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Epstein LH, Temple JL, Faith MS, Hostler D, Rizwan A. A psychobioecological model to understand the income-food insecurity-obesity relationship. Appetite 2024; 196:107275. [PMID: 38367912 DOI: 10.1016/j.appet.2024.107275] [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: 10/26/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/19/2024]
Abstract
Food insecurity, defined by unpredictable access to food that may not meet a person's nutritional needs, is associated with higher BMI (kg/m2) and obesity. People with food insecurity often have less access to food, miss meals and go hungry, which can lead to psychological and metabolic changes that favor energy conservation and weight gain. We describe a conceptual model that includes psychological (food reinforcement and delay discounting) and physiological (thermic effect of food and substrate oxidation) factors to understand how resource scarcity associated with food insecurity evolves into the food insecurity-obesity paradox. We present both animal and human translational research to describe how behavioral and metabolic adaptations to resource scarcity based on behavioral ecology theory may occur for people with food insecurity. We conclude with ideas for interventions to prevent or modify the behaviors and underlying physiology that characterize the income-food insecurity-obesity relationship.
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Affiliation(s)
- Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Jennifer L Temple
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Myles S Faith
- Department of Counseling, School and Educational Psychology, Graduate School of Education, University at Buffalo, Buffalo, NY, USA
| | - David Hostler
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Ashfique Rizwan
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Department of Counseling, School and Educational Psychology, Graduate School of Education, University at Buffalo, Buffalo, NY, USA
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Ferrante MJ, McGovern L, Epstein LH, Hollis-Hansen K, Leone LA, Anzman-Frasca S. Optimal Defaults in Online Grocery Shopping: A Secondary Analysis to Explore Impacts in Multiresident Households and Families. J Nutr Educ Behav 2024:S1499-4046(24)00007-1. [PMID: 38416095 DOI: 10.1016/j.jneb.2024.01.006] [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] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 01/17/2024] [Accepted: 01/17/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To examine whether household type (eg, families with children) moderated the effects of an optimal defaults grocery intervention and examine intervention effects on grocery purchases to be consumed by the participant vs others in the household. METHODS Participants (n = 65) diagnosed with or at risk for type 2 diabetes were recruited and randomized into an optimal default online grocery intervention or an online or in-person control group. Grocery receipt data were coded into Dietary Approaches to Stop Hypertension nutritional quality scores, and energy, carbohydrate, and sugar content were calculated. Repeated measures analysis of variance examined household types (eg, single vs multi-resident) as moderators of intervention effects. Parallel models explored foods purchased for the participant and foods purchased for other household members separately. RESULTS Household type was not a significant moderator of intervention effects on nutritional quality or other nutrients of interest (P > 0.10). The default intervention significantly increased the nutritional quality of groceries purchased across household types and for other household members besides the participant (P < 0.05). CONCLUSIONS AND IMPLICATIONS Optimal defaults may improve grocery purchases across different household types and extend to others in the household, supporting use across household types.
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Affiliation(s)
- Mackenzie J Ferrante
- Department of Nutritional Sciences, School of Environmental and Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ
| | - Lily McGovern
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY; Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY
| | - Kelseanna Hollis-Hansen
- Peter O'Donnell Jr, School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX
| | - Lucia A Leone
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY; Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY; Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY.
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Epstein LH, Rizwan A, Rashid S, Bickel WK, Ghanim H. Glucose response to sugar challenge moderates the effect of insulin resistance on reinforcing value of sugar-sweetened yogurt. Appetite 2024; 193:107160. [PMID: 38101518 DOI: 10.1016/j.appet.2023.107160] [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: 07/21/2023] [Revised: 11/20/2023] [Accepted: 12/09/2023] [Indexed: 12/17/2023]
Abstract
We have shown insulin resistance is associated with the choice of sugar-sweetened over monk fruit sweetened yogurt. This study extends this research by assessing the association between insulin resistance and reinforcing value for sugar versus monk fruit-sweetened yogurt, and testing the hypothesis that this effect is moderated by greater blood glucose response in people with insulin resistance. Eighteen people with overweight/obesity (BMI = 35.8 kg/m2, range 26.2-48.5) with varying degrees of insulin resistance (Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) = 2.6, range of 0.6-8.0) had blood glucose measured for 2 h after a sugar challenge. Over six days, they consumed, in a double-blind fashion, novel flavored-colored sugar or monk fruit-sweetened yogurts, and the reinforcing value of sugar or monk fruit-sweetened yogurts and delay discounting (DD) were measured. HOMA-IR (r = 0.62, p = .006) and insulin (r = 0.51, p = .03) were related to the reinforcing value of sugar-sweetened, but not monk fruit-sweetened yogurt (r = -0.07, -0.10, respectively). The blood glucose area under the curve moderated the relationship between HOMA-IR and the reinforcing value of sugar-sweetened yogurt (p = .02). People with greater HOMA-IR and greater blood glucose excursions responded the most for sugar-sweetened yogurt. These results extend previous research and confirm the hypothesis that individual differences in response to sugar may activate brain reward centers and condition people to prefer high-sugar foods. DD was related to sugar reinforcement (r = -0.46, p = .03), consistent with the idea that those with high sugar reinforcement desire immediate gratification, and DD moderated the relationship between HOMA-IR and the reinforcing value of sugar-sweetened yogurt (p < .001). Research should test whether reducing insulin resistance would permit people with insulin resistance to choose lower-sugar foods.
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Affiliation(s)
- Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine, And Biomedical Sciences, Buffalo, NY, USA; University at Buffalo, Buffalo, NY, USA.
| | - Ashfique Rizwan
- Department of Pediatrics, Jacobs School of Medicine, And Biomedical Sciences, Buffalo, NY, USA; University at Buffalo, Buffalo, NY, USA
| | - Sameeha Rashid
- Department of Pediatrics, Jacobs School of Medicine, And Biomedical Sciences, Buffalo, NY, USA; University at Buffalo, Buffalo, NY, USA
| | - Warren K Bickel
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at Virginia Tech Carillion School of Medicine, USA
| | - Husam Ghanim
- University at Buffalo, Buffalo, NY, USA; Division of Endocrinology Diabetes and Metabolism, Jacobs School of Medicine, and Biomedical Sciences, USA
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Smith AR, McGregor CM, Carr K, Epstein LH, Serwatka C, Paluch R, Piazza J, Shisler S, Kong KL. The impact of a music enrichment program during infancy and early toddlerhood on effortful control at age 3: A preliminary investigation. Infancy 2024; 29:72-79. [PMID: 37823562 DOI: 10.1111/infa.12563] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/05/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
Effortful control (EC), a self-regulation skill, is associated with long-term developmental outcomes. Music has been associated with infant self-regulation and may be an intervention strategy for enhancing EC during toddlerhood. This investigation included 32 parent-child dyads from a previously conducted randomized controlled trial (RCT). Participants (9-15-months old at baseline) attended either a music enrichment program or a playdate control once a week for 1 year and monthly for an additional year. At age 3, participants completed snack and gift delay effortful control tasks. Groups were compared using one-way ANOVA. We found that participants in the music group had a significantly higher score during snack delay (music mean = 3.47 ± 0.94; control mean = 2.45 ± 1.51; p = 0.03; Cohen's d = 0.84). We did not find a significant group difference for latency to peek (music mean = 39.10 ± 20.10; control mean = 30.90 ± 19.88; p = 0.25; d = 0.57) or latency to touch (music mean = 105.73 ± 417.69; control mean = 98.35 ± 28.84; p = 0.38; d = 0.29) for the gift task. This study provides initial evidence that early participation in a music enrichment program may benefit later development of EC. This study is registered at ClinicalTrials.gov (NCT02936284).
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Affiliation(s)
- Amy R Smith
- Baby Health Behavior Lab, Division of Health Services and Outcomes Research, Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, Missouri, USA
- Center for Children's Healthy Lifestyles and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Casey M McGregor
- Department of Human Development and Family Science, University of Rhode Island, Kingston, Rhode Island, USA
| | - Katelyn Carr
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Leonard H Epstein
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Catherine Serwatka
- Baby Health Behavior Lab, Division of Health Services and Outcomes Research, Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Rocco Paluch
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Jacqueline Piazza
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Shannon Shisler
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Kai Ling Kong
- Baby Health Behavior Lab, Division of Health Services and Outcomes Research, Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, Missouri, USA
- Center for Children's Healthy Lifestyles and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri, USA
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Biondolillo MJ, Carr KA, Wojcik K, Curry DC, Epstein LH. Effects of Episodic Memory Recall on Reinforcing Value of Physical Activity. Psychol Rep 2023:332941231210213. [PMID: 37890092 DOI: 10.1177/00332941231210213] [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] [Indexed: 10/29/2023]
Abstract
OBJECTIVE Many people prefer a sedentary versus an active lifestyle and have difficulty completing sufficient physical activity to improve health. While exercise can be a powerful reinforcer for some people, many prefer to be sedentary. The relative reinforcing value of physical activity (RRVPA) is influenced by a person's learning history with positive experiences strengthening the motivation to be active. Episodic memories may be critical to determining RRVPA, or RRV of different types of positive behaviors. METHOD As a potential way to increase RRVPA we examined if recalling a positive episodic memory would affect RRVPA. One hundred and thirty seven adult participants completed measures of reinforcement history and memory functions and then recalled a single positive episode of either a physical activity or of a cognitively enriching activity, rated subjective memory qualities, and completed tasks to measure the RRV of both types of activity. RESULTS Recalling a positive episodic memory increased RRV for the respective activity, and changes in RRVPA were moderated by how much the memory satisfies a basic psychological need. CONCLUSIONS This research demonstrates the impact of episodic memory on RRVPA, which could be leveraged to aid behavior change efforts.
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Affiliation(s)
- Mathew J Biondolillo
- Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Katelyn A Carr
- Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Kathleen Wojcik
- Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Damante C Curry
- Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Leonard H Epstein
- Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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Button AM, Paluch RA, Schechtman KB, Wilfley DE, Geller N, Quattrin T, Cook SR, Eneli IU, Epstein LH. Parents, but not their children, demonstrate greater delay discounting with resource scarcity. BMC Public Health 2023; 23:1983. [PMID: 37828503 PMCID: PMC10568819 DOI: 10.1186/s12889-023-16832-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Individuals with obesity tend to discount the future (delay discounting), focusing on immediate gratification. Delay discounting is reliably related to indicators of economic scarcity (i.e., insufficient resources), including lower income and decreased educational attainment in adults. It is unclear whether the impact of these factors experienced by parents also influence child delay discounting between the ages of 8 and 12-years in families with obesity. METHODS The relationship between indices of family income and delay discounting was studied in 452 families with parents and 6-12-year-old children with obesity. Differences in the relationships between parent economic, educational and Medicaid status, and parent and child delay discounting were tested. RESULTS Results showed lower parent income (p = 0.019) and Medicaid status (p = 0.021) were differentially related to greater parent but not child delay discounting among systematic responders. CONCLUSIONS These data suggest differences in how indicators of scarcity influence delay discounting for parents and children, indicating that adults with scarce resources may be shaped to focus on immediate needs instead of long-term goals. It is possible that parents can reduce the impact of economic scarcity on their children during preadolescent years. These findings suggest a need for policy change to alleviate the burden of scarce conditions and intervention to modify delay discounting rate and to improve health-related choices and to address weight disparities.
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Affiliation(s)
- Alyssa M Button
- Division of Population and Public Health Science, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Rocco A Paluch
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 3435 Main Street, Building #26, Buffalo, NY, 14214, USA
| | - Kenneth B Schechtman
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Nancy Geller
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 3435 Main Street, Building #26, Buffalo, NY, 14214, USA
| | - Stephen R Cook
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Ihouma U Eneli
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 3435 Main Street, Building #26, Buffalo, NY, 14214, USA.
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Hollis-Hansen K, Tan S, Bargnesi S, McGovern L, Drozdowsky J, Epstein LH, Leone LA, Mak E, Masci J, Anzman-Frasca S. Feasibility and implementation of a grocery shopping intervention for adults diagnosed with or at-risk for type 2 diabetes. Public Health Nutr 2023; 26:2118-2129. [PMID: 37496394 PMCID: PMC10564597 DOI: 10.1017/s1368980023001453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 05/23/2023] [Accepted: 07/05/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE To examine the feasibility and implementation of an optimal defaults intervention designed to align grocery purchases with a diet recommended for people with or at-risk for type 2 diabetes. DESIGN This was a 5-week pilot randomised trial with three groups: in-person grocery shopping, shopping online and shopping online with 'default' carts. Participants were asked to shop normally in Week One, according to group assignment in Weeks Two-Four (intervention period), and as preferred in Week Five. All groups received diabetes-friendly recipes via email each intervention week. SETTING Participants grocery shopped in person or online. Grocery receipt forms, enrolment information and exit surveys were collected remotely and used to assess feasibility and implementation. PARTICIPANTS Sixty-five adults with or at-risk for type 2 diabetes. RESULTS Sixty-two participants completed the exit survey and fifty-five submitted receipts all 5 weeks. Forty utilised recipes, 95 % of whom indicated recipes were somewhat or very useful. Orange chicken, quesadillas and pork with potato and apples were the most liked recipes. Most Defaults group participants accepted at least some default cart items. Recipes with the highest default acceptance were whole grain pasta and chicken, quesadillas with black beans and chicken with olives. Participants' primary concerns about the intervention were costs associated with online shopping, inability to select preferred foods and some recipes including ingredients household members would not eat. CONCLUSIONS The study had high retention, data were successfully collected remotely and the intervention was acceptable to most participants. Tailoring recipes to household preferences may be beneficial in future studies.
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Affiliation(s)
- Kelseanna Hollis-Hansen
- Peter O’Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Sherey Tan
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Sarah Bargnesi
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Lily McGovern
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Julia Drozdowsky
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY, USA
| | - Lucia A Leone
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY, USA
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Eunice Mak
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Jaclyn Masci
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY, USA
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Epstein LH, Rizwan A, Paluch RA, Temple JL. Delay Discounting and the Income-Food Insecurity-Obesity Paradox in Mothers. J Obes 2023; 2023:8898498. [PMID: 37766882 PMCID: PMC10522429 DOI: 10.1155/2023/8898498] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/09/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Food insecurity, defined as unpredictable access to food that may not meet a person's nutritional needs, is paradoxically associated with higher BMI (kg/m2) and obesity. Research has shown delay discounting, a behavioral economic measure of the preference for immediate rather than delayed rewards, is related to higher BMI, and moderates the relationship between income and food insecurity. Based on this research, we used regression models to test whether delay discounting, consideration of future consequences, and perceived stress were atemporal mediators of the food insecurity-BMI relation in 313 mothers, controlling for demographic variables. A secondary aim was to replicate the finding that delay discounting moderates the relationship between low income and high food insecurity. Results showed that low income was associated with higher food insecurity, and higher food insecurity was associated with higher BMI. Delay discounting was the only variable that was indirectly related to both paths of the food-insecurity-BMI relation. Delay discounting accounted for 22.2% of the variance in the low-income-food insecurity-obesity relation, and the total model accounted for 38.0% of the variance. The relation between low income and food insecurity was moderated by delay discounting. These data suggest that delay discounting is a potential mediator of the relationship between food insecurity and high BMI, which suggests reducing discounting in the future could be a novel target to reduce food insecurity and help people with food insecurity to reduce their excess body weight. Trial Registration. This trial is registered with NCT02873715.
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Affiliation(s)
- Leonard H. Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Ashfique Rizwan
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Rocco A. Paluch
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Jennifer L. Temple
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
- Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
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Ramel M, Wilfley DE, Tabak R, Lew D, Moursi NA, Kilanowski C, Cook SR, Eneli IU, Quattrin T, Schechtman KB, Epstein LH. Relationships examined: Parent and child readiness to change and sociodemographic characteristics in family based weight loss treatment. Pediatr Obes 2023; 18:e13062. [PMID: 37282798 DOI: 10.1111/ijpo.13062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/20/2023] [Accepted: 05/08/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Family based treatment is an effective, multipronged approach to address obesity as it plagues families. OBJECTIVE To investigate the relationships among sociodemographic characteristics (e.g., education and income), body mass index (BMI) and race/ethnicity with readiness to change for parents enrolled in the Primary care pediatrics, Learning, Activity and Nutrition (PLAN) study. METHODS Multivariate linear regressions tested two hypotheses: (1) White parents will have higher levels of baseline readiness to change, when compared to Black parents; (2) parents with higher income and education will have higher levels of readiness to change at baseline. RESULTS A positive relationship exists between baseline parent BMI and readiness to change (Pearson correlation, 0.09, p < 0.05); statistically significant relationships exist between parent education level (-0.14, p < 0.05), income (0.04, p < 0.05) and readiness to change. Additionally, a statistically significant relationship exists, with both White (β, -0.10, p < 0.05), and Other, non-Hispanic (-0.10, p < 0.05) parents exhibiting lower readiness to change than Black, non-Hispanic parents. Child data did not indicate significant relationships between race/ethnicity and readiness to change. CONCLUSIONS Results demonstrate that investigators should consider sociodemographic characteristic factors and different levels of readiness to change in participants enrolling in obesity interventions.
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Affiliation(s)
- Melissa Ramel
- Department of Family and Consumer Sciences, Fontbonne University, St. Louis, Missouri, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Rachel Tabak
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Daphne Lew
- Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Nasreen A Moursi
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Colleen Kilanowski
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Steven R Cook
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA
| | - Ihouma U Eneli
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Kenneth B Schechtman
- Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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Faith MS, Epstein LH. Leveraging behavioral genetics methods to accelerate obesity protection discovery: the Augmented T0 Discordant Sibling Design. Obesity (Silver Spring) 2023; 31:2215-2217. [PMID: 37551661 DOI: 10.1002/oby.23840] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 08/09/2023]
Abstract
Researchers have been reimagining strategies to accelerate the pacing of translational science progress so that basic T0 discoveries can be converted more efficiently to T1 to T4 interventions. This is certainly true in the context of childhood obesity prevention given its complex etiology and heterogeneity. Here it is submitted that behavioral genetics methods, which have transformed the understanding of childhood obesity risk, have unrealized potential to accelerate translational science into childhood obesity protection (i.e., maintaining healthy weight status despite the presence of reliable risk factors). To illustrate this opportunity, this Perspective proposes the Augmented T0 Discordant Sibling Design (DSD+ ), which leverages the traditional discordant siblings design by recruiting obesity-discordant siblings specifically from families in which parents have obesity and thereby confer heightened risk. This one modification of a tried-and-true behavior genetics design arguably opens a fascinating door of inquiry, illustrating the broader point. Moreover, as most disorders are familial, the DSD+ may stimulate ideas beyond obesity protection.
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Affiliation(s)
- Myles S Faith
- Department of Counseling, School, and Educational Psychology, Graduate School of Education, University at Buffalo, Buffalo, New York, USA
| | - Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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Brown JM, Bickel WK, Epstein LH, Stein JS. Episodic future thinking in type 2 diabetes: Further development and validation of the Health Information Thinking control for clinical trials. PLoS One 2023; 18:e0289478. [PMID: 37535609 PMCID: PMC10399790 DOI: 10.1371/journal.pone.0289478] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/19/2023] [Indexed: 08/05/2023] Open
Abstract
Episodic Future Thinking (EFT) reduces delay discounting and may have the potential as a clinical tool to increase the likelihood of health-promoting behaviors. However, evaluations of EFT in clinical settings require control conditions that match the effort and frequency of cue generation, as well as participants' expectations of improvement. The Health Information Thinking (HIT) control addresses these issues, but how this control affects delay discounting in individuals with diabetes and obesity when utilizing diabetes-management specific health-information vignettes is unknown. Moreover, little research has explored whether EFT reduces delay discounting in individuals with type 2 diabetes. To this end, we examined the impact of EFT, HIT, and a secondary no-cue control condition (NCC; assessments as usual) on delay discounting in 434 adults with self-reported type 2 diabetes and obesity recruited using Amazon Mechanical Turk. After completing an initial screening questionnaire, eligible participants reported demographics, then were randomized to EFT, HIT, or NCC conditions. Following the generation of seven EFT or HIT cues, participants assigned to EFT or HIT conditions completed a delay discounting task while imagining EFT or HIT cues; no-cue participants completed the task without cues. EFT participants demonstrated significantly lower delay discounting levels than HIT or NCC participants; no differences in delay discounting between HIT and NCC participants were observed. These results suggest that engaging in EFT, but not diabetes-specific HIT, results in lower delay discounting in adults with type 2 diabetes and obesity. This provides further evidence for the appropriateness of the HIT control for clinical trials examining the effect of EFT on delay discounting in adults with self-reported type 2 diabetes.
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Affiliation(s)
- Jeremiah M. Brown
- Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, United States of America
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Warren K. Bickel
- Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, United States of America
| | - Leonard H. Epstein
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, United States of America
| | - Jeffrey S. Stein
- Fralin Biomedical Research Institute at VTC, Roanoke, Virginia, United States of America
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, United States of America
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12
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Epstein LH, Wilfley DE, Kilanowski C, Quattrin T, Cook SR, Eneli IU, Geller N, Lew D, Wallendorf M, Dore P, Paluch RA, Schechtman KB. Family-Based Behavioral Treatment for Childhood Obesity Implemented in Pediatric Primary Care: A Randomized Clinical Trial. JAMA 2023; 329:1947-1956. [PMID: 37314275 PMCID: PMC10265310 DOI: 10.1001/jama.2023.8061] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 12/05/2022] [Accepted: 04/25/2023] [Indexed: 06/15/2023]
Abstract
Importance Intensive behavioral interventions for childhood overweight and obesity are recommended by national guidelines, but are currently offered primarily in specialty clinics. Evidence is lacking on their effectiveness in pediatric primary care settings. Objective To evaluate the effects of family-based treatment for overweight or obesity implemented in pediatric primary care on children and their parents and siblings. Design, Setting, and Participants This randomized clinical trial in 4 US settings enrolled 452 children aged 6 to 12 years with overweight or obesity, their parents, and 106 siblings. Participants were assigned to undergo family-based treatment or usual care and were followed up for 24 months. The trial was conducted from November 2017 through August 2021. Interventions Family-based treatment used a variety of behavioral techniques to develop healthy eating, physical activity, and parenting behaviors within families. The treatment goal was 26 sessions over a 24-month period with a coach trained in behavior change methods; the number of sessions was individualized based on family progress. Main Outcomes and Measures The primary outcome was the child's change from baseline to 24 months in the percentage above the median body mass index (BMI) in the general US population normalized for age and sex. Secondary outcomes were the changes in this measure for siblings and in BMI for parents. Results Among 452 enrolled child-parent dyads, 226 were randomized to undergo family-based treatment and 226 to undergo usual care (child mean [SD] age, 9.8 [1.9] years; 53% female; mean percentage above median BMI, 59.4% [n = 27.0]; 153 [27.2%] were Black and 258 [57.1%] were White); 106 siblings were included. At 24 months, children receiving family-based treatment had better weight outcomes than those receiving usual care based on the difference in change in percentage above median BMI (-6.21% [95% CI, -10.14% to -2.29%]). Longitudinal growth models found that children, parents, and siblings undergoing family-based treatment all had outcomes superior to usual care that were evident at 6 months and maintained through 24 months (0- to 24-month changes in percentage above median BMI for family-based treatment and usual care were 0.00% [95% CI, -2.20% to 2.20%] vs 6.48% [95% CI, 4.35%-8.61%] for children; -1.05% [95% CI, -3.79% to 1.69%] vs 2.92% [95% CI, 0.58%-5.26%] for parents; and 0.03% [95% CI, -3.03% to 3.10%] vs 5.35% [95% CI, 2.70%-8.00%] for siblings). Conclusions and Relevance Family-based treatment for childhood overweight and obesity was successfully implemented in pediatric primary care settings and led to improved weight outcomes over 24 months for children and parents. Siblings who were not directly treated also had improved weight outcomes, suggesting that this treatment may offer a novel approach for families with multiple children. Trial Registration ClinicalTrials.gov Identifier: NCT02873715.
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Affiliation(s)
- Leonard H. Epstein
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Colleen Kilanowski
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Steven R. Cook
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Ihuoma U. Eneli
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Nancy Geller
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Daphne Lew
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Michael Wallendorf
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Peter Dore
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Rocco A. Paluch
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Kenneth B. Schechtman
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Missouri
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13
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Carr KA, Black W, Guth C, Shapiro L, Leone LA, Temple JL, Epstein LH. Reinforcing value of food, enriched home environment, and changes in percent overweight in children. Obesity (Silver Spring) 2023; 31:1075-1084. [PMID: 36855013 DOI: 10.1002/oby.23685] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 03/02/2023]
Abstract
OBJECTIVE The decision to eat is often a choice made in the context of food and non-food alternatives. However, no research, to the authors' knowledge, has assessed the combination of the motivation to eat, as indexed by the relative reinforcing value of food (RRVFOOD ), and the enriched home environment, i.e., access to activities that can serve as alternatives to eating on weight gain. METHODS This study used a cross-sectional design to study how RRVFOOD and the enriched home environment predict percent overweight change over 2 years in 291 children aged 6 to 9 years and of varying socioeconomic status. RESULTS Results showed that RRVFOOD and access to food were positively associated with baseline percent overweight, and an enriched home environment was negatively related to baseline percent overweight. RRVFOOD and an enriched home environment interacted to predict change in percent overweight. Children with a high relative RRVFOOD and a relatively non-enriched environment showed the greatest relative weight gain. CONCLUSIONS These results suggest that providing an enriched home environment may reduce the effects of food reinforcement and being motivated to eat on weight gain in childhood, and this represents a novel approach to intervention that can be used to strengthen current behavioral approaches to prevent obesity in children.
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Affiliation(s)
- Katelyn A Carr
- Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Whitney Black
- Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Catherine Guth
- Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Lilianna Shapiro
- Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Lucia A Leone
- Department of Community Health and Health Behavior, University at Buffalo School of Public Health and Health Professions, Buffalo, New York, USA
| | - Jennifer L Temple
- Department of Community Health and Health Behavior, University at Buffalo School of Public Health and Health Professions, Buffalo, New York, USA
- Department of Exercise and Nutrition Sciences, University at Buffalo School of Public Health and Health Sciences, Buffalo, New York, USA
| | - Leonard H Epstein
- Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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Epstein LH, Biondolillo MJ, Rizwan A, Ghanim H, Dandona P, Bickel WK, Paluch RA. Insulin Resistance and Glycated Hemoglobin in Obesity Are Associated With Preference for Sugar-Sweetened Yogurt: A Pilot Study. Psychosom Med 2023; 85:289-293. [PMID: 36799726 PMCID: PMC10528876 DOI: 10.1097/psy.0000000000001171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Insulin resistance is associated with elevated activation of food reward, which should be associated with an increased reinforcing value of food. Research has also shown that sugar is a macronutrient strongly associated with reward and reinforcing value of food. This research is designed to assess whether insulin resistance is associated with a stronger preference for sugar-sweetened, thus elevating blood glucose responses in obese people with varying degrees of insulin resistance. METHODS Thirteen people with obesity (body mass index, 39.1 kg/m 2 ; range, 30.0-45.1 kg/m 2 ) with varying degrees of insulin resistance (Homeostatic Model Assessment of Insulin Resistance, 5.2; range, 0.7-11.6) consumed novel flavored-colored yogurts that were sweetened with either sugar or monkfruit daily for 6 days to assess whether when given the choice of sugar-sweetened versus monkfruit-sweetened yogurts to consume, participants preferred sugar-sweetened yogurts. RESULTS Participants consumed a greater amount ( p = .009) and percentage ( p = .04) of sugar-sweetened yogurt earned than monkfruit-sweetened yogurt. The percent of sugar-sweetened versus monkfruit-sweetened yogurt consumed in relationship to amount earned was related to insulin resistance ( r = 0.64, p = .019), glycated hemoglobin ( r = 0.61, p = .027), insulin ( r = 0.58, p = .007), and glucose ( r = 0.56, p = .048). CONCLUSIONS Insulin resistance is associated with preference for sugar-sweetened foods in participants with obesity, which may make it hard to make dietary changes. Research is needed to assess whether treatments that improve insulin resistance also change the preference for sugar-sweetened or high-glycemic-index foods.
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Affiliation(s)
- Leonard H Epstein
- From the Department of Pediatrics (Epstein, Biondolillo, Rizwan, Paluch) and Division of Endocrinology Diabetes and Metabolism (Ghanim, Dandona), Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York; and Addiction Recovery Research Center (Bickel), Fralin Biomedical Research Institute at Virginia Tech Carillion School of Medicine, Roanoke, Virginia
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15
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Anzman-Frasca S, McGovern L, Ferrante MJ, Drozdowsky J, Epstein LH, Hollis-Hansen K, Lassetter L, Leone LA, Tan S. Effects of a grocery shopping intervention designed to improve diet adherence in diabetes: a randomized trial. Obesity (Silver Spring) 2023; 31:62-73. [PMID: 36444835 DOI: 10.1002/oby.23588] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/20/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The goal of this study was to examine the potential of an optimal-defaults intervention to promote grocery purchases corresponding to a diet for diabetes. METHODS In total, 65 adults diagnosed with or at increased risk for type 2 diabetes who grocery shopped at one of two study stores were randomized to one of three groups: Defaults, Online, or Control. All groups received diabetes-friendly recipes. In addition, the Online group was asked to grocery shop online during a 3-week intervention, and the Defaults group was asked to shop online, with their online grocery carts prefilled with food items needed to prepare provided recipes. Participants provided weekly grocery receipt data at baseline, at each week of the 3-week intervention, and at post-intervention. RESULTS Overall, the Defaults group had grocery purchases of a significantly greater nutritional quality versus other groups (F = 16.3, p < 0.001). Between-group comparisons of least-squares means showed consistent effects of the Defaults intervention while intervention components were in place, with a similar pattern for energy and carbohydrate content of grocery purchases. CONCLUSIONS These results build upon emerging evidence that optimal defaults can promote healthier grocery purchases. Continued examination of this approach could promote healthy food acquisition in accordance with individual dietary preferences and needs.
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Affiliation(s)
- Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, New York, USA
| | - Lily McGovern
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Mackenzie J Ferrante
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Julia Drozdowsky
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, New York, USA
| | - Kelseanna Hollis-Hansen
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Lindsay Lassetter
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Lucia A Leone
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, New York, USA
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Sherey Tan
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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16
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Grammer AC, Best JR, Fowler LA, Stein RI, Conlon RPK, Balantekin KN, Welch RR, Perri MG, Epstein LH, Wilfley DE. Change in parent and child psychopathology following obesity treatment and maintenance: A secondary data analysis. Pediatr Obes 2023; 18:e12971. [PMID: 35971859 PMCID: PMC9772295 DOI: 10.1111/ijpo.12971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/11/2022] [Accepted: 08/01/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND General and eating disorder (ED) psychopathology are common among children and adults with overweight/obesity; few studies have examined their course of change throughout family-based behavioural obesity treatment (FBT) and maintenance. OBJECTIVES Examine: (1) the changes in the parent and child general and ED psychopathology during FBT and maintenance interventions; (2) the associations between change in psychopathology and change in weight among children or parents; (3) the associations between change in psychopathology within parent-child dyads. METHODS 172 parent-child dyads participated in 4-month FBT and were subsequently randomized to one of three 8-month maintenance interventions. General psychopathology (child anxiety/depressive symptoms, parent severity of global psychological distress), ED psychopathology (shape/weight concern), and percent overweight were assessed at baseline, post-FBT, and post-maintenance. Separate linear mixed-effects models evaluated change in general and ED psychopathology, including an interaction between maintenance condition and time. Partial correlations examined associations between change in psychopathology and percent overweight among children or parents, and associations between change in psychopathology within parent-child dyads. RESULTS Among children, significant reductions were observed from baseline to post-FBT in all forms of psychopathology and from post-FBT to post-maintenance in general psychopathology. Among parents, significant reductions were observed from baseline to post-FBT in all forms of psychopathology; reductions were maintained from post-FBT to post-maintenance. There was no significant interaction between maintenance condition and time. Correlations between change in most forms of parent or child psychopathology and percent overweight were observed. CONCLUSIONS Participation in FBT and maintenance was associated with improvements in general and ED psychopathology in both parents and children.
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Affiliation(s)
- Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John R. Best
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lauren A. Fowler
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Richard I. Stein
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rachel P. Kolko Conlon
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Katherine N. Balantekin
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - R. Robinson Welch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael G. Perri
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Leonard H. Epstein
- Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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17
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Kong KL, Eiden RD, Morris KS, Paluch RA, Carr KA, Epstein LH. Reducing relative food reinforcement of infants using a music enrichment program: a randomized, controlled trial. Am J Clin Nutr 2022; 116:1642-1653. [PMID: 36250608 PMCID: PMC9761746 DOI: 10.1093/ajcn/nqac209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/15/2022] [Accepted: 07/28/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Food reinforcement or one's motivation to eat may be established early in life; it might not be the food reinforcement per se that drives weight gain, but rather the imbalance between food and nonfood reinforcement. OBJECTIVES We implemented a 2-y randomized, controlled trial to assess the effects of a music enrichment program (music, n = 45) compared with an active play date control (control, n = 45) in 9- to 15-mo-old healthy infants who were strongly motivated to eat. METHODS The 12-mo intensive intervention phase included 4 semesters of Music Together® or a play date program (Winter, Spring, Summer, and Fall), comprised of once per week group meetings, followed by a 12-mo maintenance phase with monthly meetings. Parents were encouraged to listen to the Music Together® program CD or play with the play date group's toy with their infants at home, respectively. We performed a modified intention-to-treat analysis using all randomly assigned, non-excluded subjects for the outcome measures [relative reinforcing value of food (RRVfood), food reinforcement, music reinforcement, and weight-for-length z-score (WLZ)]. RESULTS There were significant differential group changes across time for RRVfood (group × month; P = 0.016; Cohen's f2 = 0.034). The music group had significantly greater RRVfood decreases than the control group from baseline to the end of the intensive intervention phase (music change = -0.211; control change = -0.015; P = 0.002; Cohen's D = 0.379). However, these differences were not maintained during months 12-24 (music change = -0.187; control change = -0.143; P = 0.448; D = 0.087). We observed an overall moderation effect by sex for food reinforcement and WLZ. Boys in the music group had a significant attenuation in food reinforcement and WLZ compared with boys in the control group. CONCLUSIONS This study extends our knowledge in infant eating behavior by providing insight into the role of nonfood alternatives in altering one's motivation to eat. There may be sex differences in altering one's motivation to eat.This trial was registered at clinicaltrials.gov as NCT02936284.
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Affiliation(s)
- Kai Ling Kong
- Baby Health Behavior Lab, Division of Health Services and Outcomes Research, Children's Mercy Research Institute, Children's Mercy Hospital, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri–Kansas City, Kansas City, MO, USA
- Center for Children's Healthy Lifestyles and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rina D Eiden
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Katherine S Morris
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Rocco A Paluch
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Katelyn A Carr
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Leonard H Epstein
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Abstract
Single-case experimental designs (SCEDs) represent a family of research designs that use experimental methods to study the effects of treatments on outcomes. The fundamental unit of analysis is the single case-which can be an individual, clinic, or community-ideally with replications of effects within and/or between cases. These designs are flexible and cost-effective and can be used for treatment development, translational research, personalized interventions, and the study of rare diseases and disorders. This article provides a broad overview of the family of single-case experimental designs with corresponding examples, including reversal designs, multiple baseline designs, combined multiple baseline/reversal designs, and integration of single-case designs to identify optimal treatments for individuals into larger randomized controlled trials (RCTs). Personalized N-of-1 trials can be considered a subcategory of SCEDs that overlaps with reversal designs. Relevant issues for each type of design-including comparisons of treatments, design issues such as randomization and blinding, standards for designs, and statistical approaches to complement visual inspection of single-case experimental designs-are also discussed.
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Affiliation(s)
- Leonard H Epstein
- Jacobs School of Medicine and Biomedical Sciences, Division of Behavioral Medicine, Department of Pediatrics, University at Buffalo, Buffalo, New York, United States of America
| | - Jesse Dallery
- Department of Psychology, University of Florida, Gainesville, Florida, United States of America
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Bouchard EG, Epstein LH, Patel H, Vincent PC, LaValley SA, Devonish JA, Wadium J, Wen X, Kelly KM. Behavioral parenting skills as a novel target for improving medication adherence in young children: Feasibility and acceptability of the CareMeds intervention. Pediatr Hematol Oncol 2022; 39:529-539. [PMID: 35139726 PMCID: PMC9363525 DOI: 10.1080/08880018.2022.2025964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
In pediatric cancer care, medication non-adherence is a significant driver of avoidable suffering and death. There is a lack of interventions designed for families of young children, where patient medication refusal/avoidance is a common barrier to adherence. We developed the CareMeds intervention which focuses on caregiver skills training to help young children take medicine calmly and without use of restraint techniques. The goal of this preliminary study was to assess the acceptability and feasibility of the CareMeds intervention. Caregivers of pediatric cancer patients (ages 2-10) whose children were on a home-based oral medication regimen were recruited to participate. Feasibility was examined through study enrollment and retention rates as well as reasons for refusal and drop out. Acceptability was evaluated through usability of and engagement with intervention components and an acceptability questionnaire. Feasibility: We recruited N = 9 caregivers to participate in this intervention pilot study and had a 75% enrollment rate. Reasons for declining included scheduling concerns (n = 2) and lack of interest (n = 1). The participant retention rate was 100% with 100% adherence to intervention sessions. Acceptability: Parents rated the sessions and resource materials as acceptable and reported frequent use of skills taught in the intervention. The CareMeds intervention is an acceptable and feasible strategy for caregivers of pediatric cancer patients and warrants future research to examine the efficacy of behavioral parenting skills interventions to improve medication adherence in young children.
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Affiliation(s)
- Elizabeth G. Bouchard
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | | | - Hital Patel
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | - Paula C. Vincent
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | - Susan A. LaValley
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
| | - Julia A. Devonish
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center
- Department of Medicine, Division of General Internal Medicine, University at Buffalo
| | | | - Xiaozhong Wen
- Division of Behavioral Medicine, University at Buffalo
| | - Kara M. Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center
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Epstein LH. A Brief History and Future of the Traffic Light Diet. Curr Dev Nutr 2022; 6:nzac120. [PMID: 36157846 PMCID: PMC9492278 DOI: 10.1093/cdn/nzac120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Crandall AK, Epstein LH, Fillo J, Carfley K, Fumerelle E, Temple JL. The Effect of Financial Scarcity on Reinforcer Pathology: A Dyadic Developmental Examination. Children (Basel) 2022; 9:children9091338. [PMID: 36138648 PMCID: PMC9498192 DOI: 10.3390/children9091338] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022]
Abstract
This study investigated the effects of experimentally manipulated scarcity on the reinforcing value of food (RRVfood) and delay discounting (DD), which, together, create reinforcer pathology (RP) among parents and offspring. A stratified sample of 106 families (53 parent/child aged 7−10 dyads & 53 parent/adolescent aged 15−17 dyads) from high- and low-income households visited our laboratory for three appointments. Each appointment included an experimental manipulation of financial gains and losses and DD and RRV tasks. The results showed that, regardless of food insecurity or condition, children had greater RP (β = 1.63, p < 0.001) than adolescents and parents. DD was largely unaffected by acute scarcity in any group, but families with food insecurity had greater DD (β = −0.09, p = 0.002) than food-secure families. Food-insecure parents with children responded to financial losses with an increase in their RRVfood (β = −0.03, p = 0.011), while food-secure parents and food-insecure parents of adolescents did not significantly change their responding based on conditions. This study replicates findings that financial losses increase the RRVfood among adults with food insecurity and extends this literature by suggesting that this is strongest for parents of children.
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Affiliation(s)
- Amanda K. Crandall
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA
- Correspondence:
| | - Leonard H. Epstein
- Department of Pediatrics, Jacobs School of Medicine, University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA
| | - Jennifer Fillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, The University of South Carolina, 915 Greene St Discovery I, Suite 551, Columbia, SC 29208, USA
| | - Kevin Carfley
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA
| | - Eleanor Fumerelle
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA
| | - Jennifer L. Temple
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA
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Mattes RD, Rowe SB, Ohlhorst SD, Brown AW, Hoffman DJ, Liska DJ, Feskens EJM, Dhillon J, Tucker KL, Epstein LH, Neufeld LM, Kelley M, Fukagawa NK, Sunde RA, Zeisel SH, Basile AJ, Borth LE, Jackson E. Valuing the Diversity of Research Methods to Advance Nutrition Science. Adv Nutr 2022; 13:1324-1393. [PMID: 35802522 PMCID: PMC9340992 DOI: 10.1093/advances/nmac043] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 03/31/2022] [Accepted: 04/08/2022] [Indexed: 12/13/2022] Open
Abstract
The ASN Board of Directors appointed the Nutrition Research Task Force to develop a report on scientific methods used in nutrition science to advance discovery, interpretation, and application of knowledge in the field. The genesis of this report was growing concern about the tone of discourse among nutrition professionals and the implications of acrimony on the productive study and translation of nutrition science. Too often, honest differences of opinion are cast as conflicts instead of areas of needed collaboration. Recognition of the value (and limitations) of contributions from well-executed nutrition science derived from the various approaches used in the discipline, as well as appreciation of how their layering will yield the strongest evidence base, will provide a basis for greater productivity and impact. Greater collaborative efforts within the field of nutrition science will require an understanding that each method or approach has a place and function that should be valued and used together to create the nutrition evidence base. Precision nutrition was identified as an important emerging nutrition topic by the preponderance of task force members, and this theme was adopted for the report because it lent itself to integration of many approaches in nutrition science. Although the primary audience for this report is nutrition researchers and other nutrition professionals, a secondary aim is to develop a document useful for the various audiences that translate nutrition research, including journalists, clinicians, and policymakers. The intent is to promote accurate, transparent, verifiable evidence-based communication about nutrition science. This will facilitate reasoned interpretation and application of emerging findings and, thereby, improve understanding and trust in nutrition science and appropriate characterization, development, and adoption of recommendations.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Leonard H Epstein
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | | | - Michael Kelley
- Michael Kelley Nutrition Science Consulting, Wauwatosa, WI, USA
| | - Naomi K Fukagawa
- USDA Beltsville Human Nutrition Research Center, Beltsville, MD, USA
| | | | - Steven H Zeisel
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Leone L, Haynes-Maslow L, Kasprzak C, Raja S, Epstein LH. The WIC Shopping Experience: A Qualitative Study Examining Retail-based Strategies to Increase WIC Retention and Redemption Rates. Journal of Hunger & Environmental Nutrition 2022. [DOI: 10.1080/19320248.2021.1915906] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Lucia Leone
- Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Lindsey Haynes-Maslow
- Agricultural and Human Sciences, College of Agriculture and Life Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Christina Kasprzak
- Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Samina Raja
- Urban and Regional Planning, School of Architecture and Planning, University at Buffalo, Buffalo, New York, USA
| | - Leonard H. Epstein
- SUNY Distinguished Professor of Paediatrics, Division of Behavioral Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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Fowler LA, Litt MD, Rotman SA, Conlon RPK, Jakubiak J, Stein RI, Balantekin KN, Welch RR, Perri MG, Epstein LH, Wilfley DE. Relation of social network support to child health behaviors among children in treatment for overweight/obesity. Eat Weight Disord 2022; 27:1669-1678. [PMID: 34549372 PMCID: PMC8934746 DOI: 10.1007/s40519-021-01303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/08/2021] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Little is known about the influence of social network support on child health behaviors in the context of weight-loss interventions. This study examined the associations between a child's co-participation (i.e., network support) in weight-related health behaviors (i.e., physical and sedentary activity, eating behavior) and the child's own health behaviors during family-based behavioral treatment (FBT). METHODS Children (n = 241) with overweight/obesity (mean age = 9.4 ± 1.3y; 63% female) completed semi-structured interviews assessing network support for healthy/unhealthy eating and physical/sedentary activity, and a 3-day dietary recall. Physical activity was assessed with accelerometry, and sedentary activity was measured via parent-reported child screen time use. All assessments were taken at baseline and after 4 months of FBT. Hierarchical linear regressions examined changes in network support as they related to changes in health behaviors from baseline to the end of FBT. RESULTS Changes in network support for healthy eating were related to changes in vegetable, but not fruit, intake across FBT, while changes in network support for unhealthy eating were negatively related to changes in diet quality. Changes in network support for sedentary activity were negatively related to changes in minutes of physical activity and positively related to changes in screen time. CONCLUSION The present findings suggest that a child's network support for health behaviors may relate to behavior change among children during FBT and provide opportunities for targeted intervention. LEVEL OF EVIDENCE III. cohort study.
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Affiliation(s)
- Lauren A Fowler
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
| | - Mark D Litt
- Division of Behavioral Sciences and Community Health, University of Connecticut Health Center, Storrs, CT, 263 Farmington Ave., MC 3910, Farmington, CT, 06030, USA
| | - Sophia A Rotman
- Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 451 Newton Rd, Iowa City, IA, 52242, USA
| | - Rachel P Kolko Conlon
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara St, Pittsburgh, PA, 15213, USA
| | - Jessica Jakubiak
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Richard I Stein
- Department of Internal Medicine, Washington University School of Medicine, Campus Box 8031, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, University at Buffalo, 204A Kimball Tower, Buffalo, NY, 14214, USA
| | - R Robinson Welch
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Michael G Perri
- Department of Clinical and Health Psychology, University of Florida, P.O. Box 100185, Gainesville, FL, 32610, USA
| | - Leonard H Epstein
- Department of Pediatrics, University at Buffalo, 3435 Main St, Buffalo, NY, 14214, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
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Kohn R, Vachani A, Small D, Stephens-Shields AJ, Sheu D, Madden VL, Bayes BA, Chowdhury M, Friday S, Kim J, Gould MK, Ismail MH, Creekmur B, Facktor MA, Collins C, Blessing KK, Neslund-Dudas CM, Simoff MJ, Alleman ER, Epstein LH, Horst MA, Scott ME, Volpp KG, Halpern SD, Hart JL. Comparing Smoking Cessation Interventions among Underserved Patients Referred for Lung Cancer Screening: A Pragmatic Trial Protocol. Ann Am Thorac Soc 2022; 19:303-314. [PMID: 34384042 PMCID: PMC8867367 DOI: 10.1513/annalsats.202104-499sd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/12/2021] [Indexed: 02/03/2023] Open
Abstract
Smoking burdens are greatest among underserved patients. Lung cancer screening (LCS) reduces mortality among individuals at risk for smoking-associated lung cancer. Although LCS programs must offer smoking cessation support, the interventions that best promote cessation among underserved patients in this setting are unknown. This stakeholder-engaged, pragmatic randomized clinical trial will compare the effectiveness of four interventions promoting smoking cessation among underserved patients referred for LCS. By using an additive study design, all four arms provide standard "ask-advise-refer" care. Arm 2 adds free or subsidized pharmacologic cessation aids, arm 3 adds financial incentives up to $600 for cessation, and arm 4 adds a mobile device-delivered episodic future thinking tool to promote attention to long-term health goals. We hypothesize that smoking abstinence rates will be higher with the addition of each intervention when compared with arm 1. We will enroll 3,200 adults with LCS orders at four U.S. health systems. Eligible patients include those who smoke at least one cigarette daily and self-identify as a member of an underserved group (i.e., is Black or Latinx, is a rural resident, completed a high school education or less, and/or has a household income <200% of the federal poverty line). The primary outcome is biochemically confirmed smoking abstinence sustained through 6 months. Secondary outcomes include abstinence sustained through 12 months, other smoking-related clinical outcomes, and patient-reported outcomes. This pragmatic randomized clinical trial will identify the most effective smoking cessation strategies that LCS programs can implement to reduce smoking burdens affecting underserved populations. Clinical trial registered with clinicaltrials.gov (NCT04798664). Date of registration: March 12, 2021. Date of trial launch: May 17, 2021.
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Affiliation(s)
- Rachel Kohn
- Palliative and Advanced Illness Research Center
- Department of Medicine
- Leonard Davis Institute of Health Economics
| | | | - Dylan Small
- Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | - Jannie Kim
- Palliative and Advanced Illness Research Center
| | - Michael K. Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | - Beth Creekmur
- Department of Research and Evaluation, Kaiser Permanente Southern California, Riverside, California
| | | | | | - Kristina K. Blessing
- Investigator Initiated Research Operations, Geisinger Health System, Danville, Pennsylvania
| | | | - Michael J. Simoff
- Henry Ford Cancer Institute, and
- Department of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, Michigan
| | | | - Leonard H. Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Michael A. Horst
- Lancaster General Health Research Institute, University of Pennsylvania Health System, Lancaster, Pennsylvania
| | - Michael E. Scott
- The Center for Black Health and Equity, Durham, North Carolina; and
| | - Kevin G. Volpp
- Department of Medicine
- Leonard Davis Institute of Health Economics
- Department of Medical Ethics and Health Policy, and
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Scott D. Halpern
- Palliative and Advanced Illness Research Center
- Department of Medicine
- Leonard Davis Institute of Health Economics
- Department of Biostatistics, Epidemiology and Informatics
- Department of Medical Ethics and Health Policy, and
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joanna L. Hart
- Palliative and Advanced Illness Research Center
- Department of Medicine
- Leonard Davis Institute of Health Economics
- Department of Medical Ethics and Health Policy, and
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Epstein LH, Czajkowski SM, Freedland KE. An introduction to the special issue: From ideas to efficacy in health psychology. Health Psychol 2022; 40:824-828. [PMID: 34990184 DOI: 10.1037/hea0001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The impetus for the special issue, "From Ideas to Efficacy" was the perceived need to stimulate and support a more vibrant research base that translates basic behavioral and social science research (bBSSR) discoveries to clinical and public health interventions. This special issue presents novel research that advances translational behavioral science, focusing primarily on the early phases of behavioral translation that are not as well recognized as later-phase translational science (e.g., dissemination and implementation research). The special issue includes a series of empirical, conceptual, and methodological papers, and a shining example of translational research that has had important clinical implications for the treatment of obesity and prevention of people with prediabetes from transitioning to Type II diabetes. In this introduction we will first set the context of the special issue and briefly comment on the papers. We end with several ideas in the areas of funding, training and publication of early phase translational behavioral science that can accelerate the process through which new ideas from our deepening understanding of human behavior can be more rapidly and fully brought to bear on the pressing health problems facing our nation and our world. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Epstein LH, Jimenez-Knight T, Honan AM, Paluch RA, Bickel WK. Imagine to Remember: An Episodic Future Thinking Intervention to Improve Medication Adherence in Patients with Type 2 Diabetes. Patient Prefer Adherence 2022; 16:95-104. [PMID: 35046645 PMCID: PMC8763258 DOI: 10.2147/ppa.s342118] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/15/2021] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Medication nonadherence is prevalent in diabetic populations, with "forgetting" a commonly cited reason. This issue of forgetfulness is due, in part, to a failure of prospective memory (PM). Episodic future thinking (EFT) has been shown to improve PM but has not been used to improve medication adherence. PATIENTS AND METHODS The current study used a multiple baseline design (N = 4) to test the effects of EFT on medication non-adherence for four patients with a diagnosis of type 2 diabetes or prediabetes, with comorbid high blood pressure or high cholesterol. Medication adherence was objectively measured over 15 weeks using medication event monitoring systems. RESULTS Results of visual analysis showed medication adherence was reliably improved, confirmed by mixed model analysis of variance (p < 0.001), with significant differences from baseline to treatment (Tau <0.05) for 3 of 4 participants. Improvements in two measures of PM (effect size (ES) = 0.73, 0.80) and delay discounting (ES = 1.20) were observed. CONCLUSION This study provides a feasible way to improve medication adherence in patients with prediabetes or type 2 diabetes.
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Affiliation(s)
- Leonard H Epstein
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
- Correspondence: Leonard H Epstein Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, G56, Farber Hall, Buffalo, NY, 14214, USATel +1 716-829-3400 Email
| | - Tatiana Jimenez-Knight
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Anna M Honan
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Rocco A Paluch
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Warren K Bickel
- Addiction Recovery Research Center, Fralin Biomedical Research Center, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
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Epstein LH, Bickel WK, Czajkowski SM, Paluch RA, Moeyaert M, Davidson KW. Single case designs for early phase behavioral translational research in health psychology. Health Psychol 2021; 40:858-874. [PMID: 34370494 PMCID: PMC8738131 DOI: 10.1037/hea0001055] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The biomedical research community has long recognized that much of the basic research being conducted, whether in the biological, behavioral or social sciences, is not readily translated into clinical and public health applications. This translational gap is due in part to challenges inherent in moving research findings from basic or discovery research to applied research that addresses clinical or public health problems. In the behavioral and social sciences, research designs typically used in the early phases of translational research are small, underpowered "pilot" studies that may lack sufficient statistical power to test the research question of interest. While this approach is discouraged, these studies are often employed to estimate effect sizes before embarking on a larger trial with adequate statistical power to test the research hypothesis. The goal of this paper is to provide an alternative approach to early phase studies using single case designs (SCDs). METHOD Review basic principles of SCDs; provide a series of hypothetical SCD replication experiments to illustrate (1) how data from SCDs can be analyzed to test the effects of an intervention on behavioral and biological outcomes and (2) how sample sizes can be derived for larger randomized controlled trials (RCTs) based on clinically meaningful effects from SCDs; and review feedback between SCDs and RCTs. RESULTS The paper illustrates the use of SCD reversal and multiple baseline designs for early phase translational research. CONCLUSION SCDs provide a flexible and efficient platform for the use of experimental methods in early phase translational research. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Abstract
BACKGROUND AND OBJECTIVE The novel theory of Reinforcer Pathology states that the temporal window of integration, measured by delay discounting (DD), determines the value of reinforcers. Based on the Reinforcer Pathology theory, the valuation of alternative reinforcers is positively associated with the length of the temporal window (negatively with rates of discounting). The objective of this article is to test the Reinforcer Pathology theory by reanalyzing data from a prior report (Carr & Epstein, 2018) in order to examine the association between the reinforcing value of alternative reinforcement and the length of the measured temporal window. METHOD Participants (N = 250) who completed an adjusting delay discounting task and the Pleasant Events Schedule (PES) were included in the study. PES provides a measurement of a reinforcement score (a cross-product of PES measures of frequency and pleasantness) for 45 noneating alternative activities. Analysis of Variance and Spearman product-moment correlations were completed. RESULTS Delay discounting was significantly positively correlated with sedentary reinforcement and significantly negatively correlated with cognitively enriching activities. A significant interaction was observed in the preference for between food and cognitive-enriching context as a function ln(k) in predicting the cognitive-enriching activity class. Nonsignificant relationships were also observed with the correlation of delay discounting to the reinforcement of social and physical activities. CONCLUSIONS These findings provide initial support for Reinforcer Pathology theory and indicate that the temporal window over which reinforcers are integrated may be a factor contributing to a preference for some healthy or unhealthy alternative reinforcers. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Bickel WK, Freitas-Lemos R, Tegge AN, Tomlinson DC, Epstein LH. Behavioral economic cigarette demand among individuals who smoke with and without obesity. Health Psychol 2021; 40:666-673. [PMID: 34881934 PMCID: PMC9972959 DOI: 10.1037/hea0001126] [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] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Obesity and cigarette smoking are leading preventable causes of mortality, with greater mortality risk when these disorders occur together. Comorbid obesity and cigarette smoking may affect the valuation of cigarettes. The present study examines the demand for cigarettes between obese and nonobese smokers. METHOD Participants (N = 187) from four in-laboratory studies completed the hypothetical cigarette purchase task. According to self-reported height and weight, participants were assigned to either the obese group (body mass index [BMI] ≥ 30) or to the nonobese group (BMI < 30). RESULTS Significant differences in demand intensity were observed between individuals with and without obesity, F(1, 168) = 9.284, p = .003, with individuals who smoke and are obese showing higher demand intensity (product purchasing when free). These differences in demand intensity between groups remained after adjusting for the number of cigarettes consumed per day. No differences were observed in elasticity of demand, F(1, 168) = 1.033, p = .311. CONCLUSIONS The results reported here suggest that individuals who smoke and are obese may value brief, intense, and immediate reinforcers more than individuals who smoke and are not obese. Further research may suggest reinforcer pathology as a basis for this result. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Warren K. Bickel
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | | | - Allison N. Tegge
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA,Department of Statistics, Virginia Tech, Blacksburg, VA, USA
| | - Devin C. Tomlinson
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA,Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, USA
| | - Leonard H. Epstein
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
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Davison GM, Fowler LA, Ramel M, Stein RI, Conlon RP, Saelens BE, Welch RR, Perri MG, Epstein LH, Wilfley DE. Racial and socioeconomic disparities in the efficacy of a family-based treatment programme for paediatric obesity. Pediatr Obes 2021; 16:e12792. [PMID: 33847074 PMCID: PMC8440359 DOI: 10.1111/ijpo.12792] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/27/2021] [Accepted: 03/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Family-based behavioural weight loss treatment (FBT) is an evidence-based intervention for paediatric overweight/obesity (OV/OB), but little research has examined the relative efficacy of FBT across socioeconomic status (SES), and racial groups. METHOD A total of 172 youth (7-11 years; 61.6% female; 70.1% White, 15.7% Black; child percent OV = 64.2 ± 25.2; 14.5% low-income) completed 4 months of FBT and 8 months of additional intervention (either active social facilitation-based weight management or an education control condition). Parents reported family income, social status (Barratt simplified measure of social status) and child race at baseline. Household income was dichotomized into < or >50% of the area median family income. Race was classified into White, Black or other/multi-race. Treatment efficacy was assessed by change in child % OV (BMI % above median BMI for age and sex) and change in child BMI % of 95th percentile (BMI % of the 95th percentile of weight for age and sex). Latent change score models examined differences in weight change between 0 and 4 months, 4 and 12 months and 0 and 12 months by income, social status and race. RESULTS Black children had, on average, less weight loss by 4 months compared to White children. Low-income was associated with less weight loss at 4 months when assessed independent of race. No differences by race, social status or income were detected from 4 to 12-months or from 0 to 12 months. CONCLUSIONS FBT is effective at producing child weight loss across different SES and racial groups, but more work is needed to understand observed differences in initial efficacy and optimize treatment across all groups.
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Affiliation(s)
- Genevieve M. Davison
- Department of Psychiatry, Washington University School of Medicine, Mail stop 8134-29-2100, 660 S. Euclid, St. Louis, MO 63110, USA
| | - Lauren A. Fowler
- Department of Psychiatry, Washington University School of Medicine, Mail stop 8134-29-2100, 660 S. Euclid, St. Louis, MO 63110, USA
| | - Melissa Ramel
- Department of Psychiatry, Washington University School of Medicine, Mail stop 8134-29-2100, 660 S. Euclid, St. Louis, MO 63110, USA
| | - Richard I. Stein
- Department of Medicine, Washington University School of Medicine, Campus Box 8031, 507 S. Euclid, St. Louis, MO 63110
| | - Rachel P.K. Conlon
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara St., Pittsburgh, PA 15213, USA
| | - Brian E. Saelens
- Department of Pediatrics, University of Washington and Seattle Children’s Research Institute, Seattle, WA, 2001 Eighth Ave., Suite 400, Seattle, WA 98121, USA
| | - R. Robinson Welch
- Department of Psychiatry, Washington University School of Medicine, Mail stop 8134-29-2100, 660 S. Euclid, St. Louis, MO 63110, USA
| | - Michael G. Perri
- Department of Clinical & Health Psychology, University of Florida, PO Box 100185, Gainesville, FL 32610, USA
| | - Leonard H. Epstein
- Department of Pediatrics, Division of Behavioral Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 3435 Main Street, Buffalo, NY 14214, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, Mail stop 8134-29-2100, 660 S. Euclid, St. Louis, MO 63110, USA
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Epstein LH, Schechtman KB, Kilanowski C, Ramel M, Moursi NA, Quattrin T, Cook SR, Eneli IU, Pratt C, Geller N, Campo R, Lew D, Wilfley DE. Implementing family-based behavioral treatment in the pediatric primary care setting: Design of the PLAN study. Contemp Clin Trials 2021; 109:106497. [PMID: 34389519 PMCID: PMC9664376 DOI: 10.1016/j.cct.2021.106497] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/20/2021] [Accepted: 06/27/2021] [Indexed: 12/11/2022]
Abstract
Family-based behavioral treatment (FBT) is an evidence-based treatment for pediatric obesity. FBT has primarily been implemented in specialty clinics, with highly trained interventionists. The goal of this study is to assess effectiveness of FBT implemented in pediatric primary care settings using newly trained interventionists who might implement FBT in pediatric practices. The goal is to randomize 528 families with a child with overweight/obesity (≥85th BMI percentile) and parent with overweight/obesity (BMI ≥ 25) across four sites (Buffalo and Rochester, New York; Columbus, Ohio; St. Louis, Missouri) to FBT or usual care and obtain assessments at 6-month intervals over 24 months of treatment. FBT is implemented using a mastery model, which provides quantity of treatment tailored to family progress and following the United States Preventive Services Task Force recommendations for effective dose and duration of treatment. The primary outcome of the trial is change in relative weight for children, and secondarily, for parents and siblings who are overweight/obese. Between group differences in the tendency to prefer small immediate rewards over larger, delayed rewards (delay discounting) and how this is related to treatment outcome is also evaluated. Challenges in translation of group-based interventions to individualized treatments in primary care settings, and in study implementation that arose due to the COVID-19 pandemic are discussed. It is hypothesized that the FBT intervention will be associated with better changes in relative weight for children, parents, and siblings than usual care. The results of this study can inform future dissemination and implementation of FBT into primary care settings.
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Affiliation(s)
- Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Kenneth B Schechtman
- Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Colleen Kilanowski
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Melissa Ramel
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Nasreen A Moursi
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Steven R Cook
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Ihouma U Eneli
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Charlotte Pratt
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nancy Geller
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rebecca Campo
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Daphne Lew
- Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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Bickel WK, Freitas-Lemos R, Tomlinson DC, Craft WH, Keith DR, Athamneh LN, Basso JC, Epstein LH. Temporal discounting as a candidate behavioral marker of obesity. Neurosci Biobehav Rev 2021; 129:307-329. [PMID: 34358579 DOI: 10.1016/j.neubiorev.2021.07.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 11/30/2022]
Abstract
Although obesity is a result of processes operating at multiple levels, most forms result from decision-making behavior. The aim of this review was to examine the candidacy of temporal discounting (TD) (i.e. the reduction in the value of a reinforcer as a function of the delay to its receipt) as a behavioral marker of obesity. For this purpose, we assessed whether TD has the ability to: identify risk for obesity development, diagnose obesity, track obesity progression, predict treatment prognosis/outcomes, and measure treatment effectiveness. Three databases (Pubmed, PsycINFO, and Web of Science) were searched using a combination of terms related to TD and obesity. A total of 153 papers were reviewed. Several areas show strong evidence of TD's predictive utility as a behavioral marker of obesity (e.g., distinguishing obese from non obese). However, other areas have limited and/or mixed evidence (e.g., predicting weight change). Given the positive relationship for TD in the majority of domains examined, further consideration for TD as a behavioral marker of obesity is warranted.
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Affiliation(s)
- Warren K Bickel
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA.
| | | | - Devin C Tomlinson
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA; Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, USA
| | - William H Craft
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA; Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, USA
| | - Diana R Keith
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Liqa N Athamneh
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Julia C Basso
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Leonard H Epstein
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Epstein LH, Carr KA. Food reinforcement and habituation to food are processes related to initiation and cessation of eating. Physiol Behav 2021; 239:113512. [PMID: 34217735 DOI: 10.1016/j.physbeh.2021.113512] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/25/2021] [Accepted: 06/28/2021] [Indexed: 01/11/2023]
Abstract
An individual bout of eating involves cues to start eating, as well as cues to terminate eating. One process that determines initiation of eating is food reinforcement. Foods with high reinforcing value are also likely to be consumed in greater quantities. Research suggests both cross-sectional and prospective relationships between food reinforcement and obesity, food reinforcement is positively related to energy intake, and energy intake mediates the relationship between food reinforcement and obesity. A process related to cessation of eating is habituation. Habituation is a general behavioral process that describes a reduction in physiological or affective response to a stimulus, or a reduction in the behavioral responding to obtain a stimulus. Repeated exposure to the same food during a meal can result in habituation to that food and a reduction in consumption. Habituation is also cross-sectionally and prospectively related to body weight, as people who habituate slower consume more in a meal and are more overweight. Research from our laboratory has shown that these two processes independently influence eating, as they can account for almost 60% of the variance in ad libitum intake. In addition, habituation phenotypes show reliable relationships with reinforcing value, such that people who habituate faster also find food less reinforcing. Developing a better understanding of cues to start and stop eating is fundamental to understanding how to modify eating behavior. An overview of research on food reinforcement, habituation and food intake for people with a range of weight status and without eating disorders is provided, and ideas about integrating these two processes that are related to initiation and termination of a bout of eating are discussed.
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Affiliation(s)
- Leonard H Epstein
- Jacobs School of Medicine and Biomedical Sciences, Department of Pediatrics, University at Buffalo, G56 Farber Hall, 3435 Main Street, Building #26, Buffalo, New York 14214-3000, USA.
| | - Katelyn A Carr
- Jacobs School of Medicine and Biomedical Sciences, Department of Pediatrics, University at Buffalo, G56 Farber Hall, 3435 Main Street, Building #26, Buffalo, New York 14214-3000, USA.
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Epstein LH, Jimenez-Knight T, Honan AM, Biondolillo MJ, Paluch RA, Bickel WK. A story to tell: the role of narratives in reducing delay discounting for people who strongly discount the future. Memory 2021; 29:708-718. [PMID: 34080492 PMCID: PMC8461562 DOI: 10.1080/09658211.2021.1936560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
Delay Discounting (DD) or devaluing a future, larger reward in favour of a smaller, more immediate reward, has been linked to negative health behaviours. One intervention that reduces DD is Episodic Future Thinking (EFT). EFT has participants generate cues representing positive future events that correspond to temporal windows during the DD task. The current study examined if incorporating EFT cues into narratives would strengthen effects on DD. One hundred and sixty adults were recruited from Amazon Mechanical Turk and were randomised to traditional or narrative EFT. Results showed that participants in narrative EFT discounted the future less (p = 0.034) than participants who engaged in traditional EFT. This novel approach to EFT is well grounded in research and theory on the power of narratives to influence behaviour and can open a new window into ways to reduce DD to strengthen engagement in positive choices.
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Affiliation(s)
- Leonard H Epstein
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Tatiana Jimenez-Knight
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Anna M Honan
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Mathew J Biondolillo
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Rocco A Paluch
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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Grammer AC, Best JR, Fowler LA, Balantekin KN, Stein RI, Conlon RPK, Saelens BE, Welch RR, Perri MG, Epstein LH, Wilfley DE. General and Eating Disorder Psychopathology in Relation to Short- and Long-Term Weight Change in Treatment-Seeking Children: A Latent Profile Analysis. Ann Behav Med 2021; 55:698-704. [PMID: 32914852 PMCID: PMC8240132 DOI: 10.1093/abm/kaaa076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Concurrent general psychopathology (GP) and eating disorder psychopathology (EDP) are commonly reported among youth with overweight/obesity and may impact weight change. PURPOSE We identified patterns of GP and EDP in children with overweight/obesity and examined the impact on weight change following family-based behavioral obesity treatment (FBT) and maintenance interventions. METHODS Children (N = 172) participated in 4 month FBT and subsequent 8 month weight maintenance interventions. GP and EDP were assessed prior to FBT (baseline). Child percentage overweight was assessed at baseline, post-FBT (4 months), and post-maintenance (12 months). Latent profile analysis identified patterns of baseline GP and EDP. Linear mixed-effects models examined if profiles predicted 4- and 12-month change in percentage overweight and if there were two-way and three-way interactions among these variables, adjusting for relevant covariates. RESULTS Results indicated a three-profile structure: lower GP and EDP (LOWER); subclinically elevated GP and EDP without loss of control (LOC; HIGHER); and subclinically elevated GP and EDP with LOC (HIGHER + LOC). Across profiles, children on average achieved clinically meaningful weight loss (i.e., ≥9 unit change in percentage overweight) from baseline to 4 month FBT and sustained these improvements at 12 month maintenance. There was no evidence that latent profiles were related to percentage overweight change from baseline to FBT (p > .05) or baseline to maintenance (p > .05). There was no evidence for two-way or three-way interactions (p > .05). CONCLUSION Concurrent GP and EDP do not portend differential short- or long-term weight change following FBT and maintenance. Future research is warranted on the durability of weight change among youth with GP and EDP. TRIAL REGISTRATION NCT00759746.
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Affiliation(s)
- Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - John R Best
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Lauren A Fowler
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Richard I Stein
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Rachel P Kolko Conlon
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Brian E Saelens
- Department of Pediatrics, University of Washington and Seattle Children’s Research Institute, Seattle, WA, USA
| | - R Robinson Welch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael G Perri
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Leonard H Epstein
- Department of Pediatrics, Division of Behavioral Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Epstein LH, Carr KA, Guth C, Shapiro L, Leone LA, Temple JL. The enriched home environment and dietary intake are related to percent overBMI in children. Prev Med Rep 2021; 23:101440. [PMID: 34178591 PMCID: PMC8209748 DOI: 10.1016/j.pmedr.2021.101440] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/31/2021] [Indexed: 11/23/2022] Open
Abstract
Aspects of the enriched home environment were related to child energy intake. Home environment and energy intake accounts for 18% of variance in child percent overBMI. Enriching a child’s environment is a novel approach to preventing childhood obesity.
Longitudinal research suggests that living in a cognitively enriched home environment, in which access to activities including hobbies and books are plentiful, can prevent excess weight gain and obesity in children. In order for the enriched home environment to influence weight it should influence energy and macronutrient intake and/or energy expenditure. To test this hypothesis, we used a cross sectional design to study aspects of the child’s enriched home environment along with energy and macronutrient intake. A sample of 158 6–9-year-old children measured between February 2017 – April 2019 in Buffalo, NY were selected from a larger study based on criteria for accurate reporting of energy intake using the Block Kid’s Food Frequency Questionnaire. Results showed that the Home Observation for Measurement of the Environment (HOME) subscales enriched environment, parental warmth and an integrated family structure were negatively related to child percent overBMI. Hierarchical regression showed that each of these factors improved variance in child percent overBMI accounted for beyond dietary intake or macronutrients, specifically accounting for a total of 18.2% variance in models controlling for total energy intake. These results provide the first demonstration that characteristics of a child’s home environment are associated with lower energy intake and independently associated with percent overBMI beyond knowledge of diet. Enriching a child’s home environment by providing alternative activities to eating, improving parental warmth and providing opportunities for parents to interact positively with their children may be novel ways to reduce childhood obesity that should be experimentally tested in future research.
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Affiliation(s)
- Leonard H. Epstein
- Department of Pediatrics, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, USA
- Corresponding author at: Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, G56 Farber Hall 3435 Main Street, Building #26, Buffalo, NY 14214-3000, USA.
| | - Katelyn A. Carr
- Department of Pediatrics, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, USA
| | - Catherine Guth
- Department of Pediatrics, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, USA
| | - Lilianna Shapiro
- Department of Pediatrics, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, USA
| | - Lucia A. Leone
- Department of Community Health and Health Behaviors, University at Buffalo, School of Public Health and Health Sciences, USA
| | - Jennifer L. Temple
- Department of Exercise and Nutrition Sciences, University at Buffalo, School of Public Health and Health Sciences, USA
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Epstein LH, O'Donnell S, Biondolillo MJ, Hostler D, Roemmich JN. Comparing the reinforcing value of high intensity interval training versus moderate intensity aerobic exercise in sedentary adults. Physiol Behav 2021; 238:113468. [PMID: 34033846 DOI: 10.1016/j.physbeh.2021.113468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
Exercise is a reinforcer for both animals and humans, as they will work progressively harder to gain access for the opportunity to exercise. Exercise activates brain reward pathways similar to drugs of abuse, and the magnitude of the reinforcing value of exercise is a predictor of exercise behavior. The majority of research on exercise reinforcement has studied moderate intensity aerobic exercise (MIAE) or resistance training. There is limited research on the relative reinforcing value (RRV) of high intensity interval training (HIIT), which is often reported to be a preferred form of exercise in comparison to MIAE. Experiment 1 was a pilot study of 20 sedentary females designed to compare the reliability of differences in RRVHIIT vs RRVMIAE over two sessions, assess protocols comparing different volumes of HIIT in comparison to MIAE, and estimate sample sizes needed for a fully powered study to assess which type of exercise protocol was a better substitute for a highly liked sedentary activity. Experiment 2 studied 44 participants to assess whether HIIT or MIAE would be better substitutes for highly liked sedentary activities. Experiment 1 showed that measures of RRVHIIT or RRVMIAE were reliable, and that volume of HIIT did not influence RRVHIIT, even if it was of equal amount or duration to MIAE. Experiment 2 showed that HIIT was a more preferred substitute for sedentary behaviors than MIAE. Predictors of RRVMIAE were liking of MIAE and pleasantness of affect post MIAE. These results suggest inactive people may find interval training to be more reinforcing than MIAE, and may be more likely to adopt and maintain an exercise program involving HIIT rather than MIAE. The next stage of research should be to understand how to sensitize the RRV of exercise to motivate sedentary people to be more active.
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Affiliation(s)
- Leonard H Epstein
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York.
| | - Sara O'Donnell
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Mathew J Biondolillo
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - David Hostler
- Department of Exercise and Nutrition Sciences, University at Buffalo School of Public Health and Health Sciences, Buffalo, New York
| | - James N Roemmich
- Grand Forks Human Nutrition Research Center, USDA Agricultural Research Service, Grand Forks, North Dakota
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Carr KA, Hollis-Hansen K, Austin K, Epstein LH. Written or drawn episodic future thinking cues improves delay discounting in adults. Learning and Motivation 2021; 74. [DOI: 10.1016/j.lmot.2021.101727] [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: 02/06/2023]
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Abstract
Conventional randomized clinical trials (RCTs) compare treatment effectiveness to provide support for evidence-based treatments that can be generalized to the average patient. However, the information obtained from RCTs may not always be useful for selecting the best treatment for individual patients. This article presents a complementary approach to identifying optimized treatments using experimental designs that focus on individuals. Personalized, or N-of-1, designs provide both a comparative analysis of treatments and a functional analysis demonstrating that changes in patient symptoms are likely because of the treatment implemented. This approach contributes to the zeitgeist of personalized medicine and provides clinicians with a paradigm for investigating optimal treatments for rare diseases for which RCTs are not always feasible, identifying personally effective treatments for patients with comorbidities who have historically been excluded from most RCTs, handling clinical situations in which patients respond idiosyncratically (either positively or negatively) to treatment, and shortening the time lag between identification and implementation of an evidence-based treatment. These designs merge experimental analysis of behavior methods used for decades in psychology with new methodological and statistical advances to assess significance levels of changes in individual patients, and they can be generalized to larger populations for meta-analytic purposes. This article presents a case for why these models are needed, an overview of how to apply personalized designs for different types of clinical scenarios, and a brief discussion of challenges associated with interpretation and implementation of personalized designs. The goal is to empower pediatricians to take personalized trial designs into clinical practice to identify optimal treatments for their patients.
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Affiliation(s)
- Karina W. Davidson
- Center for Personalized Health, Northwell Health, Long Island, NY,Donald and Barbara Zucker School of Medicine at Hofstra University, Long Island, NY
| | | | - Ken Cheung
- Mailman School of Public Health, Columbia University, New York, NY
| | - Rocco A. Paluch
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Leonard H. Epstein
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
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Ufholz K, Salvy SJ, Feda DM, Epstein LH, Roemmich JN. Weight discordant siblings' ability to reduce energy intake at a meal as compensation for prior energy intake from sugar-sweetened beverages (SSBs). Nutr Health 2021; 27:59-67. [PMID: 33045926 PMCID: PMC8085904 DOI: 10.1177/0260106020960990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Insufficient compensation for energy from sugar-sweetened beverages (SSBs) consumed prior to meals may promote greater overall energy intake. If so, ability to compensate for prior energy intake may account for difference in adiposity between adolescents with and without overweight. Studies of fraternal siblings discordant for weight status control for some genetic and shared within-family factors, which allows for testing how putative non-shared factors, such as parental control of feeding, predicts sibling weight differences. AIM To determine whether same-sex weight-discordant (one with, one without overweight) adolescent siblings differ in ability to compensate for prior energy intake. METHODS Same-sex biological sibling pairs (mean age = 15.4; 95% confidence interval (CI) 15.1, 15.7) (n = 38 pairs; 21 male pairs) consumed a sugar-sweetened (450 kcal) or a non-nutritive-sweetened (10 kcal) liquid preload of equal volumes on separate days, followed by an ad libitum lunch. Multilevel models examined ability to compensate, dietary restraint, and parental control of child's feeding. RESULTS Siblings showed insufficient compensation and overate (with overweight = 44 kcal; without overweight = 32 kcal). Siblings shared little within-family similarity in compensation (intra-class correlation coefficient (ICC) = 0.20). Compensation was predicted by parental restriction and general restriction (p = 0.02) Differences in siblings' BMI z-scores were associated with differences in dietary restraint (p = 0.04) not with differences in compensation. CONCLUSION Sibling differences in compensation for energy from sweetened beverages were not associated with differences in their adiposity. Compensation may be determined by a constellation of factors, including age, parental feeding practices, and food characteristics.
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Affiliation(s)
- Kelsey Ufholz
- United States Department of Agriculture, Agricultural Research Service, Grand Forks, ND, USA
| | - Sarah-Jeanne Salvy
- Cedars-Sinai Medical Center, Research Center for Health Equity, Los Angeles, CA, USA
| | - Denise M Feda
- University at Buffalo, Department of Pediatrics, Buffalo, NY, USA
- University at Buffalo, Department of Epidemiology and Environmental Health, Buffalo, NY, USA
| | | | - James N Roemmich
- United States Department of Agriculture, Agricultural Research Service, Grand Forks, ND, USA
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Tauriello S, McGovern L, Bartholomew B, Epstein LH, Leone LA, Goldsmith J, Kubiniec E, Anzman-Frasca S. Taste Ratings of Healthier Main and Side Dishes among 4-to-8-Year-Old Children in a Quick-Service Restaurant Chain. Nutrients 2021; 13:nu13020673. [PMID: 33669768 PMCID: PMC7922908 DOI: 10.3390/nu13020673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/16/2022] Open
Abstract
Restaurants are regular eating environments for many families. Children's consumption of restaurant foods has been linked with poorer diet quality, prompting emerging research examining strategies to encourage healthier eating among children in restaurants. Although taste is a primary determinant of restaurant meal choices, there is a lack of research considering children's perspectives on the taste of different healthier kids' meal options. The current study sought to examine, via objective taste testing, children's liking of and preference for healthier kids' meal options at a quick-service restaurant (QSR) and to describe bundled kids' meals with evidence of both taste acceptability and consistency with nutrition guidelines. Thirty-seven 4-to-8-year-old children completed taste tests of ten healthier main and side dish options. Liking and preference were assessed using standard methods after children tasted each food. Children also reported their ideal kids' meal. Results show the majority of children liked and preferred three main (turkey sandwich, chicken strips, peanut butter/banana sandwich) and side dishes (yogurt, applesauce, broccoli), with rank order differing slightly by age group. Accepted foods were combined into 11 bundles meeting nutritional criteria. Results highlight healthier kids' meals with evidence of appeal among children in a QSR. Findings can inform future research and may increase the success of healthy eating interventions in these settings.
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Affiliation(s)
- Sara Tauriello
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14214, USA; (S.T.); (L.M.); (L.H.E.); (J.G.); (E.K.)
| | - Lily McGovern
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14214, USA; (S.T.); (L.M.); (L.H.E.); (J.G.); (E.K.)
| | | | - Leonard H. Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14214, USA; (S.T.); (L.M.); (L.H.E.); (J.G.); (E.K.)
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY 14214, USA;
| | - Lucia A. Leone
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY 14214, USA;
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Juliana Goldsmith
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14214, USA; (S.T.); (L.M.); (L.H.E.); (J.G.); (E.K.)
| | - Elizabeth Kubiniec
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14214, USA; (S.T.); (L.M.); (L.H.E.); (J.G.); (E.K.)
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14214, USA; (S.T.); (L.M.); (L.H.E.); (J.G.); (E.K.)
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY 14214, USA;
- Correspondence:
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Athamneh LN, Stein MD, Lin EH, Stein JS, Mellis AM, Gatchalian KM, Epstein LH, Bickel WK. Setting a goal could help you control: Comparing the effect of health goal versus general episodic future thinking on health behaviors among cigarette smokers and obese individuals. Exp Clin Psychopharmacol 2021; 29:59-72. [PMID: 32191071 PMCID: PMC7501169 DOI: 10.1037/pha0000351] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Episodic Future Thinking (EFT) reduces delay discounting (DD; preference for smaller, immediate rewards) and various maladaptive behaviors. Exploring potential personalization of EFT to optimize its ability to alter DD and demand for unhealthy reinforcers is important for the development of interventions targeting long-term improvement and maintenance of health. In this investigation, using 2 separate studies, we examined the effects of EFT with and without a health goal on rates of discounting, demand, and craving for cigarettes and fast food among cigarette smokers and obese individuals, respectively. Using data collected from Amazon Mechanical Turk (mTurk), Study 1 (N = 189) examined the effect of EFT on DD and measures of cigarette demand and craving in cigarette smokers who were randomly assigned to 1 of 3 conditions: EFT-health goal, EFT-general, or Episodic Recent Thinking (ERT)-general. Study 2 (N = 255), using a 2x2 factorial design, examined the effects of health goals and general EFT on DD and measures of fast food demand and craving in obese individuals who were randomly assigned to 1 of 4 conditions: EFT-health goal, EFT-general, ERT-health goal or ERT-general. Health goal EFT was not more effective than general EFT in reducing monetary discounting. However, the addition of a health goal to general EFT was significantly associated with higher effect on intensity and elasticity of demand for cigarettes and fast food compared to EFT without a health goal. These findings suggest that the amplification of future thinking through the inclusion of a health goal may promote healthy decisions and result in positive behavior changes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | - Elysia H Lin
- Center for Transformative Research on Health Behaviors
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Hayes JF, Fowler LA, Balantekin KN, Saelens BE, Stein RI, Perri MG, Welch RR, Epstein LH, Wilfley DE. Children with Severe Obesity in Family-Based Obesity Treatment Compared with Other Participants: Conclusions Depend on Metrics. Obesity (Silver Spring) 2021; 29:393-401. [PMID: 33491306 PMCID: PMC7842730 DOI: 10.1002/oby.23071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/28/2020] [Accepted: 10/12/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study compares children with severe obesity and children with mild obesity/overweight participating in family-based obesity treatment (FBT) on change in (1) relative weight and adiposity and (2) psychosocial distress. METHODS Children 7 to 11 years old (N = 241) and their parents participated in 12 months of behavioral treatment (FBT + maintenance treatment) and completed anthropometric, adiposity, and psychosocial assessments (psychiatric disorder symptomology, quality of life). Severe obesity was defined as a baseline BMI ≥ 120% of the 95th percentile (N = 105). RESULTS At 12 months, 40% of children with baseline severe obesity no longer had severe obesity. Percent overweight and fat mass index measurements showed similar magnitudes of change among children with severe obesity and children with mild obesity/overweight, whereas BMI z score and percent body fat change was lower in the group with severe obesity. Youth with severe obesity were higher on some measures of psychosocial distress at baseline but generally experienced improvements similar to children with mild obesity/overweight. CONCLUSIONS FBT with maintenance treatment is beneficial for children with severe obesity and is recommended for use prior to more invasive treatments in severe pediatric obesity. Future studies should assess the necessity of additional treatment, as children with severe obesity still have high relative weights post intervention.
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Affiliation(s)
| | | | | | - Brian E. Saelens
- Seattle Children’s Research Institute and the University of Washington, Seattle, WA, USA
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Epstein LH, Paluch RA, Stein JS, Quattrin T, Mastrandrea LD, Bree KA, Sze YY, Greenawald MH, Biondolillo M, Bickel WK. Delay Discounting, Glycemic Regulation and Health Behaviors in Adults with Prediabetes. Behav Med 2021; 47:194-204. [PMID: 32275202 PMCID: PMC8462992 DOI: 10.1080/08964289.2020.1712581] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 01/15/2023]
Abstract
The majority of people with prediabetes transition to type 2 diabetes. Research has suggested that persons with type 2 diabetes are likely to discount the future and focus on immediate rewards. This study was designed to assess whether this process of delay discounting (DD) is associated with glycemic regulation, medication adherence and eating and exercise behaviors in adults with prediabetes. Participants included 81 adults with prediabetes who were also prescribed hypertension or dyslipidemia drugs, which is common for people with prediabetes. Participants completed adjusting amount DD $100 and $1000 tasks, as well assessments of glycemic control (Hemoglobin (Hb) A1c), medication adherence, diet quality, and objectively measured physical activity. Relationships between DD and these variables were assessed. Results showed higher rates of DD were related to higher HbA1c; as well as poorer medication adherence, lower diet quality and lower physical activity. Hierarchical regression showed that the association between minority status, a known risk factor for type 2 diabetes, was moderated by DD, as minorities with higher DD had greater HbA1c values. Delay discounting may represent a novel target to prevent progression from prediabetes to type 2 diabetes.
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Affiliation(s)
| | - Rocco A. Paluch
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences
| | | | - Teresa Quattrin
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences
| | | | - Kyle A. Bree
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences
| | - Yan Yan Sze
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences
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Fowler LA, Grammer AC, Ray MK, Balantekin KN, Stein RI, Kolko Conlon RP, Welch RR, Perri MG, Epstein LH, Wilfley DE. Examining the interdependence of parent-child dyads: Effects on weight loss and maintenance. Pediatr Obes 2021; 16:e12697. [PMID: 32720457 PMCID: PMC8186411 DOI: 10.1111/ijpo.12697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 06/05/2020] [Accepted: 06/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to further elucidate correlated weight changes in parent-child dyads enrolled in family-based treatment (FBT) by modeling the interdependence of weight changes during treatment. METHODS Parent-child dyads (n = 172) with overweight/obesity (child mean zBMI = 2.16 ± 0.39; parent mean BMI = 37.9 ± 9.4 kg/m2 ) completed 4 months of FBT and were randomized to one of three 8-month maintenance interventions (Social Facilitation Maintenance [SFM]-high dose, SFM-low dose or control). Weight/height was measured at 0, 4 and 12 months. Structural equation models simultaneously estimated the effect that an individual had on their own (actor effect) and on one another's (partner effect) weight-status across time using the actor-partner interdependence model. RESULTS Actor paths were significant over time for parent and child. Partner paths were significant for child zBMI predicting parent BMI at 4 and 12 months. Maintenance condition moderated actor/partner paths in the model. CONCLUSIONS Child weight change may motivate parents to make environmental and behavioural changes that impact their own weight. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00759746.
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Affiliation(s)
- Lauren A Fowler
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mary Katherine Ray
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, University of Buffalo, Buffalo, New York, USA
| | - Richard I Stein
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - R Robinson Welch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael G Perri
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Leonard H Epstein
- Department of Pediatrics, University at Buffalo, Buffalo, New York, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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Anzman-Frasca S, Singh A, Curry D, Tauriello S, Epstein LH, Faith MS, Reardon K, Pape D. Evaluating a Board Game Designed to Promote Young Children's Delay of Gratification. Front Psychol 2020; 11:581025. [PMID: 33262729 PMCID: PMC7686572 DOI: 10.3389/fpsyg.2020.581025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/21/2020] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Delay of gratification, or the extent to which one can resist the temptation of an immediate reward and wait for a larger reward later, is a self-regulatory skill that predicts positive outcomes. The aim of this research was to conduct initial tests of the effects of a board game designed to increase children's delay of gratification via two experimental studies. METHODS Preschool children were randomized to play the study game or a control game. In Study 1, there were 48 children in the analytic sample, with a mean age of 4.81 ± 0.55 years; Study 2 included 50 children (M = 4.02 ± 0.76 years). Delay of gratification was assessed during the study game, as well as before and after game play sessions using the Marshmallow Test. RESULTS In both studies, the intervention group's likelihood of delaying gratification during the study game increased across game-play sessions (p < 0.05). In Study 1, the intervention group also increased wait times during the Marshmallow Test versus controls (p = 0.047). In Study 2, there was no effect on Marshmallow Test wait times. CONCLUSION Results provide some initial evidence supporting potential efficacy of a board game designed to increase delay of gratification. Future research can clarify: (1) which components of game play (if any) are linked with broader changes in delay of gratification, (2) impacts of this intervention in more diverse samples, and (3) whether experimental manipulation of delay of gratification affects outcomes like achievement and weight, which have been linked to this skill in observational studies.
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Affiliation(s)
- Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY, United States
| | - Anita Singh
- Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Derek Curry
- College of Arts, Media and Design, Northeastern University, Boston, MA, United States
| | - Sara Tauriello
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Leonard H. Epstein
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY, United States
| | - Myles S. Faith
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY, United States
- Department of Counseling, School, and Educational Psychology, Graduate School of Education, University at Buffalo, Buffalo, NY, United States
| | - Kaley Reardon
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Dave Pape
- Department of Media Study, College of Arts and Sciences, University at Buffalo, Buffalo, NY, United States
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Douglas SM, Hawkins GM, Berlin KS, Crouter SE, Epstein LH, Thomas JG, Raynor HA. Rationale and protocol for translating basic habituation research into family-based childhood obesity treatment: Families becoming healthy together study. Contemp Clin Trials 2020; 98:106153. [PMID: 32950645 PMCID: PMC7686119 DOI: 10.1016/j.cct.2020.106153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 11/17/2022]
Abstract
This publication describes the rationale and protocol, including design, aims, intervention, and measures, of Families Becoming Healthy Together, a randomized clinical trial examining the effect of a limited RED (non-nutrient-dense, energy-dense) food variety prescription delivered within an 18-month family-based behavioral obesity treatment (FBT) on body mass index (BMI) and habituation rate to RED foods. One hundred fifty-six children (ages: 8-12 y; BMI: ≥ 85th percentile-for-age) and a caregiver (BMI: ≥ 25 kg/m2), both with overweight or obesity, will be randomized to one of two, interventions: FBT or FBT + Variety. All participants will receive 29 sessions of FBT and be prescribed the Traffic Light Diet (1000-1500 kcal/day, ≤ 2 RED food servings/day), and a physical activity goal (≥ 60 min/day [child] or 150 min/week [adult] of moderate-vigorous physical activity (MVPA)). FBT + Variety will also identify two RED foods, a dinner entrée and snack food, and develop meal plans that reduce variety of RED foods by regularly consuming these foods and limiting consumption of other RED foods. Measures of anthropometrics, dietary intake, habituation of salivary response to food cues, and physical activity will be assessed at 0, 6, 12, and 18-months. This study translates a line of basic behavioral research examining how dietary variety influences habituation into a dietary prescription that will be tested within an efficacy trial. It is hypothesized that a novel, limited dietary variety prescription within FBT should promote a faster food habituation rate, reducing energy intake and amplifying long-term weight loss in children.
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Affiliation(s)
- Steve M Douglas
- Department of Nutrition, University of Tennessee, Knoxville, TN, USA
| | - Grace M Hawkins
- Department of Nutrition, University of Tennessee, Knoxville, TN, USA
| | | | - Scott E Crouter
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN, USA
| | - Leonard H Epstein
- Department of Pediatrics, School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - John G Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital/Brown Alpert Medical School, Providence, RI, USA
| | - Hollie A Raynor
- Department of Nutrition, University of Tennessee, Knoxville, TN, USA.
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Stein JS, Craft WH, Paluch RA, Gatchalian KM, Greenawald MH, Quattrin T, Mastrandrea LD, Epstein LH, Bickel WK. Bleak present, bright future: II. Combined effects of episodic future thinking and scarcity on delay discounting in adults at risk for type 2 diabetes. J Behav Med 2020; 44:222-230. [PMID: 32989616 DOI: 10.1007/s10865-020-00178-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 09/02/2020] [Indexed: 12/17/2022]
Abstract
The present study sought to determine if episodic future thinking (EFT) can decrease delay discounting (DD) and demand for fast food under simulations of economic scarcity in adults at risk for diabetes (i.e., overweight/obese and with hemoglobin A1c values in, or approaching, the prediabetic range). Across two sessions, participants completed assessments of DD and food demand at baseline and while prompted to: (1) engage in either EFT or control episodic recent thinking, and (2) while reading a brief narrative describing either economic scarcity or neutral income conditions. Results showed that EFT significantly reduced DD, whereas the economic scarcity narrative significantly increased DD; no significant interaction between EFT and scarcity was observed. No significant effect of either EFT or scarcity was observed on food demand. We conclude that EFT decreases DD even when challenged by simulated economic scarcity in adults at risk for diabetes. The absence of a significant interaction between EFT and scarcity suggests that these variables operate independently to influence DD in opposing directions. Effects of EFT and economic scarcity on food demand require further study. The present study was registered on clinicaltrials.gov (NCT03664726).
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Affiliation(s)
- Jeffrey S Stein
- Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, 1 Riverside Circle, Roanoke, VA, 24016, USA.
| | - William H Craft
- Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, 1 Riverside Circle, Roanoke, VA, 24016, USA
| | - Rocco A Paluch
- School of Medicine and Biomedical Sciences, University at Buffalo Jacobs, Buffalo, NY, USA
| | - Kirstin M Gatchalian
- Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, 1 Riverside Circle, Roanoke, VA, 24016, USA
| | - Mark H Greenawald
- Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA, USA
| | - Teresa Quattrin
- School of Medicine and Biomedical Sciences, University at Buffalo Jacobs, Buffalo, NY, USA
| | - Lucy D Mastrandrea
- School of Medicine and Biomedical Sciences, University at Buffalo Jacobs, Buffalo, NY, USA
| | - Leonard H Epstein
- School of Medicine and Biomedical Sciences, University at Buffalo Jacobs, Buffalo, NY, USA
| | - Warren K Bickel
- Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute at VTC, 1 Riverside Circle, Roanoke, VA, 24016, USA
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Rung JM, Epstein LH. Translating episodic future thinking manipulations for clinical use: Development of a clinical control. PLoS One 2020; 15:e0237435. [PMID: 32810166 PMCID: PMC7433876 DOI: 10.1371/journal.pone.0237435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 07/27/2020] [Indexed: 11/18/2022] Open
Abstract
Many studies support that Episodic Future Thinking (EFT) reduces maladaptive health behaviors and how much individuals devalue the future (steepness of delay discounting). In order to understand the clinical utility of EFT, a control procedure that equates groups in non-specific treatment factors (e.g., expectancy of change, perceived connection of content to health behavior) is needed. The present research evaluated the effects of EFT relative to a novel control (health information thinking; HIT), which was designed to be structurally similar to EFT while incorporating elements from existing clinical controls. In a sample of Amazon Mechanical Turk workers (N = 254), we found that EFT reduced discounting relative to the HIT procedure and a standard EFT control. There were some affective differences across groups and differences in adherence to the intervention content, but these were unrelated to discounting. Delay discounting was not equivalent across the control groups, but this may not be a necessary condition to fulfill for a clinical control. Future research will need to identify whether the HIT procedure serves as a good control for other dependent variables when studying EFT and develop controls analogous to usual care or a "wait-list" in clinical contexts.
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Affiliation(s)
- Jillian M. Rung
- Department of Pediatrics, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
| | - Leonard H. Epstein
- Department of Pediatrics, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
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