Retta R. Evans

Benefits and barriers to medically supervised pediatric weight-management programs

Obesity in children and adolescents is now the most common chronic condition in the USA. Data indicate that approximately one in five children in the USA is now overweight. Public health professionals have increased efforts in recent years to develop medically supervised programs for this population. However, research shows that only a small amount of obese children participate in weight-reduction programs. Also, the long-term effects of these weight-reduction interventions for obese children have not been well researched. Several recent studies report that most of the successful obesity programs utilize an interdisciplinary approach that combines a diet, physical activity, parental involvement and behavioral modification. This article provides a review of the professional literature related to the benefits and barriers of medically supervised pediatric weight-management programs. It summarizes the programs that work and the perceived barriers that parents and families struggle with in adhering to treatment plans.

Ecological Strategies to Promote Healthy Body Image Among Children

BACKGROUND Personal habits of children and adolescents related to healthy body image (BI) are influenced by various determinants in the micro- and macroenvironment. These include attitudes and behaviors about eating; exercise and physical appearance modeled by parents, teachers, and peers; as well as opportunities to learn new habits and social praise for healthy choices. The coordinated school health program (CSHP) is compatible with the 5 levels of an ecological approach to developing new health behaviors. METHODS Authors systematically applied the ecological model to all 8 components of coordinated school health. Next, strategies for each of the components were developed using the professional literature as well as author expertise in the areas of health education, exercise science, and dietetics. RESULTS For each strategy, applicable health and physical education standards, as well as goals for each strategy and additional Web resources, were provided to assist educators and administrators in supporting healthy BI among students. CONCLUSIONS Educators may effectively use a coordinated approach to guide multiple intervention activities aimed at increasing healthy habits among adolescents and their families. The strength of the CSHP is its collaborative nature with active participation by students, faculty members, family caregivers, agency professionals, community residents, and health care providers.

Does Short Sleep Lead to Obesity Among Children and Adolescents? Current Understanding and Implications

Childhood obesity continues to be a major public health concern in the United States. This work reviews the current understanding of the relationship between sleep duration and obesity among children and adolescents. A systematic search was conducted for papers published between January 2000 and July 2013 using keywords: (sleep) and (overweight or obesity or obese or body mass index or BMI or adiposity or body fat or fat) and (children or child or youth or teen or pediatric or adolescent or paediatric or childhood or adolescence or boy or girl). Reference lists of relevant articles and reviews or meta-analysis articles were checked to identify additional studies. Only empirical work and longitudinal studies that focused on children and adolescents were included in this review. The search identified 22 longitudinal studies. The majority of the reviewed studies support the presence of an inverse relationship between sleep duration and obesity. However, in some studies the relationship was not significant in adjusted analyses. Differences as a function of age and gender were also noted. Despite more than a decade of research, the debate on the association between sleep duration and obesity continues. Further research with repeated assessments, valid objective measures, and better control of potential confounding variables is warranted.

Developing Valid and Reliable Online Survey Instruments Using Commercial Software Programs

The increased popularity and ease of creating online surveys may allow for professionals with little knowledge of appropriate study design and psychometrics to develop instruments with questionable methodological rigor. The present study provides one example of developing an online survey instrument using appropriate survey design. This article will provide health sciences librarians with a resource in the development of a valid and reliable survey instrument using SurveyMonkey.com. Recommendations for future research include surveying health sciences librarians and other professionals to gain a better understanding of the need for education on this topic.

Fear of physical response to exercise among overweight and obese adults

Regular physical activity has been shown to have significant impact on both physical and mental health; however, over half of adults in the US do not meet current recommendations for physical activity. Pain is one of the most commonly cited barriers to physical activity among adults. Fear of pain has been shown to have a significant correlation with pain-related disorders including back pain and arthritis, but no studies have examined the role that weight plays on these fears. We conducted three focus groups (n = 21) to explore the role of fear-avoidance beliefs related to exercise among a group of overweight and obese adults. Focus group members discussed their beliefs that overweight and obese adults have more exaggerated physical responses to exercises than normal weight adults. They also endorsed a belief that overweight and obese individuals interpret similar physical responses differently than normal weight individuals, and that these interpretations lead to fear that may result in exercise avoidance. Further exploration of the role of fear in exercise avoidance will be useful in designing tailored exercise prescriptions and physical activity interventions that may increase adherence among overweight and obese adults.

Responses of Health and Physical Educators to Overweight Children in Alabama

The purpose of this article is to provide an overview of the increasing problem of overweight children in Alabama including clinical definition, risk factors, and prevalence data. Health and physical educators should become familiar with guidelines released by national organizations, such as the Centers for Disease Control and Prevention, the Institute of Medicine, and state departments of education and public health. These guidelines provide direction to health promotion program activities in schools, community, and recreational settings aimed at modifying predisposing, reinforcing, and enabling factors. Four examples are presented in the narrative to illustrate collaborative partnerships among health care organizations, a health insurer, public schools, an academic research university, and state agencies to enhance youth health. The final section provides practical recommendations for professional health and physical educators regarding obesity risk reduction.

Utilization of online focus groups to include mothers: A use-case design, reflection, and recommendations

Advances in technology over the past decade have allowed unique methodologies to emerge, enabling the engagement of hard-to-reach populations on sensitive topics in a way that was before thought not possible with traditional face-to-face modalities. This study aimed to use online focus group discussions (FGDs) to explore breastfeeding mothers’ use of social media. Results indicate participants had a positive experience with online FGDs, and almost all preferred this method to traditional face-to-face focus groups. We discuss reflections of the online FGD experience, including best practices and recommendations for innovative ways to include time-constrained or hard-to-reach participants, for yielding rich qualitative data.

Body Mass Index and Chronic Health Conditions as Predictors of Exercise Fear-Avoidance Beliefs

Obese adults often experience heightened physical responses to exercise, and some may interpret this response as a sign that they are in danger of harm or injury. This fear of harm, or fearavoidance beliefs (FAB), leads some individuals to avoid exercise, leading to increased sedentary behavior and further difficulty maintaining weight. Evidence indicates that body mass index (BMI) is predictive of FAB, but no research has considered the impact of medical conditions on FAB in obese adults. The purpose of this study was to assess the impact of cardiorespiratory and musculoskeletal conditions on FAB. Participants (n=155) completed the Exercise Fear Avoidance Scale (EFAS), a checklist of medical conditions, and the Pain Disability Index. We calculated differences in EFAS scores between groups with and without each condition using t-tests. We used linear regression to calculate the amount of variance in EFAS scores accounted for by BMI, age, pain and condition. Individuals reporting a cardiorespiratory or musculoskeletal condition had significantly higher EFAS scores than those who did not (7.4 points, P<.001; 4.4 points, P=.001, respectively). BMI, pain and age explained significant portions of the variance in EFAS scores (P=.003; P<.001; P=.001, respectively). When added to the regression equations, no condition significantly added to the variance in EFAS scores. While those with cardiorespiratory and musculoskeletal conditions may have higher FAB than those without, BMI appears to contribute to this fear even in individuals without these conditions. Practitioners should consider FAB when discussing exercise recommendations with obese individuals regardless of cardiorespiratory or musculoskeletal history.

Component analysis and initial validity of the exercise fear avoidance scale.

OBJECTIVES To develop the Exercise Fear Avoidance Scale (EFAS) to measure fear of exercise-induced discomfort. METHODS We conducted principal component analysis to determine component structure and Cronbachs alpha to assess internal consistency of the EFAS. Relationships between EFAS scores, BMI, physical activity, and pain were analyzed using multivariate regression. RESULTS The best fit was a 3-component structure: weight-specific fears, cardiorespiratory fears, and musculoskeletal fears. Cronbachs alpha for the EFAS was α=.86. EFAS scores significantly predicted BMI, physical activity, and PDI scores. CONCLUSION Psychometric properties of this scale suggest it may be useful for tailoring exercise prescriptions to address fear of exercise-related discomfort.

Responding to Health Information and Training Needs of Individuals with Disabilities

The role of a medical librarian includes guiding consumers to search for information related to specific health needs and interpret information for personal use. Little is known about barriers to accessing health information and clinical services for those with cognitive and physical disabilities. The purpose of this article is to describe a statewide needs assessment of the health information and services needs of individuals with disabilities and their caregivers. Data from the needs assessment conducted by the Health Services Training Project of more than 1,000 respondents indicate unmet needs for outreach to increase effective use of library and information resources. Fewer consumers and their caregivers utilized the Internet to search for health information as compared to clinical service providers and students in health professions. A majority of consumers reported difficulty obtaining and understanding online health information. Service providers and students shared concerns about information quality. Consumers and caregivers expressed highest levels of trust in information provided by service providers, nonprofit health agencies, reference books, and libraries.