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Tsai SY, Tung YC, Huang CM, Lee CC. A family-based and mobile-assisted intervention for lifestyle behaviors in youths: A randomized controlled trial. Res Nurs Health 2024. [PMID: 38357993 DOI: 10.1002/nur.22374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/25/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024]
Abstract
This randomized controlled trial was conducted to assess the effectiveness of a family-based and mobile-assisted lifestyle intervention in reducing weight gain among school-age children with overweight and obesity. A total of 164 school-age children with overweight or obesity and their parents were randomized to the treatment intervention (n = 82) or an attention-control group (n = 82). The treatment intervention included three face-to-face education sessions, augmented by monthly text messages sent to parents on their mobile devices. The primary outcome was child BMI-for-age z-score. Secondary outcomes included child BMI, percent body fat, and actigraphy-assessed sleep as well as parental sleep quality. Outcomes were assessed at baseline, 3, 6, and 12 months after the intervention, with treatment effects analyzed using general linear models for repeated measures. Our results showed that children in the treatment intervention group had significantly lower BMI-for-age z score, BMI, and percent body fat than did those in the control group, with an adjusted mean difference of 0.31 units (95% CI: -0.59 to -0.03; p = 0.03), 1.34 kg/m² (95% CI, -2.42 to -0.26; p = 0.01), and 3.12% (95% CI, -5.93 to -0.30; p = 0.03), respectively. No treatment effects were observed for child and parental sleep. Our findings suggest that family-based and mobile-assisted lifestyle intervention results in significant and sustained benefits to enhanced weight management for school-age children with overweight and obesity. Nurses planning and delivering childhood overweight and obesity treatment interventions should consider a family-based approach with the assistance of mobile devices.
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Affiliation(s)
- Shao-Yu Tsai
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Ching Tung
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chuen-Min Huang
- Department of Information Management, National Yunlin University of Science and Technology, Yunlin, Taiwan
| | - Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Leung AKC, Wong AHC, Hon KL. Childhood Obesity: An Updated Review. Curr Pediatr Rev 2024; 20:2-26. [PMID: 35927921 DOI: 10.2174/1573396318666220801093225] [Citation(s) in RCA: 1] [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: 02/04/2022] [Revised: 04/05/2022] [Accepted: 05/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Childhood obesity is an important and serious public health problem worldwide. OBJECTIVE This article aims to familiarize physicians with the evaluation, management, and prevention of childhood. METHODS A PubMed search was conducted in May, 2021, in Clinical Queries using the key terms "obesity" OR "obese". The search included clinical trials, randomized controlled trials, case-control studies, cohort studies, meta-analyses, observational studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to English literature and children. The information retrieved from the above search was used in the compilation of the present article. RESULTS Most obese children have exogenous obesity characterized by a growth rate for height above the 50th percentile, normal intelligence, normal genitalia, and lack of historical or physical evidence of an endocrine abnormality or a congenital syndrome. Obese children are at risk for dyslipidemia, hypertension, diabetes mellitus, non-alcoholic fatty liver disease, obstructive sleep apnea, psychosocial disturbances, impaired quality of life, and shorter life expectancy. The multitude of serious comorbidities necessitates effective treatment modalities. Dietary modification, therapeutic exercise, and behavioral modification are the fundamentals of treatment. Pharmacotherapy and/or bariatric surgery should be considered for obese individuals who do not respond to the above measures and suffer from a serious comorbid condition. CONCLUSION Childhood obesity, once established, is often refractory to treatment. Most treatment programs lead to a brief period of weight loss, followed by rapid re-accumulation of the lost weight after the termination of therapy. As such, preventive activity is the key to solving the problem of childhood obesity. Childhood obesity can be prevented by promoting a healthy diet, regular physical activity, and lifestyle modification. Parents should be encouraged to get involved in school and community programs that improve their children's nutritional status and physical activity.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Alex H C Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, China
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong, China
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Desalegn BB, Diddana TZ, Daba AK, Tafese TA. Overnutrition in adolescents and its associated factors in Dale district schools in Ethiopia: a cross-sectional study. PeerJ 2023; 11:e16229. [PMID: 37868052 PMCID: PMC10590108 DOI: 10.7717/peerj.16229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/12/2023] [Indexed: 10/24/2023] Open
Abstract
Background Adolescence is the critical stage of an individual's growth and development that determines their nutritional status in the future. Adolescent overnutrition has become an increasing public health concern in developing countries like Ethiopia. Objective This study was designed to determine the magnitude and determinants of overnutrition among school-going adolescents in Dale District of Ethiopia. Methods An institution-based cross-sectional study was done between November and December 2020. A total of 333 school-going adolescents aged 10-19 years participated in this study. Socio-demographic, lifestyle, physical activity level, dietary energy intake, and height and weight data were collected. Body Mass Index for age Z-score (BAZ) was computed. Binary and multivariable logistic regression models were used to determine the association of outcome variable with explanatory variables, and results were reported using adjusted odds ratio (AOR) with 95% confidence interval. Results The magnitude of overnutrition was 7.2% (10.8% in the urban versus. 3.6% of rural schools). Overnutrition was positively associated with lack of sufficient play area within the school (AOR = 2.53, 95% CI [1.02-6.26]), being an urban resident (AOR = 3.05, 95% CI [1.12-8.29]), positive energy balance (AOR = 9.47, 95% CI [1.58-56.80]), consuming fast foods within a month before the survey date (AOR = 2.60, 95% CI [1.93-6.83]), having moderate (AOR = 9.28, 95% CI [6.70-71.63]) or low physical activity (PA) (AOR = 7.95, 95% CI [1.12-56.72]), and consuming snack within last one week before the survey date (AOR = 3.32, 95% CI [1.15-9.58]). Conclusion The magnitude of overnutrition among school-going adolescents was suboptimal. Sedentary lifestyles, excess calorie intake, having inadequate play areas within the school, and having snack and fast foods were determinants for overnutrition in the study area.
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Affiliation(s)
- Beruk Berhanu Desalegn
- School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, Hawassa, Sidama, Ethiopia
| | - Tona Zema Diddana
- School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, Hawassa, Sidama, Ethiopia
| | - Alemneh Kabeta Daba
- School of Nursing, College of Medicine and Health Science, Hawassa University, Hawassa, Sidama, Ethiopia
| | - Tagel Alemu Tafese
- School of Nutrition, Food Science and Technology, College of Agriculture, Hawassa University, Hawassa, Sidama, Ethiopia
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Heerman WJ, Perrin EM, Yin HS, Schildcrout JS, Delamater AM, Flower KB, Sanders L, Wood C, Kay MC, Adams LE, Rothman RL. The Greenlight Plus Trial: Comparative effectiveness of a health information technology intervention vs. health communication intervention in primary care offices to prevent childhood obesity. Contemp Clin Trials 2022; 123:106987. [PMID: 36323344 DOI: 10.1016/j.cct.2022.106987] [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: 04/01/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The first 1000 days of a child's life are increasingly recognized as a critical window for establishing a healthy growth trajectory to prevent childhood obesity and its associated long-term comorbidities. The purpose of this manuscript is to detail the methods for a multi-site, comparative effectiveness trial designed to prevent childhood overweight and obesity from birth to age 2 years. METHODS This study is a multi-site, individually randomized trial testing the comparative effectiveness of two active intervention arms: 1) the Greenlight intervention; and 2) the Greenlight Plus intervention. The Greenlight intervention is administered by trained pediatric healthcare providers at each well-child visit from 0 to 18 months and consists of a low health literacy toolkit used during clinic visits to promote shared goal setting. Families randomized to Greenlight Plus receive the Greenlight intervention plus a health information technology intervention, which includes: 1) personalized, automated text-messages that facilitate caregiver self-monitoring of tailored and age-appropriate child heath behavior goals; and 2) a web-based, personalized dashboard that tracks child weight status, progress on goals, and electronic Greenlight content access. We randomized 900 parent-infant dyads, recruited from primary care clinics across six academic medical centers. The study's primary outcome is weight for length trajectory from birth through 24 months. CONCLUSIONS By delivering a personalized and tailored health information technology intervention that is asynchronous to pediatric primary care visits, we aim to achieve improvements in child growth trajectory through two years of age among a sample of geographically, socioeconomically, racially, and ethnically diverse parent-child dyads.
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Affiliation(s)
- William J Heerman
- Vanderbilt University Medical Center, Department of Pediatrics, 2200 Children's Way, Suite 2404, Nashville, TN 37232, United States of America.
| | - Eliana M Perrin
- Johns Hopkins University, Department of Pediatrics, Schools of Medicine and Nursing, 200 N. Wolfe St, Rubenstein Building-2071, Baltimore, MD 21287, United States of America.
| | - H Shonna Yin
- New York University School of Medicine, Departments of Pediatrics and Population Health, 550 First Avenue, New York, NY 10016, United States of America.
| | - Jonathan S Schildcrout
- Vanderbilt University Medical Center, Department of Biostatistics, 1161 21st Ave S # D3300, Nashville, TN 37232, United States of America.
| | - Alan M Delamater
- University of Miami Miller School of Medicine, Department of Pediatrics, 1601 NW 12(th) Ave., Miami, FL 33136, United States of America.
| | - Kori B Flower
- University of North Carolina at Chapel Hill, Division of General Pediatrics and Adolescent Medicine, 231 MacNider Building, CB# 7225, 321 S. Columbia Street, UNC School of Medicine, Chapel Hill, NC 27599-7225, United States of America.
| | - Lee Sanders
- Stanford University School of Medicine, United States of America.
| | - Charles Wood
- Duke University School of Medicine, Department of Pediatrics, Division of General Pediatrics and Adolescent Health, 3116 N. Duke St., Durham, NC 27704, United States of America.
| | - Melissa C Kay
- Duke University School of Medicine, Department of Pediatrics, Division of General Pediatrics and Adolescent Health, 3116 N. Duke St., Durham, NC 27704, United States of America.
| | - Laura E Adams
- Vanderbilt University Medical Center, Department of Pediatrics, 2200 Children's Way, Suite 2404, Nashville, TN 37232, United States of America.
| | - Russell L Rothman
- Vanderbilt University Medical Center, Institute of Medicine and Public Health, 1161 21st Ave S # D3300, Nashville, TN 37232, United States of America.
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Tully L, Arthurs N, Wyse C, Browne S, Case L, McCrea L, O’Connell JM, O’Gorman CS, Smith SM, Walsh A, Ward F, O’Malley G. Guidelines for treating child and adolescent obesity: A systematic review. Front Nutr 2022; 9:902865. [PMID: 36313105 PMCID: PMC9597370 DOI: 10.3389/fnut.2022.902865] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Obesity is a chronic disease that compromises the physical and mental health of an increasing proportion of children globally. In high-income countries, prevalence of paediatric obesity is increasing faster in those from marginalised populations such as low-income households, suggesting the disease as one that is largely systemic. Appropriate treatment should be prioritised in these settings to prevent the development of complications and co-morbidities and manage those that already exist. An array of clinical practice guidelines are available for managing overweight and obesity in children and adolescents, but no systematic review has yet compared their quality or synthesised their recommendations. We aimed to narratively review clinical practice guidelines published in English for treating child and adolescent obesity, to identify the highest quality guidelines, and assess similarities, conflicts, and gaps in recommendations. We systematically searched academic databases and grey literature for guidelines published. We used the AGREE II tool to assess the quality, and identified nine high quality guidelines for inclusion in a narrative review of recommendations. Guidelines predominantly recommended the delivery of multi-component behaviour-change interventions aimed at improving nutrition and physical activity. Treatment outcomes were generally focussed on weight, with less emphasis on managing complications or improving quality-of-life. There was no evidence-based consensus on the best mode of delivery, setting, or treatment format. The guidelines rarely included recommendations for addressing the practical or social barriers to behaviour change, such as cooking skills or supervised physical activity. There is insufficient evidence to evaluate pharmaceutical and surgical interventions in children, and these were generally not recommended. It should be noted that this review addressed documents published in English only, and therefore the included guidelines were applicable predominantly to high-resource settings.
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Affiliation(s)
- Louise Tully
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Niamh Arthurs
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland,W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, Dublin, Ireland
| | - Cathy Wyse
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Sarah Browne
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Lucinda Case
- W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, Dublin, Ireland
| | - Lois McCrea
- W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, Dublin, Ireland
| | - Jean M. O’Connell
- St. Columcille’s Hospital Weight Management Service, St.Vincent’s University Hospital, Dublin, Ireland
| | - Clodagh S. O’Gorman
- School of Medicine, University of Limerick, Limerick, Ireland,Department of Paediatrics, University Hospital Limerick, Limerick, Ireland
| | - Susan M. Smith
- Discipline of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
| | - Aisling Walsh
- Department of Epidemiology, Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Ward
- Department of Clinical Nutrition and Dietetics, Children’s Health Ireland at Crumlin, Dublin, Ireland
| | - Grace O’Malley
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland,W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, Dublin, Ireland,*Correspondence: Grace O’Malley,
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Designing, Implementing, and Evaluating a Home-Based, Multidisciplinary, Family-Centered Pediatric Obesity Intervention: The ProxOb Program. CHILDREN 2022; 9:children9050737. [PMID: 35626914 PMCID: PMC9139264 DOI: 10.3390/children9050737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022]
Abstract
Although family-based interventions have been suggested as promising approaches for preventing and treating pediatric obesity, available studies failed to include the whole family in its own natural environment and routine. This paper aims to detail the development, implementation, and evaluation phases of the ProxOb home-based, family-centered program and present its feasibility and early results. ProxOb provides families with a 6-month multidisciplinary, home-based, and family-centered intervention followed by an 18-month maintenance phase. A global psychosocial, clinical, and behavior evaluation was conducted at baseline (T0) at the end of the 6-month intervention (T1) and after the 18-month maintenance phase (T2). A total of 130 families with at least one child with obesity completed the ProxOb program so far, and more than 90% of them also presented at least one parent with overweight or obesity. Being part of a single-parent family seemed to increase the chance of completing the intervention (63.0% vs. 33.3% in the drop-outers subgroup, p = 0.03). The BMI z-score for children with obesity (T0 = 4.38 ± 1.05; T1 = 4.06 ± 1.07; T2 = 4.29 ± 1.12) significantly decreased between T0 and T1, followed by weight regain at T2. ProxOb proposes a feasible and replicable real-life approach to address childhood obesity while involving the children’s family.
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Woo S, Ju YS, Seo YG, Kim YM, Lim H, Park KH. Additive Effects of Exercise or Nutrition Intervention in a 24-Month Multidisciplinary Treatment with a Booster Intervention for Children and Adolescents with Overweight or Obesity: The ICAAN Study. Nutrients 2022; 14:nu14020387. [PMID: 35057568 PMCID: PMC8781150 DOI: 10.3390/nu14020387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 02/01/2023] Open
Abstract
This study compared the effects of a real-world multidisciplinary intervention with additional exercise or nutritional elements and investigated the effectiveness of a booster intervention after weight regain. A total of 242 children and adolescents (age- and sex-specific body mass index [BMI] ≥ 85th percentile, mean age: 10.82 years, 60% male) were allocated to three groups: usual care, exercise, or nutrition. Six-month active treatment with 1:1 session and a maintenance stage with group activities were repeated twice to comprise a 24-month intervention. The primary outcome was change % of the BMI z-score (zBMI). A total of 110 (45.4%) participants completed the 24-month intervention. A mixed-effects model analysis indicated no significant interaction effect of the intervention group and treatment phase on the zBMI change % (p = 0.976). However, there was a significant main effect of the treatment phase on zBMI change % at 6 months (β = -2.98, [95% CI, -5.69-0.27]), 18 months (β = -3.99, [95% CI, -6.76-1.22]), and 24 months (β = -3.23, [95% CI, -5.94-0.52]; p = 0.042). The improvements in zBMI, body fat %, and cardiometabolic markers were observed only among males. Whereas the additive effect of intensive exercise or nutritional feedback was not detected in the long term, a booster intervention with 1:1 counseling was effective even after weight regain during the maintenance period. It may be useful to combine individualized counseling with a less intensive form of group care for long-term maintenance in a real-world setting.
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Affiliation(s)
- Sarah Woo
- Department of Medical Sciences, College of Medicine, Hallym University, Chuncheon-si 24252, Korea
| | - Young-Su Ju
- Department of Occupational Medicine, National Medical Center, Seoul 04564, Korea
| | - Young-Gyun Seo
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang-si 14068, Korea
| | - Yoon-Myung Kim
- University College, Yonsei University International Campus, Incheon 21983, Korea
| | - Hyunjung Lim
- Department of Medical Nutrition, Kyung Hee University, Yongin-si 17104, Korea
| | - Kyung-Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang-si 14068, Korea
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Hill EB, Chen L, Bailey MT, Singh Khalsa A, Maltz R, Kelleher K, Spees CK, Zhu J, Loman BR. Facilitating a high-quality dietary pattern induces shared microbial responses linking diet quality, blood pressure, and microbial sterol metabolism in caregiver-child dyads. Gut Microbes 2022; 14:2150502. [PMID: 36457073 PMCID: PMC9721422 DOI: 10.1080/19490976.2022.2150502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/17/2022] [Indexed: 12/04/2022] Open
Abstract
Low-resource individuals are at increased risk of obesity and cardiovascular disease (CVD), partially attributable to poor dietary patterns and dysfunctional microbiota. Dietary patterns in childhood play critical roles in physiological development and are shaped by caregivers, making caregiver-child dyads attractive targets for dietary interventions to reduce metabolic disease risk. Herein, we targeted low-resource caregiver-child dyads for a 10-week, randomized, controlled, multifaceted lifestyle intervention including: nutrition and physical activity education, produce harvesting, cooking demonstrations, nutrition counseling, and kinetic activites; to evaluate its effects on dietary patterns, CVD risk factors, and microbiome composition. Subjects in the lifestyle intervention group improved total diet quality, increased whole grain intake, decreased energy intake, and enhanced fecal elimination of the microbe-derived metabolite lithocholic acid (LCA) in contrast to control subjects. Microbiomes were highly personalized, similar within dyads, and altered by lifestyle intervention. Differential modeling of microbiome composition identified taxa associated with total diet quality, whole grain intake, and LCA elimination including recognized fiber-degrading bacteria such as Subdoligranulum, and bile acid metabolizing organisms like Bifidobacterium. Inclusion of taxa identified in diet and metabolite modeling within blood pressure models improved prediction accuracy of microbiome-blood pressure associations. Importantly, microbiota-blood pressure relationships were shared between dyads, implying shared host-microbiota responses to lifestyle intervention. Overall, these outcomes provide insight into mechanisms by which dietary interventions impact the gut-cardiovascular axis to reduce future CVD risk. Registered at clinicaltrials.gov: NCT05367674.
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Affiliation(s)
- Emily B. Hill
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO, USA
| | - Li Chen
- Department of Human Sciences and James Comprehensive Cancer Center, College of Education and Human Ecology, The Ohio State University, Columbus, OH, USA
| | - Michael T. Bailey
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- Division of Primary Care Pediatrics, Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Amrik Singh Khalsa
- Division of Primary Care Pediatrics, Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ross Maltz
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Kelly Kelleher
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Colleen K. Spees
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jiangjiang Zhu
- Department of Human Sciences and James Comprehensive Cancer Center, College of Education and Human Ecology, The Ohio State University, Columbus, OH, USA
| | - Brett R. Loman
- Department of Animal Sciences, the University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Division of Nutritional Sciences, the University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Adolescent Self-Efficacy for Diet and Exercise Following a School-Based Multicomponent Lifestyle Intervention. Nutrients 2021; 14:nu14010097. [PMID: 35010972 PMCID: PMC8746524 DOI: 10.3390/nu14010097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/17/2022] Open
Abstract
Self-efficacy is perhaps the most important parameter associated with behavioral changes. The main aim of this study was to provide insight into the diet and exercise self-efficacy of Greek adolescents and how they could be modified via a multilevel multicomponent school-based lifestyle intervention. Secondary aims were to study the associations of students’ dietary and exercise self-efficacy indices with their anthropometric and sociodemographic parameters. A representative sample of the adolescent population in Attica, consisting of 1610 adolescents aged 12–17 years, recruited from 23 public high schools in three municipalities of the Attica area in Greece, received a three-component lifestyle educational intervention for health promotion and underwent screening for characteristics of metabolic syndrome with the use of portable telemedicine. All assessments and anthropometric measurements were performed at baseline and after the 6-month intervention. Anthropometric measurements included body mass index, waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR). Assessment tools included the Self-efficacy for Diet and the Self-efficacy for Exercise questionnaires, as well as the Mediterranean Diet Quality Index in Children and Adolescents (KIDMED). Analysis included 1020 adolescent students (421 males and 599 females), who completed the self-efficacy questionnaires pre- and post-intervention. Overall, the dietary (p < 0.001) and exercise (p < 0.001) self-efficacy increased significantly post-intervention. Post-intervention, all adolescents decreased their abdominal obesity indices (WC, WHtR, WHR), and this improvement was even more pronounced and significant (p = 0.019, p = 0.019, p = 0.023 respectively) in the adolescents with overweight/obesity. Post-intervention, the proportion of adolescents with normal weight increased from 73.9% to 78.6%, whereas the proportion of adolescents with overweight and obesity decreased from 20.4% to 15.9% and from 5.7% to 5.5%, respectively. Abdominal obesity also decreased from 10.4% to 9.0%. Female adolescents achieved significantly (p = 0.010) higher changes in diet self-efficacy than males. Other sociodemographic characteristics such as family structure, parental age, parental educational level and family income showed non-significant differences. Adolescents with higher KIDMED scores manifested significantly higher dietary and exercise self-efficacy than those with lower KIDMED scores. Both adolescents with normal weight and overweight/obesity manifested a reciprocal relation between diet and exercise self-efficacy. Multicomponent lifestyle interventions in the school environment may provide a first step in students’ behavior changes and provide grounds for future prevention programs in youth.
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HomeStyles-2: Randomized controlled trial protocol for a web-based obesity prevention program for families with children in middle childhood. Contemp Clin Trials 2021; 112:106644. [PMID: 34861408 DOI: 10.1016/j.cct.2021.106644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/22/2021] [Accepted: 11/27/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Parents are children's primary role models, are food and physical activity gatekeepers, and create the home structure/lifestyle environment. Thus, parents strongly influence children's weight-related behaviors and have the opportunity to cultivate a "culture of health" within the home. Yet, there is a dearth of evidence-based obesity prevention intervention programs, especially for families with children aged 6-11 years, commonly called middle childhood. METHODS The aim of the HomeStyles-2 online learning mode RCT is to determine whether this novel, age-appropriate, family intervention enables and motivates parents to shape home environments and weight-related lifestyle practices (i.e.,diet, exercise, sleep) to be more supportive of optimal health and reduced obesity risk in middle childhood youth more than those in the control condition. The RCT will include the experimental group and an attention control group. The participants will be parents with school-age children who are systematically randomly assigned by computer to study condition. The HomeStyles intervention is predicated on the social cognitive theory and a social ecological framework. The RCT will collect sociodemographic characteristics of the participant, child, and partner/spouse; child and parent health status; parent weight-related cognitions; weight-related behaviors of the parent and child; and weight-related characteristics of the home environment. Deliverables Enrollment for this study will begin in 2022. DISCUSSION This paper describes these aspects of the HomeStyles-2 intervention: rationale; sample eligibility criteria and recruitment; study design; experimental group intervention theoretical and philosophical underpinnings, structure, content, and development process; attention control intervention; survey instrument development and components; outcome measures; and planned analyses. TRIAL REGISTRATION ClinicalTrials.gov, Protocol #NCT04802291, Registered March 14, 2021.
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11
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Li Y, Maina G, Pandey M, Amoyaw J, Fang Y. Exploring family based immigrant youth substance use prevention programmes: a scoping review protocol. BMJ Open 2021; 11:e046766. [PMID: 34039575 PMCID: PMC8160161 DOI: 10.1136/bmjopen-2020-046766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Canada has one of the highest rates of problematic opiate and alcohol use in the world. Globally, Canada was the second country that legalized marijuana for non-medical use. As Canada is an immigrant-receiving country, newcomers and immigrants contend with a substance use landscape that was likely absent in their countries of origin. Although immigrants have lower rates of substance use than the host population, the risk of substance use, especially among youth, increases with acculturation and peer pressure. While parents are best placed to mitigate the risks for substance use among their youth, immigrant parents often do not have the knowledge and skills to do so. Therefore, culturally adaptable family based interventions need be explored to build immigrant parents' capacities to mitigate substance use risks. AIM AND PURPOSE The aim of this scoping review is to explore family based substance use prevention interventions for immigrant youth, which will be guided by two questions:What is known about family based interventions for preventing immigrant adolescents' substance use?What are the features and study results of these intervention protocols? METHODS AND ANALYSIS We will apply Arksey and O'Malley's procedure for reporting scoping review and report study findings based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews. DISCUSSION We hope that the knowledge translation emanating from this review will increase immigrant parents' knowledge of substance use and enable them to effectively intervene to prevent substance use among their youth. We also hope that this work can inform policy development on best practices for substance use prevention and for the creation of culturally sensitive programmes and services for immigrant youth.
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Affiliation(s)
- Yiyan Li
- College of Nursing, University of Saskatchewan, Prince Albert, Saskatchewan, Canada
| | - Geoffrey Maina
- College of Nursing, University of Saskatchewan, Prince Albert, Saskatchewan, Canada
| | - Mamata Pandey
- Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Jonathan Amoyaw
- Department of Sociology and Social Anthropology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Yiting Fang
- College of Nursing, University of Saskatchewan, Prince Albert, Saskatchewan, Canada
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Sanders LM, Perrin EM, Yin HS, Delamater AM, Flower KB, Bian A, Schildcrout JS, Rothman RL. A Health-Literacy Intervention for Early Childhood Obesity Prevention: A Cluster-Randomized Controlled Trial. Pediatrics 2021; 147:peds.2020-049866. [PMID: 33911032 PMCID: PMC8086006 DOI: 10.1542/peds.2020-049866] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children who become overweight by age 2 have greater risk of long-term obesity and health problems. The study aim was to assess the effectiveness of a primary care-based intervention on the prevalence of overweight at age 24 months. METHODS In a cluster-randomized trial, sites were randomly assigned to the Greenlight intervention or an attention-control arm. Across 4 pediatric residency clinics, we enrolled infant-caregiver dyads at the 2-month well-child visit. Inclusion criteria included parent English- or Spanish-speaking and birth weight ≥1500 g. Designed with health-literacy principles, the intervention included a parent toolkit at each well-child visit, augmented by provider training in clear-health communication. The primary outcome was proportion of children overweight (BMI ≥85th percentile) at age 24 months. Secondary outcomes included weight status (BMI z score). RESULTS A total of 459 intervention and 406 control dyads were enrolled. In total, 49% of all children were overweight at 24 months. Adjusted odds for overweight at 24 months (treatment versus control) was 1.02 (95% confidence interval [CI]: 0.63 to 1.64). Adjusted mean BMI z score differences (treatment minus control) were -0.04 (95% CI: -0.07 to -0.01), -0.09 (95% CI: -0.14 to -0.03), -0.19 (-0.33 to -0.05), -0.20 (-0.36 to -0.03), -0.16 (95% CI: -0.34 to 0.01), and 0.00 (95% CI -0.21 to 0.21) at 4, 6, 12, 15, 18, and 24 months, respectively. CONCLUSIONS The intervention resulted in less weight gain through age 18 months, which was not sustained through 24 months. Clinic-based interventions may be beneficial for early weight gain, but greater intervention intensity may be needed to maintain positive effects.
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Affiliation(s)
- Lee M. Sanders
- Division of General Pediatrics, Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University, Stanford, California
| | - Eliana M. Perrin
- Division of Primary Care and Duke Center for Childhood Obesity Research, Department of Pediatrics, Medical Center, Duke University, Durham, North Carolina
| | - H. Shonna Yin
- Department of Pediatrics and Population Health, School of Medicine, New York University and Department of Pediatrics, Bellevue Hospital Center, New York City, New York
| | - Alan M. Delamater
- Department of Pediatrics, School of Medicine, University of Miami, Miami, Florida
| | | | - Aihua Bian
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jonathan S. Schildcrout
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Russell L. Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee; and
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13
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Kloek GC, Jongert MWA, de Vries SI. Evaluation of a school-based multicomponent behavioural intervention in deprived urban areas for children classified as overweight, obese or at risk for overweight. BMC Res Notes 2021; 14:100. [PMID: 33731166 PMCID: PMC7968221 DOI: 10.1186/s13104-021-05513-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/04/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study evaluated the effect of an after-school group-based medium-intensity multicomponent behavioural intervention programme for children aged 8-12 years classified as overweight, obese or at risk for overweight on body mass index standard deviation score (BMI SDS). In accordance with standardized protocols body weight and height were measured in 195 participants (88 boys, 107 girls) at baseline and at the end of the programme. A total of 166 children derived from a school-based monitoring system served as control group. Multivariate regression analyses examined the effect of the intervention and the independent factors associated with better outcomes in the intervention group. RESULTS Analysis of covariance showed a significant intervention effect on BMI SDS in favour of the intervention group (b-coefficient - 0.13 ± 0.03; p < 0.01) compared with the control group. Change in BMI SDS between baseline and follow-up in the intervention group was associated with baseline age (b-coefficient 0.03 ± 0.02; p = 0.04) but was independent from gender, ethnicity, baseline BMI SDS, time between baseline and follow-up, school year and attendance rate.
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Affiliation(s)
- Gitte C. Kloek
- Research Group Healthy Lifestyle in a Supporting Environment, Faculty of Health, Nutrition & Sport, The Hague University of Applied Sciences, PO Box 13336, 2501 EH The Hague, The Netherlands
| | - Martien W. A. Jongert
- Dutch Institute of Allied Health Care, PO Box 1161, 3800 BD Amersfoort, The Netherlands
| | - Sanne I. de Vries
- Research Group Healthy Lifestyle in a Supporting Environment, Faculty of Health, Nutrition & Sport, The Hague University of Applied Sciences, PO Box 13336, 2501 EH The Hague, The Netherlands
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14
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Calise TV, Spitzer N, Ruggiero L, Ryder A, Wingerter C, Hatcher A. Association between multi-component initiatives and physical activity-related behaviors: interim findings from the Healthy Schools Healthy Communities initiative. BMC Public Health 2021; 21:340. [PMID: 33579246 PMCID: PMC7881474 DOI: 10.1186/s12889-021-10312-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Although successful, assessment of multi-component initiatives (MCIs) prove to be very challenging. Further, rigorous evaluations may not be viable, especially when assessing the impact of MCIs on long-term population-level behavior change (e.g., physical activity (PA) and health outcomes (e.g., childhood obesity). The purpose of this study was to use intensity scoring, to assess whether higher intensity MCIs implemented as part of Healthy Schools Healthy Communities (HSHC) were associated with improved physical activity and reduced sedentary behaviors among youth (dependent variables). Methods PA-related interventions were assigned point values based on three characteristics: 1) purpose of initiative; 2) duration; and 3) reach. A MCI intensity score of all strategies was calculated for each school district and its respective community. Multivariate longitudinal regressions were applied, controlling for measurement period, Cohort, and student enrollment size. Results Strategy intensity scores ranged from 0.3 to 3.0 with 20% considered “higher-scoring” (score > 2.1) and 47% considered “lower-scoring” (< 1.2). Average MCI intensity scores more than tripled over the evaluation period, rising from 14.8 in the first grant year to 32.1 in year 2, 41.1 in year 3, and 48.1 in year 4. For each additional point increase in average MCI intensity score, the number of days per week that students reported PA for at least 60 min increased by 0.010 days (p < 0.01), and the number of hours per weekday that students reported engaging in screen time strategies decreased by 0.006 h (p < 0.05). An increase of 50 points in MCI intensity score was associated with an average 0.5 day increase in number of weekdays physically active and an increase of 55 points was associated with an average decrease of 20 min of sedentary time per weekday. Conclusions We found a correlation between intensity and PA and sedentary time; increased PA and reduced sedentary time was found with higher-intensity MCIs. While additional research is warranted, practitioners implementing MCIs, especially with limited resources (and access to population-level behavior data), may consider intensity scoring as a realistic and cost effective way to assess their initiatives. At a minimum, the use of intensity scoring as an evaluation method can provide justification for, or against, the inclusion of an individual strategy into an MCI, as well as ways to increase the likelihood of the MCI impacting population-health outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10312-y.
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Affiliation(s)
- Tamara Vehige Calise
- John Snow Inc. (JSI) Healthy Communities, 44 Farnsworth Street, Boston, MA, 02210, USA.
| | - Natalie Spitzer
- John Snow Inc. (JSI) Healthy Communities, 44 Farnsworth Street, Boston, MA, 02210, USA
| | - Laura Ruggiero
- John Snow Inc. (JSI) Healthy Communities, 44 Farnsworth Street, Boston, MA, 02210, USA
| | - Amanda Ryder
- John Snow Inc. (JSI) Healthy Communities, 44 Farnsworth Street, Boston, MA, 02210, USA
| | - Chloe Wingerter
- John Snow Inc. (JSI) Healthy Communities, 44 Farnsworth Street, Boston, MA, 02210, USA
| | - Ashley Hatcher
- John Snow Inc. (JSI) Healthy Communities, 44 Farnsworth Street, Boston, MA, 02210, USA
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15
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Arnason A, Langarica N, Dugas LR, Mora N, Luke A, Markossian T. Family-based lifestyle interventions: What makes them successful? A systematic literature review. Prev Med Rep 2021; 21:101299. [PMID: 33511024 PMCID: PMC7816001 DOI: 10.1016/j.pmedr.2020.101299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/02/2020] [Accepted: 12/07/2020] [Indexed: 11/17/2022] Open
Abstract
Nearly one in five young people in the United States has obesity, putting one-fifth of America’s children at higher risk of having chronic health conditions and of having obesity into adulthood. Family-based lifestyle interventions (FBLI) have been proposed as effective mechanisms to improve the health through health education and the adoption of healthier behaviors. The aim of this review is to identify and summarize effective intervention activities and lessons learned that organizations can adopt when planning health promotion interventions for families, and to assess the effect of family-based lifestyle interventions on BMI z-score. A systematic review on lifestyle health-promotion interventions for families was conducted following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) statements. Inclusion criteria were: duration ≥12 weeks and inclusion of family members. Summary data about the assessment tools, intervention strategies, and outcomes in parents and children were extracted and compared for all studies. A meta-analysis of BMI z-score change was conducted. Thirty-four articles were included in this review. Frequent strategies used were delivering education and training on healthy habits and well-being (94%), engaging community in the planning and implementation phases (80.6%) and providing reminders and feedback (47.2%). BMI z-score mean differences were reported in 40 cohorts and included in a meta-analysis, with no statistically significant differences between groups. The findings of this systematic review and meta-analysis indicate that components of a successful family lifestyle intervention program include duration between six to twelve months and delivery in a community setting. Other key factors include constructing a multidisciplinary team, using a mentor/role model approach, and reinforcing messaging with technology.
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Affiliation(s)
- Anne Arnason
- Stritch School of Medicine, Loyola University Chicago, United States
- Corresponding author at: Stritch School of Medicine, Loyola University Chicago, 2160 S. First Avenue, Maywood, IL 60153, United States.
| | - Nayeli Langarica
- Stritch School of Medicine, Loyola University Chicago, United States
| | - Lara R. Dugas
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, United States
| | - Nallely Mora
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, United States
| | - Amy Luke
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, United States
| | - Talar Markossian
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, United States
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16
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Alman KL, Lister NB, Garnett SP, Gow ML, Aldwell K, Jebeile H. Dietetic management of obesity and severe obesity in children and adolescents: A scoping review of guidelines. Obes Rev 2021; 22:e13132. [PMID: 32896058 DOI: 10.1111/obr.13132] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/06/2020] [Accepted: 08/08/2020] [Indexed: 12/11/2022]
Abstract
This scoping review describes current guidelines for the dietary management of pediatric obesity and severe obesity. Guidelines were identified via electronic searches of six databases, grey literature, and reference lists and included international clinical practice guidelines (n = 21), position papers (n = 5), and scientific/consensus statements (n = 2) produced by professional bodies and/or expert panels. All recommend multicomponent lifestyle interventions including diet, physical activity, and behavior modification as first-line treatment. Most guidelines (n = 21) recommend weight loss as a treatment goal for children and adolescents with obesity and associated comorbidities or severe obesity; 15 recommend using dietary approaches. Fourteen of 28 guidelines refer to the management of severe obesity, 10 refer to dietary approaches, and seven recommend using intensive dietary approaches. Dietary approaches to weight loss focus on caloric restriction (n = 14) with some guidelines recommending very low-energy diet (n = 4), protein-sparing modified fast (n = 2), and very low-carbohydrate/ketogenic diets (n = 2). A stronger evidence base is required for dietary management of pediatric obesity and severe obesity to improve consistency in future guidelines. Guidance on the use of dietary approaches, beyond caloric restriction, and in line with the growing evidence base on novel dietary approaches is required to facilitate personalized care and optimal patient outcomes.
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Affiliation(s)
- Kim L Alman
- Nutrition and Dietetics Group, School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, Camperdown, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia
| | - Natalie B Lister
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.,Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia
| | - Sarah P Garnett
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.,Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia.,Kids Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Megan L Gow
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.,Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia
| | - Katharine Aldwell
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia
| | - Hiba Jebeile
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.,Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia
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17
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Roseman MG, Riddell MC, McGee JJ. Kindergarten to 12th Grade School-Based Nutrition Interventions: Putting Past Recommendations Into Practice. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:808-820. [PMID: 32279938 DOI: 10.1016/j.jneb.2020.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/09/2020] [Accepted: 02/11/2020] [Indexed: 06/11/2023]
Abstract
School-based nutrition interventions are used to improve dietary habits of schoolchildren and reverse trends on obesity. This article reports on kindergarten through 12th grade nutrition interventions published between 2009 and 2018 compared with interventions published between 2000 and 2008 based on (1) behaviorally focused, (2) multicomponent, (3) healthful food/school environment (4) family involvement, (5) self-assessments, (6) quantitative evaluation, (7) community involvement, (8) ethnic/heterogeneous groups, (9) multimedia technology, and (10) sequential and sufficient duration. These 10 recommendations help guide educators, researchers, and nutritionists on more effective nutrition interventions. Future use of implementation science to determine potential drivers of adoption, nonadoption, and effectiveness of the recommendations is encouraged.
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Affiliation(s)
- Mary G Roseman
- Department of Nutrition and Hospitality Management, University of Mississippi, Oxford, MS.
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18
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Dozier SGH, Schroeder K, Lee J, Fulkerson JA, Kubik MY. The Association between Parents and Children Meeting Physical Activity Guidelines. J Pediatr Nurs 2020; 52:70-75. [PMID: 32200320 PMCID: PMC7413105 DOI: 10.1016/j.pedn.2020.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To examine the association between parents and children meeting physical activity (PA) guidelines, by gender, among 8-12 year old children with BMI ≥75th percentile DESIGN AND METHODS: This was a secondary analysis of baseline data from a school-based healthy weight management intervention in Minnesota for 8-12 year old children. Survey data about PA participation were collected from 2014 through 2018. Analyses entailed descriptive statistics and multivariate logistic regression controlling for child age, race/ethnicity, BMIz, child's perception of parent support for activity, and number of sports played. RESULTS Children's (n = 132) mean age was 9.32 ± 0.89 years, 49% were female, 63% were members of racial/ethnic minority groups, and 33% met PA Guidelines (≥60 minutes daily). Parents' (n = 132) mean age was 39.11 ± 7.05 years, mean BMI of 30.90 ± 8.44, 94% were female, 42% were members of racial/ethnic minority groups, and 57% met PA Guidelines for Americans (≥150 minutes moderate or >75 minutes vigorous PA weekly). There was no association between parents and children meeting PA guidelines for the total sample (OR = 1.43, 95% CI = 0.63-3.24, p = 0.39) or girls (OR = 0.65, 95% CI = 0.18-2.33, p = 0.51). Boys whose parents met PA guidelines had 3.84 times greater odds of meeting PA guidelines (95% CI = 1.28-13.4, p = 0.04). CONCLUSIONS PA interventions for boys may benefit from focus on parents' PA. Further research should investigate correlates of girls' PA. PRACTICE IMPLICATIONS Pediatric nurses working with children to increase PA should encourage parents' PA. For parents of boys, this may increase the child's PA. Considered broadly, nurses should be aware of gender influences on children's engagement in PA.
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Affiliation(s)
- Sarah G H Dozier
- Temple University College of Public Health, Department of Nursing, Philadelphia, PA, USA
| | - Krista Schroeder
- Temple University College of Public Health, Department of Nursing, Philadelphia, PA, USA.
| | - Jiwoo Lee
- University of Minnesota School of Nursing, Minneapolis, MN, USA
| | | | - Martha Y Kubik
- Temple University College of Public Health, Department of Nursing, Philadelphia, PA, USA
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19
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Bell L, Ullah S, Leslie E, Magarey A, Olds T, Ratcliffe J, Chen G, Miller M, Jones M, Cobiac L. Changes in weight status, quality of life and behaviours of South Australian primary school children: results from the Obesity Prevention and Lifestyle (OPAL) community intervention program. BMC Public Health 2019; 19:1338. [PMID: 31640645 PMCID: PMC6805510 DOI: 10.1186/s12889-019-7710-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 09/30/2019] [Indexed: 01/30/2023] Open
Abstract
Background Childhood obesity is a serious public health concern worldwide. Community-based obesity prevention interventions offer promise due to their focus on the broader social, cultural and environmental contexts rather than individual behaviour change and their potential for sustainability and scalability. This paper aims to determine the effectiveness of a South Australian community-based, multi-setting, multi-strategy intervention, OPAL (Obesity Prevention and Lifestyle), in increasing healthy weight prevalence in 9 to 11-year-olds. Methods A quasi-experimental repeated cross-sectional design was employed. This paper reports on the anthropometric, health-related quality of life (HRQoL) and behaviour outcomes of primary school children (9–11 years) after 2–3 years of intervention delivery. Consenting children from primary schools (20 intervention communities, INT; 20 matched comparison communities, COMP) completed self-report questionnaires on diet, activity and screen time behaviours. HRQoL was measured using the Child Health Utility 9D. Body Mass Index (BMI) z-score and weight status were determined from children’s measured height and weight. A multilevel mixed-effects model, accounting for clustering in schools, was implemented to determine intervention effect. Sequential Bonferroni adjustment was used to allow for multiple comparisons of the secondary outcomes. Results At baseline and final, respectively, 2611 and 1873 children completed questionnaires and 2353 and 1760 had anthropometric measures taken. The prevalence of children with healthy weight did not significantly change over time in INT (OR 1.11, 95%CI 0.92–1.35, p = 0.27) or COMP (OR 0.85, 95%CI 0.68–1.06, p = 0.14). Although changes in the likelihood of obesity, BMI z-score and HRQoL favoured the INT group, the differences were not significant after Bonferroni adjustment. There were also no significant differences between groups at final for behavioural outcomes. Conclusions OPAL did not have a significant impact on the proportion of 9 to 11-year-olds in the healthy weight range, nor children’s BMI z-score, HRQoL and behaviours. Long-term, flexible community-based program evaluation approaches are required . Trial registration ACTRN12616000477426 (12th April 2016, retrospectively registered).
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Affiliation(s)
- Lucinda Bell
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Shahid Ullah
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Bedford Park, South Australia, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Eva Leslie
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Anthea Magarey
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Timothy Olds
- Alliance for Research in Exercise Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Julie Ratcliffe
- Health Economics Unit, Repatriation General Hospital, Flinders University, Daws Park, South Australia, Australia.,Institute for Choice, UniSA Business School, Adelaide, South Australia, Australia
| | - Gang Chen
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Michelle Miller
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Michelle Jones
- OPAL (Obesity Prevention and Lifestyle), Public Health and Clinical Systems, SA Health, Adelaide, South Australia, Australia.,Social Work, College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia
| | - Lynne Cobiac
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.,CSIRO Health and Biosecurity, Adelaide, South Australia, Australia
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20
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Zaremski JL, Zeppieri G, Tripp BL. Injury Prevention Considerations in Adolescent Overhead-Throwing Athletes. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00224-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Cunningham SA, Chandrasekar EK, Cartwright K, Yount KM. Protecting children's health in a calorie-surplus context: Household structure and child growth in the United States. PLoS One 2019; 14:e0220802. [PMID: 31393933 PMCID: PMC6687172 DOI: 10.1371/journal.pone.0220802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 07/23/2019] [Indexed: 11/18/2022] Open
Abstract
Studies from the social and health sciences have tended to view the household as the locus of access to and distribution of care, resources, monitoring and modeling for children's wellbeing. Obesity may present a special case for the study of investments in children, being a component of health for which more of certain inputs may not lead to better outcomes. We expanded on common measures of household structure in the child health literature by considering co-residence and relatedness of parents, grandparents, other relatives, and other children. Data were from a longitudinal sample of 6,700 children participating in the Early Childhood Longitudinal Study Kindergarten Class of 1998-99 (ECLS-K), the largest U.S. national dataset with measures of child anthropometrics and household structure at seven time-points over nine years. We used lagged survey-adjusted regressions to estimate associations between household structure and subsequent changes in children's weight between ages 5 and 14 years in terms of BMI gain and incident obesity. Adjusting for household structure more thoroughly, children living in households with two parents rather than one parent did not experience advantages in terms of less excess weight gain or lower incidence of obesity during elementary and middle school. Children living with a grandmother gained more weight than children not living with a grandmother. Living with siblings and with non-related adults was associated with less weight gain. These findings corroborate a scenario in which, for health problems associated with caloric surplus, classic household factors have more complex associations with child wellbeing.
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Affiliation(s)
- Solveig A. Cunningham
- Hubert Department of Global Health and Department of Sociology, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Eeshwar K. Chandrasekar
- Department of Epidemiology and School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Kate Cartwright
- School of Public Administration, The University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Kathryn M. Yount
- Hubert Department of Global Health and Department of Sociology, Emory University, Atlanta, Georgia, United States of America
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Xiong R, Spaccarotella K, Quick V, Byrd-Bredbenner C. Generational Differences: A Comparison of Weight-Related Cognitions and Behaviors of Generation X and Millennial Mothers of Preschool Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132431. [PMID: 31323912 PMCID: PMC6651214 DOI: 10.3390/ijerph16132431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/04/2019] [Accepted: 07/06/2019] [Indexed: 01/25/2023]
Abstract
A ‘generation’ is an identifiable group sharing birth years and significant life events at critical developmental ages. There is a paucity of literature examining how parental cognitions and lifestyle behaviors differ by generation and whether generational differences are substantial enough to warrant consideration during the development of health interventions. This study compared generational differences in weight-related cognitions and lifestyle behaviors of mothers of young children who were categorized as Generation X (born 1965–1981, n = 158) and Generation Y (aka Millennials; born 1982–1999, n = 162). Survey results indicated that Generation X had significantly higher family affluence; thus, this was controlled in subsequent analyses. Analysis of covariance indicated that Millennials had more positive expectations about the benefits of engaging in healthy eating and physical activity than comparators, but not significantly so. Millennial mothers placed significantly higher value on physical activity for themselves than Generation X mothers, but both generations were neutral on the value of personal physical activity. No generational differences were noted in self-efficacy of mothers for promoting childhood obesity-prevention practices to children and self-efficacy for personally engaging in weight-protective behaviors. Millennial mothers had significantly more family meals/week, however generations did not differ on the value placed on family meals, where family meals were eaten, or whether media devices were used at mealtime. Few differences were noted between the generations for most child feeding behaviors, except that Millennials reported placing significantly less pressure on children to eat. Mothers’ modeling of weight-related behaviors as a means for children’s observational learning about healthy eating, physical activity, and sedentary behaviors did not differ by generational group. The eating behaviors of mothers differed little between generations. Millennial mothers allowed significantly more media devices in children’s bedrooms and personally engaged in more screen time daily than comparators. Overall, the two generational groups were more similar than different in weight-related cognitions as well as for personal and parenting lifestyle behaviors. The results suggest that tailoring interventions for individuals at a similar life-stage (e.g., mothers of young children) by generation may not be warranted.
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Affiliation(s)
- Ruiying Xiong
- School of Medicine, University of Pennsylvania, Blockley Hall, Philadelphia, PA 19104, USA
| | - Kim Spaccarotella
- Department of Biological Sciences, Kean University, 1000 Morris Avenue, Union, NJ 07082, USA
| | - Virginia Quick
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue, New Brunswick, NJ 08901, USA
| | - Carol Byrd-Bredbenner
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue, New Brunswick, NJ 08901, USA.
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Blanchette S, Lemoyne J, Trudeau F. Tackling Childhood Overweight: Parental Perceptions of Stakeholders' Roles in a Community-Based Intervention. Glob Pediatr Health 2019; 6:2333794X19833733. [PMID: 30911590 PMCID: PMC6425524 DOI: 10.1177/2333794x19833733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction. Collaborative efforts among communities, schools, parents, and health professionals are needed to prevent childhood obesity, which touches one third of Canadian youth. The purpose of this case study was to obtain parents’ experience and perceptions about stakeholder roles in a multidisciplinary community-based intervention aiming to tackle childhood overweight. Methods. Data were collected from semistructured interviews with 10 parents following their participation in a community-based program designed to help families with overweight children adopt a healthier lifestyle. Results and Discussion. All parents preferred a multidisciplinary health team to monitor their children’s health. They expect that a physician or a pediatrician could diagnose overweight, explain results to parents, and refer families to resources. The team could also include professionals from health and education such as nutritionists/dietitians, nurses, physical education teachers, psychologists, kinesiologists, and social workers. Parents’ own perceived role would consist of instructing and reinforcing their children about healthy behaviors, role modeling for a healthy lifestyle, and seeking for professional help when needed. Conclusion. Parents involved in a support group with overweight child consider their own role as crucial to help changing their family lifestyle. They also prefer a multidisciplinary team that can address different aspects of overweight/obesity. However, the physician was perceived as having the central role in mobilizing a group of stakeholders around youth with overweight/obese, including the parents. A further step would be to understand barriers and facilitators to collaboration among health professionals in childhood overweight prevention and treatment.
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Affiliation(s)
| | - Jean Lemoyne
- Universite du Quebec a Trois-Rivieres, Trois-Rivieres, Quebec, Canada
| | - Francois Trudeau
- Universite du Quebec a Trois-Rivieres, Trois-Rivieres, Quebec, Canada
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Guraya SY, Almaramhy HH. Mapping the factors that influence the career specialty preferences by the undergraduate medical students. Saudi J Biol Sci 2018; 25:1096-1101. [PMID: 30174508 PMCID: PMC6117166 DOI: 10.1016/j.sjbs.2017.03.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/18/2017] [Accepted: 03/28/2017] [Indexed: 01/13/2023] Open
Abstract
It is often perceived that undergraduate medical students do not select their career specialty until they are graduated. This study aimed to probe the preferences of undergraduate medical students about their career specialty and the factors influencing their choices. A self-administered questionnaire was distributed to 3rd through 5th year undergraduate medical students to record their choices of specialties and to identify the factors that influence their career selection. Out of 220 respondents, 29 (13.2%) students selected General Surgery, 24 (10.9%) Pediatrics, and 18 (8.2%) Internal Medicine as their career specialties; whereas 24 (10.9%) students were not able to select a major specialty. The least popular specialties were Gynecology and Obstetrics, Oncology, Histopathology, Orthopedics, Genetics, Psychology, each selected by one student. One hundred and seventeen (53.1%) thought their selected specialty 'matched their capabilities' and 82 (37.2%) perceived their selection as "innovative field in medicine". Career advice by friends and families and the desire to serve academic institutions could not influence career selection. Career preferences by medical students result from the interplay of a range of factors. General Surgery, Pediatrics and Internal Medicine were the most preferred specialties. The professional grooming programs to target specialties matching the trainees' capabilities and the specialties with state-of-the-art innovative technologies attract medical undergraduate students. The attained knowledge is vitally important for the policy makers in modifying the existing framework that can cater the popular and favored specialties.
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Affiliation(s)
| | - Hamdi H. Almaramhy
- Department of Surgery, The College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi Arabia
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Aperman-Itzhak T, Yom-Tov A, Vered Z, Waysberg R, Livne I, Eilat-Adar S. School-Based Intervention to Promote a Healthy Lifestyle and Obesity Prevention Among Fifth- and Sixth-Grade Children. AMERICAN JOURNAL OF HEALTH EDUCATION 2018. [DOI: 10.1080/19325037.2018.1486755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | - Zvi Vered
- Tel Aviv University
- Assaf Harofeh Medical Center
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Godakanda I, Abeysena C, Lokubalasooriya A. Sedentary behavior during leisure time, physical activity and dietary habits as risk factors of overweight among school children aged 14-15 years: case control study. BMC Res Notes 2018; 11:186. [PMID: 29558977 PMCID: PMC5859428 DOI: 10.1186/s13104-018-3292-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/10/2018] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To determine the risk of sedentary behavior during leisure time, physical activity and dietary habits on overweight among school children aged 14-15 years in Kalutara District, Sri Lanka. RESULTS School based case-control study was conducted during September to November 2013 including 176 overweight children as cases and 704 children with normal weight as controls. Cases were defined as body mass index for age and sex of ≥ +1SD and controls as those in the range of -2SD to +1SD. Validated instruments were used for data collection. Multiple logistic regression was applied and results were expressed with adjusted odds ratios (OR) and 95% confidence intervals (CI). Risk factors for overweight were insufficient physical activity (OR 1.6, 95% CI 1.1-2.4), watching video/DVD ≥ 2 h (OR 3.1, 95% CI 1.8-5.3), watching television ≥ 2 h (OR 2.6, 95% CI 1.7-3.8) and doing homework ≥ 2 h, (OR 1.8, 95% CI 1.2-2.7). Consuming meat (OR 1.9, 95% CI 1.2-3.1), fish or other sea foods (OR 1.6, 95% CI 1.1-2.8), fast food/fried rice/oily foods (OR 1.9, 95% CI 1.2-2.9), carbonated drinks or sugary drinks (OR 1.9, 95% CI 1.2-2.8), sweets, cookies or ice cream (OR 1.8, 95% CI 1.2-2.9) were dietary risk factors for overweight. Consuming legumes and seeds (OR 0.50, 95% CI 0.3-0.7), vegetables and fruits (OR 0.6, 95% CI 0.4-0.9) were protective factors for overweight.
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Affiliation(s)
| | - Chrishantha Abeysena
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
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Dupart G, Berry DC, D’Auria J, Sharpe L, McDonough L, Houser M, Flanary S, Koppelberger S. A Nurse-Led and Teacher-Assisted Adolescent Healthy Weight Program to Improve Health Behaviors in the School Setting. J Sch Nurs 2017; 35:178-188. [DOI: 10.1177/1059840517744020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Adolescents with overweight and obesity are at risk for future health problems. The purpose of this study was to examine the feasibility and initial efficacy of a weight management intervention to help adolescents develop healthy nutrition and physical activity behaviors and improve their anthropometrics. This study used a single-group repeated measures design in a small school in Durham, North Carolina (NC). The intervention consisted of a nurse-led and teacher-assisted nutrition and physical activity education and exercise classes that met twice each week for 45–60 minutes for 7 weeks. Data were collected at Time 1 (baseline), Time 2 (after intervention completion), and Time 3 (after 3 months on their own). Interview feedback, low cost, and successful completion of all planned activities indicated that all stakeholders found the project beneficial and suitable for their school. This study suggests that a weight management intervention for adolescents was feasible in the school setting.
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Affiliation(s)
- Gary Dupart
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diane C. Berry
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer D’Auria
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leslie Sharpe
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Effects of an Intensive Lifestyle Intervention to Treat Overweight/Obese Children and Adolescents. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8573725. [PMID: 28656151 PMCID: PMC5474545 DOI: 10.1155/2017/8573725] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/18/2017] [Accepted: 04/26/2017] [Indexed: 01/17/2023]
Abstract
Objective The purpose of the present study is to examine the effects of a multidisciplinary lifestyle intervention to treat overweight/obese children and adolescents. The main outcome was cardiometabolic risk based on the waist-to-height ratio (WHTR) measurement. Secondary outcomes were (1) changes in body composition; (2) adherence to a Mediterranean diet; and (3) physical performance. Method The study involved 74 overweight/obese children or adolescents. The intervention was multidisciplinary including nutrition, exercise, and psychological aspects based on a family-based approach; it was delivered for six months for children and three months for adolescents. Before and after the intervention, several anthropometric measures (height, body weight, body mass index or BMI, waist circumference, and body composition), cardiometabolic risk index (waist-to-height ratio or WHTR), and nutrition habits of the participants and their families were evaluated. In addition, a set of functional motor fitness tests was performed to evaluate physical performance measures. Results After the intervention both children and adolescents showed a significant reduction in body weight, BMI, waist circumference, fat mass, and WHTR index and an improvement of fat-free mass, adherence to the Mediterranean diet, and physical fitness performance. Conclusion A family-based multidisciplinary approach is effective in the short term in ameliorating the health status, the nutrition habits, and physical performance in children and adolescents.
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Bacopoulou F, Landis G, Rentoumis A, Tsitsika A, Efthymiou V. Mediterranean diet decreases adolescent waist circumference. Eur J Clin Invest 2017; 47:447-455. [PMID: 28407234 DOI: 10.1111/eci.12760] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 04/10/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND To explore the effects of a multicomponent-multilevel school-based educational intervention on the nutritional habits and abdominal obesity indices of a representative adolescent sample. MATERIALS AND METHODS A representative sample of 1610 adolescents aged 12-17 years in 23 public high schools of three municipalities in the Attica region in Greece participated in a programme funded by the European Union (August 2013-August 2014). Participants underwent dietary assessment with the use of the Mediterranean Diet Quality Index in children and adolescents (KIDMED), blood pressure (BP) assessment and screening for general and abdominal obesity by measuring body mass index, waist circumference (WC) and waist-to-height ratio (WHtR), at baseline and following a 6-month school-based intervention. The intervention involved nutritional education, physical activity and body image awareness using a multilevel approach to the adolescent participants, their parents, school teachers and health staff. RESULTS Analysis included 1032 adolescents (mean age ± SD 14·1 ± 1·6 years). Following intervention, mean KIDMED score ± SD increased significantly from 5·6 ± 2·4 to 5·8 ± 2·4 (P = 0·004). Higher percentage of boys (P = 0·028) and younger adolescents (P < 0·001) had optimal KIDMED scores ≥ 8. Significant decreases were observed in overweight and obesity (P = 0·033), mean systolic (P = 0·049) and diastolic (P < 0·001) BP, WC (P < 0·001) and WHtR (P < 0·001). WC decreased as the KIDMED score increased (P = 0·020). Living with both parents (P = 0·036), higher maternal (P = 0·039) and paternal (P = 0·004) education and having a younger father (P = 0·034) were associated with better adherence to Mediterranean diet, post-intervention. CONCLUSIONS Increased adherence to MD was associated with decreased WC, indicating a potential of multicomponent-multilevel school-based interventions to combat adolescent abdominal obesity.
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Affiliation(s)
- Flora Bacopoulou
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Georgios Landis
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Anastasios Rentoumis
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Artemis Tsitsika
- Adolescent Health Unit, Second Department of Pediatrics, School of Medicine National and Kapodistrian University of Athens, 'P. and A. Kyriakou' Children's Hospital, Athens, Greece
| | - Vasiliki Efthymiou
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, Athens, Greece
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Scherr RE, Linnell JD, Dharmar M, Beccarelli LM, Bergman JJ, Briggs M, Brian KM, Feenstra G, Hillhouse JC, Keen CL, Ontai LL, Schaefer SE, Smith MH, Spezzano T, Steinberg FM, Sutter C, Young HM, Zidenberg-Cherr S. A Multicomponent, School-Based Intervention, the Shaping Healthy Choices Program, Improves Nutrition-Related Outcomes. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2017; 49:368-379.e1. [PMID: 28189500 DOI: 10.1016/j.jneb.2016.12.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 12/13/2016] [Accepted: 12/17/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of the Shaping Healthy Choices Program (SHCP). DESIGN A clustered, randomized, controlled intervention lasting 1 school year. SETTING Schools in northern and central California. PARTICIPANTS Fourth-graders (aged 9-10 years) at 2 control schools (n = 179) and 2 intervention schools (n = 230). INTERVENTION Garden-enhanced education, family, and community partnerships; increased regionally procured produce in the lunchroom; and school-site wellness committees. MAIN OUTCOME MEASURES Changes in body mass index (BMI) percentiles/Z-scores; nutrition knowledge, science process skills, and vegetable identification and preferences; and reported fruit and vegetable intake. ANALYSIS Student t test, chi-square, ANOVA of change, and multilevel regression mixed model to evaluate change in outcomes with school as a random effect to account for cluster design effects. Statistical significance was set at P < .05. RESULTS There was a greater improvement in BMI percentile (-6.08; P < 0.01), BMI Z-score (-0.28; P < .001), and waist-to-height ratio (-0.02; P < .001) in the intervention compared with the control schools. CONCLUSIONS AND IMPLICATIONS The SHCP resulted in improvements in nutrition knowledge, vegetable identification, and a significant decrease in BMI percentiles. This supports the concept that the SHCP can be used to improve the health of upper elementary school students.
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Affiliation(s)
- Rachel E Scherr
- Department of Nutrition, University of California, Davis, Davis, CA; Center for Nutrition in Schools, University of California, Davis, Davis, CA
| | | | - Madan Dharmar
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA
| | - Lori M Beccarelli
- Department of Nutrition, University of California, Davis, Davis, CA; Center for Nutrition in Schools, University of California, Davis, Davis, CA
| | | | - Marilyn Briggs
- Department of Nutrition, University of California, Davis, Davis, CA; Center for Nutrition in Schools, University of California, Davis, Davis, CA
| | - Kelley M Brian
- University of California Cooperative Extension, Placer and Nevada Counties, University of California Agriculture and Natural Resources, Auburn, CA; University of California Agriculture and Natural Resources, Davis, CA
| | - Gail Feenstra
- University of California Agriculture and Natural Resources, Davis, CA; Agricultural Sustainability Institute, University of California Sustainable Agriculture Research and Education Program, University of California, Davis, Davis, CA
| | - J Carol Hillhouse
- University of California Agriculture and Natural Resources, Davis, CA; Agricultural Sustainability Institute, University of California Sustainable Agriculture Research and Education Program, University of California, Davis, Davis, CA
| | - Carl L Keen
- Department of Nutrition, University of California, Davis, Davis, CA; University of California Agriculture and Natural Resources, Davis, CA; Department of Internal Medicine, University of California, Davis, Davis, CA
| | - Lenna L Ontai
- University of California Agriculture and Natural Resources, Davis, CA; Department of Human Ecology, University of California, Davis, Davis, CA
| | - Sara E Schaefer
- Foods for Health Institute, University of California, Davis, Davis, CA
| | - Martin H Smith
- University of California Agriculture and Natural Resources, Davis, CA; Department of Human Ecology, University of California, Davis, Davis, CA; Department of Population Health and Reproduction, University of California, Davis, Davis, CA
| | - Theresa Spezzano
- University of California Agriculture and Natural Resources, Davis, CA; University of California Cooperative Extension, Merced and Stanislaus Counties, University of California Agriculture and Natural Resources, Modesto, CA
| | - Francene M Steinberg
- Department of Nutrition, University of California, Davis, Davis, CA; University of California Agriculture and Natural Resources, Davis, CA
| | - Carolyn Sutter
- Department of Human Ecology, University of California, Davis, Davis, CA
| | - Heather M Young
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA
| | - Sheri Zidenberg-Cherr
- Department of Nutrition, University of California, Davis, Davis, CA; Center for Nutrition in Schools, University of California, Davis, Davis, CA; University of California Agriculture and Natural Resources, Davis, CA.
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Byrd-Bredbenner C, Martin-Biggers J, Koenings M, Quick V, Hongu N, Worobey J. HomeStyles, A Web-Based Childhood Obesity Prevention Program for Families With Preschool Children: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e73. [PMID: 28442452 PMCID: PMC5424124 DOI: 10.2196/resprot.7544] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 03/28/2017] [Indexed: 01/15/2023] Open
Abstract
Background The home environment is where young children spend most of their time, and is critically important to supporting behaviors that promote health and prevent obesity. However, the home environment and lifestyle patterns remain understudied, and few interventions have investigated parent-led makeovers designed to create home environments that are supportive of optimal child health and healthy child weights. Objective The aim of the HomeStyles randomized controlled trial (RCT) is to determine whether the Web-based HomeStyles intervention enables and motivates parents to shape the weight-related aspects of their home environments and lifestyle behavioral practices (diet, exercise, and sleep) to be more supportive of their preschool children’s optimal health and weight. Methods A rigorous RCT utilizing an experimental group and an attention control group, receiving a bona fide contemporaneous treatment equal in nonspecific treatment effects and differing only in subject matter content, will test the effect of HomeStyles on a diverse sample of families with preschool children. This intervention is based on social cognitive theory and uses a social ecological framework, and will assess: intrapersonal characteristics (dietary intake, physical activity level, and sleep) of parents and children; family interpersonal or social characteristics related to diet, physical activity, media use, and parental values and self-efficacy for obesity-preventive practices; and home environment food availability, physical activity space and supports in and near the home, and media availability and controls in the home. Results Enrollment for this study has been completed and statistical data analyses are currently underway. Conclusions This paper describes the HomeStyles intervention with regards to: rationale, the intervention’s logic model, sample eligibility criteria and recruitment, experimental group and attention control intervention content, study design, instruments, data management, and planned analyses.
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Affiliation(s)
- Carol Byrd-Bredbenner
- Rutgers University, Department of Nutritional Sciences, New Brunswick, NJ, United States
| | | | - Mallory Koenings
- Rutgers University, Department of Nutritional Sciences, New Brunswick, NJ, United States
| | - Virginia Quick
- Rutgers University, Department of Nutritional Sciences, New Brunswick, NJ, United States
| | - Nobuko Hongu
- University of Arizona, Department of Nutritional Sciences, Tucson, AZ, United States
| | - John Worobey
- Rutgers University, Department of Nutritional Sciences, New Brunswick, NJ, United States
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Ball GDC, Mushquash AR, Keaschuk RA, Ambler KA, Newton AS. Using Intervention Mapping to develop the Parents as Agents of Change (PAC ©) intervention for managing pediatric obesity. BMC Res Notes 2017; 10:43. [PMID: 28086848 PMCID: PMC5237285 DOI: 10.1186/s13104-016-2361-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 12/21/2016] [Indexed: 01/01/2023] Open
Abstract
Background Pediatric obesity has become increasingly prevalent over recent decades. In view of the psychosocial and physical health risks, and the high likelihood that children with obesity will grow to become adults with obesity, there is a clear need to develop evidence-based interventions that can be delivered in the health care system to optimize the health and well-being of children with obesity and their families. The aim of this paper is to describe the development, implementation, and planned evaluation of a parent-based weight management intervention designed for parents of 8–12 year olds with obesity. Methods/results The principles of Intervention Mapping (IM) were used to develop an intervention called Parents as Agents of Change (PAC©). From 2006 to 2009, an environmental scan plus qualitative (individual interviews with parents and children), quantitative (medical record reviews), and literature review data were collected to gain broad insight into family factors related to pediatric obesity and its management. Theoretical frameworks and empirical evidence guided curriculum development, which was founded primarily on the tenets of family systems theory and cognitive behavioral theory. PAC was developed as a manualized, 16-session, group-based, health care professional-led intervention for parents to address individual, family, and environmental factors related to the management of pediatric obesity. The intervention was refined based on feedback from local and international experts, and has been implemented successfully in a multi-disciplinary weight management centre in a children’s hospital. Conclusion IM provided a practical framework to guide the systematic development of a pediatric weight management intervention for parents of children with obesity. This logical, step-by-step process blends theory and practice and is broadly applicable in the context of obesity management intervention development and evaluation. Following intervention development, the PAC intervention was evaluated within a randomized clinical trial. Trial registration NCT01267097; clinicaltrials.gov
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Affiliation(s)
- Geoff D C Ball
- Department of Pediatrics, University of Alberta, Room 4-515, Edmonton Clinic Health Academy, 11405-87th Ave, Edmonton, AB, T6G 1C9, Canada.
| | - Aislin R Mushquash
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Department of Psychology, Lakehead University, 955 Oliver Rd, Thunder Bay, ON, P7B 5E1, Canada
| | - Rachel A Keaschuk
- , #780 Princeton Place, 10339-124th St, Edmonton, AB, T5N 3W1, Canada
| | - Kathryn A Ambler
- Health Technology & Service Policy, Research & Innovation Branch, Strategic Planning & Policy Development Division, Alberta Health, 18th Floor, ATB Building, 10025 Jasper Ave, Edmonton, AB, T5J 1S6, Canada
| | - Amanda S Newton
- Department of Pediatrics, University of Alberta, Room 3-526, Edmonton Clinic Health Academy, 11405-87th Ave, Edmonton, AB, T6G 1C9, Canada
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Sutan R, Johari A, Hod R, Azmi MT. Measuring Factors Influencing Progression across the Stages of Readiness to Lose Weight among Overweight and Obese Adolescents. Health (London) 2017. [DOI: 10.4236/health.2017.91011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Feng D, Reed DB, Esperat MC, Uchida M. Effects of TV in the Bedroom on Young Hispanic Children. Am J Health Promot 2016; 25:310-8. [DOI: 10.4278/ajhp.080930-quan-228] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Purpose. The main purposes of this study were to assess TV viewing among Hispanic young children and to examine effects of having a TV in the child's bedroom (TVIB). Design and Setting. A quasi-experimental design was used to evaluate an intervention program that is collecting longitudinal data in West Texas. However, the current report uses only the baseline data of the ongoing study. Subjects. Predominantly low-income and Hispanic parents/guardians (N = 315) and their children of 5 to 9 years (N = 597). Measures. Children's anthropometric measures were obtained. Their overweight status was determined based on age- and gender-adjusted body mass index. A demographic questionnaire, acculturation scale (brief version of Acculturation Rating Scale for Mexican Americans II), and family survey were used among parents. Analysis. Descriptive statistics, t-tests, X2 tests, and logistic regressions were used. Results. Most children (70%) have TVIB; more than 30% were or were at risk of overweight. Demographic characteristics did not significantly predict TVIB. Children with TVIB spent .93 hours more daily watching TV/DVD (t = 3.07; df = 283; p = .003), and children (at one site) ate more fast food (X2 = 5.46; df = 1; p = .019), compared with children without TVIB whose parents better supported physical activity (t = 2.11; df = 275; p = .039). Conclusion. Most children in this low-income and Hispanic sample have TVIB, which is associated with unhealthy behaviors. (Am J Health Promot 2011;25[5]:310-318.)
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Affiliation(s)
- Du Feng
- Du Feng, PhD; Debra B. Reed, PhD, RD, LD; M. Christina Esperat, RN, PhD, FAAN; Mitsue Uchida, PhD, are from Texas Tech University, Lubbock, Texas
| | - Debra B. Reed
- Du Feng, PhD; Debra B. Reed, PhD, RD, LD; M. Christina Esperat, RN, PhD, FAAN; Mitsue Uchida, PhD, are from Texas Tech University, Lubbock, Texas
| | - M. Christina Esperat
- Du Feng, PhD; Debra B. Reed, PhD, RD, LD; M. Christina Esperat, RN, PhD, FAAN; Mitsue Uchida, PhD, are from Texas Tech University, Lubbock, Texas
| | - Mitsue Uchida
- Du Feng, PhD; Debra B. Reed, PhD, RD, LD; M. Christina Esperat, RN, PhD, FAAN; Mitsue Uchida, PhD, are from Texas Tech University, Lubbock, Texas
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Faigenbaum AD. State of the Art Reviews: Resistance Training for Children and Adolescents. Am J Lifestyle Med 2016. [DOI: 10.1177/1559827606296814] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although much of what we understand about the stimulus of resistance exercise has been gained by exploring the responses of adults to various training protocols, research into the effects of resistance exercise on children and adolescents has increased over the past decade. Despite outdated concerns that resistance training was ineffective or unsafe for youth, research increasingly suggests that resistance training can be a safe and effective method of exercise for children and adolescents provided that appropriate training guidelines are followed. In addition to enhancing motor skills and sports performance, regular participation in a youth resistance training program has the potential to positively influence several measurable indices of health. It helps strengthen bone, facilitate weight control, enhance psychosocial well-being, and improve one's cardiovascular risk profile. Furthermore, a stronger musculoskeletal system will enable boys and girls to perform life's daily activities with more energy and vigor and may increase a young athlete's resistance to sports-related injuries. Along with other types of physical activity, a properly designed youth resistance training program can offer observable health value to children and adolescents when appropriately prescribed and supervised.
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Affiliation(s)
- Avery D. Faigenbaum
- Department of Health and Exercise Science, The College of New Jersey, 2000 Pennington Road, Ewing, NJ 08628-0718,
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Kohlstadt I, Gittelsohn J, Fang Y. NutriBee Intervention Improves Diet and Psychosocial Outcomes by Engaging Early Adolescents from Diverse and Disadvantaged Communities. J Am Coll Nutr 2016; 35:443-51. [PMID: 27315580 DOI: 10.1080/07315724.2015.1110507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE NutriBee was the first clinical nutrition intervention designed to bring the Institute of Medicine recommendations for 20 hours of experiential nutrition-themed learning to grades 4-7 into club and camp settings. We piloted NutriBee to assess acceptability and impact among early adolescents in diverse and disadvantaged communities in order to evaluate its future potential as a group medical nutrition intervention. METHODS Nine communities across Guam, Maryland, Michigan, and New Mexico representing South Pacific Island, American Indian, urban African American, recently immigrated Hispanic, and rural Caucasian ethnic groups piloted NutriBee in nonclinical settings (clubs, schools, camps). The 6 club and camp pilots administered consenting NutriBee participants a 41-question pre-post survey assessing impact on food selection and the psychosocial parameters of intentions, outcome expectations, self-efficacy, and knowledge. Process measures included dose, fidelity, and acceptability questions. RESULTS Pre- and postsurveys were completed by 170 of 179 (95%) consenting, eligible participants. Impact scores increased significantly (p < 0.001): Food selection behavior (+9.3%), intentions (+19.1%), outcome expectations (+15.1%), self-efficacy (+7.4%), and knowledge (+17.6%). Each pilot (n = 6) demonstrated significant (p < 0.001) impact, a mean dose delivered of 80% (16 hours) or higher, and an acceptability score of at least 74%. Girls participating in girl-only programs (n = 72) shared greater impact than girls in coed programs (n = 41; 13.6% vs. 10.4% mean score increase, p = 0.05). CONCLUSIONS NutriBee successfully extended the impact of an IOM-aligned intervention to club and camp settings to which clinicians can refer at-risk early adolescents.
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Affiliation(s)
- Ingrid Kohlstadt
- a Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
| | - Joel Gittelsohn
- a Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
| | - Yu Fang
- b Johns Hopkins University , Baltimore , Maryland
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Abstract
Obesity is a public health crisis and continues to affect youth of increasingly younger ages. With significant medical and psychosocial comorbidities, it is critical that front-line providers feel confident in their abilities to assess, and appropriately refer, children and families to subspecialties to aid in weight management treatment. This article describes the development and utility of a 1-page screening tool for pediatricians and other providers. Utilizing research, clinical experience, and consensus opinion, a brief tool was developed that could be incorporated into medical visits to facilitate medical care decisions and management of pediatric obesity.
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Affiliation(s)
- Melissa Santos
- Connecticut Children's Medical Center/Hartford Hospital, Hartford, CT, USA
| | | | | | - Wendy Ward
- University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, AR, USA
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Physical activity and nutrition education at the school environment aimed at preventing childhood obesity: evidence from systematic reviews. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2016. [DOI: 10.1016/j.jpedp.2015.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Physical activity and nutrition education at the school environment aimed at preventing childhood obesity: evidence from systematic reviews. J Pediatr (Rio J) 2016; 92:15-23. [PMID: 26453513 DOI: 10.1016/j.jped.2015.06.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/23/2015] [Accepted: 06/03/2015] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To organize the main findings and list the most frequent recommendations from systematic reviews of interventions developed at the school environment aimed at reducing overweight in children and adolescents. DATA SOURCE Searches for systematic reviews available until December 31, 2014 were conducted in five electronic databases: Cochrane, PubMed, SciELO, SPORTDiscus, and Web of Science. Manual search for cross-references were also performed. SUMMARY OF THE FINDINGS Of the initial 2139 references, 33 systematic reviews adequately met the inclusion criteria and were included in the descriptive summary. In this set, interventions with periods of time greater than six months in duration (nine reviews), and parental involvement in the content and/or planned actions (six reviews) were identified as the most frequent and effective recommendations. Additionally, it was observed that boys respond more effectively to structural interventions, whereas girls respond to behavioral interventions. None of the included reviews was able to make inferences about the theoretical basis used in interventions as, apparently, those in charge of the interventions disregarded this component in their preparation. CONCLUSIONS Although the summary identified evidence with important applications in terms of public health, there are still gaps to be filled in this field of knowledge, such as the effectiveness of different theoretical models, the identification of the best strategies in relation to gender and age of participants and, finally, the identification of moderating variables to maximize the benefits provided by the interventions.
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Strauss WJ, Sroka CJ, Frongillo EA, Arteaga SS, Loria CM, Leifer ES, Wu CO, Patrick H, Fishbein HA, John LV. Statistical Design Features of the Healthy Communities Study. Am J Prev Med 2015; 49:624-30. [PMID: 26384932 PMCID: PMC4575768 DOI: 10.1016/j.amepre.2015.06.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/12/2015] [Accepted: 06/23/2015] [Indexed: 11/25/2022]
Abstract
The Healthy Communities Study is designed to assess relationships between characteristics of community programs and policies targeting childhood obesity and children's BMI, diet, and physical activity. The study involved a complex data collection protocol implemented over a 2-year period (2013-2015) across a diverse sample of 130 communities, defined as public high school catchment areas. The protocol involved baseline assessment within each community that included in-person or telephone interviews regarding community programs and policies and in-home collection of BMI, nutritional, and physical activity outcomes from a sample of up to 81 children enrolled in kindergarten through eighth grade in public schools. The protocol also involved medical record reviews to establish a longitudinal trajectory of BMI for an estimated 70% of participating children. Staged sampling was used to collect less detailed measures of physical activity and nutrition across the entire sample of children, with a subset assessed using more costly, burdensome, and detailed measures. Data from the Healthy Community Study will be analyzed using both cross-sectional and longitudinal models that account for the complex design and correct for measurement error and bias using a likelihood-based Markov-chain Monte Carlo methodology. This methods paper provides insights into the complex design features of the Healthy Communities Study and may serve as an example for future large-scale studies that assess the relationship between community-based programs and policies and health outcomes of community residents.
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Affiliation(s)
| | | | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - S Sonia Arteaga
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Catherine M Loria
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Eric S Leifer
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Colin O Wu
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Heather Patrick
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | | | - Lisa V John
- Battelle Health and Analytics, St. Louis, Missouri
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Three-Year Improvements in Weight Status and Weight-Related Behaviors in Middle School Students: The Healthy Choices Study. PLoS One 2015; 10:e0134470. [PMID: 26295837 PMCID: PMC4546621 DOI: 10.1371/journal.pone.0134470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 07/10/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Few dissemination evaluations exist to document the effectiveness of evidence-based childhood obesity interventions outside the research setting. OBJECTIVE Evaluate Healthy Choices (HC), a multi-component obesity prevention program, by examining school-level changes in weight-related behaviors and weight status and the association of implementation components with odds of overweight/obesity. METHODS We compared baseline and Year 3 school-level behavioral and weight status outcomes with paired t-tests adjusted for schools' socio-demographic characteristics. We used generalized estimating equations to examine the odds of overweight/obesity associated with program components. SETTING/PARTICIPANTS Consecutive sample of 45 of 51 middle schools participating in the HC program with complete baseline and follow-up survey data including a subsample of 35 schools with measured anthropomentry for 5,665 7th grade students. INTERVENTION Schools developed a multi-disciplinary team and implemented an obesity prevention curriculum, before and after school activities, environmental and policy changes and health promotions targeting a 5-2-1 theme: eat ≥ 5 servings/day of fruits and vegetables (FV), watch ≤ 2 hours of television (TV) and participate in ≥ 1 hours/day of physical activity (PA) on most days. MAIN OUTCOME MEASURES 1) School-level percent of students achieving targeted behaviors and percent overweight/obese; and 2) individual odds of overweight/obesity. RESULTS The percent achieving behavioral goals over three years increased significantly for FV: 16.4 to 19.4 (p = 0.001), TV: 53.4 to 58.2 (p = 0.003) and PA: 37.1 to 39.9 (p = 0.02), adjusting for school size, baseline mean age and percent female, non-Hispanic White, and eligible for free and reduced price lunch. In 35 schools with anthropometry, the percent of overweight/obese 7th grade students decreased from 42.1 to 38.4 (p = 0.016). Having a team that met the HC definition was associated with lower odds of overweight/obesity (OR = 0.83, CI: 0.71-0.98). CONCLUSIONS AND RELEVANCE The HC multi-component intervention demonstrated three-year improvements in weight-related behaviors and weight status across diverse middle schools. Team building appears important to the program's effectiveness.
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Martin-Biggers J, Spaccarotella K, Delaney C, Koenings M, Alleman G, Hongu N, Worobey J, Byrd-Bredbenner C. Development of the Intervention Materials for the HomeStyles Obesity Prevention Program for Parents of Preschoolers. Nutrients 2015; 7:6628-69. [PMID: 26266419 PMCID: PMC4555140 DOI: 10.3390/nu7085301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/20/2015] [Accepted: 07/30/2015] [Indexed: 12/12/2022] Open
Abstract
Home environment is key to the development of obesity-preventing behaviors during childhood, yet few resources help preschool parents address factors at home associated with obesity risk. This paper describes creation of materials for an in-home intervention (HomeStyles) with this population. An advisory group of stakeholders and target audience members determined salient factors affecting childhood obesity to address in-home and developed program materials. The Social Cognitive Theory, Faith's Core Behavior Change Strategies to Treat Childhood Obesity, Adult Learning Theory and motivational interviewing techniques guided development of 12 guides targeting strategies parents can use to shape the home environment. Interviews were conducted to determine effectiveness of the guides. Cognitive testing of guide design (n = 251) and content (n = 261) occurred in English and Spanish in New Jersey and Arizona with parents and home visitation staff who would present the guides. Interviews investigated perceptions of content usefulness and parent comprehension. Findings were also examined in light of theoretical underpinnings. Both home visitation staff and parents felt the guides were very readable and useful. Parents appreciated use of motivational interviewing techniques and Adult Learning Theory. Current research is testing these guides through an in-home, randomized control trial.
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Affiliation(s)
- Jennifer Martin-Biggers
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue New Brunswick, NJ 08901, USA; E-Mails: (J.M.-B.); (C.D.); (M.K.); (J.W.)
| | - Kim Spaccarotella
- Department of Biological Sciences, Kean University, 1000 Morris Avenue Union, NJ 07082, USA; E-Mail:
| | - Colleen Delaney
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue New Brunswick, NJ 08901, USA; E-Mails: (J.M.-B.); (C.D.); (M.K.); (J.W.)
| | - Mallory Koenings
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue New Brunswick, NJ 08901, USA; E-Mails: (J.M.-B.); (C.D.); (M.K.); (J.W.)
| | - Gayle Alleman
- Department of Nutritional Sciences, University of Arizona, 406 Shantz Building, 1177 E. 4th Street, Tucson, AZ 85721-0038, USA; E-Mails: (G.A.); (N.H.)
| | - Nobuko Hongu
- Department of Nutritional Sciences, University of Arizona, 406 Shantz Building, 1177 E. 4th Street, Tucson, AZ 85721-0038, USA; E-Mails: (G.A.); (N.H.)
| | - John Worobey
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue New Brunswick, NJ 08901, USA; E-Mails: (J.M.-B.); (C.D.); (M.K.); (J.W.)
| | - Carol Byrd-Bredbenner
- Department of Nutritional Sciences, Rutgers University, 26 Nichol Avenue New Brunswick, NJ 08901, USA; E-Mails: (J.M.-B.); (C.D.); (M.K.); (J.W.)
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Abstract
The WHO's Ottawa Charter highlights five priority areas for taking action in public health. Only one of them is at the individual level as action at more upstream intervention levels, such as community or policy levels, is critical for enabling individuals to succeed. The objective of the present paper is to give insight into the many complex processes involved in public health nutrition by describing the Ottawa Charter's five priority areas for taking action using public health nutrition initiatives I have been involved in. Evidence-based guidelines for healthy eating and infant feeding provide an essential basis for individuals to 'develop personal skills' (Action Area 1). 'Re-orienting health services' (Action Area 2) can address the needs of vulnerable population subgroups, such as the culturally sensitive diabetes prevention programme established for an Indo-Asian community in Canada. Identifying geographic areas at high risk of childhood obesity enables better strategic planning and targeting of resources to 'strengthen community action' (Action Area 3). Calorie menu labelling can 'create supportive environments' (Action Area 4) through encouraging a demand for less energy-dense, healthier food options. 'Building healthy public policy' (Action Area 5) to implement mandatory folic acid food fortification for prevention of birth defects has many advantages over a voluntary approach. In conclusion, evaluation and evidence-based decision-making needs to take account of different strategies used to take action in each of these priority areas. For this, the randomised control trial needs adaptation to determine the best practice in public health nutrition where interventions play out in real life with all its confounding factors.
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Affiliation(s)
- Mary A. T. Flynn
- Public Health Nutrition, Food Safety Authority of Ireland, Abbey Court, Abbey Street, Dublin 1, Republic of Ireland
- Faculty of Life and Health Sciences, University of Ulster, Cromore Road, Coleraine, BT52 1SA, Northern Ireland
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Burke SM, Shapiro S, Petrella RJ, Irwin JD, Jackman M, Pearson ES, Prapavessis H, Shoemaker JK. Using the RE-AIM framework to evaluate a community-based summer camp for children with obesity: a prospective feasibility study. BMC OBESITY 2015. [PMID: 26217536 PMCID: PMC4511021 DOI: 10.1186/s40608-015-0050-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Increasing rates of childhood overweight and obesity highlight a need for the evaluation of lifestyle interventions. The purpose of the study was to determine the Reach, Effectiveness, Adoption, Implementation and Maintenance of a novel family-focused program targeting children with obesity (i.e., the Children’s Health and Activity Modification Program [C.H.A.M.P.]) using the RE-AIM framework, an evaluation tool for community-based health interventions. Methods A single-centre, single cohort interventional feasibility study was conducted over the course of two years. Children with obesity and their families completed a 4-week group-based lifestyle intervention in Year 1 (n = 15; Mage = 10.6; 53% female) and/or Year 2 (n = 25; Mage = 10.6; 56% female). Outcome variables were measured pre- and post-intervention, as well as 6- and 12-months following completion of the formal program. Results Overall, C.H.A.M.P. had high reach in terms of participant representativeness. In addition, participation in the program was associated with significantly improved standardized body mass index (BMI-z), body fat percentage, lean mass percentage, and child- and parent-proxy reported quality of life (QOL; effectiveness/individual maintenance). Furthermore, a number of community partnerships were built, strengthened, and maintained prior to, during, and following implementation of the two-year program (adoption/setting maintenance, respectively). Finally, the intervention was delivered as intended as evidenced by high adherence to the schedule, attendance rates, and cost effectiveness (implementation). Conclusions Based on RE-AIM metrics, C.H.A.M.P. appears to be a promising childhood obesity program. The findings reported will inform researchers and practitioners on how to design and implement future community-based programs addressing pediatric obesity. Trial registration ISRCTN Registry, Study ID ISRCTN13143236. Registered 27 March 2015.
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Affiliation(s)
- Shauna M Burke
- School of Health Studies, Western University, London, Canada
| | - Sheree Shapiro
- Health and Rehabilitation Sciences Program, Western University, London, Canada
| | - Robert J Petrella
- Department of Family Medicine, Western University, London, Canada ; School of Kinesiology, Western University, London, Canada
| | | | - Michelle Jackman
- Section of Hospital Pediatrics & Pediatric Centre for Weight & Health, Alberta Children's Hospital, Calgary, Canada
| | - Erin S Pearson
- School of Kinesiology, Lakehead University, Thunder Bay, Canada
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Kozica S, Lombard C, Teede H, Ilic D, Murphy K, Harrison C. Initiating and continuing behaviour change within a weight gain prevention trial: a qualitative investigation. PLoS One 2015; 10:e0119773. [PMID: 25875943 PMCID: PMC4398548 DOI: 10.1371/journal.pone.0119773] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 02/01/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Preventing obesity is an international health priority. In Australia, young women who live in rural communities are at high risk of unhealthy weight gain. Interventions which engage young women and support sustainable behaviour change are needed and comprehensive evaluation of such interventions generates knowledge for population scale-up. This qualitative sub-study aims to identify enablers and barriers to behaviour change initiation and continuation within a community weight gain prevention program. METHODS In-depth semi-structured interviews were conducted with program participants 6 months after baseline. All interviews were audio-taped and transcribed verbatim. Transcripts were analysed independently by two investigators via thematic analysis. PARTICIPANTS A total of 28 women with a mean age of 39.9±6.2years and a BMI of 28.6±5.2kg/m2 were purposively recruited from the larger cohort (n = 649) that participated in the prevention trial. RESULTS Four behaviour change groups emerged were identified from participant interviews: (i) no change, (ii) relapse, (iii) intermittent and (iv) continued change. Factors influencing behaviour change initiation and continuation included realistic program expectations and the participant's ability to apply the core program elements including: setting small, achievable behaviour change goals, problem solving and using self-management techniques. Personal knowledge, skills, motivation, self-efficacy, accountability and perceived social and environmental barriers also affected behaviour change. Satisfaction with personal program progress and the perceived amount of program supports required to achieve ongoing behaviour change varied amongst participants. Women who relapsed expressed a desire for more intensive and regular support from health professionals, identified more barriers unrelated to the program, anticipated significant weight loss and had lower satisfaction with their progress. CONCLUSION Initiating and continuing behaviour change is a complex process. Our findings elucidate that initiation and continuation of behaviour change in women undertaking a weight gain prevention program may be facilitated by accurate and realistic understanding of program expectation, the ability to apply the core program messages, higher internal motivation, self-efficacy and minimal social and environmental barriers. TRIAL REGISTRATION Australia & New Zealand Clinical Trial Registry ACTRN12612000115831 www.anzctr.org.au.
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Affiliation(s)
- Samantha Kozica
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health & Preventive Medicine, Monash University, Clayton, 3168, Victoria, Australia
| | - Catherine Lombard
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health & Preventive Medicine, Monash University, Clayton, 3168, Victoria, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health & Preventive Medicine, Monash University, Clayton, 3168, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Clayton, 3168, Victoria, Australia
| | - Dragan Ilic
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, 3004, Victoria, Australia
| | - Kerry Murphy
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, 3004, Victoria, Australia
| | - Cheryce Harrison
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health & Preventive Medicine, Monash University, Clayton, 3168, Victoria, Australia
- * E-mail:
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Cooke NK, Nietfeld JL, Goodell LS. The development and validation of the childhood obesity prevention self-efficacy (COP-SE) survey. Child Obes 2015; 11:114-21. [PMID: 25585108 DOI: 10.1089/chi.2014.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Physicians can play an important role in preventing and treating childhood obesity. There are currently no validated measures of medical students' self-efficacy in these skills; therefore, we sought to develop a valid and reliable computerized survey to measure medical students' self-efficacy in skills needed to prevent and treat childhood obesity. METHODS We developed the Childhood Obesity Prevention Self-Efficacy (COP-SE) survey with input from two expert panels and cognitive interviews with medical students. We administered the 43-item COP-SE computerized survey to a nation-wide sample of medical students. RESULTS The final sample consisted of 444 medical students from 53 medical schools. Exploratory factor analysis revealed a two-factor structure with a correlation of 0.637 between factors and high reliability within factors. The correlation between the COP-SE and a measure of general self-efficacy was moderate (0.648), and reliability within factors was high (Factor 1=0.946; Factor 2=0.927). CONCLUSIONS The 18-item COP-SE is a valid and reliable measure of childhood obesity prevention self-efficacy. Factor 1 assesses self-efficacy in nutrition counseling, and Factor 2 measures self-efficacy to assess readiness to change and initiate nutrition lifestyle changes. The correlation between the COP-SE and a measure of general self-efficacy indicates that the COP-SE is a distinct, valid assessment of domain-specific self-efficacy. The high reliability of items within factors indicates the items measure the same constructs. Therefore, medical schools can use this valid and reliable instrument as a formative or summative assessment of students' self-efficacy in childhood obesity prevention and treatment.
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Affiliation(s)
- Natalie K Cooke
- 1 Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University , Raleigh, NC
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Shafiee S, Mesgarani M, Begum K. Assessment of nutritional status among adolescent boys in an urban population of South India. Glob J Health Sci 2015; 7:335-44. [PMID: 25948465 PMCID: PMC4802057 DOI: 10.5539/gjhs.v7n3p335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 10/20/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Deficiency of calories and certain micronutrients is known to cause growth faltering in children and adolescents. It is recognized that varieties of foods need to be consumed in order to meet requirements for essential nutrients. Lack of diversity in the diets is a serious problem among poor populations in the developing world. The extent of variations in intake of nutrients occurring in a homogeneous population provides useful information. SUBJECTS & METHODS This study investigates the mean intake of nutrient by 1083 adolescent males, age 10-19 years, in comparison to the RDA values suggested by ICMR for Indians. Food intakes, social class and knowledge about health education were obtained by questionnaires. Descriptive statistics, non-parametric statistics, and Chi-Square tests were performed to and interpret the data, particularly hypothesis testing. RESULTS Mean intake of calories varied from 1512 ± 532 for pre-adolescent to 1742 ± 660 for post-adolescence, the differences in intake between pre-adolescence to adolescence was statistically significant. The intake was largely different compared to the respective RDAs including proteins which were markedly lower than the RDA. The mean intake increased linearly with the advancing stages of adolescence. Intake of calcium by boys during pre-adolescence and adolescence stage were lower by 20-30% as compared to the RDA, whereas the post-adolescent boys were found to consume a fair amount and met their RDAs. Intakes of iron and ?-carotene were highly variable, the majority of the selected boys consumed much less than the RDAs. The differences in the intakes were statistically not significant. CONCLUSION Mean intakes of nutrients indicate that the majority of the selected boys consumed protein, calories, iron, calcium and ? carotene in three stages of adolescent markedly lower than the respective RDAs. Family type, birth order and SES correlated with nutrient intake among selected adolescent boys.
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Affiliation(s)
- Shahla Shafiee
- Children and Adolescents Health Research Center, Zahedan University of Medical Science, Zahedan, Iran.
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Unhealthy weight among children and adults in India: urbanicity and the crossover in underweight and overweight. Ann Epidemiol 2015; 25:336-341.e2. [PMID: 25795227 DOI: 10.1016/j.annepidem.2015.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 01/27/2015] [Accepted: 02/06/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE Urbanization may promote the rise of dual burdens of underweight and overweight in low- and middle-income countries. We assessed underweight and overweight by urban residence across the lifespan in India. METHODS Using nationally representative, directly measured height and weight data (2004-2006; n = 236,039), we estimated and compared the prevalence of underweight and overweight (including obesity) at ages 0 to 54 years by urban and rural residence; absolute burdens of underweight, overweight, and combined unhealthy weight were estimated using 2011 Census data. RESULTS Thirty-eight percent of the urban population and 36% of the rural population of India experienced unhealthy weight, amounting to 378 million underweight or overweight individuals. In urban areas, the unhealthy weight burden was largely underweight in childhood and overweight in adulthood. In rural areas, the unhealthy weight burden was largely underweight at all ages. Urban residents compared with rural residents were more likely to be overweight and less likely to be underweight at nearly all ages. CONCLUSIONS Combined unhealthy weight was comparable in urban and rural India. Although underweight continues to be the predominant nutritional problem, there is early evidence of an epidemiologic crossover from underweight to overweight. As India experiences urbanization and population aging, low overweight and obesity may be short lived.
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Leatherdale ST. An examination of the co-occurrence of modifiable risk factors associated with chronic disease among youth in the COMPASS study. Cancer Causes Control 2015; 26:519-28. [PMID: 25673505 DOI: 10.1007/s10552-015-0529-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 02/02/2015] [Indexed: 12/27/2022]
Abstract
PURPOSE To examine the prevalence of major modifiable risk factors for cancer, examine risk factor co-occurrence, and examine how demographic and social factors are associated with risk factor co-occurrence among youth in the COMPASS study. METHODS Data from 23,280 grade 9-12 students in Year 1 (2012-2013) of the COMPASS study were used to examine the prevalence of seven different modifiable risk factors and the co-occurrence of these risk factors by gender and by grade. The between-school variance in the number of risk factors was calculated, and a model was developed to examine how demographic and social factors were associated with the number of co-occurring risk factors. RESULTS Among youth in this sample, 5.5% were current smokers, 22.9% were current binge drinkers, 16.5% were current marijuana users, 20.0% were overweight/obese, 53.1% were physically inactive, 96.7% were highly sedentary, and 95.1% had inadequate fruit and vegetable consumption. The mean number of co-occurring risk factors among students was 3.2 (± 1.1) and only 0.2% (n = 42) reported having none of the risk factors and 0.4% (n = 67) reported having all seven risk factors. Significant between-school random variation in the number of co-occurring risk factors was not identified. The number of risk factors was associated with most of the correlates examined although the effect sizes were generally small. CONCLUSION This research identifies that risk factor co-occurrence is common, most of student characteristics examined are only modestly associated with the likelihood of co-occurrence and that the school environment is not associated with variability in the number of co-occurring risk factors.
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Affiliation(s)
- Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue, Waterloo, ON, N2L 3G1, Canada,
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50
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Horodyska K, Luszczynska A, van den Berg M, Hendriksen M, Roos G, De Bourdeaudhuij I, Brug J. Good practice characteristics of diet and physical activity interventions and policies: an umbrella review. BMC Public Health 2015; 15:19. [PMID: 25604454 PMCID: PMC4306239 DOI: 10.1186/s12889-015-1354-9] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/05/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND This umbrella review aimed at eliciting good practice characteristics of interventions and policies aiming at healthy diet, increasing physical activity, and lowering sedentary behaviors. Applying the World Health Organization's framework, we sought for 3 types of characteristics, reflecting: (1) main intervention/policy characteristics, referring to the design, targets, and participants, (2) monitoring and evaluation processes, and (3) implementation issues. This investigation was undertaken by the DEDPIAC Knowledge Hub (the Knowledge Hub on the DEterminants of DIet and Physical ACtivity), which is an action of the European Union's joint programming initiative. METHODS A systematic review of reviews and stakeholder documents was conducted. Data from 7 databases was analyzed (99 documents met inclusion criteria). Additionally, resources of 7 major stakeholders (e.g., World Health Organization) were systematically searched (10 documents met inclusion criteria). Overall, the review yielded 74 systematic reviews, 16 position review papers, and 19 stakeholders' documents. Across characteristics, 25% were supported by ≥ 4 systematic reviews. Further, 25% characteristics were supported by ≥ 3 stakeholders' documents. If identified characteristics were included in at least 4 systematic reviews or at least 3 stakeholders' documents, these good practice characteristics were classified as relevant. RESULTS We derived a list of 149 potential good practice characteristics, of which 53 were classified as relevant. The main characteristics of intervention/policy (n = 18) fell into 6 categories: the use of theory, participants, target behavior, content development/management, multidimensionality, practitioners/settings. Monitoring and evaluation characteristics (n = 18) were grouped into 6 categories: costs/funding, outcomes, evaluation of effects, time/effect size, reach, the evaluation of participation and generalizability, active components/underlying processes. Implementation characteristics (n = 17) were grouped into eight categories: participation processes, training for practitioners, the use/integration of existing resources, feasibility, maintenance/sustainability, implementation partnerships, implementation consistency/adaptation processes, transferability. CONCLUSIONS The use of the proposed list of 53 good practice characteristics may foster further development of health promotion sciences, as it would allow for identification of success vectors in the domains of main characteristics of interventions/policies, their implementation, evaluation and monitoring processes.
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Affiliation(s)
- Karolina Horodyska
- grid.433893.60000000121840541Department of Psychology, University of Social Sciences and Humanities, 30b Ostrowskiego St, 53238 Wroclaw, Poland
| | - Aleksandra Luszczynska
- grid.433893.60000000121840541Department of Psychology, University of Social Sciences and Humanities, 30b Ostrowskiego St, 53238 Wroclaw, Poland
- Trauma, Health, & Hazards Center, University of Colorado, 1861 Austin Bluffs Pkwy, Colorado Springs, CO 80933-7150 USA
| | - Matthijs van den Berg
- grid.31147.300000000122080118National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 Bilthoven, the Netherlands
| | - Marieke Hendriksen
- grid.31147.300000000122080118National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 Bilthoven, the Netherlands
| | - Gun Roos
- SIFO – National Institute for Consumer Research, Sandakerveien 24 C, Building B Oslo, P.O. BOX 4682, Nydalen, N-0405, Oslo Norway
| | - Ilse De Bourdeaudhuij
- grid.5342.00000000120697798Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000 Ghent, Belgium
| | - Johannes Brug
- grid.16872.3a000000040435165XVU University Medical Center, Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
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