Julie A. Wright

Real-Time Recognition of Physical Activities and Their Intensities Using Wireless Accelerometers and a Heart Rate Monitor

In this paper, we present a real-time algorithm for automatic recognition of not only physical activities, but also, in some cases, their intensities, using five triaxial wireless accelerometers and a wireless heart rate monitor. The algorithm has been evaluated using datasets consisting of 30 physical gymnasium activities collected from a total of 21 people at two different labs. On these activities, we have obtained a recognition accuracy performance of 94.6% using subject-dependent training and 56.3% using subject-independent training. The addition of heart rate data improves subject-dependent recognition accuracy only by 1.2% and subject-independent recognition only by 2.1%. When recognizing activity type without differentiating intensity levels, we obtain a subject-independent performance of 80.6%. We discuss why heart rate data has such little discriminatory power.

Testing the predictive power of the transtheoretical model of behavior change applied to dietary fat intake

This study evaluated how well predictions from the transtheoretical model (TTM) generalized from smoking to diet. Longitudinal data were used from a randomized control trial on reducing dietary fat consumption in adults (n =1207) recruited from primary care practices. Predictive power was evaluated by making a priori predictions of the magnitude of change expected in the TTM constructs of temptation, pros and cons, and 10 processes of change when an individual transitions between the stages of change. Generalizability was evaluated by testing predictions based on smoking data. Three sets of predictions were made for each stage: Precontemplation (PC), Contemplation (C) and Preparation (PR) based on stage transition categories of no progress, progress and regression determined by stage at baseline versus stage at the 12-month follow-up. Univariate analysis of variance between stage transition groups was used to calculate the effect size [omega squared (omega(2))]. For diet predictions based on diet data, there was a high degree of confirmation: 92%, 95% and 92% for PC, C and PR, respectively. For diet predictions based on smoking data, 77%, 79% and 85% were confirmed, respectively, suggesting a moderate degree of generalizability. This study revised effect size estimates for future theory testing on the TTM applied to dietary fat.

Development of Review Criteria to Evaluate Health Behavior Change Websites

A growing number of major health care organizations, such as the American Heart Association and the Mayo Clinic, are investing considerable resources in developing and marketing Internet-based programs for health promotion and disease management. These programs have the potential to provide some of the best-tailored interventions in behavior change science at relatively low costs. This report discusses review criteria developed in order to conduct a systematic evaluation of Internet programs for preventive behaviors (alcohol, diet, exercise and smoking) and disease management (pediatric asthma, depression and diabetes.) These criteria can be used to develop and evaluate the quality of health promotion programs on the Internet.

Tender points as predictors of distress and the pharmacologic management of fibromyalgia syndrome

The object of this study was to determine the association between tender point pain ratings, tender point counts and distress in people with fibromyalgia and to review the pharmacotherapy of fibromyalgia. Demographic, psychosocial, and health status information was collected from 316 health maintenance organization members with fibromyalgia. A manual tender point exam was conducted. Tender point counts predicted 3.0%, and tender point severity ratings predicted 8.3%, of the variance in distress. Little difference was found between the variance predicted for physical versus psychologic distress. A principal components analysis of all measures produced four distinct factors: global–physical functioning, tender points, psychologic, and physical. Tender point pain ratings and counts predicted a small but significant amount of variance in distress. In addition, FMS involves at least four rather distinct factors, one of which is related to tender points. Pharmacotherapeutic management is provided on a patient-specific basis including pharmacokinetics, pharmacodynamic, pathophysiologic, and psychosocial needs designed and modulated for each individual patient.

Randomized Trial of a Family-based, Automated, Conversational Obesity Treatment Program for Underserved Populations

To evaluate the acceptability and feasibility of a scalable obesity treatment program integrated with pediatric primary care (PC) and delivered using interactive voice technology (IVR) to families from underserved populations.

Weight Loss Surgery Eligibility According to Various BMI Criteria Among Adolescents

A BMI cutoff point at the 99th percentile for age and gender or at 40 kg/m2 has been suggested for more aggressive treatment of adolescent obesity. The main objective of this study was to determine the proportion of adolescents eligible for weight loss surgery (WLS) based on various BMI cutoff points. Data was extracted from the electronic medical record database of an urban pediatric ambulatory care center over 4 years. National data were used to calculate BMI percentiles (Centers for Disease Control and Prevention (CDC), 2000). Eligibility for WLS was based on a BMI percentile criterion (≥99th percentile) or the adult WLS cutoff point (≥40 kg/m2). The sample consisted of 3,220 adolescents aged 12–17.9 years, of which 53% were female, 55% were of black race, and 17% of Hispanic ethnicity. Overall, 88 (3%) adolescents had a BMI ≥40 kg/m2 and 236 (7%) had a BMI ≥99th percentile (P < 0.001). All adolescents with BMI ≥40 kg/m2 had a BMI ≥99th percentile. A total of 159/2,007 (8%) of 12–14.9‐year olds had a BMI ≥99th percentile compared with 77/1,213 (6%) 15–17.9‐year olds (P = 0.10), whereas 43/2,007 (2%) of 12–14.9‐year olds had a BMI ≥40 kg/m2 compared with 45/1,213 (4%) 15–17.9‐year olds (P = 0.003). In summary, a relatively large proportion of adolescents from a diverse urban population would qualify for WLS based on the percentile criterion. Fewer adolescents would be eligible based on the adult WLS criterion, and younger adolescents would be less likely to be eligible for WLS than older adolescents.

Depressive Symptoms and Length of U.S. Residency Are Associated with Obesity among Low-Income Latina Mothers: A Cross-Sectional Analysis

Latinos are the largest minority population group in the United States (U.S.), and low-income Latina women are at elevated risk of depression and obesity. Thus, the prevention of these two problems is a pressing public health concern in this population. Both depressive symptoms and obesity are modifiable factors that can be addressed by culturally relevant interventions. However, the association between depressive symptoms and obesity in Latina immigrant women is not well understood. Therefore, this cross-sectional study examined the association between depressive symptoms and obesity among Latina women of childbearing age (15–44). Participants (n = 147) were low-income, predominantly immigrant Latina mothers enrolled in the Latina Mothers′ Child Feeding Practices and Style Study. Women were eligible to participate if they self-identified as Latina; were enrolled in or eligible for the Special Supplemental Nutrition Program for Women, Infants and Children program; had a child between ages two and five years; and were living in the U.S. for at least one year, and residing in Rhode Island. Enrolled participants completed a survey in their language of preference (English or Spanish) administered by bilingual interviewers. About one-third (34%) of participants were classified as having obesity (BMI ≥ 30 kg/m2), 28.3% had elevated depressive symptoms (CES-D ≥ 16), and 70.1% were immigrants. Women with elevated depressive symptoms had increased odds of having obesity (odds ratio (OR) = 2.80, 95% confidence interval (CI): 1.24–6.33). Additionally, among immigrants, length of U.S. residency was associated with increased odds of obesity (OR = 1.05, 95% CI: 1.02–1.09). Findings underscore the need for screening and culturally relevant interventions designed to address both depressive symptoms and obesity among low-income Latina women of childbearing age. Furthermore, findings highlight the importance of taking into account the length of residency in the U.S. when designing interventions targeting Latina immigrants.

Physical Activity Domains/Recommendations and Leukocyte Telomere Length in U.S. Adults

Purpose The purpose of this study was to examine the associations between different physical activity (PA) domains, PA recommendations, and leukocyte telomere length (LTL) using data from a nationally representative sample of U.S. adults in the National Health and Nutrition Examination Survey, 1999–2002. Methods A total of 6933 U.S. adults (3402 men, 3531 women; age range: 20–84 yr) who completed demographic, general health and PA questionnaires and provided a blood sample were included in the analyses. Multivariable-adjusted linear regression models were used to determine associations between PA (domain-specific PA [household/yard work PA, transportation PA, moderate leisure time PA (LTPA), and vigorous LTPA], total moderate PA and PA recommendation groups), and log-transformed LTL adjusting for age, gender, education, cigarette smoking, alcohol consumption, and body mass index. Results On average, an increase of 1 h·wk−1 of vigorous LTPA was associated with a 0.31% (P < 0.001) longer LTL, and an increase of 1 h·wk−1 of household/yard work PA was associated with a 0.21% (P = 0.03) shorter LTL while adjusted for sociodemographic and health behavior covariates. Neither transportation PA nor moderate LTPA was significantly associated with LTL. In addition, compared with not meeting the PA recommendation (<150 min·wk−1), exceeding the recommended PA levels (≥300 min·wk−1) was positively associated with longer LTL (P = 0.04), whereas there was no difference in telomere length between those not meeting versus those meeting the PA recommendation (150–299 min·wk−1). Conclusion Greater engagement in vigorous LTPA and exceeding the PA recommendation may have a protective effect against telomere shortening. Future studies should examine the association between PA and LTL by exploring potential mediators such as sedentary behavior, genetics, nutrition, and chronic diseases.

Associations Between Maternal Depressive Symptoms and Nonresponsive Feeding Styles and Practices in Mothers of Young Children: A Systematic Review

Background Childhood obesity is a significant global public health problem due to increasing rates worldwide. Growing evidence suggests that nonresponsive parental feeding styles and practices are important influences on children’s eating behaviors and weight status, especially during early childhood. Therefore, understanding parental factors that may influence nonresponsive parental feeding styles and practices is significant for the development of interventions to prevent childhood obesity. Objective The objectives of this systematic review were to (1) identify and review existing research examining the associations between maternal depressive symptoms and use of nonresponsive feeding styles and practices among mothers of young children (2-8 years of age), (2) highlight the limitations of reviewed studies, and (3) generate suggestions for future research. Methods Using the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) guidelines, six electronic academic databases were searched for peer-reviewed, full-text papers published in English between January 2000 and June 2016. Only studies with mothers 18+ years old of normally developing children between 2 and 8 years of age were included. Of the 297 citations identified, 35 full-text papers were retrieved and 8 were reviewed. Results The reviewed studies provided mixed evidence for associations between maternal depressive symptoms and nonresponsive feeding styles and practices. Two out of three studies reported positive associations with nonresponsive feeding styles, in that mothers with elevated depressive symptoms were more likely than mothers without those symptoms to exhibit uninvolved and permissive or indulgent feeding styles. Furthermore, results of reviewed studies provide good evidence for association between maternal depressive symptoms and instrumental feeding (3 of 3 reviewed studies) and nonresponsive family mealtime practices (3/3), but mixed evidence for pressuring children to eat (3/6) and emotional feeding (1/3). In addition, evidence for the association between maternal depressive symptoms and restricting child food intake was mixed: one study (1/6) found a positive association; two studies (2/6) found a negative association; whereas one study (1/6) found no association. Conclusions This review indicates that the results of studies examining the associations between maternal depressive symptoms and parental feeding styles and practices are mixed. Limitations of studies included in this review should be noted: (1) the use of a diverse set of self-report questionnaires to assess parental feeding practices is problematic due to potential misclassification and makes it difficult to compare these outcomes across studies, thus caution must be taken in drawing conclusions; and (2) the majority of included studies (6/8) were cross-sectional. There is a need for additional longitudinal studies to disentangle the influence of depression on parental feeding styles and practices. Nevertheless, given that depressive symptoms and feeding styles and practices are potentially modifiable, it is important to understand their relationship to inform obesity prevention interventions and programs.

Easier said than done: a qualitative study conducted in the USA exploring Latino family child care home providers as role models for healthy eating and physical activity behaviours

Objective Latinos are the largest and most rapidly growing minority population group in the USA and are disproportionally affected by obesity and related chronic diseases. Child care providers likely influence the eating and physical activity behaviours of children in their care, and therefore are important targets for interventions designed to prevent childhood obesity. Nonetheless, there is a paucity of research examining the behaviours of family child care home (FCCH) providers and whether they model healthy eating and physical activity behaviours. Therefore, this study explored Latino FCCH providers’ beliefs and practices related to healthy eating, physical activity and sedentary behaviours, and how they view their ability to serve as role models for these behaviours for young children in their care. Methods This is a qualitative study consisting of six focus groups conducted in Spanish with a sample of 44 state-licensed Latino FCCH providers in the state of Massachusetts. Translated transcripts were analysed using thematic analyses to identify meaningful patterns. Results Analyses revealed that Latino FCCH providers have positive beliefs and attitudes about the importance of healthy eating and physical activity for children in their care, but personally struggle with these same behaviours and with maintaining a healthy weight status. The ability of Latino FCCH providers to model healthy eating and physical activity may be limited by their low self-efficacy in their ability to be physically active, eat a healthy diet and maintain a healthy weight. Conclusions Interventions designed to improve healthy eating and physical activity behaviours of children enrolled in FCCHs should address providers’ own health behaviours as well as their modelling of these health behaviours. Future research can build on the findings of this qualitative study by quantifying Latino FCCH providers’ eating and physical activity behaviours, and determining how these behaviours influence behaviours and health outcomes of children in their care.