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Konty KJ, Day SE, Larkin M, Thompson HR, D’Agostino EM. Physical fitness disparities among New York City public school youth using standardized methods, 2006-2017. PLoS One 2020; 15:e0227185. [PMID: 32271758 PMCID: PMC7144992 DOI: 10.1371/journal.pone.0227185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 12/13/2019] [Indexed: 12/23/2022] Open
Abstract
Standardized physical fitness monitoring provides a more accurate proxy for youth health when compared with physical activity. Little is known about the utilization of broad-scale individual-level youth physical fitness testing to explore health disparities. We examined longitudinal trends in population-level fitness for 4th-12th grade New York City youth during 2006/7-2016/17 (average n = 510,293 per year). Analyses were performed in 2019. The primary outcome was whether or not youth achieved sex-/age-specific performance levels (called the Healthy Fitness Zone) on the aerobic capacity, muscular strength and muscular endurance tests using the NYC FITNESSGRAM. The Cooper Institute’s most recent Healthy Fitness Zone criteria were applied to all tests and years. Prevalence estimates were weighted, accounted for school clustering, adjusted for student-level sociodemographics, and run by sociodemographic subgroups and year. The overall prevalence for meeting 3 Healthy Fitness Zones increased from 15.5% (95%CI: 13.9%-17.0%) in 2006/7 to 23.3% (95%CI: 22.2%-24.4%) in 2016/17 for students in grades 4–12. Fitness for all student groups increased over time, although Hispanic and non-Hispanic black girls consistently had the lowest prevalence of meeting 3 Healthy Fitness Zones as compared to all other race/sex subgroups. Also, 9th-12th graders had a lower prevalence of meeting 3 Healthy Fitness Zones as compared to 4th-8th graders. Given forecasted sharp increases in cardiovascular disease prevalence, routine youth fitness surveillance using standardized, criterion referenced methods can identify important fitness disparities and inform interventions.
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Affiliation(s)
- Kevin J. Konty
- NYC Department of Health and Mental Hygiene, Office of School Health, New York City, New York, United States of America
| | - Sophia E. Day
- NYC Department of Health and Mental Hygiene, Office of School Health, New York City, New York, United States of America
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Heath Policy, City University of New York, New York City, New York, United States of America
| | - Michael Larkin
- Learning, Teaching and Assessment, Plainedge School District, Massapequa, NY, United States of America
| | - Hannah R. Thompson
- Department of Community Health Sciences, School of Public Health, University of California Berkley, Berkeley, California, United States of America
| | - Emily M. D’Agostino
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Heath Policy, City University of New York, New York City, New York, United States of America
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, United States of America
- * E-mail:
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Thomas DM, Clark N, Turner D, Siu C, Halliday TM, Hannon BA, Kahathuduwa CN, Kroeger CM, Zoh R, Allison DB. Best (but oft-forgotten) practices: identifying and accounting for regression to the mean in nutrition and obesity research. Am J Clin Nutr 2020; 111:256-265. [PMID: 31552422 PMCID: PMC6997628 DOI: 10.1093/ajcn/nqz196] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 07/23/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Regression to the mean (RTM) is a statistical phenomenon where initial measurements of a variable in a nonrandom sample at the extreme ends of a distribution tend to be closer to the mean upon a second measurement. Unfortunately, failing to account for the effects of RTM can lead to incorrect conclusions on the observed mean difference between the 2 repeated measurements in a nonrandom sample that is preferentially selected for deviating from the population mean of the measured variable in a particular direction. Study designs that are susceptible to misattributing RTM as intervention effects have been prevalent in nutrition and obesity research. This field often conducts secondary analyses of existing intervention data or evaluates intervention effects in those most at risk (i.e., those with observations at the extreme ends of a distribution). OBJECTIVES To provide best practices to avoid unsubstantiated conclusions as a result of ignoring RTM in nutrition and obesity research. METHODS We outlined best practices for identifying whether RTM is likely to be leading to biased inferences, using a flowchart that is available as a web-based app at https://dustyturner.shinyapps.io/DecisionTreeMeanRegression/. We also provided multiple methods to quantify the degree of RTM. RESULTS Investigators can adjust analyses to include the RTM effect, thereby plausibly removing its biasing influence on estimating the true intervention effect. CONCLUSIONS The identification of RTM and implementation of proper statistical practices will help advance the field by improving scientific rigor and the accuracy of conclusions. This trial was registered at clinicaltrials.gov as NCT00427193.
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Affiliation(s)
- Diana M Thomas
- Department of Mathematical Sciences, US Military Academy, West Point, NY, USA,Address correspondence to DMT (e-mail: )
| | - Nicholas Clark
- Department of Mathematical Sciences, US Military Academy, West Point, NY, USA
| | - Dusty Turner
- Department of Mathematical Sciences, US Military Academy, West Point, NY, USA
| | - Cynthia Siu
- Department of Data Science, COS and Associates Ltd., Hong Kong, China
| | - Tanya M Halliday
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT, USA
| | - Bridget A Hannon
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Chanaka N Kahathuduwa
- Department of Human Development and Family Studies, Texas Tech University, Lubbock, TX, USA
| | - Cynthia M Kroeger
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia,Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Roger Zoh
- School of Public Health, Indiana University, Bloomington, IN, USA
| | - David B Allison
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
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Moore SM, Borawski EA, Love TE, Jones S, Casey T, McAleer S, Thomas C, Adegbite-Adeniyi C, Uli NK, Hardin HK, Trapl ES, Plow M, Stevens J, Truesdale KP, Pratt CA, Long M, Nevar A. Two Family Interventions to Reduce BMI in Low-Income Urban Youth: A Randomized Trial. Pediatrics 2019; 143:e20182185. [PMID: 31126971 PMCID: PMC6565337 DOI: 10.1542/peds.2018-2185] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Our primary aim was to evaluate the effects of 2 family-based obesity management interventions compared with a control group on BMI in low-income adolescents with overweight or obesity. METHODS In this randomized clinical trial, 360 urban-residing youth and a parent were randomly assigned to 1 of 2 behaviorally distinct family interventions or an education-only control group. Eligible children were entering the sixth grade with a BMI ≥85th percentile. Interventions were 3 years in length; data were collected annually for 3 years. Effects of the interventions on BMI slope (primary outcome) over 3 years and a set of secondary outcomes were assessed. RESULTS Participants were primarily African American (77%), had a family income of <25 000 per year, and obese at enrollment (68%). BMI increased over time in all study groups, with group increases ranging from 0.95 to 1.08. In an intent-to-treat analysis, no significant differences were found in adjusted BMI slopes between either of the family-based interventions and the control group (P = .35). No differences were found between the experimental and control groups on secondary outcomes of diet, physical activity, sleep, perceived stress, or cardiometabolic factors. No evidence of effect modification of the study arms by sex, race and/or ethnicity, household income, baseline levels of child and parent obesity, or exposure to a school fitness program were found. CONCLUSIONS In this low-income, adolescent population, neither of the family-based interventions improved BMI or health-related secondary outcomes. Future interventions should more fully address poverty and other social issues contributing to childhood obesity.
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Affiliation(s)
| | | | - Thomas E Love
- Departments of Educational Programs in Clinical Research and
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Sarah Jones
- Department of Nutrition Sciences, Dominican University, River Forest, Illinois
| | - Terri Casey
- Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Sarah McAleer
- Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Charles Thomas
- Frances Payne Bolton School of Nursing
- MetroHealth Medical Center, Cleveland, Ohio
| | | | - Naveen K Uli
- Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | | | | | | | - June Stevens
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kimberly P Truesdale
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Charlotte A Pratt
- Clinical Applications and Prevention Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland; and
| | | | - Ann Nevar
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
- Rainbow Babies and Children's Hospital, Cleveland, Ohio
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Seibert TS, Allen DB, Eickhoff J, Carrel AL. CDC childhood physical activity strategies fail to show sustained fitness impact in middle school children. Prev Med Rep 2018; 12:60-65. [PMID: 30181947 PMCID: PMC6120423 DOI: 10.1016/j.pmedr.2018.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 08/19/2018] [Indexed: 11/19/2022] Open
Abstract
An increasing number of children are now obese and fail to meet minimum recommendations for physical activity (PA). Schools play a critical role in impacting children's activity behaviors, including PA. Our objective was to assess whether CDC-based school-centered strategies to promote PA increase long-term cardiovascular fitness (CVF) levels in students in schools. A prospective observational trial was conducted in 26 middle schools to implement CDC school-based strategies to increase PA for 3 years. Students had CVF assessed by Fitnessgram (PACER), a 20-meter shuttle run, at the start and end of each school year. A post-study questionnaire was administered to assess each school's strategy adherence. At baseline, 2402 students with a mean age 12.2 ± 1.1 years showed a mean CVF measured by PACER of 33.2 ± 19.0 laps (estimated VO2max 44.3 ± 5.3 ml/kg/min). During the first year, there was a significant increase in the mean PACER score (Δ = 3, 95% CI: 2-4.1 laps, p < 0.001) and PACER z-score (Δ = 0.09, 95% CI: 0.04-0.14, p = 0.001). Subsequently, however, a significant negative trend in PACER z-scores occurred (β = -0.02, p < 0.0001) so that over the 3-year study period, the intervention did not increase overall CVF. This effort to implement CDC school-based PA strategies in middle schools did not result in sustained increase in CVF over 3 years. It remains to be clarified whether this limited efficacy indicates that CDC physical activity strategies are not sufficiently robust to meaningfully impact health outcomes and/or additional support is needed in schools to improve fidelity of implementation.
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Affiliation(s)
- Tasa S. Seibert
- Department of Pediatrics, Case Western Reserve University, United States of America
| | - David B. Allen
- Department of Pediatrics, University of Wisconsin, United States of America
| | - Jens Eickhoff
- Department of Pediatrics, University of Wisconsin, United States of America
| | - Aaron L. Carrel
- Department of Pediatrics, University of Wisconsin, United States of America
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