Considering Childhood Obesity through an Investigation of Maternal/Infant Factors and the Acceptability of a Text Message-Based Intervention.
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2018-05
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Abstract
Addressing childhood obesity in low-income groups in Hawai‘i and Puerto Rico requires
examination of maternal and infant risk factors and evaluation of related interventions to advance
preventive measures. This dissertation, entitled “Considering childhood obesity: an investigation
of maternal/infant factors and the acceptability of a text message-based intervention,” includes a
general overview of the dissertation, a literature review describing previous studies on factors
contributing to childhood obesity and text message-based interventions, three stand-alone
manuscripts, a concluding chapter that includes additional comments and future considerations,
and appendices containing documents pertinent to the intervention and other information. The
three stand-alone manuscripts present studies on a text message-based intervention aimed at
promoting breastfeeding and preventing excessive weight gain in infants enrolled in the Special
Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Hawai‘i and Puerto
Rico. The studies 1) assess the acceptability of the intervention; 2) examine the association
between maternal pregravid body mass index (BMI) and breastfeeding discontinuation; and 3)
examine the association between gestational weight gain and rate of infancy weight gain. Main
findings include the following: 1) the text message-based intervention was acceptable to
participants based upon qualitative and quantitative measures; 2) breastfeeding discontinuation
was not associated with pregravid BMI, but Native Hawaiian or Other Pacific Islanders (adjusted
odds ratio [AOR]=7.12; 95% confidence interval [CI]=1.34, 37.97; p=0.02) and older women
(AOR=4.21; 95% CI=1.13, 15.72; p=0.03) showed significantly higher odds of discontinuing
breastfeeding before four to six months postpartum; and 3) excessive and inadequate gestational
weight gain was associated with decreased proportional odds of rapid infancy weight gain versus
on-track (AOR=0.23; 95% CI=0.08, 0.70; p=0.01) or slow (AOR=0.29; 95% CI=0.09, 0.94;
p=0.04) infant weight gain. These findings may inform childhood obesity prevention strategies
and programs.
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Childhood Obesity, Text Message, Breastfeeding, Gestational Weight Gain, Pregravid BMI, Rapid Infancy Weight Gain
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