Using Mobile Technology for Family-Based Prevention in Families with Low Incomes: Lessons from a Randomized Controlled Trial of a Childhood Obesity Prevention Program.

Researchers are increasingly using web-based technologies to deliver family-based, prevention programming. Few studies have examined the success of such approaches for families with low incomes. The purpose of this study was to describe the level of in-class and online engagement in a childhood obesity prevention program for parents with low incomes, to examine the demographic correlates of parent engagement, and to examine dosage effects on parental feeding outcomes as a function of online exposure. All participants attended in-class nutrition education classes (Eating Smart · Being Active) as part of the Expanded Food and Nutrition Education Program (EFNEP) in Colorado and Washington State (classes were offered in English and Spanish). Participants in this analysis were 168 parents from a larger cluster randomized controlled trial who had been randomly assigned to also receive a newly developed, mobile-based version of an efficacious, feeding-focused, childhood obesity prevention program. Results showed that despite high levels of in-person attendance (70%), participants only accessed 47% of the videos (online content). Older parents and parents of girls showed higher levels of in-person attendance; currently employed parents showed lower levels. Online engagement varied as a function of ethnicity and acculturation: non-Hispanic parents accessed the most videos, low-acculturated Hispanic parents accessed the second most, and highly acculturated Hispanic parents accessed the least. In contrast, low-acculturated Hispanic parents showed the highest in-person attendance. For all but one outcome, significant online program effects were found only for parents who accessed at least half of the videos. Implications for mobile-based, family-based prevention programs for parents with low incomes are considered.ClinicalTrials.gov Identifier: NCT03170700; Registration Date: March 08, 2017.

Low-Income Latina Mothers' Scaffolding of Preschoolers' Behavior in a Stressful Situation and Children's Self-Regulation: A Longitudinal Study.

Objective: Maternal control and directiveness in Latina/o families often do not show the negative associations with child adjustment seen in European American samples. This study tested the self-determination hypotheses that Latina maternal involvement and structure would be positively associated with preschool children's later self-regulation, whereas directiveness and control would show negative relations. Design: At Time 1, 130 low-income Latina mothers were observed helping their 4- to 5-year-old children complete a stressful task. Maternal strategies for scaffolding children's responses to stress were examined with detailed event coding. At Time 1 and Time 2 18 months later, a delay of gratification task assessed children's self-regulation. Results: Children's Time 2 ability to delay gratification at 5½ to 6½ years (controlling for delay of gratification at ages 4 to 5) was predicted by Time 1 maternal scaffolding strategies. Children showing the greatest delay gratification at Time 2 (controlling for delay of gratification at Time 1) had mothers who used instructive praise and nonverbal autonomy-promoting scaffolding strategies at Time 1. Negative predictors included nonverbal attention directing and restriction. Conclusions: The findings highlight the importance of physical guidance in Latina/o families and suggest that highly directive maternal strategies may not interfere with the development of self-regulation as is often found in European American families. These findings will be useful in developing interventions to promote self-regulation in Latina/o children from low-income families.

Randomized Controlled Trial of a Program to Help Latina Mothers Help Their Children Cope with Stress: Effects on Parenting, Child Coping, and Adjustment.

"Madres Apoyando el Desarrollo Emocional de Sus Hijos" ("Mothers Supporting the Emotional Development of Their Children") is a parenting education program designed to help Latina mothers help their school-age children cope with stress. A previous randomized controlled trial, with a pre-post design, showed that the program had the predicted effects on mothers' knowledge, attitudes, and behavior. However, no data were collected from the children in that initial evaluation. The purpose of the present study was to determine if the program impacted children's coping and adjustment. One hundred twenty-two primarily first-generation Latina mothers from rural Washington State were randomly assigned to the intervention or to a no treatment control. Seven implementations of the program were conducted. Mothers and their 8- to 13-year-old children completed assessments 1 week before the program started, 1 week after its completion, and 3 months later. The results for maternal behavior were largely replicated: at posttest, intervention mothers, compared to controls, reported higher levels of emotion coaching, showed greater self-efficacy for helping their child cope with stress, and were more likely to report positive strategies for scaffolding their child's responses to stressful situations. Several maternal effects (e.g., emotion-coaching and maternal efficacy) continued at 3 months. Children of intervention mothers at posttest used more primary control coping strategies and reported fewer emotional symptoms; analyses of mothers' ratings of child adjustment replicated the posttest child effects for emotional symptoms, showed fewer other psychological problems at posttest, and showed greater child prosocial behavior at 3 months. The results further support the program's efficacy and provide the first evidence of its effects on child coping and adjustment.

Implementation Science Strategies Promote Fidelity in the Food, Feeding, and Your Family Study.

OBJECTIVE: Use of implementation science strategies to promote fidelity in the Food, Feeding, and Your Family study. DESIGN: Cluster randomized controlled trial with 3 conditions: control, in-class, or online, delivered in English or Spanish. Observations of 20% of classes. SETTING: Expanded Food and Nutrition Education Program (EFNEP) in 2 states. PARTICIPANTS: EFNEP peer educators (n = 11). INTERVENTION: Parental feeding content incorporated into EFNEP lessons (in-class) or through text with links to videos/activities (online). Extensive educator training, scripted curriculum, frequent feedback. ANALYSIS: Assessment of fidelity compliance. Qualitative analysis of verbatim educator interviews and classroom observer comments. RESULTS: During 128 class observations (40-45 per condition), peer educators followed scripted lesson plan 78% to 89% of the time. There was no evidence of cross-contamination of parental feeding content in control and only minor sharing in online conditions. Variations with fidelity were primarily tied to the EFNEP curriculum, not the parent feeding content. Educators (n = 7) expressed favorable opinions about the Food, Feeding, and Your Family study, thought it provided valuable information, and appreciated support from EFNEP leadership. CONCLUSIONS AND IMPLICATIONS: Incorporating implementation science strategies can help ensure successful adherence to research protocols. With proper training and support, EFNEP peer educators can deliver an evidence-based curriculum as part of a complex research study.

Emotion regulation strategies and childhood obesity in high risk preschoolers.

The current study examined the relationships between the specific strategies that preschool children use to regulate their emotions and childhood weight status to see if emotion regulation strategies would predict childhood weight status over and above measures of eating self-regulation. 185 4- to 5-year-old Latino children were recruited through Head Start centers in a large city in the southeastern U.S. Children completed both a delay of gratification task (emotion regulation) and an eating in the absence of hunger task (eating regulation). Eating regulation also was assessed by maternal reports. Four emotion regulation strategies were examined in the delay of gratification task: shut out stimuli, prevent movement, distraction, and attention to reward. Hierarchical linear regressions predicting children's weight status showed that both measures of eating regulation negatively predicted child obesity, and the use of prevent movement negatively predicted child obesity. Total wait time during the delay of gratification tasks was not a significant predictor. The current findings are consistent with studies showing that for preschool children, summary measures of emotion regulation (e.g., wait time) are not concurrently associated with child obesity. In contrast, the use of emotion regulation strategies was a significant predictor of lower child weight status. These findings help identify emotion regulation strategies that prevention programs can target for helping children regulate their emotions and decrease their obesity risk.