Jyu-Lin Chen

Family Functioning, Parenting Style, and Chinese Children’s Weight Status:

Childhood obesity is an important health problem affecting Chinese and Chinese American children. A cross-sectional study examined factors that contributed to children’s weight status in Taiwan and the United States. Participants were 163 Chinese children (ages 8 to 10 years) and their mothers. Mothers in both countries completed basic demographic questions and the Family Assessment Device and Attitudes Toward Child-Rearing Scale. U.S. mothers also completed the Suinn-Lew Asian Self-Identity Acculturation Scale. Children had their weight and height measured and also completed the Children Self-Administered Physical Activity Checklist, Food Frequency Questionnaire, and Schoolager’s Coping Strategies Inventory. Multiple regression analyses indicated that five variables significantly contributed to the variance in children’s body mass index: older age (10%), being a boy (5.8%), more democratic parenting style (7.4%), poor communication (8.4%), and poor behavior control (3%). Families with clear communication, adequate behavior control, and structured parenting help to regulate their children’s healthy behavior.

The efficacy of the web-based childhood obesity prevention program in Chinese American adolescents (Web ABC study).

PURPOSE To examine the feasibility and efficacy of a theory-driven and family-based program delivered online to promote healthy lifestyles and weights in Chinese American adolescents. METHODS A randomized controlled study of a web-based intervention was developed and conducted in 54 Chinese American adolescents (ages, 12-15 years) and their families. Data on anthropometry, blood pressure, dietary intake, physical activity, and knowledge and self-efficacy regarding physical activity and nutrition were collected at baseline and 2, 6, and 8 months after the baseline assessment. Data were analyzed using linear mixed modeling. RESULTS The intervention resulted in significant decreases in waist-to-hip ratio and diastolic blood pressure and increases in vegetable and fruit intake, level of physical activity, and knowledge about physical activity and nutrition. CONCLUSION This web-based behavior program for Chinese American adolescents and their families seems feasible and effective in the short-term. Long-term effects remain to be determined. This type of program can be adapted for other minority ethnic groups who are at high-risk for overweight and obesity and have limited access to programs that promote healthy lifestyles.

Cardiovascular risk factors in Chinese American children: associations between overweight, acculturation, and physical activity.

INTRODUCTION Understanding cardiovascular disease (CVD) risk factors among Chinese American children would allow us to target individuals in this group who are at the greatest risk for developing CVD early in life. The purpose of this study is to examine cardiovascular risk factors (increased blood pressure [BP], total cholesterol, low-density lipoproteins, triglycerides, decreased high-density lipoproteins, and increased body mass index [BMI]) in Chinese American children. METHOD A cross-sectional design was used. A total number of 65 children, aged 8 to 10 years, and their mothers participated in the study. Measurements of the childrens weight, height, BP, blood sample, level of physical fitness, activity level, and dietary intake were collected. Mothers completed questionnaires regarding family history of CVD and level of acculturation. RESULTS A low level of physical activity and high paternal BMI were associated with higher systolic BP in the children. A low level of physical activity was also found to be a risk factor for higher LDL and systolic BP in the children. A high birth weight and lower parental acculturation level were risk factors for higher BMI in the children. DISCUSSION The findings suggest that a low level of physical activity and high BMI are associated with increased risk of CVD in Chinese American children. The development of culturally appropriate programs that promote an active lifestyle and reduce weight is critical in CVD prevention in Chinese American populations.

Efficacy of technology-based interventions for obesity prevention in adolescents: a systematic review

About one third of adolescents in the USA are overweight and/or obese. Obesity during the adolescent years is associated with many adverse health consequences, including type 2 diabetes, hypertension, hyperlipidemia, and psychosocial problems. Because of substantial advances in technologies and wide acceptance by adolescents, it is now possible to use technology for healthy weight management and prevention of obesity. This systematic review used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and aimed to evaluate the existing literature reported on the effectiveness of technology-based intervention (web-based, e-learning, and active video games) in preventing obesity in adolescents. The primary aim of this review was to explore if components of specific interventions were associated with a reduction in body mass index. Research articles obtained from CINAHL, Embase, PubMed, PsycInfo, and the Cochrane database from1990 to 2014 were reviewed. A total of 131 published articles were identified, and 14 met the inclusion criteria of a randomized or nonrandomized clinical study with body mass index as primary outcome and/or secondary outcomes of diet/physical activity and/or psychosocial function, tested lifestyle interventions to prevent obesity, used technology, and studied adolescents (aged 12–18 years). The results indicated that six of 14 studies found body mass index and/or body fat decreased at short-term (less than 12 months) follow-up. Six of eleven studies that examined physical activity or physical activity-related outcomes found an improved physical activity outcome (time playing active video games and increase in physical activity time), while five of seven studies which assessed dietary outcomes indicated improvement in dietary behaviors. Five of seven studies suggested an improvement in psychosocial function (reduced depression, improved self-esteem and efficacy, improvement on Behavior Assessment Scale) in adolescents involved in the technology-based intervention. All effective interventions utilized dietary and physical activity strategies as part of intervention components. Because of the variation in duration of intervention (range 10 weeks to 2 years), it is not clear what length of intervention is most effective. Future research should assess the long-term impact of technology-based interventions and evaluate mediators and moderators for weight change in adolescents.

Efficacy of a child-centred and family-based program in promoting healthy weight and healthy behaviors in Chinese American children: a randomized controlled study

OBJECTIVE To examine the efficacy of an interactive, child-centred and family-based program in promoting healthy weight and healthy lifestyles in Chinese American children. DESIGN A randomized controlled study of a culturally sensitive behavioral intervention. SUBJECTS Sixty-seven Chinese American children (ages, 8-10 years; normal weight and overweight) and their families. MEASUREMENTS Anthropometry, blood pressure, measures of dietary intake, physical activity, knowledge and self-efficacy regarding physical activity and diet at baseline and 2, 6 and 8 months after baseline assessment. RESULTS Linear mixed modeling indicated a significant effect of the intervention in decreasing body mass index, diastolic blood pressure and fat intake while increasing vegetable and fruit intake, actual physical activity and knowledge about physical activity. CONCLUSION This interactive child-centred and family-based behavioral program appears feasible and effective, leading to reduced body mass index and improved overweight-related health behaviors in Chinese American children. This type of program can be adapted for other minority ethnic groups who are at high risk for overweight and obesity and have limited access to programs that promote healthy lifestyles.

Risk factors for obesity and high blood pressure in Chinese American children: maternal acculturation and children's food choices.

The objective of this study is to explore risk factors associated with overweight and high blood pressure in Chinese American children. Students and their parents were recruited from Chinese language schools in the San Francisco Bay Area. Data were collected on 67 children and their mothers, and included children’s weight, height, waist and hip circumferences, blood pressure, level of physical activity, dietary intake, usual food choice, knowledge about nutrition and physical activity, and self-efficacy regarding diet and physical activity. Mothers completed questionnaires on demographic data and acculturation. About 46% of children had a body mass index exceeding the 85th percentile. Lower level of maternal acculturation is a risk factor for overweight and higher waist to hip ratio. Children’s unhealthy food choices were predictive of high body mass index and high systolic blood pressure, whereas older age and less physical activity in children were predictors of high diastolic blood pressure. Developing culturally sensitive and developmentally appropriate interventions to reduce overweight and high blood pressure is critical to reduce health disparities among minority children.

Pilot Study of an Individually Tailored Educational Program by Mail to Promote Healthy Weight in Chinese American Children

PURPOSE To test the feasibility and impact of an individually tailored educational intervention to promote healthy weight in Chinese American children (ages 8-10). DESIGN A pre- and post-test study (N = 57) using standardized instruments to measure childrens usual food choices, knowledge of nutrition and physical activity needs, and time spent engaging in physical and sedentary activities. RESULTS We found improvement after the intervention in all three areas. PRACTICE IMPLICATIONS Healthcare providers need to provide parents and children with specific recommendations regarding childrens weight statuses, dietary intake, and levels of activity.

Correlates of physical fitness and activity in Taiwanese children

AIM This cross-sectional study examined factors related to childrens physical fitness and activity levels in Taiwan. METHODS A total of 331 Taiwanese children, aged 7 and 8, and their mothers participated in the study. Children performed physical fitness tests, recorded their physical activities during two weekdays and completed self-esteem questionnaires. Research assistants measured the childrens body mass and stature. Mothers completed demographic, parenting style and physical activity questionnaires. RESULTS Attending urban school, lower body mass index (BMI), older age and better muscular endurance contributed to the variance in better aerobic capacity, and attending rural school and better aerobic capacity contributed to the variance in better muscular endurance in boys. Attending urban school, lower BMI and better athletic competence contributed to the variance in better aerobic capacity, and younger age, rural school and higher household income contributed to the variance in better flexibility in girls. CONCLUSION Despite the limitations of the study, with many countries and regions, including Taiwan, now emphasizing the importance of improving physical fitness and activity in children, an intervention that is gender-, geographically, and developmentally appropriate can improve the likelihood of successful physical fitness and activity programmes.

Body dissatisfaction in California adolescents

Purpose: Factors that contribute to body dissatisfaction among adolescents from ethnically diverse California were examined to determine if the factors vary with gender and race. Data sources: Data from the 2005 California Health Interview Survey were used; 1807 White, Latino, and Asian American adolescents from 12 to 17 years old were included. Conclusions: Ordinal multiple logistic regression with gender and ethnicity controlled for revealed two major factors (high body mass index and poor/fair general health status) contribute to body dissatisfaction across gender and ethnicity in California adolescents. Other factors related to body dissatisfaction varied with ethnicity and gender. Implications for practice: Gender- and ethnicity-specific interventions to improve body image in adolescents must be developed.Purpose: Factors that contribute to body dissatisfaction among adolescents from ethnically diverse California were examined to determine if the factors vary with gender and race. Data sources: Data from the 2005 California Health Interview Survey were used; 1807 White, Latino, and Asian American adolescents from 12 to 17 years old were included. Conclusions: Ordinal multiple logistic regression with gender and ethnicity controlled for revealed two major factors (high body mass index and poor/fair general health status) contribute to body dissatisfaction across gender and ethnicity in California adolescents. Other factors related to body dissatisfaction varied with ethnicity and gender. Implications for practice: Gender‐ and ethnicity‐specific interventions to improve body image in adolescents must be developed.

Postpartum Lifestyle Interventions to Prevent Type 2 Diabetes Among Women with History of Gestational Diabetes: A Systematic Review of Randomized Clinical Trials.

Women with a history of gestational diabetes mellitus (GDM) are at a higher risk of developing type 2 diabetes. Several postpartum lifestyle intervention studies have been conducted for this high-risk group; however, the randomized clinical trials have not been evaluated systematically. Thus, the aim of this article is to evaluate the outcomes of clinical trials that focus on diabetes prevention among women with DGM. This systematic review utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Chinese and US databases were searched. Randomized controlled trials of postpartum lifestyle interventions to prevent type 2 diabetes in women with prior GDM were reviewed. Outcomes included in this review are type 2 diabetes incidences, insulin insistence, and weight-related measures. The effect size of these outcomes in each study was computed. Data on intervention components were extracted, including type (in-person vs. technology-based), content (diet or physical activity or both), form (individual session vs. group session), duration, intensity, evaluation time point, and program delivery. A total of 12 studies met the inclusion criteria. The mean annual type 2 diabetes mellitus (T2DM) incidence of the intervention group was lower than that of the comparison group (6.0% vs. 9.3%), although there was no statistical difference between the two groups. About 50% of these studies and two-thirds of studies, respectively, reported a significant decrease in insulin resistance-related measures and weight-related measures in the intervention group compared with the comparison group. The median intervention duration and study length were 6 months. Postpartum lifestyle interventions can be effective in reducing T2DM development and insulin resistance, and decrease weight in women with GDM history, regardless of the intervention types (technology-based or in-person). Effective interventions typically include dietary changes while some physical activity changes can also improve outcomes. However, more interventions with long-term efficacy evaluation are warranted.