Feasibility of Using a Commercial Fitness Tracker as an Adjunct to Family-Based Weight Management Treatment: Pilot Randomized Trial.

BACKGROUND: Fitness trackers can engage users through automated self-monitoring of physical activity. Studies evaluating the utility of fitness trackers are limited among adolescents, who are often difficult to engage in weight management treatment and are heavy technology users. OBJECTIVE: We conducted a pilot randomized trial to describe the impact of providing adolescents and caregivers with fitness trackers as an adjunct to treatment in a tertiary care weight management clinic on adolescent fitness tracker satisfaction, fitness tracker utilization patterns, and physical activity levels. METHODS: Adolescents were randomized to 1 of 2 groups (adolescent or dyad) at their initial weight management clinic visit. Adolescents received a fitness tracker and counseling around activity data in addition to standard treatment. A caregiver of adolescents in the dyad group also received a fitness tracker. Satisfaction with the fitness tracker, fitness tracker utilization patterns, and physical activity patterns were evaluated over 3 months. RESULTS: A total of 88 adolescents were enrolled, with 69% (61/88) being female, 36% (32/88) black, 23% (20/88) Hispanic, and 63% (55/88) with severe obesity. Most adolescents reported that the fitness tracker was helping them meet their healthy lifestyle goals (69%) and be more motivated to achieve a healthy weight (66%). Despite this, 68% discontinued use of the fitness tracker by the end of the study. There were no significant differences between the adolescent and the dyad group in outcomes, but adolescents in the dyad group were 12.2 times more likely to discontinue using their fitness tracker if their caregiver also discontinued use of their fitness tracker (95% CI 2.4-61.6). Compared with adolescents who discontinued use of the fitness tracker during the study, adolescents who continued to use the fitness tracker recorded a higher number of daily steps in months 2 and 3 of the study (mean 5760 vs 4148 in month 2, P=.005, and mean 5942 vs 3487 in month 3, P=.002). CONCLUSIONS: Despite high levels of satisfaction with the fitness trackers, fitness tracker discontinuation rates were high, especially among adolescents whose caregivers also discontinued use of their fitness tracker. More studies are needed to determine how to sustain the use of fitness trackers among adolescents with obesity and engage caregivers in adolescent weight management interventions

Using mobile technology to impact fruit and vegetable consumption in low-income youth

The benefits of fruits and vegetables (FV) include supplying nutrients and fiber to the diet, reducing risk of disease, and assisting in weight maintenance by increasing satiety and decreasing energy density of the diet. FV intake has been inadequate compared to national recommendations across the population and interventions to increase FV intake in pediatric populations have shown mixed results. This study utilized mobile health technology (mHealth, handheld computers) to deliver an Ecological Momentary Intervention (EMI) incorporating behavior change skills (e.g., goal setting, self-monitoring, problem-solving, feedback, and reward) called Growing up Strong (GuS) to increase FV consumption in low-income, ethnic minority children and adolescent girls. Compared to a paper manual control condition, participants randomized to GuS significantly increased their fruit and combined FV, but not vegetable intake from Baseline to end of intervention (Week 4). Follow-up at Week 12 showed that all treatment gains had been lost. Adherence to the electronic program was high, with participants interacting with the program on 81.1% of days and answering 50.4% of the 6 daily program prompts over the 28 days of the intervention. Results indicate an EMI is acceptable to female youth and can help boost FV intake. Creating fun FV intervention programs that can sustain interest for longevity of use might have a greater impact by preventing immediate return to previous intake levels and reinforcing longer-term lifestyle change. Recommendations are provided for integrating FV intervention into larger multiple health behavior change (MHBC) programs to increase impact on weight management and health outcomes

Games for health for children - current status and needed research

Videogames for health (G4H) offer exciting, innovative, potentially highly effective methods for increasing knowledge, delivering persuasive messages, changing behaviors, and influencing health outcomes. Although early outcome results are promising, additional research is needed to determine the game design and behavior change procedures that best promote G4H effectiveness and to identify and minimize possible adverse effects. Guidelines for ideal use of different types of G4H by children and adolescents should be elucidated to enhance effectiveness and minimize adverse effects. G4H stakeholders include organizational implementers, policy makers, players and their families, researchers, designers, retailers, and publishers. All stakeholders should be involved in G4H development and have a voice in setting goals to capitalize on their insights to enhance effectiveness and use of the game. In the future, multiple targeted G4H should be available to meet a population's diverse health needs in developmentally appropriate ways. Substantial, consistent, and sophisticated research with appropriate levels of funding is needed to realize the benefits of G4H

The Negative Impact of Excessive Screen Time on Language Development in Children Under 6-Years-Old: An Integrative Review with Screen Time Reduction Toolkit and Presentation for Outpatient Pediatric and Family Health Providers

Background. Increased amounts of recreational screen time, defined as time watching television and DVDs, playing videogames, and using computers, tablets, and cellular phones without academic purpose, and the lack of effective media use assessment and patient education being done by primary care providers is associated with increased risk of language developmental delays for young children under 6-years-old. Purpose. The purpose of this integrative review is to develop a toolkit that provides education for providers and families on the adverse effects of excessive screen time on language development in children younger than 6-years-old and evidence-based screen time reduction strategies that can be implemented in outpatient primary care clinics at all wellness visits. Toolkit and Presentation. An integrative review was conducted to describe the effects of excessive screen time on language development for children under age 6 and analyze interventions to decrease screen time. From these results, the Screen Time Reduction Toolkit was created. The toolkit includes the 2-Question Assessment for Screen Time (2-QAST), screen time reduction algorithm, provider and patient education on health risks associated with excessive screen time, screen time recommendations published by the American Academy of Pediatrics (AAP), and evidence-based screen time reduction strategies, provider resources, and patient education handouts. The integrative review findings and toolkit were presented to a group of local pediatric providers, nurses, and medical technicians for education and implementation. Outcomes/Discussion. The pre-presentation survey was created after the Health Belief Model (HBM), which served as the framework for this educational intervention. Staff members had high perceived seriousness (83%), perceived susceptibility (83%), and perceived benefit (100%), demonstrating that staff members’ attitudes and beliefs about screen time for young children were in agreement with the principles of this project. Barriers identified included lack of knowledge about health risks from excessive screen time, potential for parental resistance to screen time reduction advice, and time constraints during wellness visits. Regarding cues to action, staff members requested visual aids, handouts, and more education about screen time. The toolkit and patient education resources reduce barriers and address cues to action identified by the staff members. The post-presentation evaluation revealed that 100% of staff members found the toolkit presentation informative and said it increased their knowledge and understanding of the topic. Conclusion. The toolkit provides the education that providers need to be knowledgeable as well as confident in their ability to discuss screen time with families. Being consistent about providing a few minutes of screen time education at every wellness visit from 2-months-old to 5-years-old sets a solid foundation for parents and children to create healthier screen time habits at home

Structural and Social Determinants of Health in Asthma in Developed Economies: a Scoping Review of Literature Published Between 2014 and 2019.

PURPOSE OF REVIEW:Using the WHO Conceptual Framework for Action on the Social Determinants of Health, this review provides a discussion of recent epidemiologic, mechanistic, and intervention studies of structural and social determinants of health and asthma outcomes covering the period from 2014 to 2019. RECENT FINDINGS:A majority of studies and interventions to date focus on the intermediary determinants of health (e.g., housing), which as the name suggests, exist between the patient and the upstream structural determinants of health (e.g., housing policy). Race/ethnicity remains a profound social driver of asthma disparities with cumulative risk from many overlapping determinants. A growing number of studies on asthma are beginning to elucidate the underlying mechanisms that connect social determinants to human disease. Several effective interventions have been developed, though a need for large-scale policy research and innovation remains. Strong evidence supports the key role of the structural determinants, which generate social stratification and inequity, in the development and progression of asthma; yet, interventions in this realm are challenging to develop and therefore infrequent. Proximal, intermediary determinants have provided a natural starting point for interventions, though structural interventions have the most potential for major impact on asthma outcomes. Further research to investigate the interactive effect of multiple determinants, as well as intervention studies, specifically those that are cross-sector and propose innovative strategies to target structural determinants, are needed to address asthma morbidities, and more importantly, close the asthma disparity gap

Association between portable screen-based media device access or use and sleep outcomes

Importance Sleep is vital to children’s biopsychosocial development. Inadequate sleep quantity and quality is a public health concern with an array of detrimental health outcomes. Portable mobile and media devices have become a ubiquitous part of children’s lives and may affect their sleep duration and quality. Objective To conduct a systematic review and meta-analysis to examine whether there is an association between portable screen-based media device (eg, cell phones and tablet devices) access or use in the sleep environment and sleep outcomes. Data Sources A search strategy consisting of gray literature and 24 Medical Subject Headings was developed in Ovid MEDLINE and adapted for other databases between January 1, 2011, and June 15, 2015. Searches of the published literature were conducted across 12 databases. No language restriction was applied. Study Selection The analysis included randomized clinical trials, cohort studies, and cross-sectional study designs. Inclusion criteria were studies of school-age children between 6 and 19 years. Exclusion criteria were studies of stationary exposures, such as televisions or desktop or personal computers, or studies investigating electromagnetic radiation. Data Extraction and Synthesis Of 467 studies identified, 20 cross-sectional studies were assessed for methodological quality. Two reviewers independently extracted data. Main Outcomes and Measures The primary outcomes were inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness, studied according to an a priori protocol. Results Twenty studies were included, and their quality was assessed. The studies involved 125 198 children (mean [SD] age, 14.5 [2.2] years; 50.1% male). There was a strong and consistent association between bedtime media device use and inadequate sleep quantity (odds ratio [OR], 2.17; 95% CI, 1.42-3.32) (P < .001, I2 = 90%), poor sleep quality (OR, 1.46; 95% CI, 1.14-1.88) (P = .003, I2 = 76%), and excessive daytime sleepiness (OR, 2.72; 95% CI, 1.32-5.61) (P = .007, I2 = 50%). In addition, children who had access to (but did not use) media devices at night were more likely to have inadequate sleep quantity (OR, 1.79; 95% CI, 1.39-2.31) (P < .001, I2 = 64%), poor sleep quality (OR, 1.53; 95% CI, 1.11-2.10) (P = .009, I2 = 74%), and excessive daytime sleepiness (OR, 2.27; 95% CI, 1.54-3.35) (P < .001, I2 = 24%). Conclusions and Relevance To date, this study is the first systematic review and meta-analysis of the association of access to and the use of media devices with sleep outcomes. Bedtime access to and use of a media device were significantly associated with the following: inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness. An integrated approach among teachers, health care professionals, and parents is required to minimize device access at bedtime, and future research is needed to evaluate the influence of the devices on sleep hygiene and outcomes

Game Changer: Investing in Digital Play to Advance Children's Learning and Health

Based on a literature review and interviews with digital learning experts, explores how digital games can foster skills and knowledge for better academic performance and health. Makes recommendations for government research, partnerships, and media

Occupational Therapy Program Development For Group Threatment For Outpatient Pediatric Clinics: Technology Management

Problem Statement: Children and adolescents are experiencing difficulty managing the technology in their lives as evidenced by excessive technology use leading to negative effects on their occupational performance. The overuse of technology is associated with a variety of problems, especially for growing children and adolescents, including shorter sleep duration, reduced scholastic achievement, musculoskeletal concerns, obesity, and exacerbated symptoms of depression and anxiety (Gerwin, 2017; Glover, 2021; Gwynette, 2017). Description of Product: To address these issues, a group treatment program was developed for outpatient pediatric clinics focused on helping children and their families benefit from the use of technology without experiencing the negative effects of technology overuse. Methodology: A comprehensive literature review was completed regarding pediatric group programming, program development, technology use behaviors, impacts of technology use, and technology management. Description of Results: The intended result of this program is to make positive changes to how children and their families engage with technology to support improved occupational performance. With the ubiquity of advanced technology, it is crucial for occupational therapists to address the impact of technology on developing youth and their families