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Cheng ER, Moore C, Parks L, Taveras EM, Wiehe SE, Carroll AE. Human-centered designed communication tools for obesity prevention in early life. Prev Med Rep 2023; 35:102333. [PMID: 37564121 PMCID: PMC10410241 DOI: 10.1016/j.pmedr.2023.102333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/12/2023] Open
Abstract
Objective How we communicate about obesity is critical as treatment paradigms shift upstream. We previously identified parental perceptions, concerns, beliefs, and communication preferences about early life obesity risk. We engaged parents of children 0 to 24 months of age and pediatricians from Indianapolis, Indiana, USA in the co-design of messages and tools that can be used to facilitate parent/provider conversations about early life obesity prevention. Methods From April to June 2021, we conducted a series of co-design workshops with parents of children ages 0 to 24 months and pediatricians to identify their preferences for communicating obesity prevention in the setting of a pediatric well visit. Human-centered design techniques, including affinity diagraming and model building, were used to inform key elements of a communication model and communication strategy messages. These elements were combined and refined to create prototype tools that were subsequently refined using stakeholder feedback. Results Parent participants included 11 mothers and 2 fathers: 8 white, 4 black, and 1 Asian; median age 33 years with 38% reporting annual household incomes less than $50,000. Pediatricians included 7 female and 6 male providers; 69% white. Through an iterative process of co-design, we created an exam room poster that addresses common misconceptions about infant feeding, sleep and exercise, and a behavior change plan to foster parent/provider collaboration focused on achieving children's healthy weight. Conclusions Our hands-on, collaborative approach may ultimately improve uptake, acceptability and usability of early life obesity interventions by ensuring that parents remain at the center of prevention efforts.
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Affiliation(s)
- Erika R. Cheng
- Indiana University School of Medicine, Department of Pediatrics, Division of Children’s Health Services Research, 410 W. 10 St., Suite 2000, Indianapolis, IN 46220, United States
| | - Courtney Moore
- Indiana Clinical & Translational Sciences Institute (CTSI), Research Jam, 410 W. 10 St., Suite 1000, Indianapolis, IN 46220, United States
| | - Lisa Parks
- Indiana Clinical & Translational Sciences Institute (CTSI), Research Jam, 410 W. 10 St., Suite 1000, Indianapolis, IN 46220, United States
| | - Elsie M. Taveras
- Kraft Center for Community Health, Massachusetts General Hospital, 125 Nashua St., Boston, MA 02114, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Ave., Boston, MA 02115, United States
| | - Sarah E. Wiehe
- Indiana University School of Medicine, Department of Pediatrics, Division of Children’s Health Services Research, 410 W. 10 St., Suite 2000, Indianapolis, IN 46220, United States
- Indiana Clinical & Translational Sciences Institute (CTSI), Research Jam, 410 W. 10 St., Suite 1000, Indianapolis, IN 46220, United States
| | - Aaron E. Carroll
- Indiana University School of Medicine, Department of Pediatrics, Center for Pediatric and Adolescent Comparative and Effectiveness Research, 410 W. 10th St., Suite 2000, Indianapolis, IN, United States
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2
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Cheng ER, Cengiz AY, Miled ZB. Predicting body mass index in early childhood using data from the first 1000 days. Sci Rep 2023; 13:8781. [PMID: 37258628 PMCID: PMC10232444 DOI: 10.1038/s41598-023-35935-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 05/25/2023] [Indexed: 06/02/2023] Open
Abstract
Few existing efforts to predict childhood obesity have included risk factors across the prenatal and early infancy periods, despite evidence that the first 1000 days is critical for obesity prevention. In this study, we employed machine learning techniques to understand the influence of factors in the first 1000 days on body mass index (BMI) values during childhood. We used LASSO regression to identify 13 features in addition to historical weight, height, and BMI that were relevant to childhood obesity. We then developed prediction models based on support vector regression with fivefold cross validation, estimating BMI for three time periods: 30-36 (N = 4204), 36-42 (N = 4130), and 42-48 (N = 2880) months. Our models were developed using 80% of the patients from each period. When tested on the remaining 20% of the patients, the models predicted children's BMI with high accuracy (mean average error [standard deviation] = 0.96[0.02] at 30-36 months, 0.98 [0.03] at 36-42 months, and 1.00 [0.02] at 42-48 months) and can be used to support clinical and public health efforts focused on obesity prevention in early life.
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Affiliation(s)
- Erika R Cheng
- Division of Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, 410 W. 10th Street, Indianapolis, IN, 46220, USA.
| | - Ahmet Yahya Cengiz
- Department of Computer Science, Purdue School of Science, IUPUI, Indianapolis, IN, USA
| | - Zina Ben Miled
- Department of Electrical and Computer Engineering, School of Engineering and Technology, Indiana University Purdue University at Indianapolis, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
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3
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Rossiter C, Cheng H, Denney-Wilson E. Primary healthcare professionals' role in monitoring infant growth: A scoping review. J Child Health Care 2023:13674935231165897. [PMID: 36963017 DOI: 10.1177/13674935231165897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
Excessive weight gain in infancy is an established risk for childhood obesity. Primary healthcare professionals have regular contact with infants and are well placed to monitor their growth. This review explores primary healthcare professionals' practice in monitoring growth for infants from birth to 2 years, addressing assessment methods, practitioner confidence and interventions for unhealthy weight gain. Reviewers searched four databases for studies of primary healthcare professionals working in high-income countries that reported on practice monitoring infant growth. Thirty-six eligible studies documented health professionals' practice with infants. While most clinicians regularly weighed and measured infants, some did not record measurements comprehensively. Growth monitoring occurred regularly during well-child visits but was less common during unscheduled visits. Some participants were less proficient at interpreting growth trajectories or lacked confidence in detecting excessive weight gain and in communicating concerns to parents. Few interventions addressed unhealthy growth among infants. Primary healthcare professionals require support to monitor growth trajectories effectively, to communicate appropriately with parents and to engage them in developing healthy behaviours early. Strategies are also required to monitor infants not regularly attending primary health care.
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Affiliation(s)
- Chris Rossiter
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, 522555The University of Sydney, New South Wales, Australia
| | - Heilok Cheng
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, 522555The University of Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia
- Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Australia
| | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, 522555The University of Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia
- Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Australia
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4
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Zhu X, Yang Y, Cao M. Effect of a mutual goal-based continuous care program on self-management behaviour and health outcomes in patients after percutaneous coronary intervention: A randomized controlled trial. Nurs Open 2023; 10:3707-3718. [PMID: 36709489 PMCID: PMC10170907 DOI: 10.1002/nop2.1625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/16/2022] [Accepted: 01/13/2023] [Indexed: 01/30/2023] Open
Abstract
AIMS To evaluate the effects of mutual goal-based continuous care program on the outcomes of patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI). DESIGN A single-blinded randomized controlled trial. METHODS 87 patients with CHD after PCI in Hangzhou, Zhejiang, China, were randomly divided into study (n = 42) and control (n = 45) groups. The control group received 12-week cardiac rehabilitation and routine care. The study group received routine care and cardiac rehabilitation and the 12-week intervention program developed according to the goal attainment theory, including the mutual goal-based face-to-face guidance, and every-2-week telephone follow-ups. The self-management behaviour, quality of life, unscheduled readmission rate, and satisfaction of patients were examined. RESULTS For the patients subjected to the developed continuous nursing program based on mutual goals, achievement rates of all dimension mutual goals were at high levels (from 80.21% to 98.41%), except for the weight control (60.94%). Moreover, according to the comparable base data, compared with the control group, the self-management behaviour (study group 93.43 vs. control group 76.00), quality of life (QoL), and patients' satisfaction (study group 4.64 vs. control group 4.11) were higher, while the unscheduled readmission rate (study group 4.76% vs. control group 22.22%) was lower, in the study group, with statistically significant differences.
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Affiliation(s)
- Xuejiao Zhu
- School of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Yiting Yang
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Meijuan Cao
- School of Nursing, Hangzhou Normal University, Hangzhou, China
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5
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Friedman N, Erez-Granat O, Inbar A, Dubnov-Raz G. Obesity screening in the pediatric emergency department - A missed opportunity? Heliyon 2022; 8:e12473. [PMID: 36590528 PMCID: PMC9801120 DOI: 10.1016/j.heliyon.2022.e12473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/25/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives There is a low rate of body mass index measurements and obesity screening in primary pediatric care. Pediatric emergency department (PED) visits, with their large volumes and routine weight measurements, provide a unique opportunity to identify and address obesity. The study objectives were to examine the rate of addressing obesity in the PED and to identify its predicting factors. Methods From electronic medical records of PED visits during 2010-2019, we extracted data on age, gender, weight, time, listed diagnoses, and discharge texts. The primary outcome was a listed diagnosis of "obesity" on discharge letters of children with obesity. Secondary outcomes were addressing weight in the discharge letter and written recommendations for obesity-related treatment. Mixed models were used to test for associations between each of the three outcomes and patient/visit characteristics. Results There were 150,250 PED visits by 88,253 different children and adolescents. Obesity was found in 10,691 children (12.1%). Among these, listed "obesity" diagnosis was present in only 240 (1.5%) visits. Text addressing overweight/obesity was recorded in 721 (4.4%) visits, and weight-related recommendations were documented in 716 (4.4%) visits. "Obesity" was documented in females more often than in males, in older children, in children with higher weights, and in visits conducted during the mornings. Conclusions The rate of obesity diagnosis in the PED was extremely low, hence the potential screening ability of the PED in this matter is highly under-utilized. PEDs could increase the recognition of obesity, thus assisting in the global efforts in tackling this disease.
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Affiliation(s)
- Nir Friedman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Pediatric Emergency Department, Meir Medical Center, Kfar Saba, Israel,Corresponding author.
| | - Ortal Erez-Granat
- The Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Israel,Pediatric Emergency Department, Meir Medical Center, Kfar Saba, Israel
| | - Alon Inbar
- The Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Gal Dubnov-Raz
- The Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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6
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Ahuja TK, John JT, Olvet DM, Crilly C, Petrizzo MC, Weiner JS, Pawelczak M. Teaching Second-Year Medical Students How to Counsel Pediatric Patients with Unhealthy Body Mass Index. Child Obes 2022. [PMID: 35951010 DOI: 10.1089/chi.2022.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Obesity affects the health and well-being of children globally. Despite recommendations to routinely screen children for obesity starting at age 6 years, physicians do not consistently address weight or provide effective weight-management counseling. We developed an interactive session for second-year medical students with foundational knowledge and practical communication skills around partnership and discussion of pediatric healthy weight management. Students were administered a pre-/post-Likert survey to self-assess knowledge, comfort, and confidence in counseling patients and caregivers about weight management. Students' related counseling skills were assessed during a standardized patient encounter of a teen with rapid weight gain. The session successfully increased students' self-assessed knowledge, comfort, and confidence, and resulted in successful application of weight management skills in a simulated patient encounter. Utilization of empathy skills requires continued coaching. We propose incorporation of similar sessions into medical school curricula to address the pediatric obesity epidemic.
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Affiliation(s)
- Taranjeet Kalra Ahuja
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Janice Thomas John
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Doreen M Olvet
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Colin Crilly
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marie Cavuoto Petrizzo
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Joseph S Weiner
- Department of Psychiatry, Medicine, and Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Melissa Pawelczak
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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7
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Ray D, Sniehotta F, McColl E, Ells L. Barriers and facilitators to implementing practices for prevention of childhood obesity in primary care: A mixed methods systematic review. Obes Rev 2022; 23:e13417. [PMID: 35064723 PMCID: PMC9285925 DOI: 10.1111/obr.13417] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/23/2021] [Accepted: 12/17/2021] [Indexed: 12/16/2022]
Abstract
Primary care providers (PCPs) have an important role in prevention of excess weight gain in pre-school children. Guidelines exist to support PCPs' practices. This systematic review of PCPs' practice behaviors and their perceptions of barriers to and facilitators of implementation of guidelines was the first step toward the development of an intervention aimed at supporting PCPs. Five databases were searched to identify qualitative, quantitative, and mixed methods studies which examined PCPs' practice patterns and factors influencing implementation of recommended practices. The convergent integrated approach of the Joanna Briggs Institute (JBI) methodology for mixed methods reviews was used for data synthesis. Following analyses, the resultant factors were mapped onto the Capability, Opportunity, and Motivation model of Behaviour (COM-B). Fifty studies met the eligibility criteria. PCPs inconsistently implement recommended practices. Barriers and facilitators were identified at the provider (e.g., lack of knowledge), parent (e.g., lack motivation), and organization level (e.g., inadequate training). Factors were mapped to all three components of the COM-B model: psychological capability (e.g., lack of skills), reflective motivation (e.g., beliefs about guidelines), automatic motivation (e.g., discomfort), physical opportunity (e.g., time constraints), and social opportunity (e.g., stigma). These findings reflect the complexity of implementation of childhood obesity prevention practices.
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Affiliation(s)
- Devashish Ray
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Falko Sniehotta
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louisa Ells
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
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8
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Young JA, Hand BN, Onate JA, Valasek AE. Clinical Utility and Validity of Exercise Vital Sign in Children. Curr Sports Med Rep 2022; 21:28-33. [PMID: 35018896 DOI: 10.1249/jsr.0000000000000928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT We reviewed charts of 14,446 sports medicine patients, children aged 5 to 18 years, over a 3-year period to determine the discriminant validity of Exercise Vital Sign (EVS) questions. A logistic regression analyzed factors related to any moderate to vigorous physical activity (MVPA). A linear regression analyzed factors related to amount of MVPA for those who participated in any weekly MVPA. Overall, 48% of children reported meeting physical activity guidelines for 420 min·wk-1. Overall, children reported 400.36 ± 280.04 min·wk-1 of MVPA. Those with depression had significantly less MVPA than those without (95% confidence interval [CI], -96.65 to -26.31). Girls had significantly less MVPA than boys (95% CI, -59.15 to -40.31). Overweight and obese children reported less MVPA compared with normal weight children (95% CIs, -42.65 to -17.29 and -91.61 to -65.50, respectively). EVS demonstrates strong discriminant validity to detect differences between groups as a function of sex, body mass index, and depression.
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Affiliation(s)
| | - Brittany N Hand
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH
| | - James A Onate
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH
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9
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Cheng ER, Moore C, Parks L, Taveras EM, Wiehe SE, Carroll AE. Communicating Risk for Obesity in Early Life: Engaging Parents Using Human-Centered Design Methodologies. Front Pediatr 2022; 10:915231. [PMID: 35837240 PMCID: PMC9273946 DOI: 10.3389/fped.2022.915231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Pediatricians are well positioned to discuss early life obesity risk, but optimal methods of communication should account for parent preferences. To help inform communication strategies focused on early life obesity prevention, we employed human-centered design methodologies to identify parental perceptions, concerns, beliefs, and communication preferences about early life obesity risk. METHODS We conducted a series of virtual human-centered design research sessions with 31 parents of infants <24 months old. Parents were recruited with a human intelligence task posted on Amazon's Mechanical Turk, via social media postings on Facebook and Reddit, and from local community organizations. Human-centered design techniques included individual short-answer activities derived from personas and empathy maps as well as group discussion. RESULTS Parents welcomed a conversation about infant weight and obesity risk, but concerns about health were expressed in relation to the future. Tone, context, and collaboration emerged as important for obesity prevention discussions. Framing the conversation around healthy changes for the entire family to prevent adverse impacts of excess weight may be more effective than focusing on weight loss. CONCLUSIONS Our human-centered design approach provides a model for developing and refining messages and materials aimed at increasing parent/provider communication about early life obesity prevention. Motivating families to engage in obesity prevention may require pediatricians and other health professionals to frame the conversation within the context of other developmental milestones, involve the entire family, and provide practical strategies for behavioral change.
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Affiliation(s)
- Erika R Cheng
- Department of Pediatrics, Division of Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Courtney Moore
- Indiana Clinical and Translational Sciences Institute (CTSI), Research Jam, Indianapolis, IN, United States
| | - Lisa Parks
- Indiana Clinical and Translational Sciences Institute (CTSI), Research Jam, Indianapolis, IN, United States
| | - Elsie M Taveras
- Kraft Center for Community Health, Massachusetts General Hospital, Boston, MA, United States.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sarah E Wiehe
- Department of Pediatrics, Division of Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN, United States.,Indiana Clinical and Translational Sciences Institute (CTSI), Research Jam, Indianapolis, IN, United States
| | - Aaron E Carroll
- Department of Pediatrics, Center for Pediatric and Adolescent Comparative and Effectiveness Research, Indiana University School of Medicine, Indianapolis, IN, United States
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10
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Gehring ND, Kebbe M, Rathwell S, Perez A, Peng C, Zendher E, Ho J, Ball GDC. Physician-related predictors of referral for multidisciplinary paediatric obesity management: a population-based study. Fam Pract 2021; 38:576-581. [PMID: 33755099 DOI: 10.1093/fampra/cmab019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND It is recommended that primary care-based physicians refer children with overweight and obesity to multidisciplinary paediatric obesity management, which can help to improve weight and health. OBJECTIVE To determine predictors of referral to multidisciplinary paediatric obesity management. METHODS This retrospective, population-level study included physicians who could refer 2-17 years old with a body mass index ≥85th percentile to one of three multidisciplinary paediatric obesity management clinics in Alberta, Canada. Physician demographic and procedural data were obtained from Practitioner Claims and Provider Registry maintained by Alberta Health from January 2014 to December 2017. Physician characteristics were compared based on whether they did or did not refer children for obesity management. Univariable and multivariable logistic regression models analysed associations between physician characteristics and referral making. RESULTS Of the 3863 physicians (3468 family physicians, 395 paediatricians; 56% male; 49.3 ± 12.2 years old; 22.3 ± 12.6 years since graduation) practicing during the study period, 1358 (35.2%) referred at least one child for multidisciplinary paediatric obesity management. Multivariable regression revealed that female physicians (versus males) [odds ratio (OR): 1.68, 95% confidence interval (CI): 1.46-1.93; P < 0.0001], paediatricians (versus family physicians) (OR: 4.89, 95% CI: 3.85-6.21; P < 0.0001) and urban-based physicians (versus non-urban-based physicians) (OR: 2.17, 95% CI: 1.79-2.65; P < 0.0001) were more likely to refer children for multidisciplinary paediatric obesity management. CONCLUSIONS Approximately one-third of family physicians and paediatricians referred children for multidisciplinary paediatric obesity management. Strategies are needed to improve referral practices for managing paediatric obesity, especially among male physicians, family physicians and non-urban-based physicians as they were less likely to refer children.
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Affiliation(s)
- Nicole D Gehring
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Maryam Kebbe
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Sarah Rathwell
- Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Arnaldo Perez
- School of Dentistry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Chenhui Peng
- Pediatric Centre for Weight and Health, Stollery Children's Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Emily Zendher
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Josephine Ho
- Department of Paediatrics, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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11
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Exploration of Barriers and Facilitators to Implementing Best Practice in Exercise Medicine in Primary Pediatric Care-Pediatrician Perspectives. Pediatr Exerc Sci 2021; 33:162-169. [PMID: 34167088 DOI: 10.1123/pes.2020-0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/25/2021] [Accepted: 03/14/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Despite the known health benefits of physical activity (PA), few primary care pediatricians discuss, evaluate, or prescribe PA for children. The goal of this study was to examine pediatricians' thoughts and practices related to child PA and the perceived facilitators and barriers to implementing PA evaluation and prescription in pediatric primary care clinics. METHODS The Consolidated Framework for Implementation Research was used to explore implementation barriers and facilitators. A mixed-method design combined questionnaires and focus groups with 27 pediatricians. RESULTS Despite the pediatricians' beliefs that PA is important for patients, there was wide practice variability in their approaches to discussing PA. Several perceived barriers to implementing PA evaluation and prescription were identified, including lack of knowledge and training, managing time for PA with multiple demands, the need for a team approach and simple PA tools and resources, support for patient tailoring of PA messaging, and a need for PA best practice champions. CONCLUSION The identified barriers to implementing evidence in PA suggest several directions for improvement, including a care-team approach; quick, inexpensive, and simple PA tools; community PA partnerships; PA training in medical education; evidence-based strategies; and PA directories for families. These efforts could facilitate the implementation of PA best practices in pediatrics.
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12
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Patient-Centered Medical Homes and Pediatric Preventive Counseling. Acad Pediatr 2021; 21:488-496. [PMID: 32650049 DOI: 10.1016/j.acap.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 06/25/2020] [Accepted: 07/01/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To measure pediatric preventive counseling at patient-centered medical homes (PCMHs) compared with practices that reported undertaking some or no quality-related activities. METHODS We analyzed 4814 children and adolescents ages 0 to 17 who visited their usual sources of care in the nationally representative Medical Expenditure Panel Survey Medical Organizations Survey (MEPS-MOS), a household survey combined with a survey of household members' usual sources of care. We identified PCMHs using lists from certifying or accrediting organizations. For other practices in the MEPS-MOS, 2 quality-related activities were 1) reports to physicians about their clinical quality of care, and 2) electronic health record system reminders to physicians. Regressions controlled for practice, child, and family characteristics. RESULTS Compared with other practices, PCMHs were generally associated with greater likelihood of receiving preventive counseling. Estimates varied with the quality-related activities of the comparison practices. Counseling against smoking in the home was 10.4 to 18.7 percentage points (both P < .01) more likely for PCMHs. More associations were statistically significant for PCMHs compared with practices that undertook 1 of 2 quality-related activities examined. Among children ages 2 to 5, compared with practices undertaking both quality-related activities, those with PCMHs were more likely to receive counseling on 3 of 5 topics. Among adolescents, compared with practices undertaking both quality-related activities, those with PCMHs were more likely to receive counseling on smoking, exercise, and eating healthy. CONCLUSIONS PCMHs were associated with substantially greater receipt of pediatric preventive counseling. Evaluations of PCMHs need to account for the quality-related activities of comparison practices.
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13
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Kennedy BM, Davison G, Fowler LA, Rodriguez-Guzman E, Collins ML, Baker A, Cook S, Lindros J, Wilfley DE, Zebrick AJ, Staiano AE. Perceptions of a Pragmatic Family-Centered Approach to Childhood Obesity Treatment. Ochsner J 2021; 21:30-40. [PMID: 33828424 PMCID: PMC7993422 DOI: 10.31486/toj.19.0126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Few studies have examined both parent and child preferences regarding family-based weight management programs (WMPs) delivered in primary care settings, especially among racial minority populations. The purpose of this study was to determine the perceptions that parents and their children/adolescents have about the components that should be included in a family-based WMP and to identify perceived preferences, benefits, and/or barriers to participation. Methods: A sample of 60 participants (30 parents and 30 children/adolescents) participated in 1 of 5 separate structured focus groups, using probing questions and the nominal group technique (NGT). Parents reported demographics for themselves and their children/adolescents. Themes from probing questions were identified using thematic analysis. Results: Parents were primarily African American (93%) and diverse in income. NGT sessions revealed that parents across all groups perceived that education on healthy eating, parental involvement, and effective program leaders are most important and have the greatest impact, while parental involvement was perceived as the easiest method to implement in a family-based WMP for childhood obesity. Children/adolescents perceived that education on healthy eating and exercise would have the greatest impact, while healthy eating and meal plans were perceived as the easiest methods to implement with a family. Parents and children/adolescents also identified improved psychological well-being (eg, decreased bullying, increased self-esteem, and motivation) as a desired program outcome. Conclusion: Parents and their children/adolescents highlighted the importance of physical and psychological health as targets in treatment. Feedback from patients can inform the design and implementation of family-based WMPs delivered in primary care settings.
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Affiliation(s)
| | - Genevieve Davison
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Lauren A. Fowler
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | | | | | | | - Stephen Cook
- Department of Research, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | | | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
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14
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Wirth SH, Palakshappa D, Brown CL. Association of household food insecurity and childhood weight status in a low-income population. Clin Obes 2020; 10:e12401. [PMID: 32915524 PMCID: PMC8405045 DOI: 10.1111/cob.12401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/15/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022]
Abstract
One in seven US households with children are food insecure. The health effects of household food insecurity (HFI) are well documented, but its association with childhood weight status remains unclear. We aimed to assess this association and to describe correlates of HFI in children. We conducted a cross-sectional study of 3019 low-income children aged 2 to 17 years. Data were extracted via chart review. HFI was assessed using the hunger vital sign screener. Body mass index (BMI) was calculated from documented clinical measurements. We used adjusted linear and logistic regression to assess the association of HFI with BMI z-score (BMIz) and weight status. We used logistic regression to examine correlates of HFI including age, race/ethnicity, tobacco exposure, number of parents and siblings living at home, weight status, and census-tract poverty rate and food access. Of participants whose HFI status was documented, 91% were food secure and 9% were food insecure. The mean (SD) BMIz was 0.81 (1.11). Fifty five percentage of children were healthy weight, 18% overweight, and 26% obese. In adjusted analyses, HFI was not associated with BMIz but was associated with decreased odds of obesity (OR 0.56; 95% CI 0.36-0.87). Tobacco exposure (1.63; 1.10-2.44), additional siblings (1.16; 1.04-1.30), and residence census tract with high poverty rate (1.02; 1.01-1.03) were all associated with HFI. We concluded that food-insecure children were less likely to have obesity and had differences in household makeup, exposures, and residential location compared to food-secure children. Clinicians should understand these relationships when counselling families about weight status and food insecurity.
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Affiliation(s)
- Scott H Wirth
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Deepak Palakshappa
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Callie L Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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15
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Camp NL, Robert RC, Kelly KP. Healthy Habits Questionnaire Feasibility and Utility for High-Risk Children. Clin Pediatr (Phila) 2020; 59:978-987. [PMID: 32486901 DOI: 10.1177/0009922820927030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The American Academy of Pediatrics provides guidance for pediatric primary care providers to promote healthy weight during childhood. Screening questions on diet and activity habits can help provider assessment and assist counseling for targeted behavior change. We implemented the parent completed, 10-item 5210 Healthy Habits Questionnaire (Ages 2-9 year) in our primary care practice serving low-income minority children with high rates of overweight and obesity. Adherence to the intervention protocol was high, and providers found the content and method of assessment useful for their counseling of individual patients. The aggregate Healthy Habits Questionnaire data provided a snapshot of the health habits in our local clinic population of children, prompting greater awareness for providers and informing their patient care.
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Affiliation(s)
- Nadine L Camp
- Children's National Hospital, Washington, DC, USA.,The George Washington University, Washington, DC, USA.,The Catholic University of America, Washington, DC, USA
| | | | - Katherine P Kelly
- Children's National Hospital, Washington, DC, USA.,The George Washington University, Washington, DC, USA
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16
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Aparicio Rodrigo M, Ruiz Canela J, Buñuel Álvarez JC, García Vera C, Esparza Olcina MJ, Barroso Espadero D, González Rodríguez P, Juanes Toledo B, Martínez Rubio V, Ortega Páez E. Paediatricians provide higher quality care to children and adolescents in primary care: A systematic review. Acta Paediatr 2020; 109:1989-2007. [PMID: 32311805 DOI: 10.1111/apa.15324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 02/26/2020] [Accepted: 04/17/2020] [Indexed: 11/29/2022]
Abstract
AIM The number of primary care paediatricians is decreasing in Europe without a justifiable reason. We aimed to compare the clinical practice of paediatricians and family doctors attending children and adolescents in primary care. METHODS MEDLINE, Embase, CENTRAL, TRIP and Google Scholar were searched from December 2008 to February 2018. No language or study design restrictions were applied. Three reviewers assessed eligibility of the studies. Seven pairs of reviewers performed the data extraction and assessed the methodological quality independently. Discrepancies were resolved by consensus. RESULTS Fifty-four, out of 1150 studies preselected, were included. We found that paediatricians show more appropriate pharmacology prescription patterns for the illness being treated; they achieve higher vaccination rates and have better knowledge of vaccines and fewer doubts about vaccine safety; their knowledge and implementation of different screening tests are better; they prescribe psychoactive drugs more cautiously and more in line with current practice guidelines; their evaluation and treatment of obesity and lipid disorders follow criteria more consistently with current clinical practice guidelines; and they perform fewer diagnostic test, show a more suitable use of the test and request fewer referrals to specialists. CONCLUSION According to published data, in developed countries, paediatricians provide higher quality care to children than family doctors.
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17
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Stracciolini A, Luz J, Walker G, Edwards N, Faigenbaum AD, Myer GD. Are primary care physicians ill equipped to evaluate and treat childhood physical inactivity? PHYSICIAN SPORTSMED 2020; 48:199-207. [PMID: 31560577 DOI: 10.1080/00913847.2019.1673685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: To investigate primary care physician clinical practice patterns, barriers, and education surrounding pediatric physical activity (PA), and to compare practice patterns by discipline.Study design: Cross-sectional studyMethods: 4500 randomly selected pediatricians, family practice, and sports medicine physicians in the United States were surveyed (11% response rate). Main outcome measures were questionnaire answers on clinical effort, attitudes, and barriers surrounding PA, medical education in exercise science, and awareness of ICD-9 diagnostic codes pertaining to physical inactivity.Results: Approximately 15% of patient interaction time was spent on the evaluation and treatment of physical inactivity for a normal weight child. For an overweight or obese child, clinical time spent on PA almost doubles. Regardless of weight, sports medicine physicians spent significantly more time on the evaluation of physical activity compared to family/internal medicine physicians and pediatricians. Mean percentage of time family/internal medicine physicians spent on PA evaluation and treatment was consistently less than sports medicine physicians, and consistently more than pediatricians. Most physicians strongly agreed that PA assessment and treatment are important for disease prevention; only 28% had ever made the diagnosis of childhood physical inactivity. Limited clinical time was identified as a primary barrier to diagnosing childhood physical inactivity. Eighty-five percent of respondents were unaware of ICD-9 codes for reimbursement of PA evaluation. Eighty-one percent reported a paucity of exercise science education in medical school.Conclusion: While physicians report that PA evaluation is important in practice, behavior patterns surrounding time evaluating PA and treating childhood physical inactivity are discrepant. Pediatricians showed less favorable attitudes and effort surrounding PA compared to other primary care disciplines. The majority of physicians are unaware of physical inactivity diagnostic codes, have never made the diagnosis of childhood physical inactivity, and may not be receiving basic pediatric exercise science training required for evaluating and treating childhood physical inactivity.
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Affiliation(s)
- Andrea Stracciolini
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA, USA.,Department of Orthopaedics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Jennifer Luz
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | | | | | - Gregory D Myer
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.,The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA.,Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
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18
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Lobelo F, Muth ND, Hanson S, Nemeth BA. Physical Activity Assessment and Counseling in Pediatric Clinical Settings. Pediatrics 2020; 145:peds.2019-3992. [PMID: 32094289 DOI: 10.1542/peds.2019-3992] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Physical activity plays an important role in children's cardiovascular health, musculoskeletal health, mental and behavioral health, and physical, social, and cognitive development. Despite the importance in children's lives, pediatricians are unfamiliar with assessment and guidance regarding physical activity in children. With the release of the 2018 Physical Activity Guidelines by the US Department of Health and Human Services, pediatricians play a critical role in encouraging physical activity in children through assessing physical activity and physical literacy; providing guidance toward meeting recommendations by children and their families; advocating for opportunities for physical activity for all children in schools, communities, and hospitals; setting an example and remaining physically active personally; advocating for the use of assessment tools and insurance coverage of physical activity and physical literacy screening; and incorporating physical activity assessment and prescription in medical school curricula.
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Affiliation(s)
| | - Natalie D Muth
- Children's Primary Care Medical Group, Carlsbad, California; and
| | - Sara Hanson
- Nutrition and Health Sciences Program, Laney Graduate School and Exercise is Medicine Global Research and Collaboration Center, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Blaise A Nemeth
- American Family Children's Hospital and School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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19
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McFadden T, Fortier M, McGinn R, Levac BM, Sweet SN, Tomasone JR. Demographic differences in Canadian medical students' motivation and confidence to promote physical activity. Fam Pract 2020; 37:56-62. [PMID: 31271643 DOI: 10.1093/fampra/cmz034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Physical activity (PA) remains under prescribed by physicians. Motivation and confidence are clear drivers of frequency of promoting PA. Research shows demographic differences in physicians' preventive practices, yet none have included medical students who form habits during training. OBJECTIVES Study objectives were to (i) examine how Canadian medical students' motivation to recommend PA to future patients differs according to six demographic variables (i.e. gender, ethnicity, year of study, university, proposed specialty and academic background) and (ii) examine how Canadian medical students' confidence to recommend PA to future patients differs according to these same demographic variables. METHODS A cross-sectional design was used. First to fourth year medical students from three medical schools responded to an online survey (N = 221). RESULTS Female participants were more motivated to counsel patients on PA and refer to an exercise specialist compared to males (P < 0.01). Second year students were more motivated to assess a patients' level of PA compared to third and fourth year students (P < 0.01). Students pursuing family medicine were more confident to assess and counsel compared to students pursuing paediatrics (P < 0.01). CONCLUSION Given that motivation and confidence have a positive influence on frequency-promoting PA, these results suggest where future efforts should focus, to improve PA promotion in medical practice. Physical inactivity continues to be a major issue worldwide, and medical students as future physicians have a unique opportunity to enhance PA amongst the population.
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Affiliation(s)
- Taylor McFadden
- School of Human Kinetics, University of Ottawa, Ottawa.,Physician Health and Wellness, Canadian Medical Association, Ottawa
| | | | - Ryan McGinn
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa.,Faculty of Medicine, University of Ottawa, Ottawa
| | - Brendan M Levac
- Department of Surgery, McMaster University, Hamilton Health Sciences, Hamilton
| | - Shane N Sweet
- Department of Kinesiology and Physical Education, McGill University, Montreal
| | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, Canada
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20
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Novick MB, Wilson CT, Walker-Harding LR. Potential solutions for pediatric weight loss programs in the treatment of obesity in rural communities. Transl Behav Med 2020; 9:460-467. [PMID: 31094444 DOI: 10.1093/tbm/ibz030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Pediatric obesity remains disproportionately more prevalent in rural communities; however, multidisciplinary, pediatric weight loss programs, which are often located in tertiary-care centers, may not be accessible to rural families. Limited models to specifically address pediatric obesity in rural communities exist. Therefore, innovative solutions are required for expanded treatment of pediatric obesity in rural communities. This article discusses potential solutions for multidisciplinary, tertiary-care pediatric weight loss programs to improve access and treatment of pediatric obesity in rural communities. A selected review of the literature suggests that strategies to overcome barriers to treatment in rural communities include telephone calls and telemedicine conferencing by obesity specialists from academic centers (obesity medicine specialists, endocrinologists, dietitians, and psychotherapists) as well as training local primary care providers in rural communities to screen, diagnose, and treat patients with obesity. Multidisciplinary, tertiary-care pediatric weight loss programs have a profound opportunity to impact the treatment of pediatric obesity in rural communities by training practicing rural primary care providers as well as strengthening their commitment to educate future generations of clinicians on the treatment of pediatric obesity through medical training including physician assistant, nurse practitioner, and pediatric and family medicine resident education and skill building. This article identifies potential mechanisms for expansive treatment of pediatric obesity in rural communities by multidisciplinary, tertiary-care weight loss programs and highlights areas of specific focus needed for future investigation.
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Affiliation(s)
- Marsha B Novick
- Departments of Pediatrics and Family & Community Medicine, Pediatric Multidisciplinary Weight Loss Program, Penn State Hershey Medical Center, Hershey, PA, USA
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21
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Guseman EH, Beverly EA, Whipps J, Mort S. Foundational knowledge regarding childhood obesity: a cross-sectional study of medical students. BMC Public Health 2019; 19:1251. [PMID: 31510972 PMCID: PMC6737597 DOI: 10.1186/s12889-019-7499-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 08/14/2019] [Indexed: 11/16/2022] Open
Abstract
Background Documentation and diagnosis of childhood obesity in primary care is poor and providers are often unfamiliar with guidelines. This lack of knowledge may be attributed to insufficient training in medical school and residency; however, no studies have evaluated medical students’ knowledge of recommendations. Methods We distributed a modified version of the Physician Survey of Practice on Diet, Physical Activity, and Weight Control to medical students at a single university. Descriptive analyses assessed knowledge and attitudes of childhood obesity and diabetes. Results Of the 213 participating students, 74% indicated being unfamiliar with obesity screening recommendations. Few correctly identified BMI percentile cut-points for child overweight (21.2%), obesity (23.7%), and normal weight (29.4%). They reported screening glucose 4.5 years earlier in patients with risk factors compared to those without (p < 0.001). Conclusions Although students recognized the need for earlier diabetes screening in children with risk factors, we determined that overall, student knowledge of obesity-related preventative care was inadequate. Electronic supplementary material The online version of this article (10.1186/s12889-019-7499-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emily Hill Guseman
- Diabetes Institute, Ohio University, Athens, OH, 45701, USA. .,Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, 45701, USA.
| | - Elizabeth A Beverly
- Diabetes Institute, Ohio University, Athens, OH, 45701, USA.,Department of Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, 45701, USA
| | - Jonathon Whipps
- Translational Biomedical Sciences, Ohio University, Athens, OH, 45701, USA
| | - Sophia Mort
- Translational Biomedical Sciences, Ohio University, Athens, OH, 45701, USA.,Department of Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, 45701, USA
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22
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Turer CB, Barlow SE, Sarwer DB, Adamson B, Sanders J, Ahn C, Zhang S, Flores G, Skinner CS. Association of Clinician Behaviors and Weight Change in School-Aged Children. Am J Prev Med 2019; 57:384-393. [PMID: 31377089 PMCID: PMC6702088 DOI: 10.1016/j.amepre.2019.04.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION This study uses clinical practice data to determine whether recommended weight management clinician behaviors are associated with weight status improvement in children aged 6-12 years who are overweight or obese. METHODS Electronic health record data (2009-2014) from 52 clinics were used. Weight status was examined from 1 visit to the next as dichotomous improvement (versus worsening or no change) and change in percentage overweight (over sex/age-specific BMI95). The primary predictor was a clinician behavior variable denoting attention to high BMI alone or with assessment of medical risk/comorbidities and was defined using combinations of diagnostic codes and electronic health record orders. Covariates included time between visits and medications associated with weight gain or loss. Adjusted multilevel regression models examined the association of the clinician behavior variable with weight status improvement. Analyses were conducted from 2015 to 2018. RESULTS Children (n=7,205) had a mean age of 8.9 years; 45.5% were overweight, 54.5% obese, and 81.1% publicly insured. For 62% of overweight children, and 38%, 21%, and 11% of those in obesity classes 1-3, respectively, no attention to high BMI/medical risk assessment at any visit was identified. Children with evidence of clinician attention to high BMI alone and who underwent a medical risk assessment had significantly greater AOR of improvement in percentage of BMI95 and percentage of BMI95 change: BMI alone, AOR=1.2 (p<0.001) and β= -0.3 (p>0.05); BMI/medical risk, AOR=1.2 and β= -0.5 (both p<0.001). Other factors associated with weight status improvement included prescription medications (1 or more prescriptions associated with either weight loss or none associated with weight gain) and fewer months between visits. CONCLUSIONS This is the first study to use electronic health record data to demonstrate that widely recommended clinician behaviors are associated with weight status improvement in children aged 6-12 years who are overweight or obese.
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Affiliation(s)
- Christy B Turer
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Pediatrics, Children's Medical Center, Dallas, Texas.
| | - Sarah E Barlow
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Pediatrics, Children's Medical Center, Dallas, Texas; Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - David B Sarwer
- College of Public Health, Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania
| | - Brian Adamson
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joanne Sanders
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chul Ahn
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Song Zhang
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Glenn Flores
- Division of Research, Connecticut Children's Medical Center, Hartford, Connecticut; Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Celette Sugg Skinner
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
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23
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Sherwood NE, Levy RL, Seburg EM, Crain AL, Langer SL, JaKa MM, Kunin‐Batson A, Jeffery RW. The Healthy Homes/Healthy Kids 5-10 Obesity Prevention Trial: 12 and 24-month outcomes. Pediatr Obes 2019; 14:e12523. [PMID: 30873752 PMCID: PMC8853652 DOI: 10.1111/ijpo.12523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/22/2019] [Accepted: 02/17/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pediatric primary care is an important setting for addressing obesity prevention. OBJECTIVE The Healthy Homes/Healthy Kids 5-10 randomized controlled trial evaluated the efficacy of an obesity prevention intervention integrating pediatric primary care provider counseling and parent-targeted phone coaching. METHODS Children aged 5 to 10 years with a BMI between the 70th and 95th percentile and their parents were recruited from pediatric primary care clinics. Participants received well-child visit provider counseling about obesity and safety/injury prevention and were then randomized to a 14-session phone-based obesity prevention (OP; n = 212) or safety and injury prevention contact control (CC; n = 209) intervention. The primary outcome was 12 and 24-month child BMI percentile. RESULTS There was no overall significant treatment effect on child BMI percentile. Caloric intake was significantly lower among OP compared with CC participants at 12 months (P < .005). In planned subgroup analyses, OP condition girls had significantly lower BMI percentile (P < .05) and BMI z-score (P < .02) at 12 and 24 months relative to CC girls and were less likely to be overweight (38.0% vs 53.0%, P < .01) or (obese 3.4% vs 8.8%, P < .10) at follow-up. CONCLUSIONS AND RELEVANCE An obesity prevention intervention integrating brief provider counseling and parent-targeted phone counseling did not impact 12 and 24-month BMI status overall but did have a significant impact on BMI in girls.
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Affiliation(s)
- Nancy E. Sherwood
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Rona L. Levy
- UW School of Social Work (SSW), Seattle, WA, USA
| | | | | | - Shelby L. Langer
- UW School of Social Work (SSW), Seattle, WA, USA,Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Meghan M. JaKa
- DC Department of Behavioral Health, Applied Research and Evaluation, Washington, DC, USA
| | | | - Robert W. Jeffery
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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24
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Whipps J, Mort SC, Beverly EA, Guseman EH. Influence of Osteopathic Medical Students' Personal Health on Attitudes Toward Counseling Obese Pediatric Patients. ACTA ACUST UNITED AC 2019; 119:488-498. [PMID: 31355889 DOI: 10.7556/jaoa.2019.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Context Research has shown that physicians with positive health and lifestyle behaviors have more positive attitudes toward effective counseling, but little is known about how personal health behaviors of medical students influence their attitudes regarding pediatric obesity counseling before entering practice. Objective To determine whether the personal health status and habits of osteopathic medical students influence their attitudes toward counseling obese pediatric patients regarding lifestyle behaviors. Methods A cross-sectional survey was distributed electronically to first- through fourth-year osteopathic medical students. The survey assessed students' personal lifestyle habits and their top anticipated barriers to providing pediatric weight counseling. Results A total of 200 participants completed the survey. National physical activity recommendations were met by 81 participants (40.5%). These 81 participants had significantly more positive attitudes toward pediatric physical activity counseling than participants who did not meet the recommendations (H=-35.06, P=.001) or those who only met resistance training recommendations (H=40.63, P=.021). Participants with obesity had significantly lower pediatric weight management counseling scores than overweight participants (H=40.77, P=.028). Thirty-one participants (15.5%) consumed a healthy amount of both vegetables and fruit. These 31 participants had significantly higher dietary mean item counseling scores than those who did not (H=-30.40, P=.048). Participants identified the barriers "Time" (137 [68.5%]) and "Difficult for patients to change behavior" (99 [49.5%]) most frequently. Clinical participants identified "Poor or lacking reimbursement" (21 [28.0%]) more frequently than preclinical participants (12 [9.6]). Conclusion Medical students who exhibited healthier lifestyle habits were more likely to positively view pediatric obesity management counseling.
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25
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Nasim M, Aldamry M, Omair A, AlBuhairan F. Identifying obesity/overweight status in children and adolescents; A cross-sectional medical record review of physicians' weight screening practice in outpatient clinics, Saudi Arabia. PLoS One 2019; 14:e0215697. [PMID: 31022236 PMCID: PMC6483234 DOI: 10.1371/journal.pone.0215697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/05/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND BMI is a feasible and recommended measure for overweight and obesity screening in children and adolescents. The study aimed to determine how often physicians correctly identified obesity/ overweight status in children and adolescents by using BMI percentile charts. METHODS This retrospective cross-sectional study reviewed the paper medical records of children and adolescents (6-14 years) who visited family medicine and pediatric outpatient clinics (Jan-June 2012) in a medical city in Riyadh. Investigators calculated BMI percentiles (using height, weight, age and gender data retrieved from the records) in order to identify patient weight status. Physician documentation of obesity/overweight diagnoses in patient problem lists were cross checked against their BMI percentile to assess the accuracy of physicians' identification of weight status. The recommended management plan for identified patients was also recorded. RESULTS A total of 481 charts were reviewed, 213 (44%) children were seen by family medicine physicians and 268 (56%) by pediatricians. The sample was equally distributed by gender. Height was undocumented for 13% (71) of visiting patients. Eighteen percent of patients (86) were classified as overweight (35)/obese (51) according to age and sex adjusted BMI percentile. Physicians' correctly identified and documented weight status in 20% of overweight/obese patients: 17 out of 86 subjects. Weight status identification was higher among pediatricians-25% as compared to family medicine physicians-10% [p = 0.08]. Dietary referral was the most common management plan for the identified children. Physicians were more likely to identify obese children {≥95th} compared to overweight {≥85th - 95th} children. Subjects whose BMI for age classified them into the highest BMI percentile category {≥95th} were more likely to be correctly identified (29%) compared to those classified within {≥85th - 95th} category-6% [p = 0.007]. CONCLUSION Physician identification of obesity/ overweight status for children and adolescents was low, irrespective of their specialty, and despite the condition being prevalent in the sample. Future research that concentrates on interventions that may improve documentation of obesity/overweight diagnoses and parameters needed for BMI indices would be beneficial.
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Affiliation(s)
- Maliha Nasim
- Department of Population Health, King Abdullah International Medical Research Center/ King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Medical Education, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Aldamry
- Department of Medical Education, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Aamir Omair
- Department of Medical Education, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Fadia AlBuhairan
- Department of Pediatrics and Adolescent Medicine, Aldara Hospital and Medical Center, Riyadh, Saudi Arabia
- John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Silverio A, Khalili SP, Cunningham A. An exploratory look at comorbidities, utilization, and quality of care among obese and nonobese children in academic family medicine practice. Int J Pediatr Adolesc Med 2019; 5:83-87. [PMID: 30805539 PMCID: PMC6363266 DOI: 10.1016/j.ijpam.2018.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/28/2018] [Indexed: 11/02/2022]
Abstract
Background Obesity is one of the least addressed comorbidities among children who attend family medicine clinics. The aim of this study was to apply a population health framework to understand the differences between obese and nonobese pediatric patients in academic family medicine practice with regard to general demographics, comorbidities, and quality measures. Methods Exploratory retrospective chart reviews were conducted among obese children aged 2-17 years and a random sample of age-matched nonobese children in 2015. Data were gathered through the institute's electronic medical record system and included demographics, ICD-10 diagnosis codes, outpatient primary care and specialty care visits, in-network emergency department visits, and in-network hospital admissions. Results This exploratory study suggested that the obese pediatric population (n = 213) had a high prevalence of hypertension (P = .006) and sleep apnea (P = .05) and a larger number of diagnosed comorbidities (P = .008), whereas nonobese children had a high prevalence of environmental allergies (P = .001). There were no significant differences among quality measures between obese (n = 213) and age-matched nonobese pediatric patients (n = 219). Conclusion This study used readily available electronic health record data to highlight comorbidities that are more common among obese pediatric patients in academic family medicine practice, thus providing information that could potentially facilitate more timely screening and intervention.
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Affiliation(s)
- Alexis Silverio
- Department of Family and Community Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, 1015 Walnut St. Philadelphia, PA, 19107, United States
| | - Seyed Parham Khalili
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medical Center, 525 E 68 St, New York, NY, 10065, United States
| | - Amy Cunningham
- Department of Family and Community Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, 1015 Walnut St. Philadelphia, PA, 19107, United States
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Salahuddin M, Barlow SE, Pont SJ, Butte NF, Hoelscher DM. Development and use of an index for measuring implementation of a weight management program in children in primary care clinics in Texas. BMC FAMILY PRACTICE 2018; 19:191. [PMID: 30518321 PMCID: PMC6280362 DOI: 10.1186/s12875-018-0882-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 11/23/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The Texas Childhood Obesity Research Demonstration study was an integrated, systems-oriented intervention that incorporated primary and secondary obesity prevention approaches targeting multiple sectors, including primary care clinics, to address childhood obesity. The primary care clinic component included the American Academy of Pediatrics' Next Steps weight management counseling materials that support brief healthy lifestyle-focused visits. The current study describes the methodology and assesses the implementation of the Next Steps program in the participating primary care clinics, as well as the association of implementation with enrollment of children with overweight and obesity in the secondary prevention intervention. METHODS The study used a serial cross-sectional study design to collect data from 11 primary care clinics in Houston (n = 5) and Austin (n = 6), Texas, in 2013-2014. Responses of primary care providers on 42 self-reported survey questions assessing acceptability, adoption, appropriateness, and feasibility of the program were utilized to create a mean standardized clinic implementation index score. Provider scores were aggregated to represent Next Steps implementation scores at the clinic level. A mixed effects logistic regression test was conducted to determine the association between program implementation and the enrollment of children in the secondary prevention. RESULTS Mean implementation index score was lower at Year 2 of implementation (2014) than Year 1 (2013) although the decrease was not significant [63.2% (12.2%) in 2013 vs. 55.3% (16.5%) in 2014]. There were no significant associations between levels of implementation of Next Steps and enrollment into TX CORD secondary prevention study. CONCLUSIONS The development of an index using process evaluation measures can be used to assess the implementation and evaluation of provider-based obesity prevention tools in primary care clinics.
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Affiliation(s)
- Meliha Salahuddin
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX USA
- University of Texas Health Science Center at Tyler, Tyler, TX USA
- Population Health, Office of Health Affairs, University of Texas System, Austin, TX USA
| | - Sarah E. Barlow
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
- UT Southwestern Medical Center, Dallas, TX USA
| | - Stephen J. Pont
- Texas Center for the Prevention and Treatment of Childhood Obesity, Dell Children’s Medical Center, University of Texas at Austin Dell Medical School, Houston, TX USA
| | - Nancy F. Butte
- USDA/ARS Children’s Nutrition Research Center; Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
| | - Deanna M. Hoelscher
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX USA
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Brown CL, Perrin EM. Obesity Prevention and Treatment in Primary Care. Acad Pediatr 2018; 18:736-745. [PMID: 29852268 DOI: 10.1016/j.acap.2018.05.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 04/30/2018] [Accepted: 05/12/2018] [Indexed: 12/22/2022]
Abstract
Despite extensive public health and clinical interventions, obesity rates remain high, and evidence-based preventive strategies are elusive. Many consensus guidelines suggest that providers should screen all children after age 2 years for obesity by measuring height and weight, calculating body mass index (BMI), and sensitively communicating weight status in the context of health to the family at each visit. However, preventive counseling should begin in infancy and focus on healthy feeding, activity, and family lifestyle behaviors. For children with overweight or obesity, the American Academy of Pediatrics outlines 4 stages of treatment: 1) Primary care providers should offer "prevention plus," the use of motivational interviewing to achieve healthy lifestyle modifications in family behaviors or environments; 2) children requiring the next level of obesity treatment, structured weight management, need additional support beyond the primary care provider (such as a dietitian, physical therapist, or mental health counselor) and more structured goal setting with the team, including providers adept at weight management counseling; 3) children with severe obesity and motivated families may benefit from referral to a comprehensive multidisciplinary intervention, such as an obesity treatment clinic; and 4) tertiary care interventions are provided in a multidisciplinary pediatric obesity treatment clinic with standard clinical protocols for evaluation of interventions, including medications and surgery. Although it is certainly a challenge for providers to fit in all the desired prevention and treatment counseling during preventive health visits, by beginning to provide anticipatory guidance at birth, providers can respond to parents' questions, add to parents' knowledge base, and partner with parents and children and adolescents to help them grow up healthy. This is especially important in an increasingly toxic food environment with numerous incentives and messages to eat unhealthfully, barriers to appropriate physical activity, and concomitant stigma about obesity. Focusing on key nutrition and physical activity habits and establishing these healthy behaviors at an early age will allow children to develop a healthy growth trajectory. However, much more work is needed to determine the best evidence-based practices for providers to counsel families on improving target behaviors, environmental modifications, and parenting skills and to decrease abundant disparities in obesity prevalence and treatment.
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Affiliation(s)
- Callie L Brown
- Department of Pediatrics and Department of Epidemiology and Prevention (Dr Brown), Wake Forest School of Medicine, Winston-Salem, NC; Department of Pediatrics and Duke Center for Childhood Obesity Research (Dr Perrin), Duke University School of Medicine, Durham, NC.
| | - Eliana M Perrin
- Department of Pediatrics and Department of Epidemiology and Prevention (Dr Brown), Wake Forest School of Medicine, Winston-Salem, NC; Department of Pediatrics and Duke Center for Childhood Obesity Research (Dr Perrin), Duke University School of Medicine, Durham, NC
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VanFrank BK, Park S, Foltz JL, McGuire LC, Harris DM. Physician Characteristics Associated With Sugar-Sweetened Beverage Counseling Practices. Am J Health Promot 2018; 32:1365-1374. [PMID: 27956472 PMCID: PMC5612916 DOI: 10.1177/0890117116680472] [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: 01/04/2023]
Abstract
PURPOSE Frequent sugar-sweetened beverage (SSB) consumption is associated with chronic disease. Although physician counseling can positively affect patient behavior, physicians' personal characteristics may influence counseling practices. We explored SSB-related topics physicians discuss when counseling overweight/obese patients and examined associations between physicians' SSB-related counseling practices and their personal and medical practice characteristics. DESIGN Cross-sectional survey. SETTING DocStyles survey, 2014. PARTICIPANTS A total of 1510 practicing US physicians. MEASURES Physician's SSB counseling on calories, added sugars, obesity/weight gain, health effects, consumption frequency, water substitution, and referral. ANALYSIS Adjusted odds ratios (aORs) were calculated with multivariable logistic regression, adjusting for physician's personal and medical practice characteristics. RESULTS Most physicians (98.5%) reported SSB-related counseling. The most reported topic was obesity/weight gain (81.4%); the least reported were added sugars (53.1%) and referral (35.0%). Physicians in adult-focused specialties had lower odds than pediatricians of counseling on several topics (aOR range: 0.26-0.64). Outpatient physicians had higher odds than inpatient physicians of counseling on consumption frequency and water substitution (aOR range: 1.60-2.01). Physicians consuming SSBs ≥1 time/day (15.7%) had lower odds than nonconsumers of counseling on most topics (aOR range: 0.58-0.68). CONCLUSION Most physicians reported SSB-related counseling; obesity/weight gain was discussed most frequently. Counseling opportunities remain in other topic areas. Opportunities also exist to strengthen SSB counseling practices in adult-focused specialties, inpatient settings, and among physicians who consume SSBs daily.
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Affiliation(s)
- Brenna K. VanFrank
- Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sohyun Park
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer L. Foltz
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- US Public Health Service Commissioned Corps, USA
| | - Lisa C. McGuire
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Diane M. Harris
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Ordemann AG, Hartzog AJ, Seals SR, Spankovich C, Stringer SP. Is weight a predictive risk factor of postoperative tonsillectomy bleed? Laryngoscope Investig Otolaryngol 2018; 3:238-243. [PMID: 30062141 PMCID: PMC6057213 DOI: 10.1002/lio2.155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/16/2017] [Accepted: 03/13/2018] [Indexed: 12/27/2022] Open
Abstract
Objective To determine if a correlation exists between weight-for-age percentile and post-tonsillectomy hemorrhage in the pediatric population. Study Design Retrospective study. Methods 1418 patients under the age of 15 who underwent tonsillectomy with or without adenoidectomy at a tertiary children's hospital between June 2012 and March 2015 were included in this retrospective study. Patient demographic information, operative and postoperative variables, as well as category and day of postoperative tonsillectomy bleed, if one occurred, were recorded. Fisher's exact and ordinal logistic regression analyses were performed on the full cohort. Results The overall post-tonsillectomy hemorrhage prevalence was found to be 2.2%, with primary and secondary rates of 0.78% and 1.34%, respectively. Weight-for-age percentile, sex, indication for or method of tonsillectomy, or postoperative use of NSAIDs, antibiotics or narcotics were not significantly associated with post-tonsillectomy hemorrhage. There was a significant relationship between postoperative use of dexamethasone and higher rate of Category 3 post-tonsillectomy hemorrhage (P = .028). Conclusion The post-tonsillectomy hemorrhage rate in our study is consistent with that cited in the literature. No correlation was demonstrated between weight-for-age percentile and occurrence of post-tonsillectomy hemorrhage. Postoperative administration of dexamethasone was associated with a significant increased rate of post-tonsillectomy hemorrhage requiring surgical intervention, a novel finding. Level of Evidence 4.
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Affiliation(s)
- Allison G Ordemann
- Department of Otolaryngology University of Mississippi Medical Center Jackson Mississippi U.S.A
| | - Anna Jade Hartzog
- Department of Anesthesiology Vanderbilt University Medical Center Nashville Tennessee U.S.A
| | - Samantha R Seals
- Department of Mathematics and Statistics University of West Florida Pensacola Florida U.S.A
| | - Christopher Spankovich
- Department of Otolaryngology University of Mississippi Medical Center Jackson Mississippi U.S.A
| | - Scott P Stringer
- Department of Otolaryngology University of Mississippi Medical Center Jackson Mississippi U.S.A
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Differences in Child Passenger Safety Counseling Frequency and Attitudes by Health Care Provider Specialty. J Community Health 2018; 41:1242-1248. [PMID: 27271783 DOI: 10.1007/s10900-016-0211-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Many children are not being properly restrained in motor vehicles, resulting in unnecessary injury and fatalities. Health care provider (HCP) education is effective at increasing proper child restraint within vehicles. However, differences exist by HCP specialty in regards to frequency of child passenger safety (CPS) counseling. This study of a sample of 255 HCPs examined differences in CPS counseling by HCP specialty (pediatric vs. non-pediatric). HCPs from several upper Midwest states were surveyed about how frequently they provide CPS counseling in their practice by patient age and their attitudes toward CPS-related issues. Pediatric HCPs were twice as likely as non-pediatric HCPs to always provide CPS counseling to parents/guardians of children aged 5 or older. Non-pediatric HCPs were more likely than pediatric HCPs to feel that counseling is ineffective at increasing child seat/booster (p = 0.001) or seat belt use (p = 0.006). Non-pediatric HCPs were more likely than pediatric HCPs to feel there is inadequate time to provide CPS counseling in their practice setting (p = 0.001), and were less likely to know where to refer patients if they have questions regarding CPS issues (0.0291). The differences in HCP attitudes toward CPS counseling provision and the resulting differences in counseling frequency by patient age may contribute to disparities for patients who have limited or no access to pediatric HCPs. Additional research is needed to investigate the rationale for counseling differences seen by HCP specialty and patient age, and the potential effect on child motor vehicle injuries and fatalities.
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Imoisili OE, Goodman AB, Dooyema CA, Park S, Harrison M, Lundeen EA, Blanck H. Referrals and Management Strategies for Pediatric Obesity- DocStyles Survey 2017. Front Pediatr 2018; 6:367. [PMID: 30619783 PMCID: PMC6299881 DOI: 10.3389/fped.2018.00367] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/12/2018] [Indexed: 01/29/2023] Open
Abstract
Background: Childhood obesity care management options can be delivered in community-, clinic-, and hospital-settings. The referral practices of clinicians to these various settings have not previously been characterized beyond the local level. This study describes the management strategies and referral practices of clinicians caring for pediatric patients with obesity and associated clinician characteristics in a geographically diverse sample. Methods: This cross-sectional study used data from the DocStyles 2017 panel-based survey of 891 clinicians who see pediatric patients. We used multivariable logistic regression to estimate associations between the demographic and practice characteristics of clinicians and types of referrals for the purposes of pediatric weight management. Results: About half of surveyed clinicians (54%) referred <25% of their pediatric patients with obesity for the purposes of weight management. Only 15% referred most (≥75%) of their pediatric patients with obesity for weight management. Referral types included clinical referrals, behavioral referrals, and weight management program (WMP) referrals. Within these categories, the percentage referrals ranged from 19% for behavioral/mental health professionals to 72% for registered dieticians. Among the significant associations, female clinicians had higher odds of referral to community and clinical WMP; practices in the Northeast had higher odds of referral to subspecialists, dieticians, mental health professionals, and clinical WMP; and clinics having ≥15 well child visits per week were associated with higher odds of referral to subspecialists, mental health professionals, and health educators. Not having an affiliation with teaching hospitals and serving low-income patients were associated with lower odds of referral to mental health professionals, and community and clinical WMP. Compared to pediatricians, family practitioners, internists, and nurse practitioners had higher odds of providing referrals to mental health professionals and to health educators. Conclusion: This study helps characterize the current landscape of referral practices and management strategies of clinicians who care for pediatric patients with obesity. Our data provide insight into the clinician, clinical practice, and reported patient characteristics associated with childhood obesity referral types. Understanding referral patterns and management strategies may help improve care for children with obesity and their families.
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Affiliation(s)
- Omoye E Imoisili
- Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, United States.,Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Alyson B Goodman
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Carrie A Dooyema
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sohyun Park
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Megan Harrison
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Elizabeth A Lundeen
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Heidi Blanck
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Harrison SE, Greenhouse D. Dietary and Nutrition Recommendations in Pediatric Primary Care: A Call to Action. South Med J 2018; 111:12-17. [DOI: 10.14423/smj.0000000000000754] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cotes RO, Fernandes NK, McLaren JL, McHugo GJ, Bartels SJ, Brunette MF. Improving Cardiometabolic Monitoring of Children on Antipsychotics. J Child Adolesc Psychopharmacol 2017; 27:916-919. [PMID: 28581341 PMCID: PMC5725629 DOI: 10.1089/cap.2017.0034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study evaluated changes in cardiometabolic monitoring for children and adolescents who were prescribed an antipsychotic medication in a state mental health system before and after a quality improvement intervention. METHODS The intervention included education for prescribers, auditing on metabolic monitoring, and feedback to mental health center leaders regarding their monitoring. Research staff extracted yearly data on cardiometabolic monitoring from randomly selected community mental health center records before and after the intervention. Pre- and postintervention changes in monitoring were assessed with chi-squared tests. RESULTS Evidence of past year monitoring increased: for glucose 18.9%-42.1% (χ2 = 6.75, p < 0.001), for triglycerides 13.5%-31.0% (χ2 = 4.54, p = 0.033), for cholesterol 13.5%-33.1% (χ2 = 5.48, p = 0.019), and for weight 67.6%-84.1% (χ2 = 5.21, p = 0.022). Rates of monitoring for blood pressure and waist circumference increased but not significantly. In both years studied, weight was obtained most frequently and waist circumference was obtained least frequently. CONCLUSIONS Monitoring rates significantly improved for four out of six parameters evaluated, but overall monitoring rates remained low at the end of the study period. Prescriber education with audit and feedback may improve cardiometabolic monitoring rates, but research is needed to evaluate barriers to monitoring in children.
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Affiliation(s)
- Robert O. Cotes
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | | | - Jennifer L. McLaren
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Gregory J. McHugo
- The Dartmouth Insitute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Stephen J. Bartels
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Bureau of Mental Health Services, Department of Health and Human Services, Concord, New Hampshire
| | - Mary F. Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Bureau of Mental Health Services, Department of Health and Human Services, Concord, New Hampshire
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Tanda R, Beverly EA, Hughes K. Factors associated with Ohio nurse practitioners’ childhood obesity preventive practice patterns. J Am Assoc Nurse Pract 2017; 29:763-772. [DOI: 10.1002/2327-6924.12522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 08/06/2017] [Accepted: 08/15/2017] [Indexed: 11/11/2022]
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Sharifi M, Franz C, Horan CM, Giles CM, Long MW, Ward ZJ, Resch SC, Marshall R, Gortmaker SL, Taveras EM. Cost-Effectiveness of a Clinical Childhood Obesity Intervention. Pediatrics 2017; 140:peds.2016-2998. [PMID: 29089403 PMCID: PMC5654390 DOI: 10.1542/peds.2016-2998] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To estimate the cost-effectiveness and population impact of the national implementation of the Study of Technology to Accelerate Research (STAR) intervention for childhood obesity. METHODS In the STAR cluster-randomized trial, 6- to 12-year-old children with obesity seen at pediatric practices with electronic health record (EHR)-based decision support for primary care providers and self-guided behavior-change support for parents had significantly smaller increases in BMI than children who received usual care. We used a microsimulation model of a national implementation of STAR from 2015 to 2025 among all pediatric primary care providers in the United States with fully functional EHRs to estimate cost, impact on obesity prevalence, and cost-effectiveness. RESULTS The expected population reach of a 10-year national implementation is ∼2 million children, with intervention costs of $119 per child and $237 per BMI unit reduced. At 10 years, assuming maintenance of effect, the intervention is expected to avert 43 000 cases and 226 000 life-years with obesity at a net cost of $4085 per case and $774 per life-year with obesity averted. Limiting implementation to large practices and using higher estimates of EHR adoption improved both cost-effectiveness and reach, whereas decreasing the maintenance of the intervention's effect worsened the former. CONCLUSIONS A childhood obesity intervention with electronic decision support for clinicians and self-guided behavior-change support for parents may be more cost-effective than previous clinical interventions. Effective and efficient interventions that target children with obesity are necessary and could work in synergy with population-level prevention strategies to accelerate progress in reducing obesity prevalence.
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Affiliation(s)
- Mona Sharifi
- Department of Pediatrics, Section of General Pediatrics, Yale University School of Medicine, New Haven, Connecticut;
| | - Calvin Franz
- Eastern Research Group Inc, Lexington, Massachusetts
| | - Christine M. Horan
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | | | - Michael W. Long
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia; and
| | | | - Stephen C. Resch
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Richard Marshall
- Department of Pediatrics, Harvard Vanguard Medical Associates and Atrius Health Inc, Boston, Massachusetts
| | | | - Elsie M. Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts;,Nutrition, and
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Vallabhan MK, Kong AS, Jimenez EY, Summers LC, DeBlieck CJ, Feldstein Ewing SW. Training Primary Care Providers in the Use of Motivational Interviewing for Youth Behavior Change. Res Theory Nurs Pract 2017; 31:219-232. [PMID: 28793946 PMCID: PMC5695044 DOI: 10.1891/1541-6577.31.3.219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Adolescent obesity is a global epidemic. Motivational interviewing (MI) is a promising strategy to address adolescent obesity risk behaviors. However, primary care providers (PCPs) tend to express discomfort with learning and adopting MI practices and with addressing patient weight issues. PCP proficiency in using MI to discuss body mass index, health screening results, and nutrition and physical activity behaviors after receiving training and coaching from an MI expert and practicing the technique was evaluated. We hypothesized that comfort with MI would increase consistently over time. METHODS Self-assessment surveys in MI proficiency were administered to PCPs after every youth participant MI session. MI comfort as determined by proficiency was categorized into low, medium, and high comfort according to survey Likert scale responses. Data were analyzed using analysis of variance (ANOVA) and Fisher's exact tests. RESULTS Two hundred twenty-seven youth were seen for MI-based discussions by 4 PCPs. Two hundred twenty-six surveys had complete data for analysis. As anticipated, overall PCPs reported significantly more comfort with MI from the first to the final MI session over a 2- to 3-month period (p< .001). Comfort scores did not increase linearly over time for all PCPs. Despite standard training practices, overall MI proficiency as measured by comfort scores varied by PCP (p< .01). IMPLICATIONS FOR PRACTICE This type of MI training program should be considered for clinical nurses and nurse practitioners during their nursing education training to facilitate their ability to consistently and effectively support youth behavior change for conditions such as obesity (ClinicalTrials.gov Number NCT02502383).
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Affiliation(s)
- Monique K. Vallabhan
- Department of Pediatrics, Division of Adolescent Medicine, University of New Mexico (UNM) School of Medicine, Albuquerque, NM, USA
| | - Alberta S. Kong
- Department of Pediatrics, Division of Adolescent Medicine, University of New Mexico (UNM) School of Medicine, Albuquerque, NM, USA
- Department of Family and Community Medicine, UNM School of Medicine, Albuquerque, NM, USA
| | - Elizabeth Yakes Jimenez
- Center for Education Policy Research, UNM, Albuquerque, NM, USA
- Pacific Institute for Research and Evaluation, Albuquerque, NM, USA
| | - Linda C. Summers
- School of Nursing, College of Health and Social Services, New Mexico State University, Las Cruces, NM, USA
| | - Conni J. DeBlieck
- School of Nursing, College of Health and Social Services, New Mexico State University, Las Cruces, NM, USA
| | - Sarah W. Feldstein Ewing
- Department of Child and Adolescent Psychiatry, Oregon Health Science University, Portland, Oregon, USA
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He's just content to sit: a qualitative study of mothers' perceptions of infant obesity and physical activity. BMC Public Health 2017. [PMID: 28629410 PMCID: PMC5477242 DOI: 10.1186/s12889-017-4503-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Rates of obesity among children ages zero to five are rapidly increasing. Greater efforts are needed to promote healthy behaviors of young children. Mothers are especially important targets for promoting health as mothers’ views play a vital role in helping their children foster healthy habits from an early age. Research has found parents’ views of infants’ weight may influence their feeding practices; however, limited research has explored mothers’ view of infants’ weight in relation to the promotion of physical activity. Therefore, the purpose of this study was to explore the perceptions of mothers of normal weight infants and overweight infants about their infant’s weight and physical activity. Methods Semi-structured interviews were conducted with mothers of normal weight (n = 18) and of overweight (n = 11) infants (6.5 ± 0.5 month) in a Midwestern city in the United States. A thematic analysis was used to analyze the data. Results A majority of mothers thought infants could be overweight. However, no mothers referenced their own infant as overweight. Mothers most commonly noted infants could be overweight only if they were formula fed and/or were overfed, not if they were breastfed. Mothers views were not negatively influenced by others who mentioned that their child was either “big” or “small” and only one mother had been told her infant was overweight. A majority of mothers thought an infant could be physically active. When discussing infant activity, mothers primarily referred to it in terms of general mobility and a few thought activity level was related to a personality characteristic. Mothers intended to promote physical activity in the future either through outdoor play or specific organized activities such as sports. Despite a majority of mothers stating they were currently physically active themselves, only a few talked about interacting with their infant to promote their infant’s physical activity. Conclusions Efforts are needed by healthcare professionals and other public health professionals to inform mothers about the dangers of increased weight during infancy as well as the importance of interacting with infants to promote physical activity. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4503-5) contains supplementary material, which is available to authorized users.
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Robson SM, Bolling C, McCullough MB, Stough CO, Stark LJ. A Preschool Obesity Treatment Clinical Trial: Reasons Primary Care Providers Declined Referrals. J Pediatr 2016; 177:262-266.e1. [PMID: 27453375 PMCID: PMC5037027 DOI: 10.1016/j.jpeds.2016.06.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/21/2016] [Accepted: 06/08/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To examine referral by primary care providers (PCPs) of preschool children with obesity (≥95th percentile for body mass index [BMI]) to a weight management intervention when offered through a randomized clinical trial (RCT), and identify reasons for not referring children. STUDY DESIGN In phase I, 3 experts in obesity, psychology, and nutrition completed an open card sort and classified PCPs' reasons for declining referral into groups based on similarity of reasons. Categories were then defined and labeled. In phase II, 2 independent sorters placed each decline into 1 of the categories defined in phase I. RESULTS PCPs referred 78% of eligible children to the RCT. Compared with children declined for referral, referred children had a significantly higher weight (48.4 lb vs 46.1 lb; P < .001) and BMI percentile (97.6 vs 97.0; P < .001). Eleven categories for decline were identified in phase I. In phase II, excellent reliability was obtained between each independent sorter and the phase I categories, and also between the 2 independent sorters (κ values, 0.72-1.0). The most common reason for declining was "family not a good fit" (23.6%), followed by "doesn't believe weight is a problem" (13.9%), "family would not be interested" (12%), and "doesn't believe measurement is accurate" (11.5%). Appropriately, exclusionary criteria of the RCT was a reason as well (11.8%). CONCLUSION The availability of weight management for preschoolers through RCTs appeared to overcome barriers of resources, time, and credible treatment cited in previous studies. However, concerns about the family's response or interest in a weight management program remained barriers, as did PCPs' perceptions about obesity in young children. TRIAL REGISTRATION ClinicalTrials.gov:NCT01546727.
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Affiliation(s)
- Shannon M. Robson
- University of Delaware, Newark, Delaware, USA,Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | | | | | | | - Lori J. Stark
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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Lobelo F, de Quevedo IG. The Evidence in Support of Physicians and Health Care Providers as Physical Activity Role Models. Am J Lifestyle Med 2016; 10:36-52. [PMID: 26213523 PMCID: PMC4511730 DOI: 10.1177/1559827613520120] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 11/05/2013] [Accepted: 11/15/2013] [Indexed: 11/15/2022] Open
Abstract
Physical inactivity constitutes the fourth leading cause of death worldwide. Health care providers (HCPs) should play a key role in counseling and appropriately referring their patients to adopt physical activity (PA). Previous reports suggest that active HCPs are more likely to provide better, more credible, and motivating preventive counseling to their patients. This review summarizes the available evidence on the association between HCPs' personal PA habits and their related PA counseling practices. Based on relevant studies, a snowball search strategy identified, out of 196 studies screened, a total of 47 pertinent articles published between 1979 and 2012. Of those, 23 described HCPs' PA habits and/or their counseling practices and 24 analytic studies evaluated the association between HCPs' personal PA habits and their PA counseling practices. The majority of studies came from the United States (n = 33), and 9 studies included nonphysicians (nurses, pharmacists, and other HCPs). PA levels were mostly self-reported, and counseling was typically assessed as self-reported frequency or perceived self-efficacy in clinical practice. Most (19 out of 24) analytic studies reported a significant positive association between HCPs' PA habits and counseling frequency, with odds ratios ranging between 1.4 and 5.7 (P < .05), in 6 studies allowing direct comparison. This review found consistent evidence supporting the notion that physically active physicians and other HCPs are more likely to provide PA counseling to their patients and can indeed become powerful PA role models. This evidence appears sufficient to justify randomized trials to determine if adding interventions to promote PA among HCPs, also results in improvements in the frequency and quality of PA preventive counseling and referrals, delivered by HCPs, to patients in primary care settings. Future studies should also aim at objectively quantifying the effect of HCPs' PA role-modeling and how it influences patients' PA levels. More evidence from low-to-middle income countries is needed, where 80% of the deaths due to inactivity and related noncommunicable diseases already occur.
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Affiliation(s)
- Felipe Lobelo
- Global Health Promotion Office, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Isabel Garcia de Quevedo
- Global Health Promotion Office, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Mosher AL, Piercy KL, Webber BJ, Goodwin SK, Casavale KO, Olson RD. Dietary Guidelines for Americans: Implications for Primary Care Providers. Am J Lifestyle Med 2016; 10:23-35. [PMID: 30202257 PMCID: PMC6124854 DOI: 10.1177/1559827614521755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 12/04/2013] [Accepted: 12/06/2013] [Indexed: 11/17/2022] Open
Abstract
In the United States, high rates of obesity and chronic disease impose serious consequences on the population's health and health care system. Primary care providers are critical to broad prevention efforts aiming to reduce the burden of chronic disease in the nation and play an important role in addressing lifestyle behaviors that can result in illness and premature death. Unhealthy dietary behaviors largely contribute to morbidity and mortality in the United States despite national efforts to improve the nutritional quality of the typical American diet. This article discusses a comprehensive set of national evidence-based recommendations known as the Dietary Guidelines for Americans that can support primary care providers' efforts to improve patient outcomes through optimal nutrition and healthy lifestyle behaviors. This article also describes basic behavioral counseling techniques primary care providers can incorporate into time-limited patient encounters to help improve the dietary and physical activity behaviors of their patients.
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Affiliation(s)
- Amber L. Mosher
- Amber L. Mosher, MPH, RD, Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, 1101 Wootton Parkway, Tower Oaks Bldg, Suite LL 100, Rockville, MD 20852; e-mail:
| | - Katrina L. Piercy
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, Maryland (ALM, KLP, SKG, KOC, RDO)
- Uniformed Services University of the Health Sciences, Bethesda, Maryland (BJW)
| | - Bryant J. Webber
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, Maryland (ALM, KLP, SKG, KOC, RDO)
- Uniformed Services University of the Health Sciences, Bethesda, Maryland (BJW)
| | - Stephanie K. Goodwin
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, Maryland (ALM, KLP, SKG, KOC, RDO)
- Uniformed Services University of the Health Sciences, Bethesda, Maryland (BJW)
| | - Kellie O. Casavale
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, Maryland (ALM, KLP, SKG, KOC, RDO)
- Uniformed Services University of the Health Sciences, Bethesda, Maryland (BJW)
| | - Richard D. Olson
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, Maryland (ALM, KLP, SKG, KOC, RDO)
- Uniformed Services University of the Health Sciences, Bethesda, Maryland (BJW)
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Gamliel A, Ziv-Baran T, Siegel RM, Fogelman Y, Dubnov-Raz G. Using weight-for-age percentiles to screen for overweight and obese children and adolescents. Prev Med 2015; 81:174-9. [PMID: 26348454 DOI: 10.1016/j.ypmed.2015.08.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/27/2015] [Accepted: 08/31/2015] [Indexed: 11/24/2022]
Abstract
There are relatively low rates of screening for overweight and obesity among children and adolescents in primary care. A simplified method for such screening is needed. The study objective was to examine if weight-for-age percentiles are sufficiently sensitive in identifying overweight and obesity in children and adolescents. We used data from two distinct sources: four consecutive cycles of the National Health and Nutrition Examination Surveys (NHANES) from the years 2005 to 2012, using participants aged 2-17.9 years for whom data on age, sex, weight, and height were available (n=12,884), and primary care clinic measurements (n=15,152). Primary outcomes were the threshold values of weight-for-age percentiles which best discriminated between normal weight, overweight, and obesity status. Receiver operating characteristic analyses demonstrated that weight-for-age percentiles well discriminated between normal weight and overweight and between non-obese and obese individuals (area under curve=0.956 and 0.977, respectively, both p<0.001). Following Classification and Regression Trees analysis, the 90th and 75th weight-for-age percentiles were chosen as appropriate cutoffs for obesity and overweight, respectively. These cutoffs had high sensitivity and negative predictive value in identifying obese participants (94.3% and 98.6%, respectively, for the 90th percentile) and in identifying overweight participants (93.2% and 95.9%, respectively, for the 75th percentile). The sensitivities and specificities were nearly identical across race and sex, and in the validation data from NHANES 2011 to 2012 and primary care. We conclude that weight-for-age percentiles can discriminate between normal weight, overweight and obese children, and adolescents. The 75th and 90th weight-for-age percentiles correspond well with the BMI cutoffs for pediatric overweight and obesity, respectively.
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Affiliation(s)
- Adir Gamliel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Robert M Siegel
- Center for Better Health and Nutrition, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | | | - Gal Dubnov-Raz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Exercise, Nutrition and Lifestyle Clinic, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.
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Organizing for Quality Improvement in Health Care: An Example From Childhood Obesity Prevention. Qual Manag Health Care 2015; 24:121-8. [PMID: 26115059 DOI: 10.1097/qmh.0000000000000066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Children in rural areas face higher rates of obesity than children in urban areas, and their clinicians face challenges with preventing and managing obesity and translation of evidence into practice. We evaluated how the quality improvement (QI) intervention, Healthy Eating Active Living TeleHealth Community of Practice (HEALTH COP), at 7 rural California clinics addressed these challenges. Focus group interviews with QI team members assessed their experiences and factors related to adoption of key changes. Key challenges were clinician and staff buy-in, changing ingrained clinical practices, and motivating patient and families. Facilitators were top-down organizational requirements for QI, linkages to local QI resources, involvement of clinical champions, alignment with existing practices, incorporating a learning system connecting similar clinics, and clear and consistent communication channels. Evaluations of QI interventions should include not only measurement of effectiveness but also identification of factors associated with change and interactions with organizational processes and contexts.
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Steeves JA, Liu B, Willis G, Lee R, Smith AW. Physicians’ personal beliefs about weight-related care and their associations with care delivery: The U.S. National Survey of Energy Balance Related Care among Primary Care Physicians. Obes Res Clin Pract 2015; 9:243-55. [DOI: 10.1016/j.orcp.2014.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/22/2014] [Accepted: 08/01/2014] [Indexed: 01/30/2023]
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Nelson JM, Vos MB, Walsh SM, O'Brien LA, Welsh JA. Weight management-related assessment and counseling by primary care providers in an area of high childhood obesity prevalence: current practices and areas of opportunity. Child Obes 2015; 11:194-201. [PMID: 25585234 PMCID: PMC4382824 DOI: 10.1089/chi.2014.0052] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Childhood obesity in Georgia exceeds the national rate. The state's pediatric primary care providers (PCPs) are well positioned to support behavior change, but little is known about provider perceptions and practices regarding this role. PURPOSE The aim of this study was to assess and compare weight-management-related counseling perceptions and practices among Georgia's PCPs. METHODS In 2012-2013, 656 PCPs (265 pediatricians, 143 family practice physicians [FPs], and 248 nurse practitioners/physician assistants [NP/PAs]) completed a survey regarding weight-management-related practices at well-child visits before their voluntary participation in a free training on patient-centered counseling and child weight management. Data were analyzed in 2014. Likert scales were used to quantify responses from 1 (strongly disagree or never) to 5 (strongly agree or always). Responses of 4 and 5 responses were combined to denote agreement or usual practice. Chi-squared analyses tested for independent associations between pediatricians and others. Statistical significance was determined using two-sided tests and p value <0.05. RESULTS The majority of PCPs assessed fruit and vegetable intake (83%) and physical activity (78%), but pediatricians were more likely than FPs and NP/PAs to assess beverage intake (96% vs. 82-87%; p≤0.002) and screen time (86% vs. 74-75%; p≤0.003). Pediatricians were also more likely to counsel patients on lifestyle changes (88% vs. 71%; p<0.001) and to track progress (50% vs. 35-39%; p<0.05). Though all PCPs agreed that goal setting is an effective motivator (88%) and that behavior change increases with provider encouragement (85%), fewer were confident in their ability to counsel (72%). CONCLUSIONS Our results show that many PCPS in Georgia, particularly pediatricians, have incorporated weight management counseling into their practice; however, important opportunities to strengthen these efforts by targeting known high-risk behaviors remain.
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Affiliation(s)
| | - Miriam B. Vos
- Wellness Department, Children's Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Nutrition and Health Sciences Program, Graduate School of Biological and Biomedical Sciences, Emory University, Atlanta, GA
| | - Stephanie M. Walsh
- Wellness Department, Children's Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | | | - Jean A. Welsh
- Wellness Department, Children's Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Nutrition and Health Sciences Program, Graduate School of Biological and Biomedical Sciences, Emory University, Atlanta, GA
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Piercy KL, Dorn JM, Fulton JE, Janz KF, Lee SM, McKinnon RA, Pate RR, Pfeiffer KA, Young DR, Troiano RP, Lavizzo-Mourey R. Opportunities for public health to increase physical activity among youths. Am J Public Health 2015; 105:421-6. [PMID: 25602864 PMCID: PMC4330821 DOI: 10.2105/ajph.2014.302325] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2014] [Indexed: 11/04/2022]
Abstract
Despite the well-known benefits of youths engaging in 60 or more minutes of daily physical activity, physical inactivity remains a significant public health concern. The 2008 Physical Activity Guidelines for Americans (PAG) provides recommendations on the amount of physical activity needed for overall health; the PAG Midcourse Report (2013) describes effective strategies to help youths meet these recommendations. Public health professionals can be dynamic change agents where youths live, learn, and play by changing environments and policies to empower youths to develop regular physical activity habits to maintain throughout life. We have summarized key findings from the PAG Midcourse Report and outlined actions that public health professionals can take to ensure that all youths regularly engage in health-enhancing physical activity.
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Affiliation(s)
- Katrina L Piercy
- Katrina L. Piercy is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Joan M. Dorn, Janet E. Fulton, and Sarah M. Lee are with the US Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, GA. Kathleen F. Janz is with the Department of Health and Human Physiology, University of Iowa, Iowa City. Robin A. McKinnon and Richard P. Troiano are with the US Department of Health and Human Services, National Institutes of Health, Bethesda, MD. Russell R. Pate is with the Department of Exercise Science, University of South Carolina, Columbia. Karin A. Pfeiffer is with the Department of Kinesiology, Michigan State University, East Lansing. Deborah Rohm Young is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA. Risa Lavizzo-Mourey is with the Robert Wood Johnson Foundation, Princeton, NJ
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Hoelscher DM, Butte NF, Barlow S, Vandewater EA, Sharma SV, Huang T, Finkelstein E, Pont S, Sacher P, Byrd-Williams C, Oluyomi AO, Durand C, Li L, Kelder SH. Incorporating primary and secondary prevention approaches to address childhood obesity prevention and treatment in a low-income, ethnically diverse population: study design and demographic data from the Texas Childhood Obesity Research Demonstration (TX CORD) study. Child Obes 2015; 11:71-91. [PMID: 25555188 PMCID: PMC4696423 DOI: 10.1089/chi.2014.0084] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is consensus that development and evaluation of a systems-oriented approach for child obesity prevention and treatment that includes both primary and secondary prevention efforts is needed. This article describes the study design and baseline data from the Texas Childhood Obesity Research Demonstration (TX CORD) project, which addresses child obesity among low-income, ethnically diverse overweight and obese children, ages 2-12 years; a two-tiered systems-oriented approach is hypothesized to reduce BMI z-scores, compared to primary prevention alone. METHODS Our study aims are to: (1) implement and evaluate a primary obesity prevention program; (2) implement and evaluate efficacy of a 12-month family-centered secondary obesity prevention program embedded within primary prevention; and (3) quantify the incremental cost-effectiveness of the secondary prevention program. Baseline demographic and behavioral data for the primary prevention community areas are presented. RESULTS Baseline data from preschool centers, elementary schools, and clinics indicate that most demographic variables are similar between intervention and comparison communities. Most families are low income (≤$25,000) and Hispanic/Latino (73.3-83.8%). The majority of parents were born outside of the United States. Child obesity rates exceed national values, ranging from 19.0% in preschool to 35.2% in fifth-grade children. Most parents report that their children consume sugary beverages, have a television in the bedroom, and do not consume adequate amounts of fruits and vegetables. CONCLUSIONS Interventions to address childhood obesity are warranted in low-income, ethnically diverse communities. Integrating primary and secondary approaches is anticipated to provide sufficient exposure that will lead to significant decreases in childhood obesity.
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Affiliation(s)
- Deanna M. Hoelscher
- Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, Austin, TX
| | - Nancy F. Butte
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - Sarah Barlow
- Department of Pediatric Medicine, GI, Hepatology and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Elizabeth A. Vandewater
- Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, Austin, TX
| | - Shreela V. Sharma
- Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, Houston, TX
| | - Terry Huang
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE
| | - Eric Finkelstein
- Program in Health Services Systems Research, Duke University Global Health Institute, Singapore
| | - Stephen Pont
- Texas Center for the Prevention and Treatment of Childhood Obesity, Dell Children's Medical Center, University of Texas Southwestern–Austin, Austin, TX
| | - Paul Sacher
- Childhood Nutrition Research Center, University College, London, United Kingdom
| | - Courtney Byrd-Williams
- Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, Austin, TX
| | - Abiodun O. Oluyomi
- Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, Austin, TX
| | - Casey Durand
- Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, Houston, TX
| | - Linlin Li
- Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, Austin, TX
| | - Steven H. Kelder
- Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, Austin, TX
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Aldrich H, Gance-Cleveland B, Schmiege S, Dandreaux D. School-based health center providers' treatment of overweight children. J Pediatr Nurs 2014; 29:521-7. [PMID: 24947663 DOI: 10.1016/j.pedn.2014.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/15/2014] [Accepted: 05/16/2014] [Indexed: 11/18/2022]
Abstract
This descriptive study was to determine self-reported treatment practices of school-based health center (SBHC) providers when caring for overweight/obese children. Providers (N=33) from SBHCs in 6 states (AZ, CO, NM, MI, NY, and NC) completed a baseline survey before being trained on obesity recommendations. SBHC providers reported patient/parent barriers to be more significant to treatment than clinician/setting barriers (p<0.0001). Most providers (97%) indicated childhood overweight needs treatment, yet only 36% said they initiate treatment in children who do not want to control their weight. SBHC providers also did not commonly refer overweight/obese children to specialists.
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Affiliation(s)
- Heather Aldrich
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | | | - Sarah Schmiege
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Danielle Dandreaux
- Center for Improving Health Outcomes in Children, Teens, and Families, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ.
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Wang H, Kim J, Su D, Xu L, Chen LW, Huang TTK. Joint influence of individual choices, parenting practices, and physician advice on adolescent obesity, Nebraska, 2008. Prev Chronic Dis 2014; 11:E175. [PMID: 25299981 PMCID: PMC4193059 DOI: 10.5888/pcd11.140210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Reducing childhood obesity remains a public health priority given its high prevalence and its association with increased risk of adult obesity and chronic diseases. The objective of this study was to examine the joint influence of multiple risk factors on adolescent overweight status. Methods We conducted a random-digit-dialed telephone survey of adolescents aged 12 to 19 years in fall 2008 in a Midwestern city in Nebraska. On the basis of survey data for 791 youths aged 12 to 18 years, we conducted latent class analysis to group youths by the joint occurrence of dietary behavior, physical activity, parenting practices, and physician advice. We then examined the association between the groups and overweight status by using logistic regression, controlling for age, sex, race/ethnicity, and parent and family information. Results Youths were clustered into 3 groups. Group I (52%) were youths with healthy dietary behavior and physical activity, less permissive parenting practices, and physician advice; Group II (30%) were youths with moderately healthy dietary behavior and physical activity, less permissive parenting practices, and no physician advice; and Group III (18%) were youths with unhealthy dietary behavior and physical activity, permissive parenting practices, and physician advice. Youths in Groups I and II were less likely to be overweight than youths in Group III. Conclusions Youths with healthier behavior and less permissive parenting practices were less likely to be overweight. Study findings highlight the need to address obesity risk factors among youths with unhealthy dietary behavior, inadequate exercise, permissive parenting practices, and some physician advice. Tailored interventions should be used to target youths with different obesity risk factors.
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Affiliation(s)
- Hongmei Wang
- Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, 984350 Nebraska Medical Center, Omaha, NE 68198-4350. E-mail:
| | - Jungyoon Kim
- University of Nebraska Medical Center, Omaha, Nebraska
| | - Dejun Su
- University of Nebraska Medical Center, Omaha, Nebraska
| | - Liyan Xu
- Creighton University, Omaha, Nebraska. At the time this article was written, Dr. Xu was affiliated with the University of Nebraska Medical Center, Omaha, Nebraska
| | - Li-Wu Chen
- University of Nebraska Medical Center, Omaha, Nebraska
| | - Terry T-K Huang
- City University of New York School of Public Health, New York, New York. At the time this article was written, Dr. Huang was affiliated with the University of Nebraska Medical Center, Omaha, Nebraska
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Christison AL, Daley BM, Asche CV, Ren J, Aldag JC, Ariza AJ, Lowry KW. Pairing motivational interviewing with a nutrition and physical activity assessment and counseling tool in pediatric clinical practice: a pilot study. Child Obes 2014; 10:432-41. [PMID: 25259587 DOI: 10.1089/chi.2014.0057] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Recommendations to screen and counsel for lifestyle behaviors can be challenging to implement during well-child visits in the primary care setting. A practice intervention was piloted using the Family Nutrition and Physical Activity (FNPA) Screening Tool paired with a motivational interviewing (MI)-based counseling tool during well-child visits. Acceptability and feasibility of this intervention were assessed. Its impact on parent-reported obesigenic behavior change and provider efficacy in lifestyle counseling were also examined. METHODS This was an observational study in a pediatric primary care office. During well-child visits of 100 patients (ages 4-16 years), the FNPA tool was implemented and providers counseled patients in an MI-consistent manner based on its results. Duration of implementation, patient satisfaction of the intervention, and success of stated lifestyle goals were measured. Provider self-efficacy and acceptability were also surveyed. RESULTS The FNPA assessment was efficient to administer, requiring minutes to complete and score. Patient acceptability was high, ranging from 4.0 to 4.8 on a 5-point scale. Provider acceptability was good, with the exception of duration of counseling; self-efficacy in assessing patient "readiness for change" was improved. Parent-reported success of primary lifestyle goal was 68% at 1 month and 46% at 6 months. CONCLUSIONS The FNPA assessment with an MI-based counseling tool shows promise as an approach to identify and address obesigenic behaviors during pediatric well-child visits. It has the potential to improve provider efficacy in obesity prevention and also influence patient health behaviors, which can possibly impact childhood excessive weight gain. After refinement, this practice intervention will be used in a larger trial.
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Affiliation(s)
- Amy L Christison
- 1 Department of Pediatrics, University of Illinois College of Medicine at Peoria , Peoria, IL
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