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Featured researches published by Hong Xue.


Advances in Nutrition | 2017

A Systematic Review of Application and Effectiveness of mHealth Interventions for Obesity and Diabetes Treatment and Self-Management

Youfa Wang; Hong Xue; Yaqi Huang; Lili Huang; Dongsong Zhang

The use of mobile and wireless technologies and wearable devices for improving health care processes and outcomes (mHealth) is promising for health promotion among patients with chronic diseases such as obesity and diabetes. This study comprehensively examined published mHealth intervention studies for obesity and diabetes treatment and management to assess their effectiveness and provide recommendations for future research. We systematically searched PubMed for mHealth-related studies on diabetes and obesity treatment and management published during 2000-2016. Relevant information was extracted and analyzed. Twenty-four studies met inclusion criteria and varied in terms of sample size, ethnicity, gender, and age of the participating patients and length of follow-up. The mHealth interventions were categorized into 3 types: mobile phone text messaging, wearable or portable monitoring devices, and applications running on smartphones. Primary outcomes included weight loss (an average loss ranging from -1.97 kg in 16 wk to -7.1 kg in 5 wk) or maintenance and blood glucose reduction (an average decrease of glycated hemoglobin ranging from -0.4% in 10 mo to -1.9% in 12 mo); main secondary outcomes included behavior changes and patient perceptions such as self-efficacy and acceptability of the intervention programs. More than 50% of studies reported positive effects of interventions based on primary outcomes. The duration or length of intervention ranged from 1 wk to 24 mo. However, most studies included small samples and short intervention periods and did not use rigorous data collection or analytic approaches. Although some studies suggest that mHealth interventions are effective and promising, most are pilot studies or have limitations in their study designs. There is an essential need for future studies that use larger study samples, longer intervention (≥ 6 mo) and follow-up periods (≥ 6 mo), and integrative and personalized innovative mobile technologies to provide comprehensive and sustainable support for patients and health service providers.


Preventive Medicine | 2017

Pocket money, eating behaviors, and weight status among Chinese children : The Childhood Obesity Study in China mega-cities

Miao Li; Hong Xue; Peng Jia; Yaling Zhao; Zhiyong Wang; Fei Xu; Youfa Wang

Both the obesity rate and pocket money are rising among children in China. This study examined family correlates of childrens pocket money, associations of pocket money with eating behaviors and weight status, and how the associations may be modified by schools unhealthy food restrictions in urban China. Data were collected in 2015 from 1648 students in 16 primary and middle schools in four mega-cities in China (4 schools/city): Beijing, Shanghai, Nanjing, and Xian. Cluster robust negative binomial regression models were fit to assess family correlates of pocket money, associations of pocket money with child eating behaviors and weight outcomes, and possible modifying effects of schools unhealthy food restrictions. Sixty-nine percent of students received pocket money weekly. Students received more pocket money if mothers frequently ate out of home (IRR=2.28 [1.76, 2.94]) and/or family rarely had dinner together (IRR=1.42, 95%=[1.01, 1.99]). Students got less pocket money if parents were concerned about childs future health due to unhealthy eating (IRR=0.56 [0.32,0.98]). Students with more pocket money more frequently consumed (by 25-89%) sugary beverages, snacks, fast food, or at street food stalls, and were 45-90% more likely to be overweight/obese. Associations of pocket money with unhealthy eating and overweight/obesity were weaker in schools with unhealthy food restrictions. Pocket money is a risk factor for unhealthy eating and obesity in urban China. School policies may buffer pocket moneys negative influence on students eating and weight status.


Obesity Reviews | 2017

Applications of geographic information systems (GIS) data and methods in obesity-related research

Peng Jia; X. Cheng; Hong Xue; Youfa Wang

Geographic information systems (GIS) data/methods offer good promise for public health programs including obesity‐related research. This study systematically examined their applications and identified gaps and limitations in current obesity‐related research. A systematic search of PubMed for studies published before 20 May 2016, utilizing synonyms for GIS in combination with synonyms for obesity as search terms, identified 121 studies that met our inclusion criteria. We found primary applications of GIS data/methods in obesity‐related research included (i) visualization of spatial distribution of obesity and obesity‐related phenomena, and basic obesogenic environmental features, and (ii) construction of advanced obesogenic environmental indicators. We found high spatial heterogeneity in obesity prevalence/risk and obesogenic environmental factors. Also, study design and characteristics varied considerably across studies because of lack of established guidance and protocols in the field, which may also have contributed to the mixed findings about environmental impacts on obesity. Existing findings regarding built environment are more robust than those regarding food environment. Applications of GIS data/methods in obesity research are still limited, and related research faces many challenges. More and better GIS data and more friendly analysis methods are needed to expand future GIS applications in obesity‐related research.


International Journal of Obesity | 2017

School environment and policies, child eating behavior and overweight/obesity in urban China: the childhood obesity study in China megacities

Peng Jia; M. Li; Hong Xue; L. Lu; Fei Xu; Youfa Wang

Objectives:Childhood obesity is rising rapidly in China, especially in urban areas. Knowledge about how school environment and policies (SEPs) may have contributed to the epidemic remains limited. We examined SEP and their associations with students’ eating behaviors and overweight/obesity in urban China.Methods:Data were collected from 1648 students (plus their parents and schools) in 16 primary and middle schools (4 schools per city) in four megacities across China: Beijing, Shanghai, Nanjing and Xi’an. We examined nutrition-related SEP such as unhealthy food restriction, healthy food promotion, price control and nutrition guideline in school cafeterias (SCs), campus food stores (CFS), school vicinity food stalls (SVFS); SEP on physical activity, physical education (PE) and physical examination. Cluster robust regression models were fit to assess associations of SEP with child eating behaviors and overweight/obesity (defined based on body mass index, from measured weight and height).Results:All 16 schools had regular PE classes and annual physical examination. Most schools (n=12; 75%) had food policies in SC; few had policies on CFS (n=1; 6.25%) or SVFS (n=4; 25%). Local governments had a major role in regulating food prices, setting nutrition guidelines and regulating SVFS. Policies on CFS and SVFS were associated with less frequent intake of sugary beverage (odds ratio (OR)=0.54 (0.47–0.61); OR=0.70 (0.61–0.80)), snack (OR=0.84 (0.74–0.95); OR=0.78 (0.67–0.92)) and fast food (OR=0.58 (0.42–0.81); OR=0.56 (0.39–0.80)). The associations were stronger for boys. Policies on SC, CFS and SVFS were associated with lower likelihood for overweight/obesity (OR=0.60 (0.46–0.79); OR=0.74 (0.62–0.90); OR=0.51 (0.35–0.73)) and central obesity (OR=0.79 (0.70–0.89); OR=0.67 (0.48–0.92); OR=0.63 (0.48–0.84)) in boys. Policies on SC were associated with lower overweight/obesity odds (OR=0.48 (0.28–0.82)) for girls.Conclusions:SEP are heterogeneous in the four Chinese megacities, high-income areas. They affect child unhealthy eating and overweight/obesity, and are critical for fighting childhood obesity in China.


International Journal of Environmental Research and Public Health | 2017

Time Trend and Demographic and Geographic Disparities in Childhood Obesity Prevalence in China - Evidence from Twenty Years of Longitudinal Data

Peng Jia; Hong Xue; Ji Zhang; Youfa Wang

Childhood overweight and obesity (ow/ob) has become a serious threat to many countries, including China. However, limited evidence was obtained from longitudinal data in China. This study examined the secular trends and geographic variation in the prevalence of ow/ob and obesity only, and age, gender, and urban-rural disparities among school-aged children across China. Data from children aged 6–17 surveyed in China Health and Nutrition Survey (CHNS) from 1991 (n = 2712) to 2011 (n = 1054) were used. Overweight and obesity were defined based on the International Obesity Task Force (IOTF) recommended Asian age-sex-specific BMI cut-off-points. We found that: (1) childhood ow/ob and obesity prevalence increased from 11.7% to 25.2% and from 2.8% to 10.1% during 1991–2011, respectively; (2) children aged 6–12 experienced a 1.3 and 1.6 times increase in ow/ob and obesity prevalence than children aged 13–17, respectively; (3) the urban-rural gap in ow/ob prevalence widened; (4) ow/ob prevalence in boys was higher and increased faster than in girls, especially in an urban setting; and (5) geographic variation was observed with faster increases in more economically developed east, central and northeast regions than in the less developed west. The findings added more nuances to the picture of temporal changes in ow/ob prevalence among Chinese children.


American Journal of Preventive Medicine | 2017

Parental Expectations and Child Screen and Academic Sedentary Behaviors in China

Miao Li; Hong Xue; Weidong Wang; Youfa Wang

INTRODUCTIONnThis study examined sociodemographic patterns of parental expectations for academic performance, terminal degree, and future occupation for middle school students in China, and how these expectations influence students screen-based and academic-related sedentary behaviors through parenting control practices.nnnMETHODSnBased on data collected in 2013-2014 from 19,487 Chinese middle school students, bivariate logistic regressions tested associations between sociodemographic variables and parental expectations; structural equation models tested associations between parental expectations and students self-reported daily time on TV/Internet/homework, with parental controls as potential mediators. Analyses were performed in October 2015.nnnRESULTSnChinese students spent 0.96 (SD=1.44) hours/day on TV, 0.56 (SD=1.20) on Internet use, and 2.79 (SD=2.07) on homework. Girls spent more hours/day on homework (2.98 [SD=2.07] vs 2.62 [SD=2.04]) than boys but less on TV (0.90 [SD=1.37] vs 1.02 [SD=1.50]) and Internet (0.42 [SD=0.98] vs 0.69 [SD=1.36]). More than 30% of students were expected by parents to reach the top five of their class, almost 90% were expected to earn a college degree or higher, and >80% were expected to have a professional occupation. Students in rural areas, with siblings, and with lower parental SES tended to bear lower parental expectations. Children experiencing higher parental expectations spent more time on homework but less time on TV/Internet, partially explained by stricter parental homework and screen control.nnnCONCLUSIONSnHigh parental expectations suppress screen use but promote academic-related sedentary behaviors for Chinese children. Interventions should attend to academic-related sedentary behaviors and call for broader policies addressing sociocultural factors fueling high parental expectations.


Public Health Nutrition | 2017

Maternal perception of child overweight status and its association with weight-related parenting practices, their children’s health behaviours and weight change in China

Jungwon Min; Vivian Hc Wang; Hong Xue; Jie Mi; Youfa Wang

OBJECTIVEnChildhood obesity has increased rapidly in China, but understanding is limited on how parents perceive their childs weight status and how this perception affects weight-related parenting practices. We examined maternal perception of her childs weight status and its association with demographics, subsequent weight-related parenting practices, the childs health behaviours and weight change. Design/Setting/Subjects Maternal perception of childs weight status and health behaviours from the China Health and Nutrition Surveys were assessed at baseline and in follow-up surveys for 816 children aged 6-18 years during 2004-2011. Associations were tested using mixed models.nnnRESULTSnOverall, maternal and child perceptions of the childs weight status were fairly consistent (κ w=0·56), 63·8 % of mothers had correct perception. While 9·6 % of mothers perceived their child as overweight, 10·9 % of children did so, and 13·6 % of children were indeed overweight. Compared with mothers who viewed their children as normal weight, mothers who thought their children were overweight were more likely to encourage their children to increase their physical activity (OR; 95 % CI: 1·8; 1·0, 3·3) and to diet (4·3; 2·3, 7·8). Children perceived as overweight by their mothers were more likely to have insufficient physical activity (2·8; 1·6, 4·7) and gain more weight during follow-up (BMI Z-score, β (se): 1·0 (0·1); P<0·01) than children perceived by their mothers as normal weight.nnnCONCLUSIONSnIn China, mothers who perceive their child as overweight are more likely to encourage their child to exercise and modify their diet for weight management, but this encouragement does not seem to improve the childs health behaviours and weight status.


Pediatric Obesity | 2017

Nutrition and physical activity related school environment/policy factors and child obesity in China: A nationally representative study of 8573 students in 110 middle schools

M. Li; Hong Xue; Ming Wen; Wei Wang; Youfa Wang

Obesity is a serious threat to global health. School is a key setting for obesity intervention. Research on school risk factors for child obesity is limited in developing countries.


International Journal of Obesity | 2017

Time trends and factors in body mass index and obesity among children in China: 1997–2011

Huijun Wang; Hong Xue; Shufa Du; Jiguo Zhang; Youfa Wang; Bao-Yun Zhang

Background:Research on the shift in childrens body mass index (BMI) distribution is limited and conditional mean models used in the previous research have limitations in capturing cross-distribution variations in effects. The objectives are to analyze the shift in Chinese children’s BMI distribution and to test the associations between BMI distribution and other factors.Methods:We analyzed data collected from children 7 to 17 years old from the China Health and Nutrition Survey (CHNS) conducted in 1997, 2000, 2004, 2006, 2009 and 2011, from 2814 participants with 6799 observations. Longitudinal quantile regression (QR) was used to explore the effect of several factors on BMI trends in 2015.Results:The BMI curves shift to the right in boys and girls, with the distributions becoming wider, indicating a higher proportion of children have become overweight. The 5th, 15th, 50th, 85th and 95th BMI percentile curves all shifted upward from 1997 to 2011, and the higher percentiles had greater increases. The prevalence of overweight and obesity increased in boys and girls between 1997 and 2011, from 6.5 to 15.5% in boys and from 4.6 to 10.4% in girls. Energy intake and parents’ BMI levels had a positive association with children’s BMI. Per capita income was positively associated with changes in BMI only at the upper percentiles of the BMI distributions in boys. Increased physical activity (PA) was associated with decreased BMI in girls.Conclusions:Children in China are becoming increasingly overweight. Energy intake, parental BMI, PA and early menarche age in girls are associated with elevated BMI in children.


Pediatric Obesity | 2018

Projecting the impact of a nationwide school plain water access intervention on childhood obesity: a cost–benefit analysis

Ruopeng An; Hong Xue; Liang Wang; Youfa Wang

This study aimed to project the societal cost and benefit of an expansion of a water access intervention that promotes lunchtime plain water consumption by placing water dispensers in New York school cafeterias to all schools nationwide.

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Peng Jia

University of Twente

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Huijun Wang

Chinese Center for Disease Control and Prevention

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Fei Xu

Centers for Disease Control and Prevention

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M. Li

University at Buffalo

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Miao Li

State University of New York System

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Shufa Du

University of North Carolina at Chapel Hill

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