Using social and mobile tools for weight loss in overweight and obese young adults (Project SMART): a 2 year, parallel-group, randomised, controlled trial. The lancet. Diabetes & endocrinology 2016; 4 (9): 747-755
Few weight loss interventions are evaluated for longer than a year, and even fewer employ social and mobile technologies commonly used among young adults. We assessed the efficacy of a 2 year, theory-based, weight loss intervention that was remotely and adaptively delivered via integrated user experiences with Facebook, mobile apps, text messaging, emails, a website, and technology-mediated communication with a health coach (the SMART intervention).In this parallel-group, randomised, controlled trial, we enrolled overweight or obese college students (aged 18-35 years) from three universities in San Diego, CA, USA. Participants were randomly assigned (1:1) to receive either the intervention (SMART intervention group) or general information about health and wellness (control group). We used computer-based permuted-block randomisation with block sizes of four, stratified by sex, ethnicity, and college. Participants, study staff, and investigators were masked until the intervention was assigned. The primary outcome was objectively measured weight in kg at 24 months. Differences between groups were evaluated using linear mixed-effects regression within an intention-to-treat framework. Objectively measured weight at 6, 12, and 18 months was included as a secondary outcome. The trial is registered with ClinicalTrials.gov, number NCT01200459.Between May 18, 2011, and May 17, 2012, 404 individuals were randomly assigned to the intervention (n=202) or control (n=202). Participants' mean (SD) age was 227 (38) years. 284 (70%) participants were female and 125 (31%) were Hispanic. Mean (SD) body-mass index at baseline was 290 (28) kg/m(2). At 24 months, weight was assessed in 341 (84%) participants, but all 404 were included in analyses. Weight, adjusted for sex, ethnicity, and college, was not significantly different between the groups at 24 months (-079 kg [95% CI -202 to 043], p=0204). However, weight was significantly less in the intervention group compared with the control group at 6 months (-133 kg [95% CI -236 to -030], p=0011) and 12 months (-133 kg [-230 to -035], p=0008), but not 18 months (-067 kg [95% CI -169 to 035], p=0200). One serious adverse event in the intervention group (gallstones) could be attributable to rapid and excessive weight loss.Social and mobile technologies did not facilitate sustained reductions in weight among young adults, although these approaches might facilitate limited short-term weight loss.The National Heart, Lung, and Blood Institute of the National Institutes of Health (U01 HL096715).
View details for DOI 10.1016/S2213-8587(16)30105-X
View details for PubMedID 27426247
Effects of Three Motivationally Targeted Mobile Device Applications on Initial Physical Activity and Sedentary Behavior Change in Midlife and Older Adults: A Randomized Trial PLOS ONE 2016; 11 (6)
While there has been an explosion of mobile device applications (apps) promoting healthful behaviors, including physical activity and sedentary patterns, surprisingly few have been based explicitly on strategies drawn from behavioral theory and evidence.This study provided an initial 8-week evaluation of three different customized physical activity-sedentary behavior apps drawn from conceptually distinct motivational frames in comparison with a commercially available control app.Ninety-five underactive adults ages 45 years and older with no prior smartphone experience were randomized to use an analytically framed app, a socially framed app, an affectively framed app, or a diet-tracker control app. Daily physical activity and sedentary behavior were measured using the smartphone's built-in accelerometer and daily self-report measures.Mixed-effects models indicated that, over the 8-week period, the social app users showed significantly greater overall increases in weekly accelerometry-derived moderate to vigorous physical activity relative to the other three arms (P values for between-arm differences = .04-.005; Social vs. Control app: d = 1.05, CI = 0.44,1.67; Social vs. Affect app: d = 0.89, CI = 0.27,1.51; Social vs. Analytic app: d = 0.89, CI = 0.27,1.51), while more variable responses were observed among users of the other two motivationally framed apps. Social app users also had significantly lower overall amounts of accelerometry-derived sedentary behavior relative to the other three arms (P values for between-arm differences = .02-.001; Social vs. Control app: d = 1.10,CI = 0.48,1.72; Social vs. Affect app: d = 0.94, CI = 0.32,1.56; Social vs. Analytic app: d = 1.24, CI = 0.59,1.89). Additionally, Social and Affect app users reported lower overall sitting time compared to the other two arms (P values for between-arm differences < .001; Social vs. Control app: d = 1.59,CI = 0.92, 2.25; Social vs. Analytic app: d = 1.89,CI = 1.17, 2.61; Affect vs. Control app: d = 1.19,CI = 0.56, 1.81; Affect vs. Analytic app: d = 1.41,CI = 0.74, 2.07).The results provide initial support for the use of a smartphone-delivered social frame in the early induction of both physical activity and sedentary behavior changes. The information obtained also sets the stage for further investigation of subgroups that might particularly benefit from different motivationally framed apps in these two key health promotion areas.ClinicalTrials.gov NCT01516411.
View details for DOI 10.1371/journal.pone.0156370
View details for Web of Science ID 000378858900002
View details for PubMedID 27352250
Statistical methodologies to pool across multiple intervention studies. Translational behavioral medicine 2016; 6 (2): 228-235
Combining and analyzing data from heterogeneous randomized controlled trials of complex multiple-component intervention studies, or discussing them in a systematic review, is not straightforward. The present article describes certain issues to be considered when combining data across studies, based on discussions in an NIH-sponsored workshop on pooling issues across studies in consortia (see Belle et al. in Psychol Aging, 18(3):396-405, 2003). Several statistical methodologies are described and their advantages and limitations are explored. Whether weighting the different studies data differently, or via employing random effects, one must recognize that different pooling methodologies may yield different results. Pooling can be used for comprehensive exploratory analyses of data from RCTs and should not be viewed as replacing the standard analysis plan for each study. Pooling may help to identify intervention components that may be more effective especially for subsets of participants with certain behavioral characteristics. Pooling, when supported by statistical tests, can allow exploratory investigation of potential hypotheses and for the design of future interventions.
View details for DOI 10.1007/s13142-016-0386-8
View details for PubMedID 27356993
IDEAS (Integrate, Design, Assess, and Share): A Framework and Toolkit of Strategies for the Development of More Effective Digital Interventions to Change Health Behavior. Journal of medical Internet research 2016; 18 (12): e317
Developing effective digital interventions to change health behavior has been a challenging goal for academics and industry players alike. Guiding intervention design using the best combination of approaches available is necessary if effective technologies are to be developed. Behavioral theory, design thinking, user-centered design, rigorous evaluation, and dissemination each have widely acknowledged merits in their application to digital health interventions. This paper introduces IDEAS, a step-by-step process for integrating these approaches to guide the development and evaluation of more effective digital interventions. IDEAS is comprised of 10 phases (empathize, specify, ground, ideate, prototype, gather, build, pilot, evaluate, and share), grouped into 4 overarching stages: Integrate, Design, Assess, and Share (IDEAS). Each of these phases is described and a summary of theory-based behavioral strategies that may inform intervention design is provided. The IDEAS framework strives to provide sufficient detail without being overly prescriptive so that it may be useful and readily applied by both investigators and industry partners in the development of their own mHealth, eHealth, and other digital health behavior change interventions.
View details for DOI 10.2196/jmir.5927
View details for PubMedID 27986647
Effects of Varying Epoch Lengths, Wear Time Algorithms, and Activity Cut-Points on Estimates of Child Sedentary Behavior and Physical Activity from Accelerometer Data. PloS one 2016; 11 (3)
To examine the effects of accelerometer epoch lengths, wear time (WT) algorithms, and activity cut-points on estimates of WT, sedentary behavior (SB), and physical activity (PA).268 7-11 year-olds with BMI 85th percentile for age and sex wore accelerometers on their right hips for 4-7 days. Data were processed and analyzed at epoch lengths of 1-, 5-, 10-, 15-, 30-, and 60-seconds. For each epoch length, WT minutes/day was determined using three common WT algorithms, and minutes/day and percent time spent in SB, light (LPA), moderate (MPA), and vigorous (VPA) PA were determined using five common activity cut-points. ANOVA tested differences in WT, SB, LPA, MPA, VPA, and MVPA when using the different epoch lengths, WT algorithms, and activity cut-points.WT minutes/day varied significantly by epoch length when using the NHANES WT algorithm (p < .0001), but did not vary significantly by epoch length when using the 20 minute consecutive zero or Choi WT algorithms. Minutes/day and percent time spent in SB, LPA, MPA, VPA, and MVPA varied significantly by epoch length for all sets of activity cut-points tested with all three WT algorithms (all p < .0001). Across all epoch lengths, minutes/day and percent time spent in SB, LPA, MPA, VPA, and MVPA also varied significantly across all sets of activity cut-points with all three WT algorithms (all p < .0001).The common practice of converting WT algorithms and activity cut-point definitions to match different epoch lengths may introduce significant errors. Estimates of SB and PA from studies that process and analyze data using different epoch lengths, WT algorithms, and/or activity cut-points are not comparable, potentially leading to very different results, interpretations, and conclusions, misleading research and public policy.
View details for DOI 10.1371/journal.pone.0150534
View details for PubMedID 26938240
Interventions to Reduce Sedentary Behavior MEDICINE AND SCIENCE IN SPORTS AND EXERCISE 2015; 47 (6): 1306-1310
This article reports on the presentations and discussion from the working group on "Influences on Sedentary Behavior and Interventions To Reduce Sedentary Behavior" as part of the Sedentary Behavior: Identifying Research Priorities workshop.Interventions were discussed in the context of targeting sedentary behavior (SB) as a concept distinct from physical activity. It was recommended that interventions targeting SB should consider a life course perspective, a position predicated on the assumption that SB is age and life stage dependent. In addition, targeting environments where individuals have high exposure to SB-such as workplace sitting-could benefit from new technology (e.g., computer-based prompting to stand or move), environmental changes (e.g., active workstations), policies targeting reduced sedentary time (e.g., allowing employees regular desk breaks), or by changing norms surrounding prolonged sitting (e.g., standing meetings).There are limited data about the minimal amount of SB change required to produce meaningful health benefits. In addition to developing relevant scientific and public health definitions of SB, it is important to further delineate the scope of health and quality-of-life outcomes associated with reduced SB across the life course and to clarify what behavioral alternatives to SB can be used to optimize health gains. SB interventions will benefit from having more clarity about the potential physiological and behavioral synergies with current physical activity recommendations, developing multilevel interventions aimed at reducing SB across all life phases and contexts, harnessing relevant and effective strategies to extend the reach of interventions to all sectors of society, as well as applying state-of-the-science adaptive designs and methods to accelerate advances in the science of SB interventions.
View details for DOI 10.1249/MSS.0000000000000519
View details for Web of Science ID 000354745500027
Clinical trial management of participant recruitment, enrollment, engagement, and retention in the SMART study using a Marketing and Information Technology (MARKIT) model CONTEMPORARY CLINICAL TRIALS 2015; 42: 185-195
Advances in information technology and near ubiquity of the Internet have spawned novel modes of communication and unprecedented insights into human behavior via the digital footprint. Health behavior randomized controlled trials (RCTs), especially technology-based, can leverage these advances to improve the overall clinical trials management process and benefit from improvements at every stage, from recruitment and enrollment to engagement and retention. In this paper, we report the results for recruitment and retention of participants in the SMART study and introduce a new model for clinical trials management that is a result of interdisciplinary team science. The MARKIT model brings together best practices from information technology, marketing, and clinical research into a single framework to maximize efforts for recruitment, enrollment, engagement, and retention of participants into a RCT. These practices may have contributed to the study's on-time recruitment that was within budget, 86% retention at 24months, and a minimum of 57% engagement with the intervention over the 2-year RCT. Use of technology in combination with marketing practices may enable investigators to reach a larger and more diverse community of participants to take part in technology-based clinical trials, help maximize limited resources, and lead to more cost-effective and efficient clinical trial management of study participants as modes of communication evolve among the target population of participants.
View details for DOI 10.1016/j.cct.2015.04.002
View details for Web of Science ID 000357347800020
View details for PubMedID 25866383
Environmental strategies for portion control in children APPETITE 2015; 88: 33-38
Evidence from laboratory and field studies indicates that large portions lead to greater food and energy intake relative to small portions. However, most children and adults demonstrate limited abilities to estimate and control the amounts of food they serve and consume. Five potential environmental strategies appear promising for improving portion control in children: (1) using tall, thin, and small volume glasses and mugs, (2) using smaller diameter and volume plates, bowls and serving utensils, (3) using plates with rims, (4) reducing total television and other screen watching and (5) reducing or eliminating eating while watching television and/or other screens. Further experimental research in real world settings is needed to test these interventions as strategies for portion control and their roles in prevention and treatment of obesity.
View details for DOI 10.1016/j.appet.2014.12.001
View details for Web of Science ID 000352043900006
More hippocrates, less hypocrisy: eliminate sugar-sweetened beverages from residency lunches. Academic medicine 2015; 90 (2): 127-128
Instructional Strategies to Promote Incremental Beliefs in Youth Sport QUEST 2014; 66 (4): 357-370
Energy behaviours of northern California Girl Scouts and their families ENERGY POLICY 2014; 73: 439-449
Percent body fat prediction equations for 8-to 17-year-old American children PEDIATRIC OBESITY 2014; 9 (4): 260-271
Percent body fat equations are usually developed in specific populations and have low generalizability.To use a nationally representative sample of the American youth population (8-17 years old) from the 1999-2004 National Health and Nutrition Examination Survey data to develop gender-specific percent body fat equations.Percent body fat equations were developed for girls and boys using information on weight, height, waist circumference, triceps skin-folds, age, race/ethnicity and menses status compared to dual-emission X-ray absorptiometry. Terms were selected using forward and backward selection in regression models in a 2/3 development sample and were cross-validated in the remaining sample. Final coefficients were estimated in the full sample.Final equations included ten terms in girls and eight terms in boys including interactions with age and race/ethnicity. In the cross-validation sample, the adjusted R2 was 0.818 and the root mean squared error was 2.758 in girls. Comparable estimates in boys were 0.893 and 2.525. Systematic bias was not detected in the estimates by race/ethnicity or by body mass index categories.Gender-specific percent body fat equations were developed in youth with a strong potential for generalizability and utilization by other investigators studying adiposity-related issues in youth.
View details for DOI 10.1111/j.2047-6310.2013.00175.x
View details for Web of Science ID 000340673800003
View details for PubMedID 23670857
Visual illusions and plate design: the effects of plate rim widths and rim coloring on perceived food portion size INTERNATIONAL JOURNAL OF OBESITY 2014; 38 (5): 657-662
The Delboeuf Illusion affects perceptions of the relative sizes of concentric shapes. This study was designed to extend research on the application of the Delboeuf illusion to food on a plate by testing whether a plate's rim width and coloring influence perceptual bias to affect perceived food portion size.Within-subjects experimental design. Experiment 1 tested the effect of rim width on perceived food portion size. Experiment 2 tested the effect of rim coloring on perceived food portion size. In both experiments, participants observed a series of photographic images of paired, side-by-side plates varying in designs and amounts of food. From each pair, participants were asked to select the plate that contained more food. Multilevel logistic regression examined the effects of rim width and coloring on perceived food portion size.Experiment 1: participants overestimated the diameter of food portions by 5% and the visual area of food portions by 10% on plates with wider rims compared with plates with very thin rims (P<0.0001). The effect of rim width was greater with larger food portion sizes. Experiment 2: participants overestimated the diameter of food portions by 1.5% and the visual area of food portions by 3% on plates with rim coloring compared with plates with no coloring (P=0.01). The effect of rim coloring was greater with smaller food portion sizes.The Delboeuf illusion applies to food on a plate. Participants overestimated food portion size on plates with wider and colored rims. These findings may help design plates to influence perceptions of food portion sizes.
View details for DOI 10.1038/ijo.2013.169
View details for Web of Science ID 000335445300006
View details for PubMedID 24005858
Increasing energy- and greenhouse gas-saving behaviors among adolescents: a school-based cluster-randomized controlled trial ENERGY EFFICIENCY 2014; 7 (2): 217-242
Design and implementation of a randomized controlled social and mobile weight loss trial for young adults (project SMART) CONTEMPORARY CLINICAL TRIALS 2014; 37 (1): 10-18
To describe the theoretical rationale, intervention design, and clinical trial of a two-year weight control intervention for young adults deployed via social and mobile media.A total of 404 overweight or obese college students from three Southern California universities (Mage=22(4) years; MBMI=29(2.8); 70% female) were randomized to participate in the intervention or to receive an informational web-based weight loss program. The intervention is based on behavioral theory and integrates intervention elements across multiple touch points, including Facebook, text messaging, smartphone applications, blogs, and e-mail. Participants are encouraged to seek social support among their friends, self-monitor their weight weekly, post their health behaviors on Facebook, and e-mail their weight loss questions/concerns to a health coach. The intervention is adaptive because new theory-driven and iteratively tailored intervention elements are developed and released over the course of the two-year intervention in response to patterns of use and user feedback. Measures of body mass index, waist circumference, diet, physical activity, sedentary behavior, weight management practices, smoking, alcohol, sleep, body image, self-esteem, and depression occur at 6, 12, 18, and 24months. Currently, all participants have been recruited, and all are in the final year of the trial.Theory-driven, evidence-based strategies for physical activity, sedentary behavior, and dietary intake can be embedded in an intervention using social and mobile technologies to promote healthy weight-related behaviors in young adults.
View details for DOI 10.1016/j.cct.2013.11.001
View details for Web of Science ID 000331501400002
View details for PubMedID 24215774
Family, community and clinic collaboration to treat overweight and obese children: Stanford GOALS-A randomized controlled trial of a three-year, multi-component, multi-level, multi-setting intervention CONTEMPORARY CLINICAL TRIALS 2013; 36 (2): 421-435
To test the effects of a three-year, community-based, multi-component, multi-level, multi-setting (MMM) approach for treating overweight and obese children.Two-arm, parallel group, randomized controlled trial with measures at baseline, 12, 24, and 36months after randomization.Seven through eleven year old, overweight and obese children (BMI85th percentile) and their parents/caregivers recruited from community locations in low-income, primarily Latino neighborhoods in Northern California.Families are randomized to the MMM intervention versus a community health education active-placebo comparison intervention. Interventions last for three years for each participant. The MMM intervention includes a community-based after school team sports program designed specifically for overweight and obese children, a home-based family intervention to reduce screen time, alter the home food/eating environment, and promote self-regulatory skills for eating and activity behavior change, and a primary care behavioral counseling intervention linked to the community and home interventions. The active-placebo comparison intervention includes semi-annual health education home visits, monthly health education newsletters for children and for parents/guardians, and a series of community-based health education events for families.Body mass index trajectory over the three-year study. Secondary outcome measures include waist circumference, triceps skinfold thickness, accelerometer-measured physical activity, 24-hour dietary recalls, screen time and other sedentary behaviors, blood pressure, fasting lipids, glucose, insulin, hemoglobin A1c, C-reactive protein, alanine aminotransferase, and psychosocial measures.The Stanford GOALS trial is testing the efficacy of a novel community-based multi-component, multi-level, multi-setting treatment for childhood overweight and obesity in low-income, Latino families.
View details for DOI 10.1016/j.cct.2013.09.001
View details for Web of Science ID 000329265300012
A randomized clinical trial of the efficacy of extended smoking cessation treatment for adolescent smokers. Nicotine & tobacco research 2013; 15 (10): 1655-1662
INTRODUCTION: Relatively few well-designed smoking cessation studies have been conducted with teen smokers. This study examined the efficacy of extended cognitive-behavioral treatment in promoting longer term smoking cessation among adolescents. METHODS: Open-label smoking cessation treatment consisted of 10 weeks of school-based, cognitive-behavioral group counseling along with 9 weeks of nicotine replacement (nicotine patch). A total of 141 adolescent smokers in continuation high schools in the San Francisco Bay Area were randomized to either 9 additional group sessions over a 14-week period (extended group) or 4 monthly smoking status calls (nonextended group). Intention-to-treat logistic regression analysis was used to assess the primary outcome of biologically confirmed (carbon monoxide < 9 ppm) point prevalence abstinence at Week 26 (6-month follow-up from baseline). RESULTS: At Week 26 follow-up, the extended treatment group had a significantly higher abstinence rate (21%) than the nonextended treatment (7%; OR = 4.24, 95% CI: 1.20-15.02). Females also were more likely to be abstinent at the follow-up than males (OR = 4.15, 95% CI: 1.17-14.71). CONCLUSIONS: The significantly higher abstinence rate at follow-up for the extended treatment group provides strong support for continued development of longer term interventions for adolescent smoking cessation.
View details for DOI 10.1093/ntr/ntt017
View details for PubMedID 23460656
TURN OFF THE TV AND DANCE! PARTICIPATION IN CULTURALLY TAILORED HEALTH INTERVENTIONS: IMPLICATIONS FOR OBESITY PREVENTION AMONG MEXICAN AMERICAN GIRLS ETHNICITY & DISEASE 2013; 23 (4): 452-461
Our evaluation study identifies facilitators and barriers to participation among families participating in the treatment arm of Stanford ECHALE. This culturally tailored obesity prevention trial consisted of a combined intervention with two main treatment components: 1) a folkloric dance program; and 2) a screen time reduction curriculum designed for 7-11 year old Latinas and their families. We conducted 83 interviews (40 parents and 43 girls) in participant homes after 6 months of enrollment in the ECHALE trial. The Spradley ethnographic method and NVivo 8.0 were used to code and analyze narrative data. Three domains emerged for understanding participation: 1) family cohesiveness; 2) perceived gains; and 3) culturally relevant program structure. Two domains emerged for non-participation: program requirements and perceived discomforts. Non-parametric, Spearman's rank correlation coefficients were calculated to assess the relationships with participant attendance data. Sustained participation was most strongly influenced by the domain perceived gains when parents reported better self-esteem, confidence, improved attitude, improved grades, etc. (Spearman r = .45, P = .003). Alternatively, under the domain, perceived discomforts, with subthemes such as child bullying, participation in the combined intervention was inversely associated with attendance (Spearman r = -.38, P = .02). Family-centered, school-based, community obesity prevention programs that focus on tangible short-term gains for girls may generate greater participation rates, enhance social capital, and promote community empowerment. These factors can be emphasized in future obesity prevention program design and implementation.
View details for Web of Science ID 000329019400010
View details for PubMedID 24392608
Harnessing Different Motivational Frames via Mobile Phones to Promote Daily Physical Activity and Reduce Sedentary Behavior in Aging Adults PLOS ONE 2013; 8 (4)
On the use of robust estimators for standard errors in the presence of clustering when clustering membership is misspecified CONTEMPORARY CLINICAL TRIALS 2013; 34 (2): 248-256
This paper examines the implications of using robust estimators (REs) of standard errors in the presence of clustering when cluster membership is unclear as may commonly occur in clustered randomized trials. For example, in such trials, cluster membership may not be recorded for one or more treatment arms and/or cluster membership may be dynamic. When clusters are well defined, REs have properties that are robust to misspecification of the correlation structure. To examine whether results were sensitive to assumptions about the clustering membership, we conducted simulation studies for a two-arm clinical trial, where the number of clusters, the intracluster correlation (ICC), and the sample size varied. REs of standard errors that incorrectly assumed clustering of data that were truly independent yielded type I error rates of up to 40%. Partial and complete misspecifications of membership (where some and no knowledge of true membership were incorporated into assumptions) for data generated from a large number of clusters (50) with a moderate ICC (0.20) yielded type I error rates that ranged from 7.2% to 9.1% and 10.5% to 45.6%, respectively; incorrectly assuming independence gave a type I error rate of 10.5%. REs of standard errors can be useful when the ICC and knowledge of cluster membership are high. When the ICC is weak, a number of factors must be considered. Our findings suggest guidelines for making sensible analytic choices in the presence of clustering.
View details for DOI 10.1016/j.cct.2012.11.006
View details for Web of Science ID 000317169100009
View details for PubMedID 23220255
The Utility of Childhood and Adolescent Obesity Assessment in Relation to Adult MEDICAL DECISION MAKING 2013; 33 (2): 163-175
High childhood obesity prevalence has raised concerns about future adult health, generating calls for obesity screening of young children.To estimate how well childhood obesity predicts adult obesity and to forecast obesity-related health of future US adults.Longitudinal statistical analyses; microsimulations combining multiple data sets.National Longitudinal Survey of Youth, Population Study of Income Dynamics, and National Health and Nutrition Evaluation Surveys.The authors estimated test characteristics and predictive values of childhood body mass index to identify 2-, 5-, 10-, and 15 year-olds who will become obese adults. The authors constructed models relating childhood body mass index to obesity-related diseases through middle age stratified by sex and race.Twelve percent of 18-year-olds were obese. While screening at age 5 would miss 50% of those who become obese adults, screening at age 15 would miss 9%. The predictive value of obesity screening below age 10 was low even when maternal obesity was included as a predictor. Obesity at age 5 was a substantially worse predictor of health in middle age than was obesity at age 15. For example, the relative risk of developing diabetes as adults for obese white male 15-year-olds was 4.5 versus otherwise similar nonobese 15-year-olds. For obese 5-year-olds, the relative risk was 1.6.Main results do not include Hispanics due to sample size. Past relationships between childhood and adult obesity and health may change in the future.Early childhood obesity assessment adds limited information to later childhood assessment. Targeted later childhood approaches or universal strategies to prevent unhealthy weight gain should be considered.
View details for DOI 10.1177/0272989X12447240
View details for Web of Science ID 000316684200006
Harnessing different motivational frames via mobile phones to promote daily physical activity and reduce sedentary behavior in aging adults. PloS one 2013; 8 (4)
Mobile devices are a promising channel for delivering just-in-time guidance and support for improving key daily health behaviors. Despite an explosion of mobile phone applications aimed at physical activity and other health behaviors, few have been based on theoretically derived constructs and empirical evidence. Eighty adults ages 45 years and older who were insufficiently physically active, engaged in prolonged daily sitting, and were new to smartphone technology, participated in iterative design development and feasibility testing of three daily activity smartphone applications based on motivational frames drawn from behavioral science theory and evidence. An "analytically" framed custom application focused on personalized goal setting, self-monitoring, and active problem solving around barriers to behavior change. A "socially" framed custom application focused on social comparisons, norms, and support. An "affectively" framed custom application focused on operant conditioning principles of reinforcement scheduling and emotional transference to an avatar, whose movements and behaviors reflected the physical activity and sedentary levels of the user. To explore the applications' initial efficacy in changing regular physical activity and leisure-time sitting, behavioral changes were assessed across eight weeks in 68 participants using the CHAMPS physical activity questionnaire and the Australian sedentary behavior questionnaire. User acceptability of and satisfaction with the applications was explored via a post-intervention user survey. The results indicated that the three applications were sufficiently robust to significantly improve regular moderate-to-vigorous intensity physical activity and decrease leisure-time sitting during the 8-week behavioral adoption period. Acceptability of the applications was confirmed in the post-intervention surveys for this sample of midlife and older adults new to smartphone technology. Preliminary data exploring sustained use of the applications across a longer time period yielded promising results. The results support further systematic investigation of the efficacy of the applications for changing these key health-promoting behaviors.
View details for DOI 10.1371/journal.pone.0062613
View details for PubMedID 23638127
Expected Body Weight in Adolescents: Comparison Between Weight-for-Stature and BMI Methods PEDIATRICS 2012; 130 (6): E1607-E1613
To test the hypothesis that the weight-for-stature (WFS) and BMI methods are not equivalent in determining expected body weight (EBW) in adolescents with eating disorders and to determine the sensitivity, specificity, and positive predictive value of each method to detect those <75% EBW. We hypothesized that differences in EBW would be greatest at the extremes of height.EBW was determined for 12 047 individual adolescents aged 12 to 19 years by the WFS and BMI methods by utilizing the same National Center for Health Statistics data sets. Absolute difference between the 2 methods for each individual was calculated and plotted against height by using a generalized additive model. The number of individuals whose weights were <75% EBW was determined by each method.For girls, EBW was 3.52 3.13% higher when using the WFS method compared with the BMI method. For boys, EBW(WFS) was 3.45 2.72% higher than EBW(BMI). Among adolescent girls, 65% had EBW(WFS) higher than EBW(BMI). By using the EBW(WFS) method as the gold standard, specificity of the EBW(BMI) method to detect those <75% EBW was 0.999, but sensitivity was only 0.329. Absolute differences in EBW were most pronounced at the extremes of height.The WFS and BMI methods are not equivalent in determining EBW in adolescents and are not interchangeable. EBW(WFS) was ~3.5% higher than EBW(BMI). In adolescents with eating disorders, use of the BMI method will underestimate the degree of malnutrition compared with the WFS method. Which method better predicts meaningful clinical outcomes remains to be determined.
View details for DOI 10.1542/peds.2012-0897
View details for Web of Science ID 000314802000024
View details for PubMedID 23147977
MOBILE PHONE APPLICATIONS TO PROMOTE PHYSICAL ACTIVITY INCREASES: PRELIMINARY RESULTS SPRINGER. 2012: S204-S204
Solution-Oriented Policy Research Using Research to Drive Obesity Prevention and Control Policies ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2012; 166 (2): 189-190
Efficacy and Tolerability of Pharmacotherapies to Aid Smoking Cessation in Adolescents PEDIATRIC DRUGS 2012; 14 (2): 91-108
Adolescent smoking remains a public health problem. Despite concerns regarding adolescent nicotine dependence, few well-designed smoking cessation studies have been conducted with teen smokers. This is particularly true regarding pharmacologic treatments for nicotine dependence. Currently, pharmacologic aids are not recommended for treating adolescent nicotine dependence, as efficacy has not been shown in this population. This review includes studies that have examined the efficacy of pharmacotherapy for smoking abstinence and/or reduction in cigarette consumption among adolescent smokers who want to quit smoking, laboratory-based adolescent studies that have examined the efficacy of these medications in reducing cravings and/or withdrawal symptoms, and/or studies that have assessed the tolerability of medications for smoking cessation in adolescent smokers. It provides information on the pharmacologic action of each medication, the efficacy of each medication for adolescent smoking cessation, the tolerability of each medication based on reported adverse events, and compliance with the medication protocols. Thirteen relevant articles were identified and included in the review. Nicotine patch (NP), nicotine gum, nicotine nasal spray, bupropion, and varenicline have been studied in adolescent smokers. The adverse events reported in the studies on pharmacology for adolescent smoking suggest that the side effect profiles for nicotine replacement therapy, bupropion, and varenicline are similar to those reported in adult studies. There is some evidence of efficacy of NP and bupropion at the end of treatment (efficacy of varenicline has not been assessed), but none of the medications included in this review were efficacious in promoting long-term smoking cessation among adolescent smokers. It is noted that many of the study protocols did not follow the recommended dose or length of pharmacotherapy for adults, rendering it difficult to determine the true efficacy of medication for adolescent smoking cessation. Future efficacy studies are warranted before recommending pharmacotherapy for adolescent smoking cessation.
View details for Web of Science ID 000301274700003
View details for PubMedID 22248234
The center for healthy weight: an academic medical center response to childhood obesity INTERNATIONAL JOURNAL OF OBESITY 2012; 2 (Suppl): S33-S38
Assessing teen smoking patterns: The weekend phenomenon DRUG AND ALCOHOL DEPENDENCE 2012; 120 (1-3): 242-245
Adolescent cigarette smokers may have more daily variability in their smoking patterns than adults. A better understanding of teen smoking patterns can inform the development of more effective adolescent smoking cessation interventions.Teen smokers seeking cessation treatment (N=366) reported the number of cigarettes smoked on each day of a typical week. A paired t-test was used to examine differences between weekday (Sunday-Thursday) and weekend (Friday-Saturday) smoking. Main effects and interactions for race/ethnicity and gender were assessed using a 2-way ANOVA for the following variables: typical weekly smoking, average weekday smoking, average weekend smoking, and difference between weekday and weekend smoking. Scheff post hoc tests were used to analyze any statistically significant differences.There was significantly more weekend smoking compared to weekday smoking, p<0.001. The difference in weekday versus weekend smoking levels was larger for females than for males, p<0.05. Hispanics reported less typical weekly smoking, p<0.001, less weekday smoking, p<0.001, and less weekend day smoking, p<0.01, compared to Caucasians and multi-racial teens. There was no difference in weekend day versus weekday smoking by race/ethnic background.Using a more detailed assessment of smoking quantity captures patterns of adolescent smoking that may lead to more effective smoking cessation interventions.
View details for DOI 10.1016/j.drugalcdep.2011.07.014
View details for Web of Science ID 000299499800037
View details for PubMedID 21885211
The Stanford Climate Change Behavior Survey (SCCBS): assessing greenhouse gas emissions-related behaviors in individuals and populations CLIMATIC CHANGE 2011; 109 (3-4): 671-694
Set points, settling points and some alternative models: theoretical options to understand how genes and environments combine to regulate body adiposity DISEASE MODELS & MECHANISMS 2011; 4 (6): 733-745
The close correspondence between energy intake and expenditure over prolonged time periods, coupled with an apparent protection of the level of body adiposity in the face of perturbations of energy balance, has led to the idea that body fatness is regulated via mechanisms that control intake and energy expenditure. Two models have dominated the discussion of how this regulation might take place. The set point model is rooted in physiology, genetics and molecular biology, and suggests that there is an active feedback mechanism linking adipose tissue (stored energy) to intake and expenditure via a set point, presumably encoded in the brain. This model is consistent with many of the biological aspects of energy balance, but struggles to explain the many significant environmental and social influences on obesity, food intake and physical activity. More importantly, the set point model does not effectively explain the 'obesity epidemic'--the large increase in body weight and adiposity of a large proportion of individuals in many countries since the 1980s. An alternative model, called the settling point model, is based on the idea that there is passive feedback between the size of the body stores and aspects of expenditure. This model accommodates many of the social and environmental characteristics of energy balance, but struggles to explain some of the biological and genetic aspects. The shortcomings of these two models reflect their failure to address the gene-by-environment interactions that dominate the regulation of body weight. We discuss two additional models--the general intake model and the dual intervention point model--that address this issue and might offer better ways to understand how body fatness is controlled.
View details for DOI 10.1242/dmm.008698
View details for Web of Science ID 000296761500006
View details for PubMedID 22065844
The Stanford climate change behavior survey (SCCBS): assessing greenhous gas emmisions-related behaviors in individuals and populations Climatic Change 2011; 109: 671-694
A Randomized Controlled Trial of Culturally Tailored Dance and Reducing Screen Time to Prevent Weight Gain in Low- Income African American Girls ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2010; 164 (11): 995-1004
To test a 2-year community- and family-based obesity prevention program for low-income African American girls: Stanford GEMS (Girls' health Enrichment Multi-site Studies).Randomized controlled trial with follow-up measures scheduled at 6, 12, 18, and 24 months.Low-income areas of Oakland, California.African American girls aged 8 to 10 years (N=261) and their parents or guardians.Families were randomized to one of two 2-year, culturally tailored interventions: (1) after-school hip-hop, African, and step dance classes and a home/family-based intervention to reduce screen media use or (2) information-based health education.Changes in body mass index (BMI).Changes in BMI did not differ between groups (adjusted mean difference [95% confidence interval] = 0.04 [-0.18 to 0.27] per year). Among secondary outcomes, fasting total cholesterol level (adjusted mean difference, -3.49 [95% confidence interval, -5.28 to -1.70] mg/dL per year), low-density lipoprotein cholesterol level (-3.02 [-4.74 to -1.31] mg/dL per year), incidence of hyperinsulinemia (relative risk, 0.35 [0.13 to 0.93]), and depressive symptoms (-0.21 [-0.42 to -0.001] per year) decreased more among girls in the dance and screen time reduction intervention. In exploratory moderator analysis, the dance and screen time reduction intervention slowed BMI gain more than health education among girls who watched more television at baseline (P = .02) and/or those whose parents or guardians were unmarried (P = .01).A culturally tailored after-school dance and screen time reduction intervention for low-income, preadolescent African American girls did not significantly reduce BMI gain compared with health education but did produce potentially clinically important reductions in lipid levels, hyperinsulinemia, and depressive symptoms. There was also evidence for greater effectiveness in high-risk subgroups of girls.
View details for Web of Science ID 000283735700006
View details for PubMedID 21041592
Effects of a College Course About Food and Society on Students' Eating Behaviors AMERICAN JOURNAL OF PREVENTIVE MEDICINE 2010; 38 (5): 543-547
Health education programs for promoting a healthful diet have shown limited success in clinical trials.This paper aims to examine whether an innovative educational course focused on societal-level issues related to food and food production (Food and Society) would promote healthful eating among college students.A quasi-experimental non-RCT was conducted to compare changes in eating behaviors among students taking the Food and Society course (n=28) versus students taking health-related human biology courses about obesity, health psychology, and community health assessment (n=72). All participants were undergraduates. A Food Frequency Questionnaire was administered at the beginning and end of the four courses taught from January through March 2009. Students in the Food and Society course read selected portions of popular books and essays (e.g., Michael Pollan's Omnivore's Dilemma) and watched documentaries (e.g., Aaron Woolf's King Corn) highlighting environmental, ethical, social justice, cultural, political, and agricultural issues related to food and food production, and discussed these major themes during class sessions. In addition, students were required to (1) write an Op-Ed article and (2) create a brief YouTube video focused on themes discussed in the course.The students who took the Food and Society course reported significantly improving their healthful eating (F[2, 97]=5.72, p=0.02), with greatest improvements in increased vegetable (F[2, 97]=10.96, p=0.001) and decreased high-fat dairy (F[2, 97]=5.39, p=0.02) intakes relative to the comparison group.The results suggest that it may be possible to change dietary behaviors in college students by focusing on social, ethical, cultural, and environmental issues related to food and food production.
View details for DOI 10.1016/j.amepre.2010.01.026
View details for Web of Science ID 000277213500011
View details for PubMedID 20227847
Save the World, Prevent Obesity: Piggybacking on Existing Social and Ideological Movements OBESITY 2010; 18: S17-S22
Identifying Subgroups of US Adults at Risk for Prolonged Television Viewing to Inform Program Development AMERICAN JOURNAL OF PREVENTIVE MEDICINE 2010; 38 (1): 17-26
Although adverse health effects of prolonged TV viewing have been increasingly recognized, little population-wide information is available concerning subgroups at greatest risk for this behavior.This study sought to identify, in a U.S. population-derived sample, combinations of variables that defined subgroups with higher versus lower levels of usual TV-viewing time.A total of 5556 adults from a national consumer panel participated in the mail survey in 2001 (55% women, 71% white, 13% black, and 11% Hispanic). Nonparametric risk classification analyses were conducted in 2008.Subgroups with the highest proportions of people watching >14 hours/week of TV were identified and described using a combination of demographic (i.e., lower household incomes, divorced/separated); health and mental health (i.e., poorer rated overall health, higher BMI, more depression); and behavioral (i.e., eating dinner in front of the TV, smoking, less physical activity) variables. The subgroup with the highest rates of TV viewing routinely ate dinner while watching TV and had lower income and poorer health. Prolonged TV viewing also was associated with perceived aspects of the neighborhood environment (i.e., heavy traffic and crime, lack of neighborhood lighting, and poor scenery).The results can help inform intervention development in this increasingly important behavioral health area.
View details for DOI 10.1016/j.amepre.2009.08.032
View details for Web of Science ID 000273413800003
View details for PubMedID 20117553
Interviewing Latina girls for child health research Pract Anthropol 2010; 32: 14-18
Defining Accelerometer Thresholds for Physical Activity in Girls Using ROC Analysis JOURNAL OF PHYSICAL ACTIVITY & HEALTH 2010; 7 (1): 45-53
Receiver operating characteristic (ROC) analysis is a common method used in diagnostic and screening tests to define thresholds levels of a factor that discriminates between 2 levels of another factor. The purpose of this analysis was to use ROC analysis to determine the optimal accelerometer-measured physical activity (PA) thresholds for predicting selective cardiovascular disease (CVD) risk factors.ROC was performed using data from Stanford Girls Health Enrichment Multisite Studies trial. PA was assessed for multiple days using accelerometers. CVD variables were overweight, elevated triglyceride, reduced HDL-C, hypertension, impaired fasting glucose, fasting insulin, and clustering of multiple CVD risk factors.A sample of 261 girls participated, of which 208 had complete CVD risk measures (mean +/- SD age = 9.4 +/- 0.9yrs, BMI = 20.7 +/- 4.8kg/m2). An average of > or =11.1 minutes/day at > or =2,600 counts/min was the maximally sensitive and specific threshold for discriminating girls who were overweight, > or =16.6 minutes/day at > or =2,000 counts/min for hyperinsulinemia or with > or =2 CVD risk factors. The Area Under the Curve for overweight, hyperinsulinemia, and > or =2 CVD risk factors was of 0.66, 0.58, and 0.60, respectively. The sensitivity and specificity associated with overweight, hyperinsulinemia, and > or =2 CVD risk factors were 60.3% and 72.9%, 53.3% and 83.9%, 44.0% and 84.7%, respectively.Empirically-derived thresholds of PA to optimally discriminate between girls with and without CVD risk were lower in this sample than generally recommended. This ROC approach should be repeated in other populations to determine optimal PA thresholds with clinical validity for research, surveillance and program evaluation.
View details for Web of Science ID 000280737800007
View details for PubMedID 20231754
Withdrawal symptoms over time among adolescents in a smoking cessation intervention: Do symptoms vary by level of nicotine dependence? ADDICTIVE BEHAVIORS 2009; 34 (12): 1017-1022
Nicotine dependence may be expressed differently in teens than in adults. Thus, it may not be sufficient to build diagnostic and cessation treatment strategies for teens based on adult-derived clinical and research data. This is the first study to prospectively examine the development of withdrawal symptoms by level of nicotine dependence among adolescent smokers. Forty-seven adolescent smokers completed nicotine withdrawal symptoms measures during 10 weeks of cessation treatment. Nicotine dependence was assessed at baseline using the mFTQ. Change in withdrawal symptoms over time by level of nicotine dependence was examined via mixed model ANOVA. Nicotine withdrawal in daily adolescent smokers was strongly and prospectively associated with the level of nicotine dependence. Craving was rated as the most problematic symptom at the baseline assessment. The results of this study may help guide the development of future research on diagnostic and cessation treatment strategies for teens.
View details for DOI 10.1016/j.addbeh.2009.06.014
View details for Web of Science ID 000270472500005
View details for PubMedID 19647373
Parent-only interventions may be effective for weight loss in overweight children in rural areas. journal of pediatrics 2009; 154 (5): 776-?
Treating Pediatric Obesity Generating the Evidence ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2008; 162 (12): 1191-1192
OBJECTIVELY MEASURED PHYSICAL ACTIVITY AND CARDIOVASCULAR DISEASE RISK FACTORS IN AFRICAN AMERICAN GIRLS ETHNICITY & DISEASE 2008; 18 (4): 421-426
This study examines the associations between objectively measured physical activity and cardiovascular disease (CVD) risk factors in preadolescent African American girls.We conducted a cross-sectional analysis of data from Stanford Girls Health Enrichment Multisite Studies (GEMS) trial. Physical activity was assessed for four days by using an ActiGraph accelerometer and was correlated with anthropometric measures, blood pressure, blood lipids, glucose, and insulin. Associations between physical activity and CVD risk factors were computed using by Spearman correlations. Bonferroni adjustment alpha = .003 was used to correct for multiple testing.A total of 261 girls participated, of which 208 had complete CVD risk measures (mean age 9.4 years, mean body mass index 20.7 kg/m2). Average daily physical activity and time spent in moderate-to-vigorous physical activity (MVPA) were significantly correlated with body mass index (r = -.23, P=.0008 and r = -.29, P<.0001, respectively) and insulin (r = -.27, P=.0001 and r = -.30, P<.0001, respectively) but not to other CVD factors. After adjusting for age-adjusted pubertal stage of development, the association between MVPA and insulin remained significant.Objective measures of both average daily physical activity and MVPA were inversely associated with body mass index and insulin levels in African American girls.
View details for Web of Science ID 000260899800006
View details for PubMedID 19157245
Changes in physical activity from walking to school JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2008; 40 (5): 324-326
Team sports for overweight children - The Stanford sports to prevent obesity randomized trial (SPORT) ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2008; 162 (3): 232-237
To evaluate the feasibility, acceptability, and efficacy of an after-school team sports program for reducing weight gain in low-income overweight children.Six-month, 2-arm, parallel-group, pilot randomized controlled trial.Low-income, racial/ethnic minority community.Twenty-one children in grades 4 and 5 with a body mass index at or above the 85th percentile.The treatment intervention consisted of an after-school soccer program. The "active placebo" control intervention consisted of an after-school health education program.Implementation, acceptability, body mass index, physical activity measured using accelerometers, reported television and other screen time, self-esteem, depressive symptoms, and weight concerns.All 21 children completed the study. Compared with children receiving health education, children in the soccer group had significant decreases in body mass index z scores at 3 and 6 months and significant increases in total daily, moderate, and vigorous physical activity at 3 months.An after-school team soccer program for overweight children can be a feasible, acceptable, and efficacious intervention for weight control.
View details for Web of Science ID 000253672100006
View details for PubMedID 18316660
A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2008; 162 (3): 239-245
To assess the effects of reducing television viewing and computer use on children's body mass index (BMI) as a risk factor for the development of overweight in young children.Randomized controlled clinical trial.University children's hospital.Seventy children aged 4 to 7 years whose BMI was at or above the 75th BMI percentile for age and sex.Children were randomized to an intervention to reduce their television viewing and computer use by 50% vs a monitoring control group that did not reduce television viewing or computer use.Age- and sex-standardized BMI (zBMI), television viewing, energy intake, and physical activity were monitored every 6 months during 2 years.Children randomized to the intervention group showed greater reductions in targeted sedentary behavior (P < .001), zBMI (P < .05), and energy intake (P < .05) compared with the monitoring control group. Socioeconomic status moderated zBMI change (P = .01), with the experimental intervention working better among families of low socioeconomic status. Changes in targeted sedentary behavior mediated changes in zBMI (P < .05). The change in television viewing was related to the change in energy intake (P < .001) but not to the change in physical activity (P =.37).Reducing television viewing and computer use may have an important role in preventing obesity and in lowering BMI in young children, and these changes may be related more to changes in energy intake than to changes in physical activity.
View details for Web of Science ID 000253672100007
View details for PubMedID 18316661
Stanford GEMS phase 2 obesity prevention trial for low-income African-American girls: Design and sample baseline characteristics CONTEMPORARY CLINICAL TRIALS 2008; 29 (1): 56-69
African-American girls and women are at high risk of obesity and its associated morbidities. Few studies have tested obesity prevention strategies specifically designed for African-American girls. This report describes the design and baseline findings of the Stanford GEMS (Girls health Enrichment Multi-site Studies) trial to test the effect of a two-year community- and family-based intervention to reduce weight gain in low-income, pre-adolescent African-American girls.Randomized controlled trial with measurements scheduled in girls' homes at baseline, 6, 12, 18 and 24 month post-randomization.Low-income areas of Oakland, CA.Eight, nine and ten year old African-American girls and their parents/caregivers.Girls are randomized to a culturally-tailored after-school dance program and a home/family-based intervention to reduce screen media use versus an information-based community health education Active-Placebo Comparison intervention. Interventions last for 2 years for each participant.Change in body mass index over the two-year study.Recruitment and enrollment successfully produced a predominately low-socioeconomic status sample. Two-hundred sixty one (261) families were randomized. One girl per family is randomly chosen for the analysis sample. Randomization produced comparable experimental groups with only a few statistically significant differences. The sample had a mean body mass index (BMI) at the 74 th percentile on the 2000 CDC BMI reference, and one-third of the analysis sample had a BMI at the 95th percentile or above. Average fasting total cholesterol and LDL cholesterol were above NCEP thresholds for borderline high classifications. Girls averaged low levels of moderate to vigorous physical activity, more than 3 h per day of screen media use, and diets high in energy from fat.The Stanford GEMS trial is testing the benefits of culturally-tailored after-school dance and screen-time reduction interventions for obesity prevention in low-income, pre-adolescent African-American girls.
View details for DOI 10.1016/j.cct.2007.04.007
View details for Web of Science ID 000252584100007
View details for PubMedID 17600772
Children, television viewing, and weight status: Summary and recommendations from an expert panel meeting ANNALS OF THE AMERICAN ACADEMY OF POLITICAL AND SOCIAL SCIENCE 2008; 615: 119-132
What can we do to control childhood obesity? ANNALS OF THE AMERICAN ACADEMY OF POLITICAL AND SOCIAL SCIENCE 2008; 615: 222-224
Estimating Physical Activity From Incomplete Accelerometer Data in Field Studies JOURNAL OF PHYSICAL ACTIVITY & HEALTH 2008; 5: S112-S125
The purpose of this study was to develop a data-driven approach for analyzing incomplete accelerometer data from field-base studies.Multiple days of accelerometer data from the Stanford Girls health Enrichment Multi-site Studies (N = 294 African American girls) were summed across each minute of each day to produce a composite weekday and weekend day. Composite method estimates of physical activity were compared with those derived from methods typically described in the literature (comparison methods).The composite method retained 99.7% and 100% of participants in weekday and weekend-day analysis, respectively, versus 84.7% to 94.2% and 28.6% to 99.0% for the comparison methods. Average wearing times for the composite method for weekday and weekend day were 99.6% and 98.6%, respectively, 91.7% to 93.9% and 82.3% to 95.4% for the comparison methods. Composite-method physical activity estimates were similar to comparison-methods estimates.The composite method used more available accelerometer data than standard approaches, reducing the need to exclude periods within a day, entire days, and participants from analysis.
View details for Web of Science ID 000208015700009
View details for PubMedID 18364516
Tools for measuring individuals' climate behaviors and greenhouse gas impact Environ Law Rep 2008; 38: 10847-50
Stanford GEMS (Girls health enrichment multisite studies): Long-term efficacy of after-school dance and screen time reduction in low-income African-American girls LIPPINCOTT WILLIAMS & WILKINS. 2007: 843-843
Effects of fast food branding on young children's taste preferences ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2007; 161 (8): 792-797
To examine the effects of cumulative, real-world marketing and brand exposures on young children by testing the influence of branding from a heavily marketed source on taste preferences.Experimental study. Children tasted 5 pairs of identical foods and beverages in packaging from McDonald's and matched but unbranded packaging and were asked to indicate if they tasted the same or if one tasted better.Preschools for low-income children.Sixty-three children (mean +/- SD age, 4.6 +/- 0.5 years; range, 3.5-5.4 years).Branding of fast foods.A summary total taste preference score (ranging from -1 for the unbranded samples to 0 for no preference and +1 for McDonald's branded samples) was used to test the null hypothesis that children would express no preference.The mean +/- SD total taste preference score across all food comparisons was 0.37 +/- 0.45 (median, 0.20; interquartile range, 0.00-0.80) and significantly greater than zero (P<.001), indicating that children preferred the tastes of foods and drinks if they thought they were from McDonald's. Moderator analysis found significantly greater effects of branding among children with more television sets in their homes and children who ate food from McDonald's more often.Branding of foods and beverages influences young children's taste perceptions. The findings are consistent with recommendations to regulate marketing to young children and also suggest that branding may be a useful strategy for improving young children's eating behaviors.
View details for Web of Science ID 000248583000010
View details for PubMedID 17679662
Conversations, control, and couch-time: the assessment and stability of parental mediation styles and children's screen time J Children Media 2007; 1: 162-76
The effects of increasing outdoor play time on physical activity in Latino preschool children INTERNATIONAL JOURNAL OF PEDIATRIC OBESITY 2007; 2 (3): 153-158
A randomized controlled pilot study to test the hypothesis that increasing preschool children's outdoor free play time increases their daily physical activity levels.Physical activity was assessed by accelerometers for four consecutive school days in thirty-two Latino children (3.6+/-0.5 years) attending a preschool for low-income families. After two days of baseline physical activity assessment, participants were randomly assigned to an intervention (RECESS; n =17) or control (CON; n =15) group. The RECESS group received two additional 30-minute periods of outdoor free play time per day for two days. The CON group followed their normal classroom schedule. Between group differences in physical activity variables were tested with a Wilcoxon rank-sum test.There were no statistically significant differences between groups in changes from baseline in average total daily (CON, 48.2+/-114.5; RECESS, 58.2+/-74.6) and during school day (CON, 64.6+/-181.9; RECESS, 59.7+/-79.1) counts per minute, or total daily (CON, 0.4+/-1.3; RECESS, 0.3+/-0.8) and during school day (CON, 0.6+/-2.1; RECESS, 0.5+/-0.8) percent of time spent in moderate to vigorous physical activity.Substantially increasing preschoolers' outdoor free play time did not increase their physical activity levels.
View details for DOI 10.1080/17477160701520108
View details for Web of Science ID 000249501100004
View details for PubMedID 17852547
Do Mexican-American mothers' food-related parenting practices influence their children's weight and dietary intake? JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2006; 106 (11): 1861-1865
Food-related parenting attitudes are thought to influence children's dietary intake and weight. The objective of this study was to examine the associations between mothers' reports of food-related parenting and children's dietary intake and body mass index (BMI). A sample of 108 Mexican-American fifth-grade children and their mothers were surveyed. Children's height, weight, and three 24-hour dietary recalls were collected. Mothers reported household food insecurity status and food-related parenting attitudes. Correlational analyses were calculated among dietary intake variables, children's BMI percentiles, and food-parenting behaviors. Mothers' pressure on their children to eat was inversely correlated with children's BMI. In food-insecure families, attitudes toward making healthful foods available were inversely associated with children's daily energy intake and BMI. In contrast, in food-secure families, attitudes about making healthful foods available were positively associated with children's fruit intake and percentage energy from fat, and parental modeling of healthful food behaviors was inversely associated with the energy density. In our sample of Mexican-American families, mothers' food-related parenting was associated with their children's weight and dietary intake. These associations differed in food-secure and food-insecure households. Overall, pressure to eat was highly associated with children's weight, but the temporal nature of these relationships cannot be discerned.
View details for DOI 10.1016/j.jada.2006.08.004
View details for Web of Science ID 000241715300023
View details for PubMedID 17081838
Promoting physical activity in children and youth - A leadership role for schools - A scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Physical Activity Committee) in collaboration with the Councils on Cardiovascular Disease in the Young and Cardiovascular Nursing CIRCULATION 2006; 114 (11): 1214-1224
Definition of metabolic syndrome in preadolescent girls JOURNAL OF PEDIATRICS 2006; 148 (6): 788-792
To compare and contrast proposed definitions of metabolic syndrome in pediatrics, and to determine prevalence of metabolic syndrome in preadolescent females when applying different criteria.A literature review on definitions of metabolic syndrome and cardiovascular "risk factor clustering" in children and adolescents published in the past decade. Pediatric definitions of metabolic syndrome were then applied to a community-based study of 261 black preadolescent females (Girls Health Enrichment MultiSite studies [GEMS]) and a school-based, cross-sectional study of 240 ethnically-diverse preadolescent females (Girls Activity, Movement and Environmental Strategy [GAMES]) who had a baseline physical examination and fasting morning blood sample.Agreement among pediatric definitions of metabolic syndrome was poor. The prevalence of MS and cardiovascular risk factor clustering ranged from 0.4% to 23.0% for GEMS and 2.0% to 24.6% for GAMES with definitions adapted from the National Cholesterol Education Program Adult Treatment Panel III, and 0% to 15.3% for GEMS and 0.4% to 15.8% for GAMES using modified criteria from the World Health Organization.The prevalence of metabolic syndrome in preadolescent girls varies widely because of disagreement among proposed definitions of metabolic syndrome in pediatrics. Further investigation is needed to determine which metabolic factors and their respective cut points should be used to identify children at risk for development of clinical disease.
View details for DOI 10.1016/j.jpeds.2006.01.048
View details for Web of Science ID 000238332500019
View details for PubMedID 16769388
Does children's screen time predict requests for advertised products? Cross-sectional and prospective analyses ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2006; 160 (4): 363-368
To examine children's screen media exposure and requests for advertised toys and food/drinks.Prospective cohort study.Twelve elementary schools in northern California.Eight hundred twenty-seven third grade children participated at baseline; 386 students in 6 schools were followed up for 20 months.None.Child self-reported requests for advertised toys and foods/drinks.At baseline, children's screen media time was significantly associated with concurrent requests for advertised toys (Spearman r = 0.15 [TV viewing] and r = 0.20 [total screen time]; both P<.001) and foods/drinks (Spearman r = 0.16 [TV viewing] and r = 0.18 [total screen time]; both P<.001). In prospective analysis, children's screen media time at baseline was significantly associated with their mean number of toy requests 7 to 20 months later (Spearman r = 0.21 [TV viewing] and r = 0.24 [total screen time]; both P<.001) and foods/drinks requests (Spearman r = 0.14 [TV viewing] and r = 0.16 [total screen time]; both P<.01). After adjusting for baseline requests and sociodemographic variables, the relationship between screen media exposure and future requests for advertised foods/drinks remained significant for total TV viewing and total screen media exposure. The relationship with future requests for toys remained significant for total screen media exposure.Screen media exposure is a prospective risk factor for children's requests for advertised products. Future experimental studies on children's health- and consumer-related outcomes are warranted.
View details for Web of Science ID 000236516500004
View details for PubMedID 16585480
Effects of the SMART classroom curriculum to reduce child and family screen time JOURNAL OF COMMUNICATION 2006; 56 (1): 1-26
Obesity prevention in primary care ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2006; 160 (2): 217-218
Are certain multicenter randomized clinical trial structures misleading clinical and policy decisions? CONTEMPORARY CLINICAL TRIALS 2005; 26 (5): 518-529
Multicenter studies involving randomized clinical trials (RCTs) may have different structures. We discuss four general types. The first two, an "ideal" multicenter RCT and decentralized multicenter collaborative RCTs, we feel are, in different circumstances, highly recommended approaches. The other two, the multicenter RCT that ignores site differences and centralized multicenter collaborative RCTs, we argue, are not only not cost-effective but may also produce misleading results, thus impeding scientific progress and possibly putting patients at unnecessary risk.
View details for DOI 10.1016/j.cct.2005.05.002
View details for Web of Science ID 000232023400002
View details for PubMedID 15993653
Overweight children and adolescents - Reply NEW ENGLAND JOURNAL OF MEDICINE 2005; 353 (10): 1070-1071
The remote, the mouse, and the no. 2 pencil - The household media environment and academic achievement among third grade students ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2005; 159 (7): 607-613
Media can influence aspects of a child's physical, social, and cognitive development; however, the associations between a child's household media environment, media use, and academic achievement have yet to be determined.To examine relationships among a child's household media environment, media use, and academic achievement.During a single academic year, data were collected through classroom surveys and telephone interviews from an ethnically diverse sample of third grade students and their parents from 6 northern California public elementary schools. The majority of our analyses derive from spring 2000 data, including academic achievement assessed through the mathematics, reading, and language arts sections of the Stanford Achievement Test. We fit linear regression models to determine the associations between variations in household media and performance on the standardized tests, adjusting for demographic and media use variables.The household media environment is significantly associated with students' performance on the standardized tests. It was found that having a bedroom television set was significantly and negatively associated with students' test scores, while home computer access and use were positively associated with the scores. Regression models significantly predicted up to 24% of the variation in the scores. Absence of a bedroom television combined with access to a home computer was consistently associated with the highest standardized test scores.This study adds to the growing literature reporting that having a bedroom television set may be detrimental to young elementary school children. It also suggests that having and using a home computer may be associated with better academic achievement.
View details for Web of Science ID 000230229600002
View details for PubMedID 15996991
Clinical practice. Overweight children and adolescents. New England journal of medicine 2005; 352 (20): 2100-2109
Overweight children and adolescents. NEW ENGLAND JOURNAL OF MEDICINE 2005; 352 (20): 2100-2109
Overweight in children and adolescents - Pathophysiology, consequences, prevention, and treatment CIRCULATION 2005; 111 (15): 1999-2012
The prevalence of overweight among children and adolescents has dramatically increased. There may be vulnerable periods for weight gain during childhood and adolescence that also offer opportunities for prevention of overweight. Overweight in children and adolescents can result in a variety of adverse health outcomes, including type 2 diabetes, obstructive sleep apnea, hypertension, dyslipidemia, and the metabolic syndrome. The best approach to this problem is prevention of abnormal weight gain. Several strategies for prevention are presented. In addition, treatment approaches are presented, including behavioral, pharmacological, and surgical treatment. Childhood and adolescent overweight is one of the most important current public health concerns.
View details for DOI 10.1161/01.CIR.0000161369.71722.10
View details for Web of Science ID 000228461000021
View details for PubMedID 15837955
Evidence-based community pediatrics: Building a bridge from bedside to neighborhood PEDIATRICS 2005; 115 (4): 1142-1147
The American Academy of Pediatrics policy statement "The Pediatrician's Role in Community Pediatrics" encourages all pediatricians to partner with their communities to create and disseminate innovative programs that improve child health. This article describes 4 pillars of a bridge to evidence-based community pediatrics for pediatricians interested in pursuing effective community action: (1) collaborate with the community to establish a specific, short-term, health-related goal; (2) identify evidence-based best practice(s) for achieving the shared goal; (3) collaborate with the community to adapt this best practice to the community's unique assets and constraints; and (4) evaluate the project by using appropriate expertise. Practical elements of each pillar are described and illustrated by specific examples from community-based efforts of pediatricians and are accompanied by specific resources to aid pediatricians in their future community health work.
View details for DOI 10.1542/peds.2004-2825H
View details for Web of Science ID 000228108800008
View details for PubMedID 15821298
Preventing childhood obesity - A solution-oriented research paradigm AMERICAN JOURNAL OF PREVENTIVE MEDICINE 2005; 28 (2): 194-201
Past research has identified social and environmental causes and correlates of behaviors thought to be associated with obesity and weight gain among children and adolescents. Much less research has documented the efficacy of interventions designed to manipulate those presumed causes and correlates. These latter efforts have been inhibited by the predominant biomedical and social science problem-oriented research paradigm, emphasizing reductionist approaches to understanding etiologic mechanisms of diseases and risk factors. The implications of this problem-oriented approach are responsible for leaving many of the most important applied research questions unanswered, and for slowing efforts to prevent obesity and improve individual and population health. An alternative, and complementary, solution-oriented research paradigm is proposed, emphasizing experimental research to identify the causes of improved health. This subtle conceptual shift has significant implications for phrasing research questions, generating hypotheses, designing research studies, and making research results more relevant to policy and practice. The solution-oriented research paradigm encourages research with more immediate relevance to human health and a shortened cycle of discovery from the laboratory to the patient and population. Finally, a "litmus test" for evaluating research studies is proposed, to maximize the efficiency of the research enterprise and contributions to the promotion of health and the prevention and treatment of disease. A research study should only be performed if (1) you know what you will conclude from each possible result (whether positive, negative, or null); and (2) the result may change how you would intervene to address a clinical, policy, or public health problem.
View details for DOI 10.1016/j.amepre.2004.10.030
View details for Web of Science ID 000227057700013
View details for PubMedID 15694528
Prevention conference VII - Obesity, a worldwide epidemic related to heart disease and stroke - Group IV: Prevention/treatment CIRCULATION 2004; 110 (18): E484-E488
Major depression among adolescent smokers undergoing treatment for nicotine dependence ADDICTIVE BEHAVIORS 2004; 29 (8): 1517-1526
This is the first study to examine the prevalence and effects of major depression (MDD) in a sample of adolescent smokers (N = 211) undergoing treatment for nicotine dependence. We assessed MDD at baseline and end of treatment with the mood disorders portion of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). Eleven percent of participants reported a history of MDD (6% of males and 21% of females). Study variables did not distinguish those with and without a history of MDD. End of treatment abstinence rates and relapse rates were similar in both groups. Two participants (1%), both female, experienced onset of MDD during the treatment. The findings provide further evidence that MDD is a comparatively common disorder among children and adolescents and that clinicians should monitor and be prepared to respond to depression that may emerge during the treatment of nicotine-dependent adolescents.
View details for DOI 10.1016/j.addbeh.2004.02.029
View details for Web of Science ID 000224464000002
View details for PubMedID 15451121
Assessing weight-related biochemical cardiovascular risk factors in African-American girls OBESITY RESEARCH 2004; 12: 73S-83S
Hyperinsulinemia/insulin resistance is a risk factor for future type 2 diabetes. Fasting insulin and blood lipids serve as direct indicators of subsequent risk and as biochemical markers of metabolically significant adiposity. We examined the feasibility of obtaining fasting blood samples and report correlates of these biochemical markers in an understudied population sample.Fasting samples were requested from African-American girls, 8.00 to 10.99 years of age, for insulin, glucose, and lipid concentrations. Indices of insulin sensitivity and secretion were calculated and correlated with anthropometric, dietary, physical activity, and body composition data.Samples were obtained from 119 of 210 (57%) girls, varying from 5% to 86% across the four field centers. Glucose ranged from 71 to 104 mg/dL. Eleven percent had insulin concentrations >20 mU/liter. One girl had a triglyceride concentration >130 mg/dL. Thirteen percent had total cholesterol >200 mg/dL, whereas all subjects had high-density lipoprotein (HDL)-cholesterol of > or =35 mg/dL. Fourteen percent had low-density lipoprotein levels >130 mg/dL. Insulin concentrations showed consistently strong associations with measures of body weight (rs = 0.54 to 0.67); glucose, HDL, and LDL showed weaker correlations (rs = -0.11 to 0.22). Insulin concentration was highly correlated with indices of both insulin secretion and resistance (rs = 0.99).Fasting blood samples in young African-American girls were obtained with reasonable cooperation in three of the four field centers involved in this community-based study. Fasting insulin, glucose, LDL, and HDL concentrations may help evaluate future diabetes and cardiovascular risk in children of this age.
View details for Web of Science ID 000224581800010
View details for PubMedID 15489470
Parental cultural perspectives in relation to weight-related behaviors and concerns of African-American girls OBESITY RESEARCH 2004; 12: 7S-19S
To determine whether cultural perspectives of parents may influence children's eating and physical activity behaviors and patterns of weight gain.African-American girls (ages 8 to 10 years) and their parents (or caregivers) (n = 210) participated at one of four Girls Health Enrichment Multisite Studies Phase 1 Field Centers. At baseline, parents completed questionnaires adapted from the African-American Acculturation Scale (AAAS), the Multiethnic Identity Scale (MEIS), and an original question on Global Cultural Identity. Girls' baseline measures included physical activity assessment by accelerometer, 24-hour dietary recalls, and questionnaires about body image and weight concerns.Principal components analysis indicated the expected AAAS and MEIS factor structures, with moderate to good internal consistency (Cronbach's alpha = 0.61 to 0.82) and some intercorrelation among these measures (r = 0.17 to 0.57). Overall mean (SD) AAAS subscale scores of 4.1 (2.1) and 5.5 (1.8) of a possible 7 and 3.0 (0.9) of a possible 4 on the MEIS indicated, respectively, moderate to high levels of parental African-American cultural orientation and identity with moderate variability. Parental AAAS and MEIS scores were inversely correlated with girls' body image discrepancy and weight concern. One AAAS subscale was positively associated with total energy intake and percentage energy from fat. Overall, however, parental AAAS and MEIS scores were unrelated or inconsistently related to girls' physical activity and diet measures.The AAAS and MEIS measures had acceptable psychometric properties, except for weight concern, but did not give a consistent picture of how parental perspectives related to the girls' baseline attitudes and behaviors.
View details for Web of Science ID 000224581800003
View details for PubMedID 15489463
African-American girls' dietary intake while watching television OBESITY RESEARCH 2004; 12: 32S-37S
Television viewing has been associated with childhood obesity, although the mechanisms that link television viewing to higher BMI have not been established. Therefore, our objectives, in this report, were to describe the amount and types of foods that African-American girls consume while watching television and to examine the associations between African-American girls' BMI and the food they consume while watching television.Data were collected from 210 8- to 10-year-old African-American girls at four field centers by trained and certified nutritionists. Two nonconsecutive 24-hour dietary recalls were collected from each girl. For each eating episode reported, the girls were asked if they had been watching television while eating. Height and weight were collected using standard methods and used to calculate BMI.The data were analyzed separately by field center. The proportion of average daily energy intake that the girls consumed while watching television ranged from 26.9% to 35.0%. At all field centers, 40% to 50% of evening meals were consumed while watching television. None of the Spearman correlations between girls' BMI and the amount and type of foods consumed while watching television or at other times during the day were statistically significant (p > 0.05).This research revealed that a significant proportion of African-American girls' daily energy intake is consumed while watching television. Interventions that target reductions in food consumption while watching television or reducing television viewing may be effective strategies to decrease children's energy intakes. These results support a need for research to test the efficacy of these approaches.
View details for Web of Science ID 000224581800005
View details for PubMedID 15489465
Randomized clinical trial of the efficacy of Bupropion combined with nicotine patch in the treatment of adolescent smokers JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY 2004; 72 (4): 729-735
Adolescent smokers (N = 211) were randomized to 1 of 2 groups: (a) nicotine patch plus bupropion SR (sustained release; 150 mg per day) or (b) nicotine patch plus placebo. Group skills training sessions were conducted each week by research staff. Abstinence rates at Weeks 10 and 26 were as follows: (a) patch plus bupropion, 23% and 8%, (b) patch plus placebo, 28% and 7%. Despite the lack of a treatment effect, a large majority of adolescents in both treatment groups reduced their consumption to a few cigarettes per day or less and maintained this reduction over time. Similarly, an examination of survival curves revealed that by the end of treatment many had managed to avoid a return to daily smoking. These findings are encouraging and suggest new avenues for research. For example, treatments of the kind examined in this report, augmented by extended maintenance therapies, may yield higher long-term success rates.
View details for DOI 10.1037/0022-006X.72.4.729
View details for Web of Science ID 000222924600020
View details for PubMedID 15301658
Effectiveness of a multicomponent self-management program in at-risk, school-aged children with asthma ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY 2004; 92 (6): 611-618
Improving asthma knowledge and self-management is a common focus of asthma educational programs, but most programs have had little influence on morbidity outcomes. We developed a novel multiple-component intervention that included the use of an asthma education video game intended to promote adoption of asthma self-management behaviors and appropriate asthma care.To determine the effectiveness of an asthma education video game in reducing morbidity among high-risk, school-aged children with asthma.We enrolled 119 children aged 5 to 12 years from low-income, urban areas in and around San Francisco, CA, and San Jose, CA. Children with moderate-to-severe asthma and parental reports of significant asthma health care utilization were randomized to participate in the disease management intervention or to receive their usual care (control group). Patients were evaluated for clinical and quality-of-life outcomes at weeks 8, 32, and 52 of the study.Compared with controls, the intervention group had significant improvements in the physical domain (P = .04 and P = .01 at 32 and 52 weeks, respectively) and social activity domain (P = .02 and P = .05 at 32 and 52 weeks, respectively) of asthma quality of life on the Child Health Survey for Asthma and child (P = .02 at 8 weeks) and parent (P = .04 and .004 at 32 and 52 weeks, respectively) asthma self-management knowledge. There were no significant differences between groups on clinical outcome variables.A multicomponent educational, behavioral, and medical intervention targeted at high-risk, inner-city children with asthma can improve asthma knowledge and quality of life.
View details for Web of Science ID 000222121500007
View details for PubMedID 15237762
Children's food consumption during television viewing AMERICAN JOURNAL OF CLINICAL NUTRITION 2004; 79 (6): 1088-1094
Television viewing is associated with childhood obesity. Eating during viewing and eating highly advertised foods are 2 of the hypothesized mechanisms through which television is thought to affect children's weight.Our objectives were to describe the amounts and types of foods that children consume while watching television, compare those types with the types consumed at other times of the day, and examine the associations between children's body mass index (BMI) and the amounts and types of foods consumed during television viewing.Data were collected from 2 samples. The first sample consisted of ethnically diverse third-grade children, and the second consisted predominantly of Latino fifth-grade children. Three nonconsecutive 24-h dietary recalls were collected from each child. For each eating episode reported, children were asked whether they had been watching television. Height and weight were measured by using standard methods and were used to calculate BMI.On weekdays and weekend days, 17-18% and approximately 26% of total daily energy, respectively, were consumed during television viewing in the 2 samples. Although the fat content of the foods consumed during television viewing did not differ significantly from that of the foods consumed with the television off, less soda, fast food, fruit, and vegetables were consumed with the television on. The amount of food consumed during television viewing was not associated with children's BMI, but in the third-grade sample, the fat content of foods consumed during television viewing was associated with BMI.A significant proportion of children's daily energy intake is consumed during television viewing, and the consumption of high-fat foods on weekends may be associated with BMI in younger children.
View details for Web of Science ID 000221553500021
View details for PubMedID 15159240
Measurement characteristics of activity-related psychosocial measures in 8- to 10-year-old African-American girls in the Girls health Enrichment Multisite Study (GEMS) PREVENTIVE MEDICINE 2004; 38: S60-S68
This paper presents reliability and validity analyses of physical activity-related psychosocial questionnaires completed by 8- to 10-year-old African-American girls at baseline and follow-up assessments of pilot intervention studies in the Girls health Enrichment Multi-site Study (GEMS).Two hundred ten girls participated in the GEMS 12-week pilot studies and had their height and weight measured, wore an accelerometer for 3 days and completed a measure of their usual physical activity (PA) at baseline and after the 12-week intervention. Subgroups of girls also completed physical activity-related psychosocial measures at these two time points including: (a) self-concept; (b) self-efficacy; (c) outcome expectancies; and d) preferences. Principal components analysis was conducted on the psychosocial measures obtained at baseline. Cronbach's alpha and test-retest reliability were computed. Convergent validity was assessed by correlating the baseline psychosocial measures with baseline physical activity measures and body mass index (BMI).The following sub-scales were derived: Activity Preference, Positive Expectancies and Negative Expectancies for physical activity. Physical Performance Self-Concept and Self-Efficacy for physical activity were kept as single dimensional scales. Sub-scales, derived from principal components analyses, were Activity Preference, Positive Expectancies, and Negative Expectancies for physical activity. Internal consistency estimates for the various scales were substantial to excellent (0.67-0.85), while test-retest reliability estimates were fair to moderate (0.22-0.56). Correlations between the PA psychosocial sub-scales and measured levels of activity measures showed evidence of convergent validity for the Activity Preference sub-scale, although social desirability may have influenced the significant associations observed.The Activity Preference was a fairly reliable and valid measure. Further studies are needed to examine the utility of activity-related psychosocial measures in interventions to increase physical activity among preadolescent African-American girls.
View details for DOI 10.1016/j.ypmed.2003.12.030
View details for Web of Science ID 000221125700007
View details for PubMedID 15072860
Evaluation of quality control procedures for 24-h dietary recalls: results from the Girls health Enrichment Multisite Studies PREVENTIVE MEDICINE 2004; 38: S14-S23
Quality control methods are key components of dietary assessment, but have rarely been evaluated.One hundred forty-four 8-10-year-old African-American girls at three field centers completed two 24-h dietary recalls at baseline before a pilot weight gain prevention intervention (one recall collected in-person and one by telephone). The dietary recall data were initially reviewed by the dietary interviewer (Phase 1), then by a local lead nutritionist at the field center (Phase 2), and then by the Nutrition Coordinating Center (NCC) (Phase 3); any differences identified by NCC were reconciled (Phase 4). Bland-Altman and generalizability theory methods were used to assess agreement of consumption for selected food variables and nutrients between phases.Only small differences occurred. Quality control procedures primarily reduced the variances of nutrients rather than caused the means to shift. Most of the variability among phases was due to individual level variability in dietary intake.Decisions to review dietary recall data beyond local review should be based on the level of precision and accuracy required for the study outcomes and the availability of financial resources.
View details for DOI 10.1016/j.ypmed.2003.10.014
View details for Web of Science ID 000221125700002
View details for PubMedID 15072855
Physical activity self-report and accelerometry measures from the Girls health Enrichment Multi-site Studies PREVENTIVE MEDICINE 2004; 38: S43-S49
Valid and reliable physical activity checklists are needed to assess effectiveness of interventions. This study tested the validity and reliability of the Girls health Enrichment Multi-site Studies (GEMS) Activity Questionnaire.Two-hundred and ten African-American girls completed the GEMS Activity Questionnaire (GAQ), a checklist of 28 physical and 7 sedentary activities, including TV viewing, inquiring whether performed on the previous day ("yesterday"), and whether usually performed ("usual"). The girls wore an accelerometer (used as the criterion for validity) for three consecutive days at baseline and after a 12-week pilot intervention. Data from 172 girls at baseline and follow-up were usable for this report.Girls were (mean +/- SD) 8.8 +/- 0.8 years old with a BMI of 22.3 +/- 5.9 kg/m2. The intraclass correlation (ICC) examining reliability for the accelerometer across 3 days at baseline for the combined group was fair (ICC = 0.33, P < 0.21). The test-retest reliability coefficient for the 18-item MET-weighted GAQ yesterday scores for the comparison group of girls was 0.57 (P < 0.001). At baseline and follow-up, nonsignificant correlations were observed between 3-day accelerometer counts/minute and GAQ 18-item usual score for both comparison and intervention groups. A significant correlation was found between change in accelerometer minutes of moderate-to-vigorous activity (MVPA) between 12 noon and 6 PM and change in GAQ physical activities in the comparison girls (R = 0.35, P < 0.01). The TV-usual score was correlated with 3-day accelerometer counts/minute (R = -0.19, P = 0.02) at baseline for the total sample.Correlations between the GAQ and accelerometer were low, indicating low validity. Although the GAQ may be helpful in describing types of physical activities performed, it needs further development to improve its psychometric properties.
View details for DOI 10.1016/j.ypmed.2003.01.001
View details for Web of Science ID 000221125700005
View details for PubMedID 15072858
Measurement characteristics of weight concern and dieting measures in 8-10-year-old African-American girls from GEMS pilot studies PREVENTIVE MEDICINE 2004; 38: S50-S59
Reliability and validity were established for weight concern measures completed by 8-10-year-old African-American girls participating in a pilot obesity prevention program.Two hundred ten girls and parents participated in the program. Girls completed subscales of the McKnight Risk Factor Survey (MRFS) and body silhouette ratings, had height, weight, and body fat measured, wore accelerometers for 3 days, and completed two dietary recalls. Principal components analysis, internal consistency, and test-retest reliability were computed for weight concerns and body image measures along with convergent validity with body mass index (BMI), percent body fat (PBF), physical activity, and dietary intake.A Moderate Weight Control Behaviors (MWCB) subscale was derived from the MRFS. Overconcern with Weight and Shape (OWS) was a stand-alone scale. Internal consistency estimates for the scales were substantial ranging from 0.71 to 0.84. Test-retest reliabilities were moderate (0.45-0.58). OWS, MWCB, body silhouette rating, and body size discrepancy were positively associated with BMI and PBF. The "like to look" silhouette rating was negatively associated with PBF.Weight concern measures had reasonable levels of internal consistency and promising validity, but only moderate test-retest reliability among preadolescent African-American girls. Refinement and further validation of weight concern measures in this population are warranted.
View details for DOI 10.1016/j.ypmed.2003.12.031
View details for Web of Science ID 000221125700006
View details for PubMedID 15072859
Associations among familism, language preference, and education in Mexican-American mothers and their children JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS 2004; 25 (1): 34-40
Latino families who express a higher degree of familism are characterized by positive interpersonal familial relationships, high family unity, social support, interdependence in the completion of daily activities, and close proximity with extended family members. Retention of cultural values, such as familism, may be linked to positive health outcomes; however, little is known about how families retain culture of origin values in the face of acculturation pressures. The current study explores acculturation influences as indexed by language preference and household education on maternal and child familism. Mothers and children of Mexican descent (fourth grade students) (n = 219) completed measures of demographics, household education, language preference, and familism. Three hypotheses were examined. First, we predicted that lower household education would be correlated with higher familism scores. However, contrary to our prediction, a higher familism score was significantly associated with a higher level of household education (p <.05). Second, we predicted that higher child familism would be associated with the preference for speaking Spanish. Children who preferred to use both English and Spanish (p <.01) or English alone (p <.05) had higher familism scores than those who preferred Spanish. Third, we predicted that lower child familism scores would be associated with greater differences in mother and child language preferences. There were no significant differences in child familism based on differences between parent and child language. Protective influences of cultural maintenance deserve further attention in longitudinal studies and in relation to the physical and mental health of youth.
View details for Web of Science ID 000189076300005
View details for PubMedID 14767354
Effects of a videotape to increase use of poison control centers by low-income and Spanish-speaking families: A randomized, controlled trial PEDIATRICS 2003; 111 (1): 21-26
Poison control centers (PCCs) reduce health care costs for childhood poisonings by providing telephone advice for home management of most cases. Past research suggests that PCCs are underutilized by low-income minority and Spanish-speaking parents because of lack of knowledge and misconceptions about the PCC. A videotape intervention was designed to address these barriers to PCC use.To evaluate the effectiveness of a videotape intervention (videotape, PCC pamphlet, and PCC stickers) in improving knowledge, attitudes, behaviors, and behavioral intention regarding use of the PCC in a low-income and predominantly Spanish-speaking population in Northern California.Two hundred eighty-nine parents of children <6 years of age, attending educational classes at 2 Women, Infant, and Children (WIC) clinics participated in a randomized, controlled trial. WIC classes were randomized to receive the video intervention (video group) or to attend the regularly scheduled WIC class (control group). Participants completed a baseline questionnaire and 2 to 4 weeks later, a follow-up telephone interview. Changes from baseline to posttest were compared in the treatment and control groups using analysis of variance.Compared with the control group, the video group showed an increase in knowledge about the PCC's function, its hours of operation, and staff qualifications; was more likely to feel confident in speaking with and carrying out recommendations made by the PCC; was less likely to believe the PCC would report a mother for neglect; was more likely to have the correct PCC phone number posted in their homes; and when presented with several hypothetical emergency scenarios, was more likely to correctly answer that calling the PCC was the best action to take in a poisoning situation.This videotape intervention was highly effective in changing knowledge, attitudes, behaviors, and behavioral intentions concerning the PCC within this population. As a result, use of this video may help increase use of the PCC by low-income and Spanish-speaking families.
View details for Web of Science ID 000180135200020
View details for PubMedID 12509549
Common design elements of the Girls health Enrichment Multi-site Studies (GEMS). Ethnicity & disease 2003; 13 (1): S6-14
The Girls health Enrichment Multi-site Studies (GEMS) was a multi-center research program created for the purpose of testing interventions designed to prevent excess weight gain by African-American girls, as they enter and proceed through puberty. However, GEMS was not a "multi-center clinical trial" in the usual sense. Although these studies applied similar eligibility criteria, observed a similar follow-up schedule, and followed a similar measurement protocol, important differences existed, as well. Each field center developed its own intervention(s) and corresponding control, and tailored its study to the specific hypothesis being tested. Therefore, the study populations were somewhat different, with recruitment strategies that varied accordingly, and supplemental evaluations appropriate to the specific interventions were conducted on a site-specific basis. The purpose of this paper is to describe the common design elements of the GEMS Phase 1 pilot studies. This report presents the basic study design, a brief overview of the interventions, the measurements taken and their rationale, and procedures both for compiling the collaborative database, and performing site-specific analyses.
View details for PubMedID 12713207
Phase 1 of the Girls health Enrichment Multi-site Studies (GEMS): conclusion. Ethnicity & disease 2003; 13 (1): S88-91
This special supplement to Ethnicity & Disease presents the background and rationale, methodology, feasibility, and results of 4 separate interventions that were pilot-tested in Phase 1 of the Girls health Enrichment Multi-site Studies (GEMS) research program. The ultimate aim of the interventions was to prevent obesity in African-American girls. Four field centers, a Coordinating Center, and the National Heart, Lung, and Blood Institute were involved in a unique collaboration to generate and share ideas related to recruitment, formative assessment, and the standardization of some aspects of data collection while each field center designed and implemented a different intervention. Outcomes for recruitment, participation, and behavioral change were generally very favorable, particularly for the two field centers that have progressed to test their interventions in full-scale randomized trials in GEMS Phase 2. The intervention development and pilot study phase also provided many lessons about the importance of trust, openness, and community acceptability in implementing undertakings of this type. Given the paucity of evidence for effective strategies to prevent obesity overall and in high-risk populations, GEMS is an important step forward in developing well-grounded strategies for improving nutrition, physical activity, and weight status in African-American girls.
View details for PubMedID 12713214
Dance and reducing television viewing to prevent weight gain in African-American girls: the Stanford GEMS pilot study. Ethnicity & disease 2003; 13 (1): S65-77
To test the feasibility, acceptability, and potential efficacy of after-school dance classes and a family-based intervention to reduce television viewing, thereby reducing weight gain, among African-American girls.Twelve-week, 2-arm parallel group, randomized controlled trial.Low-income neighborhoods.Sixty-one 8-10-year-old African-American girls and their parents/guardians.The treatment intervention consisted of after-school dance classes at 3 community centers, and a 5-lesson intervention, delivered in participants' homes, and designed to reduce television, videotape, and video game use. The active control intervention consisted of disseminating newsletters and delivering health education lectures.Implementation and process measures, body mass index, waist circumference, physical activity measured by accelerometry, self-reported media use, and meals eaten with TV.Recruitment and retention goals were exceeded. High rates of participation were achieved for assessments and intervention activities, except where transportation was lacking. All interventions received high satisfaction ratings. At follow up, girls in the treatment group, as compared to the control group, exhibited trends toward lower body mass index (adjusted difference = -.32 kg/m2, 95% confidence interval [CI] -.77, .12; Cohen's d = .38 standard deviation units) and waist circumference (adjusted difference = -.63 cm, 95% CI -1.92, .67; d = .25); increased after-school physical activity (adjusted difference = 55.1 counts/minute, 95% CI -115.6, 225.8; d = .21); and reduced television, videotape, and video game use (adjusted difference = -4.96 hours/week, 95% CI -11.41, 1.49; d = .40). The treatment group reported significantly reduced household television viewing (d = .73, P = .007) and fewer dinners eaten while watching TV (adjusted difference = -1.60 meals/week, 95% CI -2.99, -.21; d = .59; P = .03). Treatment group girls also reported less concern about weight (d = .60; P = .03), and a trend toward improved school grades (d = .51; P = .07).This study confirmed the feasibility, acceptability, and potential efficacy of using dance classes and a family-based intervention to reduce television viewing, thereby reducing weight gain, in African-American girls.
View details for PubMedID 12713212
Agreement among measures of asthma status: A prospective study of low-income children with moderate to severe asthma PEDIATRICS 2002; 110 (4): 797-804
Because no validated "gold standard" for measuring asthma outcomes exists, asthma interventions are often evaluated using a large number of disease status measures. Some of these measures may be redundant, whereas others may be complementary. Use of multiple outcomes may lead to ambiguous results, increased type I error rates, and be an inefficient use of resources including caregiver and patient/participant time and effort. Understanding the relationship between these measures may facilitate more parsimonious and valid evaluation strategies without loss of information.To assess the relationships between multiple measures of asthma disease status over time.We used data from a randomized, controlled trial of a comprehensive disease management program involving 119 disadvantaged inner-city children aged 5 to 12 years with moderate to severe asthma. Spearman correlations were calculated between the following asthma disease status measures: parent-reported disease symptoms, parent-reported health care utilization, functional health status using the American Academy of Pediatrics' validated Child Health Survey for Asthma (CHSA), diary data (symptom scores, night wakings, and bronchodilator use), and pulmonary function tests at baseline, 32 weeks, 52 weeks, and changes from baseline to 52 weeks.Ninety-four (79%) of randomized patients participated at baseline and 52 weeks. Completion rates for outcome measures ranged from 79% (CHSA, spirometry data) to 64% (diary data). At baseline, asthma symptoms, health care utilization, and individual domains from the CHSA were significantly correlated (r = 0.21-0.53). These correlations were stable over the 52-week follow-up. Forced expiratory volume in 1 second and diary data did not correlate to any other measures at baseline, and these measures correlated only inconsistently with other measures at 32 weeks and 52 weeks. Baseline to 52-week changes in asthma symptoms, utilization, and the CHSA domains were significantly correlated (0.22-0.56), as were baseline to 52-week changes in symptom days, night wakings, and the CHSA domains (r = 0.24-0.64). Baseline to 52-week changes in forced expiratory volume in 1 second and diary data did not correlate with other measures.These results suggest that asthma status and change in asthma status over time after introduction of a disease management intervention are best characterized by parent-reported symptoms, parent-reported utilization, and functional health status measures. Asthma diaries and pulmonary function tests did not seem to provide additional benefit, although they may play an important role in individual patient management. Our findings suggest a parsimonious evaluation strategy would include collection of key data elements regarding symptoms, utilization, and functional health status only, without loss of vital response information.
View details for Web of Science ID 000178330200033
View details for PubMedID 12359798
Validity of children's food portion estimates - A comparison of 2 measurement aids ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2002; 156 (9): 867-871
Policy and clinical decisions regarding children's nutrition are often based on dietary intake estimates from self-reports. The accuracy of these estimates depends on memory of both the type of food eaten and the amount consumed. Although children's self-reports of food intake are widely used, there is little research on their ability to estimate food portions.To assess the validity of children's estimates of the food portions they consume by means of 2 types of measurement aids: standard 2-dimensional food portion visuals and manipulative props.Randomized controlled trial.Fifty-four African American girls aged 8 to 12 years.Girls were served a standard meal and actual intake was assessed by weighing food portions before and after the meal. On completion of the meal, dietitians collected food recalls and portion size estimates from the girls by means of both manipulative props and 2-dimensional food portion visuals, administered in a randomized order.Absolute value percentage differences between actual and estimated grams of food consumed averaged 58.0% (SD, 102.7%) for manipulative props and 32.8% (SD, 72.8%) for 2-dimensional food portion visuals. Spearman correlations between actual and estimated intakes with both portion size measurement aids were high (range, r = 0.56 to 0.79; all P<.001), with the exception of bread intake (r = 0.16, P =.43). Correlations with actual intakes did not differ significantly between the 2 methods.Children's self-reported portion size estimates are appropriate for ranking children's relative intakes, but they result in sizable errors in quantitative estimates of food and energy intakes. Caution should be used in interpreting quantitative dietary intake estimates derived from children's self-reports.
View details for Web of Science ID 000177859400006
View details for PubMedID 12197792
Cardiovascular health in childhood - A statement for health professionals from the Committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the council on cardiovascular disease in the young, American Heart Association CIRCULATION 2002; 106 (1): 143-160
Primary care interventions to reduce television viewing in African-American children AMERICAN JOURNAL OF PREVENTIVE MEDICINE 2002; 22 (2): 106-109
Data are lacking on primary care interventions to reduce children's television viewing. Low-income African-American children watch greater amounts of television than their peers.A randomized controlled pilot and feasibility trial was conducted. Twenty-eight families with 7- to 12-year-old African-American children receiving primary care at an urban community clinic serving a low-income population were randomized to receive counseling alone or counseling plus a behavioral intervention that included an electronic television time manager. The main outcome was hours of children's television, videotape, and video game use. Parents/guardians and children completed baseline and 4-week follow-up self-report surveys. Additional outcomes included overall household television use, time spent in organized physical activity and playing outside, and meals eaten by the child while watching television.Both intervention groups reported similar decreases in children's television, videotape, and video game use (mean changes of -13.7, SD=26.1 and -14.1, SD=16.8 hours per week). The behavioral intervention group reported significantly greater increases in organized physical activity (changes of +2.5, SD=5.9 and -3.6, SD=4.7 hours per week; p =0.004) and nearly significant greater increases in playing outside (changes of 1.0, SD=5.9 and -4.7, SD=9.4 hours per week; p <0.06). Changes in overall household television use and meals eaten while watching television also appeared to favor the behavioral intervention, with small to medium effect sizes, but differences were not statistically significant.This small pilot and feasibility study evaluated two promising primary care-based interventions to reduce television, videotape, and video game use among low-income African-American children. The effects on physical activity suggest that the behavioral intervention may be more effective.
View details for Web of Science ID 000174322100005
View details for PubMedID 11818179
Environmental exposure and sensitization to cockroach, dust mite, and cat allergen: Correlation with asthma symptoms in a population of disadvantaged, inner-city children in the San Francisco Bay Area MOSBY-ELSEVIER. 2002: S88-S88
Are perceived neighborhood hazards a barrier to physical activity in children? ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2001; 155 (10): 1143-1148
We hypothesized that children's perceptions of more neighborhood hazards would be associated with less physical activity, less aerobic fitness, and a higher body mass index.To examine the association between a hazardous neighborhood context and physical activity in children.Fourth-grade students (n = 796) of diverse ethnic and economic backgrounds completed measures of neighborhood hazards, self-reported physical activity, physical fitness, height, and weight. Parents (n = 518) completed telephone interviews and provided data on their education level and occupation.As expected, children from families of lower socioeconomic status perceived significantly more neighborhood hazards. Contrary to our hypothesis, the perception of more hazards was significantly associated with more reported physical activity. This finding was not explained by school heterogeneity, alteration of the hazards measure, or differences in socioeconomic status.To further examine the relationship between neighborhood hazards and physical activity, we suggest that future studies include assessments of sedentary behavior, parental fear of violence, parental regulation of children's leisure activities, and cost and quality of available play areas and organized sports.
View details for Web of Science ID 000171320800010
View details for PubMedID 11576010
Television viewing and childhood obesity PEDIATRIC CLINICS OF NORTH AMERICA 2001; 48 (4): 1017-?
Children spend a substantial portion of their lives watching television. Investigators have hypothesized that television viewing causes obesity by one or more of three mechanisms: (1) displacement of physical activity, (2) increased calorie consumption while watching or caused by the effects of advertising, and (3) reduced resting metabolism. The relationship between television viewing and obesity has been examined in a relatively large number of cross-sectional epidemiologic studies but few longitudinal studies. Many of these studies have found relatively weak, positive associations, but others have found no associations or mixed results; however, the weak and variable associations found in these studies may be the result of limitations in measurement. Several experimental studies of reducing television viewing recently have been completed. Most of these studies have not tested directly the effects of reducing television viewing behaviors alone, but their results support the suggestion that reducing television viewing may help to reduce the risk for obesity or help promote weight loss in obese children. Finally, one school-based, experimental study was designed specifically to test directly the causal relationship between television viewing behaviors and body fatness. The results of this randomized, controlled trial provide evidence that television viewing is a cause of increased body fatness and that reducing television viewing is a promising strategy for preventing childhood obesity.
View details for Web of Science ID 000170119000012
View details for PubMedID 11494635
Effects of reducing television viewing on children's requests for toys: A randomized controlled trial JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS 2001; 22 (3): 179-184
Previous attempts to reduce the effects of television advertising on children's purchase requests have had little success. Therefore, we tested the effects of a classroom intervention to reduce television, videotape, and video game use on children's toy purchase requests, in a school-based randomized controlled trial. Third- and fourth-grade children (mean age, 8.9 years) in two sociodemographically and scholastically matched public elementary schools were eligible to participate. Children in one randomly selected elementary school received an 18-lesson, 6-month classroom curriculum to reduce television, videotape, and video game use. In both schools, in September (before intervention) and April (after intervention) of a single school year, children and parents reported children's prior week's purchase requests for toys seen on television. After intervention, children in the intervention school were significantly less likely to report toy purchase requests than children in the control school, with adjusting for baseline purchase requests, gender, and age (odds ratio, 0.29; 95% confidence interval, 0.12-0.69). Among intervention school children, reductions in self-reported purchase requests were also associated with reductions in television viewing. There was no significant difference between schools in parent reports of children's requests for toy purchases. These findings suggest that reducing television viewing is a promising approach to reducing the influences of advertising on children's behavior.
View details for Web of Science ID 000169365600004
View details for PubMedID 11437193
Is parental control over children's eating associated with childhood obesity? Results from a population-based sample of third graders OBESITY RESEARCH 2001; 9 (5): 306-312
Identifying parental behaviors that influence childhood obesity is critical for the development of effective prevention and treatment programs. Findings from a prior laboratory study suggest that parents who impose control over their children's eating may interfere with their children's ability to regulate intake, potentially resulting in overweight. These findings have been widely endorsed; however, the direct relationship between parental control of children's intake and their children's degree of overweight has not been shown in a generalized sample.This study surveyed 792 third-grade children with diverse ethnic and socioeconomic backgrounds from 13 public elementary schools. Parental control over children's intake was assessed through telephone interviews using a state-of-the-art instrument, and children were measured for height, weight, and triceps skinfold thickness.Counter to the hypothesis, parental control over children's intake was inversely associated with overweight in girls, as measured by body mass index, r = -0.12, p < 0.05, and triceps skinfolds, r = -0.11, p < 0.05. This weak relationship became only marginally significant when controlling for parents' perceptions of their own weight, level of household education, and children's age. No relationship between parental control of children's intake and their children's degree of overweight was found in boys.Previous observations of the influence of parental control over children's intake in middle-class white families did not generalize to 8- to 9-year-olds in families with diverse socioeconomic and ethnic backgrounds. The present findings reveal a more complex relationship between parental behaviors and children's weight status.
View details for Web of Science ID 000168685300005
View details for PubMedID 11346672
Do adolescent smokers experience withdrawal effects when deprived of nicotine? EXPERIMENTAL AND CLINICAL PSYCHOPHARMACOLOGY 2001; 9 (2): 176-182
This is the first controlled prospective study of the effects of nicotine deprivation in adolescent smokers. Heart rate and subjective withdrawal symptoms were measured over an 8-hr period while participants smoked normally. Seven days later, participants were randomized to wear a 15-mg (16-hr) nicotine patch or a placebo patch for 8 hr, and they refrained from smoking during the session. Those wearing the placebo experienced a decrease in heart rate across sessions and an increase in subjective measures of nicotine withdrawal. Those wearing the active patch also reported significant increases for some subjective symptoms. Expectancy effects were also observed. The findings indicate that adolescent smokers experience subjective and objective changes when deprived of nicotine. As in previous research with adults, expectancies concerning the effects of nicotine replacement also influenced perceptions of withdrawal.
View details for Web of Science ID 000170981800009
View details for PubMedID 11518093
Overweight concerns and body dissatisfaction among third-grade children: The impacts of ethnicity and socioeconomic status JOURNAL OF PEDIATRICS 2001; 138 (2): 181-187
To examine the prevalence of overweight concerns and body dissatisfaction among third-grade girls and boys and the influences of ethnicity and socioeconomic status (SES).Nine hundred sixty-nine children (mean age, 8.5 years) attending 13 northern California public elementary schools completed assessments of overweight concerns, body dissatisfaction, and desired shape, height, and weight.The sample was 44% white, 21% Latino, 19% non-Filipino Asian American, 8% Filipino, and 5% African American. Twenty-six percent of boys and 35% of girls reported wanting to lose weight, and 17% of boys and 24% of girls reported dieting to lose weight. Among girls, Latinas and African Americans reported significantly more overweight concerns than Asian Americans and Filipinas, and Latinas reported significantly more overweight concerns than whites. White and Latina girls also reported greater body dissatisfaction than Asian American girls. Some differences persisted even after controlling for actual body fatness. Higher SES African American girls reported significantly more overweight concerns than lower SES African American girls, but higher SES white girls reported less overweight concerns than lower SES white girls.Overweight concerns and body dissatisfaction are highly prevalent among third-grade girls and boys, across ethnicity and SES. Young Latina and African American girls manifest equivalent or higher levels of disordered eating attitudes and behaviors as white and Asian American girls.
View details for Web of Science ID 000166905800008
View details for PubMedID 11174614
Effects of reducing children's television and video game use on aggressive behavior - A randomized controlled trial ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2001; 155 (1): 17-23
The relationship between exposure to aggression in the media and children's aggressive behavior is well documented. However, few potential solutions have been evaluated.To assess the effects of reducing television, videotape, and video game use on aggressive behavior and perceptions of a mean and scary world.Randomized, controlled, school-based trial.Two sociodemographically and scholastically matched public elementary schools in San Jose, Calif.Third- and fourth-grade students (mean age, 8.9 years) and their parents or guardians.Children in one elementary school received an 18-lesson, 6-month classroom curriculum to reduce television, videotape, and video game use.In September (preintervention) and April (postintervention) of a single school year, children rated their peers' aggressive behavior and reported their perceptions of the world as a mean and scary place. A 60% random sample of children were observed for physical and verbal aggression on the playground. Parents were interviewed by telephone and reported aggressive and delinquent behaviors on the child behavior checklist. The primary outcome measure was peer ratings of aggressive behavior.Compared with controls, children in the intervention group had statistically significant decreases in peer ratings of aggression (adjusted mean difference, -2.4%; 95% confidence interval [CI], -4.6 to -0.2; P =.03) and observed verbal aggression (adjusted mean difference, -0.10 act per minute per child; 95% CI, -0.18 to -0.03; P =.01). Differences in observed physical aggression, parent reports of aggressive behavior, and perceptions of a mean and scary world were not statistically significant but favored the intervention group.An intervention to reduce television, videotape, and video game use decreases aggressive behavior in elementary schoolchildren. These findings support the causal influences of these media on aggression and the potential benefits of reducing children's media use.
View details for Web of Science ID 000166252200004
View details for PubMedID 11177057
The 30-second effect: An experiment revealing the impact of television commercials on food preferences of preschoolers JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2001; 101 (1): 42-46
To examine whether televised food commercials influence preschool children's food preferences.In this randomized, controlled trial, preschool children viewed a videotape of a popular children's cartoon either with or without embedded commercials. Children were then asked to identify their preferences from pairs of similar products, one of which was advertised in the videotape with embedded commercials. Preschoolers' parents were interviewed to determine children's demographic characteristics and media use patterns.Forty-six 2- to 6-year-olds from a Head Start program in northern California.For demographic and media use characteristics, univariate data were examined and Student t and chi 2 tests were used to test for differences between the control and treatment groups. We calculated the Cochran Q statistic to assess whether the proportion of those choosing advertised food items was significantly higher in the treatment group than in the control group.Children exposed to the videotape with embedded commercials were significantly more likely to choose the advertised items than children who saw the same videotape without commercials (Qdiff = 8.13, df = 1, P < .01).Even brief exposures to televised food commercials can influence preschool children's food preferences. Nutritionists and health educators should advise parents to limit their preschooler's exposure to television advertisements. Furthermore, advocates should raise the public policy issue of advertising and young children, especially given the recent epidemic of childhood obesity and the ever-changing media environment.
View details for Web of Science ID 000170311800007
View details for PubMedID 11209583
The epidemic of pediatric obesity WESTERN JOURNAL OF MEDICINE 2000; 173 (4): 220-221
Are overweight children unhappy? Body mass index, depressive symptoms, and overweight concerns in elementary school children AMER MEDICAL ASSOC. 2000: 931-935
It is commonly believed that overweight children are unhappy with their weight. However, population-based data addressing this association are lacking.To evaluate the association between obesity and depressive symptoms in a diverse, school-based sample of preadolescent children, and to examine whether overweight concerns play a role in this association.Third-grade students (N = 868, mean age, 8.4 years) attending 13 public elementary schools in Northern California were measured for weight and height, and were asked to complete self-report assessments of depressive symptoms and overweight concerns.A modest association between depressive symptoms and body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) was found for girls (r = 0.14, P<.01), but not for boys (r = 0.01, P<.78). Among girls, depressive symptoms were strongly associated with overweight concerns (r = 0.32, P<.001). After controlling for level of overweight concerns, BMI was no longer significantly associated with depressive symptoms among girls. In contrast, after controlling for BMI, overweight concerns remained significantly associated with depressive symptoms.This study provides cross-sectional evidence for a relationship between depressive symptoms and BMI in preadolescent girls, but not in preadolescent boys. This relationship seems to be explained by an excess of overweight concerns. Assessing overweight concerns may be a useful method to identify those overweight girls who are at highest risk for associated depressive symptoms.
View details for Web of Science ID 000089222200012
View details for PubMedID 10980798
Can a school-based intervention to reduce television use decrease adiposity in children in grades 3 and 4? WESTERN JOURNAL OF MEDICINE 2000; 173 (1): 40-40
Interactions of diet, physical activity, and obesity: implications for prevention CVD Prevention 2000; 3: 132-6
Does the camera add 10 pounds? Media use, perceived importance of appearance, and weight concerns among teenage girls JOURNAL OF ADOLESCENT HEALTH 2000; 26 (1): 36-41
To examine the relationship between use of electronic media and perceived importance of appearance and weight concerns among adolescent girls.Physical measures and self-report surveys were obtained from 837 ninth-grade girls attending pubs lic high schools in San Jose, California (mean age = 14.9 +/- 0.47 years; 36% Latino, 24% White, 22% Asian, 8% Black, 10% other). Correlational and multiple regression analyses were performed with ethnicity, body mass index (BMI), perceived importance of appearance, weight concerns, and media use (based on self-reported average weekly use of television, videotapes, video and computer games, and music videos).Total media use was not significantly related to perceived importance of appearance or weight concerns. When media use was separated into distinct media genres, only hours of watching music videos was related to perceived importance of appearance and weight concerns (r = 0.12, p < .001, and r = .08, p < .05, respectively). In multivariate analyses, after controlling for BMI and ethnicity, no media use variables were significantly associated with either perceived importance of appearance or weight concerns.Frequent music video use may be a risk factor for increased perceived importance of appearance and increased weight concerns among adolescent girls.
View details for Web of Science ID 000084662700007
View details for PubMedID 10638716
Are overweight children unhappy? body mass index, depressive symptoms, and overweight concerns in elementary school children Arch Pediatr Adolesc Med 2000; 154: 931-5
Reducing children's television viewing to prevent obesity - A randomized controlled trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 1999; 282 (16): 1561-1567
Some observational studies have found an association between television viewing and child and adolescent adiposity.To assess the effects of reducing television, videotape, and video game use on changes in adiposity, physical activity, and dietary intake.Randomized controlled school-based trial conducted from September 1996 to April 1997.Two sociodemographically and scholastically matched public elementary schools in San Jose, Calif.Of 198 third- and fourth-grade students, who were given parental consent to participate, 192 students (mean age, 8.9 years) completed the study.Children in 1 elementary school received an 18-lesson, 6-month classroom curriculum to reduce television, videotape, and video game use.Changes in measures of height, weight, triceps skinfold thickness, waist and hip circumferences, and cardiorespiratory fitness; self-reported media use, physical activity, and dietary behaviors; and parental report of child and family behaviors. The primary outcome measure was body mass index, calculated as weight in kilograms divided by the square of height in meters.Compared with controls, children in the intervention group had statistically significant relative decreases in body mass index (intervention vs control change: 18.38 to 18.67 kg/m2 vs 18.10 to 18.81 kg/m2, respectively; adjusted difference -0.45 kg/m2 [95% confidence interval [CI], -0.73 to -0.17]; P = .002), triceps skinfold thickness (intervention vs control change: 14.55 to 15.47 mm vs 13.97 to 16.46 mm, respectively; adjusted difference, -1.47 mm [95% CI, -2.41 to -0.54]; P=.002), waist circumference (intervention vs control change: 60.48 to 63.57 cm vs 59.51 to 64.73 cm, respectively; adjusted difference, -2.30 cm [95% CI, -3.27 to -1.33]; P<.001), and waist-to-hip ratio (intervention vs control change: 0.83 to 0.83 vs 0.82 to 0.84, respectively; adjusted difference, -0.02 [95% CI, -0.03 to -0.01]; P<.001). Relative to controls, intervention group changes were accompanied by statistically significant decreases in children's reported television viewing and meals eaten in front of the television. There were no statistically significant differences between groups for changes in high-fat food intake, moderate-to-vigorous physical activity, and cardiorespiratory fitness.Reducing television, videotape, and video game use may be a promising, population-based approach to prevent childhood obesity.
View details for Web of Science ID 000083277800024
View details for PubMedID 10546696
Viewing the viewers: Ten video cases of children's television viewing behaviors JOURNAL OF BROADCASTING & ELECTRONIC MEDIA 1999; 43 (4): 506-528
Ethnic variation in cardiovascular disease risk factors among children and young adults - Findings from the Third National Health and Nutrition Examination Survey, 1988-1994 JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 1999; 281 (11): 1006-1013
Knowledge about ethnic differences in cardiovascular disease (CVD) risk factors among children and young adults from national samples is limited.To evaluate ethnic differences in CVD risk factors, the age at which differences were first apparent, and whether differences remained after accounting for socioeconomic status (SES).Third National Health and Nutrition Examination Survey, 1988-1994.Eighty-nine mobile examination centers.A total of 2769 black, 2854 Mexican American, and 2063 white (non-Hispanic) children and young adults aged 6 to 24 years.Ethnicity and household level of education (SES) in relation to body mass index (BMI), percentage of energy from dietary fat, cigarette smoking, systolic blood pressure, glycosylated hemoglobin (HbA1c), and non-high-density lipoprotein cholesterol (non-HDL-C [the difference between total cholesterol and HDL-C]).The BMI levels were significantly higher for black and Mexican American girls than for white girls, with ethnic differences evident by the age of 6 to 9 years (a difference of approximately 0.5 BMI units) and widening thereafter (a difference of >2 BMI units among 18- to 24-year-olds). Percentages of energy from dietary fat paralleled these findings and were also significantly higher for black than for white boys. Blood pressure levels were higher for black girls than for white girls in every age group, and glycosylated hemoglobin levels were highest for black and Mexican American girls and boys in every age group. In contrast, smoking prevalence was highest for white girls and boys, especially for those from low-SES homes (77% of young men and 61% of young women, aged 18-24 years, from low-SES homes were current smokers). All ethnic differences remained significant after accounting for SES and age.These findings show strong ethnic differences in CVD risk factors among youths of comparable age and SES from a large national sample. The differences highlight the need for heart disease prevention programs to begin early in childhood and continue throughout young adulthood to reduce the risk of atherosclerosis.
View details for Web of Science ID 000079079400027
View details for PubMedID 10086435
Behavioural treatment of childhood and adolescent obesity NATURE PUBLISHING GROUP. 1999: S52-S57
Current state-of-the-art behavioural treatments for childhood and adolescent obesity, produce long-term weight control in up to one-third of participants. A review of the most effective treatments suggests structural and organizational components and treatment content that are most likely to be successful. These include a group format with individualized behavioural counseling; parent participation; frequent sessions; a long treatment duration; a simple and explicit diet that produces a calorie deficit; a physical activity program emphasizing choice and reinforcing reduced sedentary behaviours; making changes in the home and family environment to help reduce cues and opportunities associated with calorie intake and inactivity, and to increase cues and opportunities for physical activity; self-monitoring; goal setting and contracting; parenting skills training; skills for managing high-risk situations; and skills for maintenance and relapse prevention. Still, there are many unanswered questions about the implementation of all the components of treatment. Further research, to identify treatment approaches that promote long-term maintenance of weight control, is greatly needed.
View details for Web of Science ID 000079659300010
View details for PubMedID 10340806
Consumers and evaluation of interactive health communication applications AMERICAN JOURNAL OF PREVENTIVE MEDICINE 1999; 16 (1): 23-29
Developers and evaluation of interactive health communication applications AMERICAN JOURNAL OF PREVENTIVE MEDICINE 1999; 16 (1): 30-34
Developers of Interactive Health Communication (IHC) are capable of providing great benefit by creating interactive programs that serve to protect and improve health. Conducting proper evaluation of these programs will ensure that they achieve these goals more successfully.This article seeks to inform developers of IHC about which types of evaluation are most important to include as a part of the development process and to examine the ways in which such evaluation can be implemented to benefit the producers--and ultimately, the consumers--of IHC.
View details for Web of Science ID 000077885300005
View details for PubMedID 9894552
Viewing the viewers: 10 video case studies of children's television viewing behaviors J Broadcast Elec Media 1999; 43: 506-28
Acculturation and eating disorder symptoms in adolescent girls J Research Adolesc 1999; 9: 67-83
Policy issues relevant to evaluation of interactive health communication applications AMERICAN JOURNAL OF PREVENTIVE MEDICINE 1999; 16 (1): 35-42
This article provides an analysis of policy-related issues associated with the evaluation of interactive health communication (IHC) applications. These include an assessment of the current health and technology policy environment pertinent to public (government, education, public health) and private (medical care providers, purchasers, consumers, IHC developers) IHC stakeholders and discussion of issues likely to merit additional consideration by these stakeholders in the future.
View details for Web of Science ID 000077885300006
View details for PubMedID 9894553
Acculturation and eating disorder symptoms in adolescent girls JOURNAL OF RESEARCH ON ADOLESCENCE 1999; 9 (1): 67-83
Television and music video exposure and risk of adolescent alcohol use PEDIATRICS 1998; 102 (5)
Alcohol use is frequently portrayed in television programming and advertising. Exposure to media portrayals of alcohol use may lead to increased drinking. To address this issue, we examined prospectively the associations between media exposure and alcohol use in adolescents.Prospective cohort study. Setting. Six public high schools in San Jose, California. Participants. Ninth-grade students (N = 1533; mean age = 14.6 years).Students reported hours of television, music video, and videotape viewing; computer and video game use; and lifetime and past 30 days' alcohol use at baseline and 18 months later. Associations between baseline media exposure and subsequent alcohol use were examined with multiple logistic regression.During the 18-month follow-up, 36.2% of baseline nondrinkers began drinking and 50.7% of baseline drinkers continued to drink. Onset of drinking was significantly associated with baseline hours of television viewing (odds ratio [OR] = 1.09; 95% confidence interval [95% CI] = 1.01-1.18), music video viewing (OR = 1.31; 95% CI = 1. 17-1.47), and videotape viewing (OR = 0.89; 95% CI = 0.79-0.99), controlling for age, sex, ethnicity, and other media use. Computer and video game use was not significantly associated with the subsequent onset of drinking. Among baseline drinkers, there were no significant associations between baseline media use and maintenance of drinking.Increased television and music video viewing are risk factors for the onset of alcohol use in adolescents. Attempts to prevent adolescent alcohol use should address the adverse influences of alcohol use in the media.
View details for Web of Science ID 000076774600006
View details for PubMedID 9794984
An evidence-based approach to interactive health communication - A challenge to medicine in the information age JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 1998; 280 (14): 1264-1269
To examine the current status of interactive health communication (IHC) and propose evidence-based approaches to improve the quality of such applications.The Science Panel on Interactive Communication and Health, a 14-member, nonfederal panel with expertise in clinical medicine and nursing, public health, media and instructional design, health systems engineering, decision sciences, computer and communication technologies, and health communication, convened by the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services.Published studies, online resources, expert panel opinions, and opinions from outside experts in fields related to IHC.The panel met 9 times during more than 2 years. Government agencies and private-sector experts provided review and feedback on the panel's work.Interactive health communication applications have great potential to improve health, but they may also cause harm. To date, few applications have been adequately evaluated. Physicians and other health professionals should promote and participate in an evidence-based approach to the development and diffusion of IHC applications and endorse efforts to rigorously evaluate the safety, quality, and utility of these resources. A standardized reporting template is proposed to help developers and evaluators of IHC applications conduct evaluations and disclose their results and to help clinicians, purchasers, and consumers judge the quality of IHC applications.
View details for Web of Science ID 000076357900034
View details for PubMedID 9786378
Psychosocial factors associated with youth involvement in community activities promoting heart health HEALTH EDUCATION & BEHAVIOR 1998; 25 (4): 489-500
This study examined factors that influence youth participation in heart disease prevention activities among 2,609 ninth graders in six inner-city public high schools. Constructs derived from social cognitive, empowerment, and community development theories informed the conceptual framework employed. Study participants were diverse with respect to gender, ethnicity, parent education, acculturation, and academic achievement. Perceived incentive value, self-efficacy, outcome expectancies, sense of community, and perceived policy control were all significantly associated with participation in community activities promoting heart health. In multivariate analyses, perceived incentive value, defined as the extent to which participants valued a heart-healthy environment, was most strongly associated with community participation, accounting for 11.9% of the total variance. These findings have implications for designing school curricula and after-school and community programs targeting adolescents' involvement in health advocacy activities.
View details for Web of Science ID 000074933300007
View details for PubMedID 9690106
Does television cause childhood obesity? JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 1998; 279 (12): 959-960
Use of the body mass index (BMI) as a measure of overweight in children and adolescents JOURNAL OF PEDIATRICS 1998; 132 (2): 191-193
Nicotine dependence among adolescent smokers ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 1998; 152 (2): 151-156
To assess nicotine dependence among adolescents to determine whether quitting smoking is associated with the emergence of nicotine withdrawal symptoms and craving, and to identify the factors associated with these symptoms.Cross-sectional survey.We studied 2197 10th-grade students in 6 San Jose, Calif, high schools.Smoking status; history of quitting smoking; Modified Fagerstrom Tolerance Questionnaire (mFTQ) scores; subjective nicotine withdrawal symptoms from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; Center for Epidemiologic Studies Depression Scale (CES-D); and saliva cotinine levels.Of the 485 participants who reported having smoked during the past 30 days, 249 reported previous attempts to quit smoking. Among the participants who had attempted to quit, the self-reported frequencies of subjective withdrawal symptoms were a strong need to smoke (45.4%), nervous and tense (31.8%), restless (29.4%), irritable (28.7%), hungry (25.3%), unable to concentrate (21.7%), miserable and sad (15.3%), and trouble sleeping (12.8%). The total number of withdrawal symptoms was correlated with the mFTQ score (Spearman r = 0.51; P < .001). In a stepwise linear regression analysis, the mFTQ score and the CES-D score accounted for approximately 35% of the variance in total number of withdrawal symptoms (R2 = 0.35; P < .001). Males smoked significantly more and had significantly higher mFTQ scores than did females, while female smokers had significantly higher CES-D scores than did their male counterparts.Considerable levels of nicotine dependence were present among adolescent smokers. Use of mFTQ scores; withdrawal symptoms including nicotine craving; CES-D scores; and saliva cotinine levels may be helpful in designing cessation programs targeted to nicotine-dependent adolescents.
View details for Web of Science ID 000071997500007
View details for PubMedID 9491041
Prospective study of risk factors for the initiation of cigarette smoking JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY 1997; 65 (6): 1011-1016
Risk factors for the initiation of cigarette smoking were examined in 2 consecutive cohorts of teenagers (N = 1,901). Students in Cohort 1 were followed over 4 years from 9th to 12th grade; those in Cohort 2 were followed over 3 years from 9th to 11th grade. Among girls with no history of smoking at baseline, those with more friends who smoked at baseline (p < .001) and those with higher sociability scores (p < .05) were significantly more likely to have tried smoking over the study interval. Among boys with no history of smoking at baseline, those with more friends who smoked at baseline (p < .05) and those with higher depression symptoms scores (p < .01) were significantly more likely to have tried smoking over the study interval. The data suggest that future research is needed to examine potential gender differences that may have implications for the next generation of smoking-prevention programs.
View details for Web of Science ID A1997YJ46300011
View details for PubMedID 9420362
School-based cardiovascular disease prevention studies: Review and synthesis ANNALS OF EPIDEMIOLOGY 1997; 7 (7): S14-S31
Do cigarette warning labels reduce smoking? Paradoxical effects among adolescents ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 1997; 151 (3): 267-272
To examine the association between adolescents knowledge of cigarette warning labels and actual smoking behavior.Cohort analytic study.Four public high schools in northern California.Seventeen hundred forty-seven ninth graders (mean age, 14.9 years). Students from 2 of the schools (n = 803) were observed for approximately 3 months.Self-reported knowledge of warning labels was assessed at baseline. Self-reports of smoking behavior were completed at baseline and at follow-up.Greater knowledge of cigarette package warning labels was significantly associated with higher levels of smoking. Knowledge of warning labels on magazine and billboard advertisements did not differ significantly by level of smoking. In the longitudinal sample, greater knowledge of cigarette package warning labels was significantly associated with a subsequent increase in smoking, controlling for the baseline level of smoking, sex, ethnicity, and knowledge of warning labels on cigarette advertisements (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.02-1.46). Knowledge of warning labels on cigarette advertisements was not associated with a significant change in smoking behavior (OR, 1.06; 95% CI, 0.82-1.35).Sizable proportions of adolescent smokers are not seeing, reading, or remembering cigarette warning labels. In addition, knowledge of warning labels on cigarette packages and advertisements is not associated with reduced smoking. The current warning labels are ineffective among adolescents.
View details for Web of Science ID A1997WN48600009
View details for PubMedID 9080935
School-based cardiovascular disease prevention studies: review and synthesis Ann Epidemiol 1997; Suppl 7: S14-S31
Ethnicity and body dissatisfaction: Are Hispanic and Asian girls at increased risk for eating disorders? JOURNAL OF ADOLESCENT HEALTH 1996; 19 (6): 384-393
To compare prevalences and correlates of body dissatisfaction among white, Hispanic, and Asian girls.A total of 939 6th and 7th grade girls (mean age 12.4 years) attending four middle schools in northern California completed self-administered assessments of age, ethnicity, desired body shape, parent education levels, mother's and father's body shapes, pubertal stage, and body dissatisfaction. Body dissatisfaction was assessed with the Body Dissatisfaction scale of the Eating Disorder Inventory. Height, weight, triceps skinfold thickness, and waist and hip circumferences were measured by trained examiners.Hispanic girls reported significantly greater body dissatisfaction than white girls, with Asian girls in-between. After adjustment for body mass index (weight/height), normal and overweight white, Hispanic, and Asian girls reported similar levels of body dissatisfaction. However, among the leanest 25% of girls, Hispanics and Asians reported significantly more body dissatisfaction than white girls. Body mass index was the strongest independent predictor of increased body dissatisfaction in all three ethnic groups. Shorter height among white girls and taller height among Asian girls also made significant independent contributions. Parent education level, a measure of socioeconomic status, was not significantly associated with body dissatisfaction.Body dissatisfaction is not limited to white girls in middle and upper socioeconomic strata. These findings suggest Hispanic and Asian girls may be at greater risk for adopting eating disorder behaviors than previously recognized.
View details for Web of Science ID A1996VY33400005
View details for PubMedID 8969369
Effects of structured encounter forms on pediatric house staff knowledge, parent satisfaction, and quality of care - A randomized, controlled trial ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 1996; 150 (9): 975-980
To evaluate the effects of health supervision structured encounter forms on pediatric house staff knowledge, parent satisfaction, and quality of care.Randomized, controlled trial.Pediatric house staff continuity clinic in a university-based children's hospital.53 pediatric house officers and 153 parents.House staff were randomized to use structured encounter forms focused on developmental milestones (group 1) or anticipatory guidance/preventive care (group 2) during health supervision visits.Changes in house staff knowledge were assessed with pretests and posttests. Parent satisfaction was assessed with surveys. Quality of care, defined as compliance with recommended guidelines for age-specific health supervision, was assessed by audiotaping visits.Group 1 demonstrated greater but not significantly different improvement in knowledge of developmental milestones than group 2, while group 2 improved more than group 1 in knowledge of anticipatory guidance/ preventive care. Parent satisfaction with developmental screening was significantly greater for group 1 visits than for group 2 visits (P < .001). Group 1 demonstrated significantly greater compliance than group 2 with recommended standards of developmental screening (P = .001).The use of structured encounter forms for health supervision in pediatric house staff continuity clinics may increase house staff knowledge of developmental milestones and anticipatory guidance/preventive care, increases parent satisfaction with developmental assessment during health supervision, and improves compliance with recommended guidelines for developmental assessment.
View details for Web of Science ID A1996VF47000016
View details for PubMedID 8790131
Predicting onset of drinking in a community sample of adolescents: The role of expectancy and temperament ADDICTIVE BEHAVIORS 1996; 21 (4): 473-480
We report results of a prospective examination of the influence of outcome expectancy variables and inherited temperaments on the onset of drinking over a 12-month period in a sample of 1,164 high school students. While univariate prospective analysis indicated that drinkers and nondrinkers were different both on measures of outcome expectancy and temperament, multivariate analysis supported, most strongly, a social learning account of the processes influencing the onset and maintenance of drinking behavior in this sample. The multivariate analysis revealed that only expectancies for enhanced social behavior were consistently associated with the onset of drinking from baseline to 12-month follow-up (p < .001). Among all nondrinkers at baseline, those entertaining higher expectancies about the positive effects of alcohol on social interaction were more likely to begin drinking between baseline and follow-up. At present, few, if any, alcohol abuse prevention studies with adolescents have explicitly attempted to alter alcohol expectancies or to establish a link between expectancy and behavior change. Our results suggest that it may be useful to do so.
View details for Web of Science ID A1996UR66600005
View details for PubMedID 8830905
Advances and future directions for school-based health promotion research: Commentary on the CATCH intervention trial PREVENTIVE MEDICINE 1996; 25 (4): 378-383
TELEVISION ADVERTISING FOR HEALTH PEDIATRIC ANNALS 1995; 24 (2): 73-?
Ethnic and gender differences in the relationships between television viewing and obesity, physical activity and dietary fat intake J Health Educ 1995; 26: S91-S98
Pursuit of thinness and onset of eating disorder symptoms in a community sample of adolescent girls: a three-year prospective analysis. International journal of eating disorders 1994; 16 (3): 227-238
Community-based prospective studies are needed to shed light on mechanisms that may influence development of eating disorders and identify variables that could serve as potential targets for prevention efforts. In this paper we examine level of weight preoccupation and other variables prospectively associated with age of onset of eating disorder symptoms over a 3-year interval in a community sample (N = 939) of young adolescent girls. 3.6% (32/887) experienced onset of symptoms over the interval. Only one factor, a measure of Weight Concerns, was significantly associated with onset (p < .001). Girls scoring in the highest quartile on the measure of Weight Concerns had the shortest survival time (12% incidence by age 14.5) and those scoring in the lowest quartile had the highest survival time (2% incidence by age 14.5; p < .001). This finding is consistent with both theoretical and clinical perspectives and represents one of the first prospective demonstrations of a linkage between weight and body shape concerns and later onset of eating disorder symptoms. An understanding of the independent variables that predispose girls to development of symptoms is a useful step towards the establishment of a rational basis for the choice of a prevention intervention target.
View details for PubMedID 7833956
PURSUIT OF THINNESS AND ONSET OF EATING DISORDER SYMPTOMS IN A COMMUNITY SAMPLE OF ADOLESCENT GIRLS - A 3-YEAR PROSPECTIVE ANALYSIS INTERNATIONAL JOURNAL OF EATING DISORDERS 1994; 16 (3): 227-238
TIMING AND RATE OF SEXUAL-MATURATION AND THE ONSET OF CIGARETTE AND ALCOHOL-USE AMONG TEENAGE GIRLS ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 1994; 148 (8): 789-795
To test the hypothesis that the patterns of pubertal progression, early vs late puberty and fast vs slow, are associated with the age at which girls start to drink alcohol and smoke cigarettes.The study included 1463 female students, 10.7 to 18.2 years of age, who were assessed five times during the 2.7-year study. Data regarding pubertal stage, alcohol use, and cigarette use were obtained at each assessment. These data were used to calculate two indexes of pubertal development, the age at which the midpoint of puberty was achieved and the rate of progression through puberty, and the ages when each subject first drank, first drank moderate amounts of alcohol, and first smoked.Girls with earlier puberty (midpoint < 12.2 years) first reported drinking any alcohol at a median age of 12.5 years, 0.7 years younger than girls whose puberty was later. Similarly, girls with earlier puberty reported drinking moderate amounts of alcohol at a median age of 13.7 years, 0.9 years younger than girls with later puberty. Girls with earlier puberty further reported first smoking cigarettes at a median age of 12.8 years, 0.6 years younger than girls with later puberty. The rate of pubertal progression was significantly associated only with the age when girls first drank moderate amounts of alcohol.Earlier puberty is associated with a younger age of onset for both drinking and smoking among adolescent girls.
View details for Web of Science ID A1994PB26400003
View details for PubMedID 8044254
Assessment and treatment of childhood obesity. Pediatrics in review 1993; 14 (9): 337-343
DOES TELEVISION VIEWING INCREASE OBESITY AND REDUCE PHYSICAL-ACTIVITY - CROSS-SECTIONAL AND LONGITUDINAL ANALYSES AMONG ADOLESCENT GIRLS PEDIATRICS 1993; 91 (2): 273-280
To examine the relationships between hours of television viewing and adiposity and physical activity among female adolescents, a cohort study with follow-up assessments 7, 14, and 24 months after baseline was conducted. All sixth- and seventh-grade girls (N = 971) attending four northern California middle schools were eligible to participate. Six hundred seventy-one students had sufficient data for baseline cross-sectional analyses, and 279 students in a no-intervention cohort had sufficient data for longitudinal analyses. The baseline sample had a mean age of 12.4 years and was 43% white, 22% Asian, 21% Latino, 6% Pacific Islander, 4% black, 2% American Indian, and 2% other. Hours of after-school television viewing, level of physical activity, and stage of sexual maturation were assessed with self-report instruments. Height, weight, and triceps skinfold thickness were measured and body mass index (ratio of weight [in kilograms] to height [in meters] squared) and triceps skinfold thickness were adjusted by level of sexual maturity for the analyses. Baseline hours of after-school television viewing was not significantly associated with either baseline or longitudinal change in body mass index or triceps skinfold thickness. Baseline hours of after-school television viewing was weakly negatively associated with level of physical activity in cross-sectional analyses but not significantly associated with change in level of physical activity over time. All results were essentially unchanged when adjusted for age, race, parent education, and parent fatness. Among adolescent girls, television viewing time appears to have only weak, if any, meaningful associations with adiposity, physical activity, or change in either over time.
View details for Web of Science ID A1993KK57800001
View details for PubMedID 8424000
Childhood obesity: what is it? what does it mean? Singapore J Nutr Diet 1993: 1-6
DEFINING OBESITY IN CHILDREN AND ADOLESCENTS - CLINICAL APPROACHES CRC PRESS INC. 1993: 313-320
For clinical utility, obesity should be defined as a condition of excess adipose tissue associated with adverse health outcomes. Based on a number of criteria, body mass index (BMI) (weight/height) is the most appropriate measure for clinical assessment of adiposity in children and adolescents. However, sufficient information regarding associations between adiposity and current or future morbidity is lacking. Available data suggest a definition of obesity based on adiposity alone would perform poorly as a clinical screening test for adverse health outcomes. In addition, labeling and attempted weight control therapy may produce more harm than benefit. Therefore, until better information regarding the risks of adiposity and risks of treatment are available, recommendations for weight control therapy should be focused primarily on those children and adolescents who currently manifest adiposity-related morbidity, those with a BMI above the 95th percentile, or those above the 85th percentile who perceive their adiposity to be a significant psychosocial problem. To produce a clinically useful definition of obesity, longitudinal data should be used to determine the sensitivities, specificities, and predictive values of comparative measures of childhood and adolescent adiposity for predicting current and future morbidity, and to evaluate the utilities of including characteristics such as age, age of adiposity rebound, persistence of increased adiposity, family adiposity, family morbidities, and fat distribution to improve predictive values and minimize misclassification. Weight control research should attempt to identify patient characteristics that predict long-term treatment success, treatment failure, and treatment side effects.
View details for Web of Science ID A1993LL12600004
View details for PubMedID 8357490
COMMUNITY-HEALTH BEHAVIOR-CHANGE THROUGH COMPUTER NETWORK HEALTH PROMOTION - PRELIMINARY FINDINGS FROM STANFORD HEALTH-NET COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 1989; 30 (2-3): 137-144
Computer-based health education has been employed in many settings. However, data on resultant behavior change are lacking. A randomized, controlled, prospective study was performed to test the efficacy of Stanford Health-Net (Stanford, CA, U.S.A.) in changing community health behaviors. Graduate and undergraduate students (N = 1003) were randomly assigned to treatment and control conditions. The treatment group received access to Health-Net, a health promotion computer network emphasizing specific self-care and preventive strategies. Over a 4-month intervention period, 26% of the treatment group used Health-Net an average of 6.4 times each (range 1-97). The most commonly cited reasons for use were curiosity, general health education, evaluation of current symptoms and anonymity of information. Users rated Health-Net favorably. The most commonly reported reasons for non-use were related to lack of health problems, limited time and lack of access to computer facilities. The mean number of ambulatory medical visits decreased 22.5% more in the treatment group than in the control group (P less than 0.05), while hospitalizations did not differ significantly between groups. In addition, perceived self-efficacy for preventing the acquisition of a sexually transmitted disease (STD) and herpes increased 577% (P less than 0.05) and 261% (P less than 0.01) more, respectively, in the treatment group than in the control group. These findings suggest that access to Stanford Health-Net can result in significant health behavior change. The advantages of the network approach make it a potential model for other communities.
View details for Web of Science ID A1989CA90600007
View details for PubMedID 2684489
THE STANFORD ADOLESCENT HEART HEALTH-PROGRAM HEALTH EDUCATION QUARTERLY 1989; 16 (2): 263-283
This study was designed to create, implement, and test a school-based multiple risk factor reduction program for high school students. All tenth graders in four senior high schools (N = 1447) from two school districts participated in the study. Within each district, one school was assigned at random to receive a special 20-session CVD risk reduction intervention and one school served as a control. The schools were matched for size and distribution of racial groups before randomization. At a two-month follow-up, knowledge gains were significantly greater for students in the treatment group on each of the risk factor domains tested: nutrition/diet (p less than 0.0001), physical activity (p less than 0.0001), and cigarette smoking (p less than 0.0001). Compared to controls, a higher proportion of those in the treatment group who were not exercising regularly at baseline, reported regular exercise at follow-up (p less than 0.0003). Almost twice as many baseline experimental smokers in the treatment group reported quitting at follow-up while only 5.6% of baseline experimental smokers in the treatment group graduated to regular smoking compared to 10.3% in the control group (p = 0.009). Students in the treatment group were more likely to report that they would choose heart healthy snack items (p less than 0.0001). Beneficial treatment effects were observed for resting heart rate (p less than 0.0001), BMI (p = 0.05), triceps skinfold thickness (p = 0.003), and subscapular skinfold thickness (p = 0.01). The results suggest that it is feasible to provide CVD risk reduction training to a large segment of the population through school-based primary prevention approaches.
View details for Web of Science ID A1989U744100011
View details for PubMedID 2732068
CARDIOVASCULAR-DISEASE RISK REDUCTION FOR 10TH GRADERS - A MULTIPLE-FACTOR SCHOOL-BASED APPROACH JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 1988; 260 (12): 1728-1733
All tenth graders in four senior high schools (N = 1447) from two school districts participated in a cardiovascular disease risk-reduction trial. Within each district, one school was assigned at random to receive a special 20-session risk-reduction intervention and one school served as a control. At a two-month follow-up, risk factor knowledge scores were significantly greater for students in the treatment group. Compared with controls, a higher proportion of those in the treatment group who were not exercising regularly at baseline reported regular exercise at follow-up. Almost twice as many baseline experimental smokers in the treatment group reported quitting at follow-up, while only 5.6% of baseline experimental smokers in the treatment group graduated to regular smoking compared with 10.3% in the control group. Students in the treatment group were more likely to report that they would choose "heart-healthy" snack items. Beneficial treatment effects were observed for resting heart rate, body mass index, triceps skin fold thickness, and subscapular skin fold thickness. The results suggest that it is feasible to provide cardiovascular disease risk-reduction training to a large segment of the population through school-based primary prevention approaches.
View details for Web of Science ID A1988Q100100023
View details for PubMedID 3411756
SCHOOL-BASED RESEARCH ON HEALTH BEHAVIOR-CHANGE - THE STANFORD-ADOLESCENT-HEART-HEALTH-PROGRAM AS A MODEL FOR CARDIOVASCULAR-DISEASE RISK REDUCTION REVIEW OF RESEARCH IN EDUCATION 1988; 15: 171-200
DEPRESSIVE SYMPTOMS AND SUBSTANCE USE AMONG ADOLESCENT BINGE EATERS AND PURGERS - A DEFINED POPULATION STUDY AMERICAN JOURNAL OF PUBLIC HEALTH 1987; 77 (12): 1539-1541
We surveyed 646 tenth grade females in Northern California to assess the prevalence of binge eating and purging behaviors. Of these, 10.3 per cent met study criteria for bulimia and an additional 10.4 per cent reported purging behaviors for weight control. Bulimics and purgers were heavier, had greater triceps and subscapular skinfold thicknesses, and reported higher rates of drunkenness, marijuana use, cigarette use, and greater levels of depressive symptomatology.
View details for Web of Science ID A1987K958400013
View details for PubMedID 3674255
PERSPECTIVES ON ADOLESCENT SUBSTANCE USE - A DEFINED POPULATION STUDY JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 1987; 258 (15): 2072-2076
We asked 1447 tenth graders to complete a survey on physical activity, nutrition, stress, and substance use and to undergo basic physical assessments. In a multiple regression analysis, increased level of substance use by both boys and girls was most strongly predicted by friends' marijuana use. For boys, this was followed by perceived safety of cigarette smoking; poor school performance; parents' education; and use of diet pills, laxatives, or diuretics for weight control, accounting for 44% of the overall variation in substance use. For girls, friends' marijuana use was followed by poor school performance; self-induced vomiting for weight control; perceived safety of cigarette smoking; use of diet pills, laxatives, or diuretics for weight control; parents' education; perceived adult attitudes about cigarettes; and nonuse of seat belts, accounting for 53% of the overall variance. Separate multiple regression analyses for each substance produced similar results. The homogeneity of the study population precluded ethnic comparisons. These findings suggest that for many purposes substance use may be considered a single behavior regardless of the specific substance(s) used and that substance use may exist as part of a syndrome of adolescent problem behaviors. In addition, the potent influence of perceived social environment suggests that a social influence resistance model may represent the most successful preventive strategy.
View details for Web of Science ID A1987K353200022
View details for PubMedID 3656622
EVIDENCE FOR AN ALCOHOL STRESS LINK AMONG NORMAL WEIGHT ADOLESCENTS REPORTING PURGING BEHAVIOR INTERNATIONAL JOURNAL OF EATING DISORDERS 1987; 6 (3): 349-356
Changing community health behaviors with a health promotion computer network: preliminary findings from Stanford Health-Net Proceedings of the 11th Annual Symposium on Computer Applications in Medical Care 1987: 514-520
Evidence for an alcohol-stress link among normal weight adolescents reporting purging behavior Int J Eat Disord 1987; 6: 349-356
CORRELATES OF SEAT-BELT USE BY ADOLESCENTS - IMPLICATIONS FOR HEALTH PROMOTION PREVENTIVE MEDICINE 1986; 15 (6): 614-623
This study examined the psychosocial and behavioral correlates of seat-belt use among 1,728 10th-graders in four Northern California high schools. Parent and friend seat-belt use patterns were most highly correlated with student seat-belt use (r = 0.66 and r = 0.61, respectively) and together accounted for 46% of the variation in use. These relationships held across differences in sex, ethnicity, and socioeconomic status. Failure to wear seat belts was associated with a higher use of alcohol, cigarettes, marijuana, and cocaine; more tolerance toward speeding and drinking while driving; less exercise; and more preference for fat in the diet. Our findings attest to the power of parent and peer influences in shaping seat-belt use by adolescents and suggest that not wearing seat belts can be conceptualized as one facet of a pattern of general risk-taking behavior. These findings suggest several possible educational interventions to increase seat-belt use by adolescents.
View details for Web of Science ID A1986E957000006
View details for PubMedID 3797393
Health-net: an interactive computer network for campus health promotion. Journal of American college health 1986; 34 (6): 284-285
SELF-INDUCED VOMITING AND LAXATIVE AND DIURETIC USE AMONG TEENAGERS - PRECURSORS OF THE BINGE-PURGE SYNDROME JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 1986; 255 (11): 1447-1449
Bulimia (binge-purge syndrome) is a recently described but apparently common eating disorder. Purging behaviors associated with bulimia can cause serious medical complications. Prevalence data on purging behaviors are lacking for younger adolescents. A survey was conducted with 1,728 tenth-grade students to assess their attitudes about eating, dieting, weight control, and frequency of purging. Height, weight, and skin-fold thicknesses were also measured. Thirteen percent reported purging behavior. Female purgers outnumbered male purgers 2 to 1. Male purgers were significantly heavier than male nonpurgers and had significantly greater skin-fold thicknesses and weight/height2 ratios. Both male and female purgers felt guiltier after eating large amounts of food, counted calories more often, dieted more frequently, and exercised less than nonpurgers. Our findings suggest that an alarming number of young adolescents may employ unhealthy weight regulation strategies. Physicians who see adolescents should look for the presence of the attitudes and behaviors that characterize bulimia; this will enhance the likelihood of detection of the disorder and prevention of its complications.
View details for Web of Science ID A1986A425900019
View details for PubMedID 3456453