Lisa Bailey-Davis

Attention deficit disorder, stimulant use, and childhood body mass index trajectory.

BACKGROUND: Childhood attention-deficit/hyperactivity disorder (ADHD) has been associated with childhood and adult obesity, and stimulant use with delayed childhood growth, but the independent influences are unclear. No longitudinal studies have examined associations of ADHD diagnosis and stimulant use on BMI trajectories throughout childhood and adolescence. METHODS: We used longitudinal electronic health record data from the Geisinger Health System on 163 820 children ages 3 to 18 years in Pennsylvania. Random effects linear regression models were used to model BMI trajectories with increasing age in relation to ADHD diagnosis, age at first stimulant use, and stimulant use duration, while controlling for confounding variables. RESULTS: Mean (SD) age at first BMI was 8.9 (5.0) years, and children provided a mean (SD) of 3.2 (2.4) annual BMI measurements. On average, BMI trajectories showed a curvilinear relation with age. There were consistent associations of unmedicated ADHD with higher BMIs during childhood compared with those without ADHD or stimulants. Younger age at first stimulant use and longer duration of stimulant use were each associated with slower BMI growth earlier in childhood but a more rapid rebound to higher BMIs in late adolescence. CONCLUSIONS: The study provides the first longitudinal evidence that ADHD during childhood not treated with stimulants was associated with higher childhood BMIs. In contrast, ADHD treated with stimulants was associated with slower early BMI growth but a rebound later in adolescence to levels above children without a history of ADHD or stimulant use. The findings have important clinical and neurobiological implications.

Antibiotic use and childhood body mass index trajectory

Background/Objectives:Antibiotics are commonly prescribed for children. Use of antibiotics early in life has been linked to weight gain but there are no large-scale, population-based, longitudinal studies of the full age range among mainly healthy children.Subjects/Methods:We used electronic health record data on 163 820 children aged 3–18 years and mixed effects linear regression to model associations of antibiotic orders with growth curve trajectories of annual body mass index (BMI) controlling for confounders. Models evaluated three kinds of antibiotic associations—reversible (time-varying indicator for an order in year before each BMI), persistent (time-varying cumulative orders up to BMIj) and progressive (cumulative orders up to prior BMI (BMIj-1))—and whether these varied by age.Results:Among 142 824 children under care in the prior year, a reversible association was observed and this short-term BMI gain was modified by age (P<0.001); effect size peaked in mid-teen years. A persistent association was observed and this association was stronger with increasing age (P<0.001). The addition of the progressive association among children with at least three BMIs (n=79 752) revealed that higher cumulative orders were associated with progressive weight gain; this did not vary by age. Among children with an antibiotic order in the prior year and at least seven lifetime orders, antibiotics (all classes combined) were associated with an average weight gain of approximately 1.4 kg at age 15 years. When antibiotic classes were evaluated separately, the largest weight gain at 15 years was associated with macrolide use.Conclusions:We found evidence of reversible, persistent and progressive effects of antibiotic use on BMI trajectories, with different effects by age, among mainly healthy children. The results suggest that antibiotic use may influence weight gain throughout childhood and not just during the earliest years as has been the primary focus of most prior studies.

Community socioeconomic deprivation and obesity trajectories in children using electronic health records

Longitudinal studies of the role of community context in childhood obesity are lacking. The objective of this study was to examine associations of community socio economic deprivation (CSD) with trajectories of change in body mass index (BMI) in childhood and adolescence.

Middle School Student and Parent Perceptions of Government-Sponsored Free School Breakfast and Consumption: A Qualitative Inquiry in an Urban Setting

Universal free access to school breakfast is available in large urban schools, but participation rates are less than half of what they are at lunch. The purpose of this qualitative study was to understand the discrepancy between access and participation in school breakfast in a low-income, urban school district. Youth (n=23) and parents (n=22) were recruited from three middle schools where ≥ 50% of students were eligible for free or reduced-price meals. Parent focus groups (n=2) and student focus groups (n=4) were conducted in the fall/winter of 2009/2010. Content analysis was conducted to code transcripts and a constant comparative technique was used to identify emergent themes. Findings were validated using triangulation methods. The following themes emerged from the student and parent perceptions: sociocultural beliefs, physical availability, economic accessibility, social stigma, and consumption practices. There was agreement between students and parents across most themes, except consumption practices. Students were commonly purchasing food and beverages on the way to school, which was in conflict with parent rules. Parents desired access to copies of the school menus to be more involved in breakfast decisions with their child and students desired input into menu planning and taste testing to overcome school meal quality concerns. Future research aiming to improve participation in the breakfast program should examine the impact of student involvement in school menu planning and environmental modifications to reduce the social stigma associated with the program.

Early-life antibiotic use and subsequent diagnosis of food allergy and allergic diseases

Antibiotic use in early life has been linked to disruptions in the microbiome. Such changes can disturb immune system development. Differences have been observed in the microbiota of children with and without allergies, but there have been few studies on antibiotic use and allergic disease.

Operationalizing the learning health care system in an integrated delivery system.

Introduction: The Learning Health Care System (LHCS) model seeks to utilize sophisticated technologies and competencies to integrate clinical operations, research and patient participation in order to continuously generate knowledge, improve care, and deliver value. Transitioning from concept to practical application of an LHCS presents many challenges but can yield opportunities for continuous improvement. There is limited literature and practical experience available in operationalizing the LHCS in the context of an integrated health system. At Geisinger Health System (GHS) a multi-stakeholder group is undertaking to enhance organizational learning and develop a plan for operationalizing the LHCS system-wide. We present a framework for operationalizing continuous learning across an integrated delivery system and lessons learned through the ongoing planning process. Framework: The framework focuses attention on nine key LHCS operational components: Data and Analytics; People and Partnerships; Patient and Family Engagement; Ethics and Oversight; Evaluation and Methodology; Funding; Organization; Prioritization; and Deliverables. Definitions, key elements and examples for each are presented. The framework is purposefully broad for application across different organizational contexts. Conclusion: A realistic assessment of the culture, resources and capabilities of the organization related to learning is critical to defining the scope of operationalization. Engaging patients in clinical care and discovery, including quality improvement and comparative effectiveness research, requires a defensible ethical framework that undergirds a system of strong but flexible oversight. Leadership support is imperative for advancement of the LHCS model. Findings from our ongoing work within the proposed framework may inform other organizations considering a transition to an LHCS.

Associations of prenatal and childhood antibiotic use with child body mass index at age 3 years

Early‐life antibiotic exposure, whether through prenatal or childhood antibiotic use, may contribute to increased child body mass. Associations of prenatal and childhood antibiotic use with body mass index z‐score (BMIz) were evaluated at age 3 years.

Exploring the forest instead of the trees: An innovative method for defining obesogenic and obesoprotective environments

Past research has assessed the association of single community characteristics with obesity, ignoring the spatial co-occurrence of multiple community-level risk factors. We used conditional random forests (CRF), a non-parametric machine learning approach to identify the combination of community features that are most important for the prediction of obesogenic and obesoprotective environments for children. After examining 44 community characteristics, we identified 13 features of the social, food, and physical activity environment that in combination correctly classified 67% of communities as obesoprotective or obesogenic using mean BMI-z as a surrogate. Social environment characteristics emerged as most important classifiers and might provide leverage for intervention. CRF allows consideration of the neighborhood as a system of risk factors.

Factors associated with parent concern for child weight and parenting behaviors.

Abstract Background: A parents perception about their childs overweight status is an important precursor or determinant of preventative actions. Acknowledgment of, and concern for, overweight may be moderated by the parents own weight status whereas engaging in healthy behaviors at home may promote healthy weight status. It is hypothesized that normal weight parents are more likely to engage in healthy behaviors and acknowledge overweight in their own children whereas heavier parents may report more concern about child weight. Methods: A total of 1745 parents of first- through fifth-grade students completed a questionnaire assessing reactions to a school BMI report and perceptions about BMI issues. Specific items included perceptions of childs weight status, concern for child weight status, and preventive practices. Parents also provided information about their own weight status. Relationships between measured child weight, perceived child weight, parent weight, parent concern, and healthy behaviors were examined. Results: Overweight parents were more likely to identify overweight in their child and report concern about their childs weight. Concern was higher for parents of overweight children than of normal weight children. Normal weight parents and parents of normal weight children reported more healthy behaviors. Conclusions: Results support the hypothesis that normal weight parents are more likely to engage in healthy behaviors and that overweight parents are more likely to report concern about child weight. However, overweight parents are also more likely to acknowledge overweight status in their own child. Future research should examine links between parent concern and actual pursuit of weight management assistance.

Depression, its comorbidities and treatment, and childhood body mass index trajectories

No prior studies have evaluated depression diagnoses and cumulative antidepressant use in relation to longitudinal body mass index (BMI) trajectories in a population‐representative sample.