Adverse childhood experiences, dispositional mindfulness, and adult health.

OBJECTIVE: To determine whether greater dispositional mindfulness is associated with better adult health across a range of exposures to adverse childhood experiences (ACEs). METHODS: In 2012, a web-based survey of 2160 Pennsylvania Head Start staff was conducted. We assessed ACE score (count of eight categories of childhood adversity), dispositional mindfulness (Cognitive and Affective Mindfulness Scale-Revised), and the prevalence of three outcomes: multiple health conditions (≥ 3 of 7 conditions), poor health behavior (≥ 2 of 5 behaviors), and poor health-related quality of life (HRQOL) (≥ 2 of 5 indicators). RESULTS: Respondents were 97% females, and 23% reported ≥ 3 ACEs. The prevalences of multiple health conditions, poor health behavior, and poor HRQOL were 29%, 21%, and 13%, respectively. At each level of ACE exposure, health outcomes were better in those with greater mindfulness. For example, among persons reporting ≥ 3 ACEs, those in the highest quartile of mindfulness had a prevalence of multiple health conditions two-thirds that of those in the lowest quartile (adjusted prevalence ratio (95% confidence interval)=0.66 (0.51, 0.86)); for those reporting no ACEs, the ratio was 0.62 (0.41, 0.94). CONCLUSION: Across a range of exposures to ACEs, greater dispositional mindfulness was associated with fewer health conditions, better health behavior, and better HRQOL.

The physical and mental health of Head Start staff: the Pennsylvania Head Start staff wellness survey, 2012.

INTRODUCTION: Despite attention to the health of low-income children in Head Start, little is known about the health of adults working for the program. The objective of our study was to compare the physical and mental health of women working in Pennsylvania Head Start programs with the health of US women who have similar sociodemographic characteristics. METHODS: We used data from a web-based survey in 2012 in which 2,199 of 3,375 (65.2%) staff in 66 Pennsylvania Head Start programs participated. For the 2,122 female respondents, we determined the prevalence of fair or poor health status, frequent (≥14 d/mo) unhealthy days, frequent (≥10 d/y) work absences due to illness, diagnosed depression, and 3 or more of 6 physical health conditions. We compared these prevalences with those found in 2 national samples of employed women of similar age, education, race/ethnicity, and marital status. RESULTS: Among Head Start staff, 85.7% were non-Hispanic white, 62.4% were married, and 60.3% had completed college. The prevalence (% [95% confidence interval]) of several health indicators was higher in Head Start staff than in the national samples: fair or poor health (14.6% [13.1%-16.1%] vs 5.1% [4.5%-5.6%]), frequent unhealthy days (28.3% [26.3%-30.2%] vs 14.5% [14.1%-14.9%]), diagnosed depression (23.5% [21.7%-25.3%] vs 17.6% [17.1%-18.0%]), and 3 or more physical health conditions (21.8% [20.0%-23.6%] vs 12.6% [11.7%-13.5%]). CONCLUSION: Women working with children in Head Start programs have poorer physical and mental health than do US women who have similar sociodemographic characteristics.

Obesity and food insecurity at the same table: how head start programs respond.

INTRODUCTION: Head Start is a federally funded early childhood education program that serves just over 900,000 US children, many of whom are at risk for obesity, are living in food insecure households, or both. The objective of this study was to describe Head Start practices related to assessing body mass index (BMI), addressing food insecurity, and determining portion sizes at meals. METHODS: A survey was mailed in 2008 to all eligible Head Start programs (N = 1,810) as part of the Study of Healthy Activity and Eating Practices and Environments in Head Start. We describe program directors' responses to questions about BMI, food insecurity, and portion sizes. RESULTS: The response rate was 87% (N = 1,583). Nearly all programs (99.5%) reported obtaining height and weight data, 78% of programs calculated BMI for all children, and 50% of programs discussed height and weight measurements with all families. In 14% of programs, directors reported that staff often or very often saw children who did not seem to be getting enough to eat at home; 55% saw this sometimes, 26% rarely, and 5% never. Fifty-four percent of programs addressed perceived food insecurity by giving extra food to children and families. In 39% of programs, staff primarily decided what portion sizes children received at meals, and in 55% the children primarily decided on their own portions. CONCLUSION: Head Start programs should consider moving resources from assessing BMI to assessing household food security and providing training and technical assistance to help staff manage children's portion sizes.

Quality of early maternal-child relationship and risk of adolescent obesity.

OBJECTIVE: The goal of this study was to determine whether obesity in adolescence is related to the quality of the early maternal-child relationship. METHODS: We analyzed data from 977 of 1364 participants in the Study of Early Child Care and Youth Development. Child attachment security and maternal sensitivity were assessed by observing mother-child interaction at 15, 24, and 36 months of age. A maternal-child relationship quality score was constructed as the number of times across the 3 ages that the child was either insecurely attached or experienced low maternal sensitivity. Adolescent obesity was defined as a measured BMI ≥95th percentile at age 15 years. RESULTS: Poor-quality maternal-child relationships (score: ≥3) were experienced by 24.7% of children compared with 22.0% who, at all 3 ages, were neither insecurely attached nor exposed to low maternal sensitivity (score: 0). The prevalence of adolescent obesity was 26.1%, 15.5%, 12.1%, and 13.0% for those with risk scores of ≥3, 2, 1, and 0, respectively. After adjustment for gender and birth weight, the odds (95% confidence interval) of adolescent obesity was 2.45 (1.49-4.04) times higher in those with the poorest quality early maternal-child relationships (score: ≥3) compared with those with the highest quality (score: 0). Low maternal sensitivity was more strongly associated with obesity than insecure attachment. CONCLUSIONS: Poor quality of the early maternal-child relationship was associated with a higher prevalence of adolescent obesity. Interventions aimed at improving the quality of maternal-child interactions should consider assessing effects on children's weight and examining potential mechanisms involving stress response and emotion regulation.

Prolonged bottle use and obesity at 5.5 years of age in US children.

OBJECTIVE: To examine the association between prolonged bottle use and the risk of obesity at 5.5 years of age. STUDY DESIGN: Data from the Early Childhood Longitudinal Study, Birth Cohort were analyzed for 6750 US children born in 2001. The outcome was obesity (body mass index ≥ 95 th percentile) at 5.5 years, and the exposure was parental report of the child using a bottle at 24 months. RESULTS: The prevalence of obesity at 5.5 years was 17.6%, and 22.3% of children were using a bottle at 24 months. The prevalence of obesity at 5.5 years was 22.9% (95% CI, 19.4% to 26.4%) in children who at 24 months were using a bottle and was 16.1% (95% CI, 14.9% to 17.3%) in children who were not. Prolonged bottle use was associated with an increased risk of obesity at 5.5 years (OR, 1.33; 95% CI, 1.05 to 1.68) after controlling for potential confounding variables (sociodemographic characteristics, maternal obesity, maternal smoking, breastfeeding, age of introduction of solid foods, screen-viewing time, and the child's weight status at birth and at 9 months of age). CONCLUSIONS: Prolonged bottle use was associated with obesity at 5.5 years of age. Avoiding this behavior may help prevent early childhood obesity.

Reaching staff, parents, and community partners to prevent childhood obesity in Head Start, 2008.

INTRODUCTION: Lowering the prevalence of childhood obesity requires a multilevel approach that targets the home, school, and community. Head Start, the largest federally funded early childhood education program in the United States, reaches nearly 1 million low-income children, and it provides an ideal opportunity for implementing such an approach. Our objective was to describe obesity prevention activities in Head Start that are directed at staff, parents, and community partners. METHODS: We mailed a survey in 2008 to all 1,810 Head Start programs in the United States. RESULTS: Among the 1,583 (87%) responding programs, 60% held workshops to train new staff about children's feeding and 63% held workshops to train new staff about children's gross motor activity. Parent workshops on preparing or shopping for healthy foods were offered by 84% of programs and on encouraging children's gross motor activity by 43% of programs. Ninety-seven percent of programs reported having at least 1 community partnership to encourage children's healthy eating, and 75% reported at least 1 to encourage children's gross motor activity. CONCLUSION: Head Start programs reported using a multilevel approach to childhood obesity prevention that included staff, parents, and community partners. More information is needed about the content and effectiveness of these efforts.

Barriers to obesity prevention in Head Start.

Head Start provides early childhood education to nearly one million low-income children, through federal grants to more than 2,000 local programs. About one-third of children who enter Head Start are overweight or obese. But program directors face difficulty in implementing policies and practices to address obesity-and in our national survey, they identified the key barriers as lack of time, money, and knowledge. Also, parents and staff sometimes shared cultural beliefs that were inconsistent with preventing obesity, such as the belief that heavier children are healthier. Minimizing those barriers will require federal resources to increase staff training and technical assistance, develop staff wellness programs, and provide healthy meals and snacks.

A national survey of obesity prevention practices in Head Start.

OBJECTIVE: To describe obesity prevention practices and environments in Head Start, the largest federally funded early childhood education program in the United States. DESIGN: Self-administered survey as part of the Study of Healthy Activity and Eating Practices and Environments in Head Start (SHAPES). SETTING: Head Start, 2008. PARTICIPANTS: Directors of all 1810 Head Start programs, excluding those in US territories. OUTCOME MEASURES: Descriptive measures of reported practices and environments related to healthy eating and gross motor activity. RESULTS: The 1583 (87%) programs responding to the survey enrolled 828 707 preschool children. Of these programs, 70% reported serving only nonfat or 1% fat milk. Ninety-four percent of programs reported that each day they served children some fruit other than 100% fruit juice; 97% reported serving some vegetable other than fried potatoes; and 91% reported both of these daily practices. Sixty-six percent of programs said they celebrated special events with healthy foods or nonfood treats, and 54% did not allow vending machines for staff. Having an on-site outdoor play area at every center was reported by 89% of programs. Seventy-four percent of programs reported that children were given structured (adult-led or -guided) gross motor activity for at least 30 minutes each day; 73% reported that children were given unstructured gross motor activity for at least 30 minutes each day, and 56% reported both of these daily practices. CONCLUSION: Most Head Start programs report doing more to support healthy eating and gross motor activity than required by federal performance standards in these areas.

Cultural scripts guide recall of intensely positive life events.

In four studies, we examined the temporal distribution of positive and negative memories of momentous life events. College students and middle-aged adults reported events occurring from the ages of 8 to 18 years in which they had felt especially good or especially bad about themselves. Distributions of positive memories showed a marked peak at ages 17 and 18. In contrast, distributions of negative memories were relatively flat. These patterns were consistent for males and females and for younger and older adults. Content analyses indicated that a substantial proportion of positive memories from late adolescence described culturally prescribed landmark events surrounding the major life transition from high school to college. When the participants were asked for recollections from life periods that lack obvious age-linked milestone events, age distributions of positive and negative memories were similar. The results support and extend Berntsen and Rubin's (2004) conclusion that cultural expectations, or life scripts, organize recall of positive, but not negative, events.

Self-esteem memories: feeling good about achievement success, feeling bad about relationship distress.

College students and middle-aged adults provided memories of occasions when they felt especially good or especially bad about themselves. Probes directed the memory search to several age intervals during childhood, adolescence, and adulthood. Predominant themes represented in self-esteem memories differed consistently as a function of emotional valence. Memories of positive self-worth frequently focused on achievement/mastery themes, whereas memories of negative self-worth frequently focused on interpersonal/affiliation themes. When people evaluate the self through the lens of autobiographical memory, interpersonal distress is portrayed as especially damaging and achievement success is portrayed as especially enhancing. The asymmetry between positive and negative self-esteem memories is explained using multiple theoretical perspectives within social and personality psychology.