Feasibility of a Virtual Group Nutrition Intervention for Adolescents with Autism Spectrum Disorder

Background: Youth with autism spectrum disorder (ASD) have an increased likelihood of being overweight or developing obesity. As children and adolescents with ASD exhibit problematic eating behaviors and may consume more energy-dense foods and fewer fruits and vegetables than typically developing youth, nutrition represents a modifiable obesity risk factor for adolescents with ASD, yet there is a lack of interventions to improve healthy eating and reduce the risk of obesity in this population. Purpose: The purpose of this study was to examine the feasibility, acceptability, and preliminary efficacy of a virtual implementation of BALANCE (Bringing Adolescent Learners with Autism Nutrition and Culinary Education), an 8-week theory-driven nutrition intervention for adolescents with ASD. Methods: Six groups of adolescents (n=27; group size ranged 2-7) diagnosed with ASD and aged 12-20 years participated in the Social Cognitive Theory (SCT) based intervention via Microsoft Teams. Fidelity checklists measured attendance, participation, homework, fidelity, and technical difficulties. Feasibility of assessing outcome measures, including the Block Kids Food Frequency Questionnaire (FFQ), a validated psychosocial survey, and height and weight, was evaluated on response rate, completion, and data quality. Six adolescent focus groups (n=12) and 21 parent interviews were audio-recorded, transcribed, and analyzed for a priori and emergent themes regarding intervention acceptability, perceived benefits, and unintended consequences. Height and weight were measured via ruler and scale as virtually instructed by research staff. Wilcoxon signed-ranked tests were used to compare pre- and post-intervention means for psychosocial determinants of dietary intake, dietary intake, and anthropometric measures. Results: Mean lesson attendance was 88%, participation was 3.5 of 4, homework completion was 51.9%, fidelity was 98.9%, and prevalence of technical difficulties was 0.4 of 2 (no technical difficulties or minor difficulties for all lessons). Baseline response rate was 100% for all outcome measures, with 98.9-100% completion. Post-intervention response rate was 92.6%-96.3%, with 99.5%-100% completion. Data quality was high for 88% of the matched FFQs and 100% of the psychosocial surveys. The intervention was generally acceptable to participants based on the focus groups and interviews with adolescents and their parents. Themes for acceptability included “virtual format,” “group setting,” “autonomy/independence,” “sensory components,” “interaction,” “reinforcement,” and “parent component.” Themes for perceived benefits included “diet changes,” “healthy weight,” “knowledge/awareness,” “behavioral skills,” “self-efficacy,” “outcome expectations,” “outcome expectancies,” and “other lifestyle changes.” “Anxiety/discomfort” during intervention lessons was an emergent theme regarding unintended consequences. Post-intervention means for three of seven psychosocial determinants of dietary intake improved after the 8-week intervention: behavioral strategies (p=0.010), self-efficacy (p\u3c0.001), and outcome expectations (p=0.009). Mean added sugar intake decreased (p=0.026), while there was no significant difference in fruit or vegetable intake. BMI percentile (p=0.013) and BMI z-score significantly decreased (p=0.010). Conclusion: BALANCE was feasible and acceptable to adolescents and parents. The findings suggest that the intervention may improve some psychosocial determinants of dietary intake immediately after the 8-week intervention. The results are also promising regarding added sugar intake and BMI z-score. Future research should examine efficacy of the intervention compared to a control group and include follow-up measures to detect longer-term outcomes

Feasibility of a Virtual Group Nutrition Intervention for Adolescents with Autism Spectrum Disorder

Background: Youth with autism spectrum disorder (ASD) have an increased likelihood of being overweight or developing obesity. As children and adolescents with ASD exhibit problematic eating behaviors and may consume more energy-dense foods and fewer fruits and vegetables than typically developing youth, nutrition represents a modifiable obesity risk factor for adolescents with ASD, yet there is a lack of interventions to improve healthy eating and reduce the risk of obesity in this population. Purpose: The purpose of this study was to examine the feasibility, acceptability, and preliminary efficacy of a virtual implementation of BALANCE (Bringing Adolescent Learners with Autism Nutrition and Culinary Education), an 8-week theory-driven nutrition intervention for adolescents with ASD. Methods: Six groups of adolescents (n=27; group size ranged 2-7) diagnosed with ASD and aged 12-20 years participated in the Social Cognitive Theory (SCT) based intervention via Microsoft Teams. Fidelity checklists measured attendance, participation, homework, fidelity, and technical difficulties. Feasibility of assessing outcome measures, including the Block Kids Food Frequency Questionnaire (FFQ), a validated psychosocial survey, and height and weight, was evaluated on response rate, completion, and data quality. Six adolescent focus groups (n=12) and 21 parent interviews were audio-recorded, transcribed, and analyzed for a priori and emergent themes regarding intervention acceptability, perceived benefits, and unintended consequences. Height and weight were measured via ruler and scale as virtually instructed by research staff. Wilcoxon signed-ranked tests were used to compare pre- and post-intervention means for psychosocial determinants of dietary intake, dietary intake, and anthropometric measures. Results: Mean lesson attendance was 88%, participation was 3.5 of 4, homework completion was 51.9%, fidelity was 98.9%, and prevalence of technical difficulties was 0.4 of 2 (no technical difficulties or minor difficulties for all lessons). Baseline response rate was 100% for all outcome measures, with 98.9-100% completion. Post-intervention response rate was 92.6%-96.3%, with 99.5%-100% completion. Data quality was high for 88% of the matched FFQs and 100% of the psychosocial surveys. The intervention was generally acceptable to participants based on the focus groups and interviews with adolescents and their parents. Themes for acceptability included “virtual format,” “group setting,” “autonomy/independence,” “sensory components,” “interaction,” “reinforcement,” and “parent component.” Themes for perceived benefits included “diet changes,” “healthy weight,” “knowledge/awareness,” “behavioral skills,” “self-efficacy,” “outcome expectations,” “outcome expectancies,” and “other lifestyle changes.” “Anxiety/discomfort” during intervention lessons was an emergent theme regarding unintended consequences. Post-intervention means for three of seven psychosocial determinants of dietary intake improved after the 8-week intervention: behavioral strategies (p=0.010), self-efficacy (p\u3c0.001), and outcome expectations (p=0.009). Mean added sugar intake decreased (p=0.026), while there was no significant difference in fruit or vegetable intake. BMI percentile (p=0.013) and BMI z-score significantly decreased (p=0.010). Conclusion: BALANCE was feasible and acceptable to adolescents and parents. The findings suggest that the intervention may improve some psychosocial determinants of dietary intake immediately after the 8-week intervention. The results are also promising regarding added sugar intake and BMI z-score. Future research should examine efficacy of the intervention compared to a control group and include follow-up measures to detect longer-term outcomes

Lifestyle Interventions with Mind-Body or Stress-Management Practices for Cancer Survivors: A Rapid Review

This rapid review examined current evidence on lifestyle interventions with stress-management or mind-body practices that assessed dietary and/or physical activity outcomes among cancer survivors. Searches were conducted in PubMed, Embase, and PsycINFO based on Cochrane Rapid Reviews Methods Group rapid review recommendations using the keywords “diet,” “physical activity,” “mind-body,” “stress,” and “intervention.” Of the 3624 articles identified from the initial search, 100 full-text articles were screened, and 33 articles met the inclusion criteria. Most studies focused on post-treatment cancer survivors and were conducted in-person. Theoretical frameworks were reported for five studies. Only one study was tailored for adolescent and young adult (AYA) cancer survivors, and none included pediatric survivors. Nine studies reported race and/or ethnicity; six reported that ≥90% participants were White. Many reported significant findings for diet and/or physical activity-related outcomes, but few used complete, validated dietary intake methods (e.g., 24-h recall; n = 5) or direct measures of physical activity (e.g., accelerometry; n = 4). This review indicated recent progress on evaluating lifestyle interventions with stress-management or mind-body practices for cancer survivors. Larger controlled trials investigating innovative, theory-based, personalized interventions that address stress and health behaviors in cancer survivors—particularly racial/ethnic minority and pediatric and AYA populations—are needed

Exploration of Multilevel Barriers and Strategies That Affected Early COVID-19 Vaccination and Testing in Rural Latino Communities in Southwest Florida

The COVID-19 pandemic has disproportionately impacted multiple racial and ethnic minority groups, including Latinos residing in rural communities. Low rates of vaccination and testing combined with social determinants of health have contributed significantly to this disparate impact. Given the needs and constraints unique to rural Latino migrant and immigrant communities, this qualitative study examined multilevel barriers and strategies that affect COVID-19 vaccination and testing uptake among these communities in southwest Florida. Four focus groups (n = 25) were conducted between March and April 2021 with various key stakeholders, including rural Latino community members, local leaders, and community health workers (‘Promotoras de Salud’). Themes that aligned with barriers to COVID-19 vaccination and testing included fear, lack of control, misinformation, lack of accessibility, and institutional/policy issues; themes that aligned with strategies to improve COVID-19 vaccination and testing uptake included faith, taking care of self, and community and family resilience. Recommendations for improving future pandemic responses for rural Latino communities include incorporating multiple levels of intervention, such as consideration of the role of the family, involving trusted community members, and ensuring the development and implementation of fair and consistent policies

Early History, Mealtime Environment, and Parental Views on Mealtime and Eating Behaviors among Children with ASD in Florida

This study was a cross-sectional study to examine problematic mealtime behaviors among children with autism spectrum disorder (ASD) in Florida. Forty-one parents completed a 48-item survey. The mean age of their children was 8.1 years and 73% were male. The data were divided and compared by age group: Ages 2⁻6, 7⁻11, and 12⁻17. Data from the 3- to 6-year-old children were extracted and compared with the references from Provost et al. (2010). There were age differences in eating difficulties at home (p = 0.013), fast food restaurants (p = 0.005), and at regular restaurants (p = 0.016). The total mealtime behavior score was significantly higher in early childhood (p < 0.001) and mid-childhood (p = 0.005) than adolescents. More parents of ages 3⁻6 with ASD reported difficulties with breastfeeding (p < 0.01); concerns about eating (p < 0.001); difficulties related to mealtime locations (p < 0.05), craving certain food (p < 0.05), and being picky eaters (p < 0.01) compared to typically developing children. The total mealtime behavior score was significantly higher in children with ASD than typically developing children (p < 0.001). The results indicate that early childhood interventions are warranted and further research in adolescents is needed

Ultra-processed food consumption and obesity indicators in individuals with and without type 1 diabetes mellitus: a longitudinal analysis of the prospective Coronary Artery Calcification in Type 1 Diabetes (CACTI) cohort study

Abstract Objective: To evaluate the associations of ultra-processed food (UPF) consumption and obesity indicators among individuals with and without type 1 diabetes mellitus (T1DM) from the Coronary Artery Calcification in Type 1 Diabetes cohort study. Design: A secondary analysis. The consumption of UPF was assessed using the dietary data collected with the Harvard FFQ, and each food item was categorised according to the NOVA food processing classification. Height, weight and waist circumference were measured at baseline and after a mean of 14·6-year follow-up. Generalised estimating equations stratified by diabetes status were used to assess the associations between UPF intake and obesity indicators over 14 years of follow-up. Setting: USA. Participants: A total of 600 adults (256 T1DM and 344 non-diabetic controls) aged 39 ± 9·1 years at baseline and followed up for over 14 years were included. Results: Participants with T1DM consumed significantly more UPF than non-diabetic controls at baseline: 7·6 ± 3·8 v. 6·6 ± 3·4 servings per day of UPF, respectively (P < 0·01). Participants with T1DM and with the highest UPF intake had the highest weight (β Q4 v. Q1 = 3·07) and BMI (β Q4 v. Q1 = 1·02, all P < 0·05) compared with those with the lowest UPF intake. Similar positive associations were observed in non-diabetic controls. Conclusions: Individuals with T1DM may consume more UPF than non-diabetic controls. Positive associations between UPF consumption and obesity indicators suggest that limiting UPF can be recommended for obesity prevention and management. Further research is needed to confirm these findings

Multi-Level Determinants of Food Insecurity among Racially and Ethnically Diverse College Students

Compared with the general population, the prevalence of food insecurity (FI) is higher among college students. The COVID-19 pandemic exacerbated FI disparities and highlighted the need for further research to better understand and address FI in this population. Although race and ethnicity are two of the strongest predictors of FI among college students, little research is available on the determinants of FI among racial/ethnic minority college students. A cross-sectional study (n = 588) based on the National Institute of Minority Health and Health Disparities research framework was examined to identify population-specific determinants of FI among racially/ethnically diverse college students through the assessment of multiple domains (behavioral, environmental, socio-cultural) and levels of influence (individual, interpersonal, and community levels). Discrimination was the sole predictor of FI for non-Hispanic Black students. Coping mechanisms for FI (savings, reduced intake) and body mass index (BMI) were predictors of FI for Hispanic and non-Hispanic White students. Additionally, decreased holistic support from faculty and staff was also observed as a predictor of FI in Hispanic students. Implications include the need for further research and the development of multi-level, tailored interventions to address FI among college students with the goal of decreasing disparities

Rationale and study protocol for a randomized controlled trial to determine the effectiveness of a culturally relevant, stress management enhanced behavioral weight loss intervention on weight loss outcomes of black women.

BackgroundObesity is a persistent public health concern and a risk factor for many chronic diseases including at least 13 different cancers. Adult Black females have the highest prevalence of obesity (57%) compared to other racial/gender groups in the U.S. Although behavioral weight loss (BWL) interventions have demonstrated effectiveness, Black females tend to lose less weight than White counterparts. The higher prevalence of chronic psychological stress reported by Black females may contribute to their disproportionate prevalence of obesity and observed suboptimal weight loss. This study will examine the effectiveness of a 12-month culturally-targeted, stress management-enhanced BWL intervention on weight loss and stress reduction among Black females in a fully-powered randomized, controlled trial.MethodsAdult Black females with obesity (n = 340) will be randomized to either a culturally targeted stress management-enhanced BWL intervention (BWL-Stress) or the same BWL intervention alone (BWL-alone). The primary outcome is weight change at month 6. Secondary outcomes will include changes in stress measures (e.g., perceived stress, cortisol), energy intake, and physical activity at month 6. We will also assess process measures (e.g., treatment adherence, treatment burden). Each outcome will also be evaluated at month 12 to assess longer-term effects of the intervention.DiscussionThis novel approach for enhancing an evidence-based BWL program with culturally-targeted stress management strategies for Black females addresses an understudied barrier to effective weight management among a population at high risk for obesity and obesity-related chronic diseases. This study will potentially elucidate psychological or behavioral mechanisms linking our novel intervention to study outcomes. If the intervention is proven to be effective, this study will have significant clinical and public health implications for weight management among Black females.Trial registrationThis study was registered on ClinicalTrials.gov , identifier NCT04335799t , on April 6, 2020