Adam P. Knowlden

Systematic review of family and home-based interventions targeting paediatric overweight and obesity.

The family and home environment is a highly influential psychosocial antecedent of paediatric obesity. The purpose of this investigation was to systematically analyze family and home‐based randomized control trials aimed at treating overweight and obesity in children ages 2–7 years. In gathering materials for this review, a search of Cumulative Index to Nursing and Allied Health, MEDLINE, Education Resources Information Center, Psychology and Behavioural Sciences Collection and CENTRAL databases was conducted for the time frame of January 2001 to August 2011. The data extraction spanned three phases resulting in a total of nine interventions that met the specified inclusion criteria. Among the identified studies, eight produced significant outcomes. The majority of the programmes incorporated educational sessions targeting parents as the primary modality for intervention delivery. Less than one‐quarter of the interventions included home visitations; however, all of the interventions included home‐based activities to reinforce behaviour modification. Only three of the interventions applied social and behavioural theory, and only two interventions employed process evaluation. Additional research is needed to gauge the efficacy of the home and family milieu for treating paediatric obesity.

Theory of reasoned action and theory of planned behavior-based dietary interventions in adolescents and young adults: a systematic review.

Background Childhood obesity has reached epidemic proportions in many nations around the world. The theory of planned behavior (TPB) and the theory of reasoned action (TRA) have been used to successfully plan and evaluate numerous interventions for many different behaviors. The aim of this study was to systematically review and synthesize TPB and TRA-based dietary behavior interventions targeting adolescents and young adults. Methods The following databases were systematically searched to find articles for this review: Academic Search Premier; Cumulative Index to Nursing and Allied Health (CINAHL); Education Resources Information Center (ERIC); Health Source: Nursing/Academic Edition; Cochrane Central Register of Controlled Trials (CENTRAL); and MEDLINE. Inclusion criteria for articles were: 1) primary or secondary interventions, 2) with any quantitative design, 3) published in the English language, 4) between January 2003 and March 2014, 5) that targeted adolescents or young adults, 6) which included dietary change behavior as the outcome, and 7) utilized TPB or TRA. Results Of the eleven intervention studies evaluated, nine resulted in dietary behavior change that was attributed to the treatment. Additionally, all but one study found there to be a change in at least one construct of TRA or TPB, while one study did not measure constructs. All of the studies utilized some type of quantitative design, with two employing quasi-experimental, and eight employing randomized control trial design. Among the studies, four utilized technology including emails, social media posts, information on school websites, web-based activities, audio messages in classrooms, interactive DVDs, and health-related websites. Two studies incorporated goal setting and four employed persuasive communication. Conclusion Interventions directed toward changing dietary behaviors in adolescents should aim to incorporate multi-faceted, theory-based approaches. Future studies should consider utilizing randomized control trial design and operationalize variables. More research is needed to identify the optimal TPB and TRA modalities to modify dietary behaviors.

A Theory of Planned Behavior research model for predicting the sleep intentions and behaviors of undergraduate college students.

The purpose of this study was to operationalize the constructs of the Theory of Planned Behavior (TPB) to predict the sleep intentions and behaviors of undergraduate college students attending a Midwestern University. Data collection spanned three phases. The first phase included a semi-structured qualitative interview (nxa0=xa011), readability by Flesch-Kincaid, face and content validity by a panel of six experts. The second phase included stability reliability by test–retest (nxa0=xa037). The final phase included construct validation applying confirmatory factor analysis, internal consistency by Cronbach’s alpha, and predictive validity (nxa0=xa0197) employing multiple regression analysis. The majority of the participants reported receiving insufficient sleep (Mxa0=xa0407.3xa0min, SDxa0=xa0100.75). Multiple regression modeled perceived behavioral control, subjective norm, and attitude toward adequate sleep behavior on behavioral intention. Collectively, the significant predictors produced an Radjusted2 value of .362. Further specification of the model identified behavioral intention as a significant predictor of sleep behavior (Radjusted2xa0=xa0.185). As a population, undergraduate college students are not achieving adequate sleep. The TPB was found to be a useful framework for predicting the sleep intentions and behaviors of undergraduate students. Practical implications and recommendations for future research are discussed.

Role of Yoga in Preventing and Controlling Type 2 Diabetes Mellitus

Yoga has been suggested as a complementary and alternative treatment for type 2 diabetes mellitus. The purpose of this study was to review studies using yoga in preventing or controlling diabetes. Inclusion criteria were as follows: (1) conducted between 1993 and September 2011; (2) published in the English language; (3) used yoga asanas, pranayama, or dhyana as intervention; (4) involved diabetic patients and healthy volunteers, with insulin or glucose levels as outcomes, or individuals at risk for diabetes; (5) used any quantitative design; and (6) had biochemical, physiological, anthropometric, or clinical outcomes. A total of 17 studies met the inclusion criteria. Of these studies, 15 used yoga asanas, 12 used pranayama, and 1 each used shatkriyas (cleansing exercises) and yoga nidra (relaxation). Of the 11 studies that measured changes in fasting blood glucose, 9 showed significant decrease. Limitations include lack of theory-based approach, small sample sizes, and inability to gauge adherence.

Impact Evaluation of Enabling Mothers to Prevent Pediatric Obesity Through Web-Based Education and Reciprocal Determinism (EMPOWER) Randomized Control Trial

Background. The family and home environment is an influential antecedent of childhood obesity. The purpose of this study was to pilot test The Enabling Mothers to Prevent Pediatric Obesity through Web-Based Education and Reciprocal Determinism (EMPOWER) intervention; a newly developed, theory-based, online program for prevention of childhood obesity. Method. The two-arm, parallel group, randomized, participant-blinded trial targeted mothers with children between 4 and 6 years of age. Measures were collected at baseline, 4 weeks, and 8 weeks to evaluate programmatic effects on constructs of social cognitive theory (SCT) and obesity-related behaviors. Process evaluation transpired concurrently with each intervention session. Results. Fifty-seven participants were randomly assigned to receive either experimental EMPOWER (n = 29) or active control Healthy Lifestyles (n = 28) intervention. Significant main effects were identified for child physical activity, sugar-free beverage consumption, and screen time, indicating that both groups improved in these behaviors. A significant group-by-time interaction was detected for child fruit and vegetable (FV) consumption as well as the SCT construct of environment in the EMPOWER cohort. An increase of 1.613 cups of FVs (95% confidence interval = [0.698, 2.529]) was found in the experimental group, relative to the active control group. Change score analysis found changes in the home environment accounted for 31.4% of the change in child FV intake for the experimental group. Conclusions. Child physical activity, sugar-free beverage consumption, and screen time improved in both groups over the course of the trial. Only the theory-based intervention was efficacious in increasing child FV consumption. The EMPOWER program was robust for inducing change in the home environment leading to an increase in child FV intake (Cohen’s f = 0.160).

Systematic review of school-based obesity interventions targeting African American and Hispanic children.

Purpose. Minority groups are disproportionally affected by the obesity epidemic. Schools represent an environment conducive to targeting obesogenic risk factors. The purpose of this review was to analyze systematically school-based interventions targeting African American and Hispanic children. Methods. Inclusion criteria were: completed experimental and quasi-experimental interventions targeting African American or Hispanic children in school settings located in the United States. Results. A total of 10 articles met the specified inclusion criteria. Programs that affected body composition included physical activity and nutritional modalities and three of the programs modified school meals. Eight of the interventions incorporated behavioral theory as the framework for the intervention; however, only two programs explicitly operationalized the theories employed. Discussion. Efficacy of school-based interventions targeting minorities can be enhanced through explicit operationalization of behavioral theories, incorporation of systematic process evaluation, long-term follow-up of intervention outcomes, and inclusion of the family and home environment.

Yoga as an alternative and complementary treatment for cancer: a systematic review.

OBJECTIVESnCancer is an important public health concern, with millions of patients affected worldwide. Given the physical, psychological, and physiologic changes associated with cancer, holistic therapies are needed to treat all aspect of the disease.nnnDESIGNnA systematic review was conducted to determine the efficacy of yoga as a treatment option for cancer since 2010. Included studies were published from January 2010 to July 2012 and were indexed in MEDLINE, CINAHL, and Alt HealthWatch.nnnRESULTSnThirteen studies met the inclusion criteria. Eight of these studies were performed in the United States, and one each was conducted in Slovenia, Italy, the United Kingdom, Canada, and Turkey.nnnCONCLUSIONSnThe evidence for efficacy of yoga as an alternative and complementary treatment for cancer is mixed, although generally positive. Limitations of the reviewed interventions included a mixed use of instruments, weak quantitative designs, small sample sizes, and a lack of theory-based studies.

Process Evaluation of the Enabling Mothers to Prevent Pediatric Obesity Through Web-Based Learning and Reciprocal Determinism (EMPOWER) Randomized Control Trial:

Family-and-home-based interventions are an important vehicle for preventing childhood obesity. Systematic process evaluations have not been routinely conducted in assessment of these interventions. The purpose of this study was to plan and conduct a process evaluation of the Enabling Mothers to Prevent Pediatric Obesity Through Web-Based Learning and Reciprocal Determinism (EMPOWER) randomized control trial. The trial was composed of two web-based, mother-centered interventions for prevention of obesity in children between 4 and 6 years of age. Process evaluation used the components of program fidelity, dose delivered, dose received, context, reach, and recruitment. Categorical process evaluation data (program fidelity, dose delivered, dose exposure, and context) were assessed using Program Implementation Index (PII) values. Continuous process evaluation variables (dose satisfaction and recruitment) were assessed using ANOVA tests to evaluate mean differences between groups (experimental and control) and sessions (sessions 1 through 5). Process evaluation results found that both groups (experimental and control) were equivalent, and interventions were administered as planned. Analysis of web-based intervention process objectives requires tailoring of process evaluation models for online delivery. Dissemination of process evaluation results can advance best practices for implementing effective online health promotion programs.

A Feasibility and Efficacy Randomized Controlled Trial of an Online Preventative Program for Childhood Obesity: Protocol for the EMPOWER Intervention

Background: The home and family environment is a highly influential psychosocial antecedent of pediatric obesity. Implementation of conventional family- and home-based childhood obesity interventions is challenging for parents, often requiring them to attend multiple educational sessions. Attrition rates for traditional interventions are frequently high due to competing demands for parents’ time. Under such constraints, an Internet-based intervention has the potential to modify determinants of childhood obesity while making judicious use of parents’ time. Theory-based interventions offer many advantages over atheoretical interventions, including reduced intervention dosage, increased likelihood of behavioral change, and efficient resource allocation. Social cognitive theory (SCT) is a robust theoretical framework for addressing childhood obesity. SCT is a behavior change model rooted in reciprocal determinism, a causal paradigm that states that human functioning is the product of a dynamic interplay of behavioral, personal, and environmental factors. Objectives: To evaluate the efficacy of the Enabling Mothers to Prevent Childhood Obesity Through Web-Based Education and Reciprocal Determinism (EMPOWER) program, an Internet-based, theory-driven intervention for preventing childhood overweight and obesity. The project goal is supported by two specific aims: (1) modification of four obesogenic protective factors related to childhood obesity (minutes engaged in physical activity, servings of fruits and vegetables consumed, servings of sugar-sweetened and sugar-free beverages consumed, and minutes engaged in screen time), and (2) reification of five maternal-mediated constructs of SCT (environment, expectations, emotional coping, self-control, and self-efficacy). Methods: We will recruit mothers with children ages 4 to 6 years from childcare centers and randomly assign them to either the theory-based (experimental) or knowledge-based (control) arm of the trial. Data for the intervention will be collected at three intervals: baseline (week 0), posttest (week 4), and follow-up (8 weeks). At each phase of data collection, we will collect from both groups (1) measures of the four obesogenic protective factors, and (2) summated SCT construct scores. Constructs will be measured by a psychometrically valid and reliable SCT-based instrument. Behaviors will be evaluated by a behavior log. We will use a repeated-measures one-between-, one-within-participants design to evaluate intervention results. Constructs will be modified through Web-based learning modules, online interactive worksheets, and mother–child home-based activities. Process evaluation will assess program fidelity.

Health belief structural equation model predicting sleep behavior of employed college students

Adequate sleep comprising 7 to 8 hours per day is vital for health and effective functioning for all adults. The purpose of this study was to specify a health belief model to measure and predict the sleep behavior of employed college students. A 52-item instrument was developed with acceptable validity and reliability. A cross-sectional, convenience sample of 188 students was recruited for this study. Structural equation modeling was used to build models. The health belief model explained 34% of the variance in sleep behavior, with perceived severity, perceived barriers, cues to action, and self-efficacy identified as significant predictors.