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Egan L, Gardner LA, Newton NC, O'Dean S, Champion KE. Moderating effects of socioeconomic status and geographical location on the Health4Life school-based intervention. Prev Med Rep 2024; 46:102855. [PMID: 39247204 PMCID: PMC11378973 DOI: 10.1016/j.pmedr.2024.102855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 08/06/2024] [Accepted: 08/06/2024] [Indexed: 09/10/2024] Open
Abstract
Objective This study evaluated the moderating effects of socioeconomic status (SES) and geographical location on the efficacy of an eHealth school-based multiple health behaviour change intervention - Health4Life - in targeting alcohol and tobacco use, dietary intake, knowledge, behavioural intentions, and psychological distress over 24-months. Methods Data from the Health4Life cluster-randomised controlled trial conducted from 2019 to 2021 in 71 Australian secondary schools were analysed (N=6639; baseline age 11-14yrs). Schools were from metropolitan (89%) and regional (11%) areas, and participants' SES was classified as low (15%), mid (37%), and high (48%) relative to the study population. Primary outcomes included alcohol and tobacco use, and a composite indicator of poor diet. Secondary outcomes were knowledge, behavioural intentions, and psychological distress. Latent growth models assessed moderating effects of SES and geographical location on between-group change over 24-months. Results Geographical location moderated the intervention's effect on odds of reporting a poor diet (OR = 1.79, 95% CI = 1.32-2.43, p < 0.001) and diet-related behavioural intentions (OR = 0.71, 95% CI = 0.56-0.89, p = 0.024) over time. Subset analyses indicated that intervention participants in regional areas had higher odds of reporting a poor diet (OR = 1.61, 95% CI = 1.13-2.29, p = 0.008), while those in metropolitan areas had higher odds of improving diet-related behavioural intentions (OR = 1.13, 95% CI = 1.01-1.27, p = 0.041), compared to the control group. No other significant moderation effects were observed. Conclusions While significant disparities were generally not observed, the geographical differences in intervention effects on diet and diet-related intentions suggest that co-designed and tailored approaches may benefit disadvantaged adolescents to address the disproportionately high rates of lifestyle risk behaviours among these priority populations.
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Affiliation(s)
- Lyra Egan
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Lauren A Gardner
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Nicola C Newton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Siobhan O'Dean
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Katrina E Champion
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
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Manzano-Felipe MÁ, Cruz-Cobo C, Bernal-Jiménez MÁ, Santi-Cano MJ. Effectiveness of a nurse-led mHealth approach in preventing obesity in adolescents: an intervention study. J Res Nurs 2024; 29:348-363. [PMID: 39291228 PMCID: PMC11403977 DOI: 10.1177/17449871241236393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
Background Obesity prevention in adolescents is a public health priority given its increasing prevalence and health impact of obesity. Aim To evaluate the effectiveness of an educational intervention in overweight and obesity using a mHealth app in improving nutritional and sports knowledge, adherence to the Mediterranean diet, physical activity and anthropometric measurements in adolescents. Methods A randomised controlled trial with parallel groups that included 305 adolescents. The app includes the use of effective behavioural strategies to achieve habit change. Primary outcome variables were nutritional and sports knowledge score (GeSNK), adherence to a Mediterranean diet (KidMed) and level of physical activity (PAQ-A). Results The study included 154 participants in the mHealth group and 151 in the control group. The level of nutritional and sports knowledge was significantly higher in the mHealth group, 47 points versus 42 points. Adherence to the Mediterranean diet improved in both groups, 9 points in the mHealth group versus 8 points in the control group. Physical activity was statistically higher in the intervention group, 160 minutes/week versus 120 minutes/week. Conclusions The mHealth intervention showed a significant improvement in the level of nutritional and sports knowledge, adherence to the Mediterranean diet and time spent on physical activity.
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Affiliation(s)
- María Ángeles Manzano-Felipe
- Registered Nurse, Certified and Researcher, Primary Health Care District of Bay of Cádiz-La Janda, Spain; Research Group on Nutrition, Molecular, Pathophysiological and Social Issues, University of Cádiz, Spain; Researcher, Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Spain
| | - Celia Cruz-Cobo
- Lecturer, PhD Candidate, Research Group on Nutrition, Molecular, Pathophysiological and Social Issues, Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain; Researcher, Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Spain
| | - María Ángeles Bernal-Jiménez
- Registered Nurse, Certified and Researcher, Research Group on Nutrition, Molecular, Pathophysiological and Social Issues, Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain; Researcher, Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Spain
| | - María José Santi-Cano
- Professor of Nutrition, Research Group on Nutrition, Molecular, Pathophysiological and Social Issues, University of Cádiz, Spain, Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain; Researcher, Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Spain
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Veselá L, Klímová Rych A, Vážná A, Kotrbatá M, Rücklová K, Aldhoon-Hainerová I. Lessons Learned from Telemedicine in Adolescent Obesity: Results of a Pilot Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:599. [PMID: 38790594 PMCID: PMC11120228 DOI: 10.3390/children11050599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/27/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
The rising prevalence of obesity in children calls for new strategies for the provision of effective care by a multidisciplinary team. Telemedicine has overall proven to be an effective tool for promoting a healthy lifestyle. The main objective of the current paper is to present the protocol of our ongoing CardioMetabolic Prevention (CAMP) study and compare its design with published studies on telemedicine in paediatric obesity. Additionally, we analysed the preliminary anthropometric and laboratory data to test the efficacy of our 12-week intensive program that combines in-person and telemedicine support. The program demonstrated a positive impact on body mass index (BMI) and its z-scores in 21 adolescents, and BMI in 18 participating parents. However, we found no effect on body composition, waist circumference, cardiometabolic parameters, or fitness evaluated via a 6-min walk test in adolescents. In conclusion, the combination of in-person and telemedicine intensive support over 35 h delivered by a multidisciplinary team can be beneficial not only for adolescents with obesity but also for their parents. The ongoing CAMP study serves as a platform for precision medicine in future decisions regarding anti-obesity medication in adolescents with obesity.
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Affiliation(s)
- Lenka Veselá
- Department of Children and Adolescents, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, 100 34 Prague, Czech Republic; (L.V.)
- Regional Hospital Kolín, Hospital of Central Bohemian a.s., 280 02 Kolín, Czech Republic
| | - Aneta Klímová Rych
- Department of Children and Adolescents, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, 100 34 Prague, Czech Republic; (L.V.)
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, 120 00 Prague, Czech Republic
| | - Anna Vážná
- Department of Children and Adolescents, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, 100 34 Prague, Czech Republic; (L.V.)
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University, 128 00 Prague, Czech Republic
| | - Markéta Kotrbatá
- Central Laboratories, Department of Biochemistry, University Hospital Královské Vinohrady, 100 34 Prague, Czech Republic
| | - Kristina Rücklová
- Department of Children and Adolescents, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, 100 34 Prague, Czech Republic; (L.V.)
| | - Irena Aldhoon-Hainerová
- Department of Children and Adolescents, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, 100 34 Prague, Czech Republic; (L.V.)
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Morales-Cahuancama B, Verdezoto N, Gonzales-Achuy E, Quispe-Gala C, Bautista-Olortegui W, Hinojosa-Mamani P, Aparco JP. Exploring Children's Knowledge of Healthy Eating, Digital Media Use, and Caregivers' Perspectives to Inform Design and Contextual Considerations for Game-Based Interventions in Schools for Low-Income Families in Lima, Peru: Survey Study. JMIR Form Res 2024; 8:e49168. [PMID: 38743472 PMCID: PMC11134240 DOI: 10.2196/49168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The prevalence of overweight and obesity in schoolchildren is increasing in Peru. Given the increased use of digital media, there is potential to develop effective digital health interventions to promote healthy eating practices at schools. This study investigates the needs of schoolchildren in relation to healthy eating and the potential role of digital media to inform the design of game-based nutritional interventions. OBJECTIVE This study aims to explore schoolchildren's knowledge about healthy eating and use of and preferences for digital media to inform the future development of a serious game to promote healthy eating. METHODS A survey was conducted in 17 schools in metropolitan Lima, Peru. The information was collected virtually with specific questions for the schoolchild and their caregiver during October 2021 and November 2021 and following the COVID-19 public health restrictions. Questions on nutritional knowledge and preferences for and use of digital media were included. In the descriptive analysis, the percentages of the variables of interest were calculated. RESULTS We received 3937 validated responses from caregivers and schoolchildren. The schoolchildren were aged between 8 years and 15 years (2030/3937, 55.8% girls). Of the caregivers, 83% (3267/3937) were mothers, and 56.5% (2223/3937) had a secondary education. Only 5.2% (203/3937) of schoolchildren's homes did not have internet access; such access was through WiFi (2151/3937, 54.6%) and mobile internet (1314/3937, 33.4%). In addition, 95.3% (3753/3937) of schoolchildren's homes had a mobile phone; 31.3% (1233/3937) had computers. In relation to children's knowledge on healthy eating, 42.2% (1663/3937) of schoolchildren did not know the recommendation to consume at least 5 servings of fruits and vegetables daily, 46.7% (1837/3937) of schoolchildren did not identify front-of-package warning labels (FOPWLs), and 63.9% (2514/3937) did not relate the presence of an FOPWL with dietary risk. Most schoolchildren (3100/3937, 78.7%) preferred to use a mobile phone. Only 38.3% (1509/3937) indicated they preferred a computer. In addition, 47.9% (1885/3937) of caregivers considered that the internet helps in the education of schoolchildren, 82.7% (3254/3937) of caregivers gave permission for schoolchildren to play games with digital devices, and 38% (1495/3937) of caregivers considered that traditional digital games for children are inadequate. CONCLUSIONS The results suggest that knowledge about nutrition in Peruvian schoolchildren has limitations. Most schoolchildren have access to the internet, with mobile phones being the device type with the greatest availability and preference for use. Caregivers' perspectives on games and schoolchildren, including a greater interest in using digital games, provide opportunities for the design and development of serious games to improve schoolchildren's nutritional knowledge in Peru. Future research is needed to explore the potential of serious games that are tailored to the needs and preferences of both schoolchildren and their caregivers in Peru in order to promote healthy eating.
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Affiliation(s)
- Bladimir Morales-Cahuancama
- Centro Nacional de Alimentación, Nutrición y Vida Saludable, Instituto Nacional de Salud, Lima, Peru
- Programa Académico de Nutrición y Dietética, Facultad de ciencias de la salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Nervo Verdezoto
- School of Computer Science and Informatics, Cardiff University, Cardiff, United Kingdom
| | - Elena Gonzales-Achuy
- Centro Nacional de Alimentación, Nutrición y Vida Saludable, Instituto Nacional de Salud, Lima, Peru
| | - Cinthia Quispe-Gala
- Centro Nacional de Alimentación, Nutrición y Vida Saludable, Instituto Nacional de Salud, Lima, Peru
| | | | - Paul Hinojosa-Mamani
- Centro Nacional de Alimentación, Nutrición y Vida Saludable, Instituto Nacional de Salud, Lima, Peru
| | - Juan Pablo Aparco
- Centro Nacional de Alimentación, Nutrición y Vida Saludable, Instituto Nacional de Salud, Lima, Peru
- Escuela Profesional de Nutrición, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
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Button AM, Staiano AE, Beyl RA, Stein RI, Newton RL, Baker A, Lima A, Lindros J, Conn AM, Welch RR, Cook SR, Wilfley DE. Validation of remote child weight and height measurements within a weight management trial. Obesity (Silver Spring) 2024; 32:660-666. [PMID: 38108115 PMCID: PMC10965384 DOI: 10.1002/oby.23972] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/30/2023] [Accepted: 11/19/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE The aim of this substudy within the Treatment Efforts Addressing Child Weight Management by Unifying Patients, Parents, and Providers (TEAM UP) pragmatic clinical trial was to compare the validity of anthropometric measurements collected remotely versus in person (≤7 days apart) among youth with obesity who were 6 to 15 years of age. METHODS Child (n = 37) weight and height were measured in person by a trained data assessor. These were compared with measurements taken remotely by the child's parent with live videoconferencing observation by a study data assessor. In-person and remote measurements were compared using Bland-Altman plots, Pearson correlations, and two one-sided paired t tests. A priori bounds of acceptability were set at ±0.68 kg to allow for typical weight fluctuations within the 7-day comparison period. RESULTS Measurements were highly correlated (height: r = 0.991, p < 0.0001; weight: r = 0.999; p = 0.03). For height, two one-sided t tests for upper, t(36) = 3.95, and lower, t(36) = -2.63, bounds (-1, 1) revealed an overall p = 0.006; absolute error was 3.5 cm. For weight, two one-sided t tests for upper, t(36) = 1.93, and lower, t(36) = -7.91, bounds (-0.68, 0.68) revealed an overall p = 0.03; absolute error was 1.7 kg. CONCLUSIONS The present findings support the utility and interpretation of remotely assessed weight management outcomes for both research and clinical purposes. These procedures may offer greater accessibility to evidence-based measurement.
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Affiliation(s)
- Alyssa M Button
- Pennington Biomedical Research Center, Population and Public Health Science, Baton Rouge, Louisiana, USA
| | - Amanda E Staiano
- Pennington Biomedical Research Center, Population and Public Health Science, Baton Rouge, Louisiana, USA
| | - Robbie A Beyl
- Pennington Biomedical Research Center, Population and Public Health Science, Baton Rouge, Louisiana, USA
| | - Richard I Stein
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert L Newton
- Pennington Biomedical Research Center, Population and Public Health Science, Baton Rouge, Louisiana, USA
| | - Alison Baker
- American Academy of Pediatrics, Child and Community Health, Itasca, Illinois, USA
| | - Angela Lima
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeanne Lindros
- American Academy of Pediatrics, Child and Community Health, Itasca, Illinois, USA
| | - Anne-Marie Conn
- University of Rochester Medical Center, Rochester, New York, USA
| | - R Robinson Welch
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephen R Cook
- University of Rochester Medical Center, Rochester, New York, USA
| | - Denise E Wilfley
- Washington University School of Medicine, St. Louis, Missouri, USA
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Power TG, Baker SS, Barale KV, Aragón MC, Lanigan JD, Parker L, Garcia KS, Auld G, Micheli N, Hughes SO. Using Mobile Technology for Family-Based Prevention in Families with Low Incomes: Lessons from a Randomized Controlled Trial of a Childhood Obesity Prevention Program. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:369-379. [PMID: 38321316 PMCID: PMC10891227 DOI: 10.1007/s11121-023-01637-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 02/08/2024]
Abstract
Researchers are increasingly using web-based technologies to deliver family-based, prevention programming. Few studies have examined the success of such approaches for families with low incomes. The purpose of this study was to describe the level of in-class and online engagement in a childhood obesity prevention program for parents with low incomes, to examine the demographic correlates of parent engagement, and to examine dosage effects on parental feeding outcomes as a function of online exposure. All participants attended in-class nutrition education classes (Eating Smart · Being Active) as part of the Expanded Food and Nutrition Education Program (EFNEP) in Colorado and Washington State (classes were offered in English and Spanish). Participants in this analysis were 168 parents from a larger cluster randomized controlled trial who had been randomly assigned to also receive a newly developed, mobile-based version of an efficacious, feeding-focused, childhood obesity prevention program. Results showed that despite high levels of in-person attendance (70%), participants only accessed 47% of the videos (online content). Older parents and parents of girls showed higher levels of in-person attendance; currently employed parents showed lower levels. Online engagement varied as a function of ethnicity and acculturation: non-Hispanic parents accessed the most videos, low-acculturated Hispanic parents accessed the second most, and highly acculturated Hispanic parents accessed the least. In contrast, low-acculturated Hispanic parents showed the highest in-person attendance. For all but one outcome, significant online program effects were found only for parents who accessed at least half of the videos. Implications for mobile-based, family-based prevention programs for parents with low incomes are considered.ClinicalTrials.gov Identifier: NCT03170700; Registration Date: March 08, 2017.
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Affiliation(s)
| | | | | | - M Catalina Aragón
- Washington State University Extension, Tacoma, WA, USA
- Maternal and Child Health, Oregon Health Authority, Portland, OR, USA
| | | | - Louise Parker
- Washington State University Extension, Seattle, WA, USA
| | - Karina Silva Garcia
- Washington State University, Pullman, WA, USA
- Department of Public Health, County of San Luis Obispo, San Luis Obispo, CA, USA
| | - Garry Auld
- Colorado State University, Ft. Collins, CO, USA
| | - Nilda Micheli
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX, 77030, USA
| | - Sheryl O Hughes
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX, 77030, USA.
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Wang W, Ruan H, Shen Y, Cheng J, Sun W, Huang C. Effectiveness of utilizing step-monitoring devices to prevent and treat obesity in children and adolescents: A systematic review and meta-analysis. Digit Health 2024; 10:20552076241272589. [PMID: 39148809 PMCID: PMC11325471 DOI: 10.1177/20552076241272589] [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: 04/24/2024] [Accepted: 07/18/2024] [Indexed: 08/17/2024] Open
Abstract
Background Children and adolescents who are overweight and obese represent a growing public health issue. The use of step-monitoring devices as an intervention tool may be a simple, cost-effective, and easily replicable solution for addressing obesity in children and adolescents. No prior systematic reviews have evaluated the effectiveness of utilizing step-monitoring devices as an intervention method for obesity in children and adolescents. Methods Previous studies on using step-monitoring devices to prevent and treat obesity in children and adolescents were identified in the following databases: Web of Science, EMBASE, PubMed, Cochrane Library, SPORTDiscus, and SCOPUS. The search period for each database ranged from the year of their inception to 8 March 2023 (updated in June 2024). Meta-analyses were performed for mean differences (MDs) in body mass index (BMI), BMI z-score (BMI-Z), body fat, waist circumference, and body weight. Results From 12,907 relevant records, 23 studies were included in this meta-analysis. The included studies were mainly at low risk of bias, except for blinding. Step-monitoring device-based interventions had significant effects in reducing BMI-Z (MD -0.06; 95% CI -0.10 to -0.02), body fat (MD -0.95%; 95% CI -1.35 to -0.54), and body weight (MD -1.23 kg; 95% CI -2.36 to -0.10). However, there was no significant effect on BMI (MD -0.16 kg/m2; 95% CI -0.55 to 0.22) and waist circumference (MD -0.33 cm; 95% CI -1.23 to 0.58). Subgroup analyses indicated that participants who were overweight or obese showed greater intervention effects on BMI and BMI-Z compared to participants with normal weight. The programs with an intervention duration of ≤6 months presented a greater intervention effect on BMI-Z than those with an intervention duration of more than 6 months. The programs that established goals had a greater intervention effect on body fat than those that did not. Conclusions Step-monitoring devices may be an effective and generalizable intervention tool for the prevention and treatment of obesity in children and adolescents. Future studies should further explore how to set step goals and the duration of interventions to achieve better intervention effects.
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Affiliation(s)
- Wentao Wang
- Department of Basic Education, Zhejiang Tongji Vocational College of Science and Technology, Hangzhou, China
- Department of Sports and Exercise Science, Zhejiang University, Hangzhou, China
| | - Hongfang Ruan
- Department of Basic Education, Zhejiang Tongji Vocational College of Science and Technology, Hangzhou, China
| | - Yi Shen
- Department of Basic Education, Zhejiang Tongji Vocational College of Science and Technology, Hangzhou, China
| | - Jing Cheng
- Department of Basic Education, Zhejiang Tongji Vocational College of Science and Technology, Hangzhou, China
| | - Wei Sun
- Department of Military and Sports, Zhejiang University of Water Resources and Electric Power, Hangzhou, China
| | - Cong Huang
- Department of Sports and Exercise Science, Zhejiang University, Hangzhou, China
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