Eleanor Mackey

Obesity and the US military family.

This review discusses the current knowledge and future directions regarding obesity within the US military family (i.e., active‐duty servicemembers, as well as military spouses, children, retirees, and veterans). The increasing rates of overweight and obesity within the US military adversely impact military readiness, limit recruitment, and place a significant financial burden on the Department of Defense.

Peer Crowd Affiliations of Adult Gay Men: Linkages With Health Risk Behaviors

The social networks of adult gay men play important roles in both the promotion and prevention of health risk. The current investigation had 2 primary goals. First, this study examined the existence of gay peer crowds using the opinions of a large (N 340) online sample of self-identified gay men. Second, it explored how these peer crowd affiliations may be differentially related to health risk. All participants provided demographic information, opinions regarding the existence of gay peer crowds, and subjective ratings of identification with each crowd. Information regarding marijuana and other drug use, binge drinking, smoking, unprotected sex, and steroid use was also collected. The majority of men surveyed believed in the existence of gay peer crowds. Identifying with Circuit Partiers, Bears, Muscle Boys, Granolas, and Goths was related to adverse health behaviors. Low-risk peer crowd affiliations included Suburbans, Professionals, Twinks, and Activists. These effects were above and beyond those of age, income, and education. Implications for future research and intervention efforts with gay men are discussed.

Randomized Clinical Trial of Clinic-Integrated, Low-Intensity Treatment to Prevent Deterioration of Disease Care in Adolescents With Type 1 Diabetes

OBJECTIVE To evaluate the efficacy of two office-based treatments designed to prevent deterioration in glycemic control in young adolescents with type 1 diabetes in a randomized clinical trial. An individualized, more intensive family teamwork Coping skills program was compared with a diabetes Education treatment. RESEARCH DESIGN AND METHODS A baseline assessment was followed by four brief treatment sessions and immediate posttesting over the course of 1.5 years. Families of 226 early adolescents (ages 11–14) were randomized to receive either individualized coping skills education or diabetes education as adjunctive treatment to quarterly medical appointments. Continued follow-up occurred at 3.5-month intervals for a long-term follow-up of up to 3 years. A post hoc Usual Care group facilitated comparisons of glycemic control. RESULTS Growth curve analysis showed that both treatment groups successfully prevented deterioration in adolescent disease care and simultaneously improved adolescent and parent quality of life that included indicators of more effective communication and reduced adherence barriers—without a concomitant increase in diabetes-related or general family conflict. However, contrary to expectation, the Education group was more efficacious than the Coping group in improvement of disease adherence and glycemic control over a 3-year follow-up. CONCLUSIONS Low-intensity office-based quarterly treatment can maintain or improve disease care adherence in early adolescence when provided to adolescent/parent dyads. Better outcomes are achieved when treatment goals and techniques match the needs of the targeted population.

Maternal depressive symptoms and disease care status in youth with type 1 diabetes.

OBJECTIVE The current study assessed relations among maternal depressive symptoms, poorer youth diabetes adherence, and glycemic control. Specifically, hypothesized mediating links of lowered expectations of parental involvement, less parental monitoring, and more conflict were examined. METHOD Participants included 225 mothers and their young adolescents, aged 11-14 years (M = 12.73 years, SD = 1.2) diagnosed with T1D. Maternal depressive symptoms and outcome expectancies for maternal involvement were evaluated with self-report questionnaires. Multisource, parent/youth, and multimethod assessment of adherence, parental monitoring, and conflict were evaluated during a baseline assessment from a larger randomized clinical trial. RESULTS The first hypothesized structural equation model demonstrated a good fit and indicated that more maternal depressive symptoms were directly associated with less parental monitoring and more conflict, which in turn each were associated with poorer adherence and glycemic control. Although higher involvement expectancies were associated with more monitoring and less conflict, they were not associated with other model variables. A second alternative model also fit the data well; poorer youth adherence was associated with more conflict that in turn related to maternal depressive symptoms. CONCLUSIONS Two models were tested by which maternal depressive symptoms and poorer youth adherence were interrelated via less monitoring and more conflict. Follow-up longitudinal evaluation can best characterize the full extent of these relations.

Brief Report: The Relationship of Parental Support and Conflict to Physical Activity in Preadolescents with Type 1 Diabetes

OBJECTIVE To use structural equation modeling to provide a preliminary examination of the relationship between parental support and conflict regarding physical activity behaviors in preadolescents with type 1 diabetes. METHOD Parent-child dyads (n = 85, M child age = 10.8) completed physical activity items from the Diabetes Family Behavior Scale, Diabetes Related Conflict Scale, and Self-Care Inventory. Children completed physical activity items from the Center for Disease Controls Youth Risk Behavior Surveillance System, and activity was further measured via 24 hr recall interviews assessing physical activity behavior on a typical day. RESULTS Parental conflict was related to less frequent physical activity, whereas parental support was related to more frequent physical activity. CONCLUSIONS In this exploratory study, parental conflict and support for physical activity were related to physical activity in preadolescents with type 1 diabetes. Further research and development of interventions aimed at improving parental support and decreasing conflict around physical activity are warranted.

Parent-child relationships in Type 1 diabetes: associations among child behavior, parenting behavior, and pediatric parenting stress.

Interactions between parents and children can influence behavioral and emotional functioning related to Type 1 diabetes (T1D), yet have been relatively unexplored during preadolescence. The present study examined associations among child problem behaviors, critical parenting behaviors, and pediatric parenting stress in a sample of preadolescent youth with T1D. Data are available from 86 preadolescent-parent dyads who participated in the initial baseline assessment of a randomized controlled trial designed to assess the efficacy of an adherence promotion program. Measures included the Eyberg Child Behavior Inventory, the Diabetes Family Behavior Checklist, and the Pediatric Inventory for Parents. After controlling for significant demographic and medical characteristics, parents who reported their childs behavior as more problematic reported more difficulty with pediatric parenting stress, which was also associated with more child-reported critical parenting behaviors. Child problem behaviors and critical parenting behaviors were associated with one another, partially via their association with increased pediatric parenting stress. Potential clinical applications include interventions geared toward helping parents manage difficult child behaviors as well as cope with pediatric parenting stress, with the ultimate goal of improving the parent-child relationship and management of T1D.

The Feasibility of an E-mail–Delivered Intervention to Improve Nutrition and Physical Activity Behaviors in African American College Students

Abstract Objectives: To evaluate the feasibility and acceptability of an e-mail–delivered program to promote nutrition and physical activity in African American college students. Participants: Forty-seven students (76% female, aged 18–20 years). Methods: Students participated in a 24-week randomized controlled trial, receiving either general health information or the intervention focused on diet and physical activity. Results: At baseline, 80.9% and 76.0% of participants reported interest in improving diet and physical activity, respectively. Participants evidenced poor nutrition behaviors and 46% were overweight or obese. At 24 weeks, most participants (70% control, 84% intervention) were “somewhat” or “very” satisfied with the program. The program was feasible to administrate, with the exception of measurement of physical activity using accelerometers. Conclusions: An innovative e-mail–delivered program promoting positive health behaviors appears to be feasible and acceptable in African American college students. Further research is needed to evaluate program efficacy in this population, including prevention of excess weight gain.

An Electronic Wellness Program to Improve Diet and Exercise in College Students: A Pilot Study

Background In transitioning from adolescence to adulthood, college students are faced with significant challenges to their health habits. Independence, stress, and perceived lack of time by college students have been known to result in poor eating and exercise habits, which can lead to increased disease risk. Objective To assess the feasibility and to determine preliminary efficacy of an electronic wellness program in improving diet and physical activity in college students. Methods A 24-week diet and physical activity program was delivered via email to 148 college students. The intervention involved weekly, tailored, and interactive diet and physical activity goals. The control group received nondiet and nonexercise-related health fact sheets. Anthropometric and blood pressure measurements, as well as food frequency and physical activity surveys were conducted at baseline, week 12, and week 24. Students’ choice of fruit as a snack was also monitored at study visits. Results Students were 18-20 years old, 69% female, and from a diverse college campus (46% Caucasian, 23% Asian, 20% African American, 11% other). At week 24, 84% of students reported reading at least half of all emails. Mean change (standard error [SE]) from baseline of saturated fat intake was marginally significant between the treatment groups at week 24, 0.7 (SE 0.42) % kcal for control and -0.3 (SE 0.30) % kcal for intervention (P=0.048). A significant difference in percent of snacks chosen that were fruit (χ2 1, N=221 = 11.7, P<0.001) was detected between the intervention and control group at week 24. Conclusions Use of an electronic wellness program is feasible in college students and resulted in a decrease in saturated fat intake and an increase in observed fruit intake compared to a control group.

Hispanic overweight and obese children: Thirty cases managed with standard WIC counseling or motivational interviewing

Through Value Enhanced Nutrition Assessment and other techniques, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) engages clients to set their own nutrition goals. A case series of 30 Hispanic children (2-4.5 years) at ≥85th body mass index (BMI) percentile and their caregivers were followed through an urban WIC clinic. The dyads received either standard counseling (n = 15) or motivational interviewing (MI; n = 15) by one bilingual WIC nutritionist during 4 regularly scheduled visits over 6 months. Repeated measurements of anthropometric data, dietary patterns, and physical activity were obtained at each visit. Longitudinal bivariate analyses of caregiver concerns and goal selection were conducted along with mean comparisons of anthropometric and food frequency measures. Participation in counseling sessions as rated by the nutritionist was assessed by comparing Wilcoxon rank-sum scores. After counseling, children lost an adjusted mean weight of 0.878 kg (95% confidence in...

Effect of Adolescent Bariatric Surgery on the Brain and Cognition: A Pilot Study

Neurocognitive deficits in pediatric obesity relate to poor developmental outcomes. We sought preliminary evidence for changes in brain and cognitive functioning relevant to obesogenic behavior following vertical sleeve gastrectomy (VSG) in adolescents relative to wait‐listed (WL) and healthy controls (HC).