Michael M. Steele

Physician Identification and Management of Psychosocial Problems in Primary Care

Often the burden of identifying children with behavioral or developmental problems is left up to the primary care physician (PCP). However, previous literature shows that PCPs consistently underidentify children with developmental/behavioral problems in pediatric primary care. For the current study, questionnaires containing three vignettes followed by questions addressing common psychosocial problems, general questions about their practice and training, and the Physician Belief Scale were distributed to physicians. Results indicated that physicians were better at identifying severe problems, had more difficulty identifying psychosocial problems with mild symptomatology, and tended to refer to a medical specialist or mental health professional more often for severe problems, depression or a developmental problem. Physicians tended to view treating psychosocial problems favorably.

Family-Based Treatment for Pediatric Overweight: Parental Weight Loss as a Predictor of Children's Treatment Success

This study examined the relative influence of nutrition and exercise education, behavioral therapy, and parental weight loss on childrens weight-related treatment outcomes. Participants included 65 children and their parents who were participating in an evidence-based multicomponential pediatric overweight intervention program. After accounting for age and sex, childrens attendance at group treatment and change in health knowledge predicted 9.7% and 5.8% of the variance in childrens weight change, respectively. However, the single greatest predictor of change in childrens body mass index was parent weight loss, which accounted for 18.8% of the variance in the model. Findings suggest that although nutrition–exercise education and group therapy are beneficial, parental weight loss best predicts childrens treatment outcomes.

Examination of adolescents' screen time and physical fitness as independent correlates of weight status and blood pressure

Abstract Physical fitness performance is an important health correlate yet is often unrelated to sedentary behaviour in early adolescence. In this study, we examined the association of sedentary behaviour (i.e. screen time) with weight-related health markers and blood pressure, after controlling for cardiorespiratory fitness performance. American middle school students (N = 153, 56% females) aged 11–15 years (mean 12.6 years, s = 0.5) completed assessments of cardiorespiratory fitness performance, screen time, weight status (BMI percentile, waist-to-height ratio), and blood pressure. Multivariate analysis of covariance, controlling for cardiorespiratory fitness performance, found those who met the daily recommendation of 2 h or less of screen time (n = 36, 23.5%) had significantly lower BMI (p < 0.05) and systolic blood pressure (p < 0.01) compared with those who exceeded this recommendation. Findings suggest specific intervention programmes may be designed to target both cardiorespiratory fitness and sedentary behaviours to maximize early adolescent health because these behaviours are likely to have unique and independent effects on youth health markers.

The PedsQL™ Oral Health Scale in Iranian children: reliability and validity

OBJECTIVE The primary objective of the study was to translate and evaluate the psychometric properties of the Pediatric Quality of Life Inventory™ (PedsQL™) Oral Health Scale in over 1000 Iranian children. METHODS A standard forward and backward translation procedure was used to convert the US English dialect version of the PedsQL™ Oral Health Scale into the Iranian language (Persian). The Iranian version of the PedsQL™ Oral Health Scale, in combination with the PedsQL™ 4.0 Generic Core Scales, was then subsequently administered to 1053 Iranian children and 1026 parents. The reliability of the PedsQL™ Oral Health Scale was evaluated using internal consistency and test-retest methods. Known-groups discriminant validity, exploratory factor analysis (EFA) of the Oral Health and the four Generic Core Scales combined, and confirmatory factor analysis (CFA) of the Oral Health Scale alone were conducted. The Benjamini-Hochberg procedure was used to correct P-values for multiple comparisons. RESULTS Good to excellent internal consistency and test-retest reliabilities were demonstrated. The PedsQL™ Oral Health Scale demonstrated discriminant validity for subgroups of children across different decayed, missing and filled teeth (DMFT) index categories and gender. The EFA supported the a priori factor model of the combined five scales. The CFA analysis confirmed the unidimensional factor structure of the Oral Health Scale. CONCLUSIONS The PedsQL™ Oral Health Scale demonstrated excellent psychometric properties in combination with the PedsQL™ 4.0 Generic Core Scales. These five scales combined can be utilized to assess the multidimensional oral-health-related quality of life of Iranian children.

The Relationship Between Self-Efficacy for Behaviors That Promote Healthy Weight and Clinical Indicators of Adiposity in a Sample of Early Adolescents

Objective: Examine the relationship between self-efficacy and various measures of adiposity in a sample of teens. Methods: A total of 132 teens were selected from schools participating in an existing research study titled Teen Eating and Activity Mentoring in Schools (TEAMS). Teens completed demographic questionnaires and healthy eating–specific and physical activity–specific measures of self-efficacy. Waist circumference (WC), triceps skinfold thickness (TSF), and body mass index (BMI) percentile scores were also obtained. Results: Regression analyses indicated that healthy eating–specific and physical activity–specific measures of self-efficacy predicted WC and TSF. ANOVA revealed significant differences in healthy eating–specific self-efficacy levels between students of recommended weight and overweight/obese status. Supplemental analyses showed significant negative relationships between a student’s ideal BMI ratio and self-efficacy. Conclusions: Because self-efficacy may be amenable to change, these findings could inform future efforts aimed at increasing behaviors that promote healthy weight status among early adolescents.

Reliability and Validity of the SE-HEPA: Examining Physical Activity– and Healthy Eating–Specific Self-Efficacy Among a Sample of Preadolescents

Objective. The purpose of this study was to examine the psychometric properties of the self-efficacy for healthy eating and physical activity measure (SE-HEPA) for preadolescents. Method. The reliability of the measure was examined to determine if the internal consistency of the measure was adequate (i.e., αs > .70). Next, in an effort to determine if a two-factor model was a better fit than a one-factor model, as hypothesized, an exploratory factor analysis in a confirmatory factor analysis framework was used to determine model fit. Additionally, the criterion-related validity of the measure was evaluated by conducting correlational analyses to determine if SE-HEPA scores were associated with preadolescent body mass index. Results. Consistent with the hypotheses, Cronbach’s alphas indicated good reliability for the measure (i.e., αs > .70) and factor analyses indicated the two-factor model provided a better fit than the one-factor model. Additionally, correlations revealed a significant relationship between the two factors (i.e., healthy eating, physical activity) and preadolescent body mass index. Conclusions. The SE-HEPA will allow researchers and clinicians to better understand self-efficacy for behaviors important to weight loss among preadolescents. This could, in turn, inform future efforts aimed at increasing behaviors that promote healthy weight status among this population within the context of family-based weight loss programs.

The Process of Curriculum Development and Implementation for an Adolescent Health Project in Middle Schools

Childhood obesity has reached epidemic levels in developed countries and is showing no signs of abating. The causes of obesity in adolescence are extremely complex, and therefore approaches to prevention and treatments must be multifaceted. Early adolescence is a developmental period when youth are becoming more independent, are influenced by peers, and are making more decisions related to their own health and lifestyles. The purpose of this article is to describe the development, implementation, and evaluation of a multilevel school-based intervention program for middle school students in the Teen Eating and Activity Mentoring in Schools (TEAMS) project. Critical components of success included an interdisciplinary approach, applying available curricula to meet contextual characteristics, and involvement of all stakeholders in planning, evaluating, and refining the program.

Weighing the Pros and Cons in Family-Based Pediatric Obesity Intervention: Parent and Child Decisional Balance as a Predictor of Child Outcomes

This investigation examined the relations among parent/child decisional balance (perception of advantages/disadvantages), child weight status, and child outcomes. Thirty-seven parent–child dyads in a family-based weight management program participated in the study. Analyses indicated that children evidenced a more positive decisional balance profile than their parents at pre-intervention. Child pre-intervention weight status was associated with child decisional balance, but not parent decisional balance. Finally, child total decisional balance was the single best predictor of child outcomes. The results of this study emphasize the important role a childs readiness to change can play in the treatment of pediatric obesity.

Multiple Behavioral Factors Related to Weight Status in a Sample of Early Adolescents: Relationships of Sleep, Screen Time, and Physical Activity

The current investigation examines sleep debt, sleepiness, screen time, physical activity, and weight status among a sample of 110 adolescents. Students completed sleep questions, a sleepiness questionnaire, a measure of physical activity; anthropometric data were gathered. Results indicated significant relationships between sleep debt and sleepiness, screen time and sleepiness, and sleepiness and physical activity levels. Additionally, significant differences were found for physical activity and screen time, but not for sleepiness, between students among different weight status categories. A better understanding of sleep behaviors and weight status may ultimately inform prevention/treatment programs designed to reduce obesity in adolescents.