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Kurtzhals M, Bjerregaard AL, Hybschmann J, Müllertz ALO, DeSilva B, Elsborg P, Timm A, Petersen TL, Thygesen LC, Kurtzhals P, Flensborg-Madsen T, Bentsen P, Mygind L. A systematic review and meta-analysis of the child-level effects of family-based interventions for the prevention of type 2 diabetes mellitus. Obes Rev 2024; 25:e13742. [PMID: 38684203 DOI: 10.1111/obr.13742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/31/2024] [Accepted: 02/28/2024] [Indexed: 05/02/2024]
Abstract
AIMS The purpose of this systematic review and meta-analysis was to investigate the effects of family-based health promotion interventions on child-level risk factors for type 2 diabetes in vulnerable families. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for systematic reviews formed the methodological framework. CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science were searched on January 12, 2024. The NTP-OHAT Risk of Bias Assessment Tool was used to assess the risk of bias in the individual studies, and meta-analyses were performed. RESULTS The 4723 studies were identified, and 55 studies met the inclusion criteria. Results showed significant effects on children's body mass index (mean difference [MD], -0.18, 95% CI [-0.33 to -0.03], p = 0.02), body fat percentage (MD, -2.00, 95% CI [-3.31 to -0.69], p = 0.003), daily activity (standardized mean difference [SMD], 0.23, 95% CI [0.01; 0.44], p = 0.04), physical activity self-efficacy (SMD, 0.73, 95% CI [0.36 to 1.10], p < 0.01), intake of snacks (MD, -0.10, 95% CI [-0.17 to -0.04], p = 0.002), and sugar-sweetened beverages (SMD, -0.21, 95% CI [-0.42 to -0.01], p = 0.04). Subgroup analyses suggested that interventions aiming to change child and parent behavior simultaneously have larger effect on fasting glucose and nutrition consumption, and that interventions longer than 26 weeks have larger effects on body composition and physical activity behavior than shorter interventions.
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Affiliation(s)
- Mette Kurtzhals
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - Jane Hybschmann
- Children's Hospital Copenhagen and Juliane Marie Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Alberte Laura Oest Müllertz
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Bianca DeSilva
- School of Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Peter Elsborg
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Health Promotion Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Anne Timm
- Health Promotion Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Peter Kurtzhals
- Novo Nordisk A/S, Global Chief Medical Office, Soeborg, Denmark
| | | | - Peter Bentsen
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Geoscience and Natural Resource Management, University of Copenhagen, Frederiksberg, Denmark
| | - Lærke Mygind
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- School of Psychology, Deakin University, Geelong, Australia
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Darling JC, Rudolf MCJ, Rubino F, Greenough A. Tackling obesity while preventing obesity stigma. Arch Dis Child 2024:archdischild-2023-325894. [PMID: 38589199 DOI: 10.1136/archdischild-2023-325894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/16/2024] [Indexed: 04/10/2024]
Abstract
Obesity is a significant public health problem. Prevalence is rising in children and young people, with lifelong health impacts and implications for paediatric clinical practice. Obesity stigma is increasingly acknowledged as a problem within health services. Health professionals can inadvertently contribute to this stigma, which is harmful and in itself can promote weight gain. A complex web of factors contributes to obesity, and a simplistic approach exclusively focused on personal responsibility, diet and exercise is unhelpful. A more nuanced, sensitive and informed approach is needed, with careful use of language and non-judgemental partnership working.
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Affiliation(s)
- Jonathan C Darling
- Division of Women's and Children's Health, University of Leeds, Leeds, UK
- Paediatric Medicine, Leeds General Infirmary, Leeds, UK
| | - Mary C J Rudolf
- Department of Population Health, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Galil Elyon, Israel
| | - Francesco Rubino
- Bariatric and Metabolic Surgery, School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, UK
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Sciences, Faculty of Life Science and Medicine, King's College London, London, UK
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Bartee RT, Heelan KA, Golden CA, Hill JL, Porter GC, Abbey BA, George K, Foster N, Estabrooks PA. Adaptations of an Effective Evidence-Based Pediatric Weight Management Intervention. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:72-84. [PMID: 37477808 PMCID: PMC11133101 DOI: 10.1007/s11121-023-01557-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 07/22/2023]
Abstract
Current childhood obesity treatment programs do not address medically underserved populations or settings where all members of an interdisciplinary team may not exist-either within one organization or within the community. In this paper, we describe the use of a community-academic partnership to iteratively adapt Epstein's Traffic Light Diet (TLD), into Building Healthy Families (BHF), a community-placed evidence-based pediatric weight management intervention (PWMI) and evaluate its effectiveness in reducing BMI z scores. Nine cohorts of families completed BHF. Participants included children aged 6-12 years with obesity (M = 9.46, SD = 1.74). The Framework for Reporting Adaptations and Modifications-Expanded guided our classification of modifications across BHF cohorts. Using the FRAME reporting structure, the changes that were documented were (1) planned and occurred pre-implementation, (2) based on decisions from local stakeholders (e.g., school administrator, members of the implementation team), and (3) specific to changes in content and context-with a focus on implementation and potential for local scale-up. The nature of the adaptations included adding elements (whole of family approach), removing elements (calorie counting), and substituting elements (steps for minutes of physical activity). Across 9 cohorts, 84 families initiated the BHF program, 69 families successfully completed the 12-week program, and 45 families returned for 6-month follow-up assessments. Results indicated that the BMI z score in children was reduced by 0.31 ± 0.17 at 6 months across all cohorts. Reduction in BMI z score ranged from 0.41 in cohort 4 to 0.13 in cohort 5. Iterative adaptations to BHF were completed to improve the fit of BHF to the setting and participants and have contributed to a sustained community PWMI that adheres to the underlying principles and core elements of other evidence-based PWMIs. Monitoring adaptations and related changes to outcomes can play a role in long-term sustainability and effectiveness.
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Affiliation(s)
- R T Bartee
- Department of Biology, University of Nebraska at Kearney, Kearney, NE, USA.
| | - K A Heelan
- Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, Kearney, NE, USA
| | - C A Golden
- School of Medicine, Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - J L Hill
- School of Medicine, Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - G C Porter
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - B A Abbey
- Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, Kearney, NE, USA
| | - K George
- Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, Kearney, NE, USA
| | - N Foster
- Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - P A Estabrooks
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
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Yudkin JS, Allicock MA, Atem FD, Galeener CA, Messiah SE, Barlow SE. Efficacy of a Primary Care eHealth Obesity Treatment Pilot Intervention Developed for Vulnerable Pediatric Patients. Child Obes 2024; 20:75-86. [PMID: 36893214 PMCID: PMC11071101 DOI: 10.1089/chi.2022.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Background: Challenges to treat excess weight in primary care settings include time constraints during encounters and barriers to multiple visits for patient families, especially those from vulnerable backgrounds. Dynamo Kids! (DK), a bilingual (English/Spanish) e-health intervention, was created to address these system-level challenges. This pilot study assessed the effect of DK use on parent-reported healthy habits and child BMI. Methods: In this 3-month, quasi-experimental cohort design, DK was offered to parents with children aged 6-12 years with BMI ≥85th percentile in three public primary care sites in Dallas, Texas. DK included three educational modules, one tracking tool, recipes, and links to internet resources. Parents completed an online survey before and after 3 months. Pre-post changes in family nutrition and physical activity (FNPA) scores, clinic-measured child %BMIp95, and self-reported parent BMI were assessed using mixed-effects linear regression modeling. Results: A total of 73 families (mean child age = 9.3 years; 87% Hispanic, 12% non-Hispanic Black, and 77% Spanish-speaking families) completed the baseline survey (participants) and 46 (63%) used the DK site (users). Among users, pre-post changes (mean [standard deviation]) showed an increase in FNPA scores (3.0 [6.3], p = 0.01); decrease in child %BMIp95 (-1.03% [5.79], p = 0.22); and decrease in parent BMI (-0.69 [1.76], p = 0.04). Adjusted models showed -0.02% [95% confidence interval: -0.03 to -0.01] change in child %BMIp95 for each minute spent on the DK website. Conclusions: DK demonstrated a significant increase in parent FNPA scores and decrease in self-reported parent BMI. e-Health interventions may overcome barriers and require a lower dosage than in-person interventions.
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Affiliation(s)
- Joshua S. Yudkin
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Campus, Dallas, TX, USA
| | - Marlyn A. Allicock
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Campus, Dallas, TX, USA
| | - Folefac D. Atem
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Campus, Dallas, TX, USA
| | - Carol A. Galeener
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Campus, Dallas, TX, USA
| | - Sarah E. Messiah
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Campus, Dallas, TX, USA
- Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Campus, Dallas, TX, USA
| | - Sarah E. Barlow
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children's Health, Dallas, TX, USA
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Lydecker JA, Ozbardakci EV, Grilo CM. The children of parents who receive treatment for binge-eating disorder experience improvements in disordered eating. Int J Eat Disord 2024; 57:745-751. [PMID: 38308384 PMCID: PMC10947894 DOI: 10.1002/eat.24153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE Parental eating disorders are associated with disordered eating behaviors and psychopathology in their children, but it is not known whether parent treatment for binge-eating disorder (BED) is associated with changes in child disordered eating behaviors and weight. Benefits or the "ripple" effect of treatment on untreated family members has been described in the obesity literature but not for BED. METHOD Participants evaluated for two randomized clinical trials for BED were screened for whether they had children. 76 parents completed baseline assessments about a school-aged child; 62 were randomized to treatment, of whom 41 completed end-of-treatment assessments about their child's eating behaviors and weight (which were not targeted in the parent treatments). RESULTS Analyses revealed a significant effect of time on children's binge-eating frequency and perceived weight category and a significant effect of parent medication on perceived weight category. Parental change in binge eating was associated significantly with changes in child secretive eating and food hoarding. Parental change in weight was not associated significantly with change in age/sex-normed child BMI percentile, but had some associations with parent-perceived child weight category. CONCLUSIONS Parent changes during their treatment were associated with changes in their children. Future longitudinal research is needed to examine when disordered eating emerges and clarify critical intervention timing related to children's age and parental BED. Further clinical research is also needed to assess the effectiveness of treating disordered eating at the family level. PUBLIC SIGNIFICANCE Prior cross-sectional work has found that parents with BED are more likely to have children who engage in binge eating compared to parents without eating-disorder psychopathology. This study was an initial exploration of change in children when parents received treatment in randomized controlled trials for BED. In this study, parent changes in binge eating were associated with reduced child secretive eating and food hoarding.
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Affiliation(s)
- Janet A Lydecker
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Elise V Ozbardakci
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Curzon MM, Dick AS, Coccia C, Graziano PA. Exploring Differences in Physical Health in Young Children With and Without ADHD. J Pediatr Psychol 2024; 49:120-130. [PMID: 38078865 PMCID: PMC10874215 DOI: 10.1093/jpepsy/jsad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE To assess differences in child physical health outcomes and metrices associated with obesity in a sample of predominantly Hispanic/Latinx young children with and without attention-deficit/hyperactivity disorder (ADHD). METHODS Participants included 127 children diagnosed with ADHD and 96 typically developing (TD) children between 4 and 7 years of age. Objective measures of children's body composition, fitness, and physical activity were conducted. Parents of children completed food recalls to assess their child's dietary intake, diet quality was calculated based on the Healthy Eating Index-2015, and parents completed a survey about their family's health habits. RESULTS Logistic regression revealed that those with ADHD were more likely to be classified as having an overweight or obese (Ov/O) body mass index (BMI). Linear regression analyses indicated that children with ADHD performed worse on a fitness test and consumed more calories relative to TD children. Moderation analyses indicated that sex differences in steps were prominent in our TD sample, but not among those with ADHD. CONCLUSIONS Young children with ADHD are at greater risk for having an Ov/O BMI, being less fit, and eating a greater intake of calories compared to TD children.
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Affiliation(s)
- Madeline M Curzon
- Department of Psychology, Center for Children and Families, Florida International University, USA
| | - Anthony S Dick
- Department of Psychology, Center for Children and Families, Florida International University, USA
| | - Catherine Coccia
- Department of Psychology, Center for Children and Families, Florida International University, USA
| | - Paulo A Graziano
- Department of Psychology, Center for Children and Families, Florida International University, USA
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Stea TH, Vettore MV, Øvrebø B, Abildsnes E. Changes in dietary habits and BMI z-score after a 6-month non-randomized cluster-controlled trial among 6-12 years old overweight and obese Norwegian children. Food Nutr Res 2023; 67:9617. [PMID: 38187797 PMCID: PMC10770647 DOI: 10.29219/fnr.v67.9617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 01/09/2024] Open
Abstract
Background Effective prevention programs to address the high prevalence of childhood overweight and obesity and the concomitant health consequences have been warranted. Objective To improve dietary habits and weight status among Norwegian children with overweight/obesity in the primary care setting. Design A 6-month non-randomized cluster-controlled intervention among 137 children, aged 6-12 years, with overweight/obesity and their parents. Intervention and control groups were recruited by public health nurses and followed-up by 12 Healthy Life Centers across Norway. The intervention group received individual family counseling and participated in nutrition courses and physical activity groups. A frequency questionnaire assessing sociodemographic characteristics and dietary habits was completed by the parents. Trained public health nurses measured height and weight using standardized methods to calculate body mass index (BMI) and BMI z-scores. Results The intervention resulted in an increased odds of consuming evening meals (OR: 3.42), a decreased availability of salty snacks (β = -0.17), a decreased intake of salty snacks (-0.18), an increased consumption of water (β = 0.20), and a decreased estimated total intake of energy (β = -0.17), carbohydrates (β = -0.17), mono- and disaccharides (β = -0.21), sucrose (β = -0.24), and saturated fatty acids (β = -0.17). The intervention directly predicted lower BMI z-score (β = -0.17), and post-treatment levels of energy (β = -0.65), saturated fat (β = 0.43), and total carbohydrates (β = 0.41) were directly linked to BMI z-score after intervention. Age and sex were indirectly associated with BMI after intervention through energy and saturated fat intake. Conclusions The intervention had a beneficial impact on nutrient intake and weight status among children with overweight/obesity. These findings provide support for implementing complex intervention programs tailored to local primary care settings. Trial registration Clinicaltrials.gov, NCT02290171. Registered 13. November 2014, https://clinicaltrials.gov/ct2/show/NCT02290171.
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Affiliation(s)
- Tonje Holte Stea
- Department of Health and Nursing Science, University of Agder, Kristiansand, Norway
| | - Mario Vianna Vettore
- Department of Health and Nursing Science, University of Agder, Kristiansand, Norway
| | - Bente Øvrebø
- Department of Health and Inequalities, Norwegian Institute of Public Health, Oslo, Norway
| | - Eirik Abildsnes
- Department of Psychosocial Health, University of Agder, Grimstad, Norway
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Jones AR, Mann KD, Cutler LR, Pearce MS, Tovée MJ, Ells LJ, Araujo-Soares V, Arnott B, Harris JM, Adamson AJ. A Randomised Control Trial Investigating the Efficacy of the MapMe Intervention on Parental Ability to Correctly Categorise Overweight in Their Child and the Impact on Child BMI Z-Score Change at 1 Year. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1577. [PMID: 37761538 PMCID: PMC10528244 DOI: 10.3390/children10091577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
Research suggests parental ability to recognise when their child has overweight is limited. It is hypothesised that recognition of child overweight/obesity is fundamental to its prevention, acting as a potential barrier to parental action to improve their child's health-related behaviours and/or help seeking. The purpose of this study was to investigate the efficacy of an intervention (MapMe) to improve parental ability to correctly categorise their child as having overweight one-month post-intervention, and reduce child body mass index (BMI) z-score 12 months post-intervention. MapMe consists of body image scales of known child BMI and information on the consequences of childhood overweight, associated health-related behaviours and sources of support. We conducted a three-arm (paper-based MapMe, web-based MapMe and control) randomised control trial in fifteen English local authority areas with parents/guardians of 4-5- and 10-11-year-old children. Parental categorisation of child weight status was assessed using the question 'How would you describe your child's weight at the moment?' Response options were: underweight, healthy weight, overweight, and very overweight. Child weight status and BMI z-scores were calculated using objectively measured height and weight data and UK90 clinical thresholds. There was no difference in the percentage of parents correctly categorising their child as having overweight/very overweight (n = 264: 41% control, 48% web-based, and 43% paper-based, p = 0.646). BMI z-scores were significantly reduced for the intervention group at 12 months post-intervention compared to controls (n = 338, mean difference in BMI z-score change -0.11 (95% CI -0.202 to -0.020, p = 0.017). MapMe was associated with a decrease in BMI z-score 12 months post-intervention, although there was no direct evidence of improved parental ability to correctly categorise child overweight status. Further work is needed to replicate these findings in a larger sample of children, investigate mechanisms of action, and determine the use of MapMe as a public health initiative.
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Affiliation(s)
- Angela R. Jones
- Population Health Sciences Institute, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK (M.S.P.); (B.A.); (A.J.A.)
- Human Nutrition and Exercise Research Centre, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK
| | - Kay D. Mann
- Health Capital Division, Queensland Health, 33 Charlotte Street, Brisbane, QLD 4000, Australia;
| | - Laura R. Cutler
- Population Health Sciences Institute, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK (M.S.P.); (B.A.); (A.J.A.)
- Human Nutrition and Exercise Research Centre, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK
| | - Mark S. Pearce
- Population Health Sciences Institute, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK (M.S.P.); (B.A.); (A.J.A.)
| | - Martin J. Tovée
- Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK;
| | - Louisa J. Ells
- School of Clinical & Applied Sciences, Leeds Beckett University, Leeds LS1 3HE, UK;
| | - Vera Araujo-Soares
- Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, D-68167 Mannheim, Germany;
| | - Bronia Arnott
- Population Health Sciences Institute, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK (M.S.P.); (B.A.); (A.J.A.)
| | - Julie M. Harris
- School of Psychology and Neuroscience, University of St Andrews, St Andrews KY16 9TS, UK;
| | - Ashley J. Adamson
- Population Health Sciences Institute, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK (M.S.P.); (B.A.); (A.J.A.)
- Human Nutrition and Exercise Research Centre, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK
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Ma X, Li W, Rukavina PB. Challenges encountered by parents from urban, lower social economic class in changing lifestyle behaviors of their children who are overweight or obese. BMC Pediatr 2023; 23:457. [PMID: 37700221 PMCID: PMC10496151 DOI: 10.1186/s12887-023-04295-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 09/06/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Parents from urban, lower social economic classes often encounter unique challenges in their lives, which shape how they work with their children who are overweight or obese to change their exercise and eating behaviors at home. The present study took an initial step to address a gap in the literature by describing the challenges that parents from lower social economic classes in an urban city encountered in changing exercise and eating behaviors of their children who are overweight or obese. METHODS A conversational style semi-structured interview with prompts and probes was conducted to 44 parents whose child is overweight or obese. Inductive content analysis and constant comparison was used to analyze the data. Data trustworthiness was established by using a variety of strategies. RESULTS Two major themes with eight sub-themes emerged from the data: Challenges to promote a healthy active lifestyle, and challenges from their child's development and lifestyle behavior. Eight sub-themes were: (1) Need for effective strategies for a lifestyle behavior change, (2) monitor and promote healthy choices, (3) money, time, and dangerous neighborhood, (4) scientific knowledge to promote a healthy active lifestyle, (5) developmental changes of adolescence, (6) unmotivated and lack of persistence, (7) sneaking eating, and (8) peer pressure. CONCLUSION The challenges, from economic to parenting, are certainly of importance, and understanding these challenges will be crucial to help school-based professionals develop interventions. Those identified challenges should be clearly placed within family-school collaboration practices.
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Affiliation(s)
- Xiao Ma
- Institute of Sport Sciences, Shanghai University of Sport, Changhai Road 399, Shanghai, 200438, P.R. China
| | - Weidong Li
- College of Education & Human Ecology, Department of Human Sciences, The Ohio State University, PAES Building A270 305 Annie and John Glenn Avenue, Columbus, OH, 43210-1224, USA.
| | - Paul B Rukavina
- Adelphi University, Woodruff hall, 1 South Avenue, Garden City, NY, USA
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Welch SB, Honegger K, O'Brien M, Capan S, Kwon S. Examination of physical activity development in early childhood: protocol for a longitudinal cohort study of mother-toddler dyads. BMC Pediatr 2023; 23:129. [PMID: 36941567 PMCID: PMC10026417 DOI: 10.1186/s12887-023-03910-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/15/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Physical activity (PA) development in toddlers (age 1 and 2 years) is not well understood, partly because of a lack of analytic tools for accelerometer-based data processing that can accurately evaluate PA among toddlers. This has led to a knowledge gap regarding how parenting practices around PA, mothers' PA level, mothers' parenting stress, and child developmental and behavioral problems influence PA development in early childhood. METHODS The Child and Mother Physical Activity Study is a longitudinal study to observe PA development in toddlerhood and examine the influence of personal and parental characteristics on PA development. The study is designed to refine and validate an accelerometer-based machine learning algorithm for toddler activity recognition (Aim 1), apply the algorithm to compare the trajectories of toddler PA levels in males and females age 1-3 years (Aim 2), and explore the association between gross motor development and PA development in toddlerhood, as well as how parenting practices around PA, mothers' PA, mothers' parenting stress, and child developmental and behavioral problems are associated with toddlerhood PA development (Exploratory Aims 3a-c). DISCUSSION This study will be one of the first to use longitudinal data to validate a machine learning activity recognition algorithm and apply the algorithm to quantify free-living ambulatory movement in toddlers. The study findings will help fill a significant methodological gap in toddler PA measurement and expand the body of knowledge on the factors influencing early childhood PA development.
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Affiliation(s)
- Sarah B Welch
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Arthur J. Rubloff Building, 420 E. Superior St, IL, 60611, Chicago, USA.
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA.
| | - Kyle Honegger
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - Megan O'Brien
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA
| | - Selin Capan
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Arthur J. Rubloff Building, 420 E. Superior St, IL, 60611, Chicago, USA
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Soyang Kwon
- Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, USA
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Vilasboas T, Le Q, Greaney ML, Lindsay AC. Brazilian Immigrant Parents' Preferences for Content and Intervention Modalities for the Design of a Family-Based Intervention to Promote Their Preschool-Age Children's Healthful Energy Balance-Related Behaviors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4817. [PMID: 36981726 PMCID: PMC10048827 DOI: 10.3390/ijerph20064817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Brazilians are a rapidly growing ethnic immigrant population in the United States (U.S.), and there is a lack of childhood obesity prevention interventions addressing the needs of Brazilian preschool-age children. Using the family ecological model (FEM) as a guide, this developmental cross-sectional study assessed the preferences (content, intervention modality, and language) of 52 individual Brazilian immigrant parents (27 mothers, 25 fathers) for a family-based intervention to promote healthful energy balance-related behaviors (EBRB). Overall, 85% or more of parents reported being interested or very interested in content related to five of the seven assessed EBRBs (increasing fruits and vegetables, reducing unhealthy foods and sugar-sweetened beverages, increasing physical activity, and reducing screen time). Parent-preferred intervention modalities were group sessions delivered by community health workers (CHWs, 86.5%), email (84.6%), and messaging (78.8%), with most parents (71.2%) indicating a preference for content in Portuguese. Interventions integrating multiple components, such as group sessions offered by CHWs and text messaging using SMS and WhatsApp, should be considered. Future steps for intervention development should include investigating different communication channels and their integration into a culturally and linguistically tailored family-based intervention designed to promote healthful EBRBs of preschool-age children in Brazilian families living in the U.S.
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Affiliation(s)
- Thaís Vilasboas
- Department of Biology, College of Science and Mathematics, University of Massachusetts Boston, Boston, MA 02125, USA
| | - Qun Le
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts—Lowell, Lowell, MA 01854, USA
| | - Mary L. Greaney
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA
| | - Ana Cristina Lindsay
- Department of Exercise and Health Sciences, Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA
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12
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Buro AW, Gray HL, Ruble K, Soca Lozano S, Sauls R, Albizu-Jacob A, Crowder SL, Mazzeo SE, Stern M. Challenges and adaptations for a cluster-randomized control trial targeting parents of pediatric cancer survivors with obesity during the COVID-19 pandemic. Transl Behav Med 2023; 13:98-103. [PMID: 36327379 PMCID: PMC9972348 DOI: 10.1093/tbm/ibac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Although the COVID-19 pandemic has increased the importance of digital technology in clinical trial implementation, there is a dearth of literature reporting on challenges and strategies related to multi-site randomized controlled trials (RCTs) among pediatric cancer survivors during the pandemic. This paper discusses challenges faced in the implementation of the NOURISH-T+ trial so far (December 2019-March 2022) and describes adaptations made as a result of these disruptions in the areas of recruitment, data collection, and overall engagement. This reflection is based on a multisite cluster-RCT that aims to examine whether an intervention targeting parents as agents of change to promote healthy eating and physical activity in pediatric cancer survivors, NOURISH-T+ (Nourishing Our Understanding of Role modeling to Improve Support and Health for Healthy Transitions), reduces body mass and improves health behaviors compared to Brief NOURISH-T (Enhanced Usual Care/EUC). The COVID-19 pandemic has created and exacerbated challenges for our trial related to participant recruitment and engagement, technology access and literacy, and data collection and management, as well as COVID-related challenges (e.g., Zoom fatigue). Strategies used to address these challenges might prove helpful in future virtual or hybrid RCTs, including developing trust and rapport with participants, providing support through multiple routes of dissemination, and using data management applications (e.g., REDCap™) for automation and project management. Extra efforts to build families' trust and rapport, offering multiple routes of support, and automating as many tasks as possible are critical to ensuring the continuation of high-quality clinical trials during the COVID-19 pandemic.
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Affiliation(s)
- Acadia W Buro
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Heewon L Gray
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Kathy Ruble
- Division of Pediatric Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Rachel Sauls
- Department of Psychology, College of Arts and Sciences, University of South Florida, Tampa, FL, USA
| | - Alexandra Albizu-Jacob
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
| | - Sylvia L Crowder
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Suzanne E Mazzeo
- Departments of Psychology and Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
| | - Marilyn Stern
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
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13
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Latomme J, Morgan PJ, Chastin S, Brondeel R, Cardon G. Effects of a family-based lifestyle intervention on co-physical activity and other health-related outcomes of fathers and their children: the 'Run Daddy Run' intervention. BMC Public Health 2023; 23:342. [PMID: 36793044 PMCID: PMC9930712 DOI: 10.1186/s12889-023-15191-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/02/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Fathers are important in establishing healthy behaviors in their children, but are rarely engaged in lifestyle programs. Focusing on physical activity (PA) of both fathers and their children by engaging them together in PA (i.e. "co-PA") is therefore a promising novel strategy for interventions. The study aim was to investigate the effect of the 'Run Daddy Run' on co-PA and PA of fathers and their children, and secondary outcomes such as weight status and sedentary behaviour (SB). METHODS This study is a non-randomized controlled trial (nRCT), including 98 fathers and one of their 6 to 8 years old children (intervention = 35, control = 63). The intervention was implemented over a 14-week period, and consisted of six (inter)active father-child sessions and an online component. Due to COVID-19, only 2/6 sessions could be implemented as planned, the remaining sessions were delivered online. In November 2019-January 2020 pre-test measurements took place, and post-test measurements in June 2020. Additional follow-up test was conducted in November 2020. PA (i.e. LPA, MPA, VPA and volume) of fathers and children were objectively measured using accelerometry, co-PA and the secondary outcomes were questioned using an online questionnaire. RESULTS Significant intervention effects were found for co-PA (+ 24 min./day in the intervention compared to the control group, p = 0.002), and MPA of the father (+ 17 min./day, p = 0.035). For children, a significant increase in LPA (+ 35 min./day, p < 0.001) was found. However, an inverse intervention effect was found for their MPA and VPA (-15 min./day, p = 0.005 and - 4 min./day, p = 0.002, respectively). Also decreases in fathers' and children's SB were found (-39 min./day, p = 0.022 and - 40 min./day, p = 0.003, respectively), but no changes in weight status, the father-child relationship, and the PA-family health climate (all p > 0.05). CONCLUSION The Run Daddy Run intervention was able to improve co-PA, MPA of fathers and LPA of children, and decreasing their SB. Inverse intervention effects were however found for MPA and VPA of children. These results are unique given their magnitude and clinical relevance. Targeting fathers together with their children might be a novel and potential intervention strategy to improve overall physical activity levels, however, further efforts should however be made to target children's MPA and VPA. Last, replicating these findings in a randomized controlled trial (RCT) is recommended for future research. TRIAL REGISTRATION NUMBER This study is registered as a clinical trial (clinicaltrials.gov, ID number: NCT04590755, date: 19/10/2020).
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Affiliation(s)
- Julie Latomme
- Department of Movement and Sports Sciences, Ghent University, 9000, Ghent, Belgium.
| | - Philip J. Morgan
- grid.266842.c0000 0000 8831 109XPRCPAN (Priority Research Centre for Physical Activity and Nutrition), School of Education, University of Newcastle, 2308 Newcastle, Australia
| | - Sebastien Chastin
- grid.5214.20000 0001 0669 8188Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Scotland, UK
| | - Ruben Brondeel
- grid.5342.00000 0001 2069 7798Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium
| | - Greet Cardon
- grid.5342.00000 0001 2069 7798Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium
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14
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Yang HM, Choo J. Effects of a parent-led childhood obesity management program for socioeconomically vulnerable families: A randomised controlled trial. Collegian 2023. [DOI: 10.1016/j.colegn.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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15
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Gago C, Aftosmes-Tobio A, Beckerman-Hsu JP, Oddleifson C, Garcia EA, Lansburg K, Figueroa R, Yu X, Kitos N, Torrico M, Leonard J, Jurkowski JK, Mattei J, Kenney EL, Haneuse S, Davison KK. Evaluation of a cluster-randomized controlled trial: Communities for Healthy Living, family-centered obesity prevention program for Head Start parents and children. Int J Behav Nutr Phys Act 2023; 20:4. [PMID: 36631869 PMCID: PMC9832428 DOI: 10.1186/s12966-022-01400-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/08/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND This study reports the outcomes of Communities for Healthy Living (CHL), a cluster randomized obesity prevention trial implemented in partnership with Head Start, a federally-funded preschool program for low-income families. METHODS Using a stepped wedge design, Head Start programs (n = 16; Boston, MA, USA) were randomly assigned to one of three intervention start times. CHL involved a media campaign and enhanced nutrition support. Parents were invited to join Parents Connect for Healthy Living (PConnect), a 10-week wellness program. At the beginning and end of each school year (2017-2019), data were collected on the primary outcome of child Body Mass Index z-score (BMIz) and modified BMIz, and secondary outcomes of child weight-related behaviors (diet, physical activity, sleep, media use) and parents' weight-related parenting practices and empowerment. Data from 2 years, rather than three, were utilized to evaluate CHL due to the COVID-19 pandemic. We used mixed effects linear regression to compare relative differences during intervention vs. control periods (n = 1274 vs. 2476 children) in (1) mean change in child BMIz and modified BMIz, (2) the odds of meeting child health behavior recommendations, (3) mean change in parenting practices, and (4) mean change in parent empowerment. We also compared outcomes among parents who chose post-randomization to participate in PConnect vs. not (n = 55 vs. 443). RESULTS During intervention periods (vs. control), children experienced greater increases in BMIz and modified BMIz (b = 0.06, 95% CI = 0.02,0.10; b = 0.07, 95% CI = 0.03, 0.12), yet were more likely to meet recommendations related to three of eight measured behaviors: sugar-sweetened beverage consumption (i.e., rarely consume; Odds Ratio (OR) = 1.5, 95% CI = 1.2,2.3), water consumption (i.e., multiple times per day; OR = 1.6, 95% CI = 1.2,2.3), and screen time (i.e., ≤1 hour/day; OR = 1.4, 95% CI = 1.0,1.8). No statistically significant differences for intervention (vs. control) periods were observed in parent empowerment or parenting practices. However, parents who enrolled in PConnect (vs. not) demonstrated greater increases in empowerment (b = 0.17, 95% CI = 0.04,0.31). CONCLUSIONS Interventions that emphasize parent engagement may increase parental empowerment. Intervention exposure was associated with statistically, but not clinically, significant increases in BMIz and increased odds of meeting recommendations for three child behaviors; premature trial suspension may explain mixed results. TRIAL REGISTRATION ClinicalTrials.gov, NCT03334669 , Registered October 2017.
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Affiliation(s)
- Cristina Gago
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Alyssa Aftosmes-Tobio
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA
| | - Jacob P Beckerman-Hsu
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA
| | - Carly Oddleifson
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA
| | - Evelin A Garcia
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Kindra Lansburg
- Action for Boston Community Development (ABCD), Boston, MA, 02111, USA
| | - Roger Figueroa
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, 14853, USA
| | - Xinting Yu
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA
| | - Nicole Kitos
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Merieka Torrico
- Action for Boston Community Development (ABCD), Boston, MA, 02111, USA
| | - Jessie Leonard
- Community Action Agency of Somerville (CAAS), Somerville, MA, 02143, USA
| | - Janine K Jurkowski
- Department of Health Policy, Management, and Behavior, State University of New York, Albany, NY, 12222, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Erica L Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Kirsten K Davison
- School of Social Work, Boston College, 140 Commonwealth Ave, 115 McGuinn Hall, Chestnut Hill, MA, 02467, USA.
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16
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Pellegrino A, Bacci S, Guido F, Zoppi A, Toncelli L, Stefani L, Boddi M, Modesti A, Modesti PA. Interaction between Geographical Areas and Family Environment of Dietary Habits, Physical Activity, Nutritional Knowledge and Obesity of Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1157. [PMID: 36673912 PMCID: PMC9859590 DOI: 10.3390/ijerph20021157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
There are marked differences in the regional distribution of childhood obesity in Italy. This study sought to investigate the interaction between geographical areas and family environment of dietary habits, physical activity, nutritional knowledge and obesity of adolescents. A cross-sectional study was conducted on 426 school-aged children and 298 parents residing in Central Italy (Florence, Tuscany) and Southern Italy (Corigliano, Calabria), in 2021. Survey questionnaire investigated anthropometry, eating behavior, nutritional knowledge and physical activity. BMI was determined and compared with reference percentile charts for adolescents. Multivariate regression analyses showed that: (1) an adolescent's BMI was directly influenced by their parents' BMI independently of parental nutritional knowledge and dietary or physical activity habits; (2) parents transmitted eating or physical activity habits to their children; (3) the geographic region of residence is not in itself an independent determinant of children's BMI. The clear message is that prevention of childhood obesity should consider family-based approaches. Parental obesity can be the point of convergence of the complex interactions between a parent's and child's habits and should be one of the most important factors to look for.
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Affiliation(s)
- Alessio Pellegrino
- Sport Medicine Unit, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Samuele Bacci
- Sport Medicine Unit, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Francesco Guido
- Sport Medicine Unit, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Andrea Zoppi
- Sport Medicine Unit, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Loira Toncelli
- Sport Medicine Unit, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Laura Stefani
- Sport Medicine Unit, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Maria Boddi
- Sport Medicine Unit, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Alessandra Modesti
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence, 50134 Florence, Italy
| | - Pietro Amedeo Modesti
- Sport Medicine Unit, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
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17
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Patel D, Krems JA, Stout ME, Byrd-Craven J, Hawkins MAW. Parents of Children With High Weight Are Viewed as Responsible for Child Weight and Thus Stigmatized. Psychol Sci 2023; 34:35-46. [PMID: 36318753 DOI: 10.1177/09567976221124951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Courts in seven U.S. states have removed children with "obesity" from parental custody until children could maintain "healthy weights." These rulings-alongside qualitative reports from parents of children with high weight (PoCHs)-suggest that PoCHs are judged as bad parents. Yet little work has tested whether people genuinely stigmatize PoCHs or what drives this phenomenon. In three experiments with U.S. online community participants (N = 1,011; two preregistered), we tested an attribution theory model: Social perceivers attribute children's weights to parents and thus stigmatize those parents. Experiments 1 and 2 support this model (across parent and child gender). Experiment 3 manipulated attributions of parental responsibility for child weight, revealing attenuated stigma with low attributions of responsibility. Findings are among the first to describe and explain stigma toward a large demographic (parents of children with obesity)-with real-world implications (e.g., for family separation, health care)-and may additionally illuminate the psychology underlying stigma toward parents of children with other potentially stigma-evoking identities.
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Affiliation(s)
- Devanshi Patel
- The Oklahoma Center for Evolutionary Analysis, Department of Psychology, Oklahoma State University.,Department of Psychology, Oklahoma State University
| | - Jaimie Arona Krems
- The Oklahoma Center for Evolutionary Analysis, Department of Psychology, Oklahoma State University.,Department of Psychology, Oklahoma State University
| | | | - Jennifer Byrd-Craven
- The Oklahoma Center for Evolutionary Analysis, Department of Psychology, Oklahoma State University.,Department of Psychology, Oklahoma State University
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18
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Examination of dietary intake of UK preschool children by varying carers: evidence from the 2008-2016 UK National Diet and Nutrition Survey. Br J Nutr 2022; 128:2063-2074. [PMID: 34842127 DOI: 10.1017/s0007114521004712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Early years caregivers can play a key role in young children's eating and the prevention of childhood obesity. The UK National Diet and Nutrition Survey (NDNS) is a large representative survey collecting detailed food and nutrition consumption data. Using these data, the aim of this study was to investigate the relationship between dietary intake of preschool children in the UK aged 2 to 4 years and accompanying adult/s. Nutrition consumption data from 1218 preschool children from years 1 to 8 of the 2008-2016 NDNS were accessed. Dietary data were captured using 3 or 4 day estimated food diaries. Regression analyses revealed significant differences in consumption when children were not accompanied by their parents. Compared with when children were with parents, children consumed significantly more energy dense meals (0·32 kJ/g, 95% CI 0·1-0·6 kJ/g), energy (62 kJ/g, (95% CI 27-97 kJ)) Na (19 mg, (95 % CI 6, 32)), added sugars (0·6 g, (95 % CI 0·1, 1·1)), vegetables (3 g, (95 % CI 1, 4)), total grams (12 g, (95 % CI 3, 21)) and saturated fat (0·2 g, (95 % CI 0·1, 0·4)) per eating occasion when accompanied by wider family. When children were accompanied by a formal childcare provider, they consumed significantly lower energy dense meals (-0·9 kJ/g, (95% CI -1·4 - -0·3 kJ/g)), less added sugars (-1·6 g, (95 % CI -2·4, -0·8)) and more fruit (12 g, (95 % CI 3, 21)) per eating occasion than when they were with their parents. The results demonstrate that non-parental caregivers might be an important target to promote healthy eating in young children. Further research is needed to establish which caregivers would benefit most.
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19
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Grimshaw SL, Taylor NF, Conyers R, Shields N. Promoting positive physical activity behaviors for children and adolescents undergoing acute cancer treatment: Development of the CanMOVE intervention using the Behavior Change Wheel. Front Pediatr 2022; 10:980890. [PMID: 36313891 PMCID: PMC9607881 DOI: 10.3389/fped.2022.980890] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background Increasing participation in physical activity has the potential to improve outcomes for children and adolescents with cancer during treatment and into survivorship. The aim of this study is to outline the theoretical process behind development of CanMOVE, a behavior change intervention designed to increase physical activity for children and adolescents with cancer. Study design This study followed a theoretical design process consistent with the Behavior Change Wheel to inform the design of a complex intervention. Materials and methods The three stages of the Behavior Change Wheel intervention design process include: (1) understanding physical activity behavior within the pediatric cancer setting, (2) identifying potential intervention functions, and (3) identifying appropriate behavior change and implementation strategies. Qualitative and behavior change literature relevant to the pediatric cancer treatment setting were used to inform each stage. Results An individualized and flexible approach to physical activity promotion that considers intrinsic factors specific to the child/adolescent and their environment is required. Fifteen behavioral change strategies were identified to form the intervention components of CanMOVE. Implementation strategies were identified to build motivation, opportunity and capacity toward increasing physical activity behaviors. Key intervention components of CanMOVE include standardized assessment and monitoring (physical activity, physical function, and health-related quality of life), provision of an activity monitor to both child/adolescent and parent, and one-on-one capacity building sessions with a healthcare professional. Capacity building sessions include education, goal setting, an active supervised physical activity session, barrier identification and problem solving, and action planning. Conclusion CanMOVE is a novel approach to physical activity promotion in the pediatric cancer treatment setting. The use of a theoretical intervention design process will aid evaluation and replication of CanMOVE when it is assessed for feasibility in a clinical setting. The design process utilized here can be used as a guide for future intervention development.
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Affiliation(s)
- Sarah L. Grimshaw
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
| | - Nicholas F. Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Rachel Conyers
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
| | - Nora Shields
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
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20
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Rezapour M, Ferraro FR, Alsubaiei S. Behavioral and emotional adaptations of obese and underweight students in response to the COVID-19 pandemic. HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS 2022; 9:326. [PMID: 36164459 PMCID: PMC9491673 DOI: 10.1057/s41599-022-01334-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 09/02/2022] [Indexed: 06/06/2023]
Abstract
Previous studies have investigated the effects of COVID-19 on the general population of college students. However, research evaluating the complex behavioral and psychological impact of the pandemic on both obese and underweight students is currently limited. We used data from a survey conducted from March to April 2020 across 2534 students enrolled in seven US universities. We examined whether the associations between taking various behaviors and being obese and underweight students are unidimensional, or varies based on various negative emotions, and their sociodemographic characteristics. Also, we checked whether emotions of obese and underweight groups are impaired, which consequently might impact taking various cautionary behaviors. The results highlight complex relationships between being obese and underweight students and other considered variables. For instance, despite the associated risk, it was found that obese students are associated with less fear, guilt and irritability due to the pandemic. However, those associations vary based on factors such as level of educations. In addition, while obese students are less likely to avoid a large group of people, the impact changes based on gender. Lack of precautions and emotions is despite the increased risk of hospitalization and death associated with obese and underweight groups. Finally, it was found that there are negative and stable associations between higher social class, income, and the lower likelihood of being obese or underweight. Significant differences and similarities were also found across factors to obese and underweight students.
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Affiliation(s)
| | - F. Richard Ferraro
- Department of Psychology, University of North Dakota, Grand Forks, ND 58201 USA
| | - Sabrina Alsubaiei
- Department of Psychology, University of North Dakota, Grand Forks, ND 58201 USA
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21
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Lee KM, Arriola-Sanchez L, Lumeng JC, Gearhardt A, Tomiyama AJ. Weight Stigma by Association Among Parents of Children With Obesity: A Randomized Trial. Acad Pediatr 2022; 22:754-760. [PMID: 34610460 DOI: 10.1016/j.acap.2021.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/22/2021] [Accepted: 09/25/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To experimentally test weight stigma and weight stigma by association in a parent-child relationship using a large, community-based sample. METHODS We conducted a randomized experiment on Amazon Mechanical Turk using an online survey. Participants were randomly assigned to view a picture of a parent-child dyad, for which the parent and child's gender (male vs. female) and weight status (with obesity vs. without obesity) were manipulated. Participants read identical parenting descriptions that adhered to the American Academy of Pediatrics' parenting recommendations, then rated the parent's perceived effectiveness, helpfulness, and level of caring using a parenting questionnaire based on Barnhart et al (2013). RESULTS Participants (N = 1862; Mage = 36.8 [11.2] years) rated parents of children with obesity as less effective compared to parents of children without obesity (P = .010) and parents with obesity as less effective compared to parents without obesity (P = .033). Participants also rated parents with obesity as less helpful compared to parents without obesity (P = .021). No differences emerged in perceived caring. Parenting evaluations did not differ across daughters versus sons or mothers versus fathers. CONCLUSIONS Parents of children with obesity may experience weight stigma by association, which could have direct consequences for the parents, the children, and the parent-child relationship.
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Affiliation(s)
- Kristen M Lee
- Department of Psychology, University of California, Los Angeles (KM Lee, L Arriola-Sanchez, and AJ Tomiyama)
| | - Lauren Arriola-Sanchez
- Department of Psychology, University of California, Los Angeles (KM Lee, L Arriola-Sanchez, and AJ Tomiyama)
| | - Julie C Lumeng
- Department of Pediatrics, Medical School, and Department of Nutritional Sciences, School of Public Health, University of Michigan (JC Lumeng), Ann Arbor, Mich
| | - Ashley Gearhardt
- Department of Psychology, University of Michigan (A Gearhardt), Ann Arbor, Mich
| | - A Janet Tomiyama
- Department of Psychology, University of California, Los Angeles (KM Lee, L Arriola-Sanchez, and AJ Tomiyama).
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22
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Golden CA, Heelan KA, Hill JL, Bartee RT, Abbey BM, Estabrooks PA. Qualitative Comparative Analysis of Program and Participant Factors That Explain Success in a Micropolitan Pediatric Weight Management Intervention. Child Obes 2022; 18:324-332. [PMID: 34780274 DOI: 10.1089/chi.2021.0160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Building Healthy Families (BHF) was developed through a community-academic partnership to provide a 12-week family-based obesity treatment program. Nine cohorts of BHF have been delivered in multiple micropolitan settings between 2009 and 2016, but participant outcomes have varied. This study sought to explore the variation in BHF outcomes to identify the necessary and sufficient conditions that are associated with larger 12-week reductions in BMI z-scores. Methods: A qualitative comparative analysis was used to determine potential causal conditions or combination of conditions associated with larger reductions in BMI z-score. Seventy-five participants with 12-week outcome data were rank ordered as the 10 most successful participants (largest reductions in BMI z-score; m ± std = -0.64 ± 0.18) and the 10 least successful participants (smallest reductions or an increase in BMI z-score; m ± std = 0.02 ± 0.04). The conditions selected for analysis were identified based on theory and the delivery team's experience with implementing BHF. Results: Necessary conditions (i.e., present in all highly successful participants, but also some less successful participants) included children with high attendance and self-regulation, at least one adult with high attendance and self-regulation, a mother who lost weight during the program and achieved clinically meaningful weight loss. Sufficient conditions (i.e., present in only the highly successful participants) included mothers with self-regulation scores >45% (range 46.7%-98.2%), and children with a combination of high attendance (72%-100%) and self-regulation scores ≥45% (45%-92.7%). Conclusion: Program implementers should continue to focus on encouraging high attendance and emphasize the necessity of enacting self-regulation strategies at both the child and parent level.
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Affiliation(s)
- Caitlin A Golden
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kate A Heelan
- Kinesiology and Sport Sciences Department, University of Nebraska at Kearney, Kearney, NE, USA
| | - Jennie L Hill
- Population Health Sciences Department, University of Utah, Salt Lake City, UT, USA
| | - R Todd Bartee
- Kinesiology and Sport Sciences Department, University of Nebraska at Kearney, Kearney, NE, USA
| | - Bryce M Abbey
- Kinesiology and Sport Sciences Department, University of Nebraska at Kearney, Kearney, NE, USA
| | - Paul A Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
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Kininmonth AR, Schrempft S, Smith A, Dye L, Lawton C, Fisher A, Llewellyn CH, Fildes A. Associations between the home environment and childhood weight change: a cross-lagged panel analysis. Int J Obes (Lond) 2022; 46:1678-1685. [PMID: 35739248 PMCID: PMC9395269 DOI: 10.1038/s41366-022-01170-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The obesogenic quality of the home environment is hypothesised to play an important role in children's weight development but few prospective studies have investigated relationships between the home environment and adiposity across childhood. OBJECTIVE To investigate the continuity and stability of the home environment from ages 4 to 12, and bi-directional relationships between the home environment and BMI-SDS from ages 4 to 12. METHODS Parents from the Gemini cohort completed the Home Environment Interview (HEI), a comprehensive measure of the obesogenic home environment, when their children were aged 4 and 12 (n = 149 families, n = 298 children). The obesogenic home environment was measured using four composite scores capturing the food, activity, media environments, and the overall home environment. Child weights and heights were used to calculate BMI-SDS. Continuity was assessed with Pearson's correlations between scores at each time point, and stability by changes in mean scores over time. Cross-lagged analyses were performed (HEI composites at age 4 to BMI-SDS at age 12 and the reverse) to measure the magnitude and direction of associations. RESULTS The home environment showed moderate-to-high continuity from ages 4 to 12 (r = 0.30-0.64). The overall home environment (r = 0.21, p < 0.01) and media composites (r = 0.23, p < 0.01) were cross-sectionally associated with child BMI-SDS at age 12, but not at age 4. Longitudinally, the home media environment at age 4 predicted increases in child BMI-SDS at age 12 (β; 95% CI = 0.18; 0.08,0.28, p < 0.01). No associations were observed for the reverse path, or the remaining composites (the overall, food and activity) in either direction. CONCLUSION This study provides evidence that the obesogenic home environment tracks across childhood and highlights the importance of the early home media environment for child weight development. The findings provide insight into key aspects of the home environment that could be targeted when developing obesity treatment or prevention strategies.
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Affiliation(s)
- Alice R Kininmonth
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK. .,Research Department of Behavioural Science and Health, University College London, London, UK.
| | - Stephanie Schrempft
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Andrea Smith
- Research Department of Behavioural Science and Health, University College London, London, UK.,MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Louise Dye
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Clare Lawton
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Abigail Fisher
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Clare H Llewellyn
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Alison Fildes
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
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Sadler JR, Persky S, Gu C, Aghababian AH, Carnell S. Is obesity in the brain? Parent perceptions of brain influences on obesity. Pediatr Obes 2022; 17:e12881. [PMID: 34939352 PMCID: PMC9373357 DOI: 10.1111/ijpo.12881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/22/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022]
Abstract
Neuroimaging studies demonstrate associations of brain structure and function with children's eating behaviour and body weight, and the feasibility of integrating brain measures into obesity risk assessment and intervention is growing. However, little is known about lay perceptions of how the brain influences obesity. We investigated parent perceptions of brain contributions to obesity in three separate studies: 1) a study of mothers of adolescents recruited for neuroimaging research (n = 88), 2) a study of ethnically Chinese parents of 5-13 year olds participating in a parent feeding survey (n = 277), and 3) a study of parents of 3-15 year olds completing an online survey (n = 113). In general, parents believed that brain factors influence obesity, but considered them less influential than behaviours such as diet and exercise. Causal attributions for brain factors were correlated with attributions for genetic factors and biological factors (e.g., metabolism). Parents who perceived their child to be overweight or had a high concern about their child becoming overweight in the future rated brain factors as more important in determining their child's weight and more likely to lessen their child's ability to control their weight. Our results suggest that parents attribute obesity to the brain to a moderate degree, and that education or feedback regarding brain influences on obesity could be a promising obesity intervention component.
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Affiliation(s)
- Jennifer R Sadler
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan Persky
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Cihang Gu
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anahys H Aghababian
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan Carnell
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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25
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Jebeile H, Kelly AS, O'Malley G, Baur LA. Obesity in children and adolescents: epidemiology, causes, assessment, and management. Lancet Diabetes Endocrinol 2022; 10:351-365. [PMID: 35248172 PMCID: PMC9831747 DOI: 10.1016/s2213-8587(22)00047-x] [Citation(s) in RCA: 213] [Impact Index Per Article: 106.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 01/14/2023]
Abstract
This Review describes current knowledge on the epidemiology and causes of child and adolescent obesity, considerations for assessment, and current management approaches. Before the COVID-19 pandemic, obesity prevalence in children and adolescents had plateaued in many high-income countries despite levels of severe obesity having increased. However, in low-income and middle-income countries, obesity prevalence had risen. During the pandemic, weight gain among children and adolescents has increased in several jurisdictions. Obesity is associated with cardiometabolic and psychosocial comorbidity as well as premature adult mortality. The development and perpetuation of obesity is largely explained by a bio-socioecological framework, whereby biological predisposition, socioeconomic, and environmental factors interact together to promote deposition and proliferation of adipose tissue. First-line treatment approaches include family-based behavioural obesity interventions addressing diet, physical activity, sedentary behaviours, and sleep quality, underpinned by behaviour change strategies. Evidence for intensive dietary approaches, pharmacotherapy, and metabolic and bariatric surgery as supplemental therapies are emerging; however, access to these therapies is scarce in most jurisdictions. Research is still needed to inform the personalisation of treatment approaches of obesity in children and adolescents and their translation to clinical practice.
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Affiliation(s)
- Hiba Jebeile
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Aaron S Kelly
- Department of Pediatrics and Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Grace O'Malley
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Child and Adolescent Obesity Service, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Louise A Baur
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Weight Management Services, The Children's Hospital at Westmead, Westmead, NSW, Australia.
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26
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Smriti D, Kao TSA, Rathod R, Shin JY, Peng W, Williams J, Mujib MI, Colosimo M, Huh-Yoo J. MICA: Motivational Interviewing Conversational Agent for Parents as Proxies for their Children in Healthy Eating (Preprint). JMIR Hum Factors 2022; 9:e38908. [PMID: 36206036 PMCID: PMC9587490 DOI: 10.2196/38908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Increased adoption of off-the-shelf conversational agents (CAs) brings opportunities to integrate therapeutic interventions. Motivational Interviewing (MI) can then be integrated with CAs for cost-effective access to it. MI can be especially beneficial for parents who often have low motivation because of limited time and resources to eat healthy together with their children. Objective We developed a Motivational Interviewing Conversational Agent (MICA) to improve healthy eating in parents who serve as a proxy for health behavior change in their children. Proxy relationships involve a person serving as a catalyst for behavior change in another person. Parents, serving as proxies, can bring about behavior change in their children. Methods We conducted user test sessions of the MICA prototype to understand the perceived acceptability and usefulness of the MICA prototype by parents. A total of 24 parents of young children participated in 2 user test sessions with MICA, approximately 2 weeks apart. After parents’ interaction with the MICA prototype in each user test session, we used qualitative interviews to understand parents’ perceptions and suggestions for improvements in MICA. Results Findings showed participants’ perceived usefulness of MICAs for helping them self-reflect and motivating them to adopt healthier eating habits together with their children. Participants further suggested various ways in which MICA can help them safely manage their children’s eating behaviors and provide customized support for their proxy needs and goals. Conclusions We have discussed how the user experience of CAs can be improved to uniquely offer support to parents who serve as proxies in changing the behavior of their children. We have concluded with implications for a larger context of designing MI-based CAs for supporting proxy relationships for health behavior change.
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Affiliation(s)
- Diva Smriti
- College of Computing and Informatics, Drexel University, Philadelphia, PA, United States
| | - Tsui-Sui Annie Kao
- College of Nursing, Michigan State University, East Lansing, MI, United States
| | - Rahil Rathod
- Tata Consultancy Services, Edison, NJ, United States
| | - Ji Youn Shin
- College of Design, University of Minnesota, Minneapolis, MN, United States
| | - Wei Peng
- College of Communication Arts and Sciences, Michigan State University, East Lansing, MI, United States
| | - Jake Williams
- College of Computing and Informatics, Drexel University, Philadelphia, PA, United States
| | - Munif Ishad Mujib
- College of Computing and Informatics, Drexel University, Philadelphia, PA, United States
| | | | - Jina Huh-Yoo
- College of Computing and Informatics, Drexel University, Philadelphia, PA, United States
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27
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Tugault-Lafleur CN, De-Jongh González O, Macdonald J, Bradbury J, Warshawski T, Ball GDC, Morrison K, Ho J, Hamilton J, Buchholz A, Mâsse L. Efficacy of the Aim2Be intervention in changing lifestyle behaviours among adolescents with overweight and obesity: A Randomized Controlled Trial (Preprint). J Med Internet Res 2022; 25:e38545. [PMID: 37097726 PMCID: PMC10170359 DOI: 10.2196/38545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/13/2022] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Aim2Be is a gamified lifestyle app designed to promote lifestyle behavior changes among Canadian adolescents and their families. OBJECTIVE The primary aim was to test the efficacy of the Aim2Be app with support from a live coach to reduce weight outcomes (BMI Z score [zBMI]) and improve lifestyle behaviors among adolescents with overweight and obesity and their parents versus a waitlist control group over 3 months. The secondary aim was to compare health trajectories among waitlist control participants over 6 months (before and after receiving access to the app), assess whether support from a live coach enhanced intervention impact, and evaluate whether the app use influenced changes among intervention participants. METHODS A 2-arm parallel randomized controlled trial was conducted from November 2018 to June 2020. Adolescents aged 10 to 17 years with overweight or obesity and their parents were randomized into an intervention group (Aim2Be with a live coach for 6 months) or a waitlist control group (Aim2Be with no live coach; accessed after 3 months). Adolescents' assessments at baseline and at 3 and 6 months included measured height and weight, 24-hour dietary recalls, and daily step counts measured with a Fitbit. Data on self-reported physical activity, screen time, fruit and vegetable intake, and sugary beverage intake of adolescents and parents were also collected. RESULTS A total of 214 parent-child participants were randomized. In our primary analyses, there were no significant differences in zBMI or any of the health behaviors between the intervention and control groups at 3 months. In our secondary analyses, among waitlist control participants, zBMI (P=.02), discretionary calories (P=.03), and physical activity outside of school (P=.001) declined, whereas daily screen time increased (P<.001) after receiving access to the app compared with before receiving app access. Adolescents randomized to Aim2Be with live coaching reported more time being active outside of school compared with adolescents who used Aim2Be with no coaching over 3 months (P=.001). App use did not modify any changes in outcomes among adolescents in the intervention group. CONCLUSIONS The Aim2Be intervention did not improve zBMI and lifestyle behaviors in adolescents with overweight and obesity compared with the waitlist control group over 3 months. Future studies should explore the potential mediators of changes in zBMI and lifestyle behaviors as well as predictors of engagement. TRIAL REGISTRATION ClinicalTrials.gov NCT03651284; https://clinicaltrials.gov/ct2/show/study/NCT03651284. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-020-4080-2.
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Affiliation(s)
- Claire N Tugault-Lafleur
- School of Nutrition Sciences, Faculty of Health Sciences, The University of Ottawa, Ottawa, ON, Canada
| | - Olivia De-Jongh González
- School of Population and Public Health, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Katherine Morrison
- Department of Pediatrics, Center for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
| | - Josephine Ho
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Jill Hamilton
- Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Annick Buchholz
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
| | - Louise Mâsse
- School of Population and Public Health, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
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28
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Gago CM, Jurkowski J, Beckerman-Hsu JP, Aftosmes-Tobio A, Figueroa R, Oddleifson C, Mattei J, Kenney EL, Haneuse S, Davison KK. Exploring a theory of change: Are increases in parental empowerment associated with healthier weight-related parenting practices? Soc Sci Med 2022; 296:114761. [PMID: 35123371 PMCID: PMC8894077 DOI: 10.1016/j.socscimed.2022.114761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Parent health-related empowerment is defined as the process by which parents realize control over their life situation and take action to promote a healthier lifestyle. For decades, researchers have described the theoretical potential of empowerment in health promotion efforts, though few have empirically examined this hypothesized relationship. This study is one of the first to examine the relationship between parental empowerment and healthy weight parenting practices (i.e., food, physical activity, sleep, and media parenting), as a mechanism for early childhood health promotion in community settings. METHODS Low-income parents of preschool-aged children attending Head Start in Greater Boston between fall 2017 and spring 2019 were invited to complete a survey in the fall and spring of each academic school year (n = 578 with two surveys and n = 45 with four). Parental empowerment and healthy weight parenting practices were assessed using validated surveys. We used a multilevel difference-in-difference approach to estimate changes in healthy weight parenting practices score by changes in parental empowerment score. RESULTS Out of a possible score of four, the unadjusted mean (SD) score in fall was 3.20 (0.40) for empowerment and 3.01 (0.40) for parenting. An increase in parental empowerment was associated with an increase in healthier parenting practices (b = 0.14; 95% CI = 0.08, 0.20; p < 0.0001). CONCLUSIONS Parent empowerment may be an important target in interventions to prevent obesity in low-income children.
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Affiliation(s)
- Cristina M. Gago
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Janine Jurkowski
- Department of Health Policy, Management, and Behavior, State University of New York, Albany, NY, 12222, USA
| | | | | | - Roger Figueroa
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, 14853, USA
| | - Carly Oddleifson
- School of Social Work, Boston College, Chestnut Hill, MA, 02467, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Erica L. Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
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29
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Flint Bretler O, Tzischinsky O, Asraf K, Shochat T. The Effects of Parental Intervention on Sleep Patterns and Electronic Media Exposure in Young Adolescents. Clocks Sleep 2022; 4:129-144. [PMID: 35323167 PMCID: PMC8947686 DOI: 10.3390/clockssleep4010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/23/2022] [Accepted: 02/15/2022] [Indexed: 11/18/2022] Open
Abstract
Objective: This study evaluated the effectiveness of a parent-focused intervention aimed at the promotion of healthy sleep patterns and controlled exposure to electronic media (EM) in young adolescents. Participants: The sample included 70 dyads of parents (68 mothers and 2 fathers) and adolescents. Intervention and control groups each consisted of 35 young adolescents with a mean age of 10.7 (0.9) years old. Methods: Three waves of data collection included baseline, post-intervention, and 3 month follow-up. In each wave, adolescents reported habitual electronic media exposure and sleep patterns for a week and wore an actigraph for five nights. Parents in the intervention group participated in a six-session interactive workshop, while parents in the control group received equivalent written information by mail. Results: The intervention led to earlier bedtimes (p < 0.001), increased sleep efficiency (p < 0.01), increased sleep duration (p < 0.001) and reduced video games exposure (p < 0.01). Benefits were maintained at the follow-up. Conclusion: Interventions tailored for parents can create lasting positive changes in sleep patterns and EM exposure in young adolescents.
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Affiliation(s)
- Ofra Flint Bretler
- Department of Behavioral Sciences, Max Stern Academic College of Emek Yezreel, Jezreel Valley 1930600, Israel; (O.F.B.); (O.T.)
| | - Orna Tzischinsky
- Department of Behavioral Sciences, Max Stern Academic College of Emek Yezreel, Jezreel Valley 1930600, Israel; (O.F.B.); (O.T.)
| | - Kfir Asraf
- Faculty of Social Sciences, University of Haifa, Haifa 3498838, Israel;
| | - Tamar Shochat
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel
- Correspondence:
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30
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Maryati S, Yunitasari P, Punjastuti B. The Effect of Interactive Education Program in Preventing Stunting for Mothers with Children under 5 Years of Age in Indonesia: A Randomized Controlled Trial. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Stunting is still a major public health issue that has had a direct impact on the country’s growth and development. Parents play a significant role in tackling the nutritional intake of children, considering their impact on the selection and quantities of food products obtainable to children. However, there is currently no specific parenting education program targeted at stunting prevention in Indonesia.
AIM: This study aimed to assess the effect of interactive education programs on preventing stunting for mothers with children under 5 years of age in Indonesia.
METHODS: This study was conducted using a randomized controlled trial single-blinded at the Public Health Center Bantul, Yogyakarta, Indonesia, from January to November 2019. The participants included the mothers of children under 5 years of age and reported the main role of feeding the child at home. The parenting program comprises 12 session workshops, biweekly within 6 months. Regression models were used to evaluate the effect of the intervention on the outcome by intervention group over time (from baseline to follow-up).
RESULTS: This study enrolled 64 people, 32 in the intervention group and 32 in the control group. There were substantial main effects or interactions for sickness in the past week and .an increase in age; children across all categories grew less stunted. Dietary diversity showed improvement for intervention caregivers compared to control. This was evidenced by improved ratings in the practice of more varied diets. The magnitudes of the effects on dietary diversity ranged from 0.30 to 0.53.
CONCLUSION: This study highlighted the effectiveness of educational programs on preventing stunting among children under 5 years of age. This study provides a new approach to stunting prevention, which can provide basic evidence of healthcare policy improvements in prevention programs in the local community.
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31
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Eichen DM, Strong DR, Rhee KE, Boutelle KN. The complicated relationship among parent and child disinhibited eating behaviors. Appetite 2022; 171:105923. [PMID: 35026372 DOI: 10.1016/j.appet.2022.105923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 11/29/2022]
Abstract
Disinhibited eating behaviors (e.g., loss of control eating (LOC) and eating in the absence of hunger (EAH)) contribute to overeating and obesity. This study aimed to evaluate whether these traits are related in parent-child dyads and how the reporter of child eating behavior (parent or child) impacts this relationship. Two-hundred and ninety treatment-seeking children, ages 8-13, with overweight or obesity (BMI percentile for age and sex 85-99.9%) and their parents were included. LOC and EAH were assessed by child report for self, parent report for self, and parent report for child. Parent and child disinhibited eating behaviors were related only when parents reported on both their own and their child's eating behaviors (p-values < 0.04). Child report of LOC and EAH for self was not associated with parent report of LOC and EAH for self (p-values > 0.05). There was a significant interaction between parent's EAH and BMI as it related to parent report of child EAH (B = 0.02; SE = 0.005; p = 0.004) such that parents with lower BMI reported their own EAH to be lower than parents with higher BMI, but parent report of child EAH was similar regardless of the parent's BMI. Disinhibited eating behaviors were related only when a single parent reported on both their own and their child's behavior, suggesting a potential reporting bias. Given that the relation between parent and child disinhibited eating behaviors varies based on who is reporting the child's behavior, it may be important to consider both parent and child report when designing research studies or in clinical settings while also recognizing potential reporting biases.
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Affiliation(s)
- Dawn M Eichen
- University of California San Diego, Department of Pediatrics, San Diego, CA, USA.
| | - David R Strong
- University of California San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, San Diego, CA, USA
| | - Kyung E Rhee
- University of California San Diego, Department of Pediatrics, San Diego, CA, USA
| | - Kerri N Boutelle
- University of California San Diego, Department of Pediatrics, San Diego, CA, USA; University of California San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, San Diego, CA, USA; University of California San Diego, Department of Psychiatry, San Diego, CA, USA
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32
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Timm A, Kragelund Nielsen K, Joenck L, Husted Jensen N, Jensen DM, Norgaard O, Terkildsen Maindal H. Strategies to promote health behaviors in parents with small children-A systematic review and realist synthesis of behavioral interventions. Obes Rev 2022; 23:e13359. [PMID: 34734473 DOI: 10.1111/obr.13359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/12/2021] [Accepted: 08/21/2021] [Indexed: 11/28/2022]
Abstract
In this systematic review and realist synthesis, we aimed to identify strategies to improve dietary and physical activity behaviors for parents with small children. A systematic literature search was conducted in MEDLINE, Embase, CINAHL, and PsycINFO in July 2021. Included studies had to: (i) target one or both parents with at least one child (0-3 years), (ii) aim to improve diet and physical activity, and (iii) report on diet and physical activity outcomes. Intervention context, delivery, and outcomes were extracted, and behavior change techniques were coded. A program theory was developed, and context-mechanism-outcome configurations were identified. In total, 17 interventions reported in 28 studies (19 effectiveness studies; nine protocols) were included. Nine interventions showed small improvements: in diet (n = 5), physical activity (n = 2), or both (n = 2) in mothers. The realist synthesis revealed three strategies to improve health behaviors: (1) using knowledge and role modelling to improve family dynamics, (2) providing various home-based activities to change home environment, and (3) offering flexible delivery, for example, phone or website-based to increase social support. Future interventions for parents with small children should consider involving the whole family, focusing on home-based and practical components, and offering various delivery modes. The protocol for the systematic review and realist synthesis was registered in Research Registry (registration ID: reviewregistry860) March 30th, 2020.
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Affiliation(s)
- Anne Timm
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Larke Joenck
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Dorte Moeller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ole Norgaard
- Department of Education, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Helle Terkildsen Maindal
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
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Kininmonth AR, Schrempft S, Smith A, Dye L, Lawton C, Fisher A, Llewellyn C, Fildes A. The Home Environment Interview and associations with energy balance behaviours and body weight in school-aged children - a feasibility, reliability, and validity study. Int J Behav Nutr Phys Act 2021; 18:167. [PMID: 34949200 PMCID: PMC8698661 DOI: 10.1186/s12966-021-01235-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/06/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The home environment is thought to influence children's weight trajectories. However, few studies utilise composite measures of the home environment to examine associations with energy balance behaviours and weight. The present study aimed to adapt and update a comprehensive measure of the obesogenic home environment previously developed for pre-schoolers, and explore associations with school-aged children's energy balance behaviours and weight. METHODS Families from the Gemini cohort (n = 149) completed the Home Environment Interview (HEI) via telephone when their children were 12 years old. The HEI comprises four composite scores: one for each domain (food, activity and media) of the environment, as well as a score for the overall obesogenic home environment. The primary caregiver also reported each child's height and weight (using standard scales and height charts), diet, physical activity and sedentary screen-based behaviours. A test-retest sample (n = 20) of caregivers completed the HEI a second time, 7-14 days after the initial interview, to establish test-retest reliability. RESULTS Children (n = 298) living in 'higher-risk' home environments (a 1 unit increase in the HEI obesogenic risk score) were less likely to consume fruits (OR; 95% CI = 0.40; 0.26-0.61, p < 0.001), and vegetables (0.30; 0.18-0.52, p < 0.001), and more likely to consume energy-dense snack foods (1.71; 1.08-2.69, p = 0.022), convenience foods (2.58; 1.64-4.05, p < 0.001), and fast foods (3.09; 1.90-5.04, p < 0.001). Children living in more obesogenic home environments also engaged in more screen-time (β (SE) = 4.55 (0.78), p < 0.001), spent more time playing video games (β (SE) = 1.56 (0.43), p < 0.001), and were less physically active (OR; 95% CI = 0.57; 0.40-0.80, p < 0.01). Additionally, there was a positive association between higher-risk overall home environment composite score and higher BMI-SDS (β (SE) = 0.23 (0.09), p < 0.01). This finding was mirrored for the home media composite (β (SE) = 0.12 (0.03), p < 0.001). The individual home food and activity composite scores were not associated with BMI-SDS. CONCLUSION Findings reveal associations between the overall obesogenic home environment and dietary intake, activity levels and screen-based sedentary behaviours, as well as BMI in 12 year olds. These findings suggest that the home environment, and in particular the home media environment, may be an important target for obesity prevention strategies.
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Affiliation(s)
| | - Stephanie Schrempft
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Andrea Smith
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- University College London, London, UK
| | - Louise Dye
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Clare Lawton
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | | | | | - Alison Fildes
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
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Barnes C, Hall A, Nathan N, Sutherland R, McCarthy N, Pettet M, Brown A, Wolfenden L. Efficacy of a school-based physical activity and nutrition intervention on child weight status: Findings from a cluster randomized controlled trial. Prev Med 2021; 153:106822. [PMID: 34599925 DOI: 10.1016/j.ypmed.2021.106822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/09/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
Despite the benefits of factorial designs in quantifying the relative benefits of different school-based approaches to prevent unhealthy weight gain among students, few have been undertaken. The aims of this 2 × 2 cluster randomized factorial trial was to evaluate the impact of a physical activity and nutrition intervention on child weight status and quality of life. Twelve primary schools in New South Wales, Australia randomly allocated to one of four groups: (i.) physical activity (150 min of planned in-school physical activity); (ii.) nutrition (a healthy school lunch-box); (iii.) combined physical activity and nutrition; or (iv.) control. Outcome data assessing child weight and quality of life were collected at baseline and 9-months post-baseline. Within Grades 4-6 in participating schools, 742 students participated in anthropometric measurements, including child body mass index (BMI) and waist circumference, at baseline and follow-up. Findings indicated that students that received the nutrition intervention had higher odds of being classified in the BMI category of underweight/healthy weight (OR 1.64 95%CI 1.07, 2.50; p = 0.0220), while those who received the physical activity intervention reported a lower waist circumference (mean difference - 1.86 95%CI -3.55, -0.18; p = 0.030). There were no significant effects of the nutrition or physical activity intervention on child BMI scores or child quality of life, and no significant synergistic effects of the two interventions combined. Future research assessing the longer-term impact of both intervention strategies, alone and combined, is warranted to better understand their potential impact on child health. TRIAL REGISTRATION: Australian Clinical Trials Registry ACTRN: ACTRN12616001228471.
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Affiliation(s)
- Courtney Barnes
- Hunter New England Population Health, Wallsend 2287, New South Wales, Australia; School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, New South Wales, Australia; Hunter Medical Research Institute, New Lambton 2305, New South Wales, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan 2308, New South Wales, Australia.
| | - Alix Hall
- Hunter New England Population Health, Wallsend 2287, New South Wales, Australia; School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, New South Wales, Australia; Hunter Medical Research Institute, New Lambton 2305, New South Wales, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan 2308, New South Wales, Australia
| | - Nicole Nathan
- Hunter New England Population Health, Wallsend 2287, New South Wales, Australia; School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, New South Wales, Australia; Hunter Medical Research Institute, New Lambton 2305, New South Wales, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan 2308, New South Wales, Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Wallsend 2287, New South Wales, Australia; School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, New South Wales, Australia; Hunter Medical Research Institute, New Lambton 2305, New South Wales, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan 2308, New South Wales, Australia
| | - Nicole McCarthy
- Hunter New England Population Health, Wallsend 2287, New South Wales, Australia; School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, New South Wales, Australia; Hunter Medical Research Institute, New Lambton 2305, New South Wales, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan 2308, New South Wales, Australia
| | - Matthew Pettet
- Hunter New England Population Health, Wallsend 2287, New South Wales, Australia; Hunter Medical Research Institute, New Lambton 2305, New South Wales, Australia
| | - Alison Brown
- Hunter New England Population Health, Wallsend 2287, New South Wales, Australia; School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, New South Wales, Australia; Hunter Medical Research Institute, New Lambton 2305, New South Wales, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan 2308, New South Wales, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Wallsend 2287, New South Wales, Australia; School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, New South Wales, Australia; Hunter Medical Research Institute, New Lambton 2305, New South Wales, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan 2308, New South Wales, Australia
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Srivastava D, Zheng LR, Dev DA. Examining correlates of feeding practices among parents of preschoolers. Nutr Health 2021; 28:555-562. [PMID: 34424083 DOI: 10.1177/02601060211032886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Parent feeding practices play a critical role in children's eating behaviors. Limited research has explored child-level correlates of parent feeding practices. Aim: To identify correlates of feeding practices (responsive and controlling) among parents of preschoolers US. Methods: Participants included parents (n = 273) of preschoolers (3-5 years), recruited from Early Care and Education settings (n = 24) located in a metropolitan city in the US. Analysis included descriptives, correlations, and multiple regression. Results: For responsive feeding practices, positive associations included child's weight with unintentional modeling (β = .17, 95% CI [0.12, 0.53]), child vegetable consumption with behavioral role modeling (β = 0.22, 95% CI [0.17, 0.44]), and parent monitoring with verbal modeling (β = 0.21, 95% CI [0.12, 0.34]). For controlling feeding practices, parent restriction was positively associated with child weight concern (β = 0.22, 95% CI [0.13, 0.39]) and parent monitoring (β = 0.13, 95% CI [0.01, 0.19]), whereas child vegetable consumption was negatively associated (β = -0.16, 95% CI [-0.27, -0.05]). Pressure to eat was negatively associated with child weight concern (β = -0.18, 95% CI [-0.45, -0.09]), child fruit consumption (β = -0.12, 95% CI [-0.37, -0.01]), household income (β = -0.13, 95% CI [-0.30, -0.02]), and parent weight (β = -0.14, 95% CI [-0.60, -0.05]), Conclusions: Findings highlight the importance of child characteristics when examining correlates of parent feeding practices, demonstrating bidirectional interactions between parent feeding practices and children's eating behaviors. Considering child-level correlates may improve the implementation of responsive feeding practices and reduce controlling feeding practices.
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Affiliation(s)
- Deepa Srivastava
- Nutrition, Family & Consumer Sciences Advisor, Cooperative Extension, 115148University of California Agriculture & Natural Resources, Davis, CA, USA
| | - Lucy R Zheng
- Department of Psychology, 8789University of California, Davis, CA, USA
| | - Dipti A Dev
- Department of Child, Youth and Family Studies, 14719University of Nebraska-Lincoln, Lincoln, NE, USA
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Tsai M, Cash SB, Anzman-Frasca S, Goldberg JP, Johnson SK, Oslund J, Folta SC. Helping parents provide vegetable snacks: Investigating price and taste as barriers. Appetite 2021; 166:105481. [PMID: 34175360 DOI: 10.1016/j.appet.2021.105481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/19/2022]
Abstract
Snacks contribute nearly one-quarter of children's daily energy intake in the USA. Snack time therefore represents an opportunity for parents to provide foods with key nutrients. Instead, the most common snack foods are major contributors to children's consumption of added sugars and sodium. Parents face major barriers to providing healthier snacks, including perceptions of high cost and lack of child acceptance. We obtained both economic and qualitative data to inform and optimize interventions for parents to promote vegetable snacks for children. We conducted a survey with parents (n = 368) to estimate how much of a discount would influence vegetable snack purchases by estimating willingness-to-pay using the contingent valuation method, using baby-cut carrots as a sample product. We conducted three focus groups (n = 19) and 1 group interview (n = 2) with children to help understand how to increase the appeal of vegetable snacks. Most (70%) parents accepted the reference price for the vegetable snack. Among those who did not, contingent valuation analysis revealed that a mean discount of approximately 30% would shift consumers to purchasing the snack. Focus group results revealed that the appeal of vegetable snacks to children was influenced by how they were prepared and presented, and the child's familiarity with the vegetables and ability to choose among them. This study lays the groundwork for effective interventions to promote the provision of vegetable snacks by parents.
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Affiliation(s)
- Marisa Tsai
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA; Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 1111 Franklin Street, Tenth Floor, Oakland, CA 94607, USA.
| | - Sean B Cash
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences and Center for Ingestive Behavior Research, University at Buffalo, G56 Farber Hall, South Campus, Buffalo, NY, USA.
| | - Jeanne P Goldberg
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
| | - Sarah K Johnson
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
| | - Jennifer Oslund
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
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Truong K, Park S, Tsiros MD, Milne N. Physiotherapy and related management for childhood obesity: A systematic scoping review. PLoS One 2021; 16:e0252572. [PMID: 34125850 PMCID: PMC8202913 DOI: 10.1371/journal.pone.0252572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 05/18/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Despite targeted efforts globally to address childhood overweight/obesity, it remains poorly understood and challenging to manage. Physiotherapists have the potential to manage children with obesity as they are experts in movement and physical activity. However, their role remains unclear due to a lack of physiotherapy-specific guidelines. This scoping review aims to explore existing literature, critically appraising and synthesising findings to guide physiotherapists in the evidence-based management of childhood overweight/obesity. METHOD A scoping review was conducted, including literature up to May 2020. A review protocol exists on Open Science Framework at https://osf.io/fap8g/. Four databases were accessed including PubMed, Embase, CINAHL, Medline via OVID, with grey literature searched through google via "file:pdf". A descriptive synthesis was undertaken to explore the impact of existing interventions and their efficacy. RESULTS From the initial capture of 1871 articles, 263 intervention-based articles were included. Interventions included qualitative focused physical activity, quantitative focused physical activity and multicomponent interventions. Various outcome measures were utilised including health-, performance- and behaviour-related outcomes. The general trend for physiotherapy involvement with children who are obese appears to favour: 1) multicomponent interventions, implementing more than one component with environmental modification and parental involvement and 2) quantitative physical activity interventions, focusing on the quantity of bodily movement. These approaches most consistently demonstrated desirable changes across behavioural and health-related outcome measures for multicomponent and quantitative physical activity interventions respectively. CONCLUSION When managing children with obesity, physiotherapists should consider multicomponent approaches and increasing the quantity of physical activity, given consistent improvements in various obesity-related outcomes. Such approaches are well suited to the scope of physiotherapists and their expertise in physical activity prescription for the management of childhood obesity. Future research should examine the effect of motor skill interventions and consider the role of environmental modification/parental involvement as factors contributing to intervention success.
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Affiliation(s)
- Kim Truong
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia
| | - Sandra Park
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia
| | - Margarita D. Tsiros
- UniSA Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
| | - Nikki Milne
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia
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‘I Think It Will Be Like This Forever’: How Family Narratives Affect Participation in a Childhood Weight Management Intervention. SOCIAL SCIENCES 2021. [DOI: 10.3390/socsci10050175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The family represents the cause of as well as the solution to childhood overweight in many family-based childhood weight management interventions. Involving the family also entails involving the individual family members’ experiences with, attitudes towards, and understandings of obesity. This study explores how families with life-long experiences of overweight manage and experience a family-based childhood weight management intervention in Northern Zealand in Denmark. The analysis is focused on family narratives and their temporal character. The families’ narratives about overweight and past weight management interventions are crucial to how they understand and manage the present intervention. Additionally, the families expect the focus on weight management to continue to be a constant part of their everyday life. The paper concludes that the understanding of weight management in interventions should take its point of departure in the life-world, which the individual family creates through members’ narratives about overweight.
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Kamody RC, Lydecker JA. Parental feeding practices and children's disordered eating among single parents and co-parents. Int J Eat Disord 2021; 54:812-820. [PMID: 33624860 PMCID: PMC8163105 DOI: 10.1002/eat.23490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Some parental feeding practices are associated with pediatric disordered eating and weight status. Existing research, however, has focused on maternal feeding practices in co-parent households. Single parents and fathers are notably understudied in this area. The current study examined associations of parental feeding practices with child disordered eating behaviors and weight, and compared associations between single mothers and fathers with a matched sample of co-parenting mothers and fathers. METHOD Parents (N = 524) of youth between 5 and 16 years completed an online survey that included measures of parental feeding practices and unhealthy eating/weight-related parenting practices. Co-parents were matched to each single parent based on gender, race, ethnicity, education level, age, and BMI. RESULTS Single parents reported significantly greater concern about their child's weight, eating and shape, and reported engaging in more restraint and restriction of their child's eating, as well as having more perceived responsibility of their child's eating than caregivers in co-parent households. Children of single parents were significantly more likely to engage in secretive eating. DISCUSSION Associations between single parents' feeding practices and child weight and disordered eating parallel the broader literature. There were differences between single mothers and fathers and co-parenting mothers and fathers, particularly in their report of their unhealthy eating/weight-related parenting practices. Such differences may influence children's longer-term eating behaviors and weight status. Further research on single-parent households is needed, including longitudinal and epidemiological studies.
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Affiliation(s)
- Rebecca C. Kamody
- Department of Psychiatry, Yale School of Medicine, 301 Cedar Street, New Haven CT, 06519, USA
| | - Janet A. Lydecker
- Department of Psychiatry, Yale School of Medicine, 301 Cedar Street, New Haven CT, 06519, USA
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Sanders LM, Perrin EM, Yin HS, Delamater AM, Flower KB, Bian A, Schildcrout JS, Rothman RL. A Health-Literacy Intervention for Early Childhood Obesity Prevention: A Cluster-Randomized Controlled Trial. Pediatrics 2021; 147:peds.2020-049866. [PMID: 33911032 PMCID: PMC8086006 DOI: 10.1542/peds.2020-049866] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children who become overweight by age 2 have greater risk of long-term obesity and health problems. The study aim was to assess the effectiveness of a primary care-based intervention on the prevalence of overweight at age 24 months. METHODS In a cluster-randomized trial, sites were randomly assigned to the Greenlight intervention or an attention-control arm. Across 4 pediatric residency clinics, we enrolled infant-caregiver dyads at the 2-month well-child visit. Inclusion criteria included parent English- or Spanish-speaking and birth weight ≥1500 g. Designed with health-literacy principles, the intervention included a parent toolkit at each well-child visit, augmented by provider training in clear-health communication. The primary outcome was proportion of children overweight (BMI ≥85th percentile) at age 24 months. Secondary outcomes included weight status (BMI z score). RESULTS A total of 459 intervention and 406 control dyads were enrolled. In total, 49% of all children were overweight at 24 months. Adjusted odds for overweight at 24 months (treatment versus control) was 1.02 (95% confidence interval [CI]: 0.63 to 1.64). Adjusted mean BMI z score differences (treatment minus control) were -0.04 (95% CI: -0.07 to -0.01), -0.09 (95% CI: -0.14 to -0.03), -0.19 (-0.33 to -0.05), -0.20 (-0.36 to -0.03), -0.16 (95% CI: -0.34 to 0.01), and 0.00 (95% CI -0.21 to 0.21) at 4, 6, 12, 15, 18, and 24 months, respectively. CONCLUSIONS The intervention resulted in less weight gain through age 18 months, which was not sustained through 24 months. Clinic-based interventions may be beneficial for early weight gain, but greater intervention intensity may be needed to maintain positive effects.
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Affiliation(s)
- Lee M. Sanders
- Division of General Pediatrics, Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University, Stanford, California
| | - Eliana M. Perrin
- Division of Primary Care and Duke Center for Childhood Obesity Research, Department of Pediatrics, Medical Center, Duke University, Durham, North Carolina
| | - H. Shonna Yin
- Department of Pediatrics and Population Health, School of Medicine, New York University and Department of Pediatrics, Bellevue Hospital Center, New York City, New York
| | - Alan M. Delamater
- Department of Pediatrics, School of Medicine, University of Miami, Miami, Florida
| | | | - Aihua Bian
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jonathan S. Schildcrout
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Russell L. Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee; and
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Marr C, Reale S, Breeze P, Caton SJ. Grandparental dietary provision, feeding practices and feeding styles when caring for preschool-aged grandchildren: A systematic mixed methods review. Obes Rev 2021; 22:e13157. [PMID: 33174344 DOI: 10.1111/obr.13157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 01/15/2023]
Abstract
Grandparents are frequently relied upon to care for their preschool-aged grandchildren. These early years are a crucial age in the development of dietary habits and preferences. This review aims to determine grandparental dietary provision, feeding practices and feeding styles when caring for their preschool-aged grandchildren. Medline, PsycInfo and Web of Science were searched in January 2020. A systematic mixed methods approach was used to synthesize the qualitative (n = 13) and quantitative (n = 7) articles describing grandparents' feeding styles (n = 9), feeding practices (n = 14) and dietary provision (n = 18). Grandparents are serving large portion sizes and encouraging their grandchildren to eat frequently. Results are mixed for the types of foods provided; grandparents provide discretionary foods high in sugar and fat, and some also choose more expensive core foods as treats (e.g., berries). Grandparents engage in feeding practices that promote healthy eating (e.g., creating a healthy feeding environment) and promote autonomy and independence (e.g., considering their grandchild's preferences). However, they also use some coercive feeding practices (e.g., using food as a reward) and may be using indulgent feeding styles, which can be conducive to obesogenic dietary intakes. Interventions targeting grandparents could be an effective way to improve dietary-related health outcomes in young children.
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Affiliation(s)
- Colette Marr
- Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Sophie Reale
- Allied Health Professions, College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Penny Breeze
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Samantha J Caton
- Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Pike JM, Moore CM, Yazel LG, Lynch DO, Haberlin-Pittz KM, Wiehe SE, Hannon TS. Diabetes Prevention in Adolescents: Co-design Study Using Human-Centered Design Methodologies. J Particip Med 2021; 13:e18245. [PMID: 33625364 PMCID: PMC7946580 DOI: 10.2196/18245] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/28/2020] [Accepted: 01/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The rise in pediatric obesity and its accompanying condition, type 2 diabetes (T2D), is a serious public health concern. T2D in adolescents is associated with poor health outcomes and decreased life expectancy. Effective diabetes prevention strategies for high-risk adolescents and their families are urgently needed. OBJECTIVE The aim of this study was to co-design a diabetes prevention program for adolescents by using human-centered design methodologies. METHODS We partnered with at-risk adolescents, parents, and professionals with expertise in diabetes prevention or those working with adolescents to conduct a series of human-centered design research sessions to co-design a diabetes prevention intervention for youth and their families. In order to do so, we needed to (1) better understand environmental factors that inhibit/promote recommended lifestyle changes to decrease T2D risk, (2) elucidate desired program characteristics, and (3) explore improved activation in diabetes prevention programs. RESULTS Financial resources, limited access to healthy foods, safe places for physical activity, and competing priorities pose barriers to adopting lifestyle changes. Adolescents and their parents desire interactive, hands-on learning experiences that incorporate a sense of fun, play, and community in diabetes prevention programs. CONCLUSIONS The findings of this study highlight important insights of 3 specific stakeholder groups regarding diabetes prevention and lifestyle changes. The findings of this study demonstrate that, with appropriate methods and facilitation, adolescents, parents, and professionals can be empowered to co-design diabetes prevention programs.
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Affiliation(s)
- Julie M Pike
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Courtney M Moore
- Research Jam, Indiana Clinical and Translational Sciences Institute Patient Engagement Core, Indiana University, Indianapolis, IN, United States
| | - Lisa G Yazel
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Dustin O Lynch
- Research Jam, Indiana Clinical and Translational Sciences Institute Patient Engagement Core, Indiana University, Indianapolis, IN, United States
| | - Kathryn M Haberlin-Pittz
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sarah E Wiehe
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Research Jam, Indiana Clinical and Translational Sciences Institute Patient Engagement Core, Indiana University, Indianapolis, IN, United States.,Children's Health Services Research Center, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Tamara S Hannon
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
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A Family-Based Lifestyle Intervention Focusing on Fathers and Their Children Using Co-Creation: Study Protocol of the Run Daddy Run Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041830. [PMID: 33668562 PMCID: PMC7918485 DOI: 10.3390/ijerph18041830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 11/18/2022]
Abstract
Fathers play a unique and important role in shaping their children’s physical activity (PA), independent from the mother. Lifestyle interventions focusing simultaneously on PA of fathers and their children (“co-PA”) are therefore a novel and promising way to improve PA of both. A theory-based lifestyle intervention was co-created with fathers (i.e., the Run Daddy Run intervention), using the behavior change wheel as a theoretical framework. The aim of the present study is to describe the protocol of the Run Daddy Run intervention study, focusing on improving (co-)PA of fathers and children, and the prospected outcomes. The developed intervention consists of six (inter)active father-child sessions and an eHealth component, delivered over a 14-week intervention period. Baseline measurements will be conducted between November 2019–January 2020, post-test measurements in June 2020, and follow-up measurements in November 2020, with (co-)PA as the primary outcome variable. Outcomes will be measured using accelerometry and an online questionnaire. To evaluate the intervention, multilevel analyses will be conducted. This study will increase our understanding on whether a theory-based, co-created lifestyle intervention focusing exclusively on fathers and their children can improve their (co-)PA behavior and has important implications for future research and health policy, where targeting fathers might be a novel and effective approach to improve (co-)PA and associated health behaviors of both fathers and their children.
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The Direct and Indirect Relationships of Environmental, Interpersonal and Personal Factors with High School Students Physical Activity: An Ecological Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030874. [PMID: 33498423 PMCID: PMC7908480 DOI: 10.3390/ijerph18030874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Across countries, young people are not sufficiently physically active. The evidence confirms that beyond demographic and individual agents, individuals participate within their social and physical environment. The ecological model enables a search for the modifiable factors in specific populations, as it allows consideration of factors affecting individuals' lives on different levels, as well as considering the interplay of those factors. The aim of this study was to examine the complex interconnections among environmental, social capital and motivational factors at different levels, within an ecological model for high school students' moderate-to-vigorous physical activity during their leisure time. METHODS This cross-sectional population-based study included 1285 students from 14 to 18 years old, with a mean age of 16.14 ± 1.22. Physical activity, neighborhood physical activity recourses, neighborhood safety, social capital, physical activity motivation and sociodemographic factors were evaluated. Logistic regression, mediation and moderation analyses were performed predicting moderate-to-vigorous physical activity during leisure time. RESULTS In the final multivariate logistic regression model, greater social participation (OR 1.03 [1.01-1.05]), higher relative autonomy index (OR 1.11 [1.06-1.15]) and male gender (OR 1.71 [1.13-2.57]) directly predicted meeting MVPA recommendations. Any significant moderation effects (p > 0.05) of environmental characteristics were not found for the relationship between social capital, motivational factors and moderate-to-vigorous physical activity. The evidence of positive indirect mediation effects was found in all five models for social capital components as all CIs for its βs do not contain 0, though standardized effect sizes were between 0.02 and 0.07, indicating small effect sizes. CONCLUSION These findings provide support for the presence of some direct and indirect pathways from social capital to moderate-to-vigorous physical activity. Future intervention strategies should focus on strengthening physical activity motivation by encouraging the development of social network and social participation as well as family, neighborhood and school social capital within the framework of the ecological model.
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Chew CSE, Oh JY, Rajasegaran K, Saffari SE, Lim CMM, Lim SC, Tan S, Kelly S. Evaluation of a group family-based intervention programme for adolescent obesity: the LITE randomised controlled pilot trial. Singapore Med J 2021; 62:39-47. [PMID: 33619579 PMCID: PMC8027163 DOI: 10.11622/smedj.2019122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION This study aimed to evaluate the LITE (Lifestyle Intervention for TEenagers) group programme, a family-based behavioural lifestyle intervention for overweight and obese adolescents. METHODS We conducted a two-arm randomised controlled trial that recruited overweight and obese adolescents who attended a tertiary care weight management clinic. Participants were randomised to the LITE programme or usual care. The primary outcome assessed was body mass index (BMI) z-score. Secondary outcomes of anthropometric measurements, metabolic profile, parenting and adolescents' perception of family support were measured at baseline, three months and six months. Feasibility and acceptability of the LITE programme were also evaluated. RESULTS 61 adolescents were enrolled, with 31 in the LITE programme and 30 in usual care. At three months, participants in the programme had a greater reduction in weight (-0.18 ± 2.40 kg vs. 1.48 ± 1.97 kg; p = 0.107), waist circumference (-1.0 ± 3.1 cm vs. 2.4 ± 2.7 cm; p = 0.016), waist-height ratio (-0.01 ± 0.02 vs. 0.01 ± 0.02; p = 0.040) and systolic blood pressure (-3.8 ± 13.7 vs. 5.7 ± 13.1; p = 0.119) compared to the usual care group. There was no significant difference in BMI z-score. At six months, there were significant improvements in adolescents' perception of family support for eating habits in the LITE group compared to the usual care group. The LITE programme had a good attendance rate of 67.7% and was well received. CONCLUSION The LITE programme showed feasibility and short-term clinical effectiveness in improving some clinical outcomes and improved adolescents' perception of family support.
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Affiliation(s)
| | - Jean Yin Oh
- Adolescent Medicine Service, KK Women’s and Children’s Hospital, Singapore
| | | | | | | | - Siew Choo Lim
- Department of Nutrition and Dietetics, KK Women’s and Children’s Hospital, Singapore
| | - Shiling Tan
- Department of Nutrition and Dietetics, KK Women’s and Children’s Hospital, Singapore
| | - Siobhan Kelly
- Psychology Service, KK Women’s and Children’s Hospital, Singapore
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The Correlation Between Parental Perceptions and Readiness to Change with Participation in a Pediatric Obesity Program Serving a Predominantly Black Urban Community: A Retrospective Cohort Study. Matern Child Health J 2020; 25:606-612. [PMID: 33237508 DOI: 10.1007/s10995-020-03058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study assessed whether maternal BMI and perceptions about weight and reported level of readiness to change was correlated with compliance to a pediatric lifestyle modification program targeting a hard-to-reach urban population with a high prevalence of severe obesity. METHODS The Parental Readiness Questionnaire (PRQ) was administered to the child's mother at program entry. The PRQ consisted of forty-seven multiple-choice and 10-point Likert scale questions regarding family demographics, exercise and eating habits, attitudes about health, body image, and weight, and the desire to improve nutrition and physical activity. Analysis was performed on PRQs of participants to compare parental perceptions and readiness for change with compliance to program requirements. Analysis was conducted on 596 questionnaires and compliance was categorized into three groups based on attendance to follow-up visits. RESULTS Significant differences were found between short-term and long-term follow-up groups in regards to parental perception of one's health as well as the health, weight, and body image of their child. Differences were found in perceptions of one's own weight and body image as well as the health of one's self and child between the group with a maternal BMI < 35 and the group with a maternal BMI ≥ 35. A lower maternal BMI was associated with a better perception of one's own weight, body image, and health, as well as the health of the child. CONCLUSION Positive parental perceptions on weight were correlated with improved compliance to a pediatric lifestyle modification program.
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Taylor A, Wilson C, Slater A, Mohr P. Self‐esteem and body dissatisfaction in young children: Associations with weight and perceived parenting style. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/j.1742-9552.2011.00038.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Amanda Taylor
- Food and Nutritional Sciences, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia
- School of Psychology, the University of Adelaide North Terrace Campus, Adelaide, South Australia
| | - Carlene Wilson
- Food and Nutritional Sciences, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia
- School of Psychology, the University of Adelaide North Terrace Campus, Adelaide, South Australia
- Cancer Council of South Australia, Eastwood
- Flinders Centre of Innovation in Cancer, Bedford Park, South Australia
| | - Amy Slater
- School of Psychology, Flinders University of South Australia, Bedford Park, South Australia
| | - Philip Mohr
- Food and Nutritional Sciences, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia
- School of Psychology, the University of Adelaide North Terrace Campus, Adelaide, South Australia
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Rissman L, Deavenport-Saman A, Corden MH, Zipkin R, Espinoza J. A pilot project: handwashing educational intervention decreases incidence of respiratory and diarrheal illnesses in a rural Malawi orphanage. Glob Health Promot 2020; 28:14-22. [PMID: 33103585 DOI: 10.1177/1757975920963889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Children who live in orphanages represent a population particularly vulnerable to transmissible diseases. Handwashing interventions have proven efficacy for reducing the rate of transmission of common infectious diseases. Few studies have analyzed the delivery of health interventions for children in orphanages in sub-Saharan Africa. To address this gap, we conducted an ecological assessment and piloted a handwashing intervention in an orphanage in rural Malawi, focusing on caregiver knowledge and behaviors, child handwashing behaviors, and disease incidence. A secondary study aim was to demonstrate program feasibility for a future randomized controlled trial. Orphanage caregivers participated in a three-module educational intervention on handwashing based on WHO recommendations and workshops on how to teach the curriculum to children. Seventeen orphanage caregivers and 65 children were monitored for handwashing behavior and child disease incidence. Friedman's tests were conducted to compare changes in caregiver knowledge and behaviors. Child handwashing behaviors and surveillance of child disease incidence were measured pre- and post-intervention. There were significant increases in caregiver hand hygiene knowledge. At six months post-intervention, handwashing with soap increased significantly among caregivers (p < 0.001) and was observed in children. The incidence of acute respiratory infections decreased from 30% to 6% post-intervention, resulting in an 80% decrease. The incidence of diarrhea decreased from 9.2% to 6.2% post-intervention, resulting in a 33% decrease. A brief educational intervention may improve handwashing knowledge and behaviors and help to decrease the incidence of common infectious diseases in an orphanage in rural Malawi. In addition, the caregiver uptake of the intervention demonstrated feasibility for future studies.
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Affiliation(s)
- Lauren Rissman
- Division of Pediatric Critical Care, Ann and Robert H. Lurie Children's Hospital of Chicago, USA
| | - Alexis Deavenport-Saman
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, USA
| | - Mark H Corden
- Department of Pediatrics, Keck School of Medicine, University of Southern California, USA.,Division of Hospital Medicine, Department of Pediatrics, Children's Hospital Los Angeles, USA
| | - Ronen Zipkin
- Department of Pediatrics, Keck School of Medicine, University of Southern California, USA.,Division of Hospital Medicine, Department of Pediatrics, Children's Hospital Los Angeles, USA
| | - Juan Espinoza
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, USA
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Chai LK, Collins C, May C, Brain K, Wong See D, Burrows T. Effectiveness of family-based weight management interventions for children with overweight and obesity: an umbrella review. ACTA ACUST UNITED AC 2020; 17:1341-1427. [PMID: 31021970 DOI: 10.11124/jbisrir-2017-003695] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The objective of the review was to synthesize the effectiveness and strategies used in family-based behavioral childhood obesity interventions in improving child weight-related outcomes. INTRODUCTION Family-based interventions are common practice in the treatment of childhood obesity. Research suggests that direct parental involvement can improve child weight-related outcomes. However, challenges remain in assessing the effects of family-based interventions on child weight and weight-related behavior due to the lack of quality programs and diversity of treatment strategies. INCLUSION CRITERIA The review included systematic reviews and/or meta-analyses of family-based behavioral interventions in children aged ≤18 who were classified as overweight and/or obese, and which reported child weight related outcomes, such as body mass index (BMI), body fat percentage and waist circumferences. METHODS Seven databases were searched from 1990 to May 2016 to identify English language publications. Reference lists of included reviews and relevant registers were also searched for additional reviews. All included systematic reviews were critically appraised by two reviewers independently. Data extracted included characteristics of included systematic reviews and weight-related outcomes reported. Data synthesis involved categorizing the interventions into seven categories and presented findings in narrative and tabular format. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS The umbrella review included 14 systematic reviews (low to moderate methodological quality), published between 2004 and 2015, including 47 independent trials ranging from one month to seven years follow-up conducted in more than 16 countries. The majority of reviews (93%) reported weight outcomes of children aged six to 13 years. All reviews except one indicated that family-based interventions were successful in improving child weight and/or weight-related behavior. Five reviews highlighted that parent-only interventions had similar (n = 4) or greater (n = 1) effectiveness compared to parent-child interventions. Effective interventions employed parent-targeted strategies, including nutrition and physical activity education sessions, positive parenting skills, role modelling and child behavior management to encourage positive healthy eating/exercise behaviors in children and/or whole family. CONCLUSIONS Family-based interventions targeting parents, alone or with their child, are effective for child weight management. Due to the lack of high quality evidence, especially in emerging parent-only interventions, further research is warranted. Health practitioners can work with parents as agents of change and focus on fostering positive parenting skills, such as monitoring, reinforcement, role modelling, and providing a nurturing environment, in order to support health behaviors in their children. Future research needs to explore whether parent-only interventions are more cost-effective compared to parent-child interventions, and to include larger populations, longer intervention duration and follow-up.
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Affiliation(s)
- Li Kheng Chai
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Clare Collins
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,The University of Newcastle Centre for Evidence Based Healthcare Informing Research (CEBHIR): a Joanna Briggs Institute Centre of Excellence
| | - Chris May
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia.,Family Action Centre, The University of Newcastle, Callaghan, Australia
| | - Katherine Brain
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Denise Wong See
- Department of Nutrition and Dietetics, John Hunter Children's Hospital, Newcastle, Australia
| | - Tracy Burrows
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
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De Craemer M, Verbestel V, Cardon G, Androutsos O, Manios Y, Chastin S. Correlates of Meeting the Physical Activity, Sedentary Behavior, and Sleep Guidelines for the Early Years among Belgian Preschool Children: The ToyBox-Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197006. [PMID: 32987961 PMCID: PMC7579535 DOI: 10.3390/ijerph17197006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 01/28/2023]
Abstract
Physical activity, sedentary behavior, and sleep guidelines for preschool children were already established and integrated into the 24 h movement behavior guidelines in 2017. The aim of the current study was to investigate correlates of meeting or not meeting the physical activity, sedentary behavior, and sleep guidelines in Belgian preschool children. In total, 595 preschool children (53.3% boys, 46.7% girls, mean age: 4.2 years) provided complete data for the three behaviors and potentially associated correlates. Physical activity was objectively measured with accelerometers. Screen time, sleep duration, and correlates were reported by parents with the use of a questionnaire. Backward logistic regression was used to identify factors associated with meeting all guidelines for weekdays and weekend days. In the final model, older preschoolers (OR = 1.89), having a normal weight compared to being underweight (OR = 0.30), having parents that do not watch a lot of television (OR = 0.99), and having a father that attained higher education (OR = 1.91) were associated with meeting all guidelines on weekdays. For weekend days, a significant association was found for attending a sports club (OR = 1.08). Overall, only a few factors were associated with meeting the guidelines. A more comprehensive measurement of preschool children’s potential correlates of physical activity, sedentary behavior, and sleep is warranted.
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Affiliation(s)
- Marieke De Craemer
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium;
- Research Foundation Flanders, 1000 Brussels, Belgium
- Correspondence: ; Tel.: +32-9332-52-08
| | - Vera Verbestel
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium;
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium;
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42100 Trikala, Greece;
| | - Yannis Manios
- School of Health Sciences & Education, Department of Nutrition and Dietetics, Harokopio University, 17676 Athens, Greece;
| | - Sebastien Chastin
- Department of Health and Community Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK;
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