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Abstract
Because schools materially influence both health and education, they substantially determine the future well-being and economic productivity of populations. Recent research suggests that healthier children learn better and that more educated adults are healthier. School health is a cross-disciplinary field of study and a fundamental strategy that can be used to improve both health and education outcomes. Modern school health programs include 10 interactive components: health education; physical education and physical activity; nutrition environment and services; health services; counseling, psychological, and social services; physical environment; social and emotional climate; family engagement; community involvement; and employee wellness. This review is written for both health and education audiences. It integrates recent research and developments in relationships among health, education, and economic outcomes; health and education systems; the school health program, its components, and their effectiveness; cross-disciplinary collaboration; local, state, national, and international infrastructures and strategies; implementation science; and relevant academic research, training, and service.
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Affiliation(s)
- Lloyd J Kolbe
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, Indiana 47405, USA;
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252
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Van Stappen V, Latomme J, Cardon G, De Bourdeaudhuij I, Lateva M, Chakarova N, Kivelä J, Lindström J, Androutsos O, González-Gil E, De Miguel-Etayo P, Nánási A, Kolozsvári LR, Manios Y, De Craemer M. Barriers from Multiple Perspectives Towards Physical Activity, Sedentary Behaviour, Physical Activity and Dietary Habits When Living in Low Socio-Economic Areas in Europe. The Feel4Diabetes Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122840. [PMID: 30551570 PMCID: PMC6313803 DOI: 10.3390/ijerph15122840] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 12/13/2022]
Abstract
This study investigated barriers towards health behaviours (physical activity, limiting sedentary behaviour and healthy dietary habits) experienced by young European families living in vulnerable areas, from multiple perspectives (parents, teachers, local community workers). Focus groups were conducted in six European countries (Belgium, Bulgaria, Finland, Hungary, Greece and Spain). In each country, three focus groups were conducted with parents, one with teachers and one with local community workers. Data were analysed using a deductive framework approach with a manifest content analysis using the software NVivo. The present study identified barriers on four levels (individual, interpersonal, organisational and macro level) of a socio-ecological model of health behaviour. From parents’ perspectives, both general barriers (e.g., financial limitations and lack of time) and country-specific barriers (e.g., organisational difficulties and inappropriate work environment) were identified. Additional barriers (e.g., lack of parental knowledge and lack of parental skills) were provided by other stakeholders (i.e., teachers and local community workers). The results of this study demonstrate the additional value of including multiple perspectives when developing a lifestyle intervention aiming to prevent type 2 diabetes in vulnerable groups. Future lifestyle interventions are recommended to include multiple components (family, school, and community) and could be implemented across European countries if country-specific adaptations are allowed.
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Affiliation(s)
- Vicky Van Stappen
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium.
| | - Julie Latomme
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium.
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium.
| | | | - Mina Lateva
- Clinic of Paediatric Endocrinology, Medical University Varna, 9002 Varna, Bulgaria.
| | - Nevena Chakarova
- Clinical Center of Endocrinology, Medical University of Sofia, 1431 Sofia, Bulgaria.
| | - Jemina Kivelä
- National Institute for Health and Welfare, 00271 Helsinki, Finland.
| | - Jaana Lindström
- National Institute for Health and Welfare, 00271 Helsinki, Finland.
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University, 176 76 Athens, Greece.
| | - Esther González-Gil
- Growth, Exercise, Nutrition and Development (GENUD), University of Zaragoza, 50009 Zaragoza, Spain.
| | - Pilar De Miguel-Etayo
- Growth, Exercise, Nutrition and Development (GENUD), University of Zaragoza, 50009 Zaragoza, Spain.
| | - Anna Nánási
- Debreceni Egyetem (UoD), University of Debrecen, 4002 Debrecen, Hungary.
| | | | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University, 176 76 Athens, Greece.
| | - Marieke De Craemer
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium.
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253
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Kubik MY, Fulkerson JA, Sirard JR, Garwick A, Temple J, Gurvich O, Lee J, Dudovitz B. School-based secondary prevention of overweight and obesity among 8- to 12-year old children: Design and sample characteristics of the SNAPSHOT trial. Contemp Clin Trials 2018; 75:9-18. [PMID: 30342255 PMCID: PMC6249099 DOI: 10.1016/j.cct.2018.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/05/2018] [Accepted: 10/16/2018] [Indexed: 01/17/2023]
Abstract
Rising levels of severe obesity among children, worsening disparities by race and ethnicity and reluctance of primary care clinicians' to provide obesity management to children are compelling reasons to consider alternatives to primary care management of childhood obesity. The Students Nurses and Parents Seeking Healthy Options Together (SNAPSHOT) trial will test the efficacy of an elementary school-based, school nurse-led, healthy weight management program to reduce excess weight gain among children, 8- to 12-years old with a body mass index (BMI) ≥75th percentile, by increasing healthy dietary practices and physical activity and decreasing sedentary behaviors. SNAPSHOT has enrolled and randomized 132 child/parent dyads to either the: (1) 9-month SNAPSHOT intervention that includes four home visits, 14 kid groups held during out-of-school time and five parent groups or (2) a newsletter program consisting of monthly mailings and family-focused healthy lifestyle information. Outcomes are assessed at baseline, 12-months (post intervention) and 24-months (follow-up) post randomization. The primary outcome is child age- and gender-adjusted BMI z-score. Secondary outcomes include child dietary intake assessed with 24-h dietary recall interviews and accelerometer-measured activity levels. The SNAPSHOT intervention is a model of secondary obesity prevention for children that addresses the urgent need for theory-informed, evidence-based and safe weight management programs, delivered by skilled health professionals in accessible settings. This report describes development of the SNAPSHOT trial, including recruitment and randomization procedures, assessments, intervention and implementation plans, and baseline characteristics of the study sample.
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Affiliation(s)
- Martha Y Kubik
- Temple University, College of Public Health, Department of Nursing, 3307 North Broad Street, Philadelphia, PA 19103, United States.
| | - Jayne A Fulkerson
- Temple University, College of Public Health, Department of Nursing, 3307 North Broad Street, Philadelphia, PA 19103, United States
| | - John R Sirard
- Temple University, College of Public Health, Department of Nursing, 3307 North Broad Street, Philadelphia, PA 19103, United States
| | - Ann Garwick
- Temple University, College of Public Health, Department of Nursing, 3307 North Broad Street, Philadelphia, PA 19103, United States
| | - Judy Temple
- Temple University, College of Public Health, Department of Nursing, 3307 North Broad Street, Philadelphia, PA 19103, United States
| | - Olga Gurvich
- Temple University, College of Public Health, Department of Nursing, 3307 North Broad Street, Philadelphia, PA 19103, United States
| | - Jiwoo Lee
- Temple University, College of Public Health, Department of Nursing, 3307 North Broad Street, Philadelphia, PA 19103, United States
| | - Bonnie Dudovitz
- Temple University, College of Public Health, Department of Nursing, 3307 North Broad Street, Philadelphia, PA 19103, United States
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254
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Acton RB, Nguyen N, Minaker LM. School Food Policies and Student Eating Behaviors in Canada: Examination of the 2015 Cancer Risk Assessment in Youth Survey. THE JOURNAL OF SCHOOL HEALTH 2018; 88:936-944. [PMID: 30392189 DOI: 10.1111/josh.12702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/11/2018] [Accepted: 07/05/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Limited evidence exists on effects of school-based nutrition policies. This study explored the influence of mandatory versus voluntary provincial school nutrition policies on student eating behaviors. METHODS A cross-sectional, school-based survey assessed student eating behaviors using self-report survey measures in a representative sample of Canadian high school students from 7 provinces (N = 12,110). Provincial school nutrition policies were characterized as mandatory or voluntary. Healthful and nonhealthful eating behaviors were analyzed across sociodemographic characteristics. Regression models were used to assess the association between policy type and eating behaviors, and to explore potential moderating variables. RESULTS Healthful and nonhealthful eating behaviors differed significantly across several sociodemographic characteristics. Overall, neither healthful nor nonhealthful eating behaviors differed significantly between schools with voluntary and mandatory nutrition policies (odds ratio [OR] = 0.83, 95% confidence interval [CI] 0.64-1.08; OR = 1.16, 95% CI 0.83-1.64). Frequency of buying lunch at school and buying lunch out moderated the association between policy enforcement level and healthful eating behaviors (p = .0472, p = .0119). Frequency of buying lunch out moderated the association between policy enforcement levels and nonhealthful eating behaviors (p = .0009). CONCLUSIONS This study documents nonhealthful components of Canadian adolescents' diets, and the results highlight important areas for future research in assessing the effectiveness of school nutrition policies.
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Affiliation(s)
- Rachel B Acton
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue, Waterloo, ON N2L 3G1, Canada
| | - Nghia Nguyen
- Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue, Waterloo, ON N2L 3G1, Canada
| | - Leia M Minaker
- School of Planning, University of Waterloo, 200 University Avenue, Waterloo, Ontario N2L 3G1, Canada
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255
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Reprint of: Cardiovascular Disease Prevention by Diet Modification. J Am Coll Cardiol 2018; 72:2951-2963. [DOI: 10.1016/j.jacc.2018.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 12/27/2022]
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256
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Goldthorpe J, Ali N, Calam R. Providing healthy diets for young children: the experience of parents in a UK inner city. Int J Qual Stud Health Well-being 2018; 13:1490623. [PMID: 29989497 PMCID: PMC6041821 DOI: 10.1080/17482631.2018.1490623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES There is a consistent body of evidence to demonstrate that obesity in very early childhood tends to continue into adolescence and through to adulthood. Parental practices in relation to food can have an effect on this trajectory, however existing studies reporting on interventions for treating obesity suggest there is a need to involve populations from demographically diverse backgrounds childhood obesity research. DESIGN/METHODS A qualitative study was carried out using semi-structured interviews with parents in a deprived inner city area. RESULTS Although parents had good intentions towards providing a health diet for their chidren, a number of barriers emerged. Findings were reported in relation to the following themes: information and education; barriers (having a child with special needs, children's food preferences and using food to promote desirable behaviour) and techniques (household rules & routines, setting limits and parameters, modelling and food preparation). CONCLUSION Parents and carers would benefit from targeted interventions based on improving techniques around food parenting practices, with a focus on equipping parents with the skills to overcome barriers encountered not only in early childhood, but as children progress to school age and through to adolescence.
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Affiliation(s)
- Joanna Goldthorpe
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Nazneen Ali
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Rachel Calam
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
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257
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Cai L, Dai M, Lin L, Yang W, Chen Y, Ma J, Jing J. Incidence of childhood overweight and obesity and its association with weight-related attitudes and behaviors in China: a national longitudinal study. Int J Behav Nutr Phys Act 2018; 15:108. [PMID: 30390717 PMCID: PMC6215687 DOI: 10.1186/s12966-018-0737-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/16/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Childhood obesity is a major public health challenge. We aimed to investigate the incidence of overweight/obesity among Chinese children; and prospectively examine the associations of weight-change intention with risk of overweight/obesity and behavioral changes in initially normal-weight children. METHODS A national sample of 21,796 children aged 6-17 years were investigated in September 2013 and followed up nine months later, of which 19,887 (91%) were normal weight and 1909 (9%) were underweight at baseline. Weight and height were objectively measured. Weight perception, weight-change intention, weight control practices, weight-related behaviors, and demographic information were obtained by questionnaires. RESULTS Among children with underweight or normal-weight, the cumulative incidence of overweight/obesity was 2.77% (95% CI 2.55-2.99). Among normal-weight children, those who overestimated their weight had higher baseline BMI z-scores and an increased relative risk (RR) of overweight/obesity (RR 1.51, 95% CI 1.15-1.99). Children who misperceived themselves as underweight or overweight had stronger weight-change intention than their counterparts. However, children with weight-change intention did not develop greater changes in dietary intakes, physical activities, or sedentary behaviors than those without intention. There was no significant association between weight-change intention and incidence after adjusting for BMI z-scores at baseline. Self-reported improving diet, increasing physical activity, and dieting were associated with certain actual behavioral improvements and smaller increase in BMI z-score, but not associated with decreased risk of overweight/obesity. CONCLUSION The 9-months cumulative incidence of overweight/obesity was 2.77% among Chinese children. Weight-change intention was not associated with incidence of overweight/obesity in normal-weight children, regardless of their weight perception. More importantly, children's weight-change intention was insufficient in achieving desirable behavioral changes. Future overweight and obesity prevention programs should directly target on promoting children's actual behavioral changes.
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Affiliation(s)
- Li Cai
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Meixia Dai
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Lizi Lin
- School of Public Health, Peking University, Beijing, China
| | - Wenhan Yang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yajun Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jun Ma
- School of Public Health, Peking University, Beijing, China
| | - Jin Jing
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
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258
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Secular trends 2013-2017 in overweight and visible dental decay in New Zealand preschool children: influence of ethnicity, deprivation and the Under-5-Energize nutrition and physical activity programme. J Dev Orig Health Dis 2018; 10:345-352. [PMID: 30378530 DOI: 10.1017/s2040174418000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Early-life intervention to reduce obesity and poor dental health through early-life nutrition will improve health outcomes in later life. This study examined the prevalence of overweight and obesity and visual dental decay in 4-year old children in New Zealand between 2013 and 2017, and the impact of a nutrition and physical activity intervention programme, Under-5-Energize (U5E), on prevalence of these conditions within ethnic groups and by deprivation. The data set included 277,963 4-year-old children, including 25,140 from the Waikato region children of whom 8067 attended one of the 121 early childhood centres (ECC) receiving the U5E programme from 2014. Purposively the U5E-ECC selected were attended by higher proportions of indigenous Māori children and children living in higher deprivation areas than non-U5E-ECC. From 2013 to 2017, the overall prevalence of obesity, as defined by World Health Organisation criteria, declined slightly but rates of dental decay did not change. In the Waikato region, the prevalence of obesity declined in non-Māori children from 2015 to 2017 and children attending U5E-ECC had lower rates of dental decay than non-U5E children. Binary logistic regression showed that between 2015 and 2017 visible dental decay was more likely in children who were Māori (3.06×3.17), living in high deprivation (1.54×1.66) and male (1.10) but less likely if attending an U5E-ECC (0.83×0.79). Early-life intervention had efficacy at reducing dental decay, and demonstrated that the origins of disparities in health such as ethnicity and deprivation need to be addressed further to break the intergenerational cycles of poor health.
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259
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Hull PC, Buchowski M, Canedo JR, Beech BM, Du L, Koyama T, Zoorob R. Childhood obesity prevention cluster randomized trial for Hispanic families: outcomes of the healthy families study. Pediatr Obes 2018; 13:686-696. [PMID: 27884047 PMCID: PMC5443700 DOI: 10.1111/ijpo.12197] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/25/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Obesity prevalence is disproportionately high among Hispanic children. OBJECTIVES The Healthy Families Study assessed the efficacy of a culturally targeted, family-based weight gain prevention intervention for Hispanic immigrant families with children ages 5-7 years. METHODS The study used a two-group, cluster randomized trial design, assigning 136 families (clusters) to the active intervention (weight gain prevention) and 136 families to attention control (oral health). The active intervention included a 4-month intensive phase (eight classes) and an 8-month reinforcement phase (monthly mail/telephone contact). Children's body mass index z-score (BMI-Z) was the primary outcome. RESULTS The BMI-Z growth rate of the active intervention group did not differ from the attention control group at short-term follow-up (median 6 months; 168 families, 206 children) or long-term follow-up (median 16 months; 142 families, 169 children). Dose response analyses indicated a slower increase in BMI-Z at short term among overweight/obese children who attended more intervention classes. Moderate physical activity on weekends increased at short term. Weekend screen time decreased at short term among those attending at least one class session. CONCLUSION Low class attendance likely impacted intention-to-treat results. Future interventions targeting this population should test innovative strategies to maximize intervention engagement to produce and sustain effects on weight gain prevention.
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Affiliation(s)
- Pamela C. Hull
- Vanderbilt University Medical Center, Department of Medicine, Division of Epidemiology, Nashville, TN, USA
| | - Maciej Buchowski
- Vanderbilt University Medical Center, Department of Medicine, Division of Gastroenterology, Hepatology, & Nutrition, Nashville, TN, USA
| | | | - Bettina M. Beech
- University of Mississippi Medical Center, Department of Pediatrics, Jackson, MS, USA
| | - Liping Du
- Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN, USA
| | - Tatsuki Koyama
- Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN, USA
| | - Roger Zoorob
- Baylor College of Medicine, Department of Family and Community Medicine, Houston, TX, USA
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260
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Trude ACB, Surkan PJ, Cheskin LJ, Gittelsohn J. A multilevel, multicomponent childhood obesity prevention group-randomized controlled trial improves healthier food purchasing and reduces sweet-snack consumption among low-income African-American youth. Nutr J 2018; 17:96. [PMID: 30373597 PMCID: PMC6206663 DOI: 10.1186/s12937-018-0406-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 10/17/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Consumption of foods and beverages rich in sugar remains high across all races and ages in the United States. Interventions to address childhood obesity and decrease sugar intake are needed, particularly in low-income settings. METHODS B'more Healthy Communities for Kids (BHCK) was a group-randomized, controlled trial implemented among 9-15-year olds in 30 low-income areas of Baltimore. We increased access to low-sugar foods and beverages at wholesalers and small food stores. Concurrently, we encouraged their purchase and consumption by children through youth-led nutrition education in recreation centers, in-store promotions, text messaging and a social media program directed at caregivers. Sugar consumption (sugar sweetened beverage (SSB), sweets) in youth was assessed pre- (n = 534) and post-intervention (n = 401) using the Block Kids Food Frequency Questionnaire. Purchasing of 38 healthier and 28 less healthier food/beverage varieties in the previous 7 days was assessed via self-report. Multilevel models at the community and individual levels were used. Analyses were stratified by age (younger: 9-12-year olds (n = 339) vs older: 13-15 (n = 170)). Models were controlled for child's sex, race, total daily caloric intake, and caregiver's age and sex. RESULTS Overall baseline mean healthier food purchasing was 2.5 (+ 3.6; min. 0, max. 34 items per week), and unhealthier food purchasing 4.6 (+ 3.7; 0-19 items per week). Mean intake at baseline for kcal from SSB was 176 (+ 189.1) and 153 (+ 142.5), and % of calories from sweets (i.e. cookies, cakes, pies, donuts, candy, ice cream, sweetened cereals, and chocolate beverages) was 15.9 (+ 9.7) and 15.9 (+ 7.7) in comparison and intervention youth, respectively. Intervention youth increased healthier foods and beverages purchases by 1.4 more items per week than comparison youth (β = 1.4; 95% CI: 0.1; 2.8). After the intervention, there was a 3.5% decrease in kcal from sweets for older intervention youth, compared to the control group (β = - 3.5; 95% CI: -7.76; - 0.05). No impact was seen on SSB consumption. CONCLUSION BHCK successfully increased healthier food purchasing variety in youth, and decreased % calories from sweet snacks in older youth. Multilevel, multicomponent environmental childhood obesity programs are a promising strategy to improve eating behaviors among low-income urban youth. TRIAL REGISTRATION NCT02181010 (July 2, 2014, retrospectively registered).
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Affiliation(s)
- Angela C. B. Trude
- Department of International Health, Global Obesity Prevention Center, and Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Pamela J. Surkan
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Lawrence J. Cheskin
- Department of Health Behavior and Society, and the Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, 550 N. Broadway, Baltimore, MD 21205 USA
| | - Joel Gittelsohn
- Department of International Health, Global Obesity Prevention Center, and Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
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261
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Askelson NM, Brady P, Ryan G, Meier C, Ortiz C, Scheidel C, Delger P. Actively Involving Middle School Students in the Implementation of a Pilot of a Behavioral Economics-Based Lunchroom Intervention in Rural Schools. Health Promot Pract 2018; 20:675-683. [PMID: 30326740 DOI: 10.1177/1524839918807717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
School-based interventions can play an important role in improving childhood and adolescent nutrition and preventing obesity. Schools offer a unique opportunity to implement policy, systems, and environmental interventions targeting healthy eating behaviors. An intervention was piloted in six middle schools featuring behavioral economics-based changes to the lunchroom, communication training, and communicate cues for food service staff. The pilot study employed a multicomponent evaluation with students and food service directors and staff including a lunchroom assessment, online surveys, production records, and interviews. Five schools increased their scores on the lunchroom assessment tool, and four schools increased the number of servings produced of healthy food items. Interviews with food service directors indicated the interventions was feasible and well received. School-based policy, systems, and environmental interventions targeting healthy eating behaviors may play a role in preventing obesity in children and adolescents.
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Affiliation(s)
- Natoshia M Askelson
- 1 University of Iowa, Iowa City, IA, USA.,2 University of Minnesota-Morris, Morris, MN, USA
| | | | - Grace Ryan
- 1 University of Iowa, Iowa City, IA, USA
| | | | | | | | - Patti Delger
- 3 Iowa Department of Education, Des Moines, IA, USA
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262
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Effect of educational interventions on health in childhood: a meta-analysis of randomized controlled trials. Public Health 2018; 164:134-147. [PMID: 30321761 DOI: 10.1016/j.puhe.2018.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/22/2018] [Accepted: 04/19/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The purpose of this study was to summarize the findings of randomized controlled trials (RCTs) investigating any potential effects of educational interventions on health in childhood. STUDY DESIGN Meta-analysis. METHODS PubMed, Embase, and the Cochrane Library databases were searched to identify all RCTs that fit our analysis through May 2016. Weighted mean difference (WMD) was used to measure the effect of educational interventions in childhood by using a random effects model. RESULTS Thirty RCTs reporting data on 35,296 children were included in the meta-analysis. The summary WMD indicated that children who received educational interventions had lower levels of body mass index (BMI) (WMD: -0.15; 95% CI: -0.24 to -0.05; P = 0.003), BMI z-score (WMD: -0.03; 95% CI: -0.05 to -0.02; P < 0.001), waist circumference (WMD: -0.97; 95% CI: -1.95 to -0.00; P = 0.050), triceps skinfold (WMD: -1.39; 95% CI: -2.41 to -0.37; P = 0.008), systolic blood pressure (WMD: -1.13; 95% CI: -2.20 to -0.07; P = 0.037), total cholesterol (WMD: -4.04; 95% CI: -7.18 to -0.90; P = 0.012), and triglyceride (WMD: -2.62; 95% CI: -4.33 to -0.90; P = 0.003). However, educational interventions were found to have little or no significant impact on the waist-to-hip ratio, diastolic blood pressure, high-density lipoprotein, and low-density lipoprotein. CONCLUSIONS The study findings prove the positive effects of educational interventions on BMI, BMI z-score, waist circumference, triceps skinfold, systolic blood pressure, total cholesterol, and triglyceride.
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263
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Sagatov RD, John LV, Gregoriou M, Arteaga SS, Weber S, Payn B, Strauss W, Weinstein N, Collie-Akers V. Recruitment outcomes, challenges and lessons learned: the Healthy Communities Study. Pediatr Obes 2018; 13 Suppl 1:27-35. [PMID: 30209890 PMCID: PMC6424514 DOI: 10.1111/ijpo.12455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 05/11/2018] [Accepted: 05/30/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Healthy Communities Study (HCS) was a national study of community programs and policies that aimed to address childhood obesity; it necessitated recruitment of a large sample of children from communities throughout the United States. OBJECTIVE The HCS aimed to complete visits with an average of 45 children and 12 key informants from at least 120 communities, diverse with respect to region of the country, urbanicity, socioeconomic status, race, ethnicity and intensity of community programs and policies that aim to address childhood obesity. METHODS Purchased address lists were utilized to select households for recruitment during Wave 1 of the study, and recruitment of families through schools was employed for Wave 2. RESULTS The HCS successfully obtained approval from 149 school districts and 478 schools in 130 communities, recruited 5138 families, and interviewed 1421 key informants to allow for characterization of overall intensity of obesity prevention/treatment efforts in each community. CONCLUSIONS Lessons learned are presented. Future studies should plan for inclusion of the following in development of recruitment strategies: literature review, formative research, pilot testing, and ongoing monitoring and adjustment.
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Affiliation(s)
| | | | | | - S. Sonia Arteaga
- National Institutes of Health, National Heart, Lung and Blood Institute, Bethesda, MD
| | | | - Betsy Payn
- University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, WA
| | - Warren Strauss
- W.J. Strauss, Health Analytics Hub, LLC – Lewis Center, OH, USA
| | | | - Vicki Collie-Akers
- Work Group for Health and Community Development, University of Kansas, Lawrence, KS
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Strauss WJ, Nagaraja J, Landgraf AJ, Arteaga SS, Fawcett SB, Ritchie LD, John LV, Gregoriou M, Frongillo EA, Loria CM, Weber SA, Collie-Akers VL, McIver KL, Schultz J, Sagatov RDF, Leifer ES, Webb K, Pate RR. The longitudinal relationship between community programmes and policies to prevent childhood obesity and BMI in children: the Healthy Communities Study. Pediatr Obes 2018; 13 Suppl 1:82-92. [PMID: 29493122 DOI: 10.1111/ijpo.12266] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/12/2017] [Accepted: 12/18/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although a national epidemic of childhood obesity is apparent, how community-based programmes and policies (CPPs) affect this outcome is not well understood. OBJECTIVES This study examined the longitudinal relationship between the intensity of CPPs in 130 communities over 10 years and body mass index (BMI) of resident children. We also examined whether these relationships differ by key family or community characteristics. METHODS Five thousand one hundred thirty-eight children in grades K-8 were recruited through 436 schools located within 130 diverse US communities. Measures of height, weight, nutrition, physical activity and behavioural and demographic family characteristics were obtained during in-home visits. A subsample of families consented to medical record review; these weight and height measures were used to calculate BMI over time for 3227 children. A total of 9681 CPPs were reported during structured interviews of 1421 community key informants, and used to calculate a time series of CPP intensity scores within each community over the previous decade. Linear mixed effect models were used to assess longitudinal relationships between childhood BMI and CPP intensity. RESULTS An average BMI difference of 1.4 kg/m2 (p-value < 0.01) was observed between communities with the highest and lowest observed CPP intensity scores, after adjusting for community and child level covariates. BMI/CPP relationships differed significantly by child grade, race/ethnicity, family income and parental education; as well as community-level race/ethnicity. CONCLUSIONS These results indicate that, over time, more intense CPP interventions are related to lower childhood BMI, and that there are disparities in this association by sociodemographic characteristics of families and communities.
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Affiliation(s)
- W J Strauss
- Health and Analytics, Battelle, Columbus, Ohio, USA
| | - J Nagaraja
- Health and Analytics, Battelle, Columbus, Ohio, USA
| | - A J Landgraf
- Health and Analytics, Battelle, Columbus, Ohio, USA
| | - S S Arteaga
- Clinical Applications and Prevention, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - S B Fawcett
- Center for Community Health and Development, University of Kansas, Lawrence, Kansas, USA
| | - L D Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, California, USA
| | - L V John
- Health and Analytics, Battelle, St. Louis, Missouri, USA
| | - M Gregoriou
- Health and Analytics, Battelle, Arlington, Virginia, USA
| | - E A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - C M Loria
- Epidemiology Branch at National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - S A Weber
- Health and Analytics, Battelle, Columbus, Ohio, USA
| | - V L Collie-Akers
- Center for Community Health and Development, University of Kansas, Lawrence, Kansas, USA
| | - K L McIver
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA
| | - J Schultz
- Center for Community Health and Development, University of Kansas, Lawrence, Kansas, USA
| | - R D F Sagatov
- Health and Analytics, Battelle, Baltimore, Maryland, USA
| | - E S Leifer
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - K Webb
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, California, USA
| | - R R Pate
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA
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Gómez SF, Casas Esteve R, Subirana I, Serra-Majem L, Fletas Torrent M, Homs C, Bawaked RA, Estrada L, Fíto M, Schröder H. Effect of a community-based childhood obesity intervention program on changes in anthropometric variables, incidence of obesity, and lifestyle choices in Spanish children aged 8 to 10 years. Eur J Pediatr 2018; 177:1531-1539. [PMID: 30027297 DOI: 10.1007/s00431-018-3207-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/15/2018] [Accepted: 07/05/2018] [Indexed: 01/17/2023]
Abstract
UNLABELLED Results of community-based childhood obesity intervention programs do not provide strong evidence for their effectiveness. In this study, we evaluated the effect of the Thao-Child Health Program (TCHP), a community-based, multisetting, multistrategy intervention program for healthy weight development and lifestyle choices. In four Catalan cities, a total of 2250 children aged 8 to 10 years were recruited. Two cities were randomly selected for the TCHP intervention, and two cities followed usual health care policy. Children were selected from 41 elementary schools. Weight, height, and waist circumference were measured at baseline and after a mean follow-up of 15 months. Physical activity and adherence to the Mediterranean diet were measured with validated questionnaires. Generalized estimating equations (GEE) models were fitted to determine the intervention's effect on body mass index (BMI) z-score, waist-to-height ratio, Mediterranean diet adherence, and physical activity. Fully adjusted models revealed that the intervention had no significant effect on the BMI z-score, incidence of general and abdominal obesity, Mediterranean diet adherence, and physical activity. Waist-to-height ratio was significantly lower in controls than in the intervention group at follow-up (p < 0.004). CONCLUSIONS The TCHP did not improve weight development, diet quality, and physical activity in the short term. What is Known: • There is inconsistent evidence for the efficacy of school-based childhood obesity prevention programs. • There is little evidence on the efficacy of childhood obesity intervention programs in other settings. What is New: • This paper contributes information about the efficacy of a multisetting and multistrategy Community Based Intervention (CBI) program that uses the municipality as its unit of randomization. • This CBI had no effect on the prevention and treatment of childhood obesity in the short term.
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Affiliation(s)
- Santiago Felipe Gómez
- Gasol Foundation, Sant Boi de Llobregat, Spain
- GREpS, Health Education Research Group, Nursing and Physiotherapy Department, University of Lleida, Lleida, Spain
| | | | - Isaac Subirana
- Cardiovascular Epidemiology and Genetics Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Lluis Serra-Majem
- Reseach Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Canary Islands, Spain
- Fundación para la Investigación Nutricional (Nutrition Research Foundation), Barcelona, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Fletas Torrent
- North Metropolitan Unit of Research Support, Jordi Gol University Institute of Research in Primary Care (IDIAP Jordi Gol), Mataró, Spain
| | - Clara Homs
- Gasol Foundation, Sant Boi de Llobregat, Spain
| | - Rowaedh Ahmed Bawaked
- Cardiovascular Risk and Nutrition Research Group, IMIM (Hospital del Mar Medical Research Institute), c/ Doctor Aiguader 88, 08003, Barcelona, Spain
- PhD Programme in Biomedicine, Universidad Pompeu Fabra, Barcelona, Spain
| | | | - Montserrat Fíto
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Cardiovascular Risk and Nutrition Research Group, IMIM (Hospital del Mar Medical Research Institute), c/ Doctor Aiguader 88, 08003, Barcelona, Spain
| | - Helmut Schröder
- CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
- Cardiovascular Risk and Nutrition Research Group, IMIM (Hospital del Mar Medical Research Institute), c/ Doctor Aiguader 88, 08003, Barcelona, Spain.
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266
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Mihrshahi S, Myton R, Partridge SR, Esdaile E, Hardy LL, Gale J. Sustained low consumption of fruit and vegetables in Australian children: Findings from the Australian National Health Surveys. Health Promot J Austr 2018; 30:83-87. [PMID: 30175423 DOI: 10.1002/hpja.201] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/29/2018] [Indexed: 01/15/2023] Open
Abstract
ISSUE ADDRESSED Intakes of fruit and vegetables in children are inadequate. Our purpose was to examine national data on the proportion of Australian children meeting the fruit and vegetable recommendations in 2011-2012 and 2014-2015, assessing changes over time and differences by age, sex and socio-economic status (SES). METHODS Secondary analysis of 2011-2012 and 2014-2015 Australian National Health Surveys of Australian children aged 2-18 years. Percentages of children meeting fruit and vegetable recommendations by survey year, age group, sex and SES tertile were calculated using population weights supplied by the Australian Bureau of Statistics (ABS). Chi-squared tests and logistic regression were used to test for the relative influence of each factor. RESULTS In 2011-2012, 64.6%, 5.1% and 4.6% of children met the recommended intake for fruit, vegetable and fruit-vegetable combined, respectively. In 2014-2015, 68.2%, 5.3% and 5.1% of all children met the recommended intake for fruit, vegetable and fruit-vegetable combined, respectively. There was a large reduction in proportions of children meeting both the fruit and vegetable recommendations between 3 and 4 years of age, which coincides with when most Australian children start pre-school. There were consistent differences by sex for both fruit and vegetables, but we found little evidence that SES is a significant factor predicting the difference in meeting the vegetable recommendations. CONCLUSION The proportion of Australian children meeting fruit and vegetable recommendations are sub-optimal across all SES groups which suggests that a national approach across demographic strata is warranted. SO WHAT?: Future health promotion interventions should have a refocus on vegetables instead of "fruit and vegetables," particularly in the key transition period when children start pre-school.
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Affiliation(s)
- Seema Mihrshahi
- Prevention Research Collaboration, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Rimma Myton
- Prevention Research Collaboration, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie R Partridge
- Prevention Research Collaboration, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Emma Esdaile
- Prevention Research Collaboration, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Louise L Hardy
- Prevention Research Collaboration, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Joanne Gale
- Prevention Research Collaboration, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia
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267
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Improving health through diet and exercise in children. Eur J Clin Nutr 2018; 72:1251-1254. [PMID: 30185856 DOI: 10.1038/s41430-018-0209-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/03/2018] [Accepted: 05/08/2018] [Indexed: 11/09/2022]
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268
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Wang CY, Neil DL, Home P. 2020 vision - An overview of prospects for diabetes management and prevention in the next decade. Diabetes Res Clin Pract 2018; 143:101-112. [PMID: 29944968 DOI: 10.1016/j.diabres.2018.06.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/24/2018] [Accepted: 06/13/2018] [Indexed: 02/08/2023]
Abstract
After a century of medical progress, people nowadays live longer with diabetes than ever before. However, current preventative approaches, compounded in part by increased life-expectancy, are failing to reduce the prevalence of diabetes. Cardiovascular sequelae account for many of the four million deaths annually attributable to diabetes. Evidence indicates that certain glucose-lowering medications can improve vascular outcomes in some people with type 2 diabetes, which, together with better understanding of using multiple therapies concurrently, offers opportunities for beneficial personalization of medication regimens. However, further well-designed long-term studies are needed to evaluate cardiovascular benefits and safety of new and older medications, particularly in users typical of everyday diabetes care. Although there are numerous other promising advances in pharmacotherapies and biotechnology, these will probably be unaffordable for most people with diabetes globally. Therefore, effective national public health approaches will be essential to reducing the incidence of diabetes and its associated burdens; these may entail politically controversial measures to change unhealthy lifestyle behaviours. Stakeholders could learn from past failures and emulate successes in other health-care initiatives. Without early action at all levels, we face a future in which approaching one-quarter of humans will have diabetes, with more than half afflicted during their lifetime.
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Affiliation(s)
- Chih-Yuan Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - David L Neil
- Scientific Development Department, Content Ed Net, Taipei, Taiwan
| | - Philip Home
- Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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269
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Wang X, Zhou G, Zeng J, Yang T, Chen J, Li T. Effect of educational interventions on health in childhood: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97:e11849. [PMID: 30200070 PMCID: PMC6133573 DOI: 10.1097/md.0000000000011849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The purpose of this study was to summarize the evidences from randomized controlled trials (RCTs) investigating the effects of educational interventions in overweight/obesity childhood by using meta-analytic approach. METHODS PubMed, Embase, and the Cochrane Library databases were searched from the inception to April 2018. Weighted mean differences (WMDs) with corresponding 95% confidence intervals (CIs) were used to measure the effects of educational interventions during childhood in the random-effects models. RESULTS Thirty RCTs reporting data on 35,296 children were included in the meta-analysis. The summary WMD indicated that children received educational interventions had lower levels of body mass index (BMI) (WMD: -0.15; 95% CI: -0.24 to -0.05; P = .003), BMI z-score (WMD: -0.03; 95% CI: -0.05 to -0.02; P < .001), waist circumference (WMD: -0.97; 95% CI: -1.95 to -0.00; P = 0.050), triceps skinfold (WMD: -1.39; 95% CI: -2.41 to -0.37; P = .008), systolic blood pressure (WMD: -1.13; 95% CI: -2.20 to -0.07; P = .037), total cholesterol (WMD: -4.04; 95% CI: -7.18 to -0.90; P = .012), and triglyceride (WMD: -2.62; 95% CI: -4.33 to -0.90; P = .003). However, educational interventions were not associated with the levels of waist-to-hip ratio, diastolic blood pressure, high-density lipoprotein, and low-density lipoprotein. CONCLUSION The study findings elucidate the positive effects of educational interventions on BMI, BMI z-score, waist circumference, triceps skinfold, systolic blood pressure, total cholesterol, and triglyceride.
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Affiliation(s)
- Xuqin Wang
- Children's Nutrition Research Center
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing
- Third Affiliated Hospital of Zunyi Medical College, Guizhou, PR China
| | - Guoqi Zhou
- Third Affiliated Hospital of Zunyi Medical College, Guizhou, PR China
| | - Jiaying Zeng
- Children's Nutrition Research Center
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing
| | - Ting Yang
- Children's Nutrition Research Center
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing
| | - Jie Chen
- Children's Nutrition Research Center
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing
| | - Tingyu Li
- Children's Nutrition Research Center
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing
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270
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Vohr BR, Heyne R, Bann CM, Das A, Higgins RD, Hintz SR. Extreme Preterm Infant Rates of Overweight and Obesity at School Age in the SUPPORT Neuroimaging and Neurodevelopmental Outcomes Cohort. J Pediatr 2018; 200:132-139.e3. [PMID: 29793869 PMCID: PMC6109599 DOI: 10.1016/j.jpeds.2018.04.073] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/23/2018] [Accepted: 04/25/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To identify rates of overweight (body mass index [BMI] ≥85th percentile) and obesity (BMI ≥95th percentile) at 6-7 years of age and associated risk factors among extremely preterm infants born at <28 weeks of gestation. STUDY DESIGN Anthropometrics, blood pressure, and active and sedentary activity levels were prospectively assessed. Three groups were compared, those with a BMI ≥85th percentile (overweight or obese for age, height, and sex) and ≥95th percentile (obese) vs <85th percentile. Multiple regression analyses estimated the relative risks of BMI ≥85th percentile and ≥95th percentile associated with perinatal and early childhood factors. RESULTS Of 388 children, 22% had a BMI of ≥85th percentile and 10% were obese. Children with obesity and overweight compared with normal weight children had higher body fat (subscapular skinfold and triceps skinfold >85th percentile), central fat (waist circumference >90th percentile), spent more time in sedentary activity (20.5 vs 18.2 vs 16.7 hours/week), and had either systolic and/or diastolic hypertension (24% vs 26% vs 14%), respectively. Postdischarge weight gain velocities from 36 weeks postmenstrual age to 18 months, and 18 months to 6-7 years were independently associated with a BMI of ≥85th percentile, whereas weight gain velocity from 18 months to 6-7 years was associated with obesity. CONCLUSIONS One in 5 former extremely preterm infants is overweight or obese and has central obesity at early school age. Postdischarge weight gain velocities were associated with overweight and obesity. These findings suggest the obesity epidemic is spreading to the most extremely preterm infants. TRIAL REGISTRATION ClinicalTrials.gov: NCT00063063 and NCT0000.
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Affiliation(s)
- Betty R Vohr
- Department of Pediatrics, Division of Neonatal Medicine, Women & Infants Hospital and Alpert Medical School of Brown University, Providence, RI.
| | - Roy Heyne
- Department of Pediatrics, Division of Neonatal Medicine, UT Southwestern, Dallas, TX
| | - Carla M Bann
- Social Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD
| | - Rosemary D Higgins
- National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Susan R Hintz
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA
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271
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Ullmann G, Kedia SK, Homayouni R, Akkus C, Schmidt M, Klesges LM, Ward KD. Memphis FitKids: implementing a mobile-friendly web-based application to enhance parents' participation in improving child health. BMC Public Health 2018; 18:1068. [PMID: 30157819 PMCID: PMC6114180 DOI: 10.1186/s12889-018-5968-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background Child obesity is a major public health challenge, increasing the risk of chronic medical conditions such as type 2 diabetes, metabolic syndrome, and hypertension. Among U.S. states, Tennessee has one of the highest rates of child obesity. Emerging communication technologies can help to deliver highly disseminable population-level interventions to improve health behavior. The aim of this paper is to report the implementation and the evaluation of the reach of Memphis FitKids, a web-based application, intended to promote healthy behaviors for families and children. Methods A community-level demonstration project, Memphis FitKids, was developed and implemented in Tennessee’s Greater Memphis Area. This application (www.memphisfitkids.org) was designed for parents to assess their children’s obesity risk through determinants such as weight, diet, physical activity, screen time, and sleep adequacy. A built-in “FitCheck” tool used this collected information to create a report with tailored recommendations on how to make healthy changes. A Geographic Information Systems component was implemented to suggest low-cost neighborhood resources that support a healthy lifestyle. A social marketing framework was used to develop and implement FitKids, and a Community Advisory Board with representatives from community partners (e.g., the YMCA of Memphis, the Pink Palace Family of Museums, and the Memphis Public Library) supported the implementation of the project. Five kiosks distributed in the community served as public access points to provide a broad reach across socioeconomic strata. Presentations at community events and the use of Facebook facilitated the promotion of FitKids. Website traffic and Facebook usage were evaluated with Google Analytics and Facebook Insights, respectively. Results In Tennessee, 33,505 users completed 38,429 FitCheck sessions between July 2014 and December 2016. Among these, 6763 sessions were completed at the five kiosks in the community. FitKids was presented at 112 community events and the social media posts reached 23,767 unique Facebook users. Conclusions The Memphis FitKids demonstration project showed that web-based health tools may be a viable strategy to increase access to information about healthy weight and lifestyle options for families. Mobile-friendly web-based applications like Memphis FitKids may also serve health professionals in their efforts to support their clients in adopting healthy behaviors. Electronic supplementary material The online version of this article (10.1186/s12889-018-5968-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gerhild Ullmann
- Social and Behavioral Sciences, School of Public Health, University of Memphis, 3825 Desoto Ave, Memphis, TN, 38152, USA.
| | - Satish K Kedia
- Social and Behavioral Sciences, School of Public Health, University of Memphis, 3825 Desoto Ave, Memphis, TN, 38152, USA
| | - Ramin Homayouni
- Bioinformatics, Biological Sciences, College of Arts and Sciences, University of Memphis, Memphis, TN, USA
| | - Cem Akkus
- Social and Behavioral Sciences, School of Public Health, University of Memphis, 3825 Desoto Ave, Memphis, TN, 38152, USA
| | - Michael Schmidt
- Art, College of Communication and Fine Arts, University of Memphis, Memphis, TN, USA
| | - Lisa M Klesges
- Epidemiology, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Kenneth D Ward
- Social and Behavioral Sciences, School of Public Health, University of Memphis, 3825 Desoto Ave, Memphis, TN, 38152, USA
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Yu E, Malik VS, Hu FB. Cardiovascular Disease Prevention by Diet Modification: JACC Health Promotion Series. J Am Coll Cardiol 2018; 72:914-926. [PMID: 30115231 PMCID: PMC6100800 DOI: 10.1016/j.jacc.2018.02.085] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 02/08/2023]
Abstract
Reduction in excess calories and improvement in dietary composition may prevent many primary and secondary cardiovascular events. Current guidelines recommend diets high in fruits, vegetables, whole grains, nuts, and legumes; moderate in low-fat dairy and seafood; and low in processed meats, sugar-sweetened beverages, refined grains, and sodium. Supplementation can be useful for some people but cannot replace a good diet. Factors that influence individuals to consume a low-quality diet are myriad and include lack of knowledge, lack of availability, high cost, time scarcity, social and cultural norms, marketing of poor-quality foods, and palatability. Governments should focus on cardiovascular disease as a global threat and enact policies that will reach all levels of society and create a food environment wherein healthy foods are accessible, affordable, and desirable. Health professionals should be proficient in basic nutritional knowledge to promote a sustainable pattern of healthful eating for cardiovascular disease prevention for both healthy individuals and those at higher risk.
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Affiliation(s)
- Edward Yu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Vasanti S Malik
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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273
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Measuring implementation fidelity of school-based obesity prevention programmes: a systematic review. Int J Behav Nutr Phys Act 2018; 15:75. [PMID: 30103764 PMCID: PMC6088402 DOI: 10.1186/s12966-018-0709-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/26/2018] [Indexed: 02/01/2023] Open
Abstract
Background Until now, there is no clear overview of how fidelity is assessed in school-based obesity prevention programmes. In order to move the field of obesity prevention programmes forward, the current review aimed to 1) identify which fidelity components have been measured in school-based obesity prevention programmes; 2) identify how fidelity components have been measured; and 3) score the quality of these methods. Methods Studies published between January 2001–October 2017 were selected from searches in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library and ERIC. We included studies examining the fidelity of obesity prevention programmes (nutrition and/or physical activity and/or sitting) at school (children aged 4–18 year) measuring at least one component of implementation fidelity. A data extraction was performed to identify which and how fidelity components were measured. Thereafter, a quality assessment was performed to score the quality of these methods. We scored each fidelity component on 7 quality criteria. Each fidelity component was rated high (> 75% positive), moderate (50–75%) or low (< 50%). Results Of the 26,294 retrieved articles, 73 articles reporting on 63 different studies were included in this review. In 17 studies a process evaluation was based on a theoretical framework. In total, 120 fidelity components were measured across studies: dose was measured most often (N = 50), followed by responsiveness (N = 36), adherence (N = 26) and quality of delivery (N = 8). There was substantial variability in how fidelity components were defined as well as how they were measured. Most common methods were observations, logbooks and questionnaires targeting teachers. The quality assessment scores ranged from 0 to 86%; most fidelity components scored low quality (n = 77). Conclusions There is no consensus on the operationalisation of concepts and methods used for assessing fidelity in school-based obesity prevention programmes and the quality of methods used is weak. As a result, we call for more consensus on the concepts and clear reporting on the methods employed for measurements of fidelity to increase the quality of fidelity measurements. Moreover, researchers should focus on the relation between fidelity and programme outcomes and determine to what extent adaptations to programmes have been made, whilst still being effective. Electronic supplementary material The online version of this article (10.1186/s12966-018-0709-x) contains supplementary material, which is available to authorized users.
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274
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Vidgen HA, Love PV, Wutzke SE, Daniels LA, Rissel CE, Innes-Hughes C, Baur LA. A description of health care system factors in the implementation of universal weight management services for children with overweight or obesity: case studies from Queensland and New South Wales, Australia. Implement Sci 2018; 13:109. [PMID: 30086782 PMCID: PMC6081901 DOI: 10.1186/s13012-018-0801-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/26/2018] [Indexed: 12/31/2022] Open
Abstract
Background The prevalence of childhood obesity poses an urgent global challenge. The World Health Organization (WHO) Commission on Ending Childhood Obesity recommends the provision of appropriate family-based, lifestyle weight management services through universal health care to support families of children with overweight or obesity; however, there are few examples of their implementation ‘at scale’. The purpose of this research was to compare and contrast the impact of system and organisational factors on the implementation of childhood obesity management services within two Australian States (New South Wales and Queensland) to comprehensively describe their influence on the achievement of the WHO recommendation. Methods Purposeful stratified sampling was used to select health service study sites (n = 16) representative of program implementation (none, discontinued, repeated) and geographic location within each State. Within each health service site, staff involved in program delivery, co-ordination and management roles participated (n = 39). An additional 11 staff involved in implementation at State level also participated. The Consolidated Framework for Implementation Research (CFIR) was used to develop interview scripts. Telephone interviews were recorded and transcribed. Transcripts were thematically coded and scored according to CFIR constructs and rating rules to identify enablers and barriers to implementation according to sample characteristics. Results New South Wales achieved ongoing implementation; Queensland did not. Enablers included a quality evidence-based program, State government recognition of the urgency of the health issue and a commitment to address it, formally appointed and funded internal implementation leaders, strong communication and reporting at all levels. Barriers included the complexity of the health issue, in particular a lack of clear roles and responsibilities for local health service delivery, inadequate ongoing funding and challenges in meeting the diverse needs of families. Conclusions This research is an important progression of the evidence base in relation to the translation of childhood obesity management trials into routine health service delivery. Understanding enablers and barriers to program implementation ‘at scale’ is imperative to inform future planning and investment by Australia and WHO member states to meet their commitment to deliver childhood weight management services as part of universal health coverage. Electronic supplementary material The online version of this article (10.1186/s13012-018-0801-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helen A Vidgen
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, 4059, QLD, Australia.
| | - Penelope V Love
- Institute of Physical Activity and Nutrition, Faculty of Health, Deakin University, Locked Bag 20001, Geelong, 3220, VIC, Australia
| | - Sonia E Wutzke
- The Australian Prevention Partnership Centre, PO Box K617, Haymarket, Sydney, 1240, NSW, Australia
| | - Lynne A Daniels
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, 4059, QLD, Australia
| | - Chris E Rissel
- NSW Office of Preventive Health, Locked Bag 7103, Liverpool BC, 1871, NSW, Australia
| | | | - Louise A Baur
- Discipline of Child and Adolescent Health, Clinical School, The Children's Hospital, University of Sydney, Locked Bag 4001, Westmead, 2145, NSW, Australia
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275
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Barkin SL, Heerman WJ, Sommer EC, Martin NC, Buchowski MS, Schlundt D, Po’e EK, Burgess LE, Escarfuller J, Pratt C, Truesdale KP, Stevens J. Effect of a Behavioral Intervention for Underserved Preschool-Age Children on Change in Body Mass Index: A Randomized Clinical Trial. JAMA 2018; 320:450-460. [PMID: 30088008 PMCID: PMC6583104 DOI: 10.1001/jama.2018.9128] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/11/2018] [Indexed: 12/29/2022]
Abstract
Importance Prevention of obesity during childhood is critical for children in underserved populations, for whom obesity prevalence and risk of chronic disease are highest. Objective To test the effect of a multicomponent behavioral intervention on child body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) growth trajectories over 36 months among preschool-age children at risk for obesity. Design, Setting, and Participants A randomized clinical trial assigned 610 parent-child pairs from underserved communities in Nashville, Tennessee, to a 36-month intervention targeting health behaviors or a school-readiness control. Eligible children were between ages 3 and 5 years and at risk for obesity but not yet obese. Enrollment occurred from August 2012 to May 2014; 36-month follow-up occurred from October 2015 to June 2017. Interventions The intervention (n = 304 pairs) was a 36-month family-based, community-centered program, consisting of 12 weekly skills-building sessions, followed by monthly coaching telephone calls for 9 months, and a 24-month sustainability phase providing cues to action. The control (n = 306 pairs) consisted of 6 school-readiness sessions delivered over the 36-month study, conducted by the Nashville Public Library. Main Outcomes and Measures The primary outcome was child BMI trajectory over 36 months. Seven prespecified secondary outcomes included parent-reported child dietary intake and community center use. The Benjamini-Hochberg procedure corrected for multiple comparisons. Results Participants were predominantly Latino (91.4%). At baseline, the mean (SD) child age was 4.3 (0.9) years; 51.9% were female. Household income was below $25 000 for 56.7% of families. Retention was 90.2%. At 36 months, the mean (SD) child BMI was 17.8 (2.2) in the intervention group and 17.8 (2.1) in the control group. No significant difference existed in the primary outcome of BMI trajectory over 36 months (P = .39). The intervention group children had a lower mean caloric intake (1227 kcal/d) compared with control group children (1323 kcal/d) (adjusted difference, -99.4 kcal [95% CI, -160.7 to -38.0]; corrected P = .003). Intervention group parents used community centers with their children more than control group parents (56.8% in intervention; 44.4% in control) (risk ratio, 1.29 [95% CI, 1.08 to 1.53]; corrected P = .006). Conclusions and Relevance A 36-month multicomponent behavioral intervention did not change BMI trajectory among underserved preschool-age children in Nashville, Tennessee, compared with a control program. Whether there would be effectiveness for other types of behavioral interventions or implementation in other cities would require further research. Trial Registration ClinicalTrials.gov Identifier: NCT01316653.
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Affiliation(s)
- Shari L. Barkin
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - William J. Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Evan C. Sommer
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nina C. Martin
- Department of Psychology and Human Development, Vanderbilt University Peabody College, Nashville, Tennessee
| | - Maciej S. Buchowski
- Division of Gastroenterology, Hepatology, & Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
| | - Eli K. Po’e
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laura E. Burgess
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Juan Escarfuller
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Charlotte Pratt
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Kimberly P. Truesdale
- Department of Nutrition, The University of North Carolina at Chapel Hill Gillings School of Global Public Health
| | - June Stevens
- Department of Nutrition and Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health
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276
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O'Neill A, Beck K, Chae D, Dyer T, He X, Lee S. The pathway from childhood maltreatment to adulthood obesity: The role of mediation by adolescent depressive symptoms and BMI. J Adolesc 2018; 67:22-30. [DOI: 10.1016/j.adolescence.2018.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 05/22/2018] [Accepted: 05/25/2018] [Indexed: 10/14/2022]
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277
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Kobes A, Kretschmer T, Timmerman G, Schreuder P. Interventions aimed at preventing and reducing overweight/obesity among children and adolescents: a meta-synthesis. Obes Rev 2018; 19:1065-1079. [PMID: 29671938 DOI: 10.1111/obr.12688] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/13/2018] [Accepted: 02/20/2018] [Indexed: 12/30/2022]
Abstract
The prevalence of child and adolescent obesity has been a major worldwide problem for decades. To stop the number of youth with overweight/obesity from increasing, numerous interventions focusing on improving children's weight status have been implemented. The growing body of research on weight-related interventions for youth has been summarized by several meta-analyses aiming to provide an overview of the effectiveness of interventions. Yet, the number of meta-analyses is expanding so quickly and overall results differ, making a comprehensive synopsis of the literature difficult. To tackle this problem, a meta-synthesis was conducted to draw informed conclusions about the state of the effectiveness of interventions targeting child and adolescent overweight. The results of the quantitative synthesis of 26 meta-analyses resulted in a standardized mean difference (SMD) of -0.12 (95%CI: -0.16, -0.08). Several moderator analyses showed that participant and intervention characteristics had little impact on the overall effect size. However, a moderator analysis distinguishing between obesity treatment and obesity prevention studies showed that obesity treatment interventions (SMD: -0.048, 95%CI: -0.60, -0.36) were significantly more effective in reducing body mass index than obesity prevention interventions (SMD: -0.08, 95%CI: -0.11, -0.06). Overall, the results of this meta-synthesis suggest that interventions result in statistically significant effects albeit of relatively little clinical relevance.
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Affiliation(s)
- A Kobes
- Department of Pedagogy and Educational Sciences, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - T Kretschmer
- Department of Pedagogy and Educational Sciences, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - G Timmerman
- Department of Pedagogy and Educational Sciences, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - P Schreuder
- Department of Pedagogy and Educational Sciences, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands
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278
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Valerio G, Maffeis C, Saggese G, Ambruzzi MA, Balsamo A, Bellone S, Bergamini M, Bernasconi S, Bona G, Calcaterra V, Canali T, Caroli M, Chiarelli F, Corciulo N, Crinò A, Di Bonito P, Di Pietrantonio V, Di Pietro M, Di Sessa A, Diamanti A, Doria M, Fintini D, Franceschi R, Franzese A, Giussani M, Grugni G, Iafusco D, Iughetti L, Lamborghini A, Licenziati MR, Limauro R, Maltoni G, Manco M, Reggiani LM, Marcovecchio L, Marsciani A, del Giudice EM, Morandi A, Morino G, Moro B, Nobili V, Perrone L, Picca M, Pietrobelli A, Privitera F, Purromuto S, Ragusa L, Ricotti R, Santamaria F, Sartori C, Stilli S, Street ME, Tanas R, Trifiró G, Umano GR, Vania A, Verduci E, Zito E. Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Ital J Pediatr 2018; 44:88. [PMID: 30064525 PMCID: PMC6069785 DOI: 10.1186/s13052-018-0525-6] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/07/2018] [Indexed: 01/06/2023] Open
Abstract
The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. The following areas were reviewed: (1) obesity definition and causes of secondary obesity; (2) physical and psychosocial comorbidities; (3) treatment and care settings; (4) prevention.The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. The evidence based efficacy of behavioral intervention versus pharmacological or surgical treatments is reported. Lastly, the prevention by promoting healthful diet, physical activity, sleep pattern, and environment is strongly recommended since the intrauterine phase.
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Affiliation(s)
- Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, via Medina 40, 80133 Naples, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Giuseppe Saggese
- Department of Pediatrics, University Hospital of Pisa, Pisa, Italy
| | | | - Antonio Balsamo
- Department of Medical and Surgical Sciences, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Simonetta Bellone
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | | | - Sergio Bernasconi
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Parma, Italy
| | - Gianni Bona
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Valeria Calcaterra
- Pediatrics Unit, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Margherita Caroli
- Italian Society for Obesity (SIO), Francavilla Fontana (Brindisi), Italy
| | | | - Nicola Corciulo
- Pediatric Unit, Hospital of Gallipoli, Gallipoli (Lecce), Italy
| | - Antonino Crinò
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Procolo Di Bonito
- Department of Internal Medicine, “S. Maria delle Grazie”, Pozzuoli Hospital, Naples, Italy
| | | | - Mario Di Pietro
- Pediatric and Neonatal Unit, “G. Mazzini”Hospital, Teramo, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonella Diamanti
- Artificial Nutrition Unit Bambino Gesù, Children’s Hospital, IRCCS, Rome, Italy
| | - Mattia Doria
- Italian Federation of Pediatricians (FIMP), Venice, Italy
| | - Danilo Fintini
- Endocrinology and Diabetology Unit Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | | | - Adriana Franzese
- Department of Translational Medical Science, Regional Center for Pediatric Diabetes, University Federico II of Naples, Naples, Italy
| | | | - Graziano Grugni
- Division of Auxology, Istituto Auxologico Italiano, IRCCS, Verbania, Italy
| | - Dario Iafusco
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Giulio Maltoni
- Department of Medical and Surgical Sciences, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Melania Manco
- Research Area for Multifactorial Diseases, Children’s Hospital Bambino Gesù, Rome, Italy
| | | | | | | | - Emanuele Miraglia del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Anita Morandi
- Pediatric Diabetes and Metabolic Disorders Unit, University Hospital of Verona, Verona, Italy
| | - Giuseppe Morino
- Nutrition Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | | | - Valerio Nobili
- Department of Pediatrics and Infantile Neuropsychiatry, Sapienza University of Rome, Rome, Italy
- Hepatometabolic Unit, Bambino Gesù Children’s Hospital, IRCSS, Rome, Italy
| | - Laura Perrone
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | | | | | | | | | | | - Roberta Ricotti
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Francesca Santamaria
- Department of Translational Medical Science, Regional Center for Pediatric Diabetes, University Federico II of Naples, Naples, Italy
| | - Chiara Sartori
- Department of Obstetrics, Gynaecology and Paediatrics, Arcispedale S.Maria Nuova-IRCCS, Reggio Emilia, Italy
| | | | - Maria Elisabeth Street
- Department of Obstetrics, Gynaecology and Paediatrics, Arcispedale S.Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Rita Tanas
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Ferrara, Italy
| | | | - Giuseppina Rosaria Umano
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Andrea Vania
- Department of Pediatrics and Infantile Neuropsychiatry, Sapienza University of Rome, Rome, Italy
| | - Elvira Verduci
- Deparment of Pediatrics, San Paolo Hospital, University of Milan, Milan, Italy
| | - Eugenio Zito
- Department of Social Sciences, University of Naples Federico II, Naples, Italy
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279
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Lin SF, Binggeli-Vallarta A, Cervantes G, Angulo J, Moody JS, McKenzie TL, Horton LA, Ayala GX. Process Evaluation of an Early Care and Education Intervention: The California Childhood Obesity Research Demonstration Study (CA-CORD). Health Promot Pract 2018; 21:298-307. [PMID: 30051727 DOI: 10.1177/1524839918786953] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Given the widespread use of out-of-home child care in the United States, early care and education (ECE) providers offer ideal settings to promote health behaviors among Hispanic/Latino children whose obesity prevalence remains high. This study details the process evaluation of ECE intervention strategies of a childhood obesity research demonstration study (California Childhood Obesity Research Demonstration [CA-CORD]) to prevent and control obesity among Hispanic/Latino children aged 2 to 12 years. Participating ECE providers received the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) materials and action planning sessions with a trained interventionist; Sports, Play, and Active Recreation for Kids (SPARK) physical activity (PA), health behavior, and body mass index assessment trainings; and health behavior toolkit, cooking kit, water dispensers, and posters to promote healthy eating, PA, water consumption, and quality sleep. Intervention logs and director/lead teacher interviews evaluated how well 14 center-based and 9 private ECE providers implemented policy, system, and environmental changes. NAP SACC was implemented with higher fidelity than other strategies, and participation in SPARK trainings was lower than health behavior trainings. ECE directors/lead teachers reported that the intervention activities and materials helped them promote the targeted behaviors, especially PA. Results demonstrated that the use of NAP SACC, trainings, and toolkit had high fidelity and were potentially replicable for implementation in ECE settings among Hispanic/Latino communities.
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Affiliation(s)
| | | | | | - Janette Angulo
- Imperial County Public Health Department, El Centro, CA, USA
| | - Jamie S Moody
- University of California, San Diego, San Diego, CA, USA
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280
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Kim EK, Ndahimana D, Ishikawa-Takata K, Lee S, Kim H, Lim K, Lee IS, Tanaka S, Kim YJ, Choi YJ, Ju MJ, Park J. Validation of Dietary Reference Intakes for predicting energy requirements in elementary school-age children. Nutr Res Pract 2018; 12:336-341. [PMID: 30090171 PMCID: PMC6078864 DOI: 10.4162/nrp.2018.12.4.336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/OBJECTIVES Dietary Reference Intakes (DRI) for energy are derived from total energy expenditure (TEE) measured using the doubly labelled water (DLW) method. The objective of this study was to assess the validity of DRI for predicting the energy requirements of elementary school-age children. SUBJECTS/METHODS The present study involved 25 elementary school-age children aged between 9 and 11 years. TEE was assessed by the DLW method, and the results were compared with the TEE predicted by the DRI equations in order to evaluate accuracy. RESULTS The subjects' TEE measured by the DLW method was 1,925.2 ± 380.9 kcal/day in boys and 1,930.0 ± 279.4 kcal/day in girls, whereas resting energy expenditure was 1,220.2 ± 176.9 kcal/day in boys and 1,245.9 ± 171.3 kcal/day for girls. The physical activity level was 1.58 ± 0.20 in boys and 1.55 ± 0.13 in girls. The mean bias between the predicted and measured TEE was 12.6% in boys and −1.6% in girls, and the percentage of accurate predictions was 28.6% and 63.6%, respectively. In boys, the equation resulted in underprediction of TEE among the subjects having low TEE values, whereas there was overprediction among subjects having high TEE values as shown by the Bland-Altman plot. On the contrary, this proportional bias was not observed in girls. CONCLUSIONS The findings of this study suggest that the DRI equation for energy could result in the overestimation of energy requirements in elementary school-age boys. In the case of girls, the equations could be accurate at the group level. However, the DRI appears to be invalid for individual girls, as more than one third of girls had their TEE inaccurately predicted. We recommend more studies for confirmation of these results.
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Affiliation(s)
- Eun-Kyung Kim
- Department of Food and Nutrition, Gangneung-Wonju National University, Gangneung 25457, Korea
| | - Didace Ndahimana
- Department of Food and Nutrition, Gangneung-Wonju National University, Gangneung 25457, Korea
| | - Kazuko Ishikawa-Takata
- Department of Nutrition and Metabolism, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan
| | - Sangjik Lee
- Division of Physical Education, Uiduk University, Gyeongju 38004, Korea
| | - Hyungryul Kim
- Division of Physical Education, Uiduk University, Gyeongju 38004, Korea
| | - Kiwon Lim
- Department of Physical Education, Konkuk University, Seoul 05029, Korea
| | - In-Sook Lee
- Division of Food Service Industry, Uiduk University, Gyeongju 38004, Korea
| | - Shigeho Tanaka
- Department of Nutrition and Metabolism, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan
| | - Ye-Jin Kim
- Department of Food and Nutrition, Gangneung-Wonju National University, Gangneung 25457, Korea
| | - Yeon-Jung Choi
- Department of Food and Nutrition, Gangneung-Wonju National University, Gangneung 25457, Korea
| | - Mun-Jeong Ju
- Department of Food and Nutrition, Gangneung-Wonju National University, Gangneung 25457, Korea
| | - Jonghoon Park
- Department of Physical Education, Korea University, 145 Anam-Ro, Seongbuk-Gu, Seoul 02841, Korea
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281
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Marks J, Sanigorski A, Owen B, McGlashan J, Millar L, Nichols M, Strugnell C, Allender S. Networks for prevention in 19 communities at the start of a large-scale community-based obesity prevention initiative. Transl Behav Med 2018; 8:575-584. [PMID: 30016518 PMCID: PMC6457086 DOI: 10.1093/tbm/iby026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Community-based obesity prevention efforts are dependent on the strength and function of collaborative networks across multiple community members and organizations. There is little empirical work on understanding how community network structure influences obesity prevention capacity. We describe network structures within 19 local government communities prior to a large-scale community-based obesity prevention intervention, Healthy Together Victoria, Australia (2012-2015). Participants were from a large, multi-site, cluster randomized trial (cRCT) of a whole-of-systems chronic disease prevention initiative. Community leaders from 12 intervention and seven comparison (non-intervention) regions identified and described their professional networks in relation to dietary, physical activity, and weight status among young children (<5 years of age). Social network measures of density, modularity, clustering, and centrality were calculated for each community. Comparison of means and tests of association were conducted for each network relationship. One-hundred and seven respondents (78 intervention; 29 comparison) reported on 996 professional network relationships (respondent average per region: 10 intervention; 8 comparison). Networks were typically sparse and highly modular. Networks were heterogeneous in size and relationship composition. Frequency of interaction, close and influential relationships were inversely associated with network density. At baseline in this cRCT there were no significant differences between community network structures of key actors with influence over environments affecting children's diet and physical activity. Tracking heterogeneity in both networks and measured outcomes over time may help explain the interaction between professional networks and intervention effectiveness of community-based obesity prevention.
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Affiliation(s)
- Jennifer Marks
- Deakin University, Geelong Australia, Global Obesity Centre, Centre for Population Health Research
| | - Andrew Sanigorski
- Deakin University, Geelong Australia, Global Obesity Centre, Centre for Population Health Research
| | - Brynle Owen
- Deakin University, Geelong Australia, Global Obesity Centre, Centre for Population Health Research
| | - Jaimie McGlashan
- Deakin University, Geelong Australia, Global Obesity Centre, Centre for Population Health Research
| | - Lynne Millar
- Australian Health Policy Collaboration, Victoria University, Melbourne, Australia
| | - Melanie Nichols
- Deakin University, Geelong Australia, Global Obesity Centre, Centre for Population Health Research
| | - Claudia Strugnell
- Deakin University, Geelong Australia, Global Obesity Centre, Centre for Population Health Research
| | - Steven Allender
- Deakin University, Geelong Australia, Global Obesity Centre, Centre for Population Health Research
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282
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Min J, Tan Z, Abadie L, Townsend S, Xue H, Wang Y. An Evaluation of the Effectiveness of the National Aeronautics and Space Administration Mission-X Child Health Promotion Program in the United States. Am J Health Promot 2018; 32:1333-1339. [PMID: 28901176 PMCID: PMC6749986 DOI: 10.1177/0890117117723959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To examine the effects of the National Aeronautics and Space Administration Mission-X: Train Like an Astronaut program (MX) on children's health-related knowledge and behaviors of a sample of US participants. DESIGN A nonexperimental pilot intervention study in 5 cities with a pre-post comparison of children's health-related knowledge and behaviors in the United States in 2014 and 2015. SAMPLE Children (n = 409) with a mean age (standard deviation) of 10.1 (1.7) years. MEASURES Children answered pre- and postintervention questionnaires. We measured the differences in children's health knowledge on nutrition and physical fitness and behaviors on diet and physical activity as scores. INTERVENTION A 6-week web- and school-based intervention for a healthier lifestyle by introducing physical fitness and science activities based on actual astronaut training under a teacher's supervision. ANALYSIS Nonparametric analysis and logistic regression models. RESULTS Participants significantly improved both of their health behaviors on physical activity ( P < .001) and diet ( P = .06) and their health knowledge regarding nutrition ( P < .001) and physical fitness ( P < .001) after the intervention. The improvement in children's behaviors ( P < .001), knowledge ( P < .001), and the total score ( P < .001) after intervention did not significantly vary by sex or age, after adjusting for year of participation and state of residency. DISCUSSION The MX seems effective in improving health behaviors and health knowledge of participating children, which may serve as a model for sustainable global child health promotion program. Further research is needed to test its long-term effects on child health.
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Affiliation(s)
- Jungwon Min
- Systems-oriented Global Childhood Obesity Intervention Program, Department of Epidemiology and Environmental Health, The State University of New York at Buffalo
- Systems-oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-being, College of Health, Ball State University
| | - Zhengqi Tan
- Systems-oriented Global Childhood Obesity Intervention Program, Department of Epidemiology and Environmental Health, The State University of New York at Buffalo
| | - Laurie Abadie
- Johnson Space Center, Human Research Program, National Aeronautics and Space Administration (NASA)
| | - Scott Townsend
- Johnson Space Center, Human Research Program, National Aeronautics and Space Administration (NASA)
| | - Hong Xue
- Systems-oriented Global Childhood Obesity Intervention Program, Department of Epidemiology and Environmental Health, The State University of New York at Buffalo
- Systems-oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-being, College of Health, Ball State University
| | - Youfa Wang
- Systems-oriented Global Childhood Obesity Intervention Program, Department of Epidemiology and Environmental Health, The State University of New York at Buffalo
- Systems-oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-being, College of Health, Ball State University
- Department of Nutrition and Health Sciences, College of Health, Ball State University
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283
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Abreo A, Gebretsadik T, Stone CA, Hartert TV. The impact of modifiable risk factor reduction on childhood asthma development. Clin Transl Med 2018; 7:15. [PMID: 29892940 PMCID: PMC5995769 DOI: 10.1186/s40169-018-0195-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/04/2018] [Indexed: 01/14/2023] Open
Abstract
Childhood asthma is responsible for significant morbidity and health care expenditures in the United States. The incidence of asthma is greatest in early childhood, and the prevalence is projected to continue rising in the absence of prevention and intervention measures. The prevention of asthma will likely require a multifaceted intervention strategy; however, few randomized controlled trials have assessed such approaches. The purpose of this review was to use previous meta-analyses to identify the most impactful risk factors for asthma development and evaluate the effect of risk factor reduction on future childhood asthma prevalence. Common and modifiable risk factors with large effects included acute viral respiratory infections, antibiotic use, birth by cesarean section, nutritional disorders (overweight, obesity), second hand smoke exposure, allergen sensitization, breastfeeding, and sufficient prenatal vitamin D level. Evaluation and estimates of risk factor modification on populations at risk should guide scientists and policymakers toward high impact areas that are apt for additional study and intervention.
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Affiliation(s)
- Andrew Abreo
- Department of Medicine, Center for Asthma Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tebeb Gebretsadik
- Department of Biostatistics, Center for Asthma Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cosby A Stone
- Department of Medicine, Center for Asthma Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tina V Hartert
- Department of Medicine, Center for Asthma Research, Vanderbilt University Medical Center, Nashville, TN, USA.
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284
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Marks J, Barnett LM, Allender S. Is school community perception of student weight status a barrier for addressing childhood obesity? Health Promot J Austr 2018; 30:28-36. [PMID: 29729211 DOI: 10.1002/hpja.172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 04/20/2018] [Indexed: 11/08/2022] Open
Abstract
ISSUE ADDRESSED Schools are a target for childhood obesity prevention strategies, yet intervention effectiveness may be hindered by school community perceptions (staff and students) and readiness to address the problem. We firstly describe students' perception of their own weight status. Secondly, we describe school staff perceptions and preparedness to address childhood obesity in their school. METHODS Measured and self-report weight status were collected simultaneously from 11- to 14-year-old students (N = 339/733; RR 46%) recruited from 42 schools in Victoria, Australia. Student objective weight status was compared to self-report. School community readiness to address childhood obesity data was collected from staff (N = 114) at all participating schools. School readiness survey data were scored and descriptive analyses conducted for further insight of derived readiness scores. RESULTS Using objective assessment, 18% (n = 62) of students were obese, but only 4% (n = 12) accurately identified themselves as obese. School communities were concerned about the problem of childhood obesity in general, yet were assessed at low stages of readiness to take action within their community. Descriptive data identified a strong focus on promoting healthy eating and physical activity through education. Further efforts to target childhood obesity appeared to be hindered by limited support, resources and engagement with the broader community. CONCLUSION Perceptions of childhood obesity prevalence, low stages of readiness and limited school capacity may hinder prevention strategies. SO WHAT?: Perceptions of what is normal weight may have implications for prevention. Efforts must be informed by accurate weight data and require a broader community approach beyond the school environment.
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Affiliation(s)
- Jennifer Marks
- Global Obesity Centre, Deakin University, Geelong, Vic., Australia.,School of Health and Social Development, Deakin University, Geelong, Vic., Australia
| | - Lisa M Barnett
- School of Health and Social Development, Deakin University, Geelong, Vic., Australia
| | - Steven Allender
- Global Obesity Centre, Deakin University, Geelong, Vic., Australia.,School of Health and Social Development, Deakin University, Geelong, Vic., Australia
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285
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Trude ACB, Kharmats AY, Jones-Smith JC, Gittelsohn J. Exposure to a multi-level multi-component childhood obesity prevention community-randomized controlled trial: patterns, determinants, and implications. Trials 2018; 19:287. [PMID: 29788977 PMCID: PMC5964684 DOI: 10.1186/s13063-018-2663-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 05/03/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND For community interventions to be effective in real-world conditions, participants need to have sufficient exposure to the intervention. It is unclear how the dose and intensity of the intervention differ among study participants in low-income areas. We aimed to understand patterns of exposure to different components of a multi-level multi-component obesity prevention program to inform our future impact analyses. METHODS B'more Healthy Communities for Kids (BHCK) was a community-randomized controlled trial implemented in 28 low-income zones in Baltimore in two rounds (waves). Exposure to three different intervention components (corner store/carryout restaurants, social media/text messaging, and youth-led nutrition education) was assessed via post-intervention interviews with 385 low-income urban youths and their caregivers. Exposure scores were generated based on self-reported viewing of BHCK materials (posters, handouts, educational displays, and social media posts) and participating in activities, including taste tests during the intervention. For each intervention component, points were assigned for exposure to study materials and activities, then scaled (0-1 range), yielding an overall BHCK exposure score [youths: mean 1.1 (range 0-7.6 points); caregivers: 1.1 (0-6.7), possible highest score: 13]. Ordered logit regression analyses were used to investigate correlates of youths' and caregivers' exposure level (quartile of exposure). RESULTS Mean intervention exposure scores were significantly higher for intervention than comparison youths (mean 1.6 vs 0.5, p < 0.001) and caregivers (mean 1.6 vs 0.6, p < 0.001). However, exposure scores were low in both groups and 10% of the comparison group was moderately exposed to the intervention. For each 1-year increase in age, there was a 33% lower odds of being highly exposed to the intervention (odds ratio 0.77, 95% confidence interval 0.69; 0.88) in the unadjusted and adjusted model controlling for youths' sex and household income. CONCLUSION Treatment effects may be attenuated in community-based trials, as participants may be differentially exposed to intervention components and the comparison group may also be exposed. Exposure should be measured to provide context to impact evaluations in multi-level trials. Future analyses linking exposure scores to the outcome should control for potential confounders in the treatment-on-the-treated approach, while recognizing that confounding and selection bias may exist affecting causal inference. TRIAL REGISTRATION ClinicalTrials.gov, NCT02181010 . Retrospectively registered on 2 July 2014.
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Affiliation(s)
- Angela Cristina Bizzotto Trude
- Global Obesity Prevention Center and Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Anna Yevgenyevna Kharmats
- Global Obesity Prevention Center and Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Jessica C Jones-Smith
- Nutritional Sciences Program, University of Washington School of Public Health University of Washington, 353410, 306B Raitt Hall, Seattle, WA, USA
| | - Joel Gittelsohn
- Global Obesity Prevention Center and Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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286
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Improving Physical Fitness and Cognitive Functions in Middle School Students: Study Protocol for the Chinese Childhood Health, Activity and Motor Performance Study (Chinese CHAMPS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15050976. [PMID: 29757933 PMCID: PMC5982015 DOI: 10.3390/ijerph15050976] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/23/2018] [Accepted: 05/09/2018] [Indexed: 11/17/2022]
Abstract
Background: Sedentary lifestyles and their associated harmful consequences are public health concerns that impact more than half of the world’s youth population in both developed and developing countries. Methods: The Chinese Childhood Health; Activity and Motor Performance Study (Chinese CHAMPS) was a cluster randomized controlled trial to modify school physical activity policies and the physical education (PE) curriculum; using teacher training and parent engagement to increase opportunities and support students’ physical activity and healthy eating. Using a 2 × 2 factorial design, the study tested the incremental effects of increasing the amount and intensity of physical activity, alongside adding support for healthy eating, on health-related and cognitive function outcomes in Chinese middle school students. Results: The intervention was implemented by PE teachers in 12 middle schools in three Chinese cities, with a targeted enrollment of 650 students from August 2015–June 2016. The assessment of the outcomes involved a test battery of physical fitness and cognitive functioning at both baseline and at the end of the intervention. Process information on implementation was also collected. Discussion: The Chinese CHAMPS is a multi-level intervention that is designed to test the influences of policy and environmental modifications on the physical activity and eating behaviors of middle school students. It also addresses some key weaknesses in school-based physical activity interventions.
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287
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Tarp J, Jespersen E, Møller NC, Klakk H, Wessner B, Wedderkopp N, Bugge A. Long-term follow-up on biological risk factors, adiposity, and cardiorespiratory fitness development in a physical education intervention: a natural experiment (CHAMPS-study DK). BMC Public Health 2018; 18:605. [PMID: 29739385 PMCID: PMC5941623 DOI: 10.1186/s12889-018-5524-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 04/27/2018] [Indexed: 12/18/2022] Open
Abstract
Background Schools are a key setting for large-scale primordial non-communicable disease prevention in young people, but little data on sustainability of impacts on cardiometabolic risk markers is available. Methods Six and a half year follow-up of a natural experiment. In 2008, six public schools in the municipality of Svendborg (Denmark) augmented their curricular physical education (intervention) and four matched schools served as controls. At long term follow up in 2015 n = 312 participants aged 5–11 years had complete data (33% of children providing necessary baseline data). The intervention, that consisted of a trebling of weekly physical education lessons and courses provided to physical education teachers, was provided at intervention schools up until 6th grade. Participants attended 6th to 10th grade at follow-up. Differences in the homeostasis model assessment of insulin resistance, blood pressure, triglycerides, cholesterol ratios, cardiorespiratory fitness, waist-circumference, and a composite score of these, between participants attending intervention and control schools were analysed by mixed linear regression models. Differences in physical activity at follow-up was analysed cross-sectionally (no baseline available) in n = 495. Results Compared to controls, children at intervention schools had a non-significant − 0.07 (− 0.32 to 0.18) standard deviations lower composite risk score 6.5 years after project initiation. Likewise, no statistically significant differences between intervention and control schools were found for any of the other outcomes (p-values ≥ 0.41). However, six of seven outcomes were in a direction favouring intervention schools. No statistically significant differences between intervention and control schools were observed for physical activity outcomes (p-values ≥ 0.13). Conclusions An augmented physical activity program including 270 min of weekly physical education provided for three to seven years did not materialize in statistically significant differences in established risk markers in children from intervention compared to control schools. As the intervention was discontinued after 6th grade, the post-intervention effect of augmented physical education throughout adolescence is unknown. School-based physical activity programs may benefit from incorporating instruments for behaviour translation to leisure time in their intervention models to increase the probability of achieving public health relevance. Trial registration ClinicalTrials.gov Identifier: NCT03510494. Electronic supplementary material The online version of this article (10.1186/s12889-018-5524-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jakob Tarp
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Eva Jespersen
- Department of Rehabilitation, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Niels Christian Møller
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Heidi Klakk
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,University College Lillebælt, Odense, Denmark
| | - Barbara Wessner
- Centre for Sport Science and University Sports, Department of Sports and Exercise Physiology, University of Vienna, Vienna, Austria
| | - Niels Wedderkopp
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,Sports Medicine Clinic, The Orthopedic Department, Hospital of Lillebaelt Middelfart, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anna Bugge
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
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288
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Brewis AA, Bruening M. Weight Shame, Social Connection, and Depressive Symptoms in Late Adolescence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15050891. [PMID: 29723962 PMCID: PMC5981930 DOI: 10.3390/ijerph15050891] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 04/18/2018] [Accepted: 04/28/2018] [Indexed: 12/24/2022]
Abstract
Child and adolescent obesity is increasingly the focus of interventions, because it predicts serious disease morbidity later in life. However, social environments that permit weight-related stigma and body shame may make weight control and loss more difficult. Rarely do youth obesity interventions address these complexities. Drawing on repeated measures in a large sample (N = 1443) of first-year (freshman), campus-resident university students across a nine-month period, we model how weight-related shame predicts depressive symptom levels, how being overweight (assessed by anthropometric measures) shapes that risk, and how social connection (openness to friendship) might mediate/moderate. Body shame directly, clearly, and repeatedly predicts depression symptom levels across the whole school year for all students, but overweight youth have significantly elevated risk. Social connections mediate earlier in the school year, and in all phases moderate, body shame effects on depression. Youth obesity interventions would be well-served recognizing and incorporating the influential roles of social-environmental factors like weight stigma and friendship in program design.
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Affiliation(s)
- Alexandra A Brewis
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ 85284-2402, USA.
| | - Meg Bruening
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ 85004, USA.
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289
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A Community-Level Initiative to Prevent Obesity: Results From Kaiser Permanente's Healthy Eating Active Living Zones Initiative in California. Am J Prev Med 2018; 54:S150-S159. [PMID: 29680115 DOI: 10.1016/j.amepre.2018.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/03/2018] [Accepted: 01/22/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION A growing number of health systems are leading health promotion efforts in their wider communities. What impact are these efforts having on health behaviors and ultimately health status? This paper presents evaluation results from the place-based Kaiser Permanente Healthy Eating Active Living Zones obesity prevention initiative, implemented in 2011-2015 in 12 low-income communities in Kaiser Permanente's Northern and Southern California Regions. METHODS The Healthy Eating Active Living Zones design targeted places and people through policy, environmental, and programmatic strategies. Each Healthy Eating Active Living Zone is a small, low-income community of 10,000 to 20,000 residents with high obesity rates and other health disparities. Community coalitions planned and implemented strategies in each community. A population-dose approach and pre and post surveys were used to assess impact of policy, program, and environmental change strategies; the analysis was conducted in 2016. Population dose is the product of reach (number of people affected by a strategy divided by target population size) and strength (the effect size or relative change in behavior for each person exposed to the strategy). RESULTS More than 230 community change strategies were implemented over 3 years, encompassing policy, environmental, and programmatic changes as well as efforts to build community capacity to sustain strategies and make changes in the future. Positive population-level results were seen for higher-dose strategies, particularly those targeting youth physical activity. Higher-dose strategies were more likely to be found in communities with the longest duration of investment. CONCLUSIONS These results demonstrate that strong (high-dose), community-based obesity prevention strategies can lead to improved health behaviors, particularly among youth in school settings. SUPPLEMENT INFORMATION This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health.
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290
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Leme ACB, Thompson D, Lenz Dunker KL, Nicklas T, Tucunduva Philippi S, Lopez T, Vézina-Im LA, Baranowski T. Obesity and eating disorders in integrative prevention programmes for adolescents: protocol for a systematic review and meta-analysis. BMJ Open 2018; 8:e020381. [PMID: 29674372 PMCID: PMC5914714 DOI: 10.1136/bmjopen-2017-020381] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Obesity and eating disorders are public health problems that have lifelong financial and personal costs and common risk factors, for example, body dissatisfaction, weight teasing and disordered eating. Obesity prevention interventions might lead to the development of an eating disorder since focusing on weight may contribute to excessive concern with diet and weight. Therefore, the proposed research will assess whether integrating obesity and eating disorder prevention procedures ('integrated approach') do better than single approach interventions in preventing obesity among adolescents, and if integrated approaches influence weight-related outcomes. METHODS AND ANALYSIS Integrated obesity and eating disorder prevention interventions will be identified. Randomised controlled trials and quasi-experimental trials reporting data on adolescents ranging from 10 to 19 years of age from both sexes will be included. Outcomes of interest include body composition, unhealthy weight control behaviours and body satisfaction measurements. MEDLINE/PubMed, PsycINFO, Web of Science and SciELO will be searched. Data will be extracted independently by two reviewers using a standardised data extraction form. Trial quality will be assessed using the Cochrane Collaboration criteria. The effects of integrated versus single approach intervention studies will be compared using systematic review procedures. If an adequate number of studies report data on integrated interventions among similar populations (k>5), a meta-analysis with random effects will be conducted. Sensitivity analyses and meta-regression will be performed only if between-study heterogeneity is high (I2 ≥75%). ETHICS AND DISSEMINATION Ethics approval will not be required as this is a systematic review of published studies. The findings will be disseminated through conference presentations and peer-reviewed journals.
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Affiliation(s)
| | - Debbe Thompson
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA
| | | | - Theresa Nicklas
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA
| | | | - Tabbetha Lopez
- Department of Health and Human Performance, College of Liberal Arts and Social Sciences, University of Houston, Houston, Texas, USA
| | - Lydi-Anne Vézina-Im
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA
| | - Tom Baranowski
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA
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291
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Myers ML, Fulkerson JA, Friend SE, Horning ML, Flattum CF. Case study: Behavior changes in the family-focused obesity prevention HOME Plus program. Public Health Nurs 2018; 35:299-306. [PMID: 29624720 DOI: 10.1111/phn.12403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this case study is to describe two successful HOME Plus participants and highlight how an intervention with individual and group components can help families make lifestyle changes that result in improvements in child weight status. DESIGN One hundred and sixty families participated in the HOME Plus study, and were randomized to either a control or intervention group. SAMPLE Two successful HOME Plus participants were chosen because of their healthful changes in weight status and behavior and high engagement in the program. MEASUREMENTS Data were collected at baseline and postintervention, 1 year later. Data included height, weight, home food inventory, dietary recalls, and psychosocial surveys. INTERVENTION Families in the intervention group participated in cooking and nutrition education sessions, goal-setting activities, and motivational interviewing telephone calls to promote behavioral goals associated with meal planning, family meal frequency, and healthfulness of meals and snacks. RESULTS Analysis of the families' behaviors showed that Oliver (fictitious name) experienced changes in nutritional knowledge and cooking skill development while Sophia's (fictitious name) changes were associated with healthful food availability and increased family meal frequency. CONCLUSION These cases show that offering a multicomponent, family-focused program allows participants to select behavior strategies to fit their unique family needs.
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Affiliation(s)
- Michelle L Myers
- School of Nursing, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Jayne A Fulkerson
- School of Nursing, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Sarah E Friend
- School of Nursing, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Melissa L Horning
- School of Nursing, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Colleen F Flattum
- School of Nursing, University of Minnesota Twin Cities, Minneapolis, MN, USA.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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292
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Zanganeh M, Adab P, Li B, Frew E. Protocol for a systematic review of methods and cost-effectiveness findings of economic evaluations of obesity prevention and/or treatment interventions in children and adolescents. Syst Rev 2018; 7:54. [PMID: 29609652 PMCID: PMC5879570 DOI: 10.1186/s13643-018-0718-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 03/22/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Childhood obesity is a major global public health problem, with governments increasingly having to undertake various strategies to reduce excess weight in their populations. Considering the increasing number of well-conducted intervention studies in the field of childhood obesity prevention, there are relatively few published economic evaluations. The proposed systematic review will explore the methods of these economic evaluations, examine the limitations and establish the evidence base for cost-effectiveness analyses. METHODS/DESIGN Systematic review methodology will be applied to identify, select and extract data from published economic evaluation studies (trial-based, non-trial based, simulation-based, decision model and trial based model economic evaluations) of obesity prevention and/or treatment interventions in children and adolescents. A systematic literature search will be conducted using bibliographic databases (MEDLINE, EMBASE, CINAHL, Web of Science, EconLit, PsycINFO, Cochrane Library, Centre for Reviews and Dissemination (CRD) and Cost-Effectiveness Analysis (CEA) Registry). The review will only include full economic evaluations. There will be no restrictions based on language, perspective, follow-up duration, sample size, country or setting. To minimise selection bias, translation of non-English language articles will be undertaken. The quality of included studies will be assessed. Following data extraction, a narrative synthesis of the results from the included studies will be undertaken. Subgroup analysis will be considered where deemed appropriate. DISCUSSION The findings from this review, which will include primary studies, will provide evidence to assist health policy decision makers interpret economic evaluations in this field. In addition, we will identify gaps in the current literature to inform future-related research. SYSTEMATIC REVIEW REGISTRATION Prospero CRD42017062236.
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Affiliation(s)
- Mandana Zanganeh
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Peymane Adab
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Bai Li
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Emma Frew
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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293
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Bleich SN, Vercammen KA, Zatz LY, Frelier JM, Ebbeling CB, Peeters A. Interventions to prevent global childhood overweight and obesity: a systematic review. Lancet Diabetes Endocrinol 2018; 6:332-346. [PMID: 29066096 DOI: 10.1016/s2213-8587(17)30358-3] [Citation(s) in RCA: 230] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/20/2017] [Accepted: 09/26/2017] [Indexed: 12/31/2022]
Abstract
In view of the prevalence, health consequences, and costs of childhood obesity, there has been substantial interest in identifying effective interventions to prevent excess weight gain in young people. In this systematic review, we expand on previous reviews of obesity prevention interventions by including recent studies (until May 23, 2017) from all parts of the world. We searched MEDLINE, Embase, CINAHL Plus, Web of Science, CAB Abstracts, and PAIS Index and included randomised controlled trials, quasi-experimental studies, or natural experiments with: (1) a control group; (2) minimum follow-up of 12 months for community-based and home-based interventions or 6 months for school-based and preschool-based interventions; and (3) a primary outcome of BMI, BMI Z score, BMI percentile, body fat percentage, skinfold thickness, waist circumference, or prevalence of overweight or obesity. School-based interventions with combined diet and physical activity components and a home element (n=41) had greatest effectiveness; evidence in support of the effect of preschool-based (n=6), community-based (n=7), and home-based (n=2) interventions was limited by a paucity of studies and heterogeneity in study design. The effectiveness of school-based interventions that combined diet and physical activity components suggests that they hold promise for childhood obesity prevention worldwide. More research with rigorous evaluation and consistent reporting is needed in non-school settings and in combinations of settings.
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Affiliation(s)
- Sara N Bleich
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Kelsey A Vercammen
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Laura Y Zatz
- Department of Nutrition and Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Johannah M Frelier
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Cara B Ebbeling
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA
| | - Anna Peeters
- School of Health and Social Development, Deakin University, Burwood, VIC, Australia
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294
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Otterbach L, Mena NZ, Greene G, Redding CA, De Groot A, Tovar A. Community-based childhood obesity prevention intervention for parents improves health behaviors and food parenting practices among Hispanic, low-income parents. BMC OBESITY 2018; 5:11. [PMID: 29610670 PMCID: PMC5870387 DOI: 10.1186/s40608-018-0188-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/15/2018] [Indexed: 12/14/2022]
Abstract
Background Given the current prevalence of childhood obesity among Hispanic populations, and the importance of parental feeding behaviors, we aimed to assess the impact of the evidence-based Healthy Children, Healthy Families (HCHF) intervention on responsive food parenting practices (FPPs) in a low-income Hispanic population. Methods This community-based pilot study used a non-experimental pre/post within-subjects design. Parents (n = 94) of children aged 3-11 years old were recruited to participate in an 8-week, weekly group-based intervention. The intervention was delivered to nine groups of parents by trained paraprofessional educators over a two-year period. Children participated in a separate curriculum that covered topics similar to those covered in the parent intervention. Parents completed self-administered pre/post surveys, which included demographic questions, seven subscales from the Comprehensive Feeding Practices Questionnaire, and the 16-item HCHF Behavior Checklist. Descriptive statistics and paired samples t-tests were used to analyze data from parents that completed the intervention. Results Fifty-two, primarily Hispanic (93%) parents completed the intervention (39% attrition rate). For parents who completed the intervention, there was a significant increase in one of the feeding practice subscales: encouragement of balance and variety (p = 0.01). There were significant improvements in several parent and child diet and activity outcomes (p ≤ 0.01). Conclusions Although attrition rates were high, parents completing the study reported enjoying and being satisfied with the intervention. For parents who completed the intervention, reported 'encouragement of balance and variety', in addition to several health behaviors significantly improved. Larger studies utilizing an experimental design, should further explore the impact of the HCHF curriculum on improving certain FPPs and health behaviors that contribute to obesity.
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Affiliation(s)
- Laura Otterbach
- 1Department of Nutrition and Food Sciences, University of Rhode Island, Fogarty Hall, 41 Lower College Rd, Kingston, RI 02881 USA
| | - Noereem Z Mena
- 1Department of Nutrition and Food Sciences, University of Rhode Island, Fogarty Hall, 41 Lower College Rd, Kingston, RI 02881 USA
| | - Geoffrey Greene
- 1Department of Nutrition and Food Sciences, University of Rhode Island, Fogarty Hall, 41 Lower College Rd, Kingston, RI 02881 USA
| | - Colleen A Redding
- 2Cancer Prevention Research Center and Department of Psychology, University of Rhode Island, Chafee Hall, 142 Flagg Road, Kingston, RI 02881 USA
| | - Annie De Groot
- 3Institute for Immunology and Informatics, University of Rhode Island, Shepard Building, 80 Washington Street, Providence, RI 02903 USA
| | - Alison Tovar
- 1Department of Nutrition and Food Sciences, University of Rhode Island, Fogarty Hall, 41 Lower College Rd, Kingston, RI 02881 USA
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295
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Prabhakaran D, Anand S, Watkins D, Gaziano T, Wu Y, Mbanya JC, Nugent R. Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition. Lancet 2018; 391:1224-1236. [PMID: 29108723 PMCID: PMC5996970 DOI: 10.1016/s0140-6736(17)32471-6] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 08/04/2017] [Accepted: 09/05/2017] [Indexed: 12/11/2022]
Abstract
Cardiovascular, respiratory, and related disorders (CVRDs) are the leading causes of adult death worldwide, and substantial inequalities in care of patients with CVRDs exist between countries of high income and countries of low and middle income. Based on current trends, the UN Sustainable Development Goal to reduce premature mortality due to CVRDs by a third by 2030 will be challenging for many countries of low and middle income. We did systematic literature reviews of effectiveness and cost-effectiveness to identify priority interventions. We summarise the key findings and present a costed essential package of interventions to reduce risk of and manage CVRDs. On a population level, we recommend tobacco taxation, bans on trans fats, and compulsory reduction of salt in manufactured food products. We suggest primary health services be strengthened through the establishment of locally endorsed guidelines and ensured availability of essential medications. The policy interventions and health service delivery package we suggest could serve as the cornerstone for the management of CVRDs, and afford substantial financial risk protection for vulnerable households. We estimate that full implementation of the essential package would cost an additional US$21 per person in the average low-income country and $24 in the average lower-middle-income country. The essential package we describe could be a starting place for low-income and middle-income countries developing universal health coverage packages. Interventions could be rolled out as disease burden demands and budgets allow. Our outlined interventions provide a pathway for countries attempting to convert the UN Sustainable Development Goal commitments into tangible action.
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Affiliation(s)
- Dorairaj Prabhakaran
- Public Health Foundation of India, Gurgaon, India; Centre for Chronic Disease Control, New Delhi, India; Department of Non-communicable Disease Epidemiology, London School of Hygiene Tropical Medicine, London, UK; Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Shuchi Anand
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - David Watkins
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Thomas Gaziano
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Center for Health Decision Science, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Yangfeng Wu
- The George Institute for Global Health, Peking University Health Science Center, Beijing, China
| | - Jean Claude Mbanya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
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296
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Weisman A, Fazli GS, Johns A, Booth GL. Evolving Trends in the Epidemiology, Risk Factors, and Prevention of Type 2 Diabetes: A Review. Can J Cardiol 2018; 34:552-564. [PMID: 29731019 DOI: 10.1016/j.cjca.2018.03.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 03/08/2018] [Accepted: 03/08/2018] [Indexed: 02/07/2023] Open
Abstract
Currently, the global prevalence of diabetes is 8.8%. This figure is expected to increase worldwide, with the largest changes projected to occur in low- and middle-income countries. The aging of the world's population and substantial increases in obesity have contributed to the rise in diabetes. Global shifts in lifestyles have led to the adoption of unhealthy behaviours such as physical inactivity and poorer-quality diets. Correspondingly, diabetes is a rapidly-increasing problem in higher- as well as lower-income countries. In Canada, the prevalence of diabetes increased approximately 70% in the past decade. Although diabetes-related mortality rates have decreased in Canada, the number of people affected by diabetes has continued to grow because of a surge in the number of new diabetes cases. Non-European ethnic groups and individuals of lower socioeconomic status have been disproportionately affected by diabetes and its risk factors. Clinical trials have proven efficacy in reducing the onset of diabetes in high-risk populations through diet and physical activity interventions. However, these findings have not been broadly implemented into the Canadian health care context. In this article we review the evolving epidemiology of type 2 diabetes, with regard to trends in occurrence rates and prevalence; the role of risk factors including those related to ethnicity, obesity, diet, physical activity, socioeconomic status, prediabetes, and pregnancy; and the identification of critical windows for lifestyle intervention. Identifying high-risk populations and addressing the upstream determinants and risk factors of diabetes might prove to be effective diabetes prevention strategies to curb the current diabetes epidemic.
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Affiliation(s)
- Alanna Weisman
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ghazal S Fazli
- The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Ashley Johns
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Gillian L Booth
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada.
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297
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Arabin B, Timmesfeld N, Noever K, Behnam S, Ellermann C, Jenny MA. How to improve health literacy to reduce short- and long-term consequences of maternal obesity? J Matern Fetal Neonatal Med 2018. [PMID: 29514529 DOI: 10.1080/14767058.2018.1450383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aim: To demonstrate the global challenge of maternal obesity and to propose models to increase awareness and health literacy. Methods: The regional perinatal data base and the international literature were reviewed to demonstrate the rising rates of maternal overweight and obesity causing major public health problems in low and high-resourced countries. A preliminary systematic review analyzing interventions in maternal obesity and a fact box based on a recent Cochrane review on dietary interventions were performed. Results: Between 2000 and 2015, the regional rates of maternal overweight and obesity have significantly increased, and the rate of morbid maternal obesity has even doubled. Pregnant women were insufficiently informed about the health risks and international recommendations for weight gain associated with pre-pregnancy body mass index. Scientific publications and guidelines of professional boards have not yet interrupted the vicious cycle of transgenerational transfer of associated health risks for the offspring. For the first time we propose a fact box to translate the results from a Cochrane review about dietary interventions into a transparent information for health care providers and patients which could help to improve awareness. Conclusions: Improving health literacy and translating clinical science into models which are understandable by policy makers, health care providers and parents is a challenge mainly if health risks are modifiable during gestation and could prevent the increasing burden of obesity for future societies.
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Affiliation(s)
- Birgit Arabin
- a Center for Mother and Child , Philipps University Marburg , Marburg , Germany.,b Clara Angela Foundation , Witten , Germany
| | - Nina Timmesfeld
- c Department of Medical Biometry , Philipps University Marburg , Marburg , Germany
| | - Kathrin Noever
- a Center for Mother and Child , Philipps University Marburg , Marburg , Germany.,b Clara Angela Foundation , Witten , Germany
| | - Susann Behnam
- a Center for Mother and Child , Philipps University Marburg , Marburg , Germany.,b Clara Angela Foundation , Witten , Germany
| | - Christin Ellermann
- d Harding Center for Risk Literacy , Max Planck Institute for Human Development , Berlin , Germany
| | - Mirjam A Jenny
- d Harding Center for Risk Literacy , Max Planck Institute for Human Development , Berlin , Germany
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298
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Mustila T, Raitanen J, Keskinen P, Luoto R. A pragmatic controlled trial to prevent childhood obesity within a risk group at maternity and child health-care clinics: results up to six years of age (the VACOPP study). BMC Pediatr 2018; 18:89. [PMID: 29486763 PMCID: PMC5828437 DOI: 10.1186/s12887-018-1065-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 02/15/2018] [Indexed: 02/02/2023] Open
Abstract
Background Obesity in childhood appears often during the toddler years. The prenatal environment influences obesity risk. Maternal gestational diabetes, the child’s diet, and physical activity in the first few years have an important role in subsequent weight gain. A study was conducted to evaluate effectiveness of a primary health-care lifestyle counselling intervention in prevention of childhood obesity up to 6 years of age. Methods The study was a controlled pragmatic trial to prevent childhood obesity and was implemented at maternity and child health-care clinics. The participants (n = 185) were mothers at risk of gestational diabetes mellitus with their offspring born between 2008 and 2010. The prenatal intervention, started at the end of the first trimester of pregnancy, consisted of counselling on diet and physical activity by municipal health-care staff. The intervention continued at yearly appointments with a public health-nurse at child health-care clinics. The paper reports the offspring weight gain results for 2–6 years of age. Weight gain up to 6 years of age was assessed as BMI standard deviation scores (SDS) via a mixed-effect linear regression model. The proportion of children at 6 years with overweight/obesity was assessed as weight-for-height percentage and ISO-BMI. Priority was not given to power calculations, because of the study’s pragmatic nature. Results One hundred forty seven children’s (control n = 76/85% and intervention n = 71/56%) weight and height scores were available for analysis at 6 years of age. There was no significant difference in weight gain or overweight/obesity proportions between the groups at 6 years of age, but the proportion of children with obesity in both groups was high (assessed as ISO-BMI 9.9% and 11.8%) relative to prevalence in this age group in Finland. Conclusion As the authors previously reported, the intervention-group mothers had lower prevalence of gestational diabetes mellitus, but a decrease in obesity incidence before school age among their offspring was not found. The authors believe that an effective intervention should start before conception, continuing during pregnancy and the postpartum period through the developmentally unique child’s first years. Trial registration ClinicalTrials.gov NCT00970710. Registered 1 September 2009. Retrospectively registered.
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Affiliation(s)
- Taina Mustila
- Seinäjoki Central Hospital, Hanneksenrinne 7, 60220, Seinäjoki, Finland.
| | - Jani Raitanen
- UKK Institute for Health Promotion, Tampere, Finland.,Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Päivi Keskinen
- Pediatric Research Centre, 33014 University of Tampere, Tampere, Finland.,Tampere University Hospital, 33521, Tampere, Finland
| | - Riitta Luoto
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
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299
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Ling J, Stommel M. Parental and Self-Weight Perceptions in U.S. Children and Adolescents, NHANES 2005-2014. West J Nurs Res 2018; 41:42-57. [DOI: 10.1177/0193945918758274] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to describe the parental and child self-weight perceptions and their associated sociodemographic factors. The 2005-2014 National Health and Nutrition Examination Survey (NHANES) sample of 16,869 children aged 2 to 17 years was used. For overweight/obese children aged 2 to 15 years, 61.2% of parents underestimated their child’s weight. For overweight/obese children aged 8 to 17 years, 55.2% underestimated their own weight. For children aged 8 to 15 years, 77.8% parents and children agreed on the weight classification. Parents of boys and those with low income were more likely to underestimate their child’s weight. Girls, older children, and those living in larger or high-income families were less likely to underestimate their own weight. Hispanic and Black children tended to underestimate their weight. With increasing child age, parents and children were more likely to disagree on the child’s weight. Future efforts should focus on low-income families with larger number of children and Hispanic and Black young children who were more likely to underestimate their weight.
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Affiliation(s)
- Jiying Ling
- Michigan State University, East Lansing, MI, USA
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300
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García-Hermoso A, Saavedra JM, Escalante Y, Domínguez AM. The Intention to be Physically Active in Sedentary Obese Children: A Longitudinal Study. Behav Sci (Basel) 2018; 8:bs8010009. [PMID: 29324710 PMCID: PMC5791027 DOI: 10.3390/bs8010009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/06/2018] [Accepted: 01/09/2018] [Indexed: 11/16/2022] Open
Abstract
Obese children are usually less active than their normal-weight counterparts, although the reasons for this remain unclear. The objective of the present study was to determine how a long-term program (3 years of intervention and 6 months of follow-up detraining) of physical exercise with or without a low calorie diet influenced sedentary obese children’s intention to be physically active. The participants were 27 children, ages from 8 to 11 years, who formed two groups according to the program that they followed. One group followed an exercise program (three 90-min sessions per week), and the other this same exercise program together with a hypocaloric diet. The intention to be physically active was assessed via the Measurement of Intention to be Physically Active (MIFA) questionnaire. The subjects’ scores at different times of the program (baseline, Year 3, and detraining) were compared using a repeated-measures ANOVA, and a post-hoc Tukey’s test was applied to confirm the differences. After both the intervention and detraining, both groups showed greater intention to be physically active. This suggests the suitability of long-term physical exercise to generate greater intention to be physically active and thus establish healthy life habits including increased levels of physical activity.
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Affiliation(s)
- Antonio García-Hermoso
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago de Chile 81583799, Chile.
| | - Jose M Saavedra
- Physical Activity, Physical Education, Health and Sport Research Centre (PAPESH), Sports Science Department, School of Science and Engineering, Reykjavik University, 101 Reykjavik, Iceland.
| | | | - Ana M Domínguez
- Real Federación Española de Salvamento y Socorrismo, 28703 Madrid, Spain.
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