Improving the dietary patterns of adolescents using a computer-based approach

Effects of the Head Start Program on Socioecological Obesogenic Factors in American Children

Head Start is a nationwide developmental program for low-income families. This study aimed to investigate the association between the Head Start program and children’s BMI status, as well as their quality of life with respect to socioecological obesogenic factors. This cross-sectional study employed the Early Childhood Longitudinal Study-Kindergarten cohort (ECLS-K) in which the data were collected in 2007 and analyzed in 2019. Propensity-score matching analysis was performed to examine the association between the Head Start program and children’s BMI status, as well as the quality of life, controlling for socioecological obesogenic factors. A total of 3753 children (representing 1,284,209 at the population level) were recruited in this study (mean age: 13.69 years; girls: 49.42%). In the final matched model, the program did not have a statistically significant effect on children’s obesity. Fewer African American children participated in school-sponsored activities, perceived themselves as overweight, lived in a household with fewer family members, had less strict TV regulations, and were more likely to be overweight than their counterparts. Outcomes suggest that multiple dimensions of sociological obesogenic factors including individual, parental, familial, and community support factors affect the weight of children from low-income families and should be considered when establishing behavioral and policy interventions to thwart the childhood obesity epidemic.

Multi-Year Examination of School-Based Programs in Preventing Childhood Obesity: A Case of a State Policy in the U.S

This study examined the association between the obesogenic factors and the risk of suffering from weight excess in school-based state programs regarding physical activity, physical education, nutrition standards, and nutrition education in preventing childhood obesity. Data were drawn from the 1999-2011 Youth Risk Behavior Survey in the State of Mississippi (N = 8862; grades 9-12). Logistic regression with year-fixed effects was performed to capture the influence of the legislation on teenage obesity, controlling for demographics and nutrition- and physical activity-related behaviors. The age-, sex-, and ethnicity-adjusted mean of the body mass index had reduced since 2007 (year 1999: 23.52; year 2001: 23.53; year 2003: 23.76; year 2007: 24.26; year 2009: 24.29; and year 2011: 23.91). The legislation was significantly associated with a decreased likelihood of being overweight (year 2007, odds ratio (OR) = 0.686; year 2009, OR = 0.739; and year 2011, OR = 0.760; all p < 0.01). Children who were more sedentary, more frequently fasted to lose weight, and were less physically active and likelier to be overweight (OR = 1.05, 1.37, and 0.97, respectively; all p < 0.05), as were African-American children (OR = 0.64; p < 0.05) and female students (OR = 1.59; p < 0.05). In conclusion, schools are among the most easily modifiable settings for preventing childhood obesity and reducing its prevalence, with the implementation of physical activity and nutritional policies.

The Effects of a Nutritional Intervention on the Nutritional Knowledge of Children and Adolescents with Visual Impairments

The purpose of this study was to investigate the effects of a nutritional program on the nutritional knowledge of children and adolescents with visual impairments. The results indicated that there was a significant difference between the scores of the experimental and control groups and that age and vision had no effect on the acquisition of nutritional knowledge.

A Mobile Game for Patients With Breast Cancer for Chemotherapy Self-Management and Quality-of-Life Improvement: Randomized Controlled Trial

Background

The application of game-based learning in clinical practice has shown potential advantages in previous studies. However, there have been little efforts to use smartphone-based mobile games in the management of adult patients with cancer.

Objective

The objective of our study was to evaluate if patient education using a mobile game may increase drug compliance, decrease physical side effects of chemotherapy, and improve psychological status in breast cancer patients.

Methods

A total of 76 patients with metastatic breast cancer who were planned to receive cytotoxic chemotherapy were enrolled in this trial. Study participants were randomly assigned to a mobile game play group (game group, n=36) or a conventional education group (control group, n=40) in a ratio of 1:1. The patients were unblinded and followed prospectively for 3 weeks. Outcome measures included time spent for education, compliance to medication, physical side effects, and psychological side effects including quality of life (QoL).

Results

Overall, 72 out of 76 patients completed the study after 3 weeks (95%). The subjects in the game group showed high levels of satisfaction with the app. The time spent playing the mobile game in the game group was longer than that spent for self-education in the control group (mean 22.2, SD 6.1 vs mean 5.5, SD 4.0 minutes a day; P<.001). The mobile game group showed better drug adherence (Korean version of the Medication Adherence Rating Scale; mean 7.6, SD 0.7 vs mean 6.5, SD 0.5; P<.001). The use of the mobile game was associated with lower rates of chemotherapy-related side effects, such as nausea, fatigue, numbness of hand or foot, and hair loss, than the control group. The game group exhibited better QoL during chemotherapy (mean 74.9, SD 3.5 vs mean 72.2, SD 5.3; P=.01). However, there were no significant differences in terms of depression and anxiety scales.

Conclusions

This study suggests the feasibility and potentiality of the use of smartphone mobile games for patients with breast cancer receiving chemotherapy. Education using a mobile game led to better patient education, improved drug compliance, decreased side effects, and better QoL compared with conventional education. Mobile games can be used as easy, fun, and effective measures for patient education and have the potential to improve treatment outcomes.

Trial Registration

ClinicalTrials.gov NCT03205969; http://clinicaltrials.gov/ct2/show/NCT03205969 (Archived by WebCite at http://www.webcitation.org/71jfSBOq9).

Effect of a School-Based Activity Tracker, Companion Social Website, and Text Messaging Intervention on Exercise, Fitness, and Physical Activity Self-Efficacy of Middle School Students

This study examined the effect of a 10-week activity tracker, companion social website, and text messaging intervention on body mass index (BMI), body fat percentage, physical fitness, and physical activity (PA) self-efficacy of children. Children (n = 98) were assigned to one of three groups: activity tracker group, text messaging group, and activity tracker + text messaging group. Pre-/posttest fitness, BMI, PA self-efficacy, and body fat percentage were measured. The activity tracker group had a significant increase in fitness, no significant difference in PA self-efficacy, and an increase in body fat percentage and BMI (p < .05). The text messaging group had a significant increase in BMI (p < .05). The activity tracker + text messaging group had no significant differences in fitness, BMI, PA self-efficacy, or body fat percentage. This study gives no clear support to the hypothesis that use of activity trackers and a text messaging intervention have a positive effect on fitness, PA self-efficacy, or body fat percentage.

An Interactive Computer Session to Initiate Physical Activity in Sedentary Cardiac Patients: Randomized Controlled Trial

Background

Physical activity (PA) improves many facets of health. Despite this, the majority of American adults are insufficiently active. Adults who visit a physician complaining of chest pain and related cardiovascular symptoms are often referred for further testing. However, when this testing does not reveal an underlying disease or pathology, patients typically receive no additional standard care services. A PA intervention delivered within the clinic setting may be an effective strategy for improving the health of this population at a time when they may be motivated to take preventive action.

Objective

Our aim was to determine the effectiveness of a tailored, computer-based, interactive personal action planning session to initiate PA among a group of sedentary cardiac patients following exercise treadmill testing (ETT).

Methods

This study was part of a larger 2x2 randomized controlled trial to determine the impact of environmental and social-cognitive intervention approaches on the initiation and maintenance of weekly PA for patients post ETT. Participants who were referred to an ETT center but had a negative-test (ie, stress tests results indicated no apparent cardiac issues) were randomized to one of four treatment arms: (1) increased environmental accessibility to PA resources via the provision of a free voucher to a fitness facility in close proximity to their home or workplace (ENV), (2) a tailored social cognitive intervention (SC) using a “5 As”-based (ask, advise, assess, assist, and arrange) personal action planning tool, (3) combined intervention of both ENV and SC approaches (COMBO), or (4) a matched contact nutrition control (CON). Each intervention was delivered using a computer-based interactive session. A general linear model for repeated measures was conducted with change in PA behavior from baseline to 1-month post interactive computer session as the primary outcome.

Results

Sedentary participants (n=452; 34.7% participation rate) without a gym membership (mean age 58.57 years; 59% female, 78% white, 12% black, 11% Hispanic) completed a baseline assessment and an interactive computer session. PA increased across the study sample (F_1,441=30.03, P<.001). However, a time by condition interaction (F_3,441=8.33, P<.001) followed by post hoc analyses indicated that SC participants exhibited a significant increase in weekly PA participation (mean 45.1, SD 10.2) compared to CON (mean -2.5, SD 10.8, P=.004) and ENV (mean 8.3, SD 8.1, P<.05). Additionally, COMBO participants exhibited a significant increase in weekly PA participation (mean 53.4, SD 8.9) compared to CON (P<.001) and ENV (P=.003) participants. There were no significant differences between ENV and CON or between SC and COMBO.

Conclusions

A brief, computer-based, interactive personal action planning session may be an effective tool to initiate PA within a health care setting, in particular as part of the ETT system.

Trial Registration

Clinicaltrials.gov NCT00432133, http://clinicaltrials.gov/ct2/show/NCT00432133 (Archived by WebCite at http://www.webcitation.org/6aa8X3mw1).

Expanding a successful community-based obesity prevention approach into new communities: Challenges and achievements

OBJECTIVE

A previously successful community-based obesity prevention intervention with a focus on school settings was expanded into new communities with varying contexts. In order to understand the complexities involved in implementing health promotion activities in schools, this study examined experiences of school staff and project officers including barriers, contextual factors and achievements.

METHODS

School environment assessments were conducted in schools across four Victorian communities with school staff (n=1-5 staff plus a trained researcher per group in 9 primary and 8 secondary schools) 12-18 months post-intervention. Process reports from project officers were also reviewed and analysed (n=4).

RESULTS

School staff commonly reported time pressures as a barrier to implementation and project officers working within schools reported competing priorities and limited health promotion experience of staff; lack of stakeholder engagement; low participation in some activities and insufficient implementation time. Contextual factors included community socioeconomic status, student ethnicity and living rurally. Achievements included student and staff enjoyment from programme activities, staff capacity building, partnerships, embedding activities into existing infrastructure and programmes, and having consistent health-related messages repeated through a variety of strategies.

CONCLUSIONS

Community-based interventions with a focus on school settings need to consider system level, organisational and contextual (i.e. socioeconomic, ethnicity, family and town characteristics) factors when expanding previously effective strategies into new communities. Implementation benefits may have added whole of school benefits in addition to child health. Focussing on overcoming the challenges experienced in this complex initiative is required for future interventions.

TRIAL REGISTRATION

ACTRN12609000892213.

Dietary intake and nutrition-related knowledge in a sample of Lebanese adolescents of contrasting socioeconomic status

BACKGROUND

Socioeconomic status (SES) is postulated to be a major predictor of dietary intake and nutrition-related knowledge in adults. To date, very few studies have addressed this effect among adolescents.

OBJECTIVE

To explore differences in nutrient intake and nutrition-related knowledge among adolescents of contrasting SES in Lebanon.

METHODS

In a cross-sectional survey, 209 males and females, aged 17 to 19 years, were recruited from a private university with high tuition and a free public university in Beirut. The participants completed a multicomponent, self-administered questionnaire that inquired about demographic characteristics and nutrition-related knowledge. Three nonconsecutive 24-hour dietary recalls were obtained through interviews. Energy-adjusted means of dietary intake and age-adjusted nutrition-related knowledge were compared between groups using a general linear model.

RESULTS

Adolescents in the high-SES group consumed more vegetables, meats, and fats and oils (p < .05). Energy and nutrient intake analysis showed that adolescents in the high-SES group consumed significantly higher amounts of calories, protein, fat, vitamin A, vitamin C, and iron (p < .001) and significantly lower amounts of carbohydrates (p < .05). Nutritional knowledge, although high among all participants, was higher in the high-SES group (p < .05).

CONCLUSIONS

Although both groups showed good nutrition-related knowledge, SES significantly affected dietary intake in a sample of Lebanese adolescents. This warrants consideration of other factors, such as cost and environment, that may modulate eating behavior among adolescents from different socioeconomic strata.

Does Behavioral Intention Predict Nutrition Behaviors Related to Adolescent Obesity?

The theory of planned behavior (TPB) proposes that the single best predictor of a person’s behavior is intention to perform that behavior. Successful application of the TPB supports that attitudes, subjective norms, and perceived behavioral control are predictive factors of behavioral intention (BI). The purpose of this study was to examine the extent to which BI predicted nutrition behaviors linked to adolescent obesity. A cross-sectional design obtained a convenience sample of 318 middle school students who completed a 129-item validated instrument. Multiple regression was used to establish predictors for fruit and vegetable (FV) consumption and sweetened beverages (SBs) versus water consumption. The mean BI scores were as follows: FV consumption, M = 12.18, standard deviation [SD] = 5.74, and SB versus water consumption, M = 12.42, SD = 6.07. This denotes a moderate intent to participate in the behavior. Regression showed that BI was predictive for consumption of FV among overweight and obese students and consumption of water versus SB in normal weight students (P < .05). BI was linked to nutrition behaviors related to obesity prevention in adolescents. Differences among those students who were considered normal weight and overweight/obese existed and should be considered when working with these populations and designing future interventions.

Efficacy of brief interventions in clinical care settings for persons living with HIV

Prevention of HIV transmission from patients living with HIV (PLH) is a high national priority and strategies that are easy to implement and sustain to eliminate sexual transmission acts among PLH are needed. We evaluated a brief intervention that focused primarily on the enhancing motivations and encouraging PLH to act in accordance with their values without providing the intensity of the existing evidence-based programs for PLH. Using a quasiexperimental design, six medical clinics in Los Angeles County, CA, were evaluated across three intervention conditions: 1) computerized delivery; 2) provider delivery; or 3) standard care. We examined longitudinal changes in patients' reports of the number of HIV-negative (HIV-) or serostatus-unknown sexual partners and the number of unprotected vaginal and anal sex acts. Among 566 PLH, PLH in the computerized delivery condition reported a significant decrease in the number of HIV-/unknown sexual partners compared with the provider delivery and standard care conditions and a significant decrease in the number of unprotected sex acts in comparison to the standard care condition. Computerized motivational interventions delivered in waiting rooms at medical clinics may be an efficient strategy to reduce unprotected sex acts among PLH.

Establishing validity and reliability of an instrument using the theory of planned behavior to predict middle school student obesity-related actions

BACKGROUND

Childhood obesity is of concern to many health professionals, parents, teachers, and school administrators because of the negative impact on the child's physical, psychological, and behavioral health. Lack of structured monitoring and evaluation has hindered the development of an evidence base to disseminate best practices in childhood obesity prevention.

PURPOSE

The purpose of this study was to develop a valid and reliable instrument which affirmed the constructs of the Theory of Planned Behavior in relation to nutrition and physical activity behaviors related to childhood obesity.

METHODS

A convenience sample of 242 students participated in the validation of the 129-item instrument, which was administered during class time, and read to students to increase response rate.

RESULTS

Confirmatory factor analysis established instrument validity, with one factor present for each behavior, and factor loadings greater than 0.32. Reliability and test-retest coefficients achieved apriori criteria of 0.70.

DISCUSSION

Truly learning how to gauge nutrition and physical activity levels in children and adolescents has proved to be difficult, yet it is imperative to understand the relationship of the proposed potentially modifiable behaviors and childhood obesity.

Design and evaluation of a computer game to promote a healthy diet for young adults

This article reports the development and evaluation of a computer game (RightWay Café) as a special medium to promote a healthy diet for young adults. Structural features of computer games, such as interactive tailoring, role playing, the element of fun, and narrative, were operationalized in the RightWay Café game to afford behavior rehearsal in a safe and entertaining way. Theories such as the health belief model, social cognitive theory, and theory of reasoned action guided the content design of the game to influence mediators of behavior change, including self-efficacy, perceived benefits, perceived barriers, and behavior change intention. A randomized controlled evaluation study with pretest, posttest, and follow-up design demonstrated that this game was effective in teaching nutrition and weight management knowledge and increasing people's self-efficacy and perceived benefits of healthy eating, as well as their intention to be on a healthy diet. Limited long-term effects were also found: participants in the game-playing group had greater self-efficacy than participants in the control group after 1 month. This study validates the computer game-based approach to health promotion for young adults. Limitations and implications are also discussed.

Computer-tailored health interventions delivered over the Web: review and analysis of key components

OBJECTIVE

This systematic review explores how computer-tailored, behavioral interventions implemented and delivered via the Web have been operationalized in a variety of settings.

METHODS

Computer-tailored, online behavioral intervention studies published from 1996 to early 2007 were selected and reviewed by two independent coders.

RESULTS

Of 503 studies screened, 30 satisfied the selection criteria. The level of sophistication of these interventions varied from immediate risk/health assessment, tailored web content to full-blown customized health programs. The most common variables for tailoring content were health behaviors and stages of change. Message tailoring was achieved through a combination mechanisms including: feedback, personalization and adaptation.

CONCLUSIONS

Tailored, self-guided health interventions delivered via the Web to date have involved a great diversity of features and formats. While some programs have been relatively brief and simple, others have involved complex, theory-based tailoring with iterative assessment, tools for development of self-regulatory skills, and various mechanisms for providing feedback.

PRACTICE IMPLICATIONS

Our ability to fully optimize the use of computer-assisted tailoring will depend on the development of empirically based guidelines for tailoring across populations, health foci, health behaviors and situations. Further outcome research is needed to enhance our understanding of how and under what conditions computer-tailoring leads to positive health outcomes in online behavioral interventions.

An overview of obesity in children with psychiatric disorders taking atypical antipsychotics

BACKGROUND

Children with psychiatric illness are at greater risk for obesity than those in the general population. In part, this greater risk is due to the escalating use of psychotropic medications. Second-generation antipsychotics effectively treat mental illness but are associated with weight gain. Data for management of obesity in this population is lacking.

METHODS

Articles on obesity, mental illness, and obesity management were reviewed. Keywords included children, adolescents, obesity, weight gain, psychiatric illness, therapy, treatment, and antipsychotic.

RESULTS

For pediatric obesity, educational, nutritional, behavioral, and family-based interventions were identified as nonpharmacological interventions. All nonpharmacological modalities indicate modest to moderate success in weight control or loss. Pharmacological agents, alone or with diet and exercise, appear promising in obesity management.

CONCLUSION

Since there are limited intervention studies available for obese children with psychiatric illness, general childhood obesity studies may be referenced for trials in this population. Long-term efficacy and safety of these interventions are not yet available. Methodological constraints of prior studies include small sample sizes and the absence of randomized, placebo-controlled, and longitudinal trials - highlighting the need for further trials addressing these issues. Clinical monitoring and management of medication-induced obesity remains an important public health concern.