Kaigang Li

A childhood obesity intervention developed by families for families: results from a pilot study

BackgroundIneffective family interventions for the prevention of childhood obesity have, in part, been attributed to the challenges of reaching and engaging parents. With a particular focus on parent engagement, this study utilized community-based participatory research to develop and pilot test a family-centered intervention for low-income families with preschool-aged children enrolled in Head Start.MethodsDuring year 1 (2009–2010), parents played an active and equal role with the research team in planning and conducting a community assessment and using the results to design a family-centered childhood obesity intervention. During year 2 (2010–2011), parents played a leading role in implementing the intervention and worked with the research team to evaluate its results using a pre-post cohort design. Intervention components included: (1) revisions to letters sent home to families reporting child body mass index (BMI); (2) a communication campaign to raise parents’ awareness of their child’s weight status; (3) the integration of nutrition counseling into Head Start family engagement activities; and (4) a 6-week parent-led program to strengthen parents’ communication skills, conflict resolution, resource-related empowerment for healthy lifestyles, social networks, and media literacy. A total of 423 children ages 2–5 years, from five Head Start centers in upstate New York, and their families were exposed to the intervention and 154 families participated in its evaluation. Child outcome measures included BMI z-score, accelerometer-assessed physical activity, and dietary intake assessed using 24-hour recall. Parent outcomes included food-, physical activity- and media-related parenting practices and attitudes.ResultsCompared with pre intervention, children at post intervention exhibited significant improvements in their rate of obesity, light physical activity, daily TV viewing, and dietary intake (energy and macronutrient intake). Trends were observed for BMI z-score, sedentary activity and moderate activity. Parents at post intervention reported significantly greater self-efficacy to promote healthy eating in children and increased support for children’s physical activity. Dose effects were observed for most outcomes.ConclusionsEmpowering parents to play an equal role in intervention design and implementation is a promising approach to family-centered obesity prevention and merits further testing in a larger trial with a rigorous research design.

Measuring parental support for children's physical activity in white and African American parents: the Activity Support Scale for Multiple Groups (ACTS-MG).

OBJECTIVES The Activity Support Scale (ACTS) was expanded for use with African American families. Its factorial invariance and internal reliability were examined for non-Hispanic white and African American parents. METHODS The ACTS was modified to improve its applicability to African American families based on information from five focus groups with 27 African American parents of elementary school-aged children. Between 2006 and 2008, the revised scale was administered to 119 African American and 117 non-Hispanic white parents in northeastern NY and Alabama. Its factorial invariance across race/ethnicity and internal consistency were examined. RESULTS Factor analysis of the revised scale, the Activity Support Scale for Multiple Groups (ACTS-MG), identified four parenting factors in white and African American parents including logistic support, modeling, use of community resources to promote physical activity (PA), and restriction of sedentary behaviors. Results supported the scales internal reliability and factorial invariance across race/ethnicity. CONCLUSION The ACTS-MG is appropriate for use with non-Hispanic white and African American families and will enable the extension of current research with white families to the examination of strategies supporting PA in African American families. Additional psychometric work with the ACTS-MG is encouraged.

Leisure-time physical activity dose-response effects on obesity among US adults: results from the 1999-2006 National Health and Nutrition Examination Survey.

Background It is not well established whether total volume of leisure-time physical activity (LTPA) has dose‑response effects on obesity. Methods The dose‑response relationship was examined using 12 227 non-institutionalised individuals, aged 20‑64 years, drawn from the 8 years (1999–2006) of the continuous National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the US population. Results The age-adjusted prevalence of womens obesity was 41.4% for those with no LTPA in the past month; 39.1% for those who engaged in LTPA but fell short of the recommended minimum amount of LTPA (ie, <450 metabolic equivalent minutes per week (MET min/week)); 31.0% for those who met the recommended minimum guideline (ie, 450 to < 750); 28.0% for those whose LTPA exceeded the minimum guideline but less than the first quartile among the overachievers (ie, 750 to <1260); 23.4% for the overachievers between the first and third quartile (ie, 1260 to <3556); and 19.5% for the overachievers at or above the third quartile (ie, 3556 MET min/week or above). This association was maintained even after occupational physical activity (OPA) was controlled. However, this pattern was not observed for Mexican and black adults and showed a floor effect as LTPA increased. Conclusions There is a crude graded inverse dose‑response relationship between total volume of LTPA and obesity in US adult women, but not in men. Gender and racial/ethnic differences exist in the relationship of accumulated LTPA with obesity due, in part, to differential ratios of LTPA to OPA.

Impaired-Driving Prevalence Among US High School Students: Associations With Substance Use and Risky Driving Behaviors

OBJECTIVES We examined the prevalence of impaired driving among US high school students and associations with substance use and risky driving behavior. METHODS We assessed driving while alcohol or drug impaired (DWI) and riding with alcohol- or drug-impaired drivers (RWI) in a nationally representative sample of 11th-grade US high school students (n = 2431). We examined associations with drinking and binge drinking, illicit drug use, risky driving, and demographic factors using multivariate sequential logistic regression analysis. RESULTS Thirteen percent of 11th-grade students reported DWI at least 1 of the past 30 days, and 24% reported RWI at least once in the past year. Risky driving was positively associated with DWI (odds ratio [OR] = 1.25; P < .001) and RWI (OR = 1.09; P < .05), controlling for binge drinking (DWI: OR = 3.17; P < .01; RWI: OR = 6.12; P < .001) and illicit drug use (DWI: OR = 5.91; P < .001; RWI: OR = 2.29; P = .05). DWI was higher for adolescents who drove after midnight (OR = 15.7), drove while sleepy or drowsy (OR = 8.6), read text messages (OR = 11.8), sent text messages (OR = 5.0), and made cell phone calls (OR = 3.2) while driving. CONCLUSIONS Our findings suggest the need for comprehensive approaches to the prevention of DWI, RWI, and other risky driving behavior.

Mental health and family functioning as correlates of a sedentary lifestyle among low-income women with young children.

The authors in this cross-sectional study examined mental health and family environmental factors related to a sedentary lifestyle, including lack of leisure-time physical activity and high levels of television viewing, among low-income mothers/female guardians of preschool-aged children. A self-administered questionnaire was completed by 131 mothers in 2010. Primary outcome measures included television viewing time (minutes/day) and leisure-time physical activity (<150 versus ≥150 minutes per week). Independent variables included depressive symptoms, perceived stress, and family functioning. Demographic factors (age, marriage, work status, education, number of children in the household, and race/ethnicity) were examined as potential covariates. Participating women watched television on average 186.1 minutes/day (i.e., >3 hours). Additionally, 36% of women engaged in less than the recommended 150-minute leisure-time physical activity per week. Hierarchical multiple regression analyses indicated that greater depressive symptoms (B = 76.4, p < 0.01) and lower family functioning (B = 33.0, p < 0.05) were independently related to greater television viewing when controlling for other variables. No independent factors were identified for lack of leisure-time physical activity when controlling for other covariates. Findings suggest that health promotion efforts to promote an active lifestyle among low-income women with young children should address mental health and family functioning factors, especially depressive symptoms.

Leisure-time physical activity and obesity in Black adults in Indianapolis.

OBJECTIVE To examine the relationship between the total volume of leisure-time physical activity (LTPA) and obesity among African American adults in Indianapolis. METHODS Logistic regression analysis with 649 African American adults. RESULTS The data show an inverse graded relationship between the total volume of LTPA and obesity for African American women, but not for men. CONCLUSIONS African American women who accumulate a high volume of LTPA (ie, 300 minutes or more per week) are less likely to be obese. Further research is needed to investigate the gender difference in the effect of LTPA on obesity.

Social Support May Buffer the Effect of Intrafamilial Stressors on Preschool Children's Television Viewing Time in Low-Income Families

BACKGROUND Excessive television (TV) viewing in preschool children has been linked to negative outcomes during childhood, including childhood obesity. In a sample of low-income families, this study examined associations between intrafamilial factors and preschool childrens TV-viewing time and the moderating effect of social support from nonfamily members on this association. METHODS In 2010, 129 mothers/female guardians of 2- to 5-year-old children enrolled at five Head Start centers in Rensselaer County, New York, completed a self-report survey. The survey assessed child TV-viewing time (including TV, DVDs, and videos) and intrafamilial risk factors, including maternal perceived stress, depressive symptoms, TV viewing, leisure-time physical activity (inactivity), and family functioning. Social support from nonfamily members (nonfamily social support) was also measured and examined as an effect modifier. RESULTS Children watched TV an average of 160 minutes per day. Moderate depressive symptoms (Personal Health Questionnaire depression scale scores ≥10), higher perceived stress, poorer family functioning, and higher maternal TV-viewing were significantly and independently associated with greater minutes of child TV viewing, controlling for covariates. In all instances, nonfamily social support moderated these associations, such that negative experiences within the family environment were linked with higher child TV-viewing time under conditions of low nonfamily social support, but not high nonfamily support. CONCLUSIONS Social support from nonfamily members may buffer potentially negative effects of intrafamilial factors on preschool childrens TV-viewing time.

Evaluation of a Childhood Obesity Awareness Campaign Targeting Head Start Families: Designed by Parents for Parents

The Communities for Healthy Living program used a community-based participatory research (CBPR) approach to empower Head Start parents in designing and pilot testing a multi-component family-centered obesity prevention program. One program component was a childhood obesity awareness campaign addressing common parental misconceptions about obesity. The campaign was designed by a community advisory board of parents to target specific issues identified within their own community. Results from pre-post intervention surveys (N=108) showed that campaign exposure was high; 92% of responding parents reported noticing the campaign. Parents also demonstrated significant increases in awareness of childhood obesity, along with decreases in obesity-related misconceptions. Findings, supported by growing literature on CBPR, suggest a CBPR approach to campaign development is an effective strategy to promote parent awareness of childhood obesity.

Social-ecological factors of leisure-time physical activity in black adults.

OBJECTIVES To develop and test an explicative model of leisure-time physical activity (LTPA), including 6 selected contributory factors: self-efficacy, self-regulation, social support, perceived physical environment, outcome-expectancy value, and policy beliefs. METHODS A social-ecological model of LTPA using the structural equation modeling technique was estimated in a regional, church-going sample of 649 African Americans. RESULTS The results indicated this model is good fit to the data. LTPA was associated with self-regulation and gender directly (P<.05) and social support, self-efficacy, perceived access to LTPA facilities, and positive outcome-expectancy value indirectly (P<.05). CONCLUSIONS Multitiered interventions considering cultural relevance are recommended to improve LTPA engagement.

Association Between Riding With an Impaired Driver and Driving While Impaired

OBJECTIVE: To examine the association between driving while alcohol/drug impaired (DWI) and the timing and amount of exposure to others’ alcohol/drug-impaired driving (riding while impaired [RWI]) and driving licensure timing among teenage drivers. METHODS: The data were from waves 1, 2, and 3 (W1, W2, and W3, respectively) of the NEXT Generation Study, with longitudinal assessment of a nationally representative sample of 10th graders starting in 2009–2010. Multivariate logistic regression was used for the analyses. RESULTS: Teenagers exposed to RWI at W1 (adjusted odds ratio [AOR] = 21.12, P < .001), W2 (AOR = 19.97, P < .001), and W3 (AOR = 30.52, P < .001) were substantially more likely to DWI compared with those reporting never RWI. Those who reported RWI at 1 wave (AOR = 10.89, P < .001), 2 waves (AOR = 34.34, P < .001), and all 3 waves (AOR = 127.43, P < .001) were more likely to DWI compared with those who never RWI. Teenagers who reported driving licensure at W1 were more likely to DWI compared with those who were licensed at W3 (AOR = 1.83, P < .05). CONCLUSIONS: The experience of riding in a vehicle with an impaired driver increased the likelihood of future DWI among teenagers after licensure. There was a strong, positive dose-response association between RWI and DWI. Early licensure was an independent risk factor for DWI. The findings suggest that RWI and early licensure could be important prevention targets.