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1.  The Interaction of Social Networks and Child Obesity Prevention Program Effects: The Pathways Trial 
Obesity (Silver Spring, Md.)  2014;22(6):1520-1526.
Social network analysis was used to examine whether peer influence from one’s social networks moderates obesity prevention program effects on obesity related behaviors: healthful behaviors and unhealthful ones.
Design and Methods
Participants included 557 children residing in Southern California. Survey assessed health promoting behaviors (i.e., physical activity at school, physical activity outside of school, and fruit and vegetable intake), as well as unhealthful ones (high calorie low nutrient intake and sedentary activity), and peer exposure calculated from social network nominations as indicators of peer influence. Multilevel models were conducted separately on outcomes predicted by program participation, peer exposure, and program participation by peer exposure.
Results indicated that peer exposure was positively associated with one’s own behavior for both healthful and unhealthful behaviors. Program participation effects were moderated by peer influence, but only when unhealthful peer influence was present. Results suggest that peer influence can diminish or amplify prevention programs
Future interventions should consider peer-led components to promote healthful influence of peers on healthful and unhealthful behaviors, and programs should be mindful that their effects are moderated by social networks.
PMCID: PMC4037361  PMID: 24616241
Social Network; Peer Influence; Obesity Prevention; Childhood Obesity; Program Effects
2.  Mindfulness-Based Interventions for Obesity-Related Eating Behaviors: A Literature Review 
Mindfulness-based interventions (MBIs) targeting eating behaviors have gained popularity in recent years. A literature review was conducted to determine the effectiveness of MBIs for treating obesity-related eating behaviors, such as binge eating, emotional eating, and external eating. A search protocol was conducted using the online databases Google Scholar, PubMed, PsycINFO, and Ovid Healthstar. Articles were required to meet the following criteria to be included in this review: (1) describe a MBI or the use of mindfulness exercises as part of an intervention, (2) include at least one obesity-related eating behavior as an outcome, (3) include quantitative outcomes, and (4) be published in English in a peer-reviewed journal. A total of N=21 articles were included in this review. Interventions used a variety of approaches to implement mindfulness training, including combined mindfulness and cognitive behavioral therapies, mindfulness-based stress reduction, acceptance-based therapies, mindful eating programs, and combinations of mindfulness exercises. Targeted eating behavior outcomes included binge eating, emotional eating, external eating, and dietary intake. Eighteen (86%) of the reviewed studies reported improvements in the targeted eating behaviors. Overall, the results of this first review on the topic support the efficacy of mindfulness-based interventions for changing obesity-related eating behaviors, specifically binge eating, emotional eating, and external eating.
PMCID: PMC4046117  PMID: 24636206
Mindfulness; obesity; eating behavior; literature review
4.  From Counselor Skill to Decreased Marijuana Use: Does Change Talk Matter? 
Client language about change, or change talk, is hypothesized to mediate the relationship between counselor fidelity in Motivational Interviewing (MI) and drug use outcomes. To investigate this causal chain, this study used data from a MI booster delivered to alternative high school students immediately after a universal classroom-based drug abuse prevention program. One hundred and seventy audio-recorded MI sessions about substance use were coded using the Motivational Interviewing Skill Code 2.5. Structural equation modeling showed that percentage of change talk on the part of the client mediated three of the four relationships between MI quality indicators and marijuana outcomes, while percentage of reflections of change talk showed a main effect of counselor skill on marijuana outcomes. Findings support change talk as an active ingredient of MI and provide new empirical support for the micro-skills of MI.
PMCID: PMC3973425  PMID: 24462244
Motivational Interviewing; Adolescent; Marijuana Use; Mediation; Mechanisms of Change
5.  Behavioral Contributions to the Pathogenesis of Type 2 Diabetes 
Current diabetes reports  2014;14(4):475.
Behavioral Contributions to the pathogenesis of prediabetes and Type 2 diabetes (T2D) include lifestyle behaviors including dietary intake, exercise, sedentariness, sleep, and stress. The purpose of this paper is to review evidence for the metabolic pathways by which the behavior is linked to T2D. Evidence for interventions which change each of the lifestyle behaviors is discussed. The article will close with a brief discussion on how new technologies may provide opportunities to better understand relationships between moment-to-moment fluctuations in behaviors and diabetes pathogenesis, as well as provide opportunities to personalize and adapt interventions to achieve successful behavior change and maintenance of that change. Especially promising are new technologies which assist in tracking lifestyle behaviors along with clinical and metabolic outcomes.
PMCID: PMC4001920  PMID: 24604714
Type 2 diabetes; behavior; pathogenesis; technology
6.  Multimodal Physical Activity Recognition by Fusing Temporal and Cepstral Information 
A physical activity (PA) recognition algorithm for a wearable wireless sensor network using both ambulatory electrocardiogram (ECG) and accelerometer signals is proposed. First, in the time domain, the cardiac activity mean and the motion artifact noise of the ECG signal are modeled by a Hermite polynomial expansion and principal component analysis, respectively. A set of time domain accelerometer features is also extracted. A support vector machine (SVM) is employed for supervised classification using these time domain features. Second, motivated by their potential for handling convolutional noise, cepstral features extracted from ECG and accelerometer signals based on a frame level analysis are modeled using Gaussian mixture models (GMMs). Third, to reduce the dimension of the tri-axial accelerometer cepstral features which are concatenated and fused at the feature level, heteroscedastic linear discriminant analysis is performed. Finally, to improve the overall recognition performance, fusion of the multi-modal (ECG and accelerometer) and multidomain (time domain SVM and cepstral domain GMM) subsystems at the score level is performed. The classification accuracy ranges from 79.3% to 97.3% for various testing scenarios and outperforms the state-of-the-art single accelerometer based PA recognition system by over 24% relative error reduction on our nine-category PA database.
PMCID: PMC4326092  PMID: 20699202
Accelerometer; cepstrum; electrocardiogram; multimodal signal processing; physical activity recognition
7.  Pioneering the Transdisciplinary Team Science Approach: Lessons Learned from National Cancer Institute Grantees 
The National Cancer Institute has been a leader in supporting transdisciplinary (TD) team science. From 2005-2010, the NCI supported Transdisciplinary Research on Energetic and Cancer I (TREC I), a center initiative fostering the TD integration of social, behavioral, and biological sciences to examine the relationships among obesity, nutrition, physical activity and cancer. In the final year of TREC I, we conducted qualitative in-depth-interviews with 31 participating investigators and trainees to learn more about their experiences with TD team science, including challenges, facilitating factors, strategies for success, and impacts. Five main challenges emerged: (1) limited published guidance for how to engage in TD team science, when TREC I was implemented; (2) conceptual and scientific challenges inherent to efforts to achieve TD integration; (3) discipline-based differences in values, terminology, methods, and work styles; (4) project management challenges involved in TD team science; and (5) traditional incentive and reward systems that do not recognize or reward TD team science. Four main facilitating factors and strategies for success emerged: (1) beneficial attitudes and beliefs about TD research and team science; (2) effective team processes; (3) brokering and bridge-building activities by individuals holding particular roles in a research center; and (4) funding initiative characteristics that support TD team science. Broad impacts of participating in TD team science in the context of TREC I included: (1) new positive attitudes about TD research and team science; (2) new boundary-crossing collaborations; (3) scientific advances related to research approaches, findings, and dissemination; (4) institutional culture change and resource creation in support of TD team science; and (5) career advancement. Funding agencies, academic institutions, and scholarly journals can help to foster TD team science through funding opportunities, institutional policies on extra-departmental and cross-school collaboration, promotion and tenure policies, and publishing opportunities for TD research.
PMCID: PMC4280018  PMID: 25554748
Cross-disciplinary; Transdisciplinary; Team science; Cancer; Energetics
8.  Hierarchical Linear Models for Energy Prediction using Inertial Sensors: A Comparative Study for Treadmill Walking 
Walking is a commonly available activity to maintain a healthy lifestyle. Accurately tracking and measuring calories expended during walking can improve user feedback and intervention measures. Inertial sensors are a promising measurement tool to achieve this purpose. An important aspect in mapping inertial sensor data to energy expenditure is the question of normalizing across physiological parameters. Common approaches such as weight scaling require validation for each new population. An alternative is to use a hierarchical approach to model subject-specific parameters at one level and cross-subject parameters connected by physiological variables at a higher level. In this paper, we evaluate an inertial sensor-based hierarchical model to measure energy expenditure across a target population. We first determine the optimal movement and physiological features set to represent data. Periodicity based features are more accurate (p<0.1 per subject) when generalizing across populations. Weight is the most accurate parameter (p<0.1 per subject) measured as percentage prediction error. We also compare the hierarchical model with a subject-specific regression model and weight exponent scaled models. Subject-specific models perform significantly better (p<0.1 per subject) than weight exponent scaled models at all exponent scales whereas the hierarchical model performed worse than both. However, using an informed prior from the hierarchical model produces similar errors to using a subject-specific model with large amounts of training data (p<0.1 per subject). The results provide evidence that hierarchical modeling is a promising technique for generalized prediction energy expenditure prediction across a target population in a clinical setting.
PMCID: PMC3891737  PMID: 24443658
Accelerometer; Bayesian Linear regression; Gyroscope; Hierarchical Linear Model
9.  Meal Skipping Linked to Increased Visceral Adipose Tissue and Triglycerides in Overweight Minority Youth 
Obesity (Silver Spring, Md.)  2013;22(5):E77-E84.
To investigate the impact of eating frequency on dietary intake, physical activity (PA), metabolic, and adiposity measures in minority youth.
Design and Methods
This analysis included 185 overweight (≥85th BMI percentile) Hispanic and African American youth (8–18 years) with the following cross-sectional measures: height, weight, BMI, dietary intake, body composition, metabolic parameters, PA, visceral adipose tissue (VAT), and subcutaneous adipose tissue. Each eating occasion (EO) was defined as ≥50 calories and ≥15 minutes from any previous EO. Participants were dichotomized based on EOs per 24-h into meal skippers <3 EO (MS; n=27) or normal/frequent eaters ≥3 EO (NFE; n=158). ANCOVAs were used to assess dietary intakes, metabolic outcomes, adiposity, and PA between eating frequency groups.
MS compared to NFE consumed 24% fewer calories per 24-h (p≤0.01), 21% more calories per EO (p≤0.01), ate 40% less often (p≤0.01), had 18% higher triglycerides (p=0.03), and 26% more VAT (p=0.03), with no differences in PA.
Although meal skipping was associated with decreased energy intake, it was linked to increased calories per EO and higher triglycerides and VAT, which are strong indicators of deleterious metabolic profiles. These findings elucidate that meal skipping may be associated with increased VAT and related metabolic diseases in high-risk minority youth.
PMCID: PMC3759606  PMID: 23613461
Eating Behaviors; Life Styles; Minorities; Visceral Fat; Triglyceride
10.  Temporal Relationship Between Insulin Sensitivity and the Pubertal Decline in Physical Activity in Peripubertal Hispanic and African American Females 
Diabetes Care  2013;36(11):3739-3745.
Little attention has been paid to possible intrinsic biological mechanisms for the decline in physical activity that occurs during puberty. This longitudinal observational study examined the association between baseline insulin sensitivity (SI) and declines in physical activity and increases in sedentary behavior in peripubertal minority females over a year.
Participants were Hispanic and African American girls (n = 55; 76% Hispanic; mean age 9.4 years; 36% obese). SI and other insulin indices were measured at baseline using the frequently sampled intravenous glucose tolerance test. Physical activity was measured on a quarterly basis by accelerometry and self-report.
Physical activity declined by 25% and time spent in sedentary behaviors increased by ∼13% over 1 year. Lower baseline SI predicted the decline in physical activity measured by accelerometry, whereas higher baseline acute insulin response to glucose predicted the decline in physical activity measured by self-report. Time spent in sedentary behavior increased by ~13% over 1 year, and this was predicted by lower baseline SI. All models controlled for adiposity, age, pubertal stage, and ethnicity.
When evaluated using a longitudinal design with strong outcome measures, this study suggests that lower baseline SI predicts a greater decline in physical activity in peripubertal minority females.
PMCID: PMC3816891  PMID: 23846812
11.  Current mHealth Technologies for Physical Activity Assessment and Promotion 
Novel mobile assessment and intervention capabilities are changing the face of physical activity (PA) research. A comprehensive systematic review of how mobile technology has been used for measuring PA and promoting PA behavior change is needed.
Evidence acquisition
Article collection was conducted using six databases from February to June 2012 with search terms related to mobile technology and PA. Articles that described the use of mobile technologies for PA assessment, sedentary behavior assessment, and/or interventions for PA behavior change were included. Articles were screened for inclusion and study information was extracted.
Evidence synthesis
Analyses were conducted from June to September 2012. Mobile phone–based journals and questionnaires, short message service (SMS) prompts, and on-body PA sensing systems were the mobile technologies most utilized. Results indicate that mobile journals and questionnaires are effective PA self-report measurement tools. Intervention studies that reported successful promotion of PA behavior change employed SMS communication, mobile journaling, or both SMS and mobile journaling.
mHealth technologies are increasingly being employed to assess and intervene on PA in clinical, epidemiologic, and intervention research. The wide variations in technologies used and outcomes measured limit comparability across studies, and hamper identification of the most promising technologies. Further, the pace of technologic advancement currently outstrips that of scientific inquiry. New adaptive, sequential research designs that take advantage of ongoing technology development are needed. At the same time, scientific norms must shift to accept “smart,” adaptive, iterative, evidence-based assessment and intervention technologies that will, by nature, improve during implementation.
PMCID: PMC4199827  PMID: 24050427
12.  Bidirectional Associations Between Future Time Perspective and Substance Use Among Continuation High-School Students 
Substance use & misuse  2013;48(8):574-580.
We examined whether a bidirectional, longitudinal relationship exists between future time perspective (FTP), measured with the Zimbardo Time Perspective Inventory, and any past 30-day use of alcohol, tobacco, marijuana, or hard drugs among continuation high school students (N = 1,310, mean age 16.8 years) in a large urban area. We found increased FTP to be protective against drug use for all substances except alcohol. While any baseline use of substances did not predict changes in FTP 1 year later. The discussion explores why alcohol findings may differ from other substances. Future consideration of FTP as a mediator of program effects is explored.
PMCID: PMC4181553  PMID: 23750661
future time perspective; future orientation; continuation high school; tobacco; alcohol; marijuana; hard drugs; adolescent; toward no drug abuse; substance use
13.  Does community type moderate the relationship between parent perceptions of the neighborhood and physical activity in children? 
To examine whether residing in a community designed to promote physical activity moderates the relationship between parent perceptions of the neighborhood and general physical activity or active commuting to school in their children.
San Bernardino County, California.
365 families (one parent and one child in grades 4th-8th). 85 reside in a smart growth community designed to be more conducive to physical activity.
Parent perceptions assessed using the Neighborhood Environment Walkability Scale. General child physical activity measured using accelerometers, and active commuting was self-reported by children.
Two sets of regressions were performed: one for general physical activity, and one for active commuting. Separate models were run in the two sets for each of the 14 NEWS factors, while controlling for demographics.
For general physical activity, walking infrastructure, lack of cul-de-sacs and social interaction had significant main effect associations (p≤0.05). No factors were moderated by community. The relationships between active commuting to school and perceived crime, traffic hazards, hilliness, physical barriers, cul-de-sac connectivity, aesthetics, and walking infrastructure were significant for those in the smart growth community only (p≤0.05).
Living in an activity friendly environment is associated with positive relationships between parent perceptions and active commuting behaviors in children. Future interventions should account for both the perceived neighborhood environment and available physical activity infrastructure.
PMCID: PMC4124624  PMID: 22747320
physical activity; built environment; active commuting; smart growth; moderation; perceptions; Manuscript format: research; Research purpose: modeling/relationship testing; Study design: quasi-experimental; Outcome measure: behavioral; Setting: family; local community; Health format: physical activity; Strategy: built environment; Target population age: youth, adults; Target population circumstance: geographic location
14.  Mobile Health Technology Evaluation 
Creative use of new mobile and wearable health information and sensing technologies (mHealth) has the potential to reduce the cost of health care and improve well-being in numerous ways. These applications are being developed in a variety of domains, but rigorous research is needed to examine the potential, as well as the challenges, of utilizing mobile technologies to improve health outcomes. Currently, evidence is sparse for the efficacy of mHealth. Although these technologies may be appealing and seemingly innocuous, research is needed to assess when, where, and for whom mHealth devices, apps, and systems are efficacious.
In order to outline an approach to evidence generation in the field of mHealth that would ensure research is conducted on a rigorous empirical and theoretic foundation, on August 16, 2011, researchers gathered for the mHealth Evidence Workshop at NIH. The current paper presents the results of the workshop. Although the discussions at the meeting were cross-cutting, the areas covered can be categorized broadly into three areas: (1) evaluating assessments; (2) evaluating interventions; and, (3) reshaping evidence generation using mHealth. This paper brings these concepts together to describe current evaluation standards, future possibilities and set a grand goal for the emerging field of mHealth research.
PMCID: PMC3803146  PMID: 23867031
15.  Modifying Influence of Dietary Sugar in the Relationship Between Cortisol and Visceral Adipose Tissue in Minority Youth 
Obesity (Silver Spring, Md.)  2013;22(2):474-481.
Cortisol has been associated with preferential visceral adipose tissue (VAT) deposition; however findings in humans are mixed, which may be clarified when diet is considered.
Design and Methods
Participants included 165 African American and Latino, overweight adolescents (BMI% 97.2±3.2%, ages 13-18, 67% Latino, 66% female). Body composition was determined by DEXA, abdominal fat depots (VAT, subcutaneous (SAT)) by multiple-slice MRI, time-controlled serum sample to measure cortisol, and 2-day multi-pass 24-hour dietary recall. Linear regression analysis examined the cross-sectional relationship between cortisol, and the interaction of diet and cortisol on adiposity measures. Sex, race, age and total body fat were a priori covariates.
There was a significant interaction between cortisol and sugar (total and added) in the prediction of VAT (pinteraction<=0.05). Amongst participants with high total or added-sugar intake, cortisol was significantly associated with VAT (β=0.031 p<0.001; β=0.026 p<0.001), with no relationship in low consumers of total or added-sugar.
Dietary sugar may play an important role in modifying the relationship between cortisol and VAT, such that cortisol is significantly associated with elevated VAT under conditions of high sugar intake.
PMCID: PMC3946447  PMID: 23929660
Adolescence; Cortisol; Omega-3 fatty acids; Sugar; visceral fat
16.  Momentary Assessment of Affect, Physical Feeling States, and Physical Activity in Children 
Most research on the interplay of affective and physical feelings states with physical activity in children has been conducted under laboratory conditions and fails to capture intraindividual covariation. The current study used Ecological Momentary Assessment (EMA) to bi-directionally examine how affective and physical feeling states are related to objectively-measured physical activity taking place in naturalistic settings during the course of children’s everyday lives.
Children (N = 119) (ages 9–13 years) (52% male, 32% Hispanic) completed eight days of EMA monitoring, which measured positive affect (PA), negative affect (NA), feeling tired, and feeling energetic up to seven times per day. EMA responses were time-matched to accelerometer assessed moderate-to-vigorous physical activity (MVPA) in the 30 minutes before and after each EMA survey.
Higher ratings of feeling energetic and lower ratings of feeling tired were associated with more MVPA in the 30 minutes after the EMA prompt. More MVPA in the 30 minutes before the EMA prompt was associated with higher ratings of PA and feeling energetic, and lower ratings of NA. Between-subject analyses indicated that mean hourly leisure-time MVPA was associated with less intraindividual variability in PA and NA.
Physical feeling states predict subsequent physical activity levels, which in turn, predict subsequent affective states in children. Active children demonstrated higher positive and negative emotional stability. Although the strength of these associations were of modest magnitude and their clinical relevance is unclear, understanding the antecedents to and consequences of physical activity may have theoretical and practical implications for the maintenance and promotion of physical activity and psychological well-being in children.
PMCID: PMC4113469  PMID: 23668846
positive affect; negative affect; fatigue; physical activity; ecological momentary assessment
17.  Genetic and Clinical Markers of Elevated Liver Fat Content in Overweight and Obese Hispanic Children 
Obesity (Silver Spring, Md.)  2013;21(12):10.1002/oby.20523.
Genetic variation in six genes has been associated with elevated liver fat and nonalcoholic fatty liver disease in adults. We sought to determine the influence of these genes on liver fat and whether a genetic risk score (GRS) would improve upon the ability of common clinical risk factors to predict elevated liver fat content (ELF) in Hispanic children.
Design and Methods
223 obese Hispanic children were genotyped for six SNPs. MRI was used to measure liver fat. A GRS was tested for association with ELF using multivariate linear regression. Predictors were assessed via ROC curves and pair-wise analysis was used to determine significance alone and combined with clinical markers.
Only variants in PNPLA3 and APOC3 genes were associated with liver fat (p<0.001, p=0.01, respectively). Subjects with a GRS=4 had ~3-fold higher liver fat content than subjects with GRS of 0 (15.1±12.7% vs. 5.1±3.7%, p=0.03). While the addition of the GRS to a model containing BMI and liver enzymes increased ROC AUC from 0.83 to 0.85 [95% CI, 0.79-0.89], (p=0.01), it does not improve detection of ELF from a clinical perspective.
Only PNPLA3 and APOC3 were related to ELF and a GRS comprised of these susceptibility alleles did not add to the discriminatory power of traditional biomarkers for clinical assessment of liver fat.
PMCID: PMC3855210  PMID: 23804528
NAFLD; liver fat; Hispanic; obesity; genetic risk
18.  Prevalence and co-occurrence of addictive behaviors among former alternative high school youth 
Background and Aims
Recent work has studied multiple addictions using a matrix measure, which taps multiple addictions through single responses for each type.
The present study investigated use of a matrix measure approach among former alternative high school youth (average age = 19.8 years) at risk for addictions. Lifetime and last 30-day prevalence of one or more of 11 addictions reviewed in other work (Sussman, Lisha & Griffiths, 2011) was the primary focus (i.e., cigarettes, alcohol, other/hard drugs, eating, gambling, Internet, shopping, love, sex, exercise, and work). Also, the co-occurrence of two or more of these 11 addictive behaviors was investigated. Finally, the latent class structure of these addictions, and their associations with other measures, was examined.
We found that ever and last 30-day prevalence of one or more of these addictions was 79.2% and 61.5%, respectively. Ever and last 30-day co-occurrence of two or more of these addictions was 61.5% and 37.7%, respectively. Latent Class Analysis suggested two groups: a generally Non-addicted Group (67.2% of the sample) and a “Work Hard, Play Hard”-addicted Group that was particularly invested in addiction to love, sex, exercise, the Internet, and work. Supplementary analyses suggested that the single-response type self-reports may be measuring the addictions they intend to measure.
Discussion and Conclusions
We suggest implications of these results for future studies and the development of prevention and treatment programs, though much more validation research is needed on the use of this type of measure.
PMCID: PMC3969796  PMID: 24701344
multiple addictions; prevalence; co-occurrence; latent class analysis; addiction groups; convergent validity
19.  Psychometrics of the Eating in Emotional Situations Questionnaire (EESQ) among low-income Latino elementary-school children 
Eating behaviors  2011;12(2):156-159.
The current study examines the psychometric properties of the Eating in Emotional Situations Questionnaire (EESQ) and the frequency of eating in emotional situations among 159 low-income Latino fourth graders. The EESQ assesses eating in emotional situations that are emotion-driven (“I eat when I am lonely”) and context-driven (“I eat when I get a really bad grade”). Internal consistencies for the EESQ subscales and total scale ranged from .70 to .86. Criterion validity of the EESQ was established by statistically significant correlations between the EESQ subscales and total scale, and uncontrollable eating, external eating, and junk food intake. Eating in emotional situations was common in the sample; almost one-half reported eating in at least 3 of the 11 types of emotional situations (e.g. when stressed, sad, bored) and 28% reported eating in at least 6 types. Overall, these findings provide support for the internal consistency and validity of the EESQ in low-income Latino children, and suggest that eating in emotional situations is moderately present in this demographic. Future studies are needed to validate the EESQ in other ethnic groups and examine the longitudinal tracking of eating in emotional situations among Latino youth.
PMCID: PMC3947794  PMID: 21385647
Eating in Emotional Situations Questionnaire (EESQ); emotional eating; children; Latino; Hispanic
20.  Prevalence and co-occurrence of addictive behaviors among former alternative high school youth 
Background and Aims: Recent work has studied multiple addictions using a matrix measure, which taps multiple addictions through single responses for each type. Methods: The present study investigated use of a matrix measure approach among former alternative high school youth (average age = 19.8 years) at risk for addictions. Lifetime and last 30-day prevalence of one or more of 11 addictions reviewed in other work (Sussman, Lisha & Griffiths, 2011) was the primary focus (i.e., cigarettes, alcohol, other/hard drugs, eating, gambling, Internet, shopping, love, sex, exercise, and work). Also, the co-occurrence of two or more of these 11 addictive behaviors was investigated. Finally, the latent class structure of these addictions, and their associations with other measures, was examined. Results: We found that ever and last 30-day prevalence of one or more of these addictions was 79.2% and 61.5%, respectively. Ever and last 30-day co-occurrence of two or more of these addictions was 61.5% and 37.7%, respectively. Latent Class Analysis suggested two groups: a generally Non-addicted Group (67.2% of the sample) and a “Work Hard, Play Hard”-addicted Group that was particularly invested in addiction to love, sex, exercise, the Internet, and work. Supplementary analyses suggested that the single-response type self-reports may be measuring the addictions they intend to measure. Discussion and Conclusions: We suggest implications of these results for future studies and the development of prevention and treatment programs, though much more validation research is needed on the use of this type of measure.
PMCID: PMC3969796  PMID: 24701344
multiple addictions; prevalence; co-occurrence; latent class analysis; addiction groups; convergent validity
21.  Locations of Joint Physical Activity in Parent-Child Pairs Based on Accelerometer and GPS Monitoring 
Parental factors may play an important role in influencing children’s physical activity levels.
This cross-sectional study sought to describe the locations of joint physical activity among parents and children.
Parent-child pairs (N = 291) wore an Actigraph GT2M accelerometer and GlobalSat BT-335 Global Positioning Systems (GPS) device over the same 7-day period. Children were ages 8–14 years. Joint behavior was defined by a linear separation distance of less than 50m between parent and child. Land use classifications were assigned to GPS data points.
Joint physical activity was spread across residential locations (35%), and commercial venues (24%), and open spaces/parks (20%). Obese children and parents performed less joint physical activity in open spaces/parks than under/normal weight children and parents (p’s < .01).
Understanding where joint parent-child physical activity naturally occurs may inform location-based interventions to promote these behaviors.
PMCID: PMC3562385  PMID: 23011914
moderate-to-vigorous physical activity; sedentary behavior; parents; children; global positioning systems; environments
22.  Imagine HEALTH: results from a randomized pilot lifestyle intervention for obese Latino adolescents using Interactive Guided ImagerySM 
There is an urgent need for innovative and developmentally appropriate lifestyle interventions to promote healthy lifestyle behaviors and to prevent the early onset of type 2 diabetes and cardiovascular disease risk in obese Latino adolescents. Guided imagery offers promise to reduce stress and promote lifestyle behavior change to reduce disease risk in obese adolescents. Our objectives were: 1) To pilot test a new 12-wk lifestyle intervention using a randomized trial design in obese Latino adolescents, in order to determine the effects of the mind-body modality of Interactive Guided ImagerySM (IGI), over and above those of a didactic lifestyle education, on insulin resistance, eating and physical activity behaviors, stress and stress biomarkers; and 2) To explore the role of intervention-related changes in stress and stress biomarkers on changes in metabolic outcomes, particularly insulin resistance.
Obese (BMI > 95th percentile), Latino adolescents (n = 35, age 14-17) were randomized to receive either 12 weekly sessions of a lifestyle education plus guided imagery program (GI), or lifestyle education plus a digital storytelling computer program (DS). Between-group differences in behavioral, biological, and psychological outcomes were assessed using unpaired T-tests and ANCOVA in the 29 subjects who completed the intervention.
The GI group demonstrated significant reductions in leisure sedentary behavior (p < .05) and increases in moderate physical activity (p < .05) compared to DS group, and a trend toward reduced caloric intake in GI vs DS (p = .09). Salivary cortisol was acutely reduced by stress-reduction guided imagery (p < .01). There were no group differences in adiposity, insulin resistance, perceived stress, or stress biomarkers across the 12-week intervention, though decrease in serum cortisol over the course of the intervention was associated with improved insulin sensitivity (p = .03) independent of intervention group and other relevant co-variates.
The improvements in physical activity and stress biomarkers following this pilot intervention support the role of guided imagery in promoting healthy lifestyle behavior change and reducing metabolic disease risk in obese Latino adolescent populations. Future investigations will be needed to determine the full effects of the Imagine HEALTH intervention on insulin resistance, stress, and stress biomarkers.
Trial registration Registry #: NCT01895595
PMCID: PMC3931490  PMID: 24433565
Guided imagery; Obesity; Childhood; Latino; Adolescents; Lifestyle; Diabetes
23.  Evaluation of the Psychometric Properties of the Revised Inventory of the Dimensions of Emerging Adulthood (IDEA-R) in a Sample of Continuation High School Students 
Evaluation & the health professions  2012;10.1177/0163278712452664.
It is now presumed that youth do not move directly from adolescence to adulthood, but rather pass through a transitional period, “emerging adulthood.” The Revised Inventory of the Dimensions of Emerging Adulthood (IDEA-R) is a self-report instrument developed to examine the attributes of this period. “At-risk” youth appear to enter emerging adulthood developmental tasks at a slightly earlier age than general population youth. In the present study, a 21-item version of the IDEA was administered to a sample of 1676 “at-risk” continuation (alternative) high school students in Southern California. Principal component factor analysis with orthogonal rotation revealed three factors the authors labeled “Identity Exploration,” “Experimentation/Possibilities,” and “Independence.” Overall, the measure demonstrated high internal consistency. Construct validity analyses indicated that the measure was correlated with demographics, risk behaviors, and psychological measures. The authors conclude that the IDEA-R is a useful instrument for measuring emerging adulthood in at-risk populations.
PMCID: PMC3796175  PMID: 22786874
emerging adulthood; continuation high school; at-risk youth; inventory of the dimensions of emerging adulthood (IDEA); psychometrics
24.  Motivational Interviewing for Adolescent Substance Use: A Review of the Literature 
Addictive behaviors  2012;37(12):1325-1334.
Motivational Interviewing (MI) is a widely-used approach for addressing adolescent substance use. Recent meta-analytic findings show small but consistent effect sizes. However, differences in intervention format and intervention design, as well as possible mediators of change, have never been reviewed. This review of the literature summarizes the most up-to-date MI interventions with adolescents, looks at differences between intervention format and design, and discusses possible theory-based mechanisms of change. Of the 39 studies included in this review, 67% reported statistically significant improved substance use outcomes. Chi square results show no significant difference between interventions using feedback or not, or interventions combined with other treatment versus MI alone. The need for systematic investigation in theory-based mechanisms of change is presented.
PMCID: PMC3496394  PMID: 22958865
Motivational Interviewing; Adolescent; Substance Use; Alcohol; Tobacco; Marijuana
25.  mHealth approaches to child obesity prevention: successes, unique challenges, and next directions 
Childhood obesity continues to be a significant public health issue. mHealth systems offer state-of-the-art approaches to intervention design, delivery, and diffusion of treatment and prevention efforts. Benefits include cost effectiveness, potential for real-time data collection, feedback capability, minimized participant burden, relevance to multiple types of populations, and increased dissemination capability. However, these advantages are coupled with unique challenges. This commentary discusses challenges with using mHealth strategies for child obesity prevention, such as lack of scientific evidence base describing effectiveness of commercially available applications; relatively slower speed of technology development in academic research settings as compared with industry; data security, and patient privacy; potentially adverse consequences of increased sedentary screen time, and decreased focused attention due to technology use. Implications for researchers include development of more nuanced measures of screen time and other technology-related activities, and partnering with industry for developing healthier technologies. Implications for health practitioners include monitoring, assessing, and providing feedback to child obesity program designers about users' data transfer issues, perceived security and privacy, sedentary behavior, focused attention, and maintenance of behavior change. Implications for policy makers include regulation of claims and quality of apps (especially those aimed at children), supporting standardized data encryption and secure open architecture, and resources for research–industry partnerships that improve the look and feel of technology. Partnerships between academia and industry may promote solutions, as discussed in this commentary.
PMCID: PMC3830013  PMID: 24294329
Childhood; Obesity; Mobile technology; mHealth; Screen time; Focused attention; Sedentary behavior

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