Hot Papers in the Literature

Receptivity to television fast-food restaurant marketing and obesity among US youth

Am J Prev Med. 2013 Nov;45(5):560–568.

McClure AC, Tanski SE, Gilbert-Diamond D, Adachi-Mejia AM, Li Z, Li Z, Sargent JD.

Background: Advertisement of fast food on TV may contribute to youth obesity.

Purpose: The goal of the study was to use cued recall to determine whether TV fast-food advertising is associated with youth obesity.

Methods: A national sample of 2541 US youth, aged 15–23 years, were surveyed in 2010–2011; data were analyzed in 2012. Respondents viewed a random subset of 20 advertisement frames (with brand names removed) selected from national TV fast-food restaurant advertisements (n=535) aired in the previous year. Respondents were asked if they had seen the advertisement, if they liked it, and if they could name the brand. A TV fast-food advertising receptivity score (a measure of exposure and response) was assigned; a 1-point increase was equivalent to affirmative responses to all three queries for two separate advertisements. Adjusted odds of obesity (based on self-reported height and weight), given higher TV fast-food advertising receptivity, are reported.

Results: The prevalence of overweight and obesity, weighted to the US population, was 20% and 16%, respectively. Obesity, sugar-sweetened beverage consumption, fast-food restaurant visit frequency, weekday TV time, and TV alcohol advertising receptivity were associated with higher TV fast-food advertising receptivity (median=3.3 [interquartile range: 2.2–4.2]). Only household income, TV time, and TV fast-food advertising receptivity retained multivariate associations with obesity. For every 1-point increase in TV fast-food advertising receptivity score, the odds of obesity increased by 19% (OR=1.19, 95% CI=1.01, 1.40). There was no association between receptivity to televised alcohol advertisements or fast-food restaurant visit frequency and obesity.

Conclusions: Using a cued-recall assessment, TV fast-food advertising receptivity was found to be associated with youth obesity.

PMID: 24139768 [PubMed - in process]

The Colorado LEAP Study: Rationale and design of a study to assess the short term longitudinal effectiveness of a preschool nutrition and physical activity program

BMC Public Health. 2013 Dec 9;13(1):1146.

Bellows LL, Johnson SL, Davies PL, Anderson J, Gavin WJ, Boles RE.

Background: The preschool years are a critical window for obesity prevention efforts; representing a time when children establish healthy eating habits and physical activity patterns. Understanding the context in which these behaviors develop is critical to formulating a model to address childhood obesity. The Colorado LEAP Study, an intervention study designed to prevent early childhood obesity, utilizes a social ecological approach to explore individual, family and environmental factors and their relationship to child weight status over a 3 year timeframe.

Methods: The study is located in 5 rural Colorado preschool centers and elementary schools (2 treatment and 3 control). Treatment sites receive The Food Friends^® nutrition (12 weeks) and physical activity (18 weeks) interventions during preschool. Observational measures assess 3 layers of the social ecological model including individual, family and organizational inputs. Children's food preferences, food intake, gross motor skills, physical activity (pedometers/accelerometers), cognitive, physical and social self-competence and height/weight are collected. Parents provide information on feeding and activity practices, child's diet, oral sensory characteristics, food neophobia, home food and activity environment, height/weight and physical activity (pedometers). School personnel complete a school environment and policy assessment. Measurements are conducted with 3 cohorts at 4 time points—baseline, post-intervention, 1- and 2-year follow-up.

Discussion: The design of this study allows for longitudinal exploration of relationships among eating habits, physical activity patterns, and weight status within and across spheres of the social ecological model. These methods advance traditional study designs by allowing not only for interaction among spheres but predictively across time. Further, the recruitment strategy includes both boys and girls from ethnic minority populations in rural areas and will provide insights into obesity prevention effects on these at risk populations. Trial registration: ClinicalTrials.gov: NCT01937481.

PMID: 24321701 [PubMed - in process]

Ninos Sanos, Familia Sana: Mexican immigrant study protocol for a multifaceted CBPR intervention to combat childhood obesity in two rural California towns

BMC Public Health. 2013 Oct 31;13(1):1033. [Epub ahead of print]

de la Torre A, Sadeghi B, Green RD, Kaiser LL, Flores YG, Jackson CF, Shaikh U, Whent L, Schaefer SE.

Background: Overweight and obese children are likely to develop serious health problems. Among children in the US, Latino children are affected disproportionally by the obesity epidemic. Ninos Sanos, Familia Sana (Healthy Children, Healthy Family) is a five-year, multi-faceted intervention study to decrease the rate of BMI growth in Mexican origin children in California's Central Valley. This paper describes the methodology applied to develop and launch the study.

Methods: Investigators use a community-based participatory research approach to develop a quasi-experimental intervention consisting of four main components including nutrition, physical activity, economic and art-community engagement. Each component's definition, method of delivery, data collection and evaluation are described. Strategies to maintain engagement of the comparison community are reported as well.

Discussion: We present a study methodology for an obesity prevention intervention in communities with unique environmental conditions due to rural and isolated location, limited infrastructure capacity and limited resources. This combined with numerous cultural considerations and an unstable population with limited exposure to researcher expectations necessitates reassessment and adaptation of recruitment strategies, intervention delivery and data collection methods. Trial registration # NCT01900613. Trial registration NCT01900613.

PMID: 24172250 [PubMed - as supplied by publisher]

Development of HomeSTEAD's physical activity and screen time physical environment inventory

Int J Behav Nutr Phys Act. 2013 Dec 5;10(1):132.

Hales D, Vaughn AE, Mazzucca S, Bryant MJ, Tabak RG, McWilliams C, Stevens J, Ward DS.

Background: The home environment has a significant influence on children's physical activity, sedentary behavior, dietary intake, and risk for obesity and chronic disease. Our understanding of the most influential factors and how they interact and impact child behavior is limited by current measurement tools, specifically the lack of a comprehensive instrument. HomeSTEAD (the Home Self-administered Tool for Environmental assessment of Activity and Diet) was designed to address this gap. This new tool contains four sections: home physical activity and media equipment inventory, family physical activity and screen time practices, home food inventory, and family food practices. This paper will describe HomeSTEAD's development and present reliability and validity evidence for the first section.

Methods: The ANGELO framework guided instrument development, and systematic literature reviews helped identify existing items or scales for possible inclusion. Refinement of items was based on expert review and cognitive interviews. Parents of children ages 3–12 years (n=125) completed the HomeSTEAD survey on three separate occasions over 12–18 days (Time 1, 2, and 3). The Time 1 survey also collected demographic information and parent report of child behaviors. Between Time 1 and 2, staff conducted an in-home observation and measured parent and child BMI. Kappa and intra-class correlations were used to examine reliability (test-retest) and validity (criterion and construct).

Results: Reliability and validity was strong for most items (97% having ICC>0.60 and 72% having r>0.50, respectively). Items with lower reliability generally had low variation between people. Lower validity estimates (r<0.30) were more common for items that assessed usability and accessibility, with observers generally rating usability and accessibility lower than parents. Small to moderate, but meaningful, correlations between physical environment factors and BMI, outside time, and screen time were observed (e.g., amount of child portable play equipment in good condition and easy to access was significantly associated with child BMI: r=–0.23), providing evidence of construct validity.

Conclusions: The HomeSTEAD instrument represents a clear advancement in the measurement of factors in the home environment related to child weight and weight-related behaviors. HomeSTEAD, in its entirety, represents a useful tool for researchers from which they can draw particular scales of greatest interest and highest relevance to their research questions.

PMID: 24313962 [PubMed - in process]

Practice-based evidence of effectiveness in an integrated nutrition and parenting education intervention for low-income parents

J Acad Nutr Diet. 2013 Dec 3. pii: S2212-2672(13)01550-5. doi: 10.1016/j.jand.2013.09.029. [Epub ahead of print]

Dickin KL, Hill TF, Dollahite JS.

Research identifying associations between parental behaviors and children's food and activity choices and weight suggests that the integration of parenting and nutrition education holds promise for promoting healthful eating and activity in families. However, translational research leading to sustainable interventions lags behind. Development and testing of interventions within actual program contexts is needed to facilitate translation to full-scale implementation. Therefore, the goal of this pilot study was to develop and test an integrated nutrition and parenting education intervention for low-income families within the Expanded Food and Nutrition Education Program in New York State. During a 21-month period, low-income parents of 3- to 11-year-olds were recruited through usual programmatic channels by nutrition program staff to participate in a series of eight workshops delivered to small groups. A validated self-administered questionnaire was used to assess behavior change outcomes among 210 parents who completed the program. Mean scores improved significantly for most behaviors, including adult fruit and vegetable intake; adult and child low-fat dairy and soda intake; and child fast-food intake, activity, and screen time (P<0.001). Many parents reported eating together with children at program entry, leaving little room to improve, but about 20% reported at least a 1-point improvement (on a 5-point scale). The most frequent change was reducing how often children ate fast food and was reported by >50% of parents. Design and testing through practice-based research can facilitate development of interventions that are both feasible and likely to improve eating and activity behaviors among low-income families.

PMID: 24315130 [PubMed - as supplied by publisher]

Assessment of active play, inactivity and perceived barriers in an inner city neighborhood

J Community Health. 2013 Dec 4. [Epub ahead of print]

Kottyan G, Kottyan L, Edwards NM, Unaka NI.

Avondale, a disadvantaged neighborhood in Cincinnati, lags behind on a number of indicators of child well-being. Childhood obesity has become increasingly prevalent, as one-third of Avondale's kindergarteners are obese or overweight. The study objective was to determine perceptions of the quantity of and obstacles to childhood physical activity in the Avondale community. Caregivers of children from two elementary schools were surveyed to assess their child's physical activity and barriers to being active. Three hundred and forty surveys were returned out of 1,047 for a response rate of 32%. On school days, 41% of caregivers reported that their children spent more than 2 h watching television, playing video games, or spending time on the computer. While over half of respondents reported that their children get more than 2 h of physical activity on school days, 14% of children were reported to be physically active less than 1 h per day. Caregivers identified violence, cost of extracurricular activities, and lack of organized activities as barriers to their child's physical activity. The overwhelming majority of caregivers expressed interest in a program to make local playgrounds safer. In conclusion, children in Avondale are not participating in enough physical activity and are exposed to more screen time than is recommended by the AAP. Safety concerns were identified as a critical barrier to address in future advocacy efforts in this community. This project represents an important step toward increasing the physical activity of children in Avondale and engaging the local community.

PMID: 24306236 [PubMed - as supplied by publisher]

Leveraging text messaging and mobile technology to support pediatric obesity-related behavior change: A qualitative study using parent focus groups and interviews

J Med Internet Res. 2013 Dec 6;15(12):e272.

Sharifi M, Dryden EM, Horan CM, Price S, Marshall R, Hacker K, Finkelstein JA, Taveras EM.

Background: Text messaging (short message service, SMS) is a widely accessible and potentially cost-effective medium for encouraging behavior change. Few studies have examined text messaging interventions to influence child health behaviors or explored parental perceptions of mobile technologies to support behavior change among children.

Objective: Our aim was to examine parental acceptability and preferences for text messaging to support pediatric obesity-related behavior change.

Methods: We conducted focus groups and follow-up interviews with parents of overweight and obese children, aged 6–12 years, seen for “well-child” care in eastern Massachusetts. A professional moderator used a semistructured discussion guide and sample text messages to catalyze group discussions. Seven participants then received 3 weeks of text messages before a follow-up one-on-one telephone interview. All focus groups and interviews were recorded and transcribed verbatim. Using a framework analysis approach, we systematically coded and analyzed group and interview data to identify salient and convergent themes.

Results: We reached thematic saturation after five focus groups and seven follow-up interviews with a total of 31 parents of diverse race/ethnicity and education levels. Parents were generally enthusiastic about receiving text messages to support healthy behaviors for their children and preferred them to paper or email communication because they are brief and difficult to ignore. Participants anticipated high responsiveness to messaging endorsed by their child's doctor and indicated they would appreciate messages 2–3 times/week or more as long as content remains relevant. Suggestions for maintaining message relevance included providing specific strategies for implementation and personalizing information. Most felt the negative features of text messaging (eg, limited message size) could be overcome by providing links within messages to other media including email or websites.

Conclusions: Text messaging is a promising medium for supporting pediatric obesity-related behavior change. Parent perspectives could assist in the design of text-based interventions.

Trial registration: Clinicaltrials.gov NCT01565161; http://clinicaltrials.gov/show/NCT01565161 (archived by WebCite at www.webcitation.org/6LSaqFyPP).

PMID: 24317406 [PubMed - in process]

Incidence of obesity among young US children living in low-income families, 2008–2011

Pediatrics. 2013 Dec;132(6):1006–1013.

Pan L, May AL, Wethington H, Dalenius K, Grummer-Strawn LM.

Objective: To examine the incidence and reverse of obesity among young low-income children and variations across population subgroups.

Methods: We included 1.2 million participants in federally funded child health and nutrition programs who were 0 to 23 months old in 2008 and were followed up 24 to 35 months later in 2010–2011. Weight and height were measured. Obesity at baseline was defined as gender-specific weight-for-length ≥95th percentile on the 2000 Centers for Disease Control and Prevention growth charts. Obesity at follow-up was defined as gender-specific BMI-for-age ≥95th percentile. We used a multivariable log-binomial model to estimate relative risk of obesity adjusting for gender, baseline age, race/ethnicity, duration of follow-up, and baseline weight-for-length percentile.

Results: The incidence of obesity was 11.0% after the follow-up period. The incidence was significantly higher among boys versus girls and higher among children aged 0 to 11 months at baseline versus those older. Compared with non-Hispanic whites, the risk of obesity was 35% higher among Hispanics and 49% higher among American Indians (AIs)/Alaska Natives (ANs), but 8% lower among non-Hispanic African Americans. Among children who were obese at baseline, 36.5% remained obese and 63.5% were nonobese at follow-up. The proportion of reversing of obesity was significantly lower among Hispanics and AIs/ANs than that among other racial/ethnic groups.

Conclusions: The high incidence underscores the importance of early-life obesity prevention in multiple settings for low-income children and their families. The variations within population subgroups suggest that culturally appropriate intervention efforts should be focused on Hispanics and AIs/ANs.

PMID: 24276843 [PubMed - in process]