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.
Childhood; Obesity; Mobile technology; mHealth; Screen time; Focused attention; Sedentary behavior
Research examined joint physical activity and sedentary behavior among 291 parent-child pairs who both wore an accelerometer and global positioning systems (GPS) device over the same 7-day period.
Children were 52.2% female, 8-14 years, and 43.0% Hispanic. Parents were 87.6% female. An Actigraph GT2M accelerometer and GlobalSat BT-335 GPS device collected activity and global positioning data, respectively. Linear distance between the parent and child for each 30-sec. epoch was calculated using geographic coordinates from the GPS. Joint behavior was defined as a separation distance less than 50m between parents and children.
On average during non-school waking hours, parents and children spent 2.4 min. (SD = 4.1) per day performing moderate-to-vigorous physical activity (MVPA) together and 92.9 min. (SD = 40.1) per day in sedentary behavior together. Children engaged in an average of 10 min. per day of MVPA during non-school waking hours when their parent was nearby but not engaging in MVPA. During this same period, parents engaged in 4.6 min. per day of MVPA when their child was nearby but not engaging in MVPA. Household income level and the child’s age were negatively associated with joint MVPA. Girls engaged in a greater percentage of their total MVPA together with their parent than boys. Girls and older children engaged in more sedentary behavior together with their parent than boys and younger children. Older parents engaged in a greater percentage of their sedentary behavior together with their children than younger parents.
Replacing the time that parents and children spend together in sedentary pursuits with joint physical activity could have health benefits, especially for girls, older children, older parents, and higher income families.
moderate-to-vigorous physical activity; accelerometer; global positioning systems; age; sex
Effective school-based obesity prevention programs are needed to prevent and reduce the growing obesity risk among youth. Utilizing the evidence-rich areas of violence and substance use prevention, translation science may provide an efficient means for developing curricula across multiple health behaviors. This paper introduces Pathways to Health, a school-based obesity prevention program that was developed by translating from evidence-based violence and drug use prevention programs, Promoting Alternative THinking Strategies and the Midwestern Prevention Project STAR (STAR). We illustrate how a hypothesized underlying behavior change mechanism in two domains of risk behavior, violence and substance use, can be applied to obesity prevention. A 4-step translational process is provided and may be relevant for use in developing other curricula to address multiple health risk behaviors. Practical application and decision points are also provided.
Evidence-based preventive interventions developed over the past two decades represent great potential for enhancing public health and well-being. Research confirming the limited extent to which these interventions have been broadly and effectively implemented, however, indicates much progress is needed to achieve population-level impact. In part, progress requires Type 2 translation research that investigates the complex processes and systems through which evidence-based interventions are adopted, implemented, and sustained on a large scale, with a strong orientation toward devising empirically-driven strategies for increasing their population impact. In this article, we address two core challenges to the advancement of T2 translation research: (1) building infrastructure and capacity to support systems-oriented scaling up of evidence-based interventions, with well-integrated practice-oriented T2 research, and (2) developing an agenda and improving research methods for advancing T2 translation science. We also summarize a heuristic “Translation Science to Population Impact (TSci Impact) Framework.” It articulates key considerations in addressing the core challenges, with three components that represent: (1) four phases of translation functions to be investigated (pre-adoption, adoption, implementation, and sustainability); (2) the multiple contexts in which translation occurs, ranging from community to national levels; and (3) necessary practice and research infrastructure supports. Discussion of the framework addresses the critical roles of practitioner–scientist partnerships and networks, governmental agencies and policies at all levels, plus financing partnerships and structures, all required for both infrastructure development and advances in the science. The article concludes with two sets of recommended action steps that could provide impetus for advancing the next generation of T2 translation science and, in turn, potentially enhance the health and well-being of subsequent generations of youth and families.
Type 2 translation research; Prevention intervention; Adoption decisions; Dissemination; Implementation; Sustainability; Public health impact; Systems approach
This study examined relationships between greenness exposure and free-living physical activity behavior of children in smart growth and conventionally designed communities. Normalized Difference Vegetation Index (NDVI) was used to quantify children’s (n=208) greenness exposure at 30-second epoch accelerometer and GPS data points. A generalized linear mixed model with a kernel density smoothing term for addressing spatial autocorrelation was fit to analyze residential neighborhood activity data. Excluding activity at home and school-time, an epoch-level analysis found momentary greenness exposure was positively associated with the likelihood of contemporaneous moderate-to-vigorous physical activity (MVPA). This association was stronger for smart growth residents who experienced a 39% increase in odds of MVPA for a 10th to 90th percentile increase in exposure to greenness (OR=1.39, 95% CI 1.36–1.44). A subject-level analysis found children who experienced >20 minutes of daily exposure to greener spaces (>90th percentile) engaged in nearly 5 times the daily rate of MVPA of children with nearly zero daily exposure to greener spaces (95% CI 3.09–7.20).
Physical activity; GPS; Built environment; Smart growth; Obesity
Despite the well established influence of peer experiences on adolescent attitudes, thoughts, and behaviors, surprisingly little research has examined the importance of peer context and the increased prevalence of depressive symptoms accompanying the transition into adolescence. Examination of social networks may provide some insight into the role of peers in the vulnerability of some adolescents to depression. To address this issue, we leveraged an existing sample of 5,563 Chinese 10th graders to incorporate social network data into a multilevel regression model of depressive symptoms. We found that, in this sample, being nominated as a friend was more important than being nominated as most liked. Social network centrality was significantly associated with depression; those adolescents who were less connected were more likely to suffer from depression. The risk of depression for those who were marginal members of classroom social networks was substantial. These findings suggest that a social network perspective could help to increase the effectiveness of programs aimed at preventing adolescent depression.
Social Network; Adolescent; Depressive Symptoms; Peer relations; China
The aim of this study is to present the development of the Meanings of Eating Index (MEI) in a diverse sample of children. Exploratory factor analysis was performed on MEI items. Factors with eigenvalues above 1.0 were retained. Items that loaded on multiple factors or with item-total correlations below 0.50 were discarded. A 24-item, 5-factor scale comprised the final MEI. Personal Negative Emotions and Disturbed Eating were positively associated with frequency of high calorie snack food intake (r=0.21, p<0.05; r=0.33, p<0.01), Personal Well Being was positively associated with eating vegetables more frequently (r=0.20; p<0.05). Eating on Behalf of Others was negatively associated with frequency of vegetable intake (r=-.20; p<0.05). Pleasure Eating was not associated with dietary intake. The MEI shows promise as a tool for understanding the affective determinants of dietary intake in minority youth.
Eating behavior; Minority; Children; Latino
Aims: To investigate whether ethnic differences in vulnerability to peer norms supportive of alcohol use is a viable, partial explanation for the ethnic differences in reported prevalence and amount of alcohol use during high school. Methods: Survey data from a sample of 680 adolescents from Project STAR (Students Taught Awareness and Resistance) of the Midwestern Prevention Project were used. Hypotheses were tested using sequential, semi-continuous growth curve models. Results: Relative to Black adolescents, White adolescents reported greater peer alcohol use during middle school and were much more likely to consume alcohol during high school. General peer norms in seventh grade and middle school growth in alcohol use norms among close friends was predictive of a greater propensity to consume alcohol in ninth grade among White adolescents. Conclusion: Lower peer norms for alcohol use among Black adolescents might better account for differences between Black and White adolescents than the possibility that White adolescents are more vulnerable to peer norms.
Smart growth is an approach to urban planning that provides a framework for making community development decisions. Despite its growing use, it is not known whether smart growth can impact physical activity. This review utilizes existing built environment research on factors that have been used in smart growth planning to determine whether they are associated with physical activity or body mass.
Searching the MEDLINE, Psycinfo and Web-of-Knowledge databases, 204 articles were identified for descriptive review, and 44 for a more in-depth review of studies that evaluated four or more smart growth planning principles.
Five smart growth factors (diverse housing types, mixed land use, housing density, compact development patterns, and levels of open space) were associated with increased levels of physical activity and walking. Results varied by gender and method of environmental assessment. Body mass was largely unaffected.
This review suggests that several features of the built environment that are typically associated with smart growth planning may promote physical activity. Future smart growth community planning could be modified to include a dedicated focus on health, and future research should explore whether combinations or a critical mass of smart growth features is associated with better population health outcomes.
Smart Growth; Built Environment; Physical Activity; Obesity
Little is known about the co-occurrence of health risk behaviors in childhood that may signal later addictive behavior. Using a survey, this study evaluated high calorie, low nutrient HCLN intake and video gaming behaviors in 964 fourth grade children over 18 months, with stress, sensation-seeking, inhibitory control, grades, perceived safety of environment, and demographic variables as predictors. SEM and growth curve analyses supported a co-occurrence model with some support for addiction specificity. Male gender, free/reduced lunch, low perceived safety and low inhibitory control independently predicted both gaming and HCLN intake. Ethnicity and low stress predicted HCLN. The findings raise questions about whether living in some impoverished neighborhoods may contribute to social isolation characterized by staying indoors, and HCLN intake and video gaming as compensatory behaviors. Future prevention programs could include skills training for inhibitory control, combined with changes in the built environment that increase safety, e.g., implementing Safe Routes to School Programs.
eating; video gaming; children; addictive behavior
Based on a maladaptive coping explanation, the relationship between major depression (MD) and obesity could be strong among nonsmokers, who may engage in unhealthy eating and sedentary behavior to cope with depression. By contrast, the MD-obesity association could be weak among smokers, who can use tobacco (instead of food or sedentary behavior) to cope with mood symptoms. This study examined smoking status and tobacco dependence as moderators of the MD-obesity link.
Correlational, cross-sectional population-based survey of 41,654 US adults.
Main Outcome Measures
Obesity (BMI ≥ 30 kg/m2) and quantitative BMI value.
Current smoking status moderated the association between past-year MD and current obesity, as well as the link between MD and body mass index (BMI) value (ps ≤ .0001). MD predicted obesity and BMI among nonsmokers (ps < .0001) but did not do so in smokers (ps ≥ .10). Similar findings emerged with tobacco dependence as the moderator. Each finding persisted after accounting for demographics, psychiatric variables, and potential confounds.
Tobacco use characteristics appear to moderate the MD-obesity association in the US population. These findings may shed light on the mechanisms linking MD and obesity and have implications for identifying which individuals may benefit most from obesity interventions that target depressive symptoms.
Major Depression; Tobacco Use; Smoking; Obesity; Body Mass Index
The current study examined the long-term relationship of early adolescent alcohol use to number of sexual partners by emerging adulthood.
Using data from a 10-year longitudinal study, we collected data on 6th and 7th grade students’ alcohol use and their lifetime number of sexual partners ten years later.
We found a significant effect of early alcohol use in the 6th and 7th grades on lifetime number of sexual partners 10 years later, controlling for gender, age, race, peer norms, and sensation seeking. Early age at first intercourse mediated the association between early alcohol use and number of sexual partners.
Interventions focused on preventing use of alcohol at an early age may have the potential to reduce risks for sexually transmitted diseases during adolescence and emerging adulthood.
The aims of the study were to identify pathways from parent marijuana use to child problem behavior and parent-child relationships, and to evaluate whether effects of an earlier prevention program delivered to parents when they themselves were early adolescents would have a protective effect on these relationships one generation later.
Structural equation models were applied to the data of a second generation study of a drug abuse prevention trial. Models assessed whether there were sustained marijuana prevention effects on adults who had at least one school-age child at the end of the emerging adulthood period (age 26, N=257), and whether these effects mediated subsequent parent-child relationships and child impulsivity when parents were between the ages of 28 and 34.
Participants originally assigned to the program group used significantly less marijuana in early adulthood than did controls. In turn, parental marijuana use was positively related to child impulsivity and negatively to parental warmth, but not significantly related to parental aggression.
Results suggest both a direct relationship from parental marijuana use to child impulsivity, as well as indirect relationships through parent-child interactions. Results also strongly support a role for early adolescent prevention programs for drug use, both for participants’ own long-term benefit, as well as for the benefit of their future children.
Marijuana; Impulsivity; Prevention; Parent-Child Relationships; Intergenerational
Non-medical/illegal use of prescription stimulants popularly have been referred to as "study drugs". This paper discusses the current prevalence and consequences of misuse of these drugs and implications of this information for drug policy.
Study drugs are being misused annually by approximately 4% of older teens and emerging adults. Yet, there are numerous consequences of misuse of prescription stimulants including addiction, negative reactions to high dosages, and medical complications. Policy implications include continuing to limit access to study drugs, finding more safe prescription drug alternatives, interdiction, and public education.
Much more work is needed on prescription stimulant misuse assessment, identifying the extent of the social and economic costs of misuse, monitoring and reducing access, and developing prevention and cessation education efforts.
Injection drug users (IDUs) are at risk for HIV and viral hepatitis, and risky injection behavior persists despite decades of intervention. Cognitive behavioral theories (CBT) are commonly used to help understand risky injection behavior. We review findings from CBT-based studies of injection risk behavior among IDUs. An extensive literature search was conducted in Spring 2007. In total 33 studies were reviewed—26 epidemiological and 7 intervention studies. Findings suggest that some theoretical constructs have received fairly consistent support (e.g., self-efficacy, social norms), while others have yielded inconsistent or null results (e.g., perceived susceptibility, knowledge, behavioral intentions, perceived barriers, perceived benefits, response efficacy, perceived severity). We offer some possible explanations for these inconsistent findings, including differences in theoretical constructs and measures across studies and a need to examine the environmental structures that influence risky behaviors. Greater integration of CBT with a risk environment perspective may yield more conclusive findings and more effective interventions in the future.
HIV risk behavior; injection drug use; Cognitive Behavioral Theory; literature review