This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.
The Aims are 1) to develop the efficacy of behavioral interventions that increase dietary adherence, improve outcomes, and enhance quality of life for children with Cystic Fibrosis, Type 1 Diabetes, and Obesity, 2) to provide the candidate protected time to mentor postdoctoral fellows and junior faculty in psychology/pediatrics that are pursuing clinical investigations in behavioral nutrition. The investigator's research has focused on behavioral factors that compromise dietary adherence and translating this into interventions that can be tested in clinical trials. For each population, the objective is to establish the efficacy of behavioral treatments through clinical outcome studies and transfer findings to improve standard care. The investigator has a track record of mentorship to fellows and junior faculty in psychology/pediatrics. The Training Plan will further the investigator's knowledge of clinical trial design and analysis of outcomes and allow him improve mentorship. The Research Plan includes two ongoing projects: an NIH funded R01 study, 'Behavioral Treatment of Eating Problems in Toddlers with Cystic Fibrosis,' and a novel study focusing on 'Barriers to Dietary Adherence in Young Children with Type 1 Diabetes.' Additionally, the investigator will continue research, on obesity prevention in low-income children. Brief descriptions of the objectives of the Cystic Fibrosis, Diabetes, and Obesity studies are below:Behavioral and Nutrition Treatment to Help Preschoolers with Cystic Fibrosis GrowEvidence-based nutritional interventions that achieve optimal growth in young children with cystic fibrosis (CF) do not exist, despite a need. Intervention could positively change the course of clinical lung disease and enhance survival for these children. Objective: To conduct a multi-center, randomized, controlled trial comparing a behavioral plus nutrition intervention condition to an attention control intervention condition.
Specific Aims : 1. determine the impact of the behavioral intervention on energy intake and weight gain; 2. examine the durability of the behavioral intervention's impact on growth (weight and height) one year following treatment; and 3. explore the relation between physical activity and growth. Central hypothesis: Behavioral intervention will lead to better growth as measured by change in weight and height for age z scores. 100 preschoolers with CF and pancreatic insufficiency age 2 to 6 years will be randomized to one of the two conditions. The two groups will be stratified so they are similar at the initiation of treatment on weight for age z score. History of Pseudomonas aeruginosa infection and gender will be used as covariates in the statistical analysis. Outcome data (energy intake measured by 7-day diet record, weight, height) will be obtained at baseline, post-treatment (6 months), and after a 12-month follow-up (18 months post baseline). Secondary measures include BMI, body composition measured by DXA and skinfolds, and growth velocity. The long-range goal is to change the standard of nutritional care for young children with CF because behavioral intervention leads to optimal growth and ultimately improves lung health. (NIH/NIDDK funding)Factors Affecting Optimal Glycemic Control in Young Children with Type 1 DiabetesMaintaining good blood sugar control is a primary goal of modern diabetes management. Insulin pump therapy, also known as continuous subcutaneous insulin infusion (CSII), is a new and safe method of delivering insulin to people with type 1 diabetes (T1DM). Insulin pumps work by giving patients with T1DM a steady stream of insulin throughout the day. Pumps also allow for patients to get higher doses of insulin when they eat. Insulin pump therapy has transformed diabetes management. Before pumps, patients with T1DM had to follow a strict schedule of meals/snacks that matched the insulin levels in their bodies. With insulin pump therapy, patients are able to eat when they want and can eat whatever they want at meals. Insulin pump therapy has been shown to improve blood sugar control in adolescents and adults with T1DM. In young children with T1DM, insulin pump therapy has improved blood sugar control in some patients, but not in other patients. We propose to study parent and child factors that may affect blood sugar control in families of young children with T1DM who are prescribed CSII therapy.
Study aims will be accomplished through a cross-sectional study of children's daily blood sugar levels, parents' behaviors for insulin administration, parents' psychosocial functioning, and children's psychosocial functioning. All data will be presented according to group means. The results of this study will be used to develop an intervention to improve blood sugar control in young children with T1DM and to improve parent functioning. (NIH/NIDDK Funding)Parenting Practices and Obesity in Low-Income African American PreschoolersThis study will refine the Preschooler Feeding Questionnaire an instrument for identifying behavioral risk factors for the development of childhood obesity for use in low-income African Americans. A two-phase research project will be conducted. The goal of the first phase is to use qualitative research methods such as focus groups and structured individual interviews to identify differences in parenting practices between two groups of low-income African American mothers with preschoolers. The goal of the second phase is to develop and test a new version of the Preschooler Feeding Questionnaire. New items will be generated using data from phase 1 of this project and tested by cognitive interviewing. The items will be developed to define constructs about feeding and parenting that we hypothesize are related to the development of overweight in preschool children. The revised questionnaire will be administered to 300 families. Relations between questionnaire findings and child and parent weight status will be examined. The next step in our research program will investigate the relation between parental feeding restriction (measured by parent report and direct observation) and child eating (measured by energy intake and a laboratory measure of eating in the absence of hunger). We will also investigate the relation between parental feeding restriction (measured by parent report and direct observation) and child weight (measured as BMI and total fat mass based upon DEXA assessment) The long-range goal of this study is to develop obesity prevention strategies for low-income preschool aged children that focus on improving parenting skills. (NIH Funding)T32 Postdoctoral Training Grant in Child Behavior and NutritionThe T32 training program is to support postdoctoral training in child behavior and nutrition, with a specific focus on pediatric chronic illnesses. This T32 grant provides the infrastructure for a multidisciplinary training program, bringing together on a cooperative basis, behavioral, biomedical, and nutrition scientists in a manner that will enhance and extend postdoctoral training in child behavioral and nutrition sciences at Cincinnati Children's Hospital Medical Center. T32 training grant is now in its third year since funding. (NIH/NIDDK funding)
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