Identifying Differences in the Prevalence of Psychological Symptoms between Underweight, Normal Weight, Overweight, and Obese Children in Primary Care.

BACKGROUND: The prevalence of childhood obesity continues to be a major public health problem. Nearly one-third of children in the United States can be classified as overweight or obese, which is particularly concerning given that obesity is associated with a number of physical and mental health problems. Past studies have examined childhood obesity and psychological symptoms using samples of referred children who have already been identified as overweight or obese, leaving out children who are classified as underweight or healthy weight. This study aims to bridge this gap in the literature by evaluating differences in psychological symptoms among children who fall within all weight ranges within primary care. METHODS: Data was obtained from a systematic chart review using EMR (Electronic Medical Record) for children ages 6 to 16 years from two primary care health clinics. Differences between weight groups regarding reported internalizing and externalizing symptoms were evaluated utilizing data from the Pediatric Behavioral Health Screen (PBHS). RESULTS: Significant overall psychological symptoms (internalizing and externalizing) were endorsed for 13.2% of the sample (p > .01). Chi-Square analyses determined that the relationship between internalizing symptoms and weight category were significant. Specifically, children who were classified as overweight or obese were more likely to report significant internalizing symptoms than underweight or healthy weight children. CONCLUSIONS: Children who fall into the overweight and obese weight categories may need to be screened for psychological symptoms and referred for mental health services following overweight/obese classification in primary care.

Prescription Drug Misuse and Associated Risk Behaviors among Public High School Students in Oklahoma: Data from the 2013 Oklahoma Youth Risk Behavior Survey.

PURPOSE: The purpose of this study was to assess the magnitude of prescription drug misuse among Oklahoma high school students, examine associated risk factors, and inform state-based prevention strategies. METHODS: Data from the 2013 Oklahoma Youth Risk Behavior Survey were used for this analysis and were representative of public school students in grades 9 through 12 in Oklahoma. Variables were examined using percentages and 95% confidence intervals. The chi-square test was used to test for differences in proportions. Logistic regression was used to produce adjusted odds ratios as measures of association between selected independent variables and prescription drug misuse. RESULTS: Nearly one in five students had ever used a prescription drug without a doctor's prescription. While there was no statistically significant difference of prescription drug misuse by gender or grade in the bivariate analysis, after covariate adjustment, females were 1.5 times more likely than males to have misused prescription drugs and twelfth graders were 1.7 times more likely than ninth graders to have misused prescription drugs. CONCLUSION: Students who had ever taken prescription drugs without a doctor's prescription were significantly more likely than students who had never taken prescription drugs without a doctor's prescription to have engaged in current tobacco use, current binge drinking, current marijuana use, and lifetime drug use and have a higher prevalence of suicide risk.

Treating rural paediatric obesity through telemedicine vs. telephone: Outcomes from a cluster randomized controlled trial.

OBJECTIVE: The objective of the current study was to examine the feasibility of telemedicine vs. telephone for the delivery of a multidisciplinary weekly family-based behavioural group intervention to treat paediatric obesity delivered to families living in rural areas using a randomized controlled trial methodology. METHODS: 103 rural children and their families were recruited. Feasibility measures included participant satisfaction, session attendance and retention. Treatment outcome measures included child Body Mass Index z-score (BMIz), parent BMI, 24-hour dietary recalls, accelerometer data, the child behavior checklist and the behavioral pediatrics feeding assessment scale. RESULTS: Participants were highly satisfied with the intervention both via telemedicine and via telephone. Completion rates were much higher than for other paediatric obesity intervention programmes, and both methodologies were highly feasible. There were no differences in telemedicine and telephone groups on primary outcomes. CONCLUSION: Both telemedicine and telephone intervention appear to be feasible and acceptable methods of delivering paediatric obesity treatment to rural children.

Youth Advocates' Perceptions of Tobacco Industry Marketing Influences on Adolescent Smoking: Can They See the Signs?

Point-of-sale (POS) advertising at retail stores is one of the key marketing avenues used by the tobacco industry. The United States Surgeon General urges actions to eliminate POS tobacco advertisements because of their influence on youth smoking. Many youth empowerment programs are implemented to address tobacco industry marketing influences, including POS tobacco advertisements. While youth are asked to take on such collective action, little is known regarding their perceptions and understanding of tobacco industry marketing influences and related advocacy activities. This mixed methods study examined Oklahoma's tobacco control youth empowerment program members' perceptions of tobacco industry marketing influences. Four focus groups were held with active program members from rural and urban areas. Overall, the focus group participants viewed the program as purposeful, as an avenue to help others, and as a way to make a difference. Specifically, the older participants (median age = 18 years) identified tobacco industry marketing influences such as POS, movies, and magazine advertisements and reported participating in activities that counter POS tobacco advertisements at retail stores. Likewise younger participants (median age = 16 years), identified similar tobacco industry marketing influences, but also included tobacco use by friends and family as tobacco industry marketing influences. Moreover, the younger participants did not report engaging in activities that addressed POS tobacco advertisements. The study results suggest that the empowerment program should tailor its programming, training, materials, and activities with input from youth of various ages. Thoughtfully developed messages and specific activities can truly empower youth and maximize their contribution as change agents who address POS or other initiatives at the retail environments to prevent chronic diseases.

Outcomes from an urban pediatric obesity program targeting minority youth: the Healthy Hawks program.

BACKGROUND: The aim of this study was to describe the outcomes of a family-based behavioral group treatment program with a group of urban, minority, low-income families. METHODS: Two hundred and ten families enrolled in a 12-week family-based behavioral group treatment program for pediatric obesity. The program was offered in English and in Spanish and targeted the enrollment of low-income highly diverse youth and families. Primary outcome measures included child BMI z-score (zBMI), maternal BMI, 3-day diet record, and accelerometer. RESULTS: Seventy-one percent of enrolled families completed the 12-week program. Significant 12-week outcomes were achieved for child zBMI (p<0.001) and for maternal BMI (p<0.001), as well as for child kcals (p<0.001), sugar-sweetened beverages (p=0.017), and red foods (p<0.001). Only change in child zBMI remained significant at 1 year (p<0.05). Physical activity outcomes were not significant and not in the expected direction. There were no differences in outcome by race/ethnicity, but by age, younger children had higher zBMI at baseline and were also more likely to decrease zBMI during the intervention. CONCLUSIONS: It is possible to enroll and maintain urban, minority, low-income families in a family-based behavioral group treatment program for pediatric obesity. Outcome data indicate that these families achieve significant outcomes on zBMI, and that children who remain available for assessment maintain this at 1 year, which is an improvement over previous research using other intervention methodologies with this population.

Relationship between daily mood and migraine in children.

BACKGROUND: Retrospective and cross-sectional studies have suggested a bidirectional relationship between migraine and mood disturbance. OBJECTIVE: The present prospective daily diary study examined the prevalence and temporal associations between migraine and daily mood, mood and next-day headache, and headache and next-day mood. METHODS: Sixty-nine children (50 females, 19 males) between the ages of 7 and 12 years and their parents attending neurology clinic appointments and having a diagnosis of migraine as defined by International Headache Classification 2nd edition criteria completed measures on the quality of life, headache disability, child emotions, and child behaviors. Children and parents then recorded children's headache occurrence, headache duration, headache severity, mood, daily hassles, and medication use on paper diaries once a day for 2 consecutive weeks. "Mood" was defined using the Facial Affective Scale, which is a visual representation of negative and positive affect. Data were analyzed using multilevel models. RESULTS: Controlling for age, sex, quality of life, headache disability, and medication use, worse mood was associated with same-day occurrence, longer duration, and more severe headache in both child and parent report. Today's mood was not consistently associated with next-day headache, and today's headache was not associated with next-day mood in either child or parent report. CONCLUSIONS: Results of this study lend support to a complex relationship between mood and headache in children with migraine. More research is needed to further elucidate the temporal nature of this relationship within a given day and over an extended period of time.

Treating rural pediatric obesity through telemedicine: outcomes from a small randomized controlled trial.

OBJECTIVE: The objective of the current study was to examine the effectiveness of a multidisciplinary weekly family-based behavioral group delivered via telemedicine to rural areas, compared with a standard physician visit intervention. METHODS: A randomized controlled trial was conducted with 58 rural children and their families comparing a family-based behavioral intervention delivered via telemedicine to a structured physician visit condition. Outcome measures included child body mass index z-score (BMIz), 24-hr dietary recalls, accelerometer data, Child Behavior Checklist, Behavioral Pediatrics Feeding Assessment Scale, and feasibility and fidelity. RESULTS: Child BMIz outcomes were not statistically different between the 2 groups (F = 0.023, p = .881). Improvements in BMIz, nutrition, and physical activity were seen for both groups. CONCLUSIONS: Both telemedicine and structured physician visit may be feasible and acceptable methods of delivering pediatric obesity treatment to rural children.

Peer relations in the anxiety-depression link: test of a mediation model.

We employed a five-month longitudinal study to test a model in which the association between anxiety and depression symptoms is mediated by peer relations difficulties among a sample of 91 adolescents ages 14-17 (M=15.5, SD=.61) years. Adolescents completed measures of anxiety symptoms, depression symptoms, peer group experiences (i.e., peer acceptance and victimization from peers), and friendship quality (i.e., positive qualities and conflict). As hypothesized, Time 1 anxiety symptoms predicted Time 2 (T2) depression symptoms, and this association was mediated by T2 low perceived peer acceptance and T2 victimization from peers, both of which emerged as unique mediators when they were considered simultaneously in the model. Contrary to expectations, qualities of adolescents' best friendships at T2 did not emerge as mediators and were largely unrelated to symptoms of anxiety and depression. Implications of the findings include the importance of addressing peer relations difficulties, especially peer acceptance and victimization, in the treatment of anxiety and the prevention of depression among anxious youth.

On using a cancer center cancer registry to identify newly affected women eligible for hereditary breast cancer syndrome testing: practical considerations.

The goals of this research were to describe the process of identifying and recruiting individuals registered with a cancer center's cancer registry who were eligible to participate in cancer genetic research. This study specifically focused on younger women with personal and family cancer histories strongly suggestive of hereditary breast cancer syndromes, as determined by genetic counselor review. Of special interest was to determine the proportion of women from minority backgrounds who were (a) identifiable in this manner and (b) interested in genetic testing for hereditary breast cancer through a family cancer clinical research program. An initial query of the 292 cases of women newly affected with breast cancer and contained within the registry indicated that 124 met demographic eligibility criteria. The personal and family cancer histories of each of these women were then reviewed by a genetic counselor and the remaining, eligible patients (n = 31) were subsequently contacted by mail and telephone: approximately three-fifths (18/31) of these patients were White and two-fifths (13/31) were Black or of another racial background. Of the women who were sent one or more study-related mailings, 10% (3/31) were unreachable by telephone due to incorrect contact information, 32% (10/31) were reachable by telephone but unresponsive to messages left, 26% (8/31) had already participated in the family cancer program (i.e., were positive controls), 6% (2/31) were interested in participating in the program, 23% (7/31) were uninterested in participating in the program, and 3% (1/31) were later determined to be ineligible. Comparing the racial backgrounds of women who were either positive controls or interested in participating (i.e., "tester" category) to women who were either unreachable, nonresponsive, uninterested, or ineligible (i.e., "nontester" category), there was a nonsignificant trend for more non-White women to fall into the nontester than tester category, Fisher's Exact Test = .09. This work underscores practical steps in planning and carrying-out cancer genetic testing research among women newly affected with breast cancer and members of special populations. It also underscores the role that genetic counseling professionals play in this process.