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Shinall JB, Schlundt DG, Sullivan MH, Frank HJ, Po’e EK, Sommer EC, Bonnet KR, Burgess LE, Barkin SL, Haws KL. Identifying meaningful dietary intake and physical activity questions for individual and population health. Clin Obes 2021; 11:e12435. [PMID: 33412615 PMCID: PMC9257901 DOI: 10.1111/cob.12435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/20/2020] [Accepted: 11/30/2020] [Indexed: 11/28/2022]
Abstract
We aimed to identify valid screening questions for adults regarding physical activity and dietary behaviours that (a) were correlated with BMI, (b) were deemed by patients and providers to be relevant to clinical care, and (c) have utility for longitudinal understanding of health behaviours in populations. The goal was to identify screening questions that could be implemented at annual health care visits. First, we identified dietary behaviour questions and solicited patient input. Next, we tested both physical activity and dietary behaviour questions in a large sample to test their potential utility. Finally, we used cognitive interviews with patients and physicians to narrow our assessment for clinical settings. We present a parsimonious and reliable six-question scale of physical activity and dietary behaviours for research settings, as well as a three-question scale for clinical settings. We demonstrate a robust relationship between these measures and obesity. Additionally, we present evidence that these measures may serve as a useful red flag for patients before they develop obesity. We provide a concise and useful tool for assessing patients' physical activity and dietary behaviours in a variety of research settings. We also highlight the importance of incorporating this tool into the clinical intake flow for inclusion in patients' Electronic Health Record.
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Affiliation(s)
| | - David G. Schlundt
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
| | - Mikaela H. Sullivan
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina
| | | | - Eli K. Po’e
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Evan C. Sommer
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Laura E. Burgess
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shari L. Barkin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelly L. Haws
- Vanderbilt University, Owen School of Management, Nashville, Tennessee
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2
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Sullivan MH, Sommer EC, Schlundt D, Shinall JB, Haws KL, Bonnet KR, Burgess LE, Po'e EK, Barkin SL. Development of Brief Child Nutrition and Physical Activity Screening Questions for Electronic Health Record Use. Child Obes 2020; 16:488-498. [PMID: 32721216 PMCID: PMC7575345 DOI: 10.1089/chi.2020.0088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: To develop and test brief nutrition and physical activity screening questions for children ages 2-11 years that could be used as a pragmatic screening tool to tailor counseling, track behavior change, and improve population health. Methods: A literature review identified existing validated questions for nutrition and physical activity behaviors in children ages 2-11 years. Response variation and concurrent validity was then assessed using a mechanical Turk (MTurk) crowdsourcing survey employed in 2018. Additionally, cognitive interviews were conducted with both providers and parents of 2- to 11-year-old children to assess screening question priorities and perceived added value. Results: The literature review identified 260 questions, and 20 items were selected with expert guidance based on prespecified criteria (simplicity and potential utility for both clinical interactions during a well-child exam and population health). MTurk surveys yielded 1147 records that met eligibility criteria and revealed 6 items that had adequate response variation and were significantly correlated with parent-reported child BMI or BMI percentile, exhibiting concurrent validity. Cognitive interviews with 10 providers and 20 parents uncovered themes regarding suggestions and usability of the questions, eliminating 3 items due to parent and provider concerns. Combining quantitative and qualitative results, 3 nutrition and physical activity screening items remained for inclusion into the electronic health record (EHR). Conclusions: The three-pronged validation methodology produced a brief, 3-item child nutrition and physical activity screener to incorporate in the EHR, where it can inform tailored counseling for well-child care and be used to test associations with population health outcomes.
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Affiliation(s)
| | - Evan C. Sommer
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | | | - Kelly L. Haws
- Vanderbilt University Owen Graduate School of Management, Nashville, TN, USA
| | | | - Laura E. Burgess
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eli K. Po'e
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shari L. Barkin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
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3
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Kim J, Kim YM, Jang HB, Lee HJ, Park SI, Park KH, Lim H. Evidence-based Nutritional Intervention Protocol for Korean Moderate-Severe Obese Children and Adolescents. Clin Nutr Res 2019; 8:184-195. [PMID: 31384597 PMCID: PMC6675960 DOI: 10.7762/cnr.2019.8.3.184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 12/30/2022] Open
Abstract
Diet-related behavioral modification for healthy eating and lifestyle is required to improve childhood obesity. The present study aimed to develop customized nutritional intervention protocol and education program to find barriers to adhere healthy diet and lifestyle for moderate to severe obese children and adolescents and their families. Theoretical framework approaches can be used to change behavior and achieve goals. Previous studies that described the relationship between behavioral modification and nutrition education theory were reviewed. The social cognitive theory and transtheoretical model were employed with behavioral changes to target a healthful diet and lifestyle. The nutrition care process (NCP) model was adopted to customize nutrition care for the participants. Customized nutritional intervention protocol was developed following as the four steps of the NCP. Firstly, nutrition status of the participants was assessed by the nutrition expert. Nutrition problems were described as "inadequate energy intake," "overweight/obesity," or "food and nutrition-related knowledge deficit." All nutrition sessions were designed for nutrition intervention to give nutritional knowledge and a practical mission in real life for individual goal setting and self-control. Meal planning, portion control, healthy snack selection and cooking with fruits and vegetables were consisted of five components of the nutrition education session. During each session, the participants and their families were interviewed by a nutrition expert for monitoring and evaluating diet-related goal setting and achievement. A theoretical and evidence-based nutritional intervention was developed for the secondary to tertiary prevention of childhood obesity. This nutrition intervention protocol and program might be helpful for the further research on childhood obesity. Trial Registration Clinical Research Information Service Identifier: KCT0002111.
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Affiliation(s)
- Jieun Kim
- Department of Medical Nutrition, Kyung Hee University, Yongin 17104, Korea.,Research Institute of Medical Nutrition, Kyung Hee University, Seoul 02447, Korea
| | - Yoon Myung Kim
- Department of Sports Industry Studies, Yonsei University International Campus, Incheon 21983, Korea
| | - Han Byul Jang
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju 28159, Korea
| | - Hye-Ja Lee
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju 28159, Korea
| | - Sang Ick Park
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju 28159, Korea
| | - Kyung-Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Hyunjung Lim
- Department of Medical Nutrition, Kyung Hee University, Yongin 17104, Korea.,Research Institute of Medical Nutrition, Kyung Hee University, Seoul 02447, Korea
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Duggan MP, Taveras EM, Gerber MW, Horan CM, Oreskovic NM. Presence of Small Screens in Bedrooms Is Associated With Shorter Sleep Duration and Later Bedtimes in Children With Obesity. Acad Pediatr 2019; 19:515-519. [PMID: 30415077 DOI: 10.1016/j.acap.2018.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/29/2018] [Accepted: 11/02/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The presence of small screens in the sleep environment has been associated with shorter sleep duration and later bedtimes in children of normal weight, but the role these devices play in the sleep environment of overweight children is unclear. We sought to examine the association of small screen presence in the sleep environment with sleep behaviors among school-age children with obesity. METHODS We surveyed 526 parents of children ages 6 to 12 years old with a body mass index ≥95th percentile who were participating in a randomized trial to treat childhood obesity. Twelve months after enrollment, parents were asked how frequently their child slept with or near a small screen (defined as a cellphone, smartphone, or texting/chat-capable device). We used multivariable linear regression to examine associations of the presence of small screens with sleep duration, waketime, and bedtime. RESULTS Compared with children who rarely/never slept with a small screen in their bedroom, children who did so 1 day or more per week had shorter sleep durations and later bedtimes. After we adjusted for television presence in the bedroom, small screen presence was still associated with shorter sleep duration (-9.9 minutes; P = .02) and later weekday (8.8 minutes; P = .03) and weekend (12.0 minutes; P = .03) bedtimes. CONCLUSIONS Children with obesity and a small screen present in their sleep environment have shorter sleep durations and later bedtimes than children who rarely/never sleep with a small screen. Pediatricians should consider inquiring about small screens in the bedroom when counseling on healthy sleep and weight management habits.
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Affiliation(s)
- Michael P Duggan
- Division of General Academic Pediatrics (MP Duggan, EM Taveras, MW Gerber, CM Horan, NM Oreskovic), Massachusetts General Hospital for Children
| | - Elsie M Taveras
- Division of General Academic Pediatrics (MP Duggan, EM Taveras, MW Gerber, CM Horan, NM Oreskovic), Massachusetts General Hospital for Children; Department of Pediatrics (EM Taveras, NM Oreskovic), Harvard Medical School; Department of Nutrition (EM Taveras), Harvard T. H. Chan School of Public Health (EM Taveras), Boston, Mass
| | - Monica W Gerber
- Division of General Academic Pediatrics (MP Duggan, EM Taveras, MW Gerber, CM Horan, NM Oreskovic), Massachusetts General Hospital for Children
| | - Christine M Horan
- Division of General Academic Pediatrics (MP Duggan, EM Taveras, MW Gerber, CM Horan, NM Oreskovic), Massachusetts General Hospital for Children
| | - Nicolas M Oreskovic
- Division of General Academic Pediatrics (MP Duggan, EM Taveras, MW Gerber, CM Horan, NM Oreskovic), Massachusetts General Hospital for Children; Department of Pediatrics (EM Taveras, NM Oreskovic), Harvard Medical School.
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Moschonis G, Michalopoulou M, Tsoutsoulopoulou K, Vlachopapadopoulou E, Michalacos S, Charmandari E, Chrousos GP, Manios Y. Assessment of the Effectiveness of a Computerised Decision-Support Tool for Health Professionals for the Prevention and Treatment of Childhood Obesity. Results from a Randomised Controlled Trial. Nutrients 2019; 11:E706. [PMID: 30917561 PMCID: PMC6471646 DOI: 10.3390/nu11030706] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/14/2019] [Accepted: 03/22/2019] [Indexed: 02/07/2023] Open
Abstract
We examined the effectiveness of a computerised decision-support tool (DST), designed for paediatric healthcare professionals, as a means to tackle childhood obesity. A randomised controlled trial was conducted with 65 families of 6⁻12-year old overweight or obese children. Paediatricians, paediatric endocrinologists and a dietitian in two children's hospitals implemented the intervention. The intervention group (IG) received personalised meal plans and lifestyle optimisation recommendations via the DST, while families in the control group (CG) received general recommendations. After three months of intervention, the IG had a significant change in dietary fibre and sucrose intake by 4.1 and -4.6 g/day, respectively. In addition, the IG significantly reduced consumption of sweets (i.e., chocolates and cakes) and salty snacks (i.e., potato chips) by -0.1 and -0.3 portions/day, respectively. Furthermore, the CG had a significant increase of body weight and waist circumference by 1.4 kg and 2.1 cm, respectively, while Body Mass Index (BMI) decreased only in the IG by -0.4 kg/m². However, the aforementioned findings did not differ significantly between study groups. In conclusion, these findings indicate the dynamics of the DST in supporting paediatric healthcare professionals to improve the effectiveness of care in modifying obesity-related behaviours. Further research is needed to confirm these findings.
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Affiliation(s)
- George Moschonis
- Department of Dietetics, Nutrition and Sport, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia.
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70 El Venizelou Avenue, Kallithea, 17671 Athens, Greece.
| | - Maria Michalopoulou
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70 El Venizelou Avenue, Kallithea, 17671 Athens, Greece.
| | - Konstantina Tsoutsoulopoulou
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70 El Venizelou Avenue, Kallithea, 17671 Athens, Greece.
| | - Elpis Vlachopapadopoulou
- Department of Endocrinology-Growth and Development, Children's Hospital P. A. Kyriakou, 11527 Athens, Greece.
| | - Stefanos Michalacos
- Department of Endocrinology-Growth and Development, Children's Hospital P. A. Kyriakou, 11527 Athens, Greece.
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism, and Diabetes, First Department of Pediatrics, University of Athens Medical School, Aghia Sophia Children's Hospital, 11527 Athens, Greece.
- Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece.
| | - George P Chrousos
- Division of Endocrinology, Metabolism, and Diabetes, First Department of Pediatrics, University of Athens Medical School, Aghia Sophia Children's Hospital, 11527 Athens, Greece.
| | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University of Athens, 70 El Venizelou Avenue, Kallithea, 17671 Athens, Greece.
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Fiechtner L, Fonte ML, Castro I, Gerber M, Horan C, Sharifi M, Cena H, Taveras EM. Determinants of Binge Eating Symptoms in Children with Overweight/Obesity. Child Obes 2018; 14:510-517. [PMID: 30153037 PMCID: PMC6249668 DOI: 10.1089/chi.2017.0311] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Examining binge eating symptoms before the diagnosis of binge eating disorder in children with obesity could provide important information on prevention of future eating disorders. METHODS We examined the prevalence and multilevel determinants of three binge eating symptoms: (1) sneaking, hiding, or hoarding food; (2) eating in the absence of hunger, and (3) inhibition or embarrassment when eating in front of others among 817 children aged 5-12 years old with overweight/obesity receiving primary care in eastern Massachusetts. We examined the associations of child and parent/household characteristics with the prevalence ratios (PRs) of these three binge eating symptoms. RESULTS Approximately one-third of parents reported that their children would sneak, hide, or hoard food; 40% ate large amounts in the absence of hunger; and 8% were inhibited/embarrassed when eating in front of others. In multivariate analyses, greater screen time was associated with a higher prevalence of sneaking, hiding, or hoarding (PR 1.06, 95% CI: 1.01-1.11). We found that children with severe obesity (PR 1.50, 95% CI: 1.24-1.81 vs. nonsevere obesity) had higher prevalence of eating in the absence of hunger. Increased hours of screen time were associated with higher prevalence of eating in the absence of hunger, (PR: 1.07, 95% CI: 1.03-1.11), whereas longer sleep duration (PR: 0.90, 95% CI: 0.82-0.99) was associated with lower prevalence of eating in the absence of hunger. CONCLUSIONS Eating in the absence of hunger was the most common symptom in our sample and was associated with screen time and sleep. ClinicalTrials.gov NCT01537510.
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Affiliation(s)
- Lauren Fiechtner
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA.,Department of Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA.,Address correspondence to: Lauren Fiechtner, MD, MPH, Division of Gastroenterology and Nutrition, Massachusetts General Hospital for Children, 175 Cambridge Street, 5th Floor, Boston, MA 02114
| | - Maria Luisa Fonte
- Unit of Human Nutrition and Dietetics, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Ines Castro
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
| | - Monica Gerber
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
| | - Chrissy Horan
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
| | - Mona Sharifi
- Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Hellas Cena
- Unit of Human Nutrition and Dietetics, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA.,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA
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7
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Criss S, Blaine RE, Palamé M, Perkins M, Davison K, Kwass JA, Taveras EM. Health Marketing for the Massachusetts Childhood Obesity Research Demonstration Study: A Case Study. Health Promot Pract 2018; 20:282-291. [PMID: 29566576 DOI: 10.1177/1524839918760842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. This case study describes the Massachusetts Childhood Obesity Research Demonstration Study (MA-CORD) health marketing campaign, examines the strategies used in such campaigns, and offers lessons learned to improve health marketing for future interventions. MA-CORD Health Marketing Components and Implementation. The three main components were an outdoor printed advertisement and texting campaign, social media with a focus on Facebook, and the Summer Passport Program, an event-based initiative in parks for children. The advertisements consisted of billboards, bus advertisements, and handouts. The text messaging component, which required families to actively text a keyword to join, had a low opt-in rate. Facebook page "likes" increased from 1,024 to 1,453 in New Bedford and from 175 to 1,091 in Fitchburg. Fitchburg received technical assistance and paid for ads on Facebook. The Summer Passport participation in parks ranged from 120 to 875 children with participation in the free park lunch program doubling in Fitchburg. Discussion. Key lessons learned are engage communication experts from each community at the beginning of the project, use text messaging components with in-person staff onsite to assist participants in the opt-in process, build momentum for a Facebook presence through purchasing Facebook advertisements, and partner with local park departments for programming.
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Affiliation(s)
| | | | | | | | | | - Jo-Ann Kwass
- Massachusetts Department of Public Health, Boston, MA, USA
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Burchett HED, Sutcliffe K, Melendez-Torres GJ, Rees R, Thomas J. Lifestyle weight management programmes for children: A systematic review using Qualitative Comparative Analysis to identify critical pathways to effectiveness. Prev Med 2018; 106:1-12. [PMID: 28865809 DOI: 10.1016/j.ypmed.2017.08.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 08/22/2017] [Accepted: 08/27/2017] [Indexed: 11/26/2022]
Abstract
This study aimed to identify critical features of successful lifestyle weight management interventions for overweight children (0-11years). Eleven qualitative UK-based studies examining children's, parents' and providers' perspectives and experiences of programmes were synthesised to identify components felt to be critical. Studies for this views synthesis were identified from existing reviews and an update of one review's search, which was run in December 2015. The identified components were then explored in a synthesis of intervention evaluations (five 'most effective' and 15 'least effective') conducted in western Europe, North America, Australia or New Zealand. The intervention evaluations were identified from existing reviews and an update of one review's search, which was run in March 2016. This evaluation synthesis was carried out using Qualitative Comparative Analysis. Three important mechanisms were present in all the most effective interventions but absent in all the least effective: 1/ showing families how to change: a) providing child physical activity sessions, b) delivering practical behaviour change strategy sessions, c) providing calorie intake advice; 2/ ensuring all the family are on board: a) delivering discussion/education sessions for both children and parents, b) delivering child-friendly sessions, c) aiming to change behaviours across the whole family; 3/ enabling social support for both parents and children by delivering both child group sessions and parent group sessions. To conclude, programmes should ensure the whole family is on board the programme, that parents and children can receive social support and are not just told what to change, but shown how.
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Affiliation(s)
- Helen E D Burchett
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - Katy Sutcliffe
- EPPI-Centre, UCL Institute of Education, University College London, London, UK
| | | | - Rebecca Rees
- EPPI-Centre, UCL Institute of Education, University College London, London, UK
| | - James Thomas
- EPPI-Centre, UCL Institute of Education, University College London, London, UK
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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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10
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Taveras EM, Perkins M, Anand S, Woo Baidal JA, Nelson CC, Kamdar N, Kwass JA, Gortmaker SL, Barrett JL, Davison KK, Land T. Clinical effectiveness of the massachusetts childhood obesity research demonstration initiative among low-income children. Obesity (Silver Spring) 2017; 25:1159-1166. [PMID: 28653504 PMCID: PMC5506684 DOI: 10.1002/oby.21866] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/21/2017] [Accepted: 03/09/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the extent to which a clinical intervention resulted in reduced BMI z scores among 2- to 12-year-old children compared to routine practice (treatment as usual [TAU]). METHODS The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project is a multifaceted initiative to prevent childhood obesity among low-income children. At the federally qualified community health centers (FQHCs) of two communities (Intervention Site #1 and #2), the following were implemented: (1) pediatric weight management training, (2) electronic decision supports for clinicians, (3) on-site Healthy Weight Clinics, (4) community health worker integration, and (5) healthful clinical environment changes. One FQHC in a demographically matched community served as the TAU site. Using electronic health records, we assessed BMI z scores and used linear mixed models to examine BMI z score change over 2 years in each intervention site compared to a TAU site. RESULTS Compared to children in the TAU site (n = 2,286), children in Intervention Site #2 (n = 1,368) had a significant decline in BMI z scores following the start of the intervention (-0.16 units/y; 95% confidence interval: -0.21 to -0.12). No evidence of an effect was found in Intervention Site #1 (n = 111). CONCLUSIONS The MA-CORD clinical interventions were associated with modest improvement in BMI z scores in one of two intervention communities compared to a TAU community.
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Affiliation(s)
- Elsie M. Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Meghan Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
| | - Shikha Anand
- National Institute for Children’s Health Quality, Boston, MA
| | - Jennifer A. Woo Baidal
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Candace C. Nelson
- Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston, MA
| | - Neil Kamdar
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
| | - Jo-Ann Kwass
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - Steven L. Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jessica L. Barrett
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Kirsten K. Davison
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Thomas Land
- Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston, MA
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11
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Franckle RL, Falbe J, Gortmaker S, Barrett JL, Giles C, Ganter C, Blaine RE, Buszkiewicz J, Taveras EM, Kwass JA, Land T, Davison KK. Student obesity prevalence and behavioral outcomes for the massachusetts childhood obesity research demonstration project. Obesity (Silver Spring) 2017; 25:1175-1182. [PMID: 28653502 PMCID: PMC5488705 DOI: 10.1002/oby.21867] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/02/2017] [Accepted: 03/17/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine changes in prevalence of obesity and target health behaviors (fruit, vegetable, and beverage consumption; physical activity; screen time; sleep duration) among students from communities that participated in the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project compared to controls. METHODS MA-CORD was implemented in two low-income communities. School-level prevalence of obesity among students in first, fourth, and seventh grades was calculated for the intervention communities and nine matched control communities pre and post intervention. Fourth- and seventh-grade students' self-reported health behaviors were measured in intervention communities at baseline and post intervention. RESULTS Among seventh-graders (the student group with greatest intervention exposure), a statistically significant decrease in prevalence of obesity from baseline to post intervention in Community 2 (-2.68%, P = 0.049) and a similar but nonsignificant decrease in Community 1 (-2.24%, P = 0.099) was observed. Fourth- and seventh-grade students in both communities were more likely to meet behavioral targets post intervention for sugar-sweetened beverages (both communities: P < 0.0001) and water (Community 1: P < 0.01; Community 2: P = 0.04) and in Community 2 for screen time (P < 0.01). CONCLUSIONS This multisector intervention was associated with a modest reduction in obesity prevalence among seventh-graders in one community compared to controls, along with improvements in behavioral targets.
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Affiliation(s)
- Rebecca L. Franckle
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jennifer Falbe
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, CA
| | - Steven Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jessica L. Barrett
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Catherine Giles
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Claudia Ganter
- Medical Faculty Mannheim, Heidelberg University, Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim, Germany
| | - Rachel E. Blaine
- Department of Family and Consumer Sciences, California State University, Long Beach, CA
| | - James Buszkiewicz
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA
| | - Elsie M. Taveras
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Jo-Ann Kwass
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - Thomas Land
- Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston, MA
| | - Kirsten K. Davison
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
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12
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Mead E, Brown T, Rees K, Azevedo LB, Whittaker V, Jones D, Olajide J, Mainardi GM, Corpeleijn E, O'Malley C, Beardsmore E, Al‐Khudairy L, Baur L, Metzendorf M, Demaio A, Ells LJ. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Cochrane Database Syst Rev 2017; 6:CD012651. [PMID: 28639319 PMCID: PMC6481885 DOI: 10.1002/14651858.cd012651] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Child and adolescent overweight and obesity has increased globally, and can be associated with significant short- and long-term health consequences. This is an update of a Cochrane review published first in 2003, and updated previously in 2009. However, the update has now been split into six reviews addressing different childhood obesity treatments at different ages. OBJECTIVES To assess the effects of diet, physical activity and behavioural interventions (behaviour-changing interventions) for the treatment of overweight or obese children aged 6 to 11 years. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of studies and systematic reviews. We did not apply any language restrictions. The date of the last search was July 2016 for all databases. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of diet, physical activity, and behavioural interventions (behaviour-changing interventions) for treating overweight or obese children aged 6 to 11 years, with a minimum of six months' follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity. DATA COLLECTION AND ANALYSIS Two review authors independently screened references, extracted data, assessed risk of bias, and evaluated the quality of the evidence using the GRADE instrument. We contacted study authors for additional information. We carried out meta-analyses according to the statistical guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS We included 70 RCTs with a total of 8461 participants randomised to either the intervention or control groups. The number of participants per trial ranged from 16 to 686. Fifty-five trials compared a behaviour-changing intervention with no treatment/usual care control and 15 evaluated the effectiveness of adding an additional component to a behaviour-changing intervention. Sixty-four trials were parallel RCTs, and four were cluster RCTs. Sixty-four trials were multicomponent, two were diet only and four were physical activity only interventions. Ten trials had more than two arms. The overall quality of the evidence was low or very low and 62 trials had a high risk of bias for at least one criterion. Total duration of trials ranged from six months to three years. The median age of participants was 10 years old and the median BMI z score was 2.2.Primary analyses demonstrated that behaviour-changing interventions compared to no treatment/usual care control at longest follow-up reduced BMI, BMI z score and weight. Mean difference (MD) in BMI was -0.53 kg/m2 (95% confidence interval (CI) -0.82 to -0.24); P < 0.00001; 24 trials; 2785 participants; low-quality evidence. MD in BMI z score was -0.06 units (95% CI -0.10 to -0.02); P = 0.001; 37 trials; 4019 participants; low-quality evidence and MD in weight was -1.45 kg (95% CI -1.88 to -1.02); P < 0.00001; 17 trials; 1774 participants; low-quality evidence.Thirty-one trials reported on serious adverse events, with 29 trials reporting zero occurrences RR 0.57 (95% CI 0.17 to 1.93); P = 0.37; 4/2105 participants in the behaviour-changing intervention groups compared with 7/1991 participants in the comparator groups). Few trials reported health-related quality of life or behaviour change outcomes, and none of the analyses demonstrated a substantial difference in these outcomes between intervention and control. In two trials reporting on minutes per day of TV viewing, a small reduction of 6.6 minutes per day (95% CI -12.88 to -0.31), P = 0.04; 2 trials; 55 participants) was found in favour of the intervention. No trials reported on all-cause mortality, morbidity or socioeconomic effects, and few trials reported on participant views; none of which could be meta-analysed.As the meta-analyses revealed substantial heterogeneity, we conducted subgroup analyses to examine the impact of type of comparator, type of intervention, risk of attrition bias, setting, duration of post-intervention follow-up period, parental involvement and baseline BMI z score. No subgroup effects were shown for any of the subgroups on any of the outcomes. Some data indicated that a reduction in BMI immediately post-intervention was no longer evident at follow-up at less than six months, which has to be investigated in further trials. AUTHORS' CONCLUSIONS Multi-component behaviour-changing interventions that incorporate diet, physical activity and behaviour change may be beneficial in achieving small, short-term reductions in BMI, BMI z score and weight in children aged 6 to 11 years. The evidence suggests a very low occurrence of adverse events. The quality of the evidence was low or very low. The heterogeneity observed across all outcomes was not explained by subgrouping. Further research is required of behaviour-changing interventions in lower income countries and in children from different ethnic groups; also on the impact of behaviour-changing interventions on health-related quality of life and comorbidities. The sustainability of reduction in BMI/BMI z score and weight is a key consideration and there is a need for longer-term follow-up and further research on the most appropriate forms of post-intervention maintenance in order to ensure intervention benefits are sustained over the longer term.
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Affiliation(s)
- Emma Mead
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Tamara Brown
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Liane B Azevedo
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Victoria Whittaker
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Dan Jones
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Joan Olajide
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Giulia M Mainardi
- School of Medicine, University of São PauloDepartment of Preventive MedicineSão PauloBrazilCEP 01246 903
| | - Eva Corpeleijn
- University Medical Centre GroningenDepartment of EpidemiologyHanzeplein 1GroningenNetherlands9713 GZ
| | - Claire O'Malley
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | | | - Lena Al‐Khudairy
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Louise Baur
- The University of SydneyDepartment of Paediatrics and Child HealthLocked Bag 4001WestmeadAustraliaNSW 2145
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | | | - Louisa J Ells
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
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13
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Rea CJ, Smith RL, Taveras EM. Associations of Parent Health Behaviors and Parenting Practices with Sleep Duration in Overweight and Obese Children. J Clin Sleep Med 2016; 12:1493-1498. [PMID: 27655464 DOI: 10.5664/jcsm.6274] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 07/18/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To examine the extent to which parent health behaviors and parenting practices are associated with school-age children's sleep duration. METHODS We surveyed 790 parents of children, aged 6 to 12 y, who had a body mass index (BMI) ≥ 90th percentile and were participating in a randomized controlled obesity trial. The main exposures were parent sleep duration, screen time and physical activity, parental limits placed on child TV viewing time and TV content, and parents' confidence regarding their ability to help their child get enough sleep. The primary outcome was child sleep duration. We used linear regression models to examine associations of parent behaviors and parenting practices with child sleep duration. RESULTS On average, children slept 9.2 h per night, whereas parents slept 6.9 h. Parents reported having an average of 1.9 h of screen time per day and 0.6 h of physical activity. There were 57.3% of parents who reported feeling very/extremely confident that they could help their child get enough sleep. In adjusted multivariate analyses, child sleep duration was 0.09 h/day (95% confidence interval: 0.03, 0.15) longer for each 1-h increment in parent sleep duration. Additionally, children whose parents reported being very/extremely confident they could help their child get age-appropriate sleep duration slept 0.67 h/day longer (95% confidence interval: 0.54, 0.81) than those whose parents were not/somewhat confident. CONCLUSIONS Educating parents about their own sleep health and enhancing parent confidence to help their children get enough sleep are potential areas of intervention to increase child sleep duration.
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Affiliation(s)
- Corinna J Rea
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Renata L Smith
- Harvard Medical School, Boston, MA.,Harvard Pilgrim Health Care Institute, Boston, MA
| | - Elsie M Taveras
- Harvard Medical School, Boston, MA.,Division of General Academic Pediatrics, Mass General Hospital for Children, Boston, MA
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14
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Oreskovic NM, Fletcher R, Sharifi M, Knutsen JD, Chilingirian A, Taveras EM. Design and rationale of the STRIVE trial to improve cardiometabolic health among children and families. Contemp Clin Trials 2016; 49:149-54. [PMID: 27417980 DOI: 10.1016/j.cct.2016.07.012] [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: 04/26/2016] [Revised: 07/05/2016] [Accepted: 07/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many of the health behaviors known to contribute to cardiometabolic risk and disease (CMRD), including physical activity, diet, sleep, and screen time, begin during childhood. Given the population-wide burden of CMRD, novel ways of assessing risk and providing feedback to support behavior change are needed. PURPOSE This paper describes the design and rationale for the Study for using Technology to Reach Individual Excellence (STRIVE), a randomized controlled trial testing the use of an integrated, closed-loop feedback system that incorporates longitudinal, patient-generated, mobile health technology (mHealth) data on health behaviors and provides clinical recommendations to help manage CMRD among at-risk families. METHODS STRIVE is a 6-month trial among 68 children, ages 6-12year olds with a body mass index≥85th percentile from Massachusetts with at least one parent with CMRD. Data on several health behaviors will be collected daily over 6months. Children and parents will each wear wristbands that collect objective physical activity, sleep, and screen time data via accelerometry, noise, and infrared detection. Sugar sweetened beverage consumption will be assessed by self-report via a smartphone application. Weight will be collected using a wireless scale. Intervention group parents receive feedback on their child's health behaviors and personalized CMRD counseling via mobile messaging. Control parents receive standard of care recommendations and weekly health behavior reports for self-guided care. CONCLUSION The STRIVE trial will test the use of mHealth and closed-loop feedback systems to improve health behaviors among families at-risk for or with established CMRD.
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Affiliation(s)
- Nicolas M Oreskovic
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, USA; Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Richard Fletcher
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Mona Sharifi
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - John D Knutsen
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Ani Chilingirian
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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15
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Fiechtner L, Kleinman K, Melly SJ, Sharifi M, Marshall R, Block J, Cheng ER, Taveras EM. Effects of Proximity to Supermarkets on a Randomized Trial Studying Interventions for Obesity. Am J Public Health 2016; 106:557-62. [PMID: 26794159 PMCID: PMC4880218 DOI: 10.2105/ajph.2015.302986] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine whether proximity to a supermarket modified the effects of an obesity intervention. METHODS We examined 498 children aged 6 to 12 years with a body mass index (BMI) at or above the 95th percentile participating in an obesity trial in Massachusetts in 2011 to 2013. The practice-based interventions included computerized clinician decision support plus family self-guided behavior change or health coaching. Outcomes were 1-year change in BMI z-score, sugar-sweetened beverage intake, and fruit and vegetable intake. We examined distance to the closest supermarket as an effect modifier. RESULTS Distance to supermarkets was an effect modifier of 1-year change in BMI z-score and fruit and vegetable intake but not sugar-sweetened beverage intake. With each 1-mile shorter distance to a supermarket, intervention participants increased their fruit and vegetable intake by 0.29 servings per day and decreased their BMI z-score by -0.04 units relative to controls. CONCLUSIONS Living closer to a supermarket is associated with greater improvements in fruit and vegetable intake and weight status in an obesity intervention.
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Affiliation(s)
- Lauren Fiechtner
- Lauren Fiechtner, Mona Sharifi, and Elsie M. Taveras are with the Department of Pediatrics, Massachusetts General Hospital for Children, Boston. Erika R. Cheng is with the Department of Pediatrics, Indiana University School of Medicine, Indianapolis. Ken Kleinman and Jason Block are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Steven J. Melly is with the Department of Environmental Health, Harvard School of Public Health, Boston. Richard Marshall is with the Harvard Vanguard Medical Associates, Boston
| | - Ken Kleinman
- Lauren Fiechtner, Mona Sharifi, and Elsie M. Taveras are with the Department of Pediatrics, Massachusetts General Hospital for Children, Boston. Erika R. Cheng is with the Department of Pediatrics, Indiana University School of Medicine, Indianapolis. Ken Kleinman and Jason Block are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Steven J. Melly is with the Department of Environmental Health, Harvard School of Public Health, Boston. Richard Marshall is with the Harvard Vanguard Medical Associates, Boston
| | - Steven J Melly
- Lauren Fiechtner, Mona Sharifi, and Elsie M. Taveras are with the Department of Pediatrics, Massachusetts General Hospital for Children, Boston. Erika R. Cheng is with the Department of Pediatrics, Indiana University School of Medicine, Indianapolis. Ken Kleinman and Jason Block are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Steven J. Melly is with the Department of Environmental Health, Harvard School of Public Health, Boston. Richard Marshall is with the Harvard Vanguard Medical Associates, Boston
| | - Mona Sharifi
- Lauren Fiechtner, Mona Sharifi, and Elsie M. Taveras are with the Department of Pediatrics, Massachusetts General Hospital for Children, Boston. Erika R. Cheng is with the Department of Pediatrics, Indiana University School of Medicine, Indianapolis. Ken Kleinman and Jason Block are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Steven J. Melly is with the Department of Environmental Health, Harvard School of Public Health, Boston. Richard Marshall is with the Harvard Vanguard Medical Associates, Boston
| | - Richard Marshall
- Lauren Fiechtner, Mona Sharifi, and Elsie M. Taveras are with the Department of Pediatrics, Massachusetts General Hospital for Children, Boston. Erika R. Cheng is with the Department of Pediatrics, Indiana University School of Medicine, Indianapolis. Ken Kleinman and Jason Block are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Steven J. Melly is with the Department of Environmental Health, Harvard School of Public Health, Boston. Richard Marshall is with the Harvard Vanguard Medical Associates, Boston
| | - Jason Block
- Lauren Fiechtner, Mona Sharifi, and Elsie M. Taveras are with the Department of Pediatrics, Massachusetts General Hospital for Children, Boston. Erika R. Cheng is with the Department of Pediatrics, Indiana University School of Medicine, Indianapolis. Ken Kleinman and Jason Block are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Steven J. Melly is with the Department of Environmental Health, Harvard School of Public Health, Boston. Richard Marshall is with the Harvard Vanguard Medical Associates, Boston
| | - Erika R Cheng
- Lauren Fiechtner, Mona Sharifi, and Elsie M. Taveras are with the Department of Pediatrics, Massachusetts General Hospital for Children, Boston. Erika R. Cheng is with the Department of Pediatrics, Indiana University School of Medicine, Indianapolis. Ken Kleinman and Jason Block are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Steven J. Melly is with the Department of Environmental Health, Harvard School of Public Health, Boston. Richard Marshall is with the Harvard Vanguard Medical Associates, Boston
| | - Elsie M Taveras
- Lauren Fiechtner, Mona Sharifi, and Elsie M. Taveras are with the Department of Pediatrics, Massachusetts General Hospital for Children, Boston. Erika R. Cheng is with the Department of Pediatrics, Indiana University School of Medicine, Indianapolis. Ken Kleinman and Jason Block are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston. Steven J. Melly is with the Department of Environmental Health, Harvard School of Public Health, Boston. Richard Marshall is with the Harvard Vanguard Medical Associates, Boston
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16
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Michels N, De Henauw S, Eiben G, Hadjigeorgiou C, Hense S, Hunsberger M, Konstabel K, Molnár D, Moreno LA, Siani A, De Bourdeaudhuij I, Pigeot I. Effect of the IDEFICS multilevel obesity prevention on children's sleep duration. Obes Rev 2015; 16 Suppl 2:68-77. [PMID: 26707017 DOI: 10.1111/obr.12327] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 08/30/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND According to recent findings, short sleep duration is associated with overweight in children. However, primary prevention efforts aimed at achieving adequate sleep among children are scarce. Therefore, the 'Identification and prevention of Dietary-induced and lifestyle-induced health EFfects In Children and infantS' (IDEFICS) study implemented a multilevel intervention that included sleep duration as a key behavioural target. The aim of this study is to evaluate sleep duration among children participating in the IDEFICS study. METHODS The IDEFICS nocturnal sleep intervention was included as part of stress reduction educational messages aimed at parents and children. Sleep was assessed by a parental 24-h recall (only weekdays; n = 8,543) and by a diary (weekdays and weekends separately; n = 4,150). Mixed linear models tested the intervention effect on sleep duration change between baseline when children were 2-9.9 years of age (2007/2008) and follow-up (2009/2010). Logistic mix models were used to study the intervention effect on the presence of TV in the children's bedroom (one of the intervention messages; n = 8,668). Additionally, parents provided qualitative data regarding exposure to the intervention. RESULTS About 51.1% of the parents in the intervention regions reported awareness of the sleep intervention. A small intervention effect was seen on weeknight sleep duration in that the decrease in sleep duration over 2 years was smaller in the intervention (15 min) as compared with control regions (19 min) (p = 0.044). There was no overall intervention effect on weekend sleep duration or on the presence of a TV in the bedroom. A small significant time effect between baseline and follow-up was found on bedroom TV presence depending on self-reported intervention exposure (3% increase in TV presence in exposed versus 6.6% increase in non-exposed). Children without a TV in the bedroom had longer nocturnal sleep duration. DISCUSSION The sleep component of the intervention did not lead to clinically relevant changes in sleep duration. Future interventions aimed at young children's sleep duration could benefit from more specific and intense messaging than that found in the IDEFICS intervention. Future research should use objective measures of sleep duration as well as intermediate outcomes (sleep knowledge, sleep environment and sleep practices).
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Affiliation(s)
- N Michels
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - S De Henauw
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Health Sciences, Vesalius, University College Ghent, Ghent, Belgium
| | - G Eiben
- Section for Epidemiology and Social Medicine, University of Gothenburg, Gothenburg, Sweden
| | - C Hadjigeorgiou
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - S Hense
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - M Hunsberger
- Section for Epidemiology and Social Medicine, University of Gothenburg, Gothenburg, Sweden
| | - K Konstabel
- National Institute for Health Development, Tallinn, Estonia
| | - D Molnár
- Department of Paediatrics, University of Pécs, Pécs, Hungary
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, School of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - A Siani
- Epidemiology & Population Genetics, Institute of Food Sciences, CNR, Avellino, Italy
| | - I De Bourdeaudhuij
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Institute of Statistics, Faculty of Mathematics and Computer Science, University Bremen, Bremen, Germany
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17
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Dietz WH, Baur LA, Hall K, Puhl RM, Taveras EM, Uauy R, Kopelman P. Management of obesity: improvement of health-care training and systems for prevention and care. Lancet 2015; 385:2521-33. [PMID: 25703112 DOI: 10.1016/s0140-6736(14)61748-7] [Citation(s) in RCA: 261] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Although the caloric deficits achieved by increased awareness, policy, and environmental approaches have begun to achieve reductions in the prevalence of obesity in some countries, these approaches are insufficient to achieve weight loss in patients with severe obesity. Because the prevalence of obesity poses an enormous clinical burden, innovative treatment and care-delivery strategies are needed. Nonetheless, health professionals are poorly prepared to address obesity. In addition to biases and unfounded assumptions about patients with obesity, absence of training in behaviour-change strategies and scarce experience working within interprofessional teams impairs care of patients with obesity. Modalities available for the treatment of adult obesity include clinical counselling focused on diet, physical activity, and behaviour change, pharmacotherapy, and bariatric surgery. Few options, few published reports of treatment, and no large randomised trials are available for paediatric patients. Improved care for patients with obesity will need alignment of the intensity of therapy with the severity of disease and integration of therapy with environmental changes that reinforce clinical strategies. New treatment strategies, such as the use of technology and innovative means of health-care delivery that rely on health professionals other than physicians, represent promising options, particularly for patients with overweight and patients with mild to moderate obesity. The co-occurrence of undernutrition and obesity in low-income and middle-income countries poses unique challenges that might not be amenable to the same strategies as those that can be used in high-income countries.
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Affiliation(s)
- William H Dietz
- Sumner M Redstone Global Center for Prevention and Wellness, George Washington University, Washington, DC, USA.
| | - Louise A Baur
- Weight Management Services, The Children's Hospital at Westmead Clinical School, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Kevin Hall
- Laboratory of Biological Modeling, Diabetes Endocrinology and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Rebecca M Puhl
- Rudd Centre for Food Policy & Obesity, Yale University, New Haven, CT, USA
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA
| | - Ricardo Uauy
- Universidad Católica de Chile, División de Pediatría, Escuela de Medicina, Santiago, Chile
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18
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Price S, Ferisin S, Sharifi M, Steinberg D, Bennett G, Wolin KY, Horan C, Koziol R, Marshall R, Taveras EM. Development and Implementation of an Interactive Text Messaging Campaign to Support Behavior Change in a Childhood Obesity Randomized Controlled Trial. JOURNAL OF HEALTH COMMUNICATION 2015; 20:843-850. [PMID: 25996181 DOI: 10.1080/10810730.2015.1018582] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Text messaging is a promising means of intervening on an array of health issues among varied populations, but little has been published about the development of such interventions. The authors describe the development and implementation of an interactive text messaging campaign for parents to support behavior change among children in a childhood obesity randomized controlled trial. The authors invited 160 parents to participate in a text messaging intervention that provided behavior change support in conjunction with health coaching phone calls and mailed materials on behavioral goals. Throughout the 1-year intervention, the authors sent 1-2 text messages per week. The first asked how the child did with a target behavior the day before; parents who replied received an immediate feedback message tailored to their response. The second included a tip about how to work toward a behavioral goal. Baseline surveys indicate that text messaging is a common means of communication for parents, and many are willing to use text messaging to support behavior change for their child. Results at 1 year indicate a high level of engagement with the text messaging intervention, with nearly two thirds responding to 75% or more of the questions they were sent by text.
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Affiliation(s)
- Sarah Price
- a Division of General Pediatrics, Department of Pediatrics , Massachusetts General Hospital , Boston , Massachusetts , USA
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Electronic health record-generated interventions to reduce asthma risk: seeing the glass half full. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 2:457-8. [PMID: 25017535 DOI: 10.1016/j.jaip.2014.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 04/04/2014] [Indexed: 11/21/2022]
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Gortmaker SL, Polacsek M, Letourneau L, Rogers VW, Holmberg R, Lombard KA, Fanburg J, Ware J, Orr J. Evaluation of a primary care intervention on body mass index: the Maine Youth Overweight Collaborative. Child Obes 2015; 11:187-93. [PMID: 25719624 PMCID: PMC4382710 DOI: 10.1089/chi.2014.0132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND We evaluated the impact of a brief primary-care-based intervention, The Maine Youth Overweight Collaborative (MYOC), on BMI (kg/m(2)) z-score change among participants with obesity (BMI ≥95th percentile for age and sex), overweight (BMI ≥85th and <95th percentile), and healthy weight (≥50th and <85th percentile). METHODS A quasi-experimental field trial with nine intervention and nine control sites in urban and rural areas of Maine, MYOC focused on improvements in clinical decision support, charting BMI percentile, identifying patients with obesity, appropriate lab tests, and counseling families/patients. Retrospective longitudinal record reviews assessed BMI z-scores preintervention (from 1999 through October 2004) and one postintervention time point (between December 2006 and March 2008). Participants were youth ages 5-18 having two visits before the intervention with weight percentile greater than or equal to 95% (N=265). Secondary analyses focused on youths who are overweight (N=215) and healthy weight youth (N=506). RESULTS Although the MYOC intervention demonstrated significant provider and office system improvements, we found no significant changes in BMI z-scores in intervention versus control youth pre- to postintervention and significant flattening of upward trends among both intervention and control sites (p<0.001). CONCLUSIONS This brief office-based intervention was associated with no significant improvement in BMI z-scores, compared to control sites. An important avenue for obesity prevention and treatment as part of a multisector approach in communities, this type of primary care intervention alone may be unlikely to impact BMI improvement given the limited dosage-an estimated 4-6 minutes for one patient contact.
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Affiliation(s)
- Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| | - Michele Polacsek
- School of Community and Population Health, University of New England, Portland, ME
| | | | - Victoria W. Rogers
- Kids CO-OP, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME
| | | | | | - Jonathan Fanburg
- Maine Medical Partners, South Portland Pediatrics, South Portland, ME
| | - James Ware
- Department of Biostatistics, Harvard School of Public Health, Boston, MA
| | - Joan Orr
- Population Health Management, MaineGeneral Health, Alfond Center for Health, Augusta, ME
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Cheng JK, Koziol RL, Taveras EM. Parental guidance advised: associations between parental television limits and health behaviors among obese children. Acad Pediatr 2015; 15:204-9. [PMID: 25306213 DOI: 10.1016/j.acap.2014.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 08/12/2014] [Accepted: 08/24/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine associations between parental limits on TV viewing and child health behaviors. METHODS We surveyed 816 parents of children 6 to 12 years of age who were participating in a primary care-based obesity intervention. The main exposures were parental limits placed on child TV viewing time and TV content. Outcomes included screen-related behaviors, sleep habits, eating routines, and physical activity. We performed bivariate and multivariable analyses to examine independent associations of parental TV viewing rules with our outcomes. RESULTS In multivariable analyses adjusted for child age, sex, race/ethnicity; parental education and US-born status; income and primary language, children whose parents set limits on TV time were less likely to have a TV in their bedroom (odds ratio [OR] 0.45; 95% confidence interval [CI] 0.31, 0.64) or to fall asleep while watching TV (OR 0.47; 95% CI 0.34, 0.67). Children with parental limits spent fewer weekday hours watching TV (-0.38 hours/day; 95% CI -0.54, -0.21), playing video or computer games (-0.15 hours/day; 95% CI -0.25, -0.04), and using the Internet (-0.08 hours/day; 95% CI -0.15, -0.006). In addition, children with limits on TV time were less likely to eat breakfast (OR 0.73; 95% CI 0.53, 0.99) or dinner (OR 0.53; 95% CI 0.39, 0.73) with the TV on, and they slept longer during weeknights: 0.21 hours/day (95% CI 0.05, 0.36). Moreover, children whose parents set rules on TV programming content were also less likely to have a TV in their bedroom (OR 0.37; 95% CI 0.18, 0.79). CONCLUSIONS The relationship between parental limits on TV viewing and obesogenic child behaviors deserves further investigation.
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Affiliation(s)
- Jennifer K Cheng
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass.
| | - Renata L Koziol
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Elsie M Taveras
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Mass
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Davison KK, Falbe J, Taveras EM, Gortmaker S, Kulldorff M, Perkins M, Blaine RE, Franckle RL, Ganter C, Woo Baidal J, Kwass JA, Buszkiewicz J, Smith L, Land T. Evaluation overview for the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project. Child Obes 2015; 11:23-36. [PMID: 25575095 PMCID: PMC5915219 DOI: 10.1089/chi.2014.0059] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project is a 2-year, multilevel, multisector community intervention to prevent and control obesity among children 2-12 years of age from two predominantly low-income communities in Massachusetts. MA-CORD includes evidence-based interventions in multiple sectors, including community health centers, early care and education centers, schools, afterschool programs, the Special Supplemental Nutrition Program for Women, Infants and Children, and the broader community. Currently, implementation of MA-CORD is complete and the final year of data collection is in progress. Here, the MA-CORD evaluation plan is described and baseline data are presented. METHODS/DESIGN The impact of MA-CORD on children's BMI, lifestyle behaviors, obesity-related care, and quality of life will be assessed using sector-specific, pre/post, time-series, and quasi-experimental designs. Change in the primary outcomes will be compared for intervention and comparison communities. Additionally, change in mean BMI and obesity prevalence in intervention school districts will be compared to similar districts throughout the state. RESULTS At baseline in 2012, approximately 16% of preschool-aged and 25% of school-aged children were obese. Moreover, 15-40% of children consumed no vegetables on the previous day, 25-75% drank a sugar-sweetened beverage on the previous day, up to 87% had insufficient physical activity, 50-75% had a television in the room where they slept, and 50-80% obtained insufficient sleep. CONCLUSIONS There is ample room for improvement in BMI and health behaviors in children in MA-CORD communities. If successful, MA-CORD may serve as a model for multilevel, multisector approaches to childhood obesity prevention and control.
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Affiliation(s)
- Kirsten K. Davison
- Department of Nutrition, Harvard School of Public Health, Boston, MA
- Department of Social and Behavioral Science, Harvard School of Public Health, Boston, MA
| | - Jennifer Falbe
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, CA
| | - Elsie M. Taveras
- Department of Nutrition, Harvard School of Public Health, Boston, MA
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Steve Gortmaker
- Department of Social and Behavioral Science, Harvard School of Public Health, Boston, MA
| | - Martin Kulldorff
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA
| | - Meghan Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Rachel E. Blaine
- Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Rebecca L. Franckle
- Department of Nutrition, Harvard School of Public Health, Boston, MA
- Department of Social and Behavioral Science, Harvard School of Public Health, Boston, MA
| | - Claudia Ganter
- Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Jennifer Woo Baidal
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Jo-Ann Kwass
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - James Buszkiewicz
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - Lauren Smith
- National Initiative for Children's Health Quality, Boston, MA
| | - Thomas Land
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
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Taveras EM, Blaine RE, Davison KK, Gortmaker S, Anand S, Falbe J, Kwass JA, Perkins M, Giles C, Criss S, Colchamiro R, Woo Baidal J, Land T, Smith L. Design of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study. Child Obes 2015; 11:11-22. [PMID: 25469676 PMCID: PMC4322791 DOI: 10.1089/chi.2014.0031] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Childhood obesity is highly prevalent, is associated with both short- and long-term adverse outcomes, disproportionately affects racial/ethnic minority and economically deprived children, and represents a major threat to public health. Among the most promising approaches for its prevention and management are multilevel, multisector strategies. METHODS/DESIGN The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) Study was a comprehensive, systematic intervention to prevent and reduce childhood obesity among low-income children ages 2-12 years in two selected cities in Massachusetts. Building on the Obesity Chronic Care Model, MA-CORD expanded a state public health department community-level obesity prevention initiative that incorporated evidence-based interventions in primary healthcare, the Women, Infants, and Children program, early care and education, schools/afterschool programs, as well as community-wide programs to improve food, beverage, physical activity (PA), and messaging environments. The study used a combination of pre- and post-time series and quasi-experimental designs to examine the extent to which the intervention resulted in changes in BMI, individual-level lifestyle behaviors, satisfaction with healthcare services, and quality of life among children, as well as changes in health policies, programs, and environments in the two intervention cities, compared to a comparison city. The intervention period was 2 years. CONCLUSIONS MA-CORD will determine the extent to which a multisetting, multilevel intervention that integrates activities in primary care with broader public health interventions in schools, early care and education, and the community at large can improve children's dietary and PA behaviors and ultimately reduce obesity in low-income children.
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Affiliation(s)
- Elsie M. Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
- Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Rachel E. Blaine
- Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Kirsten K. Davison
- Department of Nutrition, Harvard School of Public Health, Boston, MA
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| | - Steven Gortmaker
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| | - Shikha Anand
- National Initiative for Children's Healthcare Quality, Boston, MA
| | - Jennifer Falbe
- Division of Community Health and Human Development, School of Public Health, University of California Berkeley, Berkeley, CA
| | - Jo-Ann Kwass
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - Meghan Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
| | - Catherine Giles
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| | - Shaniece Criss
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| | - Rachel Colchamiro
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - Jennifer Woo Baidal
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA
- Division of Gastroenterology and Nutrition, Children's Hospital Boston, Boston, MA
| | - Thomas Land
- Office of the Commissioner, Massachusetts Department of Public Health, Boston, MA
| | - Lauren Smith
- National Initiative for Children's Healthcare Quality, Boston, MA
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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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Arsenault LN, Xu K, Taveras EM, Hacker KA. Parents' obesity-related behavior and confidence to support behavioral change in their obese child: data from the STAR study. Acad Pediatr 2014; 14:456-62. [PMID: 24816426 DOI: 10.1016/j.acap.2014.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 02/28/2014] [Accepted: 03/04/2014] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Successful childhood obesity interventions frequently focus on behavioral modification and involve parents or family members. Parental confidence in supporting behavior change may be an element of successful family-based prevention efforts. We aimed to determine whether parents' own obesity-related behaviors were related to their confidence in supporting their child's achievement of obesity-related behavioral goals. METHODS Cross-sectional analyses of data collected at baseline of a randomized control trial testing a treatment intervention for obese children (n = 787) in primary care settings (n = 14). Five obesity-related behaviors (physical activity, screen time, sugar-sweetened beverage, sleep duration, fast food) were self-reported by parents for themselves and their child. Behaviors were dichotomized on the basis of achievement of behavioral goals. Five confidence questions asked how confident the parent was in helping their child achieve each goal. Logistic regression modeling high confidence was conducted with goal achievement and demographics as independent variables. RESULTS Parents achieving physical activity or sleep duration goals were significantly more likely to be highly confident in supporting their child's achievement of those goals (physical activity, odds ratio 1.76; 95% confidence interval 1.19-2.60; sleep, odds ratio 1.74; 95% confidence interval 1.09-2.79) independent of sociodemographic variables and child's current behavior. Parental achievements of TV watching and fast food goals were also associated with confidence, but significance was attenuated after child's behavior was included in models. CONCLUSIONS Parents' own obesity-related behaviors are factors that may affect their confidence to support their child's behavior change. Providers seeking to prevent childhood obesity should address parent/family behaviors as part of their obesity prevention strategies.
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Affiliation(s)
- Lisa N Arsenault
- Cambridge Health Alliance, Institute for Community Health, Cambridge, Mass; Harvard Medical School, Boston, Mass.
| | - Kathleen Xu
- Cambridge Health Alliance, Institute for Community Health, Cambridge, Mass
| | - Elsie M Taveras
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Mass; Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Karen A Hacker
- Cambridge Health Alliance, Institute for Community Health, Cambridge, Mass; Harvard Medical School, Boston, Mass; Allegheny County Public Health Department, Pittsburgh, Pa
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Zallman L, Ibekwe L, Thompson J, Ross-Degnan D, Oken E. Development of a Mapped Diabetes Community Program Guide for a Safety Net Population. DIABETES EDUCATOR 2014; 40:453-461. [PMID: 24752180 DOI: 10.1177/0145721714531076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Enhancing linkages between patients and community programs is increasingly recognized as a method for improving physical activity, nutrition, and weight management. Although interactive mapped community program guides may be beneficial, there remains a dearth of articles that describe the processes and practicalities of creating such guides. This article describes the development of an interactive web-based mapped community program guide at a safety net institution and the lessons learned from that process. CONCLUSIONS This project demonstrated the feasibility of creating 2 maps: a program guide and a population health map. It also revealed some key challenges and lessons for future work in this area, particularly within safety net institutions. Our work underscores the need for developing partnerships outside the health care system and the importance of employing community-based participatory methods. In addition to facilitating improvements in individual wellness, mapping community programs has the potential to improve population health management by health care delivery systems such as hospitals, health centers, or public health systems, including city and state departments of health.
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Affiliation(s)
- Leah Zallman
- Institute for Community Health, Cambridge, Massachusetts, USA (Dr Zallman, Ms Ibekwe).,Cambridge Health Alliance, Cambridge, Massachusetts, USA (Dr Zallman)
| | - Lynn Ibekwe
- Institute for Community Health, Cambridge, Massachusetts, USA (Dr Zallman, Ms Ibekwe)
| | - Jennifer Thompson
- Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Ms Thompson, Dr Ross-Degnan, Dr Oken)
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Ms Thompson, Dr Ross-Degnan, Dr Oken)
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Ms Thompson, Dr Ross-Degnan, Dr Oken)
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Lucke-Wold BP, DiPasquale K, Logsdon AF, Nguyen L, Lucke-Wold AN, Turner RC, Huber JD, Rosen CL. Metabolic Syndrome and its Profound Effect on Prevalence of Ischemic Stroke. AMERICAN MEDICAL STUDENT RESEARCH JOURNAL 2014; 1:29-38. [PMID: 27284575 PMCID: PMC4896644 DOI: 10.15422/amsrj.2014.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Ischemic stroke represents a leading cause of death worldwide and the leading cause of disability in the United States. Greater than 8% of all deaths are attributed to ischemic stroke. This rate is consistent with the heightened burden of cardiovascular disease deaths. Treatments for acute ischemic stroke remain limited to tissue plasminogen activator and mechanical thrombolysis, both of which require significant medical expertise and can only be applied to a select number of patients based on time of presentation, imaging, and absence of contraindications. Over 1,000 compounds that were successful in treating ischemic stroke in animal models have failed to correlate to success in clinical trials. The search for alternative treatments is ongoing, drawing greater attention to the importance of preclinical models that more accurately represent the clinical population through incorporation of common risk factors. This work reviews the contribution of these commonly observed risk factors in the clinical population highlighting both the pathophysiology as well as current clinical diagnosis and treatment standards. We also highlight future potential therapeutic targets, areas requiring further investigation, and recent changes in best-practice clinical care.
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Affiliation(s)
- Brandon P Lucke-Wold
- Department of Neurosurgery, West Virginia University, School of Medicine, Morgantown, West Virginia; The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia
| | - Kenneth DiPasquale
- The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia; Department of Basic Pharmaceutical Sciences, West Virginia University, School of Pharmacy, Morgantown, West Virginia
| | - Aric F Logsdon
- The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia; Department of Basic Pharmaceutical Sciences, West Virginia University, School of Pharmacy, Morgantown, West Virginia
| | - Linda Nguyen
- Department of Basic Pharmaceutical Sciences, West Virginia University, School of Pharmacy, Morgantown, West Virginia
| | - A Noelle Lucke-Wold
- The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia; West Virginia University, School of Nursing, Morgantown, West Virginia
| | - Ryan C Turner
- Department of Neurosurgery, West Virginia University, School of Medicine, Morgantown, West Virginia; The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia
| | - Jason D Huber
- The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia; Department of Basic Pharmaceutical Sciences, West Virginia University, School of Pharmacy, Morgantown, West Virginia
| | - Charles L Rosen
- Department of Neurosurgery, West Virginia University, School of Medicine, Morgantown, West Virginia; The Center for Neuroscience, West Virginia University, School of Medicine, Morgantown, West Virginia
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Taveras EM, Marshall R, Horan CM, Gillman MW, Hacker K, Kleinman KP, Koziol R, Price S, Rifas-Shiman SL, Simon SR. Improving children's obesity-related health care quality: process outcomes of a cluster-randomized controlled trial. Obesity (Silver Spring) 2014; 22:27-31. [PMID: 23983130 DOI: 10.1002/oby.20612] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 08/09/2013] [Accepted: 08/16/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the extent to which an intervention using electronic decision support delivered to pediatricians at the point-of-care of obese children, with or without direct-to-parent outreach, improved health care quality measures for child obesity. DESIGN AND METHODS Process outcomes from a three-arm, cluster-randomized trial from 14 pediatric practices in Massachusetts were reported. Participants were 549 children aged 6-12 years with body mass index (BMI) ≥ 95th percentile. In five practices (Intervention-1), pediatricians receive electronic decision support at the point-of-care. In five other practices (Intervention-2), pediatricians receive point-of-care decision support and parents receive information about their child's prior BMI before their scheduled visit. Four practices receive usual care. The main outcomes were Healthcare Effectiveness Data and Information Set (HEDIS) performance measures for child obesity: documentation of BMI percentile and use of counseling codes for nutrition or physical activity. RESULTS Compared to the usual care condition, participants in Intervention-2, but not Intervention-1, had substantially higher odds of use of HEDIS codes for BMI percentile documentation (adjusted OR: 3.97; 95% CI: 1.92, 8.23) and higher prevalence of use of HEDIS codes for counseling for nutrition or physical activity (adjusted predicted prevalence 20.3% [95% CI 8.5, 41.2] for Intervention -2 vs. 0.0% [0.0, 2.0] for usual care). CONCLUSION An intervention that included both decision support for clinicians and outreach to parents resulted in improved health care quality measures for child obesity.
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Affiliation(s)
- Elsie M Taveras
- Division of General Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts, USA; Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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29
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Sharifi M, Dryden EM, Horan CM, Price S, Marshall R, Hacker K, Finkelstein JA, Taveras EM. Leveraging text messaging and mobile technology to support pediatric obesity-related behavior change: a qualitative study using parent focus groups and interviews. J Med Internet Res 2013; 15:e272. [PMID: 24317406 PMCID: PMC3869083 DOI: 10.2196/jmir.2780] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 09/20/2013] [Accepted: 09/20/2013] [Indexed: 12/24/2022] Open
Abstract
Background Text messaging (short message service, SMS) is a widely accessible and potentially cost-effective medium for encouraging behavior change. Few studies have examined text messaging interventions to influence child health behaviors or explored parental perceptions of mobile technologies to support behavior change among children. Objective Our aim was to examine parental acceptability and preferences for text messaging to support pediatric obesity-related behavior change. Methods We conducted focus groups and follow-up interviews with parents of overweight and obese children, aged 6-12 years, seen for “well-child” care in eastern Massachusetts. A professional moderator used a semistructured discussion guide and sample text messages to catalyze group discussions. Seven participants then received 3 weeks of text messages before a follow-up one-on-one telephone interview. All focus groups and interviews were recorded and transcribed verbatim. Using a framework analysis approach, we systematically coded and analyzed group and interview data to identify salient and convergent themes. Results We reached thematic saturation after five focus groups and seven follow-up interviews with a total of 31 parents of diverse race/ethnicity and education levels. Parents were generally enthusiastic about receiving text messages to support healthy behaviors for their children and preferred them to paper or email communication because they are brief and difficult to ignore. Participants anticipated high responsiveness to messaging endorsed by their child’s doctor and indicated they would appreciate messages 2-3 times/week or more as long as content remains relevant. Suggestions for maintaining message relevance included providing specific strategies for implementation and personalizing information. Most felt the negative features of text messaging (eg, limited message size) could be overcome by providing links within messages to other media including email or websites. Conclusions Text messaging is a promising medium for supporting pediatric obesity-related behavior change. Parent perspectives could assist in the design of text-based interventions. Trial Registration Clinicaltrials.gov NCT01565161; http://clinicaltrials.gov/show/NCT01565161 (Archived by WebCite at http://www.webcitation.org/6LSaqFyPP).
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Affiliation(s)
- Mona Sharifi
- Division of General Pediatrics, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, United States.
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Sousa P, Fonseca H, Gaspar P, Gaspar F. Internet-based intervention programme for obese adolescents and their families (Next.Step): research protocol of a controlled trial. J Adv Nurs 2013; 70:904-14. [PMID: 24020828 DOI: 10.1111/jan.12245] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2013] [Indexed: 11/28/2022]
Abstract
AIM This paper describes the design and rationale of a controlled trial that aims to determine the effectiveness of an intervention programme in which the internet is used. BACKGROUND Adolescent obesity is a major health problem, there being urgency to find effective interventions that induce behavioural change. The inclusion of the internet in the intervention may improve adolescents' adherence to the weight management programme and lead to adoption of healthier lifestyles. DESIGN A clinical trial with a control group (non-randomized). METHODS Participants are adolescents with appointments at a paediatric obesity clinic (Portugal). Sample size was calculated according to the power analysis. The experimental group will follow the standard treatment protocol and receive free access to the e-therapeutic platform. The control group will follow the standard treatment protocol and join a waiting list. Intervention length will be 36 weeks (24 weeks of direct intervention with a follow-up for 12 weeks). This study was approved by the Ethical Committee for Health (Lisbon, Portugal) in January 2012 and funded by the Foundation for Science and Technology (Portugal) in December 2012. DISCUSSION The results of this research will promote reflection on new approaches directed to treat adolescent obesity and on the promotion of healthy behaviours. We expect to gather empirical evidence of the intervention programme effectiveness. The expectations lie on the population health gains, empowerment in decision-making and adoption of healthier lifestyles.
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Affiliation(s)
- Pedro Sousa
- School of Health Sciences, Polytechnic Institute of Leiria, Portugal; Health Research Unit (UIS) of the Polytechnic Institute of Leiria, Portugal
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