William T. Dalton

A coordinated school health approach to obesity prevention among Appalachian youth: the Winning with Wellness pilot project.

Childhood obesity has been an increasing problem in the United States, especially in rural areas. Effective prevention approaches are needed. This article describes the development, implementation, effectiveness, feasibility, and sustainability of a school-based obesity prevention pilot project, Winning with Wellness. The program was based on the coordinated school health model and included a community-based participatory research approach aimed at promoting healthy eating and physical activity in a rural Appalachian elementary school. Findings from this preliminary project revealed improvements in nutrition offerings and increased physical activity during the school day. In addition, the program was found to be acceptable to teachers, successfully implemented utilizing both existing and newly developed resources, and sustainable as evidenced in continued practice and expansion to other area schools.

Parental Report of Medication Acceptance Among Youth : Implications for Everyday Practice

Objective: Evidence-based interventions for pill swallowing training exist but are primarily implemented in pediatric specialty hospitals. Given increasing interest in the translation of brief and effective interventions to the wider population, there is a need to examine medication acceptance in a normative sample. Methods: Participants (N = 304) completed the Medication Acceptance Survey, which assessed child/adolescent liquid and pill medication history and acceptance as well as parental interest in pill swallowing training. Results: Results showed that 30–40% of youth had rejected/refused a pill or liquid formulation. Over half were unable to swallow a standard size pill or small capsule. Despite these difficulties, most parents did not express interest in an empirically supported pill swallowing training intervention. Conclusions: The results provide directions for future research as well as the translation of pill swallowing interventions to primary care.

Health Behaviors and Health-Related Quality of Life among Middle School Children in Southern Appalachia: Data from the Winning with Wellness Project

UNLABELLED Health-related quality of life (HRQoL) is linked to health status in a variety of conditions. Less is known about the relation between quality of life and modifiable health behaviors, especially among medically underserved populations. OBJECTIVE The purpose of the current study was to examine HRQoL as it relates to physical activity, sedentary behavior, and eating patterns in youth residing in Southern Appalachia. METHODS The Pediatric Quality of Life Inventory and questions on physical activity and eating behaviors was completed by 152 sixth grade students in a regional sample of schools participating in the Winning with Wellness child obesity prevention project. RESULTS The current study found higher physical activity levels and lower levels of screen time to be associated with reports of more positive HRQoL. CONCLUSIONS A more comprehensive understanding of factors surrounding health behavior may hold implications for obesity prevention/intervention programs.

Treatment of eating disorders in primary care: a systematic review.

This review evaluated psychological treatments for Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder conducted in primary care. Five studies met inclusion criteria. Guided self-help cognitive-behavioral therapy via a self-help book may be a beneficial, first-line treatment for reducing binging and purging symptoms. Outcomes combining self-help with antidepressants remain unclear, although antidepressants alone may provide reduction of symptoms. High attrition and non-compliance rates among studies reviewed indicate the importance of a strong therapeutic alliance between provider and patient. Further research in primary care is needed to develop a standard of care for patients with eating disorders.

Gender, smoking status, and risk behavior attitudes explain adolescents' patterns of nicotine replacement therapy use.

Treatment studies provide minimal support for nicotine replacement therapy (NRT) with youth; however, survey studies suggest that adolescents use NRT, and may engage in inappropriate use. The current study sought to examine patterns of NRT use and risk factors for use to further aid smoking cessation efforts including prevention of potential misuse. In-school surveys assessing socio-demographic and behavioral factors associated with NRT use, gum or patch, were completed by 4078, predominantly African American, high school students. Approximately 5% of students reported former or current use of NRT products: 42% gum, 29% patch, and 29% both gum and patch. Among smokers, 5.4% reported use of both NRT gum and patch, with exclusive use of gum twice as likely as exclusive use of the patch. Those with high-risk-taking attitudes were more likely than low-risk takers (3% vs. 1%) to report use of both products, with exclusive gum use more prevalent than patch use. A cumulative logit model revealed males, risk takers, and/or smokers were at greatest odds for NRT use. Among this adolescent sample, NRT gum was used more often than the patch. Adolescent males, risk takers, and/or smokers appear more likely to use NRT (gum and/or patch) compared to their counterparts, despite limited empirical support for effective use of these products as cessation aids among adolescents. Smoking cessation and prevention programs may emphasize appropriate NRT use, specifically within these populations.

Psychosocial Variables Associated With Husbands' Adjustment Three Months Following Wives' Diagnosis of Breast Cancer

Background. Husbands of women with breast cancer may experience adjustment difficulties. We examined psychosocial predictors of husbands’ adjustment to their wives’ breast cancer 3 months following diagnosis.Methods. Women (N=45) with Stage I or II breast cancer who were 3 months postdiagnosis and their husbands completed measures of adjustment, coping, marital adjustment, and quality of life.Results. Multiple regression analyses showed husbands’ avoidant coping and wives’ adjustment accounted for approximately 54% of the variance in husbands’ adjustment.Conclusions. Further research on predictors of husbands’ adjustment following wives’ diagnoses of breast cancer is needed to inform intervention efforts.

Parent-Led Activity and Nutrition (PLAN) for healthy living: Design and methods

Child obesity has become an important public health concern, especially in rural areas. Primary care providers are well positioned to intervene with children and their parents, but encounter many barriers to addressing child overweight and obesity. This paper describes the design and methods of a cluster-randomized controlled trial to evaluate a parent-mediated approach utilizing physicians brief motivational interviewing and parent group sessions to treat child (ages 5-11 years) overweight and obesity in the primary care setting in Southern Appalachia. Specific aims of this pilot project will be 1) to establish a primary care based and parent-mediated childhood overweight intervention program in the primary care setting, 2) to explore the efficacy of this intervention in promoting healthier weight status and health behaviors of children, and 3) to examine the acceptability and feasibility of the approach among parents and primary care providers. If proven to be effective, this approach may be an exportable model to other primary care practices.

Self-reported versus actual weight and height data contribute to different weight misperception classifications.

Objectives The purpose of the study was to examine potential differences between two approaches to defining adolescent weight misperception. Specifically, weight status perception was compared with self-reported weight status and actual weight status (based on body mass index percentiles calculated from self-reported and actual weights and heights, respectively). Furthermore, the accuracy of assigning weight status based on body mass index percentiles calculated from self-reported weights and heights was assessed by comparing them with actual weight status. Methods Data were extracted from Team Up for Healthy Living, an 8-week, school-based obesity prevention program in southern Appalachia. Participants (N = 1509) were predominately white (93.4%) and ninth graders (89.5%), with approximately equivalent representation of both sexes (50.7% boys). Results The study revealed significant differences between the approaches to defining weight misperception (&khgr;2 = 16.2; P = 0.0003). Conclusions Researchers should interpret study findings with awareness of potential differences based on the method of calculating weight misperception.

Weight status misperception as related to selected health risk behaviors among middle school students.

BACKGROUND Weight misperception has been documented among children although the impact on health risk behaviors is less understood, particularly among middle school students. The goals of this study were to describe sociodemographic differences in actual and perceived weight, correspondence between actual and perceived weight, and weight-related health risk behaviors, as well as to examine weight misperception and interactions with sociodemographic variables in explaining weight-related health risk behaviors. METHODS Participants were recruited at 11 public school districts participating in the Tennessee Coordinated School Health (CSH) pilot program. A total of 10,273 middle school students completed the Centers for Disease Control and Preventions Youth Risk Behavior Survey administered by teachers in the school setting. RESULTS Findings revealed sociodemographic differences in actual and perceived weight as well as weight misperception. Although overestimating ones weight was significantly related to greater likelihood of weight-related health risk behaviors, significant interactions showed this relationship to be especially pronounced in females. Additional distinctions based on sociodemographic variables are indicated. CONCLUSIONS Results highlight the importance of screening for health risk behaviors including weight misperception among middle school students. The CSH program offers an opportunity to understand health risk behaviors among students while also informing and evaluating methods for intervention.

Relationships between Weight and Body Dissatisfaction, Body Esteem, and Teasing in African American Girls.

This study assessed the relation between weight and weight-related factors (i.e., body dissatisfaction, body esteem, teasing frequency, and the effects of teasing) in a community sample of prepubescent African American girls. African American girls (N = 97) in Grades 3 to 5 completed the McKnight Risk Factor Survey—Third Edition and had their heights and weights taken to calculate body mass index (BMI). Participants were from two public elementary schools with a predominantly African American student population in a Southern metropolitan city of the United States. Increased weight was associated with higher levels of body dissatisfaction and a greater frequency of weight teasing by peers. Weight was not associated with body esteem. These relationships between weight and related factors may be important for understanding how weight affects psychosocial functioning in a community sample of African American girls.