Prenatal and Pediatric Primary Care-Based Child Obesity Prevention: Effects of Adverse Social Determinants of Health on Intervention Attendance and Impact.

Background: Adverse social determinants of health (SDoHs), specifically psychosocial stressors and material hardships, are associated with early childhood obesity. Less is known about whether adverse SDoHs modify the efficacy of early childhood obesity prevention programs. Methods: We conducted a secondary analysis of publicly insured birthing parent-child dyads with Latino backgrounds participating in a randomized controlled trial of the Starting Early Program (StEP), a child obesity prevention program beginning in pregnancy. We measured baseline adverse SDoHs categorized as psychosocial stressors (low social support, single marital status, and maternal depressive symptoms) and material hardships (food insecurity, housing disrepair, and financial difficulties) individually and cumulatively in the third trimester. Logistic regression models tested effects of adverse SDoHs on StEP attendance. We then tested whether adverse SDoHs moderated intervention impacts on weight at age 2 years. Results: We observed heterogeneous effects of adverse SDoHs on outcomes in 358 parent-child dyads. While housing disrepair decreased odds of higher attendance [adjusted odds ratio (aOR) 0.52, 95% confidence interval (CI): 0.29-0.94], high levels of psychosocial stressors doubled odds of higher attendance (aOR 2.36, 95% CI: 1.04-5.34). Similarly, while certain adverse SDoHs diminished StEP impact on weight (e.g., housing disrepair), others (e.g., high psychosocial stress) enhanced StEP impact on weight. Conclusions: Effects of adverse SDoHs on intervention outcomes depend on the specific adverse SDoH. Highest engagement and benefit occurred in those with high psychosocial stress at baseline, suggesting that StEP components may mitigate aspects of psychosocial stressors. Findings also support integration of adverse SDoH assessment into strategies to enhance obesity prevention impacts on families with material hardships. Trial Registration: This study is registered on clinicaltrials.gov: Starting Early Obesity Prevention Program (NCT01541761); https://clinicaltrials.gov/ct2/show/NCT01541761.

Promoting toddlers' self-regulation and healthy eating habits among families living in poverty: A randomized controlled trial of Recipe 4 Success.

The Recipe 4 Success preventive intervention targeted multiple factors critical to the health and well-being of toddlers living in poverty. This randomized controlled trial, which was embedded within Early Head Start home visits for 12 weeks, included 242 racially and ethnically diverse families (51% girls; toddler mean age = 2.58 years; data collected 2016-2019). Compared to parents in usual practice home visits, parents in Recipe 4 Success displayed greater sensitive scaffolding of toddlers' learning and more responsive food parenting practices (Cohen's d = .21-.30). Toddlers in Recipe 4 Success exhibited greater self-regulation and had healthier eating habits (Cohen's d = |.16-.35|). Results highlight the value of Recipe 4 Success in promoting parent and toddler behavior change that could have life-long benefits.

Household Food Insecurity and Maternal-Toddler Fruit and Vegetable Dietary Concordance.

OBJECTIVE: To examine whether prenatal or concurrent household food insecurity influences associations between maternal and toddler fruit and vegetable (FV) intake. DESIGN: Application of a life-course framework to an analysis of a longitudinal dataset. SETTING: Early childhood obesity prevention program at a New York City public hospital. PARTICIPANTS: One-hundred and fifty-six maternal-toddler dyads self-identifying as Hispanic or Latino. VARIABLES MEASURED: Maternal and toddler FV intake was measured using Centers for Disease Control and Prevention dietary measures when toddlers were aged 19 months. Household food insecurity (measured prenatally and concurrently at 19 months) was measured using the US Department of Agriculture Food Security Module. ANALYSIS: Regression analyses assessed associations between adequate maternal FV intake and toddler FV intake. Interaction terms tested whether prenatal or concurrent household food insecurity moderated this association. RESULTS: Adequate maternal FV intake was associated with increased toddler FV intake (B = 6.2 times/wk, 95% confidence interval, 2.0-10.5, P = 0.004). Prenatal household food insecurity was associated with decreased toddler FV intake (B = -6.3 times/wk, 95% confidence interval, -11.67 to -0.9, P = 0.02). There was a significant interaction between the level of maternal-toddler FV association (concordance or similarity in FV intake between mothers and toddlers) and the presence of food insecurity such that maternal-toddler FV association was greater when prenatal household food insecurity was not present (B = -11.6, P = 0.04). CONCLUSIONS AND IMPLICATIONS: Strategies to increase FV intake across the life course could examine how the timing of household food insecurity may affect intergenerational maternal-child transmission of dietary practices.

Heterogeneous Effects of Depression on Parenting Competence and Child Behavior Among Families Living in Poverty.

This study examined how depression and psychosocial protective factors, such as self-efficacy and conscientiousness, were related to parenting competence and child behavior among families living in poverty. The sample included 238 families (37% White, 25% Black, 19% Latinx, 17% Multiracial, and 2% Asian; 42% of parents reporting clinically significant symptoms of depression) with young children (mean age = 31 months, 51% female). Latent profile analysis identified five distinct subgroups of parents who differed on levels of depression and psychosocial protective factors. A small group of parents who had high levels of depression and low levels of protective factors displayed the least parenting competence and had children with lower levels of adjustment. At the same time, parents in two other profiles had high levels of depression, but moderate or high levels of protective factors, and displayed average parenting competence and had children who displayed average or above average levels of adjustment. In this study, depression appeared less predictive of parenting competence and child behavior than the psychosocial protective factors. This study suggests that many parents, despite having depression and living in poverty, exhibit psychosocial protective factors that are associated with high levels of parenting competence and rear children who are doing well.

Parents' Self-Reported Psychological Impacts of COVID-19: Associations With Parental Burnout, Child Behavior, and Income.

OBJECTIVE: The current study investigates associations between parents' perceived coronavirus disease 2019 (COVID-19) psychological impacts and experiences of parental burnout, children's behaviors, and income. METHODS: Data were collected during an online survey of parents' (N = 1000) pandemic experiences in April 2020. Parents (M = 36.5 years old, SD = 6.0; 82.1% White) with at least one child 12 years or younger reported on measures of mental health, perceived COVID-19 impacts, parental burnout, and perceived increases in children's stress and positive behaviors. RESULTS: Path model analyses revealed that parents who perceived increased psychological impacts from COVID-19 reported higher levels of parental burnout, greater increases in children's stress behaviors, and less positive behavior in children. Additionally, there were significant indirect effects of parental burnout on the link between COVID-19 psychological impacts and children's behaviors. Finally, family income moderated associations between psychological impacts and children's stress behaviors, such that the association was stronger for families with lower income. CONCLUSIONS: These results suggest parents' perceptions of how the COVID-19 pandemic has impacted their mental health has implications for parent and child well-being, with stronger associations for low-income families. Given the potential for spillover effects between parents and children, promoting family well-being through practice and policy initiatives is crucial, including providing financial and caregiving relief for parents, and mental and behavioral health support for families.

The Utility of Text Message Reminders for Acne Patients: A Pilot Study.

BACKGROUND: Acne vulgaris is one of the three most common cutaneous disorders, affecting approximately 50 million people in the US and many more throughout the world. OBJECTIVE: We designed a pilot program to explore how patients may interact with cell phone technology to supplement medical care beyond patient reminders that would encompass education, interaction, and data capturing. METHODS: Twenty-four patients completed a 3-month study in which participants received daily text message reminders for the first 2 weeks of the study, then once weekly thereafter, to take their oral medication or apply topical therapy either once or twice daily. RESULTS: Over a 3-month time period, patients become less responsive to text message reminders over time. Our survey data demonstrated a very high satisfaction with the program, helping patients follow their acne treatment recommendations (mean score 4.31 out of 5) and results demonstrated the mobile application device was easy to use (mean score 4.56 out of 5). LIMITATIONS: Small sample size of the patient population. CONCLUSION: Patients find this approach acceptable and helpful, and it is a viable method for counseling patients. Based on our results, for future randomized controlled studies, we suggest maximizing messaging during the first month of therapy.

Merkel cell carcinoma in a patient treated with adalimumab: case report.

Merkel cell carcinoma (MCC) is a rare aggressive neuroendocrine tumor that manifests as an asymptomatic enlarging lesion often in the setting of immunosuppression, advanced age, or UV exposure. Immunosuppression has been associated with melanoma, lymphoma, and nonmelanoma skin cancer (NMSC). We present a case of a patient with a long-standing history of rheumatoid arthritis treated with adalimumab, methotrexate, and prednisone who developed a painless, rapidly enlarging lesion that was found to be MCC with lymph node involvement. As the use of tumor necrosis factor (TNF) alpha inhibitors becomes more popular, it is important to identify the potential long-term risks associated with chronic immune modulation. Systemic immunosuppression may be a risk factor for the development of advanced-stage MCC. Treatment with the TNF-alpha inhibitor adalimumab may enhance this risk.