A School Nurse-Delivered Intervention for Overweight and Obese Adolescents: Lessons Learned

Dr. Pbert will present work from an academic and community partnership between UMMS and the School Health Unit of the Massachusetts Department of Public Health to design and test a brief intervention for school nurses to provide weight management assistance to overweight and obese adolescents in the school health setting. She will discuss why the school nurse and school health setting are promising venues for addressing adolescent overweight, present results from their pilot study, and discuss facilitators, barriers and strategies to implementing this treatment model

Psychosocial, behavioral and clinical correlates of children with overweight and obesity

Background Psychological and behavioral correlates are considered important in the development and persistence of obesity in both adults and youth. This study aimed to identify such features in youth with severe obesity (BMI ≥ 120% of 95thpercentile of sex-specific BMI-for-age) compared to those with overweight or non-severe obesity. Methods Youth with BMI ≥ 85th percentile were invited to participate in a prospective research registry where data was collected on attributes such as family characteristics, eating behaviors, dietary intake, physical activity, perception of health and mental well-being, and cardiometabolic parameters. Results In a racially/ethnically diverse cohort of 105 youth (65% female, median age 16.1 years, range 4.62–25.5), 51% had severe obesity. The body fat percent increased with the higher levels of obesity. There were no differences in the self-reported frequency of intake of sugar sweetened beverages or fresh produce across the weight categories. However, the participants with severe obesity reported higher levels of emotional eating and eating when bored (p = 0.022), levels of stress (p = 0.013), engaged in fewer sports or organized activities (p = 0.044), and had suboptimal perception of health (p = 0.053). Asthma, depression and obstructive sleep apnea were more frequently reported in youth with severe obesity. The presence of abnormal HDL-C, HOMA-IR, hs-CRP and multiple cardiometabolic risk factors were more common among youth with severe obesity. Conclusions Youth with severe obesity have identifiable differences in psychosocial and behavioral attributes that can be used to develop targeted intervention strategies to improve their health

Effect of the planet health intervention on eating disorder symptoms in Massachusetts middle schools, 2005-2008

INTRODUCTION: The Planet Health obesity prevention curriculum has prevented purging and abuse of diet pills (disordered weight control behavior [DWCB]) in middle-school girls in randomized trials, but the effects of Planet Health on DWCB when implemented by schools under dissemination conditions are not known. METHODS: Massachusetts Department of Public Health and Blue Cross Blue Shield of Massachusetts disseminated Planet Health as part of the 3-year, Healthy Choices obesity prevention program in middle schools. We conducted an evaluation in 45 schools from fall 2005 to spring 2008. We gathered data from school staff to quantify intervention activities, and we gathered anonymous cross-sectional survey data from students on DWCB at baseline and Year 3 follow-up (n = 16,369). Multivariate logistic analyses with generalized estimating equations examined the effect of intervention activities on odds of students reporting DWCB at follow-up. RESULTS: Students in schools reaching a high number of youth with Planet Health lessons on reducing television viewing had lower odds of DWCB at follow-up (odds ratio [OR], 0.80 per 100 lesson-exposures; 95% confidence interval [CI], 0.74-0.85). In addition, reduced odds of DWCB at follow-up were found in schools with active staff teamwork (OR, 0.76; 95% CI, 0.66-0.86) and the presence of programs addressing television viewing goals with staff (OR, 0.38; 95% CI, 0.28-0.53). CONCLUSION: Combined evidence from efficacy and effectiveness trials and now from dissemination research indicates that appropriately designed obesity prevention programs can achieve DWCB prevention on a large scale

Effect of the Planet Health Intervention on Eating Disorder Symptoms in Massachusetts Middle Schools, 2005–2008

Introduction: The Planet Health obesity prevention curriculum has prevented purging and abuse of diet pills (disordered weight control behavior [DWCB]) in middle-school girls in randomized trials, but the effects of Planet Health on DWCB when implemented by schools under dissemination conditions are not known. Methods: Massachusetts Department of Public Health and Blue Cross Blue Shield of Massachusetts disseminated Planet Health as part of the 3-year, Healthy Choices obesity prevention program in middle schools. We conducted an evaluation in 45 schools from fall 2005 to spring 2008. We gathered data from school staff to quantify intervention activities, and we gathered anonymous cross-sectional survey data from students on DWCB at baseline and Year 3 follow-up (n = 16,369). Multivariate logistic analyses with generalized estimating equations examined the effect of intervention activities on odds of students reporting DWCB at follow-up. Results: Students in schools reaching a high number of youth with Planet Health lessons on reducing television viewing had lower odds of DWCB at follow-up (odds ratio [OR], 0.80 per 100 lesson-exposures; 95% confidence interval [CI], 0.74–0.85). In addition, reduced odds of DWCB at follow-up were found in schools with active staff teamwork (OR, 0.76; 95% CI, 0.66–0.86) and the presence of programs addressing television viewing goals with staff (OR, 0.38; 95% CI, 0.28–0.53). Conclusion: Combined evidence from efficacy and effectiveness trials and now from dissemination research indicates that appropriately designed obesity prevention programs can achieve DWCB prevention on a large scale

Perspective:Dietary Biomarkers of Intake and Exposure - Exploration with Omics Approaches

While conventional nutrition research has yielded biomarkers such as doubly labeled water for energy metabolism and 24-h urinary nitrogen for protein intake, a critical need exists for additional, equally robust biomarkers that allow for objective assessment of specific food intake and dietary exposure. Recent advances in high-throughput MS combined with improved metabolomics techniques and bioinformatic tools provide new opportunities for dietary biomarker development. In September 2018, the NIH organized a 2-d workshop to engage nutrition and omics researchers and explore the potential of multiomics approaches in nutritional biomarker research. The current Perspective summarizes key gaps and challenges identified, as well as the recommendations from the workshop that could serve as a guide for scientists interested in dietary biomarkers research. Topics addressed included study designs for biomarker development, analytical and bioinformatic considerations, and integration of dietary biomarkers with other omics techniques. Several clear needs were identified, including larger controlled feeding studies, testing a variety of foods and dietary patterns across diverse populations, improved reporting standards to support study replication, more chemical standards covering a broader range of food constituents and human metabolites, standardized approaches for biomarker validation, comprehensive and accessible food composition databases, a common ontology for dietary biomarker literature, and methodologic work on statistical procedures for intake biomarker discovery. Multidisciplinary research teams with appropriate expertise are critical to moving forward the field of dietary biomarkers and producing robust, reproducible biomarkers that can be used in public health and clinical research

Exploratory research to design a school nurse-delivered intervention to treat adolescent overweight and obesity

OBJECTIVE: In preparation for a pilot study to evaluate the efficacy of a school nurse-delivered intervention, focus groups were conducted to gain insight into the perceptions of stakeholders regarding the design and implementation of the intervention. SETTING AND PARTICIPANTS: Fifteen focus groups at participating schools. One hundred subjects, including overweight and obese high school students, parents, high school nurses, and staff. MAIN OUTCOME MEASURE: Stakeholders\u27 perceptions. ANALYSIS: Focus groups were audiotaped and transcribed verbatim. Theme instances related to the research aim were identified, coded, and sorted into theme categories. RESULTS: Major topics discussed included teen issues, family support, intervention implementation-related concerns, and curriculum content. Teen issues included dealing with peer pressure, avoiding emotional eating, and support from friends. Many participants thought it should be the teen\u27s choice to involve parents. Confidentiality was the most commonly identified potential barrier to implementation. Recommendations for nutrition and physical activity curriculum content focused on concrete, practical strategies. CONCLUSIONS AND IMPLICATIONS: Results of this research provided insight into stakeholder\u27s needs and perceptions regarding the content and structure of a school nurse-delivered intervention to treat adolescent overweight and obesity. Findings were used in the design and implementation of intervention protocols and materials. Elsevier Inc. All rights reserved

Feasibility of a Smartphone App with Mindfulness Training for Adolescent Smoking Cessation: Craving to Quit (C2Q)-Teen

Objectives: The use of mobile technology for smoking cessation holds promise for adolescents, who do not typically access traditional treatments, but most are not grounded in theory or mechanism. Operant conditioning theory suggests an addictive smoking loop is formed between nicotine use and affective states, leading to habitual cue-induced craving and automatic behavior; mindfulness training may bring automated smoking behavior into awareness, so smokers may work mindfully with cravings. Mindfulness training delivered via smartphone technology therefore has potential to help adolescent smokers break this addictive loop and quit smoking. This pair-matched cluster-randomized controlled school-based pilot study evaluated program feasibility and preliminary smoking outcomes in relation to intervention engagement. Methods: Six high schools were pair matched and randomly assigned to one of three interventions: (1) mindfulness training delivered via mobile smoking cessation application (Craving to Quit, C2Q), (2) NCI\u27s QuitSTART smoking cessation application (NCI), and (3) written cessation materials (Materials). Adolescents (n = 146) smoking 5 or more cigarettes per day were recruited. Interventions were implemented over four weeks and study assessments were collected at baseline and 3- and 6- month follow-up, including self-reported 7-day point prevalence abstinence, program usage, smoking-related measures, and psychosocial factors. Results: Overall cotinine-validated abstinence at 6 months was 15.8% and was similar between conditions. Odds of abstinence increased with each quartile increase in app/materials use with no significant differences between conditions (OR=1.60 (C2Q), 1.66 (Materials), and 2.69 (NCI)). Of participants still smoking at 6 months, for each quartile increase in engagement the number of cigarettes smoked in the previous 7 days showed a significantly greater decline in the C2Q condition (-5.71) compared to the Materials (-0.95) and NCI (+7.73) condition (p=0.02 for differences between conditions). Conclusions: Cotinine-validated abstinence was similar between intervention conditions and tended to increase with greater engagement in each condition. Greater C2Q app engagement among continuing smokers was associated with a significantly greater decline in number of cigarettes smoked compared to the other conditions. The Craving to Quit (C2Q) mobile smoking cessation application with mindfulness training was feasible to use and has promise in assisting adolescents to quit or decrease cigarette smoking. Clinical Trial Registration: Developing a Smartphone App with Mindfulness Training for Teen Smoking Cessation: ClinicalTrials.gov Identifier: NCT02218281

Body mass index, but not physical activity, is associated with C-reactive protein

Elevated high-sensitivity c-reactive protein (hs-CRP) is associated with increased risk of future first and recurrent coronary events and has been associated with both high body mass index (BMI) and low physical activity in cross sectional studies. Purpose: To longitudinally examine the effects of BMI and both current and previous-year physical activity on hs-CRP in healthy men and women (N = 109). Methods: BMI and hs-CRP were measured five times (baseline and quarterly) over 1 yr. Current physical activity was assessed 12-15 times during the study via 24-h recall. Previous-year physical activity was assessed using the Baecke questionnaire at baseline. Results: Mean BMI and hs-CRP were unchanged over the course of the study, but current physical activity increased on visit 3. Average hs-CRP was not related to average current physical activity or to natural changes in current physical activity across the five visits. Additionally, current physical activity on any given visit was not associated with hs-CRP on the following visit. When current physical activity, BMI, age, gender, and smoking were included in the statistical model, only BMI was significantly related to hs-CRP (P \u3c 0.001). Average hs-CRP was significantly correlated with average BMI (r = 0.50; P \u3c 0.001) but was not related to previous-year (Baecke) physical activity levels (r = 0.02; P = 0.89). When subjects were grouped by BMI (\u3c25 kg·m-2, 25-29.9 kg·m-2, \u3e30 kg·m-2) hs-CRP was significantly greater in obese (3.2 ± 1.9 mg·L-1) and overweight (2.1 ± 1.7 mg·L-1) than normal weight (1.1 ± 1.0 mg·L-1) subjects (ANOVA P \u3c 0.05). Current physical activity was similar between the three BMI groups at all times, and was unrelated to hs-CRP in all groups, throughout the study period. Conclusion: These data indicate that BMI, but not previous-year or current physical activity, predicts hs-CRP