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Han J, Koser K, Mamey MR, Vanderbilt DL, Schonfeld DJ, Yin L, Deavenport-Saman A. Mediation of Parental Aggravation in the Association Between ADHD Severity and Electronic Media Use: A National Survey of Children's Health Study. J Atten Disord 2024; 28:127-138. [PMID: 37905519 DOI: 10.1177/10870547231205028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To determine whether the association between ADHD severity and electronic media use was mediated by parental aggravation. METHODS This was a retrospective analysis from the 2016 to 2017 National Survey of Children's Health (NSCH) involving children ages of 3 to 17 years with parent-reported ADHD (n = 5,930). Path analyses were used to model the relationships between ADHD severity with parental aggravation (PA) as a mediator, and electronic device (ED) and television (TV) use as outcomes, controlling for covariates. RESULTS Parental aggravation mediated the relationship between ADHD severity and ED use and TV use (indirect effects: β = .02, p < .001; β = .01, p = .004). When stratified by age, the mediation effect between ADHD and ED use remained significant for adolescents and school-age children, and mediation between ADHD and TV use remained significant only for adolescents. CONCLUSION These findings suggest a need to develop targeted interventions to address PA and manage excessive electronic media use in children with moderate/severe ADHD.
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Affiliation(s)
- Jennifer Han
- Kaiser Permanente Riverside Medical Center, CA, USA
| | | | | | - Douglas L Vanderbilt
- Children's Hospital Los Angeles, CA, USA
- USC Keck School of Medicine, Los Angeles, CA, USA
| | - David J Schonfeld
- Children's Hospital Los Angeles, CA, USA
- USC Keck School of Medicine, Los Angeles, CA, USA
| | - Larry Yin
- USC Keck School of Medicine, Los Angeles, CA, USA
- Children's Hospital Los Angeles, CA, USA
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2
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Wu YQ, Liu F, Chan KQ, Wang NX, Zhao S, Sun X, Shen W, Wang ZJ. Childhood psychological maltreatment and internet gaming addiction in Chinese adolescents: Mediation roles of maladaptive emotion regulation strategies and psychosocial problems. CHILD ABUSE & NEGLECT 2022; 129:105669. [PMID: 35598385 DOI: 10.1016/j.chiabu.2022.105669] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 04/18/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Internet gaming addiction (IGA) is a global concern, especially among young children. There have been some suggestions that childhood psychological maltreatment influences the development of IGA, but evidence for this has thus far been lacking. OBJECTIVE The goal of this study was to investigate the association between childhood psychological maltreatment and IGA in adolescents and the mediation roles of maladaptive emotion regulation strategies and psychosocial problems (depression and social anxiety). METHODS This study recruited 1280 (girls = 690) middle school students with a mean age of 16.09 ± 0.98 years old. All participants undertook a standardized assessment of childhood psychological maltreatment, maladaptive emotion regulation strategies, psychosocial problems (depression and social anxiety), and IGA. RESULTS We examined whether the effect of childhood psychological maltreatment on IGA was mediated by maladaptive emotion regulation strategies and psychosocial problems (depression and social anxiety). Both parallel and sequential mediation analysis showed that maladaptive emotion regulation strategies and depression mediated the relationship between childhood psychological maltreatment and IGA. CONCLUSIONS Childhood psychological maltreatment is positively associated with IGA in adolescents. Maladaptive emotion regulation strategies and depression both significantly mediated the relationship between childhood psychological maltreatment and IGA.
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Affiliation(s)
- Yu-Qing Wu
- Department of Psychology, Ningbo University, China
| | - Fang Liu
- Department of Psychology, Ningbo University, China
| | - Kai Qin Chan
- Department of Psychology, James Cook University, Singapore
| | | | - Shu Zhao
- Department of Psychology, Ningbo University, China
| | - Xin Sun
- Department of Psychology, Ningbo University, China
| | - Wangbing Shen
- School of Public Administration, Hohai University, China
| | - Zuo-Jun Wang
- Department of Psychology, Ningbo University, China; School of Public Administration, Hohai University, China.
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Kininmonth AR, Schrempft S, Smith A, Dye L, Lawton C, Fisher A, Llewellyn CH, Fildes A. Associations between the home environment and childhood weight change: a cross-lagged panel analysis. Int J Obes (Lond) 2022; 46:1678-1685. [PMID: 35739248 PMCID: PMC9395269 DOI: 10.1038/s41366-022-01170-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The obesogenic quality of the home environment is hypothesised to play an important role in children's weight development but few prospective studies have investigated relationships between the home environment and adiposity across childhood. OBJECTIVE To investigate the continuity and stability of the home environment from ages 4 to 12, and bi-directional relationships between the home environment and BMI-SDS from ages 4 to 12. METHODS Parents from the Gemini cohort completed the Home Environment Interview (HEI), a comprehensive measure of the obesogenic home environment, when their children were aged 4 and 12 (n = 149 families, n = 298 children). The obesogenic home environment was measured using four composite scores capturing the food, activity, media environments, and the overall home environment. Child weights and heights were used to calculate BMI-SDS. Continuity was assessed with Pearson's correlations between scores at each time point, and stability by changes in mean scores over time. Cross-lagged analyses were performed (HEI composites at age 4 to BMI-SDS at age 12 and the reverse) to measure the magnitude and direction of associations. RESULTS The home environment showed moderate-to-high continuity from ages 4 to 12 (r = 0.30-0.64). The overall home environment (r = 0.21, p < 0.01) and media composites (r = 0.23, p < 0.01) were cross-sectionally associated with child BMI-SDS at age 12, but not at age 4. Longitudinally, the home media environment at age 4 predicted increases in child BMI-SDS at age 12 (β; 95% CI = 0.18; 0.08,0.28, p < 0.01). No associations were observed for the reverse path, or the remaining composites (the overall, food and activity) in either direction. CONCLUSION This study provides evidence that the obesogenic home environment tracks across childhood and highlights the importance of the early home media environment for child weight development. The findings provide insight into key aspects of the home environment that could be targeted when developing obesity treatment or prevention strategies.
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Affiliation(s)
- Alice R Kininmonth
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK. .,Research Department of Behavioural Science and Health, University College London, London, UK.
| | - Stephanie Schrempft
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Andrea Smith
- Research Department of Behavioural Science and Health, University College London, London, UK.,MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Louise Dye
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Clare Lawton
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Abigail Fisher
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Clare H Llewellyn
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Alison Fildes
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
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4
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Saunders TJ, McIsaac T, Campbell J, Douillette K, Janssen I, Tomasone JR, Ross-White A, Prince SA, Chaput JP. Timing of sedentary behaviour and access to sedentary activities in the bedroom and their association with sleep quality and duration in children and youth: a systematic review. Health Promot Chronic Dis Prev Can 2022; 42:139-149. [PMID: 35481336 PMCID: PMC9116723 DOI: 10.24095/hpcdp.42.4.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The purpose of this study was to systematically review the relationship between the timing of sedentary behaviours and access to sedentary activities in the bedroom with sleep duration and quality in children and youth. A secondary purpose was to examine whether these relationships differ when comparing screen-based and non-screen-based sedentary activities. METHODS We searched four databases for peer-reviewed studies published between 1 January 2010 and 19 January 2021. Risk of bias assessment for each study and certainty of evidence were assessed using the GRADE framework. RESULTS We identified 44 eligible papers reporting data from 42 separate datasets and including 239 267 participants. Evening participation in screen-based sedentary behaviours and access to screen-based devices in the bedroom were associated with reduced sleep duration and quality. Daytime screen use was also associated with reduced sleep duration, although this was examined in relatively few studies. Whether performed during the day or night, non-screen-based sedentary behaviours were not consistently associated with sleep duration or quality. The quality of evidence was rated as low to very low for all outcomes. CONCLUSION In order to maximize sleep duration and quality, children and youth should be encouraged to minimize screen time in the evening and remove screens from bedrooms. (PROSPERO registration no.: CRD42020189082).
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Affiliation(s)
- Travis J Saunders
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Travis McIsaac
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Jenny Campbell
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Kevin Douillette
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Ian Janssen
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Amanda Ross-White
- Queen's University Library, Queen's University, Kingston, Ontario, Canada
| | - Stephanie A Prince
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Jean-Philippe Chaput
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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Berleze A, Valentini NC. Intervention for Children with Obesity and Overweight and Motor Delays from Low-Income Families: Fostering Engagement, Motor Development, Self-Perceptions, and Playtime. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2545. [PMID: 35270238 PMCID: PMC8909693 DOI: 10.3390/ijerph19052545] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/12/2022] [Accepted: 02/17/2022] [Indexed: 02/01/2023]
Abstract
Obesity is increasing globally, affecting children’s health and development. This study examines the influence of a motor skill intervention on the daily routine, self-perceptions, body mass index, motor development, and engagement in physical education lessons of children with obesity and overweight with motor delays. Children were randomly assigned to intervention and control groups. The daily routine at home, self-perceptions, motor development, BMI, and engagement were assessed. Significant group by time interactions were found for play (p < 0.0001) and television (p < 0.0001) time, perceived social (p = 0.003) and motor (p < 0.0001) competence, global self-worth (p < 0.0001), BMI (p = 0.001), motor development (p < 0.0001), and engagement (p = 0.029). From pre-to-post intervention, children with obesity and overweight in the intervention group increased (1) playtime at home; (2) self-perceptions of social and motor competence and global worth; (4) engagement in the lessons, and improved scores, in motor skills; and (6) reduced BMI and screen time. The intervention promoted the health and improved the self-concept of children with obesity/ overweight.
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Affiliation(s)
| | - Nadia Cristina Valentini
- Universidade Federal do Rio Grande do Sul, Rua Felizardo 750, Porto Alegre 90690-200, RS, Brazil;
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Kininmonth AR, Schrempft S, Smith A, Dye L, Lawton C, Fisher A, Llewellyn C, Fildes A. The Home Environment Interview and associations with energy balance behaviours and body weight in school-aged children - a feasibility, reliability, and validity study. Int J Behav Nutr Phys Act 2021; 18:167. [PMID: 34949200 PMCID: PMC8698661 DOI: 10.1186/s12966-021-01235-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/06/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The home environment is thought to influence children's weight trajectories. However, few studies utilise composite measures of the home environment to examine associations with energy balance behaviours and weight. The present study aimed to adapt and update a comprehensive measure of the obesogenic home environment previously developed for pre-schoolers, and explore associations with school-aged children's energy balance behaviours and weight. METHODS Families from the Gemini cohort (n = 149) completed the Home Environment Interview (HEI) via telephone when their children were 12 years old. The HEI comprises four composite scores: one for each domain (food, activity and media) of the environment, as well as a score for the overall obesogenic home environment. The primary caregiver also reported each child's height and weight (using standard scales and height charts), diet, physical activity and sedentary screen-based behaviours. A test-retest sample (n = 20) of caregivers completed the HEI a second time, 7-14 days after the initial interview, to establish test-retest reliability. RESULTS Children (n = 298) living in 'higher-risk' home environments (a 1 unit increase in the HEI obesogenic risk score) were less likely to consume fruits (OR; 95% CI = 0.40; 0.26-0.61, p < 0.001), and vegetables (0.30; 0.18-0.52, p < 0.001), and more likely to consume energy-dense snack foods (1.71; 1.08-2.69, p = 0.022), convenience foods (2.58; 1.64-4.05, p < 0.001), and fast foods (3.09; 1.90-5.04, p < 0.001). Children living in more obesogenic home environments also engaged in more screen-time (β (SE) = 4.55 (0.78), p < 0.001), spent more time playing video games (β (SE) = 1.56 (0.43), p < 0.001), and were less physically active (OR; 95% CI = 0.57; 0.40-0.80, p < 0.01). Additionally, there was a positive association between higher-risk overall home environment composite score and higher BMI-SDS (β (SE) = 0.23 (0.09), p < 0.01). This finding was mirrored for the home media composite (β (SE) = 0.12 (0.03), p < 0.001). The individual home food and activity composite scores were not associated with BMI-SDS. CONCLUSION Findings reveal associations between the overall obesogenic home environment and dietary intake, activity levels and screen-based sedentary behaviours, as well as BMI in 12 year olds. These findings suggest that the home environment, and in particular the home media environment, may be an important target for obesity prevention strategies.
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Affiliation(s)
| | - Stephanie Schrempft
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Andrea Smith
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- University College London, London, UK
| | - Louise Dye
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Clare Lawton
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | | | | | - Alison Fildes
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
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Paduano S, Greco A, Borsari L, Salvia C, Tancredi S, Pinca J, Midili S, Tripodi A, Borella P, Marchesi I. Physical and Sedentary Activities and Childhood Overweight/Obesity: A Cross-Sectional Study among First-Year Children of Primary Schools in Modena, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3221. [PMID: 33804662 PMCID: PMC8003752 DOI: 10.3390/ijerph18063221] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 01/04/2023]
Abstract
Children obesity is a serious public health issue. This study aimed to investigate physical/sedentary activities of first-year primary schools children in Modena, and their association with overweight/obesity and dietary habits of children and family characteristics to identify the risk factors for unhealthy lifestyles. Child physical/sedentary activities were gathered through an anonymous questionnaire administered to parents, as well as family characteristics and weight/height of child and parents. Logistic regression models, eventually adjusted for parents' sociodemographic characteristics, were used to analyze data. Questionnaires were delivered by 660 families (74.2%), of which 72 without anthropometric data were excluded. Three out of four children spent in physical activities less than 7 h/week, while 63.9% dedicated to sedentary activities two or more hours/day. From multivariate analysis, the habit significantly affecting children's overweight/obesity was spending time on tablets/Personal Computers/mobile phones/videogames. Higher parental education level resulted in a protective factor for implementing unhealthy lifestyles in terms of time dedicated to physical/sedentary activities. Our results suggest the need of interventions to increase time for physical activity and to promote a responsible use of digital media involving the entire families to reach all parents regardless of their education and nationality with a possible relapse on other family members.
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Affiliation(s)
- Stefania Paduano
- Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, 41125 Modena, Italy; (S.T.); (P.B.); (I.M.)
| | - Antonella Greco
- Department of Public Health, AUSL Modena, 41126 Modena, Italy; (A.G.); (L.B.)
| | - Lucia Borsari
- Department of Public Health, AUSL Modena, 41126 Modena, Italy; (A.G.); (L.B.)
| | - Chiara Salvia
- Primary Care Health Authority and Services, AUSL Modena, 41124 Modena, Italy;
| | - Stefano Tancredi
- Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, 41125 Modena, Italy; (S.T.); (P.B.); (I.M.)
| | - Jenny Pinca
- Department of Public Health, Food Hygiene and Nutrition Service, AUSL Modena, 41126 Modena, Italy; (J.P.); (S.M.); (A.T.)
| | - Simona Midili
- Department of Public Health, Food Hygiene and Nutrition Service, AUSL Modena, 41126 Modena, Italy; (J.P.); (S.M.); (A.T.)
| | - Alberto Tripodi
- Department of Public Health, Food Hygiene and Nutrition Service, AUSL Modena, 41126 Modena, Italy; (J.P.); (S.M.); (A.T.)
| | - Paola Borella
- Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, 41125 Modena, Italy; (S.T.); (P.B.); (I.M.)
| | - Isabella Marchesi
- Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, 41125 Modena, Italy; (S.T.); (P.B.); (I.M.)
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Cavalli E, Anders R, Chaussoy L, Herbillon V, Franco P, Putois B. Screen exposure exacerbates ADHD symptoms indirectly through increased sleep disturbance. Sleep Med 2021; 83:241-247. [PMID: 34049043 DOI: 10.1016/j.sleep.2021.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/01/2021] [Accepted: 03/06/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was twofold. First, to confirm the deleterious aspect of evening screen exposure in school-aged children, in particular the effect of screens in the bedroom. Second, to explore the three-way association between degree of screen exposure, sleep disturbance, and ADHD symptoms. Solid evidence exists on the link between sleep disturbance and ADHD symptoms, and screen exposure and sleep disturbance. However, no studies have formally assessed the impact of screen exposure on ADHD symptoms in children, as a function of sleep disturbance. METHODS Parents of 374 French children (201 girls, 173 boys, mean age of 10.8 ± 2.8 years old) completed the Sleep Disturbance Scale for Children (SDSC), the Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale, and a questionnaire about their children's screen habits (total hours in the morning, afternoon, and evening per day). Correlational analyses between evening screen exposure, sleep quality and behavioral problems were conducted. Then, formal mediation analyses were run in order to quantify the relationship between variables. RESULTS School-aged children with screens in their bedrooms demonstrated more sleep and behavioral problems. Evening TV exposure was associated with higher SDSC and ADHD scores. Furthermore, the Structural Equation Modelling approach confirmed that evening screen exposure is directly associated with more disrupted sleep, which in turn is directly associated with behavioral problems. CONCLUSIONS These findings encourage families to avoid putting screens in their children's bedrooms, and limit evening screen exposure. They furthermore demonstrate the importance of taking into account screen exposure time (morning, afternoon, evening) and location (bedroom or elsewhere) in future studies.
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Affiliation(s)
- Eddy Cavalli
- EMC (Etude des Mécanismes Cognitifs) Laboratory, University of Lyon 2, Lyon, France
| | - Royce Anders
- EMC (Etude des Mécanismes Cognitifs) Laboratory, University of Lyon 2, Lyon, France
| | - Louise Chaussoy
- EMC (Etude des Mécanismes Cognitifs) Laboratory, University of Lyon 2, Lyon, France; Centre de Recherches sur la Cognition et l'Apprentissage (CeRCA), UMR CNRS 7295, Poitiers, France
| | - Vania Herbillon
- Pediatric Sleep Unit, Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, University Lyon 1, Lyon, France
| | - Patricia Franco
- Pediatric Sleep Unit, Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, University Lyon 1, Lyon, France; Swiss Distance Learning University, Faculty of Psychology, Brig, Switzerland
| | - Benjamin Putois
- Pediatric Sleep Unit, Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, University Lyon 1, Lyon, France; Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon 1 University, France; Swiss Distance Learning University, Faculty of Psychology, Brig, Switzerland.
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9
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Kininmonth AR, Smith AD, Llewellyn CH, Dye L, Lawton CL, Fildes A. The relationship between the home environment and child adiposity: a systematic review. Int J Behav Nutr Phys Act 2021; 18:4. [PMID: 33407598 PMCID: PMC7788808 DOI: 10.1186/s12966-020-01073-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/14/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Extensive research has demonstrated the role of the Home Environment (HE) in shaping children's energy balance behaviours. Less is known about direct relationships with bodyweight. This review examines associations between the social and physical aspects of three pre-defined Home Environment domains (food, physical activity and media) and adiposity measures in children ≤12 years. METHODS Six electronic databases (PubMed, Medline, EBSCO CINAHL, EMBASE, Web of Science, PsycInfo) were systematically searched up to October 2020. Studies reporting at least one physical and/or social aspect of the food, physical activity and/or media domains of the Home Environment in relation to child adiposity outcomes were included (n = 62). RESULTS Most studies examined one (n = 41) or two domains (n = 16). Only five studies assessed all three domains of the Home Environment. Most consistent relationships were observed for physical aspects of the home media environment; with greater availability of electronic devices associated with higher child adiposity (21/29 studies). Findings were less consistent for the smaller number of studies examining physical aspects of the home food or physical activity environments. 8/15 studies examining physical food environments reported null associations with adiposity. Findings were similarly mixed for physical activity environments; with 4/7 reporting null associations, 2/7 reporting negative associations and 1/7 reporting positive associations between access to physical activity equipment/garden space and adiposity. Fewer studies assessed social aspects (e.g. caregiver modelling or limit setting) of the Home Environment in relation to child adiposity and findings were again mixed; 9/16 media environment, 7/11 food environment and 9/13 physical activity environment studies reported null associations with child adiposity outcomes. CONCLUSIONS The home media environment was most consistently associated with adiposity in childhood. Findings were less consistent for the home food and physical activity environments. Greater agreement on definitions and the measurement of the obesogenic home environment is required in order to clarify the strength and direction of relationships with child adiposity. Robust longitudinal research using comprehensive measures of the holistic home environment is needed to better identify which aspects contribute to excess weight gain in childhood. TRIAL REGISTRATION PROSPERO Systematic review registration number: CRD42018115139 .
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Affiliation(s)
| | - Andrea D Smith
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Clare H Llewellyn
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Louise Dye
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Clare L Lawton
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Alison Fildes
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
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Sallis JF, Conway TL, Cain KL, Geremia C, Bonilla E, Spoon C. Electronic Devices as Correlates of Sedentary Behavior and Screen Time Among Diverse Low-Income Adolescents During the School Year and Summer Time. JOURNAL OF HEALTHY EATING AND ACTIVE LIVING 2020; 1:27-40. [PMID: 37790138 PMCID: PMC10544927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Excessive screen time among adolescents increases risk for overweight and obesity. Having electronic devices in the adolescent's bedroom is associated with more screen time. The present study expanded on previous studies by also examining portable personal electronic devices and social media membership as correlates of screen time use and total sedentary time in the school year and summer among diverse low-income adolescents. Adolescents aged 10-17 years were recruited from lower-income areas; n=150 (34 African Americans, 23 American Indians, 16 Asian/Pacific Islanders, 39 Latinos, and 38 White/non-Hispanics) completed surveys and wore accelerometers in both the school year and summer. Total sedentary time was computed from accelerometers. Recreational screen time was assessed with a 3-item validated scale. Adolescents reported the presence of 6 electronic devices in their bedrooms, ownership of 4 portable devices, and social media membership. General linear modeling was conducted for both time periods, with demographic covariates and interactions with sex and race/ethnicity. More electronic devices in bedrooms were related to more screen time during the school year and summer, and to more total sedentary time in summer. Personal electronics were related only to more screen time in the school year. Social media membership was related to more total sedentary time in summer, but only among African Americans, American Indians, and non-Hispanic Whites. Electronic devices in bedrooms was confirmed as a risk factor for sedentary behavior among low-income adolescents of color. Social media membership and use should be further studied with diverse adolescents.
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11
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Rodrigues D, Gama A, Machado-Rodrigues AM, Nogueira H, Silva MRG, Rosado-Marques V, Padez C. Social inequalities in traditional and emerging screen devices among Portuguese children: a cross-sectional study. BMC Public Health 2020; 20:902. [PMID: 32522168 PMCID: PMC7288526 DOI: 10.1186/s12889-020-09026-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 06/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children are often exposed to too much screen time but few studies have explored the use of old and new digital media among young children. This study assesses screen time, including traditional and mobile devices, in pre-school and elementary school-aged children, according to their gender, age, and socioeconomic position (SEP). METHODS A total of 8430 children (3 to 10 years; 50.8% boys) from the north, center and south-central Portugal were included in the present study. Data was collected by a parental questionnaire during 2016/2017. Children's screen time (by media device, weekdays and at the weekend; calculated by mean minutes per day) were reported by parents. Analysis were carried to compare screen time by children's age, gender and family SEP (classified using father's educational degree). RESULTS Daily screen time was high both in children aged 3 to 5 and 6 to 10 years - 154 min/day (95% CI: 149.51-158.91) and 200.79 min/day (95% CI: 197.08-204.50), respectively - and the majority of children, independently of their gender, exceed the recommended 2 h/day of screen viewing. Children are still primarily engaging in screen time through television but the use of mobile devices, particularly tablets, were already high among 3 year-old children and increased with age. SEP was a negative predictor of screen time in the linear regression analysis, including after adjustment. CONCLUSIONS Considering the negative health impacts of excessive screen time, recognizing subgroups at risk of excessive screen time and identifying how each device is used according to age is fundamental to enable appropriate future interventions. The screen time in children aged 3-10 years is longer than the recommended, particularly among boys and in those children from lower SEP. Parents and policymakers should have in mind that children spend most of their screen time watching television but mobile devices are becoming extremely popular starting at a young age.
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Affiliation(s)
- Daniela Rodrigues
- CIAS - Research Centre for Anthropology and Health, University of Coimbra, Ed. São Bento, Calçada Martim de Freitas, 3000-456, Coimbra, Portugal. .,Department of Life Sciences, University of Coimbra, Coimbra, Portugal.
| | - Augusta Gama
- CIAS - Research Centre for Anthropology and Health, University of Coimbra, Ed. São Bento, Calçada Martim de Freitas, 3000-456, Coimbra, Portugal.,Department of Animal Biology, Faculty of Sciences of the University of Lisbon, Lisbon, Portugal
| | - Aristides M Machado-Rodrigues
- CIAS - Research Centre for Anthropology and Health, University of Coimbra, Ed. São Bento, Calçada Martim de Freitas, 3000-456, Coimbra, Portugal.,High School of Education, Polytechnic Institute of Viseu, Viseu, Portugal
| | - Helena Nogueira
- CIAS - Research Centre for Anthropology and Health, University of Coimbra, Ed. São Bento, Calçada Martim de Freitas, 3000-456, Coimbra, Portugal
| | - Maria-Raquel G Silva
- CIAS - Research Centre for Anthropology and Health, University of Coimbra, Ed. São Bento, Calçada Martim de Freitas, 3000-456, Coimbra, Portugal.,Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
| | - Vítor Rosado-Marques
- CIAS - Research Centre for Anthropology and Health, University of Coimbra, Ed. São Bento, Calçada Martim de Freitas, 3000-456, Coimbra, Portugal.,Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Cristina Padez
- CIAS - Research Centre for Anthropology and Health, University of Coimbra, Ed. São Bento, Calçada Martim de Freitas, 3000-456, Coimbra, Portugal.,Department of Life Sciences, University of Coimbra, Coimbra, Portugal
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Nobusako S, Tsujimoto T, Sakai A, Shuto T, Furukawa E, Osumi M, Nakai A, Maeda T, Morioka S. Manual Dexterity is not Related to Media Viewing but is Related to Perceptual Bias in School-Age Children. Brain Sci 2020; 10:brainsci10020100. [PMID: 32069947 PMCID: PMC7071373 DOI: 10.3390/brainsci10020100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/12/2020] [Accepted: 02/12/2020] [Indexed: 12/03/2022] Open
Abstract
Although the media can have both negative and positive effects on children’s cognitive and motor functions, its influence on their perceptual bias and manual dexterity is unclear. Thus, we investigated the association between media viewing time, media preference level, perceptual bias, and manual dexterity in 100 school-aged children. Questionnaires completed by children and their parents were used to ascertain media viewing time and preference levels. Perceptual bias and manual dexterity were measured using the visual-tactile temporal order judgment task and Movement Assessment Battery for Children—2nd edition, respectively. There were significant positive correlations between age and media viewing time and between media viewing time and media preference level. There was also a significant negative correlation between visual bias and manual dexterity. Hierarchical multiple regression analysis revealed that increasing visual bias was a significant predictor of decreasing manual dexterity. Further, children with low manual dexterity showed significant visual bias compared to those with high manual dexterity, when matched for age and gender. The present results demonstrated that, in school-aged children, although viewing media was not associated with perceptual bias and manual dexterity, there was a significant association between perceptual bias and manual dexterity.
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Affiliation(s)
- Satoshi Nobusako
- Neurorehabilitation Research Center, Kio University, Nara 635-0832, Japan
- Graduate School of Health Science, Kio University, Nara 635-0832, Japan
- Correspondence: ; Tel.: +81-745-54-1601
| | - Taeko Tsujimoto
- Department of Rehabilitation, Nishide Clinic, Osaka 532-0002, Japan
| | - Ayami Sakai
- Department of Rehabilitation, Higashi Osaka Yamaji Hospital, Osaka 578-0925, Japan
| | - Takashi Shuto
- Department of Home-Visit Rehabilitation, Ishida Clinic, Osaka 592-0002, Japan
| | - Emi Furukawa
- Neurorehabilitation Research Center, Kio University, Nara 635-0832, Japan
| | - Michihiro Osumi
- Neurorehabilitation Research Center, Kio University, Nara 635-0832, Japan
- Graduate School of Health Science, Kio University, Nara 635-0832, Japan
| | - Akio Nakai
- Graduate School of Clinical Education & The Center for the Study of Child Development, Institute for Education, Mukogawa Women’s University, Hyogo 663-8558, Japan
| | - Takaki Maeda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Shu Morioka
- Neurorehabilitation Research Center, Kio University, Nara 635-0832, Japan
- Graduate School of Health Science, Kio University, Nara 635-0832, Japan
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13
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Parkes A, Green M, Pearce A. Do bedroom screens and the mealtime environment shape different trajectories of child overweight and obesity? Research using the Growing Up in Scotland study. Int J Obes (Lond) 2019; 44:790-802. [PMID: 31827254 DOI: 10.1038/s41366-019-0502-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 11/06/2019] [Accepted: 11/17/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate how mealtime setting, mealtime interaction and bedroom screens are associated with different trajectories of child overweight and obesity, using a population sample. METHODS Growth mixture modelling used data from children in the Growing Up in Scotland Study born in 2004/5 (boys n = 2085, girls n = 1991) to identify trajectories of overweight or obesity across four time points, from 46 to 122 months. Using data from children present at all sweeps, and combining sexes (n = 2810), mutually adjusted associations between primary exposures (mealtime setting, mealtime interaction and bedroom screens) and trajectory class were explored in multinomial models; controlling for early life factors, household organisation and routines, and children's diet patterns, overall screen use, physical activity and sleep. RESULTS Five trajectories were identified in both sexes: Low Risk (68% of sample), Decreasing Overweight (9%), Increasing Overweight (12%), High/Stable Overweight (6%) and High/Increasing Obesity (5%). Compared with the Low Risk trajectory, High/Increasing Obesity and High/Stable Overweight trajectories were characterised by early increases in bedroom screen access (respective relative risk ratios (RRR) and 95% confidence intervals: 2.55 [1.30-5.00]; 1.62 [1.01-2.57]). An informal meal setting (involving mealtime screen use, not eating in a dining area and not sitting at a table) characterised the High/Increasing Obesity and Increasing Overweight trajectories (respective RRRs compared with Low Risk trajectory: 3.67 [1.99-6.77]; 1.75 [1.17-2.62]). Positive mealtime interaction was associated with membership of the Increasing Overweight trajectory (RRR 1.64 [1.13-2.36]). CONCLUSION Bedroom screen access and informal mealtime environments were associated with higher-risk overweight and obesity trajectories in a representative sample of Scottish children, after adjusting for a wide range of confounders. Findings may challenge the notion that positive mealtime interaction is protective. Promoting mealtimes in a screen-free dining area and removing screens from bedrooms may help combat childhood obesity.
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Affiliation(s)
- Alison Parkes
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
| | - Michael Green
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Anna Pearce
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Barnett TA, Kelly AS, Young DR, Perry CK, Pratt CA, Edwards NM, Rao G, Vos MB. Sedentary Behaviors in Today's Youth: Approaches to the Prevention and Management of Childhood Obesity: A Scientific Statement From the American Heart Association. Circulation 2019; 138:e142-e159. [PMID: 30354382 DOI: 10.1161/cir.0000000000000591] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This scientific statement is about sedentary behavior and its relationship to obesity and other cardiometabolic outcomes in youth. A deleterious effect of sedentary behavior on cardiometabolic health is most notable for screen-based behaviors and adiposity; however, this relation is less apparent for other cardiometabolic outcomes or when sedentary time is measured with objective movement counters or position monitors. Increasing trends of screen time are concerning; the portability of screen-based devices and abundant access to unlimited programming and online content may be leading to new patterns of consumption that are exposing youth to multiple pathways harmful to cardiometabolic health. This American Heart Association scientific statement provides an updated perspective on sedentary behaviors specific to modern youth and their impact on cardiometabolic health and obesity. As we reflect on implications for practice, research, and policy, what emerges is the importance of understanding the context in which sedentary behaviors occur. There is also a need to capture the nature of sedentary behavior more accurately, both quantitatively and qualitatively, especially with respect to recreational screen-based devices. Further evidence is required to better inform public health interventions and to establish detailed quantitative guidelines on specific sedentary behaviors in youth. In the meantime, we suggest that televisions and other recreational screen-based devices be removed from bedrooms and absent during meal times. Daily device-free social interactions and outdoor play should be encouraged. In addition, parents/guardians should be supported to devise and enforce appropriate screen time regulations and to model healthy screen-based behaviors.
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15
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Abstract
PURPOSE OF REVIEW To review the literature and provide a guide to assessing patients with problematic interactive media use (PIMU). RECENT FINDINGS 0.3-1.0% of the world population meets criteria for internet gaming disorder (IGD). 26.8-83.3% of adolescents meeting criteria for internet addiction have comorbid attention-deficit/hyperactivity disorder. IGD is associated with increased anxiety and social anxiety/phobias. Group counseling, cognitive behavioral therapy, and sports intervention are associated with significant reductions in internet addiction. SUMMARY With the Diagnostic and Statistical Manual of Mental Disorders-5 inclusion of IGD under 'Conditions for Further Study' and the addition of gaming disorder to International Classification of Diseases (ICD)-11, the idea that PIMU is a mental health disorder gained traction. Although certain populations may be at increased risk, all children and adolescents should be screened for PIMU given now-normal heavy media usage rates. Effective treatment of PIMU starts with identification and management of comorbid mental and behavioral health problems. Depending on their degree of functional impairment, patients may benefit from various forms of psychotherapy with coordinated outpatient management or may warrant higher level of care in one of several established residential treatment programs. Few studies have evaluated pharmacologic approaches to treating PIMU, but some medications targeting comorbid mental and behavioral health conditions improve PIMU-related behaviors.
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16
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Helm AF, Spencer RMC. Television use and its effects on sleep in early childhood. Sleep Health 2019; 5:241-247. [PMID: 30987948 DOI: 10.1016/j.sleh.2019.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the impacts of television (TV) viewing and bedroom TV presence on young children's sleep as measured by actigraphy. DESIGN Analyses of covariance were run to examine differences in sleep duration and quality among children based on the presence of TVs in their bedrooms and the amount of TV watched. SETTING Recruited in preschools in Massachusetts; recorded ambulatory (in home, environs). PARTICIPANTS Participants were 470 children between 33 and 71 months of age (M = 51.02). MEASUREMENTS Children were instructed to wear an actigraph watch for 16 days. Caregivers reported demographic information, completed behavior questionnaires, and answered questions regarding their child's TV use. RESULTS Children who watched more TV and had TVs in their bedroom displayed significantly shorter sleep duration and worse sleep, but they also napped significantly longer in the daytime. Nonetheless, total 24-hour sleep was shorter for those who watched more TV and had TVs in their bedroom compared to those who did not have TVs in their bedrooms or watch TV frequently. Children who had TVs in their bedrooms watched TV later at night, watched more adult TV programs, and had higher negative affect than children without TVs in their bedrooms. CONCLUSIONS These findings suggest that TV use in young children does impact sleep duration and quality as measured by actigraphy, and daytime napping does not offset these negative impacts.
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Affiliation(s)
- Abigail F Helm
- Department of Psychological & Brain Sciences, University of Massachusetts, Amherst
| | - Rebecca M C Spencer
- Department of Psychological & Brain Sciences, University of Massachusetts, Amherst.
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17
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Pfledderer CD, Burns RD, Brusseau TA. Association between Access to Electronic Devices in the Home Environment and Cardiorespiratory Fitness in Children. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E8. [PMID: 30634403 PMCID: PMC6352277 DOI: 10.3390/children6010008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/04/2019] [Accepted: 01/04/2019] [Indexed: 01/06/2023]
Abstract
This study examined the association between access to electronic devices in the home and cardiorespiratory fitness in children. Participants were children aged 8⁻12 years from a local elementary school (n = 106, mean age = 9.7 + 1.1 years, male = 50). Child access to electronic devices was measured with a 37-item parent-reported questionnaire. Estimated maximal aerobic capacity (VO2 Peak) was calculated from The Progressive Aerobic Cardiovascular Endurance Run (PACER) using a validated algorithm. The association between access to electronic devices in the home and cardiorespiratory fitness was explored by employing hierarchical ridge regression, using the Ordinary Least Squares (OLS) model, controlling for the covariates of sex, age, and Body Mass Index (BMI). Controlling for sex, age, and BMI, the number of electronic items in a child's bedroom was significantly inversely related to the estimated VO2 Peak (b = -1.30 mL/kg/min, 95% C.I.: -2.46 mL/kg/min, -0.15 mL/kg/min, p = 0.028) and PACER laps (b = -3.70 laps, 95% C.I.: -6.97 laps, -0.41 laps, p = 0.028) However, the total number of electronic items in the home and total number of electronic items owned did not significantly relate to the estimated VO2 Peak (p = 0.847, 0.964) or the number of PACER laps (p = 0.847, 0.964). Child health behavior interventions focused on the home environment should devote specific attention to the bedroom as a primary locus of easily modifiable intervention.
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Affiliation(s)
- Christopher D Pfledderer
- Department of Health, Kinesiology and Recreation, University of Utah, Salt Lake City, UT 84112, USA.
| | - Ryan D Burns
- Department of Health, Kinesiology and Recreation, University of Utah, Salt Lake City, UT 84112, USA.
| | - Timothy A Brusseau
- Department of Health, Kinesiology and Recreation, University of Utah, Salt Lake City, UT 84112, USA.
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18
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Collings PJ, Kelly B, West J, Wright J. Associations of TV Viewing Duration, Meals and Snacks Eaten When Watching TV, and a TV in the Bedroom with Child Adiposity. Obesity (Silver Spring) 2018; 26:1619-1628. [PMID: 30269425 PMCID: PMC6207926 DOI: 10.1002/oby.22288] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to examine the associations of TV parameters with adiposity in early life. METHODS Data were collected as part of the Born in Bradford (BiB) longitudinal birth cohort study. Child TV viewing duration was parent reported, and BMI, the sum of triceps and subscapular skinfolds, and waist circumference were measured at ~12, 18, 24, and 36 months of age in 1,338 children. Mixed effects models were used to quantify adjusted associations of TV viewing duration with adiposity markers, incorporating data from all time points. Linear regression was used to investigate differences in adiposity levels across frequencies of eating meals and snacks while watching TV at age ~24 months and between children who did and did not have a TV in their bedroom at age ~36 months. RESULTS Every 1 h/d of TV viewing was associated with a 0.075-cm larger (95% CI: 0.0034-0.15) waist circumference, independent of covariates including sleep duration, dietary factors, and physical activity level. There was no evidence for any other associations. CONCLUSIONS TV viewing duration is independently associated with abdominal adiposity in young children. Limiting TV viewing from an early age may be important for primary prevention of obesity.
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Affiliation(s)
- Paul J. Collings
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation TrustBradfordUK
- Department of Health SciencesUniversity of YorkUK
| | - Brian Kelly
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation TrustBradfordUK
| | - Jane West
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation TrustBradfordUK
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation TrustBradfordUK
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Biddle SJ, Pearson N, Salmon J. Sedentary Behaviors and Adiposity in Young People: Causality and Conceptual Model. Exerc Sport Sci Rev 2018; 46:18-25. [DOI: 10.1249/jes.0000000000000135] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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20
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Lee J, Kubik MY, Fulkerson JA. Media Devices in Parents' and Children's Bedrooms and Children's Media Use. Am J Health Behav 2018; 42:135-143. [PMID: 29320346 DOI: 10.5993/ajhb.42.1.13] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The American Academy of Pediatrics advises having no media devices in children's bedrooms. We examined the link between media devices in parents' and children's bedrooms and children's media use. METHODS Ninety parent-child dyads participated in a community- based healthy weight management study targeting 8-to-12-year-olds with body mass index (BMI)-for-age ≥75th percentile. Parents and children reported the number of media devices in their bedrooms and hours spent using media devices on weekdays and weekend days. RESULTS Most children (61%) and parents (92%) had at least one media device in their bedrooms. The numbers of devices in parents' and children's bedrooms were positively correlated. Children with no bedroom media devices reported less weekday media use compared to children with bedroom devices. A similar non-significant pattern was found for children's weekend media use. CONCLUSIONS Study findings indicate similar media devices in the bedrooms of parents and children and a significant association between media devices in children's bedrooms and their weekday media use. Efforts to reduce media in parent bedrooms may enhance interventions targeting reduction of media use among children, especially those with higher BMI.
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Affiliation(s)
- Jiwoo Lee
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Martha Y. Kubik
- Department of Nursing, College of Public Health, Temple University, Philadelphia, PA, USA
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Sociodemographic, anthropometric and behavioural risk factors for ultra-processed food consumption in a sample of 2–9-year-olds in Brazil. Public Health Nutr 2017; 21:77-86. [DOI: 10.1017/s1368980017002452] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AbstractObjectiveThe present study aimed to identify food patterns among 2–9-year-olds and investigate sociodemographic, anthropometric and behavioural predictors of less healthy dietary patterns.DesignCross-sectional study. Parents of 2–9-year-olds completed an FFQ and factor analysis was applied to identify dietary patterns. Parents also completed questionnaires assessing sociodemographic, anthropometric and behavioural characteristics of parents and children, including parental feeding practices.SettingParticipants were recruited from private schools of Campinas and São Paulo, SP, Brazil, between April and June 2014.SubjectsParents of 2–9-year-olds (n 929).ResultsTwo dietary patterns emerged: ‘traditional food’ and ‘ultra-processed food’. Lower maternal education (OR=2·05, P=0·010) and higher maternal weight status (OR=1·43, P=0·044) were associated with a greater likelihood of the ultra-processed food pattern. Lower perceived parental responsibility for adequacy of food group intake (OR=2·41, P=0·020), and lower scores on the parental feeding practices of ‘Healthy Eating Guidance’ (OR=1·83, P<0·001) and ‘Monitoring’ (OR=2·52, P<0·001), were also associated with the presence of this pattern, as was higher child’s screen use during mealtimes (OR=1·61, P=0·004).ConclusionsThe present study is the first to evaluate associations between less healthy dietary patterns of Brazilian 2–9-year-olds and parental feeding practices. Our findings highlight sociodemographic, anthropometric and behavioural factors within families that could be used to target tailored policies to at-risk populations.
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Dube N, Khan K, Loehr S, Chu Y, Veugelers P. The use of entertainment and communication technologies before sleep could affect sleep and weight status: a population-based study among children. Int J Behav Nutr Phys Act 2017; 14:97. [PMID: 28724380 PMCID: PMC5517950 DOI: 10.1186/s12966-017-0547-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 07/03/2017] [Indexed: 12/24/2022] Open
Abstract
Background Short sleep duration and poor sleep quality have been demonstrated to be associated with childhood obesity. It has been suggested that electronic entertainment and communication devices (EECDs) including TVs, computers, tablets, video games and cell phones interfere with sleep in children and youth. The aim of this study was to assess the impact that the use of EECDs in the hour before bedtime has on sleep and weight status to inform sleep promotion interventions and programs to prevent childhood obesity. Methods A provincially representative sample of 2334 grade 5 children and their parents in Alberta, Canada was surveyed. Parents reported their child’s bedtime and wake-up time along with how often their child snored, felt sleepy during the day, woke-up at night and woke-up in the morning feeling unrefreshed. Sleep duration, sleep quality and sleep efficiency were derived from these indicators. Parents also reported on the presence of EECDs in their child’s bedroom, while children reported use of EECDs during the day and frequency of using each of these devices during the hour before sleep. The height and weight of children were measured. Multivariable mixed effect linear and logistic regression models were used to determine how sleep duration, sleep quality, sleep efficiency and weight status are influenced by (i) access to EECDs in children’s bedrooms, (ii) use of EECDs during the hour before sleep, and (iii) calming activities specifically reading during the hour before sleep. Results Sleep duration was shorter by −10.8 min (cell phone), −10.2 min (computer) and −7.8 min (TV) for those with bedroom access to and used these EECDs during the hour before sleep compared to no access and no use. Good sleep quality was hindered by bedroom access to and use of all EECDs investigated during the hour before sleep, particularly among users of cell phones (OR = 0.64, 95% CI: 0.58–0.71) and computers (OR = 0.72, 95% CI: 0.65–0.80). Very good sleep efficiency was decreased by access to and frequent use of a TV (54%), cell phone (52%), tablet (51%) and video games (51%). Odds of obesity were doubled by bedroom access to and use of a TV and computer during the hour before sleep. Children who rarely read a printed book in the bedroom during the hour before sleep had a shorter sleep duration and poorer sleep quality and sleep efficiency compared to their peers. Having access to an EECD in the bedroom was associated with increased obesity despite frequently reading during the hour before sleep. Conclusions Our findings suggest that sleep duration, sleep quality, sleep efficiency and weight status are better among children who do not have EECDs in the bedroom and frequently read a book during the hour before sleep as opposed to those who use EECDs during this hour. Education of limits against EECD use by parents may improve sleep outcomes. These findings will inform health promotion messages and may give rise to national recommendations regarding EECD use. Trial registration ClinicalTrials.gov NCT01914185. Registered 31 July 2013 Retrospectively registered.
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Affiliation(s)
- Nomathemba Dube
- Department of Public Health Sciences, Population Health Intervention Research Unit, School of Public Health, University of Alberta, 3-50 University Terrace, 8303 112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Kaviul Khan
- Department of Public Health Sciences, Population Health Intervention Research Unit, School of Public Health, University of Alberta, 3-50 University Terrace, 8303 112 Street, Edmonton, AB, T6G 2T4, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sarah Loehr
- Department of Public Health Sciences, Population Health Intervention Research Unit, School of Public Health, University of Alberta, 3-50 University Terrace, 8303 112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Yen Chu
- Department of Public Health Sciences, Population Health Intervention Research Unit, School of Public Health, University of Alberta, 3-50 University Terrace, 8303 112 Street, Edmonton, AB, T6G 2T4, Canada.,Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, BC, Canada
| | - Paul Veugelers
- Department of Public Health Sciences, Population Health Intervention Research Unit, School of Public Health, University of Alberta, 3-50 University Terrace, 8303 112 Street, Edmonton, AB, T6G 2T4, Canada.
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Duraccio KM, Carbine KA, Barnett KA, Stevens KS, Jensen CD. The utility of the Children’s Sleep Habits Questionnaire: Associations between parental report and an objective measure of sleep behavior. CHILDRENS HEALTH CARE 2017. [DOI: 10.1080/02739615.2017.1316198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | | | - Chad D. Jensen
- Psychology Department, Brigham Young University, Provo, UT
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Boylan S, Hardy LL, Drayton BA, Grunseit A, Mihrshahi S. Assessing junk food consumption among Australian children: trends and associated characteristics from a cross-sectional study. BMC Public Health 2017; 17:299. [PMID: 28381213 PMCID: PMC5382385 DOI: 10.1186/s12889-017-4207-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 03/30/2017] [Indexed: 01/19/2023] Open
Abstract
Background The ubiquitous supply of junk foods in our food environment has been partly blamed for the increased rates in overweight and obesity. However, consumption of these foods has generally been examined individually perhaps obscuring the true extent of their combined consumption and impact on health. An overall measure of children’s junk food consumption may prove useful in the development of child obesity prevention strategies. We describe the development of a children’s Junk Food Intake Measure (JFIM) to summarise temporal change in junk food consumption and examine the association between the JFIM and health-related behaviours. Methods Cross-sectional population surveillance survey of Australian children age 5–16 years collected in 2010 and 2015. Data were collected by questionnaire with parent’s proxy reporting for children in years K, 2 and 4 and children in years 6, 8 and 10 by self-report. Information on diet, screen-time and physical activity was collected using validated questionnaires. The JFIM comprised consumption of fried potato products, potato crisps/salty snacks, sweet and savoury biscuits/cakes/doughnuts, confectionary and, ice cream/ice blocks. Results A total of 7565 (missing = 493, 6.1%) and 6944 (missing n = 611, 8.1%) children had complete data on consumption of junk foods, in 2010 and 2015, respectively. The 2015 survey data showed that among students from high socio-economic status neighbourhoods, there were fewer high junk food consumers than low junk food consumers. Children from Middle Eastern cultural backgrounds had higher junk food consumption. High junk food consumers were more likely to consume take-away ≥3/week, eat dinner in front of the television, receive sweet rewards, be allowed to consume snacks anytime, have soft drinks available at home and a TV in their bedroom. There was a lower proportion of high junk food consumers in 2015 compared to 2010. Conclusion This is the first study to provide and examine a summary measure of overall junk food consumption among Australian children. The results indicate that junk food consumption among Australian children is lower in 2015, compared with 2010. Still, the public health workforce must continue their efforts as levels of junk food consumption remain of concern among Australian children.
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Affiliation(s)
- S Boylan
- Prevention Research Collaboration, School of Public Health, The Hub, The University of Sydney, Charles Perkins Centre D17, Level 6, Sydney, NSW, 2006, Australia.
| | - L L Hardy
- Prevention Research Collaboration, School of Public Health, The Hub, The University of Sydney, Charles Perkins Centre D17, Level 6, Sydney, NSW, 2006, Australia
| | - B A Drayton
- NSW Biostatistics Training Program, NSW Ministry of Health, Sydney, Australia
| | - A Grunseit
- Prevention Research Collaboration, School of Public Health, The Hub, The University of Sydney, Charles Perkins Centre D17, Level 6, Sydney, NSW, 2006, Australia
| | - S Mihrshahi
- Prevention Research Collaboration, School of Public Health, The Hub, The University of Sydney, Charles Perkins Centre D17, Level 6, Sydney, NSW, 2006, Australia
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Alqaderi H, Goodson JM, Subramanian SV, Tavares M. Short Sleep Duration and Screen-Based Activities: A Longitudinal Multilevel Analysis. Am J Lifestyle Med 2016; 12:340-348. [PMID: 32063819 DOI: 10.1177/1559827616667048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/13/2016] [Accepted: 08/10/2016] [Indexed: 12/28/2022] Open
Abstract
Objective. The aim of this study was to identify lifestyle habits that contribute to night sleep reduction in the Kuwaiti population. Methods. Children were 10 to 12 years old and were approximately equally distributed among 138 elementary schools representing the 6 governorates of Kuwait. In the first phase of the study, data were collected from 8317 children. The same data were collected 2 years later from 6316 of the children from the first phase of the study. Calibrated examiners conducted sleep evaluation, lifestyle habits interviews, and body weight measurements. A multilevel random intercept and slope model was conducted to determine the effect of screen-based activities on the daily night sleep hours at 3 levels: within schools, among children, and over time. The primary dependent variable was the number of daily sleep hours. Independent variables assessed were lifestyle habits including screen-based activity variables including TV and video game use. Results. Screen-based activities were significant factors that reduced daily sleep hours (P < .05). There were statistically significant variations between schools and children over time. Conclusion. Longitudinal analysis of Kuwaiti children revealed that TV and video game use were major risk behaviors contributing to decreased sleep duration with strong clustering effect of the observations within schools across time.
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Affiliation(s)
- Hend Alqaderi
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts (HA, MT).,Department of Applied Oral Sciences, the Forsyth Research Institute, Cambridge, Massachusetts (JMG, MT).,Department of Social and Behavior Science, Harvard School of Public Health, Boston, Massachusetts (SVS)
| | - J Max Goodson
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts (HA, MT).,Department of Applied Oral Sciences, the Forsyth Research Institute, Cambridge, Massachusetts (JMG, MT).,Department of Social and Behavior Science, Harvard School of Public Health, Boston, Massachusetts (SVS)
| | - S V Subramanian
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts (HA, MT).,Department of Applied Oral Sciences, the Forsyth Research Institute, Cambridge, Massachusetts (JMG, MT).,Department of Social and Behavior Science, Harvard School of Public Health, Boston, Massachusetts (SVS)
| | - Mary Tavares
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts (HA, MT).,Department of Applied Oral Sciences, the Forsyth Research Institute, Cambridge, Massachusetts (JMG, MT).,Department of Social and Behavior Science, Harvard School of Public Health, Boston, Massachusetts (SVS)
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Koppen IJN, Kuizenga-Wessel S, Saps M, Di Lorenzo C, Benninga MA, van Etten-Jamaludin FS, Tabbers MM. Functional Defecation Disorders and Excessive Body Weight: A Systematic Review. Pediatrics 2016; 138:peds.2016-1417. [PMID: 27531145 DOI: 10.1542/peds.2016-1417] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Several studies have suggested an association between functional defecation disorders (FDDs) and overweight/obesity in children. OBJECTIVE To synthesize current evidence evaluating the association between FDDs and overweight/obesity in children. DATA SOURCES PubMed, Medline, and Embase were searched from inception until January 25, 2016. STUDY SELECTION Prospective and cross-sectional studies investigating the association between FDDs and overweight/obesity in children 0 to 18 years were included. DATA EXTRACTION Data generation was performed independently by 2 authors and quality was assessed by using quality assessment tools from the National Heart, Lung, and Blood Institute. RESULTS Eight studies were included: 2 studies evaluating the prevalence of FDDs in obese children, 3 studies evaluating the prevalence of overweight/obesity in children with FDDs, and 3 population-based studies. Both studies in obesity clinics revealed a higher prevalence of functional constipation (21%-23%) compared with the general population (3%-16%). In 3 case-control studies, the prevalence of overweight (12%-33%) and obesity (17%-20%) was found to be higher in FDD patients compared with controls (13%-23% and 0%-12%, respectively), this difference was significant in 2/3 studies. One of 3 population-based studies revealed evidence for an association between FDDs and overweight/obesity. Quality of 7/8 studies was rated fair or poor. LIMITATIONS Due to heterogeneity of the study designs, we refrained from statistically pooling. CONCLUSIONS Although several studies have revealed the potential association between FDDs and excessive bodyweight in children, results across included studies in this review differ strongly and are conflicting. Therefore, this systematic review could not confirm or refute this association.
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Affiliation(s)
- Ilan J N Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands; Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
| | - Sophie Kuizenga-Wessel
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands
| | - Miguel Saps
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
| | - Carlo Di Lorenzo
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands
| | | | - Merit M Tabbers
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands
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Cameron JD, Maras D, Sigal RJ, Kenny GP, Borghese MM, Chaput JP, Alberga AS, Goldfield GS. The mediating role of energy intake on the relationship between screen time behaviour and body mass index in adolescents with obesity: The HEARTY study. Appetite 2016; 107:437-444. [PMID: 27545672 DOI: 10.1016/j.appet.2016.08.101] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 08/08/2016] [Accepted: 08/17/2016] [Indexed: 12/23/2022]
Abstract
Adolescents spend up to 6-8 h/day in sedentary screen behaviour and screen time is an independent risk factor for obesity. However, the mechanisms by which screen time confers obesity risk remain unclear. Via community level recruitment this study examined whether the relationship between screen time behaviours and body mass index (BMI: kg/m2) was mediated by total energy intake or macronutrient consumption. In a cross-sectional study of post-pubertal adolescents (N = 283: 86M, 197F) with overweight or obesity at baseline of an intervention for weight control, we examined self-reported total energy intake (mean Calories from 3 day food diary), macronutrient intake (grams/day of carbohydrate, fat, protein) and total screen time (aggregate of hours/day watching TV, playing seated video games, and recreational computer use). BMI was objectively measured and converted to standardized scores (z-BMI). Simple and multiple mediation analyses were conducted using the bootstrapping approach described by Preacher and Hayes. Covariates included age, sex, ethnicity, parental education, Tanner stage, and self-reported physical activity. The relationship between screen time and z-BMI was significantly mediated by energy intake. Higher levels of carbohydrate intake, but not fat or protein intake, significantly mediated the relationship between screen time and z-BMI (95% bias-corrected and accelerated confidence interval [0.0004, 0.0074]). Higher carbohydrate intake mediated the relationship between TV viewing and z-BMI, and video gaming and z-BMI. In conclusion, the relationship between screen time and BMI appears to be mediated by increased energy intake, primarily in the form of higher carbohydrate intake. It is possible that reducing time spent watching TV and playing video games may reduce food intake and help promote dietary adherence needed for weight management in obese adolescents. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov ID: NCT00195858.
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Affiliation(s)
- Jameason D Cameron
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Danijela Maras
- Department of Psychology, Carleton University, Ottawa, Canada
| | - Ronald J Sigal
- Department of Medicine, Cardiac Sciences and Community Health Sciences, Faculties of Medicine and Kinesiology, University of Calgary, Calgary, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Glen P Kenny
- School of Human Kinetics, University of Ottawa, Ottawa, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Michael M Borghese
- School of Kinesiology and Health Studies, Department of Public Health Sciences, Queen's University, Kingston, Canada
| | - Jean-Philippe Chaput
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; School of Human Kinetics, University of Ottawa, Ottawa, Canada; Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Angela S Alberga
- Werklund School of Education, University of Calgary, Calgary, Canada
| | - Gary S Goldfield
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; School of Human Kinetics, University of Ottawa, Ottawa, Canada; Department of Psychology, Carleton University, Ottawa, Canada; Department of Pediatrics, University of Ottawa, Ottawa, Canada; School of Psychology, University of Ottawa, Ottawa, Canada.
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28
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Koppen IJN, Velasco-Benítez CA, Benninga MA, Di Lorenzo C, Saps M. Is There an Association between Functional Constipation and Excessive Bodyweight in Children? J Pediatr 2016; 171:178-82.e1. [PMID: 26787379 DOI: 10.1016/j.jpeds.2015.12.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/12/2015] [Accepted: 12/11/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To determine the prevalence of functional constipation, overweight, and obesity in a cross-sectional observational study among children in Colombia and to examine the association between functional constipation and excessive bodyweight in this population. STUDY DESIGN Demographics, anthropometric data, and questionnaires were collected from 2820 children between 8 and 18 years of age across 4 regions in Colombia. A Spanish translation of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version was used to determine the prevalence of functional constipation. Anthropometric measurements of weight, height, and body mass index (BMI) were obtained following World Health Organization guidelines; overweight was defined as a BMI z-score (adjusted for sex and age) between 1 and 2, obesity was defined as a BMI z-score >2. RESULTS A total of 368 children (13.0%) were found to have functional constipation, 542 children (19.2%) were overweight, and 188 children (6.7%) were obese. Functional constipation did not occur more frequently in children who were obese (14.9%) or overweight (13.1%) compared with children with normal weight (12.9%, P = .73). The prevalence of functional constipation, overweight, and obesity differed significantly between regions. Functional constipation and excessive bodyweight were significantly more common in children attending private schools compared with children attending public schools. CONCLUSIONS Functional constipation, overweight, and obesity are commonly observed in children in Colombia. No association between functional constipation and overweight or obesity was found.
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Affiliation(s)
- Ilan J N Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands; Department of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH.
| | | | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Carlo Di Lorenzo
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
| | - Miguel Saps
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
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