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Pratt KJ, Boles RE, Michalsky MP, Inge TH, Jenkins TM. Associations between marital status and weight loss trajectories entering into early adulthood: a Teen-LABS study. Surg Obes Relat Dis 2024; 20:376-382. [PMID: 38267352 DOI: 10.1016/j.soard.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/01/2023] [Accepted: 11/12/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Among adolescents who underwent metabolic and bariatric surgery (MBS), it is unclear how relationships and specifically marital status (MS) may be associated with long-term weight loss. OBJECTIVE In this analysis, we tested for associations between the MS of adolescents who underwent MBS and the MS of their primary caregiver and weight loss trajectory over 8 years. SETTING Teen-LABS participating sites. METHODS This sample included 231 participants (75.3% female, 71.4% White, 68.0% Roux-en-Y gastric bypass, 27.7% vertical sleeve gastrectomy, 4.3% laparoscopic adjustable gastric band). A linear mixed model was conducted with the dependent variable percent body mass index (BMI) change from preoperatively through 8 years with between-participant factors (1) participant MS, (2) caregiver MS, and (3) interaction between caregiver and participant MS. RESULTS One third of participants and 87% of caregivers were ever married (EM). Compared with never-married (NM) participants and caregivers (-14.6%), EM participants and caregivers (-20.6%), EM participants and NM caregivers (-25.9%), and NM participants and EM caregivers (-19.8%), each had significantly greater BMI loss at 8 years (each P < .05). No other group comparisons achieved statistical significance. CONCLUSIONS NM participants with NM caregivers had less favorable long-term BMI. Additional research is needed to better understand how relationships affect behavior change and weight loss after MBS.
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Affiliation(s)
- Keeley J Pratt
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio.
| | - Richard E Boles
- Department of Pediatrics, University of Colorado Anschutz Medical School, Aurora, Colorado
| | - Marc P Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Thomas H Inge
- Department of Surgery, Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Todd M Jenkins
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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2
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Barrett KJ, Hibbs-Shipp S, Hobbs S, Boles RE, Nelson TL, Johnson SL, Bellows LL. Maternal Risk of Cardiovascular Disease Is Associated With Higher BMI Among Preschool-Aged Children: A Cross-Sectional Study. Child Obes 2024; 20:141-146. [PMID: 36888544 PMCID: PMC10902273 DOI: 10.1089/chi.2022.0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Childhood obesity is an ongoing concern in the United States. Higher weight status in early childhood is associated with higher weight status at older ages. The Maternal Obesity Matters (MOMs) Study investigated associations between maternal risk of cardiovascular disease (CVD) and child BMI z-scores (BMIz) among preschool-aged children. This cross-sectional exploratory study included mothers and their 3- to 5-year-old children in Colorado, United States. Maternal nonfasting blood samples, blood pressure, and maternal and child anthropometrics were collected. Maternal CVD risk was assessed on a scale of 0-5 using five health measures. Multivariate regression tested associations between maternal CVD risk and child BMIz. Each 1-point increase in maternal CVD risk was associated with a 0.18 increase in child BMIz, controlling for maternal employment. Intervening upon maternal health may be an important strategy for addressing childhood obesity.
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Affiliation(s)
- Katherine J. Barrett
- Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sarah Hibbs-Shipp
- Department of Food Sciences and Human Nutrition, Colorado State University, Fort Collins, CO, USA
| | - Savannah Hobbs
- Department of Food Sciences and Human Nutrition, Colorado State University, Fort Collins, CO, USA
| | - Richard E. Boles
- Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tracy L. Nelson
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
- Colorado School of Public Health, Fort Collins, CO, USA
| | - Susan L. Johnson
- Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Laura L. Bellows
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
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3
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Eygnor A, Angulo A, Cobian M, Wilson R, Coan E, Reynolds A, Friedman S, Boles RE. Assessing Community Needs for Autism Spectrum Disorder: A Review of Rural/Frontier Needs Through Community Outreach With Developmental Pediatrics. Clin Pediatr (Phila) 2024:99228241233803. [PMID: 38379157 DOI: 10.1177/00099228241233803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Early intervention is known to improve long-term outcomes for individuals with autism spectrum disorder (ASD). Access barriers to care limit timely engagement with supportive services. This report characterized the community needs and supportive services for children and families with suspected or diagnosed ASD. Families and providers participating in outreach clinics identified available services and their attitudes about support for ASD diagnosis. Chart reviews provided referral history, insurance, and current services. Children were nearly 6 years old, 95% of families relied on public health insurance, whereas 50% reported traveling 11 miles or greater for supportive services. Most providers (83%) were medically trained in primary care and placed 1-5 referrals per month to a tertiary referral hospital. Providers reported travel difficulty as the primary reason for referring patients for evaluation. Multiple barriers for supportive services were identified, highlighting the importance to increase the capacity and availability of local ASD supportive services.
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Affiliation(s)
| | - Abigail Angulo
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Maritza Cobian
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rebecca Wilson
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth Coan
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ann Reynolds
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sandra Friedman
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Richard E Boles
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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4
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Reaven J, Pickard K, Meyer AT, Hayutin L, Middleton C, Reyes NM, Tanda T, Stahmer A, Blakeley-Smith A, Boles RE. Implementing school-based cognitive behavior therapy for anxiety in students with autism or suspected autism via a train-the-trainer approach: Results from a clustered randomized trial. Autism 2024; 28:484-497. [PMID: 37208894 DOI: 10.1177/13623613231175951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
LAY ABSTRACT Autistic youth frequently experience anxiety that can negatively affect them at home, with friends, and at school. Autistic youth have difficulty accessing mental health care, and this is particularly true for youth from traditionally underserved backgrounds. Providing mental health programs in schools may increase access to care for autistic youth with anxiety. The purpose of the study was to train interdisciplinary school providers to deliver school-based Facing Your Fears, a cognitive behavior therapy program for anxiety in autistic youth. Seventy-seven interdisciplinary school providers across 25 elementary/middle schools were trained by their colleagues and members of the research (train-the-trainer approach). Eighty-one students with autism or suspected autism, ages 8-14 years, were randomly assigned to either school-based Facing Your Fears or usual care. Students in school-based Facing Your Fears showed significant reductions in anxiety compared to students in usual care according to caregiver and student report. Other measures involved examining change in provider cognitive behavior therapy knowledge after training and determining how well interdisciplinary school providers were able to deliver school-based Facing Your Fears. Results indicated that interdisciplinary school providers showed significant improvements in cognitive behavior therapy knowledge after training. Interdisciplinary school providers were able to deliver most of school-based Facing Your Fears activities and with good quality. The positive outcomes in this study are encouraging. Training interdisciplinary school providers to deliver school-based Facing Your Fears may increase access to care for anxious autistic students. Future directions and limitations are discussed.
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Affiliation(s)
- Judy Reaven
- University of Colorado Anschutz Medical Campus, USA
| | | | | | - Lisa Hayutin
- University of Colorado Anschutz Medical Campus, USA
| | | | - Nuri M Reyes
- University of Colorado Anschutz Medical Campus, USA
| | - Tanea Tanda
- University of Colorado Anschutz Medical Campus, USA
| | - Aubyn Stahmer
- Davis Health Center, University of California, Davis, USA
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Burke E, Jenkins T, Boles RE, Mitchell JE, Inge T, Gunstad J. Cognitive function 10 years after adolescent bariatric surgery. Surg Obes Relat Dis 2024:S1550-7289(24)00033-9. [PMID: 38413319 DOI: 10.1016/j.soard.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/24/2023] [Accepted: 01/13/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Adolescent bariatric surgery produces substantial weight loss and reduction of medical co-morbidities. Research in adult samples shows improved cognitive function postoperatively, although much less is known about the potential cognitive benefits of bariatric surgery in adolescents-especially at extended follow-up. OBJECTIVE Examine cognitive function 10 years after adolescent bariatric surgery. SETTING University hospital. METHODS A total of 99 young adults who underwent bariatric surgery as adolescents completed a computerized cognitive test battery as part of a larger 10-year postoperative assessment. All had been long-term participants in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. RESULTS Cognitive dysfunction was prevalent on tests of attention and executive function (e.g., Continuous Performance Test - Reaction Time 30%; Maze Errors - Overrun 30%), and 53.5% met research criteria for mild cognitive impairment (MCI). Modified Poisson regression with robust error variance revealed participants with preoperative hypertension and those completing Roux-en-Y gastric bypass were more likely to meet criteria for MCI at 10-year follow-up. CONCLUSIONS The current findings indicate that cognitive deficits are common 10 years after bariatric surgery. Additional studies are needed to clarify possible cohort effects, determine whether these cognitive deficits persist to even later follow-up (e.g., 20 yr after surgery), and identify underlying mechanisms and mitigation strategies.
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Affiliation(s)
- Erin Burke
- Department of Psychological Sciences, Kent State University, Kent, Ohio
| | - Todd Jenkins
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Richard E Boles
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - James E Mitchell
- Sanford Center for Biobehavioral Research, Fargo, North Dakota; University of North Dakota School of Medicine and Health Science, Fargo, North Dakota
| | - Thomas Inge
- Department of Surgery, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, Ohio.
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6
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Frazier JA, Li X, Kong X, Hooper SR, Joseph RM, Cochran DM, Kim S, Fry RC, Brennan PA, Msall ME, Fichorova RN, Hertz-Picciotto I, Daniels JL, Lai JS, Boles RE, Zvara BJ, Jalnapurkar I, Schweitzer JB, Singh R, Posner J, Bennett DH, Kuban KCK, O'Shea TM. Perinatal Factors and Emotional, Cognitive, and Behavioral Dysregulation in Childhood and Adolescence. J Am Acad Child Adolesc Psychiatry 2023; 62:1351-1362. [PMID: 37207889 PMCID: PMC10654259 DOI: 10.1016/j.jaac.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 03/01/2023] [Accepted: 05/10/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVE This cohort study assessed perinatal factors known to be related to maternal and neonatal inflammation and hypothesized that several would be associated with emotional, cognitive, and behavioral dysregulation in youth. METHOD The Environmental influences on Child Health Outcomes (ECHO) is a research consortium of 69 pediatric longitudinal cohorts. A subset of 18 cohorts that had both Child Behavior Checklist (CBCL) data on children (6-18 years) and information on perinatal exposures including maternal prenatal infections was used. Children were classified as having the CBCL-Dysregulation Profile (CBCL-DP) if the sum of their T scores for 3 CBCL subscales (attention, anxious/depressed, and aggression) was ≥180. Primary exposures were perinatal factors associated with maternal and/or neonatal inflammation, and associations between these and outcome were assessed. RESULTS Approximately 13.4% of 4,595 youth met criteria for CBCL-DP. Boys were affected more than girls (15.1% vs 11.5%). More youth with CBCL-DP (35%) were born to mothers with prenatal infections compared with 28% of youth without CBCL-DP. Adjusted odds ratios indicated the following were significantly associated with dysregulation: having a first-degree relative with a psychiatric disorder; being born to a mother with lower educational attainment, who was obese, had any prenatal infection, and/or who smoked tobacco during pregnancy. CONCLUSION In this large study, a few modifiable maternal risk factors with established roles in inflammation (maternal lower education, obesity, prenatal infections, and smoking) were strongly associated with CBCL-DP and could be targets for interventions to improve behavioral outcomes of offspring. DIVERSITY & INCLUSION STATEMENT We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
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Affiliation(s)
- Jean A Frazier
- Eunice Kennedy Shriver Center, UMass Chan Medical School, Worchester, Massachusetts.
| | - Xiuhong Li
- Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - David M Cochran
- Eunice Kennedy Shriver Center, UMass Chan Medical School, Worchester, Massachusetts
| | - Sohye Kim
- Eunice Kennedy Shriver Center, UMass Chan Medical School, Worchester, Massachusetts
| | | | | | - Michael E Msall
- University of Chicago Comer Children's Hospital, Chicago, Illinois, and Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, The University of Chicago, Chicago, Illinois
| | - Raina N Fichorova
- Brigham and Women's Hospital, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts
| | | | | | - Jin-Shei Lai
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard E Boles
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Isha Jalnapurkar
- Eunice Kennedy Shriver Center, UMass Chan Medical School, Worchester, Massachusetts
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7
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White GE, Boles RE, Courcoulas AP, Yanovski SZ, Zeller MH, Jenkins TM, Inge TH. A Prospective Cohort of Alcohol Use and Alcohol-related Problems Before and After Metabolic and Bariatric Surgery in Adolescents. Ann Surg 2023; 278:e519-e525. [PMID: 36538630 PMCID: PMC10188659 DOI: 10.1097/sla.0000000000005759] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe alcohol use, alcohol-related harm, and alcohol-related problems preoperatively and up to 8 years following metabolic and bariatric surgery (MBS) in adolescents. BACKGROUND Risk for alcohol use and alcohol use disorders (AUD) increases post-Roux-en-Y gastric bypass and vertical sleeve gastrectomy in adults. However, data are lacking in adolescents who undergo MBS. METHODS This study includes 217 adolescents (aged 13-19 y) enrolled in a 5-center prospective cohort study who underwent Roux-en-Y gastric bypass or vertical sleeve gastrectomy (2007-2011) and reported alcohol use preoperatively and annually postoperatively for up to 8 years. Time to elevated Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) score, alcohol-related harm, and alcohol-related problems were analyzed with Kaplan-Meier estimates of cumulative incidence. RESULTS Preoperatively, the median age was 17 years; the median body mass index was 51 kg/m 2 . Alcohol use frequency and average quantity of drinks per drinking day increased postoperatively (2% consumed alcohol 2-4 times/month 6 months versus 24% 8 years postoperatively, P <0.001; 2% consumed≥3 drinks per drinking day 6 months versus 35% 8 years postoperatively, P <0.001). Cumulative incidence of postoperative onset elevated AUDIT-C score, alcohol-related harm, and alcohol-related problems at year 8 were 45% (95% CI:37-53), 43% (95% CI:36-51), and 47% (95% CI:40-55), respectively. CONCLUSIONS Nearly half of those who underwent MBS as adolescents screened positively for AUD, symptoms of alcohol-related harm, or alcohol-related problems 8 years post-MBS, highlighting the risk for alcohol use and AUD after MBS in adolescents. AUD evaluation and treatment should be integrated into routine long-term care for adolescents undergoing MBS.
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Affiliation(s)
| | | | | | - Susan Z Yanovski
- National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Division of Digestive Diseases and Nutrition, Bethesda, MD
| | - Meg H Zeller
- University of Cincinnati College of Medicine, Cincinnati, OH
| | - Todd M Jenkins
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Thomas H Inge
- Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL
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8
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Bellows LL, Lou Y, Nelson R, Reyes LI, Brown RC, Mena NZ, Boles RE. A Narrative Review of Dietary Assessment Tools for Preschool-Aged Children in the Home Environment. Nutrients 2022; 14:nu14224793. [PMID: 36432478 PMCID: PMC9694043 DOI: 10.3390/nu14224793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Preschool-aged children in the U.S. have suboptimal diets. Interventions to improve child nutrition focus on parents and their role in shaping social and physical home environments, which influence children's eating behaviors. Dietary assessment tools selected to measure intervention objectives, and how results are interpreted in key findings, are essential when examining children's diets. The objectives of this review were to (1) describe dietary assessment tools used in intervention studies in young children focused within the home environment; and (2) examine how the application of these dietary assessment tools addressed intervention objectives. PubMed and Web of Science were searched for English-language nutrition intervention studies that included children aged 2-5 years, had a home environment component, used a dietary assessment tool, and reported on diet-related outcomes. Seventeen studies were included. Intervention objectives focused on overall diet, specific food groups, eating occasions, and obesity prevention/treatment. Concordance of key findings with intervention objectives, type of tool used, and multiple tools within the same study varied with 8 studies aligning in objective and tool, 1 discordant in both, and 8 partially concordant or too broad to determine. This review highlights current challenges in measuring dietary intake in preschoolers and provides recommendations for alternative applications and strategies.
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Affiliation(s)
- Laura L. Bellows
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
- Correspondence:
| | - Yuanying Lou
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
| | - Rachel Nelson
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
| | - Ligia I. Reyes
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
| | - Renae C. Brown
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
| | - Noereem Z. Mena
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
- Department of Agriculture, Nutrition and Food Systems, University of New Hampshire, Durham, NH 03842, USA
| | - Richard E. Boles
- Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA
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9
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Barrett KJ, Hibbs-Shipp SK, Hobbs S, Boles RE, Johnson SL, Bellows LL. Validation of a Home Food Environment Instrument Assessing Household Food Patterning and Quality. Nutrients 2021; 13:nu13113930. [PMID: 34836185 PMCID: PMC8619541 DOI: 10.3390/nu13113930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 11/16/2022] Open
Abstract
The home food environment (HFE) is associated with dietary intake; yet measuring HFE quality often requires burdensome collection of detailed inventories. This project evaluated the capacity of the Home Inventory to Describe Eating and Activity, version 2 (Home-IDEA2) to capture HFE quality by measuring the presence or absence of household foods. Validity was tested using a modified application of the Healthy Eating Index-2010 (HEI). Comparative data were drawn from the National Food Acquisition and Purchase Survey (FoodAPS) Food-at-Home Public Use File. HEI scores were calculated for 4202 households in FoodAPS using Home-IDEA2 inventories and full reported inventories. Paired t-tests compared: (1) estimated vs. total edible grams (EEG; TEG); (2) limited vs. all reported foods; and (3) EEG + limited foods vs. TEG + all reported foods. Sensitivity and range of scores were compared. Mean HEI scores for Home-IDEA2 were higher (p < 0.003) than FoodAPS: (1) 51.6 ± 16.1 vs. 49.6 ± 18.1 (food amounts); (2) 53.5 ± 15.8 vs. 49.8 ± 15.4 (food items); (3) 55.5 ± 15.7 vs. 49.8 ± 15.4 (full instrument); differences were small. Scores demonstrated comparable sensitivity and range. The study found that the Home-IDEA2 can capture HFE quality adequately with low data collection burden.
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Affiliation(s)
- Katherine J. Barrett
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (K.J.B.); (R.E.B.); (S.L.J.)
| | - Sarah K. Hibbs-Shipp
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO 80523, USA; (S.K.H.-S.); (S.H.)
| | - Savannah Hobbs
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO 80523, USA; (S.K.H.-S.); (S.H.)
| | - Richard E. Boles
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (K.J.B.); (R.E.B.); (S.L.J.)
| | - Susan L. Johnson
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (K.J.B.); (R.E.B.); (S.L.J.)
| | - Laura L. Bellows
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO 80523, USA; (S.K.H.-S.); (S.H.)
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
- Correspondence:
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10
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Blakeley-Smith A, Meyer AT, Boles RE, Reaven J. Group Cognitive Behavioural Treatment for Anxiety in Autistic Adolescents with Intellectual Disability: A Pilot and Feasibility Study. J Appl Res Intellect Disabil 2021; 34:777-788. [PMID: 33410240 DOI: 10.1111/jar.12854] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/09/2020] [Accepted: 12/22/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adolescents with Autism Spectrum Disorder (ASD) and intellectual disability evidence significant anxiety. This study aimed to adapt a group cognitive behaviour therapies (CBT) programme designed for youth with ASD and anxiety to meet the cognitive, communication, and behavioural needs of adolescents with intellectual disability, and assess initial feasibility and efficacy of the intervention. METHODS Structural, content and procedural adaptations were made to a 14-week family-focused CBT intervention. Twenty-three adolescents with ASD, intellectual disability and anxiety were included. Treatment acceptability along with adolescent anxiety symptoms was assessed via parent report measures. RESULTS Of the 23 participants, 19 completed treatment and attended 94% of sessions. Parent acceptability was high. Significant reductions were noted on anxiety symptoms post-intervention. CONCLUSIONS Results indicate that the CBT group was feasible and acceptable. Preliminary outcomes suggest that adolescent anxiety improved, although replication with a larger sample and comparison to a control group is needed.
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Affiliation(s)
- Audrey Blakeley-Smith
- JFK Partners, Psychiatry & Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Allison T Meyer
- JFK Partners, Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Richard E Boles
- JFK Partners, Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Judy Reaven
- JFK Partners, Psychiatry & Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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11
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Moore JM, Glover JJ, Jackson BM, Coughlin CR, Kelsey MM, Inge TH, Boles RE. Development and application of an ethical framework for pediatric metabolic and bariatric surgery evaluation. Surg Obes Relat Dis 2020; 17:425-433. [PMID: 33191162 DOI: 10.1016/j.soard.2020.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/16/2020] [Accepted: 09/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND As severe obesity continues to rise among youth, metabolic and bariatric surgery (MBS) will increasingly be used as a treatment of choice for durable weight loss and improvement of obesity-related complications. MBS for youth with intellectual and developmental disabilities (IDD) and for preadolescents has raised ethical questions. OBJECTIVES The purpose of this article is to present the creation and application of an ethical framework that supports why MBS should be considered in pediatrics based on the principle of justice without automatic exclusions. This framework also provides a guide for how to conduct a robust, ethically grounded evaluation of pediatric patients presenting for MBS in general, and among subpopulations including youth with IDD and preadolescents. SETTING Academic medical center, United States. METHODS An ethical framework was developed and applied through a collaboration between an MBS center at a children's hospital and the institution's ethics consult service. RESULTS Application of the ethical framework to address 4 core ethical questions is illustrated using 2 hypothetical cases: 1 that highlights an adolescent with IDD and 1 that highlights a preadolescent. CONCLUSIONS We have demonstrated the application of a novel, overarching framework to conduct the ethical evaluation of youth presenting for MBS. This framework resulted from a collaboration between MBS and ethics consult teams and has the potential to be used as a prototype for other youth-focused MBS programs. Next steps include prospective data collection to test the framework and determine its validity in the target population.
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Affiliation(s)
- Jaime M Moore
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado.
| | - Jacqueline J Glover
- Department of Pediatrics, Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, Colorado
| | - Brian M Jackson
- Department of Pediatrics, Section of Pediatric Critical Care, Center for Bioethics and Humanities, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Curtis R Coughlin
- Department of Pediatrics, Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, Colorado
| | - Megan M Kelsey
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Thomas H Inge
- Department of Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Richard E Boles
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
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12
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Abstract
The decision to pursue metabolic and bariatric surgery (MBS) for pediatric patients has become increasingly accepted by patients and their families and by health care professionals. The advancement of pre- and post-operative MBS guidelines, based on accumulating evidence for safety, efficacy, and cost-effectiveness help to map the clinical pathway for MBS consideration. Ethical issues remain possible for each case, however, and consultation with ethical experts can provide clarity in the consideration of MBS. Specifically, ethical issues related to principles of autonomy, justice, beneficence, and non-maleficence may need to be resolved based on patient characteristics, including preadolescent patients and those who present with intellectual disabilities. Institutions that offer MBS for pediatric patients will benefit from collaborating with ethics consultants to develop a structured approach that helps ensure that ethical principles have been adequately addressed for patients presenting for MBS.
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Affiliation(s)
- Richard E. Boles
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Aurora, CO 80045, United States,Corresponding author. (R.E. Boles)
| | - Jaime M. Moore
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Aurora, CO 80045, United States
| | - Jacqueline J. Glover
- University of Colorado Anschutz Medical Campus, Department of Pediatrics and Center for Bioethics and Humanities, Aurora, CO 80045, United States
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13
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Njardvik U, Gunnarsdottir T, Olafsdottir AS, Craighead LW, Boles RE, Bjarnason R. Incorporating Appetite Awareness Training Within Family-Based Behavioral Treatment of Pediatric Obesity: A Randomized Controlled Pilot Study. J Pediatr Psychol 2019; 43:1017-1027. [PMID: 30010923 DOI: 10.1093/jpepsy/jsy055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 06/20/2018] [Indexed: 02/07/2023] Open
Abstract
Objective To assess additive effects of incorporating appetite awareness training (AAT), a strategy to encourage eating in response to hunger and satiety cues, within a family-based behavioral treatment (FBT) for childhood obesity. Methods Total 84 families with a child with obesity in the age range of 8-12 years, Body Mass Index Standard Deviation Score (BMI-SDS) ≥ 2, and a participating parent were randomly allocated to two conditions; standard FBT was compared with FBT incorporating AAT strategies (FBT-AAT). Treatment consisted of group therapy sessions (held separately for children and parents) as well as single-family (parent-child dyad) sessions (24 sessions total) delivered over 18 weeks at a tertiary care outpatient clinic. One booster session was provided 1-year posttreatment and a final follow-up assessment was conducted at 2 years. The primary outcome was change in child standardized body mass index (BMI-SDS). Results The two conditions did not differ significantly at posttest, but the FBT-AAT group was at a significantly lower weight compared with FBT at both the first-year, F(1, 82) = 4.150, p<.05, and the second-year follow-ups, F(1, 82) = 14.912, p <.001. It was notable that over the second-year of follow-up, the FBT-AAT group continued to show improvement, whereas the FBT group did not. Conclusions Incorporating specific self-regulatory training in attending to hunger and fullness signals during a standardized family-based treatment may have enhanced the long-term maintenance of treatment effects. Findings are promising and warrant further study.
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Affiliation(s)
| | | | - Anna S Olafsdottir
- Faculty of Health Promotion, Sport and Leisure Studies, University of Iceland
| | | | - Richard E Boles
- Anschutz Medical Campus School of Medicine, University of Colorado
| | - Ragnar Bjarnason
- Faculty of Medicine, University of Iceland and Children's Medical Centre, Landspitali University Hospital, Reykjavik, Iceland
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14
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Johnson SL, Ryan SM, Kroehl M, Moding KJ, Boles RE, Bellows LL. A longitudinal intervention to improve young children's liking and consumption of new foods: findings from the Colorado LEAP study. Int J Behav Nutr Phys Act 2019; 16:49. [PMID: 31159810 PMCID: PMC6547533 DOI: 10.1186/s12966-019-0808-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 05/08/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Many interventions have been conducted to improve young children's liking and consumption of new foods however their impacts on children's consumption have been limited. Consistent evidence supports the use of repeated exposure to improve liking for new foods however longitudinal effects lasting greater than 6 months often have not been demonstrated. Here we report the eating-related findings of the Colorado Longitudinal Eating And Physical Activity (LEAP) Study, a multi-component intervention, delivered primarily in the school setting, which aimed to improve children's liking and consumption of a target food via repeated exposure and positive experiential learning. METHODS Four sites in rural Colorado, each housing Head Start preschool programs, matched on state vital statistics for childhood obesity rates, (2 intervention and 2 control sites) took part in a quasi-experimental study design which included 4 time points (baseline, post-intervention, one-year [Y1] and two- year [Y2] follow ups). A total of 250 children and families were enrolled (n = 143 intervention and n = 107 control; 41% Hispanic and 69% low-income). A 12-week intervention, Food Friends - Fun With New Foods®, delivered by trained preschool teachers and which focuses on positive and repeated experiences with new foods, and a 5-month (1 unit/month) social marketing "booster program" was delivered in kindergarten (one-year follow up) and 1st grade (two-year follow up). Main outcome measures included change in children's liking for new foods, analyzed by ordinal regression using generalized estimating equations, and change in weighed consumption of new foods over time, analyzed using a hierarchical mixed effects model. RESULTS The intervention was delivered with good fidelity (87%). Both intervention and control groups demonstrated an increase in liking for the target food over time (p = 0.0001). The pattern of consumption of the target food was different, over time, for intervention and control groups (p < 0.005). In particular the change in intake between baseline and post-intervention was significantly greater in the intervention compared to the control group (p < 0.0001) though this pattern of change did not hold between baseline and Y2 follow up (p = 0.1144). Children in the intervention group who liked the target food consumed nearly double their baseline consumption at post-intervention (p < 0.0001;) and maintained this increase at Y2 follow up (p < 0.0001). CONCLUSIONS The Food Friends intervention, which utilized positive, repeated experiences with new foods, and was delivered with good fidelity by trained preschool teachers, found that larger improvements were observed in children's eating behaviors than would be expected with developmentally-based changes in eating behaviors. TRIAL REGISTRATION NUMBER This trial is registered at ClinicalTrials.gov : NCT01937481. Date registered: 09/09/2013; Retrospectively registered. Date first participant registered: 09/15/2010.
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Affiliation(s)
- Susan L. Johnson
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO USA
| | - Sarah M. Ryan
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Aurora, CO USA
| | - Miranda Kroehl
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Aurora, CO USA
| | - Kameron J. Moding
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO USA
| | - Richard E. Boles
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO USA
| | - Laura L. Bellows
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO USA
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15
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Zeng N, Johnson SL, Boles RE, Bellows LL. Associations between Parents’ Physical Activity and Young Children’s Health Outcomes. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562084.95047.e0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Bellows LL, Boles RE, Hibbs-Shipp SK, Burdell A, Johnson SL. Checklist to Capture Food, Physical Activity, and Sedentary Devices in the Home Environment: The Home Inventory Describing Eating and Activity (Home-IDEA2). J Nutr Educ Behav 2019; 51:589-597. [PMID: 30733165 DOI: 10.1016/j.jneb.2018.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/16/2018] [Accepted: 12/17/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To modify and test a self-report checklist for the home food and activity environment, Home-Inventory Describing Eating and Activity (IDEA2), psychometrically with families of young children. DESIGN A mixed-methods approach: (1) cognitive interviews informed instrument design (content validity), (2) parent and trained independent raters concurrently and independently completed the Home-IDEA2 during home visits (criterion validity); (3) the Home-IDEA2 was compared with a national sample via the Food Acquisition and Purchase Survey (FoodAPS) database (construct validity). SETTING Rural communities in Colorado. PARTICIPANTS Families of preschoolers: cognitive interviews (n = 20) and home visits (n = 26). MAIN OUTCOME MEASURES AND ANALYSIS Content validity: responses to each question were analyzed using a general inductive approach. Criterion validity: Cohen's kappa (κ) coefficient was calculated for each Home-IDEA2 item. Construct validity: frequencies were calculated to determine the proportion of Home-IDEA2 food items found in FoodAPS households. RESULTS Cognitive interviews identified the need for more food descriptions and the reduction of total items from 154 to 134. Testing resulted in acceptable agreement (κ = 0.6-1.0) for 82 items (58 food, 16 physical activity, and 8 electronics), moderate agreement for 36 (35 food and 1 physical activity; κ = 0.4-0.5), and poor agreement for 16 (15 food and 1 electronics; κ ≤ 0.3). Overall reliability improved from 55% to 65% for Home-IDEA2 items. Comparison of Home-IDEA2 items with FoodAPS demonstrated that 60% of foods found in US homes were covered by the Home-IDEA2. CONCLUSIONS AND IMPLICATIONS This study resulted in a valid, reliable, and low-burden self-report measure for food, activity, and electronic home environments by low-income, minority parents of preschoolers.
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Affiliation(s)
- Laura L Bellows
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO.
| | - Richard E Boles
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Sarah K Hibbs-Shipp
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO
| | - Alexandra Burdell
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO
| | - Susan L Johnson
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
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17
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Boles RE, Johnson SL, Burdell A, Davies PL, Gavin WJ, Bellows LL. Home food availability and child intake among rural families identified to be at-risk for health disparities. Appetite 2019; 134:135-141. [DOI: 10.1016/j.appet.2018.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/28/2018] [Accepted: 12/07/2018] [Indexed: 01/28/2023]
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18
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Zeng N, Johnson SL, Boles RE, Bellows LL. Social-ecological correlates of fundamental movement skills in young children. J Sport Health Sci 2019; 8:122-129. [PMID: 30997258 PMCID: PMC6450923 DOI: 10.1016/j.jshs.2019.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 05/30/2023]
Abstract
PURPOSE To identify the social-ecological correlates associated with fundamental movement skills at the child, family, and environment levels in young children. METHODS Preschool children from 4 Colorado Head Start/preschool centers were recruited from 2010 to 2012. Two hundred twenty-eight children (128 girls; age = 56.08 ± 4.09 months; body mass index (BMI) z-score = 0.53 ± 1.12 (mean ± SD); 42.1% Hispanic/Latino) and 159 families were included in the final analysis. Children's perceived competence and fundamental movement skills were assessed via the Pictorial Scale of Perceived Competence and Social Acceptance and the Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition. Data on the number of children in the family, parent age, BMI, education, employment status, family income, perception of child coordination, and home physical activity environment were collected via a questionnaire. Linear regressions adjusted for child BMI, age, sex, and school site were performed at each level. RESULTS Child perceived cognitive competence was positively associated with locomotor skills (p = 0.04; adjusted R 2 = 0.035) and object-control skills (p = 0.003; adjusted R 2 = 0.083) at the child level. Parent education, BMI, and perception of child coordination were positively associated with locomotor skills and explained 8.8% of variance, but only parent education was significant (p = 0.04) at the family level. In addition, physical environment was positively associated with locomotor skills (p = 0.02) and explained 5.5% of variance at the environment level. CONCLUSION Social-ecological correlates associated with young children's fundamental movement skills are multidimensional and differ according to skill category at the child, family, and environment levels.
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Affiliation(s)
- Nan Zeng
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO 80523, USA
| | - Susan L. Johnson
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Richard E. Boles
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Laura L. Bellows
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO 80523, USA
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19
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Hibbs-Shipp SK, Boles RE, Johnson SL, McCloskey ML, Hobbs S, Bellows LL. Development of a Quality Score for the Home Food Environment Using the Home-IDEA2 and the Healthy Eating Index-2010. Nutrients 2019; 11:nu11020372. [PMID: 30759760 PMCID: PMC6412482 DOI: 10.3390/nu11020372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 01/22/2023] Open
Abstract
The home food environment (HFE) is an important factor in the development of food preferences and habits in young children, and the availability of foods within the home reflects dietary intake in both adults and children. Therefore, it is important to consider the holistic quality of the HFE. The purpose of this study was to apply the Healthy Eating Index (HEI; a measure of diet quality in conformance to the Dietary Guidelines for Americans) algorithm to the Home-IDEA2, a valid and reliable food inventory checklist, to develop a Home-IDEA2 HEI Score. After an initial score was developed, it was psychometrically tested for content, criterion, and construct validity. Content validity testing resulted in 104 foods being retained. Internal criterion testing demonstrated that 42 foods (40%) changed component scores by >5%; however, no single food changed a total Home-IDEA2 HEI score by >5%. Testing of hypothetical HFEs resulted in a range of scores in the expected directions, establishing sensitivity to varied HFEs. This study resulted in a validated methodology to assess the overall quality of the HFE, thus contributing a novel approach for examining home food environments. Future research can test interventions modifying the HFE quality to improve individual dietary intake.
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Affiliation(s)
- Sarah K Hibbs-Shipp
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO 80523, USA.
| | - Richard E Boles
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Susan L Johnson
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Morgan L McCloskey
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO 80523, USA.
| | - Savannah Hobbs
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO 80523, USA.
| | - Laura L Bellows
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO 80523, USA.
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20
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Andersen LM, Boles RE, Kaar JL, Gance-Cleveland B, Gauthier KI, Cason-Wilkerson R, Federspiel D, Valenzuela M, Thompson DA. Use of the Delphi Technique to Obtain Community Input on Leading Contributors to Early Childhood Obesity in Latino Communities. Hisp Health Care Int 2018; 16:113-119. [PMID: 30207164 DOI: 10.1177/1540415318798839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION In the United States, Latino children are disproportionately affected by childhood obesity and related comorbidities. Stakeholder engagement has the potential to heighten the efficacy of interventions, thereby reducing the disparate prevalence of obesity among Latino children. The objective of this study was to identify stakeholders' opinions on factors influencing early childhood obesity in Latino children aged 0 to 5 years. METHOD This study used the Delphi technique to gather and prioritize stakeholders' opinions about the factors and barriers considered most influential in early (age 0-5 years) childhood obesity intervention or prevention within the Latino community. Three sequential phases were used. Participants included Latina women as well as staff from community organizations serving Denver metropolitan's Latino population. RESULTS Study results revealed that stakeholders value the role of the child's primary care provider in the identification of overweight children and desire more educational support to reduce intake of nonnutritious foods. Participants further determined that obesity-related knowledge gaps and affordability of healthy foods and activities were the largest barriers to helping Latino children maintain healthy weights. CONCLUSION Use of this stakeholder-informed data could assist in the development of future culturally tailored interventions aimed at reducing the rates of early childhood obesity in the Latino population.
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Affiliation(s)
- Leisha M Andersen
- 1 University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,2 University of Massachusetts, Amherst, MA, USA
| | - Richard E Boles
- 1 University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jill L Kaar
- 1 University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | | | | | | | | | - Darcy A Thompson
- 1 University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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21
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Thompson DA, Schmiege SJ, Johnson SL, Vandewater EA, Boles RE, Zambrana RE, Lev J, Tschann JM. Screen-Related Parenting Practices in Low-Income Mexican American Families. Acad Pediatr 2018; 18:820-827. [PMID: 29777781 PMCID: PMC6211555 DOI: 10.1016/j.acap.2018.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To (1) examine whether the Information-Motivation-Behavioral Skills Model predicts maternal screen-related parenting practices and (2) evaluate the relationship of American Academy of Pediatrics (AAP)-recommended parenting practices with child television (TV) use behaviors. METHODS In this cross-sectional study, 312 Spanish-speaking and/or English-speaking female primary caregivers of Mexican descent with a child 3 to 5 years of age were recruited from safety-net pediatric clinics. Participants completed a phone interview and screen media diary. Measures included maternal screen-related beliefs, self-efficacy, parenting practices (time restriction, TV in the child's bedroom, allowing viewing while eating meals and while eating snacks), and child viewing behaviors (amount of TV viewing, frequency of eating while viewing). Two path analytic models were estimated. RESULTS Positive general beliefs about TV viewing and positive functional beliefs were negatively associated with maternal self-efficacy to restrict TV time (β = -0.14, P < .05; β = -0.27, P < .001). Greater self-efficacy to restrict time was associated with more maternal restriction of time (β = 0.29, P < .001). Greater positive functional beliefs were associated with less self-efficacy to restrict TV viewing with snacks (odds ratio = 0.56; 95% confidence interval, 0.38-0.81). High self-efficacy to restrict viewing with snacks was associated with less allowing of viewing while snacking (β = -0.16, P < .01). Time restriction, TV in the child's bedroom, and allowing viewing while snacking were associated with child TV viewing behaviors. CONCLUSIONS Providers should consider maternal beliefs, including beliefs regarding the functional use of screens, and self-efficacy to engage in AAP-recommended parenting practices, when counseling on screen use in this population.
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Affiliation(s)
- Darcy A Thompson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora.
| | - Sarah J Schmiege
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora
| | - Susan L Johnson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Elizabeth A Vandewater
- Division of Health Promotion and Behavioral Sciences, University of Texas School of Public Health-Austin Regional Campus
| | - Richard E Boles
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Ruth E Zambrana
- Department of Women's Studies, University of Maryland, College Park
| | - Jerusha Lev
- Department of Pediatrics, Denver Health, Denver, Colo
| | - Jeanne M Tschann
- Department of Psychiatry, University of California at San Francisco
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22
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Thompson DA, Johnson SL, Schmiege SJ, Vandewater EA, Boles RE, Lev J, Tschann JM. Beliefs About Child TV Viewing in Low-Income Mexican American Parents of Preschoolers: Development of the Beliefs About Child TV Viewing Scale (B-TV). Matern Child Health J 2018; 22:849-857. [PMID: 29423583 DOI: 10.1007/s10995-018-2458-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objectives Parental beliefs about child television viewing may affect the way parents regulate child television viewing. Despite this, little research has focused on the development of measures of parental beliefs about child television viewing, particularly among ethnic minority parents and parents of young children. This study's objective was to develop and test a culturally-based measure of parental beliefs about television viewing in low-income Mexican American mothers of preschoolers. Methods Using a cross-sectional study design, 22 items reflecting parental beliefs about influences of TV on children were developed and assessed for psychometric properties in a sample of 312 low-income Mexican American mothers of preschoolers. Results Using exploratory factor analysis, we identified four factors reflecting four domains of parental beliefs: positive general beliefs, positive sleep-related beliefs, positive functional beliefs, and negative general beliefs. Internal reliabilities were acceptable (Cronbach's alpha = 0.70-0.89) for all factors except negative general beliefs (Cronbach's alpha = 0.61). Positive sleep-related beliefs and Positive Functional Beliefs were correlated with children's average daily hours of TV (r = 0.16, p < .01; r = 0.22, p < .001, respectively) and with mother's average daily hours of TV (r = 0.14, p < .05; r = 0.22, p < .001, respectively), providing initial support for construct validity. Conclusions for Practice The Beliefs about Child TV viewing scale measures four domains of parental beliefs regarding child TV viewing, and has good initial reliability and validity for three factors. Future use will allow investigators to conduct more in-depth evaluations on the influence of parental beliefs on the way parents shape their child's use of the TV.
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Affiliation(s)
- Darcy A Thompson
- Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Mail Stop F561, 12631 East 17th Avenue, Room 2605, Aurora, CO, 80045, USA.
| | - Susan L Johnson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarah J Schmiege
- Department of Biostatistics and Informatics, University of Colorado, Colorado School of Public Health, Aurora, CO, USA
| | - Elizabeth A Vandewater
- Division of Health Promotion and Behavioral Sciences, University of Texas School of Public Health-Austin Regional Campus, Houston, TX, USA
| | - Richard E Boles
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jerusha Lev
- Department of Pediatrics, Denver Health, Denver, CO, USA
| | - Jeanne M Tschann
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA
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Thorsteinsdottir S, Gunnarsdottir T, Boles RE, Njardvik U. Weight status and disordered sleep in preschool children, parents’ negative mood states and marital status. Children's Health Care 2017. [DOI: 10.1080/02739615.2017.1392305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | - Richard E. Boles
- Department of Pediatrics, University of Colorado Denver School of Medicine
| | - Urdur Njardvik
- Department of Psychology, School of Health Sciences, University of Iceland
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Bellows LL, Davies PL, Courtney JB, Gavin WJ, Johnson SL, Boles RE. Motor skill development in low-income, at-risk preschoolers: A community-based longitudinal intervention study. J Sci Med Sport 2017; 20:997-1002. [PMID: 28506451 DOI: 10.1016/j.jsams.2017.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 04/01/2017] [Accepted: 04/04/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to: (1) determine the status of fundamental movement skill (FMS) performance in low-income, at-risk preschoolers; and (2) evaluate the impact of the Food Friends Get Movin' with Mighty Moves (MM) program on improving children's FMS at two-year follow-up. DESIGN Longitudinal, quasi-experimental study with matched controls. METHODS The Colorado LEAP study was conducted in four Head Start/preschools (two intervention, two control) serving children aged 3-5 years. MM was delivered to the intervention group during preschool. The Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) subtests for balance, running speed and agility, upper-limb coordination (object control (OC) skills) and strength were administered to children at baseline, post-intervention in preschool, one-year follow-up (kindergarten), and two-year follow-up (first grade). RESULTS Compared to the normative sample's mean, the mean scaled score for all participants at baseline was significantly lower for balance (p=0.016) and OC skills (p<0.001). At two-year follow-up, the means of balance for all participants and OC skills for just the control group were significantly lower than those of the normative sample (p≤0.001). Hierarchical linear regression analyses revealed a significant intervention effect for OC skills with the overall model accounting for 41% of variance at two-year follow-up, F(6,165)=20.45, p<0.001. No intervention effects were found for the other three BOT-2 subtests. CONCLUSIONS Delivering the MM program in preschool confers a lasting impact on FMS, specifically OC skills, in at-risk elementary school children. Results suggest that at-risk preschoolers are already behind in FMS development and these delays will continue through first grade.
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Affiliation(s)
- Laura L Bellows
- Department of Food Science & Human Nutrition, Colorado State University, United States.
| | - Patricia L Davies
- Department of Occupational Therapy, Colorado State University, United States
| | - Jimikaye B Courtney
- Department of Food Science & Human Nutrition, Colorado State University, United States
| | - William J Gavin
- Department of Human Development & Family Studies, Colorado State University, United States
| | - Susan L Johnson
- Department of Pediatrics, University of Colorado, United States
| | - Richard E Boles
- Department of Pediatrics, University of Colorado, United States
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Rhodes ET, Boles RE, Chin K, Christison A, Testa EG, Guion K, Hawkins MJ, Petty CR, Sallinen Gaffka B, Santos M, Shaffer L, Tucker J, Hampl SE. Expectations for Treatment in Pediatric Weight Management and Relationship to Attrition. Child Obes 2017; 13:120-127. [PMID: 28092464 PMCID: PMC5369386 DOI: 10.1089/chi.2016.0215] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Attrition in pediatric weight management negatively impacts treatment outcomes. A potentially modifiable contributor to attrition is unmet family expectations. This study aimed to evaluate the association between adolescent and parent/guardian treatment expectations and attrition. PATIENTS AND METHODS A prospective, nonrandomized, uncontrolled, single-arm pilot trial was conducted among 12 pediatric weight management programs in the Children's Hospital Association's FOCUS on a Fitter Future collaborative. Parents/guardians and adolescents completed an expectations/goals survey at their initial visit, with categories including healthier food/drinks, physical activity/exercise, family support/behavior, and weight management goals. Attrition was assessed at 3 months. RESULTS From January to August 2013, 405 parents/guardians were recruited and reported about their children (203 adolescents, 202 children <12 years). Of the 203 adolescents, 160 also self-reported. Attrition rate was 42.2% at 3 months. For adolescents, greater interest in family support/behavior skills was associated with decreased odds of attrition at 3 months [odds ratio (OR) 0.75, 95% confidence interval (CI) 0.57-0.98, p = 0.04]. The more discordant the parent/adolescent dyad responses in this category, the higher the odds of attrition at 3 months (OR 1.36, 95% CI 1.04-1.78, p = 0.02). Weight loss was an important weight management goal for both adolescents and parents. For adolescents with this goal, the median weight-loss goal was 50 pounds. Attrition was associated with adolescent weight-loss goals above the desired median (50% above the median vs. 28% below the median, p = 0.02). CONCLUSIONS Assessing initial expectations may help tailor treatment to meet families' needs, especially through focus on family-based change and realistic goal setting. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT01753063.
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Affiliation(s)
- Erinn T. Rhodes
- Division of Endocrinology, Boston Children's Hospital, Boston, MA
| | | | - Kimberly Chin
- Clinical Research Center, Boston Children's Hospital, Boston, MA
| | | | | | | | | | - Carter R. Petty
- Clinical Research Center, Boston Children's Hospital, Boston, MA
| | - Bethany Sallinen Gaffka
- Pediatric Comprehensive Weight Management Center, University of Michigan Health System, Ann Arbor, MI
| | | | | | - Jared Tucker
- Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Sarah E. Hampl
- Pediatrics and Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Hospital, Kansas City, MO
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Boles RE, Halbower AC, Daniels S, Gunnarsdottir T, Whitesell N, Johnson SL. Family Chaos and Child Functioning in Relation to Sleep Problems Among Children at Risk for Obesity. Behav Sleep Med 2017; 15:114-128. [PMID: 26745822 PMCID: PMC4938783 DOI: 10.1080/15402002.2015.1104687] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study evaluated the influence of child and family functioning on child sleep behaviors in low-income minority families who are at risk for obesity. A cross-sectional study was utilized to measure child and family functioning from 2013 to 2014. Participants were recruited from Head Start classrooms while data were collected during home visits. A convenience sample of 72 low-income Hispanic (65%) and African American (32%) families of preschool-aged children were recruited for this study. We assessed the association of child and family functioning with child sleep behaviors using a multivariate multiple linear regression model. Bootstrap mediation analyses examined the effects of family chaos between child functioning and child sleep problems. Poorer child emotional and behavioral functioning related to total sleep behavior problems. Chaos associated with bedtime resistance significantly mediated the relationship between Behavioral and Emotional Screening System (BESS) and Bedtime Resistance. Families at high risk for obesity showed children with poorer emotional and behavioral functioning were at higher risk for problematic sleep behaviors, although we found no link between obesity and child sleep. Family chaos appears to play a significant role in understanding part of these relationships. Future longitudinal studies are necessary to establish causal relationships between child and family functioning and sleep problems to further guide obesity interventions aimed at improving child sleep routines and increasing sleep duration.
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Johnson SL, Ryan SE, Kroehl ME, Boles RE, Davies P, Gavin WJ, Bellows LL. The Effects of a Preschool Intervention Aimed at Improving Young Children's Willingness to Consume Novel Foods. FASEB J 2016. [DOI: 10.1096/fasebj.30.1_supplement.1155.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Susan L Johnson
- PediatricsUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Sarah E Ryan
- Colorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Miranda E Kroehl
- Colorado School of Public Health/BiostatisticsUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Richard E Boles
- PediatricsUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Patricia Davies
- Department of Occupational TherapyColorado State UniversityFort CollinsCO
| | - William J Gavin
- Human Development and Family StudiesColorado State UniversityFort CollinsCO
| | - Laura L Bellows
- Food Science and Human NutritionColorado State UniversityFort CollinsCO
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Johnson SL, Gavin WJ, Davies P, Taylor B, Boles RE, Bellows LL. Caregivers’ Estimations of 4–7‐y‐old Children's Food Neophobia and Eating Temperament and Observations of Children's Food Refusals. FASEB J 2016. [DOI: 10.1096/fasebj.30.1_supplement.276.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Susan L Johnson
- PediatricsUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - William J Gavin
- Human Development and Family StudiesColorado State UniversityFort CollinsCO
| | - Patricia Davies
- Department of Occupational TherapyColorado State UniversityFort CollinsCO
| | - Brittany Taylor
- Human Development and Family StudiesColorado State UniversityFort CollinsCO
| | - Richard E Boles
- PediatricsUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Laura L Bellows
- Food Science and Human NutritionColorado State UniversityFort CollinsCO
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Boles RE, Yun L, Hambidge SJ, Davidson A. Influencing the Home Food and Activity Environment of Families of Preschool Children Receiving Home-Based Treatment for Obesity. Clin Pediatr (Phila) 2015; 54:1387-90. [PMID: 25676834 PMCID: PMC4534366 DOI: 10.1177/0009922815570614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Lourdes Yun
- Denver Public Health, Denver Health, Denver, CO, USA
| | - Simon J. Hambidge
- University of Colorado School of Medicine, Aurora, CO, USA,Denver Community Health Services, Denver Health, Denver, CO, USA
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Johnson SL, Davies PL, Boles RE, Gavin WJ, Bellows LL. Young Children's Food Neophobia Characteristics and Sensory Behaviors Are Related to Their Food Intake. J Nutr 2015; 145:2610-6. [PMID: 26423739 DOI: 10.3945/jn.115.217299] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/03/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Food neophobia in children has been associated with poor dietary variety and nutrient intakes. Underlying characteristics that may predispose a child to neophobia have not been widely studied. OBJECTIVE We investigated the associations between children's food neophobia, sensory sensitivity, and dietary intake in a diverse sample of typically developing preschoolers. METHODS Caregiver reports of children's food neophobia and sensory behaviors (SBs) as measured by the Food Neophobia Scale and the Sensory Profile, children's observed weight outcome [body mass index z score (BMIz)], and children's food intake as estimated from the Block Kids Food Screener were collected at baseline in the Colorado LEAP (Longitudinal Eating and Physical Activity Study) study of childhood obesity. Preschool-aged children (n = 249; 136 girls, 113 boys; aged 55.6 ± 4.7 mo; BMIz = 0.54 ± 1.14) and caregivers [n = 180; 57 Hispanic, 119 non-Hispanic white (NHW), 4 unknown] participated. Data were analyzed by Pearson correlations and multivariate hierarchical linear regression analyses. RESULTS Lower scores for children's oral sensory characteristics (i.e., more atypical) were related to higher neophobia ratings (r = -0.53, P < 0.001), and neophobia was negatively associated with reported vegetable intake (r = -0.31, P = 0.001) and dietary variety (r = -0.22, P < 0.001). Hispanic caregivers reported more atypical child SB scores (46.2 ± 8.8) than did NHW caregivers (50.5 ± 7.6; P = 0.006); however, no differences were noted for neophobia and SB scores by parent income and education or child sex. Neophobia was negatively associated with vegetable intake and dietary variety (P < 0.001 for both). SBs were associated with children's energy intake from sugar-sweetened beverages in bivariate analyses (r = -0.18, P < 0.05); however, in regression models, only ethnicity was significantly associated with energy from sugar-sweetened beverages (P < 0.001). Hispanic ethnicity was positively associated with sugar-sweetened beverage consumption (P < 0.001). CONCLUSIONS Children's neophobia and sensory sensitivity may be important in understanding underlying issues related to limited food acceptance in typically developing young children and for helping caregivers facilitate healthy dietary intake patterns for their children. This trial was registered at clinicaltrials.gov as NCT01937481.
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Affiliation(s)
- Susan L Johnson
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO; and
| | | | - Richard E Boles
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO; and
| | | | - Laura L Bellows
- Food Science and Human Nutrition, Colorado State University, Fort Collins, CO
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Bellows LL, Gavin WJ, Johnson SL, Boles RE, Davies P. Obesity Prevention Study: A Physical Activity Program Improved Gross Motor Skills in Preschool Children. Am J Occup Ther 2015. [DOI: 10.5014/ajot.2015.69s1-rp304d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 4/18/2015
A physical activity program, part of an obesity prevention study implemented by teachers in rural areas, improved the motor skills in children. This study demonstrates that programs developed by an interdisciplinary team, including occupational therapists (OTs), affected healthy outcomes in young children in underserved areas.
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Shadlow JO, Boles RE, Roberts MC, Winston L. Native American Children and Their Reports of Hope: Construct Validation of the Children's Hope Scale. J Child Fam Stud 2015; 24:1707-1714. [PMID: 26622164 PMCID: PMC4662259 DOI: 10.1007/s10826-014-9974-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Child reports of hope continue to be utilized as predictors of positive adjustment; however, the utilization of the hope construct has not been assessed within the culturally diverse Native American child group. The present study investigated the applicability of the Hope theory among 96 Native American children in the Midwest. Measures included the Children's Hope Scale and a Hope Interview. Native American children in the current sample appear to conceptualize hope as a way to reach goals as did the children in the normative sample. Results from the factor analysis demonstrate that the factor structure found in the current study was similar to the factor structure found in the standardization sample. Because of the similar Hope theory conceptualization and factor structure, interventions focused on the positive psychology construct of hope may be applicable within a Native American child population.
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Affiliation(s)
- Joanna O. Shadlow
- Department of Psychology, The University of Tulsa, Tulsa, OK 74104, USA
| | - Richard E. Boles
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael C. Roberts
- Clinical Child Psychology Program, The University of Kansas, Lawrence, KS, USA
| | - Lauren Winston
- Department of Psychology, The University of Tulsa, Tulsa, OK 74104, USA
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Yun L, Boles RE, Haemer MA, Knierim S, Dickinson LM, Mancinas H, Hambidge SJ, Davidson AJ. A randomized, home-based, childhood obesity intervention delivered by patient navigators. BMC Public Health 2015; 15:506. [PMID: 26002612 PMCID: PMC4492174 DOI: 10.1186/s12889-015-1833-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/13/2015] [Indexed: 12/31/2022] Open
Abstract
Background Although Colorado is perceived as a healthy state, in 2010, 14.1 % of children aged 2–5 were overweight and 9.1 % were obese. Despite the high prevalence of obesity in this population, evidence to support particular strategies to treat obese preschoolers is lacking. The efficacy of home-based, childhood obesity interventions to reduce a child’s body mass index is inconclusive. However, this model uniquely provides an opportunity to observe and intervene with the home food and activity environment and engage the entire family in promoting changes that fit each family’s unique dynamics. Methods/design Eligible participants are children aged 2–5 years who attended a well-child care visit at a Denver Health Community Health Service clinic within 12 months prior to recruitment and on that visit had a body mass index (BMI) >85th percentile-for-age. Participants are randomly recruited at study inception and allocated to the intervention in one of five defined 6-month stepped wedge engagements; the delayed intervention groups serves as control groups until the start of the intervention. The program is delivered by a patient navigator at the family’ home and consists of a 16-session curriculum focused on 1) parenting styles, 2) nutrition, and 3) physical activity. At each visit, a portion of curriculum is delivered to guide parents and children in selecting one goal for behavior change in each of three work areas to work on during the following week. The primary study outcome measure is change in BMI z-score from baseline to post-intervention period. Discussion This childhood obesity study, innovative for its home-based intervention venue, provides rich data characterizing barriers and facilitators to healthy behavior change within the home. The study population is innovative as it is focused on preschool-aged, Latino children from low-income families; this population has not typically been targeted in obesity management assessments. The home-based intervention is linked to clinical care through update letters and assessment of the program’s impact to the child’s medical providers. Informing primary care providers about a child’s accomplishments and challenges, allows the clinician to support the health weight effort when seeing families during subsequent clinical visits. Trial registration ClinicalTrials.gov NCT02024360 Registered December 21, 2013
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Affiliation(s)
- Lourdes Yun
- Denver Public Health, 605 Bannock Street, Denver, CO, 80204, USA.
| | - Richard E Boles
- Department of Pediatrics, University of Colorado Denver School of Medicine, 12631 East 17th Avenue, Aurora, CO, 80045, USA.
| | - Matthew A Haemer
- Department of Pediatrics, University of Colorado Denver School of Medicine, 12631 East 17th Avenue, Aurora, CO, 80045, USA.
| | - Shanna Knierim
- Denver Health Ambulatory Care Services, Department of Pediatrics, 777 Bannock Street, Denver, 80204, USA.
| | - L Miriam Dickinson
- Department of Family Medicine, University of Colorado Denver, 12631 E. 17th Avenue, Aurora, CO, 80045, USA.
| | - Heather Mancinas
- Denver Public Health, 605 Bannock Street, Denver, CO, 80204, USA.
| | - Simon J Hambidge
- Denver Health, Division of Ambulatory Care, 666 Bannock Street, Denver, 80204, USA.
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Affiliation(s)
- Richard E. Boles
- Department of Pediatrics University of Colorado Anschutz Medical
Campus
| | - Thrudur Gunnarsdottir
- Anschutz Center for Health and Wellness University of Colorado
Denver Anschutz Medical Campus Aurora, Colorado
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35
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Towner EK, Reiter-Purtill J, Boles RE, Zeller MH. Predictors of caregiver feeding practices differentiating persistently obese from persistently non-overweight adolescents. Appetite 2014; 84:120-7. [PMID: 25246031 DOI: 10.1016/j.appet.2014.08.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 07/31/2014] [Accepted: 08/11/2014] [Indexed: 11/16/2022]
Abstract
Understanding the contribution of caregiver feeding practices to adolescent diet and weight is important to refining caregiver roles within the context of adolescent obesity prevention and treatment. This secondary data analysis examined whether feeding practices of female caregivers differentiated persistently non-overweight (n = 29) from persistently obese (n = 47) adolescents. Families who previously participated in a cross-sectional study on correlates of obesity were recruited for this follow-up study. At the time of the follow-up study, anthropometric measures were taken for all female caregivers and adolescents, and caregivers completed the Child Feeding Questionnaire-Adolescent version. Socioeconomic, demographic, female caregiver anthropometric, and psychological (caregiver perceived self-weight and concern for adolescent overweight) variables were examined as predictors of feeding practices found to differentiate the two groups. Female caregivers of persistently obese adolescents reported significantly greater use of restriction and monitoring compared to female caregivers of persistently non-overweight adolescents. Restriction was predicted by female caregiver age and concern for adolescent overweight whereas monitoring was predicted by concern for adolescent overweight only. Caregiver feeding strategies may be an important target for adolescent obesity prevention and intervention efforts particularly among those with heightened concern about their teen's weight status.
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Affiliation(s)
- Elizabeth K Towner
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, 3335 Burnet Ave., MLC 3015, Cincinnati, OH 45229-3039, USA.
| | - Jennifer Reiter-Purtill
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, 3335 Burnet Ave., MLC 3015, Cincinnati, OH 45229-3039, USA
| | - Richard E Boles
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, 3335 Burnet Ave., MLC 3015, Cincinnati, OH 45229-3039, USA
| | - Meg H Zeller
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, 3335 Burnet Ave., MLC 3015, Cincinnati, OH 45229-3039, USA
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36
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Boles RE, Burdell A, Johnson SL, Gavin WJ, Davies PL, Bellows LL. Home food and activity assessment. Development and validation of an instrument for diverse families of young children. Appetite 2014; 80:23-7. [PMID: 24798760 DOI: 10.1016/j.appet.2014.04.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/20/2014] [Accepted: 04/29/2014] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to refine and psychometrically test an instrument measuring the home food and activity environment of geographically and economically diverse families of preschool aged children. Caregivers of preschool aged children (n = 83) completed a modified self-report questionnaire. Reliably trained researchers conducted independent observations on 25 randomly selected homes. Agreement statistics were conducted at the item level (154 total items) to determine reliability. Frequency counts were calculated to identify item availability. Results showed Kappa statistics were high (.67-1.00) between independent researchers but varied between researchers and parents resulting in 85 items achieving criterion validity (Kappa >.60). Analyses of reliable items revealed the presence in the home of a high frequency of unhealthy snack foods, high fat milk and low frequency of availability of fruits/vegetables and low fat milk. Fifty-two percent of the homes were arranged with a television in the preschool child's bedroom. Physical Activity devices also were found to have high frequency availability. Families reporting lower education reported higher levels of sugar sweetened beverages and less low-fat dairy (p < .05) compared with higher education families. Low-income families (<$27K per year) reported significantly fewer Physical Activity devices (p < .001) compared with higher income families. Hispanic families reported significantly higher numbers of Sedentary Devices (p < .05) compared with non-Hispanic families. There were no significant differences between demographic comparisons on available fruits/vegetables, meats, whole grains, and regular fat dairy. A modified home food and activity instrument was found to reliably identify foods and activity devices with geographically and economically diverse families.
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Affiliation(s)
- Richard E Boles
- Anschutz Medical Campus, University of Colorado Denver, Aurora, CO, USA.
| | | | - Susan L Johnson
- Anschutz Medical Campus, University of Colorado Denver, Aurora, CO, USA
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Bellows LL, Johnson SL, Davies PL, Anderson J, Gavin WJ, Boles RE. The Colorado LEAP study: rationale and design of a study to assess the short term longitudinal effectiveness of a preschool nutrition and physical activity program. BMC Public Health 2013; 13:1146. [PMID: 24321701 PMCID: PMC3867674 DOI: 10.1186/1471-2458-13-1146] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 12/04/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The preschool years are a critical window for obesity prevention efforts; representing a time when children establish healthy eating habits and physical activity patterns. Understanding the context in which these behaviors develop is critical to formulating a model to address childhood obesity. The Colorado LEAP Study, an intervention study designed to prevent early childhood obesity, utilizes a social ecological approach to explore individual, family and environmental factors and their relationship to child weight status over a 3 year timeframe. METHODS The study is located in 5 rural Colorado preschool centers and elementary schools (2 treatment and 3 control). Treatment sites receive The Food Friends nutrition (12 weeks) and physical activity (18 weeks) interventions during preschool. Observational measures assess 3 layers of the social ecological model including individual, family and organizational inputs. Children's food preferences, food intake, gross motor skills, physical activity (pedometers/accelerometers), cognitive, physical and social self-competence and height/weight are collected. Parents provide information on feeding and activity practices, child's diet, oral sensory characteristics, food neophobia, home food and activity environment, height/weight and physical activity (pedometers). School personnel complete a school environment and policy assessment. Measurements are conducted with 3 cohorts at 4 time points - baseline, post-intervention, 1- and 2-year follow-up. DISCUSSION The design of this study allows for longitudinal exploration of relationships among eating habits, physical activity patterns, and weight status within and across spheres of the social ecological model. These methods advance traditional study designs by allowing not only for interaction among spheres but predictively across time. Further, the recruitment strategy includes both boys and girls from ethnic minority populations in rural areas and will provide insights into obesity prevention effects on these at risk populations. TRIAL REGISTRATION ClinicalTrials.gov: NCT01937481.
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Affiliation(s)
- Laura L Bellows
- Colorado State University, Department of Food Science & Human Nutrition, 1571 Campus Delivery, Fort Collins, CO 80523-1571, USA
| | - Susan L Johnson
- Department of Pediatrics, Section of Nutrition, University of Colorado Denver Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Patricia L Davies
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO 80523, USA
| | - Jennifer Anderson
- Colorado State University, Department of Food Science & Human Nutrition, 1571 Campus Delivery, Fort Collins, CO 80523-1571, USA
| | - William J Gavin
- Department of Human Development & Family Studies, Colorado State University, Fort Collins, CO 80523, USA
| | - Richard E Boles
- Department of Pediatrics, Section of Nutrition, University of Colorado Denver Anschutz Medical Campus, Aurora, CO 80045, USA
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Abstract
OBJECTIVE To assess the interaction of parent and child characteristics with feeding practices and mealtime functioning. DESIGN Longitudinal, predictive study comparing baseline characteristics with follow-up assessments. PARTICIPANTS The caregivers of 52 persistently obese youth and 32 nonoverweight comparison youth completed measurements of child temperament, parental feeding practices, parenting styles, and interactions during mealtimes. RESULTS Adolescents with persistent obesity were significantly more likely to be parented using problematic feeding practices when parents also reported difficult child temperaments. Additionally, adolescents with persistent obesity and difficult temperaments were significantly more likely to have lower levels of positive mealtime interactions. CONCLUSION Persistently obese youth are at increased risk for problematic parental feeding practices and mealtime functioning, particularly when youth are described as having difficult temperaments. These results indicate that further investigations are needed to better understand the mechanisms linking parent and child characteristics with health-related behaviors for adolescents with obesity.
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Affiliation(s)
- Richard E. Boles
- School of Medicine, University of Colorado Denver, Aurora, CO, USA
| | | | - Meg H. Zeller
- College of Medicine, University of Cincinnati, OH, USA
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Brannon EE, Kuhl ES, Boles RE, Aylward BS, Ratcliff MB, Valenzuela JM, Johnson SL, Powers SW. Strategies for Recruitment and Retention of Families from Low-Income, Ethnic Minority Backgrounds in a Longitudinal Study of Caregiver Feeding and Child Weight. Child Health Care 2013; 42:198-213. [PMID: 24078763 DOI: 10.1080/02739615.2013.816590] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Children from low-SES and ethnic minority backgrounds are at heightened risk for overweight, yet are underrepresented in the pediatric obesity literature. METHODS The current paper describes strategies employed to minimize barriers to recruitment and retention of African-American families receiving WIC services in a longitudinal study examining caregiver feeding and child weight. RESULTS Seventy-six families enrolled in the study over 3.5 years, and 50% of the families completed the study. IMPLICATIONS FOR PRACTICE Despite effortful planning, unanticipated barriers likely contributed to lengthy recruitment and a modest retention rate. Future research should incorporate lessons learned to modify and develop effective strategies for increasing engagement of low-SES and ethnic minority families in research.
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Affiliation(s)
- Erin E Brannon
- Department of Psychology, Oklahoma State University, Stillwater, OK
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Boles RE, Scharf C, Filigno SS, Saelens BE, Stark LJ. Differences in home food and activity environments between obese and healthy weight families of preschool children. J Nutr Educ Behav 2013; 45:222-231. [PMID: 23380192 PMCID: PMC3640661 DOI: 10.1016/j.jneb.2012.09.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 09/21/2012] [Accepted: 09/21/2012] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To develop and test a home food and activity instrument to discriminate between the home environments of obese and healthy weight preschool children. DESIGN A modified questionnaire about home environments was tested as an observation tool. SETTING Family homes. PARTICIPANTS A total of 35 obese children with at least 1 obese caregiver were compared with 47 healthy weight children with no obese caregivers. MAIN OUTCOME MEASURES Home observation assessments were conducted to evaluate the availability of devices supporting activity behaviors and foods based on availability, accessibility, and readiness to be eaten. ANALYSIS Agreement statistics were conducted to analyze psychometrics and MANOVAs were conducted to assess group differences, significance, P < .05. RESULTS Home observations showed acceptable agreement statistics between independent coders across food and activity items. Families of obese preschoolers were significantly less likely to have fresh vegetables available or accessible in the home, were more likely to have a television in the obese child's bedroom, and had fewer physical activity devices compared with healthy weight preschoolers. CONCLUSIONS AND IMPLICATIONS Families of young children live in home environments that were discriminatively characterized based on home observations. Future tool refinement will further clarify the impact of the home environment on early growth.
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Affiliation(s)
- Richard E Boles
- Department of Pediatrics, University of Colorado Denver, Aurora, CO 80045, USA.
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41
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Affiliation(s)
| | | | | | - William Gavin
- Occupational TherapyColorado State UniversityFort CollinsCO
| | - Laura Bellows
- Food Science and Human NutritionColorado State UniversityFort CollinsCO
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Abstract
We evaluated the effects of rewarded scheduled toilet sits on non-retentive encopretic behavior of an elementary-school student receiving services for serious emotional disturbance. A multidisciplinary team implemented the 8-week intervention using a multiple baseline across settings design. The results showed an increase in sitting on the toilet and a decline in encopretic episodes in both school and home settings. These findings support the use of a behavioral intervention for children with significant behavioral disorders within a classroom setting.
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Davis AM, James RL, Boles RE, Goetz JR, Belmont J, Malone B. The use of TeleMedicine in the treatment of paediatric obesity: feasibility and acceptability. Matern Child Nutr 2011; 7:71-9. [PMID: 21108739 DOI: 10.1111/j.1740-8709.2010.00248.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To assess the feasibility of conducting empirically supported family-based paediatric obesity group treatment via TeleMedicine. Seventeen families were randomly assigned to one of two conditions (physician visit, TeleMedicine). Measures included feasibility, satisfaction and intervention outcome measures such as BMI percentile, and nutrition and activity behaviours. Measures were completed at baseline, post-treatment and at 1-year follow-up. Analyses indicate that both feasibility and satisfaction data regarding the TeleMedicine intervention were positive. Intervention outcome indicates no change in BMI percentile or nutrition and activity behaviours for either treatment group. A behavioural family-based weight loss intervention delivered via TeleMedicine was well received by both parents and providers. Due to the small sample size, null findings regarding intervention outcome should be interpreted with caution. Future research should focus on methods to increase the impact of this intervention on key outcome variables.
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Affiliation(s)
- Ann McGrath Davis
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas 66160, USA.
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Boles RE, Scharf C, Stark LJ. Developing a Treatment Program for Obesity in Preschool-Age Children: Preliminary Data. Children's Health Care 2010; 39:34. [DOI: 10.1080/02739610903455137] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Boles RE, Nelson TD, Chamberlin LA, Valenzuela JM, Sherman SN, Johnson SL, Powers SW. Confirmatory factor analysis of the Child Feeding Questionnaire among low-income African American families of preschool children. Appetite 2010; 54:402-5. [PMID: 20043964 DOI: 10.1016/j.appet.2009.12.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 12/22/2009] [Indexed: 11/25/2022]
Abstract
This study examined the factor structure for three of the Child Feeding Questionnaire (CFQ) subscales, a widely used measure of parental feeding practices, among 296 low-income parents of African American preschool children. Confirmatory factor analysis showed an overall poor fit among CFQ subscales; Restriction, Pressure to Eat, and Concern about Child Weight, (chi(2), (df=87=300.249, CFI=1.00, NNFI=1.07, RMSEA=.091). Additionally, Cronbach's Alpha coefficients for 2 of the three subscales were below acceptable recommendations (Restriction=0.69; Pressure to Eat=0.58). These results suggest further psychometric clarification is needed to understand commonly reported feeding practice constructs among low-income African American mothers of preschool aged children.
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Affiliation(s)
- Richard E Boles
- University of Colorado Denver, Department of Pediatrics, Aurora, CO 80045, USA.
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Zeller MH, Boles RE, Reiter-Purtill J. The additive and interactive effects of parenting style and temperament in obese youth seeking treatment. Int J Obes (Lond) 2008; 32:1474-80. [PMID: 18698318 DOI: 10.1038/ijo.2008.125] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine maternal parenting behaviors, child temperament and their potential interactions in families of obese children and demographically similar families of nonoverweight children. DESIGN A total of 77 obese youth (M body mass index (BMI) z-score values, zBMI=2.4; ages 8-16, 59% female, 50% African American) and their parents were recruited from a pediatric weight management clinic and compared to 69 families of nonoverweight youth (M zBMI=-0.03). Comparison youth were classmates of each obese participant matched on gender, race and age. MEASUREMENTS Maternal report of child temperament, parenting style and anthropometric assessments were obtained. RESULTS Compared to nonoverweight youth, mothers of obese youth described their child as having a more difficult temperament and their parenting style as lower in behavioral control. A logistic regression model indicated that difficult temperament, lower behavioral control and the interaction of low maternal warmth and difficult child temperament were associated with increased odds of a child being classified as obese. CONCLUSIONS Treatment-seeking obese youth and their parents are characterized by different parent and child factors when compared to nonoverweight comparison families. These findings direct investigators to test more complex models of the relation between parent and child characteristics and their mutual role in the weight-related behavior change process.
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Affiliation(s)
- M H Zeller
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
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Davis AM, Boles RE, James RL, Sullivan DK, Donnelly JE, Swirczynski DL, Goetz J. Health behaviors and weight status among urban and rural children. Rural Remote Health 2008; 8:810. [PMID: 18426334 PMCID: PMC2702202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION Pediatric overweight is currently reaching epidemic proportions but little information exists on differences in weight related behaviors between urban and rural children. OBJECTIVE To assess health behaviors and weight status among urban and rural school-age children. METHODS Fifth-grade children at two urban and two rural schools were invited to participate in an assessment study of their health behaviors and weight status. A total of 138 children (mean age = 10 years; % female = 54.6) chose to participate. RESULTS Children in rural and urban areas consumed equivalent calories per day and calories from fat, but rural children ate more junk food and urban children were more likely to skip breakfast. Urban children engaged in more metabolic equivalent tasks and had slightly higher total sedentary activity than rural children. The BMI percentile was equivalent across rural and urban children but rural children were more often overweight and urban children were more often at risk for overweight. CONCLUSIONS Although some variables were equivalent across urban and rural children, results indicate some key health behavior differences between groups. Results should be interpreted with caution as the sample size was small and there were demographic differences between urban and rural samples.
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Affiliation(s)
- Ann M Davis
- University of Kansas Medical Center, Department of Pediatrics, Kansas City, Kansas, USA.
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Abstract
OBJECTIVE To examine the effects of parenting distractions on supervising behaviors in relation to child risky behaviors. METHODS Forty preschool-aged children and their parents were randomly assigned to occupy a simulated home living room for 45 min with the parent involved in either (a) no planned distraction, (b) a telephone call distraction, (c) a TV show distraction, or (d) a computer assignment distraction. Parent and child behaviors were recorded and coded. RESULTS Parent supervising behaviors were significantly intercorrelated but revealed no relation to risky child behavior. Children showed higher risky behavior during parental distractions and steadily over time when parent distractions occurred. Additionally, younger children were more likely to engage in risky behavior when compared to older children. CONCLUSIONS Parents showed significant reductions in their ability to supervise children during distractions, limiting the ability to provide education or to take immediate action necessary to prevent or minimize possible injuries.
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Affiliation(s)
- Richard E Boles
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, MLC 3015, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
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Abstract
OBJECTIVE To examine the effects of parent viewing of their child's actual risk behavior on home safety practices. METHODS Sixty-one 4-to 7-year-old children and their caregivers participated in a three session project. Parents were exposed to one of three videos: (a) their own child with simulated home hazards, (b) a pilot child with hazards, or (c) a control child development video. Observations of home hazards as well as parent measures of supervision and vulnerability were completed pre and post-intervention. RESULTS Exposure to a video of a parent's own child playing with simulated hazards resulted in improved home safety practices. Exposure to a pilot child interacting with home hazards did not increase parent safety behaviors. No group differences in levels of vulnerability were found. CONCLUSIONS Parental attitudes are an important consideration in designing successful injury interventions. Increasing parental awareness of their child's risk to injury may be a valuable tool to change safety behaviors.
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Affiliation(s)
- Keri J Brown
- Children's Research Institute, Columbus Children's Hospital, Center for Injury Research and Policy, 700 Children's Way, Columbus, Ohio 43205, USA.
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