Karla Klein

Effects of decreasing sedentary behavior and increasing activity on weight change in obese children.

Obese children 8-12 years old from 61 families were randomized to treatment groups that targeted increased exercise, decreased sedentary behaviors, or both (combined group) to test the influence of reinforcing children to be more active or less sedentary on child weight change. Significant decreases in percentage overweight were observed after 4 months between the sedentary and the exercise groups (-19.9 vs. -13.2). At 1 year, the sedentary group had a greater decrease in percentage overweight than did the combined and the exercise groups (-18.7 vs. -10.3 and -8.7) and greater decrease in percentage of body fat (-4.7 vs. -1.3). All groups improved fitness during treatment and follow-up. Children in the sedentary group increased their liking for high-intensity activity and reported lower caloric intake than did children in the exercise group. These results support the goal of reducing time spent in sedentary activities to improve weight loss.

Parental physical illness and child functioning

Abstract Although physical illness among adults is prevalent, few studies exist which examine the relationship between parental illness and child functioning. We reviewed the existing studies and tentatively conclude that an association does exist. We also delineated variables that have been identified as qualifiers of this relationship, outlined dimensions of physical illness which may be important in the relationship, and discussed possible mechanisms for the association between physical illness and child functioning. The need for more research and the consideration of parental physical illness within a broader family context is emphasized.

Effects of mastery criteria and contingent reinforcement for family-based child weight control.

This study tested the effects of mastery criteria and contingent reinforcement in a family-based behavioral weight control program for obese children and their parents over two years. Families with obese children were randomized to one of two groups. The experimental group was targeted and reinforced for mastery of diet, exercise, weight loss, and parenting skills. The control group was taught behavior-change strategies and provided noncontingent reinforcement at a pace yoked to the experimental group. Both groups received the same behavioral family-based educational components over 6 months of weekly meetings and six monthly follow-up meetings. Results showed significantly better relative weight change at 6 months and 1 year for children in the experimental compared to the control group, but these effects were not maintained at 2 years. These results suggest the introduction of mastery criteria and contingent reinforcement for mastery can improve outcome during treatment in behavioral treatments for childhood obesity.

Family Processes as Resources for African American Children Exposed to a Constellation of Sociodemographic Risk Factors

Examined positive functions of family processes among African American children exposed to a constellation of stresses associated with urban residence and low socioeconomic status. Several measures of risk were integrated to form a risk factor index (RFI), which quantified the degree of each childs exposure to stresses. Two family process variables were examined: parental monitoring and a supportive mother-child relationship. The direct and interactive associations between risk factors, family process variables, and childrens depressive mood and disruptive behavior were assessed. For both domains of child functioning, higher scores on the RFI were cross-sectionally associated with less optimal functioning. Results consistently revealed significant associations between a more supportive mother-child relationship and more optimal child functioning. Higher levels of parental monitoring were also associated with lower levels of depressive mood and disruptive behavior. Limited support was found for a moderating role of parental monitoring in the association between risk and child functioning, such that low levels of monitoring appeared to increase high-risk childrens vulnerability to depressive mood.

Child and parent factors that influence psychological problems in obese children.

This study assessed the influence of child and parental obesity and parental psychiatric symptoms on psychological problems in obese 8-11-year-old children. Child psychological problems were measured using the Child Behavior Checklist/4-18, whereas adult psychiatric symptoms were measured using the Cornell Medical Index. Multiple linear regression analyses showed parental psychiatric symptoms were related to child psychological problems for six of eight problem behavior scales. Child obesity made no independent contribution to child psychological problems, and parental obesity was related to child problems on only one scale. The most prevalent problems were Anxiety/Depression for 15% of the boys and Social Problems for 20% of the boys and 12.8% of the girls. These results suggest a broader conceptualization of factors that influence behavior problems of obese children than their degree of obesity.

Disclosure of parental HIV infection to children in the families of men with hemophilia: Description, outcomes, and the role of family processes.

Disclosure of serostatus is a difficult issue faced by individuals who have the AIDS virus, particularly when the HIV-infected individual is a parent and the question is whether to disclose to a child. The present study examined disclosure of paternal HIV status and the associations between disclosure and child functioning in the families of men who have hemophilia and are HIV infected. Results indicated that disclosure of HIV status was more common with older children, among Caucasian families, and in families in which fathers are more ill. The parent-child relationship, but not disclosure, was significantly associated with child functioning when disclosure was considered within the content of the family processes. A more positive parent-child relationship was related to lower levels of child depression and externalizing problems and to better grades.

Coping with illness: Interrelationships across family members and predictors of psychological adjustment.

This study examined coping in families in which there was a chronically ill parent. Husbands, wives, and one child (ages 7-18 years) from 75 families in which the husband had hemophilia participated. Coping styles and psychological adjustment were assessed, and patterns of coping among family members were examined. Avoidant coping was associated with poorer adjustment for all family members. In addition, the coping style of one family member was found to be related to the psychological adjustment of other family members. Avoidant coping by one spouse related to poorer psychological functioning in the other spouse, and avoidant coping by either parent related to greater child adjustment problems for girls and boys.

Adolescent family predictors of substance use during early adulthood: A theoretical model

Abstract One hundred and three subjects and their mothers were assessed at three points during adolescence and young adulthood in a longitudinal examination of the predictive and mediational relationships between family variables and substance abuse. Latent variable path analysis with partial least-squares estimation procedures (LVPLS) was utilized to test a theoretical model including constructs of family structure, family environment (maternal depressive mood and interparental conflict), mother/adolescent dynamics (mother/adolescent supportive relationship and maternal control), and substance abuse (problematic alcohol use and marijunana/hard drug use). Higher levels of interparental conflict were consistently related to poorer quality of the mother/adolescent relationship and stricter maternal control. As hypothesized, family environment variables mediated the impact of family structure, and mother/adolescent dynamics variables mediated the impact of the family environment. Results revealed notable differences between the trajectories for males and females, as well as between different types of substance abuse. Implications for substance abuse prevention efforts are discussed.

Effects of setting and number of observations on generalizability of parent-child interactions in childhood obesity treatment

The generalizability of behaviors across observational conditions is a critical issue in behavioral assessment. Generalizability theory was used to examine two aspects of audio recorded parent-child interactions recorded over 6 days of home measurement and 1 day of laboratory measurement in a behavioral treatment program for childhood obesity. Families audiotaped parent-child home meetings during which they reviewed self-monitored diet and exercise records that were coded for the following types of interactions: praise statements, negative statements, prompts for new behaviors, and statements promoting problem solving. A similar meeting was audiotaped in our laboratory. The first question explored was the number of measurements needed to generalize to the universe of the six home measures. Results showed an increase in generalizability over measurements for each behavioral category. Using generalizability coefficients of .60 or more, praise, negative comments and prompts, respectively, could be reliably observed based on 1, 4, or 4 days of measurement. Second, the effects of setting (laboratory versus home) were assessed for 1 day of measurement in each environment. Again using generalizability coefficients of .60, generalizability analysis showed that the lab setting could not be generalized to the home setting based on 1 day of measurement, with generalizability coefficients ranging from .27 for negative comments to .57 for praise. Results suggest that 4 days of behavioral assessment in the home can be used to establish generalizable data for all the dependent measures studied. However, generalizability coefficients suggested that 1 day of laboratory measurement was not adequate to generalize to typical home behavior.