Evaluating dose delivered of a behavioral intervention for childhood obesity prevention: a secondary analysis.

BACKGROUND: Current recommendations for intensive behavioral interventions for childhood obesity treatment do not account for variable participant attendance, optimal duration of the intervention, mode of delivery (phone vs. face-to-face), or address obesity prevention among young children. A secondary analysis of an active one-year behavioral intervention for childhood obesity prevention was conducted to test how "dose delivered" was associated with body mass index z-score (BMI-Z) across 3 years of follow-up. METHODS: Parent-child pairs were eligible if they qualified for government assistance and spoke English or Spanish. Children were between three and 5 years old and were at risk for but not yet obese (BMI percentiles ≥50th and < 95th). The intended intervention dose was 18 h over 3-months via 12 face-to-face "intensive sessions" (90 min each) and 6.75 h over the next 9 months via 9 "maintenance phone calls" (45 min each). Ordinary least-squares multivariable regression was utilized to test for associations between dose delivered and child BMI-Z immediately after the 1-year intervention, and at 2-, and 3-year follow-up, including participants who were initially randomized to the control group as having "zero" dose. RESULTS: Among 610 parent-child pairs (intervention n = 304, control n = 306), mean child age was 4.3 (SD = 0.9) years and 51.8% were female. Mean dose delivered was 10.9 (SD = 2.5) of 12 intensive sessions and 7.7 (SD = 2.4) of 9 maintenance calls. Multivariable linear regression models indicated statistically significant associations of intensive face-to-face contacts (B = -0.011; 95% CI [- 0.021, - 0.001]; p = 0.029) and maintenance calls (B = -0.015; 95% CI [- 0.026, - 0.004]; p = 0.006) with lower BMI-Z immediately following the 1-year intervention. Their interaction was also significant (p = 0.04), such that parent-child pairs who received higher numbers of both face-to-face intensive sessions (> 6) and maintenance calls (> 8) were predicted to have lower BMI-Z. Sustained impacts were not statistically significant at 2- or 3-year follow-up. CONCLUSIONS: In a behavioral intervention for childhood obesity prevention, the combination of a modest dose of face-to-face sessions (> 6 h over 3 months) with sustained maintenance calls (> 8 calls over 9 months) was associated with improved BMI-Z at 1-year for underserved preschool aged children, but sustained impacts were not statistically significant at 2 or 3 year follow-up. CLINICAL TRIAL REGISTRATION: The trial was registered on ClinicalTrials.gov (NCT01316653) on March 16, 2011, which was prior to participant enrollment.

Predicting Early Emergence of Childhood Obesity in Underserved Preschoolers.

OBJECTIVE: To determine the magnitude of risk of factors that contribute to the emergence of childhood obesity among low-income minority children. STUDY DESIGN: We conducted a prospective cohort analysis of parent-child pairs with children aged 3-5 years who were nonobese (n = 605 pairs) who participated in a 3-year randomized controlled trial of a healthy lifestyle behavioral intervention. After baseline, height and weight were measured 5 times over 3 years to calculate body mass index (BMI) percentiles and classify children as normal, overweight, or obese. Multivariable logistic regression was used to estimate the odds of obesity after 36 months. Predictors included age, sex, birth weight, gestational age, months of breastfeeding, ethnicity, baseline child BMI, energy intake, physical activity, food security, parent baseline BMI, and parental depression. RESULTS: Among this predominantly low-income minority population, 66% (398/605) of children were normal weight at baseline and 34% (n = 207/605) were overweight. Among normal weight children at baseline, 24% (85/359) were obese after 36 months; among overweight children at baseline, 55% (n = 103/186) were obese after 36 months. Age at enrollment (OR 2.11, 95% CI 1.64-2.72), child baseline BMI (OR 3.37, 95% CI 2.51-4.54), and parent baseline BMI (OR for a 6-unit change 1.36, 95% CI 1.09-1.70) were significantly associated with the odds of becoming obese for children. CONCLUSIONS: The combination of child age, parent BMI, and child overweight as predictors of child obesity suggest a paradigm of family-centered obesity prevention beginning in early childhood, emphasizing the relevance of child overweight as a phenotype highly predictive of child obesity. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01316653.

Effect of a Behavioral Intervention for Underserved Preschool-Age Children on Change in Body Mass Index: A Randomized Clinical Trial.

Importance: Prevention of obesity during childhood is critical for children in underserved populations, for whom obesity prevalence and risk of chronic disease are highest. Objective: To test the effect of a multicomponent behavioral intervention on child body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) growth trajectories over 36 months among preschool-age children at risk for obesity. Design, Setting, and Participants: A randomized clinical trial assigned 610 parent-child pairs from underserved communities in Nashville, Tennessee, to a 36-month intervention targeting health behaviors or a school-readiness control. Eligible children were between ages 3 and 5 years and at risk for obesity but not yet obese. Enrollment occurred from August 2012 to May 2014; 36-month follow-up occurred from October 2015 to June 2017. Interventions: The intervention (n = 304 pairs) was a 36-month family-based, community-centered program, consisting of 12 weekly skills-building sessions, followed by monthly coaching telephone calls for 9 months, and a 24-month sustainability phase providing cues to action. The control (n = 306 pairs) consisted of 6 school-readiness sessions delivered over the 36-month study, conducted by the Nashville Public Library. Main Outcomes and Measures: The primary outcome was child BMI trajectory over 36 months. Seven prespecified secondary outcomes included parent-reported child dietary intake and community center use. The Benjamini-Hochberg procedure corrected for multiple comparisons. Results: Participants were predominantly Latino (91.4%). At baseline, the mean (SD) child age was 4.3 (0.9) years; 51.9% were female. Household income was below $25 000 for 56.7% of families. Retention was 90.2%. At 36 months, the mean (SD) child BMI was 17.8 (2.2) in the intervention group and 17.8 (2.1) in the control group. No significant difference existed in the primary outcome of BMI trajectory over 36 months (P = .39). The intervention group children had a lower mean caloric intake (1227 kcal/d) compared with control group children (1323 kcal/d) (adjusted difference, -99.4 kcal [95% CI, -160.7 to -38.0]; corrected P = .003). Intervention group parents used community centers with their children more than control group parents (56.8% in intervention; 44.4% in control) (risk ratio, 1.29 [95% CI, 1.08 to 1.53]; corrected P = .006). Conclusions and Relevance: A 36-month multicomponent behavioral intervention did not change BMI trajectory among underserved preschool-age children in Nashville, Tennessee, compared with a control program. Whether there would be effectiveness for other types of behavioral interventions or implementation in other cities would require further research. Trial Registration: ClinicalTrials.gov Identifier: NCT01316653.

Parental perception of built environment characteristics and built environment use among Latino families: a cross-sectional study.

BACKGROUND: Perception of undesirable features may inhibit built environment use for physical activity among underserved families with children at risk for obesity. METHODS: To examine the association of perceived availability, condition, and safety of the built environment with its self-reported use for physical activity, we conducted a cross-sectional analysis on baseline data from a randomized controlled trial. Adjusted Poisson regression was used to test the association between the primary independent variables (perceived availability, physical condition, and safety) with the primary outcome of self-reported use of built environment structures. RESULTS: Among 610 parents (90% Latino) of preschool-age children, 158 (26%) reported that there were no available built environment structures for physical activity in the neighborhood. The use of built environment structures was associated with the perceived number of available structures (B = 0.34, 95% CI 0.31, 0.37, p < 0.001) and their perceived condition (B = 0.19, 95% CI 0.12, 0.27, p = 0.001), but not with perceived safety (B = 0.00, 95% CI -0.01, 0.01, p = 0.7). CONCLUSIONS: In this sample of underserved families, perceived availability and condition of built environment structures were associated with use rather than perceived safety. To encourage physical activity among underserved families, communities need to invest in the condition and availability of built environment structures. TRIAL REGISTRATION: Registered at ClinicalTrials.gov ( NCT01316653 ) on March 11, 2011.

Predictors of Youths' Posttraumatic Stress Symptoms Following a Natural Disaster: The 2010 Nashville, Tennessee, Flood.

Framed by a previously established conceptual model of youths' posttraumatic stress (PTS) responses following a disaster, the current longitudinal study examined the relation of predisaster child characteristics (age, gender, depressive symptoms, ruminative coping), predisaster environmental characteristics (negative life events and supportive and negative friendship interactions), and level of disaster exposure to youths' PTS symptoms in the wake of a natural disaster. Prior to the 2010 Nashville, Tennessee, flood, 239 predominantly Caucasian youth from four elementary and middle schools (ages = 10-15, 56% girls) completed measures of depressive symptoms, rumination, negative life events, and social support in the form of both supportive and negative friendship interactions. Approximately 10 days after returning to school, 125 completed measures of disaster exposure and postflood PTS symptoms. Bivariate correlations revealed that disaster-related PTS symptoms were unrelated to age, gender, or predisaster supportive friendship interactions and significantly positively related to level of disaster exposure and predisaster levels of negative life events, depressive symptoms, rumination, and negative friendship interactions. After controlling for level of disaster exposure and other predisaster child and environmental characteristics, depressive symptoms and negative friendship interactions predicted postdisaster PTS symptoms. The effect of child's flood-related experiences on PTS symptoms was not moderated by any of the preexisting child characteristics or environmental indicators. Faced with limited resources after a natural disaster, school counselors and other health professionals should focus special attention on youths who experienced high levels of disaster-related losses and whose predisaster emotional and interpersonal lives were problematic.

A randomized controlled trial of a cognitive-behavioral program for the prevention of depression in adolescents compared with nonspecific and no-intervention control conditions.

Adolescent depression is a common and recurrent disorder associated with significant impairment and other forms of psychopathology. Finding an effective intervention that prevents depression in adolescents is an important public health priority. Participants were 518 high school students (mean age = 15.09; SD = 0.76) from the mid-south of the United States. Participants were randomly assigned to 1 of 3 conditions: a cognitive-behavioral program (CB; n = 166), nonspecific control (NSp; n = 175), or a no-intervention control condition (NIC; n = 177). Both the CB and NSp conditions consisted of 90-min sessions administered once a week over a 10-week period during regular school hours. Depressive symptoms were assessed with the Children's Depression Inventory (CDI) at baseline; postintervention; and at 4-, 8-, and 12-month follow-ups. The Time × Condition interaction was significant, F(8, 478.57) = 3.32, p = .001, indicating that at the 4-month follow-up, youth in the CB condition had significantly lower CDI scores compared with those in the NSp (p = .047, g = 0.29; CI [0.06, 0.52]) and the NIC conditions (p = .003, g = 0.30; CI [0.07, 0.53]). Future studies need to examine the importance of theory-driven change mechanisms, interpersonal relationships, and structural circumstances in schools as factors impacting the long-term effects of CB prevention programs.

Family resilience and childhood obesity among children exposed to adverse childhood experiences in a national survey.

OBJECTIVE: Adverse childhood experiences (ACEs) contribute to poor overall health among children with obesity. This study evaluated how one potential protective factor-family resilience-affects the association between ACEs and childhood obesity. METHODS: This analysis was a secondary analysis of the 2016-2018 National Survey of Children's Health (NSCH), a repeated cross-sectional survey based on parent report. Nine ACEs were queried. Family resilience was assessed with four items (potential range 0-12). The primary outcome was child weight status. Multivariable ordinal logistic regression was used, adjusting for potential confounders and the interaction between ACEs and family resilience. RESULTS: For 49,365 children ages 10-17, the median number of ACEs was 1 (IQR 0, 2), the median family resilience score was 10 (IQR 8,12), 15.3% of children had overweight, and 15.4% of children had obesity. Among the 51.3% of children who experienced one or more ACEs, higher family resilience scores attenuated the odds of being in a higher weight category. This pattern was not observed in children with zero ACEs. CONCLUSIONS: In the 2016-2018 NSCH, children ages 10-17 who were exposed to ACEs had higher rates of overweight and obesity, the odds of which may be reduced when children also have higher family resilience.

A longitudinal analysis of relationships between neighborhood context and underserved children's physical activity in a rapidly growing city.

Neighborhood context, which may be impacted by urban growth or residential mobility, is associated with childhood physical activity. This secondary analysis examined associations of objectively measured neighborhood characteristics with young children's moderate-to-vigorous physical activity (MVPA) and sedentary/rest time (SRT) over a period of rapid infrastructure change. Underserved preschoolers (n = 426) from a 36-month obesity prevention intervention were included in a secondary analysis (2019-2020). Based on household addresses, participants were coded as movers or non-movers and linked to four neighborhood variables: 1) distance to recreation sites, 2) annual crimes, 3) annual stray dogs, and 4) Gini index of income inequality. Accelerometry captured MVPA and SRT at baseline and 36 months. Baseline-to-follow-up neighborhood variables within moved and non-moved groups were compared. Multivariable regression assessed associations between follow-up MVPA/SRT and neighborhood variables. 45.3% of participants (n = 193) moved. Distance to the closest recreation site decreased significantly for non-movers (0.75 to 0.72 mi, p < 0.001). Nearby crimes significantly decreased for both groups (movers: 90 to 80, p < 0.001; non-movers: 77 to 74, p < 0.001) as did stray dogs (movers: 36 to 15, p < 0.001; non-movers: 36 to 18, p < 0.001). Neighborhood income inequality decreased significantly for movers (0.41 to 0.38, p = 0.03). Child MVPA minutes/day significantly decreased over time from median = 84.7 [Q1 = 64.1, Q3 = 103.9] to median = 73.6 [Q1 = 56.1, Q3 = 96.0], p < 0.001). No significant associations were detected between neighborhood variables and child physical activity. In a rapidly growing county, neighborhood context generally improved over time regardless of move status. Within this context, no associations between neighborhood characteristics and MVPA/SRT were detected in children.

Hopelessness and depressive symptoms in children and adolescents: An integrative data analysis.

Although hopelessness has been linked to depression for centuries, the diagnostic criteria for depression are inconsistent with regard to the status of hopelessness. Most research on hopelessness and depression has focused on adults. The current study examined this relation in children and adolescents. Integrative data analyses with a pooled sample (N = 2466) showed that clinical levels of hopelessness multiplied the odds of having a clinical diagnosis of depression 10-fold. Conversely, not having clinical levels of hopelessness multiplied the odds of endorsing no clinical level of depressive symptoms 28-fold. Moreover, results differed by levels of depression: (a) among youths with clinical levels of depression, hopelessness was associated with six depressive symptoms; (b) among youths without clinical levels of depression, hopelessness was associated with nine depressive symptoms. We found that hopelessness helps to explain the heterogeneity of depressive presentations. Our finding supports the consideration of hopelessness in the diagnosis (if not treatment and prevention) of depression in children and adolescents. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The temporal relation between depression and comorbid psychopathology in adolescents at varied risk for depression.

BACKGROUND: This study examined the temporal comorbidity of depressive disorders with anxiety, externalizing, and substance use disorders in adolescents who varied in risk for depression. METHODS: Participants were 240 adolescents and their mothers who had either a history of depression (high-risk, n = 185) or were lifetime-free of psychiatric disorders (low-risk, n = 55). Children (54.2% females) were first evaluated in 6th grade (mean age = 11.86, SD = .57) with the K-SADS-PL to assess current and lifetime diagnoses, and then annually through 12th grade with the A-LIFE to assess diagnoses since the previous evaluation. RESULTS: For girls, the rate of depression was high regardless of prior anxiety, whereas for boys, the odds that those with prior subthreshold anxiety would have subsequent subthreshold depression were 1.5 times those of boys with no prior subthreshold anxiety, controlling for risk. In addition, the odds that girls with prior substance use disorders would have a threshold depressive disorder subsequently were three times those of girls with no prior substance use disorders, controlling for risk. CONCLUSIONS: These results highlight the importance of early detection of various forms of psychopathology in youth who then can be targeted for intervention. The prospective paths to comorbidity differed by sex, thus suggesting that interventions need to be constructed with sensitivity to these distinct diagnostic trajectories.

Longitudinal and Incremental Relation of Cybervictimization to Negative Self-Cognitions and Depressive Symptoms in Young Adolescents.

Adolescents are among the most frequent users of social media websites, raising concern about the dangers of cyber bullying or cybervictimization (CV). A 12-month longitudinal study examined the unique, prospective relation of CV to the development of negative self-cognitions and depressive symptoms in a community sample of 827 children and young adolescents (ages 8-13; 55.1 % female) from the southeastern United States. Over and above conventional types of peer victimization, CV significantly predicted changes in self-referential negative cognitions, victimization-related cognitive reactions, and depressive symptoms, even after controlling for baseline levels of the dependent variables. Results also showed that CV was significantly less stable than other forms of victimization and tended to increase slightly with time. The study highlights the unique effects of CV and has implications for research and practice.

Empirical and conceptual problems with longitudinal trait-state models: introducing a trait-state-occasion model.

The latent trait-state-error model (TSE) and the latent state-trait model with autoregression (LST-AR) represent creative structural equation methods for examining the longitudinal structure of psychological constructs. Application of these models has been somewhat limited by empirical or conceptual problems. In the present study, Monte Carlo analysis revealed that TSE models tend to generate improper solutions when N is too small, when waves are too few, and when occasion factor stability is either too large or too small. Mathematical analysis of the LST-AR model revealed its limitation to constructs that become more highly auto-correlated over time. The trait-state-occasion model has fewer empirical problems than does the TSE model and is more broadly applicable than is the LST-AR model.

The longitudinal structure of the Children's Depression Inventory: testing a latent trait-state model.

In a 6-wave longitudinal study, children (Grades 4-6, n = 648), adolescents (Grades 7-9, n = 1,489), and their parents completed child-adolescent or parent versions of the Children's Depression Inventory (CDI; M. Kovacs, 1981). Using structural equation modeling, the authors conducted latent trait-state analyses to distinguish between a stable trait dimension of depression (in which individual differences are stable over time) and an autoregressive dimension (in which individual differences are less stable over time). Children's CDIs reflected the autoregressive dimension more than a stable trait dimension, whereas parents' CDIs reflected a stable trait dimension more than an autoregressive dimension. Reports from adolescents and their parents reflected a stable trait dimension more than an autoregressive dimension of depressive symptoms. Results suggest that the longitudinal structure of the CDI varies considerably depending on the age of the target and the type of informant.

Survival analysis in family research.

Within the field of family psychology, questions regarding the risk of event occurrence may be common. Such questions, about whether and when events occur and what predicts these occurrences, pose particular methodological challenges and are often best addressed via a statistical method known as survival analysis. This article provides a brief overview of that method, explicating through a data example the major components of a discrete-time survival analysis. Readers not familiar with this method are encouraged to use this article as an introduction to survival analysis and recognize its potential usefulness within the field of family psychology.

Linking peer victimization to the development of depressive self-schemas in children and adolescents.

Previous theory and research suggest that childhood experiences are more likely to generate depressive self-schemas when they focus attention on negative information about oneself, generate strong negative affect, and are repetitive or chronic. Persistent peer victimization meets these criteria. In the current study, 214 youths (112 females) with empirically-validated histories of high or low peer victimization completed self-report measures of negative and positive self-cognitions as well as incidental recall and recognition tests following a self-referent encoding task. Results supported the hypothesis that depressive self-schemas are associated with peer victimization. Specifically, peer victimization was associated with stronger negative self-cognitions, weaker positive self-cognitions, and an elimination of the normative memorial bias for recall of positive self-referential words. Effects were stronger for relational and verbal victimization compared to physical victimization. Support accrues to a model about the social-developmental origins of cognitive diatheses for depression.

Peer victimization (and harsh parenting) as developmental correlates of cognitive reactivity, a diathesis for depression.

Prior research has shown cognitive reactivity to be a diathesis for depression. Seeking evidence for the developmental origins of such diatheses, the current study examined peer victimization and harsh parenting as developmental correlates of cognitive reactivity in 571 children and adolescents (ages 8-13 years). Four major findings emerged. First, a new method for assessing cognitive reactivity in children and adolescents showed significant reliability and demonstrated construct validity vis-à-vis its relation to depression. Second, history of more severe peer victimization was significantly related to cognitive reactivity, with verbal victimization being more strongly tied to cognitive reactivity than other subtypes of peer victimization. Third, harsh parenting was also significantly related to cognitive reactivity. Fourth, both peer victimization and harsh parenting made unique statistical contributions to cognitive reactivity, after controlling for the effects of the other. Taken together, these findings provide preliminary support for a developmental model pertaining to origins of cognitive reactivity in children and adolescents.

Effects of rumination on child and adolescent depressive reactions to a natural disaster: the 2010 Nashville flood.

The current longitudinal study tested hypotheses about Nolen-Hoeksema's (1987, 1991) response styles theory (RST) of depression in a sample of child and adolescent public school students. Wave 1 measures of rumination, distraction, and depression were obtained 6 months prior to the 2010 Nashville flood. Similar measures plus a measure of flood-related stressors were administered at Wave 2, approximately ten days after students returned to school after the flood. Results revealed an indirect effect of preflood rumination on postflood depressive symptoms via the intervening variable of postflood rumination, and partial mediation of the effect of preflood depression on postflood depression. Further, the interaction of rumination with flood-related stressors was moderated by age, suggesting that rumination may not become a strong cognitive diathesis for depression until adolescence. Developmental implications emerged for the treatment of child and adolescent victims of natural disasters and for the application of RST to children and adolescents.

Does supportive parenting mitigate the longitudinal effects of peer victimization on depressive thoughts and symptoms in children?

Cohen and Wills (Cohen, S., & Wills, T. A., 1985, Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310-357) described two broad models whereby social support could mitigate the deleterious effects of stress on health: a main effect model and stress-buffering model. A specific application of these models was tested in a three-wave, multimethod study of 1888 children to assess ways parental support (social support) mitigates the effects of peer victimization (stress) on children's depressive symptoms and depression-related cognitions (health-related outcomes). Results revealed that (a) both supportive parenting and peer victimization had main effects on depressive symptoms and cognitions; (b) supportive parenting and peer victimization did not interact in the prediction of depressive thoughts and symptoms; (c) these results generalized across age and gender; and (d) increases in depressive symptoms were related to later reduction of supportive parenting and later increase in peer victimization. Although supportive parenting did not moderate the adverse outcomes associated with peer victimization, results show that its main effect can counterbalance or offset these effects to some degree. Implications for practice and future research are discussed.

Are increased weight and appetite useful indicators of depression in children and adolescents?

During childhood and adolescence, physiological, psychological, and behavioral processes strongly promote weight gain and increased appetite while also inhibiting weight loss and decreased appetite. The Diagnostic and Statistical Manual-IV (DSM-IV) treats both weight-gain/increased-appetite and weight-loss/decreased-appetite as symptoms of major depression during these developmental periods, despite the fact that one complements typical development and the other opposes it. To disentangle the developmental versus pathological correlates of weight and appetite disturbance in younger age groups, the current study examined symptoms of depression in an aggregated sample of 2307 children and adolescents, 47.25% of whom met criteria for major depressive disorder. A multigroup, multidimensional item response theory model generated three key results. First, weight loss and decreased appetite loaded strongly onto a general depression dimension; in contrast, weight gain and increased appetite did not. Instead, weight gain and increased appetite loaded onto a separate dimension that did not correlate strongly with general depression. Second, inclusion or exclusion of weight gain and increased appetite affected neither the nature of the general depression dimension nor the fidelity of major depressive disorder diagnosis. Third, the general depression dimension and the weight-gain/increased-appetite dimension showed different patterns across age and gender. In child and adolescent populations, these results call into question the utility of weight gain and increased appetite as indicators of depression. This has serious implications for the diagnostic criteria of depression in children and adolescents. These findings inform a revision of the DSM, with implications for the diagnosis of depression in this age group and for research on depression.

Structure and measurement of depression in youths: applying item response theory to clinical data.

Our goals in this article were to use item response theory (IRT) to assess the relation of depressive symptoms to the underlying dimension of depression and to demonstrate how IRT-based measurement strategies can yield more reliable data about depression severity than conventional symptom counts. Participants were 3,403 children and adolescents from 12 contributing clinical and nonclinical samples; all participants had received the Kiddie Schedule of Affective Disorders and Schizophrenia for School-Aged Children. Results revealed that some symptoms reflected higher levels of depression and were more discriminating than others. Furthermore, use of IRT-based information about symptom severity and discriminability in the measurement of depression severity was shown to reduce measurement error and increase measurement fidelity.