A scoping review of the role of policy in mitigating childhood obesity in underserved populations using the RE-AIM framework.

BACKGROUND: Childhood obesity is an escalating crisis in the United States. Health policy may impact this epidemic which disproportionally affects underserved populations. AIM: The aim was to use the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to assess health policy impact on preventing or treating school-aged children (5 > 18 years) with obesity in underserved populations. METHODS: A scoping review of 842 articles was conducted. Twenty-four articles met the inclusion criteria and underwent data extraction. RESULTS: Twelve studies included subgroup analysis, with four suggesting an impact of policy on at-risk groups. None of the 24 studies fully applied the RE-AIM framework. Policies positively impacted childhood obesity in 12 studies across the sample. LINKING EVIDENCE TO ACTION: Our review revealed inconsistent evidence for the effectiveness of policy on childhood obesity, perhaps due to the lack of focus on the social determinants of health. In addition, many studies did not evaluate the outcomes for underserved populations. Therefore, we propose more attention to social determinants in future legislation and evaluation of policy effectiveness on underserved populations. Findings identify an urgent need for the design, implementation, and evaluation of policies specifically directed to address the inequities of racism, social injustices, and social determinants of health that impact childhood obesity in the United States. Future work needs to identify who was reached by the policy, who benefitted from the policy, and how policies were implemented to address obesity-related health disparities. Nurses should advocate for the evaluation of childhood obesity policies, particularly in underserved populations, to determine effectiveness. Nurses, particularly those trained in population and community health and research, should advocate for policy research that considers inequities rather than controls for these variables. Multi-layered interventions can then be tailored to sub-populations and evaluated more effectively.

A systematic review of the evidence: the effects of portion size manipulation with children and portion education/training interventions on dietary intake with adults.

BACKGROUND: Evidence shows that 3-5-year-old children undergo important physical and behavioral changes that include being affected by the amount of food they are served, with larger portions of food served resulting in greater dietary intake. This may be a key finding as researchers continue to identify effective treatments for the growing number of preschool children who are overweight or obese. Knowledge of the effects of varying portion sizes on young children's dietary intake is important; however, because parents of young children control the manner in which children are fed, educating parents regarding the estimation of portion sizes is an approach worth exploring as a way to affect the trajectory of their young child's weight gain. AIMS: The purposes of this systematic review were to determine (1) findings regarding the effect of varying portion sizes with young children and (2) the evidence regarding the effects of educating adults to estimate portion sizes. Evidence from this review may guide clinical practice and future research efforts. METHODS: A comprehensive literature search was conducted with multiple databases using MeSH Headings and keywords. This search strategy was supplemented by ancestry searches of all relevant articles. Two independent, trained pediatric practitioners determined quality of the studies using established criteria. RESULTS: Nine studies met the inclusion criteria as portion-manipulation interventions or portion-education/training interventions and were appraised. Evidence showed the positive effect of portion sizes on the energy intake of children. In addition, the ability of adults to accurately estimate portion size improved following education/training. CONCLUSIONS: Although many studies have focused on a variety of portion-related interventions, the influence of portion education with parents of young children has not been well researched. More research is needed to understand the effect of parent-focused, portion-education interventions that encourage appropriate energy intake and healthy weight attainment in young children.

Wearable Devices and Nurses' Health: Protocol for an Integrative Review.

BACKGROUND: Nurses comprise over half of the global health care workforce, and the nursing care they provide is critical for the global population's health. High patient volumes and increased medical complexity have increased the workload and stress of nurses. As a result, the health of nurses is often negatively impacted. Wearables are used within the health care setting to assess patient outcomes; however, efforts to synthesize the use of wearable devices focusing on nurses' health are limited. OBJECTIVE: The primary objective of our integrative review is to synthesize available data concerning the utility of wearable devices for evaluating or improving (or both) the health of nurses. METHODS: We are conducting an integrative review synthesizing data specific to wearable devices and nurses' health. The research question for this review aims to answer how wearable devices are used to evaluate health outcomes among nurses. We searched the following electronic databases from inception until July 2022: PubMed, Embase, CINAHL, Web of Science, IEEE Explore, and AS&T. Titles and abstracts were imported into Covidence software, where citations were screened and duplicates removed. Title and abstract screening has been completed; however, full-text screening has not been started. Further screening is being conducted independently and in duplicate by 2 teams of 2 reviewers each. These reviewers will extract data independently. RESULTS: Search strategies have been developed, and data were extracted from 6 databases. After the removal of duplicates, we collected 8603 studies for title and abstract screening. Two independent reviewers conducted the title and abstract review, and after resolving conflicts, 277 full-text articles are available for review to determine whether they meet the inclusion criteria. CONCLUSIONS: This integrative review will provide synthesized data to inform nurses and other stakeholders about the extent of wearable device-related work done with nurses and provide direction for future research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/48178.

Childhood obesity within the lens of racism.

Despite decades of research and a multitude of prevention and treatment efforts, childhood obesity in the United States continues to affect nearly 1 in 5 (19.3%) children, with significantly higher rates among Black, Indigenous, and People of Colour communities. This narrative review presents social foundations of structural racism that exacerbate inequity and disparity in the context of childhood obesity. The National Institute of Minority Health and Health Disparities' Research Framework guides the explication of structurally racist mechanisms that influence health disparities and contribute to childhood obesity: biologic and genetic, health behaviours, chronic toxic stress, the built environment, race and cultural identity, and the health care system. Strategies and interventions to combat structural racism and its effects on children and their families are reviewed along with strategies for research and implications for policy change. From our critical review and reflection, the subtle and overt effects of societal structures sustained from years of racism and the impact on the development and resistant nature of childhood obesity compel concerted action.

Pediatric nurse practitioners' assessment and management of childhood overweight/obesity: results from 1999 and 2005 cohort surveys.

INTRODUCTION: Recently, public and professional emphasis has been placed on addressing the increasing prevalence of childhood overweight. METHOD: This survey study was conducted with two cohorts of pediatric nurse practitioners (N = 413) to explore differences in self-reported practice skills over time. RESULTS: Significant improvements in assessment, screening, and laboratory evaluations were reported, although reduced adherence to recommended psychosocial assessments was noted. DISCUSSION: This study outlines self-reported barriers to effective childhood weight management. One support that participants requested was evidence-based guidelines. Motivational interviewing may be an additional strategy to enhance provider skills to assess and manage challenging patient behavior change (e.g., dietary and activity changes).

Research evidence review and appraisal: pediatric central venous catheter care bundling.

Central venous catheters are integral to the care of acutely ill children, providing reliable vascular access for infusions, hemodynamic monitoring, and blood sampling. However, there are risks associated with their use, the most common of which is central line-associated blood stream infections. These infections result in increased lengths of stay, increased costs, and high mortality rates. A thorough review of research evidence has been completed to fully appreciate the state of the evidence regarding the effects of bundling together the care for central venous catheters, and practice recommendations have been provided. Published studies have been appraised and evaluated for clinical and statistical significance. This appraisal has resulted in clear and specific recommendations for evidence-based practice applications, and potential policy implications are outlined in this article.

Exploring the meaning of excess child weight and health: shared viewpoints of Mexican parents of preschool children.

In the United States, the prevalence of childhood overweight and obesity has reached epidemic levels, with U.S. Hispanic children, a sub-group mainly composed of children of Mexican decent, disproportionately affected. Prior research has suggested that Mexican parents may view overweight in early childhood as desirable; however, it is unclear if this is still the case. Therefore, this qualitative study explored the beliefs of 11 Mexican parents of preschoolers regarding weight and health. Following coding and clustering of themes from the transcribed audio-recorded meetings, six patterns were identified: (a) meanings and relationships about excess weight in childhood and child health, (b) causes of overweight and obesity, (c) uncertainty about knowing and not knowing, (d) from Mexico to America: enticements of a new land and time as a commodity, (e) the effects of society on personal and parental goals: the work of parenting in the United States, and (f) identified needs and action strategies. In summary, parents involved in this group discussion readily associated overweight/obesity with poor mental and physical health; however, they were uncertain how they would "know" if their children were overweight.

The evidence on how to best treat sunburn in children: a common treatment dilemma.

While many have suggested that prevention is key regarding sun over exposure, individuals (including children) still frequently experience sunburn. The Skin Cancer Foundation (2008) reported that 42% of individuals polled endured at least one sunburn per year. Furthermore, the Centers for Disease Control and Prevention (CDC) reports indicate that the incidence of sunburn rose from 31.8% in 1999 to 33.7% in 2004 (CDC, 2007). Children are more susceptible to skin damage because their skin is more sensitive than the skin of adults and it burns more easily (The Skin Cancer Foundation, 2008). Other risk factors include a fair complexion, found commonly in people with blueor green eyes, freckles, and light-colored hair (The Skin Cancer Foundation, 2008).

Over-the-counter cough and cold medication use in young children.

During a 2-year period from 2004 and 2005, emergency departments treated over 1,500 children under the age of 2 years for adverse events related to over-the-counter (OTC) cough and cold medication use; these incidents include 3 infant deaths. The risk of overdose, incorrect dosing and adverse events is increased in young children due to the greater number of colds they acquire each year. Lack of evidence to support the use of OTC medications in young children is well documented in the literature; however, people continue to use OTC medications with young children. The common cold is generally a mild, self-limited illness that usually improves with time. Recommended care and treatment for the common cold includes symptomatic treatment. This article presents and reviews the available evidence regarding the use of OTC cough and cold medications for pediatric healthcare providers. This review of the evidence will be helpful for healthcare providers to minimize risks to young children who intentionally or unintentionally ingest these medications and to educate child caregivers regarding proper use of OTC cough and cold medications with children.

The COPE Healthy Lifestyles TEEN program: feasibility, preliminary efficacy, & lessons learned from an after school group intervention with overweight adolescents.

INTRODUCTION: There has been a paucity of theory-based interventions to improve health outcomes in overweight adolescents. Therefore, two intervention studies were conducted to: (a) determine the feasibility of implementing the Creating Opportunities for Personal Empowerment (COPE) Healthy Lifestyles Thinking, Emotions, Exercise, and Nutrition (TEEN) program with overweight adolescents; (b) obtain feedback that could be used to refine the program; and (c) examine the preliminary efficacy of the COPE program on the adolescents' weight and body mass index (BMI). METHOD: Phase I and Phase II clinical trials were conducted with 23 overweight teens. The Phase 1 trial used a pre-experimental design with one group of 11 urban adolescents. The Phase 2 trial was conducted with 12 suburban teens using a randomized controlled pilot study. COPE teens received a 15-session cognitive-behavioral skills building program that included physical activity, while the control group received an attention control program. Weight change and BMI were the key outcomes. RESULTS: COPE teens experienced a significantly greater reduction in weight and BMI than did teens in the control group, who gained weight over time. Although the COPE program was well received by all of the teens, retention of subjects across time and parent involvement in the program were challenges in the urban high school. DISCUSSION: These studies provide preliminary data to indicate that the implementation of COPE is feasible and may lead to a reduction in weight and BMI in overweight teens. Implementing COPE within the context of the school day may be more successful in sustaining adolescent involvement in the program versus using an after-school format.

A Pilot Intervention Designed to Address Behavioral Factors That Place Overweight/Obese Young Children at Risk for Later-Life Obesity.

The purpose of this pilot randomized controlled trial (RCT) was to intervene with parents of overweight/obese 4- to 8-year-old children to improve child internalizing and externalizing behaviors. Parent-child dyads ( N = 60) were randomly assigned to treatment or comparison conditions. Parents attended four intervention sessions at their child's primary health care office over 3 months. Child behaviors were assessed at 0, 3, 6, and 12 months post intervention. Parental beliefs in their skills/abilities increased in the experimental group parents, but there was no statistical difference between groups at any time. Child externalizing behaviors significantly decreased from baseline to postintervention for both groups ( F = 3.26, p = .020). Post hoc model testing suggests that this change was more pronounced in the intervention group ( F = 0.56, p = .692). Child somatic symptoms significantly decreased over time ( F = 4.55, p = .004), and there were group differences in child depressive behaviors ( F = 6.19, p = .020). These findings suggest that a parent-focused intervention program demonstrated positive preliminary effects on children's behaviors.

Mental health correlates of healthy lifestyle attitudes, beliefs, choices, and behaviors in overweight adolescents.

INTRODUCTION: A tripling in the number of overweight adolescents has occurred during the past two decades, with type 2 diabetes reaching epidemic proportions. Although obesity has been identified as a correlate of depression and low self-esteem in adolescents, the relationships among key cognitive/mental health variables and healthy attitudes, beliefs, choices, and behaviors in overweight teens have yet to be explored. Therefore, the aim of this study was to describe these relationships so that an effective intervention program to promote and sustain healthy lifestyle behaviors could be implemented. METHODS: A descriptive correlational study was conducted with 23 overweight teens. Key variables measured included depressive symptoms, state and trait anxiety, self-esteem, beliefs/confidence about engaging in a healthy lifestyle, perceived difficulty in leading a healthy lifestyle, and healthy attitudes, choices, and behaviors. FINDINGS: Teens with higher state and trait anxiety as well as depressive symptoms had less healthy lifestyle beliefs, and teens with higher self-esteem had stronger beliefs about their ability to engage in a healthy lifestyle. Stronger beliefs about the ability to engage in healthy lifestyles were related to healthier living attitudes and healthier lifestyle choices. Teens who perceived healthy lifestyles as more difficult had less healthy attitudes and reported less healthier choices and behaviors. DISCUSSION: Including a strong cognitive behavioral skills building component into clinical interventions with overweight teens may be key in boosting their beliefs/confidence about being able to engage in healthy behaviors and lessening their perceived difficulty in performing them, which should result in healthier choices and lifestyle behaviors.

Child Obesity and Mental Health: A Complex Interaction.

Prevalence rates of childhood obesity have risen steeply over the last 3 decades. Given the increased national focus, the frequency of this clinical problem, and the multiple mental health factors that coexist with it, make obesity a public health concern. The complex relationships between mental health and obesity serve to potentiate the severity and interdependency of each. The purpose of this review is to create a contextual connection for the 2 conditions as outlined by the research literature and consider treatment options that affect both health problems.

Correlates of Healthy Lifestyle Beliefs and Behaviors in Parents of Overweight or Obese Preschool Children Before and After a Cognitive Behavioral Therapy Intervention With Text Messaging.

INTRODUCTION: Significant gaps exist in the published literature regarding the treatment of overweight/obesity in preschool-aged children, especially in primary care settings. Parental influence plays an important factor in the development of healthy behaviors in children, yet there is no consensus about why some behavior change intervention strategies for parents of young children are more influential and effective than others. OBJECTIVE: The purpose of this secondary data analysis was to assess correlations among the study variables (healthy lifestyle beliefs, perceived difficulty, and healthy lifestyle behaviors) in parents of overweight/obese preschool children. A second aim explored if the parent's level of cognitive beliefs and perceived difficulty of engaging in healthy lifestyle behaviors correlated with text messaging cognitive behavioral support. METHODS: Fifteen preschool-parent dyads from primary care clinics completed a 7-week cognitive behavioral skills building intervention. Beck's Cognitive Theory guided the intervention content, and Fogg's Behavior Model guided the implementation. The intervention was delivered using a combination of face-to-face clinic visits and ecological momentary interventions using text messaging. RESULTS: Supported are the interconnected relationships among the study variables, that is, parental healthy lifestyle beliefs, thoughts, and behaviors. At baseline, parental healthy lifestyle belief scores significantly correlated with perceived difficulty (rs = 0.598, p < .05) and healthy lifestyle behaviors (rs = 0.545, p < .05). These associations strengthened after the intervention. Furthermore, as parental healthy lifestyle beliefs increased and perceived difficulty lessened, their response rate and subsequent feedback lessened to the static text messaging support. DISCUSSION: Findings from this study support the interconnections between parents' thoughts, feelings, and actions toward healthy lifestyles. As parental beliefs became stronger through cognitive behavioral skills building and tailored text messaging, the need for general support via text messaging lessened, warranting additional research.

Automated Behavioral Text Messaging and Face-to-Face Intervention for Parents of Overweight or Obese Preschool Children: Results From a Pilot Study.

BACKGROUND: Children are 5 times more likely to be overweight at the age of 12 years if they are overweight during the preschool period. OBJECTIVE: The purpose of this study was to establish the feasibility, acceptability, and preliminary effects of a cognitive behavioral intervention (TEXT2COPE) synergized with tailored mobile technology (mHealth) on the healthy lifestyle behaviors of parents of overweight and obese preschoolers delivered in a primary care setting. METHODS: Fifteen preschooler-parent dyads recruited through primary care clinics completed a manualized 7-week cognitive behavioral skills building intervention. Beck's Cognitive Theory guided the TEXT2COPE intervention content and Fogg's Behavior Model guided the implementation. The intervention employed a combination of face-to-face clinic visits and ecological momentary interventions using text messaging (short message service, SMS). To enhance the intervention's relevance to the family's needs, parents dictated the wording of the text messages and also were able to adapt the frequency and timing of delivery throughout program implementation. RESULTS: Self-reported findings indicate that the program is feasible and acceptable in this population. The intervention showed preliminary effects with significant improvements on parental knowledge about nutrition (P=.001) and physical activity (P=.012) for their children, parental beliefs (P=.001) toward healthy lifestyles, and parental behaviors (P=.040) toward engaging in healthy lifestyle choices for their children. Effect sizes were medium to large for all variables. The timing, frequency, and wording of the text messages were tailored to the individual families, with 69% of parents (9/13) increasing the frequency of the tailored SMS from being sent once weekly to as many as 5 times a week. CONCLUSIONS: Utilizing a cognitive behavioral skills intervention with SMS has great potential for supporting clinical care of overweight and obese preschool children and their families. Further exploration of the potential effects on health and behavioral outcomes is warranted.

Preparing Leaders in Maternal-Child Health Nursing.

OBJECTIVE: To describe leadership and patient outcomes from an international leadership development program undertaken by a nursing organization (Sigma Theta Tau International Honor Society of Nursing) in partnership with Johnson & Johnson Corporate Contributions to strengthen the leadership base of maternal-child bedside nurses. DESIGN: Pretest/posttest design with no control group program evaluation. SETTING: Health care facilities, academic institutions, and public health clinics. PARTICIPANTS: Mentor/fellow dyads (N = 100) of the Maternal-Child Health Nurse Leadership Academy (MCHNLA). INTERVENTION/MEASUREMENTS: The MCHNLA engaged participants in an 18-month mentored leadership experience within the context of an interdisciplinary team project. Each mentor/fellow dyad was paired with a faculty member during the program. RESULTS: One hundred dyads have participated and conducted projects to improve health care for childbearing women and children up to age 5 years during the past decade. For the two cohorts for which consistent data were obtained, mentors and fellows enhanced leadership knowledge, skills, and behaviors. Review of 2010 to 2011 cohort project reports revealed they had the potential to influence more than 1000 students, 4000 nurses, and 1300 other health care students or professionals during the project period. CONCLUSIONS: This leadership development model is replicable in other areas of nursing and other professions.

Twelve-Month Effects of the COPE Healthy Lifestyles TEEN Program on Overweight and Depressive Symptoms in High School Adolescents.

BACKGROUND: We evaluated the 12-month effects of the COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, Nutrition) program versus an attention control program (Healthy Teens) on overweight/obesity and depressive symptoms in high school adolescents. METHODS: A cluster randomized controlled trial was conducted. Participants were 779 culturally diverse adolescents in the US Southwest. COPE is a cognitive-behavioral skills-building intervention with 20 min of physical activity integrated into a health course and taught by teachers once a week for 15 weeks. Outcome measures included body mass index (BMI) and depressive symptoms. RESULTS: COPE teens had a significantly lower BMI at 12 months (F(1,698) = 11.22, p = .001) than Healthy Teens (24.95 versus 25.48). There was a significant decrease in the proportion of overweight and obese COPE teens from baseline to 12 months (χ(2) = 5.40, p = .02) as compared with Healthy Teens. For youth who began the study with extremely elevated depressive symptoms, COPE teens had significantly lower depression at 12 months compared with Healthy Teens (COPE M = 42.39; Healthy Teens M = 57.90); (F(1 ,12) = 5.78, p = .03). CONCLUSIONS: COPE can improve long-term physical and mental health outcomes in teens.

Mental health worries, communication, and needs in the year of the U.S. terrorist attack: national KySS survey findings.

INTRODUCTION: To reduce the escalating rate of mental health/psychosocial morbidities in children and adolescents, NAPNAP initiated a new national campaign entitled Keep your children/yourself Safe and Secure (KySS). The objective of the first phase of this campaign was to conduct a national survey to assess the mental health knowledge, attitudes, worries, communication, and needs for intervention of children/teens, parents, and pediatric health care providers. This first report from the KySS survey describes the child/teen and parental findings. METHODS: A cross-section of 621 children/teens and 603 of their parents from 24 states completed the KySS survey during visits to their primary health care providers. RESULTS: The five greatest worries of both children/teens and their parents included knowing how to cope with stressful things in their lives, anxiety, depression, parent-child relationships, and problems with self-esteem. The majority of children/teens and their parents reported that they do not talk to their primary care providers about these issues. Participants expressed a multitude of needs and suggestions regarding how to better recognize, prevent, and deal with mental health problems. CONCLUSION: Opportunities must be created for children/teens and their parents to communicate their mental health worries and needs to each other and to their pediatric primary care providers to facilitate earlier diagnosis and treatment of mental health problems. Interventions are urgently needed to assist children and teens in coping with the multitude of stressors related to growing up in today's society.

The preliminary effects of a primary care-based randomized treatment trial with overweight and obese young children and their parents.

INTRODUCTION: Twenty-three percent of preschoolers are overweight/obese, which puts these children at risk for the development of chronic health comorbidities. The purpose of this randomized control pilot study was to determine the feasibility and preliminary effects of a theoretically based, primary care intervention on the physical outcomes of 60 overweight/obese preschool/early school-aged 4- to 8-year-old children. METHODS: After recruitment and baseline assessment, parent-child dyads were randomly assigned to either the treatment or the control condition. Four intervention sessions were conducted with the parents in their child's primary health care office. The impact of the intervention was evaluated by assessing child anthropometric measures (e.g., waist, waist-by-height ratio, and body mass index [BMI]) immediately, 3 months, and 6 months after the intervention period. RESULTS: Analysis of variance models suggested that children in the experimental group were found to have reduced waist circumference and waist-by-height ratio immediately after the intervention that persisted for 3 and 6 months (f = 0.33, 0.35, respectively). BMI and BMI percentile were not differentially affected. DISCUSSION: These promising findings suggest that a primary care-based, parent-focused overweight/obesity treatment program is feasible and demonstrated positive preliminary effects, improving the children's overall health trajectory.