Ariana M. Chao

Psychological Experience of Parents of Children With Type 1 Diabetes A Systematic Mixed-Studies Review

Purpose The purpose of this review is to describe the prevalence of psychological distress in parents of children with type 1 diabetes (T1DM), the relationship between parental psychological distress and health outcomes, and parents’ psychological experience of having a child with T1DM. Clinical and research implications are presented. Method A systematic mixed-studies review was undertaken to review the quantitative and qualitative research on the parental experience of having a child with T1DM. A total of 34 articles met the inclusion criteria and were included in the review. Results The prevalence of parental psychological distress across all studies ranged from 10% to 74%, with an average of 33.5% of parents reporting distress at diagnosis and 19% of parents reporting distress 1 to 4 years after diagnosis. Parental psychological distress in parents of children with T1DM, regardless of how it was defined, was associated with higher child self-report of stress and depressive symptoms, more problematic child behavior, and lower child self-report of quality of life. Parental psychological distress also had negative effects on diabetes management. Themes of the qualitative synthesis indicated that parents perceived T1DM as a difficult diagnosis that contributed to significant family disruption. Adjustment occurred over time; however, ongoing stress was experienced. Conclusions Screening for psychological distress in parents of children with T1DM is indicated, and preventive interventions are needed.

Methods for knowledge synthesis: An overview

OBJECTIVES To highlight recent advances in knowledge synthesis methods and reporting guidelines. BACKGROUND Knowledge synthesis is critical to advancing practice, research, and policy, but synthesizing knowledge from an often-heterogeneous body of literature is challenging. METHODS A review of knowledge synthesis methods and reporting guidelines for health sciences research was completed using Google Scholar, Medline, CINAHL, and PsycInfo. Relevant information was critiqued and summarized for applicability to health science and practice. RESULTS Recent advances and guidelines pertaining to systematic reviews, meta-analysis, qualitative synthesis, mixed studies reviews, integrative reviews, scoping reviews, RE-AIM reviews, and umbrella reviews are discussed and examples of the application of each method to cardiopulmonary research are provided. Methods of quality appraisal are also presented. CONCLUSIONS Advancements in knowledge synthesis and reporting guidelines enhance the quality, scope, and applicability of results; thus improving health science and clinical practice, and advancing health policy.

Food cravings, food intake, and weight status in a community-based sample

The aims of this study were to 1) determine the relationships between BMI and the frequency of food cravings for different categories of foods, 2) examine the associations between cravings for different types of foods and self-reported, habitual intake of these foods, and 3) assess how these relationships differ by BMI. Six hundred and forty-six participants (55.7% female; 66.4% White; mean age 29.5±9.1 years; mean BMI 27.3±5.5 kg/m(2)) completed a comprehensive assessment battery including the Food Craving Inventory (FCI) and a semi-quantitative food frequency questionnaire (FFQ). There was a significant positive relationship between BMI and food cravings. There were significant positive associations of cravings for sweets, high fats, carbohydrates/starches, and fast-food fats on respective intake of these types of foods; however, there were no significant interactions between food cravings and BMI on the respective type of food intake. This study indicates significant positive relationships between specific categories of food cravings and habitual intake of those foods.

Classroom Standing Desks and Sedentary Behavior: A Systematic Review

CONTEXT: Reducing sedentary behaviors, or time spent sitting, is an important target for health promotion in children. Standing desks in schools may be a feasible, modifiable, and acceptable environmental strategy to this end. OBJECTIVE: To examine the impact of school-based standing desk interventions on sedentary behavior and physical activity, health-related outcomes, and academic and behavioral outcomes in school-aged children. DATA SOURCES: Ovid Embase, Medline, PsycINFO, Web of Science, Global Health, and CINAHL. STUDY SELECTION: Full-text peer-reviewed journal publications written in English; samples of school-aged youth (5–18 years of age); study designs including the same participants at baseline and follow-up; and use of a standing desk as a component of the intervention. DATA EXTRACTION: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Eight studies satisfied selection criteria and used quasi-experimental (n = 4), randomized controlled trial (n = 3), and pre–post, no control (n = 1) designs. When examined, time spent standing increased in all studies (effect sizes: 0.38–0.71), while sitting time decreased from a range of 59 to 64 minutes (effect sizes: 0.27–0.49). Some studies reported increased physical activity and energy expenditure and improved classroom behavior. LIMITATIONS: One-half of the studies had nonrandomized designs, and most were pilot or feasibility studies. CONCLUSIONS: This initial evidence supports integrating standing desks into the classroom environment; this strategy has the potential to reduce sitting time and increase standing time among elementary schoolchildren. Additional research is needed to determine the impact of standing desks on academic performance and precursors of chronic disease risk.

Association between weight bias internalization and metabolic syndrome among treatment-seeking individuals with obesity.

Weight stigma is a chronic stressor that may increase cardiometabolic risk. Some individuals with obesity self‐stigmatize (i.e., weight bias internalization, WBI). No study to date has examined whether WBI is associated with metabolic syndrome.

Food cravings, binge eating, and eating disorder psychopathology: Exploring the moderating roles of gender and race.

OBJECTIVE To examine the moderating effects of gender and race on the relationships among food cravings, binge eating, and eating disorder psychopathology in a community sample. METHODS Data were collected from a convenience sample of 320 adults (53% male; mean age 28.5±8.2years; mean BMI 27.1±5.2kg/m(2); mean education 15.1±2.2years; 64% white, 24% black, and 13% other race) participating in a cross-sectional study examining the interactions between stress, self-control and addiction. Participants completed a comprehensive assessment panel including a demographic questionnaire, the Food Craving Inventory, and Eating Disorder Examination Questionnaire. Data were analyzed using multiple logistic regression for binge eating behavior and multiple linear regression for eating disorder psychopathology. RESULTS Overall, food cravings demonstrated significant main effects for binge eating behavior (adjusted OR=2.65, p<.001) and global eating disorder psychopathology (B=.47±.09, p<.001). Females had a stronger relationship between food cravings and eating disorder psychopathology than males; there were no statistically significant differences by race. CONCLUSION These findings, based on a diverse sample recruited from the community, suggest that food cravings are associated with binge eating and eating disorder psychopathology and may represent an important target for interventions.

Evaluating Intervention Programs Targeting Parents to Manage Childhood Overweight and Obesity: A Systematic Review Using the RE-AIM Framework

Intervention programs targeting parents to manage childhood overweight and obesity have emerged based on parents influence on the health behaviors of their children. The purpose of this review was to systematically evaluate intervention programs targeting parents to manage childhood overweight and obesity using the Reach, Efficacy, Adopt, Implementation, and Maintenance (RE-AIM) framework. There was a moderate risk of bias across all studies. The overall proportion of studies (n=7) reporting on each dimension of the RE-AIM framework ranged from 78.6% (reach) to 23.8% (maintenance). The majority of intervention programs demonstrated improvement in child BMI. However intervention programs did not reach families of diverse race/ethnicity, were provided by highly trained professionals, and demonstrated high attrition, thus limiting generalizability.

Food cravings mediate the relationship between chronic stress and body mass index

This study examined the relationships between chronic stress, food cravings, and body mass index. A community-based sample of adults (N = 619) completed a comprehensive assessment battery and heights and weights were measured. Chronic stress had a significant direct effect on food cravings, and food cravings had a significant direct effect on body mass index. The total effect of chronic stress on body mass index was significant. Food cravings partially mediated the relationship between chronic stress and body mass index. These findings are consistent with research that chronic stress may potentiate motivation for rewarding substances and behaviors and indicate that high food cravings may contribute to stress-related weight gain.

Self-management in early adolescence and differences by age at diagnosis and duration of type 1 diabetes.

Purpose The purpose of the study was to describe the frequency of diabetes self-management activities, processes, and goals among early adolescents. In addition, differences in self-management by age at diagnosis and duration of diabetes were explored. Methods A cross-sectional design was used to analyze baseline data from 320 adolescents with T1DM enrolled in a multisite clinical trial. Participants completed questionnaires on demographic/clinical characteristics and self-management. Results There was a transitional pattern of self-management with a high frequency of diabetes care activities, problem solving, and goals and variable amounts of collaboration with parents. After controlling for therapy type and age, youth with short diabetes duration reported performing significantly more diabetes care activities than individuals with a longer duration. Individuals with short diabetes duration had more frequent communication than individuals with a longer duration, which was associated with diagnosis in adolescence. Among those diagnosed as school age children, those with short diabetes duration reported significantly more diabetes goals than those with a longer duration. Conclusions A more specific understanding of self-management may help clinicians provide more targeted education and support. Adolescents with a long duration of diabetes need additional self-management support, particularly for diabetes care activities and communication.

Implementation of a School-based Internet Obesity Prevention Program for Adolescents

OBJECTIVE To evaluate the reach, adoption, and implementation of HEALTH[e]TEEN, a school-based Internet obesity prevention program, and examine differences in student participation and satisfaction by school, gender, age, and race/ethnicity. DESIGN Concurrent mixed method evaluation. SETTING Three public high schools in Connecticut. PARTICIPANTS Three hundred eighty-four adolescents, 8 teachers. INTERVENTION(S) HEALTH[e]TEEN vs HEALTH[e]TEEN plus coping skills training. MAIN OUTCOME MEASURE(S) Demographic and state-available data, measurements of student satisfaction and participation, interviews with school administrators and teachers. ANALYSIS Mixed and logistic models, content analysis. RESULTS The sample (n = 384) was diverse (35% white), with a mean age of 15.3 years and mean body mass index of 24.7 kg/m(2). Student participation (83% of lessons completed) and satisfaction (mean 3.6 out of 5) was high. Schools implementing the program in class had higher satisfaction and participation compared with schools that implemented the program as homework (P ≤ .001 and < .001, respectively). Girls had higher satisfaction and participation compared with boys (P = .02 and .03, respectively). Younger students had higher participation compared with older students, but no difference in satisfaction was noted (P = .03). CONCLUSIONS AND IMPLICATIONS Two school-based Internet programs to decrease obesity reached diverse adolescents, and were adopted and implemented with high student satisfaction and participation. Implementation of the intervention was influenced by setting (classroom vs homework), teacher characteristics, student age, and gender.