Marilyn Stern - US grants

This research examines the cognitive content, behavioral impact, and mitigating factors of a negative vulnerability stereotype associated with the knowledge of an infant's prematurity. The dynamics of the expectancy confirmation process suggest the potential for detrimental and adverse effects of this negative stereotype on the development of prematurely born infants through iatrogenic caretaker behavior which produces the expected vulnerability in the child. The present study extends and integrates previous research in the area which has found evidence for this negative impact. The study aims to fill several gaps which exist in the literature, and at the same time provide information to health care professionals on improving service delivery as well a information which can enhance the development of infants born prematurely. First, the study further explores the content of the stereotype in an ecologically valid group of subjects (i.e., mothers of premature infants). Second, the study focuses on the impact of the stereotype on maternal behavior. the study will be the first to assess the behavioral reactions of mothers of premature infants to premature infants labeled full-term and premature. third, the study evaluates the impacts of the stereotype on maternal perceptions and behavior in the context of testing the viability of an educationally based intervention strategy in mitigating the prematurity stereotype. Fourth, the study assesses how individual differences in coping styles might impact receptivity to the intervention. Two mothers and their prematurely born infants (a total of 64) will be contacted to participate in the study and each mother will engage in a structured interaction with the other mother's premature infant The infant will be introduced to the mother as either being born full-term or prematurely. Based on the previous research in the area, it is hypothesized that mothers of premature infants who are given information stressing the similarities between full-term and premature infant development prior to their interactions toward infants labeled premature or full-term. However, mothers not given such information will exhibit perceptual and behavioral negative stereotyping biases toward infants labeled premature.

DESCRIPTION (provided by applicant): Rates of overweight and obesity for off-treatment pediatric cancer survivors (PCS) are high, ranging from about 40% in Acute Lymphoblastic Leukemia survivors to 50% among survivors of some sarcomas. However, in comparison to the general pediatric population where rates of overweight and obesity are also high (approx. 30%), the risk for concomitant negative health consequences is significantly greater in PCS. In line with recent calls in the literature and in accordance with the Institute of Medicine's (IOM) report on the importance of follow-up in promoting healthy behaviors in survivors, we propose a feasibility trial to deal with the increasing overweight and obesity rates among PCS by targeting their caregivers as key agents for PCS behavior change. We specifically focus on caregivers' behaviors, attitudes and roles in promoting healthier eating and physical activity (PA) in PCS and adapt an evidence-informed manualized parent intervention -- NOURISH -- found to be effective for caregivers of overweight and obese children and adolescents. We adapt NOURISH for caregivers of five - 11 year old PCS (6 months to 4 years off active cancer treatment). We propose a pilot feasibility RCT- NOURISH-T (Nourishing Our Understanding of Role modeling to Improve Support for Healthy Transitions) to evaluate 1) the preliminary effectiveness of NOURISH-T for pediatric cancer survivors, compared to an Enhanced Usual Care (EUC) control condition; and 2) factors to consider to improve future adaptations of the intervention, including determining the best time post-cancer treatment to offer the intervention to caregivers based on caregiver participation rates and response variability as a function of the PCS age, gender, race, and time since end of treatment. The proposed project will enroll caregivers of a total of 66 PCS at Virginia Commonwealth University (VCU) and the University of Pittsburgh and Children's Hospital of Pittsburgh (UP) to participate in the 6-session group intervention with assessments occurring pre and post the intervention and at a 6-month follow-up. Primary Specific Aims: 1. to document the feasibility of an optimal time post-cancer treatment to offer a health behavior change intervention (NOURISH-T) targeting eating and physical activity behaviors to caregivers of overweight and obese pediatric cancer survivors (PCS). 2. To test the preliminary efficacy of NOURISH-T on improving child dietary intake, PA, QOL and BMI. Secondary Aim: 3. To explore whether caregivers in NOURISH-T show improved dietary intake, PA, QOL, BMI, and lowered child vulnerability perceptions and child over-protectiveness than caregivers in EUC.

Project Summary Latino youth have the highest prevalence of obesity as compared to Black or White youth, and are at high- risk for adult obesity-related complications including cardiovascular disease. Moreover, Latino youth living in rural communities have an increased risk of adult obesity and mortality due to obesity-related chronic disease than Latinos living elsewhere. We synthesized our prior childhood obesity intervention and tailored our evidence-informed, theory-based, multi-family behavioral intervention, Adaptando Dieta y Acción Para Todos (ADAPT), to the acculturation status, language, and national origin or our target population - obese, school aged (8-12 years old) Latino youth and their parents living in rural areas. However, because the role of parent stress on obesity has not been adequately addressed in interventions aimed at reducing obesity in Latino youth, we argue that mindfulness parent stress reduction strategies may be a key component to improving eating and physical activity (PA) behaviors in both children and their parents. This NIH Stage I R34 proposes a refinement and optimization of the original ADAPT obesity intervention protocol to include mindfulness parent stress reduction strategies (now ADAPT+) (Stage IA) and feasibility assessment of ADAPT+ implementation (Stage IB). This mixed methods R34 sets the basis for a Stage 2 larger R01 trial to determine ADAPT+'s efficacy in improving Latino families' eating and PA behaviors. Two main aims guide our application. Aim 1: Refinement of ADAPT+ (ADAPT + mindfulness parent stress reduction) intervention. ? We assess acceptability of the integration of mindfulness parenting stress reduction into ADAPT to increase healthy lifestyle behaviors by: conducting a series of focus groups with our community health facilitators/ promotoras and parents of children (8-12 years old) with obesity to obtain feedback about and refine each of our 8 integrated sessions and evaluate optimization of ADAPT+ sessions. Aim 2: Feasibility and Acceptability trial. A randomized trial testing feasibility of ADAPT+ vs. Enhanced Usual Care/EUC conducted in two rural communities evaluates: ? study sample selection and recruitment, willingness to be randomized and retention. ? fidelity of intervention administration, intervention adherence, and further refinement of manuals. ? feasibility of data collection procedures, including collecting a battery of measures from parents and children, data quality and sensitivity of our measures to our intervention effects over time ? (pre- post- 3 mos post). ? We anticipate that compared to EUC, ADAPT+ dyads will have a lower attrition rate and will report greater satisfaction. We also explore whether our eating, PA and stress indices are sensitive to the intervention. This application is significant, as it addresses an urgent public health epidemic among a specific at-risk, ethnic and geographical minority group; innovative, as it implements a unique intervention that addresses many limitations in the current state of obesity prevention and employs a rigorous scientific approach.

Project Summary There is an unmet need for interventions that address overweight/obesity in pediatric cancer survivors (PCS) after treatment. Rates of overweight and obesity for off-treatment pediatric cancer survivors (PCS) are higher than in the general pediatric population, ranging from 40% to 50%, significantly increasing their risk for concomitant negative health consequences. By the time survivors reach young adulthood they are 10.8 times more likely to have cardiovascular disease than healthy siblings. Reducing the risk of adult obesity in PCS who are overweight or obese by promoting healthy dietary and physical activity (PA) behaviors may serve an important preventive function for these survivors. We recently evaluated the feasibility of our intervention, NOURISH for Healthy Transitions (NOURISH-T), for PCS with obesity by targeting parents as agents for change. Results demonstrated that NOURISH-T was not only feasible, but showed promise of efficacy. We further refined our intervention, now referred to as NOURISH-T+, and implement these in this larger, multi-site RCT, with the aim of evaluating the efficacy of our intervention across diverse pediatric oncology clinics. We focus on parents to model healthy eating and PA behaviors to promote PCS behavior change. Topics relevant to parents of PCS (e.g., transitioning to survivorship and late effects) are discussed. Parents of PCS with overweight/obesity (BMI > 85th%ile), age 5-11, 1- <5 years off treatment will be randomly assigned to the NOURISH-T+ intervention or Enhanced Usual Care (EUC) comparison. Parents in NOURISH-T+ participate in a 6-session, manualized intervention, with an additional dietician session and 2 PCS sessions, as well as post- intervention booster sessions. Sessions are conducted via a videoconferencing platform. EUC consists of a one-time informational session, nationally available brochures and follow-up check-ins. Parents and PCS are assessed on anthropometric measures, PA and dietary behaviors at baseline, 3-, 6-, and 12-months post-intervention. We will enroll a highly diverse group of 260 parents/PCS dyads from Johns Hopkins Medical Center (JH), Nicklaus Children?s Hospital, Miami Children?s Health Care System (MC), Johns Hopkins/All Children?s Hospital (ACH), and Virginia Commonwealth University (VCU). University of South Florida (USF) serves as the coordinating center for intervention, data management and analyses. ? Aim 1a: Evaluate NOURISH-T+ for its impact on the primary outcome of child BMI z-score. ? Aim 1b: Evaluate NOURISH-T+ on secondary outcomes: PCS waist-to-hip-ratio (WHR), PA and eating behaviors. ? Aim 2: Evaluate the impact of NOURISH-T+ on parents, including BMI, WHR, PA and eating behaviors, and perceptions of child-family eating and PA practices. ? Exploratory Aim: Evaluate potential moderators of the intervention and examine the dyadic relations between parents and children.

Project Summary Latino youth have the highest prevalence of obesity as compared to Black or White youth, and are at high- risk for adult obesity-related complications including cardiovascular disease. Moreover, Latino youth living in rural communities have an increased risk of adult obesity and mortality due to obesity-related chronic disease than Latinos living elsewhere. We synthesized our prior childhood obesity intervention and tailored our evidence-informed, theory-based, multi-family behavioral intervention, Adaptando Dieta y Acción Para Todos (ADAPT), to the acculturation status, language, and national origin or our target population - obese, school aged (8-12 years old) Latino youth and their parents living in rural areas. However, because the role of parent stress on obesity has not been adequately addressed in interventions aimed at reducing obesity in Latino youth, we argue that mindfulness parent stress reduction strategies may be a key component to improving eating and physical activity (PA) behaviors in both children and their parents. This NIH Stage I R34 proposes a refinement and optimization of the original ADAPT obesity intervention protocol to include mindfulness parent stress reduction strategies (now ADAPT+) (Stage IA) and feasibility assessment of ADAPT+ implementation (Stage IB). This mixed methods R34 sets the basis for a Stage 2 larger R01 trial to determine ADAPT+'s efficacy in improving Latino families' eating and PA behaviors. Two main aims guide our application. Aim 1: Refinement of ADAPT+ (ADAPT + mindfulness parent stress reduction) intervention. ? We assess acceptability of the integration of mindfulness parenting stress reduction into ADAPT to increase healthy lifestyle behaviors by: conducting a series of focus groups with our community health facilitators/ promotoras and parents of children (8-12 years old) with obesity to obtain feedback about and refine each of our 8 integrated sessions and evaluate optimization of ADAPT+ sessions. Aim 2: Feasibility and Acceptability trial. A randomized trial testing feasibility of ADAPT+ vs. Enhanced Usual Care/EUC conducted in two rural communities evaluates: ? study sample selection and recruitment, willingness to be randomized and retention. ? fidelity of intervention administration, intervention adherence, and further refinement of manuals. ? feasibility of data collection procedures, including collecting a battery of measures from parents and children, data quality and sensitivity of our measures to our intervention effects over time ? (pre- post- 3 mos post). ? We anticipate that compared to EUC, ADAPT+ dyads will have a lower attrition rate and will report greater satisfaction. We also explore whether our eating, PA and stress indices are sensitive to the intervention. This application is significant, as it addresses an urgent public health epidemic among a specific at-risk, ethnic and geographical minority group; innovative, as it implements a unique intervention that addresses many limitations in the current state of obesity prevention and employs a rigorous scientific approach.