A review of family and environmental correlates of health behaviors in high-risk youth

Tracking the Prevalence of Obesity in Portuguese School-Aged Children: What Future to Expect?

BACKGROUND

Childhood obesity presents a significant public health concern globally, with implications for cardiovascular health and metabolic syndrome. In Portugal, approximately 31.6% of children are affected, highlighting the urgency for intervention strategies. This study aimed to assess the prevalence of overweight and obesity in Portuguese school-aged children, with a focus on sex and age differences.

METHODS

Anthropometric measurements were conducted on 1564 children aged 6-10 years, including weight, height, and skinfold thickness. Body Mass Index (BMI) and the percentage of body fat were calculated using established methods.

RESULTS

The results revealed significant differences in BMI (≤0.001) and body fat percentage (≤0.001) among different BMI categories, with a notable prevalence of overweight and obesity, particularly among boys. A total of 37% of the studied population is overweight or obese, among which 40.1% and 33.9% are boys and girls, respectively.

CONCLUSIONS

This study highlights statistically significant differences in BMI and body fat percentage for both sexes in different BMI categories. A large proportion of the population is overweight or obese, with a greater prevalence in boys. In short, childhood obesity has a negative impact on body composition and is associated with significant differences in anthropometric parameters, emphasizing the importance of preventative and intervention strategies to address this health problem.

Reprint of: Determining the association between grocery nutrition scores and number of medications taken for metabolic syndrome: A pilot study

BACKGROUND

Metabolic syndrome is a cluster of disease states that increases an individual's risk of developing diabetes or cardiovascular disease. When treating metabolic syndrome, lifestyle and diet are primary areas for interventions. A dietician-led grocery nutrition system scoring patients' purchases may correlate to better control of metabolic health.

OBJECTIVE

To compare the number of medications taken for metabolic syndrome for patients with grocery nutrition scores at goal versus those below goal as pre-defined by the dietician team.

PRACTICE DESCRIPTION

This exploratory, retrospective cohort pilot study took place in a single pharmacy within a large community pharmacy chain in Northwest Ohio.

PRACTICE INNOVATION

This retrospective cohort study compared the number of medications taken for metabolic syndrome between two groups: patients with a grocery nutrition score at a dietician-set goal and patients not at goal.

EVALUATION METHODS

Data were collected from May 2022 to March 2023, with patients completing a questionnaire collecting information on demographics. In addition, the questionnaire, grocery nutrition scores, and patient medication records were collected. Descriptive statistics were calculated for demographic items. A number of medications taken for metabolic syndrome by patients at dietician-set grocery nutrition score goal and not at goal were compared using a Mann-Whitney U test.

RESULTS

A total of 40 patients were enrolled in this study. There was not a significant difference in a number of medications taken for metabolic syndrome between groups, with patients who had a grocery nutrition score at goal taking an average of 1.20 medications compared to 1.96 for those with grocery nutrition scores below goal.

CONCLUSIONS

While no statistical difference in mean medication use was identified, grocery nutrition scores may help understand patients' dietary habits. Larger studies are required to test the relationship between grocery nutrition scores, patient-specific factors, and medications taken for metabolic syndrome.

Determining the association between grocery nutrition scores and number of medications taken for metabolic syndrome: A pilot study

BACKGROUND

Metabolic syndrome is a cluster of disease states that increases an individual's risk of developing diabetes or cardiovascular disease. When treating metabolic syndrome, lifestyle and diet are primary areas for interventions. A dietician-led grocery nutrition system scoring patients' purchases may correlate to better control of metabolic health.

OBJECTIVE

To compare the number of medications taken for metabolic syndrome for patients with grocery nutrition scores at goal versus those below goal as pre-defined by the dietician team.

PRACTICE DESCRIPTION

This exploratory, retrospective cohort pilot study took place in a single pharmacy within a large community pharmacy chain in Northwest Ohio.

PRACTICE INNOVATION

This retrospective cohort study compared the number of medications taken for metabolic syndrome between two groups: patients with a grocery nutrition score at a dietician-set goal and patients not at goal.

EVALUATION METHODS

Data were collected from May 2022 to March 2023, with patients completing a questionnaire collecting information on demographics. In addition, the questionnaire, grocery nutrition scores, and patient medication records were collected. Descriptive statistics were calculated for demographic items. A number of medications taken for metabolic syndrome by patients at dietician-set grocery nutrition score goal and not at goal were compared using a Mann-Whitney U test.

RESULTS

A total of 40 patients were enrolled in this study. There was not a significant difference in a number of medications taken for metabolic syndrome between groups, with patients who had a grocery nutrition score at goal taking an average of 1.20 medications compared to 1.96 for those with grocery nutrition scores below goal.

CONCLUSIONS

While no statistical difference in mean medication use was identified, grocery nutrition scores may help understand patients' dietary habits. Larger studies are required to test the relationship between grocery nutrition scores, patient-specific factors, and medications taken for metabolic syndrome.

Use of Focus Groups to Inform a New Community-Based Youth Diabetes Prevention Program

There have been few youth-led diabetes prevention programs. Our objective was to conduct focus groups to explore peer influences on adolescent lifestyle behaviors and strategies for implementing a youth peer education model for diabetes prevention. We conducted six focus groups with 52 youth (ages 13-22; 62% male, 38% female; 64% Hispanic, 36% non-Hispanic Black) from East Harlem, NYC. We used a Thematic Analysis approach to identify major themes, compared findings, and resolved differences through discussion and consensus. Three dominant themes arose: (1) Adolescents generally encounter more unhealthy peer influences on diet and more healthy peer influences on physical activity; (2) Adolescents endorse youth-led diabetes prevention strategies and describe ideal qualities for peer leaders and methods to support and evaluate leaders; (3) Adolescents prefer text messaging to monitor behaviors, track goals, and receive personalized guidance. Using study findings, our Community Action Board developed a peer-led diabetes prevention program for prediabetic adolescents.

Examining the state, quality and strength of the evidence in the research on built environments and physical activity among children and youth: An overview of reviews from high income countries

BACKGROUND

Built environments have shown to be associated with health, with physical activity (PA) considered one of the critical pathways for achieving benefits. Navigating available evidence on the built environment and PA is challenging given the number of reviews.

OBJECTIVE

Examine the current state and quality of research looking at associations between built environments and total PA and domains of PA (i.e., leisure/recreation, transportation, school) among children and youth (1-18 years).

METHODS

We systematically searched the grey literature and six bibliographic databases from January 2000 to May 2020. Review quality was assessed using the AMSTAR2. Results by age group were synthesized using narrative syntheses and harvest plots, and certainty of the evidence was assessed using a modified GRADE approach.

RESULTS

This overview included 65 reviews. Most reviews were of very low-to-low quality. High certainty was found for positive associations between transportation PA and walking/cycling/active transportation (AT) infrastructure. There was high certainty for positive associations between streets/play streets and total PA, alongside lower certainty for transportation and leisure PA. Very low-to-moderate certainty supports schoolyards designed to promote PA were positively associated with total PA, but mixed for school PA (except children). Less consistent positive associations were found for forests/trees, greenspace/open space, recreation facilities, street lighting, traffic safety, population/residential density, proximity/access to destinations, neighbourhood characteristics, and home environments. There is very low-to-moderate certainty for negative associations between greater distance to school and traffic volume and domains of PA. Generally, null or mixed associations were observed for aesthetics, parks, AT comfort infrastructure, land-use mix, street connectivity, urban/rural status, and public transit.

DISCUSSION

There remains a need for high quality systematic reviews and studies to evaluate the effects of environmental changes across the pediatric age spectrum and using a PA domain approach. Given the global physical inactivity crisis the built environment remains and important means to promote PA among children/youth.

Determinants of vegetable intake among urban socio-economically disadvantaged adolescents: a systematic review of quantitative studies

OBJECTIVE

To investigate the determinants of vegetable intake in urban socio-economically disadvantaged adolescents to inform the development of an intervention programme.

DESIGN

A narrative systematic review was carried out by searching five electronic databases from 2013 to 2020. The descriptors used for the search strategy were vegetable intake, adolescents, determinants and correlates. Inclusion criteria were including a sample of socio-economically disadvantaged adolescents aged 12-18 years, evaluation of the association between vegetable intake and determinants of intake, and conducted in urban settings of high-income countries. Thirteen studies met the inclusion criteria. Identified determinants of vegetable intake were reported according to the five levels of the socio-ecological model of health.

SETTING

Studies included in the review were conducted in four countries: USA (n 8), Australia (n 3), Ireland (n 1) and New Zealand (n 1).

PARTICIPANTS

Adolescents aged 12-18 years from socio-economically disadvantaged backgrounds living in urban settings.

RESULTS

Thirty-nine determinants were identified. Nutrition knowledge was the only determinant consistently investigated in several independent samples which was not associated with vegetable intake in socio-economically disadvantaged adolescents. For the remaining potential determinants, it was not possible to examine the consistency of evidence as there were not enough studies investigating the same determinants. Most of the studies followed a cross-sectional design and were carried out in school settings.

CONCLUSIONS

There is a need for further studies on the determinants of vegetable intake in this population preferably with longitudinal designs and beyond the school setting in different countries to guide the development of successful interventions.

Dynamics of the complex food environment underlying dietary intake in low-income groups: a systems map of associations extracted from a systematic umbrella literature review

Background

Inequalities in obesity pertain in part to differences in dietary intake in different socioeconomic groups. Examining the economic, social, physical and political food environment of low-income groups as a complex adaptive system – i.e. a system of multiple, interconnected factors exerting non-linear influence on an outcome, can enhance the development and assessment of effective policies and interventions by honouring the complexity of lived reality. We aimed to develop and apply novel causal loop diagramming methods in order to construct an evidence-based map of the underlying system of environmental factors that drives dietary intake in low-income groups.

Methods

A systematic umbrella review was conducted on literature examining determinants of dietary intake and food environments in low-income youths and adults in high/upper-middle income countries. Information on the determinants and associations between determinants was extracted from reviews of quantitative and qualitative studies. Determinants were organised using the Determinants of Nutrition and Eating (DONE) framework. Associations were synthesised into causal loop diagrams that were subsequently used to interpret the dynamics underlying the food environment and dietary intake. The map was reviewed by an expert panel and systems-based analysis identified the system paradigm, structure, feedback loops and goals.

Results

Findings from forty-three reviews and expert consensus were synthesised in an evidence-based map of the complex adaptive system underlying the food environment influencing dietary intake in low-income groups. The system was interpreted as operating within a supply-and-demand, economic paradigm. Five sub-systems (‘geographical accessibility’, ‘household finances’, ‘household resources’, ‘individual influences’, ‘social and cultural influences’) were presented as causal loop diagrams comprising 60 variables, conveying goals which undermine healthy dietary intake.

Conclusions

Our findings reveal how poor dietary intake in low-income groups can be presented as an emergent property of a complex adaptive system that sustains a food environment that increases the accessibility, availability, affordability and acceptability of unhealthy foods. In order to reshape system dynamics driving unhealthy food environments, simultaneous, diverse and innovative strategies are needed to facilitate longer-term management of household finances and socially-oriented practices around healthy food production, supply and intake. Ultimately, such strategies must be supported by a system paradigm which prioritises health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01164-1.

Patterns of daily activity among young people with epilepsy

AIM

To: (1) explore how young people with epilepsy spend time on physical activity, screen-time, and sleep in a 24-hour period; (2) compare these findings to young people without epilepsy; and (3) evaluate the findings relative to the Canadian 24-hour movement guidelines for children and youth.

METHOD

The study is based on Canadian data from the 2013 to 2014 'Health Behaviour in School-aged Children study' (HBSC), a cross-sectional sample of young people aged 10 to 17 years. Three groups participated: 163 young people with epilepsy, 3613 young people with non-neurological conditions, and 18 339 population norms. Self-reported activity data were compared across groups.

RESULTS

Demographics were similar across groups. Young people with epilepsy spent 5.8 hours per week on moderate-to-vigorous physical activity versus 5.6 hours per week in population norms; 32% met the recommended 1 hour or more per day. Screen-time was 8.7 hours per day versus 7.4 hours per day in population norms; only 5.4% met the 2 hours or less per day recommendation. Sleep duration was 10.2 hours per day versus 9.8 hours per day in population norms, and 50.7% met the recommendation. Overall, 25.7% of young people with epilepsy did not meet any of the guidelines, 60.5% met one, 13.5% met two, and 0.3% met all three recommendations; whereas 2.8% of population norms and 2% of young people with non-neurological conditions met all three recommendations.

INTERPRETATION

These data could inform future interventions and alert policy-makers, health care professionals, parents, educators, and advocacy-groups to the low adherence of young people with epilepsy with Canadian guidelines and their risk for poor health.

WHAT THIS PAPER ADDS

Young people with epilepsy adhere poorly to Canadian guidelines for daily sleep duration, physical activity, and sedentary screen time. Young people with epilepsy accumulate more screen-time than those with non-neurological conditions or population norms.

Predicting Hawaiian Youth's Physical Activity and Fruit and Vegetable Consumption Behaviors: A 10-Year Cohort Study

Background: Health behaviors in childhood and adolescence are implicated in health behaviors and chronic disease risk in adulthood for the majority of the US population. However, little is known about these relationships in Hawaiian youth. This study investigated the extent to which childhood physical activity (PA) and fruit and vegetable consumption behaviors predicted later behaviors across a 10-year period in Hawaiian youth. Methods: Three cohorts of fourth- to sixth-grade students who participated in an elementary after-school program (Fun 5) provided baseline data (Y1-data collected between 2003 and 2007), 5-year (Y5-data collected between 2008 and 2012), and 10-year (Y10-data collected between 2013 and 2017) follow-up surveys. Demographic, PA, and fruit and vegetable consumption measures were completed at all 3 time points. Bivariate and multiple regressions were computed in 2018. Results: Y1 and Y5 behavior predicted PA in young adulthood. For fruit and vegetable consumption, Y1 behavior predicted Y5 behavior but not Y10 behavior, and Y5 behavior predicted Y10 behaviors. Conclusions: Similar to mainland US youth, it is important to address PA and nutrition early in the life span for Hawaiian youth to increase long-term preventive health behaviors and reduce long-term chronic disease risk.

Built Environment and Health Behaviors: Deconstructing the Black Box of Interactions-A Review of Reviews

A review of reviews following a scoping review study design was conducted in order to deconstruct the black box of interactions between the built environment and human behaviors pertaining to physical activity and/or diet. In the qualitative analysis 107 records were included, 45 of which were also coded. Most review papers confirmed the influence of the built environment on the behaviors of interest with some noting that a same built environment feature could have different behavioral outcomes. The conceptual model developed sheds light on these mixed results and brings out the role of several personal and behavioral factors in the shift from the measured to the perceived built environment. This shift was found to shape individuals' behaviors critically and to have the power of redefining the strength of every interaction. Apart from its theoretical relevance, this model has high practical relevance especially for the design and implementation of interventions with a behavioral component. Intervention researchers can use the model developed to identify and label the built environment and individual factors that can be measured objectively or perceived as facilitators, concurrent options and barriers, in order to develop comprehensive and multi-component intervention strategies.

Neighbourhood social capital and obesity: a systematic review of the literature

Social capital, defined as the resources accessed by individuals and groups through social connections, has been posited to be a social determinant of obesity. However, empirical evidence for this association has been inconsistent - namely, some studies have found a protective association while others have reported no correlation. We sought to conduct a systematic review on the relation between neighbourhood social capital and obesity, considering potential differences on the results based on the measures used and the covariates and mediators included in the studies. PRISMA statement guidelines were followed. Our results indicate that an association between neighbourhood social capital and obesity exists, but that it depends on the measures and covariates used in the study design. Understanding the role of social capital in the development and/or maintenance of obesity will require the use of strong methodological designs and a thorough conceptualization of how this relationship may arise.

Childcare Correlates of Physical Activity, Sedentary Behavior, and Adiposity in Preschool Children: A Cross-Sectional Analysis of the SPLASHY Study

Background

The childcare (CC) environment can influence young children's physical activity (PA), sedentary behavior (SB), and adiposity. The aim of the study was to identify a broad range of CC correlates of PA, SB, and adiposity in a large sample of preschoolers.

Methods

476 preschool children (mean age 3.9 yrs; 47% girls) participated in the Swiss Preschoolers' Health Study (SPLASHY). PA and SB were measured by accelerometry. Outcome measures included total PA (TPA), moderate-to-vigorous PA (MVPA), SB, body mass index (BMI), and skinfold thickness (SF). PA measures consisted of both daily PA during CC attendance days and overall daily PA (CC and non-CC days).

Results

We identified the following CC correlates for higher TPA and/or higher MVPA or lower SB during CC attendance days: older age, sex (boys), more frequent child-initiated interactions during CC, mixing different ages within a group, and the presence of a written PA policy in the CC (all p ≤ 0.02). The CC correlates for overall TPA and/or MVPA or lower overall SB including both CC and non-CC days were the following: older age, sex (boys), more frequent child-initiated interactions during CC, mixing different ages within a group, less parental PA involvement in the CC, and having a larger surface area in CC (all p ≤ 0.046). Correlates for lower SF were sex (boys) and parental PA involvement in the CC (all p ≤ 0.02), and, for lower BMI, only increased age (p=0.001) was a correlate.

Conclusions

More frequent child-initiated interactions and mixing different ages in CC, the presence of a written PA policy, and a larger CC surface are correlates of PA and SB during CC attendance days and/or of overall PA. Parental involvement in CC PA projects was a correlate for reduced body fat. These novel factors are mostly modifiable and can be tackled/addressed in future interventions.

Life Satisfaction in Adolescents: The Role of Individual and Social Health Assets

The aim of this study is to explore the relationship between adolescents' life satisfaction and individual and social health assets. A nationally representative sample of 3,494 Portuguese adolescents (mean age = 14.94 ± 1.30 years; 53.6% girls) completed the Health Behavior in School-aged Children survey measuring a variety of health behaviors and beliefs. A sequential regression analysis was conducted with gender, individual assets (academic achievement, social competence, self-regulation and life objectives) and social assets (family support, peer support, parental monitoring and school connectedness) entered in separate steps. A second regression analysis was conducted with social assets entered before individual assets. The final model explained 18.3% of life satisfaction. School connectedness (β = .198, p < .001) and family support (β = .154, p < .001) were the strongest predictors of adolescents' life satisfaction followed by social competence (β = .152, p < .001), academic achievement (β = .116, p < .001) and self-regulation (β = .064, p < .001). Social assets explained a larger variance of life satisfaction than individual assets when entered first in the regression (r2 = .134 and r2 = .119, respectively, p < .001). When entered last step in the regression analysis, social assets added more to life satisfaction's variance than when individual assets were added in the last step (r2 = .060 and r2 = .045, respectively, p < .001). These results reinforce the role social interaction and social capital models in the promotion of well-being.

Predicting weight status in Chinese pre-school children: independent and interactive effects of caregiver types and feeding styles

Objective

To investigate caregiver type as a potential moderating effect in the relationship between feeding style and weight status among Chinese pre-school children.

Design

Cross-sectional data collected with the Caregiver’s Feeding Style Questionnaire (CFSQ), anthropometric data, childcare and sociodemographic information.

Setting

Shenyang, China.

Subjects

Caregiver–child dyads (n 857).

Results

After controlling for confounders, authoritarian feeding style was associated with a 0·30 lower BMI Z-score. Fathers as primary caregivers were related to lower BMI Z-score (β=−0·66), while grandparents as main caregivers were associated with higher BMI Z-score (β=0·66) after adjusting for covariates. Mothers buffered the relationship between authoritarian (β=0·50, 95 % CI 0·04, 0·95) or indulgent (β=−0·60, 95 % CI −1·06, −0·14) feeding styles and BMI Z-score. Grandparents strengthened the trend that indulgent feeding style was related to higher BMI Z-score (β=0·54, 95 % CI 0·01, 1·08).

Conclusions

The results of independent and interactive effects of specific feeding styles and caregiver types had different influences on child BMI Z-scores. Longitudinal investigations are needed to evaluate the effect of fathers’ and grandparents’ feeding on their children’s nutrition and weight status.

Correlates of mobile screen media use among children aged 0-8: a systematic review

OBJECTIVE

This study is a systematic review of the peer-reviewed literature to identify the correlates of mobile screen media use among children aged 8 years and less.

SETTING

Home or community-based studies were included in this review while child care or school-based studies were excluded.

PARTICIPANTS

Children aged 8 years or less were the study population. Studies that included larger age groups without subgroup analysis specific to the 0-8 years category were excluded. Eight electronic databases were searched for peer-reviewed English language primary research articles published or in press between January 2009 and March 2017 that have studied correlates of mobile screen media use in this age group.

OUTCOME MEASURE

Mobile screen media use was the primary outcome measure. Mobile screen media use refers to children's use of mobile screens, such as mobile phones, electronic tablets, handheld computers or personal digital assistants.

RESULTS

Thirteen studies meeting the inclusion criteria were identified of which a total of 36 correlates were examined. Older children, children better skilled in using mobile screen media devices, those having greater access to such devices at home and whose parents had high mobile screen media use were more likely to have higher use of mobile screen media devices. No association existed with parent's age, sex and education.

CONCLUSION

Limited research has been undertaken into young children's mobile screen media use and most of the variables have been studied too infrequently for robust conclusions to be reached. Future studies with objective assessment of mobile screen media use and frequent examination of the potential correlates across multiple studies and settings are recommended.

TRIAL REGISTRATION NUMBER

This review is registered with PROSPERO International Prospective Register of Ongoing Systematic Reviews (registration number: CRD42015028028).

Home Sweet Home: Parent and Home Environmental Factors in Adolescent Consumption of Sugar-Sweetened Beverages

OBJECTIVE

Sugar-sweetened beverages (SSBs) are key contributors to obesity among youth. We investigated associations among parental and home-related factors (parental attitudes and consumption; home availability) regarding 3 types of SSBs-soda, sports drinks, and fruit-flavored drinks-with consumption of each type of SSB in a general school-based sample of adolescents.

METHODS

Data were collected across 3 school semesters, from 2009 to 2011. A total of 1313 seventh grade student-parent dyads participated. Students completed in-class surveys across 9 schools in a large Los Angeles school district; their parents completed telephone interviews. Youth were asked about their SSB consumption (soda, sports drinks, and fruit-flavored drinks), and parents were asked about their attitudes, consumption, and home availability of SSBs.

RESULTS

We estimated expected rates of youth SSB consumption for hypothetical parents at very low (5th) and very high (95th) percentiles for home/parental risk factors (ie, they consumed little, had negative attitudes, and did not keep SSBs in the home; or they consumed a lot, had positive attitudes, and did keep SSBs in the home). Youth of lower-risk parents (at the 5th percentile) were estimated to drink substantially less of each type of beverage than did youth of higher-risk parents (at the 95th percentile). For example, youth with higher-risk parents averaged nearly double the SSB consumption of youth of lower-risk parents (2.77 vs 1.37 glasses on the previous day; overall model significance F_22,1312 = 3.91, P < .001).

CONCLUSIONS

Results suggest a need to focus on parental and home environmental factors when intervening to reduce youths' SSB consumption.

Do family environment factors play a role in adolescents' involvement in organized activities?

The study assessed the association of family environment factors with adolescents' participation in organized leisure-time activities (OLTA). We used data on 10,472 Czech adolescents aged 11-15 years (49.2% boys) from the 2013/2014 Health Behaviour in School-aged Children study. The associations of family support, the presence of parental screen-time rules and joint family activities with participation in at least one OLTA were assessed using logistic regression. High family support and the presence of parental screen-time rules were associated with higher odds of OLTA participation. Moreover, adolescents playing sports, indoor games and going for walks with their families at least weekly were more likely to participate in OLTA. Conversely, those spending time in joint family TV/video watching on most days were less likely to do so. A supportive family environment and direct parental involvement in their adolescent children's leisure are associated with OLTA participation in early to middle adolescence.

The role of neighborhood characteristics and the built environment in understanding racial/ethnic disparities in childhood obesity

BACKGROUND

Childhood obesity prevalence remains high and racial/ethnic disparities may be widening. Studies have examined the role of health behavioral differences. Less is known regarding neighborhood and built environment mediators of disparities. The objective of this study was to examine the extent to which racial/ethnic disparities in elevated child body mass index (BMI) are explained by neighborhood socioeconomic status (SES) and built environment.

METHODS

We collected and analyzed race/ethnicity, BMI, and geocoded address from electronic health records of 44,810 children 4 to 18years-old seen at 14 Massachusetts pediatric practices in 2011-2012. Main outcomes were BMI z-score and BMI z-score change over time. We used multivariable linear regression to examine associations between race/ethnicity and BMI z-score outcomes, sequentially adjusting for neighborhood SES and the food and physical activity environment.

RESULTS

Among 44,810 children, 13.3% were black, 5.7% Hispanic, and 65.2% white. Compared to white children, BMI z-scores were higher among black (0.43units [95% CI: 0.40-0.45]) and Hispanic (0.38 [0.34-0.42]) children; black (0.06 [0.04-0.08]), but not Hispanic, children also had greater increases in BMI z-score over time. Adjusting for neighborhood SES substantially attenuated BMI z-score differences among black (0.30 [0.27-0.34]) and Hispanic children (0.28 [0.23-0.32]), while adjustment for food and physical activity environments attenuated the differences but to a lesser extent than neighborhood SES.

CONCLUSIONS

Neighborhood SES and the built environment may be important drivers of childhood obesity disparities. To accelerate progress in reducing obesity disparities, interventions must be tailored to the neighborhood contexts in which families live.

Physical Activity Self-Efficacy and Fitness: Family Environment Relationship Correlates and Self-Esteem as a Mediator among Adolescents Who Are Overweight or Obese

BACKGROUND

Little is known regarding how dimensions of the family social environment relate to fitness levels and physical activity self-efficacy (PASE) among adolescents who are overweight or obese and whether these relationships are mediated by self-esteem.

METHODS

Potential associations were evaluated between relationship subdomains (cohesion, conflict, expressivity) of the Family Environment Scale (FES), self-esteem (Rosenberg Self-Esteem Scale, RSES), and PASE and fitness, using recovery heart rate [RHR, beats per minute (bpm)] from a 3-minute submaximal step test at baseline. Participants were 108 adolescents who were overweight or obese and were seeking weight-loss treatment as part of the Healthy Kids, Healthy Weight 12-week multidisciplinary pediatric weight management program. Structural equation modeling (SEM) was used to simultaneously evaluate paths between these variables and test for mediation.

RESULTS

In multivariable models, higher FES cohesion (β = -2.18, s.e. = 0.98; p = 0.02), expressivity (β = -1.97, s.e. = 0.99; p < 0.05), and PASE (β = -0.64, s.e. = 0.33; p < 0.05) scores were associated with lower RHR, which represents higher fitness. Furthermore, higher FES conflict scores were associated with lower RSES scores (β = -0.83, s.e. = 0.29; p < 0.01), and FES conflict (β = -0.63, s.e. = 0.22; p < 0.01) and RSES (β = 0.33, s.e. = 0.07; p < 0.01) were associated with PASE scores. In a good-fitting multivariate SEM [Comparative Fit Index (CFI) = 1.00; Standardized Root Mean Square Residual (SRMR) = 0.02; Tucker-Lewis index (TLI) = 1.22; Root Mean Squared Error of Approximation (RMSEA) <0.01], RSES mediated the relationship between FES conflict and PASE (sum of indirect paths: β = -0.30, s.e. = 0.11; p < 0.01) scores.

CONCLUSIONS

Our results highlight the importance of the relationship domain of the family environment on self-esteem, PASE, and physical fitness in adolescents who are overweight or obese.

High School Students Residing in Educational Public Institutions: Health-Risk Behaviors

Although several health-risk behaviors of adolescents have been described in the literature, data of high school students who reside at educational institutions in developing countries are scarce. This study aimed to describe behaviors associated with health risks among high school students who reside at an educational public institution and to associate these variables with the length of stay at the institution. This cross-sectional study was conducted during the year 2015 and included 122 students aged 14-19 years at a federal educational institution in the Midwest of Brazil; students were divided into residents of <8 months and those of >20 months. Information concerning the family socioeconomic status and anthropometric, dietary and behavioral profiles was investigated. Despite being physically active, students exhibited risk-associated behaviors such as cigarette and alcohol use and risky sexual behaviors that were exacerbated by fragile socioeconomic conditions and distance from family. A longer time in residence at the institution was associated with an older age (p ≤ 0.001), adequate body mass index (BMI; p = 0.02), nutritional knowledge (p = 0.01), and less doses of alcohol consumption (p ≤ 0.01) compared with those with shorter times in residence. In conclusion, the students exhibited different health-risk behaviors, and a longer institutional residence time, compared with a shorter time, was found to associate with the reduction of health-risk behaviors.

Correlates of mobile screen media use among children aged 0-8: protocol for a systematic review

BACKGROUND

Childhood is a crucial period for shaping healthy behaviours; however, it currently appears to be dominated by screen time. A large proportion of young children do not adhere to the screen time recommendations, with the use of mobile screen devices becoming more common than fixed screens. Existing systematic reviews on correlates of screen time have focused largely on the traditional fixed screen devices such as television. Reviews specially focused on mobile screen media are almost non-existent. This paper describes the protocol for conducting a systematic review of papers published between 2009 and 2015 to identify the correlates of mobile screen media use among children aged 0-8 years.

METHODS

A systematic literature search of electronic databases will be carried out using different combinations of keywords for papers published in English between January 2009 and December 2015. Additionally, a manual search of reference lists and citations will also be conducted. Papers that have examined correlates of screen time among children aged 0-8 will be included in the review. Studies must include at least one type of mobile screen media (mobile phones, electronic tablets or handheld computers) to be eligible for inclusion. This study will identify correlates of mobile screen-viewing among children in five categories: (i) child biological and demographic correlates, (ii) behavioural correlates, (iii) family biological and demographic correlates, (iv) family structure-related correlates and (v) socio-cultural and environmental correlates. PRISMA statement will be used for ensuring transparency and scientific reporting of the results.

DISCUSSION

This study will identify the correlates associated with increased mobile screen media use among young children through the systematic review of published peer-reviewed papers. This will contribute to addressing the knowledge gap in this area. The results will provide an evidence base to better understand correlates of mobile screen media use and potentially inform the development of recommendations to reduce screen time among those aged 0-8 years.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42015028028 .

Longitudinal patterns and predictors of multiple health risk behaviors among adolescents: The TRAILS study

BACKGROUND

Most studies on multiple health risk behaviors among adolescents have cross-sectionally studied a limited number of health behaviors or determinants.

PURPOSE

To examine the prevalence, longitudinal patterns and predictors of individual and multiple health risk behaviors among adolescents.

METHODS

Eight health risk behaviors (no regular consumption of fruit, vegetables or breakfast, overweight or obesity, physical inactivity, smoking, alcohol use and cannabis use) were assessed in a prospective population study (second and third wave). Participants were assessed in three waves between ages 10 and 17 (2001-2008; n=2230). Multiple linear regression was used to assess the influence of gender, self-control, parental health risk behaviors, parental monitoring and socioeconomic factors on the number of health risk behaviors adjusted for preceding multiple health risk behaviors (analysis: 2013-2014).

RESULTS

Rates of >5 health risk behaviors were high: 3.6% at age 13.5 and 10.2% at age 16. Smoking at age 13.5 was frequently associated with health risk behaviors at age 16. No regular consumption of fruit, vegetables and breakfast, overweight or obesity, physical inactivity and smoking predicted the co-occurrence of health risk behaviors at follow-up. Significant predictors of the development of multiple health risk behaviors were adolescents' levels of self-control, socioeconomic status and maternal smoking.

CONCLUSIONS

Multiple health risk behaviors are common among adolescents. Individual and social factors predict changes in multiple health risk behaviors, showing that prevention targeting multiple risk behaviors is needed. Special attention should be paid to adolescents with low self-control and families with low socioeconomic status or a mother who smokes.

Use of Focus Groups to Inform a Youth Diabetes Prevention Model

OBJECTIVE

To explore minority adolescents' perceptions of their diabetes risk, barriers and facilitators to adopting lifestyle changes, and ideas for adapting a youth diabetes prevention model.

METHODS

The study was conducted at collaborating community sites in East Harlem, NY. Trained moderators facilitated focus groups, which were audio taped and transcribed. Participants were 21 Latino and African American adolescents aged 14-18 years with a family history of diabetes and no reported personal history of diabetes. The phenomenon of interest was youth input in adapting a diabetes prevention model. Two researchers independently coded transcripts, identified major themes, compared findings, and resolved differences through discussion and consensus.

RESULTS

Dominant themes included (1) the impact of diabetes on quality of life within adolescents' personal networks; (2) conflict between changing diet and activity and their current lifestyle; (3) lifestyle choices being dictated by cost, mood, body image, and environment, not health; and (4) family, social, and environmental pressures reinforcing sedentary behaviors and unhealthy diets.

CONCLUSIONS AND IMPLICATIONS

Themes from youth focus groups were framed in the context of an existing youth diabetes prevention conceptual model, with results informing expansion of the model and identification and organization of potential intervention components.

A Conceptual Framework for the Expansion of Behavioral Interventions for Youth Obesity: A Family-Based Mindful Eating Approach

BACKGROUND

Currently, over 30% of US youth are overweight and 1 in 6 have metabolic syndrome, making youth obesity one of the major global health challenges of the 21st century. Few enduring treatment strategies have been identified in youth populations, and the majority of standard weight loss programs fail to adequately address the impact of psychological factors on eating behavior and the beneficial contribution of parental involvement in youth behavior change.

METHODS

A critical need exists to expand treatment development efforts beyond traditional education and cognitive-behavioral programs and explore alternative treatment models for youth obesity. Meditation-based mindful eating programs represent a unique and novel scientific approach to the current youth obesity epidemic given that they address key psychological variables affecting weight.

RESULTS

The recent expansion of mindfulness programs to include family relationships shows the immense potential for broadening the customarily individual focus of this intervention to include contextual factors thought to influence youth health outcomes.

CONCLUSIONS

This article provides an overview of how both mindful eating and family systems theory fits within a conceptual framework in order to guide development of a comprehensive family-based mindful eating program for overweight youth.

Family-related risk factors of obesity among preschool children: results from a series of national epidemiological surveys in China

Background

Family-based child obesity prevention and control strategy has not yet established in many countries or regions, including China, thus what it needs to do now is to continuously develop and improve the strategies. The purpose of this study were to describe a wider spectrum of risk factors of obesity among preschool children and add to the mounting evidence for further improving suggested intervention measures in future family-based programs.

Methods

Data was collected as part of a series of national epidemiological surveys in childhood conducted in 9 Chinese cities. A population-based, 1:1 matched case–control design was employed to examine risk factors of obesity by means of conditional logistic regression. Obesity was defined as the International Obesity Task Force (IOTF) BMI-for-age cut offs. Eligible subjects were 1234 boys and 610 girls aged 3–7 years in 1996 and 2290 boys and 1008 girls in 2006, including obese and non-obese.

Results

High birth weight, gestational hypertension and parents’ BMI were closely associated with childhood obesity. Breast feeding in the first 4 months was a protective factor in univariate model in 2006 (OR = 0.834, P = 0.0234), but the association was not seen in multivariate. Appetite, eating speed, daily time and intensity for outdoor activities, night sleep time, and time for TV viewing were identified statistically by multivariate model. Those children brought up in extended family or mainly raised by their grandparents or lived in high income or low education families might have an increased risk of becoming obese. Parents’ attitudes on weight control of their children significantly differed between obese and non-obese groups.

Discussion

A wider spectrum of risk factors and an empirical aggregation of family-related risk factors are discussed to further improve future family-based child obesity prevention and control strategies. Most of the risk factors identified by this study presented ranked or quantitative characteristics which might be transformed from unhealthy threshold to healthy range by behavior modification. Some variables are likely to interact each other, such as appetite and eating speed, or outdoor activity and TV viewing, or BMI and income, but which needs to be further explored in future surveys.

Conclusions

The family-related risk factors were summarized from our identified risk factors of obesity among preschool children which strongly supported the further development of family-based programs in preschool period.

Variability and Stability in Daily Moderate-to-Vigorous Physical Activity among 10 Year Old Children

Day-to-day variability and stability of children's physical activity levels across days of the week are not well understood. Our aims were to examine the day-to-day variability of moderate-to-vigorous physical activity (MVPA), to determine factors influencing the day-to-day variability of MVPA and to estimate stability of MVPA in children. The sample comprises 686 Portuguese children (10 years of age). MVPA was assessed with an accelerometer, and BMI was computed from measured height and weight. Daily changes in MVPA and their correlates (gender, BMI, and maturity) were modeled with a multilevel approach, and tracking was calculated using Foulkes &amp; Davies γ. A total of 51.3% of boys and 26.2% of girls achieved 60 min/day of MVPA on average. Daily MVPA was lower during the weekend (23.6% of boys and 13.6% of girls comply with the recommended 60 min/day of MVPA) compared to weekdays (60.8% and 35.4%, boys and girls, respectively). Normal weight children were more active than obese children and no effect was found for biological maturation. Tracking is low in both boys (γ = 0.59 ± 0.01) and girls (γ = 0.56 ± 0.01). Children's MVPA levels during a week are highly unstable. In summary, boys are more active than girls, maturation does not affect their MVPA, and obese children are less likely to meet 60 min/day of MVPA. These results highlight the importance of providing opportunities for increasing children's daily MVPA on all days of week, especially on the weekend.

The Relationship of Adverse Childhood Experiences to PTSD, Depression, Poly-Drug Use and Suicide Attempt in Reservation-Based Native American Adolescents and Young Adults

Adverse childhood experiences (ACEs) are associated with numerous risk behaviors and mental health outcomes among youth. This study examines the relationship between the number of types of exposures to ACEs and risk behaviors and mental health outcomes among reservation-based Native Americans. In 2011, data were collected from Native American (N = 288; 15-24 years of age) tribal members from a remote plains reservation using an anonymous web-based questionnaire. We analyzed the relationship between six ACEs, emotional, physical, and sexual abuse, physical and emotional neglect, witness to intimate partner violence, for those <18 years, and included historical loss associated symptoms, and perceived discrimination for those <19 years; and four risk behavior/mental health outcomes: post-traumatic stress disorder (PTSD) symptoms, depression symptoms, poly-drug use, and suicide attempt. Seventy-eight percent of the sample reported at least one ACE and 40 % reported at least two. The cumulative impact of the ACEs were significant (p < .001) for the four outcomes with each additional ACE increasing the odds of suicide attempt (37 %), poly-drug use (51 %), PTSD symptoms (55 %), and depression symptoms (57 %). To address these findings culturally appropriate childhood and adolescent interventions for reservation-based populations must be developed, tested and evaluated longitudinally.

Relationships of parental monitoring and emotion regulation with early adolescents' sexual behaviors

OBJECTIVE

The purpose of this study was to examine the moderating influence of parental monitoring (e.g., unsupervised time with opposite sex peers) and adolescent emotional competence on sexual behaviors, among a sample of at-risk early adolescents.

METHODS

This study included 376 seventh-grade adolescents (age, 12-14 years) with behavioral or emotional difficulties. Questionnaires were completed on private laptop computers and assessed adolescent Emotional Competence (including Regulation and Negativity/Lability), Unsupervised Time, and a range of Sexual Behaviors. Generalized linear models were used to evaluate the independent and combined influence of Emotional Competency and Unsupervised Time on adolescent report of Sexual Behaviors. Analyses were stratified by gender to account for the notable gender differences in the targeted moderators and outcome variables.

RESULTS

Findings indicated that more unsupervised time was a risk factor for all youth but was influenced by an adolescent's ability to regulate their emotions. Specifically, for males and females, poorer Emotion Regulation was associated with having engaged in a greater variety of Sexual Behaviors. However, lower Negativity/Lability and >1× per week Unsupervised Time were associated with a higher number of sexual behaviors among females only.

CONCLUSIONS

Based on the findings of this study, a lack of parental supervision seems to be particularly problematic for both male and female adolescents with poor emotion regulation abilities. It may be important to impact both emotion regulation abilities and increase parental knowledge and skills associated with effective monitoring to reduce risk-taking for these youth.

Family Cohesion and Moderate-to-Vigorous Physical Activity Among Mexican Origin Adolescents: A Longitudinal Perspective

BACKGROUND

Existing racial/ethnic disparities in physical activity during childhood increase Hispanics' risk of developing chronic diseases, which serves to increase health disparities. This study examined associations of family cohesion and conflict with self-reported moderate-to-vigorous physical activity (MVPA), controlling for psychosocial covariates such as subjective social status, anxiety, and sensation-seeking.

METHODS

1000 Mexican origin adolescents reported their MVPA levels approximately 2 years apart. Psychosocial covariates, family cohesion and conflict were measured at the first assessment. Generalized Linear Models were used to prospectively examine the relationship between family cohesion and conflict and subsequent MVPA based on 711 participants who had low levels of baseline MVPA.

RESULTS

35% of boys and 24% of girls reported adequate MVPA levels at follow-up; girls were less likely to report adequate MVPA (RR = 0.76; 95% CI: 0.61-0.93) than boys. Overall, family cohesion was associated with MVPA (P = .01), but family cohesion was not (P = .41). Gender-based analyses revealed that adequate MVPA was associated with family cohesion (RR = 1.40; 95% CI: 1.03-1.88), sensation seeking (RR = 1.05; 95% CI: 1.00-1.10), and age (RR = 0.85; 95% CI: 0.74-0.98) among girls and with subjective social status (RR = 1.20; 95% CI: 1.08-1.33) among boys.

CONCLUSIONS

The family social environment and gender differences should be addressed in health promotion programs targeting MVPA.

Determinants of dietary behavior among youth: an umbrella review

BACKGROUND

The literature on determinants of dietary behavior among youth is extensive and unwieldy. We conducted an umbrella review or review-of-reviews to present a comprehensive overview of the current knowledge.

METHODS

Therefore, we included systematic reviews identified in four databases (i.e. PubMed, PsycINFO, The Cochrane Library and Web of Science) that summarized determinants of observable child and adolescent dietary behaviors. Data extraction included a judgment of the importance of determinants, strength of evidence and evaluation of the methodological quality of the eligible reviews.

RESULTS

In total, 17 reviews were considered eligible. Whereas social-cognitive determinants were addressed most intensively towards the end of the 20th century, environmental determinants (particularly social and physical environmental) have been studied most extensively during the past decade, thereby representing a paradigm shift. With regard to environmental determinants, mixed findings were reported. Sedentary behavior and intention were found to be significant determinants of a wide range of dietary behaviors in most reviews with limited suggestive evidence due to the cross-sectional study designs. Other potential determinants such as automaticity, self-regulation and subjective norm have been studied in relatively few studies, but results are promising.

CONCLUSION

The multitude of studies conducted on potential determinants of dietary behavior provides quite convincing evidence of the importance of several determinants (i.e. quite some variables were significantly related to dietary behavior). However, because of the often used weak research designs in the studies covered in the available reviews, the evidence for true determinants is suggestive at best.

Socioeconomic disparities in the health of african americans with rheumatoid arthritis from the southeastern United States

OBJECTIVE

To examine cross-sectional baseline data from the Consortium for the Longitudinal Evaluation of African Americans with Early Rheumatoid Arthritis registry for the association between socioeconomic status (SES) with clinical and self-report health outcomes.

METHODS

We analyzed data on 937 African Americans who provided comprehensive sociodemographic data in addition to self-reported health outcomes. SES measures included educational attainment, homeownership, household income, and occupation. Outcomes included measures of disease activity, joint damage, autoantibody status, and self-reported measures. Multivariable linear, logistic, and zero-inflated Poisson regression models were used to estimate associations of each SES measure with rheumatoid arthritis (RA) outcomes, controlling for sex, age, disease duration, comorbid conditions, body mass index, smoking, methotrexate/leflunomide use, and biologic agent use.

RESULTS

The mean age was 54 years, 86% were women, and the mean RA disease duration was 7.8 years. Approximately 24% had less than a high school degree, 56% had a nonprofessional occupation, 75% had a household income ≤$30,000, and 55% were nonhomeowners. In multivariable regression models, significantly increased associations of disease activity measures and self-reported health outcomes were observed with low household income (≤$30,000/year) and nonhomeownership. Education less than high school was primarily associated with self-reported health outcomes. Among participants with disease duration <2 years, associations of SES were confined to self-reported measures.

CONCLUSION

Our results indicate significant socioeconomic disparities in self-reported physical and mental health, clinical disease activity measures, and autoantibody status among African Americans with RA not explained by differences in demographics, medication use, and health behaviors.

"It is about being outside": Canadian youth's perspectives of good health and the environment

Drawing on qualitative data generated from an ethnographic study exploring Canadian youth's understanding of health, this paper examines youth's perspectives of the relationships between health and environment. Seventy-one youth (12 to 19 years of age) took part in individual and focus group interviews, as well as in photovoice interviews. Although initial discourse about health mainly focused on healthy eating and exercise, youth were more enthused and able to share their thoughts and feelings about the relationships between health and environment during the photovoice interviews. For these youth, good health was defined and visualized as "being outside" in a safe, clean, green, and livable space. Youth talked about conditions contributing to healthy environments and how healthy environments contributed to a strong sense of place. Overall, the conversations about the environment evoked many feelings in the youth. Results are discussed in the context of current research and in relation to youth, but also more broadly in relation to research on health and environment.

Systematic review and meta-analysis of health promotion interventions for children and adolescents using an ecological framework

OBJECTIVE

To evaluate and quantify the evidence for health promotion interventions in children and adolescents.

METHOD

96 independent samples of smoking, physical activity, and diet studies were included. Outcomes included both objective and self-reports of health behavior, as well as proxy measures such as fitness.

RESULTS

The aggregated effect was significant (g = .20, 95% confidence interval [CI] = 0.08-0.32, n = 96). A significant effect of intervention was observed at approximately 1-year follow-up (g = .07, 95% CI = 0.02-0.14, n = 20). The greatest risk of bias was failure to blind outcome assessment, which occurred in 21% of studies. Most studies lacked sufficient detail to determine the quality of their randomization sequence (58%). Additional concerns about risk of bias for individual studies were minimal. Overall, the quality of this finding was moderate using the Grading of Recommendations Assessment, Development, and Evaluation criteria.

CONCLUSION

Health promotion interventions are effective for modifying health behavior; however, effect sizes are small.

Associations of social and environmental supports with sedentary behavior, light and moderate-to-vigorous physical activity in obese underserved adolescents

Background

Evidence to support differential health impacts of sedentary behavior (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) is building. However, few studies have examined individual, social, and environmental supports across the full range of sedentary and physical activities, including key influences such as self-efficacy, parenting factors, and home and neighborhood resources. This may be particularly important in underserved (low-income, minority), overweight/obese adolescents due to the social and environmental challenges (lack of resources, etc.) associated with increasing MVPA. This study evaluated a range of bioecological factors including individual (self-efficacy), parental (parental support, monitoring, limit-setting, and nurturance), and environmental (perceived home resources for PA and neighborhood support for PA) predictors of SB, LPA and MVPA in overweight/obese adolescents.

Methods

Overweight/obese and predominantly minority adolescents and caregivers (n = 181) completed measures in 2010 in the US including surveys assessing self-efficacy for PA, parenting variables related to PA and home and neighborhood supports for PA. Outcomes included 7-day accelerometer estimates of SB, LPA, and MVPA.

Results

Regression analyses showed parental social support and neighborhood support were significantly associated with LPA. No significant associations were found for SB or MVPA.

Conclusions

Results emphasized the importance of examining a range of sedentary and PA intensities and highlighted the role of parental and neighborhood social supports for LPA. These results have important implications that suggest that health promotion efforts should target social and environmental supports for increasing LPA in youth who are overweight/obese.

Determinants of fruit and vegetable intake in low-income children and adolescents

Although low-income youth are likely to have low or less frequent fruit and vegetable intake, current understanding of the influences on intake in youth is limited. A systematic review of quantitative research on determinants of fruit and vegetable intake among low-income youth (i.e., persons aged <20 years) was conducted. The aims were to identify which determinants have been studied and which are consistently associated with intake. Fifty-eight papers published between 2003 and August 2013 were included. Across studies, 85 unique determinants were identified. Those best supported by evidence were race/ethnicity (with intake consistently higher among Hispanic as compared with African American and white youth), fruit and vegetable preferences, and maternal fruit and vegetable intake. For many potential determinants, the consistency of evidence could not be examined because of a lack of studies. Findings highlight racial/ethnic differences in fruit and vegetable intake and influences on intake that should be considered when designing dietary interventions for low-income youth. Further research on intake determinants in this at-risk population is needed to establish an evidence base to guide interventions.

Children with Obesity Prioritize Social Support against Stigma: A Qualitative Study for Development of an Obesity Prevention Intervention

BACKGROUND

Childhood obesity is a world-wide health problem and development of interventions to prevent or control it is a priority. Obesity is prevalent and on the increase among school-students in Iran, too. As the first step for development of an intervention, the current study was designed to complete our understanding of ideas, attitudes, beliefs, and preferences of primary school children in Tehran, Iran.

METHODS

Twenty-seven primary school-students (11 boys, 16 girls) in grade-five, most of whom were overweight or obese, participated in four focus-group discussions (FGDs). All FGD notes were analyzed to find the main themes.

RESULTS

Nine themes in three main categories emerged after analysis. The themes in the category of barriers of losing weight included environmental, psychological and physiological barriers. Category of intervention components included nutrition improvement, physical activity promotion, social support and education. Setting and deliverer of the intervention were included in the intervention conditions category. The children proposed a multi-component approach for development of an intervention. They mentioned nutrition and physical activity improvement, social support and education as the main elements of an effective intervention.

CONCLUSIONS

The findings indicate that obese children need to be supported against different barriers of losing weight, mainly social barriers, especially humiliation by the community.

Long-term feeding on powdered food causes hyperglycemia and signs of systemic illness in mice

AIMS

Dietary habits are crucial factors affecting metabolic homeostasis. However, few animal experiments have addressed the effects of long-term feeding with soft food on parameters reflecting systemic health.

MAIN METHODS

Using mice, we compared the effects of short (3 days) and long (17 weeks from weaning) feeding periods between powdered food and normal pellet food on the levels of blood glucose, serum levels of insulin, catecholamines, and corticosterone, blood pressure, and/or social interaction behaviors. In addition, the effects of a human glucagon-like peptide-1 analog, liraglutide (a new drug with protective effects against neuronal and cardiovascular diseases), were compared between the powder and pellet groups.

KEY FINDING

(i) Powdered food, even for such a short period, resulted in a greater glycemic response than pellet food, consistent with powdered food being more easily digested and absorbed. (ii) Long-term feeding on powdered food induced hyperglycemia and related systemic signs of illness, including increases in serum adrenaline, noradrenaline, and corticosterone, higher blood pressures (especially diastolic), and increased social interaction behaviors. (iii) Liraglutide, when administered subcutaneously for the last 2 weeks of the 17-week period of feeding, improved these changes (including those in social interaction behaviors).

SIGNIFICANCE

The hyperglycemia associated with long-term powdered-food feeding may lead to certain systemic illness signs, such as elevations of blood glucose, hypertension, and abnormal behaviors in mice. Mastication of food of adequate hardness may be very important for the maintenance of systemic (physical and mental) health, possibly via reduction in the levels of blood glucose and/or adrenal stress hormones (catecholamines and glucocorticoids).

Physical activity, aerobic fitness and parental socio-economic position among adolescents: the German Health Interview and Examination Survey for Children and Adolescents 2003-2006 (KiGGS)

Background

The positive association between parental socio-economic position (PSEP) and health among adolescents may be partly explained by physical activity behaviour. We investigated the associations between physical activity, aerobic fitness and PSEP in a population based sample of German adolescents.

Methods

5,251 participants, aged 11–17 years, in the German Health Interview and Examination Survey for Children and Adolescents 2003–2006 (KiGGS) underwent a sub-maximal cycle ergometer test and completed a questionnaire obtaining information on physical activity and media use. The associations between physical activity, media use, aerobic fitness and PSEP were analysed with multivariate logistic regression models for boys and girls separately. Odds ratios (ORs) of PSEP (education, occupation and income) on the outcomes were calculated adjusted for age, region, and other influencing factors.

Results

Parental education was more strongly associated with the outcome variables than parental occupation and income. After adjusting for age and region, a higher parental education level was associated with better aerobic fitness – with an OR of 1.5 (95% CI 1.2-1.9) for girls whose parents had secondary education and 1.9 (1.4-2.5) for girls whose parents had tertiary education compared to girls whose parents had primary education. The corresponding ORs for boys were 1.3 (1.0-1.6) and 1.6 (1.2-2.1), respectively. Higher parental education level was associated with lower media use: an OR of 2.1 (1.5-3.0) for girls whose parents had secondary education and 2.7 (1.8-4.1) for girls whose parents had primary education compared to girls whose parents had tertiary education. The corresponding ORs for boys were 1.5 (1.2-1.9) and 1.9 (1.5-2.5), respectively. Higher parental education level was associated with a higher physical activity level only among girls: an OR of 1.3 (1.0-1.6) for girls whose parents had secondary education and 1.2 (0.9-1.5) for girls whose parents had tertiary education compared to girls whose parents had primary education. The corresponding ORs for boys were 0.9 (0.8-1.2) and 0.8 (0.6-1.0), respectively.

Conclusions

Adolescents of parents with low SEP showed a lower level of aerobic fitness and higher levels of media use than adolescents of parents with higher SEP. Health-promotion interventions need to reach adolescents of parents with low PSEP and stimulate physical activity.

Family health climate scale (FHC-scale): development and validation

BACKGROUND

The family environment is important for explaining individual health behaviour. While previous research mostly focused on influences among family members and dyadic interactions (parent-child), the purpose of this study was to develop a new measure, the Family Health Climate Scale (FHC-Scale), using a family-based approach. The FHC is an attribute of the whole family and describes an aspect of the family environment that is related to health and health behaviour. Specifically, a questionnaire measuring the FHC (a) for nutrition (FHC-NU) and (b) for activity behaviour (FHC-PA) was developed and validated.

METHODS

In Study 1 (N=787) the FHC scales were refined and validated. The sample was randomly divided into two subsamples. With random sample I exploratory factor analyses were conducted and items were selected according to their psychometric quality. In a second step, confirmatory factor analyses were conducted using the random sample II. In Study 2 (N=210 parental couples) the construct validity was tested by correlating the FHC to self-determined motivation of healthy eating and physical activity as well as the families' food environment and joint physical activities.

RESULTS

Exploratory factor analyses with random sample I (Study 1) revealed a four (FHC-NU) and a three (FHC-PA) factor model. These models were cross-validated with random sample II and demonstrated an acceptable fit [FHC-PA: χ(2)=222.69, df=74, p<.01; χ(2)/df=3.01; CFI=.96; SRMR=.04; RMSEA=.07, CI .06/.08; FHC-NU: χ(2)=278.30, df=113, p<.01, χ(2)/df=2.46, CFI=.96; SRMR=.04; RMSEA=.06, CI .05/.07]. The perception of FHC correlated (p<.01) with the intrinsic motivation of healthy eating (r=.42) and physical activity (r=.56). Moreover, parental perceptions of FHC-NU correlated with household soft drink availability (r=-.31) and perceptions of FHC-PA with the frequency of joint physical activities with the child (r=.51). These patterns were found on the intraindividual and interindividual level.

CONCLUSIONS

Two valid instruments measuring the FHC within families were developed. The use of different informants' ratings demonstrated that the FHC is a family level variable. The results confirm the high relevance of the FHC for individuals' health behaviour. The FHC and the measurement instruments are useful for examining health-related aspects of the family environment.

A Framework to Examine the Role of Epigenetics in Health Disparities among Native Americans

Background. Native Americans disproportionately experience adverse childhood experiences (ACEs) as well as health disparities, including high rates of posttraumatic stress, depression, and substance abuse. Many ACEs have been linked to methylation changes in genes that regulate the stress response, suggesting that these molecular changes may underlie the risk for psychiatric disorders related to ACEs. Methods. We reviewed published studies to provide evidence that ACE-related methylation changes contribute to health disparities in Native Americans. This framework may be adapted to understand how ACEs may result in health disparities in other racial/ethnic groups. Findings. Here we provide evidence that links ACEs to methylation differences in genes that regulate the stress response. Psychiatric disorders are also associated with methylation differences in endocrine, immune, and neurotransmitter genes that serve to regulate the stress response and are linked to psychiatric symptoms and medical morbidity. We provide evidence linking ACEs to these epigenetic modifications, suggesting that ACEs contribute to the vulnerability for developing psychiatric disorders in Native Americans. Conclusion. Additional studies are needed to better understand how ACEs contribute to health and well-being. These studies may inform future interventions to address these serious risks and promote the health and well-being of Native Americans.

Independent associations of childhood and current socioeconomic status with risk of self-reported doctor-diagnosed arthritis in a family-medicine cohort of North-Carolinians

Background

Associations of socioeconomic status (SES) with the prevalence of various forms of arthritis are well documented. Increasing evidence suggests that SES during childhood is a lasting determinant of health, but its association with the onset of arthritis remains unclear.

Methods

Cross-sectional data on 1276 participants originated from 22 family practices in North-Carolina, USA. We created 4-level (high, medium, low, lowest) current SES and childhood SES summary scores based on parental and participant education, occupation and homeownership. We investigated associations of individual SES characteristics, summary scores and SES trajectories (e.g. high/low) with self-reported arthritis in logistic regression models progressively adjusted for race and gender, age, then BMI, and clustered by family practice.

Results

We found evidence for independent associations of both childhood and current SES with the reporting of arthritis across our models. In covariate-adjusted models simultaneously including current and childhood SES, compared with high SES participants in the lowest childhood SES category (OR = 1.39 [95% CI = 1.04, 1.85]) and those in the low (OR = 1.66 [95% CI = 1.14, 2.42]) and lowest (OR = 2.08 [95% CI = 1.16, 3.74]) categories of current SES had significantly greater odds of having self-reported arthritis.

Conclusions

Current SES and childhood SES are both associated with the odds of reporting arthritis within this primary-care population, although the possibly superseding influence of existing circumstances must be noted. BMI was a likely mechanism in the association of childhood SES with arthritis onset, and research is needed to elucidate further pathways linking the socioeconomic environment across life-stages and the development of rheumatic diseases.

Independent influences of current and childhood socioeconomic status on health outcomes in a North Carolina family practice sample of arthritis patients

OBJECTIVE

Compelling evidence suggests that socioeconomic status (SES) is a determinant of health outcomes among persons with arthritis. SES in early life has likewise been associated with various aspects of health, but the connection between childhood SES and health among people with arthritis remains to be investigated. The purpose of this study was to determine the influences of current and childhood SES on self-reported disability, depression, and physical and mental health among people with self-reported doctor-diagnosed arthritis.

METHODS

Data originated from a North Carolina network of primary care centers. Participants with self-reported arthritis with complete sociodemographic and relevant health information were retained in our sample (n = 782). We created summary measures for current and childhood SES from indicators of education, occupation, and homeownership, using parental SES as a proxy for participants' childhood SES. Linear regression models were used to assess the associations between health outcomes and SES variables separately and together, adjusting for key covariates.

RESULTS

Lower childhood and current SES scores were associated with worse disability and physical health. Current SES was furthermore associated with mental health and depressive symptoms. Associations of low current and childhood SES with health outcomes remained significant when concurrently included in a linear model.

CONCLUSION

Childhood and current SES are both determinants of health among persons with arthritis. This underscores the importance of childhood SES as a determinant of adult health among individuals with arthritis. Further studies should focus on these associations in different populations and across different types of arthritis.

Parental perception of child bodyweight and health among Mexican-American children with acanthosis nigricans

Acanthosis nigricans (AN) is a cutaneous marker associated with elevated risk of type 2 diabetes. This study assesses mother-father differences in perception of child's bodyweight and health by Mexican-American parents with AN-positive children. The study used medical records in conjunction with survey data collected between 2011 and 2012 for 309 Mexican-American children with AN in South Texas. Multivariate logit models were estimated to assess mother-father differences in perception of child bodyweight and health controlling for selected child- and parent-level covariates. About 91 % of the children in the sample were obese and 6.5 % were overweight. One fifth of mothers and 38.5 % of fathers in the sample expressed no concern of their children's bodyweight. After adjusting for selected explanatory variables at both the child and parent level, the odds for fathers, relative to mothers, to be concerned about child's bodyweight were 82 % lower (OR = 0.18, p < 0.05). Similar findings also hold for parental awareness of child's AN (OR = 0.19, p < 0.05). Among Mexican-American families with AN-positive children, the lack of concern over child's bodyweight, unawareness of AN, and misconception of child's health on the part of many parents, especially of fathers, constitutes a challenge to diabetes prevention. Health education programs targeting Mexican-American families with AN-positive children might be more cost effective to consider mother-father differences in perception of child health and bodyweight.