Leanne Whiteside-Mansell - Academia.edu (original) (raw)

Papers by Leanne Whiteside-Mansell

Implementation Science Communications

Background Despite the importance of sustainability for nutrition and physical activity in public... more Background Despite the importance of sustainability for nutrition and physical activity in public health interventions, limited studies have explored the factors that promote and inhibit evidence-based program sustainment in the childcare setting. This study protocol describes a mixed-methods approach to develop novel sustainability strategies based on real-world settings and stakeholder feedback, with the goal of providing support for future obesity prevention programs and related studies on intervention sustainability. Two interventions, Together, We Inspire Smart Eating (WISE) and The Food Friends’ (FF) Fun with New Foods and Get Movin’ with Might Moves, are studied to this end. Methods The study will deploy an explanatory, sequential mixed-methods design. First, the research team will collect a quantitative survey to assess rates of sustainment among WISE and Food Friends sites. We expect to collect 150 surveys from WISE and FF sites combined. Data from these surveys will be use...

Engaging families of preschool children in partnerships with early childcare providers includes, ... more Engaging families of preschool children in partnerships with early childcare providers includes, among other activities, engaging in meaningful conversation, linking parents to needed services, and supporting parents as they capitalize on family protective factors. Early childhood programs struggle to implement systematic processes to support teachers in engaging families and documenting the interactions. This report summarizes the development and implementation of a tool designed to facilitate family engagement with childcare. The study targets a rural, multi-center agency serving Early Head Start families using an inventory called The Family Map. This report provides evidence of the feasibility of implementation, the reliability, and validity of the screening questions, and the range of risk and strengths identified in Early Head Start families served.

AIDS and Behavior, 2021

The southern U.S. has both high HIV and incarceration rates in comparison to its population. As i... more The southern U.S. has both high HIV and incarceration rates in comparison to its population. As in the rest of the country, HIV prevention is based on education, behavior change, and biomedical efforts, such as pre-exposure prophylaxis (PrEP). This study examined the implementation of an educational intervention and supportive services to obtain PrEP in a population of individuals (N = 218) involved in an Adult Drug Court (ADC) or on probation or parole (P-P). Nearly all ADC and P-P participants self-reported risk behaviors linked to HIV acquisition. Results supported the acceptance and usefulness of the intervention as rated by participants. Participants showed increased knowledge of HIV risks and testing post-education. In multivariate analysis, predictors of interest in using PrEP included low stigma beliefs, specifically their level of prejudice views, high depressive symptoms, and white race. The intervention shows promise. Given the high risk documented for ADC and P-P individ...

Journal of the National Medical Association, 2020

This study examined the prediction of HIV knowledge on multiple dimensions of stigma beliefs. Met... more This study examined the prediction of HIV knowledge on multiple dimensions of stigma beliefs. Methods: We assessed clinical staff (N ¼ 153) in rural clinics (2017) HIV stigma beliefs and knowledge. Using multiple regression, we examined the ability of knowledge to predict stigma beliefs organized into meaningful dimensions. Results: There was high variability in HIV knowledge among the medical professionals surveyed with a score of 70/100 (i.e., a 'C'). Of the five stigma factors explored, only two had a score greater than 80 (ie., a 'B' score on the 'test'). Controlling for demographic factors, there was a significant effect of HIV Knowledge on Discrimination (F (4,146) ¼ 2.02, p ¼ 0.03), Prejudice (F (4,146) ¼ 2.13, p ¼ 0.04), Service Provision (F (4,145) ¼ 2.30. p ¼ 0.02), and Perceived Risk in Practice (F (4,91) ¼ 5.75, p < 0.01). Conclusions: The relatively low knowledge score and link between knowledge and stigma beliefs indicated a need for continued basic HIV education. Increased education around HIV risk is critical in the eradication of HIV given the link between high stereotyping beliefs and low testing rate.

Social Science Protocols, 2020

Background: Sudden Infant Death Syndrome (SIDS) and suffocation account for more than half of all... more Background: Sudden Infant Death Syndrome (SIDS) and suffocation account for more than half of all Sudden Unexpected Infant Deaths (SUID) and are leading causes of post-neonatal deaths. Risk reduction strategies, including supine sleep position and safe sleep environment, are critical for prevention. Teen mothers, especially those in rural, poor, southern states, are at higher risk due to low compliance with recommendations. Methods: We will conduct a randomized trial to test a tailored educational intervention on the sleep-related safety behaviors of teen mothers. In one study arm, the intervention will include not only the teen mothers but also senior caregivers (SCGs) to assess the influence they have in the decision-making of young mothers regarding infant health and safety. Our hypotheses are H1) teen mothers exposed to intervention will be more likely than controls to adopt safe sleep practices, and H2) teen mothers will be more likely to use those practices when they and their...

International Journal of Environmental Research and Public Health, 2019

Background: Maternal Depression (MD) has been implicated in the etiology of obesity. The present ... more Background: Maternal Depression (MD) has been implicated in the etiology of obesity. The present study investigated MD and both child fruit/vegetable consumption (FVC) and household food insecurity (FI) in an early childhood population. Methods: This cross-sectional study was conducted in Arkansas, United States, in 26 Head Start centers. Teachers obtained the Family Map (FM), an interview assessment tool used by Head Start staff to identify potential risk factors that affect child learning and development. The FM contains a two-item screener of parent depression—the Patient Health Questionaire-2, two questions about family FI, and two questions about FVC. The FM was completed in 693 households. Chi square analyses and logistic regressions utilizing adjusted and unadjusted odds ratios were utilized to compare differences in risk for children of mothers with no symptoms compared to mothers with low- or high-level depressive symptoms. Results: Children whose mothers had high MD were 2...

Journal of Clinical and Translational Science, 2019

Introduction:Sudden unexpected infant death is the leading cause of infant mortality with black: ... more Introduction:Sudden unexpected infant death is the leading cause of infant mortality with black: white infant mortality remaining at 2:1 for the last decade. Smartphone technology provides a convenient and accessible tool for injury prevention anticipatory guidance among at-risk communities.Materials and Methods:A convenience sample of pregnant teen mothers who own a smartphone. During a 1-month postnatal home visit, a safe sleep environment survey was administered, infant sleep practices were observed, and mothers trained to take and submit standard infants’ sleep environment photographs. Photographs were independently assessed for inter-rater reliability (IRR) across five sleep safety domains (primary outcome): sleep location, surface, position, presence of soft items, and hazards near the sleep area. Expert and novice coders IRR was measured using Cohen’s kappa coefficient (K). Sleep safety correlation between photographs and observation, and parent report and observation was det...

Maternal and Child Health Journal, 2018

Global Pediatric Health, 2019

This study examined the implementation of a school-based, obesity prevention curriculum, Together... more This study examined the implementation of a school-based, obesity prevention curriculum, Together, We Inspire Smart Eating (WISE), targeting 3- to 7-year-old low-income children. Survey data from a convenience sample were collected from educators and parents (N = 73, N = 188, respectively) at the beginning and end of a school year in which WISE was implemented. Educators also reported on lessons weekly. Measures to evaluate the success of the implementation were conceptually distinct implementation outcomes (Educators: Perceived Barriers, Appropriateness, Acceptability, Feasibility, Fidelity; Parents: Adoption, Appropriateness). WISE was successfully implemented in 33 target classrooms representing 7 preschool centers and 2 elementary schools. Based on educator report, perceived barriers were reduced. Educators rated Appropriateness, Acceptability, and Feasibility high. Evidence of Fidelity was mixed. Parents reported indicators of Adoption and Appropriateness high. The study provid...

International Journal of Environmental Research and Public Health, 2019

Adverse childhood experiences (ACEs) have long-term health consequences. Young children in the so... more Adverse childhood experiences (ACEs) have long-term health consequences. Young children in the southern part of the United States (US) are at greater risk than children in other parts of the US. This study assessed preschool children ACEs using a family-friendly tool, the Family Map (FMI), and compared children living in rural/urban areas while examining the potential moderation of race. The FMI–ACE score was examined as a total and two sub-scores. We found that race did not moderate the FMI–ACE score but that Black children (Cohen’s d = 0.52) and children in urban and large rural areas were at highest risk (Cohen’s d = 0.38). However, the subscale FMI–ACEs parenting risk was moderated by race such as that Black children were less at risk in rural areas than urban (Cohen’s d = 0.62). For FMI–ACEs environmental risk, race moderated risk such that Black children were most at risk in large rural areas but less so in small rural areas (Cohen’s d = 0.21). Hispanic children were most at r...

Health Education Research, 2018

This study examined nutrition intervention curriculum, Together We Inspire Smart Eating (WISE). W... more This study examined nutrition intervention curriculum, Together We Inspire Smart Eating (WISE). WISE is a research-based, nutrition promotion curriculum specifically designed for preschool children from families with limited resources. The design was non-randomized treatment/control with standardized pre-/post-test assessments. Children (n ¼ 268) in six Head Start centers received weekly food experiences from educators trained in WISE. Children (n ¼ 258) in nine Head Start centers received weekly food experiences structured at the discretion of the educators untrained in WISE. Parents in both conditions (n ¼ 268 WISE classroom, n ¼ 258 comparison) were interviewed by educators twice over the school year using a data collection tool, The Family Map Inventory. Analyses using full information maximum likelihood controlling for preintervention consumption and key demographic characteristics were used to predict consumption at post-intervention assessment. Results indicated children in WISE centers consumed healthier food at home than children in non-WISE classrooms. The study suggested that WISE curriculum is an effective method to improve children's diets in at-risk environments. Key messages. The intervention, Together, We Inspire Smart Eating (WISE), was developed as an evidence-based curriculum and offers advantages over other preschool programs targeting healthy consumption by young children.. Parents of children enrolled in WISE classrooms reported increased consumption of fruits and vegetables after a year of participation in the intervention.. When compared with children in classrooms without WISE intervention, children in classrooms that implemented WISE consumed more fruits and vegetables controlling for pre-intervention consumption, child and family characteristics.

Maternal and child health journal, Jan 28, 2018

Objectives Improving family retention and engagement is crucial to the success of home visiting p... more Objectives Improving family retention and engagement is crucial to the success of home visiting programs. Little is known about retaining and engaging depressed parents in services. The purpose of the study is to examine how home visit content moderates the association between depression and retention and engagement. Methods The sample (N = 1322) was served by Healthy Families America (n = 618) and Parents as Teachers (n = 704) between April 1, 2012 and June 30, 2016. Parents averaged 23 years (SD = 6). Nearly half of the parents were White (48%) and the majority was single (71%). Depression was screened with the Patient Health Questionnaire-2. Home visitors reported the percent of time focused on particular content and parent engagement at every home visit. Results Multilevel regression analyses showed the amount of time that home visitors spent supporting parent-child interaction moderated the association between depression and retention at 6 (B = .08, SE = .03, p = .003) and 12 (...

Families, systems & health : the journal of collaborative family healthcare, Dec 1, 2017

Adverse childhood experiences (ACEs) have lifetime consequences for health and development. This ... more Adverse childhood experiences (ACEs) have lifetime consequences for health and development. This study examined whether there is evidence to support a screening approach that assesses children's current exposures to risks that act as proxies for ACEs, measured in a way that falls below a threshold of explicit abuse, neglect, or illegal behavior. We used data collected during routine home visitations of at-risk children aged 0-5. Home visitors used the Family Map Inventories (FMI; Whiteside-Mansell et al., 2007) to screen ACEs and measure health outcomes, and the Ages and Stages Questionnaire (3rd ed.; ASQ-3; Squires, Twombly, Bricker, & Potter, 2009) to screen child development. Parents (N = 2,004) were 28 years of age on average and most were White (60%). Children were 32 months of age on average and equally divided on gender (51% male). Children were exposed at rates of 27%, 17%, 11%, and 11% to 1, 2, 3, and 4 or more FMI-ACEs, respectively. Logistic regressions revealed signi...

Implementation Science, 2017

Background: Despite the potential to reach at-risk children in childcare, there is a significant ... more Background: Despite the potential to reach at-risk children in childcare, there is a significant gap between current practices and evidence-based obesity prevention in this setting. There are few investigations of the impact of implementation strategies on the uptake of evidence-based practices (EBPs) for obesity prevention and nutrition promotion. This study protocol describes a three-phase approach to developing and testing implementation strategies to support uptake of EBPs for obesity prevention practices in childcare (i.e., key components of the WISE intervention). Methods: Informed by the i-PARIHS framework, we will use a stakeholder-driven evidence-based quality improvement (EBQI) process to apply information gathered in qualitative interviews on barriers and facilitators to practice to inform the design of implementation strategies. Then, a Hybrid Type III cluster randomized trial will compare a basic implementation strategy (i.e., intervention as usual) with an enhanced implementation strategy informed by stakeholders. All Head Start centers (N = 12) within one agency in an urban area in a southern state in the USA will be randomized to receive the basic or enhanced implementation with approximately 20 classrooms per group (40 educators, 400 children per group). The educators involved in the study, the data collectors, and the biostastician will be blinded to the study condition. The basic and enhanced implementation strategies will be compared on outcomes specified by the RE-AIM model (e.g., Reach to families, Effectiveness of impact on child diet and health indicators, Adoption commitment of agency, Implementation fidelity and acceptability, and Maintenance after 6 months). Principles of formative evaluation will be used throughout the hybrid trial. Discussion: This study will test a stakeholder-driven approach to improve implementation, fidelity, and maintenance of EBPs for obesity prevention in childcare. Further, this study provides an example of a systematic process to develop and test a tailored, enhanced implementation strategy.

Pediatrics, 2016

Neonatal hypoglycemia has been associated with abnormalities on brain imaging and a spectrum of d... more Neonatal hypoglycemia has been associated with abnormalities on brain imaging and a spectrum of developmental delays, although historical and recent studies show conflicting results. We compared the cognitive, academic, and behavioral outcomes of preterm infants with neonatal hypoglycemia with those of normoglycemic controls at 3 to 18 years of age. A secondary analysis of data from the Infant Health and Development Program, a national, multisite, randomized controlled longitudinal intervention study of long-term health and developmental outcomes in preterm infants. Of the 985 infants enrolled in the Infant Health and Development Program, 745 infants had glucose levels recorded. Infants were stratified into 4 groups by glucose level. By using standardized cognitive, academic, and behavioral assessments performed at 3, 8, and 18 years of age, we compared groups after adjusting for intervention status, birth weight, gestational age, sex, severity of neonatal course, race, maternal edu...

Journal of Nutrition Education and Behavior, 2014

Being able to describe growth appropriately and succinctly is important in many contexts, includi... more Being able to describe growth appropriately and succinctly is important in many contexts, including biology, epidemiology and statistics. Various approaches are used varying from differential equations, deterministic modeling and statistical approaches like regression. Often, with epidemiologic data we want to model growth in the context of demographic variables and other potential mediators. However, growth is non-linear, so the addition of covariates may be problematic. Additionally, measurements may be unevenly spaced and there may even be missing data so some form of modeling that will deal with this is needed. We investigate growth models implemented in SAS/STAT® using anthropometric data (height, weight, and body mass index,) from the Infant Health and Development Program (IHDP). This program was an eight-site randomized controlled trial testing the efficacy of early intervention to enhance the cognitive, behavioral, and health status of low birth weight, premature infants. Th...

Journal of Substance Abuse Treatment, 2006

This article examines the treatment outcomes of 305 women enrolled in a comprehensive, residentia... more This article examines the treatment outcomes of 305 women enrolled in a comprehensive, residential substance abuse treatment program for pregnant and parenting women and their children. The women were assessed at intake and three times in the year after discharge. Analyses focused on change in client functioning over time, and investigating the impact of length of stay in treatment on client outcomes. Comparisons of clients' functioning before and after treatment suggest significant improvements in a number of domains, including substance use, employment, legal involvement, mental health, parenting attitudes, and risky behaviors. For most outcome domains, results suggest that longer treatment stays are associated with more positive outcomes.

Journal of Perinatology, 2011

Objective: The objective of this study was to determine the evolution of obesity status (OS) in a... more Objective: The objective of this study was to determine the evolution of obesity status (OS) in a longitudinal cohort of low birth weight preterm (LBWPT) infants to an age of 8 years, and to determine whether rapid weight gain in the first year of life independently predicts 8-year OS. Study Design: In total, 985 infants (birth weight p2500 g, gestation age p37 weeks) were recruited from the nursery in an eight-site intervention research program and were evaluated at an age of 3, 5, 6.5 and 8 years. Weight and height were measured by standard protocol at each visit and body mass index was calculated. Obesity status is X95% for age and sex. Multiple logistic analyses were performed on 8-year OS with predictor variables including infant race, gender, small for gestational age status, birth weight category, neonatal health index, treatment group and first-year weight gain; maternal education and weight status before conception; and HOME Inventory. Result: Overall, 2.3% were OS at an age of 3 years, 6.1% at an age of 5 years, 7.7% at age 6.5 years and 8.7% at an age 8 years. OS varied by birth weight category at each visit. The infants born p1500 g had the lowest prevalence of OS at each age. In the logistic regression, maternal race (Hispanic) (adjusted odds ratio ¼ 2.8, confidence interval ¼ 1.2 to 6.8), maternal obese status (adjusted odds ratio 3.4, confidence interval ¼ 1.5 to 7.8) and first-year weight gain (adjusted odds ratio ¼ 2.7, confidence interval ¼ 1.9 to 3.9), significantly predicted 8-year OS. Conclusion: OS is common in LBWPT infants during childhood, and prevalence varies by birth weight category. High weight gain in the first year of life is an important predictor of the development of OS in LBWPT children.

Journal of Perinatology, 2013

OBJECTIVE: To assess the long-term cognitive, behavioral and academic status of preterm children ... more OBJECTIVE: To assess the long-term cognitive, behavioral and academic status of preterm children exposed to clinical chorioamnionitis. STUDY DESIGN: In total, 985 infants (o37 weeks and 2500 g at birth) were recruited in a multisite interventional research program. Of these, 43 case-infants were identified based on documented diagnosis of maternal clinical chorioamnionitis. Infants with chorioamnionitis were compared with the remainder of the cohort after controlling for maternal and infant variables. All infants underwent cognitive, behavioral and academic achievement assessments at 3, 8 and 18 years. Standardized cognitive and academic achievement scores were cutoff at 2 s.d.'s below the mean, behavioral scores were cutoff at a T-score 470 and examined with w 2 statistics. Mean scores were evaluated using preliminary bivariate analysis and were followed by multiple regression models predicting child outcomes. RESULT: Overall, children with chorioamnionitis did not have lower scores on any assessment at any age. Children without chorioamnionitis performed significantly lower at 8 years on the Woodcock-Johnson reading subscore and the mean score of the Peabody Picture Vocabulary Test (PPVT). No significant difference persisted to 18-year follow-up. In logistic regression, chorioamnionitis independently predicted higher PPVT scores at 8 years, but not lower performance scores on the Woodcock-Johnson reading subscore. CONCLUSION: Clinical chorioamnionitis was not associated with adverse neurodevelopmental outcomes in this group of preterm infants o37 weeks and 2500 g.

Implementation Science Communications

Background Despite the importance of sustainability for nutrition and physical activity in public... more Background Despite the importance of sustainability for nutrition and physical activity in public health interventions, limited studies have explored the factors that promote and inhibit evidence-based program sustainment in the childcare setting. This study protocol describes a mixed-methods approach to develop novel sustainability strategies based on real-world settings and stakeholder feedback, with the goal of providing support for future obesity prevention programs and related studies on intervention sustainability. Two interventions, Together, We Inspire Smart Eating (WISE) and The Food Friends’ (FF) Fun with New Foods and Get Movin’ with Might Moves, are studied to this end. Methods The study will deploy an explanatory, sequential mixed-methods design. First, the research team will collect a quantitative survey to assess rates of sustainment among WISE and Food Friends sites. We expect to collect 150 surveys from WISE and FF sites combined. Data from these surveys will be use...

Engaging families of preschool children in partnerships with early childcare providers includes, ... more Engaging families of preschool children in partnerships with early childcare providers includes, among other activities, engaging in meaningful conversation, linking parents to needed services, and supporting parents as they capitalize on family protective factors. Early childhood programs struggle to implement systematic processes to support teachers in engaging families and documenting the interactions. This report summarizes the development and implementation of a tool designed to facilitate family engagement with childcare. The study targets a rural, multi-center agency serving Early Head Start families using an inventory called The Family Map. This report provides evidence of the feasibility of implementation, the reliability, and validity of the screening questions, and the range of risk and strengths identified in Early Head Start families served.

AIDS and Behavior, 2021

The southern U.S. has both high HIV and incarceration rates in comparison to its population. As i... more The southern U.S. has both high HIV and incarceration rates in comparison to its population. As in the rest of the country, HIV prevention is based on education, behavior change, and biomedical efforts, such as pre-exposure prophylaxis (PrEP). This study examined the implementation of an educational intervention and supportive services to obtain PrEP in a population of individuals (N = 218) involved in an Adult Drug Court (ADC) or on probation or parole (P-P). Nearly all ADC and P-P participants self-reported risk behaviors linked to HIV acquisition. Results supported the acceptance and usefulness of the intervention as rated by participants. Participants showed increased knowledge of HIV risks and testing post-education. In multivariate analysis, predictors of interest in using PrEP included low stigma beliefs, specifically their level of prejudice views, high depressive symptoms, and white race. The intervention shows promise. Given the high risk documented for ADC and P-P individ...

Journal of the National Medical Association, 2020

This study examined the prediction of HIV knowledge on multiple dimensions of stigma beliefs. Met... more This study examined the prediction of HIV knowledge on multiple dimensions of stigma beliefs. Methods: We assessed clinical staff (N ¼ 153) in rural clinics (2017) HIV stigma beliefs and knowledge. Using multiple regression, we examined the ability of knowledge to predict stigma beliefs organized into meaningful dimensions. Results: There was high variability in HIV knowledge among the medical professionals surveyed with a score of 70/100 (i.e., a 'C'). Of the five stigma factors explored, only two had a score greater than 80 (ie., a 'B' score on the 'test'). Controlling for demographic factors, there was a significant effect of HIV Knowledge on Discrimination (F (4,146) ¼ 2.02, p ¼ 0.03), Prejudice (F (4,146) ¼ 2.13, p ¼ 0.04), Service Provision (F (4,145) ¼ 2.30. p ¼ 0.02), and Perceived Risk in Practice (F (4,91) ¼ 5.75, p < 0.01). Conclusions: The relatively low knowledge score and link between knowledge and stigma beliefs indicated a need for continued basic HIV education. Increased education around HIV risk is critical in the eradication of HIV given the link between high stereotyping beliefs and low testing rate.

Social Science Protocols, 2020

Background: Sudden Infant Death Syndrome (SIDS) and suffocation account for more than half of all... more Background: Sudden Infant Death Syndrome (SIDS) and suffocation account for more than half of all Sudden Unexpected Infant Deaths (SUID) and are leading causes of post-neonatal deaths. Risk reduction strategies, including supine sleep position and safe sleep environment, are critical for prevention. Teen mothers, especially those in rural, poor, southern states, are at higher risk due to low compliance with recommendations. Methods: We will conduct a randomized trial to test a tailored educational intervention on the sleep-related safety behaviors of teen mothers. In one study arm, the intervention will include not only the teen mothers but also senior caregivers (SCGs) to assess the influence they have in the decision-making of young mothers regarding infant health and safety. Our hypotheses are H1) teen mothers exposed to intervention will be more likely than controls to adopt safe sleep practices, and H2) teen mothers will be more likely to use those practices when they and their...

International Journal of Environmental Research and Public Health, 2019

Background: Maternal Depression (MD) has been implicated in the etiology of obesity. The present ... more Background: Maternal Depression (MD) has been implicated in the etiology of obesity. The present study investigated MD and both child fruit/vegetable consumption (FVC) and household food insecurity (FI) in an early childhood population. Methods: This cross-sectional study was conducted in Arkansas, United States, in 26 Head Start centers. Teachers obtained the Family Map (FM), an interview assessment tool used by Head Start staff to identify potential risk factors that affect child learning and development. The FM contains a two-item screener of parent depression—the Patient Health Questionaire-2, two questions about family FI, and two questions about FVC. The FM was completed in 693 households. Chi square analyses and logistic regressions utilizing adjusted and unadjusted odds ratios were utilized to compare differences in risk for children of mothers with no symptoms compared to mothers with low- or high-level depressive symptoms. Results: Children whose mothers had high MD were 2...

Journal of Clinical and Translational Science, 2019

Introduction:Sudden unexpected infant death is the leading cause of infant mortality with black: ... more Introduction:Sudden unexpected infant death is the leading cause of infant mortality with black: white infant mortality remaining at 2:1 for the last decade. Smartphone technology provides a convenient and accessible tool for injury prevention anticipatory guidance among at-risk communities.Materials and Methods:A convenience sample of pregnant teen mothers who own a smartphone. During a 1-month postnatal home visit, a safe sleep environment survey was administered, infant sleep practices were observed, and mothers trained to take and submit standard infants’ sleep environment photographs. Photographs were independently assessed for inter-rater reliability (IRR) across five sleep safety domains (primary outcome): sleep location, surface, position, presence of soft items, and hazards near the sleep area. Expert and novice coders IRR was measured using Cohen’s kappa coefficient (K). Sleep safety correlation between photographs and observation, and parent report and observation was det...

Maternal and Child Health Journal, 2018

Global Pediatric Health, 2019

This study examined the implementation of a school-based, obesity prevention curriculum, Together... more This study examined the implementation of a school-based, obesity prevention curriculum, Together, We Inspire Smart Eating (WISE), targeting 3- to 7-year-old low-income children. Survey data from a convenience sample were collected from educators and parents (N = 73, N = 188, respectively) at the beginning and end of a school year in which WISE was implemented. Educators also reported on lessons weekly. Measures to evaluate the success of the implementation were conceptually distinct implementation outcomes (Educators: Perceived Barriers, Appropriateness, Acceptability, Feasibility, Fidelity; Parents: Adoption, Appropriateness). WISE was successfully implemented in 33 target classrooms representing 7 preschool centers and 2 elementary schools. Based on educator report, perceived barriers were reduced. Educators rated Appropriateness, Acceptability, and Feasibility high. Evidence of Fidelity was mixed. Parents reported indicators of Adoption and Appropriateness high. The study provid...

International Journal of Environmental Research and Public Health, 2019

Adverse childhood experiences (ACEs) have long-term health consequences. Young children in the so... more Adverse childhood experiences (ACEs) have long-term health consequences. Young children in the southern part of the United States (US) are at greater risk than children in other parts of the US. This study assessed preschool children ACEs using a family-friendly tool, the Family Map (FMI), and compared children living in rural/urban areas while examining the potential moderation of race. The FMI–ACE score was examined as a total and two sub-scores. We found that race did not moderate the FMI–ACE score but that Black children (Cohen’s d = 0.52) and children in urban and large rural areas were at highest risk (Cohen’s d = 0.38). However, the subscale FMI–ACEs parenting risk was moderated by race such as that Black children were less at risk in rural areas than urban (Cohen’s d = 0.62). For FMI–ACEs environmental risk, race moderated risk such that Black children were most at risk in large rural areas but less so in small rural areas (Cohen’s d = 0.21). Hispanic children were most at r...

Health Education Research, 2018

This study examined nutrition intervention curriculum, Together We Inspire Smart Eating (WISE). W... more This study examined nutrition intervention curriculum, Together We Inspire Smart Eating (WISE). WISE is a research-based, nutrition promotion curriculum specifically designed for preschool children from families with limited resources. The design was non-randomized treatment/control with standardized pre-/post-test assessments. Children (n ¼ 268) in six Head Start centers received weekly food experiences from educators trained in WISE. Children (n ¼ 258) in nine Head Start centers received weekly food experiences structured at the discretion of the educators untrained in WISE. Parents in both conditions (n ¼ 268 WISE classroom, n ¼ 258 comparison) were interviewed by educators twice over the school year using a data collection tool, The Family Map Inventory. Analyses using full information maximum likelihood controlling for preintervention consumption and key demographic characteristics were used to predict consumption at post-intervention assessment. Results indicated children in WISE centers consumed healthier food at home than children in non-WISE classrooms. The study suggested that WISE curriculum is an effective method to improve children's diets in at-risk environments. Key messages. The intervention, Together, We Inspire Smart Eating (WISE), was developed as an evidence-based curriculum and offers advantages over other preschool programs targeting healthy consumption by young children.. Parents of children enrolled in WISE classrooms reported increased consumption of fruits and vegetables after a year of participation in the intervention.. When compared with children in classrooms without WISE intervention, children in classrooms that implemented WISE consumed more fruits and vegetables controlling for pre-intervention consumption, child and family characteristics.

Maternal and child health journal, Jan 28, 2018

Objectives Improving family retention and engagement is crucial to the success of home visiting p... more Objectives Improving family retention and engagement is crucial to the success of home visiting programs. Little is known about retaining and engaging depressed parents in services. The purpose of the study is to examine how home visit content moderates the association between depression and retention and engagement. Methods The sample (N = 1322) was served by Healthy Families America (n = 618) and Parents as Teachers (n = 704) between April 1, 2012 and June 30, 2016. Parents averaged 23 years (SD = 6). Nearly half of the parents were White (48%) and the majority was single (71%). Depression was screened with the Patient Health Questionnaire-2. Home visitors reported the percent of time focused on particular content and parent engagement at every home visit. Results Multilevel regression analyses showed the amount of time that home visitors spent supporting parent-child interaction moderated the association between depression and retention at 6 (B = .08, SE = .03, p = .003) and 12 (...

Families, systems & health : the journal of collaborative family healthcare, Dec 1, 2017

Adverse childhood experiences (ACEs) have lifetime consequences for health and development. This ... more Adverse childhood experiences (ACEs) have lifetime consequences for health and development. This study examined whether there is evidence to support a screening approach that assesses children's current exposures to risks that act as proxies for ACEs, measured in a way that falls below a threshold of explicit abuse, neglect, or illegal behavior. We used data collected during routine home visitations of at-risk children aged 0-5. Home visitors used the Family Map Inventories (FMI; Whiteside-Mansell et al., 2007) to screen ACEs and measure health outcomes, and the Ages and Stages Questionnaire (3rd ed.; ASQ-3; Squires, Twombly, Bricker, & Potter, 2009) to screen child development. Parents (N = 2,004) were 28 years of age on average and most were White (60%). Children were 32 months of age on average and equally divided on gender (51% male). Children were exposed at rates of 27%, 17%, 11%, and 11% to 1, 2, 3, and 4 or more FMI-ACEs, respectively. Logistic regressions revealed signi...

Implementation Science, 2017

Background: Despite the potential to reach at-risk children in childcare, there is a significant ... more Background: Despite the potential to reach at-risk children in childcare, there is a significant gap between current practices and evidence-based obesity prevention in this setting. There are few investigations of the impact of implementation strategies on the uptake of evidence-based practices (EBPs) for obesity prevention and nutrition promotion. This study protocol describes a three-phase approach to developing and testing implementation strategies to support uptake of EBPs for obesity prevention practices in childcare (i.e., key components of the WISE intervention). Methods: Informed by the i-PARIHS framework, we will use a stakeholder-driven evidence-based quality improvement (EBQI) process to apply information gathered in qualitative interviews on barriers and facilitators to practice to inform the design of implementation strategies. Then, a Hybrid Type III cluster randomized trial will compare a basic implementation strategy (i.e., intervention as usual) with an enhanced implementation strategy informed by stakeholders. All Head Start centers (N = 12) within one agency in an urban area in a southern state in the USA will be randomized to receive the basic or enhanced implementation with approximately 20 classrooms per group (40 educators, 400 children per group). The educators involved in the study, the data collectors, and the biostastician will be blinded to the study condition. The basic and enhanced implementation strategies will be compared on outcomes specified by the RE-AIM model (e.g., Reach to families, Effectiveness of impact on child diet and health indicators, Adoption commitment of agency, Implementation fidelity and acceptability, and Maintenance after 6 months). Principles of formative evaluation will be used throughout the hybrid trial. Discussion: This study will test a stakeholder-driven approach to improve implementation, fidelity, and maintenance of EBPs for obesity prevention in childcare. Further, this study provides an example of a systematic process to develop and test a tailored, enhanced implementation strategy.

Pediatrics, 2016

Neonatal hypoglycemia has been associated with abnormalities on brain imaging and a spectrum of d... more Neonatal hypoglycemia has been associated with abnormalities on brain imaging and a spectrum of developmental delays, although historical and recent studies show conflicting results. We compared the cognitive, academic, and behavioral outcomes of preterm infants with neonatal hypoglycemia with those of normoglycemic controls at 3 to 18 years of age. A secondary analysis of data from the Infant Health and Development Program, a national, multisite, randomized controlled longitudinal intervention study of long-term health and developmental outcomes in preterm infants. Of the 985 infants enrolled in the Infant Health and Development Program, 745 infants had glucose levels recorded. Infants were stratified into 4 groups by glucose level. By using standardized cognitive, academic, and behavioral assessments performed at 3, 8, and 18 years of age, we compared groups after adjusting for intervention status, birth weight, gestational age, sex, severity of neonatal course, race, maternal edu...

Journal of Nutrition Education and Behavior, 2014

Being able to describe growth appropriately and succinctly is important in many contexts, includi... more Being able to describe growth appropriately and succinctly is important in many contexts, including biology, epidemiology and statistics. Various approaches are used varying from differential equations, deterministic modeling and statistical approaches like regression. Often, with epidemiologic data we want to model growth in the context of demographic variables and other potential mediators. However, growth is non-linear, so the addition of covariates may be problematic. Additionally, measurements may be unevenly spaced and there may even be missing data so some form of modeling that will deal with this is needed. We investigate growth models implemented in SAS/STAT® using anthropometric data (height, weight, and body mass index,) from the Infant Health and Development Program (IHDP). This program was an eight-site randomized controlled trial testing the efficacy of early intervention to enhance the cognitive, behavioral, and health status of low birth weight, premature infants. Th...

Journal of Substance Abuse Treatment, 2006

This article examines the treatment outcomes of 305 women enrolled in a comprehensive, residentia... more This article examines the treatment outcomes of 305 women enrolled in a comprehensive, residential substance abuse treatment program for pregnant and parenting women and their children. The women were assessed at intake and three times in the year after discharge. Analyses focused on change in client functioning over time, and investigating the impact of length of stay in treatment on client outcomes. Comparisons of clients' functioning before and after treatment suggest significant improvements in a number of domains, including substance use, employment, legal involvement, mental health, parenting attitudes, and risky behaviors. For most outcome domains, results suggest that longer treatment stays are associated with more positive outcomes.

Journal of Perinatology, 2011

Objective: The objective of this study was to determine the evolution of obesity status (OS) in a... more Objective: The objective of this study was to determine the evolution of obesity status (OS) in a longitudinal cohort of low birth weight preterm (LBWPT) infants to an age of 8 years, and to determine whether rapid weight gain in the first year of life independently predicts 8-year OS. Study Design: In total, 985 infants (birth weight p2500 g, gestation age p37 weeks) were recruited from the nursery in an eight-site intervention research program and were evaluated at an age of 3, 5, 6.5 and 8 years. Weight and height were measured by standard protocol at each visit and body mass index was calculated. Obesity status is X95% for age and sex. Multiple logistic analyses were performed on 8-year OS with predictor variables including infant race, gender, small for gestational age status, birth weight category, neonatal health index, treatment group and first-year weight gain; maternal education and weight status before conception; and HOME Inventory. Result: Overall, 2.3% were OS at an age of 3 years, 6.1% at an age of 5 years, 7.7% at age 6.5 years and 8.7% at an age 8 years. OS varied by birth weight category at each visit. The infants born p1500 g had the lowest prevalence of OS at each age. In the logistic regression, maternal race (Hispanic) (adjusted odds ratio ¼ 2.8, confidence interval ¼ 1.2 to 6.8), maternal obese status (adjusted odds ratio 3.4, confidence interval ¼ 1.5 to 7.8) and first-year weight gain (adjusted odds ratio ¼ 2.7, confidence interval ¼ 1.9 to 3.9), significantly predicted 8-year OS. Conclusion: OS is common in LBWPT infants during childhood, and prevalence varies by birth weight category. High weight gain in the first year of life is an important predictor of the development of OS in LBWPT children.

Journal of Perinatology, 2013

OBJECTIVE: To assess the long-term cognitive, behavioral and academic status of preterm children ... more OBJECTIVE: To assess the long-term cognitive, behavioral and academic status of preterm children exposed to clinical chorioamnionitis. STUDY DESIGN: In total, 985 infants (o37 weeks and 2500 g at birth) were recruited in a multisite interventional research program. Of these, 43 case-infants were identified based on documented diagnosis of maternal clinical chorioamnionitis. Infants with chorioamnionitis were compared with the remainder of the cohort after controlling for maternal and infant variables. All infants underwent cognitive, behavioral and academic achievement assessments at 3, 8 and 18 years. Standardized cognitive and academic achievement scores were cutoff at 2 s.d.'s below the mean, behavioral scores were cutoff at a T-score 470 and examined with w 2 statistics. Mean scores were evaluated using preliminary bivariate analysis and were followed by multiple regression models predicting child outcomes. RESULT: Overall, children with chorioamnionitis did not have lower scores on any assessment at any age. Children without chorioamnionitis performed significantly lower at 8 years on the Woodcock-Johnson reading subscore and the mean score of the Peabody Picture Vocabulary Test (PPVT). No significant difference persisted to 18-year follow-up. In logistic regression, chorioamnionitis independently predicted higher PPVT scores at 8 years, but not lower performance scores on the Woodcock-Johnson reading subscore. CONCLUSION: Clinical chorioamnionitis was not associated with adverse neurodevelopmental outcomes in this group of preterm infants o37 weeks and 2500 g.