early intervention a priority. The aim of this study was to systematically review the literature to examine the effectiveness of interventions to prevent obesity or improve obesity related behaviours in children 0-5 years from socioeconomically disadvantaged or Indigenous families. Methods: Searches of major electronic databases identified articles published from 1993-2013 targeting feeding practices, anthropometric, diet, activity or sedentary behaviour outcomes. This was supplemented with snowballing from existing reviews and primary studies. Data extraction was undertaken by one author and cross checked by another. Quality assessments included both internal and external validity.
Although mothers of young children frequently experience negative affect, little is known about t... more Although mothers of young children frequently experience negative affect, little is known about the association between these symptoms and their children's eating behaviors. We aimed to test a model in which maternal negative affect would be related to maternal emotional eating which in turn would be associated with child emotional eating through maternal feeding practices (emotional and instrumental feeding) in a cross-sectional sample of mothers and their children. A sample of 306 mothers (mean age = 35.0 years, SD = 0.46) of 2-year-old children completed a survey assessing symptoms of depression, anxiety and stress, maternal emotional eating, maternal feeding practices, and child emotional eating. Maternal symptoms of depression, anxiety, and stress were correlated with maternal emotional eating (p < .001), and child emotional eating (p < .05). The initial model proposed was not a good fit to the data. Modification indices indicated that the model would be improved if a direct pathway was added between maternal and child emotional eating. As this model was theoretically plausible these changes were made. The resulting model proved a good fit to the data, χ2 = 17.36, p = .098, and explained 29% of the variance in child emotional eating. High levels of negative affect and associated emotional eating in mothers may contribute to the use of instrumental and emotional feeding practices. Our findings suggested that maternal negative affect has an indirect effect on children's emotional eating, primarily through mothers' own emotional eating and feeding her child to regulate the child's emotions.
Objective: To examine the potential efficacy of a brief telephone-based parental intervention in ... more Objective: To examine the potential efficacy of a brief telephone-based parental intervention in increasing fruit and vegetable consumption in children aged 3-5 years and to examine the feasibility of intervention delivery and acceptability to parents. Design: A pre-post study design with no comparison group. Telephone surveys were conducted approximately 1 week before and following intervention delivery. Setting: Participants were recruited through pre-schools in the Hunter region, New South Wales, Australia. Subjects: Thirty-four parents of 3-5-year-olds received four 30-min interventional telephone calls over 4 weeks administered by trained telephone interviewers. The scripted support calls focused on fruit and vegetable availability and accessibility within the home, parental role modelling of fruit and vegetable consumption and on implementing supportive family eating routines. Results: Following the intervention, the frequency and variety of fruit and vegetable consumption increased (P 5 0?027), as measured by a subscale of the children's dietary questionnaire. The intervention was feasible to be delivered to parents, as all participants who started the intervention completed all four calls, and all aspects of the interventional calls, including the number, length, content, format and relevance, were considered acceptable by more than 90 % of parents. Conclusions: A brief telephone-based parental intervention to encourage fruit and vegetable consumption in pre-school-aged children may be effective, feasible and acceptable. Further investigation is warranted in a randomised controlled trial.
Parents have a major influence on young children's diets, food choices and habit formation. 1 How... more Parents have a major influence on young children's diets, food choices and habit formation. 1 However, research concerning parental influence on children's diets is limited. Qualitative 2 research informs quantitative research with a narrative of 'what works', and is a valuable tool 3 to inform intervention design and practice. This paper presents a systematic review of 4 qualitative research with parents of preschool children and their influence on their child's 5 diet. Nine studies were identified. Findings highlight the need to promote culturally tailored 6 programs to combat specific cultural differences such as attitudes, perceptions and concerns, 7 address common barriers to providing healthy foods and challenges faced by lower income 8 families, the use of food to shape a child's behaviour , that children will grow out of excess 9 weight, common misconceptions such as a heavier child is healthier and depriving a child's 10 food request could result in starvation. Research on parental understanding of healthy diets 11 and feeding practices is lacking. Further insights into how to positively influence children's 12 diets will come from research examining parent feeding practices and nutrition knowledge. 13 14
International Journal of Behavioral Nutrition and Physical Activity, 2014
Background: To investigate the effect of an early childhood obesity prevention intervention, inco... more Background: To investigate the effect of an early childhood obesity prevention intervention, incorporating a parent modelling component, on fathers' obesity risk-related behaviours. Methods: Cluster randomized-controlled trial in the setting of pre-existing first-time parents groups organised by Maternal and Child Health Nurses in Victoria, Australia. Participants were 460 first-time fathers mean age = 34.2 (s.d.4.90) years. Dietary pattern scores of fathers were derived using principal component analysis, total physical activity and total television viewing time were assessed at baseline (infant aged three to four months) and after 15 months. Results: No significant beneficial intervention effect was observed on fathers' dietary pattern scores, total physical activity or total television viewing time. Conclusion: Despite a strong focus on parent modelling (targeting parents own diet, physical activity and television viewing behaviours), and beneficial impact on mothers' obesity risk behaviours, this intervention, with mothers as the point of contact, had no effect on fathers' obesity risk-related behaviours. Based on the established links between children's obesity risk-related behaviors and that of their fathers, a need exists for research testing the effectiveness of interventions with a stronger engagement of fathers.
Multiple factors combine to support a compelling case for interventions that target the developme... more Multiple factors combine to support a compelling case for interventions that target the development of obesity-promoting behaviours (poor diet, low physical activity and high sedentary behaviour) from their inception. These factors include the rapidly increasing prevalence of fatness throughout childhood, the instigation of obesity-promoting behaviours in infancy, and the tracking of these behaviours from childhood through to adolescence and adulthood. The Infant Feeding Activity and Nutrition Trial (INFANT) aims to determine the effectiveness of an early childhood obesity prevention intervention delivered to first-time parents. The intervention, conducted with parents over the infant's first 18 months of life, will use existing social networks (first-time parent's groups) and an anticipatory guidance framework focusing on parenting skills which support the development of positive diet and physical activity behaviours, and reduced sedentary behaviours in infancy.
Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30-5... more Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30-50% reported in early pregnancy. Maternal adiposity is a costly challenge for Australian obstetric care, with associated serious maternal and neonatal complications. Excess gestational weight gain is an important predictor of offspring adiposity into adulthood and higher maternal weight later in life. Current public health and perinatal care approaches in Australia do not adequately address excess perinatal maternal weight or gestational weight gain. This paper argues that the failure of primary health-care providers to offer systematic advice and support regarding women's weight and related lifestyle behaviours in child-bearing years is an outstanding 'missed opportunity' for prevention of inter-generational overweight and obesity. Barriers to action could be addressed through greater attention to: clinical guidelines for maternal weight management for the perinatal period, training and support of maternal health-care providers to develop skills and confidence in raising weight issues with women, a variety of weight management programs provided by state maternal health services, and clear referral pathways to them. Attention is also required to service systems that clearly define roles in maternal weight management and ensure consistency and continuity of support across the perinatal period.
Cameron: Clustering of obesity-related behaviours 2 Abstract Purpose To examine the clustering an... more Cameron: Clustering of obesity-related behaviours 2 Abstract Purpose To examine the clustering and patterns of obesity-related behaviours in children and their mothers and the concordance between mother and child pairs.
Keywords: BRCA1, BRCA2, psychological distress, breast cancer, peer support, RCT Running head: Pe... more Keywords: BRCA1, BRCA2, psychological distress, breast cancer, peer support, RCT Running head: Peer support for women with mutations in the BRCA genes Word count: 2999 words (excluding references and acknowledgements) Financial Disclosure: No Financial disclosures to report for any author 4 Abstract Purpose: To assess the effectiveness of a telephone-based peer-delivered intervention, in reducing distress among women with a BRCA1 or BRCA2 gene mutation. The intervention involved trained peer volunteers contacting women multiple times over a four-month period to provide informational, emotional and practical support. Methods: 337 participants completed the baseline questionnaire and those reporting interest in talking to other mutation carriers were randomized to either usual care (UCG) (n = 102) or the intervention (n = 105) (IG). Participants and researchers were not blinded to group allocation. Two follow-up questionnaires were completed: i) at the end of the intervention (four months after randomization, Time 2) and ii) two months later (Time 3). Outcomes included breast cancer distress (primary outcome), unmet information needs, cognitive appraisals about mutation testing and feelings of isolation.
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Papers by Karen Campbell