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Thomas Robinson, MD, MPH

  • Thomas Nathaniel Robinson
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Work and Education

Professional Education

Stanford University School of Medicine, Stanford, CA, 06/30/1988


Children's Hospital Boston, Boston, MA, 06/30/1991


Stanford University School of Medicine - Office of Graduate Affairs - Postdoctoral Affairs, Stanford, CA, 06/30/1993

Board Certifications

Pediatrics, American Board of Pediatrics

All Publications

A community-based, multi-level, multi-setting, multi-component intervention to reduce weight gain among low socioeconomic status Latinx children with overweight or obesity: The Stanford GOALS randomised controlled trial. The lancet. Diabetes & endocrinology Robinson, T. N., Matheson, D., Wilson, D. M., Weintraub, D. L., Banda, J. A., McClain, A., Sanders, L. M., Haskell, W. L., Haydel, K. F., Kapphahn, K. I., Pratt, C., Truesdale, K. P., Stevens, J., Desai, M. 2021


BACKGROUND: There are few long-term studies of interventions to reduce in low socioeconomic status children with overweight or obesity. The Stanford GOALS trial evaluated a 3-year, community-based, multi-level, multi-setting, multi-component (MMM) systems intervention, to reduce weight gain among low socioeconomic status, Latinx children with overweight or obesity.METHODS: We did a two-arm, parallel group, randomised, open-label, active placebo-controlled trial with masked assessment over 3 years. Families from low-income, primarily Latinx communities in Northern California, CA, USA, with 7-11-year-old children with overweight or obesity were randomly assigned to a MMM intervention or a Health Education (HE) comparison intervention. The MMM intervention included home environment changes and behavioural counselling, community after school team sports, and reports to primary health-care providers. The primary outcome was child BMI trajectory over three years. Secondary outcomes included one- and two-year changes in BMI. This trial is registered with ClinicalTrials.govNCT01642836.FINDINGS: Between July 13, 2012, and Oct 3, 2013, 241 families were recruited and randomly assigned to MMM (n=120) or HE (n=121). Children's mean age was 95 (SD 14) years, 134 (56%) were female and 107 (44%) were male, and 236 (98%) were Latinx. 238 (99%) children participated in year 1, 233 (97%) in year 2, and 227 (94%) in year 3 of follow-up assessments. In intention-to-treat analysis, over 3 years, the difference between intervention groups in BMI trajectory was not significant (mean adjusted difference -025 [95% CI -090 to 040] kg/m2; Cohen's d=0.10; p=045). Children in the MMM intervention group gained less BMI over 1 year than did children in the HE intervention group (-073 [-107 to -039] kg/m2, d=0.55); the same was true over 2 years (-063 [-113 to -014] kg/m2; d =0.33). No differential adverse events were observed.INTERPRETATION: The MMM intervention did not reduce BMI gain versus HE over 3 years but the effects over 1 and 2 years in this rigorous trial show the promise of this systems intervention approach for reducing weight gain and cardiometabolic risk factors in low socioeconomic status communities.FUNDING: US National Institutes of Health.

View details for DOI 10.1016/S2213-8587(21)00084-X

View details for PubMedID 33933181

The Idiosyncrasies of Everyday Digital Lives: Using the Human Screenome Project to Study User Behavior on Smartphones. Computers in human behavior Brinberg, M. n., Ram, N. n., Yang, X. n., Cho, M. J., Sundar, S. S., Robinson, T. N., Reeves, B. n. 2021; 114


Most methods used to make theory-relevant observations of technology use rely on self-report or application logging data where individuals' digital experiences are purposively summarized into aggregates meant to describe how the average individual engages with broadly defined segments of content. This aggregation and averaging masks heterogeneity in how and when individuals actually engage with their technology. In this study, we use screenshots (N > 6 million) collected every five seconds that were sequenced and processed using text and image extraction tools into content-, context-, and temporally-informative "screenomes" from 132 smartphone users over several weeks to examine individuals' digital experiences. Analyses of screenomes highlight extreme between-person and within-person heterogeneity in how individuals switch among and titrate their engagement with different content. Our simple quantifications of textual and graphical content and flow throughout the day illustrate the value screenomes have for the study of individuals' smartphone use and the cognitive and psychological processes that drive use. We demonstrate how temporal, textual, graphical, and topical features of people's smartphone screens can lay the foundation for expanding the Human Screenome Project with full-scale mining that will inform researchers' knowledge of digital life.

View details for DOI 10.1016/j.chb.2020.106570

View details for PubMedID 33041494

View details for PubMedCentralID PMC7543997

Tropical cyclone frequency under varying SSTs in aquaplanet simulations Geophysical Research Letters Burnett, A. C., Sheshadri, A., Silvers, L. G., Robinson, T. 2021

View details for DOI 10.1029/2020GL091980

Screenomics: A Framework to Capture and Analyze Personal Life Experiences and the Ways that Technology Shapes Them. Human-computer interaction Reeves, B. n., Ram, N. n., Robinson, T. N., Cummings, J. J., Giles, C. L., Pan, J. n., Chiatti, A. n., Cho, M. J., Roehrick, K. n., Yang, X. n., Gagneja, A. n., Brinberg, M. n., Muise, D. n., Lu, Y. n., Luo, M. n., Fitzgerald, A. n., Yeykelis, L. n. 2021; 36 (2): 150201


Digital experiences capture an increasingly large part of life, making them a preferred, if not required, method to describe and theorize about human behavior. Digital media also shape behavior by enabling people to switch between different content easily, and create unique threads of experiences that pass quickly through numerous information categories. Current methods of recording digital experiences provide only partial reconstructions of digital lives that weave - often within seconds - among multiple applications, locations, functions and media. We describe an end-to-end system for capturing and analyzing the "screenome" of life in media, i.e., the record of individual experiences represented as a sequence of screens that people view and interact with over time. The system includes software that collects screenshots, extracts text and images, and allows searching of a screenshot database. We discuss how the system can be used to elaborate current theories about psychological processing of technology, and suggest new theoretical questions that are enabled by multiple time scale analyses. Capabilities of the system are highlighted with eight research examples that analyze screens from adults who have generated data within the system. We end with a discussion of future uses, limitations, theory and privacy.

View details for DOI 10.1080/07370024.2019.1578652

View details for PubMedID 33867652

View details for PubMedCentralID PMC8045984

Using Metrics of Kilograms (or Pounds) Overweight or Kilograms (or Pounds) Obese to Help Interpret and Communicate Magnitudes of Excess Body Mass Index. JAMA pediatrics Robinson, T. N. 2020

View details for DOI 10.1001/jamapediatrics.2020.5196

View details for PubMedID 33346794

Rollman and Brent: Phonotype. Journal of general internal medicine Robinson, T. N., Reeves, B., Ram, N. 2020

View details for DOI 10.1007/s11606-020-05798-y

View details for PubMedID 32221856

Developing a Scalable Dynamic Norm Menu-Based Intervention to Reduce Meat Consumption SUSTAINABILITY Sparkman, G., Weitz, E., Robinson, T. N., Malhotra, N., Walton, G. M. 2020; 12 (6)

View details for DOI 10.3390/su12062453

View details for Web of Science ID 000523751400300

Time for the Human Screenome Project NATURE Reeves, B., Robinson, T., Ram, N. 2020; 577 (7790): 31417

View details for Web of Science ID 000509570100014

View details for PubMedID 31942062

Reducing meat consumption by appealing to animal welfare: protocol for a meta-analysis and theoretical review. Systematic reviews Mathur, M. B., Robinson, T. N., Reichling, D. B., Gardner, C. D., Nadler, J., Bain, P. A., Peacock, J. 2020; 9 (1): 3


BACKGROUND: Reducing meat consumption may improve human health, curb environmental damage and greenhouse gas emissions, and limit the large-scale suffering of animals raised in factory farms. Previous work has begun to develop interventions to reduce individual meat consumption, often by appealing directly to individual health motivations. However, research on nutritional behavior change suggests that interventions additionally linking behavior to ethical values, identity formation, and existing social movements may be particularly effective and longer-lasting. Regarding meat consumption, preliminary evidence and psychological theory suggest that appeals related to animal welfare may have considerable potential to effectively leverage these elements of human psychology. We aim to conduct a systematic review and quantitative meta-analysis evaluating the effectiveness of animal welfare-related appeals on actual or intended meat consumption or purchasing. Our investigation will critically synthesize the current state of knowledge regarding psychological mechanisms of intervening on individual meat consumption and empirically identify the psychological characteristics underlying the most effective animal welfare-based interventions.METHODS: We will systematically search eight academic databases and extensively search unpublished grey literature. We will include studies that assess interventions intended to reduce meat consumption or purchase through the mention or portrayal of animal welfare, that measure outcomes related to meat consumption or purchase, and that have a control condition. Eligible studies may recruit from any human population, be written in any language, and be published or released any time. We will meta-analyze the studies, reporting the pooled point estimate and additional metrics that describe the distribution of potentially heterogeneous effects. We will assess studies' risk of bias and conduct sensitivity analyses for publication bias. We describe possible follow-up analyses to investigate hypothesized moderators of intervention effectiveness.DISCUSSION: The findings of the proposed systematic review and meta-analysis, including any identified methodological limitations of the existing literature, could inform the design of successful evidence-based interventions with broad potential to improve human, animal, and environmental well-being.SYSTEMATIC REVIEW REGISTRATION: The protocol was preregistered via the Open Science Framework (

View details for DOI 10.1186/s13643-019-1264-5

View details for PubMedID 31907028

Dietary patterns and associations with body mass index in low-income, ethnic minority youth in the United States according to baseline data from four randomized controlled trials. The British journal of nutrition LeCroy, M. N., Nicastro, H. L., Truesdale, K. P., Matheson, D. M., Ievers-Landis, C. E., Pratt, C. A., Jones, S. n., Sherwood, N. E., Burgess, L. E., Robinson, T. N., Yang, S. n., Stevens, J. n. 2020: 126


Few studies have derived data-driven dietary patterns in youth in the United States (US). This study examined data-driven dietary patterns and their associations with BMI measures in predominantly low-income, racial/ethnic minority US youth. Data were from baseline assessments of the four Childhood Obesity Prevention and Treatment Research (COPTR) Consortium trials: NET-Works (N=534; 2-4-year-olds), GROW (N=610; 3-5-year-olds), GOALS (N=241; 7-11-year-olds), and IMPACT (N=360; 10-13-year-olds). Weight and height were measured. Children/adult proxies completed 3 24-hour dietary recalls. Dietary patterns were derived for each site from 24 food/beverage groups using k-means cluster analysis. Multivariable linear regression models examined associations of dietary patterns with BMI and percentage of the 95th BMI percentile. Healthy (produce and whole grains) and Unhealthy (fried food, savory snacks, and desserts) patterns were found in NET-Works and GROW. GROW additionally had a dairy and sugar-sweetened beverage based pattern. GOALS had a similar Healthy pattern and a pattern resembling a traditional Mexican diet. Associations between dietary patterns and BMI were only observed in IMPACT. In IMPACT, youth in the Sandwich (cold cuts, refined grains, cheese, and miscellaneous [e.g., condiments]) compared to Mixed (whole grains and desserts) cluster had significantly higher BMI [=0.99 (95% CI: 0.01, 1.97)] and percentage of the 95th BMI percentile [=4.17 (95% CI: 0.11, 8.24)]. Healthy and Unhealthy patterns were the most common dietary patterns in COPTR youth, but diets may differ according to age, race/ethnicity, or geographic location. Public health messages focused on healthy dietary substitutions may help youth mimic a dietary pattern associated with lower BMI.

View details for DOI 10.1017/S0007114520003852

View details for PubMedID 32993818

Childhood Obesity Evidence Base Project: A Systematic Review and Meta-Analysis of a New Taxonomy of Intervention Components to Improve Weight Status in Children 2-5 Years of Age, 2005-2019. Childhood obesity (Print) Scott-Sheldon, L. A., Hedges, L. V., Cyr, C. n., Young-Hyman, D. n., Khan, L. K., Magnus, M. n., King, H. n., Arteaga, S. n., Cawley, J. n., Economos, C. D., Haire-Joshu, D. n., Hunter, C. M., Lee, B. Y., Kumanyika, S. K., Ritchie, L. D., Robinson, T. N., Schwartz, M. B. 2020; 16 (S2): S221S248


Objective: To evaluate the efficacy of childhood obesity interventions and conduct a taxonomy of intervention components that are most effective in changing obesity-related health outcomes in children 2-5 years of age. Methods: Comprehensive searches located 51 studies from 18,335 unique records. Eligible studies: (1) assessed children aged 2-5, living in the United States; (2) evaluated an intervention to improve weight status; (3) identified a same-aged comparison group; (4) measured BMI; and (5) were available between January 2005 and August 2019. Coders extracted study, sample, and intervention characteristics. Effect sizes [ESs; and 95% confidence intervals (CIs)] were calculated by using random-effects models. Meta-regression was used to determine which intervention components explain variability in ESs. Results: Included were 51 studies evaluating 58 interventions (N=29,085; mean age=4 years; 50% girls). Relative to controls, children receiving an intervention had a lower BMI at the end of the intervention (g=0.10, 95% CI=0.02-0.18; k=55) and at the last follow-up (g=0.17, 95% CI=0.04-0.30; k=14; range=18-143 weeks). Three intervention components moderated efficacy: engage caregivers in praise/encouragement for positive health-related behavior; provide education about the importance of screen time reduction to caregivers; and engage pediatricians/health care providers. Conclusions: Early childhood obesity interventions are effective in reducing BMI in preschool children. Our findings suggest that facilitating caregiver education about the importance of screen time reduction may be an important strategy in reducing early childhood obesity.

View details for DOI 10.1089/chi.2020.0139

View details for PubMedID 32936038

Childhood Obesity Evidence Base Project: Methods for Taxonomy Development for Application in Taxonomic Meta-Analysis. Childhood obesity (Print) King, H. n., Magnus, M. n., Hedges, L. V., Cyr, C. n., Young-Hyman, D. n., Kettel Khan, L. n., Scott-Sheldon, L. A., Saul, J. A., Arteaga, S. n., Cawley, J. n., Economos, C. D., Haire-Joshu, D. n., Hunter, C. M., Lee, B. Y., Kumanyika, S. K., Ritchie, L. D., Robinson, T. N., Schwartz, M. B. 2020; 16 (S2): S27S220


Meta-analysis has been used to examine the effectiveness of childhood obesity prevention efforts, yet traditional conventional meta-analytic methods restrict the kinds of studies included, and either narrowly define mechanisms and agents of change, or examine the effectiveness of whole interventions as opposed to the specific actions that comprise interventions. Taxonomic meta-analytic methods widen the aperture of what can be included in a meta-analysis data set, allowing for inclusion of many types of interventions and study designs. The National Collaborative on Childhood Obesity Research Childhood Obesity Evidence Base (COEB) project focuses on interventions intended to prevent childhood obesity in children 2-5 years old who have an outcome measure of BMI. The COEB created taxonomies, anchored in the Social Ecological Model, which catalog specific outcomes, intervention components, intended recipients, and contexts of policies, initiatives, and interventions conducted at the individual, interpersonal, organizational, community, and societal level. Taxonomies were created by discovery from the literature itself using grounded theory. This article describes the process used for a novel taxonomic meta-analysis of childhood obesity prevention studies between the years 2010 and 2019. This method can be applied to other areas of research, including obesity prevention in additional populations.

View details for DOI 10.1089/chi.2020.0138

View details for PubMedID 32936039

Screenomics: A New Approach for Observing and Studying Individuals' Digital Lives. Journal of adolescent research Ram, N. n., Yang, X. n., Cho, M. J., Brinberg, M. n., Muirhead, F. n., Reeves, B. n., Robinson, T. N. 2020; 35 (1): 1650


This study describes when and how adolescents engage with their fast-moving and dynamic digital environment as they go about their daily lives. We illustrate a new approach - screenomics - for capturing, visualizing, and analyzing screenomes, the record of individuals' day-to-day digital experiences.Over 500,000 smartphone screenshots provided by four Latino/Hispanic youth, age 14-15 years, from low-income, racial/ethnic minority neighborhoods.Screenomes collected from smartphones for one to three months, as sequences of smartphone screenshots obtained every five seconds that the device is activated, are analyzed using computational machinery for processing images and text, machine learning algorithms, human-labeling, and qualitative inquiry.Adolescents' digital lives differ substantially across persons, days, hours, and minutes. Screenomes highlight the extent of switching among multiple applications, and how each adolescent is exposed to different content at different times for different durations - with apps, food-related content, and sentiment as illustrative examples.We propose that the screenome provides the fine granularity of data needed to study individuals' digital lives, for testing existing theories about media use, and for generation of new theory about the interplay between digital media and development.

View details for DOI 10.1177/0743558419883362

View details for PubMedID 32161431

View details for PubMedCentralID PMC7065687

Applying the Behavior Change Technique Taxonomy to Four Multicomponent Childhood Obesity Interventions. Western journal of nursing research JaKa, M. M., Wood, C. n., Veblen-Mortenson, S. n., Moore, S. M., Matheson, D. n., Stevens, J. n., Atkins, L. n., Michie, S. n., Adegbite-Adeniyi, C. n., Olayinka, O. n., Po'e, E. K., Kelly, A. M., Nicastro, H. n., Bangdiwala, S. I., Barkin, S. L., Pratt, C. n., Robinson, T. N., Sherwood, N. E. 2020: 193945920954782


Applying the Behavior Change Technique Taxonomy has the potential to facilitate identification of effective childhood obesity intervention components. This article evaluates the feasibility of coding Childhood Obesity Prevention and Treatment Consortium interventions and compares reliability between external taxonomy-familiar coders and internal intervention-familiar coders. After training, coder pairs independently coded prespecified portions of intervention materials. An adjudication process was used to explore coding discrepancies. Reliability between internal and external coders was moderate (prevalence and bias-adjusted kappa .38 to .55). Reliability for specific target behaviors varied with substantial agreement for physical activity (.63 to .76) and moderate for dietary intake (.44 to .63). Applying the taxonomy to these interventions was feasible, but agreement was modest. Coding discrepancies highlight the importance of refining coding to capture the complexities of childhood obesity interventions, which often engage multiple recipients (e.g., parents and/or children) and address multiple behaviors (e.g., diet, physical activity, screen time).

View details for DOI 10.1177/0193945920954782

View details for PubMedID 32909523

Time for the Human Screenome Project NATURE Reeves, B., Robinson, T., Ram, N. 2020; 577 (7790): 31417
Screenomics: A New Approach for Observing and Studying Individuals' Digital Lives JOURNAL OF ADOLESCENT RESEARCH Ram, N., Yang, X., Cho, M., Brinberg, M., Muirhead, F., Reeves, B., Robinson, T. N. 2019
Recruitment strategies for predominantly low-income, multi-racial/ethnic children and parents to 3-year community-based intervention trials: Childhood Obesity Prevention and Treatment Research (COPTR) Consortium. Trials Cui, Z., Truesdale, K. P., Robinson, T. N., Pemberton, V., French, S. A., Escarfuller, J., Casey, T. L., Hotop, A. M., Matheson, D., Pratt, C. A., Lotas, L. J., Po'e, E., Andrisin, S., Ward, D. S. 2019; 20 (1): 296


BACKGROUND: The recruitment of participants into community-based randomized controlled trials studying childhood obesity is often challenging, especially from low-income racial/ethnical minorities and when long-term participant commitments are required. This paper describes strategies used to recruit and enroll predominately low-income racial/ethnic minority parents and children into the Childhood Obesity Prevention and Treatment Research (COPTR) consortium.METHODS: The COPTR consortium has run four independent 3-year, multi-level (individual, family, school, clinic, and community) community-based randomized controlled trials. Two were prevention trials in preschool children and the other two were treatment trials in pre-adolescents and adolescent youth. All trials reported monthly participant recruitment numbers using a standardized method over the projected 18-24months of recruitment. After randomization of participants was completed, recruitment staff and investigators from each trial retrospectively completed a survey of recruitment strategies and their perceived top three recruitment strategies and barriers.RESULTS: Recruitment was completed in 15-21months across trials, enrolling a total of 1745 parent-child dyads- out of 6314 screened. The number of children screened per randomized child was 4.6 and 3.5 in the two prevention trials, and 3.1 and 2.5 in the two treatment trials. Recruitment strategies reported included: (1) careful planning, (2) working with trusting community partners, (3) hiring recruitment staff who were culturally sensitive, personality appropriate, and willing to work flexible hours, (4) contacting potential participants actively and repeatedly, (5) recruiting at times and locations convenient for participants, (6) providing incentives to participants to complete baseline measures, (7) using a tracking database, (8) evaluating whether participants understand the activities and expectations of the study, and (9) assessing participants' motivation for participating. Working with community partners, hiring culturally sensitive staff, and contacting potential participants repeatedly were cited by two trials among their top three strategies. The requirement of a 3-year commitment to the trial was cited by two trials to be among the top three recruitment barriers.CONCLUSIONS: Comprehensive strategies that include community partnership support, culturally sensitive recruitment staff, and repeated contacts with potential participants can result in successful recruitment of low-income racial/ethnic minority families into obesity prevention and treatment trials.TRIAL REGISTRATION: NET-Works trial:, NCT01606891 . Registered on 28 May 2012. GROW trial:, NCT01316653 . Registered on 16 March 2011. GOALS trial:, NCT01642836 . Registered on 17 July 2012. IMPACT trial:, NCT01514279 . Registered on 23 January 2012.

View details for DOI 10.1186/s13063-019-3418-0

View details for PubMedID 31138278

Snacking characteristics and patterns and their associations with diet quality and BMI in the Childhood Obesity Prevention and Treatment Research Consortium. Public health nutrition LeCroy, M. N., Truesdale, K. P., Matheson, D. M., Karp, S. M., Moore, S. M., Robinson, T. N., Berge, J. M., Nicastro, H. L., Thomas, A. J. 2019: 111


OBJECTIVE: To describe snacking characteristics and patterns in children and examine associations with diet quality and BMI.DESIGN: Children's weight and height were measured. Participants/adult proxies completed multiple 24 h dietary recalls. Snack occasions were self-identified. Snack patterns were derived for each sample using exploratory factor analysis. Associations of snacking characteristics and patterns with Healthy Eating Index-2010 (HEI-2010) score and BMI were examined using multivariable linear regression models.SETTING: Childhood Obesity Prevention and Treatment Research (COPTR) Consortium, USA: NET-Works, GROW, GOALS and IMPACT studies.PARTICIPANTS: Predominantly low-income, racial/ethnic minorities: NET-Works (n 534, 2-4-year-olds); GROW (n 610, 3-5-year-olds); GOALS (n 241, 7-11-year-olds); IMPACT (n 360, 10-13-year-olds).RESULTS: Two snack patterns were derived for three studies: a meal-like pattern and a beverage pattern. The IMPACT study had a similar meal-like pattern and a dairy/grains pattern. A positive association was observed between meal-like pattern adherence and HEI-2010 score (P for trend < 001) and snack occasion frequency and HEI-2010 score (beta coefficient (95 % CI): NET-Works, 014 (004, 023); GROW, 012 (002, 021)) among younger children. A preference for snacking while using a screen was inversely associated with HEI-2010 score in all studies except IMPACT (beta coefficient (95 % CI): NET-Works, -315 (-537, -092); GROW, -244 (-427, -061); GOALS, -580 (-874, -286)). Associations with BMI were almost all null.CONCLUSIONS: Meal-like and beverage patterns described most children's snack intake, although patterns for non-Hispanic Blacks or adolescents may differ. Diets of 2-5-year-olds may benefit from frequent meal-like pattern snack consumption and diets of all children may benefit from decreasing screen use during eating occasions.

View details for DOI 10.1017/S1368980019000958

View details for PubMedID 31112114

Effect of Wearable Digital Intervention for Improving Socialization in Children With Autism Spectrum Disorder A Randomized Clinical Trial JAMA PEDIATRICS Voss, C., Schwartz, J., Daniels, J., Kline, A., Haber, N., Washington, P., Tariq, Q., Robinson, T. N., Desai, M., Phillips, J. M., Feinstein, C., Winograd, T., Wall, D. P. 2019; 173 (5): 44654
Advocating for a cautious, conservative approach to screen time guidelines in young children JOURNAL OF PEDIATRICS Okely, A. D., Tremblay, M. S., Reilly, J. J., Draper, C., Robinson, T. N. 2019; 207: 26162
Effect of Wearable Digital Intervention for Improving Socialization in Children With Autism Spectrum Disorder: A Randomized Clinical Trial. JAMA pediatrics Voss, C., Schwartz, J., Daniels, J., Kline, A., Haber, N., Washington, P., Tariq, Q., Robinson, T. N., Desai, M., Phillips, J. M., Feinstein, C., Winograd, T., Wall, D. P. 2019


Importance: Autism behavioral therapy is effective but expensive and difficult to access. While mobile technology-based therapy can alleviate wait-lists and scale for increasing demand, few clinical trials exist to support its use for autism spectrum disorder (ASD) care.Objective: To evaluate the efficacy of Superpower Glass, an artificial intelligence-driven wearable behavioral intervention for improving social outcomes of children with ASD.Design, Setting, and Participants: A randomized clinical trial in which participants received the Superpower Glass intervention plus standard of care applied behavioral analysis therapy and control participants received only applied behavioral analysis therapy. Assessments were completed at the Stanford University Medical School, and enrolled participants used the Superpower Glass intervention in their homes. Children aged 6 to 12 years with a formal ASD diagnosis who were currently receiving applied behavioral analysis therapy were included. Families were recruited between June 2016 and December 2017. The first participant was enrolled on November 1, 2016, and the last appointment was completed on April 11, 2018. Data analysis was conducted between April and October 2018.Interventions: The Superpower Glass intervention, deployed via Google Glass (worn by the child) and a smartphone app, promotes facial engagement and emotion recognition by detecting facial expressions and providing reinforcing social cues. Families were asked to conduct 20-minute sessions at home 4 times per week for 6 weeks.Main Outcomes and Measures: Four socialization measures were assessed using an intention-to-treat analysis with a Bonferroni test correction.Results: Overall, 71 children (63 boys [89%]; mean [SD] age, 8.38 [2.46] years) diagnosed with ASD were enrolled (40 [56.3%] were randomized to treatment, and 31 (43.7%) were randomized to control). Children receiving the intervention showed significant improvements on the Vineland Adaptive Behaviors Scale socialization subscale compared with treatment as usual controls (mean [SD] treatment impact, 4.58 [1.62]; P=.005). Positive mean treatment effects were also found for the other 3 primary measures but not to a significance threshold of P=.0125.Conclusions and Relevance: The observed 4.58-point average gain on the Vineland Adaptive Behaviors Scale socialization subscale is comparable with gains observed with standard of care therapy. To our knowledge, this is the first randomized clinical trial to demonstrate efficacy of a wearable digital intervention to improve social behavior of children with ASD. The intervention reinforces facial engagement and emotion recognition, suggesting either or both could be a mechanism of action driving the observed improvement. This study underscores the potential of digital home therapy to augment the standard of care.Trial Registration: identifier: NCT03569176.

View details for PubMedID 30907929

Advocating for a cautious, conservative approach to screen time guidelines in young children. The Journal of pediatrics Okely, A. D., Tremblay, M. S., Reilly, J. J., Draper, C., Robinson, T. N. 2019

View details for PubMedID 30626482

Turning the tables on obesity: young people, IT and social movements. Nature reviews. Endocrinology Nikolaou, C. K., Robinson, T. N., Sim, K. A., Lean, M. E. 2019


Despite the rising incidence of childhood obesity, international data from Eurostat show that the prevalence of obesity among those aged 15-19 years remains under 5%, which offers an important opportunity for preventing subsequent adult obesity. Young people engage poorly, even obstructively, with conventional health initiatives and are often considered 'hard to reach'. However, when approached in the language of youth, via IT, they express great concern, and unwanted weight gain in young people can be prevented by age-appropriate, independent, online guidance. Additionally, when shown online how 'added value' by industry can generate consumer harms as free market 'externalities', and how obesogenic 'Big Food' production and distribution incur environmental and ethical costs, young people make lasting behavioural changes that attenuate weight gain. This evidence offers a novel approach to obesity prevention, handing the initiative to young people themselves and supporting them with evidence-based methods to develop, propagate and 'own' social movements that can simultaneously address the geopolitical concerns of youth and obesity prevention.

View details for DOI 10.1038/s41574-019-0288-1

View details for PubMedID 31784715

Digital Diabetes Congress 2019. Journal of diabetes science and technology Han, J. n., King, F. n., Klonoff, D. n., Drincic, A. n., Crosby, K. P., Robinson, T. n., Gabbay, R. A., Oley, L. n., Ahn, D. n., Evans, B. n., Salber, P. n., Cruz, M. n., Ginsberg, B. n., Adi, S. n., Armstrong, D. n., Kerr, D. n. 2019; 13 (5): 97989


New applications of digital health software and sensors for diabetes are rapidly becoming available. The link between healthcare, wearable or carryable devices, and the use of smartphones is increasingly being used by patients for timely information and by healthcare professionals to deliver information and personalized advice and to encourage healthy behavior. To assemble stakeholders from academia, industry, and government, Diabetes Technology Society and Sansum Diabetes Research Institute hosted the 3rd Annual Digital Diabetes Congress on May 14-15, 2019 in San Francisco. Physicians, entrepreneurs, attorneys, psychologists, and other leaders in the diabetes technology field came together to discuss current and future trends and applications of digital tools in diabetes. The meeting focused on eight topics: 1) User Interface/User Experience (UI/UX) for Digital Health, 2) clinical aspects, 3) marketing, 4) investment, 5) regulation, 6) who owns the data, 7) engagement, and 8) the future of digital health. This meeting report contains summaries of the meeting's eight plenary sessions and eight panel discussions, which were all focused on an important aspect of the development, use, and regulation of diabetes digital tools.

View details for DOI 10.1177/1932296819872107

View details for PubMedID 31466480

Using Screenshots to Predict Task Switching on Smartphones Yang, X., Ram, N., Robinson, T., Reeves, B., Assoc Comp Machinery ASSOC COMPUTING MACHINERY. 2019
#Science: The potential and the challenges of utilizing social media and other electronic communication platforms in health care. Clinical and translational science Gijsen, V. n., Maddux, M. n., Lavertu, A. n., Gonzalez-Hernandez, G. n., Ram, N. n., Reeves, B. n., Robinson, T. n., Ziesenitz, V. n., Shakhnovich, V. n., Altman, R. n. 2019


Electronic communication is becoming increasingly popular worldwide, as evidenced by its widespread and rapidly growing use. In medicine however, it remains a novel approach to reach out to patients. Yet, they have the potential for further improving current health care. Electronic platforms could support therapy adherence and communication between physicians and patients. The power of social media as well as other electronic devices can improve adherence as evidenced by the development of the app bant. Additionally, systemic analysis of social media content by Screenome can identify health events not always captured by regular health care. By better identifying these health care events we can improve our current health care system as we will be able to better tailor to the patients' needs. All these techniques are a valuable component of modern health care and will help us into the future of increasingly digital health care. This article is protected by copyright. All rights reserved.

View details for DOI 10.1111/cts.12687

View details for PubMedID 31392837

Screenomics: a framework to capture and analyze personal life experiences and the ways that technology shapes them Human-Computer Interaction Reeves, B. 2019
Sleep duration, timing, variability and measures of adiposity among 8- to 12-year-old children with obesity. Obesity science & practice Zhou, M., Lalani, C., Banda, J. A., Robinson, T. N. 2018; 4 (6): 53544


Objectives: Sleep disruption in laboratory studies increases adiposity and decreases glucose tolerance. However, few epidemiological studies have used objective measures of sleep. This study aims to assess associations between sleep duration, timing and regularity with measures of adiposity.Methods: This is a cross-sectional study of 188 children with obesity (age: 10.501.39years; body mass index: 29.245.04kgm-2). Nightly sleep duration, bedtime and wake time were measured by multiple-day actigraphy and parent reports. Per cent overweight (per cent over median body mass index for age and sex) was chosen as the primary measure of obesity status. Objective measures of height, weight, waist circumference, blood pressure, fasting blood lipids, glucose, insulin, glycated haemoglobin and C-reactive protein were obtained. Television screen time and total caloric intake were assessed via parent questionnaire.Results: Each hour later in weekday bedtime was associated with an additional 6.17 per cent overweight (95% confidence interval [CI]: 1.42-10.92). Each hour greater in day-to-day variability in weekday bedtime and weekday wake time was associated with an additional 10.20 (95% CI: 0.50-19.91) and 10.02 (95% CI: 1.55-18.50) per cent overweight, respectively. Associations were similar after controlling for other obesity-related behaviours (television screen time, total caloric intake and physical activity.).Conclusions: Among children with obesity, later bedtime and greater variability in bedtime and wake time are associated with greater adiposity, independent of other obesity-related behaviours. Early bedtime and wake time and consistent day-to-day sleep timing may be strategies to reduce adiposity in high-risk children.

View details for PubMedID 30574347

Community Healthcare and Technology to Enhance Communication in Pediatric Obesity Care: Expert Exchange Workgroup's Views CHILDHOOD OBESITY Siegel, R. M., Haemer, M., Kharofa, R. Y., Christison, A. L., Hampl, S. E., Tinajero-Deck, L., Lockhart, M., Reich, S., Pont, S. J., Stratbucker, W., Robinson, T. N., Shaffer, L. A., Woolford, S. J. 2018


Childhood obesity continues to be a critical healthcare issue and a paradigm of a pervasive chronic disease affecting even our youngest children. When considered within the context of the socioecological model, the factors that influence weight status, including the social determinants of health, limit the impact of multidisciplinary care that occurs solely within the medical setting. Coordinated care that incorporates communication between the healthcare and community sectors is necessary to more effectively prevent and treat obesity. In this article, the Expert Exchange authors, with input from providers convened at an international pediatric meeting, provide recommendations to address this critical issue. These recommendations draw upon examples from the management of other chronic conditions that might be applied to the treatment of obesity, such as the use of care plans and health assessment forms to allow weight management specialists and community personnel (e.g., school counselors) to communicate about treatment recommendations and responses. To facilitate communication across the healthcare and community sectors, practical considerations regarding the development and/or evaluation of communication tools are presented. In addition, the use of technology to enhance healthcare-community communication is explored as a means to decrease the barriers to collaboration and to create a web of connection between the community and healthcare providers that promote wellness and a healthy weight status.

View details for PubMedID 29878851

Adiposity in Juvenile Psoriatic Arthritis JOURNAL OF RHEUMATOLOGY Samad, A., Stoll, M. L., Lavi, I., Hsu, J. J., Strand, V., Robinson, T. N., Mellins, E. D., Zisman, D., CARRA Legacy Registry In 2018; 45 (3): 41118


Adult patients with psoriatic arthritis are at increased risk for obesity and metabolic syndrome, but data regarding adiposity in children with juvenile psoriatic arthritis (JPsA) are limited. Our study assessed adiposity in children with JPsA in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry.Patients with JPsA in the CARRA registry were divided into nonoverweight and overweight groups using recommendations from the US Centers for Disease Control, and differences in demographic and clinical characteristics between groups at baseline and after 1-year followup were assessed using chi-square test, Fisher's exact test, T test, or Mann-Whitney U test, as appropriate. The prevalence of overweight status in the JPsA registry patients was compared to rheumatoid factor-positive and -negative polyarticular juvenile idiopathic arthritis (RF+polyJIA; RF-polyJIA) registry cohorts and the US pediatric population, using a chi-square goodness-of-fit test.Overweight children represented 36.3% of this JPsA cohort (n = 320). Compared to nonoverweight children, they were significantly older at symptom onset and rheumatologist's first assessment, and scored significantly worse on patient/physician outcome measures. At 1-year followup, changes in body mass index were not associated with changes in clinical features or outcome measures. The prevalence of overweight and obesity in patients with JPsA was significantly higher than in RF+polyJIA patients, RF-polyJIA patients, and the US pediatric population.In this registry, almost 1 in 5 patients with JPsA were obese and more than one-third were overweight. This is significantly more than expected compared to the US pediatric population, and appropriate longterm followup of this JPsA subgroup is warranted.

View details for PubMedID 29247150

Potential corner case cautions regarding publicly available implementations of the National Cancer Institute's nonwear/wear classification algorithm for accelerometer data. PloS one Moore, H. E., Haydel, K. F., Banda, J. A., Fiterau, M., Desai, M., Robinson, T. N. 2018; 13 (12): e0210006


The National Cancer Institute's (NCI) wear time classification algorithm uses a rule based on the occurrence of physical activity data counts-a cumulative measure of movement, influenced by both magnitude and duration of acceleration-to differentiate between when a physical activity monitoring (PAM) device (ActiGraph accelerometer) is being worn by a participant (wear) from when it is not (nonwear). It was applied to PAM data generated from the 2003-2004 National Health and Nutrition Examination Survey (NHANES 2003-2004). We discuss two corner case conditions that can produce unexpected, and perhaps unintended results when the algorithm is applied. We show, using simulated data of two special cases, how this algorithm classifies a 24-hour period with only 72 total counts as 100% wear in one case, and classifies a 24-hour period with 96,000 counts as 0.1% wear in another. The prevalence of like scenarios in the NHANES 2003-2004 PAM dataset is presented with corresponding summary statistics for varying degrees of the algorithm's nonwear classification threshold (T). The number of participants with valid days, defined as 10 or more hours classified as wear time in a 24-hour day, increased while the mean counts-per-minute (CPM) decreased as the threshold for excluding non-wear was reduced from the allowed 4,000 counts in an hour. The number of participants with four or more valid days increased 2.29% (n = 113) and mean CPM dropped 2.45% (9.5 CPM) when adjusting the nonwear classification threshold to 50 counts an hour. Applying the most liberal criteria, only excluding hours as nonwear which contained 1 count or less, resulted in a 397 more participants (7.83% increase) and 26.5 fewer CPM (6.98% decrease) in NHANES 2003-2004 participants with four or more valid days. The algorithm should be used with caution due to the potential influence of these corner cases.

View details for PubMedID 30596771

Screen Media Exposure and Obesity in Children and Adolescents PEDIATRICS Robinson, T. N., Banda, J. A., Hale, L., Lu, A., Fleming-Milici, F., Calvert, S. L., Wartella, E. 2017; 140: S97S101


Obesity is one of the best-documented outcomes of screen media exposure. Many observational studies find relationships between screen media exposure and increased risks of obesity. Randomized controlled trials of reducing screen time in community settings have reduced weight gain in children, demonstrating a cause and effect relationship. Current evidence suggests that screen media exposure leads to obesity in children and adolescents through increased eating while viewing; exposure to high-calorie, low-nutrient food and beverage marketing that influences children's preferences, purchase requests, consumption habits; and reduced sleep duration. Some evidence also suggests promise for using interactive media to improve eating and physical activity behaviors to prevent or reduce obesity. Future interdisciplinary research is needed to examine the effects of newer mobile and other digital media exposures on obesity; to examine the effectiveness of additional interventions to mitigate the adverse effects of media exposures on obesity and possible moderators and mediators of intervention effects; to effectively use digital media interventions to prevent and reduce obesity; and to uncover the mechanisms underlying the causal relationships and interactions between obesity-related outcomes and media content, characteristics, and context.

View details for PubMedID 29093041

View details for PubMedCentralID PMC5769928

Multilevel Interventions Targeting Obesity: Research Recommendations for Vulnerable Populations AMERICAN JOURNAL OF PREVENTIVE MEDICINE Stevens, J., Pratt, C., Boyington, J., Nelson, C., Truesdale, K. P., Ward, D. S., Lytle, L., Sherwood, N. E., Robinson, T. N., Moore, S., Barkin, S., Cheung, Y. K., Murray, D. M. 2017; 52 (1): 115-124
Multilevel Interventions Targeting Obesity: Research Recommendations for Vulnerable Populations. American journal of preventive medicine Stevens, J. n., Pratt, C. n., Boyington, J. n., Nelson, C. n., Truesdale, K. P., Ward, D. S., Lytle, L. n., Sherwood, N. E., Robinson, T. N., Moore, S. n., Barkin, S. n., Cheung, Y. K., Murray, D. M. 2017; 52 (1): 11524


The origins of obesity are complex and multifaceted. To be successful, an intervention aiming to prevent or treat obesity may need to address multiple layers of biological, social, and environmental influences.NIH recognizes the importance of identifying effective strategies to combat obesity, particularly in high-risk and disadvantaged populations with heightened susceptibility to obesity and subsequent metabolic sequelae. To move this work forward, the National Heart, Lung, and Blood Institute, in collaboration with the NIH Office of Behavioral and Social Science Research and NIH Office of Disease Prevention convened a working group to inform research on multilevel obesity interventions in vulnerable populations. The working group reviewed relevant aspects of intervention planning, recruitment, retention, implementation, evaluation, and analysis, and then made recommendations.Recruitment and retention techniques used in multilevel research must be culturally appropriate and suited to both individuals and organizations. Adequate time and resources for preliminary work are essential. Collaborative projects can benefit from complementary areas of expertise and shared investigations rigorously pretesting specific aspects of approaches. Study designs need to accommodate the social and environmental levels under study, and include appropriate attention given to statistical power. Projects should monitor implementation in the multiple venues and include a priori estimation of the magnitude of change expected within and across levels.The complexity and challenges of delivering interventions at several levels of the social-ecologic model require careful planning and implementation, but hold promise for successful reduction of obesity in vulnerable populations.

View details for PubMedID 28340973

Effect of a mobile app intervention on vegetable consumption in overweight adults: a randomized controlled trial. The international journal of behavioral nutrition and physical activity Mummah, S. n., Robinson, T. N., Mathur, M. n., Farzinkhou, S. n., Sutton, S. n., Gardner, C. D. 2017; 14 (1): 125


Mobile applications (apps) have been heralded as transformative tools to deliver behavioral health interventions at scale, but few have been tested in rigorous randomized controlled trials. We tested the effect of a mobile app to increase vegetable consumption among overweight adults attempting weight loss maintenance.Overweight adults (n=135) aged 18-50 years with BMI=28-40 kg/m(2) near Stanford, CA were recruited from an ongoing 12-month weight loss trial (parent trial) and randomly assigned to either the stand-alone, theory-based Vegethon mobile app (enabling goal setting, self-monitoring, and feedback and using "process motivators" including fun, surprise, choice, control, social comparison, and competition) or a wait-listed control condition. The primary outcome was daily vegetables servings, measured by an adapted Harvard food frequency questionnaire (FFQ) 8 weeks post-randomization. Daily vegetable servings from 24-hour dietary recalls, administered by trained, certified, and blinded interviewers 5 weeks post-randomization, was included as a secondary outcome. All analyses were conducted according to principles of intention-to-treat.Daily vegetable consumption was significantly greater in the intervention versus control condition for both measures (adjusted mean difference: 2.0 servings; 95% CI: 0.1, 3.8, p=0.04 for FFQ; and 1.0 servings; 95% CI: 0.2, 1.9; p=0.02 for 24-hour recalls). Baseline vegetable consumption was a significant moderator of intervention effects (p=0.002) in which effects increased as baseline consumption increased.These results demonstrate the efficacy of a mobile app to increase vegetable consumption among overweight adults. Theory-based mobile interventions may present a low-cost, scalable, and effective approach to improving dietary behaviors and preventing associated chronic NCT01826591. Registered 27 March 2013.

View details for PubMedID 28915825

View details for PubMedCentralID PMC5603006

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 Mummah, S. A., Robinson, T. N., King, A. C., Gardner, C. D., Sutton, S. 2016; 18 (12): 205-218


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 Web of Science ID 000391065600019

View details for PubMedID 27986647

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 Godino, J. G., Merchant, G., Norman, G. J., Donohue, M. C., Marshall, S. J., Fowler, J. H., Calfas, K. J., Huang, J. S., Rock, C. L., Griswold, W. G., Gupta, A., Raab, F., Fogg, B. J., Robinson, T. N., Patrick, K. 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, 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 a behaviour change intervention for Girl Scouts on child and parent energy-saving behaviours NATURE ENERGY Boudet, H., Ardoin, N. M., Flora, J., Armel, K. C., Desai, M., Robinson, T. N. 2016; 1
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 King, A. C., Hekler, E. B., Grieco, L. A., Winter, S. J., Sheats, J. L., Buman, M. P., Banerjee, B., Robinson, T. N., Cirimele, J. 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 NCT01516411.

View details for DOI 10.1371/journal.pone.0156370

View details for Web of Science ID 000378858900002

View details for PubMedID 27352250

View details for PubMedCentralID PMC4924838

Statistical methodologies to pool across multiple intervention studies. Translational behavioral medicine Bangdiwala, S. I., Bhargava, A., O'Connor, D. P., Robinson, T. N., Michie, S., Murray, D. M., Stevens, J., Belle, S. H., Templin, T. N., Pratt, C. A. 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

View details for PubMedCentralID PMC4927450

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 Banda, J. A., Haydel, K. F., Davila, T., Desai, M., Bryson, S., Haskell, W. L., Matheson, D., Robinson, T. N. 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

Multiple Imputation When Rate of Change is the Outcome of Interest. Journal of modern applied statistical methods : JMASM Desai, M. n., Mitani, A. A., Bryson, S. W., Robinson, T. n. 2016; 15 (1): 16092


Little research has been devoted to multiple imputation (MI) of derived variables. This study investigates various MI approaches for the outcome, rate of change, when the analysis model is a two-stage linear regression. Simulations showed that competitive approaches depended on the missing data mechanism and presence of auxiliary terms.

View details for PubMedID 30766452

Interventions to Reduce Sedentary Behavior MEDICINE AND SCIENCE IN SPORTS AND EXERCISE Manini, T. M., Carr, L. J., King, A. C., Marshall, S., Robinson, T. N., Rejeski, W. J. 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

View details for PubMedID 25222818

View details for PubMedCentralID PMC4362870

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 Gupta, A., Calfas, K. J., Marshall, S. J., Robinson, T. N., Rock, C. L., Huang, J. S., Epstein-Corbin, M., Servetas, C., Donohue, M. C., Norman, G. J., Raab, F., Merchant, G., Fowler, J. H., Griswold, W. G., Fogg, B. J., Patrick, K. 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 PubMedID 25866383

Environmental strategies for portion control in children. Appetite Robinson, T. N., Matheson, D. M. 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 PubMedID 25485874

View details for PubMedCentralID PMC4355088

More hippocrates, less hypocrisy: eliminate sugar-sweetened beverages from residency lunches. Academic medicine Nagata, J. M., Chamberlain, L. J., Robinson, T. N. 2015; 90 (2): 127-128

View details for DOI 10.1097/ACM.0000000000000601

View details for PubMedID 25628132

Instructional Strategies to Promote Incremental Beliefs in Youth Sport QUEST Vella, S. A., Cliff, D. P., Okely, A. D., Weintraub, D. L., Robinson, T. N. 2014; 66 (4): 357-370
Energy behaviours of northern California Girl Scouts and their families ENERGY POLICY Boudet, H., Ardoin, N. M., Flora, J., Armel, K. C., Desai, M., Robinson, T. N. 2014; 73: 439-449
Percent body fat prediction equations for 8-to 17-year-old American children PEDIATRIC OBESITY Stevens, J., Cai, J., Truesdale, K. P., Cuttler, L., Robinson, T. N., Roberts, A. L. 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 McClain, A. D., van den Bos, W., Matheson, D., Desai, M., McClure, S. M., Robinson, T. N. 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

View details for PubMedCentralID PMC3947396

Increasing energy- and greenhouse gas-saving behaviors among adolescents: a school-based cluster-randomized controlled trial ENERGY EFFICIENCY Cornelius, M., Armel, K. C., Hoffman, K., Allen, L., Bryson, S. W., Desai, M., Robinson, T. N. 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 Patrick, K., Marshall, S. J., Davila, E. P., Kolodziejczyk, J. K., Fowler, J. H., Calfas, K. J., Huang, J. S., Rock, C. L., Griswold, W. G., Gupta, A., Merchant, G., Norman, G. J., Raab, F., Donohue, M. C., Fogg, B. J., Robinson, T. N. 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 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 Robinson, T. N., Matheson, D., Desai, M., Wilson, D. M., Weintraub, D. L., Haskell, W. L., McClain, A., McClure, S., A Banda, J., Sanders, L. M., Haydel, K. F., Killen, J. D. 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 PubMedID 24028942

A randomized clinical trial of the efficacy of extended smoking cessation treatment for adolescent smokers. Nicotine & tobacco research Bailey, S. R., Hagen, S. A., Jeffery, C. J., Harrison, C. T., Ammerman, S., Bryson, S. W., Killen, D. T., Robinson, T. N., Killen, J. D. 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



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

On the use of robust estimators for standard errors in the presence of clustering when clustering membership is misspecified CONTEMPORARY CLINICAL TRIALS Desai, M., Bryson, S. W., Robinson, T. 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

View details for PubMedCentralID PMC3677755

The Utility of Childhood and Adolescent Obesity Assessment in Relation to Adult MEDICAL DECISION MAKING Goldhaber-Fiebert, J. D., Rubinfeld, R. E., Bhattacharya, J., Robinson, T. N., Wise, P. H. 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

View details for PubMedID 22647830

Harnessing different motivational frames via mobile phones to promote daily physical activity and reduce sedentary behavior in aging adults. PloS one King, A. C., Hekler, E. B., Grieco, L. A., Winter, S. J., Sheats, J. L., Buman, M. P., Banerjee, B., Robinson, T. N., Cirimele, J. 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

View details for PubMedCentralID PMC3636222

Harnessing Different Motivational Frames via Mobile Phones to Promote Daily Physical Activity and Reduce Sedentary Behavior in Aging Adults. PloS one King, A. C., Hekler, E. B., Grieco, L. A., Winter, S. J., Sheats, J. L., Buman, M. P., Banerjee, B., Robinson, T. N., Cirimele, J. 2013; 8 (4)

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 Golden, N. H., Yang, W., Jacobson, M. S., Robinson, T. N., Shaw, G. M. 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 PubMedID 23147977

MOBILE PHONE APPLICATIONS TO PROMOTE PHYSICAL ACTIVITY INCREASES: PRELIMINARY RESULTS King, A. C., Hekler, E., Grieco, L., Winter, S., Buman, M., Banerjee, B., Cirimele, J., Robinson, T. N., Mezias, B., Chen, F. SPRINGER. 2012: S204S204
Solution-Oriented Policy Research Using Research to Drive Obesity Prevention and Control Policies ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Robinson, T. N. 2012; 166 (2): 189-190

View details for Web of Science ID 000301211000014

View details for PubMedID 22312178

Assessing teen smoking patterns: The weekend phenomenon DRUG AND ALCOHOL DEPENDENCE Bailey, S. R., Jeffery, C. J., Hammer, S. A., Bryson, S. W., Killen, D. T., Ammerman, S., Robinson, T. N., Killen, J. D. 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

View details for PubMedCentralID PMC3245765

The Center for Healthy Weight: an academic medical center response to childhood obesity. International journal of obesity supplements Robinson, T. N., Kemby, K. M. 2012; 2 (Suppl 1): S33S38


Childhood obesity represents a worldwide medical and public health challenge. Academic medical centers cannot avoid the effects of the obesity epidemic, and must adopt strategies for their academic, clinical and public policy responses to childhood obesity. The Center for Healthy Weight at Stanford University and Lucile Packard Children's Hospital at Stanford provides an example and model of one such strategy. The design provides both breadth and depth through six cores: Research, Patient Care, Community Programs, Advocating for Public Policy Change, Training and Professional Education, and the Healthy Hospital Initiative. The Center and its cores are designed to facilitate interdisciplinary collaboration across the university, medical school, children's hospital and surrounding community. The foci of these cores are likely to be relevant to almost any academic medical center's mission and functions.

View details for PubMedID 25089192

Efficacy and Tolerability of Pharmacotherapies to Aid Smoking Cessation in Adolescents PEDIATRIC DRUGS Bailey, S. R., Crew, E. E., Riske, E. C., Ammerman, S., Robinson, T. N., Killen, J. D. 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 PubMedID 22248234

The center for healthy weight: an academic medical center response to childhood obesity INTERNATIONAL JOURNAL OF OBESITY 2012; 2 (Suppl): S33-S38
The Stanford Climate Change Behavior Survey (SCCBS): assessing greenhouse gas emissions-related behaviors in individuals and populations CLIMATIC CHANGE Armel, K. C., Yan, K., Todd, A., Robinson, T. N. 2011; 109 (3-4): 671-694


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

Set points, settling points and some alternative models: theoretical options to understand how genes and environments combine to regulate body adiposity DISEASE MODELS & MECHANISMS Speakman, J. R., Levitsky, D. A., Allison, D. B., Bray, M. S., de Castro, J. M., Clegg, D. J., Clapham, J. C., Dulloo, A. G., Gruer, L., Haw, S., Hebebrand, J., Hetherington, M. M., Higgs, S., Jebb, S. A., Loos, R. J., Luckman, S., Luke, A., Mohammed-Ali, V., O'Rahilly, S., Pereira, M., Perusse, L., Robinson, T. N., Rolls, B., Symonds, M. E., Westerterp-Plantenga, M. S. 2011; 4 (6): 733-745


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 PubMedID 21041592

The Stanford climate change behavior survey (SCCBS): assessing greenhous gas emmisions-related behaviors in individuals and populations Climatic Change Armel KC, Yan K, Todd A, Robinson TN 2011; 109: 671-694


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

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 Robinson, T. N., Matheson, D. M., Kraemer, H. C., Wilson, D. M., Obarzanek, E., Thompson, N. S., Alhassan, S., Spencer, T. R., Haydel, K. F., Fujimoto, M., Varady, A., Killen, J. D. 2010; 164 (11): 995-1004

View details for DOI 10.1038/oby.2009.427

View details for Web of Science ID 000274208100005

View details for PubMedID 20107456

Effects of a College Course About Food and Society on Students' Eating Behaviors AMERICAN JOURNAL OF PREVENTIVE MEDICINE Hekler, E. B., Gardner, C. D., Robinson, T. N. 2010; 38 (5): 543-547


Metformin has been proffered as a therapy for adolescent obesity, although long-term controlled studies have not been reported.To test the hypothesis that 48 weeks of daily metformin hydrochloride extended release (XR) therapy will reduce body mass index (BMI) in obese adolescents, as compared with placebo.Multicenter, randomized, double-blind, placebo-controlled clinical trial.The 6 centers of the Glaser Pediatric Research Network from October 2003 to August 2007.Obese (BMI > or = 95th percentile) adolescents (aged 13-18 years) were randomly assigned to the intervention (n = 39) or placebo groups. Intervention Following a 1-month run-in period, subjects following a lifestyle intervention program were randomized 1:1 to 48 weeks' treatment with metformin hydrochloride XR, 2000 mg once daily, or an identical placebo. Subjects were monitored for an additional 48 weeks. Main Outcome Measure Change in BMI, adjusted for site, sex, race, ethnicity, and age and metformin vs placebo.After 48 weeks, mean (SE) adjusted BMI increased 0.2 (0.5) in the placebo group and decreased 0.9 (0.5) in the metformin XR group (P = .03). This difference persisted for 12 to 24 weeks after cessation of treatment. No significant effects of metformin on body composition, abdominal fat, or insulin indices were observed.Metformin XR caused a small but statistically significant decrease in BMI when added to a lifestyle intervention Identifiers: NCT00209482 and NCT00120146.

View details for PubMedID 20124139

Save the World, Prevent Obesity: Piggybacking on Existing Social and Ideological Movements OBESITY Robinson, T. N. 2010; 18: S17-S22


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

Metformin Extended Release Treatment of Adolescent Obesity A 48-Week Randomized, Double-Blind, Placebo-Controlled Trial With 48-Week Follow-up ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Wilson, D. M., Abrams, S. H., Aye, T., Lee, P. D., Lenders, C., Lustig, R. H., Osganian, S. V., Feldman, H. A. 2010; 164 (2): 116-123


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

Identifying Subgroups of US Adults at Risk for Prolonged Television Viewing to Inform Program Development AMERICAN JOURNAL OF PREVENTIVE MEDICINE King, A. C., Goldberg, J. H., Salmon, J., Owen, N., Dunstan, D., Weber, D., Doyle, C., Robinson, T. N. 2010; 38 (1): 17-26


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

View details for PubMedCentralID PMC2739258

Interviewing Latina girls for child health research Pract Anthropol Azevedo K, Fernndez M, Mendoza S, Castillo-Tirumalai E, Haydel KF, Fujimoto M, Garc_a K, G_mez E, Dvila T, Romn G, Ram_rez V, Torres M, Mendoza R, Robinson TN 2010; 32: 14-18

View details for DOI 10.1016/j.jpeds.2009.02.046

View details for PubMedID 19364569

Defining Accelerometer Thresholds for Physical Activity in Girls Using ROC Analysis JOURNAL OF PHYSICAL ACTIVITY & HEALTH Alhassan, S., Robinson, T. N. 2010; 7 (1): 45-53

View details for Web of Science ID 000261286300014

View details for PubMedID 19047549

Withdrawal symptoms over time among adolescents in a smoking cessation intervention: Do symptoms vary by level of nicotine dependence? ADDICTIVE BEHAVIORS Bailey, S. R., Harrison, C. T., Jeffery, C. J., Ammerman, S., Bryson, S. W., Killen, D. T., Robinson, T. N., Schatzberg, A. F., Killen, J. D. 2009; 34 (12): 1017-1022


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

Parent-only interventions may be effective for weight loss in overweight children in rural areas. journal of pediatrics Robinson, T. N. 2009; 154 (5): 776-?

View details for DOI 10.1016/j.jneb.2007.12.002

View details for Web of Science ID 000259425600012

View details for PubMedID 18725153

View details for PubMedCentralID PMC2556128

Treating Pediatric Obesity Generating the Evidence ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Robinson, T. N. 2008; 162 (12): 1191-1192


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



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

View details for PubMedCentralID PMC2291289

Changes in physical activity from walking to school JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR Sirard, J. R., Alhassan, S., Spencer, T. R., Robinson, T. N. 2008; 40 (5): 324-326


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 PubMedID 17600772

Team sports for overweight children - The Stanford sports to prevent obesity randomized trial (SPORT) ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Weintraub, D. L., Tirumalai, E. C., Haydel, K. F., Fujimoto, M., Fulton, J. E., Robinson, T. N. 2008; 162 (3): 232-237
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 Epstein, L. H., Roemmich, J. N., Robinson, J. L., Paluch, R. A., Winiewicz, D. D., Fuerch, J. H., Robinson, T. N. 2008; 162 (3): 239-245
Stanford GEMS phase 2 obesity prevention trial for low-income African-American girls: Design and sample baseline characteristics CONTEMPORARY CLINICAL TRIALS Robinson, T. N., Kraemer, H. C., Matheson, D. M., Obarzanek, E., Wilson, D. M., Haskell, W. L., Pruitt, L. A., Thompson, N. S., Haydel, K. F., Fujimoto, M., Varady, A., McCarthy, S., Watanabe, C., Killen, J. D. 2008; 29 (1): 56-69


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

Children, television viewing, and weight status: Summary and recommendations from an expert panel meeting ANNALS OF THE AMERICAN ACADEMY OF POLITICAL AND SOCIAL SCIENCE Jordan, A. B., Robinson, T. N. 2008; 615: 119-132
What can we do to control childhood obesity? ANNALS OF THE AMERICAN ACADEMY OF POLITICAL AND SOCIAL SCIENCE Dietz, N. H., Robinson, T. N. 2008; 615: 222-224


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

Estimating Physical Activity From Incomplete Accelerometer Data in Field Studies JOURNAL OF PHYSICAL ACTIVITY & HEALTH Alhassan, S., Sirard, J. R., Spencer, T. R., Varady, A., Robinson, T. N. 2008; 5: S112-S125


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

Tools for measuring individuals' climate behaviors and greenhouse gas impact Environ Law Rep Armel KC, Robinson TN 2008; 38: 10847-50


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

Stanford GEMS (Girls health enrichment multisite studies): Long-term efficacy of after-school dance and screen time reduction in low-income African-American girls 80th Annual Scientific Session of the American-Heart-Association (AHA) Robinson, T. N., Matheson, D. M., Kraemer, H. C., Obarzanek, E., Wilson, D. M., Haskell, W. L., Pruitt, L. A., Thompson, N. S., Haydel, K. F., Fujimoto, M., Varady, A., Killen, J. D. LIPPINCOTT WILLIAMS & WILKINS. 2007: 84343
Effects of fast food branding on young children's taste preferences ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Robinson, T. N., Borzekowski, D. L., Matheson, D. M., Kraemer, H. C. 2007; 161 (8): 792-797


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 PubMedID 16769388

Conversations, control, and couch-time: the assessment and stability of parental mediation styles and children's screen time J Children Media Borzekowski DLG, Robinson TN 2007; 1: 162-76


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

The effects of increasing outdoor play time on physical activity in Latino preschool children INTERNATIONAL JOURNAL OF PEDIATRIC OBESITY Alhassan, S., Sirard, J. R., Robinson, T. N. 2007; 2 (3): 153-158
Do Mexican-American mothers' food-related parenting practices influence their children's weight and dietary intake? JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Matheson, D. M., Robinson, T. N., Varady, A., Killen, J. D. 2006; 106 (11): 1861-1865

View details for Web of Science ID 000235234200016

View details for PubMedID 16461881

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 Pate, R. R., Davis, M. G., Robinson, T. N., Stone, E. J., McKenzie, T. L., Young, J. C. 2006; 114 (11): 1214-1224


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

Definition of metabolic syndrome in preadolescent girls JOURNAL OF PEDIATRICS Chi, C. H., Wang, Y., Wilson, D. M., Robinson, T. N. 2006; 148 (6): 788-792
Does children's screen time predict requests for advertised products? Cross-sectional and prospective analyses ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Chamberlain, L. J., Wang, Y., Robinson, T. N. 2006; 160 (4): 363-368


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

Effects of the SMART classroom curriculum to reduce child and family screen time JOURNAL OF COMMUNICATION Robinson, T. N., Borzekowski, D. L. 2006; 56 (1): 1-26

View details for PubMedID 15901863

Obesity prevention in primary care ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Robinson, T. N. 2006; 160 (2): 217-218
Are certain multicenter randomized clinical trial structures misleading clinical and policy decisions? CONTEMPORARY CLINICAL TRIALS Kraemer, H. C., Robinson, T. N. 2005; 26 (5): 518-529


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

Overweight children and adolescents - Reply NEW ENGLAND JOURNAL OF MEDICINE Dietz, W. H., Robinson, T. N. 2005; 353 (10): 1070-1071


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

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 Borzekowski, D. L., Robinson, T. N. 2005; 159 (7): 607-613


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

Clinical practice. Overweight children and adolescents. New England journal of medicine Dietz, W. H., Robinson, T. N. 2005; 352 (20): 2100-2109
Overweight children and adolescents. NEW ENGLAND JOURNAL OF MEDICINE Dietz, W. H., Robinson, T. N. 2005; 352 (20): 2100-2109


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

Overweight in children and adolescents - Pathophysiology, consequences, prevention, and treatment CIRCULATION Daniels, S. R., Arnett, D. K., Eckel, R. H., Gidding, S. S., Hayman, L. L., Kumanyika, S., Robinson, T. N., Scott, B. J., St Jeor, S., Williams, C. L. 2005; 111 (15): 1999-2012


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 PubMedID 15489470

Evidence-based community pediatrics: Building a bridge from bedside to neighborhood PEDIATRICS Sanders, L. M., Robinson, T. N., Forster, L. Q., Plax, K., Brosco, J. P., Brito, A. 2005; 115 (4): 1142-1147


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

Preventing childhood obesity - A solution-oriented research paradigm 1st Annual Active Living Research Conference Robinson, T. N., Sirard, J. R. ELSEVIER SCIENCE INC. 2005: 194201


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

Prevention conference VII - Obesity, a worldwide epidemic related to heart disease and stroke - Group IV: Prevention/treatment CIRCULATION Mullis, R. M., Blair, S. N., Aronne, L. J., Bier, D. M., Denke, M. A., Dietz, W., Donato, K. A., Drewnowski, A., French, S. A., Howard, B. V., Robinson, T. N., Swinburn, B., Wechsler, H. 2004; 110 (18): E484-E488


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

Major depression among adolescent smokers undergoing treatment for nicotine dependence ADDICTIVE BEHAVIORS Killen, J. D., Robinson, T. N., Ammerman, S., Hayward, C., Rogers, J., Samuels, D., Schatzberg, A. F. 2004; 29 (8): 1517-1526


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

Assessing weight-related biochemical cardiovascular risk factors in African-American girls OBESITY RESEARCH Wilson, D. M., Wang, Y., Cullen, K. W., Baranowski, T., Himes, J. H., Gross, M., McClanahan, B. S., Robinson, T. N. 2004; 12: 73S-83S


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

Parental cultural perspectives in relation to weight-related behaviors and concerns of African-American girls OBESITY RESEARCH Beech, B. M., Kumanyika, S. K., Baranowski, T., Davis, M., Robinson, T. N., Sherwood, N. E., Taylor, W. C., Relyea, G., Zhou, A. N., Pratt, C., Owens, A., Thompson, N. S. 2004; 12: 7S-19S


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

African-American girls' dietary intake while watching television OBESITY RESEARCH Matheson, D. M., Wang, Y., Klesges, L. M., Beech, B. M., Kraemer, H. C., Robinson, T. N. 2004; 12: 32S-37S


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

Randomized clinical trial of the efficacy of Bupropion combined with nicotine patch in the treatment of adolescent smokers JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Killen, J. D., Robinson, T. N., Ammerman, S., Hayward, C., Rogers, J., Stone, C., Samuels, D., Levin, S. K., Green, S., Schatzberg, A. F. 2004; 72 (4): 729-735


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

Effectiveness of a multicomponent self-management program in at-risk, school-aged children with asthma ANNALS OF ALLERGY ASTHMA & IMMUNOLOGY Shames, R. S., Sharek, P., Mayer, M., Robinson, T. N., Hoyte, E. G., Gonzalez-Hensley, F., Bergman, D. A., Umetsu, D. T. 2004; 92 (6): 611-618


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

Children's food consumption during television viewing AMERICAN JOURNAL OF CLINICAL NUTRITION Matheson, D. M., Killen, J. D., Wang, Y., Varady, A., Robinson, T. N. 2004; 79 (6): 1088-1094


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

Measurement characteristics of weight concern and dieting measures in 8-10-year-old African-American girls from GEMS pilot studies PREVENTIVE MEDICINE Sherwood, N. E., Beech, B. M., Klesges, L. M., Story, M., Killen, J., McDonald, T., Robinson, T. N., Pratt, C., Zhou, A. N., Cullen, K., Baranowski, J. 2004; 38: S50-S59


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

Evaluation of quality control procedures for 24-h dietary recalls: results from the Girls health Enrichment Multisite Studies PREVENTIVE MEDICINE Cullen, K. W., Watson, K., Himes, J. H., Baranowski, T., Rochon, J., Waclawiw, M., Sun, W., Stevens, M., Slawson, D. L., Matheson, D., Robinson, T. N. 2004; 38: S14-S23


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

Physical activity self-report and accelerometry measures from the Girls health Enrichment Multi-site Studies PREVENTIVE MEDICINE Treuth, M. S., Sherwood, N. E., Baranowski, T., Butte, N. F., Jacobs, D. R., McClanahan, B., Gao, S., Rochon, J., Zhou, A., Robinson, T. N., Pruitt, L., Haskell, W., Obarzanek, E. 2004; 38: S43-S49


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

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 Sherwood, N. E., Taylor, W. C., Treuth, M., Klesges, L. M., Baranowski, T., Zhou, A. N., Pratt, C., McClanahan, B., Robinson, T. N., Pruitt, L., Miller, W. 2004; 38: S60-S68


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

Associations among familism, language preference, and education in Mexican-American mothers and their children JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Romero, A. J., Robinson, T. N., Haydel, K. F., Mendoza, F., Killen, J. D. 2004; 25 (1): 34-40


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

Phase 1 of the Girls health Enrichment Multi-site Studies (GEMS): conclusion. Ethnicity & disease Kumanyika, S. K., Obarzanek, E., Robinson, T. N., Beech, B. M. 2003; 13 (1): S88-91


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

Dance and reducing television viewing to prevent weight gain in African-American girls: the Stanford GEMS pilot study. Ethnicity & disease Robinson, T. N., Killen, J. D., Kraemer, H. C., Wilson, D. M., Matheson, D. M., Haskell, W. L., Pruitt, L. A., Powell, T. M., Owens, A. S., Thompson, N. S., Flint-Moore, N. M., Davis, G. J., Emig, K. A., Brown, R. T., Rochon, J., Green, S., Varady, A. 2003; 13 (1): S65-77
Effects of a videotape to increase use of poison control centers by low-income and Spanish-speaking families: A randomized, controlled trial PEDIATRICS Kelly, N. R., Huffman, L. C., Mendoza, F. S., Robinson, T. N. 2003; 111 (1): 21-26


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

Common design elements of the Girls health Enrichment Multi-site Studies (GEMS). Ethnicity & disease Rochon, J., Klesges, R. C., Story, M., Robinson, T. N., Baranowski, T., Obarzanek, E., Mitchell, M. 2003; 13 (1): S6-14
Agreement among measures of asthma status: A prospective study of low-income children with moderate to severe asthma PEDIATRICS Sharek, P. J., Mayer, M. L., Loewy, L., Robinson, T. N., Shames, R. S., Umetsu, D. T., Bergman, D. A. 2002; 110 (4): 797-804


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

Validity of children's food portion estimates - A comparison of 2 measurement aids ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Matheson, D. M., Hanson, K. A., McDonald, T. E., Robinson, T. N. 2002; 156 (9): 867-871


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

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 Williams, C. L., Hayman, L. L., Daniels, S. R., Robinson, T. N., Steinberger, J., Paridon, S., Bazzarre, T. 2002; 106 (1): 143-160


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

Primary care interventions to reduce television viewing in African-American children AMERICAN JOURNAL OF PREVENTIVE MEDICINE Ford, B. S., McDonald, T. E., Owens, A. S., Robinson, T. N. 2002; 22 (2): 106-109


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

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 Taylor, K. L., Hoyte, E. G., Taylor, S. N., Mayer, M. L., Biederman, K. T., Sharek, P. J., Robinson, T. N., Bergman, D. A., Shames, R. S., Umetsu, D. T. MOSBY-ELSEVIER. 2002: S88S88


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

Are perceived neighborhood hazards a barrier to physical activity in children? ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Romero, A. J., Robinson, T. N., Kraemer, H. C., Erickson, S. J., Haydel, K. F., Mendoza, F., Killen, J. D. 2001; 155 (10): 1143-1148


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

Television viewing and childhood obesity PEDIATRIC CLINICS OF NORTH AMERICA Robinson, T. N. 2001; 48 (4): 1017-?


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

Effects of reducing television viewing on children's requests for toys: A randomized controlled trial JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Robinson, T. N., Saphir, M. N., Kraemer, H. C., Varady, A., Haydel, K. F. 2001; 22 (3): 179-184


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

Is parental control over children's eating associated with childhood obesity? Results from a population-based sample of third graders OBESITY RESEARCH Robinson, T. N., Kiernan, M., Matheson, D. M., Haydel, K. F. 2001; 9 (5): 306-312

View details for Web of Science ID 000089589900001

View details for PubMedID 11017963

Do adolescent smokers experience withdrawal effects when deprived of nicotine? EXPERIMENTAL AND CLINICAL PSYCHOPHARMACOLOGY Killen, J. D., Ammerman, S., Rojas, N., Varady, J., Haydel, F., Robinson, T. N. 2001; 9 (2): 176-182


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

Overweight concerns and body dissatisfaction among third-grade children: The impacts of ethnicity and socioeconomic status JOURNAL OF PEDIATRICS Robinson, T. N., Chang, J. Y., Haydel, K. F., Killen, J. D. 2001; 138 (2): 181-187

View details for Web of Science ID 000087929500020

View details for PubMedID 10903291

The 30-second effect: An experiment revealing the impact of television commercials on food preferences of preschoolers JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION Borzekowski, D. L., Robinson, T. N. 2001; 101 (1): 42-46


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

Effects of reducing children's television and video game use on aggressive behavior - A randomized controlled trial ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Robinson, T. H., Wilde, M. L., Navracruz, L. C., Haydel, K. F., Varady, A. 2001; 155 (1): 17-23


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

The epidemic of pediatric obesity WESTERN JOURNAL OF MEDICINE Robinson, T. N. 2000; 173 (4): 220-221
Are overweight children unhappy? Body mass index, depressive symptoms, and overweight concerns in elementary school children Annual Meeting of the Pediatric-Academic-Societies Erickson, S. J., Robinson, T. N., Haydel, K. F., Killen, J. D. AMER MEDICAL ASSOC. 2000: 93135


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

Can a school-based intervention to reduce television use decrease adiposity in children in grades 3 and 4? WESTERN JOURNAL OF MEDICINE Robinson, T. N. 2000; 173 (1): 40-40


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

Are overweight children unhappy? body mass index, depressive symptoms, and overweight concerns in elementary school children Arch Pediatr Adolesc Med Erickson SJ, Robinson TN, Haydel KF, Killen JD 2000; 154: 931-5


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

Does the camera add 10 pounds? Media use, perceived importance of appearance, and weight concerns among teenage girls JOURNAL OF ADOLESCENT HEALTH Borzekowski, D. L., Robinson, T. N., Killen, J. D. 2000; 26 (1): 36-41
Interactions of diet, physical activity, and obesity: implications for prevention CVD Prevention Robinson TN 2000; 3: 132-6


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

Reducing children's television viewing to prevent obesity - A randomized controlled trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Robinson, T. N. 1999; 282 (16): 1561-1567

View details for Web of Science ID 000077885300004

View details for PubMedID 9894551

Viewing the viewers: Ten video cases of children's television viewing behaviors JOURNAL OF BROADCASTING & ELECTRONIC MEDIA Borzekowski, D. L., Robinson, T. N. 1999; 43 (4): 506-528


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

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 Winkleby, M. A., Robinson, T. N., Sundquist, J., Kraemer, H. C. 1999; 281 (11): 1006-1013


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 PubMedID 9786378

Behavioural treatment of childhood and adolescent obesity Conference on Obesity in Childhood and Adolescence - Assessment, Prevention and Treatment Robinson, T. N. NATURE PUBLISHING GROUP. 1999: S52S57


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

Policy issues relevant to evaluation of interactive health communication applications AMERICAN JOURNAL OF PREVENTIVE MEDICINE Patrick, K., Robinson, T. N., Alemi, F., Eng, T. R. 1999; 16 (1): 35-42

View details for Web of Science ID 000072563600040

View details for PubMedID 9544774

Acculturation and eating disorder symptoms in adolescent girls JOURNAL OF RESEARCH ON ADOLESCENCE Gowen, L. K., Hayward, C., Killen, J. D., Robinson, T. N., Taylor, C. B. 1999; 9 (1): 67-83


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

Developers and evaluation of interactive health communication applications AMERICAN JOURNAL OF PREVENTIVE MEDICINE Henderson, J., Noell, J., Reeves, T., Robinson, T., Strecher, V. 1999; 16 (1): 30-34

View details for Web of Science ID 000072344800001

View details for PubMedID 9506622

Viewing the viewers: 10 video case studies of children's television viewing behaviors J Broadcast Elec Media Borzekowski DLG, Robinson TN 1999; 43: 506-28


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 PubMedID 9420362

Acculturation and eating disorder symptoms in adolescent girls J Research Adolesc Gowen LK, Hayward C, Killen JD, Robinson TN, Taylor CB 1999; 9: 67-83
Consumers and evaluation of interactive health communication applications AMERICAN JOURNAL OF PREVENTIVE MEDICINE Gustafson, D. H., Robinson, T. N., Ansley, D., Adler, L., Brennan, P. F. 1999; 16 (1): 23-29


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

Television and music video exposure and risk of adolescent alcohol use PEDIATRICS Robinson, T. N., Chen, H. L., Killen, J. D. 1998; 102 (5)


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 PubMedID 8969369

An evidence-based approach to interactive health communication - A challenge to medicine in the information age JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Robinson, T. N., Patrick, K., Eng, T. R., Gustafson, D. 1998; 280 (14): 1264-1269


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

Psychosocial factors associated with youth involvement in community activities promoting heart health HEALTH EDUCATION & BEHAVIOR Altman, D. G., Feighery, E., Robinson, T. N., Haydel, K. F., Strausberg, L., Lorig, K., Killen, J. D. 1998; 25 (4): 489-500


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 PubMedID 8830905

Does television cause childhood obesity? JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Robinson, T. N. 1998; 279 (12): 959-960

View details for Web of Science ID A1996VB78300001

View details for PubMedID 8812816

Nicotine dependence among adolescent smokers ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Rojas, N. L., Killen, J. D., Haydel, K. F., Robinson, T. N. 1998; 152 (2): 151-156

View details for Web of Science ID A1995QG12900002

View details for PubMedID 7724253

Use of the body mass index (BMI) as a measure of overweight in children and adolescents JOURNAL OF PEDIATRICS Dietz, W. H., Robinson, T. N. 1998; 132 (2): 191-193


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

Prospective study of risk factors for the initiation of cigarette smoking JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Killen, J. D., Robinson, T. N., Haydel, K. F., Hayward, C., Wilson, D. M., Hammer, L. D., Litt, I. F., Taylor, C. B. 1997; 65 (6): 1011-1016


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 Web of Science ID A1994PN81000002

School-based cardiovascular disease prevention studies: Review and synthesis Conference on Community Trials for Cardiopulmonary Health - Directions for Public Health Practice, Policy and Research Resnicow, K., Robinson, T. N. ELSEVIER SCIENCE INC. 1997: S14S31


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

Do cigarette warning labels reduce smoking? Paradoxical effects among adolescents ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Robinson, T. N., Killen, J. D. 1997; 151 (3): 267-272

View details for PubMedID 8247968

School-based cardiovascular disease prevention studies: review and synthesis Ann Epidemiol Resnicow K, Robinson TN 1997; Suppl 7: S14-S31


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 PubMedID 8424000

Ethnicity and body dissatisfaction: Are Hispanic and Asian girls at increased risk for eating disorders? JOURNAL OF ADOLESCENT HEALTH Robinson, T. N., Killen, J. D., Litt, I. F., Hammer, L. D., Wilson, D. M., Haydel, K. F., Hayward, C., Taylor, C. B. 1996; 19 (6): 384-393


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

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 Zenni, E. A., Robinson, T. N. 1996; 150 (9): 975-980


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

Predicting onset of drinking in a community sample of adolescents: The role of expectancy and temperament ADDICTIVE BEHAVIORS Killen, J. D., Hayward, C., Wilson, D. M., Haydel, K. F., Robinson, T. N., Taylor, C. B., Hammer, L. D., Varady, A. 1996; 21 (4): 473-480


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

Advances and future directions for school-based health promotion research: Commentary on the CATCH intervention trial PREVENTIVE MEDICINE Resnicow, K., Robinson, T. N., Frank, E. 1996; 25 (4): 378-383


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

Ethnic and gender differences in the relationships between television viewing and obesity, physical activity and dietary fat intake J Health Educ Robinson TN, Killen JD 1995; 26: S91-S98


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

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 Killen, J. D., Taylor, C. B., Hayward, C., Wilson, D. M., Haydel, K. F., Hammer, L. D., SIMMONDS, B., Robinson, T. N., Litt, I., Varady, A. 1994; 16 (3): 227-238


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



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

Assessment and treatment of childhood obesity. Pediatrics in review Dietz, W. H., Robinson, T. N. 1993; 14 (9): 337-343

View details for PubMedID 3745693



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

Childhood obesity: what is it? what does it mean? Singapore J Nutr Diet Robinson TN 1993: 1-6
THE STANFORD ADOLESCENT HEART HEALTH-PROGRAM HEALTH EDUCATION QUARTERLY Killen, J. D., Robinson, T. N., Telch, M. J., Saylor, K. E., Maron, D. J., Rich, T., Bryson, S. 1989; 16 (2): 263-283
PERSPECTIVES ON ADOLESCENT SUBSTANCE USE - A DEFINED POPULATION STUDY JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Robinson, T. N., Killen, J. D., Taylor, C. B., Telch, M. J., Bryson, S. W., Saylor, K. E., Maron, D. J., MACCOBY, N., Farquhar, J. W. 1987; 258 (15): 2072-2076
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 Robinson TN, Walters PA Jr 1987: 514-520
Evidence for an alcohol-stress link among normal weight adolescents reporting purging behavior Int J Eat Disord Killen JD, Taylor CB, Telch MJ, Saylor KE, Maron DJ, Robinson TN 1987; 6: 349-356
CORRELATES OF SEAT-BELT USE BY ADOLESCENTS - IMPLICATIONS FOR HEALTH PROMOTION PREVENTIVE MEDICINE Maron, D. J., Telch, M. J., Killen, J. D., Vranizan, K. M., Saylor, K. E., Robinson, T. N. 1986; 15 (6): 614-623
Health-net: an interactive computer network for campus health promotion. Journal of American college health Robinson, T. N., WALTERS, P. A. 1986; 34 (6): 284-285