The NOURISH randomised control trial : positive feeding practices and food preferences in early childhood - a primary prevention program for childhood obesity

Background Primary prevention of childhood overweight is an international priority. In Australia 20-25% of 2-8 year olds are already overweight. These children are at substantially increased the risk of becoming overweight adults, with attendant increased risk of morbidity and mortality. Early feeding practices determine infant exposure to food (type, amount, frequency) and include responses (eg coercion) to infant feeding behaviour (eg. food refusal). There is correlational evidence linking parenting style and early feeding practices to child eating behaviour and weight status. A focus on early feeding is consistent with the national focus on early childhood as the foundation for life-long health and well being. The NOURISH trial aims to implement and evaluate a community-based intervention to promote early feeding practices that will foster healthy food preferences and intake and preserve the innate capacity to self-regulate food intake in young children. Methods/Design This randomised controlled trial (RCT) aims to recruit 820 first-time mothers and their healthy term infants. A consecutive sample of eligible mothers will be approached postnatally at major maternity hospitals in Brisbane and Adelaide. Initial consent will be for re-contact for full enrolment when the infants are 4-7 months old. Individual mother- infant dyads will be randomised to usual care or the intervention. The intervention will provide anticipatory guidance via two modules of six fortnightly parent education and peer support group sessions, each followed by six months of regular maintenance contact. The modules will commence when the infants are aged 4-7 and 13-16 months to coincide with establishment of solid feeding, and autonomy and independence, respectively. Outcome measures will be assessed at baseline, with follow up at nine and 18 months. These will include infant intake (type and amount of foods), food preferences, feeding behaviour and growth and self-reported maternal feeding practices and parenting practices and efficacy. Covariates will include sociodemographics, infant feeding mode and temperament, maternal weight status and weight concern and child care exposure. Discussion Despite the strong rationale to focus on parents’ early feeding practices as a key determinant of child food preferences, intake and self-regulatory capacity, prospective longitudinal and intervention studies are rare. This trial will be amongst to provide Level II evidence regarding the impact of an intervention (commencing prior to age 12 months) on children’s eating patterns and behaviours. Trial Registration: ACTRN12608000056392

Cross-cultural differences in self-reported decision-making style and confidence

The Melbourne Decision Making Questionnaire (Mann, Burnett, Radford, & Ford, 1997) measures selfreported decision-making coping patterns. The questionnaire was administered to samples of University students in the US (N = 475), Australia (N = 262), New Zealand (N = 260), Japan (N = 359), Hong Kong (N = 281), and Taiwan (N = 414). As predicted, students from the three Western, individualistic cultures (US, Australia, and New Zealand) were more con® dent of their decision-making ability than students from the three East Asian, group-oriented cultures (Japan, Hong Kong, Taiwan). No cross-cultural differences were found in scores on decision vigilance (a careful decision-making style). However, compared with Western students, the Asian students tended to score higher on buck-passing and procrastination (avoidant styles of decision making) as well as hypervigilance (a panicky style of decision making). Japanese students scored lowest on decision self-esteem and highest on procrastination and hypervigilance. It was argued that the con¯ ict model and its attendant coping patterns is relevant for describing and comparing decision making in both Western and Asian cultures.

Self-esteem and self-talk enhancement in upper primary school children

Not all programmes aimed at enhancing children's self-esteem have been successful. This article evaluates the impact of two programmes and offers activities which can be used in the classroom.

Gender and grade differences in upper elementary school children’s descriptive and evaluative self-statements and self-esteem

Gender and developmental differences in self-description, self-evaluation and self-esteem were investigated using 957 elementary school children in grades 3 to 7. Gender differences were found for six of the seven descriptive statements and for five of the seven evaluative statements. The major gender stereotypical findings from previous studies were replicated. Boys reported higher scores than girls on descriptive and evaluative statements about their physical abilities and mathematics, while girls reported higher scores on descriptive and evaluative statements about reading. Declines over time were noted for all self-evaluations except having good relations with peers and for global self-esteem, providing some support for the notion that the decline in self-concepts and self-esteem may be attributed to the children's perceptions of themselves becoming more accurate and less egocentric in line with their cognitive capacity to integrate external feedback realistically.

An investigation of the social learning and symbolic interaction models for the development of self-concepts and self-esteem

Two studies were conducted to investigate empirical support for two models relating to the development of self-concepts and self-esteem in upper-primary school children. The first study investigated the social learning model by examining the relationship between mothers' and fathers' self-reported self-concepts and self-esteem and the self-reported self-concepts and self-esteem of their children. The second study investigated the symbolic interaction model by examining the relationship between children's perception of the frequency of positive and negative statements made by parents and their self-reported self-concepts and self-esteem. The results of these studies suggested that what parents say to their children and how they interact with them is more closely related to their children's self-perceptions than the role of modelling parental attitudes and behaviours. The findings highlight the benefits of parents talking positively to their children.

Children's self-talk and significant others' positive and negative statements

A sample of 675 elementary school children in Grades 3-7 were administered the Self-talk Inventory and the Significant Others' Statements Inventory. The psychometric properties of both scales were investigated and the relationships between positive and negative self-talk and significant others' (parents, teachers, siblings and peers) positive and negative statements were explored using correlational and multiple regression analyses. Sex and age differences were also examined. The significant relationships and differences are described.

The relationship between closeness to significant others and self-esteem

One hundred and forty-three children (61 boys and 82 girls) between 8 and 12 years of age participated in a study which focused on closeness to significant others and its relationship with self-esteem. A closeness rating scale was developed to determine quantitatively how close children feel to their mother, father, two closest peers, and current teacher. Marsh's (1990) eight general self-concept items from the Self-Description Questionnaire 1 (SDQI), together with eight items from Burnett's (1994) Self-scale, were administered to the children, who ranged in age from 8 to 12 years, to measure their self-esteem. Closeness to mother was found to correlate most significantly with a child's self-esteem, while closeness to teacher was related more strongly to self-esteem for girls than for boys.

Cognitive behaviour therapy vs rational-emotive education : impact on children's self-talk, self-esteem and irrational beliefs

This study investigated the impact of Cognitive-Behavioural Therapy (CBT) and Rational~Emotive Education (REE) self-enhancement programs on children's self-talk, self-esteem and irrational beliefs. A total of 116 children (50.9% girls) with a mean age of 9.8 years attending Years 4 and 6 at two primary schools participated in the study. eBT resulted in a reduction in negative self-talk while REE seemed to enhance independence beliefs. Both programs were associated with increased positive self-talk and with having increased rationality in Conformity and Discomfort Intolerance beliefs.

Self-talk in upper primary school children : its relationship with irrational beliefs, self-esteem and depression

Self-talk, irrational beliefs, self-esteem and depression were measured in a sample of 105 elementary school children in Grades 4 to 7. Sex and grade differences in positive self-talk were found. The pattern of correlation coefficients for positive self-talk supported the substantive position that positive self-talk is positively related to self-esteem and negatively related to irrational beliefs and depression in a non-clinical sample of children. However, the same support was not forthcoming for the reverse relationships for negative self-talk. Therapeutic implications are outlined as are suggestions for future research in the area of children's self-talk.

Self-concept and self-esteem in elementary school children

Confusion exists with regard to the empirical and substantive link between self-concept and self-esteem in elementary school children and their relationship to self-description, self-evaluation, and global beliefs and feelings about oneself as a person. This study reports the results of investigating the relationships between these self-constructs using 957 elementary school children in Grades 3 to 7. The evidence suggests that self-concept is comprised of both descriptive and evaluative beliefs that children hold about certain characteristics, whereas self-esteem can be viewed as the global feelings and beliefs that children have about themselves as people.

Self-concept or self-esteem

Confusion exists with regard to the substantive difference between self-concept and self-esteem. In an endeavour to cast some light on this confusion two studies were conducted with 1193 preadolescents using modified versions of two commonly used instruments designed to measure self-concept and self-esteem. Exploratory factor analysis indicated that both these instruments measure specific facets of the same construct, namely self.-concept. General or global self-concept proved to be a difficult construct to measure in preadolescent students.