1
|
Nunes MA, Melnyk BM, Almeida S, Cardoso A, Vieira M. Psychometric Properties of the Healthy Lifestyle Behaviors Scale in Portuguese Pregnant Women. West J Nurs Res 2024; 46:428-435. [PMID: 38616562 PMCID: PMC11088217 DOI: 10.1177/01939459241245217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND Pregnancy provides a privileged and opportune moment to implement interventions promoting healthy lifestyle behaviors and significantly improving perinatal outcomes. The Healthy Lifestyle Behaviors Scale (HLBES) can be used to assess health promoting behaviors, such as diet, physical activity, and mental health. PURPOSE This study aimed to examine the psychometric properties of the HLBES in Portuguese pregnant women. METHODS A methodological study was conducted on a convenience sample of 192 pregnant women receiving prenatal care. After cross-cultural adaptation, an exploratory factor analysis and internal consistency assessment were carried out to evaluate the psychometric properties of the scale. Data collected included the Healthy Lifestyle Beliefs Scale to assess the HLBES' criterion validity. RESULTS Exploratory factor analysis with Varimax rotation yielded 2 subscales that explained 45.23% of the total variance. The scale revealed an overall internal consistency of 0.78 and a good criterion validity with the Healthy Lifestyle Beliefs Scale (r = 0.65, P < .01). CONCLUSION Our results suggest that the HLBES is an instrument for reporting healthy lifestyle behaviors in Portuguese pregnant women; however, further studies are recommended. This scale can be used to not only describe healthy lifestyle behaviors in pregnant women but also to determine the effects of health promoting interventions.
Collapse
Affiliation(s)
- Maria Arminda Nunes
- Centre for Interdisciplinary Research in Health, Institute of Health Sciences, Universidade Católica Portuguesa, Porto, Portugal
| | - Bernadette Mazurek Melnyk
- College of Nursing, The Ohio State University, Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, Columbus, OH, USA
| | - Sofia Almeida
- Centre for Interdisciplinary Research in Health, Institute of Health Sciences, Universidade Católica Portuguesa, Porto, Portugal
| | | | - Margarida Vieira
- Centre for Interdisciplinary Research in Health, Institute of Health Sciences, Universidade Católica Portuguesa, Porto, Portugal
| |
Collapse
|
2
|
Melnyk BM. The evidence-based COPE program: Reducing the time between diagnosing and treating depression and anxiety in youth. Nurse Pract 2024; 49:40-47. [PMID: 38386473 PMCID: PMC10878455 DOI: 10.1097/01.npr.0000000000000152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
ABSTRACT The soaring prevalence of depression and anxiety in children, teenagers, and young adults is now a public health epidemic, yet access to timely evidence-based mental health treatment is often lacking due to a severe shortage of mental health providers. This article provides an overview of the current state of depression and anxiety in children and adolescents as well as first-line evidence-based treatment. The Creating Opportunities for Personal Empowerment (COPE) program, a cognitive-behavioral skills-building intervention, is highlighted as an evidence-based intervention for timely treatment that can be delivered by NPs, physicians, and physician associates/assistants in primary care settings, school-based health centers, and chronic care clinics with reimbursement as well as in schools and universities as a preventive mental health intervention.
Collapse
Affiliation(s)
- Bernadette Mazurek Melnyk
- Bernadette Mazurek Melnyk is creator of the COPE program and founder of COPE2Thrive, LLC. She is a globally recognized expert, speaker, author, and researcher in the areas of evidence-based practice, mental health and well-being, and intervention research
| |
Collapse
|
3
|
Neil-Sztramko SE, Caldwell H, Dobbins M. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev 2021; 9:CD007651. [PMID: 34555181 PMCID: PMC8459921 DOI: 10.1002/14651858.cd007651.pub3] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Physical activity among children and adolescents is associated with lower adiposity, improved cardio-metabolic health, and improved fitness. Worldwide, fewer than 30% of children and adolescents meet global physical activity recommendations of at least 60 minutes of moderate to vigorous physical activity per day. Schools may be ideal sites for interventions given that children and adolescents in most parts of the world spend a substantial amount of time in transit to and from school or attending school. OBJECTIVES The purpose of this review update is to summarise the evidence on effectiveness of school-based interventions in increasing moderate to vigorous physical activity and improving fitness among children and adolescents 6 to 18 years of age. Specific objectives are: • to evaluate the effects of school-based interventions on increasing physical activity and improving fitness among children and adolescents; • to evaluate the effects of school-based interventions on improving body composition; and • to determine whether certain combinations or components (or both) of school-based interventions are more effective than others in promoting physical activity and fitness in this target population. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, BIOSIS, SPORTDiscus, and Sociological Abstracts to 1 June 2020, without language restrictions. We screened reference lists of included articles and relevant systematic reviews. We contacted primary authors of studies to ask for additional information. SELECTION CRITERIA Eligible interventions were relevant to public health practice (i.e. were not delivered by a clinician), were implemented in the school setting, and aimed to increase physical activity among all school-attending children and adolescents (aged 6 to 18) for at least 12 weeks. The review was limited to randomised controlled trials. For this update, we have added two new criteria: the primary aim of the study was to increase physical activity or fitness, and the study used an objective measure of physical activity or fitness. Primary outcomes included proportion of participants meeting physical activity guidelines and duration of moderate to vigorous physical activity and sedentary time (new to this update). Secondary outcomes included measured body mass index (BMI), physical fitness, health-related quality of life (new to this update), and adverse events (new to this update). Television viewing time, blood cholesterol, and blood pressure have been removed from this update. DATA COLLECTION AND ANALYSIS: Two independent review authors used standardised forms to assess each study for relevance, to extract data, and to assess risk of bias. When discrepancies existed, discussion occurred until consensus was reached. Certainty of evidence was assessed according to GRADE. A random-effects meta-analysis based on the inverse variance method was conducted with participants stratified by age (children versus adolescents) when sufficient data were reported. Subgroup analyses explored effects by intervention type. MAIN RESULTS Based on the three new inclusion criteria, we excluded 16 of the 44 studies included in the previous version of this review. We screened an additional 9968 titles (search October 2011 to June 2020), of which 978 unique studies were potentially relevant and 61 met all criteria for this update. We included a total of 89 studies representing complete data for 66,752 study participants. Most studies included children only (n = 56), followed by adolescents only (n = 22), and both (n = 10); one study did not report student age. Multi-component interventions were most common (n = 40), followed by schooltime physical activity (n = 19), enhanced physical education (n = 15), and before and after school programmes (n = 14); one study explored both enhanced physical education and an after school programme. Lack of blinding of participants, personnel, and outcome assessors and loss to follow-up were the most common sources of bias. Results show that school-based physical activity interventions probably result in little to no increase in time engaged in moderate to vigorous physical activity (mean difference (MD) 0.73 minutes/d, 95% confidence interval (CI) 0.16 to 1.30; 33 studies; moderate-certainty evidence) and may lead to little to no decrease in sedentary time (MD -3.78 minutes/d, 95% CI -7.80 to 0.24; 16 studies; low-certainty evidence). School-based physical activity interventions may improve physical fitness reported as maximal oxygen uptake (VO₂max) (MD 1.19 mL/kg/min, 95% CI 0.57 to 1.82; 13 studies; low-certainty evidence). School-based physical activity interventions may result in a very small decrease in BMI z-scores (MD -0.06, 95% CI -0.09 to -0.02; 21 studies; low-certainty evidence) and may not impact BMI expressed as kg/m² (MD -0.07, 95% CI -0.15 to 0.01; 50 studies; low-certainty evidence). We are very uncertain whether school-based physical activity interventions impact health-related quality of life or adverse events. AUTHORS' CONCLUSIONS Given the variability of results and the overall small effects, school staff and public health professionals must give the matter considerable thought before implementing school-based physical activity interventions. Given the heterogeneity of effects, the risk of bias, and findings that the magnitude of effect is generally small, results should be interpreted cautiously.
Collapse
Affiliation(s)
| | - Hilary Caldwell
- Department of Kinesiology, Child Health & Exercise Medicine Program, McMaster University, Hamilton, Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, Hamilton, Canada
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
| |
Collapse
|
4
|
Rich BW, Stager SL. Mindful BALANCE (breathe act learn about 'now' care everyday): A pilot project for depressed female adolescents. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2021; 34:125-132. [PMID: 33616309 DOI: 10.1111/jcap.12308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 11/19/2020] [Accepted: 01/29/2021] [Indexed: 12/21/2022]
Abstract
PROBLEM Major depressive episodes in adolescent females have increased during the past decade, placing them at risk to engage in unhealthy lifestyle behaviors, unsafe thoughts, suicidal ideation, and lethal actions. Mindfulness, a tool for stress management, is underutilized. METHODS Mindful BALANCE (Breathe Act Learn About 'Now' Care Everyday), a group therapy pilot program introduced a variety of mindfulness activities. The extended mindfulness followed the Creating Opportunities for Personal Empowerment (COPE), a Cognitive Behavioral Therapy Skills Building (CBSB) Healthy Lifestyle program. The pilot program was offered in an outpatient mental health department for 7 weeks. FINDINGS Mindful BALANCE is a feasible program as an adjunct to individualized psychotherapy. Six subjects engaged without absence with a completion rate of 83%. Six subjects had pre- and post-scores for depression and anxiety decrease. Mindfulness practice was reported to decrease the perception of stress. CONCLUSION Mindful BALANCE decreased perceived depression and anxiety symptoms while positively impacting healthy activities in adolescent females. Further research is necessary to readdress feasibility and extended mindfulness components in improving global well-being and diminishing suicide risk.
Collapse
Affiliation(s)
- Beverly Waldman Rich
- Emma Pendleton Bradley Hospital, Providence, Rhode Island, USA.,Rhode Island College, Providence, Rhode Island, USA
| | | |
Collapse
|
5
|
McGovern C, Arcoleo K, Melnyk B. Sustained Effects From a School-Based Intervention Pilot Study for Children With Asthma and Anxiety. J Sch Nurs 2020; 38:347-357. [PMID: 32588717 DOI: 10.1177/1059840520934178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Children with chronic conditions (i.e., asthma) are more likely to have anxiety or depressive symptoms. Comorbid asthma and anxiety in children leads to increased morbidity, causing children to miss instructional time and parent/caregiver (CG) work absences. Asthma educational programs and mental health interventions have been developed, though no scalable programs integrate asthma education and mental health behavioral interventions for school-aged children. This study evaluated the sustained preliminary effects of an integrated asthma education and cognitive behavioral skills-building program, Creating Opportunities for Personal Empowerment for Asthma. Thirty-two children ages 8-12 years with asthma and symptoms of anxiety received the intervention. At 6-weeks postintervention, anxiety and CG-reported behavioral symptoms were significantly reduced, there were fewer missed doses of asthma controller medications, and asthma-related self-efficacy, personal beliefs, and the children's understanding of asthma significantly increased. Most children (n = 29, 91%) reported continued use of coping skills.
Collapse
Affiliation(s)
- Colleen McGovern
- School of Nursing, University of North Carolina at Chapel Hill, NC, USA
| | | | - Bernadette Melnyk
- College of Nursing, The Ohio State University, Columbus, OH, USA.,College of Medicine, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
6
|
McGovern CM, Arcoleo K, Melnyk B. COPE for asthma: Outcomes of a cognitive behavioral intervention for children with asthma and anxiety. ACTA ACUST UNITED AC 2020; 34:665-676. [PMID: 31697152 DOI: 10.1037/spq0000310] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Asthma is the most common childhood chronic condition and a major contributor to school absences and lost instructional time. Children with asthma have a higher risk of internalizing disorders, such as anxiety and depression, which can further complicate asthma management. The purpose of this pilot study was to assess the feasibility, acceptability, and preliminary effects of a manualized, cognitive-behavioral skills-building intervention for children with asthma and anxiety. The design for this study was a one-group, pre/posttest preexperimental with a 6-week follow-up. This article presents the immediate posttest follow-up results. Children between 8 and 12 years of age and their caregivers were recruited from three elementary schools in a large public school district in Ohio. Thirty-two children with asthma and symptoms of anxiety completed the Creating Opportunities for Personal Empowerment (COPE) for Asthma program. Caregivers completed surveys, but they did not participate in the intervention. Results indicated that the program was feasible to implement in small groups during the school day. Self-reported findings indicated a significant reduction in separation anxiety and increased personal beliefs, child-management self-efficacy, and asthma illness representations. Parents and caregivers reported symptom reduction in their children on the Pediatric Symptom Checklist. The subgroup of children scoring high on anxiety at baseline showed reductions with the intervention, having large positive effect sizes for separation and social anxiety as well as medium and large positive effect sizes on the personal beliefs and asthma illness representations, respectively. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
|
7
|
Reducing Healthcare Costs for Mental Health Hospitalizations With the Evidence-based COPE Program for Child and Adolescent Depression and Anxiety: A Cost Analysis. J Pediatr Health Care 2020; 34:117-121. [PMID: 31615687 DOI: 10.1016/j.pedhc.2019.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/29/2019] [Accepted: 08/28/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Although depression and anxiety affect approximately 20% of children and adolescents, many of those affected do not receive treatment because, in large part to the shortage of mental health providers across the United States. As an alternative to traditional mental health counseling, the Creating Opportunities for Personal Empowerment (COPE) program is an evidence-based manualized 7-session cognitive behavioral therapy-based program that is being effectively delivered to children and teens with depression and anxiety by pediatric and family healthcare providers in primary care practices with reimbursement from insurers. METHODS The purpose of this study was to perform a cost analysis of delivering COPE and compare it to the cost of hospitalization for primary mental health diagnosis. RESULTS Findings indicated a cost savings of $14,262 for every hospitalization that is prevented. DISCUSSION Implementation of COPE can improve outcomes for children and teens with depression and anxiety, and could potentially result in millions of dollars of cost savings for the U.S. healthcare system.
Collapse
|
8
|
Santilhano M. Online intervention to reduce pediatric anxiety: An evidence-based review. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2019; 32:197-209. [PMID: 31682052 DOI: 10.1111/jcap.12256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/07/2019] [Accepted: 10/02/2019] [Indexed: 12/25/2022]
Abstract
TOPIC Online intervention for school-age youth suffering from symptoms of generalized anxiety disorder. PURPOSE A review of the evidence was conducted to examine the effects of nonpharmacological interventions available online for a reduction of symptoms of generalized anxiety disorder in school-age youth. SOURCES USED The search strategy included the databases of Pubmed, PsychINFO, CINAHL, Cochrane Systematic Reviews, and Cochrane Clinical Trials, and Evidence-Based Reviews. A combination of search terms was used to identify studies with database-specific truncations: "Child* and youth* anxiety screen and intervention" AND "meta-analysis", "child anxiety" AND "systematic review", "child anxiety and personal empowerment and SR", "SCARED*", "COPE", and "SCARED* and SR". Studies published between 2007 and 2017 were included for this review. Twenty studies met criteria and represented level one or two using Melnyk and Fineout-Overholt, Level of Evidence Rating System for intervention inquiries. CONCLUSION Positive outcomes of improved physiological, social, and cognitive development are supported in the studies using cognitive behavior therapy such as the Creating Opportunities for Personal Empowerment (COPE) program. The COPE-online program is a cost-effective strategy to complements models used for early screening and timely interventions for school-age youth who struggle with symptoms of generalized anxiety disorder.
Collapse
|
9
|
Morrison-Beedy D, Mazurek Melnyk B. Making a Case for Integrating Evidence-Based Sexual Risk Reduction and Mental Health Interventions for Adolescent Girls. Issues Ment Health Nurs 2019; 40:932-941. [PMID: 31403363 PMCID: PMC7080305 DOI: 10.1080/01612840.2019.1639087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Recently identified as the top concern of teens, mental health issues now compete with sexual health risks as major threats to the well-being of adolescent females. Depression and anxiety can lead to or compound the negative repercussions of sexual behavior choices that result in disproportionately high rates of sexually-transmitted infections (STIs), hetero-sexually acquired HIV, and unplanned pregnancy rates in girls ages 15-19. There are a limited number of CDC- and DHHS-recognized HIV/STI and teen pregnancy evidence-based interventions (EBIs) targeted to adolescent girls of diverse races/ethnicities and none that simultaneously address common mental health disorders. The Health Improvement Project for Teens (HIPTeens), a manualized gender-specific sexual risk reduction intervention, and the Creating Opportunities for Personal Empowerment (COPE) Program, a manualized cognitive-behavioral skills intervention that reduces depression and anxiety, are recognized by national agencies as strong EBIs that have successfully improved their targeted outcomes. Baseline data from the HIPTeens clinical trial revealed that a substantial portion of the more than 700 girls enrolled had moderate to high levels of depressive symptoms as well as other mental health challenges (e.g., binge drinking and eating, cannabis use). Thus, there is an urgent need to combine EBIs, such as HIPTeens and COPE, to curtail these leading public health problems confronting today's adolescents.
Collapse
Affiliation(s)
| | - Bernadette Mazurek Melnyk
- Department of Pediatrics & Psychiatry, College of Nursing and College of Medicine, The Helene Fuld Health Trust National Institute for EBP, The Ohio State University , Columbus , OH , USA
| |
Collapse
|
10
|
Morrison-Beedy D, Melnyk BM. Making a Case for Integrating Evidence-Based Sexual Risk Reduction and Mental Health Interventions for Adolescent Girls. Issues Ment Health Nurs 2019:1-9. [PMID: 31599658 DOI: 10.1080/01612840.2019.1640322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
|
11
|
Doumit R, Kazandjian C, Militello LK. COPE for Adolescent Syrian Refugees in Lebanon: A Brief Cognitive-Behavioral Skill-Building Intervention to Improve Quality of Life and Promote Positive Mental Health. Clin Nurs Res 2018; 29:226-234. [PMID: 30477312 DOI: 10.1177/1054773818808114] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lebanon has the highest per-capita concentration of refugees worldwide. There is an urgent need to offer psychosocial interventions to vulnerable groups such as Syrian refugee adolescents. To assess the feasibility, acceptability, and preliminary effects of a cognitive-behavioral intervention (Creating Opportunities for Patient Empowerment [COPE]) on depression, anxiety, and quality of life (QOL) in a sample of adolescent refugees (13-17 years) living in Lebanon. A preexperimental study design was used. COPE 7-Session was delivered to 31 adolescent Syrian refugees. Participants were assessed for depression (Personal Health Questionnaire-9), anxiety (General Anxiety Disorders Scale), and QOL (Pediatric Quality of Life Inventory). Feasibility and acceptability findings indicated that the COPE program was a positive experience for teens. Significant decreases in depression and anxiety, and increases in QOL were also reported. COPE is an effective cognitive-behavioral intervention that can be delivered in an Arabic/Middle-Eastern setting for teen refugees to improve mental health and QOL.
Collapse
Affiliation(s)
- Rita Doumit
- Lebanese American University, Byblos, Lebanon.,Sigma Theta Tau International Chi Iota Chapter, American University of Beirut, Lebanon
| | | | | |
Collapse
|
12
|
McGovern CM, Militello LK, Arcoleo KJ, Melnyk BM. Factors Associated With Healthy Lifestyle Behaviors Among Adolescents. J Pediatr Health Care 2018; 32:473-480. [PMID: 29941235 PMCID: PMC7265997 DOI: 10.1016/j.pedhc.2018.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 04/11/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Guided by cognitive theory, this study tested an explanatory model for adolescents' beliefs, feelings, and healthy lifestyle behaviors and sex differences in these relationships. METHODS Structural equation modeling evaluated cross-sectional data from a healthy lifestyle program from 779 adolescents 14 through 17 years old. RESULTS Theoretical relationships among thoughts, feelings, and behaviors were confirmed and sex differences identified. Thoughts had a direct effect on feelings and an indirect effect through feelings on healthy behaviors for both sexes. A direct effect from thoughts to behaviors existed for males only. DISCUSSION Findings provide strong support for the thinking-feeling-behaving triangle for adolescents. To promote healthy lifestyle behaviors in adolescents, interventions should incorporate cognitive behavioral skills-building activities, strengthening healthy lifestyle beliefs, and enhancing positive health behaviors.
Collapse
|
13
|
Abstract
Stress and negative emotions pose a major threat to public health, by increasing the risk of obesity. Since the management process for emotions (emotion regulation; ER) is developed in childhood, we present a novel conceptual framework model for the role of ER in the prevention and treatment of childhood obesity. A narrative review of the literature by electronic database search (MEDLINE, Web of Knowledge and Scopus) was conducted of observational and interventional/experimental literature on ER and obesity and the underlying concepts. We also present an overview of ER intervention techniques. Our model indicates that childhood ER is a link between stress and obesity. Stress along with ineffective ER leads to abnormal cortisol patterns, emotional eating, sedentary lifestyle, reduction of physical activity, and sleep problems. Simultaneously, a healthy lifestyle could show benefits on ER and in developing adaptive ER strategies. In the development of obesity and ER, parents also play a role. By contrast, effective ER skills decrease obesity-related unhealthy behaviour and enhance protective factors, which boost health. The literature contains some observational studies of children but very few intervention studies, most of which are pilot or on-going studies. In conclusion, encouraging effective ER could be a useful new approach for combating and treating childhood obesity. Future ER intervention studies are needed to confirm the validity of this model in children.
Collapse
|
14
|
Martin A, Booth JN, Laird Y, Sproule J, Reilly JJ, Saunders DH. Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight. Cochrane Database Syst Rev 2018; 3:CD009728. [PMID: 29499084 PMCID: PMC5865125 DOI: 10.1002/14651858.cd009728.pub4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The global prevalence of childhood and adolescent obesity is high. Lifestyle changes towards a healthy diet, increased physical activity and reduced sedentary activities are recommended to prevent and treat obesity. Evidence suggests that changing these health behaviours can benefit cognitive function and school achievement in children and adolescents in general. There are various theoretical mechanisms that suggest that children and adolescents with excessive body fat may benefit particularly from these interventions. OBJECTIVES To assess whether lifestyle interventions (in the areas of diet, physical activity, sedentary behaviour and behavioural therapy) improve school achievement, cognitive function (e.g. executive functions) and/or future success in children and adolescents with obesity or overweight, compared with standard care, waiting-list control, no treatment, or an attention placebo control group. SEARCH METHODS In February 2017, we searched CENTRAL, MEDLINE and 15 other databases. We also searched two trials registries, reference lists, and handsearched one journal from inception. We also contacted researchers in the field to obtain unpublished data. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials (RCTs) of behavioural interventions for weight management in children and adolescents with obesity or overweight. We excluded studies in children and adolescents with medical conditions known to affect weight status, school achievement and cognitive function. We also excluded self- and parent-reported outcomes. DATA COLLECTION AND ANALYSIS Four review authors independently selected studies for inclusion. Two review authors extracted data, assessed quality and risks of bias, and evaluated the quality of the evidence using the GRADE approach. We contacted study authors to obtain additional information. We used standard methodological procedures expected by Cochrane. Where the same outcome was assessed across different intervention types, we reported standardised effect sizes for findings from single-study and multiple-study analyses to allow comparison of intervention effects across intervention types. To ease interpretation of the effect size, we also reported the mean difference of effect sizes for single-study outcomes. MAIN RESULTS We included 18 studies (59 records) of 2384 children and adolescents with obesity or overweight. Eight studies delivered physical activity interventions, seven studies combined physical activity programmes with healthy lifestyle education, and three studies delivered dietary interventions. We included five RCTs and 13 cluster-RCTs. The studies took place in 10 different countries. Two were carried out in children attending preschool, 11 were conducted in primary/elementary school-aged children, four studies were aimed at adolescents attending secondary/high school and one study included primary/elementary and secondary/high school-aged children. The number of studies included for each outcome was low, with up to only three studies per outcome. The quality of evidence ranged from high to very low and 17 studies had a high risk of bias for at least one item. None of the studies reported data on additional educational support needs and adverse events.Compared to standard practice, analyses of physical activity-only interventions suggested high-quality evidence for improved mean cognitive executive function scores. The mean difference (MD) was 5.00 scale points higher in an after-school exercise group compared to standard practice (95% confidence interval (CI) 0.68 to 9.32; scale mean 100, standard deviation 15; 116 children, 1 study). There was no statistically significant beneficial effect in favour of the intervention for mathematics, reading, or inhibition control. The standardised mean difference (SMD) for mathematics was 0.49 (95% CI -0.04 to 1.01; 2 studies, 255 children, moderate-quality evidence) and for reading was 0.10 (95% CI -0.30 to 0.49; 2 studies, 308 children, moderate-quality evidence). The MD for inhibition control was -1.55 scale points (95% CI -5.85 to 2.75; scale range 0 to 100; SMD -0.15, 95% CI -0.58 to 0.28; 1 study, 84 children, very low-quality evidence). No data were available for average achievement across subjects taught at school.There was no evidence of a beneficial effect of physical activity interventions combined with healthy lifestyle education on average achievement across subjects taught at school, mathematics achievement, reading achievement or inhibition control. The MD for average achievement across subjects taught at school was 6.37 points lower in the intervention group compared to standard practice (95% CI -36.83 to 24.09; scale mean 500, scale SD 70; SMD -0.18, 95% CI -0.93 to 0.58; 1 study, 31 children, low-quality evidence). The effect estimate for mathematics achievement was SMD 0.02 (95% CI -0.19 to 0.22; 3 studies, 384 children, very low-quality evidence), for reading achievement SMD 0.00 (95% CI -0.24 to 0.24; 2 studies, 284 children, low-quality evidence), and for inhibition control SMD -0.67 (95% CI -1.50 to 0.16; 2 studies, 110 children, very low-quality evidence). No data were available for the effect of combined physical activity and healthy lifestyle education on cognitive executive functions.There was a moderate difference in the average achievement across subjects taught at school favouring interventions targeting the improvement of the school food environment compared to standard practice in adolescents with obesity (SMD 0.46, 95% CI 0.25 to 0.66; 2 studies, 382 adolescents, low-quality evidence), but not with overweight. Replacing packed school lunch with a nutrient-rich diet in addition to nutrition education did not improve mathematics (MD -2.18, 95% CI -5.83 to 1.47; scale range 0 to 69; SMD -0.26, 95% CI -0.72 to 0.20; 1 study, 76 children, low-quality evidence) and reading achievement (MD 1.17, 95% CI -4.40 to 6.73; scale range 0 to 108; SMD 0.13, 95% CI -0.35 to 0.61; 1 study, 67 children, low-quality evidence). AUTHORS' CONCLUSIONS Despite the large number of childhood and adolescent obesity treatment trials, we were only able to partially assess the impact of obesity treatment interventions on school achievement and cognitive abilities. School and community-based physical activity interventions as part of an obesity prevention or treatment programme can benefit executive functions of children with obesity or overweight specifically. Similarly, school-based dietary interventions may benefit general school achievement in children with obesity. These findings might assist health and education practitioners to make decisions related to promoting physical activity and healthy eating in schools. Future obesity treatment and prevention studies in clinical, school and community settings should consider assessing academic and cognitive as well as physical outcomes.
Collapse
Affiliation(s)
- Anne Martin
- University of EdinburghCentre for Population Health SciencesMedical School, Teviot PlaceEdinburghUKEH8 9AG
- University of GlasgowMRC/CSO Social and Public Health Sciences Unit200 Renfield StreetGlasgowUKG2 3QB
| | - Josephine N Booth
- The University of EdinburghInstitute for Education, Community and SocietyMoray House School of EducationRoom 2.17, St John's LandEdinburghUKEH8 8AQ
| | - Yvonne Laird
- University of EdinburghScottish Collaboration for Public Health Research and Policy (SCPHRP)20 West Richmond StreetEdinburghUKEH8 9DX
| | - John Sproule
- Institute for Sport, Physical Education and Health Sciences (SPEHS), University of EdinburghMoray House School of EducationHolyrood RoadEdinburghEH8 8AQUK
| | - John J Reilly
- University of StrathclydePhysical Activity for Health Group, School of Psychological Sciences and Health50 George StreetGlasgowUKG1 1QE
| | - David H Saunders
- University of EdinburghPhysical Activity for Health Research Centre (PAHRC)St Leonards LandHolyrood RoadEdinburghMidlothianUKEH8 8AQ
| | | |
Collapse
|
15
|
Martin A, Booth JN, Laird Y, Sproule J, Reilly JJ, Saunders DH. Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight. Cochrane Database Syst Rev 2018; 1:CD009728. [PMID: 29376563 PMCID: PMC6491168 DOI: 10.1002/14651858.cd009728.pub3] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The global prevalence of childhood and adolescent obesity is high. Lifestyle changes towards a healthy diet, increased physical activity and reduced sedentary activities are recommended to prevent and treat obesity. Evidence suggests that changing these health behaviours can benefit cognitive function and school achievement in children and adolescents in general. There are various theoretical mechanisms that suggest that children and adolescents with excessive body fat may benefit particularly from these interventions. OBJECTIVES To assess whether lifestyle interventions (in the areas of diet, physical activity, sedentary behaviour and behavioural therapy) improve school achievement, cognitive function (e.g. executive functions) and/or future success in children and adolescents with obesity or overweight, compared with standard care, waiting-list control, no treatment, or an attention placebo control group. SEARCH METHODS In February 2017, we searched CENTRAL, MEDLINE and 15 other databases. We also searched two trials registries, reference lists, and handsearched one journal from inception. We also contacted researchers in the field to obtain unpublished data. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials (RCTs) of behavioural interventions for weight management in children and adolescents with obesity or overweight. We excluded studies in children and adolescents with medical conditions known to affect weight status, school achievement and cognitive function. We also excluded self- and parent-reported outcomes. DATA COLLECTION AND ANALYSIS Four review authors independently selected studies for inclusion. Two review authors extracted data, assessed quality and risks of bias, and evaluated the quality of the evidence using the GRADE approach. We contacted study authors to obtain additional information. We used standard methodological procedures expected by Cochrane. Where the same outcome was assessed across different intervention types, we reported standardised effect sizes for findings from single-study and multiple-study analyses to allow comparison of intervention effects across intervention types. To ease interpretation of the effect size, we also reported the mean difference of effect sizes for single-study outcomes. MAIN RESULTS We included 18 studies (59 records) of 2384 children and adolescents with obesity or overweight. Eight studies delivered physical activity interventions, seven studies combined physical activity programmes with healthy lifestyle education, and three studies delivered dietary interventions. We included five RCTs and 13 cluster-RCTs. The studies took place in 10 different countries. Two were carried out in children attending preschool, 11 were conducted in primary/elementary school-aged children, four studies were aimed at adolescents attending secondary/high school and one study included primary/elementary and secondary/high school-aged children. The number of studies included for each outcome was low, with up to only three studies per outcome. The quality of evidence ranged from high to very low and 17 studies had a high risk of bias for at least one item. None of the studies reported data on additional educational support needs and adverse events.Compared to standard practice, analyses of physical activity-only interventions suggested high-quality evidence for improved mean cognitive executive function scores. The mean difference (MD) was 5.00 scale points higher in an after-school exercise group compared to standard practice (95% confidence interval (CI) 0.68 to 9.32; scale mean 100, standard deviation 15; 116 children, 1 study). There was no statistically significant beneficial effect in favour of the intervention for mathematics, reading, or inhibition control. The standardised mean difference (SMD) for mathematics was 0.49 (95% CI -0.04 to 1.01; 2 studies, 255 children, moderate-quality evidence) and for reading was 0.10 (95% CI -0.30 to 0.49; 2 studies, 308 children, moderate-quality evidence). The MD for inhibition control was -1.55 scale points (95% CI -5.85 to 2.75; scale range 0 to 100; SMD -0.15, 95% CI -0.58 to 0.28; 1 study, 84 children, very low-quality evidence). No data were available for average achievement across subjects taught at school.There was no evidence of a beneficial effect of physical activity interventions combined with healthy lifestyle education on average achievement across subjects taught at school, mathematics achievement, reading achievement or inhibition control. The MD for average achievement across subjects taught at school was 6.37 points lower in the intervention group compared to standard practice (95% CI -36.83 to 24.09; scale mean 500, scale SD 70; SMD -0.18, 95% CI -0.93 to 0.58; 1 study, 31 children, low-quality evidence). The effect estimate for mathematics achievement was SMD 0.02 (95% CI -0.19 to 0.22; 3 studies, 384 children, very low-quality evidence), for reading achievement SMD 0.00 (95% CI -0.24 to 0.24; 2 studies, 284 children, low-quality evidence), and for inhibition control SMD -0.67 (95% CI -1.50 to 0.16; 2 studies, 110 children, very low-quality evidence). No data were available for the effect of combined physical activity and healthy lifestyle education on cognitive executive functions.There was a moderate difference in the average achievement across subjects taught at school favouring interventions targeting the improvement of the school food environment compared to standard practice in adolescents with obesity (SMD 0.46, 95% CI 0.25 to 0.66; 2 studies, 382 adolescents, low-quality evidence), but not with overweight. Replacing packed school lunch with a nutrient-rich diet in addition to nutrition education did not improve mathematics (MD -2.18, 95% CI -5.83 to 1.47; scale range 0 to 69; SMD -0.26, 95% CI -0.72 to 0.20; 1 study, 76 children, low-quality evidence) and reading achievement (MD 1.17, 95% CI -4.40 to 6.73; scale range 0 to 108; SMD 0.13, 95% CI -0.35 to 0.61; 1 study, 67 children, low-quality evidence). AUTHORS' CONCLUSIONS Despite the large number of childhood and adolescent obesity treatment trials, we were only able to partially assess the impact of obesity treatment interventions on school achievement and cognitive abilities. School and community-based physical activity interventions as part of an obesity prevention or treatment programme can benefit executive functions of children with obesity or overweight specifically. Similarly, school-based dietary interventions may benefit general school achievement in children with obesity. These findings might assist health and education practitioners to make decisions related to promoting physical activity and healthy eating in schools. Future obesity treatment and prevention studies in clinical, school and community settings should consider assessing academic and cognitive as well as physical outcomes.
Collapse
Affiliation(s)
| | - Josephine N Booth
- The University of EdinburghInstitute for Education, Community and SocietyMoray House School of EducationRoom 2.17, St John's LandEdinburghUKEH8 8AQ
| | - Yvonne Laird
- University of EdinburghScottish Collaboration for Public Health Research and Policy (SCPHRP)20 West Richmond StreetEdinburghUKEH8 9DX
| | - John Sproule
- Institute for Sport, Physical Education and Health Sciences (SPEHS), University of EdinburghMoray House School of EducationHolyrood RoadEdinburghUK
| | - John J Reilly
- University of StrathclydePhysical Activity for Health Group, School of Psychological Sciences and Health50 George StreetGlasgowUKG1 1QE
| | - David H Saunders
- University of EdinburghPhysical Activity for Health Research Centre (PAHRC)St Leonards LandHolyrood RoadEDINBURGHUKEH8 8AQ
| |
Collapse
|
16
|
Ewald DR, Bond SH, Haldeman LA. Hypertension in Low-Income Adolescents. Glob Pediatr Health 2017; 4:2333794X17741819. [PMID: 29204459 PMCID: PMC5703095 DOI: 10.1177/2333794x17741819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/03/2017] [Indexed: 12/27/2022] Open
Abstract
Disadvantaged adolescents are at higher risk for undiagnosed and untreated obesity and hypertension. Using nurse-measured weight, height, and blood pressure (BP) as well as self-reported age and activity/lifestyle behaviors, we assessed the prevalence of obesity and hypertension in 573 adolescent patients aged 13.0 to 17.9 years (females: n = 267, 46.6%; males: n = 306, 53.4%) from a clinic serving low-income, ethnically diverse pediatric patients. Body mass index distribution was as follows: 11, underweight (1.9%); 330, healthy weight (57.6%); 105, overweight (18.3%); and 127, obese (22.2%). The age-adjusted height percentile was normally distributed, but distribution by BP category was 326 normotensive (56.9%), 147 prehypertensive (25.7%), 60 with stage 1 hypertension (10.5%), and 40 with stage 2 hypertension (7.0%). Activity and lifestyle behaviors did not adequately explain obesity and hypertension rates. Efforts to prevent/reduce childhood overweight, obesity, and hypertension in underserved populations need to include dietary education, weight control interventions, and physical activity programs specifically tailored to overweight/obese youth and parents.
Collapse
Affiliation(s)
- D Rose Ewald
- The University of North Carolina at Greensboro, NC, USA
| | | | | |
Collapse
|
17
|
Dray J, Bowman J, Campbell E, Freund M, Hodder R, Wolfenden L, Richards J, Leane C, Green S, Lecathelinais C, Oldmeadow C, Attia J, Gillham K, Wiggers J. Effectiveness of a pragmatic school-based universal intervention targeting student resilience protective factors in reducing mental health problems in adolescents. J Adolesc 2017; 57:74-89. [PMID: 28384523 DOI: 10.1016/j.adolescence.2017.03.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 11/29/2022]
Abstract
Worldwide, 10-20% of adolescents experience mental health problems. Strategies aimed at strengthening resilience protective factors provide a potential approach for reducing mental health problems in adolescents. This study evaluated the effectiveness of a universal, school-based intervention targeting resilience protective factors in reducing mental health problems in adolescents. A cluster randomised controlled trial was conducted in 20 intervention and 12 control secondary schools located in socio-economically disadvantaged areas of NSW, Australia. Data were collected from 3115 students at baseline (Grade 7, 2011), of whom 2149 provided data at follow up (Grade 10, 2014; enrolments in Grades 7 to 10 typically aged 12-16 years; 50% male; 69.0% retention). There were no significant differences between groups at follow-up for three mental health outcomes: total SDQ, internalising problems, and prosocial behaviour. A small statistically significant difference in favour of the control group was found for externalising problems. Findings highlight the continued difficulties in developing effective, school-based prevention programs for mental health problems in adolescents. TRIAL REGISTRATION ANZCTR (Ref no: ACTRN12611000606987).
Collapse
Affiliation(s)
- Julia Dray
- Faculty of Science and IT, School of Psychology, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter New England Population Health Research Group, Hunter New England Local Health District, Wallsend, NSW 2287, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2310, Australia.
| | - Jenny Bowman
- Faculty of Science and IT, School of Psychology, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2310, Australia
| | - Elizabeth Campbell
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter New England Population Health Research Group, Hunter New England Local Health District, Wallsend, NSW 2287, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2310, Australia
| | - Megan Freund
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2310, Australia
| | - Rebecca Hodder
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter New England Population Health Research Group, Hunter New England Local Health District, Wallsend, NSW 2287, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2310, Australia
| | - Luke Wolfenden
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter New England Population Health Research Group, Hunter New England Local Health District, Wallsend, NSW 2287, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2310, Australia
| | - Jody Richards
- Faculty of Science and IT, School of Psychology, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Catherine Leane
- Hunter New England Population Health Research Group, Hunter New England Local Health District, Wallsend, NSW 2287, Australia
| | - Sue Green
- Hunter New England Population Health Research Group, Hunter New England Local Health District, Wallsend, NSW 2287, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2310, Australia
| | - Christophe Lecathelinais
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter New England Population Health Research Group, Hunter New England Local Health District, Wallsend, NSW 2287, Australia
| | - Christopher Oldmeadow
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2310, Australia
| | - John Attia
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2310, Australia
| | - Karen Gillham
- Hunter New England Population Health Research Group, Hunter New England Local Health District, Wallsend, NSW 2287, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2310, Australia
| | - John Wiggers
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter New England Population Health Research Group, Hunter New England Local Health District, Wallsend, NSW 2287, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW 2310, Australia
| |
Collapse
|
18
|
Ardic A, Erdogan S. The effectiveness of the COPE healthy lifestyles TEEN program: a school-based intervention in middle school adolescents with 12-month follow-up. J Adv Nurs 2016; 73:1377-1389. [PMID: 27878848 DOI: 10.1111/jan.13217] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2016] [Indexed: 11/26/2022]
Abstract
AIM The goal of this study is to assess the applicability and long-term effectiveness of the T-COPE Healthy TEEN program on adolescent health. BACKGROUND Obesity and mental health disorders are major public health problems in adolescents. In this context, including long-term and multiple behavioural obesity prevention programs are becoming increasingly important. DESIGN A quasi-experimental design with pre-test/post-test control group and repeated measurements. METHODS Eighty-seven (45 in intervention group, 42 in control group) adolescents were included from two different middle schools in the intervention program. The data were analysed by using descriptive statistics, Pearson chi-square, Fisher's exact test, Student-t test, repeated measures of variance analysis and Cohen's d effect size. RESULTS No significant difference was found between the intervention and control groups in terms of descriptive characteristics, behavioural and cognitive variables of the adolescents. Following the intervention, the adolescents in intervention groups showed improvements in nutritional behaviour, physical activity and stress management. These improvements concerned increased physical walking measured in the number of physical steps per week daily fruit and vegetable consumption and the daily quantity of water ingested. While their nutrition/physical activity knowledge significantly increased, their weight and anxiety symptoms significantly decreased. The effect of the program on body mass index, depression and health beliefs of the adolescents were not significant compared with the control group. CONCLUSION The applicability of the T-COPE Healthy TEEN program on Turkish adolescents and its effectiveness on their health behaviours, nutrition and physical activity knowledge and stress management were revealed in this study.
Collapse
Affiliation(s)
- Aysun Ardic
- Florence Nightingale Faculty of Nursing, Istanbul University, Turkey
| | - Semra Erdogan
- Florence Nightingale Faculty of Nursing, Istanbul University, Turkey
| |
Collapse
|
19
|
Salerno JP. Effectiveness of Universal School-Based Mental Health Awareness Programs Among Youth in the United States: A Systematic Review. THE JOURNAL OF SCHOOL HEALTH 2016; 86:922-931. [PMID: 27866385 PMCID: PMC5123790 DOI: 10.1111/josh.12461] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/29/2016] [Indexed: 05/07/2023]
Abstract
BACKGROUND Stigmatizing attitudes toward mental illness and low mental health literacy have been identified as links to social adversity, and barriers to seeking and adhering to treatment among adolescents suffering from mental illness. Prior research has found that it is possible to improve these outcomes using school-based mental health awareness interventions. The purpose of this study was to review empirical literature pertaining to universal mental health awareness interventions aiming to improve mental health related outcomes among students enrolled in US K-12 schools, especially minorities vulnerable to health disparities. METHODS PsycINFO, Cochrane Library, PUBMED, and reference lists of relevant articles were searched for K-12 school-based mental health awareness interventions in the United States. Universal studies that measured knowledge, attitudes, and/or help-seeking pertinent to mental health were included. RESULTS A total of 15 studies were selected to be part of the review. There were 7 pretest/post-test case series, 5 nonrandomized experimental trial, 1 Solomon 4-groups, and 2 randomized controlled trial (RCT) designs. Nine studies measuring knowledge, 8 studies measuring attitudes, and 4 studies measuring help-seeking, indicated statistically significant improvements. CONCLUSIONS Although results of all studies indicated some level of improvement, more research on implementation of universal school-based mental health awareness programs is needed using RCT study designs, and long-term follow-up implementation.
Collapse
Affiliation(s)
- John P. Salerno
- Community Engagement, Research Training & Education Cores Coordinator, University of Miami – School of Nursing & Health Studies, Center of Excellence for Health Disparities Research: El Centro, 5030 Brunson Drive, Coral Gables, FL 33146, Phone: (305) 284-4109, Fax: (305) 284-4249
| |
Collapse
|
20
|
Militello L, Melnyk BM, Hekler EB, Small L, Jacobson D. Automated Behavioral Text Messaging and Face-to-Face Intervention for Parents of Overweight or Obese Preschool Children: Results From a Pilot Study. JMIR Mhealth Uhealth 2016; 4:e21. [PMID: 26976387 PMCID: PMC4810011 DOI: 10.2196/mhealth.4398] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 09/11/2015] [Accepted: 11/11/2015] [Indexed: 12/15/2022] Open
Abstract
Background Children are 5 times more likely to be overweight at the age of 12 years if they are overweight during the preschool period. Objective The purpose of this study was to establish the feasibility, acceptability, and preliminary effects of a cognitive behavioral intervention (TEXT2COPE) synergized with tailored mobile technology (mHealth) on the healthy lifestyle behaviors of parents of overweight and obese preschoolers delivered in a primary care setting. Methods Fifteen preschooler-parent dyads recruited through primary care clinics completed a manualized 7-week cognitive behavioral skills building intervention. Beck’s Cognitive Theory guided the TEXT2COPE intervention content and Fogg’s Behavior Model guided the implementation. The intervention employed a combination of face-to-face clinic visits and ecological momentary interventions using text messaging (short message service, SMS). To enhance the intervention’s relevance to the family’s needs, parents dictated the wording of the text messages and also were able to adapt the frequency and timing of delivery throughout program implementation. Results Self-reported findings indicate that the program is feasible and acceptable in this population. The intervention showed preliminary effects with significant improvements on parental knowledge about nutrition (P=.001) and physical activity (P=.012) for their children, parental beliefs (P=.001) toward healthy lifestyles, and parental behaviors (P=.040) toward engaging in healthy lifestyle choices for their children. Effect sizes were medium to large for all variables. The timing, frequency, and wording of the text messages were tailored to the individual families, with 69% of parents (9/13) increasing the frequency of the tailored SMS from being sent once weekly to as many as 5 times a week. Conclusions Utilizing a cognitive behavioral skills intervention with SMS has great potential for supporting clinical care of overweight and obese preschool children and their families. Further exploration of the potential effects on health and behavioral outcomes is warranted.
Collapse
Affiliation(s)
- Lisa Militello
- The Ohio State University, College of Nursing, Columbus, OH, United States.
| | | | | | | | | |
Collapse
|
21
|
Ewald DR, Haldeman PhD LA. Risk Factors in Adolescent Hypertension. Glob Pediatr Health 2016; 3:2333794X15625159. [PMID: 27335997 PMCID: PMC4784559 DOI: 10.1177/2333794x15625159] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 11/27/2015] [Accepted: 11/30/2015] [Indexed: 12/12/2022] Open
Abstract
Hypertension is a complex and multifaceted disease, with many contributing factors. While diet and nutrition are important influences, the confounding effects of overweight and obesity, metabolic and genetic factors, racial and ethnic predispositions, socioeconomic status, cultural influences, growth rate, and pubertal stage have even more influence and make diagnosis quite challenging. The prevalence of hypertension in adolescents far exceeds the numbers who have been diagnosed; studies have found that 75% or more go undiagnosed. This literature review summarizes the challenges of blood pressure classification in adolescents, discusses the impact of these confounding influences, and identifies actions that will improve diagnosis and treatment outcomes.
Collapse
Affiliation(s)
- D Rose Ewald
- The University of North Carolina at Greensboro, NC, USA
| | | |
Collapse
|
22
|
Melnyk BM, Jacobson D, Kelly SA, Belyea MJ, Shaibi GQ, Small L, O'Haver JA, Marsiglia FF. Twelve-Month Effects of the COPE Healthy Lifestyles TEEN Program on Overweight and Depressive Symptoms in High School Adolescents. THE JOURNAL OF SCHOOL HEALTH 2015; 85:861-70. [PMID: 26522175 PMCID: PMC5117907 DOI: 10.1111/josh.12342] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 03/27/2015] [Accepted: 04/28/2015] [Indexed: 05/02/2023]
Abstract
BACKGROUND We evaluated the 12-month effects of the COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, Nutrition) program versus an attention control program (Healthy Teens) on overweight/obesity and depressive symptoms in high school adolescents. METHODS A cluster randomized controlled trial was conducted. Participants were 779 culturally diverse adolescents in the US Southwest. COPE is a cognitive-behavioral skills-building intervention with 20 min of physical activity integrated into a health course and taught by teachers once a week for 15 weeks. Outcome measures included body mass index (BMI) and depressive symptoms. RESULTS COPE teens had a significantly lower BMI at 12 months (F(1,698) = 11.22, p = .001) than Healthy Teens (24.95 versus 25.48). There was a significant decrease in the proportion of overweight and obese COPE teens from baseline to 12 months (χ(2) = 5.40, p = .02) as compared with Healthy Teens. For youth who began the study with extremely elevated depressive symptoms, COPE teens had significantly lower depression at 12 months compared with Healthy Teens (COPE M = 42.39; Healthy Teens M = 57.90); (F(1 ,12) = 5.78, p = .03). CONCLUSIONS COPE can improve long-term physical and mental health outcomes in teens.
Collapse
Affiliation(s)
- Bernadette M Melnyk
- College of Medicine, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210.
| | - Diana Jacobson
- Arizona State University College of Nursing & Health Innovation, 500 North 3rd Street, Phoenix, AZ 85004.
| | | | - Michael J Belyea
- Arizona State University College of Nursing & Health Innovation, 500 North 3rd Street, Phoenix, AZ 85004.
| | - Gabriel Q Shaibi
- Arizona State University College of Nursing & Health Innovation, 500 North 3rd Street, Phoenix, AZ 85004.
| | - Leigh Small
- Family and Community Health Nursing, Virginia Commonwealth University School of Nursing, P.O. Box 980567, Richmond, VA 23298-0567.
| | - Judith A O'Haver
- Phoenix Children's Medical Group - Dermatology, 1919 E Thomas Rd, Phoenix, AZ 85016-7710.
| | - Flavio F Marsiglia
- School of Social Work Director of the Southwest Interdisciplinary Research Center (SIRC), School of Social Work - College of Public Programs, Arizona State University, 411 N. Central Ave., Suite 720, Phoenix, AZ 85004.
| |
Collapse
|
23
|
Melnyk BM, Amaya M, Szalacha LA, Hoying J, Taylor T, Bowersox K. Feasibility, Acceptability, and Preliminary Effects of the COPE Online Cognitive-Behavioral Skill-Building Program on Mental Health Outcomes and Academic Performance in Freshmen College Students: A Randomized Controlled Pilot Study. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2015; 28:147-54. [PMID: 26268362 DOI: 10.1111/jcap.12119] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PROBLEM Despite the increasing prevalence of mental health disorders in university students, few receive needed evidence-based treatment. OBJECTIVE The purpose of this study was to assess the feasibility and preliminary effects of a seven-session online cognitive-behavioral skill-building intervention (i.e., COPE, Creating Opportunities for Personal Empowerment) versus a comparison group on their anxiety, depressive symptoms, and grade performance. METHODS A randomized controlled pilot study was conducted from September 2012 to May 2013 with 121 college freshmen enrolled in a required one credit survey course. FINDINGS Although there were no significant differences in anxiety and depressive symptoms between the groups, only COPE students with an elevated level of anxiety at baseline had a significant decline in symptoms. Grade point average was higher in COPE versus comparison students. Evaluations indicated that COPE was a positive experience for students. CONCLUSIONS COPE is a promising brief intervention that can be integrated effectively into a required freshman course.
Collapse
Affiliation(s)
- Bernadette Mazurek Melnyk
- College of Nursing, The Ohio State University, Columbus, OH, USA.,College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Megan Amaya
- Health Promotion and Wellness, The Ohio State University, Columbus, OH, USA
| | - Laura A Szalacha
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | | | | | | |
Collapse
|
24
|
Leme ACB, Philippi ST. The “Healthy Habits, Healthy Girls” randomized controlled trial for girls: study design, protocol, and baseline results. CAD SAUDE PUBLICA 2015; 31:1381-94. [DOI: 10.1590/0102-311x00136014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 03/16/2015] [Indexed: 11/22/2022] Open
Abstract
The purpose of this article is to describe the study design, protocol, and baseline results of the “Healthy Habits, Healthy Girls” program. The intervention is being evaluated through a randomized controlled trial in 10 public schools in the city of São Paulo, Brazil. Data on the following variables were collected and assessed at baseline and will be reevaluated at 7 and 12 months: body mass index, waist circumference, dietary intake, nutrition, physical activity, social cognitive mediators, physical activity level, sedentary behaviors, self-rated physical status, and overall self-esteem. According to the baseline results, 32.4% and 23.4% of girls were overweight in the intervention and control groups, respectively, and in both groups a higher percentage failed to meet daily recommendations for moderate and vigorous physical activity and maximum screen time (TV, computer, mobile devices). There were no significant differences between the groups for most of the variables, except age (p = 0.000) and waist circumference (p = 0.014). The study showed a gap in the Brazilian literature on protocols for randomized controlled trials to prevent obesity among youth. The current study may thus be an important initial contribution to the field.
Collapse
|
25
|
Kelly SA, Oswalt K, Melnyk BM, Jacobson D. Comparison of intervention fidelity between COPE TEEN and an attention-control program in a randomized controlled trial. HEALTH EDUCATION RESEARCH 2015; 30:233-47. [PMID: 25355179 PMCID: PMC4364055 DOI: 10.1093/her/cyu065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 10/03/2014] [Indexed: 05/18/2023]
Abstract
Fidelity in implementing an intervention is critical to accurately determine and interpret the effects of an intervention. It is important to monitor the manner in which the behavioral intervention is implemented (e.g. adaptations, delivery as intended and dose). Few interventions are implemented with 100% fidelity. In this study, high school health teachers implemented the intervention. To attribute study findings to the intervention, it was vital to know to what degree the intervention was implemented. Therefore, the purposes of this study were to evaluate intervention fidelity and to compare implementation fidelity between the creating opportunities for personal empowerment (COPE) Healthy Lifestyles TEEN (thinking, emotions, exercise, and nutrition) program, the experimental intervention and Healthy Teens, an attention-control intervention, in a randomized controlled trial with 779 adolescents from 11 high schools in the southwest region of the United States. Thirty teachers participated in this study. Findings indicated that the attention-control teachers implemented their intervention with greater fidelity than COPE TEEN teachers. It is possible due to the novel intervention and the teachers' unfamiliarity with cognitive-behavioral skills building, COPE TEEN teachers had less fidelity. It is important to assess novel skill development prior to the commencement of experimental interventions and to provide corrective feedback during the course of implementation.
Collapse
Affiliation(s)
- Stephanie A Kelly
- College of Nursing, The Ohio State University, 1585 Neal Ave, Columbus, OH 43210, USA, Prevention Research Center, Arizona State University, 900 S. McAllister Ave, Suite 205, Tempe, AZ 85287, USA and College of Nursing & Health Innovation, Arizona State University, 400 N. 3 St, Phoenix, AZ 85004, USA
| | - Krista Oswalt
- College of Nursing, The Ohio State University, 1585 Neal Ave, Columbus, OH 43210, USA, Prevention Research Center, Arizona State University, 900 S. McAllister Ave, Suite 205, Tempe, AZ 85287, USA and College of Nursing & Health Innovation, Arizona State University, 400 N. 3 St, Phoenix, AZ 85004, USA
| | - Bernadette Mazurek Melnyk
- College of Nursing, The Ohio State University, 1585 Neal Ave, Columbus, OH 43210, USA, Prevention Research Center, Arizona State University, 900 S. McAllister Ave, Suite 205, Tempe, AZ 85287, USA and College of Nursing & Health Innovation, Arizona State University, 400 N. 3 St, Phoenix, AZ 85004, USA
| | - Diana Jacobson
- College of Nursing, The Ohio State University, 1585 Neal Ave, Columbus, OH 43210, USA, Prevention Research Center, Arizona State University, 900 S. McAllister Ave, Suite 205, Tempe, AZ 85287, USA and College of Nursing & Health Innovation, Arizona State University, 400 N. 3 St, Phoenix, AZ 85004, USA
| |
Collapse
|
26
|
Hoare E, Fuller-Tyszkiewicz M, Skouteris H, Millar L, Nichols M, Allender S. Systematic review of mental health and well-being outcomes following community-based obesity prevention interventions among adolescents. BMJ Open 2015; 5:e006586. [PMID: 25564145 PMCID: PMC4289720 DOI: 10.1136/bmjopen-2014-006586] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES This paper aimed to systematically evaluate the mental health and well-being outcomes observed in previous community-based obesity prevention interventions in adolescent populations. SETTING Systematic review of literature from database inception to October 2014. Articles were sourced from CINAHL, Global Health, Health Source: Nursing and Academic Edition, MEDLINE, PsycARTICLES and PsycINFO, all of which were accessed through EBSCOhost. The Cochrane Database was also searched to identify all eligible articles. PRISMA guidelines were followed and search terms and search strategy ensured all possible studies were identified for review. PARTICIPANTS Intervention studies were eligible for inclusion if they were: focused on overweight or obesity prevention, community-based, targeted adolescents (aged 10-19 years), reported a mental health or well-being measure, and included a comparison or control group. Studies that focused on specific adolescent groups or were treatment interventions were excluded from review. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were measures of mental health and well-being, including diagnostic and symptomatic measures. Secondary outcomes included adiposity or weight-related measures. RESULTS Seven studies met the inclusion criteria; one reported anxiety/depressive outcomes, two reported on self-perception well-being measures such as self-esteem and self-efficacy, and four studies reported outcomes of quality of life. Positive mental health outcomes demonstrated that following obesity prevention, interventions included a decrease in anxiety and improved health-related quality of life. Quality of evidence was graded as very low. CONCLUSIONS Although positive outcomes for mental health and well-being do exist, controlled evaluations of community-based obesity prevention interventions have not often included mental health measures (n=7). It is recommended that future interventions incorporate mental health and well-being measures to identify any potential mechanisms influencing adolescent weight-related outcomes, and equally to ensure interventions are not causing harm to adolescent mental health.
Collapse
Affiliation(s)
- Erin Hoare
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Burwood, Victoria, Australia
| | | | - Helen Skouteris
- School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Lynne Millar
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Burwood, Victoria, Australia
| | - Melanie Nichols
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Burwood, Victoria, Australia
| | - Steven Allender
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Burwood, Victoria, Australia
| |
Collapse
|
27
|
Rationale and study protocol for the ‘Active Teen Leaders Avoiding Screen-time’ (ATLAS) group randomized controlled trial: An obesity prevention intervention for adolescent boys from schools in low-income communities. Contemp Clin Trials 2014; 37:106-19. [DOI: 10.1016/j.cct.2013.11.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 11/12/2013] [Accepted: 11/15/2013] [Indexed: 01/28/2023]
|
28
|
Mazurek Melnyk B, Kelly S, Lusk P. Outcomes and Feasibility of a Manualized Cognitive-Behavioral Skills Building Intervention: Group COPE for Depressed and Anxious Adolescents in School Settings. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2013; 27:3-13. [PMID: 24131237 DOI: 10.1111/jcap.12058] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PROBLEM Despite the increasing prevalence of depressive and anxiety disorders in adolescents, less than 25% of affected teens receive any treatment. METHODS A preexperimental one-group pre- and posttest pilot study design with 4-week follow-up was used to assess the feasibility and preliminary effects of the COPE (Creating Opportunities for Personal Empowerment) brief-focused manualized seven-session cognitive-behavioral skills building group intervention delivered in two high schools to 16 adolescents referred by a school-based nurse practitioner for depression or elevated anxiety symptoms. FINDINGS Adolescents reported significant decreases in depression and anxiety on the Beck Youth Inventory as well as increases in personal beliefs about managing negative emotions. Evaluations indicated that the group COPE intervention was a positive experience for the teens. CONCLUSIONS COPE is a promising brief-focused cognitive behavioral therapy-based intervention that can be delivered effectively to teens in school settings using a group format.
Collapse
Affiliation(s)
- Bernadette Mazurek Melnyk
- The Ohio State University College of Nursing, Columbus, OH, USA.,The Ohio State University College of Medicine, Columbus, OH, USA
| | - Stephanie Kelly
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - Pamela Lusk
- The Ohio State University College of Nursing, Columbus, OH, USA
| |
Collapse
|