Digital Commons Network^™

Correlates Of Zero-Dose Vaccination Status Among Children Aged 12-59 Months In Sub-Saharan Africa: A Multilevel Analysis Of Individual And Contextual Factors, Chamberline Ozigbu, Bankole Olatosi, Zhenlong Li, James W. Hardin, Nicole L. Hair

Faculty Publications

Despite ongoing efforts to improve childhood vaccination coverage, including in hard-to-reach and hard-to-vaccinate communities, many children in sub-Saharan Africa (SSA) remain unvaccinated. Considering recent goals set by the Immunization Agenda 2030 (IA2030), including reducing the number of zero-dose children by half, research that goes beyond coverage to identify populations and groups at greater risk of being unvaccinated is urgently needed. This is a pooled cross-sectional study of individual- and country-level data obtained from Demographic and Health Surveys Program and two open data repositories. The sample includes 43,131 children aged 12–59 months sampled between 2010 and 2020 in 33 SSA countries. …

Determining Diagnosis Date Of Diabetes Using Structured Electronic Health Record (Ehr) Data: The Search For Diabetes In Youth Study, Kristin M. Lenoir, Lynne E. Wagenknecht, Jasmin Divers, Ramon Casanova, Dana Dabelea, Sharon Saydah, Catherine Pihoker, Angela D. Liese Ph.D., Debra Standiford, Richard Hamman, Brian J. Wells, The Search For Diabetes In Youth Study Group

Faculty Publications

Background Disease surveillance of diabetes among youth has relied mainly upon manual chart review. However, increasingly available structured electronic health record (EHR) data have been shown to yield accurate determinations of diabetes status and type. Validated algorithms to determine date of diabetes diagnosis are lacking. The objective of this work is to validate two EHR-based algorithms to determine date of diagnosis of diabetes. Methods A rule-based ICD-10 algorithm identified youth with diabetes from structured EHR data over the period of 2009 through 2017 within three children’s hospitals that participate in the SEARCH for Diabetes in Youth Study: Cincinnati Children’s Hospital, …

Household Food Insecurity And Children’S Physical Activity And Sedentary Behaviour In The United States: The Healthy Communities Study, Sophia M. Navarro, Marisa M. Tsai, Lorrene D. Ritchie, Edward A. Frongillo Jr., Barbara A. Laraia, Russell R. Pate, Lauren E. Au

Faculty Publications

OBJECTIVE: To examine associations between household food insecurity and children's physical activity and sedentary behaviours. DESIGN: Secondary analysis was conducted on the Healthy Communities Study, an observational study from 2013 to 2015. Household food insecurity was assessed by two items from the US Department of Agriculture's 18-item US Household Food Security Survey Module. Physical activity was measured using the 7-d Physical Activity Behavior Recall instrument. Data were analyzed using multilevel statistical modelling. SETTING: A total of 130 communities in the USA. PARTICIPANTS: In sum, 5138 US children aged 4-15 years. RESULTS: No associations were found for the relationship between household …

Factor Structure And Equivalence Of Maternal Resources For Care In Bangladesh, Vietnam, And Ethiopia, Sulochana Basnet, Edward A. Frongillo Jr., Phuong Hong Nguyen, Spencer Moore, Mandana Arabi

Faculty Publications

Objectives: Resources for care among women are crucial for children's growth and development. The objectives of this cross-sectional study were to determine if: (1) the factor structure of measures of maternal resources for care was comparable across countries and consistent with the theoretical constructs and (2) the measures showed equivalence across contexts.

Methods: The study included 4400, 4029 and 2746 women from Bangladesh, Vietnam, and Ethiopia, respectively. The measures of resources for care were maternal education, knowledge, height, body mass index, mental well-being, financial autonomy, decision-making, employment, support in chores, and perceived support.

Results: The factor analysis demonstrated that a …

Elementary Classroom Teachers’ Self-Reported Use Of Movement Integration Products And Perceived Facilitators And Barriers Related To Product Use, Roddrick Dugger, Aaron Rafferty, Ethan Hunt, Michael W. Beets, Collin Andrew Webster, Brian Chen, Jeffrey Michael Rehling, Robert Glenn Weaver

Faculty Publications

Movement integration (MI) products are designed to provide children with physical activity during general education classroom time. The purpose of this study was to examine elementary classroom teachers’ self-reported use of MI products and subsequent perceptions of the facilitators of and barriers to MI product use. This study utilized a mixed-methods design. Elementary classroom teachers (n = 40) at four schools each tested four of six common MI products in their classroom for one week. Teachers completed a daily diary, documenting duration and frequency of product use. Following each product test, focus groups were conducted with teachers to assess facilitators …

Agricultural And Finance Intervention Increased Dietary Intake And Weight Of Children Living In Hiv-Affected Households In Western Kenya, Lisa M. Butler, Shiva Bhandari, Phelgona Otieno, Sheri D. Weiser, Craig R. Cohen, Edward A. Frongillo Jr.

Faculty Publications

We tested whether a multisectoral household agricultural and finance intervention increased the dietary intake and improved the nutritional status of HIV-affected children. Two hospitals in rural Kenya were randomly assigned to be either the intervention or the control arm. The intervention comprised a human-powered water pump, microfinance loan for farm commodities, and training in sustainable farming practices and financial management. In each arm, 100 children (0-59 mo of age) were enrolled from households with HIV-infected adults 18-49 y old. Children were assessed beginning in April 2012 and every 3 mo for 1 y for dietary intake and anthropometry. Children in …

Community Engagement And Outreach Programs For Lead Prevention In Mississippi, Amal K. Mitra, Charkarra Anderson-Lewis

Faculty Publications

The objective of the project was to encourage health promotion through education, outreach, and community-based training. The people attending health fairs (n = 467), community events (n = 469), and Kindergarten classes (n = 241) were the study participants. Hands-on training was offered at homebuilding retail stores (n = 25). U.S. Department of Housing and Urban Development (HUD)’s online visual training was given to realtors (n = 220), and inspectors, contractors, and Do-It-Yourself (DIY) workers (n = 75). Training workshops were attended by home-buyers and rental home owners at the Neighborhood Association Meetings ( …

Parenting Styles Are Associated With Overall Child Dietary Quality Within Low-Income And Food-Insecure Households, Michael P. Burke, Sonya J. Jones, Edward A. Frongillo Jr., Christine E. Blake, Maryah S. Fram

Faculty Publications

Objective: To examine the association between parenting styles and overall child dietary quality within households that are low-income and food-insecure.

Design: Child dietary intake was measured via a 24 h dietary recall. Dietary quality was assessed using the Healthy Eating Index-2005 (HEI-2005). Parenting styles were measured and scored using the Parenting Styles and Dimensions Questionnaire. Linear regressions were used to test main and interaction associations between HEI-2005 scores and parenting styles.

Setting: Non-probability sample of low-income and food-insecure households in South Carolina, USA.

Participants: Parent–child dyads (n 171). Parents were ≥18 years old and children were …

Introduction Of Iodised Salt Benefits Infants’ Mental Development In A Community-Based Cluster-Randomised Effectiveness Trial In Ethiopia, Karim Bougma, Frances E. Aboud, Tizita M. Lemma, Edward A. Frongillo Jr., Grace S. Marquis

Faculty Publications

The effectiveness of salt iodisation in improving the mental development of young children has not been assessed. We implemented a community-based cluster-randomised effectiveness trial in sixty randomly selected districts in the Amhara region of Ethiopia. We randomly allocated each district to treatment and randomly selected one of its villages. In parallel to national salt iodisation efforts, iodised salt was brought early into the markets of the thirty intervention villages before it became widely available in the thirty control villages 4–6 months later. The primary outcome was children’s mental development scores on the Bayley Scales. This was an intention-to-treat analysis using …

Evaluation Of Programs To Improve Complementary Feeding In Infants And Young Children, Edward A. Frongillo Jr.

Faculty Publications

Evaluation of complementary feeding programs is needed to enhance knowledge on what works,to document responsible use of resources, and for advocacy. Evaluation is done during program conceptualization and design, implementation, and determination of effectiveness. This paper explains the role of evaluation in the advancement of complementary feeding programs,presenting concepts and methods and illustrating them through examples. Planning and investments for eval-uations should occur from the beginning of the project life cycle. Essential to evaluation is articu-lation of a program theory on how change would occur and what program actions are required for change. Analysis of program impact pathways makes explicit …

Using Height-For-Age Differences (Had) Instead Of Height-For-Age Z-Scores (Haz) For The Meaningful Measurement Of Population-Level Catch-Up In Linear Growth In Children Less Than 5 Years Of Age, Jef L. Leroy, Marie Ruel, Jean-Pierre Habicht, Edward A. Frongillo Jr.

Faculty Publications

Background: Evidence from studies conducted in nutritionally deprived children in low- and middle-income countries (LIMC) in past decades showed little or no population-level catch-up in linear growth (mostly defined as reductions in the absolute height deficit) after 2 years of age. Recent studies, however, have reported population-level catch-up growth in children, defined as positive changes in mean height-for-age z-scores (HAZ). The aim of this paper was to assess whether population-level catch-up in linear growth is found when height-for-age difference (HAD: child’s height compared to standard, expressed in centimeters) is used instead of HAZ. Our premise is that HAZ is inappropriate …

Three-Year Change In The Wellbeing Of Orphaned And Separated Children In Institutional And Family-Based Care Settings In Five Low- And Middle-Income Countries, Kathryn Whetten, Jan Ostermann, Brian W. Pence, Rachel A. Whetten, Lynne C. Messer, Sumedha Ariely, Karen O'Donnell, Augustine I. Wasonga, Vanroth Vann, Dafrosa Itemba, Misganaw Eticha, Ira Madan, Nathan M. Thielman, The Positive Outcomes For Orphans (Pofo) Research Team

Faculty Publications

Background With more than 2 million children living in group homes, or “institutions”, worldwide, the extent to which institution-based caregiving negatively affects development and wellbeing is a central question for international policymakers.

Methods A two-stage random sampling methodology identified community representative samples of 1,357 institution-dwelling orphaned and separated children (OSC) and 1,480 family-dwelling OSC aged 6–12 from 5 low and middle income countries. Data were collected from children and their primary caregivers. Survey-analytic techniques and linear mixed effects models describe child wellbeing collected at baseline and at 36 months, including physical and emotional health, growth, cognitive development and memory, and …

Correlates Of Poor Health Among Orphans And Abandoned Children In Less Wealthy Countries: The Importance Of Caregiver Health, Nathan Thielman, Jan Ostermann, Kathryn Whetten, Rachel Whetten, Karen O’Donnell, Positive Outcomes For Orphans (Pofo) Research Team

Faculty Publications

Background: More than 153 million children worldwide have been orphaned by the loss of one or both parents, and millions more have been abandoned. We investigated relationships between the health of orphaned and abandoned children (OAC) and child, caregiver, and household characteristics among randomly selected OAC in five countries.

Methodology: Using a two-stage random sampling strategy in 6 study areas in Cambodia, Ethiopia, India, Kenya, and Tanzania, the Positive Outcomes for Orphans (POFO) study identified 1,480 community-living OAC ages 6 to 12. Detailed interviews were conducted with 1,305 primary caregivers at baseline and after 6 and 12 months. Multivariable logistic …

Acquisition Of Initial Mental Graphemic Representations By Children At Risk For Literacy Development, Kenn Apel, Shurita Thomas-Tate, Elizabeth B. Wilson-Fowler, Danielle Brimo

Faculty Publications

We examined the acquisition of initial mental graphemic representations (MGRs) by 46 kindergarten children (mean age = 5 years, 9 months) at risk for literacy development because of low socioeconomic status. Using a storybook context, we exposed children to novel nonwords that varied in their phonotactic and orthotactic probabilities and then assessed the children's development of initial MGRs through spelling and reading recognition tasks. The children developed some initial MGRs but less than past reports of children from middle socioeconomic backgrounds. Children with more advanced word recognition abilities developed more initial MGRs than their peers with less advanced word recognition …

The Impact Of A 3-Year After-School Obesity Prevention Program In Elementary School Children, Zenong Yin, Justin B. Moore, Maribeth H. Johnson, Marlo M. Vernon, Bernard Gutin

Faculty Publications

Background: Children tend to be sedentary during the after-school hours, and this has deleterious effects on their health. The objective of the present study was to determine the effects of a 3-year after-school physical activity (PA) program, without restriction of dietary energy intake, on percent body fat (%BF), cardiorespiratory fitness (CRF), and cardiometabolic markers in children.

Methods: A cluster randomization design was employed. A total of 574 3^rd grade children from 18 elementary schools in the south-eastern United States participated. The intervention consisted of 80 minutes of age-appropriate moderate-to-vigorous PA each school day. The main outcomes of interest were …

Associations Of American Indian Children's Screen-Time Behavior With Parental Television Behavior, Parental Perceptions Of Children's Screen Time, And Media-Related Resources In The Home, Daheia J. Barr-Anderson, Jayne A. Fulkerson, Mary Smyth, John H. Himes, Peter J. Hannan, Bonnie Holy Rock, Mary Story

Faculty Publications

Introduction: American Indian children have high rates of overweight and obesity, which may be partially attributable to screen-time behavior. Young children's screen-time behavior is strongly influenced by their environment and their parents' behavior. We explored whether parental television watching time, parental perceptions of children's screen time, and media-related resources in the home are related to scree time (ie, television, DVD/video, video game, and computer use) among Oglala Lakota youth residing on or near the Pine Ridge Reservation in South Dakota.

Methods: We collected baseline data from 431 child and parent/caregiver pairs who participated in Bright Start, a group-randomized, controlled, school-based …

The Contribution Of Dance To Daily Physical Activity Among Adolescent Girls, Jennifer R. O'Neill, Russell R. Pate, Steven P. Hooker

Faculty Publications

Background: Structured physical activity (PA) programs are well positioned to promote PA among youth, however, little is known about these programs, particularly dance classes. The aims of this study were to: 1) describe PA levels of girls enrolled in dance classes, 2) determine the contribution of dance classes to total moderate-to-vigorous physical activity (MVPA), and 3) compare PA between days with a dance class (program days) and days without a dance class (non-program days).

Methods: Participants were 149 girls (11-18 years) enrolled in dance classes in 11 dance studios. Overall PA was assessed with accelerometry for 8 consecutive days, and …

How Many Steps/Day Are Enough? For Children And Adolescents, Catrine Tudor-Locke, Cora L. Craig, Michael W. Beets, Sarahjane Belton, Greet M. Cardon, Scott Duncan, Yoshiro Hatano, David R. Lubans, Timothy S. Olds, Anders Raustorp, David A. Rowe, John C. Spence, Shigeho Tanaka, Steven N. Blair

Faculty Publications

Worldwide, public health physical activity guidelines include special emphasis on populations of children (typically 6-11 years) and adolescents (typically 12-19 years). Existing guidelines are commonly expressed in terms of frequency, time, and intensity of behaviour. However, the simple step output from both accelerometers and pedometers is gaining increased credibility in research and practice as a reasonable approximation of daily ambulatory physical activity volume. Therefore, the purpose of this article is to review existing child and adolescent objectively monitored step-defined physical activity literature to provide researchers, practitioners, and lay people who use accelerometers and pedometers with evidence-based translations of these public …

Associations Between Sport And Screen-Entertainment With Mental Health Problems In 5-Year-Old Children, Lucy J. Griffiths, Marsha Dowda, Carol Dezateux, Russell R. Pate

Faculty Publications

Background: Few studies have examined the benefits of regular physical activity, and risks of sedentary behavior, in young children. This study investigated associations between participation in sports and screen-entertainment (as components of physical activity and sedentary behavior), and emotional and behavioral problems in this population.

Methods: Cross-sectional analysis of data from 13470 children (50.9% boys) participating in the nationally representative UK Millennium Cohort Study. Time spent participating in sports clubs outside of school, and using screen-entertainment, was reported by the child's mother at child age 5 years, when mental health was also measured using the Strengths and Difficulties Questionnaire.

Results …

Who Guidelines For Antimicrobial Treatment In Children Admitted To Hospital In An Area Of Intense Plasmodium Falciparum Transmission: Prospective Study, Behzad Nadjm, Ben Amos, George Mtove, Jan Ostermann, Semkini Chonya, Hannah Wangai, Juma Kimera, Walii Msuya, Frank Mtei, Denise Dekker, Rajabu Malahiyo, Raimos Olomi, John A. Crump, Christopher J. M. Whitty, Hugh Reyburn

Faculty Publications

Objectives To assess the performance of WHO’s “Guidelines for care at the first-referral level in developing countries” in an area of intense malaria transmission and identify bacterial infections in children with and without malaria.

Design Prospective study.

Setting District hospital in Muheza, northeast Tanzania.

Participants Children aged 2 months to 13 years admitted to hospital for febrile illness.

Main outcome measures Sensitivity and specificity of WHO guidelines in diagnosing invasive bacterial disease; susceptibility of isolated organisms to recommended antimicrobials.

Results Over one year, 3639 children were enrolled and 184 (5.1%) died; 2195 (60.3%) were blood slide positive for Plasmodium falciparum …

Sedentary Behavior And Obesity In A Large Cohort Of Children, Jonathan A. Mitchell, Calum Mattocks, Andy R. Ness, Sam D. Leary, Russell R. Pate, Marsha Dowda, Steven N. Blair, Chris Riddoch

Faculty Publications

The purpose of this study was to examine the association between sedentary behavior and obesity among 12-year-old children, while adjusting for moderate-to-vigorous physical activity (MVPA) and other potential confounding variables.

Cross-sectional analyses were carried out with data from 5434 children who participated in the Avon Longitudinal Study of Parents and Children (ALSPAC). Fat mass was derived using dual x-ray emission absorptiometry (DXA), and height and weight measurements were used to calculate body mass index (BMI; kg/m²). The children wore an accelerometer for seven days. The cut points for sedentary behavior and MVPA were ≤199 cpm and ≥3600 cpm, …

Lead Poisoning: An Alarming Public Health Problem In Bangladesh, Amal K. Mitra, Akhlaque Haque, Manirul Islam, S.A. M.K. Bashar

Faculty Publications

To assess the risk of lead poisoning among preschool and school-aged children in Bangladesh, 345 children were screened for blood lead levels (BLLs) from one rural and two urban areas in Bangladesh from September 2007 through January 2008. An urban industrial area at Tongi was identified as a disaster area, where 99% (104/105) of those tested had BLLs >= 10 mu g/dL. Industrial emissions and use of leaded gasoline by two-stroke engine vehicles were identified as possible sources of lead in that area. A rural nonindustrial area at Chirirbandar, Dinajpur was identified as another high-risk area, where 14% of the …

Physical Activity And Blood Pressure In Childhood: Findings From A Population-Based Study, Sam D. Leary, Andy R. Ness, George Davey Smith, Calum Mattocks, Kevin Deere, Steven N. Blair, Chris J. Riddoch

Faculty Publications

The pathological processes associated with development of cardiovascular disease begin early in life. For example, elevated blood pressure (BP) can be seen in childhood and tracks into adulthood. The relationship between physical activity (PA) and BP in adults is well-established, but findings in children have been inconsistent, with few studies measuring PA mechanically. Children aged 11 to 12 years were recruited from the Avon Longitudinal Study of Parents and Children. 5505 had systolic and diastolic BP measurements, plus valid (at least 10 hours for at least 3 days) accelerometer measures of PA; total PA recorded as average counts per minute …

Objectively Measured Physical Activity And Fat Mass In A Large Cohort Of Children, Andy R. Ness, Sam D. Leary, Calum Mattocks, Steven N. Blair, John J. Reilly, Jonathan Wells, Sue Ingle, Kate Tilling, George Davey Smith, Chris J. Riddoch

Faculty Publications

Background: Previous studies have been unable to characterise the association between physical activity and obesity, possibly because most relied on inaccurate measures of physical activity and obesity.

Methods and Findings: We carried out a cross sectional analysis on 5,500 12-year-old children enrolled in the Avon Longitudinal Study of Parents and Children. Total physical activity and minutes of moderate and vigorous physical activity (MVPA) were measured using the Actigraph accelerometer. Fat mass and obesity (defined as the top decile of fat mass) were measured using the Lunar Prodigy dual x-ray emission absorptiometry scanner. We found strong negative associations between MVPA and …

Correlates Of Vigorous Physical Activity For Children In Grades 1 Through 12: Comparing Parent-Reported And Objectively Measured Physical Activity, James F. Sallis, Wendell C. Taylor, Marsha Dowda, Patty S. Freedson, Russell R. Pate

Faculty Publications

Correlates of physical activity were examined in young people in grades 1 through 12, and analyses were conducted separately for eight age/grade and sex subgroups. Twenty-one explanatory variables were assessed by parental report. Physical activity was assessed in 781 young people via parent report, and 200 wore an accelerometer for seven days. Between 11% and 36% of parent-reported child vigorous physical activity was explained. The most consistent correlates were peer support and use of afternoon time for active rather than sedentary recreation. Peer support was the only significant correlate of objectively monitored activity in multiple subgroups.

The Use Of Uniaxial And Triaxial Accelerometers To Measure Children's "Free-Play" Physical Activity, Alise E. Ott, Russell R. Pate, Stewart G. Trost, Dianne S. Ward, Ruth P. Saunders

Faculty Publications

In order to effectively measure the physical activity of children, objective monitoring devices must be able to quantify the intermittent and nonlinear movement of free play. The purpose of this study was to investigate the validity of the Computer Science and Applications (CSA) uniaxial accelerometer and the TriTrac-R3D triaxial accelerometer with respect to their ability to measure 8 "free-play" activities of different intensity. The activities ranged from light to very vigorous in intensity and included activities such as throwing and catching, hopscotch, and basketball. Twenty-eight children, ages 9 to 11, wore a CSA and a heart rate monitor while performing …

Children's Understanding Of The Concept Of Physical Activity, Stewart G. Trost, Angela M. Morgan, Ruth P. Saunders, Gwen A. Felton, Dianne S. Ward, Russell R. Pate

Faculty Publications

This study evaluated 4th-grade students' understanding of the concept of physical activity and assessed the effects of two interventions to enhance the students' understanding of this concept. Students were randomly assigned to 1 of 3 conditions: the video group (n=40) watched a 5-min video describing physical activity; the verbal group (n=42) listened to a generic description of physical activity; the control group received no instruction (n=45). Students completed a 17-item checklist testing their understanding of the concept of physical activity. Compared to controls, students in the verbal and video group demonstrated significantly higher checklist …

Validity Of The Previous Day Physical Activity Recall (Pdpar) In Fifth-Grade Children, Stewart G. Trost, Dianne S. Ward, Ben Mcgraw, Russell R. Pate

Faculty Publications

This study evaluated the validity of the Previous Day Physical Activity Recall (PDPAR) self-report instrument in quantifying after-school physical activity behavior in fifth-grade children. Thirty-eight fifth-grade students (mean age, 10.8 ± 0.1; 52.6%; female; 26.3% African American) from two urban elementary schools completed the PDPAR after wearing a CSA WAM 7164 accelerometer for a day. The mean within-subject correlation between self-reported MET level and total counts for each 30-min block was 0.57 (95% C.I., 0.51-0.62). Self-reported mean MET level during the after-school period and the number of 30-min blocks with activity rated at > 6 METs were significantly correlated with the …

Correlates To Performance On Field Tests Of Muscular Strength, Jeffrey A. Woods, Russell R. Pate, Maria L. Burgess

Faculty Publications

Field tests of upper body muscular strength and endurance (UBMSE) are often administered to children, but little is known about the determinants of performance on these tests. Therefore the purpose of this investigation was to examine potential determinants of performance on several common field tests of UBMSE including pull-ups, flexed-arm hang, push-ups, and two types of modified pull-ups. Subjects were 56 girls, and 38 boys, ages 9 to 11 years. Potential determinants assessed were age, height, weight, gender, % fat, physical activity, and laboratory measures of muscular strength and endurance. Multiple regression analysis revealed that the laboratory measures of UBMSE …