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Abbey BM, Heelan KA, Bartee RT, George K, Foster NL, Estabrooks PA, Hill JL. Building Healthy Families: Outcomes of an Adapted Family Healthy Weight Program Among Children in a Rural Mid-Western Community. Child Obes 2024. [PMID: 38569168 DOI: 10.1089/chi.2023.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Background: This study aimed to evaluate the effectiveness of implementing an adapted, evidence-based 12-week Family Healthy Weight Program (FHWP), Building Healthy Families, on reducing BMI metrics and clinical health indicators in a real-world community setting. Methods: Ninety child participants with a BMI percentile greater or equal to the 95th percentile for gender and age and their parents/guardians (n = 137) enrolled in the program. Families attended 12 weekly group-based sessions of nutrition education, family lifestyle physical activity, and behavior modification. A pre-post study design with a 6-month follow-up was used. Results: Nine cohorts of families between 2009 and 2016 completed the program with 82.1% retention at 12 weeks and 53.6% at 6 months. Participants had statistically significant improvements at 12 weeks in BMI z-score, %BMIp95, body mass, body fat, fat mass, fat-free mass, and systolic blood pressure with greater improvement at 6 months in body mass, BMI metrics, body fat, fat mass, fat-free mass, and systolic blood pressure. Parents/guardians of the participants had similar statistically significant body composition and blood pressure improvements (p < 0.05). In addition, children had significant improvements in high-density lipoprotein (HDL) cholesterol and aspartate aminotransferase (AST) liver enzymes at 6 months. Conclusions: Overall, this study demonstrated that an evidence-based FHWP can result in statistically meaningful declines in BMI z-score and accompanied clinically meaningful changes in health risk. Participants lost ∼4% of their body mass in 12 weeks, while their parents/guardians lost closer to 7% of their body mass, which supports previous literature suggesting body mass changes influence health.
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Affiliation(s)
- Bryce M Abbey
- Department of Kinesiology and Sport Sciences and University of Nebraska at Kearney, Kearney, NE, USA
| | - Kate A Heelan
- Department of Kinesiology and Sport Sciences and University of Nebraska at Kearney, Kearney, NE, USA
| | - R Todd Bartee
- Department of Biology, University of Nebraska at Kearney, Kearney, NE, USA
| | - Kaiti George
- Department of Kinesiology and Sport Sciences and University of Nebraska at Kearney, Kearney, NE, USA
| | - Nancy L Foster
- Psychology Department, Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA
| | - Paul A Estabrooks
- Department of Health and Kinesiology, College of Health and School of Medicine; University of Utah, Salt Lake City, UT, USA
| | - Jennie L Hill
- Department of Population Health Sciences, School of Medicine; University of Utah, Salt Lake City, UT, USA
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Gao L, Peng W, Xue H, Wu Y, Zhou H, Jia P, Wang Y. Spatial-temporal trends in global childhood overweight and obesity from 1975 to 2030: a weight mean center and projection analysis of 191 countries. Global Health 2023; 19:53. [PMID: 37542334 PMCID: PMC10403851 DOI: 10.1186/s12992-023-00954-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/26/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND The geographic information science-based interactive map provided good prospects for the public health to study disease prevalence. The purpose of this study is to understand global spatial-temporal trends of childhood overweight and obesity and underlying causes help formulating intervention strategies. METHODS This multiple cross-sectional study included data on childhood overweight and obesity prevalence, gross national income per capita, and urbanization rate for 191 countries from 1975-2016. Autoregressive integrated moving average model, standard deviational ellipse model and mixed-effects models were used to explore spatial-temporal trends of childhood overweight and obesity and associations with gross national income per capita and urbanization rate. RESULTS Globally, childhood overweight and obesity rate would reach 30.0% in 2030 (boys: 34.2%, girls: 27.4%). By 2030, it would reach 58.3% in middle- and high-income countries and 68.1% in Western Pacific region. Spatial-temporal trendline for childhood overweight and obesity in 1975-2030 exhibited a "C" shape, migrating from 1975 (15.6。E, 24.6。N) to 2005 (10.6。E, 21.7。N), then to 2030 (14.8。E, 17.4。N). The trendline for urbanization rate was also an irregular "C", and the turning point appeared five years earlier than childhood overweight and obesity. CONCLUSIONS Globally, childhood overweight and obesity prevalence will continue to increase. Its weight mean center migrated from western countries to Asia and Africa following economic development.
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Affiliation(s)
- Liwang Gao
- School of Public Health, Capital Medical University, Beijing, China.
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.
| | - Wen Peng
- Nutrition and Health Promotion Center, Department of Public Health, Medical College, Qinghai University, Xining, China
- International Obesity and Metabolic Disease Research Center, Xi'an Jiaotong University, Xi'an, China
| | - Hong Xue
- International Obesity and Metabolic Disease Research Center, Xi'an Jiaotong University, Xi'an, China
- Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, VA, USA
| | - Yang Wu
- International Obesity and Metabolic Disease Research Center, Xi'an Jiaotong University, Xi'an, China
- Department of Sociology, Jiangxi University of Finance and Economics, Nanchang, China
| | - Haixia Zhou
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.
- International Obesity and Metabolic Disease Research Center, Xi'an Jiaotong University, Xi'an, China.
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Spence ND, Newton AS, Keaschuk RA, Ambler KA, Holt NL, Jetha MM, Mushquash AR, Rosychuk RJ, Sharma AM, Spence JC, Ball GDC. Parents as Agents of Change in Managing Pediatric Obesity: A Randomized Controlled Trial Comparing Cognitive Behavioral Therapy versus Psychoeducation Interventions. Child Obes 2023; 19:71-87. [PMID: 35442813 DOI: 10.1089/chi.2021.0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Obesity interventions for parents of children with obesity can improve children's weight and health. This randomized controlled trial (RCT) evaluated whether a parent-based intervention based on cognitive behavioral therapy (CBT) principles was superior to a parent-based intervention based on a psychoeducation program (PEP) in improving children's obesity. Methods: This study was a pragmatic, two-armed, parallel, superiority RCT. Conducted at a Canadian outpatient pediatric obesity management clinic (September 2010-January 2014), this trial included families with children 8-12 years with an age- and sex-specific BMI ≥85th percentile. The 16-week manualized interventions were similar in content and delivered to parents exclusively, with different theoretical underpinnings. The primary outcome was children's BMI z-score at postintervention (4 months). Secondary outcomes included anthropometric, lifestyle, psychosocial, and cardiometabolic variables. Data were collected at preintervention (0 months), postintervention (4 months), 10, and 16 months. Intention-to-treat analysis using linear mixed models was used to assess outcomes. Results: Among 52 randomly assigned children, the mean age (standard deviation) was 9.8 (1.7) years and BMI z-score was 2.2 (0.3). Mean differences in BMI z-score were not significantly different between the CBT (n = 27) and PEP (n = 25) groups from 0 to 4-, 10-, and 16-month follow-up. At 4 months, the mean difference in BMI z-score from preintervention between the CBT (-0.05, 95% CI = -0.09 to 0.00) and PEP (-0.04, 95% CI = -0.09 to 0.01) groups was -0.01 (95% CI = -0.08 to 0.06, p = 0.80). Similar results were found across all secondary outcomes. Conclusions: Our CBT-based intervention for parents of children with obesity was not superior in reducing BMI z-score vs. our PEP-based intervention.
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Affiliation(s)
- Nicholas D Spence
- Department of Sociology, University of Toronto, Toronto, Ontario, Canada.,Department of Health and Society, University of Toronto, Toronto, Ontario, Canada
| | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Rachel A Keaschuk
- Alberta Health Services, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Kathryn A Ambler
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas L Holt
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Mary M Jetha
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Aislin R Mushquash
- Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Rhonda J Rosychuk
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Arya M Sharma
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - John C Spence
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Ho RST, Yajun Huang W, Lo HY, Liu KKY, Wong SHS. Parental Factors Associated With Physical Activity Among East Asian Children/Youth: A Meta-Analysis Based on the Active Healthy Kids Report Cards. Asia Pac J Public Health 2022; 34:493-500. [PMID: 35670593 DOI: 10.1177/10105395221103377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Insufficient physical activity (PA) is a leading risk factor for mortality. The Active Healthy Kids Report Cards provide comprehensive evidence related to PA in children/adolescents. Associations of (1) parental support for PA with amount of moderate-to-vigorous-intensity PA (MVPA) performed by children/adolescents and (2) amount of MVPA performed by parents with amount of MVPA performed by children/adolescents, as indicated by Report Cards, have not been critically synthesized in meta-analysis. We selected data in Asian countries/regions Report Cards and performed meta-analyses to assess pooled associations of influence indicators and behavior indicators among children/adolescents in Asian countries/regions. Our meta-analyses included five studies that assessed association of parental support or MVPA performance with child/adolescent MVPA performance. Positive association was observed between the amount of time spent by parents on MVPA per week, regardless of gender, and the amount of time spent by children and adolescents on MVPA per week (r = .11; 95% confidence interval [CI] [0.06, 0.16]; I2 = 40%; p < .0001). In East Asia, the amount of MVPA performed by parents appears to be an important factor influencing the participation of children/adolescents in PA.
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Affiliation(s)
- Robin Sze-Tak Ho
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Wendy Yajun Huang
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Ho-Yau Lo
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Kenneth Kang-Yue Liu
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Stephen Heung-Sang Wong
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
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Fowler LA, Litt MD, Rotman SA, Conlon RPK, Jakubiak J, Stein RI, Balantekin KN, Welch RR, Perri MG, Epstein LH, Wilfley DE. Relation of social network support to child health behaviors among children in treatment for overweight/obesity. Eat Weight Disord 2022; 27:1669-1678. [PMID: 34549372 PMCID: PMC8934746 DOI: 10.1007/s40519-021-01303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/08/2021] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Little is known about the influence of social network support on child health behaviors in the context of weight-loss interventions. This study examined the associations between a child's co-participation (i.e., network support) in weight-related health behaviors (i.e., physical and sedentary activity, eating behavior) and the child's own health behaviors during family-based behavioral treatment (FBT). METHODS Children (n = 241) with overweight/obesity (mean age = 9.4 ± 1.3y; 63% female) completed semi-structured interviews assessing network support for healthy/unhealthy eating and physical/sedentary activity, and a 3-day dietary recall. Physical activity was assessed with accelerometry, and sedentary activity was measured via parent-reported child screen time use. All assessments were taken at baseline and after 4 months of FBT. Hierarchical linear regressions examined changes in network support as they related to changes in health behaviors from baseline to the end of FBT. RESULTS Changes in network support for healthy eating were related to changes in vegetable, but not fruit, intake across FBT, while changes in network support for unhealthy eating were negatively related to changes in diet quality. Changes in network support for sedentary activity were negatively related to changes in minutes of physical activity and positively related to changes in screen time. CONCLUSION The present findings suggest that a child's network support for health behaviors may relate to behavior change among children during FBT and provide opportunities for targeted intervention. LEVEL OF EVIDENCE III. cohort study.
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Affiliation(s)
- Lauren A Fowler
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
| | - Mark D Litt
- Division of Behavioral Sciences and Community Health, University of Connecticut Health Center, Storrs, CT, 263 Farmington Ave., MC 3910, Farmington, CT, 06030, USA
| | - Sophia A Rotman
- Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 451 Newton Rd, Iowa City, IA, 52242, USA
| | - Rachel P Kolko Conlon
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara St, Pittsburgh, PA, 15213, USA
| | - Jessica Jakubiak
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Richard I Stein
- Department of Internal Medicine, Washington University School of Medicine, Campus Box 8031, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, University at Buffalo, 204A Kimball Tower, Buffalo, NY, 14214, USA
| | - R Robinson Welch
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Michael G Perri
- Department of Clinical and Health Psychology, University of Florida, P.O. Box 100185, Gainesville, FL, 32610, USA
| | - Leonard H Epstein
- Department of Pediatrics, University at Buffalo, 3435 Main St, Buffalo, NY, 14214, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
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Carpena Lucas PJ, Sánchez-Cubo F, Vargas Vargas M, Mondéjar Jiménez J. Influence of Lifestyle Habits in the Development of Obesity during Adolescence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4124. [PMID: 35409807 PMCID: PMC8998286 DOI: 10.3390/ijerph19074124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 12/18/2022]
Abstract
Background: The alarming increase in childhood obesity is a global public health problem since it has significant health consequences. This cross-sectional study aimed to identify the potentially modifiable risk factors for developing excess weight and determine the importance of developing certain habits to prevent childhood overweight and obesity. Methods: The sample included 416 students between the ages of 12 and 14 (12.8 ± 0.62) first-year high school students from Murcia in Spain. Data were collected on their lifestyle habits through the ENHASA questionnaire, and the somatometry of the participants was measured. Such data were studied through structural equation modeling and importance-performance map analyses. Results: The modifiable risk factors that presented the greatest potency directly regarding when developing excess weight in adolescents were ‘use of electronic devices’ and ‘not performing physical activity’ (p < 0.001). ‘Social and school environment’ and ‘diet’ showed relationships but no significant differences with overweight or obesity. Globally, the lifestyle habit of the greatest importance for not being overweight was ‘engagement in extracurricular physical activities’. On the other hand, the habits related to using new technologies in a sedentary way showed the best capacity for improvement. Therefore, it would be very efficient to focus on them to control excess weight. Conclusion: Responsible and limited use of screens and engaging in extracurricular physical activities may be the most remarkable and cost-effective strategies for obesity prevention programs.
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Affiliation(s)
| | - Francisco Sánchez-Cubo
- Department of Political Economy and Public Finance, Economic and Business Statistics and Economic Policy, Faculty of Social Sciences, University of Castilla-La Mancha, 16007 Cuenca, Spain;
| | - Manuel Vargas Vargas
- Faculty of Economic and Business Sciences, University of Castilla-La Mancha, 02006 Albacete, Spain;
| | - José Mondéjar Jiménez
- Department of Statistics, Faculty of Social Sciences in Cuenca, University of Castilla-La Mancha, 16007 Cuenca, Spain;
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Skrypnyk M, Petrushanko T, Neporada K, Skrypnyk R, Petrushanko V, Skrypnyk I. Dependence of the dental status of young individuals with different body weights on their eating behavior. ACTA FACULTATIS MEDICAE NAISSENSIS 2022. [DOI: 10.5937/afmnai39-35901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Obesity is a global problem of modern society. According to the WHO, in 2016, more than 1.9 billion adults are overweight and about 650 million adults are obese. Numerous studies indicate the role of overweight, obesity and metabolic status on periodontal health, however, the mechanism of their development is not fully understood. Aim. The aim of the study was to explore the mechanism of periodontal disease development in patients with diverse body mass index and the mechanism of extra weight and obesity onset in these patients. Methods. The study involved 132 Ukrainian males and females, 18 - 22 years old. Body mass index was determined in all patients. Information on life history, illness and family history was collected. The assessment of dental status was conducted by indicating the oral and tongue hygiene indices and periodontal indices. Eating behaviour was assessed using the standardised Dutch eating behaviour questionnaire (DEBG) and the three-factor eating questionnaire (TFEQ R-18). Diet assessment was determined by standardized diet questionnaire. Results. More than 60% of young people with the 1st and 2nd degree obesity had eating disorders, the most prevalent were disturbance of cognitive restraint and emotional eating components of eating behavior. The prevalence of periodontal disease was significantly higher in obese individuals, up to 87% in patients with the 1st and 2nd degree obesity. Conclusion. Eating behavior disturbances play a crucial role in the development of obesity in young adults and onset of gingivitis. The cause of non-plaque-induced gingivitis in patients with the 1st and 2nd degree obesity is a impaired general host response to the pathogenic factors of the oral cavity, caused by excess adipose tissue, which led to the development of chronic systemic mild inflammation. That is why these patients need a specific, integrated periodontal treatment.
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8
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Lindquist K, Mann G, Farris A, Gordon K, Misyak S. Parent Perspectives of Packing School Lunches. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021. [DOI: 10.1080/19320248.2021.1994081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kayla Lindquist
- Department Nutrition and Hospitality Management, University of Mississippi, University, MS, USA
| | - Georgianna Mann
- Department Nutrition and Hospitality Management, University of Mississippi, University, MS, USA
| | - Alisha Farris
- Nutrition and Foods Program, Appalachian State University, Boone, USA
| | - Kymberle Gordon
- Department Nutrition and Hospitality Management, University of Mississippi, University, MS, USA
| | - Sarah Misyak
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
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Ayala GX, Monge-Rojas R, King AC, Hunter R, Berge JM. [Entorno social y obesidad infantil: implicaciones para la investigación y la práctica en Estados Unidos y en los países latinoamericanos]. Obes Rev 2021; 22 Suppl 5:e13350. [PMID: 34708540 PMCID: PMC9138052 DOI: 10.1111/obr.13350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/02/2022]
Abstract
The environments of children influence their risk for childhood obesity through, among other factors, a child's weight-related behaviors (i.e., diet and physical activity). In this article, we present evidence on social environmental factors associated with a child's diet and physical activity, and more generally, the prevention and control of childhood obesity among Hispanic/Latinx children in the United States and children from countries in Latin America. Using a socio-ecologic lens, we present evidence from cross-sectional and longitudinal studies conducted in the United States involving Hispanic/Latinx children, and evidence from studies involving children in Latin America. Studies examining parenting factors in the home environment (e.g., parenting strategies) are especially emphasized, with more limited evidence on social environmental factors in other lived contexts (e.g., school). The influence of acculturation on social relationships cuts across levels of the socio-ecological framework. Intervention research identified strategies and research gaps for intervening on social factors to promote healthy behaviors and reduce risk for childhood obesity. Community health workers and others forms of peer support were identified as relevant approaches at multiple levels of the socio-ecological framework. This article concludes with directions for future research to further understand the environment using newer information and communication technologies.
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Affiliation(s)
- Guadalupe X Ayala
- School of Public Health, San Diego State University, the Institute for Behavioral and Community Health, and the SDSU HealthLINK Center, San Diego, California, EE. UU
| | - Rafael Monge-Rojas
- Unidad de Salud y Nutrición, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica
| | - Abby C King
- Departments of Epidemiology & Population Health and Medicine (Stanford Prevention Research Center), Stanford University School of Medicine, Stanford, California, EE. UU
| | - Ruth Hunter
- Centre for Public Health, Queen's University Belfast, Irlanda del Norte, Belfast, Reino Unido
| | - Jerica M Berge
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, Mineápolis, Minesota, EE. UU
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Hill JL, Heelan KA, Bartee RT, Wichman C, Michaud T, Abbey BM, Porter G, Golden C, Estabrooks PA. A Type III Hybrid Effectiveness-Implementation Pilot Trial Testing Dissemination and Implementation Strategies for a Pediatric Weight Management Intervention: The Nebraska Childhood Obesity Research Demonstration Project. Child Obes 2021; 17:S70-S78. [PMID: 34569848 DOI: 10.1089/chi.2021.0170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Several family-based efficacious pediatric weight management interventions (PWMIs) have been developed to reduce child weight status. These programs are typically based in larger cities delivered by an interdisciplinary team in a hospital or medical center. The degree to which these efficacious PWMIs have been translated to, and are feasible in, rural or micropolitan areas is unclear. This study protocol describes a pilot Type III hybrid effectiveness-implementation (T3HEI) trial testing a multilevel strategy that focuses on the adoption, implementation, and sustainability of a PWMI online training program and resource package designed for implementation in micropolitan and rural areas. Methods: The trial design employed the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate outcomes and the Promoting Action on Research Implementation in Health Services framework to specify potential mechanisms of adoption, implementation, and sustainability. The study will test the feasibility of a fund and contract dissemination strategy in the adoption of a PWMI in four to eight rural communities, compare a learning collaborative implementation strategy including embedded training and sustainability action planning with communities who receive the PWMI online program and resources alone, and determine whether the PWMI reach, effectiveness, and maintenance are of magnitude similar to previous effectiveness trials. The dissemination and implementation process focused on an integrated research-practice partnership process model that includes a systems-based approach with multiple sectors and vertical decision-making representation. Conclusions: Our pilot T3HEI study has the potential to inform how best to move and sustain evidence-based PWMIs into practice. The findings will inform larger scale dissemination, implementation, and sustainability efforts in medically underserved areas across the country. Trial registration: This protocol is registered with clinicaltrials.gov (NCT04719442).
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Affiliation(s)
- Jennie L Hill
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kate A Heelan
- Kinesiology and Sport Sciences Department, University of Nebraska at Kearney, Kearney, NE, USA
| | - R T Bartee
- Kinesiology and Sport Sciences Department, University of Nebraska at Kearney, Kearney, NE, USA
| | - Christopher Wichman
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tzeyu Michaud
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Bryce M Abbey
- Kinesiology and Sport Sciences Department, University of Nebraska at Kearney, Kearney, NE, USA
| | - Gwenndolyn Porter
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Caitlin Golden
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Paul A Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
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11
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Bessette H, Song M, Lyons KS, Stoyles S, Lee CS, Hansen L, Winters-Stone K. Enrolling Caregivers in Obesity Interventions to Improve Obesity-Related Outcomes in Children. West J Nurs Res 2021; 44:966-971. [PMID: 34353179 DOI: 10.1177/01939459211037057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this study, we assessed the influences of change in moderate-to-vigorous physical activity (MVPA)/sedentary time (ST) of caregivers participating in a commercial weight-loss program on their children's change in MVPA/ST. Data from 29 caregivers and their children were collected over 8 weeks. We used multivariable linear regression to assess associations of changes in caregiver's percent of time spent in MVPA/ST and changes in their child's percent of time spent in MVPA/ST. For caregivers that decreased body mass index (BMI) over 8 weeks, changes in caregivers' MVPA was strongly associated with the change in children's MVPA (β = 2.61 [95% CI: 0.45, 4.77]) compared to caregivers who maintained/increased BMI (β = 0.24 [-2.16, 2.64]). Changes in caregivers' ST was strongly associated with changes in children's ST (β = 2.42 [1.02, 3.81]) compared to caregivers who maintained/increased BMI (β = 0.35 [-0.45, 1.14]). Findings reinforce encouraging caregivers to enroll in weight-loss programs for the benefit of their children as well as for themselves.
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Affiliation(s)
- Hannah Bessette
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - MinKyoung Song
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Karen S Lyons
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Sydnee Stoyles
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Christopher S Lee
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Lissi Hansen
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
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12
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Social Determinants of Health Influencing the New Zealand COVID-19 Response and Recovery: A Scoping Review and Causal Loop Diagram. SYSTEMS 2021. [DOI: 10.3390/systems9030052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Coronavirus pandemic of 2019–20 (COVID-19) affected multiple social determinants of health (SDH) across the globe, including in New Zealand, exacerbating health inequities. Understanding these system dynamics can support decision making for the pandemic response and recovery measures. This study combined a scoping review with a causal loop diagram to further understanding of the connections between SDH, pandemic measures, and both short- and long-term outcomes in New Zealand. The causal loop diagram showed the reinforcing nature of structural SDH, such as colonization and socio-economic influences, on health inequities. While balancing actions taken by government eliminated COVID-19, the diagram showed that existing structural SDH inequities could increase health inequities in the longer term, unless the opportunity is taken for socio-economic policies to be reset. Such policy resets would be difficult to implement, as they are at odds with the current socio-economic system. The causal loop diagram highlighted that SDH significantly influenced the dynamics of the COVID-19 impact and response, pointing to a need for purposeful systemic action to disrupt the reinforcing loops which increase health inequities over time. This will require strong systems leadership, and coordination between policy makers and implementation at local level.
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Ayala GX, Monge‐Rojas R, King AC, Hunter R, Berge JM. The social environment and childhood obesity: Implications for research and practice in the United States and countries in Latin America. Obes Rev 2021; 22 Suppl 3:e13246. [PMID: 33951272 PMCID: PMC8365653 DOI: 10.1111/obr.13246] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/17/2022]
Abstract
The environments of children influence their risk for childhood obesity through, among other factors, a child's weight-related behaviors (i.e., diet and physical activity). In this article, we present evidence on social environmental factors associated with a child's diet and physical activity, and more generally, the prevention and control of childhood obesity among Hispanic/Latinx children in the United States and children from countries in Latin America. Using a socio-ecologic lens, we present evidence from cross-sectional and longitudinal studies conducted in the United States involving Hispanic/Latinx children, and evidence from studies involving children in Latin America. Studies examining parenting factors in the home environment (e.g., parenting strategies) are especially emphasized, with more limited evidence on social environmental factors in other lived contexts (e.g., school). The influence of acculturation on social relationships cuts across levels of the socio-ecological framework. Intervention research identified strategies and research gaps for intervening on social factors to promote healthy behaviors and reduce risk for childhood obesity. Community health workers and others forms of peer support were identified as relevant approaches at multiple levels of the socio-ecological framework. This article concludes with directions for future research to further understand the environment using newer information and communication technologies.
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Affiliation(s)
- Guadalupe X. Ayala
- School of Public HealthSan Diego State University, the Institute for Behavioral and Community Health, and the SDSU HealthLINK CenterSan DiegoCaliforniaUSA
| | - Rafael Monge‐Rojas
- Health and Nutrition UnitCosta Rican Institute for Research and Education on Nutrition and Health (INCIENSA)CartagoCosta Rica
| | - Abby C. King
- Departments of Epidemiology & Population Health and Medicine (Stanford Prevention Research Center)Stanford University School of MedicineStanfordCaliforniaUSA
| | - Ruth Hunter
- Centre for Public HealthQueen's University Belfast, North IrelandBelfastUK
| | - Jerica M. Berge
- Department of Family Medicine and Community Health, Medical SchoolUniversity of MinnesotaMinneapolisMinnesotaUSA
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Goldthorpe J, Epton T, Keyworth C, Calam R, Brooks J, Armitage C. What do children, parents and staff think about a healthy lifestyles intervention delivered in primary schools? a qualitative study. BMJ Open 2020; 10:e038625. [PMID: 32819951 PMCID: PMC7440822 DOI: 10.1136/bmjopen-2020-038625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Primary schools are crucial settings for early weight management interventions but effects on children's weight are small and evidence shows that deficiencies in intervention implementation may be responsible. Very little is known about the roles of multiple stakeholders in the process of implementation. We used a multiple-stakeholder qualitative research approach to explore the implementation of an intervention developed to improve the diet and increase the levels of physical activity for children living in some of the most deprived areas of England. DESIGN For this qualitative study, interviews and focus groups were carried out using semi-structured topic guides. Data were analysed thematically. SETTING Seven primary schools (pupils aged 4 to 11) in Manchester, England. PARTICIPANTS We conducted 14 focus groups with children aged 5 to 10 years and interviews with 19 staff members and 17 parents. INTERVENTION Manchester Healthy Schools (MHS) is a multicomponent intervention, developed to improve diet and physical activity in schools with the aim of reducing and preventing childhood obesity. RESULTS Three themes were developed from the data: common understandings of health and health behaviours; congruence and consistency of messages; negotiations of responsibility. CONCLUSION All participant groups had a common conceptualisation of health as having physical and psychological components and that action could be taken in childhood to change behaviours that protect long-term health. When parents and staff felt a shared sense of responsibility for children's health and levels of congruence between home and school norms around diet and physical activity were high, parents and children were more likely to accept the policies implemented as part of MHS. Effective two-way communication between home and school is therefore vital for successful implementation of this intervention.
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Affiliation(s)
- Joanna Goldthorpe
- Manchester Center for Health Psychology, University of Manchester, Manchester, UK
| | - Tracy Epton
- Manchester Center for Health Psychology, University of Manchester, Manchester, UK
| | - Chris Keyworth
- Manchester Center for Health Psychology, University of Manchester, Manchester, UK
| | - Rachel Calam
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Joanna Brooks
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Chris Armitage
- Manchester Center for Health Psychology, University of Manchester, Manchester, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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Mansouri V, Riahi R, Khademian M, Qorbani M, Heidari-Beni M, Heshmat R, Motlagh ME, Ziaodini H, Dashti R, Taheri M, Daniali S, Kelishadi R. Factors Associated with Tendency for Weight Loss in a Representative Sample of Children and Adolescents: The CASPIAN-V Study. Int J Prev Med 2020; 11:123. [PMID: 33088451 PMCID: PMC7554429 DOI: 10.4103/ijpvm.ijpvm_358_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/20/2020] [Indexed: 11/18/2022] Open
Abstract
Background: This study aims to determine the factors affecting the tendency to lose weight (TLW) and its methods in Iranian children and adolescents. Methods: In this cross-sectional nationwide study 14800 students, aged 7–18 years, living in 30 provinces of Iran were selected via multistage cluster random sampling method. The dietary and physical activity habits and TLW as well as psychosocial health status, anxiety, self-satisfaction, and change in dietary behaviors were assessed by the global school-based student health survey (WHO-GSHS) questionnaire. Multivariate logistic regression model was used to identify factors influencing TLW. Results: Overall, 14274 students (participation rate of 99%), consisting of 51% boys and 71.4% urban residents, completed the study. Of them, 37.7% (51.4% Girls and 48.6% boys) tended to lose weight. In multivariate model, the odds for TLW was 12% higher in students aged 13–18 years than those aged 6–12 years (OR = 1.12, 95% CI: 1.02 to 1.23; P < 0.001). Students with high anxiety level were 43% more likely to have TLW (OR = 1.43, 95% CI: 1.28–1.59; P < 0.001). The odds of increasing physical activity for weight loss was 22% lower in obese than in normal weight students (OR = 0.78, 95% CI: 0.66 to 0.93; P < 0.001). Conclusions: TLW was significantly higher in girls, as well as in those with higher anxiety level. In addition to dietary change, increasing physical activity should be encouraged among children and adolescents with excess weight. Public education regarding proper lifestyle change for reaching healthy weight should be underscored.
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Affiliation(s)
- Vahid Mansouri
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Riahi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Khademian
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mostafa Qorbani
- Department of Epidemiology, Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Motahar Heidari-Beni
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ramin Heshmat
- Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hasan Ziaodini
- Department of Health Psychology, Research Center of Education Ministry Studies, Tehran, Iran
| | - Razieh Dashti
- Bureau of Family, Population, Youth and School Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Majzoubeh Taheri
- Bureau of Family, Population, Youth and School Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Shahrebanoo Daniali
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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Blanco M, Veiga OL, Sepúlveda AR, Izquierdo-Gomez R, Román FJ, López S, Rojo M. [Family environment, physical activity and sedentarism in preadolescents with childhood obesity: ANOBAS case-control study]. Aten Primaria 2020; 52:250-257. [PMID: 30898477 PMCID: PMC7118555 DOI: 10.1016/j.aprim.2018.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/25/2018] [Accepted: 05/17/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The aim of this study is to compare the levels of physical activity and sedentary behaviours in children with obesity and normal weight through accelerometer measures, and analyze the family environment related to physical activity. DESIGN Case-control study. LOCATION A health center and colleges of the Community of Madrid. PARTICIPANTS A total of 50 obese children between 8 and 12 years of age (P > 97) and their mothers were matched by age, sex and socioeconomic status of their parents (1: 1) with 50 children with normopeso (GN; P < 85). MAIN MEASUREMENTS Physical activity levels were measured by accelerometer (ActiGraph GT3X), levels of physical activity of the primary caregiver were measured through physical activity questionnaire (IPAQ) and the environment in relation to the physical activity was measured by the Home Environment Scale (HES-S). RESULTS The group GO showed less vigorous physical activity than their peers in the GN group. Vigorous physical activity in the GO group was associated with modeling and parental policies regarding physical activity. A multiple regression analysis revealed that 21% of the variance of weight status of children was explained by sex, vigorous physical activity and maternal body mass index. CONCLUSIONS The levels of vigorous physical activity and the family environment differ between children with obesity and normal weight. Therefore, it is important to continue working on the awareness of illness and the promotion of healthy habits from Primary Care and the school and institutional context.
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Affiliation(s)
- Miriam Blanco
- Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, España.
| | - Oscar L Veiga
- Departamento de Educación Física, Deporte y Motricidad Humana, Universidad Autónoma de Madrid, Madrid, España
| | - Ana R Sepúlveda
- Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, España
| | - Rocío Izquierdo-Gomez
- Facultad de Educación, Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, España
| | - Francisco J Román
- Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, España
| | - Sara López
- Departamento de Enfermería Pediátrica, Centro de Salud Daroca, Madrid, España
| | - Marta Rojo
- Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, España
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Song M, Lee CS, Lyons KS, Stoyles S, Winters-Stone KM. Assessing the feasibility of parent participation in a commercial weight loss program to improve child body mass index and weight-related health behaviors. SAGE Open Med 2018; 6:2050312118801220. [PMID: 30302248 PMCID: PMC6170954 DOI: 10.1177/2050312118801220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 08/26/2018] [Indexed: 11/23/2022] Open
Abstract
Objectives: Little is known about how children’s health might be affected by parents’
participation in commercial weight loss programs. Given that more than
3.2 million people subscribe to just one commercial weight loss program,
Weight Watchers, any secondary effects on children’s
weight-related health behaviors (e.g. dietary behaviors, physical activity,
and sedentary time) and body mass index from parent participation in
commercial weight loss programs may have significant public health
implications. This study examined the feasibility of conducting a study to
assess such effects. Methods for recruitment and retention, and perceived
acceptability and satisfaction among participants in small-scale preliminary
study, were evaluated. Changes in body mass index and health behaviors among
the parent–child dyads were also measured to test whether a larger-scale
study would be warranted. Methods: This was an 8-week, pre–post observational feasibility study involving 20
parent–child dyads where both members had overweight or obesity. Physical
and behavioral data were collected at baseline and 8 weeks from both members
of the dyads. Parenting data were collected at the same time periods through
parents’ self-report. Bivariate correlation was used to quantify the
associations in changes for dyad members. Results: Feasibility goals for retention and perceived acceptability/satisfaction
among participants were met. We reached approximately 80% of our enrollment
goal. Parents showed a significant decrease in body mass index of 0.53
points (p < 0.05), while children showed a significant increase in raw
body mass index (0.42, p < 0.05) and body mass index percentile (0.59,
p < 0.05). However, correlation between changes in parent body mass index
and changes in children body mass index percentile was positively correlated
(r = 0.24, p = 0.31). A decrease in parent intake of total fat was
associated with a decrease in the intake of fat in their children (r = 0.47,
p < 0.05). Conclusion: Our findings support the viability of a larger-scale follow-up to assess the
potential of using parent-only commercial weight loss program as a mechanism
for improving health behaviors and body mass index in children with
overweight or obesity.
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Affiliation(s)
- MinKyoung Song
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Christopher S Lee
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
| | - Karen S Lyons
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Sydnee Stoyles
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
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Kracht CL, Sisson SB. Sibling influence on children's objectively measured physical activity: a meta-analysis and systematic review. BMJ Open Sport Exerc Med 2018; 4:e000405. [PMID: 30364499 PMCID: PMC6196974 DOI: 10.1136/bmjsem-2018-000405] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2018] [Indexed: 12/26/2022] Open
Abstract
Abstract Children without siblings (only children) have higher rates of obesity than children with siblings. Childhood obesity may be prevented by minimising sedentary behaviour and accumulating sufficient physical activity in young children. A growing number of articles have examined the influence of siblings on physical activity and sedentary behaviour, yet these articles have not been synthesised. Objective To synthesise literature and describe the influence of siblings on objectively measured physical activity and sedentary behaviour of children (ages 2–18 years). Design Outcomes were analysed in a systematic review and meta-analysis. Data sources PubMed, EMBASE, Web of Science and Medline OVID were searched for articles related to siblings, physical activity, sedentary behaviour and obesity outcomes from 1947 to March 2018. Eligibility criteria Articles that evaluated sibling status on physical activity objectively measured by accelerometer or pedometer were included. Results Nineteen articles, representing 17 independent datasets, were included in the review. Nine were included in the quantitative analysis. Pooled data from nine articles indicated children with siblings had higher moderate-to-vigorous physical activity (MVPA) relative to only children, with a potential dose response for higher number of children in household and higher MVPA (Mean Difference=3.13, 95% CI 1.90 to 4.35, p=0.001). Findings were mixed for the influence of siblings on sedentary behaviour and light physical activity. Summary/Conclusion Children with siblings had healthier physical activity patterns, as measured by accelerometer or pedometer, than did only children. Suggested mechanisms include peer modelling, encouraging active transport and sports participation, opportunity for playmate and serving as additional caregivers. Trial registration number CRD42017055463.
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Affiliation(s)
- Chelsea L Kracht
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Susan B Sisson
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Dynamics of Implementation and Maintenance of Organizational Health Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14080917. [PMID: 28809807 PMCID: PMC5580620 DOI: 10.3390/ijerph14080917] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 07/26/2017] [Accepted: 08/11/2017] [Indexed: 12/22/2022]
Abstract
In this study, we present case studies to explore the dynamics of implementation and maintenance of health interventions. We analyze how specific interventions are built and eroded, how the building and erosion mechanisms are interconnected, and why we can see significantly different erosion rates across otherwise similar organizations. We use multiple comparative obesity prevention case studies to provide empirical information on the mechanisms of interest, and use qualitative systems modeling to integrate our evolving understanding into an internally consistent and transparent theory of the phenomenon. Our preliminary results identify reinforcing feedback mechanisms, including design of organizational processes, motivation of stakeholders, and communication among stakeholders, which influence implementation and maintenance of intervention components. Over time, these feedback mechanisms may drive a wedge between otherwise similar organizations, leading to distinct configurations of implementation and maintenance processes.
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Morgan PJ, Young MD, Lloyd AB, Wang ML, Eather N, Miller A, Murtagh EM, Barnes AT, Pagoto SL. Involvement of Fathers in Pediatric Obesity Treatment and Prevention Trials: A Systematic Review. Pediatrics 2017; 139:peds.2016-2635. [PMID: 28130430 PMCID: PMC6200318 DOI: 10.1542/peds.2016-2635] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2016] [Indexed: 12/26/2022] Open
Abstract
CONTEXT Despite their important influence on child health, it is assumed that fathers are less likely than mothers to participate in pediatric obesity treatment and prevention research. OBJECTIVE This review investigated the involvement of fathers in obesity treatment and prevention programs targeting children and adolescents (0-18 years). DATA SOURCES A systematic review of English, peer-reviewed articles across 7 databases. Retrieved records included at least 1 search term from 2 groups: "participants" (eg, child*, parent*) and "outcomes": (eg, obes*, diet*). STUDY SELECTION Randomized controlled trials (RCTs) assessing behavioral interventions to prevent or treat obesity in pediatric samples were eligible. Parents must have "actively participated" in the study. DATA EXTRACTION Two authors independently extracted data using a predefined template. RESULTS The search retrieved 213 eligible RCTs. Of the RCTs that limited participation to 1 parent only (n = 80), fathers represented only 6% of parents. In RCTs in which participation was open to both parents (n = 133), 92% did not report objective data on father involvement. No study characteristics moderated the level of father involvement, with fathers underrepresented across all study types. Only 4 studies (2%) suggested that a lack of fathers was a possible limitation. Two studies (1%) reported explicit attempts to increase father involvement. LIMITATIONS The review was limited to RCTs published in English peer-reviewed journals over a 10-year period. CONCLUSIONS Existing pediatric obesity treatment or prevention programs with parent involvement have not engaged fathers. Innovative strategies are needed to make participation more accessible and engaging for fathers.
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Affiliation(s)
- Philip J. Morgan
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia;,Address correspondence to Philip J. Morgan, PhD, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, University Dr, Callaghan NSW, 2308, Australia. E-mail:
| | - Myles D. Young
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Adam B. Lloyd
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Monica L. Wang
- Department of Community Health Sciences, Boston University, Boston, Massachusetts;,Department of Social and Behavioral Sciences, Harvard University, Boston, Massachusetts
| | - Narelle Eather
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Andrew Miller
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Elaine M. Murtagh
- Department of Arts Education and Physical Education, Mary Immaculate College, University of Limerick, Limerick, Ireland; and
| | - Alyce T. Barnes
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Sherry L. Pagoto
- Department of Medicine, University of Massachusetts, Worcester, Massachusetts
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