Joan K. Orrell-Valente

Media exposure, internalization of the thin ideal, and body dissatisfaction: Comparing Asian American and European American college females

Internalization of the thin ideal mediates the media exposure-body dissatisfaction relation in young adult European American females. There is little related research on Asian Americans. We used structural equations modeling to test: (1) whether media exposure was associated with body dissatisfaction in Asian American young adult females, (2) internalization of the thin ideal mediated any such association, and (3) whether the mediational model provided equivalent fit for European American and Asian American samples. Participants were 287 college females (154 Asian Americans, 133 European Americans). Internalization of the thin ideal explained the media exposure-body dissatisfaction association equally well for both groups. Results suggest that Asian Americans may be employing unhealthy weight control behaviors, and may be prone to developing eating disorders, at rates similar to European American young adult females. Clinicians need to screen carefully for body dissatisfaction, unhealthy weight control behaviors, and eating disorders in Asian American females.

Does Delivering Preventive Services in Primary Care Reduce Adolescent Risky Behavior

PURPOSE To determine whether the delivery of preventive services changes adolescent behavior. This exploratory study examined the trajectory of risk behavior among adolescents receiving care in three pediatric clinics, in which a preventive services intervention was delivered during well visits. METHODS The intervention consisted of screening and brief counseling from a provider, followed by a health educator visit. At age 14 (year 1), 904 adolescents had a risk assessment and intervention, followed by a risk assessment 1 year later at age 15 (year 2). Outcomes were changes in adolescent behavior related to seat belt and helmet use; tobacco, alcohol, and drug use; and sexual behavior. Analysis involved age-related comparisons between the intervention and several cross-sectional comparison samples from the age of 14-15 years. RESULTS The change in helmet use in the intervention sample was 100% higher (p < .05), and the change in seat belt use among males was 50% higher (p = .14); the change in smoking among males was 54% lower (p < .10), in alcohol use was no different, and in drug use was 10% higher (not significant [NS]); and the change in rate of sexual intercourse was 18% and 22% lower than cohort comparison samples (NS). CONCLUSIONS The intervention had the strongest effect in the area of helmet use, shows promise for increasing seat belt use and reducing smoking among male adolescents, and indicates a nonsignificant trend toward delaying the onset of sexual activity. Participation in the intervention seemed to have no effect on the rates of experimentation with alcohol and drugs between the ages of 14 and 15 years.

A Clinic-Based Lifestyle Intervention for Pediatric Obesity: Efficacy and Behavioral and Biochemical Predictors of Response

AIM To examine efficacy and predictors of response to a lifestyle intervention for obese youth. METHODS Retrospective chart review of 214 children and adolescents aged 8-19 years. Linear regression identified baseline predictors of response (delta BMI z-score) at first and ultimate follow-up visits. RESULTS Mean delta BMI z-score from baseline was -0.04 (p < 0.001) at first follow-up and -0.09 (p < 0.001) at ultimate follow-up (median time 10 mo) among 156 children and adolescents. Higher baseline BMI z-score predicted poor response at first and ultimate follow-up, explaining 10% of variance in response. Fasting insulin explained 6% of response variance at first follow-up. delta BMI z-score at the first visit along with baseline BMI z-score explained up to 50% of variance in response at ultimate visit. CONCLUSION Clinic-based interventions improve weight status. Baseline variables predict only a small proportion of response; response at the first visit is a more meaningful tool to guide clinical decisions.

Parents' Specific Concerns about Daily Asthma Medications for Children

Specific concerns from 706 parents regarding their childrens (M age = 8.0, SD = 3.9) use of daily asthma medications were systematically identified and organized. 270 (38.2%) of 706 parents expressed a total of 470 concerns (M = 1.74, SD = 0.93; Range 1–5), including concerns about side effects (48.9%; e.g., growth retardation); aspects of the regimen (29.3%; e.g., medication amount); and “steroid” use (10.4%). Independent predictors of parental concern included use of inhaled corticosteroids (OR = 1.60, 95% CI 1.07–2.40), nasal corticosteroids (OR = 1.70, 95% CI 1.21–2.38), and alternative therapies (OR = 1.84, 95% CI 1.32–2.56). Providers should be prepared to address a wide range of medication concerns, especially those related to side effects.

Children's and Parents' Report of Asthma Education Received from Physicians

Objective. Clinical practice guidelines recommend that physicians provide asthma education to patients and their families. To characterize parents’ and children’s perception of physician practice, we examined: (i) proportion of parents and children reporting physician discussion of asthma education topics; (ii) age-group differences in children’s report; (iii) site differences in children’s and parents’ report; (iv) sociodemographic and disease characteristics associated with children’s report; and (v) the relation between children’s report and adherence to daily controller medications. Methods. We conducted a cross-sectional study of 125 children with asthma (mean age = 11.3 years; 62% were male) and their parents. Parents provided demographic and disease data. Children reported whether physicians had ever discussed each of 16 asthma education topics with them. We used logistic regression to examine age-group and site differences in children’s report of physician discussion of each topic. Multivariate linear regression was used to determine associations between demographic (e.g., child age, race) and disease (e.g., symptom severity) variables and topics discussed. Results. On average, 34.7% of children reported physician discussion of a topic; 8–10-year-olds reported significantly fewer topics discussed than children aged 11 and older (p < .05). Whereas parents’ report differed by practice setting, children’s report did not. In multivariate analyses, child age (β = 0.46 (SE: 0.17); p < .01), persistent symptoms (β = 1.59 (SE: 0.80); p < .05), and number of outpatient asthma visits (β = 0.19 (SE: 0.08); p < .05) remained significantly associated with number of topics discussed. Conclusion. These results suggest that the majority of children either may not receive, or may not recall receiving, information from their physicians about the fundamentals of asthma management. Physicians have an invaluable teaching opportunity in the medical office visit and should consider capitalizing on this opportunity to build children’s sense of self-efficacy and competence in their self-care.

Decreasing Frequency of Asthma Education in Primary Care

Background: Provision of asthma education is associated with decreased hospitalizations and emergency department visits for patients with asthma. Our objective was to describe national trends in the provision of asthma education by primary care physicians in office settings. Methods: We used the National Ambulatory Medical Care Survey, a nationally representative dataset of patient visits to office-based physicians. We identified visits to primary care physicians for patients where asthma was a reason for the visit (asthma-related visits) or who had a diagnosis of asthma, but asthma was not a specific reason for the visit (asthma-unrelated visits) and estimated the percentage of visits where asthma education was provided. Data were available for asthma-related visits from 2001–2006 and from 2005–2006 only for asthma-unrelated visits. We examined time trends in asthma education and used multivariable logistic regression to identify independent patient and system-related factors that were predictors of asthma education. Results: The percentage of asthma-related visits where asthma education was provided declined during the study period, from 50% in 2001–2002 to 38% in 2005–2006 (p = 0.03). Asthma education was provided less frequently during asthma-unrelated visits compared to asthma-related visits (12% vs. 38%, p<0.0001). Independent predictors of providing asthma education included age ≤18 years, receipt of a controller medication, incorporation of an allied health professional during the visit, longer visit duration and Northeast region. Conclusions: Asthma education is underused by primary care physicians and rates have declined from 2001–2006. Interventions designed to promote awareness and greater use of asthma education are needed.