May May Leung

The Association between Marital Transitions, Body Mass Index, and Weight: A Review of the Literature.

Objective. To examine the association between different marital transitions and changes in body mass index (BMI) and body weight. Methods. A systematic literature search was conducted for peer-reviewed articles published between January 1990 and December 2011. Longitudinal studies were included if they compared dependent variables, such as BMI or weight, before and after a change in marital status. Results. Twenty articles were included: 4 articles described only transitions into marriage and/or cohabitation, 2 articles described only transitions out of marriage and/or cohabitation, and 14 articles described both. Overall, transitions into marriage were associated with weight gain, whereas transitions out of marriage were associated with weight loss. No major differences were observed between genders or across specific marital transition states. Conclusions. Additional research is warranted to better understand this phenomenon and the impact of marital transitions on obesity and obesity-related behaviors. This paper highlights potential opportunities to incorporate programs, practices, and policies that aim to promote and support healthy weights and lifestyles upon entering or leaving a marriage or cohabiting relationship.

Disseminating evidence from research and practice: a model for selecting evidence to guide obesity prevention.

Finding more effective ways to slow the rise of this country’s obesity epidemic is one of the primary challenges facing public health. Two-thirds of adults and close to one-third of children and youth are either overweight or obese.1,2 Obesity increases risk for heart disease, diabetes, and cancer, and annual health costs related to obesity have been estimated at close to

Communicating risk and promoting disease mitigation measures in epidemics and emerging disease settings

147 billion.3 Despite obesity’s impact, only a limited number of effective obesity prevention interventions are available for use in public health. To prevent obesity, public health practitioners need to address the behaviors that increase risk, most notably physical inactivity and poor diet. These behavioral risk

Voices Through Cameras: Using Photovoice to Explore Food Justice Issues With Minority Youth in East Harlem, New York

Abstract Objective: This review aims to identify and assess evidence on interventions to communicate risk and promote disease mitigation measures in epidemics and emerging disease outbreak settings. The study focuses on data that are relevant to low and middle-income country (LMIC) settings. Methods: We conducted a comprehensive literature search using five major electronic databases (Pubmed Medline, Biomed Central, EMBASE, Science of Citation Index, and Cochrane Library) and other sources to identify relevant studies published from January 2002 to July 2013. The review was guided by the socio-ecological model/perspective of public health and the ideation theory and focused on interventions at the community, healthcare, and multi-sectoral settings, which also reflect key intervention levels of the Ottawa Charter for Health Promotion. Eligible quantitative studies were selected according to specific study criteria and assessed using the Critical Appraisal Skills Program (CASP) framework. Conversely, qualitative studies, reviews, case studies, and editorials were not included. Studies were selected by two independent reviewers. Results: Twenty-nine relevant studies from 16 countries were included. Most studies focused on a single intervention or intervention level, rather than multi-sectoral interventions. The majority of the evidence relates to programs aimed at behavioral and social results (or relevant intermediate steps) within a specific population group. Two studies included implications for improvements in health service delivery, two studies examined the intervention’s impact on health systems-related outcomes, and three had also implications for environmental health outcomes. Cost- and health equity-related implications for select evidence were also discussed. Conclusions: The paucity of well-designed quantitative evaluations of interventions to communicate health risk and promote disease control measures in LMICs does not allow for any definitive conclusions. Yet, the review identified several promising interventions and areas for future investigation. Among them, community-based and participatory interventions seemed to be central within epidemic and emerging disease settings, particularly in low-resource settings. Yet, evidence on their effectiveness is not conclusive and needs to be explored by future studies. Other promising areas for future investigation include multi-component and multi-sectoral approaches to intervention design. Major research gaps referred to any evaluation of the impact of these kinds of interventions on health policy adoption and/or implementation, and social determinants of health. Research on cost-effectiveness also needs to be strengthened. This review identified several research gaps and questions, and discusses potential future directions for increasing capacity for future and more rigorous assessments.

Treating Obesity in Latino Children: A Systematic Review of Current Interventions

Engaging and empowering youth to promote health could be important in promoting sustainable positive behaviors. Photovoice is a community-based participatory research tool giving priority populations opportunities for active community engagement and advocacy through photography. Our project objective was to better understand youth perceptions related to food justice within their own community and identify solutions to promote positive change, using photovoice. Twelve minority youth from a low-income New York City neighborhood participated. Six photovoice sessions were conducted within a 24-week after-school food justice program, which included three photo assignments aimed at answering, “What influences me to eat healthy and unhealthy in my community and home environment?” Photos guided interviews and discussions. Inductive and deductive processes were used to identify codes; similar codes were grouped into themes. Five major themes emerged from the data: (1) attitudes toward food industry and food safety, (2) environmental influences of food choices, (3) social influences of food choices, (4) diet impact on health and well-being, and (5) solutions to improve the food environment. Participants shared their photos with community members at a celebration/photo exhibit. Photovoice could be a useful tool for youth to reflect on their food environment and engage in promoting positive change within their community.

Feasibility and Reliability of the System for Observing Play and Leisure Activity in Youth (SOPLAY) for Measuring Moderate to Vigorous Physical Activity in Children Visiting an Interactive Children’s Museum Exhibition

Childhood obesity remains a significant public health issue in the U.S. and globally. Rates are disproportionately higher in Latinos than other ethnic groups. This review provides a qualitative synthesis of the current evidence for childhood obesity treatment interventions among Latino children. A systematic search was performed in PubMed, Web of Science and Google Scholar for articles published from September 2010 to December 2015. Randomized controlled trials treating childhood overweight/obesity in Latino children ages 5-19 focused on diet and/or physical activity (PA) behaviors were included. Of the records initially identified (n=1,592), 11 studies met the inclusionary criteria. The majority included a family-based component (n=8; 73%). Nearly half (n=5) focused on children ages 5-12, with three specifically developed for the pre-adolescence stage (ages 8-12). Nine studies acknowledged cultural tailoring, most frequently by seeking input from their intended population and utilizing bilingual delivery staff. Improvements in anthropometric measures (e.g. body mass index (BMI) z-score) were observed in 55% of the studies (n=6). Many interventions with a combined focus of diet and PA, in the form of nutrition education in a group setting and in-person activity/exercise sessions and incorporated a parent/family component reported positive anthropometric results. Three (27%) studies included a follow-up period, all of which observed a sustained decrease in BMI over time. Overall, family-based interventions focusing on both diet and PA demonstrated promising results. However, additional research incorporating a follow-up period is warranted to assess sustainability of these outcomes. Additionally, more interventions could be developed specifically for the critical developmental stage of pre-adolescence.

Fight for Your Right to Fruit: Psychosocial Outcomes of a Manga Comic Promoting Fruit Consumption in Middle-School Youth

Purpose: To test the feasibility and reliability of a direct observation method for measuring moderate to vigorous physical activity (MVPA) in children visiting an interactive children’s museum exhibition. Design: Direct observation was used to assess MVPA in children visiting an interactive children’s museum exhibition on 2 weekend days in winter 2013. Setting: The Children’s Museum of Manhattan’s EatSleepPlay™: Building Health Every Day exhibition. Participants: Children (group level) visiting the museum exhibition. Measures: System for Observing Play and Leisure Activity in Youth (SOPLAY). Analyses: Interobserver reliability was analyzed for MVPA and activity type. Two-group analyses were conducted using a series of Wilcoxon rank sum tests. Results: A total of 545 children were observed over 288 observations. No significant differences were found between observers for MVPA (r = .91, P = .6804) or activity type (κ = .90, P = .6334). Children participated in MVPA during 35.2% of all observations. No significant differences were found for participation in MVPA between boys (37.6%) and girls (32.8%, P = .1589). Conclusion: The SOPLAY may be a useful tool for measuring MVPA in interactive children’s museum exhibitions. Research with multiple museum settings and diverse groups of children over longer periods of time is warranted to further establish the feasibility and reliability of the SOPLAY for measuring MVPA in this novel setting.

Diet-related determinants of childhood obesity in urban settings: a comparison between Shanghai and New York

ABSTRACT The purpose of this study was to determine whether exposure to a manga comic (Japanese comic art) with messages promoting fruit consumption influenced psychosocial variables associated with increased fruit intake in middle-school youth. A three-group, randomized, single-session study was conducted in two public middle schools in central North Carolina. Participants were randomly assigned to one of three groups: (a) comic (manga comic promoting fruit consumption, (b) newsletter (newsletter about fruit), or (c) attention-control (newsletter about ancient Greece). Participants included N = 263 youth, with a mean age of 13.18 years (SD = 1.12). Outcome expectations, self-efficacy, and knowledge related to fruit intake were measured at baseline and immediately after reading. Secondary outcomes included transportation (degree to which participants are immersed in their media) and enjoyment, measured at posttest. Data were analyzed using regression analyses. Comic group participants tended to have greater change in outcome expectations related to fruit intake compared to the attention-control group and greater transportation and enjoyment than the newsletter and attention-control groups. Study results are promising and suggest that manga comics may be a useful format to promote positive health beliefs in youth.

Community-Based Approaches to Obesity Prevention: The Role of Environmental and Policy Change

Over the past three decades, both Shanghai and New York City (NYC), have experienced dramatic rises in childhood obesity rates. Given the role that obesity plays in the aetiology of chronic diseases such as diabetes and heart disease, the elevated rates are a major concern. Despite differences in governance systems and cultures, Shanghai and NYC have experienced rapid industrialization, a growing population and a rise in income inequality. The prevalence of childhood obesity in Shanghai and NYC is greater than their respective national rate. However, the trajectory and development of this epidemic has differed between the cities. The distribution of obesity by race and ethnicity, socio-economic status, sex, and age differs markedly between the two cities. To reduce prevalence and inequities within this complex epidemic requires an understanding of the dynamic changes in living conditions among social groups in each city and the behaviours that are influenced by such changes. By comparing changes in the influences on dietary behaviours, such as food distribution, pricing, gender values, and media and marketing, this highlights opportunities for Shanghai, NYC, and other world cities with high or rising rates of childhood obesity to inform future program and policy initiatives. It reiterates the importance of a comprehensive and multilevel approach that includes action at the individual, family, community, municipal, national, and global levels.

A Web-based Interactive Tool to Reduce Childhood Obesity Risk in Urban Minority Youth: Usability Testing Study (Preprint)

One could argue that it was environmental and policy change that “got us into this mess” regarding the obesity epidemic. The built environment is perhaps the most obvious example, where urban sprawl and increasing dependence on the automobile have been linked with prevalence of obesity in adults (see Chapter 8). The cars on which we depend have ever expanding numbers and sizes of beverage holders, making it easy for us to accommodate the oversized calorie-laden drinks now available on nearly every corner in many urban areas. Meanwhile, state level school policies related to high stakes testing and increasing pressure for instructional time have squeezed out opportunities for physical activity by limiting recess and physical education classes in many schools (National Association for Sport and Physical Education & American Heart Association, 2006). Obesity is a complex and multi-factorial problem, and preventing it will require multi-level change. Just as environmental and policy changes over time have contributed to exacerbating the obesity epidemic; if handled properly, such changes can also greatly contribute to the reversal of this public health epidemic. There are many common elements in the strategies needed to overcome society-wide public health problems such as automotive safety, tobacco, and gun control (Economos, Brownson, DeAngelis, Novelli, Foerster, Foreman, Gregson, Kumanyika, & Pate, 2001; Institute of Medicine, 2005). However, in certain ways food and physical activity are very different from these other public health issues with respect to environmental and policy change. Behaviors associated with obesity prevention are not ones that can be accomplished with a ‘swift arm motion and click’ —like fastening a seat belt— or controlled by the cessation of a discrete behavior, such as the use of cigarettes. While legal approaches to tobacco, alcohol, and gun control have had a positive public health impact, litigation for dietary change associated with fast food has not been widely used or accepted as a direct approach to environmental or policy change (Evans, Finkelstein, Kamerow, & Renaud, 2005; Evans, Renaud, Finkelstein, Kamerow, & Brown, 2006). While it’s not easy to institute strict controls on any industry, it is relatively easier when one Chapter 13