Disconnect between sympathetically-induced hunger suppression and consumption among highly restrained eaters following stress.

Despite emphasis on findings suggesting restrained eaters increase food consumption under stress, unrestrained eaters' reduction in intake is more robust. Early proposals asserted unrestrained eaters significantly reduced intake after certain threats due to the hunger-inhibiting effects of autonomic influences, presuming unrestrained eaters are more responsive to these effects and restrained eaters rely less on physiological cues for eating. However, scant empirical evidence has substantiated these claims. This study examined whether a sequence exists whereby stress elicits autonomic activation, autonomic activation impacts hunger, and hunger then impacts eating, with dietary restraint altering the hunger-intake link. It was hypothesized that sympathetic nervous system activation would be greatest when ongoing safety from stress was uncertain, sympathetic activation would be linked to reduced hunger, and lower hunger would be associated with attenuated intake. Restraint, conceptualized via Hagan et al.'s (2017) latent restraint factors, was hypothesized to reduce the association between hunger and intake. Female participants (n = 147) were randomized to a stress + certain safety, stress + uncertain safety, or control condition. Sympathetic nervous system activity was recorded prior to a bogus taste test, which quantified ad libitum consumption of highly-palatable snack foods post-stress. Only the stress + uncertain safety condition exhibited greater sympathetic nervous system activity than the control condition. A significant index of moderated serial mediation emerged for Preoccupation with Dieting and Weight-Focused Restraint in the stress + uncertain safety condition. Though sympathetic activation decreased hunger similarly regardless of dietary restraint, only less restrained individuals significantly decreased intake. More restrained individuals ate more despite experiencing lower hunger. The disconnect between hunger and intake in more restrained eaters suggests that focus on enhancing attunement to hunger may yield greater benefit than enhancing restraint. 281 words.

Heavy episodic drinking is a trait-state: a cautionary note.

BACKGROUND: Heavy episodic (binge) drinking is common in and problematic for undergraduates. Researchers often assume that an individual's heavy episodic drinking is stable and trait-like. However, this fails to consider fluctuating, state-like variation in heavy episodic drinking. This study proposes and tests a novel conceptualization of heavy episodic drinking as a trait-state wherein the contribution of both trait-like stability and state-like fluctuations are quantified. It was hypothesized that heavy episodic drinking is a trait-state such that individuals have trait-like tendencies to engage in heavy episodic drinking, and state-like differences in the expression of this tendency over time. METHODS: A sample of 114 first-year undergraduates from a Canadian university completed self-report measures of heavy episodic drinking at 3 time points across 130 days. Hypotheses were tested with repeated-measures analysis of variance (ANOVA), test-retest correlations, and generalizability theory analyses. RESULTS: A substantial proportion of the variance in heavy episodic drinking is attributable to trait-like stability, with a smaller proportion attributable to state-like fluctuations. CONCLUSIONS: The heavy episodic drinker seems characterized by a stable, trait-like tendency to drink in a risky manner, and this trait-like tendency seems to fluctuate in degree of expression over time. Findings complement research suggesting that people have trait-like predispositions that increase their risk for heavy episodic drinking. However, despite this stable tendency to drink heavily, the frequency of heavy episodic drinking appears to be at least partly sporadic or situation dependent. These findings serve as a caution to alcohol researchers and clinicians who often assume that a single assessment of heavy episodic drinking captures a person's usual drinking behavior.

Clarifying the pathway from anxiety sensitivity to binge eating: The mediating role of depressive symptoms in a 3-week, 3-wave longitudinal study of undergraduates.

Anxiety sensitivity (AS) - characterized by a persistent fear that arousal-related bodily sensations will lead to serious cognitive, physical, and/or social consequences - is associated with various psychopathologies, including depressive symptoms and binge eating. This 3-week, 3-wave longitudinal study examined the relation between AS (including its global AS factor and lower-order AS cognitive, physical, and social concern dimensions), depressive symptoms, and binge eating among 410 undergraduates from two universities. Using generalized estimating equation models, we found that global AS, AS social concerns, and depressive symptoms predicted binge eating during any given week. Mediation analyses showed that global AS (as a latent variable with its lower-order AS dimensions as indicators), AS cognitive concerns, and AS physical concerns at Wave 1 predicted subsequent increases in depressive symptoms at Wave 2, which, in turn, led to increases in binge eating at Wave 3. Findings contribute to a better understanding of the interplay between AS, depressive symptoms, and binge eating, highlighting the role of binge eating as a potential coping mechanism for individuals with high AS, particularly in managing depressive symptoms. This study underscores the importance of AS-targeted intervention and prevention efforts in addressing depressive symptoms and binge eating.

Increasing access to mental health supports for 12-17-year-old Indigenous youth with the JoyPop mobile mental health app: study protocol for a randomized controlled trial.

BACKGROUND: Indigenous youth in Northwestern Ontario who need mental health supports experience longer waits than non-Indigenous youth within the region and when compared to youth in urban areas. Limited access and extended waits can exacerbate symptoms, prolong distress, and increase risk for adverse outcomes. Innovative approaches are urgently needed to provide support for Indigenous youth in Northwestern Ontario. Using a randomized controlled trial design, the primary objective of this study is to determine the effectiveness of the JoyPop app compared to usual practice (UP; monitoring) in improving emotion regulation among Indigenous youth (12-17 years) who are awaiting mental health services. The secondary objectives are to (1) assess change in mental health difficulties and treatment readiness between youth in each condition to better understand the app's broader impact as a waitlist tool and (2) conduct an economic analysis to determine whether receiving the app while waiting for mental health services reduces other health service use and associated costs. METHODS: A pragmatic, parallel arm randomized controlled superiority trial will be used. Participants will be randomly allocated in a 1:1 ratio to the control (UP) or intervention (UP + JoyPop) condition. Stratified block randomization will be used to randomly assign participants to each condition. All participants will be monitored through existing waitlist practices, which involve regular phone calls to check in and assess functioning. Participants in the intervention condition will receive access to the JoyPop app for 4 weeks and will be asked to use it at least twice daily. All participants will be asked to complete outcome measures at baseline, after 2 weeks, and after 4 weeks. DISCUSSION: This trial will evaluate the effectiveness of the JoyPop app as a tool to support Indigenous youth waiting for mental health services. Should findings show that using the JoyPop app is beneficial, there may be support from partners and other organizations to integrate it into usual care pathways. TRIAL REGISTRATION: https://clinicaltrials.gov/study/NCT05898516 [registered on June 1, 2023].

"Staying in the present moment is important": Examining the impact of a short-term classroom-based mindfulness intervention among first-year students.

Objective: To determine the impact of four classroom-based sessions on mindfulness and symptoms of psychological distress among first-year students. A secondary objective was to explore participants' involvement experiences. Participants: First-year undergraduate students at a Canadian university were recruited. Methods: A mixed-methods pre-experimental design with repeated measures was used. The mindfulness intervention involved four, 15-minute sessions delivered by a counselor from the university's Student Health and Wellness center. Results: A significant positive change to participants' mindfulness scores from pre- to post-intervention was observed. Qualitatively, themes relating to intervention benefits, challenges, and logistics emerged. Conclusions: Collectively, results supported the utility of this brief mindfulness intervention delivered to first-year students. Participants were appreciative of the techniques learned and the "in-class" delivery format. Given the pressures faced by post-secondary students, collaborating with student wellness centers in this way may represent a novel and efficient approach for attenuating health risks while promoting their personal wellness.

Perfectionistic concerns and binge eating in mother-daughter dyads: An actor-partner interdependence model.

Perfectionism is linked to a range of psychopathology, including binge eating. Our study enhanced understanding of the role maternal perfectionistic concerns play in the maintenance of binge eating in emerging adult daughters. A sample of 73 mother-daughter dyads (mean age = 49.51 years for mothers and 19.89 years for daughters) reported on perfectionistic concerns (composite of doubt about actions and concern over mistakes), binge eating, and binge drinking (composite of frequency, severity, and perceptions). Using actor-partner interdependence modelling, mothers' and daughters' perfectionistic concerns were positively associated with their own binge eating (actor effects). Mothers' perfectionistic concerns were positively associated with daughters' binge eating (partner effect), but not vice versa. Perfectionistic concerns did not show significant actor or partner associations with binge drinking, supporting the specificity of our model. Findings suggest binge eating has characterological and interpersonal antecedents.

Female youth and mental health service providers' perspectives on the JoyPop™ app: a qualitative study.

Introduction: Mobile health (mHealth) apps are a promising adjunct to traditional mental health services, especially in underserviced areas. Developed to foster resilience in youth, the JoyPop™ app has a growing evidence base showing improvement in emotion regulation and mental health symptoms among youth. However, whether this novel technology will be accepted among those using or providing mental health services remains unknown. This study aimed to evaluate the JoyPop™ app's acceptance among (a) a clinical sample of youth and (b) mental health service providers. Method: A qualitative descriptive approach involving one-on-one semi-structured interviews was conducted. Interviews were guided by the Technology Acceptance Model and were analyzed using a deductive-inductive content analysis approach. Results: All youth (n = 6 females; Mage = 14.60, range 12-17) found the app easy to learn and use and expressed positive feelings towards using the app. Youth found the app useful because it facilitated accessibility to helpful coping skills (e.g., journaling to express their emotions; breathing exercises to increase calmness) and positive mental health outcomes (e.g., increased relaxation and reduced stress). All service providers (n = 7 females; Mage = 43.75, range 32-60) perceived the app to be useful and easy to use by youth within their services and expressed positive feelings about integrating the app into usual care. Service providers also highlighted various organizational factors affecting the app's acceptance. Youth and service providers raised some concerns about apps in general and provided recommendations to improve the JoyPop™ app. Discussion: Results support youth and service providers' acceptance of the JoyPop™ app and lend support for it as an adjunctive resource to traditional mental health services for youth with emotion regulation difficulties.

Parents as Agents of Change in Managing Pediatric Obesity: A Randomized Controlled Trial Comparing Cognitive Behavioral Therapy versus Psychoeducation Interventions.

Background: Obesity interventions for parents of children with obesity can improve children's weight and health. This randomized controlled trial (RCT) evaluated whether a parent-based intervention based on cognitive behavioral therapy (CBT) principles was superior to a parent-based intervention based on a psychoeducation program (PEP) in improving children's obesity. Methods: This study was a pragmatic, two-armed, parallel, superiority RCT. Conducted at a Canadian outpatient pediatric obesity management clinic (September 2010-January 2014), this trial included families with children 8-12 years with an age- and sex-specific BMI ≥85th percentile. The 16-week manualized interventions were similar in content and delivered to parents exclusively, with different theoretical underpinnings. The primary outcome was children's BMI z-score at postintervention (4 months). Secondary outcomes included anthropometric, lifestyle, psychosocial, and cardiometabolic variables. Data were collected at preintervention (0 months), postintervention (4 months), 10, and 16 months. Intention-to-treat analysis using linear mixed models was used to assess outcomes. Results: Among 52 randomly assigned children, the mean age (standard deviation) was 9.8 (1.7) years and BMI z-score was 2.2 (0.3). Mean differences in BMI z-score were not significantly different between the CBT (n = 27) and PEP (n = 25) groups from 0 to 4-, 10-, and 16-month follow-up. At 4 months, the mean difference in BMI z-score from preintervention between the CBT (-0.05, 95% CI = -0.09 to 0.00) and PEP (-0.04, 95% CI = -0.09 to 0.01) groups was -0.01 (95% CI = -0.08 to 0.06, p = 0.80). Similar results were found across all secondary outcomes. Conclusions: Our CBT-based intervention for parents of children with obesity was not superior in reducing BMI z-score vs. our PEP-based intervention.

Incorporation of patient and family values and preferences for health-related outcomes in paediatric obesity management: A systematic review.

OBJECTIVE: A systematic review of value and preference studies conducted in children and their caregivers related to the estimated benefits and harms of interventions for managing paediatric obesity. METHODS: We searched Ovid Medline (1946-2022), Ovid Embase (1974-2022), EBSCO CINAHL (inception to 2022), Elsevier Scopus (inception to 2022), and ProQuest Dissertations & Theses (inception to 2022). Reports were eligible if they included: behavioural and psychological, pharmacological, or surgical interventions; participants between (or had a mean age within) 0-18 years old with overweight or obesity; systematic reviews, primary quantitative, qualitative, or mixed/multiple methods studies; and values and preferences as main study outcomes. At least two team members independently screened studies, abstracted data, and appraised study quality. RESULTS: Our search yielded 11 010 reports; eight met the inclusion criteria. One study directly assessed values and preferences based on hypothetical pharmacological treatment for hyperphagia in individuals with Prader-Willi Syndrome. Although not having reported on values and preferences using our a priori definitions, the remaining seven qualitative studies (n = 6 surgical; n = 1 pharmacological) explored general beliefs, attitudes, and perceptions about surgical and pharmacological interventions. No studies pertained to behavioural and psychological interventions. CONCLUSION: Future research is needed to elicit the values and preferences of children and caregivers using the best available estimates of the benefits and harms for pharmacological, surgical, and behavioural and psychological interventions.

The Building Emotional Awareness and Mental health (BEAM) program developed with a community partner for mothers of infants: protocol for a feasibility randomized controlled trial.

BACKGROUND: Drastic increases in the rates of maternal depression and anxiety have been reported since the COVID-19 pandemic began. Most programs aim to improve maternal mental health or parenting skills separately, despite it being more effective to target both concurrently. The Building Emotional Awareness and Mental health (BEAM) program was developed to address this gap. BEAM is a mobile health program aiming to mitigate the impacts of pandemic stress on family well-being. Since many family agencies lack infrastructure and personnel to adequately treat maternal mental health concerns, a partnership will occur with Family Dynamics (a local family agency) to address this unmet need. The study's objective is to examine the feasibility of the BEAM program when delivered with a community partner to inform a larger randomized controlled trial (RCT). METHODS: A pilot RCT will be conducted with mothers who have depression and/or anxiety with a child 6-18 months old living in Manitoba, Canada. Mothers will be randomized to the 10 weeks of the BEAM program or a standard of care (i.e., MoodMission). Back-end App data (collected via Google Analytics and Firebase) will be used to examine feasibility, engagement, and accessibility of the BEAM program; cost-effectiveness will also be examined. Implementation elements (e.g., maternal depression [Patient Health Questionnaire-9] and anxiety [Generalized Anxiety Disorder-7]) will be piloted to estimate the effect size and variance for future sample size calculations. DISCUSSION: In partnership with a local family agency, BEAM holds the potential to promote maternal-child health via a cost-effective and an easily accessible program designed to scale. Results will provide insight into the feasibility of the BEAM program and will inform future RCTs. TRIAL REGISTRATION {2A}: This trial was retrospectively registered with ClinicalTrial.gov ( NCT05398107 ) on May 31st, 2022.

Coping during COVID-19: examining student stress and depressive symptoms.

Objective: College students have faced widespread changes and challenges as a result of the novel coronavirus disease of 2019 (COVID-19) pandemic. How students cope with these disruptions is important in determining the ongoing impacts of the pandemic on mental health and well-being. We evaluated the associations between COVID-19 stress, coping responses, and symptoms of depression. Participants: A sample of 131 students (106 female; 25 male) was recruited throughout May 2020. Methods: Participants completed online self-report measures of study constructs. Results: As predicted, students experiencing more stress related to COVID-19 endorsed more symptoms of depression. Student stress was also associated with less use of engagement coping responses. Primary engagement and secondary engagement coping responses mediated the relationship between COVID-19 stress and symptoms of depression. Conclusions: Students lacking in adaptive, engagement coping responses may be particularly at risk for psychopathology when faced with high levels of stress related to COVID-19.

Predictors of Land-Based Activity Participation in a National Representative Sample of Indigenous Individuals Living Off-Reserve.

This study examined data from the 2017 Aboriginal Peoples Survey to consider predictors of land-based activity engagement. We hypothesized that higher self-reported mental and physical health scores, an increased sense of cultural belonging, living in a rural community, and no prior individual or family history of residential school attendance would predict a higher frequency of land-based activity engagement among First Nations individuals living off-reserve. Results from linear regression analyses suggested that an increased sense of cultural belonging, being male, and living in a rural community with a population of less than 1000 people were significant predictors of the frequency of land-based activity engagement. With these preliminary findings, further research can explore how physical and mental health outcomes influence the frequency of land-based activity engagement, in addition to how community-specific indicators may promote higher frequency of these activities, particularly among First Nations individuals living off-reserve.

Romance Behind the Screens: Exploring the Role of Technoference on Intimacy.

Intimacy is essential for fulfilling romantic relationships. Although many factors can impact intimacy, the increased regular use of technological devices within our daily lives makes technoference an important one to consider. Technoference (i.e., interference in face-to-face interactions caused by the use of technological devices) is commonly associated with relationship difficulties, including conflict, dissatisfaction, and decreased relational well-being. However, less is known about the direct and indirect impact of technoference on intimacy among couples. We hypothesized that negative perceptions of a partner's technology use and poor communication satisfaction within a romantic relationship help explain the association between technoference and intimacy. University students (N = 141), who were in a romantic relationship of at least 6 months duration, completed online questionnaires assessing technoference, perceptions of their partner's technology use, communication satisfaction, and intimacy in their romantic relationship. PROCESS macro model 6 was used to test the serial mediation models. Results suggest that the relationship between technoference (general, partner's, and participant's) and intimacy is serially mediated by negative perceptions of partner's technology use and communication satisfaction. These findings can help to identify and inform strategies to maximize intimacy levels between couples, thus fortifying romantic relationships as a whole.

Intergenerational residential school attendance and increased substance use among First Nation adults living off-reserve: An analysis of the aboriginal peoples survey 2017.

Introduction: The Truth and Reconciliation Commission of Canada (TRCC) published 94 Calls to Action in 2015 to address long-term, intergenerational effects of the residential school system, highlighting the pervasive impact of colonialism on the wellbeing of Indigenous peoples in Canada. Indeed, research with Indigenous populations in Canada has captured that prior experiences of residential schools contributes to the intergenerational transmission of mental and physical health disparities. Despite these studies, further research is needed that contextualizes the influence of residential schools within broader frameworks that consider Indigenous social determinants of health in Canada. As such, the purpose of the present study was to examine patterns of substance use and mental and physical health among individuals with a history of residential school attendance (RSA) and individuals reporting parent or two-generation (parent and grandparent) RSA. Method: Data from the Aboriginal Peoples Survey (2017), involving 10,030 First Nations individuals living off reserve, were analyzed. Results: Self-reported mental and physical health scores were significantly lower among those had attended residential schools, whose parents attended residential schools, and whose grandparents attended residential schools, when compared to those who did not. Further, family RSA was associated with increased substance use among participants, though the findings were variable based on sex and specific substance analyzed. Meanwhile, individual and family RSA was not associated with increased likelihood of a mental health diagnosis. Discussion: These findings provide additional support for how both parental and two-generation family histories of RSA are associated with individual physical and mental health outcomes. Further, these findings articulate the need for the TRCC's Calls to Action to be actually implemented, including community-based approaches that harness the strength of Indigenous people and communities who aim to close the gap in these health disparities for their children and families.

Is There a Role for Self-Referral in Pediatric Weight Management?

Background: A physician or health care provider (HCP) referral is usually needed for children to access multidisciplinary health services for obesity management; however, offering families the option to self-refer can enhance equity and access to care. Methods: We completed a retrospective medical record review to explore patient characteristics and program engagement of children with obesity who were self- (n = 18) or HCP-referred (n = 120) for obesity management. Results: Our descriptive data suggested that children who were self-referred presented with a healthier clinical profile and missed fewer appointments than their peers referred by HCPs. Conclusions: Prospective research is needed to examine whether health services and treatment outcomes differ between self- and HCP-referred children in obesity management.

Adverse Childhood Experiences and Building Resilience With the JoyPop App: Evaluation Study.

BACKGROUND: The effects of adverse childhood experiences (ACEs) on mental health, self-regulatory capacities, and overall resilience are well-known. Given such effects, ACEs may play a role in how individuals adjust to challenges later in life. Of interest in this study is the transition to university, a time of heightened stress when adapting to circumstances is required and when those with ACEs may need additional in-the-moment support to exercise resilience. A smartphone app may provide a worthwhile and readily accessible medium for a resilience intervention, provided behavioral outcomes are adequately evaluated. OBJECTIVE: This study evaluates the impact of an innovative, smartphone app-based resilience intervention. The JoyPop app was designed to promote resilience through the use of self-regulatory skills such as emotion regulation and executive functioning. Among a sample of first-year undergraduate students, we explored whether use of the app would be associated with positive changes in resilience and related outcomes, and whether these benefits were influenced by level of childhood adversity. METHODS: Participants (N=156) were requested to use the JoyPop app for 4 weeks, at least twice daily. Changes in resilience, emotion regulation, executive functioning, and depression were assessed after 2 and 4 weeks of app usage using multilevel modeling. RESULTS: The sample of 156 participants included 123 females and 33 males, with a mean age of 19.02 years (SD 2.90). On average participants used the app on 20.43 of the possible 28 days (SD 7.14). App usage was associated with improvements in emotion regulation (χ21=44.46; P<.001), such that it improved by 0.25 points on the 18-point scale for each additional day of app usage, and symptoms of depression (χ21=25.12; P<.001), such that depression symptoms were reduced by .08 points on the 9-point scale with each additional day of app usage. An interaction between ACEs and days of app usage existed for emotion regulation, such that participants with more adversity evidenced a faster rate of change in emotion regulation (P=.02). CONCLUSIONS: Results highlight that daily incorporation of an app-based resilience intervention can help youth who have experienced adversity to improve emotion regulation skills and experience reductions in depression. The JoyPop app represents an important step forward in the integration of resilience intervention research with a technology-based medium that provides in-the-moment support.

User Perspectives on a Resilience-Building App (JoyPop): Qualitative Study.

BACKGROUND: Resilience is the capability, resources, and processes that are available to a person or system to adapt successfully in the face of stress or adversity. Given that resilience can be enhanced, using advances in technology to deliver and evaluate the impact of resilience interventions is warranted. Evidence supports the effectiveness of the resilience-building JoyPop app in improving resilience-related outcomes after use; however, experiential data from users is also needed to provide a more comprehensive account of its utility. OBJECTIVE: The aim of this study was to explore users' experiences with the JoyPop app and their perspectives on its utility. METHODS: This qualitative description study involved a combination of group and one-on-one semistructured interviews with a subset of first-year undergraduate students who participated in a larger evaluation of the JoyPop app. Participants used the app for a 4-week period and were subsequently asked about their frequency of app use, most and least used features (and associated reasons), most and least helpful features (and associated reasons), barriers to use, facilitators of use and continuation, and recommendations for improvement. Data were coded and categorized through inductive content analysis. RESULTS: The sample of 30 participants included 24 females and 6 males, with a mean age of 18.77 years (SD 2.30). App use ranged from 1 to 5 times daily (mean 2.11, SD 0.74), with the majority indicating that they used the app at least twice daily. The Rate My Mood, Journal, and SquareMoves features were reported to be used most often, while the Rate My Mood, Journal, and Breathing Exercises features were identified as the most helpful. A number of themes and subthemes pertaining to facilitators of app use (prompts, creating routine, self-monitoring opportunities, expressive opportunities), barriers to app use (editing, lack of variety, student lifestyle), outcomes of app use (increased awareness, checking in with oneself, helpful distraction, emotional control), and recommendations for app improvement (adding more features, enhancing existing features, enhancing tracking abilities, providing personalization) were identified. CONCLUSIONS: This study provides insight into the aspects of the JoyPop app that motivated and benefitted users, as well as measures that can be taken to improve user experiences and promote longer-term uptake. Users were willing to engage with the app and incorporate it into their routine, and they valued the ability to self-monitor, express emotion, and engage in distraction.

Age modifies the association between driver's body mass index and death following motor vehicle crashes.

OBJECTIVE: We explored the association between body mass index (BMI) and the odds of a driver being fatally injured in a motor vehicle crash (MVC) after controlling for driver, crash, and vehicle factors known to independently contribute to injury severity. We hypothesized that BMI would be related to risk of fatal injury after controlling for other risk factors but that BMI would also interact with age. METHOD: We analyzed crashes involving 2 passenger type vehicles (1998-2015) from the Fatality Analysis Reporting System using binary logistic regression (with generalized estimating equations) to compute odds ratios and 95% confidence intervals of fatality by BMI status. RESULTS: Our results indicate that BMI status confers varying levels of risk at different ages. For example, a very low BMI of 18 increased the odds of fatality (relative to BMI = 21.75) more at age 85 (adjusted odds ratio [aOR] = 1.17, 95% confidence interval [CI], 1.09, 1.26) than at age 25 (aOR = 1.03, 95% CI, 1.01, 1.06). Similarly, a very high BMI of 42.5 increased the odds of fatality (relative to BMI = 21.75) more at age 85 (aOR = 2.17, 95% CI, 1.64, 2.87) than at age 25 (aOR = 1.33, 95% CI, 1.21, 1.45). Conversely, a moderate BMI of 27.5 was protective for drivers aged 85 (aOR = 0.94, 95% CI, 0.88, 0.99) but had no effect for drivers aged 25 (aOR = 1.00, 95% CI, 0.98, 1.02). We also found that a higher BMI was associated with higher odds of wearing a seat belt improperly or not wearing one at all. CONCLUSION: The relationship between BMI and fatality risk needs to be considered by policymakers, public health officials, and vehicle manufacturers to ensure that vehicles are safe for all occupants regardless of their weight, size, or shape.

Examining the Accuracy and Use of Portion Size Estimation Aids in Parents of Children With Obesity: A Randomized Controlled Trial.

OBJECTIVE: To determine parents' (1) accuracy in using portion size estimation aids (PSEAs) to estimate portion sizes and (2) use of PSEAs at home. METHODS: Parents (n = 37) of children in a pediatric weight management clinic were recruited, enrolled in a parallel-design, randomized, controlled trial, and assigned to receive a 2-dimensional (2D) or 3D PSEA. Percent absolute estimation accuracy was examined across groups and food types. Survey responses were organized according to frequencies and percentages were calculated. RESULTS: Main effects of group, food type, and group × food type interaction were significant (all P < .05). The 2D PSEAs yielded more accurate estimates of portion sizes for amorphous foods. Overall, parents' estimation accuracy was poor. Participants were satisfied and found the PSEAs to be useful. CONCLUSIONS AND IMPLICATIONS: The 2D PSEAs led to greater accuracy in estimating portions of amorphous foods. Parents showed poor accuracy in estimating portion sizes. This study highlights the role of dietitians and nutrition educators in enhancing portion estimation accuracy.