Lori Francis - Academia.edu (original) (raw)

Papers by Lori Francis

Journal of Nutrition Education and Behavior, Apr 1, 2021

The Cruciferous Crew intervention was implemented over 3 weeks with 24 children (aged 3−5 years; ... more The Cruciferous Crew intervention was implemented over 3 weeks with 24 children (aged 3−5 years; 58% female) enrolled in 2 classrooms at a university-based child care center in

Clinical Trials, Apr 19, 2023

Background/Aims: Preventing the development of childhood obesity requires multilevel, multicompon... more Background/Aims: Preventing the development of childhood obesity requires multilevel, multicomponent, comprehensive approaches. Study designs often do not allow for systematic evaluation of the efficacy of individual intervention components before the intervention is fully tested. As such, childhood obesity prevention programs may contain a mix of effective and ineffective components. This article describes the design and rationale of a childhood obesity preventive intervention developed using the multiphase optimization strategy, an engineering-inspired framework for optimizing behavioral interventions. Using a series of randomized experiments, the objective of the study was to systematically test, select, and refine candidate components to build an optimized childhood obesity preventive intervention to be evaluated in a subsequent randomized controlled trial. Methods: A 24 full factorial design was used to test the individual and combined effects of four candidate intervention components intended to reduce the risk for childhood obesity. These components were designed with a focus on (a) improving children’s healthy eating behaviors and nutrition knowledge, (b) increasing physical activity and reducing sedentary activity in the childcare setting, (c) improving children’s behavioral self-regulation, and (d) providing parental web-based education to address child target outcomes. The components were tested with approximately 1400 preschool children, ages 3–5 years in center-based childcare programs in Pennsylvania, the majority of which served predominantly Head-Start eligible households. Primary child outcomes included healthy eating knowledge, physical and sedentary activity, and behavioral self-regulation. Secondary outcomes included children’s body mass index and appetitive traits related to appetite regulation. Results: Four intervention components were developed, including three classroom curricula designed to increase preschool children’s nutrition knowledge, physical activity, and behavioral, emotional, and eating regulation. A web-based parent education component included 18 lessons designed to improve parenting practices and home environments that would bolster the effects of the classroom curricula. A plan for analyzing the specific contribution of each component to a larger intervention was developed and is described. The efficacy of the four components can be evaluated to determine the extent to which they, individually and in combination, produce detectable changes in childhood obesity risk factors. The resulting optimized intervention should later be evaluated in a randomized controlled trial, which may provide new information on promising targets for obesity prevention in young children. Conclusion: This research project highlights the ways in which an innovative approach to the design and initial evaluation of preventive interventions may increase the likelihood of long-term success. The lessons from this research project have implications for childhood obesity research as well as other preventive interventions that include multiple components, each targeting unique contributors to a multifaceted problem.

Obesity, Mar 23, 2020

This study aimed to identify obesity trajectories from childhood to adolescence (2-15 years of ag... more This study aimed to identify obesity trajectories from childhood to adolescence (2-15 years of age) and investigate differences in behavioral, eating, and adrenocortical regulation by trajectory membership. Methods: A total of 1,077 households from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were included. Anthropometrics were measured 11 times between ages 15 months and 15 years. Behavioral selfregulation was assessed at ages 3 and 4 years. Disordered eating behaviors and awakening cortisol were assessed at age 15 years. Results: Latent growth curve modeling identified four BMI trajectories: two nonoverweight trajectories based on average BMI at the 40th and 70th percentiles and overweight/obesity and severe obesity trajectories. Youth in the severe obesity trajectory exhibited lower behavioral self-regulation in early childhood and lower awakening cortisol at age 15 years compared with youth in the nonoverweight trajectories. Youth in the overweight/obesity and severe obesity trajectories showed higher levels of disordered eating behaviors at age 15 years. Conclusions: Obesity trajectories were associated with biobehavioral markers of dysregulation in early childhood and adolescence. Dysregulation across biobehavioral domains was particularly apparent among youth who developed severe obesity. Further work is needed to better understand resilience factors that distinguish youth who develop obesity and severe obesity from those who do not.

Pediatrics, Feb 1, 2009

OBJECTIVES-In this study we examined the relation between mental health problems and weight in a ... more OBJECTIVES-In this study we examined the relation between mental health problems and weight in a population-based study of youth aged 12 to 17 years and whether the association between mental health problems and weight is moderated by race and ethnicity. METHODS-We used 2003 National Survey on Children's Health data. Logistic regression was used to arrive at adjusted odds ratios showing the relation between BMI and mental health problems. RESULTS-Compared with their nonoverweight counterparts, both white and Hispanic youth who were overweight were significantly more likely to report depression or anxiety, feelings of worthlessness or inferiority, behavior problems, and bullying of others. Odds ratios relating mental health problems and BMI in black subjects were not statistically significant except for physician diagnosis of depression. CONCLUSIONS-Our results suggest that, when addressing youth overweight status, mental health problems also need to be addressed. Given that the relationship between mental health problems and youth overweight differs according to race/ethnic group, public health programs that target overweight youth should be cognizant of potential comorbid mental health problems and that race/ethnicity may play a role in the relationship between mental health and overweight status. Keywords adolescent health; black; Latino health; mental health; obesity Adolescent obesity is a growing epidemic in the United States that is known to present a risk for a number of adverse physical outcomes, including type 2 diabetes mellitus, hypertension, musculoskeletal problems, and, more recently, mental health problems.1,2 The relationship between obesity and mental health has been documented nationally and internationally in adults and children.3-6 Obese children are more likely to suffer from psychiatric disorders,7 depression,8 behavior problems,9 and social marginalization,10 and obese children are often victims of bullying.11 Findings from a study by Kolody and Sallis12 provided evidence for

Journal of Nutrition Education and Behavior, Jul 1, 2017

intervention sites. No improvements were observed in children's BMI. These results indicate that ... more intervention sites. No improvements were observed in children's BMI. These results indicate that the youth advocacy can contribute toward creating environments that support healthy snacking within rural schools and food stores, which in turn can improve children's snacking behaviors, but that further interventions are needed to change children's BMI.

American Journal of Preventive Medicine, Feb 1, 2010

Background-The acculturation hypothesis proposes an overall disadvantage in health outcomes for H... more Background-The acculturation hypothesis proposes an overall disadvantage in health outcomes for Hispanic immigrants with more time spent living in the U.S., but little is known about how generational status and language may influence Hispanic children's relative weight and activity patterns. Purpose-The association between generation and language was investigated with relative weight (BMI z-scores), physical activity, screen time, and participation in extracurricular activities (e.g., sports, clubs) in a U.S.-based, nationally representative sample of Hispanic children. Methods-Participants included 2,012 Hispanic children aged 6-11 years from the cross-sectional, 2003 National Survey of Children's Health. Children were grouped according to generational status (1 st , 2 nd or 3 rd), and the primary language spoken in the home (English vs non-English). Primary analyses included adjusted logistic and multinomial logistic regression to examine the relationships among variables; all analyses were conducted between 2008 and 2009. Results-Compared to 3rd generation, English speakers, 1 st and 2 nd generation, non-English speakers were over two times more likely to be obese. Moreover, 1 st generation, non-English speakers were half as likely to engage in regular physical activity and sports. Both 1 st and 2 nd generation, non-English speakers were less likely to participate in clubs compared to 2 nd and 3 rd generation, English speakers. Overall, all non-English speaking groups reported less screen time compared to 3 rd generation, English speakers. Conclusions-The hypothesis that Hispanics lose their health protection with more time spent in the U.S. was not supported in this sample of Hispanic children.

Journal of Immigrant and Minority Health, Nov 4, 2011

The patient-centered medical home model has the potential to reduce healthcare disparities among ... more The patient-centered medical home model has the potential to reduce healthcare disparities among immigrant children. The purpose of this study is to examine the relationship between medical home (MH) participation and receipt of preventive services among immigrant children age 0-17. The study employed extant data from the National Survey of Children's Health, 2007 (NSCH). Logistic regression analyses were employed to assess the relationship between receipt of preventive services and MH status among immigrant and non-immigrant children. Due to primarily the lack of family-centered care, only 40% of immigrant children met the medical home criteria versus approximately 62% of non-immigrant children. Immigrant children have decreased odds of receiving preventive care despite MH status. Improving the family-centered care aspect of the MH is necessary to increasing medical home access to immigrant children and the receipt of preventive services for immigrant children who meet the MH criteria.

Psychoneuroendocrinology, Feb 1, 2019

Background: Awakening cortisol, an index of hypothalamicpituitary-adrenocortical (HPA) axis regul... more Background: Awakening cortisol, an index of hypothalamicpituitary-adrenocortical (HPA) axis regulation, has been linked to obesity. We examined its relation to body mass index (BMI) trajectories from 2y to 15y, and its associations with psychosocial, familial, and community-level risk factors (e.g. poverty) and protective factors (e.g. maternal education). Methods: Longitudinal data were drawn from 789 households that were primarily white and low to middle income. Results: Three BMI trajectories were identified: "Maintained Normal Weight" (68%), "Delayed Weight Gain" (24%), and "Accelerated Weight Gain" (8%). At 15y, the "Accelerated Weight Gain" class displayed higher awakening cortisol levels (p < .05) and were more likely to be severely obese (p < .001), compared to the other classes. Children with higher cumulative risk and lower protective factors between 2 to 5 y were more likely to be in the "Delayed Weight Gain" and "Accelerated Weight Gain" classes than the "Maintained Normal Weight" class (p's < .05). Children scoring lower on protective factors were more likely to be in the "Accelerated Weight Gain" class than the "Delayed Weight Gain" class (p < .05). Abstracts / Psychoneuroendocrinology 100S (2019) S1-S64 S27 Conclusions: A BMI trajectory characterized by accelerated weight gain and severe obesity in childhood and adolescence was associated with higher levels of awakening cortisol, a marker of children's capacity to regulate stress, in addition to the presence of greater cumulative risk and lower protective factors. These findings suggest that cardiometabolic dysregulation is related to biological dysregulation, and that association may be partially explained by exposure to adversity; however, more work is needed.

The Journal of Pediatrics, 2021

Objectives To identify body mass index (BMI) trajectories using methods and graphing tools that m... more Objectives To identify body mass index (BMI) trajectories using methods and graphing tools that maintain and visualize variability of BMIs ³95th percentile, and to investigate individual differences in early sociodemographic risk, infant growth and feeding patterns, and maternal weight status among these trajectories. Study design Participants included 1041 predominantly rural, poor families from the Family Life Project, a longitudinal birth cohort. Youth anthropometrics were measured 8 times between ages 2 months and 12 years. Mothers reported sociodemographic information, infant birth weight, and infant feeding at 2 months and reported child weight and height at 2 months and 12 years. At 6 months, mothers reported breastfeeding. At 2 years, maternal weight and height were measured. Results Three BMI trajectories were identified: "maintained non-overweight," "developed obesity," and "developed severe obesity." Compared with the non-overweight trajectory, children with heavier trajectories were breastfed for a shorter duration and had heavier mothers at all assessments. The children with the "developed obesity" trajectory were not heavier at birth than those with the non-overweight trajectory, yet they displayed a greater change in weight-for-length percentile during infancy; in addition, their mothers had the greatest change in BMI between 2 months and 12 years. Children with the "developed severe obesity" trajectory were heavier at birth and more likely to have been heavy during infancy and to have been fed solid foods early. Conclusions Using informed analytical and graphing approaches, we described patterns of growth, and identified early predictors of obesity and severe obesity trajectories among a diverse sample of rural, poor youth. Researchers are urged to consider these approaches in future work, and to focus on identifying protective factors in youth with obesity and severe obesity.

Annals of Epidemiology, Sep 1, 2007

PURPOSE: Massachusetts introduced a comprehensive tobacco control program (MTCP) in January 1993.... more PURPOSE: Massachusetts introduced a comprehensive tobacco control program (MTCP) in January 1993. Tobacco smoke is a serious health hazard, particularly for pregnant women. Low birth weight (LBW) is a common condition that has been shown consistently to be causally related to smoking during pregnancy. METHODS: We calculated population attributable risk (PAR), using the conventional formula in addition to the effect measure, which is relative risk (RR) in this study. Because the database used (Mass CHIP) captures all pregnant women including their smoking status across the state, and also links birth files with death files, this database is a valuable resource for calculating overall smoking prevalence among pregnant women. Infant mortality rates (IMR) from 1989 to 2004 were also calculated. Multiple births and pregnant women with unknown smoking status (!1%) were excluded from the analysis. LBW was classified into three groups (0-1499 grams, 1500-2499 grams and >2500 grams). RESULTS: More than 91,000 live-births occurred in 1989 as opposed to 78,250 live-births in 2004. Almost 22% of mothers smoked during pregnancy in 1989, reducing to 7.4% in 2004 (66% decline). IMR among smoking mothers declined from 11.6/ 1000 live-births in 1989 to 5.7 in 2004 (O50% decline), while IMR in non-smoking mothers decreased from 6.7 in 1989 to 4.2/ 1000 live-births in 2004 (a 37% decline). The proportions of sudden infant death syndrome babies showed a significant annual decline of-6% among non-smokers. The very low LBW babies among smokers showed an annual decline of 8.4% (95%CI:-9.1;-7.7). In the 15-year study period, RR of LBW among smokers has decreased from 2.0 to 1.71 (a 29% overall decline). PAR decreased from 18% to 5% over the 15-year period contributing to almost 300 fewer LBW babies between 1989 and 2004. CONCLUSION: Approximately 300 fewer LBW babies were born between 1989 and 2004 in Massachusetts that could be attributed to reductions in smoking prevalence during pregnancy. Such an effect can also in part be due to the beneficial impact of the MTCP. The fact that almost 5,800 pregnant mothers still continue smoking is of concern. Health promotional activities should be focused on target populations both for an accelerated decline and for a substantial impact.

Journal of Physical Activity and Health, Aug 1, 2012

Background: This study examines relations between parent and youth physical activity (PA; days pe... more Background: This study examines relations between parent and youth physical activity (PA; days per week), sports participation, and overweight (BMI ≥ 85th percentile) among U.S. youth, and whether this relationship varies by immigrant generation and sex. Methods: Participants included 28,691 youth ages 10-17 years from the 2007 National Survey of Children's Health. Youth were grouped into first, second, and third or higher generation. Primary analyses include Chi-square and post hoc tests to assess mean differences, and adjusted logistic regressions to test associations between weight status and independent variables. Results: Each additional day youth participated in PA decreased their odds of overweight (OW) by 10% [OR: 0.90 (0.87-0.94)]; participation in sports significantly reduced their odds of OW by 17% [OR: 0.83 (0.71-0.98)]. First generation boys who participated in sports had 70% lower odds of OW [OR: 0.30 (0.11-0.83)] compared with first generation boys who did not participate in sports. For third generation girls, participation in sports reduced the odds of OW by 23% [OR: 0.77 (0.62-0.96)] compared with those who did not participate in sports. Conclusion: The protective influence of PA on youth's risk of OW varies by immigrant generation and sex. Parent PA was not related to youth's risk of OW.

Frontiers in Nutrition, 2022

Appetitive traits that contribute to appetite self-regulation have been shown to relate to non-fo... more Appetitive traits that contribute to appetite self-regulation have been shown to relate to non-food-related regulation in general domains of child development. Latent profile analysis (LPA) was used to identify typologies of preschool children's behavioral self-regulation (BSR) and appetitive traits related to appetite self-regulation (ASR), and we examined their relation with children's BMIz and food parenting practices. Participants included 720 children and their parents (90% mothers), drawn from the baseline assessment of a childhood obesity preventive intervention. BSR measures included teacher reports of children's inhibitory control, impulsivity and attentional focusing, as well as an observed measure of inhibitory control. ASR was assessed using parents' reports of children's appetitive traits related to food avoidance (e.g., satiety responsiveness, slowness in eating) and food approach (e.g., enjoyment of food, food responsiveness). Children's body m...

Pediatrics, 2022

BACKGROUND AND OBJECTIVES Little attention has been given to the study of early childhood factors... more BACKGROUND AND OBJECTIVES Little attention has been given to the study of early childhood factors that protect against the development of obesity and severe obesity. We investigated whether exposure to familial psychosocial assets and risks in infancy (1–15 months) and early childhood (24–54 months) and child behavioral regulation in early childhood predict longitudinal change in BMI (2 to 15 years). METHODS Participants included 1077 predominantly non-Hispanic, White, English-speaking mother-child dyads from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development dataset. Cumulative familial asset and risk indices were created using measures (eg, maternal parenting sensitivity, poverty) from 2 developmental periods (1–15 months, 24–54 months). A child behavioral regulation index was created on the basis of behavioral tasks and parent reports. Previously published BMI trajectories (nonoverweight [40th percentile], nonoverweight [7...

Journal of Nutrition Education and Behavior, 2021

Journal of Nutrition Education and Behavior, 2018

provides a small step to promote health equity and facilitates parents' and other primary caregiv... more provides a small step to promote health equity and facilitates parents' and other primary caregivers' efficacy to prevent and reduce overweight and obesity in their children.

Journal of Nutrition Education and Behavior, 2019

To implement and evaluate an integrated Spanish-language program to improve nutrition, increase p... more To implement and evaluate an integrated Spanish-language program to improve nutrition, increase physical activity, and strengthen family function among Mexican-heritage (MH) families. We describe research (stepped wedge cluster randomized controlled trial NP3 (continued) Continued on page S12

The Diabetes Educator, 2017

Purpose Guided by the PEN-3 Cultural Model, the purpose of this study is to generate culturally f... more Purpose Guided by the PEN-3 Cultural Model, the purpose of this study is to generate culturally framed insight into diabetes knowledge, management, and prevention among Haitians. Despite the disproportionate distribution of type II diabetes mellitus among US minorities, limited research explores outcomes within racial ethnic groups. It is particularly important to disaggregate the large racial-ethnic groups of black given the population growth among foreign-born blacks, such as Haitians, whose population has more than quadrupled in recent decades. Methods Focus group interviews were employed to understand diabetes knowledge, management, and prevention in the Haitian immigrant population in Philadelphia. Interviews were conducted in 2 groups: (1) people living with diabetes and (2) an at-risk sample for diabetes (defined as 30 and older with self-reported family history of diabetes). Interviews were recorded and transcribed verbatim in preparation for content analysis. Results Of the...

Journal of Nutrition Education and Behavior, 2016

Journal of Physical Activity and Health, 2012

Background:This study examines relations between parent and youth physical activity (PA; days per... more Background:This study examines relations between parent and youth physical activity (PA; days per week), sports participation, and overweight (BMI ≥ 85th percentile) among U.S. youth, and whether this relationship varies by immigrant generation and sex.Methods:Participants included 28,691 youth ages 10–17 years from the 2007 National Survey of Children’s Health. Youth were grouped into first, second, and third or higher generation. Primary analyses include Chi-square and post hoc tests to assess mean differences, and adjusted logistic regressions to test associations between weight status and independent variables.Results:Each additional day youth participated in PA decreased their odds of overweight (OW) by 10% [OR: 0.90 (0.87–0.94)]; participation in sports significantly reduced their odds of OW by 17% [OR: 0.83 (0.71–0.98)]. First generation boys who participated in sports had 70% lower odds of OW [OR: 0.30 (0.11–0.83)] compared with first generation boys who did not participate ...