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BORG MARIKA, CAUCHI DANIEL, GAUCI CHARMAINE, CALLEJA NEVILLE. Addressing childhood obesity through policy: A cross-sectional study in Malta. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2023; 64:E323-E336. [PMID: 38125997 PMCID: PMC10730052 DOI: 10.15167/2421-4248/jpmh2023.64.3.2938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/23/2023] [Indexed: 12/23/2023]
Abstract
Introduction Childhood overweight and obesity are major public health challenges, with Malta having one of the highest prevalences among European countries. The COVID-19 pandemic may further worsen this epidemic. The food and physical activity environments impact children's behaviours. This study looks at barriers to maintain a healthy weight, responsibility to address obesity, and assesses parental support for 22 policies aimed at addressing childhood obesity. Public support for policy is key because it influences which policies are adopted and their success. Methods A cross-sectional, paper-based, quantitative survey was conducted amongst parents of primary school-aged children in Malta in 2018-2019. Ethical approval was obtained. Statistical analysis was performed using SPSS. Results 1,169 parents participated. The food environment was more commonly identified as a barrier to maintain a healthy weight than the physical activity environment. Parents were least supportive of taxation policies, and most in favour of increasing spaces available for safe physical activity (94.0%), followed by providing free weight management services for children (90.8%). The level of support varied significantly by various socio-demographic/economic characteristics; parents with a higher educational level were significantly more supportive of most policies. Most findings were consistent with the international literature. Conclusions Most policies supported are trans-sectoral; a health-in-all policies approach is needed to address the obesogenic environment. The strong public support identified for several policies should embolden policymakers to consider policy options that were not previously considered.
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Affiliation(s)
- MARIKA BORG
- Department of Public Health, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - DANIEL CAUCHI
- Department of Public Health, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - CHARMAINE GAUCI
- Department of Public Health, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - NEVILLE CALLEJA
- Department of Public Health, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Hagerman CJ, Ferrer RA, Persky S. How beliefs about weight malleability and risk perceptions for obesity influence parents' information seeking and feeding. J Health Psychol 2021; 27:2714-2728. [PMID: 34886689 PMCID: PMC10150795 DOI: 10.1177/13591053211061412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study surveyed 185 parents to determine whether their perceived risk of their child developing obesity and their implicit theories about the malleability of weight independently and/or interactively predict their child-feeding and pursuit of child-related obesity risk information. Higher risk perceptions were associated with healthier feeding intentions and more information seeking. More incremental (malleable) beliefs predicted healthier feeding intentions and greater pursuit of environmental, but not genetic, information. Contrary to hypotheses, the influence of implicit theories and risk perceptions were primarily independent; however, more incremental beliefs predicted less "junk food" feeding among only parents with lower perceived risk.
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Affiliation(s)
- Charlotte J Hagerman
- National Human Genome Research Institute, USA.,The George Washington University, USA.,Drexel University, USA
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Xu J, Pratt K, Chaudhari M, Henry R, Hubbard RA, Siegel R, Eneli I. On a Different Page! Perceptions on the Onset, Diagnosis, and Management of Type 2 Diabetes Among Adolescent Patients, Parents, and Physicians. Glob Pediatr Health 2021; 8:2333794X211046430. [PMID: 34595332 PMCID: PMC8477706 DOI: 10.1177/2333794x211046430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/29/2021] [Indexed: 11/17/2022] Open
Abstract
To examine perceptions about the diagnostic process and post-diagnosis care of type 2 diabetes (T2D) from adolescent patients, parents, and diabetes care physicians, semi-structured interviews were conducted with 8 individuals from each group. Interview transcripts were coded using content analysis. Emerged categories were compared among 3 groups. Half of adolescent patients and parents were surprised by the T2D diagnosis, despite most reporting that patients experienced common symptoms of T2D prior to diagnosis. Adolescents and parents recognized diet, exercise, and weight gain as risk factors after diagnosis, whereas physicians noted weight gain as a common risk factor pre-diagnosis. All 3 groups noted the importance of maintaining a healthy lifestyle and adherence to T2D management, though physicians noted the challenges from socioeconomic structural inequalities. Adolescent and parents were surprised by the T2D diagnosis, suggesting the need for increasing awareness of risk factors and symptomatology of T2D among at-risk adolescents and parents.
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Affiliation(s)
- Jinyu Xu
- Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Monika Chaudhari
- Nationwide Children's Hospital, Columbus, OH, USA.,The Ohio State University, Columbus, OH, USA
| | - Rohan Henry
- Nationwide Children's Hospital, Columbus, OH, USA.,The Ohio State University, Columbus, OH, USA
| | | | - Robert Siegel
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati, Cincinnati, OH, USA
| | - Ihuoma Eneli
- Nationwide Children's Hospital, Columbus, OH, USA.,The Ohio State University, Columbus, OH, USA
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Bunten A, Porter L, Burgess-Allen J, Howell-Jones R, Jackson J, Ward D, Staples V, Staples P, Rowthorn H, Saei A, van Schaik P, Tydeman E, Blair P, Hugueniot O, Gold N, Chadborn T. Using behavioural insights to reduce sugar in primary school children's packed lunches in derby; A cluster randomised controlled trial. Appetite 2020; 157:104987. [PMID: 33039508 DOI: 10.1016/j.appet.2020.104987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/15/2020] [Accepted: 10/01/2020] [Indexed: 01/11/2023]
Abstract
Children's packed lunches contain more sugar than school-provided meals. Interventions to improve the provision of healthier packed lunches have modest effects on lunch contents. This cluster randomised controlled trial tested an intervention to encourage healthier provision of packed lunches by parents of primary school children in Derby. Schools were randomised to intervention (n = 8) or control (n = 9) using blocked random allocation. In the intervention group, parents of children who brought packed lunches to school in years 3-6 (age 7-11 years) received three bundles of materials (including packed lunch planner, shopping list, information on sugar content of popular lunchbox items and suggestions for healthier swap alternatives) in bookbags/lunchboxes over a 4-week period. Control parents received no materials. Photos of lunchbox contents were taken at baseline, immediately post-intervention and at three-month follow-up. A parental survey aimed to assess capability, opportunity and motivation for packing a healthier lunchbox. No intervention effects were observed for primary outcomes (presence and number of sugary snacks or chilled sugary desserts). The intervention had a significant impact on one secondary outcome (increased number of healthier "swap" items suggested in intervention materials) immediately post-intervention, but this effect had disappeared at three-month follow-up. No intervention effects were found on survey variables. Parent comments revealed that materials were either received positively (as they reinforced existing behaviours) or negatively (as they were not perceived to be helpful or appropriate). The results of this study suggest that providing educational materials and resources to parents of primary school children in Derby was not sufficient to increase provision of healthier packed lunches. Future research should investigate how behavioural science can support families to improve the nutritional content of primary school children's lunchboxes.
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Affiliation(s)
- Amanda Bunten
- Public Health England Behavioural Insights, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Lucy Porter
- Public Health England Behavioural Insights, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK.
| | | | - Rebecca Howell-Jones
- Public Health England Behavioural Insights, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | | | - Derek Ward
- Medical School, University of Lincoln, Brayford Way, Brayford Pool, Lincoln, LN6 7TS, UK; Public Health Division, Adult Care and Community Wellbeing, Lincolnshire County Council, County Offices, Newland, Lincoln, LN1 1YL, UK
| | - Vicki Staples
- University of Derby, Kedleston Road, Derby, DE22 1GB, UK
| | - Paul Staples
- University of Derby, Kedleston Road, Derby, DE22 1GB, UK
| | - Harriet Rowthorn
- Public Health England Behavioural Insights, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK; Department of Psychology, University of Warwick, Coventry, CV4 7AL, UK
| | - Ayoub Saei
- Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Paul van Schaik
- School of Social Sciences and Law, Teesside University, Campus Heart, Southfield Rd, Middlesbrough, TS1 3BX, UK
| | - Elizabeth Tydeman
- Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Penny Blair
- Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Orla Hugueniot
- Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Natalie Gold
- Public Health England Behavioural Insights, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Tim Chadborn
- Public Health England Behavioural Insights, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
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Chadi N, Winickoff JP, Drouin O. Parental Optimism and Perceived Control over Children's Initiation of Tobacco, Cannabis, and Opioid Use. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6181. [PMID: 32858864 PMCID: PMC7504556 DOI: 10.3390/ijerph17176181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/05/2020] [Accepted: 08/23/2020] [Indexed: 11/17/2022]
Abstract
Families play an important role in helping teenagers avoid using tobacco, cannabis, and opioids, but some parents may underestimate the risk of their children using those substances. This study aimed to determine parents' perceived likelihood of their child initiating tobacco, cannabis, and opioid use, as well as the control they have in preventing their child from using those substances. We surveyed 427 parents of children aged 0-18 years old using the online Amazon Mechanical Turk platform in the spring of 2019. We measured participants' perceived likelihood of their child initiating tobacco, cannabis, or opioid use before the age of 18 compared to other children, using a five-point Likert scale. This perceived likelihood was dichotomized between optimistic (less likely than average) and non-optimistic (average or more likely than average). Independent variables included parental tobacco use, perceived parental control, and perceived severity of the behavior. Participants with missing data and participants with children who had already initiated substance use were excluded from statistical analyses. Mean age of participants was 38.1 years (Standard Deviation 8.4); 67% were female. Level of parental optimism was 59% for cannabis, 77% for tobacco, and 82% for opioids. Perceived severity was significantly lower for cannabis use (71/100) than tobacco (90/100) and opioid use (92/100) (p < 0.001). Current smokers were less likely than never smokers to be optimistic about their child's risk of initiating using tobacco (Adjusted Odds Ratio (AOR): 0.18 [95% Confidence Interval (CI) 0.10-0.34]) or cannabis (AOR: 0.21 [95% CI 0.12-0.38]). Parental perceived likelihood of a child initiating substance use represents an understudied and potential target for substance use prevention.
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Affiliation(s)
- Nicholas Chadi
- Sainte-Justine University Hospital Centre, Division of Adolescent Medicine, Department of Pediatrics, University of Montreal, Montreal, QC H3T 1C5, Canada
| | - Jonathan P. Winickoff
- Massachusetts General Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA 02114, USA;
| | - Olivier Drouin
- Sainte-Justine University Hospital Centre, Division of General Pediatrics, Department of Pediatrics, University of Montreal, Montreal, QC H3T 1C5, Canada;
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Hoeeg D, Christensen U, Grabowski D. Intra-familial health polarisation: how diverse health concerns become barriers to health behaviour change in families with preschool children and emerging obesity. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:1243-1258. [PMID: 32304261 DOI: 10.1111/1467-9566.13091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In a disadvantaged rural area in Denmark, severe challenges have been identified concerning overweight and obesity in families with preschool-age children. The present paper examines how families with young children and emerging obesity issues perceive 'healthy living' and barriers to practising it. Using data from qualitative workshops with families and professionals working with them, we reveal health perceptions and related family dynamics. Drawing on P. Bourdieu's theory of habitus and 'tastes of necessity', K.L. Frohlich et al.'s notion of 'collective lifestyles' and E. Lindbladh and C. H. Lyttken's theory of preconditions for health behaviour change and reactions to risk-related information, we analyse how risk perceptions and related health practices within the families are influenced by the local contexts in the disadvantaged area under study. Despite shared perceptions of 'healthy living', we found that diverse health-risk perceptions created family dynamics in which parents performed opposed health behaviours, which became a huge barrier to becoming a healthier family. Based on our theoretical approach, we propose that risk perceptions and reactions are highly context dependent, as illustrated in both micro-contexts (family dynamics) and the macro-context (the disadvantaged area).
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Affiliation(s)
- Didde Hoeeg
- Department of Health Promotion, Steno Diabetes Centre Copenhagen, Gentofte, Denmark
| | - Ulla Christensen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Dan Grabowski
- Department of Health Promotion, Steno Diabetes Centre Copenhagen, Gentofte, Denmark
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Lauer R, Traub M, Hansen S, Kilian R, Steinacker JM, Kesztyüs D. Longitudinal changes and determinants of parental willingness to pay for the prevention of childhood overweight and obesity. HEALTH ECONOMICS REVIEW 2020; 10:15. [PMID: 32468490 PMCID: PMC7257510 DOI: 10.1186/s13561-020-00266-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 03/27/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Willingness to Pay (WTP) is an alternative to measure quality-adjusted life years for cost-effectiveness analyses. The aim was to evaluate longitudinal changes and determinants of parental WTP for the prevention of childhood overweight and obesity. METHODS Longitudinal data from post- (T2) and follow-up (T3) measurements of a school-based health promotion program in Germany. Parental questionnaires included general WTP and the corresponding amount to reduce incidental childhood overweight and obesity by half. Longitudinal differences were examined with the McNemar test for general WTP and the Wilcoxon signed-rank test for the amount of WTP. Regression analyses were conducted to detect determinants. RESULTS General parental WTP significantly decreased from 48.9% to 35.8% (p < 0.001, n = 760). Logistic regression analysis (n = 561) showed that parents with a tertiary education level and a positive general WTP at T2, families with a higher monthly household income, and those with abdominally obese children were significant predictors of general WTP at T3. Median amount of WTP at T3 was €20.00 (mean = €27.96 ± 26.90, n = 274). Assuming a WTP of €0 for those who were generally not willing to pay or did not answer, resulted in a median amount of WTP at T3 of €0 (m = €8.45, sd = €19.58, n = 906). According to linear regression analysis WTP at T2 was the only significant predictor for the amount of WTP at T3 (p = 0.000, n = 181). CONCLUSIONS Despite the decline of general WTP, these results are a reflection of the public awareness of the problem and the need for action. Policy makers should recognize this and initiate sustainable public preventive strategies. TRIAL REGISTRATION DRKS, DRKS00000494. Registered 25 August 2010, https://www.drks.de/drks_web/.
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Affiliation(s)
- Romy Lauer
- Division of Sport and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
| | - Meike Traub
- Division of Sport and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
- Department of University Sports / Workplace Health Management, Ulm University, Ulm, Germany
| | - Sylvia Hansen
- Ceres - Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health, Unversity of Cologne, Cologne, Germany
| | - Reinhold Kilian
- Section Health Economics and Health Services Research, Department of Psychiatry II, Ulm University Medical Center, Günzburg, Germany
| | | | - Dorothea Kesztyüs
- Division of Sport and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
- Institute of General Practice, Ulm University Medical Center, Ulm, Germany
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Drouin O, Winickoff JP, Thorndike AN. Parental Optimism About Children's Risk of Future Tobacco Use and Excessive Weight Gain. Acad Pediatr 2019; 19:90-96. [PMID: 30248470 DOI: 10.1016/j.acap.2018.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/12/2018] [Accepted: 09/18/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Adults tend to underestimate their personal risk of disease, but little is known about parents' perceptions of children's risk. METHODS In total, 648 parents of children 0 to 18 years old attending 2 pediatric practices were surveyed about their children's exposure to smoking; 344 parents with children ≥2 years old also were asked about their children's sugar-sweetened beverage (SSB) consumption and physical activity. Children were categorized as "at risk" or "not at risk" for each factor. Parents estimated the risk of their child becoming a smoker or gaining excessive weight and were categorized as "optimistic" if they believed their children were less likely than others to use tobacco or gain weight. RESULTS Overall, 92% of parents thought their children were at lower risk than average for tobacco use, and 86% believed their children were at lower risk for excessive weight gain. A high frequency of optimistic bias occurred even among parents with "at-risk" children, including parents with children exposed to tobacco use (70.4%), SSB consumption (77.6%), >2 hours of screen time (82.1%), and low physical activity (84.1%). In multivariable analyses, parents with children exposed to tobacco smoke (odds ratio = 0.21, 95% confidence interval, 0.09-0.51); or who consumed SSBs daily (odds ratio = 0.44, 95% confidence interval 0.20-0.97) were less likely to be optimistic about their child's future tobacco use and excessive weight gain, respectively. CONCLUSIONS Most parents believed their children were at lower risk than average for tobacco use or excessive weight gain. Eliciting parents' optimistic biases might facilitate behavior change counseling in pediatric settings.
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Affiliation(s)
- Olivier Drouin
- Division of General Academic Pediatrics (O Drouin and JP Winickoff); Harvard-wide Pediatric Health Services Research Fellowship (O Drouin).
| | - Jonathan P Winickoff
- Division of General Academic Pediatrics (O Drouin and JP Winickoff); Harvard Medical School (JP Winickoff and AN Thorndike), Boston, Mass; Julius B. Richmond Center of Excellence, American Academy of Pediatrics (JP Winickoff), Itasca, Ill
| | - Anne N Thorndike
- Division of General Internal Medicine, Department of Medicine (AN Thorndike), Massachusetts General Hospital; Julius B. Richmond Center of Excellence, American Academy of Pediatrics (JP Winickoff), Itasca, Ill
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Wright DR, Christakis DA, Lozano P, Saelens BE. Healthy, Wealthy, and Wise? Exploring Parent Comparative Optimism About Future Child Outcomes. MDM Policy Pract 2018; 3:2381468318774776. [PMID: 30288445 PMCID: PMC6157425 DOI: 10.1177/2381468318774776] [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: 09/01/2017] [Accepted: 03/27/2018] [Indexed: 12/02/2022] Open
Abstract
Objectives. Comparative optimism is present in parental predictions of their child’s long-term, obesity-related health outcomes and some of this optimism is unrealistic. An understanding of how comparative optimism relates to parents’ predictions of health versus other child outcomes could contribute to the development of interventions and strategies pediatricians can use to improve risk assessment. Methods. In a nationally representative survey, we asked American parents of 6- to 17-year-old children (n = 410) to estimate the chances that their child and “a typical child in their community” would be affected by overweight, get married, and complete a 4-year college degree by age 30, and the child’s future salary at age 30. We collected data on family demographic and health characteristics. We modeled the difference in parent predictions for their child versus the typical child using multivariate linear regressions. Results. Compared to the typical child, parents were less likely to predict that their child would be affected by overweight (−26.6 percentage points, 95% confidence interval [CI]: −35.6, −17.7) and more likely to predict that their child would complete a 4-year degree (16.7 percentage points, 95% CI: 2.5, 31.0). Parents predicted their child would have a higher income than the typical child at age 30 ($15,266, 95% CI: $7,487, $23,046). Parents did not predict that their child would be more likely than the typical child to be married by age 30 (−2.2 percentage points, 95% CI: −8.1, 3.7). Conclusions. Some parents appear to exhibit comparative optimism around their child’s future weight status, education, and economic outcomes, but not marriage. Future experimental work should assess whether risk communication approaches that consider optimism bias influence parent risk perception and parenting behaviors.
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Affiliation(s)
- Davene R Wright
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Dimitri A Christakis
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Paula Lozano
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Brian E Saelens
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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Priest M. Are Obese Children Abused Children? Hastings Cent Rep 2018; 48:31-41. [DOI: 10.1002/hast.871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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