Associations Between Trauma and Health Behaviors and Outcomes Among Sexual Minoritized Adults: A Scoping Review.

Sexual minoritized (SM) adults experience health disparities and report higher rates of trauma history compared to heterosexual adults. This scoping review synthesizes the extant literature that investigates associations between trauma and physical health among SM adults. It also describes research instruments utilized to assess trauma in relation to health outcomes among SM adults. We searched CINAHL, LGBT+ Life, PsycINFO, and PubMed to identify studies meeting inclusion criteria: peer-reviewed, English, assessed trauma as an independent variable, and assessed health behaviors or outcomes among SM adults. From 587 nonduplicate articles, 69 full texts were reviewed; 18 met criteria and were included in this review. To enhance rigor, we utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Scoping Reviews checklist. Most (n = 12) of the included studies were cross-sectional. Trauma was assessed 16 different ways, including 9 validated measures, in relation to 5 health behaviors and 17 health conditions. Trauma was operationalized by history of childhood sexual abuse, adverse childhood experiences, lifetime rape, current symptoms of post-traumatic stress disorder, and lifetime victimization among SM adults. All but one study found associations between trauma and one or more unfavorable health behaviors or outcomes. Studies used widely heterogeneous instruments to assess trauma, health, and SM identity. Greater specification and standardization of measurement is needed, along with contextualized assessments of trauma and its impact on health such as sexual minority stress-related victimization and resilience, and post-traumatic growth and recovery processes.

Maternal Depressive Symptoms and Their Association with Breastfeeding and Child Weight Outcomes.

Children of mothers with depressive symptoms are at a higher risk for psychosocial, behavioral, and developmental problems. However, the effects of maternal depression on children's physical growth are not well understood. To address the gaps in the literature, this study examined the association between maternal depressive symptoms, breastfeeding behaviors, and child weight outcomes. Data from 204 mother-child dyads who participated in the STRONG Kids 1 Study were used. Mothers and children were assessed twice when the children were 3 and 4 years old. Height and weight measurements of children and mothers were collected by trained researchers during both assessments. Multiple linear regression and analysis of covariance tests were used to examine the associations between maternal depressive symptoms, breastfeeding, and age and sex-adjusted child body mass index percentile. Recurrent maternal depressive symptoms when the child was 3 and 4 years old were not associated with child body mass index percentiles (BMI-P) at age 4. Mothers who breastfed for at least 6 months had significantly lower depressive symptoms when their children were 3 years of age, but the differences did not persist at age 4. In this community sample, maternal depressive symptoms were not associated with child BMI-P, regardless of breastfeeding duration.

Productivity, impact, and collaboration differences between transdisciplinary and traditionally trained doctoral students: A comparison of publication patterns.

Transdisciplinary (TD) approaches are increasingly used to address complex public health problems such as childhood obesity. Compared to traditional grant-funded scientific projects among established scientists, those designed around a TD, team-based approach yielded greater publication output after three to five years. However, little is known about how a TD focus throughout graduate school training may affect students' publication-related productivity, impact, and collaboration. The objective of this study was to compare the publication patterns of students in traditional versus TD doctoral training programs. Productivity, impact, and collaboration of peer-reviewed publications were compared between traditional (n = 25) and TD (n = 11) students during the first five years of the TD program. Statistical differences were determined by t-test or chi square test at p < 0.05. The publication rate for TD students was 5.2 ± 10.1 (n = 56) compared to 3.6 ± 4.5 per traditional student (n = 82). Publication impact indicators were significantly higher for TD students vs. traditional students: 5.7 times more citations in Google Scholar, 6.1 times more citations in Scopus, 1.3 times higher journal impact factors, and a 1.4 times higher journal h-index. Collaboration indicators showed that publications by TD students had significantly more co-authors (1.3 times), and significantly more disciplines represented among co-authors (1.3 times), but not significantly more organizations represented per publication compared to traditional students. In conclusion, compared to doctoral students in traditional programs, TD students published works that were accepted into higher impact journals, were more frequently cited, and had more cross-disciplinary collaborations.

Latino immigrants, depressive symptoms, and cognitive behavioral therapy: A systematic review.

BACKGROUND: In order to address the needs of the growing Latino immigrant population, this study aimed to systematically review peer-reviewed articles of intervention studies that used cognitive behavioral therapy to treat depressive symptoms among Latino immigrants in the U.S. METHODS: We searched PsycINFO, PubMed, and Medline databases from January 1995 through July 2016 as part of a registered review protocol (PROSPERO) following PRISMA guidelines. Inclusion criteria were intervention studies that used cognitive behavioral techniques to treat depressive symptoms among a predominantly U.S. Latino immigrant sample -- or subsample with disaggregated results, and the use of standardized measures of depression. We used the National Heart, Lung, and Blood Institute quality assessment tools for systematic reviews to assess risk of bias. RESULTS: We identified 11 studies that met inclusion criteria. Nine of the included studies reported a reduction of depressive symptoms. Each study used a least one cultural adaptation to deliver the intervention. Using an existing content model, cultural adaptations were categorized as (a) cognitive-informational adaptations, (b) affective-motivational adaptations, and (c) environmental adaptations. LIMITATIONS: Heterogeneity of articles in terms of sample size, cultural adaptations, methodological rigor, and setting limited comparability of effectiveness across studies. CONCLUSIONS: Culturally adapted CBT to address depressive symptoms among Latino immigrants appears promising but further research is needed. The most commonly used cultural adaptations included language, inclusion of migration experience, and adjusting for literacy level. Study design elements and adaptations were often responsive to geographic characteristics and available resources.

Perceptions of early body image socialization in families: Exploring knowledge, beliefs, and strategies among mothers of preschoolers.

This study sought to explore parental perceptions of body image in preschoolers. We conducted semi-structured interviews with 30 primary caregivers of preschoolers to examine knowledge, beliefs, and strategies regarding early body image socialization in families. Thematic Analysis yielded three themes highlighting knowledge gaps, belief discrepancies, and limited awareness of strategies. Findings regarding knowledge: Most participants defined body image as objective attractiveness rather than subjective self-assessment (53%) and focused on negative body image. Beliefs: Although 97% of participants believed weight and shape impact children's self-esteem, 63% believed preschoolers too young to have a body image. Strategies: Most participants (53%) said family was a primary influence on body image, but identified few effective strategies and 63% said they did not do anything to influence children's body image. Findings suggested family body image socialization in preschoolers is occurring outside the awareness of parents and the concept of positive body image is underdeveloped.

Feasibility and validity of a statistical adjustment to reduce self-report bias of height and weight in wave 1 of the Add Health study.

BACKGROUND: Bias in adolescent self-reported height and weight is well documented. Given the importance and widespread use of the National Longitudinal Study of Adolescent to Adult Health (Add Health) data for obesity research, we developed and tested the feasibility and validity of an empirically derived statistical correction for self-report bias in wave 1 (W1) of Add Health, a large panel study in the United States. METHODS: Participants in grades 7-12 with complete height and weight data at W1 were included (n = 20,175). We used measured and self-reported (SR) height and weight and relevant biopsychosocial factors from wave 2 (W2) of Add Health (n = 14,190) to identify sources of bias and derive the most efficient sex-specific estimates of corrected height and weight. Measured, SR, and corrected W2 BMI values were calculated and compared, including sensitivity and specificity. Final correction equations were applied to W1. RESULTS: After correction, weight status misclassification rates among those who underestimated their weight status were reduced from 6.6 to 5.7 % for males and from 8.0 to 5.6 % for females compared to self-report; and the correlation between SR and measured BMI in W2 increased slightly from 0.92 to 0.93. Among females, correction procedures resulted in a 3.4 % increase in sensitivity to detect overweight/obesity (BMI ≥ 25) and 5.9 % increase in sensitivity for obesity (BMI ≥ 30). CONCLUSIONS: Findings suggest that application of the proposed statistical corrections can reduce bias of self-report height and weight in W1 of the Add Health data and may be useful in some analyses. In particular, the corrected BMI values improve sensitivity --the ability to detect a true positive-for overweight/obesity among females, which addresses a major concern about self-report bias in obesity research. However, the correction does not improve sensitivity to identify underweight or healthy weight adolescents and so should be applied selectively based on research questions.

Eating, feeding, and feeling: emotional responsiveness mediates longitudinal associations between maternal binge eating, feeding practices, and child weight.

BACKGROUND: Although it is known that maternal disordered eating is related to restrictive feeding practices, there is little research exploring mechanisms for this association or its effects on other feeding practices. The purpose of this study was to assess whether maternal emotion responses mediate the association between maternal binge eating (BE) and child feeding practices, in order to identify potential risk factors for feeding practices that influence child weight. METHODS: This longitudinal observational study included (n = 260) mothers and children from the STRONG Kids Panel Survey. At Wave 1, children were an average of 37 months old (SD = 6.9), and at Wave 2 children were an average of 57 months old (SD = 8.3). Mothers self-reported their frequency of binge eating behavior (Wave 1), responses to children's negative emotions (Wave 1), feeding practices (Wave 1 and Wave 2), and child height and weight were measured at both time points. Using bias-corrected bootstrapping procedures, we tested the hypothesis that longitudinal associations between maternal BE and nonresponsive parent feeding practices would be mediated by parents' unsupportive responses to children's negative emotion. We also tested a serial mediation model positing that maternal BE predicts child body mass index (BMI) percentile change 18-24 months later, indirectly through unsupportive responses to negative emotion and nonresponsive feeding practices. RESULTS: Maternal BE predicted use of more nonresponsive feeding practices (e.g. Emotion Regulation, Restriction for Health, Pressure to Eat, and Food as Reward), indirectly through more Distress responses to children's negative emotions. In the serial mediation model, maternal BE was associated with greater use of Distress responses, which indirectly predicted higher child BMI percentile through Food as Reward feeding practices. CONCLUSIONS: These results suggest that maternal eating and emotion responsiveness are important for understanding the interpersonal context of feeding behaviors, and child weight outcomes. Distress responses may serve as a risk factor for use of unhealthful feeding practices among mothers with BE and these responses may increase children's risk for weight gain. TRIAL REGISTRATION: This study used an observational prospective design. Therefore, it has not been registered as a clinical intervention trial.

Family correlates of childhood binge eating: A systematic review.

OBJECTIVE: Binge Eating Disorder is the most prevalent eating disorder in the US, and binge eating has been identified in children as young as five. As part of a larger registered systematic review, we identified family correlates of binge eating in children (C-BE) aged 12 and under. METHOD: Using established guidelines, we searched PubMed and PsycInfo for peer-reviewed studies published in English between 1980 and April 2015 that examined family correlates and predictors of C-BE. This yielded 736 records for review; after exclusions fifteen studies were reviewed. Risk of bias was assessed. A risk factor typology was used to classify correlates. RESULTS: Nine of the included studies were cross-sectional and six longitudinal. Family weight teasing and parent emotional unresponsiveness were correlates of C-BE. Parent weight, education/socio-economic situation, and parent race/ethnicity were not associated with C-BE in any study reviewed. There was insufficient or unclear evidence regarding associations between C-BE and parent disordered eating, weight or thinness concern, harsh discipline, maternal dieting, attachment security, and mealtimes and feeding practices. Limitations included too few studies on many of the correlates to summarize, inconsistency of findings, homogenous samples, and predominately cross-sectional designs. DISCUSSION: Weight-related teasing in families and parental emotional unresponsiveness are correlates of C-BE and important areas to address in parent education and eating disorder prevention programs with families. Further longitudinal studies on putative risk factors for binge eating in childhood are needed to address current limitations, enable synthesis across studies, and inform public health efforts to prevent binge eating problems in children.

Parent binge eating and restrictive feeding practices: Indirect effects of parent's responses to child's negative emotion.

OBJECTIVE: Parents' emotion regulation difficulties are related to binge eating (BE), and to responses to children's negative emotion. However, less is known about how responses to children's negative emotion are related to eating and feeding in the parenting context. We examined the degree to which BE had both direct and indirect effects on parental restrictive feeding practices, through parents' reported responses to negative emotion. METHOD: Parents of preschoolers (n=441) completed validated questionnaires about their feeding strategies, responses to children's negative emotion, and their children's eating behaviors. Height and weight were measured in children and self-reported by parents. Unsupportive (Distress, Minimizing, and Punitive), and Supportive (Emotion-focused, Problem-focused, and Expressive Encouragement) responses to negative emotion were measured using the Coping with Children's Negative Emotions Scale. RESULTS: Parent's BE was correlated with Distress responses, Restriction for health, and Restriction for weight control. Controlling for confounders, BE was associated with Restriction for weight control, and Restriction for health. Model testing revealed that BE had significant direct (R(2) [SE]=.073 [.031], 95% CI [.013, .134]) and indirect effects (R(2) [SE]=.011 [.005], 95% CI [.003, .023]) on Restriction for weight control, through Distress responses, but only indirect effects on Restriction for health (R(2) [SE]=.018 [.009], 95% CI [.004, .039]). CONCLUSIONS: This study shows an association between emotion regulation and energy-intake regulation in the parenting context. Efforts to modify feeding practices may be more effective if parents' eating behaviors and their emotional responsiveness to distress are taken into account.

Health literacy and parent attitudes about weight control for children.

The purpose of this study was to examine associations between parental health literacy and parent attitudes about weight control strategies for young children. Parental low health literacy has been associated with poor child health outcomes, yet little is known about its relationship to child weight control and weight-related health information-seeking preferences. Data were drawn from the STRONG Kids Study, a Midwest panel survey among parents of preschool aged children (n = 497). Parents endorsed an average of 4.3 (SD =2.8) weight loss strategies, 53% endorsed all three recommended weight loss strategies for children, and fewer than 1% of parents endorsed any unsafe strategies. Parents were most likely to seek child weight loss information from healthcare professionals but those with low (vs. adequate) health literacy were significantly less likely to use the Internet or books and more likely to use minister/clergy as sources. Poisson and logistic regressions showed that higher health literacy was associated with endorsement of more strategies overall, more recommended strategies, and greater odds of endorsing each specific recommended strategy for child weight control, after adjusting for parent age, education, race/ethnicity, income, marital status, weight concern, and child BMI percentile. Findings suggest that health literacy impacts parental views about child weight loss strategies and health information-seeking preferences. Pediatric weight loss advice to parents should include assessment of parent attitudes and prior knowledge about child weight control and facilitate parent access to reliable sources of evidence-informed child weight control information.

Longitudinal Associations Between Immigrant Ethnic Density, Neighborhood Processes, and Latino Immigrant Youth Depression.

Depression rates rise in adolescence and the prevalence of depression is higher among Latino adolescents than other race/ethnic groups. Ethnic density among immigrant populations is associated with better health and mental health outcomes among adults, but little is known about its effects among adolescents or its mechanisms. This study examines the pathways by which immigrant density may affect mental health outcomes among Latino youth. Using data from the National Longitudinal Study of Adolescent Health (Add Health), we drew a sample of 2,678 Hispanic youth. Multivariate multilevel logistic regression analyses found that Latino immigrant density predicted lower odds of depression among both male and female immigrant but not non-immigrant Latino adolescents. No mediating effects of neighborhood efficacy, perceived safety or perceived contentment were observed in this study. Results reaffirm the need to further explore the mechanisms through which ethnic density exerts its salubrious effect on immigrant youth mental health.

Sleep, but not other daily routines, mediates the association between maternal employment and BMI for preschool children.

BACKGROUND: It has been established that the more time mothers spend working outside of the home, the more likely their preschool-aged children are to be overweight. However, the mechanisms explaining this relationship are not well understood. Our objective was to explore child sleep, dietary habits, TV time, and family mealtime routines as mediators of the relationship between maternal employment status (full-time, part-time, and no or minimal employment) and child body mass index (BMI) percentile. METHODS: Data were drawn from waves 1 and 2 of STRONG Kids, a prospective panel study examining childhood obesity among parent-preschooler dyads (n = 247). Mothers reported their own work hours, their child's hours of nighttime sleep, dietary habits, TV time, and mealtime routines. Trained staff measured child height and weight. RESULTS: Compared to working 0-19 h/week, both full-time (>35 h/week) and part-time (20-34 h/week) employment predicted higher child BMI percentile 1 year later. Hours of child nighttime sleep partially mediated the association between maternal full-time employment and child BMI percentile. Adjusting for individual and family characteristics, children whose mothers were employed full time were less likely to sleep longer hours than children whose mothers were employed 0-19 h/week (b = -0.49, p < 0.04). Shorter child nighttime sleep was associated with higher BMI percentile (b = -7.31, p < 0.001). None of the other mediation pathways tested were significant. CONCLUSIONS: These findings add to the growing literature on the importance of adequate sleep for young children's health.

Obesity prevalence among youth investigated for maltreatment in the United States.

The objective of this study is to determine the prevalence and correlates of obesity among youth investigated for maltreatment in the United States. Participants were drawn from the National Survey of Child and Adolescent Well-Being II, a national probability study of 5,873 children aged birth to 17 years under investigation for maltreatment in 2008. From child weight reported by caregivers, we estimated obesity (weight-for-age ≥95th percentile) prevalence among children aged 2 through 17 (n=2,948). Sex-specific logistic regression models by developmental age were used to identify obesity risk factors, including child age, race/ethnicity, and maltreatment type. Obesity prevalence was 25.4% and was higher among boys than girls (30.0% vs. 20.8%). African American adolescent boys had a lower risk for obesity than white boys (OR=0.28, 95% CI [0.08, 0.94]). Compared with girls aged 2-5 with a neglect allegation, girls with a sexual abuse allegation were at greater risk for obesity (OR=3.54, 95% CI [1.01, 12.41]). Compared with adolescent boys with a neglect allegation, boys with a physical abuse allegation had a lower risk for obesity (OR=0.24, 95% CI [0.06, 0.99]). Adolescent girls with a prior family history of investigation were at greater risk for obesity than those without a history of investigation (OR=3.97, 95% CI [1.58, 10.02]). Youth investigated for maltreatment have high obesity rates compared with national peers. Opportunities to modify and evaluate related child welfare policies and health care practices should be pursued.

Longitudinal predictors of dieting and disordered eating among young adults in the U.S.

OBJECTIVE: To assess longitudinal associations between cognitive and behavioral characteristics in adolescence and dieting and eating pathology in young adulthood. METHOD: Data from the National Longitudinal Study of Adolescent Health and multivariate logistic regressions were used to examine the unique and cumulative effects of adolescent behavior and cognition on four weight-related health indicators in young adulthood: dieting, extreme weight loss behaviors (EWLB), binge eating, and eating disorder (ED) diagnosis (N = 14,322). RESULTS: Early dieting, depression, and body image distortion (BID) prospectively predicted dieting or EWLB at Wave 3. In addition, early depression and dieting were associated with binge eating in young adulthood, and early BID was associated with ED diagnosis. Gender differences were observed. In the prospective models, the effect of depression on the onset of EWLB was stronger for women than men; while association between early depression and ED diagnosis was significantly stronger for men than women. Findings supported a cumulative risk effect. Among women, each additional correlate was associated with greater odds of eating pathology in young adulthood; among men, each additional correlate was associated with greater odds of ever reporting ED diagnosis. Overall prevalence of dieting and eating pathology among young adults was higher among women than men and increased over time for both sexes. DISCUSSION: Early weight control behavior and cognition affect long term eating patterns and are salient for both young adult men and women. Transition to young adulthood is a critical period for assessing and preventing weight and eating-related health problems.

Employee use and perceived benefit of a complementary and alternative medicine wellness clinic at a major military hospital: evaluation of a pilot program.

OBJECTIVES: The objectives of this study were to examine the feasibility of a weekly on-site complementary and alternative medicine (CAM) wellness clinic for staff at a military hospital, and to describe employees' perceptions of program effectiveness. SETTING: The study setting was the Restore & Renew(®) Wellness Clinic at a United States Department of Defense hospital. SUBJECTS: The subjects were hospital nurses, physicians, clinicians, support staff, and administrators. INTERVENTIONS: The walk-in wellness clinic was open 8:00 am-2:00 pm 1 day a week. Participants selected one or more modalities each visit: ear acupuncture, clinical acupressure, and Zero Balancing.(®) OUTCOME MEASURES: A self-report survey was done after each clinic visit to evaluate clinic features and perceived impact on stress-related symptoms, compassion for patients, sleep, and workplace or personal relationships. RESULTS: Surveys completed after first-time and repeat visits (n=2,756 surveys) indicated that most participants agreed or strongly agreed they felt more relaxed after sessions (97.9%), less stress (94.5%), more energy (84.3%), and less pain (78.8%). Ninety-seven percent (97%) would recommend it to a co-worker. Among surveys completed after five or more visits, more than half (59%-85%) strongly agreed experiencing increased compassion with patients, better sleep, improved mood, and more ease in relations with co-workers. Perceived benefits were sustained and enhanced by number of visits. The most frequently reported health habit changes were related to exercise, stress reduction, diet/nutrition, and weight loss. CONCLUSIONS: This evaluation suggests that a hospital-based wellness clinic based on CAM principles and modalities is feasible, well-utilized, and perceived by most participants to have positive health benefits related to stress reduction at work, improved mood and sleep, and lifestyle.

Health literacy: critical opportunities for social work leadership in health care and research.

One-third of U.S. adults do not have adequate health literacy to manage their health care needs; and low health literacy is a major concern due to its association with poor health outcomes, high health care costs, and health communication problems. Low health literacy is a potential driver of health disparities, and its alleviation is central to the values and concerns of the social work profession. Despite the extensive knowledge and skills that social workers can bring to bear to assist patients with low health literacy, the concept of health literacy is underused in social work scholarship.This gap reflects missed opportunities for social workers to contribute their expertise to the evolving field of health literacy and to strategically align their work with organizational and national priorities.To address this gap, this article provides an overview of health literacy, its relevance to social work, and its representation in disciplinary literature; and it outlines opportunities for health social workers to systematically incorporate health literacy concepts and tools into their practices with patients and families. Implications for a social work research and practice agenda in health literacy are discussed.

Body image distortion and three types of weight loss behaviors among nonoverweight girls in the United States.

PURPOSE: To examine the relationship between body image distortion (BID) and onset of three types of weight loss behavior among nonoverweight girls in the United States. METHODS: Data were from the National Longitudinal Study of Adolescent Health (Add Health) (n = 20,745) and included 5,173 nonoverweight (body mass index [BMI] < 85th percentile) adolescent females aged 11-19 years who completed Wave I and II interviews. Actual and perceived weight statuses were compared to assess BID. Logistic regression was used to predict onset of three types of weight loss behaviors at Wave II from BID at Wave I, adjusting for Wave I weight loss behaviors and demographics. RESULTS: At Wave I, 85% of nonoverweight girls engaged in weight control behaviors, and 29% displayed BID (i.e., overestimation of weight status). When compared to girls without BID, those with BID at Wave I had 4.3 times greater odds of onset of extreme weight loss behavior (e.g., vomiting, laxatives, diet pills) (OR = 4.5, CI = 2.44-7.42) and 2.3 times higher odds of onset of dieting to control weight (OR = 2.30, CI = 1.72-3.06) 1 year later. Girls who practiced extreme weight loss had 10.7 times greater odds of continuing unsafe practices 1 year later than girls who did not (OR = 10.67, CI = 4.27-26.63). BID was unrelated to exercise for weight control. CONCLUSIONS: BID predicts onset of unsafe, but not safe, weight loss behavior among nonoverweight girls. Brief assessment of BID may help identify nonoverweight girls at risk for unsafe weight loss practices and strengthen prevention efforts.