***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To use an ecological systems approach to examine individual- , family- , community- and area-level risk factors for overweight ( including obesity )  in 3-year-old children . Methods : A prospect i ve nationally representative cohort study conducted in Engl and , Wales , Scotl and , Northern Irel and . Participants included 13 188 singleton children aged 3 years in the Millennium Cohort Study , born between 2000 and 2002 , who had complete height/weight data . The main outcome measure was childhood overweight ( including obesity ) defined by the International Obesity TaskForce cut-offs for body mass index . Results : 23.0 % of 3-year-old children were overweight or obese . In the fully adjusted model , primarily individual- and family-level factors were associated with early childhood overweight : birthweight z-score ( adjusted odds ratio , 1.36 , 95 % CI 1.30 to 1.42 ) , black ethnicity ( 1.41 , 1.11 to 1.80 ) ( compared with white ) , introduction to solid foods < 4 months ( 1.12 , 1.02 to 1.23 ) , lone motherhood ( 1.32 , 1.15 to 1.51 ) , smoking during pregnancy ( 1–9 cigarettes daily : 1.34 , 1.17 to 1.54 ; 10–19 : 1.49 , 1.26 to 1.75 ; 20 + : 1.34 , 1.05 to 1.70 ) , parental overweight ( both : 1.89 , 1.63 to 2.19 ; father only : 1.45 , 1.28 to 1.63 ; mother only : 1.37 , 1.18 to 1.58 ) , prepregnancy overweight ( 1.28 , 1.14 to 1.45 ) and maternal employment ⩾21 hours/week ( 1.23 , 1.10 to 1.37 ) ( compared with never worked ) . Breastfeeding ⩾4 months ( 0.86 , 0.76 to 0.97 ) ( compared with none ) and Indian ethnicity ( 0.63 , 0.42 to 0.94 ) were associated with a decreased risk of early childhood overweight . Children from Wales were also more likely to be overweight than children from Engl and . Conclusions : Most risk factors for early childhood overweight are modifiable or would allow at-risk groups to be identified . Policies and interventions should focus on parents and providing them with an environment to support healthy behaviours for themselves and their children STUDY OBJECTIVE : To see whether the community mothers ' programme , using lay volunteer mothers to deliver a childhood development programme , could be extended successfully to the travelling community in Irel and . DESIGN : This was a prospect i ve study of the travelling community ; comparisons were made with results of a previous r and omised trial of settled mothers . SETTING : A regional health authority in Irel and . PARTICIPANTS : These comprised 39 traveller and 127 settled intervention mother/ infant pairs ( r and omised controlled trial ( RCT ) intervention ) ; settled community mothers ; 105 settled control pairs ( RCT control ) . All mothers received st and ard support ; traveller and RCT intervention groups also received the services of a community mother . MAIN RESULTS : The travellers ' sociodemographic profile differed significantly from the other groups . At the end of the study , traveller and intervention children were exposed to more  cognitive games and nursery rhymes .  There were significant differences in the proportions who received all three shots of their primary immunisation schedule before 12 months of age and who received " three in one " vaccination , with traveller children doing least well . The diet of traveller children surpassed that of RCT controls in all food groups except fruit ; they were less likely to begin cows ' milk before 26 weeks of age . Traveller mothers ' diet was superior to that of RCT control and similar to RCT intervention mothers . Traveller and RCT intervention mothers were less likely to feel tired , feel miserable , and want to stay indoors than RCT control mothers . CONCLUSIONS : The results of the community mothers ' programme in the travelling community are encouraging ; poor immunisation uptake remains a challenge Food preferences are established in early childhood and track later in life . Therefore , it is important to promote healthy feeding practice s as early as possible . A r and omized field trial was conducted with 500 mother-child pairs from a low-income area of São Leopoldo , State of Rio Gr and e do Sul , Brazil , to evaluate the impact of a nutritional intervention in the first year of life on the dietary quality of 3- to 4-y-old children . Mother-child pairs were r and omized either to intervention and control groups and dietary counseling was provided for mothers in the intervention group during 10 home visits in the course of the first year of life . These visits were carried out by fieldworkers who counseled the mothers about the Ten Steps for Healthy Feeding from Birth to Two Years of Age , based on the WHO guidelines . Dietary intake was assessed at 3 - 4 y of age for 345 children using two 24-h food recalls . Overall diet quality was determined by the Healthy Eating Index . The prevalence of poor diet in the intervention group was lower compared with the control group [ relative risk ( RR ) = 0.30 ; 95 % CI = 0.13 - 0.71 ) . The number of children who achieved the 75th percentile for the vegetable and fruit component score was higher in the intervention than in control group ( RR = 1.95 ; 95 % CI = 1.31 - 2.89 and RR = 1.49 ; 95 % CI = 1.07 - 2.07 , respectively ) . Such data provide evidence that dietary counseling for mothers during the first year of life improves the overall dietary quality of children in a low-income population OBJECTIVES : Despite recent efforts to increase breastfeeding , young African American mothers continue to breastfeed at low rates , and commonly introduce complementary foods earlier than recommended . This study examines the effects of a community doula home visiting intervention on infant feeding practice s among young mothers . METHODS : Low-income , African American mothers ( n = 248 ) under age 22 years participated in a r and omized trial of a community doula intervention . Intervention-group mothers received services from paraprofessional doulas : specialized home visitors trained as childbirth educators and lactation counselors . Doulas provided home visits from pregnancy through 3 months postpartum , and support during childbirth . Control-group mothers received usual prenatal care . Data were obtained from medical records and maternal interviews at birth and 4 months postpartum . RESULTS : Intent-to-treat analyses showed that doula-group mothers attempted breastfeeding at a higher rate than control-group mothers ( 64 % vs 50 % ; P = .02 ) and were more likely to breastfeed longer than 6 weeks ( 29 % vs 17 % ; P = .04 ) , although few mothers still breastfed at 4 months . The intervention also impacted mothers ’ cereal/solid food introduction ( P = .008 ) : fewer doula-group mothers introduced complementary foods before 6 weeks of age ( 6 % vs 18 % ) , while more waited until at least 4 months ( 21 % vs 13 % ) compared with control-group mothers . CONCLUSIONS : Community doulas may be effective in helping young mothers meet breastfeeding and healthy feeding guidelines . The intervention ’s success may lie in the relationship that develops between doula and mother based on shared cultural background and months of prenatal home visiting , and the doula ’s presence at the birth , where she supports early breastfeeding experiences BACKGROUND The American Academy of Pediatrics , the Special Supplemental Nutrition Program for Women , Infants , and Children ( WIC ) , and the World Health Organization recommend that infants receive only breast milk or formula for the first 4 to 6 months of life , followed by the introduction of complementary foods . Despite these recommendations , many infants , particularly those with adolescent mothers , receive solid foods ( often cereal mixed with formula in a bottle ) and liquids other than formula or breast milk in the first few weeks of life . Decisions on early feeding are often guided by gr and mothers and influenced by beliefs that infants need complementary food to counteract signals of hunger , reduce crying , and sleep through the night . OBJECTIVE This investigation evaluated the efficacy of an intervention to delay the early introduction of complementary feeding among first-time , black , adolescent mothers living in multigenerational households . The intervention focused on reducing the cultural barriers to the acceptance of the recommendations of the American Academy of Pediatrics , WIC , and World Health Organization on complementary feeding by highlighting 3 topics : 1 ) recognition of infants ' cues ; 2 ) nonfood strategies for managing infant behavior ; and 3 ) mother-gr and mother negotiation strategies . The intervention was delivered through a mentorship model in which a videotape made by an advisory group of black adolescent mothers was incorporated into a home-visiting program and evaluated through a r and omized , controlled trial . METHODS One hundred eighty-one first-time , low-income , black mothers < 18 years old , living in multigenerational households were recruited from 3 urban hospitals . Infants were born at term , with birth weight appropriate for gestational age and no congenital problems . Shortly after delivery , mothers and gr and mothers completed a baseline assessment and mothers were r and omized into an intervention or control group . Intervention group mothers received home visitation every other week for 1 year . At 3 months , a subset of 121 adolescent mothers reported on their infant 's intake through a food frequency question naire . Mothers who fed their infant only breast milk , formula , or water were classified as optimal feeders . Mothers who provided complementary foods other than breast milk , formula , or water were classified as less optimal feeders . RESULTS Sixty-one percent of the infants received complementary foods before 3 months old . Multivariate hierarchical logistic regression was used to evaluate the determinants of being in the optimal versus less optimal feeders group . After controlling for infant age and family income , mothers of infants in the optimal feeders group were more likely to report accurate messages from WIC regarding the timing of complementary food and nearly 4 times more likely to be in the intervention group . The most common complementary food was cereal mixed with formula in the bottle . CONCLUSIONS The success of this relatively brief intervention demonstrates the importance of using ecological theory and ethnographic research to design interventions that enable participants to alter their behavior in the face of contradictory cultural norms . The intervention focused on interpreting infants ' cues , nonfood methods of managing infant behavior , and mother-gr and mother negotiations . It was delivered through methods that were familiar and acceptable to adolescent mothers-a mentorship model incorporating home visits and videotape . The skill-oriented aspects of the intervention delivered in a culturally sensitive context may have enabled the young mothers to follow the guidelines that they received from WIC and from their pediatricians . Strategies , such as those used in this intervention , may be effective in promoting other caregiving recommendations , thereby enabling providers to meet the increasing dem and s from parents for advice regarding children 's early growth and development OBJECTIVE : To test the effect of a culturally tailored , family-centered , short-term behavioral intervention on BMI in Latino-American preschool-aged children . METHODS : In a r and omized controlled trial , 54 parent – child dyads were allocated to the intervention and 52 dyads were allocated to an alternative school-readiness program as the control condition .  Parent – child dyads were eligible if the parent self-defined Latino , was at least 18 years old , had a 2- to 6-year-old child not currently enrolled in another healthy lifestyle program , had a valid telephone number , and planned on remaining in the city for the next 6 months . The Salud Con La Familia ( Health with the Family ) program consisted of 12 weekly 90-minute skills-building sessions design ed to improve family nutritional habits and increase  physical activity  . Both programs were conducted in a community recreation center serving an urban neighborhood of mostly Spanish-speaking residents . RESULTS : Forty-two percent of participating preschool-aged children  were overweight or obese . Controlling for child age , gender , and baseline BMI , the effect of the treatment condition on postintervention absolute BMI was B = –0.59 ( P < .001 ) . The intervention effect seemed to be strongest for obese children . CONCLUSIONS : A skills-building , culturally tailored intervention involving parent – child dyads changed short-term early growth patterns in these Latino-American preschool-aged children . Examining long-term effects would be a prudent next step Background Early childhood provides a window of opportunity for the promotion of physical activity . Given the limited effectiveness of interventions to date , new approaches are needed . Socio-ecological models suggest that involving parents as intervention targets may be effective in fostering healthier lifestyles in children . This study describes the effectiveness of a family-focused ‘ Active Play ’ intervention in decreasing sedentary time and increasing total physical activity in preschool children . MethodS eventy-seven families were recruited from 8 r and omly selected SureStart children ’s centres in the North West of Engl and . Centres were r and omly assigned to either an intervention ( n = 4 ) or a comparison group ( n = 4 ) . Parents and children in the intervention group received a 10-week active play programme delivered by trained active play professionals ; this included an activity and educational component . Families in the comparison group were asked to maintain their usual routine . Each participating parent and child wore a  uni-axial acceler 
    Output:
    
Findings amongst pre-schoolers ( 3–5 years ) were mixed , with the more successful interventions requiring high levels of parental engagement , use of behaviour change techniques , a focus on skill building and links to community re sources .
The findings from the growing body of intervention research focusing on obesity prevention amongst young children from socioeconomically disadvantaged families suggest intervention effects are modest but promising .