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Objective: Using baseline data from a community-based weight-gain prevention intervention study, the authors examined whether coping self-efficacy moderated the associations between chaotic home environment and psychosocial health (perceived psychosocial stress, depressive symptoms, and positive and negative affect) in low-income women who are overweight or obese., Method: Participants ( N = 740; M age = 28.06 ± 5.12) completed validated self-report measures of coping self-efficacy, chaotic home environment, perceived psychosocial stress, depressive symptoms, and positive and negative affect. Composite indicator structural equation modeling was used to test the moderation effects. Effect size was calculated using proportion of maximum possible (POMP) scores in the endogenous variables per unit change in the exogenous variable., Results: Coping self-efficacy significantly moderated the associations between chaotic home environment and depressive symptoms ( p < .001, POMP = -0.62%) and between chaotic home environment and negative affect ( p < .01, POMP = -0.36%). However, coping self-efficacy did not moderate the association between chaotic home environment and perceived psychosocial stress or positive affect., Conclusions: This study suggests that coping self-efficacy could explain some individual differences in responses to home chaos or to interventions aimed at alleviating depressive symptoms and negative affect in low-income women who are overweight or obese and who experience chaos at home. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective: To identify demographic risk factors associated with high stress and examine the relationships between levels of stress, demographics and dietary fat, fruit and vegetable intakes in low-income pregnant women with overweight or obesity., Design: A cross-sectional study., Setting: Participants were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children in Michigan, USA.ParticipantsParticipants (n 353) were non-Hispanic Black (black) or White (white)., Results: Women aged 35 years or older (OR=4·09; 95% CI 1·45, 11·51) and who had high school or less education (OR=1·88; 95% CI 1·22, 2·89) or were unemployed (OR=1·89; 95% CI 1·15, 3·12) were significantly more likely to report high stress than women who were younger, had at least some college education or were employed/homemakers. However, race and smoking status were not associated with level of stress. Women with high stress reported significantly lower fruit and vegetable intakes but not fat intake than women with low stress. Women aged 35 years or older reported significantly higher vegetable but not fat or fruit intake than women who were 18-24 years old. Black women reported significantly higher fat but not fruit or vegetable intake than white women. Education, employment and smoking status were not significantly associated with dietary intake of fat, fruits and vegetables., Conclusions: Nutrition counselling on reducing fat and increasing fruit and vegetable intakes may consider targeting women who are black or younger or who report high stress, respectively.

Background: Mothers in Motion (MIM), a community-based intervention program, was designed to help young, low-income women with overweight or obesity prevent further weight gain by promoting stress management, healthy eating, and physical activity. This paper presents the MIM's intervention effect on self-efficacy to cope with stress, emotional coping response, social support for stress management, stress, depressive symptoms, and positive and negative affect., Methods: Participants (N = 612) were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children in Michigan. They were randomly assigned to an intervention group (410 participants) or comparison group (202 participants). During the 16-week intervention, intervention participants watched ten video lessons at home and joined ten peer support group teleconferences. Surveys with established validity and reliability were used to measure self-efficacy to cope with stress, emotional coping response, and social support for stress management. The Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and Positive and Negative Affect Scale were used to measure stress, depressive symptoms, and positive and negative affect, respectively. A general linear mixed model was applied to test the intervention effect at the end of the 16-week intervention (T2, n = 338) and at three-month follow-up (T3, n = 311)., Results: At T2, the intervention group reported significantly higher self-efficacy to cope with stress (effect size [Cohen's d] = 0.53), better emotional coping response (d = 0.38), less stress (d = 0.34), fewer depressive symptoms (d = - 0.27), and more positive affect (d = 0.31) than the comparison group. However, there were no significant differences in social support for stress management and negative affect between these two groups. At T3, the intervention group still reported significantly higher self-efficacy to cope with stress (d = 0.32) and better emotional coping response (d = 0.34) than the comparison group but did not report significantly higher social support for stress management, stress, depressive symptoms, and positive and negative affect., Conclusions: To help young, low-income women with overweight or obesity manage stress, researchers and program planners may consider focusing on building self-efficacy to cope with stress., Trial Registration: Clinical Trials NCT01839708 ; registered February 28, 2013.

Objective This study explored fast food intake as a potential mediator of the relationships among employment status; stress; depression; and fruit, vegetable, and fat intakes by race (African American vs. Non-Hispanic White) and body mass index (BMI category: overweight vs. obesity). Methods Low-income overweight and obese pregnant women (N = 332) were recruited from the Special Supplemental Nutrition Program for Women, Infants and Children in Michigan. Path analysis was performed to explore mediation effects by race and BMI category. Results Fast food intake mediated the relationship between employment status and fat intake (p = 0.02) in Non-Hispanic White women, but no mediation effect was detected in African American women. For overweight women, fast food intake mediated the relationship between employment status and fat intake (p = 0.04) and the relationship between depression and vegetable intake (p = 0.01). Also, fast food intake partially mediated the relationship between depression and fat intake (p = 0.003). For obese women, fast food intake mediated the relationship between employment status and fat intake (p = 0.04). Conclusion Fast food is an important topic for nutrition education for overweight and obese pregnant women. Future interventions may be more successful if they address issues associated with employment status (e.g., lack of time to plan and cook healthy meals) and depressive mood (e.g., inability to plan meals or shop for groceries when coping with negative emotions).

Background: Existing physical activity surveys have not been validated for use with low-income overweight and obese young mothers. This study aimed to validate the Pregnancy Infection and Nutrition 3 (PIN3) physical activity survey and to explore whether its validity varied by race/ethnicity and body mass index (BMI) category when including or excluding child and adult care activities in the target population., Methods: Participants were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and were asked to fill out the PIN3 survey and wear an Actigraph accelerometer. Validity was assessed (N = 42) using Spearman correlation coefficient., Results: Regardless of inclusion or exclusion of child and adult care activity, the PIN3 survey showed evidence of validity for moderate (correlation coefficients 0.33 [p = 0.03]; 0.40 [p = 0.08]) but not vigorous (-0.01 [p = 0.91]; -0.06 [p = 0.69]) physical activity. The mean minutes per week spent in moderate, vigorous and moderate-vigorous physical activity measured by the PIN3 were substantially higher than when measured by accelerometer, for example, 588 (PIN3) versus 148 (accelerometer) minutes per week. Also, correlations between self-reported and objective monitored activity varied substantially by race/ethnicity and BMI category, for example, 0.29 (p = 0.18) for overweight women versus 0.57 (p = 0.007) for obese women; 0.27 (p = 0.20) for African American versus 0.66 (p = 0.001) for white., Conclusions: The PIN3 survey may be adequate for many applications where quick and practical assessments are needed for moderate physical activity data in low-income overweight and obese young mothers. The substantial differences in mean minutes per week between the PIN3 and accelerometer may be due to over-reported physical activity by the study participants., Trial Registration: Clinical Trials Number: NCT01839708.

Background: Over 45% of American women 20-39 years old are at risk for type 2 diabetes, cardiovascular disease, and other health conditions because they are overweight or obese. The prevalence of overweight and obesity is disproportionately high among low-income women. This paper describes the study design and rationale of a community based intervention (Mothers In Motion, MIM) aimed to prevent weight gain among low-income overweight and obese mothers 18-39 years old by promoting stress management, healthy eating, and physical activity., Methods/design: Peer recruiters approach participants from 5 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Michigan. The MIM delivers theory-based, culturally-sensitive intervention messages via a combination of DVDs and peer support group teleconferences (PSGTs). The DVD features African American and white overweight and obese WIC mothers who participated in a healthy lifestyle intervention patterned after MIM. The PSGTs are led by paraprofessionals from Michigan State University Extension and WIC providers in Michigan who are trained in motivational interviewing and group facilitation skills. Participants are randomly assigned to an intervention (n=350) or comparison group (n=175). The intervention group receives a 16-week intervention on a weekly or bi-weekly basis. Participants are asked to watch 10 MIM DVD chapters at home and join 10 PSGT sessions by phone. The comparison group receives printed educational materials. The primary outcome is body weight. Secondary outcomes include dietary fat, fruit, and vegetable intake; physical activity; stress, and affect. Mediators are self-efficacy, emotional coping response, social support, and autonomous motivation. Telephone interviews and in-person data collection at WIC offices occur at 3 time points: baseline, immediately, and 3 months after the 16-week intervention., Discussion: If MIM shows effectiveness, it could have a favorable impact on public health and community programs. The DVDs and PSGTs will be disseminated in WIC, Extension, clinical practice that promote healthy lifestyles for similar target audiences to make a broad contribution to the prevention of weight gain in low-income mothers. Also, our methodology can be adapted by researchers and community stakeholders to help other low-income populations prevent weight gain., Trial Registration: Clinical Trials Number: NCT01839708.

Objective: To examine the influence of personal and environmental factors on healthful weight management behaviors mediated through self-efficacy among low-income obese mothers., Design: Cross-sectional design., Setting: Special Supplemental Nutrition Program for Women, Infants, and Children in Wisconsin., Participants: Two hundred eighty-four obese mothers aged 18-34 years., Main Outcome Measures: Personal factors (eg, eating low-fat/low-calorie food for weight management), environmental factors, self-efficacy, and weight management behaviors. Data were collected via self-administered written questionnaires., Analysis: Latent class cluster analysis and structural logistic regression., Results: Women who perceived more importance of eating low-fat/low-calorie food for weight management were more likely to practice multiple behavioral strategies to manage their weight (odds ratio = 0.37) than women who perceived less importance of eating low-fat/low-calorie food for weight management. Women who reported higher positive mood self-efficacy were more likely (odds ratio = 1.63) to practice multiple strategies to manage their weight than women who reported lower positive mood self-efficacy. Environmental factors did not predict use of multiple healthful weight management behaviors. No mediation effect was found., Conclusions and Implications: Stressing the importance of food choices and reinforcing learners' self-confidence to make healthful choices at parties and celebrations may be helpful ways to address common barriers to healthful weight management., (Copyright © 2011 Society for Nutrition Education. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine whether predictors of fat intake behavior were the same for normal-weight and obese WIC mothers when applying the PRECEDE-PROCEED model and to identify predictors for each group., Design: Proportional stratified convenience sampling., Subjects: Five hundred eighty-one nonpregnant, black and white normal-weight (n = 180) or obese (n = 401) women., Settings: The Special Supplemental Nutrition Program for Women, Infants and Children in six counties in southern Wisconsin., Measures: The independent variables were predisposing, enabling, and reinforcing factors. Predisposing factors included beliefs in diet and health, beliefs in diet and body shape, health concerns in food choice, health concerns in nutrition, and eating habits. Enabling factors were cost of food, availability of time to prepare food, and accessibility to purchase food. Reinforcing factors were weight control intentions, sensory appeal, and mood. The dependent variable was fat intake behavior. Structural equation modeling was performed., Results: When controlling for covariates, certain factors affectingfat intake behavior differed between the normal-weight and the obese groups. For the normal-weight group, only reinforcing factors were positively associated with fat intake behavior For the obese group, reinforcing and enabling, but not predisposing, factors were positively associated with fat intake behavior., Conclusions: Interventions to modify low-income women's fat intake behavior might benefit from targeting behavioral predictors that differ with body size. Messages that emphasize weight control intentions, sensory appeal, and mood are likely to affect both normalweight and obese women. Information about cost of food, availability of time to prepare food, and accessibility to purchase food is likely to be more effective with obese women.

Objective: To establish reliability and construct and discriminant validity of selected factors adapted from the Health and Taste Attitudes Questionnaire developed in Finland and the Food Choice Questionnaire developed in England for use with low-income mothers in the United States., Design: Cross-sectional., Setting: Head Start and the Special Supplemental Nutrition Program for Women, Infants and Children sites in south-central Wisconsin., Participants: A convenience sample of 211 nonpregnant non-Hispanic black and white women., Variables Measured: Predisposing, enabling, and reinforcing constructs of the PRECEDE-PROCEED model., Analysis: Factor analyses., Results: After modification, the resulting measurement models of predisposing, enabling, and reinforcing constructs demonstrated good reliability and construct and discriminant validity. These models showed excellent model fit (chi-square/df range 1.5-2.0, root mean square error of approximate range.05-.07, non-normed fit index range.97-1.0, comparative fit index range.98-1.0, incremental fit index range.98-1.0), with all factor loadings significant (P <.001). Items previously developed with European adults demonstrated different pattern structures in predisposing and enabling constructs but the same structures for reinforcing construct when applied to low-income mothers in the United States., Conclusion and Implication: This modified instrument provides a tool for researchers and educators to further explore factors affecting fat intake behaviors in low-income mothers.

Objective: To develop a valid self-efficacy measure for eating low-fat diets in low-income women., Design: Cognitive interviews followed by self-administered questionnaires., Participants/settings: 206 (6 + 200) nonpregnant black and white women participating in Head Start and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in Wisconsin. VARIABLES MEASURES: A 13-item self-efficacy measure for eating low-fat diets., Analysis: Content analysis and factor analyses., Results: After cognitive interviews, 3 items were removed from a draft instrument. Factor analyses were carried out using data from 200 questionnaires that were randomly selected from a pool of 487 respondents: 100 for exploratory factor analysis (EFA) and 100 for confirmatory factor analysis (CFA). Based on EFA, the 10-item pool was further reduced to 8 items, and 3 domains emerged: negative affect, positive affect, and availability. The results of CFA showed excellent model fit to the data (chi 2/df = 1.2, non-normed fit index = 1.0, comparative fit index = 1.0, incremental fit index = 1.0, root mean square error of approximate =.046). This measure demonstrated excellent reliabilities (Cronbach alpha : .82-.92; composite reliability: .92-.99) and construct and convergent validities., Conclusions and Implications: Information obtained from this revised instrument can be used among low-income women to measure self-efficacy for eating low-fat diets. This is an important step in developing more targeted and thus more effective education messages to help low-income women modify their fat intake behaviors.

Background: Long-term management of hypertension and diabetes, which are more prevalent in minority and socioeconomically disadvantaged populations, presents challenges for healthcare providers in community health centers., Objectives: The purpose of the study was twofold: to examine health outcomes for persons with hypertension and diabetes and to compare these outcomes for disparities in patients who were Black, Hispanic, or White., Methods: Medical records (N = 280) from an urban community health center that serves predominantly uninsured adults were reviewed for selected clinical outcomes of primary care. Measures included outcomes of hypertension and diabetes control, lifestyle behaviors, preventive care, and patient status. Chi-square tests, t tests, and one-way analysis of covariance were used to analyze racial/ethnic group differences., Results: Data revealed significant differences in smoking status, influenza immunization, and blood pressure. Racial/ethnic group differences were minimal compared with the overall high prevalence of risk factors such as smoking and obesity. Regular access to primary care did not result in improved clinical outcomes., Conclusion: The findings support the need for more effective interventions that promote healthy lifestyle if health disparities in low-income populations with chronic conditions are to be reduced.

Using data from a community-based lifestyle behavioral intervention study, this secondary data analysis investigated whether emotional coping, coping self-efficacy, and autonomous motivation mediated the association between the intervention and perceived stress in low-income overweight or obese mothers of young children. Results showed that coping self-efficacy significantly mediated the association between the intervention and perceived stress. However, emotional coping and autonomous motivation did not significantly mediate the association between intervention and perceived stress. Interventions may be more effective in helping the target audience reduce stress if they incorporate practical skills that can increase a sense of coping self-efficacy. [ABSTRACT FROM AUTHOR]

Background: Little is known about associations between perceived stress, psychosocial factors (social support, emotional coping, coping self-efficacy, and autonomous motivation), and depressive symptoms in low-income overweight or obese mothers of young children. Using baseline data of a lifestyle intervention study, this secondary analysis investigates whether perceived stress might mediate the associations between the psychosocial factors and depressive symptoms.Methods: Convenience sampling was applied. Low-income overweight or obese mothers of young children were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children in Michigan, US. Survey data were collected through phone interviews. Participants (N = 740) responded to valid surveys measuring perceived stress, social support, emotional coping, coping self-efficacy, autonomous motivation, and depressive symptoms. Composite indicator structural equation modeling was performed to test for potential mediation.Results: When investigating the potential role of perceived stress as a mediator, the indirect effects of social support (b = - 2.10, p < 0.01), emotion coping (b = - 3.81, p < 0.05), and coping self-efficacy (b = - 7.53, p < 0.01) on depressive symptoms through perceived stress were significant, but the indirect effect of autonomous motivation was not.Conclusion: Future intervention studies aiming to alleviate depressive symptoms in low-income overweight or obese mothers of young children might consider including practical strategies to promote social support, emotional coping, and coping self-efficacy to reduce perceived stress, which might potentially decrease depressive symptoms.Trial Registration: Clinical Trials NCT01839708 ; registered February 28, 2013. [ABSTRACT FROM AUTHOR]

Background: Mothers In Motion (MIM), a community-based lifestyle behavioral intervention, was designed and conducted to help low-income overweight and obese young mothers prevent further weight gain via promotion of stress management, healthy eating, and physical activity. This paper presents intervention effect on body weight (primary outcome) and summarizes lessons learned.Methods: Participants (N = 612) were recruited from 7 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) offices in Michigan and were individually randomized to an intervention n= 410) or a comparison (n =202) group (2: 1 ratio). During the 16-week intervention, intervention participants watched theory-based culturally sensitive videos (in DVD format) featuring peers from the target audience to learn skills for managing stress, eating healthier, and being more physically active. They also dialed into peer support group teleconferences to enhance skills learned in the videos and increase motivation for lifestyle behavioral changes. Body weight, the primary outcome, was measured at baseline, immediately after the 16-week intervention, and 3 months after the 16-week intervention. Intervention effect was tested via general linear mixed model for repeated measures, using baseline measures as adjusting covariates.Results: At baseline, the mean age of the participants was 28.5 ± 5.0 years (intervention: 28.4 ± 5.0, comparison: 28.9 ± 5.0); the mean body weight was 190.2 ± 1.4 lbs (intervention: 191.8 ± 30.0, comparison: 188.5 ± 29.1); and the mean body mass index (BMI) was 32.2 ± 4.4 (intervention: 32.2 ± 4.4, comparison: 31.7 ± 4.2). Of sample, 64.7% were obese. At 3 months after the 16-week intervention, no significant weight differences were found between the intervention (188.3 ± 10.6 lbs, BMI: 31.6 ± 1.8) and comparison groups (187.7 ± 10.6 lbs, BMI: 31.53 ± 1.8) when controlling for baseline body weight.Conclusions: This lifestyle behavioral intervention that focused on stress management, healthy eating and physical activity was not effective in helping low-income overweight and obese young mothers prevent further weight gain.Trial Registration: Clinical Trials NCT01839708 . This trial was registered retrospectively on February 28, 2013. [ABSTRACT FROM AUTHOR]

This study examined consumption proportions and factors associated with sugar-sweetened beverages (SSBs), artificially sweetened beverages (ASBs), and 100% fruit juice (FJ) consumption. We recruited Non-Hispanic Black (n = 136) and White (n = 192) low-income overweight or obese pregnant women aged 18 to 46 years (mean = 25.7 years) from the Special Supplemental Nutrition Program for Women, Infants, and Children clinics in Michigan, USA. Independent variables included weight status, trimester, smoking, stress, education, employment, race, and age. Dependent variables were high (consuming ≥ 1 serving/day) versus low consumptions of SSB, ASB, and 100% FJ. Multivariate logistic regression modeling was performed to examine factors associated with beverage consumption. Out of the sample, 48.2%, 6.7%, and 31.3% reported high SSB, ASB, and 100% FJ consumption, respectively. SSB consumption was associated with smoking (OR: 3.77, p < 0.001), education (OR: 0.57, p = 0.03), and race (OR: 1.69, p = 0.03). Artificially sweetened beverage consumption was not associated with any factors examined. One hundred percent FJ consumption was associated with stress (OR: 0.90, p = 0.03) and race (OR: 4.48, p < 0.001). Clinicians may advocate for reductions in SSB and 100% FJ consumption tailored to client consumption characteristics. [ABSTRACT FROM AUTHOR]

Purpose: We investigated whether autonomous motivation and self-efficacy might mediate the association between a lifestyle behavior intervention and dietary fat intake in low-income overweight or obese women with young children.Methods: Participants were randomized to an intervention or comparison group. Intervention participants received a 16-week intervention aimed to prevent weight gain through promotion of stress management, healthy eating and physical activity. During the intervention phase, participants viewed a designated video lesson at home and dialed in a peer support group teleconference every week (weeks 1-4) then every other week (weeks 5-16). Potential mediation effects were analyzed using sequential mixed-effects linear models and path analysis.Results: The intervention led to increased autonomous motivation (β = 0.34, standard error [SE] = 0.15, P = 0.005), which subsequently increased self-efficacy (β = 0.18, SE = 0.35, P < 0.001), and higher levels of self-efficacy were associated with decreased dietary fat intake (β = -0.22, SE = 0.28, P < 0.001). In other words, autonomous motivation and self-efficacy mediated the association between the lifestyle behavior intervention and dietary fat intake.Conclusion: To decrease dietary fat intake for low-income overweight or obese women with young children, strategies, such as those promoting peer encouragement, may be warranted in interventions to enhance autonomous motivation and/or practical skills for increasing self-efficacy. [ABSTRACT FROM AUTHOR]