Predictors of adherence to a brief sleep extension protocol in emerging adults.

OBJECTIVES: This study examined how mental health symptoms (i.e., depression, anxiety, stress) and baseline sleep characteristics (i.e., sleep quality and levels of daytime sleepiness) predicted adherence to and initial success of a brief sleep extension research protocol in emerging adults. METHODS: 184 emerging adults (ages 18-25; M = 20.96, SD = 2.04) were asked to extend their nightly sleep opportunity to 8 hr for 1 week and to anchor bedtime and waketime. Sleep outcomes (adherence and initial protocol success) were tracked using actigraphy. Baseline sleep quality, daytime sleepiness, depression, anxiety, and stress were assessed using self-report questionnaires. RESULTS: Poorer baseline sleep quality predicted better adherence to the protocol (p = .002). Other baseline sleep characteristics and mental health were not predictive of adherence (ps>.50). Lower levels of baseline daytime sleepiness approached significance in predicting greater initial protocol success following the protocol (p = .05). Baseline sleep quality and mental health did not predict initial protocol success (ps > 0.34). CONCLUSIONS: Mental health symptoms did not significantly predict adherence to or the success of a sleep extension protocol. Surprisingly, individuals with poor baseline sleep quality were more likely to adhere to the extension protocol, perhaps suggesting heightened motivation for change or increased risk for sleep problems. This research provides valuable insight into factors that predict adherence to sleep extension protocols in emerging adults.

Abnormalities in deep-brain morphology and orbitofrontal cortical thinning relate to reward processing and body mass in adolescent girls.

BACKGROUND: Research examining the neural correlates of obesity has recently expanded. However, limited attention has focused on identifying unique brain signatures associated with obesity, particularly in adolescents. The aim of this study was to use surface-based approaches to examine the integrity of brain structures involved in processing the pleasurable effects of food with body mass and food reward sensitivity in adolescent girls. METHODS: Structural morphology of the nucleus accumbens, amygdala, pallidum, and orbitofrontal cortex was examined in 89 adolescent girls with body mass ranging from normal to obese. High-resolution T1-weighted MPRAGE images were used to characterize deep-brain nuclei with high-dimensional diffeomorphic mapping procedures, while cortical thickness was derived from the FreeSurfer toolkit. RESULTS: Results revealed that zBMI was significantly associated with the shape of the left amygdala (ß = -1.1, p < 0.021, 95% CI = -2.02, -0.16), volume of the right and left pallidum (ß = 49.66, p < 0.010, 95% CI = 11.74, 87.58; ß = 47.87, p < 0.017, 95% CI = 8.48, 87.25), and cortical thickness of the lateral and right medial orbitofrontal cortex (ß = -0.06, p < 0.001, 95% CI = -0.09, -0.04; ß = -0.05, p = 0.004, 95% CI = -0.08, -0.02). Sensitivity to food reward significantly predicted volume of the right nucleus accumbens (ß = 0.66, p = 0.047, 95% CI = 0.01, 1). Contrast mapping for surface shape of the amygdala revealed significant outward deformation of the posterior lateral left amygdala and an inward deformation of the basolateral left amygdala in the group with overweight/obesity. CONCLUSIONS: Integrity of the left amygdala and orbitofrontal cortex varies as a function of body mass, with greater localized amygdalar volume loss, pallidum volume, and increased cortical thinning of the orbitofrontal cortex occurring as weight increases. Thus, overweight/obesity may be associated with surface-based abnormalities in brain structures associated with processing of reward value related to food. Overall, findings highlight the importance of understanding changes in reward-related brain regions and how they pertain to variability in body mass in adolescent girls.

Neural mechanisms that promote food consumption following sleep loss and social stress: an fMRI study in adolescent girls with overweight/obesity.

STUDY OBJECTIVES: Insufficient sleep and social stress are associated with weight gain and obesity development in adolescent girls. Functional magnetic resonance imaging (fMRI) research suggests that altered engagement of emotion-related neural networks may explain overeating when under stress. The purpose of this study is to explore the effects of acute sleep restriction on female adolescents' neural responding during social evaluative stress and their subsequent eating behavior. METHODS: Forty-two adolescent females (ages 15-18 years) with overweight or obesity completed a social stress induction task in which they were told they would be rated by peers based on their photograph and profile. Participants were randomly assigned to one night of sleep deprivation or 9 h of sleep the night before undergoing fMRI while receiving positive and negative evaluations from their peers. After which, subjects participated in an ad libitum buffet. RESULTS: Sleep deprived, relative to nondeprived girls had distinct patterns of neural engagement to positive and negative evaluation in anterior, mid, and posterior aspects of midline brain structures. Moreover, a sleep deprivation-by-evaluation valence-by-caloric intake interaction emerged in bilateral dorsal anterior cingulate. Among sleep deprived girls, greater engagement during negative, but not positive, feedback was associated with lower caloric intake. This was not observed for nonsleep deprived girls. CONCLUSIONS: Results suggest an interaction between acute sleep loss and social evaluation that predicts emotion-related neural activation and caloric intake in adolescents. This research helps to elucidate the relationship between sleep loss, social stress, and weight status using a novel health neuroscience model.

Does iPhone night shift mitigate negative effects of smartphone use on sleep outcomes in emerging adults?

OBJECTIVES: Apple's iPhone Night Shift feature purports to reduce short-wavelength light emissions and improve sleep. We aimed to investigate these claims by comparing emerging adults' sleep outcomes associated with smartphone use before bed with iPhone's Night Shift enabled to two comparison conditions (iPhone use with no Night Shift, no iPhone use). DESIGN: Participants were randomly assigned to one of three conditions specifying iPhone use during the hour preceding bedtime for seven consecutive nights: iPhone use with Night Shift enabled; iPhone use with Night Shift disabled; and no phone use. SETTING: Participants were recruited from a western undergraduate university. PARTICIPANTS: A sample of 167 emerging adults (ages 18-24; 71.3% female) with iPhones participated in the study. MEASUREMENTS: Sleep outcomes (sleep latency, duration, efficiency and wake after sleep onset) were tracked using wrist-worn accelerometers. RESULTS: There were no significant differences in sleep outcomes across the three experimental groups. Post-hoc exploratory stratified analyses revealed a significant main effect of phone condition on sleep efficiency (P = .014) and WASO (P = .013) for participants averaging more than 6.8 hours of sleep per night, with the no phone condition demonstrating the best sleep outcomes. For those averaging less than 6.8 hours of sleep, there was no effect of phone condition on sleep outcomes. CONCLUSIONS: Across our full study sample, there were no differences in sleep outcomes attributable to Night Shift. For individuals who regularly obtained adequate sleep, abstaining from screen use resulted in better quality sleep than did phone use with Night Shift enabled.

Maternal self-efficacy is associated with mother-child feeding practices in middle childhood.

OBJECTIVE: Maternal self-efficacy (MSE) is a well-established correlate of health outcomes in young children, though little is known about this association in older children. The purpose of this cross-sectional study was to examine how MSE relates to mother-child feeding practices in middle childhood. METHODS: A total of 306 children ages 8-12 (Mean age = 9.72, SD = 0.91, 52.9% female) and their mothers participated in this study. Mothers completed the New General Self-Efficacy Scale and the Child Feeding Questionnaire. A series of hierarchical regression models were used to examine how MSE related to maternal food restriction, maternal pressure to eat, and maternal food monitoring. RESULTS: After accounting for maternal Body Mass Index (BMI), education, and age, and child Body Mass Index Percentile (BMI%ile) and age within the first step of each regression model, MSE emerged as a significant predictor for maternal restriction of foods (p = .024) and maternal food monitoring (p = .048). MSE was not significantly related to maternal pressure to eat. CONCLUSIONS: This study is the first to establish that higher MSE is significantly related to healthier mother-child feeding practices in middle childhood, providing preliminary justification for enhancing MSE within comprehensive family interventions to support child weight-related health.

Does inhibitory control training reduce weight and caloric intake in adults with overweight and obesity? A pre-registered, randomized controlled event-related potential (ERP) study.

A cognitive intervention that may reduce weight and caloric intake is inhibitory control training (ICT; having individuals repeatedly withhold dominant responses to unhealthy food images). We conducted a randomized controlled trial where 100 individuals with overweight or obesity were assigned to complete a generic (n = 48) or food-specific ICT (n = 52) training four times per week for four weeks. Weight and caloric intake were obtained at baseline, four-weeks, and 12-weeks. Participants also completed high-calorie and neutral go/no-go tasks while N2 event-related potential (ERP) data, a neural indicator of inhibitory control, was measured at all visits. Results from mixed model analyses indicate that neither weight, caloric intake, nor N2 ERP component amplitude towards high-calorie foods changed at post-testing or at the 12-week follow up. Regression analyses suggest that individuals with smaller N2 difference amplitudes to food may show greater weight loss and reductions in caloric intake after a generic ICT, while individuals with larger N2 difference amplitudes to food may show greater weight loss and reductions in caloric intake after a food-specific ICT. Overall, multiple food-specific or generic ICT sessions over the course of a four-week period do not affect overall weight loss, caloric intake, or N2 ERP amplitude.

Associations Between Parent-Child Communication and Connectedness, Parent Feeding Behavior, and Child Body Mass in Pre-Adolescent Children.

OBJECTIVE: This study evaluated associations between parent-child connectedness and communication, parent feeding behaviors (restriction, pressure to eat, and monitoring), and age- and sex-standardized child body mass index (zBMI) in a sample of pre-adolescent children aged 8-12 years. METHODS: A community sample of three hundred and eight child-parent dyads completed measures of communication and connectedness. Parents completed a feeding behavior measure and children were weighed and their height was measured. We examined whether parental feeding behaviors and parent-child communication and connectedness predicted child zBMI and whether parental feeding behaviors moderated the association between parent-child communication and connectedness and child zBMI. RESULTS: Feeding restriction was positively associated with zBMI, while both pressure to eat and food monitoring exhibited negative associations with zBMI. Child-reported communication was inversely associated with zBMI and parental pressure to eat moderated this association such that lower pressure to eat predicted a stronger association between communication and zBMI. CONCLUSIONS: These findings are consistent with previous research suggesting that parent feeding strategies and parent-child communication are important contributors to child weight status. This study also provides preliminary evidence suggesting that adaptive parent-child communication is associated with lower body mass when parents avoid pressuring their child to eat. Our study provides an important extension of this body of research into middle childhood, a relatively understudied developmental stage.

White matter integrity disparities between normal-weight and overweight/obese adolescents: an automated fiber quantification tractography study.

Obese adults have been shown to have poorer white brain matter integrity relative to normal-weight peers, but few studies have tested whether white matter integrity is compromised in overweight and obese adolescents. Also, it is unclear if age interacts with body mass to affect white matter integrity in adolescents. We used Automated Fiber Quantification, a tractography method, to compare fractional anisotropy between normal-weight and overweight/obese adolescents in the corpus callosum, corticospinal tract, cingulum, inferior fronto-occipital fasciculus, and uncinate fasciculus. Further, we tested whether any differences were moderated by age. Forty-seven normal-weight and forty overweight/obese adolescents were scanned using a diffusion tensor imaging (DTI) scan sequence. Overweight/obese compared to normal-weight adolescents had decreased white matter integrity in the superior frontal corpus callosum, left and right uncinate fasciculi, left inferior fronto-occipital fasciculus, and left corticospinal tract, which may be related to heightened reward processing. Overweight/obese compared to normal-weight adolescents had increased white matter integrity in the orbital and anterior frontal corpus callosum, right inferior fronto-occipital fasciculus, left cingulum, and left corticospinal tract, which may be related to heightened attentional processing. As age increased, six tracts showed poorer white matter integrity as body mass index percentile (BMI%) increased, but three tracts showed greater white matter integrity as BMI% increased. Future research examining associations between white matter integrity and neural indices of food-related reward and attention are needed to clarify the functional significance of white matter integrity discrepancies between normal-weight and overweight/obese adolescents.

Effects of Sleep Restriction on Food-Related Inhibitory Control and Reward in Adolescents.

OBJECTIVE: This experimental study evaluated associations between sleep duration, food-related inhibitory control, and food reward in adolescents aged 12-18 with normal weight and overweight/obesity. The potential moderating effect of weight status on the associations between sleep, inhibitory control, and food reward was also examined. METHODS: Thirty-two adolescents with normal weight and 32 adolescents with overweight/obesity (ages 12-18) participated in this study. Participants spent 5 hr in bed per night (restricted sleep) or 9 hr in bed per night (habitual sleep) for five nights with experimental periods separated by 3 weeks. Participants completed a food-related inhibitory control task and a questionnaire assessing food reward on the sixth day of each study phase. RESULTS: Repeated measures analyses of variance revealed that adolescents performed more poorly on a food-related inhibitory control task and had heightened food reward following sleep restriction. Adolescents with overweight/obesity demonstrated heightened food reward compared with adolescents with normal weight; there was no main effect of weight on food-related inhibitory control. There was a significant interaction between sleep condition and weight status on food reward, with adolescents with normal weight demonstrating heightened food reward following sleep restriction. Adolescents with overweight/obesity showed consistently high food reward with no effect of sleep duration. CONCLUSIONS: When sleep restricted, adolescents demonstrated heightened food reward and were less able to inhibit prepotent responses to food images. Adolescents with normal weight who experience acute sleep restriction may perceive foods to be more rewarding relative to normal sleep.

Sleep duration differentially affects brain activation in response to food images in adolescents with overweight/obesity compared to adolescents with normal weight.

STUDY OBJECTIVES: Sleep is an important behavior that affects appetite and eating in adolescents. Our study examined food-related neural activation in brain regions associated with food reward and inhibition in adolescents under sleep-restricted and well-rested conditions. METHODS: In this within-subjects study, 52 adolescents (ages 12-18; 46% female; M age = 15.96 years, SD = 1.56) with normal weight (NW; N = 29, M body mass index % [BMI%] = 54.55, SD = 24.54) or overweight/obesity (OV/OB; N = 23, M BMI% = 93.78, SD = 4.60) spent 5 hours in bed at home each night for five consecutive nights and 9 hours in bed at home each night for 5 consecutive nights, with the first day of each condition occurring 4 weeks apart. The morning following each sleep modification period, functional magnetic resonance imaging (fMRI) data were collected while participants performed an inhibitory (go/no-go) task with food stimuli. RESULTS: We found significantly greater activation in brain regions associated with inhibition in adolescents with NW in response to food cues when sleep restricted. No increase in inhibition-related neural activation was observed in adolescents with OV/OB when sleep restricted. We also found neural activation consistent with greater reward processing associated with food cues following sleep restriction regardless of weight status. CONCLUSIONS: These findings suggest that chronic sleep restriction may increase the likelihood of suboptimal dietary behavior for adolescents with OV/OB because they do not experience increased inhibition-related neural responding to counter possible increased reward-related neural responding following sleep restriction.

Associations between physical and sedentary activity regularity and sleep in preschoolers and kindergartners.

Short sleep duration in childhood has been associated with increased risk for overweight and obesity. Research suggests that physical activity might mediate this association. However, studies examining associations between physical activity and sleep in young children have reported equivocal findings. A possible explanation for these inconsistencies is that past studies have looked at total physical activity rather than examining physical activity regularity. We aimed to explore the associations between physical and sedentary activity regularity (ie, consistent vs intermittent behavior) and sleep in preschoolers and kindergartners. One hundred and thirty-one children (ages 4-6) wore waist-worn accelerometers for 3 days and 3 nights. Associations between physical and sedentary activity regularity and attaining adequate sleep duration were assessed using logistic regression. There was no association between the number of days that children engaged in ≥60 minutes of total physical activity and sufficient sleep. Furthermore, there was no association between the number of days that children engaged in ≥20 minutes of vigorous activity and sufficient sleep. Children who engaged in minimal sedentary activity had greater odds of obtaining sufficient sleep as compared with children who engaged in more sedentary activity.

Effectiveness of a Parent Health Report in Increasing Fruit and Vegetable Consumption Among Preschoolers and Kindergarteners.

OBJECTIVE: To determine the effectiveness of a parent health report on fruit and vegetable consumption among preschoolers and kindergarteners. DESIGN: Pre-post open design trial and a randomized controlled trial. SETTING: A university-sponsored preschool and kindergarten. PARTICIPANTS: A total of 63 parents of preschool and kindergarten students participated in the pre-post open design trial and 65 parents participated in the randomized controlled trial. INTERVENTION: Parents in intervention groups were given a parent health report providing information about their child's fruit and vegetable intake as well as recommendations for how to increase their child's fruit and vegetable consumption. MAIN OUTCOME MEASURE: Change in fruit and vegetable consumption. ANALYSIS: Latent growth curve modeling with Bayesian estimation. RESULTS: Vegetable consumption increased by 0.3 servings/d in the open trial and 0.65 servings/d in the randomized trial. Fruit consumption did not increase significantly in either study. CONCLUSIONS AND IMPLICATIONS: Results from both an open trial and a randomized controlled trial suggested that the parent health report may be a beneficial tool to increase vegetable consumption in preschoolers and kindergarteners. Increases in vegetable consumption can lead to the establishment of lifelong habits of healthy vegetable intake and decrease risk for chronic diseases.

Executive Control Mediates the Association Between Aerobic Fitness and Emotion Regulation in Preadolescent Children.

Objective: This study evaluated direct and indirect associations between aerobic fitness, executive control, and emotion regulation among a community sample of preadolescent children. Methods: Two-hundred and seventy-eight children aged 8-12 years completed measures of aerobic fitness (Progressive Aerobic Cardiovascular Endurance Run) and executive control (Stroop Test). Parents completed questionnaires assessing child emotion regulation and executive control (Emotion Regulation Checklist; Early Adolescent Temperament Questionnaire). We evaluated associations between these constructs using structural equation modeling. Results: Study findings supported a moderate direct association between childhood aerobic fitness and executive control, a strong direct negative association between executive control and emotion regulation, and a moderate indirect association between aerobic fitness and emotion regulation through executive control. Conclusions: These findings provide preliminary evidence that executive control functions as a mediator between aerobic fitness and emotion regulation and may help explain the mechanism by which aerobic exercise influences emotional well-being among preadolescent children.

Motivational Impact of Palatable Food Correlates With Functional Brain Responses to Food Images in Adolescents.

Objective: To examine associations between motivational impact of palatable foods and neural activity in brain regions involved in inhibitory control among adolescents. Methods: Thirty-four adolescents aged 14-20 years underwent functional magnetic resonance imaging while viewing images of high- and low-energy foods. Participants completed the Power of Food Scale (PFS). Whole-brain analyses of variance tested for neural activation differences and correlations between brain activation and PFS scores were tested. Results: We found an interaction between food type (high energy vs. low energy) and PFS scores in the right dorsolateral prefrontal cortex and right inferior parietal lobule. We also found that PFS scores correlated negatively with activation to high-energy foods in prefrontal cortical and parietal regions. Conclusions: These findings suggest that individuals with high motivation for high-energy foods also demonstrate lower neural activation in inhibition-related brain regions when viewing images of high-energy foods, indicating that they may have difficulty inhibiting consumption impulses.

Appropriateness of the food-pics image database for experimental eating and appetite research with adolescents.

BACKGROUND: Research examining effects of visual food cues on appetite-related brain processes and eating behavior has proliferated. Recently investigators have developed food image databases for use across experimental studies examining appetite and eating behavior. The food-pics image database represents a standardized, freely available image library originally validated in a large sample primarily comprised of adults. The suitability of the images for use with adolescents has not been investigated. The aim of the present study was to evaluate the appropriateness of the food-pics image library for appetite and eating research with adolescents. METHODS: Three hundred and seven adolescents (ages 12-17) provided ratings of recognizability, palatability, and desire to eat, for images from the food-pics database. Moreover, participants rated the caloric content (high vs. low) and healthiness (healthy vs. unhealthy) of each image. RESULTS: Adolescents rated approximately 75% of the food images as recognizable. Approximately 65% of recognizable images were correctly categorized as high vs. low calorie and 63% were correctly classified as healthy vs. unhealthy in 80% or more of image ratings. These results suggest that a smaller subset of the food-pics image database is appropriate for use with adolescents. CONCLUSIONS: With some modifications to included images, the food-pics image database appears to be appropriate for use in experimental appetite and eating-related research conducted with adolescents.

An Evaluation of a Smartphone-Assisted Behavioral Weight Control Intervention for Adolescents: Pilot Study.

BACKGROUND: The efficacy of adolescent weight control treatments is modest, and effective treatments are costly and are not widely available. Smartphones may be an effective method for delivering critical components of behavioral weight control treatment including behavioral self-monitoring. OBJECTIVE: To examine the efficacy and acceptability of a smartphone assisted adolescent behavioral weight control intervention. METHODS: A total of 16 overweight or obese adolescents (mean age=14.29 years, standard deviation=1.12) received 12 weeks of combined treatment that consisted of weekly in-person group behavioral weight control treatment sessions plus smartphone self-monitoring and daily text messaging. Subsequently they received 12 weeks of electronic-only intervention, totaling 24 weeks of intervention. RESULTS: On average, participants attained modest but significant reductions in body mass index standard score (zBMI: 0.08 standard deviation units, t (13)=2.22, P=.04, d=0.63) over the in-person plus electronic-only intervention period but did not maintain treatment gains over the electronic-only intervention period. Participants self-monitored on approximately half of combined intervention days but less than 20% of electronic-only intervention days. CONCLUSIONS: Smartphones likely hold promise as a component of adolescent weight control interventions but they may be less effective in helping adolescents maintain treatment gains after intensive interventions.

Topical Review: Unique Contributions of Magnetic Resonance Imaging to Pediatric Psychology Research.

OBJECTIVE: This review aims to provide a brief introduction of the utility of magnetic resonance imaging (MRI) methods in pediatric psychology research, describe several exemplar studies that highlight the unique benefits of MRI techniques for pediatric psychology research, and detail methods for addressing several challenges inherent to pediatric MRI research. METHODS: Literature review. RESULTS: Numerous useful applications of MRI research in pediatric psychology have been illustrated in published research. MRI methods yield information that cannot be obtained using neuropsychological or behavioral measures. CONCLUSIONS: Using MRI in pediatric psychology research may facilitate examination of neural structures and processes that underlie health behaviors. Challenges inherent to conducting MRI research with pediatric research participants (e.g., head movement) may be addressed using evidence-based strategies. We encourage pediatric psychology researchers to consider adopting MRI techniques to answer research questions relevant to pediatric health and illness.

Functional brain response to food images in successful adolescent weight losers compared with normal-weight and overweight controls.

OBJECTIVE: Research conducted with adults suggests that successful weight losers demonstrate greater activation in brain regions associated with executive control in response to viewing high-energy foods. No previous studies have examined these associations in adolescents. Functional neuroimaging was used to assess brain response to food images among groups of overweight (OW), normal-weight (NW), and successful weight-losing (SWL) adolescents. METHODS: Eleven SWL, 12 NW, and 11 OW participants underwent functional magnetic resonance imaging while viewing images of high- and low-energy foods. RESULTS: When viewing high-energy food images, SWLs demonstrated greater activation in the dorsolateral prefrontal cortex (DLPFC) compared with OW and NW controls. Compared with NW and SWL groups, OW individuals demonstrated greater activation in the ventral striatum and anterior cingulate in response to food images. CONCLUSIONS: Adolescent SWLs demonstrated greater neural activation in the DLPFC compared with OW/NW controls when viewing high-energy food stimuli, which may indicate enhanced executive control. OW individuals' brain responses to food stimuli may indicate greater reward incentive processes than either SWL or NW groups.

A qualitative study of successful adolescent and young adult weight losers: implications for weight control intervention.

BACKGROUND: Our study aims to provide an in-depth analysis of behavioral strategies, psychological factors, and social contributors to adolescent weight loss and weight loss maintenance among participants in the Adolescent Weight Control Registry (AWCR). METHODS: Qualitative analyses were conducted using semi-structured interview data from 40 participants from the AWCR who successfully lost ≥10 lbs and maintained their weight loss for at least one year. RESULTS: In contrast to existing literature, our findings suggest that primary motivating factors for adolescent weight loss may be intrinsic (e.g., desire for better health, desire to improve self-worth) rather than extrinsic. In addition, life transitions (e.g., transition to high school) were identified as substantial motivators for weight-related behavior change. Peer and parental encouragement and instrumental support were widely endorsed as central to success. The most commonly endorsed weight loss maintenance strategies included attending to dietary intake and physical activity levels, and making self-corrections when necessary. CONCLUSIONS: Results from this study highlight considerations for future adolescent weight control treatment development.