Prospectively predicting naturalistic exposure to fitspiration and thinspiration in young women with disordered eating by leveraging an ecological momentary assessment design.

OBJECTIVE: Although a growing body of research has examined the impacts of ED-salient content, such as fitspiration and thinspiration, on eating disorder (ED) symptoms, there is less known about the characteristics of who may be at risk for accessing this content on Instagram. Current research is limited by cross-sectional and retrospective designs. This prospective study used ecological momentary assessment (EMA) to predict naturalistic exposure to ED-salient content on Instagram. METHODS: Female university students with disordered eating (N = 171, Mage = 20.23, SD = 1.71, range = 18-25) completed a baseline session, followed by a seven-day EMA protocol, in which they reported on Instagram use and exposure to fitspiration and thinspiration. Mixed-effects logistical regressions were used to predict exposure to ED-salient content on Instagram from four principal components (e.g., behavioral ED symptoms and trait social comparison) controlling for duration of Instagram use (i.e., dose) and day of study. RESULTS: Duration of use was positively associated with all types of exposure. Purging/cognitive restraint and excessive exercise/muscle building prospectively predicted access to any ED-salient content and fitspiration only. Restricting positively predicted thinspiration only access. Purging/cognitive restraint positively predicted accessing fitspiration and thinspiration (dual exposure). Day of study was negatively associated with any exposure, fitspiration only, and dual exposure. CONCLUSIONS: Baseline ED behaviors were differentially associated with exposure to ED-salient Instagram content; however, duration of use was also a significant predictor. Limiting use of Instagram may be important for young women with disordered eating to reduce probability of encountering ED-salient content.

Temporal discounting modifies the effect of microtemporal hedonic hunger on food consumption: An ecological momentary assessment study.

INTRODUCTION: Steeper delay discounting, or preference for small rewards sooner versus larger rewards later, has been linked to disinhibited eating and obesity. The overconsumption of food may also be motivated by hedonic hunger, or the drive to consume foods for pleasure rather than energy need. The present study hypothesized that hedonic hunger would modify the relation between temporal discounting and palatable food consumption. METHODS: Seventeen adolescents between the ages of 13-18 (M = 15.12,SD = 1.80) completed a temporal discounting measure at baseline followed by daily ecological momentary assessments of food intake (e.g., self-reported servings of sweet, starchy, fatty, fast foods) and hedonic hunger for 20 days on a mobile phone. Multilevel models examined between-person (BP) and within-person (WP) hedonic hunger, monetary temporal discounting, and their interactions, on food consumption. RESULTS: The models for sweet, starchy, and fast food consumption had significant interactions between WP hedonic hunger and temporal discounting. For each of these interactions, those with average-or-lower temporal discounting rates were at less risk of consuming sweet, starchy, and fast foods when hedonic hunger was higher than typical while those with high rates of discounting were at higher risk of consuming these types of foods when hedonic hunger was elevated. CONCLUSION: Increases in daily hedonic hunger may confer risk for sweet, starchy, and fast food consumption. However, preference for larger rewards later may serve as a protective factor against consumption of these palatable foods. Future studies should further investigate this and other reward-driven processes that may influence food consumption.

Microtemporal Relationships in the Fear Avoidance Model: An Ecological Momentary Assessment Study.

OBJECTIVES: Current literature in pediatric pain evaluates the Fear Avoidance model (FAM) pathways at the trait (or macrotemporal) level, but it is unknown if these pathways also occur at the state (or microtemporal) level. Identifying microtemporal processes can improve our understanding of how the relationships within the Fear Avoidance constructs vary when specific Fear Avoidance variables wax and wane. We hypothesized that changes in FAM constructs would be associated with changes in the next variable in the sequence on a microtemporal level, including: (1) higher pain when there is more pain-related fear, (2) higher pain-related fear when there is more avoidance, and (3) higher avoidance when there is more reported disability. METHODS: 71 pediatric patients with chronic abdominal pain ( M =13.34 y, SD=2.67 y) reported pain severity, pain-related fear, and avoidance via ecological momentary assessments over 14 days. RESULTS: Our results indicated significant microtemporal relationships between Fear Avoidance constructs for pain predicting pain-related fear, pain-related fear predicting avoidance, and avoidance predicting disability. DISCUSSION: The current study suggests that the ways in which the FAM is related to various aspects of pain functioning differs on a state-level, which adds new clinical and research opportunities.

Applying Behavioral Economics Theories to Interventions for Persons with Diabetes.

PURPOSE OF REVIEW: To introduce behavioral economics (BE), provide a description of how recent prevention and treatment interventions in persons with diabetes have incorporated BE in their intervention strategies, and discuss how BE could be used to inform new treatments for the clinical setting or research. RECENT FINDINGS: In most of the trials described, researchers incorporated BE into their design in the form of incentives, which can align with present bias, optimism bias, and loss aversion. With only two exceptions, these trials reported preliminary support for using incentives to promote lifestyle modifications and diabetes-related tasks. Additionally, two trials reported promising results for behavior change strategies informed by default bias, while three trials reported promising results for behavior change strategies informed by social norms. Recent trials incorporating BE in prevention and treatment interventions for persons with diabetes generally report promising results, though gaps exist for research and clinical deployment.

Evaluating associations between fitspiration and thinspiration content on Instagram and disordered-eating behaviors using ecological momentary assessment: A registered report.

INTRODUCTION: Greater use of appearance-focused social media, such as Instagram, is associated with increased body dissatisfaction and eating disorder (ED) symptoms; however, questions remain about the mechanism connecting social media use to disordered-eating behaviors (DEBs). The proposed study evaluates how and for whom exposure to fitspiration or thinspiration on Instagram is associated with DEBs. METHODS: We will evaluate a hypothesized pathway from Instagram use to disordered-eating mediated by negative affect. We will test how individual differences in internalized weight stigma, trait self-esteem, and trait self-comparison moderate the pathway from social media use to negative affect. We will recruit 175 undergraduate women who report engaging in DEBs on average at least once per week over the past 3 months. Participants will complete a 7-day ecological momentary assessment protocol, during which they will report their Instagram use, affect, and engagement in DEBs. RESULTS: Multi-level modeling will be used to assess moderated mediation. Results from this study will provide increased specificity about how Instagram usage is linked to eating pathology and who may be most vulnerable to experiencing distress. DISCUSSION: Information about negative affect from Instagram and engagement in DEBs could contribute to the development of Just-In-Time Interventions for problematic social media use.

Tailoring Individualized Evaluation of Pediatric Abdominal Pain Using Ecological Momentary Assessment (EMA): A Pilot Study Testing Feasibility and Acceptability.

OBJECTIVE: The current study aimed to determine if it was feasible and acceptable to use ecological momentary assessment to assess individual associations between biopsychosocial contributors to chronic abdominal pain with 2 objective sensors and a mobile application. Specifically, we aimed to determine if it was possible to identify individualized associations between idiopathic pain associations. The goal was to determine if idiographic profiles have clinical value while the field works torward consensus about nomothetic trends. MATERIALS AND METHODS: Participants included 30 pediatric chronic abdominal pain patients, aged 8 to 17, who wore a physiological monitor and accelerometer that measured sleep and physical activity and answered 4 surveys per day on an app over the course of a 14-day study period. RESULTS: Results indicated that participants were 96.2% and 95.5% compliant to the wrist-worn accelerometer measuring sleep and physical activity, respectively. Participants completed 76.3% of expected surveys and were least adherent to the physiological monitor (37.9%). In addition, it was possible to generate 24 (80%) personalized reports describing unique associations with pain for participants in the study. DISCUSSION: Findings provide initial support for the use of ecological momentary assessment over a 2-week period to inform and create personalized profiles for improved clinical care in this population.

Initial development and validation of a fecal incontinence-specific quality of life measure.

BACKGROUND/PURPOSE: Fecal incontinence is a prevalent pediatric condition with psychosocial impacts on both children and their caregivers. We sought to develop and validate the Cincinnati Fecal Incontinence Scale (CINCY-FIS) as a psychometrically valid measure to assess the quality of life and caregiver impacts of pediatric fecal incontinence. METHODS: Items were generated through review of previous measures, expert consensus, and pilot testing with feedback from 8 families. Initial study measures were completed by 222 caregivers. Following item reduction, 18 items were subjected to confirmatory factor analysis. Convergent and criterion validity were assessed using correlation. Reliability was established using internal consistency statistics and test-retest reliability at baseline and 2-week follow-up. RESULTS: A five factor first-order structure with two higher-order factors demonstrated acceptable fit to the data, was consistent with a priori hypotheses, and was more parsimonious than the alternative model. Convergent validity and criterion-related validity were established for all of the CINCY-FIS scales. Reliability was high and consistent across both measurement occasions. CONCLUSIONS: The CINCY-FIS is a reliable and valid assessment of pediatric fecal incontinence-specific quality of life and parenting stress. The score is highly sensitive to patient changes making it suitable for both clinical and research purposes. TYPE OF STUDY: Prospective observational. LEVEL OF EVIDENCE: Study of Diagnostic Test Level II.

Goal feedback from whom? A physical activity intervention using an N-of-1 RCT.

OBJECTIVE: Adolescents are not meeting the recommended guidelines for physical activity. Social support and self-regulatory skills are two factors known to impact physical activity and sedentary behaviour. The study sought to examine how targeting feedback as part of a self-regulatory process could increase physical activity, and the individual who should be providing the feedback. DESIGN: The study utilised an aggregated N-of-1 RCT which allows for an iterative process of intervention development, and examines variability within participants to answer the question for whom did the intervention work. Ten adolescents (ages 13-18) set a daily physical activity goal. Adolescents received a SMS text message providing feedback on goal attainment daily from a parent, peer, behavioural health specialist; or no text message (control). MAIN OUTCOME MEASURES: A bioharness heart rate monitor assessed heart rate as proxy for goal attainment. Adolescents also self-monitored their physical activity in the Calorie Counter and Diet Tracker by MyFitnessPalTM app (commercially available). RESULTS: Intervention demonstrated a significant effect for 30% of the sample in increasing MVPA (Mincrease = 52 min), with no significant effect on sedentary behaviour. CONCLUSION: A single occasion of text messaging from the right person can produce changes, however, careful consideration should be given to who provides the feedback.

The promise of wearable sensors and ecological momentary assessment measures for dynamical systems modeling in adolescents: a feasibility and acceptability study.

Intervention development can be accelerated by using wearable sensors and ecological momentary assessment (EMA) to study how behaviors change within a person. The purpose of this study was to determine the feasibility and acceptability of a novel, intensive EMA method for assessing physiology, behavior, and psychosocial variables utilizing two objective sensors and a mobile application (app). Adolescents (n = 20) enrolled in a 20-day EMA protocol. Participants wore a physiological monitor and an accelerometer that measured sleep and physical activity and completed four surveys per day on an app. Participants provided approximately 81 % of the expected survey data. Participants were compliant to the wrist-worn accelerometer (75.3 %), which is a feasible measurement of physical activity/sleep (74.1 % complete data). The data capture (47.8 %) and compliance (70.28 %) with the physiological monitor were lower than other study variables. The findings support the use of an intensive assessment protocol to study real-time relationships between biopsychosocial variables and health behaviors.

Child Maltreatment, Trauma, and Physical Health Outcomes: The Role of Abuse Type and Placement Moves on Health Conditions and Service Use for Youth in Foster Care.

OBJECTIVE: The purpose of the study was to investigate the relations between abuse types, non-maltreatment-related trauma, and health service utilization in a sample of youth in foster care with and without chronic medical conditions. METHOD: A total of 213 youth, aged 8-21 years, provided self-report of general trauma and abuse exposure. Medicaid claims for each child were collected from official state databases. RESULTS: Exposure to sexual abuse, neglect, or general trauma but not exposure to physical abuse or psychological abuse increased the rates of medical visits, while only general trauma increased medical hospitalizations. CONCLUSIONS: Trauma types are not equally predictive of health care utilization for youth with chronic health conditions.

Caregiver concern in adolescents with persistent obesity: the importance of quality of life assessment.

OBJECTIVE: To examine female caregiver and adolescent dyad characteristics that predict the female caregiver's concern about their adolescent's weight and the degree to which caregiver concern predicts desire for physician intervention. METHOD: Fifty-three caregivers of adolescents with persistent obesity were asked to report on their adolescent's quality of life (QOL), weight status, concern about their adolescent's weight, and desire for physician intervention. RESULTS: Results indicated that only caregiver-reported QOL was a meaningful predictor of caregiver concern for African-American adolescents with persistent obesity accounting for 51% of the variance and that caregiver concern predicted desire for physician intervention accounting for 46% of the variance. CONCLUSION: Based on these findings, it is recommended that practitioners assess caregiver perception of obesity-specific QOL in their adolescent patients with persistent obesity, particularly those who are African-American.

Quality of life assessment between laparoscopic appendectomy at presentation and interval appendectomy for perforated appendicitis with abscess: analysis of a prospective randomized trial.

PURPOSE: The current study examined the impact of immediate laparoscopic surgery vs nonoperative initial management followed by interval appendectomy for appendicitis with abscess on child and family psychosocial well-being. METHODS: After obtaining Internal Review Board approval, 40 patients presenting with a perforated appendicitis and a well-formed abscess were randomized to surgical condition. Parents were asked to complete child quality of life and parenting stress ratings at presentation, at 2 weeks postadmission, and at approximately 12 weeks postadmission (2 weeks postoperation for the interval appendectomy group). RESULTS: Children in the interval arm experienced trends toward poorer quality of life at 2 and 12 weeks postadmission. However, no group differences in parenting stress were observed at 2 weeks postoperation. At 12 weeks postadmission, participants in the interval condition demonstrated significant impairment in both frequency and difficulty of problems contributing to parenting distress. CONCLUSION: Families experience significant parenting distress related to the child's functioning and disruption in the child's quality of life that may be because of the delay in fully resolving the child's medical condition. In addition, parents experience negative consequences to their own stress as a result of the delay before the child's appendectomy.

A meta-analytic review of eHealth interventions for pediatric health promoting and maintaining behaviors.

OBJECTIVE: The current study quantitatively evaluated the impact of eHealth interventions on pediatric health promoting and maintaining behaviors believed to impact the development or worsening of a physical disease and their associated outcomes. METHOD: PsycINFO, PUBMED/MEDLINE, Educational Resources Information Center (ERIC), and reference sections of identified articles were searched. RESULTS: An omnibus weighted mean effect size for all identified eHealth interventions revealed a small, but significant, effect (mean d = .118, 95% confidence interval [CI] = .066-.171). However, when considered independently, educational interventions demonstrated no significant effect on pediatric health behavior or health outcomes. Behavioral eHealth interventions produced relatively homogeneous effects that were small but significantly different from zero (mean d = .354, 95% CI = .232-.475). CONCLUSION: eHealth interventions that incorporate behavioral methods (e.g., self-monitoring, goal setting, immediate feedback, contingency management) produce larger effect sizes for health behaviors and their associated outcomes than interventions that rely solely on education.