Maternal Child Health Newsletter 6/25/04

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Maternal Child Health Newsletter 6/25/04

Postby laura » Fri Jun 25, 2004 08:37 am

MCH Alert
Tomorrow's Policy Today

National Center for Education in Maternal and Child Health
Search past issues of the MCH Alert and other MCH Library resources at

June 25, 2004

1. Web Site Provides Resources for Parents to Help Their Daughters Develop
Bone-Healthy Habits
2. Study Analyzes Effects of Mothers' Employment on Children's Nutrition
3. Authors Describe a Social Marketing Campaign to Increase Physical
Activity Among Children
4. Study Reveals Inconsistencies in Assessing Mothers' Beliefs or
Behaviors Associated with Childhood Obesity
5. Article Compares Adolescent-Violence-Related Behaviors Across Five


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The Powerful Bones, Powerful Girls campaign promotes optimal bone health
in girls ages 9 to 12 in an effort to reduce their risk of developing
osteoporosis later in life. The campaign Web site for parents, which is
part of the National Bone Health Campaign, offers suggestions on ways
parents can integrate healthy behaviors into their daughter's social
lifestyles. The Web site provides information on calcium and physical
activity, and also includes the Powerful Bones Toolbox. The toolbox
contains recipes and shopping lists, explanations of nutritional
requirements, examples of weight-bearing physical activities, and
question-and-answer sections providing parents with an array of resources.
The Web site is available at



Maternal Employment and Children's Nutrition presents findings from a
study designed to explore the effects of mothers' work on their children's
nutrition. The study, funded by the U.S. Department of Agriculture's
(USDA's) Economic Research Service, analyzed differences in nutrition and
nutrition-related outcomes among children whose mothers work full time,
part time, and not at all. The findings are presented in two volumes. The
first volume includes an analysis of the role the USDA's Child and Adult
Care Food Program plays in meeting the nutrition needs of participating
children, especially those whose mothers work. The second volume includes
information on food program participation, children's eating patterns,
household food acquisition and sufficiency, and children's physical
activity and risk of overweight. The reports are available at



"Success in changing behavior among tweens is more likely to be achieved
when the following conditions are met: consumers have an in-depth
understanding of the product and price associated with it, they have easy
access to appropriate places where they can perform the behavior in
everyday life, and product promotion portrays benefits in a positive,
appealing fashion and reaches audiences through channels they value,"
state the authors of an article published in the July 2004 issue of
Preventing Chronic Disease. The article describes how the four principles
of social marketing (product, price, place, and promotion) were applied to
formulate the strategies and tactics of VERB, a multiethnic media campaign
to increase and maintain physical activity among children ages 9 to 13
(tweens). The article also provides examples of the multimedia materials
that were created for the campaign.

VERB was launched by the Centers for Disease Control and Prevention in
June 2002 with a goal of increasing and maintaining physical activity
among tweens. Parents (especially mothers) ages 29 to 46 and other
individuals who influence tweens are the secondary audiences of the VERB
initiative. Before launching the campaign, planners conducted extensive
research to gain an understanding of physical-activity-related attitudes,
beliefs, and behaviors of tweens and their parents. Campaign planners
applied findings from the audience research, along with the four
principles of commercial marketing, to develop VERB as a social marketing

Product -- Product is the desired behavior for the targeted audience. The
VERB campaign's product is physical activity. Early VERB advertising
stimulated curiosity about the brand and enticed tweens to identify and
try the activities that most appealed to them.

Price -- Price represents a balance of product benefits and costs. For
physical activity, the costs of changing behavior can be financial,
psychological, environmental, or time related. VERB messages are designed
to convince tweens and their parents that physical activity has the "right
price" -- that benefits outweigh costs.

Place -- Place is where the target audience either performs the behavior
or accesses programs or services. Place must be readily available. A VERB
place is where tweens can be physically active in a safe environment.
Keeping VERB a "cool brand for tweens" is a critically important goal for
partners (e.g., parks, schools, youth-serving organizations) as they
collaborate on the campaign.

Promotion -- Promotion includes multiple ways to reach the target audience
to promote the benefits of the behavior change, including product, price,
and place components. Some of the promotion strategies and tactics
employed by the VERB campaign include paid media advertising,
community-based events, contests and sweepstakes, community and corporate
partnerships, and Web sites.

"A lifestyle or behavior change such as increasing physical activity is
difficult to achieve and even more difficult to sustain," state the
authors. A baseline survey was conducted before the campaign's launch, and
two follow-up surveys, one in 2003 and one in 2004, will measure the
effectiveness of the campaign in motivating tweens to be more active.

Wong F, Huhman M, Heitzler C, et al. 2004. VERB -- A social marketing
campaign to increase physical activity among youth. Preventing Chronic
Disease: Public Health Research, Practice, and Policy 1(3):1-7. Available

Readers: Formative research reports about the VERB campaign are available

More information about physical activity and children and adolescents is
available on the Bright Futures Web site at ... about.html and from the MCH
Library knowledge path, Physical Activity and Children and Adolescents, at ... ivity.html.



"The interviews found instances where urban, low-income African American
mothers of preschool children understood a construct and a question item
differently from the investigators," state the authors of an article
published in the June 2004 issue of Appetite. The authors developed and
employed an instrument called the Preschooler Feeding Questionnaire (PFQ)
to assess specific maternal beliefs and practices about child feeding
perceived to be associated with the development of obesity in children.
However, the results did not reveal consistent associations between the
practices assessed and the weight status of preschool-age children. The
article describes a study to assess question interpretation and the
presence and relevance of particular feeding constructs.

The PFQ assesses eight factors perceived to be related to childhood
obesity, including (1) difficulty in child feeding, (2) concern about
child overeating or being overweight, (3) pushing the child to eat more,
(4) using food to calm the child, (5) concern about the child being
underweight, (6) the child's control of feeding interactions, (7)
structure during feeding interactions, and (8) age-inappropriate feeding.
Although the original questionnaire was pilot-tested and revised before
implementation, qualitative or open-ended techniques were not used to
assess how respondents understood or interpreted the questions.

Women considered eligible for this study were enrolled in WIC, were
African American, and were the biological mothers of children ages 25-59
months at the time of the study (July and August 2001). The women were
invited to participate in a 1-hour, audiotaped interview about "how they
feed their child." The authors determined whether the women interpreted
questions similarly and if their interpretations were well matched with
what was intended during item development.

The authors found that three of the eight constructs (difficulty in child
feeding, pushing the child to eat more, and using food to calm the child)
were consistently misunderstood. For example:

Question: Was he/she a picky eater?
Intention: The term "picky eater" was intended to describe a child that
was difficult to feed because he/she either ate less than the mother
expected or ate only a few types of foods.
Interpretation: To these mothers, picky eaters were selective about what
they ate or the manner in which food was prepared; to them; the term was
not associated with how much the children ate and whether mothers thought
they were difficult to feed. Furthermore, to these mothers, being a picky
eater was not necessarily a negative trait.

Question: Did you ever punish him/her or remove privileges to get him/her
to eat more?
Intention: The intention was that the mother would describe what happened
if her child did not eat enough at mealtime.
Interpretation: To these mothers, punishment meant spanking (with hand),
whooping (hitting with another object), or some action like being given a
time-out or being made to stand in the corner. None of the mothers used
what they called "punishment" to encourage eating.

Question: When he/she was fussy, was giving him/her something to eat or
drink the first thing you would do?
Intention: The intention was to determine whether the mother would readily
use feeding as a technique to calm her child's emotional distress.
Interpretation: Mothers easily revealed friends' behaviors, but the tone
of the question seemed to make them hesitate to admit their own use of
food to calm their child.

The authors suggest that "similar problems in item wording may
characterize other feeding questionnaires, and this may contribute to the
ambiguous relationship between particular maternal feeding practices and
changes in child weight."

Jain A, Sherman SN, Chamberlin LA, et al. 2004. Mothers misunderstand
questions on a feeding questionnaire. Appetite 42(3):249-254.

Readers: More information about child and adolescent nutrition is
available from the Bright Futures Web site at and from the MCH
Library's knowledge path, Child and Adolescent Nutrition, at ... dnutr.html.



"In this cross-national comparison of violence-related behaviors in
adolescents, our results show that youth in 5 different countries behaved
remarkably similarly with respect to violent behaviors," state the authors
of an article published in the June 2004 issue of Archives of Pediatric
and Adolescent Medicine. The authors state that violent behavior among
adolescents is a significant problem worldwide and that three developed
countries, Israel, France, and Norway, now join the United States as
nations in which firearms are the second leading mechanism of death among
15- to 24-year-olds. However, the literature on violent behavior among
adolescents outside the United States is relatively limited. The study
described in this article used information from the World Health
Organization-coordinated cross-national Study of Health Behavior in
School-Aged Children to derive country-specific distributions of certain
violent behaviors and to assess country-specific explanatory factors,
which then provided a basis for comparing violence-related behaviors in
five developed countries (Ireland, Israel, Portugal, Sweden, and the
United States).

The analysis is based on cross-national, school-based surveys conducted
during the 1997-1998 school year of students at mean ages of 11.5, 13.5,
and 15.5 years. The numbers of participating students, as well as the
response rate, for each country are as follows: Ireland: 4,398 (response
rate: 74%), Israel: 5,054 (response rate: 75.0%), Portugal: 3,721
(response rate: 94.0%), Sweden: 3,802 (response rate: 91.7%), and United
States: 5,168 (response rate: 87.0%). The main outcome measures were
frequency of physical fighting, bullying, weapon carrying, and fighting
injuries in relation to other risk behaviors and characteristics in home
and school settings.

The authors found that

* The frequencies of any fighting, frequent fighting, weapon carrying, and
fighting injuries were remarkably similar across countries.

* The frequency of bullying ranged from 14.8% in Sweden to 42.9% in Israel
for students who bullied once or more per school term.

* Violence-related behaviors often occurred together in adolescents

* Fighting was associated with smoking, alcohol use, feeling irritable or
bad tempered, having been bullied, and not living with the father.

The authors concluded that "These findings are particularly important to
today's climate, in which violent behavior in youth has increased to
epidemic proportions and high-publicity school shootings in the United
States and recently in Germany have raised public concern about teenage
violence even further."

Smith-Khuri E, Iachan R, Scheldt PC. 2004. A cross-national study of
violence-related behavior in adolescents. Archives of Pediatric and
Adolescent Medicine 158(6):539-344.

Readers: Information about adolescent violence prevention is available
from the MCH Library's knowledge path at ... olvio.html and the
organizations list at ... ce&-search.


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