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Lupini F, Basch M, Cooke F, Vagadori J, Gutierrez-Colina A, Kelly KP, Streisand R, Shomaker L, Mackey ER. BREATHE-T1D: Using iterative mixed methods to adapt a mindfulness-based intervention for adolescents with type 1 diabetes: Design and development. Contemp Clin Trials 2024; 142:107551. [PMID: 38692428 DOI: 10.1016/j.cct.2024.107551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/02/2024] [Accepted: 04/27/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Negative affect is prevalent among adolescents with type 1 diabetes (T1D) and may impact diabetes self-management and outcomes through stress-related behaviors such as disordered eating. METHODS We describe the development of and design for the adaptation of a mindfulness-based intervention (MBI) for adolescents with T1D and negative affect. BREATHE-T1D is an MBI designed to target negative affect that has been tailored to address the unique lived experiences of adolescents with T1D. Qualitative interviews with stakeholders and participants were used to inform iterative adaptations to the intervention and control curricula over the course of the study. The primary aim of this paper is to describe the design, development, and protocol of the present pilot feasibility trial. CONCLUSIONS Iterative, qualitative methodology throughout the adaptation of an intervention is important for ensuring the resulting intervention is relevant and meaningful for the target population. CLINICAL TRIAL REGISTRATION NUMBER NCT05268393.
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Affiliation(s)
- Francesca Lupini
- Children's National Hospital, 111 Michigan Avenue, Washington, DC 20010, United States of America.
| | - Molly Basch
- Children's National Hospital, 111 Michigan Avenue, Washington, DC 20010, United States of America; The George Washington University School of Medicine, Washington, DC, United States of America
| | - Frances Cooke
- Children's National Hospital, 111 Michigan Avenue, Washington, DC 20010, United States of America.
| | - Jack Vagadori
- Children's National Hospital, 111 Michigan Avenue, Washington, DC 20010, United States of America.
| | - Ana Gutierrez-Colina
- Colorado State University, Fort Collins, CO, United States of America; University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America.
| | - Katherine Patterson Kelly
- Children's National Hospital, 111 Michigan Avenue, Washington, DC 20010, United States of America; The George Washington University School of Medicine, Washington, DC, United States of America.
| | - Randi Streisand
- Children's National Hospital, 111 Michigan Avenue, Washington, DC 20010, United States of America; The George Washington University School of Medicine, Washington, DC, United States of America.
| | - Lauren Shomaker
- Colorado State University, Fort Collins, CO, United States of America; University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America; Children's Hospital Colorado, Aurora, CO, United States of America.
| | - Eleanor R Mackey
- Children's National Hospital, 111 Michigan Avenue, Washington, DC 20010, United States of America; The George Washington University School of Medicine, Washington, DC, United States of America.
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Sanchez N, Chen M, Ho S, Spinner H, Vagadori J, Neiser A, Padilla K, Bristol M, Winfield E, Thorstad I, Gulley LD, Lucas-Thompson RG, Pyle L, Thompson T, Estrada DE, Basch M, Tanofsky-Kraff M, Kelsey MM, Mackey ER, Shomaker LB. Mindfulness-based intervention for depression and insulin resistance in adolescents: Protocol for BREATHE, a multisite, pilot and feasibility randomized controlled trial. Contemp Clin Trials 2024; 141:107522. [PMID: 38580104 DOI: 10.1016/j.cct.2024.107522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/18/2024] [Accepted: 04/02/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Elevated depression symptoms have been associated with higher insulin resistance in adolescents, and consequently, greater risk for type 2 diabetes (T2D). Mindfulness-based intervention (MBI) may be suited for adolescents at risk for T2D given its potential to decrease depression and improve stress-related behavior/physiology underpinning insulin resistance. To prepare for a future multisite efficacy randomized controlled trial, a rigorous, multisite, pilot and feasibility study is needed to test this approach. The current paper describes the design and protocol for a multisite, pilot and feasibility randomized controlled trial of six-week MBI, cognitive-behavioral therapy (CBT), and health education (HealthEd) group interventions, to assess multisite fidelity, feasibility, and acceptability. METHODS Participants are N = 120 adolescents ages 12-17, with body mass index (BMI) ≥85th percentile, elevated depression symptoms (20-item Center for Epidemiologic Studies-Depression Scale total score > 20), and family history of diabetes. Enrollment occurs across four United States (US) sites, two in Colorado, one in Washington, D·C., and one in Maryland. Group interventions are delivered virtually by trained psychologists and co-facilitators. Assessments occur at baseline, six-week follow-up, and one-year follow-up. RESULTS Primary outcomes are intervention implementation fidelity, based upon expert ratings of audio-recorded sessions (≥80% adherence/competence), and recruitment feasibility, based upon percentage enrollment of eligible youth (≥80%). Secondary outcomes are intervention training fidelity/feasibility/acceptability, recruitment timeframe, and retention/assessment feasibility. CONCLUSION Findings will inform optimization of training, recruitment, intervention delivery, retention, and assessment protocols for a multisite, efficacy randomized controlled trial evaluating MBI for decreasing depression and improving insulin resistance in adolescents at risk for developing T2D.
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Affiliation(s)
- Natalia Sanchez
- Department of Human Development and Family Studies, Colorado State University, USA.
| | - Michele Chen
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, USA
| | - Sally Ho
- Center for Translational Research, Children's National Hospital, USA
| | - Holly Spinner
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, USA
| | - Jack Vagadori
- Center for Translational Research, Children's National Hospital, USA
| | - Abigail Neiser
- Department of Human Development and Family Studies, Colorado State University, USA
| | - Kimberly Padilla
- Department of Human Development and Family Studies, Colorado State University, USA
| | - Madison Bristol
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, USA
| | - Elijah Winfield
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, USA
| | - Isabel Thorstad
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, USA
| | - Lauren D Gulley
- Department of Human Development and Family Studies, Colorado State University, USA; Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, USA
| | - Rachel G Lucas-Thompson
- Department of Human Development and Family Studies, Colorado State University, USA; Colorado School of Public Health, Fort Collins, Colorado, USA
| | - Laura Pyle
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, USA
| | - Talia Thompson
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, USA
| | - Doris E Estrada
- Center for Translational Research, Children's National Hospital, USA; Department of Pediatrics, Division of Diabetes and Endocrinology, Children's National Hospital, USA
| | - Molly Basch
- Center for Translational Research, Children's National Hospital, USA
| | - Marian Tanofsky-Kraff
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, USA; Department of Medical and Clinical Psychology, Uniformed Services University, USA
| | - Megan M Kelsey
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, USA
| | - Eleanor R Mackey
- Center for Translational Research, Children's National Hospital, USA
| | - Lauren B Shomaker
- Department of Human Development and Family Studies, Colorado State University, USA; Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine and Children's Hospital Colorado, USA; Colorado School of Public Health, Fort Collins, Colorado, USA
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Lupini F, Rubinstein TB, Mackey ER, Sule S. Behavioral health outcomes and social determinants of health in children with diabetes and juvenile arthritis. Res Sq 2023:rs.3.rs-3610878. [PMID: 38076886 PMCID: PMC10705696 DOI: 10.21203/rs.3.rs-3610878/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Objective Children with chronic illnesses, including arthritis, are at increased risk for adverse psychosocial outcomes influenced by social determinants of health (SDOH). Comparing psychosocial outcomes in families affected by juvenile arthritis compared to other chronic illnesses may help identify areas in need of special attention vs areas that may be addressed through adopting other disease examples' care models. We examined child and parent behavioral health outcomes for families with juvenile arthritis compared to diabetes, accounting for SDOH. Methods Secondary data analysis of the National Survey of Children's Health including 365 children (<18yrs) with arthritis and 571 children with diabetes. Psychosocial outcomes were depression, anxiety, ADHD, physical pain, behavioral problems, and treatment for mental health. School outcomes were school engagement, school absence, involvement in clubs/organization, and involvement in organized activities. Parent outcomes were family resilience, emotional support, coping with daily demands of raising a child, job change due to problems with childcare, and parent mental health. SDOH variables were food insecurity, food/cash assistance, unsafe neighborhood, detracting neighborhood elements, parent education, households earning <100% of the federal poverty line. Logistic regression analyses were utilized to examine variation in child and parent outcomes, variation in SDOH, and the role of SDOH. Results Children with arthritis experienced significantly more physical pain, anxiety, depression, ADHD, and behavior problems compared to children with diabetes. Children with arthritis were more likely to see a mental health professional and get treatment for problems with emotions/behaviors. When considering SDOH, children with arthritis were still more likely to experience adverse psychosocial outcomes but were no longer more likely to get treatment. Children with arthritis had increased likelihood of school absence and were less involved in organized activities than children with diabetes. Parents of children with arthritis had poorer mental health than parents of children with diabetes. SDOH were more prevalent in children with arthritis than children with diabetes. Conclusions Increased risk for adverse psychosocial outcomes in youth with arthritis compared to youth with diabetes indicates a need to mirror endocrinology models of care in rheumatology clinics. The role of SDOH highlights the need for regular SDOH screening in clinic.
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Affiliation(s)
| | | | - Eleanor R Mackey
- Children's National Medical Center: Children's National Hospital
| | - Sangeeta Sule
- Children's National Medical Center: Children's National Hospital
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Mackey ER, Burton ET. Rosalind Franklin Society Proudly Announces the 2022 Award Recipient for Childhood Obesity. Child Obes 2023; 19:363. [PMID: 37651593 DOI: 10.1089/chi.2023.29017.rfs2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Inverso H, Moore HR, Lupini F, Wang CH, Streisand R, Shomaker LB, Mackey ER. Mindfulness-Based Interventions: Focus on Pediatric Type 1 and Type 2 Diabetes. Curr Diab Rep 2022; 22:493-500. [PMID: 35984566 DOI: 10.1007/s11892-022-01492-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Mindfulness-based interventions (MBIs) focus on promoting nonjudgmental, purposeful awareness of the present experience, and they include specific components such as body scan, meditation, and breathing techniques for healthier coping with stress and reduced negative affect. In adult populations with chronic illness (e.g., type 1 diabetes [T1D], type 2 diabetes [T2D], overweight), MBIs have been shown to improve psychosocial outcomes with some improvements in health outcomes as well. Youth with T1D/T2D frequently experience heightened depression as well as diabetes distress, which are associated with less frequent blood glucose monitoring, insulin administration, and nutrition oversight. Thus, MBIs have potential to alleviate psychosocial distress in youth with T1D/T2D and also improve health outcomes. This paper is a review of the literature on potential psychosocial and health benefits of MBIs for youth with T1D/T2D. RECENT FINDINGS Among youth with T1D/T2D, MBIs have been shown to reduce symptoms of depression and diabetes distress. Improvements in health outcomes, such as A1c, have been inconsistent across studies. Although research on the efficacy of MBIs to improve psychosocial and health outcomes in youth with T1D/T2D is promising, this area of study is in its early stages. Future investigation of MBIs in youth with T1D and T2D is warranted, recognizing that these are heterogeneous groups with potential benefit of specifically tailored interventions.
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Affiliation(s)
- Hailey Inverso
- Center for Translational Research, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Hailey R Moore
- Center for Translational Research, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Francesca Lupini
- Center for Translational Research, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Christine H Wang
- Center for Translational Research, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Randi Streisand
- Center for Translational Research, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
- The George Washington University School of Medicine, Washington, DC, USA
| | - Lauren B Shomaker
- Colorado State University, Fort Collins, CO, USA
- Children's Hospital Colorado/University of Colorado Anschutz, Aurora, CO, USA
- Colorado School of Public Health, Fort Collins and Aurora, CO, USA
| | - Eleanor R Mackey
- Center for Translational Research, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.
- The George Washington University School of Medicine, Washington, DC, USA.
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6
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Mackey ER, Tully C, Rose M, Hamburger S, Wang J, Herrera N, Cogen F, Henderson C, Monaghan M, Hornack S, Streisand R. Promoting glycemic control in young children with type I diabetes: Results from a pilot intervention for parents. Fam Syst Health 2022; 40:239-251. [PMID: 35666897 PMCID: PMC9749792 DOI: 10.1037/fsh0000672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Nutrition and physical activity are key components of daily diabetes care in young children with type I diabetes (T1D). Normative developmental behavioral challenges related to nutrition and physical activity complicate management of T1D. The current pilot study evaluated the feasibility, acceptability, and indications of behavior change of an intervention aimed at improving nutrition and physical activity in young children with T1D. METHOD Thirty-6 parents of young children (ages 2-5 years, M = 4.2) with T1D from 2 clinics in the Washington, DC area were randomized to receive the type One Training (TOTs) program or Usual Care (UC). Assessments included recruitment and completion rates, participant acceptability, and outcomes including glycemic variability via continuous glucose monitoring, nutritional intake via remote food photography, physical activity via accelerometers, and parental report on behavior and psychosocial functioning. RESULTS Despite recruitment challenges, the TOTs program was feasible to administer, with high program and assessment completion rates. Acceptability ratings were very high but differed by recruitment site. Participants randomized to TOTs had an increase in percent of time in target glycemic range and reduction in behavioral feeding problems between baseline and follow-up while those randomized to UC did not. Participants in UC demonstrated a decrease in in moderate to vigorous physical activity at follow-up. CONCLUSIONS The TOTs program demonstrated preliminary feasibility and acceptability. Future research will examine components of treatment for evidence of efficacy and target the intervention to those most likely to benefit. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | - Fran Cogen
- Department of Psychology and Behavioral Health
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7
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Fischer L, Bodrick N, Mackey ER, McClenny A, Dazelle W, McCarron K, Mork T, Farmer N, Haemer M, Essel K. Feasibility of a Home-Delivery Produce Prescription Program to Address Food Insecurity and Diet Quality in Adults and Children. Nutrients 2022; 14:nu14102006. [PMID: 35631144 PMCID: PMC9144615 DOI: 10.3390/nu14102006] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023] Open
Abstract
Produce prescription programs aim to improve food insecurity (FI) and nutrition but their effectiveness is unclear. We conducted a pilot study to demonstrate the feasibility and explore the potential impact of a family-based, home-delivery produce prescription and nutrition education program. We measured enrollment, satisfaction, participation, and retention as measure of feasibility. Adult participants answered pre-post self-report questionnaires assessing FI, child and adult fruit and vegetable intake, and culinary literacy and self-efficacy. To understand participants' lived experiences, qualitative interviews were conducted at the 6-month time point. Twenty-five families were enrolled. Feasibility measures indicate participants were generally satisfied with the program but there were important barriers to participation. Qualitative data revealed themes around reduced food hardship, healthy eating, budget flexibility, and family bonding. Fruit and vegetable consumption increased in a small subgroup of children, but post-intervention intake remained below recommended levels, particularly for vegetables. FI scores were not significantly different post-intervention, but qualitative findings indicated improved access and reliability of food. This is the first intervention of its kind to be evaluated for feasibility and our results suggest the intervention is well-received and supportive. However, further study, with a larger sample size, is needed to understand factors influencing participation and assess effectiveness.
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Affiliation(s)
- Laura Fischer
- Department of General and Community Pediatrics, Children’s National Hospital, Washington, DC 20010, USA; (L.F.); (N.B.)
- School of Medicine and Health Sciences, George Washington University, Washington, DC 20037, USA; (E.R.M.); (W.D.)
| | - Nia Bodrick
- Department of General and Community Pediatrics, Children’s National Hospital, Washington, DC 20010, USA; (L.F.); (N.B.)
- School of Medicine and Health Sciences, George Washington University, Washington, DC 20037, USA; (E.R.M.); (W.D.)
| | - Eleanor R. Mackey
- School of Medicine and Health Sciences, George Washington University, Washington, DC 20037, USA; (E.R.M.); (W.D.)
- Center for Translational Research, Children’s National Hospital, Washington, DC 20010, USA
| | | | - Wayde Dazelle
- School of Medicine and Health Sciences, George Washington University, Washington, DC 20037, USA; (E.R.M.); (W.D.)
| | - Kristy McCarron
- YMCA of Metropolitan Washington, Washington, DC 20009, USA; (K.M.); (T.M.)
| | - Tessa Mork
- YMCA of Metropolitan Washington, Washington, DC 20009, USA; (K.M.); (T.M.)
| | - Nicole Farmer
- National Institutes of Health Clinical Center, Translational Biobehavioral and Health Disparities Branch, Bethesda, MD 20892, USA;
| | - Matthew Haemer
- Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80121, USA;
| | - Kofi Essel
- Department of General and Community Pediatrics, Children’s National Hospital, Washington, DC 20010, USA; (L.F.); (N.B.)
- School of Medicine and Health Sciences, George Washington University, Washington, DC 20037, USA; (E.R.M.); (W.D.)
- Correspondence: ; Tel.: +1-202-994-0275
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8
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Tashiro J, McKenna E, Alberto EC, Mackey ER, Nadler EP. The impact of parental bariatric surgery and patient age on laparoscopic sleeve gastrectomy outcomes in adolescents. Surg Endosc 2022; 36:7392-7398. [PMID: 35403902 DOI: 10.1007/s00464-022-09149-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/15/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adolescent obesity is multifactorial, but parental history is the most significant risk factor. Laparoscopic sleeve gastrectomy (LSG) is part of the multidisciplinary approach to adolescent weight loss. OBJECTIVE We aimed to evaluate the effects of parental history of bariatric surgery, as well as age at time of operation, on adolescents who underwent LSG at our institution. METHODS We performed a retrospective review of patients, aged 10 to 19 years, who underwent LSG from January 2010 to December 2019. The adolescent bariatric surgical dataset maintained by our group was used to obtain patient demographics, weight, body mass index (BMI), and parental history of bariatric surgery. RESULTS Among 328 patients, 76 (23.2%) had parents who had previously undergone bariatric surgery. These patients were significantly heavier by weight (p = 0.012) at the time of operation but had no difference in postoperative weight loss. When all patients were compared by age at operation (< 16 years, n = 102, ≥ 16 years, n = 226), there were few differences in outcomes. CONCLUSIONS LSG is an effective approach to surgical weight loss in adolescents. Patient age should not be a barrier to weight loss surgery, especially among patients with a parental history of obesity. By intervening at a younger age, the metabolic sequelae of obesity may be reduced.
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Affiliation(s)
- Jun Tashiro
- Division of Pediatric Surgery, New York University Langone Health, New York, NY, USA.
| | - Elise McKenna
- Division of Pediatric Surgery, Children's National Hospital, Washington, DC, USA
| | - Emily C Alberto
- Division of Pediatric Surgery, Children's National Hospital, Washington, DC, USA
| | - Eleanor R Mackey
- Division of Pediatric Surgery, Children's National Hospital, Washington, DC, USA
| | - Evan P Nadler
- Division of Pediatric Surgery, Children's National Hospital, Washington, DC, USA
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Mackey ER, Burton ET, Cadieux A, Getzoff E, Santos M, Ward W, Beck AR. Addressing Structural Racism Is Critical for Ameliorating the Childhood Obesity Epidemic in Black Youth. Child Obes 2022; 18:75-83. [PMID: 34491828 DOI: 10.1089/chi.2021.0153] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Racism and childhood obesity are both pervasive factors adversely affecting the health and wellbeing of children and adolescents in the United States. The association between racism and obesity has been touched upon in the literature; yet most work has focused on a few dimensions of intersectionality of these two domains at one time. The renewed focus on structural racism as the primary contributor to distress of Black individuals in the United States has highlighted the urgency of identifying the contributions of racism to the childhood obesity epidemic. The current article is not a complete review of the literature, rather, it is meant to take a broad narrative review of the myriad ways in which racism contributes to the obesity epidemic in Black youth to serve as a call to action for more research, prevention, and intervention. The current article illustrates how a number of mechanisms for the etiology and maintenance of obesity are heavily influenced by racism and how addressing racism is critical for ameliorating the childhood obesity epidemic.
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Affiliation(s)
- Eleanor R Mackey
- Children's National Hospital, Center for Translational Research, Washington, DC, USA.,The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - E Thomaseo Burton
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Adelle Cadieux
- Department of Behavioral Health, Helen DeVos Children's Hospital, Grand Rapids, MI, USA.,Department of Pediatrics and Human Development, Michigan State University, Lansing MI, USA
| | - Elizabeth Getzoff
- Department of Psychology and Neuropsychology, Mt. Washington Pediatric Hospital, Baltimore, MD, USA
| | - Melissa Santos
- Division of Pediatric Psychology, Connecticut Children's, Hartford, CT, USA
| | - Wendy Ward
- Department of Pediatrics, College of Medicine, University of Arkansas Medical Center, Little Rock, AR, USA
| | - Amy R Beck
- Center for Children's Healthy Lifestyles and Nutrition and Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, MO, USA.,Department of Pediatrics, University of Missouri, Kansas City School of Medicine, Kansas City, MO, USA
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10
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Burton ET, Mackey ER, Reynolds K, Cadieux A, Gaffka BJ, Shaffer LA. Psychopathology and Adolescent Bariatric Surgery: A Topical Review to Support Psychologists in Assessment and Treatment Considerations. J Clin Psychol Med Settings 2021; 27:235-246. [PMID: 32333235 DOI: 10.1007/s10880-020-09717-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The rising rates of severe obesity among adolescents in the United States indicate a dire need for more intensive weight management strategies. While current evidence suggests that bariatric surgery is a safe and efficacious intervention for adolescents, the linkages with psychopathology before and after surgery are not well understood. Psychologists are an integral part of the interdisciplinary surgery team and play an important role in preparing youth for bariatric surgery as well as supporting adolescents post-surgery. The present manuscript reviews the literature on psychopathology in the context of adolescent bariatric surgery, discusses consideration of psychopathology as a contraindication for surgery, and provides recommendations on how psychologist members of the bariatric surgery team may balance attention to motivation and adherence to medical recommendations with assessment and treatment of psychopathology. Finally, the importance of continued research to confirm clinical consensus regarding decision-making and expansion of psychological resources within adolescent bariatric surgery programs are discussed.
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Affiliation(s)
- E Thomaseo Burton
- Department of Pediatrics, University of Tennessee Health Science Center, 50 N. Dunlap Street, Room 452R, Memphis, TN, 38103, USA. .,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA.
| | - Eleanor R Mackey
- Center for Translational Research, Children's National Health System, Washington, DC, USA.,Department of Psychiatry and Behavioral Science, The George Washington University School of Medicine, Washington, DC, USA
| | - Kimberly Reynolds
- Institute on Development and Disability, Oregon Health & Science University, Portland, OR, USA
| | - Adelle Cadieux
- Helen DeVos Children's Hospital, Grand Rapids, MI, USA.,Michigan State University, East Lansing, MI, USA
| | - Bethany J Gaffka
- Department of Pediatrics, C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI, USA
| | - Laura A Shaffer
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
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11
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Mackey ER, Efron LA. The use of surveys to improve the clinical psychology internship program and intern recruitment process. Clinical Practice in Pediatric Psychology 2020. [DOI: 10.1037/cpp0000307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Mackey ER, Rose M, Tully C, Monaghan M, Hamburger S, Herrera N, Streisand R. The current state of parent feeding behavior, child eating behavior, and nutrition intake in young children with type 1 diabetes. Pediatr Diabetes 2020; 21:841-845. [PMID: 32061034 DOI: 10.1111/pedi.12997] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/22/2020] [Accepted: 02/12/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND One integral component of type 1 diabetes (T1D) management is attention to nutrition, which can be particularly challenging in young children. OBJECTIVE The current study reports on parent and child eating/feeding behavior and nutrition intake as compared with current recommendations for pediatric T1D. SUBJECTS Participants were 46 children ages 2 to 5 diagnosed with T1D and one parent. METHODS The Behavioral Pediatrics Feeding Assessment Scale (BPFAS) was used to assess parent feeding and child eating behaviors. The Remote Food Photography Method (RFPM) was used to analyze nutrition intake at breakfast. Demographic and medical information were collected via self-report and medical chart review. RESULTS In the current sample, 37% of BPFAS scores were above the cutoff for problem child eating behavior. Only 28% of participants met the recommended goals for glycemic control (hemoglobin A1c, HbA1c < 7.5). Children who did not meet glycemic control targets reported higher carbohydrate intake than those meeting targets. Protein recommendations were met by 46%; 22.7% met the recommendation for carbohydrate intake, and 45.5% met fat intake recommendations. The majority of the sample did not meet body mass index percentile (BMI%) recommendations with 51% having a BMI% above the 85th percentile. CONCLUSIONS Many parents of young children with T1D report problem child eating behaviors. Further, a significant number of young children are not meeting glycemic, nutritional, or BMI guidelines for T1D. Routine screening for dietary difficulties in young children is warranted. Future research should aim to examine interventions targeting families with young children not meeting nutrition, glycemic, or BMI guidelines.
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Affiliation(s)
- Eleanor R Mackey
- Children's National Hospital, Washington, District of Columbia, USA.,George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Meredith Rose
- Children's National Hospital, Washington, District of Columbia, USA.,George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Carrie Tully
- Children's National Hospital, Washington, District of Columbia, USA.,George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Maureen Monaghan
- Children's National Hospital, Washington, District of Columbia, USA.,George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Samantha Hamburger
- Children's National Hospital, Washington, District of Columbia, USA.,George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Nicole Herrera
- Children's National Hospital, Washington, District of Columbia, USA.,George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Randi Streisand
- Children's National Hospital, Washington, District of Columbia, USA.,George Washington University School of Medicine, Washington, District of Columbia, USA
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13
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Mackey ER, Jacobs M, Nadler EP, Olson A, Pearce A, Cherry JBC, Magge SN, Mietus-Snyder M, Vaidya C. Cognitive Performance as Predictor and Outcome of Adolescent Bariatric Surgery: A Nonrandomized Pilot Study. J Pediatr Psychol 2019; 43:916-927. [PMID: 29788390 DOI: 10.1093/jpepsy/jsy028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 04/14/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives Evidence in adults suggests that improvements in cognitive performance may follow weight loss resulting from bariatric surgery, and baseline cognitive performance may be associated with weight loss following surgery. This has not been evaluated in adolescents. Method Participants were 38 adolescents of age 14-21 years composed of three groups: (1) 12 adolescents with severe obesity who received vertical sleeve gastrectomy during the study (VSG); (2) 14 adolescents with severe obesity who were wait-listed for VSG (WL); and (3) 12 healthy weight controls (HC). Participants completed testing of visual memory, verbal memory, and executive functioning at baseline (T1), which occurred presurgery for the VSG group, and approximately 4 months after baseline (T2). Body mass index (BMI) was assessed at T1, T2, and additionally at 6 months following VSG for the adolescents who received surgery. Results Although there was evidence of greater improvement for the VSG as compared with WL and HC groups in visual and verbal memory, group differences did not reach significance and effect sizes were small (η2 < 0.01). There was a significant positive association between indices of baseline executive functioning and excess BMI loss at 6 months postsurgery. Conclusions This small pilot study showed no significant differences by group in cognitive performance post-VSG. There was a significant association of baseline cognitive performance with weight loss outcomes. Given the very preliminary nature of these results in a small sample, future research should examine these relationships in a larger sample and evaluate mechanisms of these associations (e.g., insulin resistance, sleep, physical activity).
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Affiliation(s)
- Eleanor R Mackey
- Children's National Medical Center, Center for Translational Sciences and
| | - Marni Jacobs
- Children's National Medical Center, Center for Translational Sciences and
| | - Evan P Nadler
- Children's National Medical Center, Center for Translational Sciences and
| | - Alexandra Olson
- Children's National Medical Center, Center for Translational Sciences and
| | | | | | - Sheela N Magge
- Children's National Medical Center, Center for Translational Sciences and
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14
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Hornack SE, Nadler EP, Wang J, Hansen A, Mackey ER. Sleeve Gastrectomy for Youth With Cognitive Impairment or Developmental Disability. Pediatrics 2019; 143:peds.2018-2908. [PMID: 30988024 DOI: 10.1542/peds.2018-2908] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Youth with cognitive impairment or developmental disability (CI/DD) face higher rates of obesity and secondary medical issues. Bariatric surgery may be a helpful tool for health improvement because it has been shown efficacious for adolescents. We aim to contribute to literature regarding bariatric surgery for adolescents with CI/DD and explore the association between cognitive functioning and weight loss outcomes. METHODS Adolescents (N = 64) received a preoperative psychological evaluation, including cognitive assessment, and bariatric surgery at 1 weight loss program between 2010 and 2017. For these adolescents with measured cognitive performance, CI/DD was defined by an IQ <80 or previous diagnosis. In analyses, we compared adolescents with and without CI/DD. Structural equation modeling was used to assess the impact of cognitive functioning on weight loss 3 to 24 months postsurgery. RESULTS There were no significant differences between adolescents with or without CI/DD in terms of preoperative BMI, age, and sex. Having CI/DD did not significantly impact weight loss or weight loss trajectory in the 2 years after surgery, although modeling revealed a trend toward individuals with CI/DD losing more weight over time. Similarly, intelligence scores did not predict weight loss after surgery. CONCLUSIONS Bariatric surgery may be a helpful tool for adolescents with severe obesity and CI/DD. They could benefit from the surgery as much as those with typical development, and having CI/DD should not be used as a criterion to deny surgery. Continuing research with this population can be used to determine long-term outcomes in addition to defining best practices.
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Affiliation(s)
- Sarah E Hornack
- Center for Translational Research, Children's National Health System, Washington, District of Columbia; .,School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia; and
| | - Evan P Nadler
- Center for Translational Research, Children's National Health System, Washington, District of Columbia.,School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia; and
| | - Jichuan Wang
- Center for Translational Research, Children's National Health System, Washington, District of Columbia.,School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia; and
| | - Amysue Hansen
- Department of Psychology, George Mason University, Fairfax, Virginia
| | - Eleanor R Mackey
- Center for Translational Research, Children's National Health System, Washington, District of Columbia.,School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia; and
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15
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Vaughns JD, Williams EF, Mackey ER, Muret JC, van den Anker J, Nadler EP, Quezado ZM. Analgesic Requirements in Adolescents Undergoing Bariatric Surgery-an Observational Study. Obes Surg 2019; 29:1557-1562. [PMID: 30737764 DOI: 10.1007/s11695-019-03727-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM To examine the impact of preexisting psychiatric/psychological diagnoses on perioperative analgesic requirements in adolescents with morbid obesity undergoing bariatric surgery. METHODS A retrospective cohort study of adolescents with morbid obesity undergoing bariatric surgery. Primary and secondary outcomes included perioperative analgesic intake and pain scores (Numerical Rating Scale (0-10) NRS) throughout the hospital stay. RESULTS From our Bariatric Surgery Research Registry, we identified 17 adolescents with psychiatric/psychological diagnoses prior to undergoing bariatric surgery. Fifteen patients from the same registry and without such diagnosis undergoing bariatric surgery during the same time interval served as controls. In both groups, there was a predominance of female patients. During the perioperative period, in both groups, oral morphine equivalent and ketorolac and acetaminophen intake were similar. Notably, the perioperative median pain scores at the times examined were below 5 for all patients. The median pain scores in the PACU, day of surgery, and first postoperative day were similar. Conversely, on postoperative day 2, pain scores were higher in patients with diagnoses of psychiatric/psychological disorders (p = 0.004) compared to those without. CONCLUSION In this cohort of morbidly obese adolescents undergoing bariatric surgery, patients with and without preexisting psychiatric/psychological diagnoses had similar analgesic requirements during the perioperative period. This finding appears contrary to those suggesting that preexisting depression and/or anxiety might be associated with increased analgesic requirements during the perioperative period.
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Affiliation(s)
- Janelle D Vaughns
- Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Health System/The George Washington University School of Medicine and Health Sciences, Washington, DC., Washington, DC, USA. .,Division of Pediatric Clinical Pharmacology, Children's National Health System/The George Washington University School of Medicine and Health Sciences, Washington, DC., Washington, DC, USA.
| | - Elaine F Williams
- Division of Pediatric Clinical Pharmacology, Children's National Health System/The George Washington University School of Medicine and Health Sciences, Washington, DC., Washington, DC, USA
| | - Eleanor R Mackey
- Division of Psychology, Children's National Health System/The George Washington University School of Medicine and Health Sciences, Washington, DC., Washington, DC, USA
| | - Jane C Muret
- Division of Pediatric Clinical Pharmacology, Children's National Health System/The George Washington University School of Medicine and Health Sciences, Washington, DC., Washington, DC, USA.,Departement Anesthésie Reanimation Douleur, Institut Curie PSL Research University, Paris, France
| | - John van den Anker
- Division of Pediatric Clinical Pharmacology, Children's National Health System/The George Washington University School of Medicine and Health Sciences, Washington, DC., Washington, DC, USA.,Division of Paediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, Basel, Switzerland
| | - Evan P Nadler
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System/The George Washington University School of Medicine and Health Sciences, Washington, DC., Washington, DC, USA
| | - Zenaide M Quezado
- Department of Perioperative Medicine, National Institutes of Health Clinical Center, Bethesda, MD, USA
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16
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Mackey ER, Wang J, Harrington C, Nadler EP. Psychiatric Diagnoses and Weight Loss Among Adolescents Receiving Sleeve Gastrectomy. Pediatrics 2018; 142:peds.2017-3432. [PMID: 29858452 DOI: 10.1542/peds.2017-3432] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Severe obesity is associated with higher risk of psychiatric difficulties. Bariatric surgery is the most effective treatment of severe obesity. Few guidelines exist regarding the association of psychiatric diagnoses in adolescents and outcomes after surgery because of the lack of longitudinal research. Our objective is to evaluate the rates of psychiatric diagnoses in adolescents undergoing surgery compared with those not receiving surgery and the association of preoperative psychiatric diagnoses with postsurgical weight loss outcomes. METHODS Adolescents (N = 222) referred for psychological evaluation at one institution for bariatric surgery (2009-2017) completed semistructured clinical interviews to assess the presence and number of psychiatric diagnoses. Comparison analyses were conducted between those who did not end up receiving surgery (N = 53) and those who did (N = 169). Using longitudinal modeling, we assessed the association of preoperative diagnoses with weight loss outcomes between 3 and 12 months after surgery. RESULTS Seventy-one percent of adolescents qualified for a psychiatric disorder. There were no differences in rates of specific disorders or numbers of diagnoses between those receiving surgery and those not receiving surgery. The presence or absence or number of diagnoses before surgery was not associated with weight loss outcomes after surgery. CONCLUSIONS Psychiatric diagnoses are prevalent among adolescents with severe obesity. These diagnoses are not associated with weight loss outcomes. The presurgical psychological evaluation serves as an opportunity to identify adolescents experiencing psychiatric problems and provide them with care but should not necessarily be considered a contraindication to surgery.
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Affiliation(s)
- Eleanor R Mackey
- Center for Translational Science, Children's National Health System, Washington, District of Columbia; and .,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Jichuan Wang
- Center for Translational Science, Children's National Health System, Washington, District of Columbia; and.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Chloe Harrington
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Evan P Nadler
- Center for Translational Science, Children's National Health System, Washington, District of Columbia; and.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
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17
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Rose MH, Nadler EP, Mackey ER. Impulse Control in Negative Mood States, Emotional Eating, and Food Addiction are Associated with Lower Quality of Life in Adolescents with Severe Obesity. J Pediatr Psychol 2017; 43:443-451. [DOI: 10.1093/jpepsy/jsx127] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/26/2017] [Indexed: 12/31/2022] Open
Affiliation(s)
- Meredith H Rose
- Center for Translational Sciences, Children’s National Health System
| | - Evan P Nadler
- Department of Surgery, Children’s National Health System
| | - Eleanor R Mackey
- Center for Translational Sciences, Children’s National Health System
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18
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Schweitzer AL, Ross JT, Klein CJ, Lei KY, Mackey ER. An Electronic Wellness Program to Improve Diet and Exercise in College Students: A Pilot Study. JMIR Res Protoc 2016; 5:e29. [PMID: 26929118 PMCID: PMC4791526 DOI: 10.2196/resprot.4855] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/14/2015] [Accepted: 11/13/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In transitioning from adolescence to adulthood, college students are faced with significant challenges to their health habits. Independence, stress, and perceived lack of time by college students have been known to result in poor eating and exercise habits, which can lead to increased disease risk. OBJECTIVE To assess the feasibility and to determine preliminary efficacy of an electronic wellness program in improving diet and physical activity in college students. METHODS A 24-week diet and physical activity program was delivered via email to 148 college students. The intervention involved weekly, tailored, and interactive diet and physical activity goals. The control group received nondiet and nonexercise-related health fact sheets. Anthropometric and blood pressure measurements, as well as food frequency and physical activity surveys were conducted at baseline, week 12, and week 24. Students' choice of fruit as a snack was also monitored at study visits. RESULTS Students were 18-20 years old, 69% female, and from a diverse college campus (46% Caucasian, 23% Asian, 20% African American, 11% other). At week 24, 84% of students reported reading at least half of all emails. Mean change (standard error [SE]) from baseline of saturated fat intake was marginally significant between the treatment groups at week 24, 0.7 (SE 0.42) % kcal for control and -0.3 (SE 0.30) % kcal for intervention (P=0.048). A significant difference in percent of snacks chosen that were fruit (χ(2)1, N=221 = 11.7, P<0.001) was detected between the intervention and control group at week 24. CONCLUSIONS Use of an electronic wellness program is feasible in college students and resulted in a decrease in saturated fat intake and an increase in observed fruit intake compared to a control group.
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Affiliation(s)
- Amy L Schweitzer
- Children's National Health System, Clinical Research Center, Washington, DC, United States.
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19
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Abstract
Obesity is widespread, associated with several physical and psychosocial comorbidities, and is difficult to treat. Prevention of obesity across the lifespan is critical to improving the health of individuals and society. Screening and prevention efforts in primary care are an important step in addressing the obesity epidemic. Each period of human development is associated with unique risks, challenges, and opportunities for prevention and intervention. Screening tools for overweight/obesity, although imperfect, are quick and easy to administer. Screening should be conducted at every primary care visit and tracked longitudinally. Screening tools and cutoffs for overweight and obesity vary by age group.
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Affiliation(s)
- Eleanor R Mackey
- Department of Psychology and Behavioral Health, Children's National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA.
| | - Alexandra Olson
- Children's National Health System, Center for Translational Science, 111 Michigan Avenue Northwest, Washington, DC 20010, USA
| | - Marc DiFazio
- Department of Neurology, Children's National Health System, 9850 Key West Avenue, 4th Floor, Rockville, MD 20850, USA
| | - Omni Cassidy
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
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20
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Romirowsky AM, Kushner MR, Matherne CE, Nadler EP, Mackey ER. Evidence-based psychological interventions to support an adolescent undergoing bariatric surgery: A case report. Clinical Practice in Pediatric Psychology 2015. [DOI: 10.1037/cpp0000085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Mackey ER, Struemph K, Powell PW, Chen R, Streisand R, Holmes CS. Maternal depressive symptoms and disease care status in youth with type 1 diabetes. Health Psychol 2014; 33:783-91. [PMID: 24799001 DOI: 10.1037/hea0000066] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The current study assessed relations among maternal depressive symptoms, poorer youth diabetes adherence, and glycemic control. Specifically, hypothesized mediating links of lowered expectations of parental involvement, less parental monitoring, and more conflict were examined. METHOD Participants included 225 mothers and their young adolescents, aged 11-14 years (M = 12.73 years, SD = 1.2) diagnosed with T1D. Maternal depressive symptoms and outcome expectancies for maternal involvement were evaluated with self-report questionnaires. Multisource, parent/youth, and multimethod assessment of adherence, parental monitoring, and conflict were evaluated during a baseline assessment from a larger randomized clinical trial. RESULTS The first hypothesized structural equation model demonstrated a good fit and indicated that more maternal depressive symptoms were directly associated with less parental monitoring and more conflict, which in turn each were associated with poorer adherence and glycemic control. Although higher involvement expectancies were associated with more monitoring and less conflict, they were not associated with other model variables. A second alternative model also fit the data well; poorer youth adherence was associated with more conflict that in turn related to maternal depressive symptoms. CONCLUSIONS Two models were tested by which maternal depressive symptoms and poorer youth adherence were interrelated via less monitoring and more conflict. Follow-up longitudinal evaluation can best characterize the full extent of these relations.
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Affiliation(s)
| | - Kari Struemph
- Department of Psychology, Virginia Commonwealth University
| | | | - Rusan Chen
- Center For New Designs In Learning & Scholarship, Georgetown University
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22
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Sweenie R, Mackey ER, Streisand R. Parent-child relationships in Type 1 diabetes: associations among child behavior, parenting behavior, and pediatric parenting stress. Fam Syst Health 2014; 32:31-42. [PMID: 24294984 PMCID: PMC3950351 DOI: 10.1037/fsh0000001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Interactions between parents and children can influence behavioral and emotional functioning related to Type 1 diabetes (T1D), yet have been relatively unexplored during preadolescence. The present study examined associations among child problem behaviors, critical parenting behaviors, and pediatric parenting stress in a sample of preadolescent youth with T1D. Data are available from 86 preadolescent-parent dyads who participated in the initial baseline assessment of a randomized controlled trial designed to assess the efficacy of an adherence promotion program. Measures included the Eyberg Child Behavior Inventory, the Diabetes Family Behavior Checklist, and the Pediatric Inventory for Parents. After controlling for significant demographic and medical characteristics, parents who reported their child's behavior as more problematic reported more difficulty with pediatric parenting stress, which was also associated with more child-reported critical parenting behaviors. Child problem behaviors and critical parenting behaviors were associated with one another, partially via their association with increased pediatric parenting stress. Potential clinical applications include interventions geared toward helping parents manage difficult child behaviors as well as cope with pediatric parenting stress, with the ultimate goal of improving the parent-child relationship and management of T1D.
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23
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Abstract
Through Value Enhanced Nutrition Assessment and other techniques, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) engages clients to set their own nutrition goals. A case series of 30 Hispanic children (2-4.5 years) at ≥85th body mass index (BMI) percentile and their caregivers were followed through an urban WIC clinic. The dyads received either standard counseling ( n = 15) or motivational interviewing (MI; n = 15) by one bilingual WIC nutritionist during 4 regularly scheduled visits over 6 months. Repeated measurements of anthropometric data, dietary patterns, and physical activity were obtained at each visit. Longitudinal bivariate analyses of caregiver concerns and goal selection were conducted along with mean comparisons of anthropometric and food frequency measures. Participation in counseling sessions as rated by the nutritionist was assessed by comparing Wilcoxon rank-sum scores. After counseling, children lost an adjusted mean weight of 0.878 kg (95% confidence interval = 0.280-1.717). A decline in median BMI of more than 3 percentiles ( P = .042) was observed with both counseling approaches. Caregiver-reported vegetable intake of children increased an average of one additional serving in the MI-counseled group by visit 3 ( P = .013) despite MI recipient caregivers being scored as significantly more distracted than standard WIC participants in the first visit ( P = .036). MI is a viable option for WIC counseling to improve diet and health outcomes in participants, particularly in addressing child BMI status and vegetable intake. Public health professionals should examine scalability of the MI approach among larger samples of WIC participants and other innovative techniques to improve client focus during counseling.
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Affiliation(s)
- Linda C. Ogu
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, The George Washington University, Washington, DC (LCO, HJH)
- Children’s National Medical Center, Washington, DC (JJ, LM, ERM)
- University of Maryland, College Park, Maryland (APV)
- LSRO Solutions, Bethesda, Maryland (CJK)
| | - Jayasri Janakiram
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, The George Washington University, Washington, DC (LCO, HJH)
- Children’s National Medical Center, Washington, DC (JJ, LM, ERM)
- University of Maryland, College Park, Maryland (APV)
- LSRO Solutions, Bethesda, Maryland (CJK)
| | - Heather J. Hoffman
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, The George Washington University, Washington, DC (LCO, HJH)
- Children’s National Medical Center, Washington, DC (JJ, LM, ERM)
- University of Maryland, College Park, Maryland (APV)
- LSRO Solutions, Bethesda, Maryland (CJK)
| | - Libia McDonough
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, The George Washington University, Washington, DC (LCO, HJH)
- Children’s National Medical Center, Washington, DC (JJ, LM, ERM)
- University of Maryland, College Park, Maryland (APV)
- LSRO Solutions, Bethesda, Maryland (CJK)
| | - Ana P. Valencia
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, The George Washington University, Washington, DC (LCO, HJH)
- Children’s National Medical Center, Washington, DC (JJ, LM, ERM)
- University of Maryland, College Park, Maryland (APV)
- LSRO Solutions, Bethesda, Maryland (CJK)
| | - Eleanor R. Mackey
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, The George Washington University, Washington, DC (LCO, HJH)
- Children’s National Medical Center, Washington, DC (JJ, LM, ERM)
- University of Maryland, College Park, Maryland (APV)
- LSRO Solutions, Bethesda, Maryland (CJK)
| | - Catherine J. Klein
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, The George Washington University, Washington, DC (LCO, HJH)
- Children’s National Medical Center, Washington, DC (JJ, LM, ERM)
- University of Maryland, College Park, Maryland (APV)
- LSRO Solutions, Bethesda, Maryland (CJK)
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Tanofsky-Kraff M, Sbrocco T, Theim KR, Cohen LA, Mackey ER, Stice E, Henderson JL, McCreight SJ, Bryant EJ, Stephens MB. Obesity and the US military family. Obesity (Silver Spring) 2013; 21:2205-20. [PMID: 23836452 PMCID: PMC4010088 DOI: 10.1002/oby.20566] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 06/28/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This review discusses the current knowledge and future directions regarding obesity within the US military family (i.e., active-duty servicemembers, as well as military spouses, children, retirees, and veterans). The increasing rates of overweight and obesity within the US military adversely impact military readiness, limit recruitment, and place a significant financial burden on the Department of Defense. DESIGN AND METHODS The following topics are reviewed: 1) The prevalence of and the financial, physical, and psychological costs associated with overweight in military communities; 2) military weight regulations, and challenges faced by the military family related to overweight and disordered eating; 3) the continued need for rigorous program evaluations and new intervention development. RESULTS Overweight and its associated sequelae impact the entire military family. Military families share many similarities with their civilian counterparts, but they face unique challenges (e.g., stress related to deployments and relocations). Although the military has weight management resources, there is an urgent need for rigorous program evaluation and the development of enhanced obesity prevention programs across the lifespan of the military family-several of which are proposed herein. CONCLUSIONS Interdisciplinary and collaborative research efforts and team-based interventions will continue to inform understanding of obesity treatment and prevention within military and civilian populations.
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Affiliation(s)
- Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Tracy Sbrocco
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kelly R. Theim
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - L. Adelyn Cohen
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Eleanor R. Mackey
- Children's National Medical Center, Washington, District of Columbia, USA
| | - Eric Stice
- Oregon Research Institute, Eugene, Oregon, USA
| | - Jennifer L. Henderson
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sarah J. McCreight
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Edny J. Bryant
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Mark B. Stephens
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Streisand R, Mackey ER, Elliot BM, Mednick L, Slaughter IM, Turek J, Austin A. Parental anxiety and depression associated with caring for a child newly diagnosed with type 1 diabetes: opportunities for education and counseling. Patient Educ Couns 2008; 73:333-8. [PMID: 18692342 DOI: 10.1016/j.pec.2008.06.014] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Revised: 05/19/2008] [Accepted: 06/22/2008] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To examine demographic and clinical characteristics, such as pediatric parenting stress and self-efficacy for diabetes care, of parents of children newly diagnosed with type 1 diabetes that are associated with parental anxiety and depression. METHODS 102 parents reported on their levels of depression (CESD), state anxiety (STAI), pediatric parenting stress (PIP), and self-efficacy for diabetes care (SED) within 4 weeks of their child's diagnosis with type 1 diabetes. Data were analyzed using hierarchical multiple regression. RESULTS Parents' scores in the clinical range for depression and anxiety were associated with increased frequency and difficulty of pediatric parenting stress, and there was a trend for depression to be related to lower self-efficacy for diabetes care. The association of female gender with anxiety and depression was partially mediated by more frequent pediatric parenting stress. CONCLUSION Parents of children newly diagnosed with type 1 diabetes are at risk for experiencing anxiety and depression, related, in part, to their experiences of pediatric parenting stress. PRACTICE IMPLICATIONS Providers and educators should be aware of the risk for depression and anxiety in parents and should work to decrease pediatric parenting stress, increase self-efficacy, and refer parents who are experiencing significant anxiety or depression following their child's diagnosis to a mental health specialist.
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Affiliation(s)
- Randi Streisand
- Department of Psychiatry & Behavioral Sciences,, Children's National Medical Center, Washington, DC 20010, USA.
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Willoughby BLB, Lai BS, Doty ND, Mackey ER, Malik NM. Peer crowd affiliations of adult gay men: Linkages with health risk behaviors. Psychology of Men & Masculinity 2008. [DOI: 10.1037/1524-9220.9.4.235] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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