Exploring Factors Associated With Accelerometer Validity Among Ethnically Diverse Toddlers

PURPOSE

Studying physical activity in toddlers using accelerometers is challenging due to noncompliance with wear time (WT) and activity log (AL) instructions. The aims of this study are to examine relationships between WT and AL completion and (1) demographic and socioeconomic variables, (2) parenting style, and (3) whether sedentary time differs by AL completion.

METHODS

Secondary analysis was performed using baseline data from a community wellness program randomized controlled trial for parents with toddlers (12-35 mo). Parents had toddlers wear ActiGraph wGT3x accelerometers and completed ALs. Valid days included ≥600-minute WT. Analysis of variance and chi-square analyses were used.

RESULTS

The sample (n = 50) comprised racial and ethnically diverse toddlers (mean age = 27 mo, 58% male) and parents (mean age = 31.7 y, 84% female). Twenty-eight families (56%) returned valid accelerometer data with ALs. Participants in relationships were more likely to complete ALs (P < .05). Toddler sedentary time did not differ between those with ALs and those without.

CONCLUSIONS

We found varied compliance with WT instructions and AL completion. Returned AL quality was poor, presenting challenges in correctly characterizing low-activity counts to improve internal validity of WT and physical activity measures. Support from marital partners may be important for adherence to study protocols.

Associations of regular consumption of breakfast, lunch and dinner with Body Mass Index during adolescence: longitudinal findings by weight status among the Eating and Activity over Time 2010-2018 cohort

OBJECTIVE

To examine how the associations between meal consumption and BMI over 8 years differ by weight status in a sample of adolescents.

DESIGN

Longitudinal, population-based study. Breakfast, lunch and dinner consumption and BMI were self-reported. Linear regressions were used to examine how the associations between meal consumption and BMI differed by weight status.

SETTING

Adolescents in the Minneapolis/St. Paul metropolitan area.

PARTICIPANTS

Adolescents (n 1,471) were surveyed as part of the EAT 2010-2018 in 2009-2010 (Mage = 14·3 years) and 2017-2018 (Mage = 22·0 years).

RESULTS

The prevalence of regular breakfast, lunch and dinner consumption (≥ 5 times/week) ranged from 45 to 65 %, 75 to 89 % and 76 to 94 %, respectively, depending on weight status category. Among adolescents with a sex- and age-specific BMI < 15th percentile, regular consumptions of breakfast, lunch and dinner during adolescence were positively associated with BMI in emerging adulthood compared with irregular consumption of breakfast, lunch and dinner (<5 times/week) after adjustment for socio-demographic characteristics (β = 5·43, β = 5·39 and β = 6·46, respectively; all P-values <0·01). Among adolescents in the BMI 15-85th and 85-95th percentiles, regular consumptions of breakfast, lunch and dinner were positively associated with BMI but to a lesser extent (P-values <0·01). For participants with a BMI ≥ 95th percentile, regular consumptions of breakfast, lunch and dinner were positively associated with BMI, but the associations were not statistically significant (P-values > 0·05).

CONCLUSIONS

The relationship between meal consumption during adolescence and BMI in emerging adulthood differs by adolescent weight status. Future studies should investigate underlying factors related to meal consumption routines and BMI.

Response to school-based interventions for overweight and obesity: A systematic scoping review

Heterogeneity of response to paediatric obesity interventions is one of the greatest challenges to obesity care. While evaluating school-based interventions by mean changes compared to control is important, it does not provide an understanding of the individual variability in response to intervention. The objective of this study was to comprehensively review school-based interventions that reported study results in terms of response and identify definitions of response used. A scoping review was conducted using a systematic search of five scientific databases from 2009 to 2021. Inclusion criteria included randomized controlled trial design, school-based setting, weight-based outcomes (e.g., BMI, BMI z-score), weight-based outcomes analysed among youth with overweight/obesity, a study conducted in a developed country and publication in English. A total of 26 reports representing 25 unique studies were included. Overall, 19% (5/26) of articles reported response. Response was defined in three ways: maintenance/decrease in BMI z-score, decrease in BMI z-score ≥0.10, and decrease in BMI z-score ≥0.20. Few school-based interventions identified an a priori intervention goal or identified the proportion of participants who responded to the intervention. Without such evaluation participants who do not benefit are likely to be overlooked.

Exploratory Decision Trees to Predict Obesity Intervention Response among Hispanic American Youth

Introduction: Individual variability in weight-related outcomes from obesity intervention is widely acknowledged, yet infrequently addressed. This study takes a first step to address individual variation by determining characteristics that distinguish responsive (improvements in BMI) from unresponsive individuals. Methods: Classification regression tree (CRT) analysis grouped 185 low-income, Hispanic American middle school students who received a school-based obesity intervention. Predictors included baseline age, gender, standardized BMI, health-related quality of life (PedsQL), minutes of moderate-vigorous physical activity (MVPA; accelerometry), energy consumption, and dietary quality (Block Kids 2004 Food Frequency Questionnaire). Response regarding weight-related outcomes to the intervention was defined according to the American Academy of Pediatrics (AAP) guidelines. Six trees were produced, one for 3- and one for 6-month outcomes among all participants, participants with healthy weight status, and participants with overweight/obesity at baseline. Results: The AAP criteria for response were met by 57.3% and 35.1% of participants at 3 and 6 months, respectively. CRT produced six unique trees. Notably, minutes of MVPA appeared twice (the first time at the top of the tree) in most 3-month models. In addition, response at 3 months consistently appeared as the first variable in all the 6-month models. Conclusions: Overall, the number of distinct pathways and the repeated appearance of the same variable within a pathway illustrate the complex, interactive nature of factors predicting an intervention response. Initially unresponsive individuals were unlikely to respond later in the intervention. More complex modeling is needed to better understand how to best predict who will be responsive to interventions.

Incorporating Nutrition Counseling into Lifestyle Medicine

Despite considerable evidence that plant-based diets can significantly improve health, medical professionals seldom discuss this with their patients. This issue might occur due to minimal training received in medical education, lack of time, and low self-efficacy for counseling patients about diet. Nutrition and lifestyle change should be considered a core competency for all physicians and health professionals looking for cost-effective ways to improve patient health outcomes and reduce nutrition-related chronic diseases. Strategies for health professionals to acquire nutrition counseling skills in medical training and clinical practices are discussed.

Harmonizing Ratings From Different School Environment Assessment Methods: A Simplified Approach

BACKGROUND

This study describes a method for harmonizing data collected with different tools to compute a rating of compliance with national recommendations for school physical activity (PA) and nutrition environments.

METHODS

We reviewed questionnaire items from 84 elementary schools that participated in the Childhood Obesity Research Demonstration (CORD) project, which was 3 distinct childhood obesity prevention projects in 7 communities in California, Massachusetts, and Texas. Each project used tools specific to its programs, schools, and communities. While this approach increased the feasibility of data collection, it created a challenge with the need to combine data across projects. We evaluated all questionnaire items and retained only those items that assessed one or more recommendations and constructed several items to indicate compliance or noncompliance with the respective associated recommendations.

RESULTS

Ten constructed items covered 11 of the 20 recommendations. Analysis indicated that the scores detected variability in compliance both among communities and among school within communities.

CONCLUSIONS

The scores captured differences in compliance with the national recommendations at multiple levels. Our method, designed for creating common scores, may be useful in integrated data analysis, systematic reviews, or future studies requiring harmonizing of data collected via different tools.

A staged approach to address youth unresponsive to initial obesity intervention: a randomized clinical trial

Background/objective

Maintenance interventions inherently require BMI improvement to maintain. This overlooks individuals initially unresponsive to obesity interventions. Staged pediatric clinical treatment guidelines were adapted to the school setting to develop an escalated treatment option for individuals initially unresponsive. This staged randomized controlled trial examined differences between escalated treatment (Take CHARGE!) and a maintenance program (PE Planners). Take CHARGE was hypothesized to have greater improvements in BMI as a percentage of the 95th BMI Percentile (%BMIp95) than PE Planners.

Subjects/methods

From 2018 to 2020, 171 middle and high schoolers (BMI Percentile ≥ 85) were recruited from a Houston school district to participate in a staged obesity intervention in their physical education (PE) class. After receiving a semester-long intensive lifestyle intervention (ILI) with established efficacy, all participants were randomized to Take CHARGE (n = 85) or PE Planners (n = 86). Take CHARGE escalated the behavioral treatment of obesity received in ILI with more frequent individual sessions, additional opportunities for parental and school staff involvement, and increased mentorship from trained college students. PE Planners allowed participants to decide how they wanted to be active in PE class. Mixed linear modeling examined %BMIp95 overtime between groups. This trial was registered at ClinicalTrials.gov (#NCT04362280).

Results

Participants were 13.63 ± 1.32 years old; 59% were female, and 85% were Hispanic. Among those initially unresponsive to ILI, Take CHARGE had significantly greater decreases in %BMIp95 than PE Planners (β = −0.01, p < 0.01). Conversely, among those initially responsive, Take CHARGE had significantly smaller decreases in %BMIp95 than PE Planners (β = 0.02, p < 0.05). Intention-to-treat analysis had similar results.

Conclusions

Participant outcomes in semester two differed based on initial response. Individuals responsive to initial intervention were most likely to benefit from a maintenance intervention and those initially unresponsive benefited more from escalated treatment. This indicates the need for staged intervention protocols to better address obesity in the school setting.

Feasibility and Efficacy of the "FUNPALs Playgroup" Intervention to Improve Toddler Dietary and Activity Behaviors: A Pilot Randomized Controlled Trial

This study evaluated the feasibility and effects of the Families Understanding Nutrition and Physically Active Lifestyles (FUNPALs) Playgroup on toddler (12–36-month-old) diet and activity behaviors. Parent–toddler dyads were recruited from disadvantaged communities and randomly assigned to receive 10-weekly sessions of the FUNPALs Playgroup (n = 24) or dose-matched health education control group (n = 26). FUNPALs Playgroups involved physical and snack activities, delivery of health information, and positive parenting coaching. The control group involved group health education for parents only. Process outcomes (e.g., retention rate, fidelity) and focus groups determined feasibility and perceived effects. To evaluate preliminary effects, validated measures of toddler diet (food frequency questionnaire and a carotenoid biomarker), physical activity (PA; accelerometers), general and feeding parenting (self-report surveys), and home environment (phone interview) were collected pre and post. The sample comprised parents (84% female) who self-identified as Hispanic/Latino (38%) and/or African American (32%). Retention was high (78%). Parents from both groups enjoyed the program and perceived improvements in their children’s health behaviors. Objective measures demonstrated improvement with large effects (η² = 0.29) in toddler diet (p < 0.001) but not PA (p = 0.099). In conclusion, the FUNPALs Playgroup is feasible and may improve toddler eating behaviors.

Exploring qualities of ethnically diverse parents related to the healthy home environment of toddlers

Parents serve as role models and household policy makers for their children's home social environment. Also, parents may influence the home physical environment through the provision of resources to support their children's dietary, activity, and sleep behaviors. Understanding the parental characteristics related to children's home environment may allow for tailoring obesity interventions to families' needs. This study aimed to explore parental qualities (general parenting styles, parent feeding practices, and parental BMI) related to healthy home food, physical activity, media and sleep environment of toddlers. A total of 50 multi-ethnic parents with toddler age children who were enrolled in a randomized pilot study of a wellness program completed the Structure and Control in Parent Feeding (SCPF) questionnaire and Comprehensive General Parenting Questionnaire (CGPQ). Parental BMI was calculated using self-reported weight and height data. The Healthy Home Survey, the Home Food Inventory, the Sleep Environment Questionnaire, and items developed for this study were standardized and summed to create home food, physical activity, screen media, and sleep environment scores; high scores reflected healthier environments. To examine the relationships between parental qualities and the home environment, Pearson's correlation test was performed. Parental BMI and overall healthy home environment were inversely associated (r = -0.306; p = 0.032). Structure in general parenting and parental feeding practice were positively correlated with the overall healthy home environment (r = 0.336; p = 0.026) and healthy home food environment (r = 0.415; p = 0.003), respectively. The coercive control general parenting was inversely related to overall healthy home environment score (r = -0.333; p = 0.022). Based on the findings from this study, parents who provide clear communication, set consistent rules, avoid pressure to control their child's behavior, and have lower BMI tend to live in a home environment that support children's health behaviors.

The Importance of Health Values Among Health Care Providers

Medical professionals' healthy eating and physical activity behaviors are likely to wane as other life events and everyday pressures increase. This is vital because as health behaviors decrease, the likelihood that this topic is addressed with patients also decreases. Increased training to improve health care providers' knowledge about lifestyle behaviors may be inadequate to actually bring about a healthier lifestyle. The area of personal identity and value formation may shed light on a significant barrier in this area. Developing health care professionals who have values consistent with a healthy diet and physical activity, instead of just being informed about it, would increase the likelihood that healthy behavior changes are discussed with patients. Strategies to encourage value formation around healthy lifestyles among medical professionals are discussed.

Randomized Controlled Trial to Increase Physical Activity Among Hispanic-American Middle School Students

BACKGROUND

Moderate-to-vigorous physical activity (MVPA) declines during adolescence, particularly among girls. In this randomized control trial, we examined MVPA in a physical activity intervention compared to physical education (PE) class as usual (TAU), stratified by sex and weight classification. Standardized BMI (zBMI) overtime was also examined.

METHODS

Hispanic-American middle school students (N = 193) were recruited from a school district in Houston, Texas. Participants were randomized to either a circuit-based physical activity intervention or TAU (PE class as usual). MVPA was assessed using accelerometry at baseline and 6 months. Repeated measures ANCOVA were conducted to examine changes in MVPA, overall and stratified by sex and weight classification. This procedure was repeated for zBMI.

RESULTS

Participants were 12.10 ± 0.63 years old and 53% were girls. Overall those in intervention increased weekday MVPA more than TAU (F(1,190) = 7.03, p < .01). Intervention girls increased weekday MVPA; whereas TAU girls decreased weekday MVPA (F(1,99) = 7.36, p < .01). Among those with obesity, there was no difference in MVPA between conditions (F(1, 56) = 0.33, p = .57), but Intervention decreased zBMI significantly more than TAU (F(1, 56) = 6.16, p < .05).

CONCLUSIONS

Structured PE classes grounded in behavioral theory may be an important strategy to prevent typical decreases in MVPA during adolescence, particularly among girls and for youth with obesity.

The Role of Early and Later Response on Overall Outcomes in School-Based Obesity Intervention

OBJECTIVE

Early response to obesity intervention consistently predicts long-term BMI reductions. However, little is known about how changes in weight at other times in an intervention may impact long-term outcomes. This study examined the relationship between weight-related changes that occurred early and later during an intervention and the association between these changes with overall outcomes.

METHODS

A secondary analysis of a school-based obesity intervention with replicated efficacy among Hispanic middle school students was conducted (n = 174). Linear regression models were developed in which first and second semester changes in BMI represented as a percentage of the 95th BMI percentile (%BMIp95) were separately used to predict overall %BMIp95 outcomes. First semester changes in %BMIp95 were used to predict subsequent %BMIp95 change (i.e., second semester).

RESULTS

Changes in %BMIp95 during both the first and second semesters were independently associated with overall changes from baseline (e.g., at 24 months: first semester, β = 0.59, P < 0.01; second semester, β = 1.02, P < 0.001). First semester %BMIp95 change was not associated with second semester change (β = -0.07, P = 0.32).

CONCLUSIONS

Change at any point during the intervention was predictive of overall weight outcomes. Additional research is needed to understand patterns of weight changes throughout interventions to better understand long-term outcomes.

Physical Activity During Early Childhood: The Importance of Parental Modeling

Increasing physical activity (PA) is a critical issue in improving overall health. Prior attempts by public health campaigns to promote PA through health-focused messaging have faced challenges. As PA and sedentary behaviors are developed during the early childhood period (ages 0 to 5 years), this stage represents a unique opportunity for clinicians to encourage activity at the family level. Clinicians should discuss the holistic benefits of PA, including the development of social skills and relationships, motor skills that could be applicable to sports later in life, and cognitive skills that could translate to academic achievements in school. For PA to occur in children, parents should also be engaged in and model the PA behaviors, increasing the likelihood of young children learning to be physically active.

Screen Media: A Powerful Reinforcement

The use of screen media has significantly increased and several lifestyle consequences have occurred following this change. Screen media exposure is more common among younger age children. Multiple factors may be the reason for this; however, their use is likely reinforced. Parents seek support from screen media devices, which can help calm and occupy their children in a matter of minutes. However, resorting to electronic devices for instant relief is likely to persist due to both negative and positive reinforcement. Reinforcing screen media in this way will make the use of screen devices inextricable for parents and their children. Explaining the issue clearly and coming up with feasible solutions will help minimize the negative health effects of prolonged screen use, the general desirability of screen media devices, and also improve (and increase) healthy screen time habits in children.

Integrating Mindfulness Into Eating Behaviors

Food choices and eating behaviors are influenced by a wide variety of factors. However, traditional dietary advice primarily addresses health-related reasons for eating. Lifestyle medicine outcomes may be improved by helping individuals become more aware of why they eat and support individuals to increase their skills in reconciling eating for health and nonhealth purposes. Intuitive eating aims to increase individuals' awareness of why, what, and how much they eat through mindfulness. This framework and concepts such as flexible restraint can be used to teach individuals skills that may help them improve psychological well-being and manage their weight.

Differences among participants' response to a wellness intervention for individuals with spinal cord injuries

BACKGROUND

Individuals with spinal cord injuries (SCI) often struggle with lifestyle adjustment following injury. Effective wellness interventions may aid in improving quality of life; however, treatment response heterogeneity is a concern for behavioral interventions.

OBJECTIVE

To identify differences among adults with SCI who were responders and non-responders in a wellness intervention.

METHODS

There were 29 persons with SCI who received a wellness intervention. Participants engaged in six in-person workshops over a 3-month period, led by wellness experts with peer mentors available. Individual intervention participant change was compared to the mean among control group participants target outcomes variables (i.e., satisfaction with life, self-efficacy for health practices, secondary conditions, health promoting behaviors, and perceived stress) to classify responders versus non-responders.

RESULTS

Of the 29 participants, 18 who completed the intervention were classified as responders and 11 were non-responders. The mean age was 43.2 ± 11.2 years, and years post-injury were 12.0 ± 9.8. Decision tree regression analysis for demographic variables and injury characteristics showed that single/divorced participants were more likely to not respond to the intervention (52%), compared to married participants (17%). Further, participants who were single/divorced and ≤50 years old were more likely to not respond to the intervention (62%) than those who were older (25%).

CONCLUSIONS

Single/divorced individuals with SCI may respond differently to behavioral wellness interventions than married individuals. Additionally, the effects of age on treatment response in behavioral interventions should be further examined. Identifying non-modifiable factors related to response heterogeneity may help guide the creation of tailored interventions specific to patient characteristics.

Lessons Learned From Implementing of Garden Education Program in Early Child Care

Background. Early childhood is a critical life period for promoting health behaviors, and early child care and education centers (ECECs) are critical settings, as 60% of U.S. children attend ECECs. Yet few programs or curricula that promote physical activity and nutrition in this setting exist. This study explored the acceptability, feasibility, and sustainability of the Sustainability via Active Garden Education (SAGE) program. Method. Preintervention interviews were conducted to inform the design of SAGE and postintervention interviews were conducted to evaluate the implementation of SAGE in the ECEC setting. A constant comparison approach was used to capture emergent themes on acceptability, feasibility, and sustainability from interviews. Participants. ECEC directors (N = 10, 90% female, 20% Hispanic, 30% African American). Results. Directors expressed that SAGE was acceptable and feasible as it was age-appropriate, engaging, and aligned with existing curricula and accreditation standards. Most directors reported that SAGE improved activity and nutrition related knowledge while building other social and academic skills (e.g., expanding vocabulary) that are critical to this important developmental period. Suggestions for improving the sustainability of the program included stronger parental involvement and opportunities for ECEC staff trainings.

Sustainability via Active Garden Education: Translating Policy to Practice in Early Care and Education

BACKGROUND

We describe the development of sustainability via active garden education (SAGE), an early care and education (ECE) garden-based curriculum developed from a 5-year community partnership to link national health policy guidelines with ECE accreditation standards.

METHODS

National health guidelines and ECE accreditation standards were reviewed, and community advisory board members, ECE staff, and parents provided feedback and support throughout the development of the curriculum. The SAGE curriculum components were guided by the Ecologic Model of Physical Activity and Social Cognitive Theory. Strengths-weaknesses-opportunities-threat analyses were used to refine and revise the curriculum to overcome challenges to implementation.

RESULTS

Twelve 1-hour, developmentally appropriate, modularized lessons were created using the garden as a metaphor for human development. Lessons featured songs, simple games, pretend play, modeling, and garden activities. Parents were engaged via weekly newsletters with information about activities in the classroom, strategies to improve health habits at home, and free community resources.

CONCLUSION

SAGE partnered scientific theory and rigor with community ingenuity and innovation to create a clear translation of policy guidelines to easily implementable practice in a fun and engaging manner.

Association of parental body mass index (BMI) with child's health behaviors and child's BMI depend on child's age

Background

Parent’s and child’s body mass index (BMI) are strongly associated, but their relationship varies by child’s sex and age. Parental BMI reflects, among other factors, parents’ behaviors and home environment, which influence their child’s behaviors and weight. This study examined the indirect effect of parent’s BMI on child’s BMI via child health behaviors, conditional on child’s sex and age.

Methods

Data from 2039 children and 1737 parents from eight cities of the U.S. involved in the Childhood Obesity Research Demonstration project tested the association between parental BMI and child’s percentage of 95th BMI percentile (%BMIp95). A generalized structural equation modeling approach to path analysis was used to estimate and test simultaneously the associations among parental BMI and child’s health behaviors and BMI across three age groups (preschool 2-4 yr., elementary 5-10 yr., and middle school 11-12 yr). Child’s health behaviors were examined as mediators.

Results

Parental BMI was related to %BMIp95 across all age groups, and was strongest in 11-12 yr. children. Parental BMI was positively associated with boys’ fruit and vegetable (FV) intake and girls’ sugar-sweetened beverage (SSB) intake. Compared to 2-4 yr., older children had less FVs and physical activity, more screen time and SSB, and higher %BMIp95. Mediation effects were not significant.

Conclusions

Parental BMI was associated with child’s %BMIp95 and some child behaviors, and this association was stronger in older children; older children also exhibited less healthy behaviors. Age- and sex-specific interventions that focus on age-related decreases in healthy behaviors and parental strategies for promoting healthy behaviors among at-risk children are needed to address this epidemic of childhood obesity.

Well on wheels intervention: Satisfaction with life and health for adults with spinal cord injuries

Objective/Background: To examine how demographic and injury characteristics identify satisfaction with life (SWL), and assess the differential effects of a wellness intervention by baseline SWL groups.Design: Baseline and longitudinal analysis of a randomized controlled pilot intervention using decision tree regression and linear mixed models.Setting: Community based.Participants: Seventy-two individuals with spinal cord injury (SCI) were randomized to an intervention group (n = 39) or control group (n = 33). Participants were aged 44.1 ± 13.0 years and 13.1 ± 10.6 years post-injury. Most participants were male (n = 50; 69.4%) and had paraplegia (n = 38; 52.7%). Participants were classified as high versus low SWL at baseline using a cutoff score of 20.Interventions: The intervention aimed to increase self-efficacy, and in turn, increase engagement in health-promoting behaviors related to SWL. Six 4-hour in-person workshops were conducted over a 3-month period led by experts and peer-mentors who were available for support.Outcome measure(s): Self-efficacy for health practices, secondary condition severity, health-promoting behaviors, perceived stress, and SWL.Results: At baseline, participants with low SWL were recently injured (<4.5 years), while persons with high SWL were married and younger (<49 years old). Intervention participants with low SWL at baseline significantly improved SWL over time compared to those with high SWL (P = 0.02).Conclusion: Certain injury and demographic characteristics were associated with SWL, and intervention participants with low SWL at baseline improved their SWL over 2 years. Healthcare providers should consider time post-injury, marital status, and age in identifying individuals at risk for low SWL that may benefit from wellness interventions.

A pilot test of the GoWoman weight management intervention for women with mobility impairments in the online virtual world of Second Life®

Objective: Pilot test GoWoman, a small-group weight management intervention for mobility impaired women that was a disability- and gender-responsive adaptation of the Diabetes Prevention Program delivered in the online virtual world of Second Life^®. Objectives were to (1) examine pre-/post-intervention differences in weight, waist circumference, diet, physical activity, self-efficacy for diet and physical activity, nutrition knowledge and social support for weight management, (2) determine intervention feasibility (fidelity, attrition, engagement, acceptability). Design: Single-group modified interrupted time series quasi-experimental design whereby participants served as their own controls. Results: Thirteen women attended ≥8 of 16 GoWoman weekly sessions and lost an average of 5.97 pounds (2.71 kg) (3.31%) body weight (Cohen's d = 0.74) and 1.44 inches (3.66 cm) (3.58%) waist circumference (Cohen's d = 0.83). There were significant improvements in physical activity, diet and self-efficacy for diet and physical activity. All benchmarks for feasibility were met. Ratings of intervention content, group interactions and support and virtual world experiences were highly positive. Conclusion: Findings suggest that a disability- and gender-responsive weight management intervention with peer group support delivered in an online virtual world is feasible, meaningful and may assist with weight management for mobility impaired women. Implications for Rehabilitation This study addresses a gap in the general and rehabilitation research literature by addressing the disproportionately high rates of obesity among women with mobility impairments, who are generally excluded from tests of weight management interventions if they have limited ability to engage in vigorous physical activity. The GoWoman program is an adaptation of the Diabetes Prevention Program Lifestyle Change curriculum that is tailored to meet the unique weight management needs of women with mobility impairments, and was created to become a publicly available, disability- and gender-responsive intervention that can be used in community and rehabilitation settings. More rehabilitation and health promotion program should be offered in the free, online, virtual world of Second Life^® since participants in this pilot study offered many favorable comments about the new learning and social opportunities available to them there and they did not have to deal with the disability-related environmental and health challenges that often prevent them from participating in face-to-face workshops. Preliminary indications of improvements in body weight, waist circumference, diet and physical activity after attending the GoWoman weight management intervention offered in Second Life^® tell us that these strategies are feasible for helping women with mobility impairments manage their weight and should undergo further testing.

Sustainability via Active Garden Education (SAGE): results from two feasibility pilot studies

Background

Low physical activity (PA) and fruit and vegetable (F&V) consumption in early childhood are continued public health challenges. This manuscript describes outcomes from two pilot studies for Sustainability via Active Garden Education (SAGE), a program designed to increase PA and F&V consumption among 3 to 5 year old children.

Methods

SAGE was developed using community-based participatory research (CBPR) and delivered to children (N = 89) in early care and education centers (ECEC, N = 6) in two US cities. Children participated in 12 one-hour sessions that included songs, games, and interactive learning activities involving garden maintenance and taste tests. We evaluated reach, efficacy, adoption, implementation, and potential for maintenance of SAGE following the RE-AIM framework. Reach was evaluated by comparing demographic characteristics among SAGE participants and residents of target geographic areas. Efficacy was evaluated with accelerometer-measured PA, F&V consumption, and eating in the absence of hunger among children, parenting practices regarding PA, and home availability of F&V. Adoption was evaluated by the number of ECEC that participated relative to the number of ECEC that were recruited. Implementation was evaluated by completion rates of planned SAGE lessons and activities, and potential for maintenance was evaluated with a parent satisfaction survey.

Results

SAGE reached ECEC in neighborhoods representing a wide range of socioeconomic status, with participants’ sociodemographic characteristics representing those of the intervention areas. Children significantly increased PA during SAGE lessons compared to usual lessons, but they also consumed more calories in the absence of hunger in post- vs. pre-intervention tests (both p < .05). Parent reports did not suggest changes in F&V consumption, parenting PA practices, or home F&V availability, possibly due to low parent engagement. ECEC had moderate-to-high implementation of SAGE lessons and curriculum. Potential for maintenance was strong, with parents rating SAGE favorably and reporting increases in knowledge about PA and nutrition guidelines for young children.

Conclusions

SAGE successfully translated national PA guidelines to practice for young children but was less successful with nutrition guidelines. High adoption and implementation and favorable parent reports suggest high potential for program sustainability. Further work to engage parents and families of young children in ECEC-based PA and nutrition programming is needed.

Developing a transcultural academic-community partnership to arrest obesity

Innovative and empirically tested strategies are needed to define and understand obesity prevention and reduction in a transcultural society. This manuscript describes the development of Science & Community, a partnership developed over a 3-year period with the end goal of implementing a community-based participatory research (CBPR) trial to reduce and prevent obesity. Outreach strategies focused on promoting the project via existing and new channels and identifying and contacting potential partners using established strategies. Science & Community developed and fostered partnerships by hosting a series of interactive meetings, including three Opportunity Receptions, four Community Open Forum Symposia, and quarterly Community Advisory Board (CAB) meetings. Opportunity Reception (N = 62) and Symposia attendees (N = 103) represented the diversity of the community, and participants reported high satisfaction with content and programming. From these events, the CAB was formed and was comprised of 13 community representatives. From these meetings, a Partnership representing 34 organizations and 614 individuals emerged that has helped to guide the development of future proposals and strategies to reduce obesity in Houston/Harris County.

Effects of children's self-regulation of eating on parental feeding practices and child weight

The purpose of this study was to determine whether self-regulation of eating in minority preschool-aged children mediates the relationship between parent feeding practices and child weight. Participants were 299 low-income African American and Hispanic parents and their preschool-aged children who participated in Head Start. Parents completed questionnaires about controlling feeding practices (pressure to eat, restriction) and children's appetitive characteristics (enjoyment of food, food responsiveness, satiety responsiveness). Path analyses were used to determine whether children's self-regulation of eating mediated the relationship between feeding practices and child weight. Greater satiety responsiveness in African American preschool-age children partially mediated the inverse association between pressure to eat and children's weight, B (SE) = -0.073 (0.036), P < .05. Enjoyment of food and food responsiveness did not mediate the relationship between pressure to eat and weight in the African American sample, ps > .05, nor did appetitive characteristics mediate the relationship between restriction and child weight, ps > .05. Appetitive characteristics did not mediate the relationship between controlling feeding practices and child weight in the Hispanic sample, ps > .05. Implications include the need for culturally sensitive self-report measures and for researchers to account for the possible effects of racial/ethnic differences when designing interventions.

Solving the obesity epidemic: voices from the community

"Science and Community: Ending Obesity Improving Health" (S&C) aimed to reduce obesity in Houston by developing community partnerships to identify research priorities and develop a sustainable obesity reduction program. Partnership members were recruited from S&C events and invited to participate in in-depth interviews to gain insight into obesity prevalence, causes, and solutions. Members (n = 22) completed a 60-90-min in-depth interview. The interview guide consisted of 30 questions about pressing health problems in the community, potential solutions to health problems and obesity and how the environment has impacted obesity and health behaviors in the community. Interviewees (n = 12 women and 10 men) were mostly Hispanic/Latino (n = 9) and African American (n = 7). Common problems identified were childhood obesity, balancing a healthy diet and physical inactivity. Interviewees identified obesity as a major problem in their communities and cited access to quality food and physical activity resources as both a problem and a solution. Additional emergent themes focused on solutions, including increasing awareness and education, coordinated efforts among organizations and using an ecologic approach to combat obesity. Community insight gleaned from this study may be used to enhance relevance and sustainability of programs developed to reduce obesity and suggests possible avenues for participatory research and intervention.

Recognition and treatment of depression and anxiety symptoms in heart failure

OBJECTIVE

The aim of this prospective study was to examine the prevalence, recognition, and treatment of depression and anxiety in ambulatory patients with heart failure.

METHOD

A total of 158 heart failure participants were enrolled between November 2006 and April 2007. Each patient completed a telephone screening interview that included an assessment of heart-failure severity (New York Heart Assciation criteria) as well as measures for depression (Geriatric Depression Scale [GDS]) and anxiety (Geriatric Anxiety Inventory [GAI]). Following study recruitment, each patient's electronic medical record was comprehensively reviewed for the 12 months prestudy and 6 months poststudy assessments to determine whether patients had been recognized as having and/or treated for depression or anxiety.

RESULTS

Prevalence of depression (GDS score ≥ 6) was 41.8%, and prevalence of anxiety (GAI score ≥ 9) was 25.3%. Of patients with a positive GDS or GAI result, 57.5% had a diagnosis or medical-record notation for depression and/or anxiety, and 60.3% received mental health treatment during the 18-month period of the EMR review. Of patients with a documented diagnosis of depression or anxiety, 92.3% received mental health treatment. Results showed that higher GDS scores were associated with recognition of depression/anxiety in the medical record, and a positive primary care depression screening predicted documented mental health treatment.

CONCLUSION

These data suggest that symptomatic depression and anxiety are underrecognized in heart failure patients and that mental health screening may be important for receipt of care. Notably, once depression and/or anxiety was documented in the medical record, patients were highly likely to receive mental health treatment.

Components of the diet associated with child adiposity: a cross-sectional study

OBJECTIVE

This study sought to determine which components of youths' diets were related to adiposity while controlling for potential often-neglected confounders such as moderate to vigorous physical activity (MVPA) and dietary reporting error. Secondary goals of this study were to determine the extent to which MVPA confounded the associations between diet and adiposity and whether associations between diet and adiposity would differ depending on reporting error.

METHODS

An ethnically diverse urban sample of 342 children aged 9-10 years and 323 adolescents aged 17-18 years were recruited for this cross-sectional study. Body mass index (BMI) and waist circumference (WC) were measured in the school; dietary assessment included three 24-hour recalls via telephone in the evenings, and MVPA assessment included 5 days of accelerometry. Over (n = 68), under (n = 250), or plausible (n = 347) dietary intake reporters were identified with the Huang calculation method. Linear regression assessed the relationship between adiposity indicators (BMI z-score and WC) and components of the diet (energy intake, food groups, macronutrients) after controlling for reporting error, demographic variables, and MVPA.

RESULTS

When dietary reporting error and potential confounders such as MVPA and demographic variables were controlled, energy intake (EI), vegetables, refined grains, total fat, total protein, and total carbohydrate were positively related to BMI z-score and WC and artificially sweetened beverages to WC. MVPA was a significant confounder. For BMI z-score, but not WC, relationships and strength of these relationships differed depending on dietary reporting error group (plausible, underreporter, overreporter).

CONCLUSIONS

Among plausible reporters, as expected, EI, refined grains, and all macronutrients were positively related to adiposity; however, artificially sweetened beverages and vegetables, which are low-energy-dense foods, were also positively related to adiposity. Reporting error interfered with associations between diet and BMI z-score but not WC, suggesting WC is a more robust measure of adiposity in relation to diet.

Analysis of body composition methods in a community sample of African American women

The purposes of the authors in this study were: (1) to determine whether published body mass index and bioelectrical impedance analysis equations agreed with dual energy x-ray absorptiometry body fat percentage measures and (2) to estimate new body mass index and bioelectrical impedance analysis equations in a sample of African American women. Linear regression was used to determine how well 10 body mass index and bioelectrical impedance analysis equations reflected dual energy x-ray absorptiometry body fat percentage measures in this sample of 74 African American women; new body mass index and bioelectrical impedance analysis equations were created using dual energy x-ray absorptiometry body fat percentage measures as the dependent variable. Participants (M = 47.6 years, SD = 7.7) were classified as overweight or obese (BMI Mean BF% = 35.4, SD = 8.2; BIA Mean BF% = 43.3, SD = 6.9; DXA Mean BF% = 41.5, SD = 6.1). R(2) and SEE values indicated that all body mass index and bioelectrical impedance analysis equations were a poorer fit with less precision, and the new bioelectrical impedance analysis equation discussed in this article was a better fit and was more precise. All 10 body mass index and bioelectrical analysis equations inaccurately estimated dual energy x-ray absorptiometry body fat percentage measures in our sample. The new body mass index equation discussed in this article had less estimation bias and more precision than the published body mass index equations and may be a more accurate equation in African American women.

Home Availability and the Impact of Weekly Stressful Events Are Associated with Fruit and Vegetable Intake among African American and Hispanic/Latina Women

Background. Mediating and moderating variables may interfere with the association between neighborhood availability of grocery stores (NAG) and supermarkets (NAS) and fruit and vegetable (FV) intake. Objective. The purpose of this study was to test mediation of home availability of FV (HAFV) and moderation of impact of weekly stressful events (IWSE) on the association between NAG and NAS with FV consumption among African American (AA) and Hispanic/Latina (HL) women. Methods. Three hundred nine AA and HL, 25-60 year old women in the Health Is Power (HIP) randomized controlled trial completed validated measures of HAFV, IWSE, and FV intake at baseline. Trained field assessors coded NAG and NAS. Institutional Review Board approval was obtained. Results. NAG and NAS were not associated with FV intake or HAFV, so HAFV was not a mediator. HAFV (std. Beta = .29, P < 0.001) and IWSE (std. Beta = .17; P < 0.05) were related to FV intake (R(2) = 0.17; P < 0.001), but IWSE was not a moderator. Conclusion. Increasing HAFV and decreasing the IWSE should increase FV consumption. The extent to which the neighborhood environment is related to the home food environment and diet, and the mechanisms for the association between IWSE and diet should be examined in future research.

Relationship of fruit and vegetable intake with adiposity: a systematic review

Fruit and vegetable (FV) intake has been proposed to protect against obesity. The purpose of this paper was to assess the FV consumption to adiposity relationship. Twenty-three publications were included.

INCLUSION CRITERIA

longitudinal or experimental designs; FV intake tested in relation to adiposity; child, adolescent or adult participants; published in English-language peer-reviewed journals.

EXCLUSION CRITERIA

dietary pattern and cross-sectional designs; participants with health concerns. Experimental studies found increased FV consumption (in conjunction with other behaviours) contributed to reduced adiposity among overweight or obese adults, but no association was shown among children. Longitudinal studies among overweight adults found greater F and/or V consumption was associated with slower weight gain, but only half of child longitudinal studies found a significant inverse association. Limitations in methods prevented a thorough examination of the role of increased FV intake alone or mechanisms of effect. An inverse relationship between FV intake and adiposity among overweight adults appears weak; this relationship among children is unclear. Research needs to clarify the nature of, and mechanisms for, the effects of FV consumption on adiposity. Whether increases in FV intake in isolation from lower caloric intake or increased physical activity will result in declines or slower growth in adiposity remains unclear.

The developmental toxicity of orally administered oxytetracycline in rats and mice

Timed-pregnant CD rats and CD-1 mice were dosed by gavage with oxytetracycline hydrochloride (OXT) in corn oil on gestational days (gd) 6-15 (0, 1200, 1350, or 1500 mg/kg/day for rats; 0, 1325, 1670, or 2100 mg/kg/day for mice). Deaths among treated females occurred in a dose-related manner in all OXT dose groups (2-7%, mice; 5-24%, rats), but no maternal deaths occurred in the vehicle control groups. Significant dose-related decreases in maternal weight gain during treatment, as well as for corrected gestational weight gain (i.e., maternal gestational weight gain minus gravid uterine weight), were observed at all doses in rats but not in mice. Gravid uterine weight was reduced in a dose-related manner only in mice, with the high-dose group significantly reduced compared to the control group. At termination (gd 20, rats; gd 17, mice), the status of uterine implantation sites was recorded and live fetuses were weighed. Fetuses were examined for external, visceral, and skeletal abnormalities. There were no significant effects of OXT in either species on the incidence of postimplantation loss (resorptions plus dead fetuses) or malformations. In both species, there was a significant trend toward reduced fetal body weight, and each group of rats receiving OXT was significantly reduced compared to the control group. Administration of OXT during organogenesis at doses exceeding the therapeutic range for humans produced maternal and fetal toxicity, but did not produce any treatment-related increase in malformations.

Teratologic evaluation of dinitrotoluene in the Fischer 344 rat

Technical grade dinitrotoluene (DNT) was administered by gavage (po) to timed-pregnant Fischer 344 rats on Gestational Days (gd) 7 through 20. Mortality rates for the DNT (14, 35, 37.5, 75, 100, or 150 mg/kg/day) groups were 4.5, 7.7, 0.0, 0.0, 4.3, and 46.2% of treated females, respectively. No deaths occurred in the positive control (hydroxyurea, 200 mg/kg/day) or vehicle control (corn oil) groups. At sacrifice on gd 20, the hematological profile for dams in the 100-mg/kg/day group exhibited characteristic signs of DNT toxicity. Treatment-related increases in maternal relative liver and spleen weight (% body weight), and a dose-related decrease in absolute maternal weight gain during gestation (i.e., minus gravid uterine weight) were observed across all DNT groups. A notable increase in prenatal mortality occurred at the high dose (16.8% resorptions or late fetal deaths per litter for controls vs 49.6% for DNT), but but did not reach statistical significance. No statistically significant effects on fetal growth or morphological development as a result of DNT treatment were observed. Hydroxyurea produced mild hematoxicity in dams and fetuses. Effects of hydroxyurea on fetal growth and morphological development included decreased fetal body weight and crown-rump length, and an increased percentage of malformed fetuses (30% per litter). In conclusion, DNT was not found to be teratogenic following oral administration to Fischer 344 rats; embryo/fetal toxicity was observed only at a dose which also produced 46.2% maternal mortality.

Teratologic and postnatal evaluation of aniline hydrochloride in the Fischer 344 rat

Timed-pregnant Fischer 344 rats were dosed by gavage with aniline hydrochloride (10, 30, or 100 mg/kg/day), a positive control agent (hydroxyurea, 200 mg/kg/day), or vehicle (distilled water) on gestational days (gd) 7 through 20 or gd 7 through parturition. At termination on gd 20 confirmed-pregnant dams exhibited characteristic signs of aniline HCl toxicity, i.e., methemoglobinemia, increased relative spleen weight, decreased red blood cell (RBC) count, and hematological changes indicative of increased hematopoietic activity. High-dose dams exhibited mild methemoglobinemia, increased relative spleen weight, and increased RBC size at termination on postnatal day (pnd) 30. At termination on gd 20, fetuses from aniline-treated dams exhibited increased relative liver weight and enhanced hematopoietic activity, but no evidence of an embryolethal or teratogenic effect was observed. Postnatal signs of toxicity in litters from aniline-treated dams (i.e., decreased body weight, elevated relative liver weight, and elevated relative spleen weight) were transient, and no evidence of toxicity was observed in pups surviving to pnd 60. Hydroxyurea (200 mg/kg/day) administered by gavage proved to be an excellent positive control for embryotoxicity, maternal toxicity, teratogenicity, and postnatal maturational deficits in the Fischer 344 rat. In conclusion, aniline hydrochloride was not teratogenic to Fischer 344 rats, even at maternally toxic doses; transient signs of toxicity were observed postnatally in the offspring in conjunction with mild, but persistent signs of maternal toxicity through pnd 30.

Teratogenicity of a commercial xylene mixture in the mouse

Pregnant outbred albino (CD-1) mice received (gavage, three times a day in cottonseed oil) a xylene mixture (60.2% m-xylene, 9.1% o-xylene, 13.6% p-xylene, and 17.0% ethyl benzene) on d 6-15 of gestation (d 1 being the day vaginal plugs were observed). The mice were killed on d 18, the general and reproductive health of the dams evaluated, and the fetuses examined and processed to characterize external, visceral, and skeletal malformation. At 3.6 ml/kg.d, xylene killed 12 of 38 dams and caused a significantly (p less than 0.05) smaller average weight gain during pregnancy than did the vehicle (cottonseed oil). Fetuses from dams treated with xylene at 2.4 ml/kg.d and higher doses had average fetal weights significantly lower than that of the control fetuses. However, the percent of resorptions for xylene was significantly greater than for the control only at 3.6 ml/kg-d. At 2.4, 3.0, and 3.6 ml/kg-d xylene produced a significantly (p less than 0.01) greater average percent of malformed fetuses than did the control. Cleft palate was the major malformation at all three doses. When bilateral (multiple) wavy ribs were counted as a malformation, the average percent of malformed fetuses increased from 7.8 to 10.5 at 3.0 ml/kg.d and from 9.1 to 13.4 at 3.6 ml/kg.d. It is concluded that xylene (mixed isomers) is teratogenic to the CD-1 mouse at 2.4 and 3.0 ml/kg.d, doses approaching lethal levels.

Teratogenic evaluation of 2-nitro-p-phenylenediamine, 4-nitro-o-phenylenediamine, and 2,5-toluenediamine sulfate in the mouse

Pregnant outbred albino (CD-1) mice were given 2-nitro-p-phenylenediamine (2NPPD; 32-256 mg/kg/day), 4-nitro-o-phenylenediamine (4NOPD; 16-1024 mg/kg/day) or 2,5-toluenediamine sulfate (2,5TDS; 16-64 mg/kg/day) by subcutaneous injection on Days 6-15 of gestation. The mice were killed on Day 18, the general health and reproductive health of the dams evaluated, and the fetuses examined and processed in order to characterize external, visceral, and skeletal malformations. The 32 and 128 through 256 mg/kg/day dose levels of 2NPPD produced a significant (p less than 0.05) reduction in average weight gain by the dam during pregnancy. There was also a significance reduction in average fetal weight at 128 mg/kg/day and above. Although 2NPPD administration led to a significant increase in the average percentage of malformed fetuses at 160 mg/kg/day and above, these effects occurred only at dosages which produced significant maternal toxicity. Teratogenic effects were observed with 4NOPD, as administration of this dye led to a significance increase in the average percent of malformed fetuses at 256 mg/kg/day and above. A significant reduction in average weight gain by the dam during pregnancy also was observed at these dose levels, as well as significant reduction in average fetal weight. Although 2,5TDS killed 4 of 31 dams at 48 mg/kg/day, and 9 of 11 dams at 64 mg/kg/day, this compound did not cause a significant increase in the average percent of malformed fetuses. There were indications of embryotoxicity, however, as dosages of 32 mg/kg/day and above led to significant reductions in average fetal weight.