Racial/Ethnic Disparities in Meeting 5-2-1-0 Recommendations among Adolescents in the United States

BACKGROUND: Obesity prevention has become a major focus of public health efforts in the United States. The Federal Government set forth national nutrition and physical activity recommendations to prevent obesity and promote well-being among children. A succinct message developed through a program in Maine “Let’s Go! 5-2-1-0” summarizes these obesity prevention behaviors including ≥5 fruit and vegetables, ≤2 hours of screen time, ≥1 hour of physical activity, and 0 sugar sweetened beverages daily. The study evaluates racial/ethnic disparities among adolescents meeting the 5-2-1-0 targets in a nationally representative sample. METHODS: The 2011-2012 NHANES dataset was used to conduct a cross sectional analysis of Hispanic (n=287), non-Hispanic Black (n=321), Asian (n=145) and non-Hispanic White (n=234) adolescents 12-19 years old. The 5-2-1-0 targets were evaluated using dietary recalls, Global Physical Activity Questionnaire, and questions about sedentary activities. Differences in the proportion of racial/ethnic groups meeting the 5-2-1-0 targets were compared using chi-square tests. Logistic models accounting for the complex sampling design were used to evaluate racial/ethnic disparities in meeting the 5-2-1-0 targets. RESULTS: There were no adolescents that met all four 5-2-1-0 targets. Meeting individual targets and meeting none of the targets differed by racial/ethnic group. The study found 28% of White, 39% of Hispanic, 44% of Black and 35% of Asian adolescents met zero 5-2-1-0 targets. Adolescents from different racial/ethnic groups had increased odds of meeting no 5-2-1-0 targets compared to their White peers (adjusted odds ratio [95% Confidence Interval] – Hispanic: 1.76 [1.04-2.98], Black: 1.82[1.04-3.17], Asian: 1.48[1.08-2.04]). CONCLUSION: Understanding the uptake of national nutrition and physical activity recommendations is necessary to reduce future obesity and health consequences in adulthood. Despite national initiatives, adolescents in the United States are far from meeting the 5-2-1-0 targets and there are racial/ethnic disparities in meeting the recommendations

Exploring Perceptions of Sugar Sweetened Beverages Among Early Adolescents in Worcester, MA: a Qualitative Study

Background: Among adolescents, sugar-sweetened beverages (SSBs) are the primary source of added dietary sugar and constitute 10-15% of their total caloric intake. A range of factors influence adolescent dietary behaviors and food choices. This study aimed to explore adolescents\u27 attitudes and knowledge about SSBs, how they receive messages about SSBs, and motivations for SSB consumption. Methods: We conducted 5 focus groups with youth aged 12-14 years that attend one of the eight Youth Connect programs in Worcester, MA in 2016-2017. Groups were sex-specific because of changes during adolescence and experiences with body image and health behaviors between the groups. A semi-structured guide was used to facilitate a discussion with adolescents\u27 around SSBs. The audio recorded data were transcribed and all transcripts were double coded. The data were analyzed using thematic analysis. Results: Discussions included 16 boys in three focus groups and 17 girls in two groups. Participants were 12-14 years old, 27% identified as Hispanic, 24% black and 33% white. One third speaks more than one language at home and the majority consume SSBs daily. Qualitative analysis led to the identification and classification of various subdimensions under the following analytic categories: Attitudes, Motivations, Knowledge, and SSB Messaging. Common themes that emerge under each category will be reported. Analyses are in progress. Conclusions: This research will present a deeper understanding of factors that influence Worcester adolescents\u27 beverage choices from their own perspective. The information can be used in public health messaging in Worcester around obesogenic behaviors such as excess caloric intake from SSBs

Home Matters: Adolescents Drink More Sugar Sweetened Beverages When They Are Available at Home

Objective: Sugar sweetened beverage (SSB) consumption has increased by 300% in the past three decades and the largest source of both added sugar and calories in the diets of US adolescents. It has been argued that the increased intake of SSBs has contributed to the rising prevalence of obesity. The availability and accessibility of foods/drinks in multiple levels of an adolescent’s environment can influence one’s choices and impact consumption. The aim of this study is to examine the association between adolescent self-report of the availability of SSBs in their home and SSB consumption and whether neighborhood and school SSB availability modifies the association between availability of SSBs in the home and adolescent SSB consumption. Methods: The Family Life, Activity, Sun, Health and Eating (FLASHE) was used to conduct a cross sectional analysis of 1,484 parent-adolescent dyads. Each dyad completed four online surveys about dietary and activity health behaviors. Ordinal logistic regression analyses were conducted to determine the association between the measures of SSB availability in the home and teen SSB consumption behaviors. The potential moderators, school SSB availability and neighborhood SSB availability, were tested separately using stratified ordinal logistic regression analyses. Results: The greater frequency of availability of SSB’s in the home had a positive association with teen SSB consumption. This association remained present despite the availability of SSB’s in other locations. There was no moderation effect present in either school SSB availability and neighborhood SSB availability. Conclusion: Understanding the impact of the availability of SSB’s in multiple environments on consumption is important for obesity prevention efforts. This study found that parents can be important factors in reducing adolescent SSB consumption by influencing the home environment. Despite the availability of SSB’s in other environments, the home remains important for impacting consumption. Also Presented at the 2018 Society of Behavioral Medicine Annual Meeting

Racial/ethnic representation in lifestyle weight loss intervention studies in the United States: A systematic review

Obesity remains a persistent public health and health disparity concern in the United States. Eliminating health disparities, particularly among racial/ethnic minority groups, is a major health priority in the US. The primary aim of this review was to evaluate representation of racial/ethnic sub-group members in behavioral weight loss interventions conducted among adults in the United States. The secondary aims were to assess recruitment and study design approaches to include racial/ethnic groups and the extent of racial/ethnic sub-group analyses conducted in these studies. PubMed, PsycInfo, Medline, and CINAHL were searched for behavioral weight loss intervention trials conducted in 2009-2015 using keywords: weight, loss, overweight, obese, intervention and trial. Most of the 94 studies included a majority of White participants compared to any other racial/ethnic group. Across the included studies, 58.9% of participants were White, 18.2% were African American, 8.7% were Hispanic/Latino, 5.0% were Asian and 1.0% were Native Americans. An additional 8.2% were categorized as Other . Nine of the 94 studies exclusively included minority samples. Lack of adequate representation of racial and ethnic minority populations in behavioral trials limits the generalizability and potential public health impact of these interventions to groups that might most benefit from weight loss. Given racial/ethnic disparities in obesity rates and the burden of obesity and obesity-related diseases among minority groups in the United States, greater inclusion in weight loss intervention studies is warranted

Design and methods of the Healthy Kids and Families study: a parent-focused community health worker-delivered childhood obesity prevention intervention

Background: One third of U.S. children and two thirds of adults are overweight or obese. Interventions to prevent obesity and thus avert threats to public health are needed. This paper describes the design and methods of the Healthy Kids and Families study, which tested the effect of a parent-focused community health worker (CHW)-delivered lifestyle intervention to prevent childhood obesity. Methods: Participants were English or Spanish-speaking parent-child dyads (n = 247) from nine elementary schools (grades K-6) located in racial/ethnically diverse low-income communities in Worcester, Massachusetts. Using a quasi-experimental design with the school as the level of allocation, the study compared the lifestyle intervention vs. an attention-control comparison condition. The lifestyle intervention was guided by social cognitive theory and social ecological principles. It targeted the child\u27s social and physical home environment by intervening with parental weight-related knowledge, beliefs, and skills for managing child obesogenic behaviors; and addressed families\u27 needs for community resources supportive of a healthy lifestyle. The two-year CHW-delivered intervention was structured based on the 5As model (Agenda, Assess, Advise, Assist, Arrange follow up) and included two in person sessions and two telephone follow-ups per year with the parent, with a personalized letter and print materials sent after each contact. Parents also received quarterly newsletters, Facebook messages, and invitations to community events. The attention-control comparison condition used the same format and contact time as the intervention condition, but targeted positive parenting skills. Measurements occurred at baseline, and at 6-, 12-, 18- and 24-month follow-up. Assessments included anthropometrics, accelerometry, global positioning system (GPS), and self-report surveys. The primary outcome was child body mass index (BMI) z score. Secondary outcomes were parent BMI; and parent and child diet, physical activity, sedentariness, and utilization of community resources supportive of a healthy lifestyle. Discussion: A CHW-delivered parent-focused lifestyle intervention may provide a translatable model for targeting the high priority public health problem of childhood obesity among low-income diverse communities. If demonstrated effective, this intervention has potential for high impact. Trial registration: ClinicalTrials NCT03028233. Registered January 23,2017. The trial was retrospectively registered

Perceived weight status and weight change among a U.S. adult sample

OBJECTIVE: Examine bidirectional associations between weight perception and weight change over time among adults. METHODS: Data are from adult employees (N = 623) across 12 U.S. public high schools participating in a cluster-randomized multilevel weight gain prevention intervention. Data were collected at baseline, 12 months, and 24 months. Perceived weight status (very/somewhat underweight, just right, somewhat overweight, very overweight) were obtained via self-administered surveys. Weight (kg) was measured by trained staff. Change in weight was calculated as the difference between baseline weight and weight at each follow-up time point. Structural equation models were used to assess bidirectional associations of perceived weight status and change in weight over time. Models were adjusted for study condition, gender, age, race/ethnicity, education level, and previous time point. RESULTS: The sample was 65% female with a mean age of 44.6 (SD = 11.3). Nearly two thirds of the sample consisted of people with overweight (38.8%) or obesity (27.3%). Structural equation models indicated that baseline weight predicted subsequent perceived weight status (beta = 0.26; P \u3c 0.001), whereas baseline perceived weight status did not predict subsequent change in weight, adjusting for previous time point and covariates. CONCLUSIONS: Results do not support bidirectional causality between weight perception and weight change in an adult sample

Methodological quality of behavioural weight loss studies: a systematic review

This systematic review assessed the methodological quality of behavioural weight loss intervention studies conducted among adults and associations between quality and statistically significant weight loss outcome, strength of intervention effectiveness and sample size. Searches for trials published between January, 2009 and December, 2014 were conducted using PUBMED, MEDLINE and PSYCINFO and identified ninety studies. Methodological quality indicators included study design, anthropometric measurement approach, sample size calculations, intent-to-treat (ITT) analysis, loss to follow-up rate, missing data strategy, sampling strategy, report of treatment receipt and report of intervention fidelity (mean = 6.3). Indicators most commonly utilized included randomized design (100%), objectively measured anthropometrics (96.7%), ITT analysis (86.7%) and reporting treatment adherence (76.7%). Most studies (62.2%) had a follow-up rate \u3e 75% and reported a loss to follow-up analytic strategy or minimal missing data (69.9%). Describing intervention fidelity (34.4%) and sampling from a known population (41.1%) were least common. Methodological quality was not associated with reporting a statistically significant result, effect size or sample size. This review found the published literature of behavioural weight loss trials to be of high quality for specific indicators, including study design and measurement. Identified for improvement include utilization of more rigorous statistical approaches to loss to follow up and better fidelity reporting

Fresh Start, a postpartum weight loss intervention for diverse low-income women: design and methods for a randomized clinical trial

Background: Overweight and obesity are prevalent among young women and are greater among minority and low-income women. The postpartum period is critical in women’s weight trajectories as many women do not lose their pregnancy weight, and others lose some and then plateau or experience weight gain. Excess weight puts women at greater risk of chronic disease and thus weight loss in the postpartum period may be key to the long-term health of young women. This paper describes the design and methods of a randomized clinical trial of Fresh Start, an innovative narrative-based group intervention aimed at promoting postpartum weight loss among low-income, diverse women. Methods/design Study participants were recruited from the five sites of the Women, Infants and Children (WIC) program in central Massachusetts. Participants were English-speaking, age ≥ 18 years, 6 weeks to 6 months postpartum, with a body mass index (BMI) ≥ 27 kg/m2. The Fresh Start postpartum weight loss intervention, adapted from the Diabetes Prevention Program (DPP) in collaboration with WIC staff and clients, consisted of an 8-week group-based curriculum followed by nine monthly telephone calls. It included a narrative component (i.e., storytelling), group discussions, print materials and access to exercise facilities. The study is a two-arm randomized controlled trial. The control condition included print materials and access to exercise facilities. In-person assessments were conducted at baseline and at 6 and 12 months following the eight-week intervention phase. Discussion The Fresh Start intervention translated key elements of an evidence-based weight loss protocol into a format that is hypothesized to be relevant, acceptable and effective for the target audience of low-SES postpartum women. This novel intervention was developed in collaboration with WIC to be sustainable within the context of its clinics, which reach approximately 9 million individuals per year across the U.S. via 10,000 clinics. Trial registration clinicaltrials.gov NCT02176915. Registered 25 June 2014

Objective measurement of physical activity outcomes in lifestyle interventions among adults: A systematic review

Valid, reliable, and direct measures of physical activity (PA) are critical to assessing the impact of lifestyle PA interventions. However, little is known about the extent to which objective measures have been used to assess the outcomes of lifestyle PA interventions. This systematic review had two aims: 1) evaluate the extent to which PA is measured objectively in lifestyle PA interventions targeting adults and 2) explore and summarize what objective measures have been used and what PA dimensions and metrics have been reported. Pubmed, Cochrane Central Register, and PsychInfo were searched for lifestyle PA interventions conducted between 2006 and 2016. Of the 342 articles that met the inclusion criteria, 239 studies measured PA via subjective measures and 103 studies measured PA via objective measures. The proportion of studies using objective measures increased from 4.4% to 70.6% from 2006 to 2016. All studies measuring PA objectively utilized wearable devices; half (50.5%) used pedometers only and 40.8% used accelerometers only. A majority of the 103 studies reported steps (73.8%) as their PA metric. Incorporating objective measures of PA should continue to be a priority in PA research. More work is needed to address the challenges of comprehensive and consistent collecting, reporting, and analyzing of PA metrics. Keywords: Accelerometry, Pedometer, Physical activity, Interventions, Systematic review/meta-analysi

Reporting of Physical Activity Device Measurement and Analysis Protocols in Lifestyle Interventions

This systematic review examined the extent to which lifestyle physical activity interventions that used wearable devices (eg, pedometers, accelerometers) reported on the length of device wear time requested in their protocols, criteria for analytic inclusion of data, and participant compliance with device use protocols. Literature were searches were conducted using PubMed, Cochrane Central Register, and PsychInfo. Studies were included if they were the main outcomes paper of a trial that reported on a randomized or quasi-randomized trial focused on increasing lifestyle physical activity and were published between January 1, 2006 and March 30, 2016. Titles and abstracts were screened by 2 independent reviewers; eligible full texts were retrieved and reviewed by 2 independent reviewers. A total of 104 studies used wearable devices (n = 57 pedometers, n = 47 accelerometers). Most studies (n = 65, 67.3%) asked participants to wear devices for 7 days. Almost half of the studies (n = 46, 44.2%) did not report minimum device wear time required for analytic inclusion of data, and variation existed among studies reporting these criteria. Most studies (n = 60, 57.7%) did not report average device wear time, or participant compliance with device wear. Overall, there was heterogeneity in reporting of physical activity device data. Refinement and streamlining of guidelines for device use, analysis, and reporting of data could improve comparability across studies