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  • 1.

    【2hr】Adolescent Physical Education Class Participation as a Predictor for Adult Physical Activity

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    机译 青少年体育课参与度可预测成人体育活动
    摘要：Background: The aim of this study was to determine whether engagement in more physical education (PE) classes during one high school year is associated with change in physical activity (PA) from adolescence to young adulthood.Methods: Data were from 1774 participants in Waves 2 (high school, 1996) and 4 (young adulthood, 2008) of the National Longitudinal Study of Adolescent to Adult Health. The predictor was number of PE classes/week in high school (daily, some, or none). The outcome was change in moderate-to-vigorous physical activity (ΔMVPA) over the 12-year period. ΔMVPA was based on differences in MVPA scores derived at each wave from responses to a physical activity behavior recall (range, −9 to 9 scale score or −15 to 15 MVPA episodes/week). Multivariable generalized linear models examined the association between PE participation and ΔMVPA, adjusting for sociodemographics, weight status, and school clustering.Results: In high school, 34.7% participated in daily PE, whereas 50.1% participated in none. Participation in more PE classes was associated with greater MVPA in high school (mean MVPAW2none = 3.11, standard deviation [SD] = 1.99; mean MVPAW2some = 3.70, SD = 2.00; mean MVPAW2daily = 4.31, SD = 1.95; p < 0.0001). Overall, MVPA decreased over the 12 years (median ΔMVPA = −1.0, or 1–2 MVPA episodes/week). MVPA decreased more for males (median ΔMVPAmale = −1.0, interquartile range [IQR] = −3.0 ± 1.0; median ΔMVPAfemale = 0.0, IQR = −2.0 ± 2.0; p < 0.0001) and those who had participated in some/daily PE (median ΔMVPAsome = −1.0, IQR = −3.0 ± 1.0; median ΔMVPAdaily = −1.0, IQR = −3.0 ± 1.0) than those not in PE (median ΔMVPAnone = 0.0, IQR = −2.0 ± 2.0; p < 0.0001). The relationship between PE and ΔMVPA was maintained in multivariable analyses (βsome = −0.58, standard error [SE] = 0.18; p = 0.002; βdaily = −0.93, SE = 0.16; p < 0.001).Conclusions: High school PE participation did not prevent declining PA from adolescence to young adulthood.
  • 2.

    【2hr】Early Childhood Screen Time and Parental Attitudes Toward Child Television Viewing in a Low-Income Latino Population Attending the Special Supplemental Nutrition Program for Women, Infants, and Children

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    机译 参加针对妇女，婴儿和儿童的特殊补充营养计划的低收入拉丁裔人口的幼儿屏幕放映时间和父母对儿童电视观看的态度
    摘要：Background: Early childhood media exposure is associated with obesity and multiple adverse health conditions. The aims of this study were to assess parental attitudes toward childhood television (TV) viewing in a low-income population and examine the extent to which child BMI, child/parent demographics, and household media environment are associated with adherence to American Academy of Pediatrics (AAP) guidelines for screen time.Methods: This was a cross-sectional survey study of 314 parents of children ages 0–5 years surveyed in English or Spanish by self-administered questionnaire at a Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinic in Oregon.Results: In this majority Latino sample (73%), half (53%) of the children met AAP guidelines on screen time limits, 56% met AAP guidelines for no TV in the child's bedroom, and 29% met both. Children were more likely to meet AAP guidelines when there were <2 TVs in the home, there was no TV during dinner, or their parents spent less time viewing electronic media. Parents who spent less time viewing electronic media were more likely to report believing that TV provides little value or usefulness.Conclusions: In this low-income, predominantly Latino population attending WIC, parent media-viewing and household media environment are strongly associated with child screen time. Programs aimed at reducing child screen time may benefit from interventions that address parental viewing habits.
  • 3.

    【2hr】A Conceptual Framework for the Expansion of Behavioral Interventions for Youth Obesity: A Family-Based Mindful Eating Approach

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    机译 扩大青少年肥胖的行为干预的概念框架：基于家庭的正念饮食方法
    摘要：Background: Currently, over 30% of US youth are overweight and 1 in 6 have metabolic syndrome, making youth obesity one of the major global health challenges of the 21st century. Few enduring treatment strategies have been identified in youth populations, and the majority of standard weight loss programs fail to adequately address the impact of psychological factors on eating behavior and the beneficial contribution of parental involvement in youth behavior change.Methods: A critical need exists to expand treatment development efforts beyond traditional education and cognitive-behavioral programs and explore alternative treatment models for youth obesity. Meditation-based mindful eating programs represent a unique and novel scientific approach to the current youth obesity epidemic given that they address key psychological variables affecting weight.Results: The recent expansion of mindfulness programs to include family relationships shows the immense potential for broadening the customarily individual focus of this intervention to include contextual factors thought to influence youth health outcomes.Conclusions: This article provides an overview of how both mindful eating and family systems theory fits within a conceptual framework in order to guide development of a comprehensive family-based mindful eating program for overweight youth.
  • 4.

    【2hr】Nutrition and Physical Activity Environments of Home-Based Child Care: What Hispanic Providers Have to Say

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    机译 家庭育儿的营养和体育活动环境：西班牙裔提供者必须说些什么
    摘要：Background: It is important to understand the perceptions and beliefs of family child care providers (FCCPs) regarding which factors influence children's physical activity (PA), screen-time (ST), and dietary behaviors in order to develop and implement appropriate obesity prevention interventions. The aim of this qualitative study was to explore the aforementioned perceptions and beliefs of FCCPs in Rhode Island.Methods: Four focus groups (n = 30) were held with FCCPs. Providers were female, Hispanic, and Spanish speaking. Providers were asked about different aspects of feeding, PA, and ST behaviors. Themes were coded using NVivo10 (QSR International Pty Ltd, Doncaster, Victoria, Australia). Content analysis was used to analyze final themes.Results: Providers understood the importance of providing opportunities for healthy eating and PA for the children they cared for, but there was room for improvement, especially with regard to certain feeding and ST practices. Several barriers were evident, including the lack of physical infrastructure for PA, cultural beliefs and practices related to child feeding, and difficulties working with parents to provide consistent messages across environments.Conclusions: Given that FCCPs are aware of the importance of healthy eating and PA, there is a need to address the specific barriers they face, and operationalize some of their knowledge into practical everyday actions. This formative work will inform the development of a culturally relevant, multicomponent intervention for ethnically diverse FCCPs to improve the food and PA environments of their homes, which should, in turn, improve the dietary, PA, and ST behaviors of the 2- to 5-year-old children they care for.
  • 5.

    【2hr】Body Mass Index Mediates the Effects of Low Income on Preschool Children's Executive Control, with Implications for Behavior and Academics

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    机译 体重指数介导了低收入对学龄前儿童执行控制的影响，对行为和学术有影响
    摘要：Background: Children from low-income backgrounds are more likely to have cognitive impairments, academic problems, and obesity. Biological mechanisms for the relationship between adiposity and neurocognitive functioning have been suggested, but the direction of effects is unclear.Methods: The relations among income, BMI, and cognitive-behavioral functioning were modeled longitudinally. Children (n = 306) were assessed at 36–39 months (Time 1; T1) and 63–67 months (Time 4; T4) through anthropometry, measures of executive control (EC), delay ability (DA), and questionnaires on academic readiness, social competence, and behavioral adjustment.Results: Income was positively related to T1 EC and DA and negatively related to T1 BMI. T1 BMI was negatively related to T4 EC, after controlling for T1 EC, but was unrelated to changes in DA. Neither T1 EC nor DA was related to changes in BMI. T4 EC predicted greater academic readiness and social competence and lower adjustment problems at T4. T4 BMI was related to higher T4 adjustment problems. There was an indirect effect of income on T4 EC through T1 BMI. There were indirect effects of T1 BMI on academic readiness, social competence, and adjustment through T4 EC. Children who were obese at T1 had a 19% lower rate of growth of EC, compared to nonobese children.Conclusions: BMI mediates the effect of income on children's EC and has negative implications for academic readiness, social competence, and behavioral adjustment. The dual impact of obesity and cognitive-behavioral problems underscores the importance of early identification of and intervention for overweight children which could have neurocognitive and social-emotional benefits.What's New: BMI mediates the effect of income on preschoolers' executive control (EC) and has negative implications for academic readiness and behavioral adjustment. EC and delay ability did not predict changes in BMI. Early identification of, and intervention for, overweight children may have neurocognitive and social-emotional benefits.
  • 6.

    【2hr】Clinicians' Implicit and Explicit Attitudes about Weight and Race and Treatment Approaches to Overweight for American Indian Children

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    机译 临床医生对体重和种族的内隐和外显态度以及美国印第安儿童的超重治疗方法
    摘要：Purpose: Obesity is one of the most serious health problems among American Indian/Alaska Native (AI/AN) children. We investigated Indian Health Service (IHS) primary care providers' implicit and explicit attitudes about weight and race and their association with treatment approaches to overweight in children.Methods: We conducted an online survey of long-term primary care clinicians in two western regions of the IHS. We used the existing Weight Attitude Implicit Association Test (IAT) and developed a new Native American Attitude IAT to measure implicit attitudes. Explicit attitudes about weight and race were assessed through self-report. We assessed self-rated treatment approaches to childhood overweight. We used linear regression models to evaluate the association of attitudes about weight and race with treatment approaches.Results: Our sample included 75 clinicians (56% response rate) who, on average, saw 74 patients per week. Fifty-five percent of clinicians reported that 30–60% of their child and adolescent patients were overweight or obese, and 25% of clinicians reported that 60–100% of their patients were overweight or obese. We found strong implicit bias favoring thin people (Cohen's d=1.44) and weak implicit bias favoring whites (Cohen's d=0.35). We found no association between implicit or explicit bias scores and self-reported treatment of childhood overweight. Continuing education on obesity was associated with self-rated success and competence in weight management.Conclusions: Weight and race bias exists among long-term IHS clinicians, but may not influence treatment approaches for overweight AI/AN children. Further research should assess the effect of clinicians' attitudes on real-world weight management.
  • 7.

    【2hr】Adolescent Obesity and Inflammation in Relation to Colorectal Cancer Risk: Recent Findings and Future Implications

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    机译 青少年肥胖和炎症与大肠癌风险的关系：最新发现和未来意义
    摘要：
  • 8.

    【2hr】Promoting Weight Maintenance among Overweight and Obese Hispanic Children in a Rural Practice

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    机译 在农村实践中促进超重和肥胖的西班牙裔儿童的体重维持
    摘要：Background: US Hispanic children experience a disproportionate burden of overweight and obesity. Comprehensive high-intensity behavioral programs have demonstrated effectiveness in improving weight status among obese children. However, there remains a need to develop more efficient interventions that are feasible in primary care and demonstrate effectiveness in Hispanic children.Methods: The pilot study used a two-group randomized design. Eligible overweight (BMI between the 85th and 94th percentile for age and gender) or obese (BMI ≥95th percentile) Hispanic children and their parents (N=118 child/parent dyads) were recruited from a rural pediatric clinic and randomized to: standard care (SC; n=61 dyads) or behavioral intervention (INT; n=57 dyads). The primary outcomes—weight, waist circumference, and zBMI—were measured at baseline, 2, 6, and 18 weeks. Multivariate logistic regression was used to examine the effect of INT on the likelihood of weight maintenance adjusting for potential confounding variables.Results: Significantly fewer INT children (68.5%) experienced weight gain, compared to SC children (89.7%; p=0.009). The same pattern was observed for waist circumference, where fewer INT children (44%) experienced an increase in waist circumference, compared to SC children (68.6%; p=0.02). Although a trend of improvement in favor of the INT was observed for zBMI, it was not significant.Conclusions: This study provides preliminary evidence for the feasibility of a primary-care–based approach to promoting weight maintenance among a high-risk population.
  • 9.

    【2hr】Sugar-Sweetened Beverages and Obesity among Children and Adolescents: A Review of Systematic Literature Reviews

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    机译 儿童和青少年的含糖饮料和肥胖：系统文献综述
    摘要：Background: The prevalence of overweight and obesity among children and adolescents has increased worldwide and has reached alarming proportions. Currently, sugar-sweetened beverages (SSBs) are the primary source of added sugar in the diet of children and adolescents. Contradictive findings from studies and reviews have fueled an endless debate on the role of SSBs in the development of childhood obesity.Methods: The primary aim of the present review of reviews was to assess how review- and study-level methodological factors explain conflicting results across reviews and meta-analyses by providing an up-to-date synthesis of recent evidence regarding the association between SSB consumption and weight gain, overweight, and obesity in a population of 6-month-old to 19-year-old children and adolescents. The secondary aim was to assess the quality of included reviews using the Assessment of Multiple SysTemAtic Reviews (AMSTAR) measurement tool. Systematic literature reviews and meta-analyses were included. The literature search was performed through the platforms Pubmed/Medline, Cinahl, and Web of Knowledge.Results: Thirteen reviews and meta-analyses were included. Nine reviews concluded that there was a direct association between SSBs and obesity in children and adolescents and four others did not. The quality of the included reviews was low to moderate, and the two reviews with the highest quality scores showed discrepant results.Conclusions: The majority of reviews concluded that there was a direct association between SSB consumption and weight gain, overweight, and obesity in children and adolescents. However, recent evidence from well-conducted meta-analyses shows discrepant results regarding the association between SSB and weight gain, overweight, and obesity among children and adolescents. Improving methodological quality of studies and reviews as well as ensuring responsible conduct of research and scientific integrity is essential for the provision of objective results.
  • 10.

    【2hr】A Community-Based Intervention Increases Physical Activity and Reduces Obesity in School-Age Children in North Carolina

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    机译 基于社区的干预措施增加了北卡罗莱纳州学龄儿童的体育锻炼并减少肥胖
    摘要：Background: Community-based interventions are promising approaches to obesity prevention, but few studies have prospectively evaluated them. The aim of this study was to evaluate a natural experiment—a community intervention designed to promote active living and decrease obesity within a small southern town.Methods: In 2011, community leaders implemented the Mebane on the Move intervention—a community-wide effort to promote physical activity (PA) and decrease obesity among residents of Mebane, North Carolina. We measured child PA and BMI before and after the intervention, using a nearby town not implementing an intervention as the comparison. In total, we assessed 64 children from Mebane and 40 from the comparison community 6 months before, as well as 34 and 18 children 6 months after the intervention. We assessed PA with accelerometers worn for 7 days and calculated BMI z-scores using children's height and weight. We conducted multivariable linear regressions examining pre- to postintervention change in minutes of PA and BMI z-score, adjusting for confounders.Results: At follow-up, children in Mebane modestly increased their moderate-to-vigorous PA (1.3 minutes per hour; 95% confidence interval (CI): 0.2, 2.3; p=0.03) and vigorous activity (0.8 minutes per hour; 95% CI: 0.1, 1.5; p=0.04) more than comparison children. In intervention children, BMI z-scores decreased 0.5 units (kg/m2; 95% CI: −0.9, −0.02; p=0.045), compared to children in the comparison community.Conclusions: We observed positive effects on PA level and weight status of children in Mebane, despite high rates of attrition, suggesting that the community-based intervention may have been successful.
  • 11.

    【2hr】Child Care Provider Adherence to Infant and Toddler Feeding Recommendations: Findings from the Baby Nutrition and Physical Activity Self-Assessment for Child Care (Baby NAP SACC) Study

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    机译 托儿服务提供者遵守婴幼儿喂养建议：婴儿营养和体育锻炼自我评估的婴儿发现（婴儿NAP SACC）研究结果
    摘要：Background: Identifying characteristics associated with the Institute of Medicine's (IOM) recommended feeding practices among infant and toddler care providers in child care centers could help in preventing childhood obesity.Methods: In 2009, at baseline in a pilot intervention study of 29 licensed Massachusetts child care centers with at least 50% of enrolled children identified as racial minorities, 57 infant and 109 toddler providers completed feeding questionnaires. To assess provider adherence to six IOM-recommended behaviors, we used cluster-adjusted multivariable logistic regression models including provider type (infant or toddler), race, education, and center Child and Adult Care Food Program (CACFP) participation.Results: In multivariable analysis, CACFP participation was associated with providers sitting with children at meals (odds ratio [OR], 5.2; 95% confidence interval [CI], 1.2–21.7), offering fruits and vegetables (OR, 3.3; 95% CI 1.7–6.2), and limiting fast food (OR, 3.5; 95% CI, 1.8–6.7). Providers at centers serving meals family style were less likely to allow children to leave food unfinished (OR, 0.27; 95% CI, 0.09–0.77). Infant providers were more likely than toddler providers to sit with children at meals (OR, 6.98; 95% CI, 1.51–32.09), allow children to eat when hungry (OR, 3.50; 95% CI, 1.34–9.16), and avoid serving sugary (OR, 8.74; 95% CI, 3.05–25.06) or fast foods (OR, 11.56; 95% CI, 3.20–41.80).Conclusions: CACFP participation may encourage IOM-recommended feeding practices among infant and toddler providers. Child care providers may benefit from education about how to feed infants and toddlers responsively, especially when offering foods family style. Future research should explore ways to promote child-centered feeding practices, while addressing barriers to providing children with nutrient-rich foods.
  • 12.

    【2hr】Treatment of Child/Adolescent Obesity Using the Addiction Model: A Smartphone App Pilot Study

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    机译 使用成瘾模型治疗儿童/青少年肥胖：智能手机应用程序先导研究
    摘要：Background: The aim of this study was to test a weight loss program for young people based on an addiction treatment approach.Methods: A pilot study (n=43) was conducted of a 20-week child/adolescent obesity intervention based on an addiction treatment model (staged, incremental withdrawal from problem foods, snacking/grazing, and excessive amounts at meals) and implemented by a server-integrated smartphone app with health professional support. The primary outcome was standardized %overBMI measured at four time points. Secondary outcomes were participants' self-ratings of self-esteem, control over food, and the degree they turned to food when stressed. User satisfaction data were collected with an online questionnaire. Latent growth modeling techniques were used to identify independent variables and possible mediating treatment process variables associated with weight change.Results: Mean age of participants was 16 years (range, 10–21), 65% girls, and 84% Caucasian. Twenty-seven (63%) completed the program. There was a significant decrease in %overBMI over time of 7.1. There were significant improvements in participant ratings of self-esteem, control over food, and a reduction in turning to food when stressed. Males, younger participants, and participants with higher levels of program compliance achieved better weight loss. Participants who reported that calling obesity an addiction made their guilt worse experienced poorer weight loss. Females were more likely than males to report “addiction guilt,” and this partly mediated the overall gender effect.Conclusions: The staged, incremental food withdrawal approach was feasible to implement and was useful in helping reduce excessive weight, particularly among boys.
  • 13.

    【2hr】Weight Management-Related Assessment and Counseling by Primary Care Providers in an Area of High Childhood Obesity Prevalence: Current Practices and Areas of Opportunity

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    机译 与肥胖管理相关的评估和儿童肥胖症高发地区的初级保健提供者的咨询：当前的实践和机会领域
    摘要：Background: Childhood obesity in Georgia exceeds the national rate. The state's pediatric primary care providers (PCPs) are well positioned to support behavior change, but little is known about provider perceptions and practices regarding this role.Purpose: The aim of this study was to assess and compare weight-management–related counseling perceptions and practices among Georgia's PCPs.Methods: In 2012–2013, 656 PCPs (265 pediatricians, 143 family practice physicians [FPs], and 248 nurse practitioners/physician assistants [NP/PAs]) completed a survey regarding weight-management–related practices at well-child visits before their voluntary participation in a free training on patient-centered counseling and child weight management. Data were analyzed in 2014. Likert scales were used to quantify responses from 1 (strongly disagree or never) to 5 (strongly agree or always). Responses of 4 and 5 responses were combined to denote agreement or usual practice. Chi-squared analyses tested for independent associations between pediatricians and others. Statistical significance was determined using two-sided tests and p value <0.05.Results: The majority of PCPs assessed fruit and vegetable intake (83%) and physical activity (78%), but pediatricians were more likely than FPs and NP/PAs to assess beverage intake (96% vs. 82–87%; p≤0.002) and screen time (86% vs. 74–75%; p≤0.003). Pediatricians were also more likely to counsel patients on lifestyle changes (88% vs. 71%; p<0.001) and to track progress (50% vs. 35–39%; p<0.05). Though all PCPs agreed that goal setting is an effective motivator (88%) and that behavior change increases with provider encouragement (85%), fewer were confident in their ability to counsel (72%).Conclusions: Our results show that many PCPS in Georgia, particularly pediatricians, have incorporated weight management counseling into their practice; however, important opportunities to strengthen these efforts by targeting known high-risk behaviors remain.
  • 14.

    【2hr】Effects of a Cognitive-Behavioral Therapy-Based Immersion Obesity Treatment Program for Adolescents on Weight, Fitness, and Cardiovascular Risk Factors: A Pilot Study

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    机译 基于认知行为疗法的青少年浸入式肥胖治疗计划对体重，健身和心血管危险因素的影响：一项初步研究
    摘要：Background: Comprehensive, residential treatment for severe obesity in adolescents may be an alternative to bariatric surgery and more efficacious than outpatient treatment. The aim of this study was to evaluate the effects of a long-term cognitive-behavioral therapy–based immersion obesity treatment program for adolescents.Methods: Twelve obese adolescents with BMIs above the 95th percentile completed a 14- to 18-week multicomponent intervention.Results: We observed significant improvements in BMI z-score, waist circumference, mile run time, and blood lipids.Conclusion: This study suggests that the tested program may be effective, at least in the short term; a randomized, controlled trial to further assess this model is warranted.
  • 15.

    【2hr】Evaluation of a Primary Care Intervention on Body Mass Index: The Maine Youth Overweight Collaborative

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    机译 体重指数的初级保健干预评估：缅因州青年超重合作组织
    摘要：Background: We evaluated the impact of a brief primary-care–based intervention, The Maine Youth Overweight Collaborative (MYOC), on BMI (kg/m2) z-score change among participants with obesity (BMI ≥95th percentile for age and sex), overweight (BMI ≥85th and <95th percentile), and healthy weight (≥50th and <85th percentile).Methods: A quasi-experimental field trial with nine intervention and nine control sites in urban and rural areas of Maine, MYOC focused on improvements in clinical decision support, charting BMI percentile, identifying patients with obesity, appropriate lab tests, and counseling families/patients. Retrospective longitudinal record reviews assessed BMI z-scores preintervention (from 1999 through October 2004) and one postintervention time point (between December 2006 and March 2008). Participants were youth ages 5–18 having two visits before the intervention with weight percentile greater than or equal to 95% (N=265). Secondary analyses focused on youths who are overweight (N=215) and healthy weight youth (N=506).Results: Although the MYOC intervention demonstrated significant provider and office system improvements, we found no significant changes in BMI z-scores in intervention versus control youth pre- to postintervention and significant flattening of upward trends among both intervention and control sites (p<0.001).Conclusions: This brief office-based intervention was associated with no significant improvement in BMI z-scores, compared to control sites. An important avenue for obesity prevention and treatment as part of a multisector approach in communities, this type of primary care intervention alone may be unlikely to impact BMI improvement given the limited dosage—an estimated 4–6 minutes for one patient contact.
  • 16.

    【2hr】Incorporating Primary and Secondary Prevention Approaches To Address Childhood Obesity Prevention and Treatment in a Low-Income, Ethnically Diverse Population: Study Design and Demographic Data from the Texas Childhood Obesity Research Demonstration (TX CORD) Study

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    机译 结合一级和二级预防方法来解决低收入，种族多样化人群中的儿童肥胖症预防和治疗：来自德克萨斯州儿童肥胖症研究示范（TX CORD）研究的研究设计和人口统计学数据
    摘要：Background: There is consensus that development and evaluation of a systems-oriented approach for child obesity prevention and treatment that includes both primary and secondary prevention efforts is needed. This article describes the study design and baseline data from the Texas Childhood Obesity Research Demonstration (TX CORD) project, which addresses child obesity among low-income, ethnically diverse overweight and obese children, ages 2–12 years; a two-tiered systems-oriented approach is hypothesized to reduce BMI z-scores, compared to primary prevention alone.Methods: Our study aims are to: (1) implement and evaluate a primary obesity prevention program; (2) implement and evaluate efficacy of a 12-month family-centered secondary obesity prevention program embedded within primary prevention; and (3) quantify the incremental cost-effectiveness of the secondary prevention program. Baseline demographic and behavioral data for the primary prevention community areas are presented.Results: Baseline data from preschool centers, elementary schools, and clinics indicate that most demographic variables are similar between intervention and comparison communities. Most families are low income (≤$25,000) and Hispanic/Latino (73.3–83.8%). The majority of parents were born outside of the United States. Child obesity rates exceed national values, ranging from 19.0% in preschool to 35.2% in fifth-grade children. Most parents report that their children consume sugary beverages, have a television in the bedroom, and do not consume adequate amounts of fruits and vegetables.Conclusions: Interventions to address childhood obesity are warranted in low-income, ethnically diverse communities. Integrating primary and secondary approaches is anticipated to provide sufficient exposure that will lead to significant decreases in childhood obesity.
  • 17.

    【2hr】Evaluation Protocol To Assess an Integrated Framework for the Implementation of the Childhood Obesity Research Demonstration Project at the California (CA-CORD) and Massachusetts (MA-CORD) Sites

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    机译 评估协议，以评估在加利福尼亚州（CA-CORD）和马萨诸塞州（MA-CORD）基地实施的儿童肥胖研究示范项目的综合框架
    摘要：Background: The long-term success of child obesity prevention and control efforts depends not only on the efficacy of the approaches selected, but also on the strategies through which they are implemented and sustained. This study introduces the Multilevel Implementation Framework (MIF), a conceptual model of factors affecting the implementation of multilevel, multisector interventions, and describes its application to the evaluation of two of three state sites (CA and MA) participating in the Childhood Obesity Research Demonstration (CORD) project.Methods/Design: A convergent mixed-methods design is used to document intervention activities and identify determinants of implementation effectiveness at the CA-CORD and MA-CORD sites. Data will be collected from multiple sectors and at multiple levels of influence (e.g., delivery system, academic-community partnership, and coalition). Quantitative surveys will be administered to coalition members and staff in participating delivery systems. Qualitative, semistructured interviews will be conducted with project leaders and key informants at multiple levels (e.g., leaders and frontline staff) within each delivery system. Document analysis of project-related materials and in vivo observations of training sessions will occur on an ongoing basis. Specific constructs assessed will be informed by the MIF. Results will be shared with project leaders and key stakeholders for the purposes of improving processes and informing sustainability discussions and will be used to test and refine the MIF.Conclusions: Study findings will contribute to knowledge about how to coordinate and implement change strategies within and across sectors in ways that effectively engage diverse stakeholders, minimize policy resistance, and maximize desired intervention outcomes.
  • 18.

    【2hr】The Relationship between Childhood Obesity, Low Socioeconomic Status, and Race/Ethnicity: Lessons from Massachusetts

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    机译 儿童肥胖，低社会经济地位与种族/民族之间的关系：马萨诸塞州的经验教训
    摘要：Background: Previous studies have shown race/ethnicity, particularly African American and/or Hispanic status, to be a predictor of overweight/obese status in children. However, these studies have failed to adjust for low socioeconomic status (SES). This study assessed whether race/ethnicity remained an independent predictor of childhood obesity when accounting for variations in SES (low-income) among communities in Massachusetts.Methods: This study was based on 2009 summarized data from 68 Massachusetts school districts with 111,799 students in grades 1, 4, 7, and 10. We studied the relationship between the rate of overweight/obese students (mean = 0.32; range = 0.10–0.46), the rate of African American and Hispanic students (mean = 0.17; range = 0.00–0.90), and the rate of low-income students (mean = 0.27; range = 0.02–0.87) in two and three dimensions. The main effect of the race/ethnicity rate, the low-income rate, and their interaction on the overweight and obese rate was investigated by multiple regression modeling.Results: Low-income was highly associated with overweight/obese status (p < 0.0001), whereas the effect of race/ethnicity (p = 0.27) and its interaction (p = 0.23) with low-income were not statistically significant. For every 1% increase in low-income, there was a 1.17% increase in overweight/obese status. This pattern was observed across all African American and Hispanic rates in the communities studied.Conclusions: Overweight/obese status was highly prevalent among Massachusetts students, varying from 10% to 46% across communities. Although there were higher rates of overweight/obese status among African American and Hispanic students, the relationship disappeared when controlling for family income. Our findings suggest low SES plays a more significant role in the nation's childhood obesity epidemic than race/ethnicity.
  • 19.

    【2hr】Obesity Risk in Children: The Role of Acculturation in the Feeding Practices and Styles of Low-Income Hispanic Families

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    机译 儿童肥胖风险：适应性在低收入西班牙裔家庭的喂养方式和风格中的作用
    摘要：Background: Parent feeding has been associated with child overweight/obesity in low-income families. Because acculturation to the United States has been associated with increased adult obesity, our study aim was to determine whether acculturation was associated with feeding in these populations.Methods: Low-income Hispanic mothers of preschoolers were recruited to participate in a longitudinal study examining child eating behaviors. At baseline, mothers completed questionnaires on feeding styles, feeding practices, and acculturation. Regression analyses compared feeding styles and food parenting practices of first-generation, immigrant mothers born outside the United States (n = 138) and mothers born in the United States (n = 31). The correlates of acculturation with these same constructs were also examined.Results: Immigrant mothers reported using highly directive food parenting practices more often than mothers born in the United States, including pressuring their child to consume more food, using food as a reward, and controlling child food intake by limiting less-healthy foods. First-generation mothers were more likely to show authoritarian, and less likely to show indulgent, feeding styles. Greater maternal acculturation was associated with less restriction of food for weight reasons.Conclusions: Although first-generation, immigrant mothers reported using highly controlling food parenting practices with their children, those born in the United States were more indulgent with their children in the feeding context. Mechanisms that promote greater indulgence in more-acculturated mothers need to be identified.
  • 20.

    【2hr】Friends Like Me: Associations in Overweight/Obese Status among Adolescent Friends by Race/Ethnicity, Sex, and Friendship Type

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    机译 像我这样的朋友：按种族/民族，性​​别和友谊类型分类的青少年朋友中超重/肥胖状况的协会
    摘要：Background: Little is known about how interpersonal friend relationships are associated with obesity in young people, particularly with regard to how race/ethnicity, type of friendship, and sex affect the association between friends' and adolescents' weight status. This study examined associations in weight status among adolescents and their friends, exploring magnitudes of associations across friendship type, sex, and race/ethnicity.Methods: As part of EAT-2010 (Eating and Activity in Teens), friend nominations and anthropometrics were obtained from adolescents (n = 2099: 54% female; 80% nonwhite; mean age: 14.2 ± 1.9 years). Generalized estimating equation logistic regression models were used to test associations between adolescents' overweight/obese status and friends' (i.e., friend group, female friends, male friends, female best friends, and male best friends) overweight/obese status. Interactions by adolescent race/ethnicity were examined.Results: The majority of significant associations were observed among white female adolescents' who had a 22–40% higher prevalence of overweight/obesity if their friends were overweight compared to white females whose friends were not overweight. In contrast, there were few significant differences for other adolescent female and male racial/ethnic groups for girls and boys. Results for friend groups and best friends were generally similar to one another.Conclusions: The association between friend and adolescent overweight/obese status depended on adolescents' sex, race/ethnicity, and friendship type. Given the similarities among friends, obesity interventions targeting youth, especially white females, should consider involving friends.
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