Associations of social cohesion and quality of life with objective and perceived built environments: a latent profile analysis among seniors.

BACKGROUND: Healthy aging requires support from local built and social environments. Using latent profile analysis, this study captured the multidimensionality of the built environment and examined relations between objective and perceived built environment profiles, neighborhood social cohesion and quality of life among seniors. METHODS: In total, 693 participants aged 66-97 were sampled from two US locales in 2005-2008 as part of the Senior Neighborhood Quality of Life Study (SNQLS). Perceived social cohesion and quality of life were assessed using validated surveys. Six objective (geographic information system (GIS)-based) and seven perceived built environment latent profiles generated in previous SNQLS publications were used for analyses. Mixed-effects models estimated social cohesion and quality of life separately as a function of the built environment profiles. RESULTS: More walkable and destination-rich perceived built environment profiles were associated with higher social cohesion and quality of life. Objective built environment profiles were not associated with social cohesion and only positively associated with quality of life in only one locale (Baltimore/DC). CONCLUSIONS: Latent profile analysis offered a comprehensive approach to assessing the built environment. Seniors who perceived their neighborhoods to be highly walkable and recreationally dense experienced higher neighborhood social cohesion and quality of life, which may set the stage for healthier aging.

Transit Use and Health Care Costs: A Cross-sectional Analysis.

INTRODUCTION: Greater transit use is associated with higher levels of physical activity, which is associated with lower health risks and better health outcomes. However, there is scant evidence about whether health care costs differ based on level of transit ridership. METHODS: A sample (n=947) of members of Kaiser Permanente in the Portland, Oregon area were surveyed in 2015 about their typical use of various modes of travel including transit. Electronic medical record-derived health care costs were obtained among these members for the prior three years. Analysis examined proportional costs between High transit users (3+ days/week), Low transit users (1-2 days/week), and Non-users adjusting for age and sex, and then individually (base models) and together for demographic and health status variables. RESULTS: In separate base models across individual covariates, High transit users had lower total health care costs (59-69% of Non-user's costs) and medication costs (31-37% of Non-users' costs) than Non-users. Low transit users also had lower total health care (69%-76% of Non-users' costs) and medication costs (43-57% transit of Non-user's costs) than Non-users. High transit users' outpatient costs were also lower (77-82% of Non-users). In fully-adjusted models, total health care and medication costs were lower among High transit users' (67% and 39%) and Low transit users' (75% and 48%) compared to Non-users, but outpatient costs did not differ by transit use. CONCLUSIONS: Findings have implications for the potential cost benefit of encouraging and supporting more transit use, although controlled longitudinal and experimental evidence is needed to confirm findings and understand mechanisms.

Home and neighbourhood built environment features in family-based treatment for childhood obesity.

BACKGROUND: Family-based behavioural weight loss treatment (FBT) for childhood obesity helps families develop strategies to facilitate healthy choices in their home and other environments (e.g. home neighbourhood). The current study examines how the home food environment, both pre-FBT and post-FBT, and the neighbourhoods in which families live are associated with child weight and weight-related outcomes in FBT. METHODS: Parent-child dyads (n = 181) completed a 16-session FBT programme and completed home environment, anthropometric and child dietary/activity assessments at pre-FBT and post-FBT. Parents reported on availability of food, electronics and physical activity equipment in the home. The neighbourhood food and recreation environments around each dyad's residence was characterized using existing data within a geographic information system. RESULTS: Families successfully made healthy home environment modifications during FBT. Regression models showed reducing RED (e.g. high-energy-dense and low-nutrient-dense) foods and electronics in the home during FBT had positive effects on child weight and weight-related outcomes. No neighbourhood food or recreation environment variables were significantly related to outcomes, although having a larger density of public recreation spaces was associated with increases in physical activity at the trend-level. CONCLUSIONS: Modifying the home environment, specifically reducing RED foods and electronics, may be particularly important for FBT success.

A comparison of parent and childcare provider's attitudes and perceptions about preschoolers' physical activity and outdoor time.

BACKGROUND: Young children depend on adult caregivers to provide opportunities for physical activity. Research has focused on barriers and facilitators to children's physical activity while in childcare, but parental influences remain largely unknown. This study examines parent's attitudes about preschoolers' physical activity and outdoor time, compares them with those of childcare providers and determines the association between parental attitudes and preschoolers' measured activity. METHODS: Parents and childcare providers from 30 childcare centres were surveyed regarding attitudes towards preschoolers' physical activity and outdoor time. Children's moderate-to-vigorous physical activity was determined by using 24-h accelerometry. Parent and childcare providers' responses were compared. Mixed-effect linear regression examined moderate-to-vigorous physical activity and sedentary time as outcomes with parental attitudes as predictors, family demographics as covariates and centre as a random effect. RESULTS: Three hundred eighty-eight parents and 151 childcare providers participated. On average, children were 4.3 (0.7) years old. Parents and childcare providers both considered daily physical activity important for preschoolers, but providers rated the importance of daily outdoor time higher on a 10-point scale (8.9 vs. 7.6, P < 0.001). More parents than providers believed that children would get sick by playing outside in the cold (25 vs. 11%, P < 0.05). Parents were more comfortable with their child playing outside at childcare compared with outside at home (8.9 vs. 6.9, P < 0.001). Lower income parents felt less comfortable than higher income parents with their child playing outside either near home or at childcare. Neither home nor total child activity levels were associated with most parental attitudes queried. CONCLUSIONS: While parents and childcare providers value daily physical activity for children, some parents expressed discomfort about their young children engaging in outdoor play, especially around home and in cold weather. These findings highlight the importance of childcare-based interventions to promote preschoolers' physical activity and outdoor play.

Parental factors in children's active transport to school.

OBJECTIVE: Identify non-distance factors related to children's active transport (AT) to school, including parental, home, and environment characteristics. Understanding the factors related to children's AT to school, beyond distance to school, could inform interventions to increase AT and children's overall physical activity. STUDY DESIGN: Participants were in the Neighborhood Impact on Kids Study, a longitudinal, observational cohort study of children aged 6-11 and their parents in King County, WA and San Diego County, CA between 2007 and 2009. Parents reported frequency and mode of child transport to school, perceived neighbourhood, home and family environments, parental travel behaviours, and sociodemographics. METHODS: Children living less than a 20 minute walk to school were in this analysis. Children classified as active transporters (walked/bicycled to or from school at least once per week) were compared with those not using AT as often. RESULTS: Children using AT were older and had parents who reported themselves using active transport. Having a family rule that restricts the child to stay within sight of the parent or home and more parent working hours were related to lower odds of a child using AT. CONCLUSIONS: Children's AT to school is associated with parental AT to work and other locations. Interventions should be considered that enable whole family AT, ameliorate safety concerns and decrease the need for parental supervision, such as walking school buses.

The development of a walkability index: application to the Neighborhood Quality of Life Study.

Emerging evidence supports a link between neighbourhood built environment and physical activity. Systematic methodologies for characterising neighbourhood built environment are needed that take advantage of available population information such as census-level demographics. Based on transportation and urban planning literatures, an integrated index for operationalising walkability using parcel-level information is proposed. Validity of the walkability index is examined through travel surveys among areas examined in the Neighborhood Quality of Life Study (NQLS), a study investigating built environment correlates of adults' physical activity.

A multicomponent program for nutrition and physical activity change in primary care: PACE+ for adolescents.

BACKGROUND: Most adolescents do not meet national recommendations for nutrition and physical activity. However, no studies of physical activity and nutrition interventions for adolescents conducted in health care settings have been published. The present study was an initial evaluation of the PACE+ (Patient-centered Assessment and Counseling for Exercise plus Nutrition) program, delivered in primary care settings. PARTICIPANTS: Adolescents aged 11 to 18 years (N = 117) were recruited from 4 pediatric and adolescent medicine outpatient clinics. Participants' mean (SD) age was 14.1 (2.0) years, 37% were girls, and 43% were ethnic minorities. INTERVENTION: Behavioral targets were moderate physical activity, vigorous physical activity, fat intake, and fruit and vegetable intake. All patients completed a computerized assessment, created tailored action plans to change behavior, and discussed the plans with their health care provider. Patients were then randomly assigned to receive no further contact or 1 of 3 extended interventions: mail only, infrequent telephone and mail, or frequent telephone and mail. MEASURES: Brief, validated, self-report measures of target behaviors were collected at baseline and 4 months later. RESULTS: All outcomes except vigorous physical activity improved over time, but adolescents who received the extended interventions did not have better 4-month outcomes than those who received only the computer and provider counseling components. Adolescents who targeted a behavior tended to improve more than those who did not target the behavior, except for those who targeted vigorous physical activity. CONCLUSIONS: A primary care-based interactive health communication intervention to improve physical activity and dietary behaviors among adolescents is feasible. Controlled experimental research is needed to determine whether this intervention is efficacious in changing behaviors in the short- and long-term.

Changes in eating disorder symptoms with pediatric obesity treatment.

OBJECTIVE: To evaluate the effects of behavioral, family-based treatment on disordered eating and child behavior problems for obese 8- to 12-year-old children. STUDY DESIGN: We examined disordered eating in children and parents using the Kids' Eating Disorder Survey (KEDS) and the Binge Eating Scale, respectively; and psychologic problems in children and their parents using the Child Behavior Checklist and Symptom Checklist-90, respectively, in 47 families who participated in a family-based obesity treatment program. RESULTS: Obese children showed significant decreases (-12.5 +/- 13.5) in percent overweight, internalizing problems (-7.0 +/- 7.3), and total behavior problems (-4.8 +/- 6.6) and increases in behavioral competence (3.7 +/- 5.0) over 2 years of measurement; and their parents showed significant decreases in weight (-5.0 +/- 8.3 kg) and reductions in parental distress (-2.3 +/- 7.6) and in disturbed eating and weight-related cognition (-3.2 +/- 5.3). No significant changes were observed in total KEDS (-0.2 +/- 1.9), weight dissatisfaction (-0.3 +/- 1.7), or purging/restricting (0.2 +/- 0.6) scores. Decreases in total KEDS were related to decreases in total behavior problems and externalizing behavior problems. CONCLUSIONS: These results document improvements in child behavior problems and competence and no change in symptoms of disordered eating in a standardized behavioral weight control program.

Problem solving in the treatment of childhood obesity.

This study randomized obese children from 67 families to groups that received a 6-month family-based behavioral weight-control program plus parent and child problem solving, child problem solving, or standard treatment with no additional problem solving. The standard group showed larger body mass index (BMI) decreases than the parent + child group through 2 years, with significant differences in the percentage of children who showed large BMI changes. Significant statistical and clinical improvements were observed over time in child behavior problems and parental distress. Parent problem solving increased in the parent + child condition relative to the other conditions, whereas child problem solving increased equally in all conditions. The bulk of evidence suggests that problem solving did not add to treatment effectiveness beyond the standard family-based treatment.

Maternal child feeding practices and obesity: a discordant sibling analysis.

BACKGROUND: The relationship between maternal feeding practices and weight status of 7-12 year-old obese and nonobese siblings was evaluated in 18 families using a discordant sibling design. METHOD: Mothers completed measures of concern and perception of children's weight and eating behavior, their control over child feeding, and maternal eating behavior. RESULTS: Intraclass correlations suggested similarity between obese and nonobese siblings in maternal control over feeding. Mothers perceived differences between their obese and nonobese children's eating regulation. Mothers' weight status was positively associated with disinhibition of their own eating as well as concern about both their obese and nonobese children's weight and health. DISCUSSION: These findings fail to support the hypothesis that maternal control over child feeding is related to childhood obesity, but highlight the impact of maternal weight history and eating habits on her impression of children's future weight and health independent of the child's weight status.

Empirically supported treatments in pediatric psychology: pediatric obesity.

OBJECTIVE: To review the efficacy of existing interventions for pediatric obesity with reference to the Chambless criteria. METHODS: Chambless criteria for determining treatment efficacy were applied to 42 randomized studies involving nonschool-based programs targeting childhood and adolescent weight loss. RESULTS: We summarize the following dimensions of the pediatric obesity treatment literature: description of participants, diagnostic criteria for study participation, experimental design, treatment protocol, treatment outcome, and follow-up. CONCLUSIONS: There is strong evidence for the short- and long-term efficacy of multicomponential behavioral treatment for decreasing weight among children relative to both placebo and education-only treatments. Conclusions about adolescent obesity treatment programs are more tentative as they have been less frequently examined, less rigorously controlled, and usually have not conducted long-term follow-up. Current research appears to be working to identify more efficacious treatments for pediatric obesity by exploring the specific behavioral strategies that will be most effective in modifying children's eating and physical activity habits.

The rate of sedentary activities determines the reinforcing value of physical activity.

In this study, the authors examined whether the reinforcing efficacy of sedentary behaviors was related to their base rates. Base rates of 3 sedentary and 1 physical activity were determined for 40 sedentary adults. Participants were randomized to groups in which either high-rate, moderate-rate, low-rate, or no sedentary activity was contingent on being physically active. Noncontingent sedentary activities remained freely available. Contingent high- or moderate-rate sedentary activities increased physical activity, whereas no increases in physical activity were observed for contingent low-rate or control conditions. Thus, sedentary behaviors can be used to reinforce physical activity, their reinforcing efficacy depends in part on their base rates, and they are not completely substitutable.

Behavioral engineering of activity choice in obese children.

This laboratory study examined whether making sedentary activities contingent upon being physically active would increase obese children's physical activity. Fourteen obese children aged 8-12 y participated in a baseline session in which they had free choice among a variety of sedentary activities and riding a stationary bicycle. Children were then randomized to either a contingent group in which watching video cassette recorder (VCR) movies and playing video games were contingent upon riding the bicycle or a control group in which all physical and sedentary activities remained freely available. Contingent group children increased physical activity and decreased television activities in comparison to the control, even though other sedentary activities remained freely available. Findings suggest that highly valued sedentary activities can reinforce physical activities and that sedentary activities do not completely substitute amongst themselves. The automated system used to make television activities contingent upon physical activity has potential for modifying activity in the treatment of obesity.

Treatment of pediatric obesity.

The primary goal of childhood obesity interventions is regulation of body weight and fat with adequate nutrition for growth and development. Ideally, these interventions are associated with positive changes in the physiologic and psychological sequelae of obesity. To contribute to long-term weight maintenance, interventions should modify eating and exercise behaviors such that new, healthier behaviors develop and replace unhealthy behaviors, thereby allowing healthier behaviors to persist throughout development and into adulthood. This overview of pediatric obesity treatment, using predominantly randomized, controlled studies, highlights important contributions and developments in primarily dietary, activity, and behavior change interventions, and identifies characteristics of successful treatment and maintenance interventions. Potential positive (eg, reduction in blood pressure, serum lipids, and insulin resistance) and negative (eg, development of disordered eating patterns) side effects of treatment also are described. Recommendations for improving implementation of childhood obesity treatments, including application of behavioral choice theory, improving knowledge of response extinction and recovery in regards to behavior relapse, individualization of treatment, and integration of basic science with clinical outcome research, are discussed.

Relationships between TriTrac-R3D vectors, heart rate, and self-report in obese children.

The TriTrac (Professional Products, Inc., Madison, WI) triaxial accelerometer and diary self report were compared with adjusted heart rates to evaluate 3 d of leisure-time activity in 35 8- to 12-yr-old obese children. Adjusted heart rates were calculated by subtracting preexercise resting heart rates from heart rates measured in the field. TriTrac and self-reported data were converted to multiples of resting metabolic rate (METs). Correlations between accelerometer METs and adjusted heart rates (r = 0.71) were significantly higher (P < 0.001) than correlations between adjusted heart rates and self-reported METs (r = 0.36) or accelerometer and self-reported METs (r = 0.38). Self-reported METs had higher mean standard errors in estimating heart rates (13.93 +/- 6.15 beats.min-1) than did accelerometer METs (10.94 +/- 5.62 beats.min-1; P < 0.001), were significantly greater than accelerometer METs (2.50 +/- 1.48 vs 1.80 +/- 1.48; P < 0.05) and systematically overestimated accelerometer METs. The anteroposterior vector accounted for 36%, and the vector magnitude score accounted for 34% of the variance in unadjusted heart rates. The mediolateral vector and vector magnitude score accounted for 69% of the variance in self-reported METs. The vertical vector did not account for variance in either unadjusted heart rates or self-reported METs. It was concluded that the TriTrac yielded a better estimate of activity in obese children than self report. In addition, the vector magnitude composite score of the TriTrac accounted for significantly more variance in both self-reported activity and unadjusted heart rates as compared with the vertical directional vector of the TriTrac.

Effects of decreasing sedentary behaviors on activity choice in obese children.

In this study, methods of decreasing highly preferred sedentary behaviors were compared and the consequent effects on activity choice were examined. Following free choice of sedentary and physical activities, 34 obese children either were positively reinforced for decreases in high-preference sedentary activity, were punished for high-preference sedentary activity, had access to high-preference sedentary activity restricted, or had no contingencies on activity (control group). Children randomized to reinforcement and punishment were more physically active on intervention days than the control group. Liking for targeted sedentary activity decreased in the reinforcement group, but increased in the restriction and control groups. Results suggest that reinforcing decreases in high-preference sedentary activity can increase physical activity and decrease liking for targeted sedentary activities.

Reinforcing value of food in obese and non-obese women.

Food is a powerful reinforcer, and individual differences in the reinforcing efficacy of food may provide a mechanism to explain the excess intake and positive energy balance responsible for obesity. The present study tested the hypothesis that eating palatable food would be more reinforcing than engaging in sedentary activities (e.g. playing computer games) for obese in comparison to non-obese non-dietary restrained female college students. Subjects could choose to eat food or engage in sedentary activities based on their responding in a computer-generated concurrent schedules task. The reinforcement schedule associated with earning access to sedentary activities was held at variable ratio 2 (VR2) while the food reinforcement schedule was set at VR2 in the first trial of the choice task and doubled across the four subsequent trials from VR4 to VR32. Choice and consumption results indicated that eating was significantly more reinforcing than engaging in sedentary activities for obese subjects than non-obese subjects. Hedonics for the activities and foods were not correlated with total food reinforcers earned and did not differ between the groups. These results confirm the hypothesis that eating food is more reinforcing than selected alternative activities to a greater extent for obese than for non-obese young women.

Effects of reinforcing increases in active behavior versus decreases in sedentary behavior for obese children.

This experiment tested the effects of reinforcing obese children lo be more active or less sedentary in their choice of active versus sedentary behaviors. On days I and 5, there were no contingencies for sedentary or active behaviors. During days 2 through 4, children in the Activity group were reinforced for being more active, and they significantly increased their activity and decreased time spent on preferred sedentary activities. Children in the Sedentary group were reinforced for not engaging in preferred sedentary behaviors, and they significantly decreased time spent on these sedentary behaviors, with lime reallocated both to being more active and to substitution of lower preference sedentary behaviors. Children randomized to the Control group were reinforced for attendance and made choices among the alternatives as usual, allocating most or their time during all 5 days for their preferred sedentary behaviors. These laboratory results support the idea that activity can be increased by either reinforcing children for being more active or for reducing lime spent in sedentary activities.