Latent Profiles of Physical Activity and Sedentary Behavior in Elementary School-Age Youth:Associations With Health-Related Quality of Life.

Objective: The objectives were to identify and describe profiles of elementary school-age youth based on objective measurements of total time spent in moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SB) and in bouts of the activities, to examine predictors of profiles, and to examine whether profiles were differentially associated with physical and psychosocial health-related quality of life (HRQOL). Methods: Participants included 204 youth (aged 8-11 years) who wore accelerometers to gather objective activity data. The average proportion of time in MVPA and SB and average proportion of time in MVPA and SB bouts were used for analyses. Participants completed a self-report measure of HRQOL. Latent variable mixture modeling was conducted. Results: Overall, participants did not meet the MVPA guideline (M = 50.7 min) and spent 47% of waking hours in SB, indicating that elementary school is a critical developmental period to study activity levels. Three profiles emerged: "Active," "Inactive," and "Moderate." Boys were significantly more likely to be in the Active profile than the other profiles, and older youth were significantly more likely to be in the Inactive profile. After controlling for child sex and age, participants in the Active profile reported significantly higher psychosocial HRQOL than the participants in the other profiles; however, no significant differences were found in physical HRQOL. Conclusions: Identification of these naturally occurring profiles suggests need for interventions early in development focused on increasing the intensity of physical activity from light to moderate-to-vigorous for at least 60 min per day as way to improve psychosocial HRQOL.

Bidirectional Associations Between Disordered Eating and Health-Related Quality of Life in Elementary School-Age Youth.

Objective: To examine longitudinal, bidirectional associations between disordered eating and physical/psychosocial health-related quality of life (HRQOL) in a nonclinical community sample of elementary school-age youth. Methods: Participants included 130 children between the ages of 7 and 10 years ( M age = 8.62). Disordered eating and physical/psychosocial HRQOL were assessed using self-report measures at three time points. The potential bidirectional associations were examined using a longitudinal panel model. Results: Higher disordered eating predicted lower psychosocial HRQOL during a 6-month period within the same academic year, and lower HRQOL predicted higher disordered eating during a 6-month period across academic years. Conclusion: The current study found longitudinal, bidirectional associations between disordered eating and psychosocial, but not physical, HRQOL. The results provide evidence for psychosocial HRQOL as a potential predictor and consequence of disordered eating attitudes. Limitations, future directions, and implications of this research are discussed.

An Evaluation of the Children's Report of Sleep Patterns Using Confirmatory and Exploratory Factor Analytic Approaches.

OBJECTIVE: To explore the psychometric properties of the Children's Report of Sleep Patterns (CRSP) in school-aged children by conducting a factor analysis of the Sleepiness Scale and the Sleep Disturbances Scales. METHODS: Participants included 155 children from two elementary schools (Mage = 9.82) who completed the self-report CRSP. A confirmatory factor analysis (CFA) was conducted using the originally hypothesized structure. A subsequent exploratory factor analysis (EFA) was conducted to determine an alternative factor structure. RESULTS: CFA revealed that the hypothesized factor structure was not supported. The EFA produced an alternative six-factor solution, which supports the conceptualization of three new scales, Restless Legs Report, Sleep Initiation, and Sleep Maintenance/Night Wakings. CONCLUSION: The revised measure adds increased specificity with scales related to insomnia and restless leg symptoms. Researchers and clinicians interested in using the CRSP should continue to assess its validity by exploring the relationship between the measure and objective measures of sleep behavior.

The Effect of Body Mass Index, Negative Affect, and Disordered Eating on Health-Related Quality of Life in Preadolescent Youth.

OBJECTIVE: To examine the indirect effect of body mass index z-score (BMIz) on health-related quality of life (HRQOL) through disordered eating attitudes and behaviors in a community sample of preadolescent children, and the degree to which negative affect moderated the association between BMIz and disordered eating attitudes and behaviors. METHODS: Participants included 165 children between 8 and 12 years of age (M = 9.41). HRQOL, disordered eating attitudes and behaviors, and negative affect were assessed using self-report measures. Height and weight were collected by research staff. RESULTS: Consistent with previous research in treatment-seeking and adolescent samples, the indirect effect of BMIz on HRQOL through disordered eating attitudes and behaviors was significant. Negative affect did not moderate the relationship between BMIz and disordered eating attitudes and behaviors. CONCLUSION: Intervening on disordered eating attitudes and behaviors in preadolescents with higher weight status is critical to prevent the risk for poor HRQOL.

A Longitudinal Examination of Hope and Optimism and Their Role in Type 1 Diabetes in Youths.

OBJECTIVES: To test the longitudinal associations between hope and optimism and health outcomes (i.e., HbA1c and self-monitored blood glucose [SMBG]) among youths with Type 1 diabetes mellitus (T1DM) over a 6-month period. METHODS: A total of 110 participants (aged 10-16 years) completed study measures at Time 1, and 81 completed measures at Time 2. Analyses examined hope and optimism as predictors of change in health outcomes, and examined SMBG as a mediator of the relationship between hope and optimism, and HbA1c. RESULTS: Change in hope, but not optimism, was associated with change in SMBG and HbA1c. Change in SMBG mediated the relationship between change in hope and HbA1c, but not between optimism and HbA1c. CONCLUSIONS: It may be beneficial to assess hope in pediatric T1DM patients to identify youths who may be at risk for poor diabetes management, and to test the benefit of hope-based intervention efforts in clinical studies.

Comparison of two measures of weight criticism in youth: associations with physical activity engagement and attitudes, weight status, and health-related quality of life.

The objective of this study was to examine the degree to which 2 measures of weight criticism, the Weight Criticism During Physical Activity (WCA) scale and the Perceptions of Teasing Scale (POTS), represent distinct constructs and in what circumstances each is most appropriately used. A community sample of 307 fourth and fifth graders completed these measures, as well as measures of health-related quality of life, physical activity engagement, and attitudes toward physical activity. Body mass index was also calculated. Results of confirmatory factor analysis indicated that the WCA scale and the POTS represented correlated but distinct constructs and related differently to measures of physical activity and weight status. Findings suggested that the WCA scale may be representing criticism regarding athletic competency, not criticism of weight status as described in the literature. The POTS subscales appear to be accurately described and used in the literature.

Weighing physical activity: the impact of a family-based group lifestyle intervention for pediatric obesity on participants' physical activity.

OBJECTIVES: To examine differences in self-reported physical activity (PA) between participants enrolled in the treatment versus active control condition of a pediatric obesity intervention, and to test associations between parent and child PA. METHODS: Participants (N = 93) included children aged 7-17 years and their parent. Analyses tested whether participants in the treatment condition reported greater PA at postintervention and 12-month follow-up compared with the control condition. Further, researchers examined change in PA across time and whether change in parent PA was associated with change in child PA. RESULTS: Children in the treatment condition reported greater PA at 12-month follow-up. Parents in the treatment group reported a significant increase in PA between baseline and postintervention. Change in parent PA was associated with changes in child PA across multiple periods. CONCLUSIONS: Family-based obesity interventions may promote long-term change in self-reported PA among youths, and change in parent PA may be a contributing factor.

Medium is the message: moderate parental control of feeding correlates with improved weight outcome in a pediatric obesity intervention.

OBJECTIVE: Previous studies have suggested complex associations among variables related to parental control of feeding and child/adolescent obesity. The current study examined associations between parental food control variables and weight outcomes in the context of a behaviorally based family treatment program. METHODS: Parents of youths (n = 93) enrolled in a clinical trial comparing 2 weight management interventions completed the Child Feeding Questionnaire pre- and post-treatment, and at a 12-month follow-up. RESULTS: Latent growth curve modeling indicated that mean levels of restriction decreased over the course of treatment in the Positively Fit (PF) condition. Youths in the PF treatment condition whose parents increased their restriction of food experienced greater decreases in zBMI over treatment. CONCLUSIONS: Results echo previous reports that high and low parental control over food intake are associated with higher zBMI. Moderate parental control can be associated with beneficial outcomes in youths enrolled in behavioral treatment programs for obesity.

Commentary: pediatric eHealth interventions: common challenges during development, implementation, and dissemination.

OBJECTIVE: To provide an overview of common challenges that pediatric eHealth researchers may encounter when planning, developing, testing, and disseminating eHealth interventions along with proposed solutions for addressing these challenges. METHODS: The article draws on the existing eHealth literature and the authors' collective experience in pediatric eHealth research. RESULTS AND CONCLUSIONS: The challenges associated with eHealth interventions and their proposed solutions are multifaceted and cut across a number of areas from eHealth program development through dissemination. Collaboration with a range of individuals (e.g., multidisciplinary colleagues, commercial entities, primary stakeholders) is the key to eHealth intervention success. To ensure adequate resources for design, development, and planning for sustainability, a number of public and private sources of funding are available. A study design that addresses ethical concerns and security issues is critical to ensure scientific integrity and intervention dissemination. Table I summarizes key issues to consider during eHealth intervention development, testing, and dissemination.

Systematic review and meta-analysis of comprehensive behavioral family lifestyle interventions addressing pediatric obesity.

PURPOSE: To conduct a meta-analysis of randomized controlled trials examining the efficacy of comprehensive behavioral family lifestyle interventions (CBFLI) for pediatric obesity. METHOD: Common research databases were searched for articles through April 1, 2013. 20 different studies (42 effect sizes and 1,671 participants) met inclusion criteria. Risk of bias assessment and rating of quality of the evidence were conducted. RESULTS: The overall effect size for CBFLIs as compared with passive control groups over all time points was statistically significant (Hedge's g = 0.473, 95% confidence interval [.362, .584]) and suggestive of a small effect size. Duration of treatment, number of treatment sessions, the amount of time in treatment, child age, format of therapy (individual vs. group), form of contact, and study use of intent to treat analysis were all statistically significant moderators of effect size. CONCLUSION: CBFLIs demonstrated efficacy for improving weight outcomes in youths who are overweight or obese.

Evaluation of child health matters: a web-based tutorial to enhance school nurses' communications with families about weight-related health.

The goal of the current study was to assess the efficacy and acceptability of a web-based tutorial (Child Health Matters, CHM) designed to improve school nurses' communications with families about pediatric weight-related health issues. Using a randomized wait-list control design, a nationally representative sample of school nurses was assigned to immediate or delayed access conditions. Pre-, post-, and follow-up assessments of knowledge, barriers to providing obesity treatment, and intended practices were conducted. Results indicated that, relative to wait-list controls, immediate-access nurses demonstrated significant increases in knowledge and decreases in perceived barriers to discussing weight-related health, and significantly greater intentions to assess physical activity, and to recommend dietary changes and physical activity. Wait-list nurses demonstrated significant within-group improvements after completing CHM. Nurses reported a high degree of satisfaction with CHM. Results suggest that web-based tutorials can effect changes in nurses' knowledge, perceived barriers, and intended practices with regard to weight-related health care.

Examining the Association Between Digital Stress Components and Psychological Wellbeing: A Meta-Analysis.

Extant research suggests that digital stress (DS) and its various components (Hall et al. in Psychol Assess 33(3):230-242, 2021) may mediate the association between social media use and psychosocial distress among adolescents and young adults. Yet no systematic review and meta-analysis has been conducted to examine the direct associations among DS components (i.e., approval anxiety, availability stress, fear of missing out [FOMO], connection overload, and online vigilance) and psychological outcomes. Thus, we aimed to comprehensively synthesize and quantify the association between these five DS components and psychosocial distress, and to examine whether these associations were statistically different from one another. Our search of PubMed, PsycINFO, and Communication and Mass Media Complete yielded a wide range of article abstracts across the five DS components. After reviewing inclusion and exclusion criteria, 7, 73, 60, 19, and 16 studies were included for availability stress, approval anxiety, FOMO, connection overload, and online vigilance, respectively. The results suggested that all five digital stress components had significant medium association with psychosocial distress (r = .26 to .34; p < .001). Age and sex did not significantly moderate the association between most digital stress components and psychosocial distress. However, age moderated the association between connection overload and psychosocial distress. Our findings further suggested no statistical differences among the associations between the five digital stress components and psychosocial distress. Notwithstanding its limitations, our outcomes help integrate the disparate effect sizes in the literature, indicate the strength of associations, and suggest directions for clinical intervention and future research.

Longitudinal associations between teasing and health-related quality of life among treatment-seeking overweight and obese youth.

OBJECTIVES: To examine concurrent and prospective associations between perceptions of teasing and health-related quality of life (HRQOL) over the course of a behavioral/educational intervention and the subsequent year in a sample of overweight and obese children and adolescents. METHOD: A clinical sample of 93 overweight or obese youths (ages 7-17 years) and 1 parent/guardian completed measures of teasing and HRQOL at pre- and posttreatment and follow-up assessments. Structural equation modeling was used to examine the factor structure of the measures and to assess prospective associations over a 15-month period. RESULTS: Results indicate that, concurrently, weight-related teasing is inversely associated with HRQOL and that, prospectively, HRQOL is inversely associated with subsequent teasing. CONCLUSIONS: Study findings are suggestive of a directional relationship with lower quality of life predicting subsequent higher levels of teasing. Results suggest the potential for interventions designed to improve HRQOL to reduce teasing experiences for overweight and obese youth.

Psychometric properties of sizing me up in a community sample of 4th and 5th grade students with overweight and obesity.

OBJECTIVE: To extend the health-related quality of life assessment literature by examining the reliability and validity of Sizing Me Up in a community sample of nontreatment-seeking overweight and obese children. METHODS: Participants included 302 students (M age = 10.34) recruited from 6 elementary schools, who completed self-report measures of health-related quality of life and weight-related health. RESULTS: 134 overweight and obese children were included in the analyses to establish validity for the measure. Confirmatory factor analyses supported a 5-factor first-order factor structure with 1 second-order factor representing a total score. Convergent and criterion-related validity was established among overweight and obese children. Estimates of internal consistency for the 5-factor Sizing Me Up factor structure indicated that the subscales are not acceptable outside of a structural equation modeling approach. CONCLUSION: Outside of a structural equation modeling framework, only the total score appears to be appropriate in this population.

Comparison of a family-based group intervention for youths with obesity to a brief individual family intervention: a practical clinical trial of positively fit.

OBJECTIVE: To examine the effectiveness of a family-based behavioral group intervention (Positively Fit; PF) for pediatric obesity relative to a brief family intervention (BFI) in a sample of treatment-seeking children and adolescents. METHODS: Families (n = 93) were randomized to treatment condition. Assessments were conducted at pre- and posttreatment and at 12-month follow-up. Outcome indices included standardized body mass index (BMI) and quality of life (QOL). RESULTS: Results indicated a significant reduction in zBMI at posttreatment and follow-up across both conditions. At follow-up, BFI and PF participants evidenced average reductions of .12 and .19 zBMI units, respectively. Children demonstrated better outcomes than adolescents across both conditions. Results indicated clinically significant improvements in parent-reported QOL at postintervention and in self-reported QOL at follow-up for PF participants. CONCLUSIONS: Results suggest the effectiveness of family-based interventions for pediatric obesity in clinical settings among younger children. Neither intervention was effective in terms of reducing zBMI among adolescents.

An evaluation of a personal electronic device to enhance self-monitoring adherence in a pediatric weight management program using a multiple baseline design.

OBJECTIVE: To examine the effectiveness of a personal electronic device (PED) in order to improve adherence to self-monitoring of dietary intake and physical activity. METHOD: The impact of a PED on adherence to self-monitoring goals was examined in a multiple baseline design across three overweight adolescents. During baseline, a traditional paper-and-pencil method of self-monitoring was utilized. The subsequent study phase introduced a PED for self-monitoring. Percent self-monitoring goal attainment was the outcome of interest. RESULTS: During baseline, attainment of self-monitoring goals was low for all three participants (3-4%). Each subject's percent attainment of self-monitoring goal increased upon the introduction of the PED. For two of the three subjects this increase was stable (~75 and 100%) post-intervention. For the third subject the increase in percent attainment of self-monitoring goal was more variable but remained above baseline levels. CONCLUSION: PEDs have potential for improving self-monitoring in the context of behavioral weight management treatment for adolescents.

Weight-related criticism and self-perceptions among preadolescents.

OBJECTIVE: To examine the relationships among weight-related criticism (WRC), body size perceptions, and body size dissatisfaction among a sample of preadolescent children. METHOD: A community sample of 382 fifth and sixth graders (M age = 10.8) completed measures of WRC, nonweight-related criticism (NWRC), body size perceptions, body size dissatisfaction, and general self-esteem. Body mass index for each participant was collected during a standard school assessment. RESULTS: WRC was a significant and unique predictor of body size perceptions and body size dissatisfaction, controlling for actual BMI percentile and NWRC. Weight status moderated these relationships, with significant effects for WRC found only in the overweight group. NWRC was a significant predictor of self-esteem. DISCUSSION: The results suggest that WRC is specifically and uniquely associated with preadolescent children's body self-perceptions beyond its association with general, nonweight-related victimization. Prevention efforts may be needed to limit WRC and its potentially harmful effects.

The development and evaluation of a measure assessing school nurses' perceived barriers to addressing pediatric obesity.

School nurses represent an important resource for addressing pediatric obesity and weight-related health. However, school nurses perceive numerous barriers that prevent them from addressing the weight-related health of students. The current study developed and tested a new, comprehensive measure of nurses' perceptions of 10 types of barriers to addressing pediatric weight in a nationally representative sample of 214 school nurses. The measure was developed in the context of Bronfenbrenner's (1979) ecological systems theory and includes subscales assessing nurses' perceptions of skills-based, job-related, and societal barriers. Confirmatory factor analyses (CFAs) provided evidence for the validity of the measure, including the three barrier subscales. In addition, the subscales demonstrated adequate internal consistencies. Results indicate that school nurses perceive barriers to addressing weight-related health on multiple ecological levels, which may inform intervention or continuing education efforts. Future pediatric weight programs that involve school nurses might consider using the measure to assess nurses' perceptions of barriers.

Systematic Review on the Application of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for Preschool-Aged Children.

Trauma-focused cognitive behavioral therapy (TF-CBT) is one of the most widely studied and disseminated treatments for posttraumatic stress disorder (PTSD) and other comorbid conditions, and has been identified as a "level one" or "well-established" intervention for school-aged children and adolescents. The present systematic review examined the literature on the application of TF-CBT within a preschool-aged population (i.e., children ages three to six), as well as the developmental literature that could increase the efficacy of TF-CBT for preschool-aged children. Information on the use of TF-CBT with preschool-aged children was extracted from randomized controlled trials, case studies, meta-analyses, and other forms of empirical evidence, as part of the evidence-based practice in psychology framework. In comparison to research with school-aged children and adolescents, fewer studies have directly assessed the efficacy of TF-CBT for preschool-aged children who have been exposed to trauma. Given the few studies published to date and difference in treatment protocols for TF-CBT used with preschool-age children, TF-CBT appears to meet criteria as a "level two" or "probably efficacious" intervention for preschool-aged children specifically. According to the available literature, language and cognitive abilities, family context, culture, and clinician expertise are considered as potential variables to address when contemplating the use of TF-CBT for preschool-aged children with symptoms of post-traumatic stress.

Development and initial evaluation of a multidimensional digital stress scale.

Digital stress is believed to play a role in the association between social media use and psychosocial outcomes. However, the literature is limited by a lack of measures that conform to published theoretical models of the construct. The present investigation details the development of a new multidimensional measure of digital stress. Based on an earlier conceptualization of Digital Stress (Steele et al., 2020), Study 1 identified items from extant measures of digital stress, conducted a qualitative review of the literature to compose new items, and conducted focus groups with young adults and adolescents (N = 23) to improve item wording and interpretation. Study 2 conducted an exploratory factor analysis (EFA) of items with a young adult sample (N = 247) collected online, yielding support for four hypothesized factors (i.e., availability stress, approval anxiety, fear of missing out [FoMO], and connection overload) plus one unanticipated factor (i.e., online vigilance). In Study 3, college students (N = 174) completed paper-and-pencil surveys, and EFA results showed a similar structure as detected in Study 2. In Study 4, confirmatory factor analysis examining the five-factor model was conducted on data from adolescents (N = 163) and college students (N = 152). These procedures yielded 24 items measuring 5 components of digital stress: availability stress, approval anxiety, FoMO, connection overload, and online vigilance. Associations between digital stress and psychosocial distress and functioning are reported to demonstrate convergent and divergent validity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).