Fight for Your Right To Fruit©: Development and Testing of a Manga Comic Promoting Fruit Intake in Middle-School Youth

Innovative interventions addressing childhood obesity are needed to capture the attention of youth living in a multi-media environment. The purpose of this study was to develop a Manga comic (Japanese comic art) promoting fruit intake and evaluate its impact on related psycho-social variables in middle-school youth. This dissertation followed three aims. Aim 1 consisted of a content analysis of nutrition and physical activity (PA)-related behaviors in four Shonen (Boys) and four Shojo (Girls) Manga comics. Most common positive health behaviors represented were fruit/vegetable consumption, family meals and moderate/vigorous PA, while large portion sizes, intake of high energy-dense foods and television/other screen time usage were the most frequent negative health behaviors depicted. In Aim 2, seven focus groups and two interviews (N=28) were conducted with youth to better understand such topics as enjoyable components of Manga comics and important health concepts. Most frequently mentioned themes related to enjoyable Manga comic components were detailed graphics and artistic style of text used to convey sound effects. Majority of the participants said eating fruits/vegetables was the most important nutrition behavior for proper health. Aim 3 consisted of a three-group, randomized single-session study with middle-school students. Participants (n=263) were randomly assigned to receive a Manga comic about fruit (Comic group), a newsletter about fruit (Newsletter group), or a newsletter about ancient Greece (Control group). Psycho-social variables related to fruit consumption were measured at baseline and immediately after reading. Post-intervention focus groups were conducted to evaluate acceptability and comprehension of the comic. Outcome expectations tended to be different in the Comic group compared to the Control group (p=0.03), while the Comic group reported greater transportation (p<0.01), enjoyment (p<0.05) and engagement (p=0.00) than the Newsletter and Control groups. Focus group data show the majority of Comic group participants enjoyed the graphics and storyline, understood the main message and felt like eating more fruit. Results are promising and suggest that Manga comics may create an entertaining and informative learning environment that has potential to help promote behavior change in youth. Further research should be conducted to explore its impact on health behaviors

Intervening to Reduce Sedentary Behaviors and Childhood Obesity among School-Age Youth: A Systematic Review of Randomized Trials

Objective. To assess the effectiveness of interventions that focus on reducing sedentary behavior (SB) among school-age youth and to identify elements associated with interventions' potential for translation into practice settings. Methods. A comprehensive literature search was conducted using 4 databases for peer-reviewed studies published between 1980 and April 2011. Randomized trials, which lasted at least 12 weeks, aimed at decreasing SB among children aged 6 to 19 years were identified. Results. Twelve studies were included; 3 focused only on SB, 1 focused on physical activity (PA), 6 were combined SB and PA interventions, and 2 studies targeted SB, PA, and diet. The majority of the studies were conducted in a school setting, while others were conducted in such settings as clinics, community centers, and libraries. Conclusions. Overall, interventions that focused on decreasing SB were associated with reduction in time spent on SB and/or improvements in anthropometric measurements related to childhood obesity. Several of the studies did consider elements related to the intervention's potential for translation into practice settings

Testing a Web-Based Interactive Comic Tool to Decrease Obesity Risk Among Minority Preadolescents: Protocol for a Pilot Randomized Control Trial

Background: Childhood obesity is a public health crisis, particularly in low-income, minority populations in the United States. Innovative and technology-enhanced interventions may be an engaging approach to reach at-risk youth and their parents to improve dietary behaviors and feeding practices. However, such tools are limited, especially ones that are theory-based; co-developed with user-centered approaches; tailored to low-income, minority preadolescents; and include parent-focused content. Objective: The objectives of this study include assessing the feasibility and acceptability and exploring the potential impact of the Intervention INC (Interactive Nutrition Comics for urban, minority preadolescents) Web-based tool, which is focused on decreasing childhood obesity risk in black/African American and Latino children aged 9 to 12 years. Methods: Intervention INC is underpinned by the narrative transportation theory, social cognitive theory, and health belief model, and it was co-developed by children and parents from the intended population. The child component consists of a 6-chapter interactive nutrition comic optimized for use on tablet devices, a goal-setting and self-assessment feature, and weekly text/email messages and reminders. The parental component consists of 6 Web-based newsletters, access to the child comic, and weekly text/email messages and reminders. The tool was evaluated using a pilot, single-blind, 2-group randomized controlled study design. Child-parent dyads were randomized to either the experimental or comparison group and assigned to a targeted behavior (increase fruit/vegetable or water intake) based on initial screening questions. Data were collected at 4 time points: baseline (T1), intervention midpoint (T2), intervention endpoint (T3), and 3 months postintervention (T4). Primary measures comprise usage, usability, and feasibility of the Web-based tool. Secondary measures comprise dietary knowledge, preferences, and intake and anthropometric measures (for child) and feeding practices and home food environment (for parent). Results: Study enrollment was completed in November 2017. A total of 89 child-parent dyads were randomized to either the experimental (n=44) or comparison (n=45) group. Data analysis is currently being conducted. Conclusions: This study aims to implement and assess an innovative approach to deliver health messages and resources to at-risk minority preadolescents and their parents. If found to be acceptable, engaging, feasible, and a potential approach to improve dietary behaviors, a full-fledged randomized controlled trial will be conducted to assess its efficacy and potential impact. Trial Registration: ClinicalTrials.gov NCT03165474; https://clinicaltrials.gov/ct2/show/NCT03165474 (Archived by WebCiteat http://www.webcitation.org/73122IjgP) International Registered Report Identifier (IRRID): RR1-10.2196/1068

Unbearable wearables

As wearable devices play an increasing role in the management of health and disease, adverse skin reactions to wearables have become more common. However, the management of allergic contact dermatitis is challenging and new treatment options more compatible with wearable devices are needed. In a 40-year-old woman with contact dermatitis to a continuous glucose monitoring device, topical clobetasol propionate 0.05% spray proved to be an effective treatment that was compatible with the application of adhesive wearables. This case demonstrates that spray formulations of topical steroids are a good option for the treatment of dermatitis under wearable devices such as continuous glucose monitors or ostomy appliance

Treating Obesity in Latino Children: A Systematic Review of Current Interventions

Childhood obesity remains a significant public health issue in the U.S. and globally. Rates are disproportionately higher in Latinos than other ethnic groups. This review provides a qualitative synthesis of the current evidence for childhood obesity treatment interventions among Latino children. A systematic search was performed in PubMed, Web of Science and Google Scholar for articles published from September 2010 to December 2015. Randomized controlled trials treating childhood overweight/obesity in Latino children ages 5-19 focused on diet and/or physical activity (PA) behaviors were included. Of the records initially identified (n=1,592), 11 studies met the inclusionary criteria. The majority included a family-based component (n=8; 73%). Nearly half (n=5) focused on children ages 5-12, with three specifically developed for the pre-adolescence stage (ages 8-12). Nine studies acknowledged cultural tailoring, most frequently by seeking input from their intended population and utilizing bilingual delivery staff. Improvements in anthropometric measures (e.g. body mass index (BMI) z-score) were observed in 55% of the studies (n=6). Many interventions with a combined focus of diet and PA, in the form of nutrition education in a group setting and in-person activity/exercise sessions and incorporated a parent/family component reported positive anthropometric results. Three (27%) studies included a follow-up period, all of which observed a sustained decrease in BMI over time. Overall, family-based interventions focusing on both diet and PA demonstrated promising results. However, additional research incorporating a follow-up period is warranted to assess sustainability of these outcomes. Additionally, more interventions could be developed specifically for the critical developmental stage of pre-adolescence

A Web-Based Interactive Tool to Reduce Childhood Obesity Risk in Urban Minority Youth: Usability Testing Study

Background: Childhood obesity is a serious public health issue among minority youth in the United States. Technology-enhanced approaches can be effective for promoting healthy behavior change. Objective: The purpose of this study was to test the usability of prototypes of a Web-based interactive tool promoting healthy dietary behaviors to reduce childhood obesity risk in urban minority youth. The Web-based tool comprised a manga-style comic with interactive features (eg, sound effects, clickable pop-ups), tailored messaging, and goal setting, and was optimized for use on tablet devices. Methods: Latino and black/African American children ages 9 to 13 years were recruited to participate in two rounds of usability testing. A modified think-aloud method was utilized. Self-reported surveys and field notes were collected. Audio recordings and field notes from usability testing sessions were systematically reviewed by extracting and coding user feedback as either positive comments or usability or negative issues. The quantitative data from self-reported questionnaires were analyzed using descriptive statistics. Results: Twelve children (four female; eight black/African American) with a mean age of 10.92 (SD 1.16) years participated. Testing highlighted overall positive experiences with the Web-based interactive tool, especially related to storyline, sound effects, and color schemes. Specific usability issues were classified into six themes: appearance, content, special effects, storyline, terminology, and navigation. Changes to the Web-based tool after round 1 included adding a navigation guide, making clickable icons more visible, improving graphic designs, and fixing programming errors. In round 2 of testing (after modifications to the Web-based tool were incorporated), many of the usability issues that were identified in round 1 did not emerge. Conclusions: Results of testing will inform further development and finalization of the tool, which will be tested using a two-group pilot randomized study, with the goal of reducing childhood obesity risk in minority, low-income youth

Exploring the use of an iPhone App: a Novel Approach to Dietary Assessment

Recent advancements in smartphone technology have provided new methods of dietary assessment. An iTunes application (app) called Meal Snap lets users take pictures of the meal they eat, and then estimates the calories of the food items eaten. We conducted a pilot study to explore the user-friendliness and calorie estimation functions of the Meal Snap app. Two female nutrition graduate students pilot-tested the Meal Snap app. Using the app, each student took pictures of foods and drinks consumed daily for two weeks. The data were analyzed using the Nutritionist ProTM software, version 4.4.0. The mean daily caloric intake obtained from the Meal Snap was then compared with that of Nutritionist ProTM. Paired samples t-tests and correlations were carried out using SPSS, version 19. Results indicated there was no significant difference in mean daily caloric consumption between Meal Snap and Nutritionist ProTM (p= 0.706). Additionally, there was a significant correlation between Meal Snap and Nutritionist ProTM calorie counts (Spearman r= 0.625, p\u3c 0.001). It took about 35 minutes per week (or 5 minutes/day) to snap pictures and edit descriptions, whereas entering data for calorie analysis with Nutritionist ProTM took about 85-90 minutes per week (about 13 minutes/day). Findings suggest that Meal Snap may be a user-friendly tool to estimate dietary intake. Future research should include a larger sample and people of diverse ethnic backgrounds, dietary habits and age groups

Monte Carlo Studies of the Intrinsic Second Hyperpolarizability

The hyperpolarizability has been extensively studied to identify universal properties when it is near the fundamental limit. Here, we employ the Monte Carlo method to study the fundamental limit of the second hyperpolarizability. As was found for the hyperpolarizability, the largest values of the second hyperpolarizability approaches the calculated fundamental limit. The character of transition moments and energies of the energy eigenstates are investigated near the second hyperpolarizability's upper bounds using the missing state analysis, which assesses the role of each pair of states in their contribution. In agreement with the three-level ansatz, our results indicate that only three states (ground and two excited states) dominate when the second hyperpolarizability is near the limit.Comment: 8 pages, 7 figure

Intergenerational Differences in Dietary Acculturation among Ghanaian Immigrants Living in New York City: A Qualitative Study

Dietary acculturation may explain the increasing risk of diet-related diseases among African immigrants in the United States (US). We interviewed twenty-five Ghanaian immigrants (Youth n 13, Age (Mean ± SD) 20 y±5⋅4, Parents (n 6) and Grandparents (n 6) age 58⋅7± 9⋅7) living in New York City (NYC) to (a) understand how cultural practices and the acculturation experience influence dietary patterns of Ghanaian immigrants and (b) identify intergenerational differences in dietary acculturation among Ghanaian youth, parents and grandparents. Dietary acculturation began in Ghana, continued in NYC and was perceived as a positive process. At the interpersonal level, parents encouraged youth to embrace school lunch and foods outside the home. In contrast, parents preferred home-cooked Ghanaian meals, yet busy schedules limited time for cooking and shared meals. At the community level, greater purchasing power in NYC led to increased calories, and youth welcomed individual choice as schools and fast food exposed them to new foods. Global forces facilitated nutrition transition in Ghana as fast and packaged foods became omnipresent in urban settings. Adults sought to maintain cultural foodways while facilitating dietary acculturation for youth. Both traditional and global diets evolved as youth and adults adopted new food and healthy social norms in the US

Moderate Alcohol Use and Mortality from Ischaemic Heart Disease: A Prospective Study in Older Chinese People

Abstract Background: Moderate alcohol use is generally associated with lower ischaemic heart disease (IHD) mortality but it is difficult to ascertain whether this is due to attributes of moderate alcohol users or the properties of alcohol itself. Evidence from populations with different patterns of alcohol use and IHD can provide crucial evidence. We assessed the association of moderate alcohol use with IHD mortality in older Chinese people from Hong Kong. Methodology We used Cox regression to determine whether moderate alcohol use was associated with IHD mortality in a prospective, population-based cohort study of all 56167 attendees, aged 65 years or over, from July 1998 to December 2000 at all 18 Elderly Health Centers operated by the Department of Health in Hong Kong. Principal Findings After a median follow-up of 4.2 years, there were 406 (188 in men, 218 in women) deaths from IHD in 54,090 subjects (96.3% successful follow-up). Moderate alcohol use in men was not associated with IHD mortality adjusted only for age [Hazard Ratio, HR 1.01 (95% CI 0.55 to 1.84) compared with never drinkers] or additionally adjusted for socioeconomic status and lifestyle. Almost all women were occasional drinkers and their current alcohol use was not significantly associated with IHD mortality [HR 0.88, (95% CI 0.51 to 1.53)]. Conclusions Moderate alcohol use had no effect on IHD mortality in older Chinese men. Lack of replication of the usual protective effect of moderate alcohol use in a setting with a different pattern of alcohol use and IHD could be due to chance or could suggest that the protective effect of alcohol on IHD does not extend to all populations