Accelerated Weight Gain Among Children During Summer Versus School Year and Related Racial/Ethnic Disparities: A Systematic Review

Introduction: The objective of this study was to compile and summarize research examining variations in weight gain among students during the summer in comparison to the school year, with a focus on racial/ethnic disparities and students who are at risk of overweight. Methods: A systematic search of PubMed and Embase was conducted. Reference lists of identified articles and Google Scholar were also reviewed. Studies that assessed summer weight gain in school children were included. Inclusion criteria were: 1) a focus on children and adolescents aged 5 to 17 attending school; 2) a measured body composition before and after the summer vacation; 3) English-language articles; and 4) publication in a peer-reviewed journal since January 1, 1990. Data were extracted from selected studies in the following categories: study purpose, setting, study design, population, sample size, data collection method, and findings. Results: Seven eligible studies were included in the review. Six of the 7 studies reported accelerated summer weight gain for at least a portion of the study population, with an effect of summer on weight gain identified for the following subgroups: black, Hispanic, and overweight children and adolescents. Conclusion: There may be a trend in increased rate of weight gain during summer school vacation, particularly for high-risk groups, including certain racial/ethnic populations and overweight children and adolescents. Potential solutions for the problem of accelerated summer weight gain include greater access to recreational facilities, physical activity programming, and summer food programs. Further research in this area is needed as summer weight gain may exacerbate existing health disparities

App Store for EHRs and Patients Both

The Substitutable Medical Applications, Reusable Technologies (SMART) Platforms project ( www.smartplatforms.org ) seeks to develop an iPhone-like health information technology platform with substitutable apps constructed around core services. It is funded by a grant from the Office of the National Coordinator of Health Information Technology’s Strategic Health IT Advanced Research Projects (SHARP) Program. SMART technologies enable existing electronic health records and HIT platforms to run substitutable apps. Substitutability is the capability inherent in a system of replacing one application with another of similar functionality. We created a patient-facing SMART instance using the open source Indivo personally controlled health record (PCHR). The SMART “read-only” API has been deployed on multiple systems, including the Cerner installation at Boston Children’s Hospital and the World Vista EHR. We sought to SMART-enable Indivo, the open source reference PCHR upon which HealthVault and other PCHRs were modeled. PCHRs provide patients with a secure repository of their health information that can be exposed to apps across a programming interface. We updated the open source Indivo PCHR to support the SMART API, enabling Indivo to act as a patient-facing apps platform, running the same or similar versions of apps that face clinicians

Sugar-Sweetened Beverages and Their Role in Obesity Prevention Programs and Policies

It is well established that sugar-sweetened beverages (SSBs) are associated with obesity and chronic diseases. Although there is some emerging evidence that consumption of added sugars is declining in the United States, on average Americans’ consumption still exceeds recommended levels. Consequently, it is imperative that researchers continue to delve further into the question of exactly how SSBs influence obesity and associated chronic diseases, as well as consider creative and novel strategies for reducing their impact on consumers’ health. Several important gaps in the research are addressed by this dissertation. Chapter one considers the role of SSBs and overall diet quality with respect to the growing body of evidence that demonstrates an association between sleep duration and obesity. We used linear regression to examine the associations of sleep duration with dietary indicators in elementary school students taking part in a multi-sector, community-based obesity prevention intervention (the Massachusetts Childhood Obesity Research Demonstration Project). We found that students who reported sleeping <10 hours/day consumed soda more frequently and vegetables less frequently compared with students who reported optimal sleep. Chapter two assesses whether fast food customers are worse at estimating the caloric content of their meal when their purchase includes a high-calorie beverage (HCB). We used linear regression to examine the association between purchasing HCB and calorie estimation among adult and adolescent fast food customers, and found that among adults, drinking HCB contributes to underestimating calories. HCB may be influencing calorie estimation in a unique way compared to high-calorie food items. Chapter three considers the relevance of SSBs with respect to proposed changes to the Supplemental Nutrition Assistance Program (SNAP). Using sales data from a large supermarket chain in the Northeast, we used multivariate analysis of variance to determine whether there is an association between SNAP receipt and shopping patterns. We found that SNAP shoppers spent more than non-SNAP shoppers on sugar-sweetened beverages, red meat, and cold convenience foods, and spent less on fruits, vegetables and poultry. Each chapter lends additional support for a focus on SSB consumption in obesity prevention efforts and will inform the development of prevention strategies in the future

Maternal depression and childhood obesity: A systematic review

Objective. Maternal depression is prevalent and has been associated with parenting practices that influence child weight. In this systematic review we aimed to examine the prospective association between maternal depression and child overweight.Methods. We searched four databases (PsycINFO, PubMed, Embase, and Academic Search Premier) to identify studies for inclusion. We included studies with a prospective design with at least one year follow-up, measuring maternal depression at any stage after childbirth, and examining child overweight or obesity status, body mass index z-score or percentile, or adiposity. Two authors extracted data independently and findingswere qualitatively synthesized.Results. We identified nine prospective studies for inclusion. Results were examined separately for episodic depression (depression at a single measurement occasion) and chronic depression (depression on multiple measurement occasions). Mixed results were observed for the relationship between episodic depression and indicators of child adiposity. Chronic depression, but not episodic depression,was associated with greater risk for child overweight.Conclusions.While chronic depression may be associated with child overweight, further research is needed. Research is also needed to determine whether maternal depression influences child weight outcomes in adolescence and to investigate elements of the family ecology that may moderate the effect of maternal depression on child overweight

Using School Staff Members to Implement a Childhood Obesity Prevention Intervention in Low-Income School Districts: the Massachusetts Childhood Obesity Research Demonstration (MA-CORD Project), 2012–2014

Introduction: Although evidence-based interventions to prevent childhood obesity in school settings exist, few studies have identified factors that enhance school districts’ capacity to undertake such efforts. We describe the implementation of a school-based intervention using classroom lessons based on existing “Eat Well and Keep Moving” and “Planet Health” behavior change interventions and schoolwide activities to target 5,144 children in 4th through 7th grade in 2 low-income school districts. Methods: The intervention was part of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project, a multisector community-based intervention implemented from 2012 through 2014. Using mixed methods, we operationalized key implementation outcomes, including acceptability, adoption, appropriateness, feasibility, implementation fidelity, perceived implementation cost, reach, and sustainability. Results: MA-CORD was adopted in 2 school districts that were facing resource limitations and competing priorities. Although strong leadership support existed in both communities at baseline, one district’s staff reported less schoolwide readiness and commitment. Consequently, fewer teachers reported engaging in training, teaching lessons, or planning to sustain the lessons after MA-CORD. Interviews showed that principal and superintendent turnover, statewide testing, and teacher burnout limited implementation; passionate wellness champions in schools appeared to offset implementation barriers. Conclusion: Future interventions should assess adoption readiness at both leadership and staff levels, offer curriculum training sessions during school hours, use school nurses or health teachers as wellness champions to support teachers, and offer incentives such as staff stipends or play equipment to encourage school participation and sustained intervention activities