Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-18 (of 18 Records) |
Query Trace: Wethington H[original query] |
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A Community Guide systematic review: School dietary and physical activity interventions
Buchanan LR , Wethington HR , Finnie RKC , Mercer SL , Merlo C , Michael S , Sliwa S , Pratt CA , Ochiai E . Am J Prev Med 2022 64 (3) 441-451 CONTEXT: Schools can play an important role in supporting a healthy lifestyle by offering nutritious foods and beverages and providing opportunities for physical activity. A healthy diet and regular physical activity may reduce the risk of obesity. This manuscript reports on a Community Guide systematic review examining the effectiveness of interventions in schools combining school meal or fruit and vegetable snack programs and physical activity. EVIDENCE ACQUISITION: Studies meeting the intervention definition were identified from a literature search (search period: January 1990-November 2019). Community Guide systematic review methods were used to assess effectiveness as measured by dietary behavior, physical activity, and weight changes; analyses were conducted in 2020. EVIDENCE SYNTHESIS: Interventions (n=24 studies) were considered effective for increasing physical activity (median increase=21.8 minutes/day; interquartile interval= -0.8 to 27.4 minutes/day), modestly increasing fruit and vegetable intake (median relative increase=12.1%; interquartile interval= -4.6%, 73.4%), and decreasing the prevalence of overweight and obesity (median decrease=2.5 percentage points; interquartile interval= -8.1, -1.6 percentage points) among elementary school students through sixth grade. There were not enough studies to determine the effectiveness of interventions for middle- and high-school students. CONCLUSIONS: School meal or fruit and vegetable snack interventions combined with physical activity were effective in increasing physical activity, with modest effects for improving fruit and vegetable consumption and reducing the prevalence of overweight and obesity among elementary students. These results may inform researchers and school administrators about healthy eating and physical activity interventions. |
Priority topics for the Community Preventive Services Task Force, 2020-2025: A data-driven, partner-informed approach
Lansky A , Wethington HR , Mattick K , Chin MH , Alston A , Racine-Parshall J , Minor SL , Cobb J , Hopkins DP . Am J Prev Med 2022 62 (6) e375-e378 INTRODUCTION: The Community Preventive Services Task Force periodically engages in a process to identify priority topics to guide their work. This article described the process and results for selecting priority topics to guide the work of the Community Preventive Services Task Force for the period 2020-2025. METHODS: The Community Preventive Services Task Force started with Healthy People 2020 topics. They solicited input on topics from partner organizations and the public. The Community Preventive Services Task Force considered information on 8 criteria for each topic. They conducted preliminary voting and applied a priori decision rules regarding the voting results. The Community Preventive Services Task Force then engaged in facilitated deliberations and took a final vote. This process occurred October 2019-June 2020. RESULTS: From Healthy People 2020, a total of 37 topics were selected as the starting point. The initial voting and decision rules resulted in 3 topics being determined as priorities. Community Preventive Services Task Force members considered data and information on the criteria to inform their deliberations on an additional 7 topics. A total of 9 topics were selected as the set of priorities for 2020-2025. CONCLUSIONS: Having a process that is routine and data-driven ensures that the selection of priorities is sound. By reviewing priority topics every 5 years, the Community Preventive Services Task Force will continue to provide relevant recommendations on community preventive services to improve the nation's health. |
Intimate Partner and Sexual Violence Prevention Among Youth: A Community Guide Systematic Review
Finnie RKC , Okasako-Schmucker DL , Buchanan L , Carty D , Wethington H , Mercer SL , Basile KC , DeGue S , Niolon PH , Bishop J , Titus T , Noursi S , Dickerson SA , Whitaker D , Swider S , Remington P . Am J Prev Med 2021 62 (1) e45-e55 INTRODUCTION: Intimate partner violence and sexual violence are widespread and often occur early in life. This systematic review examines the effectiveness of interventions for primary prevention of intimate partner violence and sexual violence among youth. METHODS: Studies were identified from 2 previous systematic reviews and an updated search (January 2012-June 2016). Included studies were implemented among youth, conducted in high-income countries, and aimed to prevent or reduce the perpetration of intimate partner violence or sexual violence. In 2016-2017, Guide to Community Preventive Services (Community Guide) methods were used to assess effectiveness as determined by perpetration, victimization, or bystander action. When heterogeneity of outcomes prevented usual Community Guide methods, the team systematically applied criteria for favorability (statistically significant at p<0.05 or approaching significance at p<0.10) and consistency (75% of results in the same direction). RESULTS: A total of 28 studies (32 arms) met inclusion and quality of execution criteria. Interventions used combinations of teaching healthy relationship skills, promoting social norms to protect against violence, or creating protective environments. Overall, 18 of 24 study arms reported favorable results on the basis of the direction of effect for decreasing perpetration; however, favorability for bystander action diminished with longer follow-up. Interventions did not demonstrate consistent results for decreasing victimization. A bridge search conducted during Fall 2020 confirmed these results. DISCUSSION: Interventions for the primary prevention of intimate partner violence and sexual violence are effective in reducing perpetration. Increasing bystander action may require additional follow-up as effectiveness diminishes over time. Findings may inform researchers, school personnel, public health, and other decision makers about effective strategies to prevent intimate partner violence and sexual violence among youth. |
Living systematic reviews and other approaches for updating evidence
Lansky A , Wethington HR . Am J Public Health 2020 110 (11) 1687-1688 Systematic reviews use predetermined criteria to identify studies on a clearly defined issue, then assess their quality, synthesize the evidence, and draw conclusions from the included studies. In some cases, conclusions from systematic reviews are linked to recommendations, such as those made by the US Preventive Services Task Force and the Community Preventive Services Task Force,1 or to guidelines for clinical practice. For recommendations or guidelines to be accurate and a reliable resource for decision-makers, the evidence must be up to date. A relatively new method for updating systematic reviews is called a “living” systematic review, in which a systematic review is updated as new research becomes available and relevant evidence is incorporated into the review. |
Healthier food and beverage interventions in schools: Four Community Guide systematic reviews
Wethington HR , Finnie RKC , Buchanan LR , Okasako-Schmucker DL , Mercer SL , Merlo C , Wang Y , Pratt CA , Ochiai E , Glanz K . Am J Prev Med 2020 59 (1) e15-e26 CONTEXT: Healthy eating during childhood is important for optimal growth and helps reduce the risk of obesity, which has potentially serious health consequences. Changing the school food environment may offer one way to improve students' dietary intake. This manuscript reports 4 Community Guide systematic reviews examining the effectiveness of interventions in schools promoting healthy eating and weight. EVIDENCE ACQUISITION: School obesity prevention programs aiming to improve diet were identified from a 2013 Agency for Health Care Research and Quality systematic review and an updated search (August 2012-January 4, 2017). In 2017-2018, Community Guide systematic review methods were used to assess effectiveness as determined by dietary behavior and weight changes. EVIDENCE SYNTHESIS: Interventions improving school meals or offering fruits and vegetables (n=27 studies) are considered effective. Evidence is insufficient to determine the effectiveness of interventions supporting healthier snack foods and beverages outside of school meal programs given inconsistent findings (n=13 studies). Multicomponent interventions to increase availability of healthier foods and beverages are considered effective. These interventions must include 1 component from school meals or fruit and vegetable programs and interventions supporting healthier snack foods and beverages (n=12 studies). There is insufficient evidence to determine the effectiveness of interventions to increase water access because only 2 studies met inclusion criteria. CONCLUSIONS: A total of 2 school-based dietary interventions have favorable effects for improving dietary habits and modest effects for improving or maintaining weight. More evidence is needed regarding interventions with insufficient findings. These reviews may inform researchers and school administrators about healthy eating and obesity prevention interventions. |
Reducing recreational sedentary screen time: A Community Guide systematic review
Ramsey Buchanan L , Rooks-Peck CR , Finnie RK , Wethington HR , Jacob V , Fulton JE , Johnson DB , Kahwati LC , Pratt CA , Ramirez G , Glanz K . Am J Prev Med 2016 50 (3) 402-15 CONTEXT: Sedentary time spent with screen media is associated with obesity among children and adults. Obesity has potentially serious health consequences, such as heart disease and diabetes. This Community Guide systematic review examined the effectiveness and economic efficiency of behavioral interventions aimed at reducing recreational (i.e., neither school- nor work-related) sedentary screen time, as measured by screen time, physical activity, diet, and weight-related outcomes. EVIDENCE ACQUISITION: For this review, an earlier ("original") review (search period, 1966 through July 2007) was combined with updated evidence (search period, April 2007 through June 2013) to assess effectiveness of behavioral interventions aimed at reducing recreational sedentary screen time. Existing Community Guide systematic review methods were used. Analyses were conducted in 2013-2014. EVIDENCE SYNTHESIS: The review included 49 studies. Two types of behavioral interventions were evaluated that either (1) focus on reducing recreational sedentary screen time only (12 studies); or (2) focus equally on reducing recreational sedentary screen time and improving physical activity or diet (37 studies). Most studies targeted children aged ≤13 years. Children's composite screen time (TV viewing plus other forms of recreational sedentary screen time) decreased 26.4 (interquartile interval= -74.4, -12.0) minutes/day and obesity prevalence decreased 2.3 (interquartile interval= -4.5, -1.2) percentage points versus a comparison group. Improvements in physical activity and diet were reported. Three study arms among adults found composite screen time decreased by 130.2 minutes/day. CONCLUSIONS: Among children, these interventions demonstrated reduced screen time, increased physical activity, and improved diet- and weight-related outcomes. More research is needed among adolescents and adults. |
Fruits and vegetables as a healthier snack throughout the day among families with older children: findings from a survey of parent-child dyads
Smith TM , Pinard CA , Byker Shanks C , Wethington H , Blanck HM , Yaroch AL . Eat Behav 2015 17c 136-139 Most U.S. youth fail to eat the recommended amount of fruits and vegetables (FV) however many consume too many calories as added sugars and solid fats, often as snacks. The aim of this study was to assess factors associated with serving FV as snacks and with meals using parent-child dyads. A cross-sectional sample of U.S. children aged 9 to 18, and their caregiver/parent (n=1522) were part of a Consumer Panel of households for the 2008 YouthStyles mail survey. Chi-square test of independence and multivariable logistic regression were used to assess associations between serving patterns of FV as snacks with variations in serving patterns, and covariates including dietary habits. Most parents (72%) reported serving FV at meals and as snacks. Fruit was most frequently served as a snack during the day (52%) and vegetables were most frequently served as a snack during the day (22%) but rarely in the morning. Significant differences in child FV intake existed among FV as a snack serving patterns by parents. Compared to children whose parents served FV only at meals, children whose parents reported serving FV as snacks in addition to meals were significantly more likely to have consumed FV the day before (using a previous day screener), P<0.05. Contributing to the growing collection of literature describing parent-child dyad dietary behaviors, these findings suggest promoting FV access and intake throughout the day, not only at meals, by including serving as snacks, may increase FV intake among older children and adolescents. |
Characteristics of US health care providers who counsel adolescents on sports and energy drink consumption
Xiang N , Wethington H , Onufrak S , Belay B . Int J Pediatr 2014 2014 987082 OBJECTIVE: To examine the proportion of health care providers who counsel adolescent patients on sports and energy drink (SED) consumption and the association with provider characteristics. METHODS: This is a cross-sectional analysis of a survey of providers who see patients ≤17 years old. The proportion providing regular counseling on sports drinks (SDs), energy drinks (EDs), or both was assessed. Chi-square analyses examined differences in counseling based on provider characteristics. Multivariate logistic regression calculated adjusted odds ratios (aOR) for characteristics independently associated with SED counseling. RESULTS: Overall, 34% of health care providers regularly counseled on both SEDs, with 41% regularly counseling on SDs and 55% regularly counseling on EDs. On adjusted modeling regular SED counseling was associated with the female sex (aOR: 1.44 [95% CI: 1.07-1.93]), high fruit/vegetable intake (aOR: 2.05 [95% CI: 1.54-2.73]), family/general practitioners (aOR: 0.58 [95% CI: 0.41-0.82]) and internists (aOR: 0.37 [95% CI: 0.20-0.70]) versus pediatricians, and group versus individual practices (aOR: 0.59 [95% CI: 0.42-0.84]). Modeling for SD- and ED-specific counseling found similar associations with provider characteristics. CONCLUSION: The prevalence of regular SED counseling is low overall and varies. Provider education on the significance of SED counseling and consumption is important. |
Health-related quality of life and body mass index among US adolescents
Cui W , Zack MM , Wethington H . Qual Life Res 2014 23 (7) 2139-50 PURPOSE: To examine the magnitude of differences in health-related quality of life (HRQOL) by body mass index (BMI) in a population-based sample of United States adolescents overall and by sex, and to provide national prevalence estimates of reported HRQOL outcomes for not only obese and overweight but also underweight adolescents. METHODS: From the 2001 through 2010 cross-sectional National Health and Nutrition Examination Surveys, we estimated the percentages of four HRQOL outcomes-self-rated health, physically unhealthy days, mentally unhealthy days, and activity limitation days-in four BMI categories-obese, overweight, normal weight, and underweight-of approximately 6,000 US adolescents aged 12-17 years. We also estimated the percentages for boys and girls separately. RESULTS: Substantial gaps in self-rated health exist between normal-weight adolescents and those who are obese and overweight, but not underweight. Eighteen percent (95 % CI 15-22) of obese adolescents reported fair or poor health compared to only 5 % (95 % CI 4-7) of normal-weight adolescents. Thirty-seven percent (95 % CI 33-42) of obese adolescents reported excellent or very good health, compared to 65 % (94 % CI 63-67) of normal-weight adolescents. However, all BMI groups reported similar percentages of physically unhealthy days, mentally unhealthy days, and activity limitation days. The associations between HRQOL and BMI groups did not vary by sex. Boys generally reported significantly better self-rated health and mental health than girls. Specifically, obese boys reported better self-rated health, mental health, and fewer activity limitation days than obese girls. CONCLUSIONS: Substantially, significant differences in some domains of HRQOL are found between above normal-weight and normal-weight US adolescents. This relationship between BMI and HRQOL is robust and observed among both boys and girls. |
Caregiver and adolescent responses to food and beverage marketing exposures through an online survey
Kumar G , Zytnick D , Onufrak S , Harris JL , Wethington H , Kingsley B , Park S . Child Obes 2014 10 (1) 64-71 BACKGROUND: The Institute of Medicine noted that current food and beverage marketing practices promote unhealthful diets. However, little public health research has been conducted on food marketing directed toward adolescents, especially using caregiver- and adolescent-reported data. METHODS: We assessed perceived frequency of food/beverage advertising exposure and common locations of food/beverage marketing exposure for adolescents using 2012 Summer ConsumerStyles and YouthStyles survey data on US adults ≥18 years of age and their children ages 12-17 (n=847), respectively. Exposure to advertisements for fast food, soda, fruit drinks, sports drinks, energy drinks, and bottled water were categorized as <1 time/week, 1-6 times/week, and ≥1 time/day, and don't know. Weighted chi-square tests were used to examine the difference between caregivers' and adolescents' responses. RESULTS: The majority of caregivers and adolescents reported that adolescents viewed advertisements ≥1 time/day across all food/beverage categories with the highest, at least daily, exposure reported for fast food. Caregivers more frequently reported that adolescents viewed all food/beverage advertisements ≥1 time/day than the adolescents reported (chi-square tests, p<0.0001). Both caregivers and adolescents reported that the adolescents view food/beverage marketing most frequently on television followed by at the supermarket. CONCLUSIONS: Our study showed that adolescents reported lower frequency of food and beverage advertising exposure than their caregivers. Further research may be needed to verify self-reported exposure data on food and beverage advertising as a way to obtain data for use in research on its relationship with diet quality and obesity. |
Incidence of obesity among young US children living in low-income families, 2008-2011
Pan L , May AL , Wethington H , Dalenius K , Grummer-Strawn LM . Pediatrics 2013 132 (6) 1006-13 OBJECTIVE: To examine the incidence and reverse of obesity among young low-income children and variations across population subgroups .METHODS: We included 1.2 million participants in federally funded child health and nutrition programs who were 0 to 23 months old in 2008 and were followed up 24 to 35 months later in 2010-2011. Weight and height were measured. Obesity at baseline was defined as gender-specific weight-for-length ≥95th percentile on the 2000 Centers for Disease Control and Prevention growth charts. Obesity at follow-up was defined as gender-specific BMI-for-age ≥95th percentile. We used a multivariable log-binomial model to estimate relative risk of obesity adjusting for gender, baseline age, race/ethnicity, duration of follow-up, and baseline weight-for-length percentile. RESULTS: The incidence of obesity was 11.0% after the follow-up period. The incidence was significantly higher among boys versus girls and higher among children aged 0 to 11 months at baseline versus those older. Compared with non-Hispanic whites, the risk of obesity was 35% higher among Hispanics and 49% higher among American Indians (AIs)/Alaska Natives (ANs), but 8% lower among non-Hispanic African Americans. Among children who were obese at baseline, 36.5% remained obese and 63.5% were nonobese at follow-up. The proportion of reversing of obesity was significantly lower among Hispanics and AIs/ANs than that among other racial/ethnic groups. CONCLUSIONS: The high incidence underscores the importance of early-life obesity prevention in multiple settings for low-income children and their families. The variations within population subgroups suggest that culturally appropriate intervention efforts should be focused on Hispanics and AIs/ANs. |
The association of screen time, television in the bedroom, and obesity among school-aged youth: 2007 National Survey of Children's Health
Wethington H , Pan L , Sherry B . J Sch Health 2013 83 (8) 573-81 BACKGROUND: Among school-aged youth, we sought to identify characteristics associated with (1) exceeding screen time recommendations (ie, television/videos/video games more than 2 hours/weekday), and (2) exceeding screen time recommendations, the presence of a television in the bedroom, and obesity. METHODS: Using 2007 National Survey of Children's Health data, we used multivariable logistic regression to identify sociodemographic and behavioral characteristics associated with excessive screen time among 6 to 11- and 12 to 17-year-olds on a typical weekday. For 12 to 17-year-olds only, we used logistic regression to examine the odds of obesity using the same variables as above, with the addition of screen time. RESULTS: Overall, 20.8% of 6 to 11-year-olds and 26.1% of 12 to 17-year-olds had excessive screen time. For both age groups, having a bedroom TV was significantly associated with excessive screen time. For the older age group, the dual scenario of excessive screen time with a bedroom TV had the strongest association with obesity (OR = 2.5, 95% CI 1.9, 3.2). CONCLUSIONS: Given the similar risk factors for excess screen time and having a TV in the bedroom, a public health challenge exists to design interventions to reduce screen time among school-aged youth. |
Disability prevalence among healthy weight, overweight, and obese adults
Armour BS , Courtney-Long EA , Campbell VA , Wethington HR . Obesity (Silver Spring) 2013 21 (4) 852-5 OBJECTIVE: Obesity is associated with adverse health outcomes in people with and without disabilities. However, little is known about disability prevalence among people who are obese. The purpose of this study is to determine the prevalence and type of disability among adults who are obese. DESIGN AND METHODS: Pooled data from the 2003-2009 National Health Interview Survey (NHIS) were analyzed to obtain national prevalence estimates of disability, disability type and obesity. The disability prevalence was stratified by body mass index (BMI): healthy weight (BMI 18.5-<25.0), overweight (BMI 25.0-<30.0), and obese (BMI ≥ 30.0). RESULTS: In this pooled sample, among the 25.4% of US adults who were obese, 41.7% reported a disability. In contrast, 26.7% of those with a healthy weight and 28.5% of those who were overweight reported a disability. The most common disabilities among respondents with obesity were movement difficulty (32.5%) and work limitation (16.6%). CONCLUSIONS: This research contributes to the literature on obesity by including disability as a demographic in assessing the burden of obesity. Because of the high prevalence of disability among those who are obese, public health programs should consider the needs of those with disabilities when designing obesity prevention and treatment programs. |
Use of calorie information at fast food and chain restaurants among US youth aged 9-18 years, 2010
Wethington H , Maynard LM , Blanck HM . J Public Health (Oxf) 2013 35 (3) 354-60 BACKGROUND: To examine whether youth use calorie information when it is available at fast food/chain restaurants and what factors are associated with using this information to make their food selection. METHODS: A cross-sectional analysis was conducted on a sample of 721 youth (9-18 years) using the 2010 YouthStyles and HealthStyles surveys. The outcome measure was reported use of calorie information at fast food/chain restaurants. Multivariable logistic regression was used to examine the associations between sociodemographic variables and the use of calorie information at fast food/chain restaurants. RESULTS: Of those who visited fast food/chain restaurants, 42.4% reported using calorie information at least sometimes. Girls were more likely than boys (adjusted odds ratio (aOR) = 1.8, 95% confidence interval (CI) = 1.2-2.5) and youth who were obese were more likely than those at a healthy weight (aOR = 1.7, 95% CI = 1.04-2.9) to use calorie information, and youth eating at a fast food/chain restaurant twice a week or more versus once a week or less were half as likely to report using calorie information (aOR = 0.5, 95% CI = 0.4-0.8). CONCLUSION: Public health education efforts can benefit from research to determine how to increase usage among youth so that their food choices are appropriate for their caloric needs. |
Estimating disability prevalence among adults by body mass index: 2003-2009 National Health Interview Survey
Armour BS , Courtney-Long E , Campbell VA , Wethington HR . Prev Chronic Dis 2012 9 E178 INTRODUCTION: Obesity is associated with adverse health outcomes in people with and without disabilities; however, little is known about disability prevalence among people who are obese. The purpose of this study was to determine the prevalence and type of disability among obese adults in the United States. METHODS: We analyzed pooled data from sample adult modules of the 2003-2009 National Health Interview Survey (NHIS) to obtain national prevalence estimates of disability, disability type, and obesity by using 30 questions that screened for activity limitations, vision and hearing impairment, and cognitive, movement, and emotional difficulties. We stratified disability prevalence by category of body mass index (BMI, measured as kg/m(2)): underweight, less than 18.5; normal weight, 18.5 to 24.9; overweight, 25.0 to 29.9; and obese, 30.0 or higher. RESULTS: Among the 25.3% of adult men and 24.6% of women in our pooled sample who were obese, 35.2% and 46.9%, respectively, reported a disability. In contrast, 26.7% of men and 26.8% women of normal weight reported a disability. Disability was much higher among obese women than among obese men (46.9% vs 35.2%, P < .001). Movement difficulties were the most common disabilities among obese men and women, affecting 25.3% of men and 37.9% of women. CONCLUSION: This research contributes to the literature on obesity by including disability as a demographic in characterizing people by body mass index. Because of the high prevalence of disability among those who are obese, public health programs should consider the needs of those with disabilities when designing obesity prevention and treatment programs. |
The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: two systematic reviews for the Guide to Community Preventive Services
Chin HB , Sipe TA , Elder R , Mercer SL , Chattopadhyay SK , Jacob V , Wethington HR , Kirby D , Elliston DB , Griffith M , Chuke SO , Briss SC , Ericksen I , Galbraith JS , Herbst JH , Johnson RL , Kraft JM , Noar SM , Romero LM , Santelli J , Community Preventive Services Task Force . Am J Prev Med 2012 42 (3) 272-94 CONTEXT: Adolescent pregnancy, HIV, and other sexually transmitted infections (STIs) are major public health problems in the U.S. Implementing group-based interventions that address the sexual behavior of adolescents may reduce the incidence of pregnancy, HIV, and other STIs in this group. EVIDENCE ACQUISITION: Methods for conducting systematic reviews from the Guide to Community Preventive Services were used to synthesize scientific evidence on the effectiveness of two strategies for group-based behavioral interventions for adolescents: (1) comprehensive risk reduction and (2) abstinence education on preventing pregnancy, HIV, and other STIs. Effectiveness of these interventions was determined by reductions in sexual risk behaviors, pregnancy, HIV, and other STIs and increases in protective sexual behaviors. The literature search identified 6579 citations for comprehensive risk reduction and abstinence education. Of these, 66 studies of comprehensive risk reduction and 23 studies of abstinence education assessed the effects of group-based interventions that address the sexual behavior of adolescents, and were included in the respective reviews. EVIDENCE SYNTHESIS: Meta-analyses were conducted for each strategy on the seven key outcomes identified by the coordination team-current sexual activity; frequency of sexual activity; number of sex partners; frequency of unprotected sexual activity; use of protection (condoms and/or hormonal contraception); pregnancy; and STIs. The results of these meta-analyses for comprehensive risk reduction showed favorable effects for all of the outcomes reviewed. For abstinence education, the meta-analysis showed a small number of studies, with inconsistent findings across studies that varied by study design and follow-up time, leading to considerable uncertainty around effect estimates. CONCLUSIONS: Based on these findings, group-based comprehensive risk reduction was found to be an effective strategy to reduce adolescent pregnancy, HIV, and STIs. No conclusions could be drawn on the effectiveness of group-based abstinence education. |
Physician practices related to use of BMI-for-age and counseling for childhood obesity prevention: a cross-sectional study
Wethington HR , Sherry B , Polhamus B . BMC Fam Pract 2011 12 80 BACKGROUND: Screening for obesity and providing appropriate obesity-related counseling in the clinical setting are important strategies to prevent and control childhood obesity. The purpose of this study is to document pediatricians (PEDs) and general practitioners (GPs) with pediatric patients use of BMI-for-age to screen for obesity, confidence in explaining BMI, access to referral clinics, and characteristics associated with screening and counseling to children and their caregivers. METHODS: The authors used 2008 DocStyles survey data to examine these practices at every well child visit for children aged two years and older. Counseling topics included: physical activity, TV viewing time, energy dense foods, fruits and vegetables, and sugar-sweetened beverages. Chi-square tests were used to examine differences in proportions and logistic regression to identify characteristics associated with screening and counseling. RESULTS: The final analytic sample included 250 PEDs and 621 GPs. Prevalence of using BMI-for-age to screen for obesity at every well child visit was higher for PEDs than GPs (50% vs. 22%, chi(2) = 67.0, p ≤ 0.01); more PEDs reported being very/somewhat confident in explaining BMI (94% vs. GPs, 87%, p < 0.01); more PEDs reported access to a pediatric obesity specialty clinic for referral (PEDs = 65% vs. GPs = 42%, chi(2) = 37.5, p ≤ 0.0001).In general, PEDs reported higher counseling prevalence than GPs. There were significant differences in the following topics: TV viewing (PEDs, 79% vs. GPs, 61%, chi(2) = 19.1, p ≤ 0.0001); fruit and vegetable consumption (PEDs, 87% vs. GPs, 78%, chi(2) = 6.4, p ≤ 0.01). The only characteristics associated with use of BMI for GPs were being female (OR = 2.3, 95% CI = 1.5-3.5) and serving mostly non-white patients (OR = 1.8, 95% CI = 1.1-2.9); there were no significant associations for PEDs. CONCLUSIONS: The findings for use of BMI-for-age, counseling habits, and access to a pediatric obesity specialty clinic leave room for improvement. More research is needed to better understand why BMI-for-age is not being used to screen at every well child visit, which may increase the likelihood overweight and obese patients receive counseling and referrals for additional services. The authors also suggest more communication between PEDs and GPs through professional organizations to increase awareness of existing resources, and to enhance access and referral to pediatric obesity specialty clinics. |
Use of parks or playgrounds: reported access to drinking water fountains among US adults, 2009
Park S , Sherry B , Wethington H , Pan L . J Public Health (Oxf) 2011 34 (1) 65-72 BACKGROUND: As a first step to determining the public availability of drinking water, self-reported access to water fountains in parks and playgrounds was examined. METHODS: A cross-sectional analysis was conducted on a convenience sample of 4163 US adults (aged ≥18 years) using the 2009 HealthStyles Survey. The outcome measure was reported access to water fountains in parks/playgrounds. Among those who reported using parks/playgrounds, multivariable logistic regression was used to examine the associations between sociodemographic variables and reported access to water fountains. RESULTS: About half (54.7%) of participants used parks/playgrounds. Among those, 55.0% reported access to water fountains. Factors significantly associated with reported access to water fountains were being male [odds ratio (OR) = 1.42; 95% confidence interval (CI) = 1.09, 1.85] and living in the Pacific region (versus East North Central region, OR = 2.56; 95% CI = 1.61, 4.06). Age, race/ethnicity, household income, marital status, education, smoking and physical activity were not significantly associated with reported access to water fountains. CONCLUSIONS: Among 54.7% of adults using parks/playgrounds, reported access to water fountains was significantly differed by sex and region. This study provides information that can be considered when developing interventions to increase access to drinking water in public facilities. |
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