Maureen M. Black - US grants

The proposed project builds on an existing trial of micronutrient supplementation on children's growth, immune functioning, and morbidity, administered from birth through 9 months among full-term infants born small-for-gestational age in a low-income community in India. The trial had four cells: riboflavin with and without zinc, and other micronutrients [riboflavin, calcium, phosphorus, folate, and iron] with and without zinc. In April 1999 the children will range in age from 14 to 32 months, providing a unique opportunity to examine the protective effects of early micronutrient supplementation on children's behavior and development during the second and third years of life when the children are consuming community diets. We will use a cross-lag panel design to follow 600 children who participated in the micronutrient supplementation trial and a comparison group of 225 children, born at term with birth weight appropriate for gestational age. Children will be studied in clinical and home settings at 18, 24, 30, and 36 months of age to determine if differences in behavior and development are related to: (i) the micronutrient supplementation they received during infancy and (2) the timing and duration of their micronutrient deficiency during toddlerhood. The project tests the theory of functional isolation which hypothesizes that the lethargy and social isolation that often accompany nutritional deficiency interfere with reciprocal, stimulating interactions with caregivers, thereby leading to developmental and behavioral delays. The design and analysis are based on an ecological model in which behavior and development are influenced by birth weight, supplementation history, growth, temperament, parent-children interaction, and family environment contribute to children's behavior and development. Analysis will be conducted by longitudinal strategies, including multiple regression and hierarchial linear modeling. The results have important public health implications regarding the timing of micronutrient supplementation and the relationship between micronutrient deficiency and children's behavior and development.

urban area; low socioeconomic status; lifestyle; diet; obesity; adolescence (12-20); African American; experimental designs; body physical activity; family medicine; behavioral /social science research tag; nutrition related tag; human subject; clinical research;

DESCRIPTION (provided by applicant): This application extends a previously funded investigation among low-income, urban African American children through longitudinal follow-up into adolescence. The Experimental Group (High or Low Exposure) was prenatally exposed to cocaine, documented by toxicology tests at delivery. A comparison group was comprised of an unexposed matched sample of children from the same community. This translational application has two phases. The first phase examines how prenatal substance exposure is related to proximal brain functioning during adolescence, assessed through neuropsychological measures of attention, memory, and executive functioning; the neural correlates of working memory and response to risk and reward evaluation measured by fMRI; and diurnal rhythms of salivary cortisol. Because prenatal substance exposure often occurs in the context of environmental challenges (poverty, ongoing drug use, and disruptions in care), the application will examine whether the effects of prenatal substance exposure are moderated by environmental factors. In the second phase, the application will examine how prenatal substance exposure is related to adolescents' distal functioning via academic performance, socio-emotional development, and early drug use (marijuana). Response to acute challenges, measured by salivary cortisol, will be used to understand the adolescents' ability to adapt to environmental pressures and ultimately their resilience or vulnerability to early drug use. The application will examine whether the relationship from prenatal substance exposure to distal behavior is direct or mediated through proximal brain functioning. With developmental-ecological theory as a guide, a multi-method, multi-informant strategy is used, incorporating reports from adolescents, caregivers, and teachers; standardized measures of neuropsychological, academic, and socio-emotional performance; brain imaging; and biomarkers of the stress response (salivary cortisol) and drug use (hair and urine). This application examines academic performance, socio-emotional functioning, and drug use among adolescents exposed to cocaine and/or heroin prenatally.

his application extends a previously funded investigation among low-income, urban African American children through longitudinal follow-up into adolescence. The Experimental Group (High or Low Exposure) was prenatally exposed to cocaine, documented by toxicology tests at delivery. A comparison group was comprised of an unexposed matched sample of children from the same community. This translational application has two phases. The first phase examines how prenatal substance exposure is related to proximal brain functioning during adolescence, assessed through neuropsychological measures of attention, memory, and executive functioning;the neural correlates of working memory and response to risk and reward evaluation measured by fMRI;and diurnal rhythms of salivary cortisol. Because prenatal substance exposure often occurs in the context of environmental challenges (poverty, ongoing drug use, and disruptions in care), the application will examine whether the effects of prenatal substance exposure are moderated by environmental factors. In the second phase, the application will examine how prenatal substance exposure is related to adolescents'distal functioning via academic performance, socio-emotional development, and early drug use (marijuana). Response to acute challenges, measured by salivary cortisol, will be used to understand the adolescents'ability to adapt to environmental pressures and ultimately their resilience or vulnerability to early drug use. The application will examine whether the relationship from prenatal substance exposure to distal behavior is direct or mediated through proximal brain functioning. With developmental-ecological theory as a guide, a multi-method, multi-informant strategy is used, incorporating reports from adolescents, caregivers, and teachers;standardized measures of neuropsychological, academic, and socioemotional performance;brain imaging;and biomarkers of the stress response (salivary cortisol) and drug use (hair and urine). This application examines adacemic performance, socio-emotional functioning, and drug use among adolescents exposed to cocaine and/or heroin prenatally

DESCRIPTION (provided by applicant): Pediatric overweight is a serious public health problem that is increasing in prevalence, particularly among minority children from low-income families. Although there has been much attention directed toward overweight prevention programs administered through the schools, most programs have not been effective in halting the accumulation of body fat that occurs during adolescence. The objectives of this application are to develop and implement a multilevel small group and school-wide intervention to prevent overweight among adolescent females by increasing consumption of healthy foods (fruits and vegetables) and time spent in physical activity. This application extends a recently completed randomized trial of a home and community-based health promotion/overweight prevention program (the Challenge Program), conducted by assigning college mentors to low-income, urban African-American adolescents. Adolescents enrolled in the intervention were statistically less likely to become overweight than adolescents in the control group over the 18-month study period. In the proposed project, the Challenge Program, which is based on developmental-ecological and social cognitive theory, has been extended to a small group format and pilot tested in schools. The proposed program retains many of the elements of the original program, including the college mentors, family and community modules, and collaboration with two urban YMCAs. The primary aim of the proposed project is to use a factorial design to compare a multi-level (school and small group) intervention with school-only, small group-only, or no intervention on body composition, diet, and physical activity among 800 low-income, urban, minority 12- 13 year old girls from 10 middle schools. The second aim is to examine whether the impact of the intervention on body composition, diet, and physical activity varies by: 1) family and peer support for adopting a healthy diet and engaging in physical activity or 2) stage of change for diet and physical activity. The final aim is to examine whether the impact of the intervention on adolescents'body composition, diet, and physical activity is mediated by changes in self-efficacy. In addition to evaluating the intervention, findings from the proposed study will enhance our understanding of how family and peer support, stage of change, and adolescents'self-efficacy for diet and physical activity are related to changes in body composition. Public Health Relevance: The objective of this application is to evaluate whether small group and school-wide interventions among 12-13 year old females in urban middle schools are effective in increasing consumption of healthy foods (fruits and vegetables) and time spent in physical activity. The 12-session small group intervention will be implemented by college mentors in collaboration with the YMCA and the school-wide intervention is a partnership among school personnel, students, parents, community members, and university representatives. Positive findings would suggest that interventions to prevent overweight among middle- school females should include school-wide and small group components with family, school, and community involvement.

Overweight is a serious public health problem that begins as early as toddlerhood, and has negative health and developmental consequences throughout life. Although caregiver-child interaction patterns influence children's growth and behavior, most overweight prevention programs have focused exclusively on diet and physical activity, with little attention to feeding styles, the socio-emotional environment that the family establishes around meals. This application takes advantage of a unique opportunity afforded by a recently funded randomized controlled trial to prevent rapid weight gain among low-income toddlers in collaboration with the Special Supplemental Nutrition Program among Women, Infants, and Children (WIC). The overall aim is to examine feeding styles among low-income families of toddlers. The specific aims are: 1) to examine the feeding styles used by low-income mothers of toddlers and to identify caregiver and child characteristics associated with feeding styles, 2) to assess how feeding styles are related to toddler weight and rapid weight gain, and 3) to examine whether feeding styles are altered by an intervention to prevent rapid weight gain among toddlers. A multimodal process will be used to measure feeding and parenting styles, including maternal self-report and home visits with videotaped observations of mothers and their toddlers during meal and playtime. The proposed project involves 288 low-income mothers, fathers, and toddlers, recruited at 12-30 months and followed for 12 months. Following a baseline evaluation, families will be randomized to one of three 8-session intervention groups (maternal diet and activity, parenting/toddler, and safety), with follow-up evaluations 6 and 12 months following recruitment. In addition to changes in weight, height, and dietary intake supported by an existing project, the proposed project will evaluate feeding styles at baseline and during the two follow-up evaluations. By focusing on how caregiver toddler interaction patterns are related to toddler weight and weight gain, the proposed study will enhance our understanding of feeding styles and strategies to promote healthy growth and avoid overweight among toddlers. Overweight often begins as early as toddlerhood, setting children on a negative pathway toward obesity. Most interventions include recommendations on diet and physical activity, with little attention to the socio-emotional mealtime environment patterns, known as feeding styles. A focus on feeding styles addresses the interactive context in which feeding occurs and provides information on mechanisms leading to rapid weight gain that can be built into subsequent interventions to establish healthy dietary patterns early in life.

PROJECT SUMMARY/ABSTRACT Pediatric obesity, a defining health problem of the century, leads to long-term health disparities. This application evaluates strategies to prevent health disparities early in life by developing environmental wellness-related interventions focused on child-care center staff and families. Child-care centers provide an excellent opportunity to build healthy dietary and physical activity lifestyle habits and avoid the rapid weight gain that leads to health disparities. Building on a statewide survey among child-care centers and a pilot evaluation of an environmental intervention, this 3-cell randomized trial evaluates the impact of a staff-focused environmental wellness intervention and a staff and family-focused intervention, against a control condition. The trial will be conducted in 48 child-care centers throughout Maryland, enrolling 1080 children age 30-54 months from low-income families, 1080 parents, and 450 staff members. The aims are: 1) to examine the impact of the wellness intervention individually and combined with the family intervention versus control on child-care center staff wellness-related attitudes and behaviors; parent wellness-related attitudes and behaviors; and child dietary intake, food preferences, physical activity, and growth; 2) to examine the sustainability of the interventions; and 3) to examine whether changes in outcomes measures for children?s food preferences, growth, and feeding behavior are mediated by changes in the child-care staff wellness-related attitudes and behaviors and/or parent wellness-related attitudes and behaviors. Findings from the trial will inform programs and policies in child-care centers to prevent obesity and reduce disparities, and will be disseminated locally, regionally, and nationally through conferences, information briefs, social media, and peer-reviewed journal articles. The overall objective through our university/state agency/non-profit partnership (University of Maryland School of Medicine; Maryland State Department of Education and Department of Health and Mental Hygiene; and Maryland Family Network) is to promote statewide environmental strategies that reduce pediatric obesity and the long-term health disparities.