Publications by authors named "Jungwon Min"

41 Publications

Higher total ultrafiltration volume during cardiopulmonary bypass-assisted infant cardiac surgery is associated with acute kidney injury and fluid overload.

Pediatr Nephrol 2021 Mar 2. Epub 2021 Mar 2.

Division of Pediatric Cardiology, University of Michigan C.S. Mott Children's Hospital, 1540 E Hospital Drive, Ann Arbor, MI, 48109, USA.

Background: Ultrafiltration (UF) is used for fluid removal during and after infant cardiopulmonary bypass (CPB) surgery to reduce fluid overload. Excessive UF may have the opposite of its intended effect, resulting in acute kidney injury (AKI), oliganuria, and fluid retention.

Methods: This is a single-center, retrospective review of infants treated with conventional and/or modified UF during CPB surgery. UF volume was indexed to weight. AKI was defined using serum creatinine "Kidney Disease Improving Global Outcome (KDIGO)" criteria. Fluid balance was defined according to: [Formula: see text]. Peak fluid overload was determined on postoperative day 3. Multivariable logistic regression adjusted for multiple covariates was used to explore associations with UF, AKI, and fluid overload.

Results: Five hundred thirty subjects < 1 year of age underwent CPB-assisted congenital heart surgery with UF. Sixty-four (12%) developed postoperative AKI. On multivariable regression, higher indexed total UF volume was associated with increased AKI risk (OR 1.11, 95% CI=1.04-1.19, p = 0.003). UF volume > 119.9 mL/kg did not reduce peak fluid overload. Subjects with AKI took longer to reach a negative fluid balance (2 vs. 3 days, p = 0.04). Those with more complex surgery were at highest AKI risk (STAT 3 [25-75 percentile: 3-4] in AKI group versus STAT 3 [25-75 percentile: 2-4] in non-AKI group, p = 0.05). AKI was reduced in subjects undergoing more complex surgery and treated with UF volume < 119.9 mL/kg.

Conclusions: Judicious use of UF in more complex congenital cardiac surgery reduces the risk of AKI.
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http://dx.doi.org/10.1007/s00467-021-04976-2DOI Listing
March 2021

Racial-Ethnic Disparities in Obesity and Biological, Behavioral, and Sociocultural Influences in the United States: A Systematic Review.

Adv Nutr 2021 Jan 11. Epub 2021 Jan 11.

Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-being, College of Health, Ball State University, Muncie, IN, USA.

For a comprehensive understanding of high-level obesity in the USA, we studied the trends of obesity prevalence since 2007, and related biological, behavioral, and sociocultural factors in obesity racial/ethnic disparities. We searched PubMed, Embase, and national data archives for the studies using national survey data and published in English from January 1, 2007 to September 11, 2020. Forty-seven studies met the inclusion criteria and were systematically reviewed. After a short leveling-off during 2009-2012, the US national prevalence of obesity has steadily increased. Although women had higher racial/ethnic disparities in obesity and severe obesity than men, it decreased due to the significant drop in non-Hispanic black (NHB) women in the last 10 y. However, obesity and severe obesity prevalence increased in Mexican-American (MA) men, MA boys, and MA girls and became similar to or surpassing NHB groups. Substantial racial/ethnic disparities remained in the past decade. Even at the same level of BMI, MAs and non-Hispanic Asians had a higher percent of body fat and metabolic syndrome than other ethnic/racial groups. NHB's cultural preference for a large body significantly associated weight misperception and lower weight control practices. In addition to socioeconomic status, health behaviors, neighborhood environments, and early childhood health factors explained substantial racial/ethnic differences in obesity. Differences in biological, behavioral, and sociocultural characteristics should be considered in future public health intervention efforts to combat obesity in the USA.
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http://dx.doi.org/10.1093/advances/nmaa162DOI Listing
January 2021

Cardiac evaluation of patients with 22q11.2 duplication syndrome.

Am J Med Genet A 2021 03 27;185(3):753-758. Epub 2020 Dec 27.

Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

The 22q11.2 duplication syndrome (22q11.2DupS) is characterized by phenotypic heterogeneity, from seemingly asymptomatic to severely affected patients. Our study sought to detail the cardiac phenotype associated with 22q11.2DupS, the prevalence of aortic arch anomalies and aortic root dilation in 22q11.2DupS, and to assess how frequently new congenital heart disease (CHD) is diagnosed at outpatient cardiac evaluation following genetic diagnosis. In our cohort of 85 patients, 20.0% had CHD, with a wide range of phenotypes. Sixty-eight patients had complete cardiac evaluations detailing aortic arch sidedness and branching pattern, of which 5 (7.4%) had an aortic arch anomaly, all of whom had concurrent intracardiac CHD. Of 53 patients without CHD who had complete cardiac evaluations, only 3 (5.7%) had evidence of aortic root dilation. Of 46 patients who underwent outpatient cardiac evaluation following diagnosis of 22q11.2DupS, only one (2.2%) was found to have CHD, an isolated bicuspid aortic valve without stenosis. Therefore, the CHD phenotype in 22q11.2DupS, when present, is heterogeneous. Aortic arch anomalies are uncommon, and no patient in our cohort had one in isolation. Isolated aortic root dilation is also uncommon. Finally, outpatient cardiac evaluation following genetic diagnosis without previously known CHD infrequently identified minor cardiac malformations.
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http://dx.doi.org/10.1002/ajmg.a.62032DOI Listing
March 2021

Standardized Feeding Approach Mitigates Weight Loss in Infants with Congenital Heart Disease.

J Pediatr 2020 Dec 23. Epub 2020 Dec 23.

Children's Hospital of Philadelphia, Nursing and Clinical Care Services, Philadelphia, PA; University of Pennsylvania, School of Nursing, Philadelphia, PA.

Objective: To evaluate the effect of a standardized feeding approach using a clinical nutrition pathway on weight-for-age Z score (WAZ) over hospital length of stay (HLOS) for infants with congenital heart disease (CHD).

Study Design: A 10-year retrospective cohort study examined eligible infants who underwent neonatal cardiac surgery between July 2009 and December 2018 (n = 987). Eligibility criteria included infants born at least 37 weeks of gestation and a minimum birth weight of 2 kg who underwent cardiac surgery for CHD within the first 30 days of life. Using the best linear unbiased predictions from a linear mixed effects model, WAZ change over HLOS was estimated before and after January 2013, when the standardized feeding approach was initiated. The best linear unbiased predictions model included adjustment for patient characteristics including sex, race, HLOS, and class of cardiac defect.

Results: The change in WAZ over HLOS was significantly higher from 2013 to 2018 than from 2009 to 2012 (β = 0.16; SE = 0.02; P < .001), after controlling for sex, race, HLOS, and CHD category, indicating that infants experienced a decreased WAZ loss over HLOS after the standardized feeding approach was initiated. Additionally, differences were found in WAZ loss over HLOS between infants with single ventricle CHD (β = 0.26; SE = 0.04; P < .001) and 2 ventricle CHD (β = 0.04; SE = 0.02; P = .04).

Conclusions: These data suggest that an organized, focused approach for nutrition therapy using a standardized pathway improves weight change outcomes before hospital discharge for infants with single and 2 ventricle CHD who require neonatal cardiac surgery.
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http://dx.doi.org/10.1016/j.jpeds.2020.12.047DOI Listing
December 2020

Does social trust slow down or speed up the transmission of COVID-19?

Authors:
Jungwon Min

PLoS One 2020 17;15(12):e0244273. Epub 2020 Dec 17.

Faculty of Economics and Management, Sophia University, Tokyo, Japan.

Social trust has been an important mechanism in overcoming crises throughout history. Several societies are now emphasizing its role in combating the COVID-19 pandemic. This study aims to investigate how variations in social trust across 68 countries are related to the transmission speed of COVID-19. Specifically, using cross-national index data from the World Value Survey, the study tests how variations in social trust across countries generate different time durations at which each country reaches the peak in terms of increases in new infections of COVID-19. Using data drawn between December 31, 2019 and July 31, 2020, this study found that in countries with a high level of social trust, particularly trust among ingroup members, or with a narrower or wider range than the intermediate range of trustees, the number of new infections tended to reach the first peak within a shorter time duration than in other countries. These results imply that in such societies, on the one hand, high cooperation among people to achieve common goals and strong compliance to social norms may allow them to begin neutralizing COVID-19 faster. On the other hand, however, the low risk perception and prevalence of cohesive relationships among people may lead to speedier transmission of COVID-19 before neutralization takes place.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244273PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746305PMC
December 2020

Racial/Ethnic Disparities in Female Sexual Health from Adolescence to Young Adulthood: How Adolescent Characteristics Matter?

J Pediatr Adolesc Gynecol 2020 Nov 20. Epub 2020 Nov 20.

Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address:

Study Objective: To describe sexual initiation patterns in female adolescents and examine their association with adolescent characteristics and racial disparities in adverse sexual health across adolescence into early adulthood.

Design: A prospective, longitudinal, observational study from adolescence to adulthood.

Setting: Nationally representative, the National Longitudinal Study of Adolescent to Adult Health data, in the range of 24-32 years old at final assessment.

Participants: Data from 43,577 US women from 1994 to 2008.

Interventions And Main Outcome Measures: Adolescent sex-related characteristics at the individual-, family-, and school peer-level were assessed, and multiple sex partners, sexually transmitted infections (STIs)/HIV, and intimate partner violence (IPV) were longitudinally tracked. The sexual initiation pattern and its longitudinal association with sexual health were analyzed using latent class analysis and mixed effects Poisson regression models.

Results: Of the 43,577 subjects, the sexual initiation patterns were determined as normative (n = 28,712, 65.9%), late (n = 10,799, 24.8%), and early but unempowered (n = 4,066, 9.3%). The highest rate of the early-unempowered group was shown in Hispanic individuals (1,054/7,307 = 14.4%); they were more likely to be depressed, unsatisfied with their bodies, receiving welfare, and have less educated/permissive parents to their sexual initiation than others. The late group had a higher body mass index and greater satisfaction with their bodies. The highest number of STIs/HIV and IPV victimization was shown in non-Hispanic Black (NHB) and Hispanic individuals, respectively. However, NHB females' higher number of STIs/HIV was shown in the late/normative groups, not in the early-unempowered group. Among Hispanic females, adolescent sexual initiation patterns were not directly associated with their frequent IPV victimization.

Conclusion: NHB females' higher STI/HIV in late/normative groups and Hispanic females' frequent IPV victimization regardless of their sexual initiation patterns might indicate that racial/ethnic disparities in female sexual health was not directly determined by adolescent risk behaviors.
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http://dx.doi.org/10.1016/j.jpag.2020.11.005DOI Listing
November 2020

Cortical thickness and resting-state cardiac function across the lifespan: A cross-sectional pooled mega-analysis.

Psychophysiology 2020 Oct 10. Epub 2020 Oct 10.

Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Understanding the association between autonomic nervous system [ANS] function and brain morphology across the lifespan provides important insights into neurovisceral mechanisms underlying health and disease. Resting-state ANS activity, indexed by measures of heart rate [HR] and its variability [HRV] has been associated with brain morphology, particularly cortical thickness [CT]. While findings have been mixed regarding the anatomical distribution and direction of the associations, these inconsistencies may be due to sex and age differences in HR/HRV and CT. Previous studies have been limited by small sample sizes, which impede the assessment of sex differences and aging effects on the association between ANS function and CT. To overcome these limitations, 20 groups worldwide contributed data collected under similar protocols of CT assessment and HR/HRV recording to be pooled in a mega-analysis (N = 1,218 (50.5% female), mean age 36.7 years (range: 12-87)). Findings suggest a decline in HRV as well as CT with increasing age. CT, particularly in the orbitofrontal cortex, explained additional variance in HRV, beyond the effects of aging. This pattern of results may suggest that the decline in HRV with increasing age is related to a decline in orbitofrontal CT. These effects were independent of sex and specific to HRV; with no significant association between CT and HR. Greater CT across the adult lifespan may be vital for the maintenance of healthy cardiac regulation via the ANS-or greater cardiac vagal activity as indirectly reflected in HRV may slow brain atrophy. Findings reveal an important association between CT and cardiac parasympathetic activity with implications for healthy aging and longevity that should be studied further in longitudinal research.
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http://dx.doi.org/10.1111/psyp.13688DOI Listing
October 2020

Normative Values for Cardiopulmonary Exercise Stress Testing Using Ramp Cycle Ergometry in Children and Adolescents.

J Pediatr 2021 Feb 11;229:61-69.e5. Epub 2020 Sep 11.

Division of Cardiology, Exercise Physiology laboratory, Children's Hospital of Philadelphia, Philadelphia, PA.

Objectives: To provide sex, age, and race specific reference values for ramp cycle ergometer cardiopulmonary exercise test (CPET) in children in the US.

Study Design: Retrospective review was conducted of all cardiopulmonary CPET data from our Exercise Physiology Laboratory on healthy children and adolescents (6-18 years) with body mass index between the 5th and 95th percentiles and structurally normal hearts who performed a ramp cycle ergometry stress test between 1999 and 2015. Twenty-eight exercise variables were included: peak oxygen consumption, oxygen consumption at ventilatory anaerobic threshold, peak work rate, resting and peak heart rate and blood pressure, resting pulmonary function testing, and ventilatory responses to progressive exercise using breath-by-breath gas exchange. Owing to the nonlinear association between CPET results and age, fractional polynomials were used in the mixed-effects regression models to describe the sex- and age-specific normative values with 95% CIs, after adjusting for race and body mass index.

Results: We analyzed data on 1829 children (average age, 13.6 ± 2.6 years; 52% male). After 12 years of age, males generally had higher peak values for aerobic capacity and work rate. There were progressive increases with age for both sexes in resting pulmonary function and ventilatory response to exercise, peak aerobic and work rate, and oxygen pulse. Notably, there was an age-related decrease in ventilatory equivalents of oxygen and carbon dioxide at the ventilatory anaerobic threshold.

Conclusions: Future research using prospective, inclusive, and statistically planned cohorts with standardized laboratory approaches and confirmed interoperability should be considered as a focus for validating normative pediatric CPET values in the future.
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http://dx.doi.org/10.1016/j.jpeds.2020.09.018DOI Listing
February 2021

Association of neighborhood-level social determinants and food environments with pediatric hypertension care.

Health Place 2020 Sep 19;65:102383. Epub 2020 Aug 19.

Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. Electronic address:

Despite the apparent relationship between neighborhood characteristics and health, few studies of child health address neighborhood-level barriers, which may contribute to clinic no-show rates and difficulties following treatment plans in children and youth. We used longitudinal data from an outpatient hypertension clinic to examine neighborhood social disorganization, built environments, and their associations with patients' clinic attendance and the risk of obesity/hypertension using mixed-effects regression models. Patients from disorganized neighborhoods were less likely to attend a baseline visit, and more likely to develop overweight/obesity and hypertension during follow-up. High-level fast-food expenditures in the neighborhood were associated with higher BMI percentiles and SBP during follow-up.
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http://dx.doi.org/10.1016/j.healthplace.2020.102383DOI Listing
September 2020

The Impact of Early Recognition and Treatment of Systemic Hypertension on Reducing Blood Pressure: The Hypertension and Vascular Evaluation Program.

Clin Pediatr (Phila) 2020 10 1;59(11):970-977. Epub 2020 Jun 1.

Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.

This study aimed to evaluate the effect of an outpatient systemic hypertension program and associated factors with attending recommended follow-up visit. All visits were tracked in the program, 2011 to 2018. We examined patient characteristics by follow-up status and changes in systolic blood pressure (SBP) and the risk of hypertension in follow-up patients using a mixed-effects regression model. Among 310 patients with first visits, 113 patients returned for a follow-up visit. Patients who did not attend a follow-up were older and less likely to have a severe chronic condition or a family history of hypertension than followed-up patients. The risk of hypertension was significantly reduced by the number of follow-up visits (odds ratio = 0.53, 95% confidence interval = 0.31-0.92). Adolescent SBP and body mass index percentiles decreased with more follow-up visits. As the risk of hypertension is significantly reduced with follow-up visits, additional effort should be made to improve the likelihood of follow-up attendance.
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http://dx.doi.org/10.1177/0009922820927037DOI Listing
October 2020

Effectiveness of Mobile Health Interventions on Diabetes and Obesity Treatment and Management: Systematic Review of Systematic Reviews.

JMIR Mhealth Uhealth 2020 04 28;8(4):e15400. Epub 2020 Apr 28.

Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, United States.

Background: Diabetes and obesity have become epidemics and costly chronic diseases. The impact of mobile health (mHealth) interventions on diabetes and obesity management is promising; however, studies showed varied results in the efficacy of mHealth interventions.

Objective: This review aimed to evaluate the effectiveness of mHealth interventions for diabetes and obesity treatment and management on the basis of evidence reported in reviews and meta-analyses and to provide recommendations for future interventions and research.

Methods: We systematically searched the PubMed, IEEE Xplore Digital Library, and Cochrane databases for systematic reviews published between January 1, 2005, and October 1, 2019. We analyzed 17 reviews, which assessed 55,604 original intervention studies, that met the inclusion criteria. Of those, 6 reviews were included in our meta-analysis.

Results: The reviews primarily focused on the use of mobile apps and text messaging and the self-monitoring and management function of mHealth programs in patients with diabetes and obesity. All reviews examined changes in biomarkers, and some reviews assessed treatment adherence (n=7) and health behaviors (n=9). Although the effectiveness of mHealth interventions varied widely by study, all reviews concluded that mHealth was a feasible option and had the potential for improving patient health when compared with standard care, especially for glycemic control (-0.3% to -0.5% greater reduction in hemoglobin A) and weight reduction (-1.0 kg to -2.4 kg body weight). Overall, the existing 6 meta-analysis studies showed pooled favorable effects of these mHealth interventions (-0.79, 95% CI -1.17 to -0.42; I2=90.5).

Conclusions: mHealth interventions are promising, but there is limited evidence about their effectiveness in glycemic control and weight reduction. Future research to develop evidence-based mHealth strategies should use valid measures and rigorous study designs. To enhance the effectiveness of mHealth interventions, future studies are warranted for the optimal formats and the frequency of contacting patients, better tailoring of messages, and enhancing usability, which places a greater emphasis on maintaining effectiveness over time.
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http://dx.doi.org/10.2196/15400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7218595PMC
April 2020

HIV Testing Among Adolescents With Acute Sexually Transmitted Infections.

Pediatrics 2020 04 16;145(4). Epub 2020 Mar 16.

Craig Dalsimer Division of Adolescent Medicine and.

Background And Objectives: Rates of sexually transmitted infections (STIs) have increased over the decade. Guidelines recommend HIV testing with incident STIs. Prevalence and factors associated with HIV testing in acute STIs are unknown in adolescents. Our objective was to determine the prevalence of completed HIV testing among adolescents with incident STIs and identify patient and health care factors associated with HIV testing.

Methods: Retrospective study of STI episodes (gonorrhea, , trichomoniasis, or syphilis) of adolescents between 13 and 24 years old from July 2014 to December 2017 in 2 urban primary care clinics. We performed mixed effects logistic regression modeling to identify patient and health care factors associated with HIV testing within 90 days of STI diagnosis.

Results: The 1313 participants contributed 1816 acute STI episodes. Mean age at STI diagnosis was 17.2 years (SD = 1.7), 75% of episodes occurred in females, and 97% occurred in African Americans. Only half (55%) of acute STI episodes had a completed HIV test. In the adjusted model, female sex, previous STIs, uninsured status, and confidential sexual health encounters were associated with decreased odds of HIV testing. Patients enrolled in primary care at the clinics, compared with those receiving sexual health care alone, and those with multipathogen STI diagnoses were more likely to have HIV testing.

Conclusions: HIV testing rates among adolescents with acute STIs are suboptimal. Patient and health care factors were found to be associated with receipt of testing and should be considered in clinical practice.
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http://dx.doi.org/10.1542/peds.2019-2265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579673PMC
April 2020

Has the prevalence of overweight, obesity and central obesity levelled off in the United States? Trends, patterns, disparities, and future projections for the obesity epidemic.

Int J Epidemiol 2020 06;49(3):810-823

Johns Hopkins Weight Management Center, Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, MD, USA.

Background: Obesity (OB) is a serious epidemic in the United States.

Methods: We examined OB patterns and time trends across socio-economic and geographic parameters and projected the future situation. Large national databases were used. Overweight (OW), OB and severe obesity (SOB) were defined using body mass index cut-points/percentiles; central obesity (CO), waist circumference cut-point in adults and waist:height ratio cutoff in youth. Various meta-regression analysis models were fit for projection analyses.

Results: OB prevalence had consistently risen since 1999 and considerable differences existed across groups and regions. Among adults, men's OB (33.7%) and OW (71.6%) levelled off in 2009-2012, resuming the increase to 38.0 and 74.7% in 2015-2016, respectively. Women showed an uninterrupted increase in OB/OW prevalence since 1999, reaching 41.5% (OB) and 68.9% (OW) in 2015-2016. SOB levelled off in 2013-2016 (men: 5.5-5.6%; women: 9.7-9.5%), after annual increases of 0.2% between 1999 and 2012. Non-Hispanic Blacks had the highest prevalence in women's OB/SOB and men's SOB. OB prevalence in boys rose continuously to 20.6% and SOB to 7.5% in 2015-2016, but not in girls. By 2030, most Americans will be OB/OW and nearly 50% of adults OB, whereas ∼33% of children aged 6-11 and ∼50% of adolescents aged 12-19 will be OB/OW. Since 1999, CO has risen steadily, and by 2030 is projected to reach 55.6% in men, 80.0% in women, 47.6% among girls and 38.9% among boys. Regional differences exist in adult OB prevalence (2011-2016) and across ethnicities; South (32.0%) and Midwest (31.4%) had the highest rates.

Conclusions: US obesity prevalence has been rising, despite a temporary pause in 2009-2012. Wide disparities across groups and geographical regions persist. Effective, sustainable, culturally-tailored interventions are needed.
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http://dx.doi.org/10.1093/ije/dyz273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394965PMC
June 2020

A 3-year longitudinal study of effects of parental perception of children's ideal body image on child weight change: The Childhood Obesity Study in China mega-cities.

Prev Med 2020 03 30;132:105971. Epub 2019 Dec 30.

Global Health Institute, Xi'an Jiaotong University Health Science Center, China; School of Public Health, Xi'an Jiaotong University Health Science Center, China; Fisher Institute of Health and Well-Being, Department of Nutrition and Health Science, College of Health, Ball State University, USA. Electronic address:

This study examined prevalence of childhood overweight and obesity (ov/ob) and central obesity in five mega-cities across China (Beijing, Shanghai, Xi'an, Nanjing and Chengdu); described parental perceptions of children's ideal body image (IBI); and prospectively examined associations between parental perception of child IBI and child weight changes over 3 years. In this NIH-funded, open cohort study, data were collected from students and their parents in 2015, 2016 and 2017 (n = 3298, in 3 waves). Cross-sectional analysis included all 3298 children; longitudinal data analysis used mixed effects models and included 1691 children aged 6-17 years with ≥two body mass index (BMI) measurements during 2015-2017. Ov/ob prevalence based on Chinese age-sex-specific BMI cut-points was 30.0%. Based on waist-to-height ratio (WHtR), the abdominal obesity rate was 19.8%. Parents reported different preferred IBI for boys vs girls, being about 3 times more likely to select ov/ob as ideal for boys than for girls (4.5% vs 1.5%, respectively, P < .001). In longitudinal analysis, children whose parents selected ov/ob as ideal had higher BMI Z-scores and WHtR increase over time than those whose parents selected an average body image (β [SE] = 0.042 [0.011], and β [SE] = 0.010 [0.004], respectively, all P < .05). Ov/ob rates were high among children in major cities in China. Chinese parents preferred a heavier ideal body image for their boys. Health promotion programs should help empower parents and their children to develop appropriate body images and maintain healthy body weight.
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http://dx.doi.org/10.1016/j.ypmed.2019.105971DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7024657PMC
March 2020

Disease Burdens and Risk Factors for Diabetes, Hypertension, and Hyperlipidemia among Refugees in Buffalo, New York, 2004-2014.

J Health Care Poor Underserved 2019 ;30(3):1119-1131

Introduction: Limited is known about prevalence and risk factors for diabetes, hypertension, and hyperlipidemia among refugees.

Methods: At a refugee clinic in Buffalo, N.Y. (2004-2014), 1,570 adults were studied using multivariate logistic regression.

Results: Prevalences of diabetes, hypertension, and hyperlipidemia were 7.8%, 24.1%, and 27.1%, respectively. Among refugees, 49.2% of diabetes and 46.7% of hypertension were uncontrolled. Obesity (odds ratio [OR]=2.49; 95% confidence interval [CI]=1.61-3.85) and length of stay (OR=1.25; 95%CI=1.16-1.35) were risk factors for diabetes. Eastern European origin (OR=4.09; 95%CI=2.00-8.38), obesity (OR=2.62; 95%CI=1.92-3.58), length of follow-up (OR=1.06; 95%CI=1.00-1.12), gender (OR=0.59; 95%CI=0.44-0.78) and tobacco use (OR=1.54; 95%CI=1.00-2.38) were associated with hypertension. Age (OR=1.02; 95%CI=1.01-1.04) was associated with hyperlipidemia.

Conclusions: Refugees had comparable burden of non-communicable diseases, but a greaterleast once during the study period proportion of refugees than of the U.S. population had uncontrolled conditions. Duration of follow-up, obesity, tobacco use, gender, age, and region of origin were risk factors for diagnosis. Culturally-tailored chronic disease management strategies are needed.
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http://dx.doi.org/10.1353/hpu.2019.0077DOI Listing
April 2020

NASA Mission X Program for Healthy Eating and Active Living among Taiwanese Elementary School Students.

J Pediatr Nurs 2019 Nov - Dec;49:e8-e14. Epub 2019 Jul 12.

Department of Nursing, Mackay Medical College, New Taipei City, Taiwan. Electronic address:

Purpose: This study assessed the effects of an intervention program adapted from the NASA Mission X (MX) program on children's Healthy Eating Active Living (HEAL) knowledge and behaviors and anthropometry.

Methods: This clustered randomized control trial recruited 8 elementary schools in remote rural areas of Northern Taiwan. The intervention was the 8-week MX program. All the 3rd and 4th graders were invited to the study (n = 245). Children's weight, height, HEAL knowledge and behaviors were measured pre- and post-intervention.

Results: The intervention group had significantly more improvements than control group in physical activity knowledge score (+0.91 vs. +0.25, p = 0.002), diet knowledge score (+0.62 vs. +0.17, p = 0.044), and score of interests in NASA and space exploration (+0.34 vs. -0.07, p < 0.0001). BMI increased from 18.4 to 18.6 (p < 0.05) for the control group but did not change for the intervention group. The changes in BMI between groups did not differ significantly.

Conclusion And Practice Implications: This randomized controlled trial showed that the NASA MX program was feasible and acceptable among children in Taiwan, and improved children's HEAL knowledge. (ClinicalTrials.gov registration: NCT03355131).
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http://dx.doi.org/10.1016/j.pedn.2019.06.016DOI Listing
July 2020

Mismatch in Children's Weight Assessment, Ideal Body Image, and Rapidly Increased Obesity Prevalence in China: A 10-Year, Nationwide, Longitudinal Study.

Obesity (Silver Spring) 2018 11 3;26(11):1777-1784. Epub 2018 Oct 3.

Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, Indiana, USA.

Objective: This study examined secular trends in children's weight-status assessment, measured weight status, and ideal body image and their associations with subsequent changes in BMI, and it explored the differences between sociodemographic groups in China.

Methods: Longitudinal data from the China Health and Nutrition Survey of 4,605 children aged 6 to 17 collected between 2000 and 2011 were used and fitted to mixed models.

Results: From 2000 to 2011, overweight/obesity prevalence increased from 6.5% to 16.8%, but the percentage of children with self-perceived weight status as "fat" remained around 2.0%; 49.0% of children underestimated their weight status at baseline. Self-perceived body image of most participants was tracked during follow-up. Children who perceived themselves as being fat at baseline had a higher BMI increase over time during follow-up than those with an average body image (β [SE] = 0.99 [0.14] kg/m per year, P < 0.001). Boys, young children, recent cohorts, and rural children had higher BMI increases than their counterparts. Over time, the thin-body silhouette became more desirable (8.4 percentage points higher, P < 0.001).

Conclusions: Chinese children experience a large incongruence between their weight-status assessment, ideal body image, and actual weight status. Health promotion programs should examine their role in assisting children in developing a healthy body image and gaining greater self-motivation toward promoting a healthy lifestyle.
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http://dx.doi.org/10.1002/oby.22310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202186PMC
November 2018

Americans' Perceptions about Fast Food and How They Associate with Its Consumption and Obesity Risk.

Adv Nutr 2018 Sep;9(5):590-601

Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-being, College of Health, Ball State University, Muncie, IN.

We aimed to systematically examine Americans' perceptions of fast food (FF) and how these perceptions might affect fast food consumption (FFC) and obesity risk. We searched PubMed and Google for studies published in English until February 17, 2017 that reported on Americans' perceptions (defined as their beliefs, attitudes, and knowledge) regarding FF as well as those on their associations with FFC and obesity risk. Thirteen articles met inclusion criteria. Limited research has been conducted on these topics, and most studies were based on convenience samples. A 2013 nationally representative phone survey of about 2000 subjects showed that one-fifth of Americans thought FF was good for health, whereas two-thirds considered FF not good. Even over two-thirds of weekly FF consumers (47% of the total population) thought FF not good. Americans seem to have limited knowledge of calories in FF. Negative and positive FF perceptions were associated with FFC. Those who consumed less FF seemed more likely to view FF negatively. When Americans valued the convenience and taste of FF and preferred FF restaurants with kid's menus and play areas, they were likely to purchase more FF. Available research indicates neither perceived availability of FF nor Geographical Information System (GIS)-based FF presence in the neighborhood has significant associations with weekly FFC. No studies examined potential links between FF perceptions and obesity risk. Americans' perceptions of FF and how they might associate with FFC and obesity risk are understudied. Considerable variation was observed in Americans' perceptions and FFC.
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http://dx.doi.org/10.1093/advances/nmy032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140449PMC
September 2018

Ethnic disparities in childhood BMI trajectories and obesity and potential causes among 29,250 US children: Findings from the Early Childhood Longitudinal Study-Birth and Kindergarten Cohorts.

Int J Obes (Lond) 2018 09 15;42(9):1661-1670. Epub 2018 Jun 15.

Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-being, College of Health, Ball State University, Muncie, IN, USA.

Background/objectives: Study sex- and ethnic-specific childhood BMI growth trajectories of US children, and explore the potential causes of ethnic disparities in childhood BMI trajectories, including household socio-economic status (SES) and parenting practice using nationally representative longitudinal data.

Subjects/methods: BMI trajectory curves between 7 months to 16 years of age were fitted using mixed effect models with fractional polynomial functions using pooled 10-year (1998-2008) longitudinal data collected from 29,254 children from two US nationally representative cohorts-Early Childhood Longitudinal Study-Birth (ECLS-B, 2001) and Kindergarten (ECLS-K, 1998-99). A multivariable regression model was used to examine the effects of SES and parenting factors on ethnic disparities in childhood BMI trajectory.

Results: Hispanic boys (HB) and African-American girls (AAG) continuously had the highest prevalence of overweight and obesity (HB: 52.5%, AAG: 49.1% around age of 11) and mean BMI after adiposity rebound than their counterparts. They had the earliest adiposity rebound (age mean [SD]: HB- 57.9 [7.8]; AAG- 59.0 [7.2] months), steeper BMI growth velocity (HB- 5.7 [1.8]; AAG- 7.0 [1.5] 10 kg/m/month), and highest area under curve (HB- 2724.5 [489.8]; AAG- 2681.2 [426.7] kg/m*month) from adiposity rebound to 16 years of age. The racial/ethnic disparities in childhood BMI trajectories were associated with household SES and family rules for children's regular bedtime (p < 0.05).

Conclusions: In the US, ethnic disparities in childhood BMI trajectories and obesity are apparent starting from adiposity rebound around age of five. Some minority groups have unfavorable BMI trajectories. These disparities are partially explained by household SES and parenting factors.
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http://dx.doi.org/10.1038/s41366-018-0091-4DOI Listing
September 2018

Burden of Mental Illness and Non-communicable Diseases and Risk Factors for Mental Illness Among Refugees in Buffalo, NY, 2004-2014.

J Racial Ethn Health Disparities 2019 02 21;6(1):56-63. Epub 2018 May 21.

Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-being, College of Health, Ball State University, Muncie, IN, USA.

Introduction: Limited is known about mental illness and non-communicable diseases (NCDs) and their risk factors among refugees. These were studied using data collected from a refugee population in Buffalo, NY.

Methods: Longitudinal data collected on 1055 adults (> 18 years) at a large refugee health center in Buffalo, NY, during 2004-2014 were used. Main outcomes were hypertension, diabetes, tobacco use, obesity, overweight/obesity, and mental illness. Risk factors were assessed using multivariate regression models.

Results: Compared to those without mental illness, refugees with mental illness had higher rates of hypertension (16.9 vs 28.4%, P < 0.001), diabetes (8.4 vs 13.6%, P = 0.03), tobacco use (9.3 vs 18.3%, P < 0.001), obesity (13.0 vs 25.4%, P < 0.001), and overweight/obesity rates (45.0 vs 61.5%, P < 0.001). During 2004-2014, obesity rates increased among those with mental illness (25.4 to 36.7%, P < 0.001) and without mental illness (13.0 to 24.5%, P < 0.001). The overall mental illness prevalence among refugees was 16%, ranging from 6.9% among Asians to 43.9% among Cubans. Women were more likely to have mental illness (odds ratio = 2.45; 95% confidence interval [CI] = 1.68-3.58) than men. Refugees who lived longer in the USA were more likely to carry psychiatric diagnoses (OR = 1.12; 95% CI = 1.04-1.21).

Conclusion: Mental illness rates varied considerably across various refugee groups. Rates of obesity and NCDs among refugees with mental illness were higher than among those without mental disorders. Gender, region of origin, and length of stay in the USA were associated with mental illness. Accurate and culturally sensitive screenings and assessments of mental illness are needed to reduce these health disparities.
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http://dx.doi.org/10.1007/s40615-018-0498-6DOI Listing
February 2019

A kindergarten-based child health promotion program: the Adapted National Aeronautics and Space Administration (NASA) Mission X for improving physical fitness in South Korea.

Glob Health Promot 2019 12 23;26(4):52-61. Epub 2018 Mar 23.

Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-Being, College of Health, Ball State University, USA.

Background: Effective and sustainable intervention programs are needed to promote physical activity (PA) in children.

Objectives: To adapt the NASA Mission X: Train Like an Astronaut program for use with South Korean children, and to evaluate its feasibility and effectiveness for promoting children's physical fitness.

Methods: Children 5 years old ( = 212) and their parents were recruited from three kindergartens in three cities to participate in a 6-week intervention program in fall 2014. We assessed the children's PA and related changes, and parental changes in attitude and beliefs, after participation in the intervention.

Results: Girls reported less PA than boys (40.7 vs. 59.0, < 0.01). Children with a normal body mass index (BMI) were more likely to be active than underweight children (< 10 percentile) or overweight children (⩾ 85 percentile). After the intervention, about one-half of the children had increased their level of PA (49.4%), increased interest in PA (59.1%) and found psychological need satisfaction in exercise (52.6%). The majority of parents became aware of the necessity of childhood PA (94.2%), their child's PA capability (64.3%), and the relationship of PA with their children's self-esteem (79.9%).

Conclusions: The adapted NASA Mission X program was feasible and effective in promoting PA in kindergarteners, and also improved their parents' attitude and beliefs about children's PA in South Korea. This study provided a model for promoting childhood health through child care and educational settings.
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http://dx.doi.org/10.1177/1757975918760517DOI Listing
December 2019

What factors may contribute to sex differences in childhood obesity prevalence in China?

Public Health Nutr 2018 08 26;21(11):2056-2064. Epub 2018 Feb 26.

2Systems-oriented Global Childhood Obesity Intervention Program,Fisher Institute of Health and Well-being,College of Health,Ball State University,Muncie, IN,USA.

Objective: Previous studies in China showed large sex differences in childhood overweight and obesity (OW/OB) rates. However, limited research has examined the cause of these sex differences. The present study aimed to examine individual and parental/familial factors associated with sex differences in childhood OW/OB rates in China.

Design: Variables associated with child weight status, beliefs and behaviours, and obesity-related parenting practices were selected to examine their sex differences and association with a sex difference in child OW/OB outcomes using logistic regression analysis.

Setting: Cross-sectional data analysis using the 2011 China Health and Nutrition Survey.

Subjects: Children aged 6-17 years (n 1544) and their parents.

Results: Overall child OW/OB prevalence was 16·8 %. Adolescent boys (AB; 12-17 years) were about twice as likely to be overweight/obese as adolescent girls (AG; 15·5 v. 8·4 %, P<0·05). AB more likely had energy intake exceeding recommendations, self-perceived underweight, underestimated their body weight and were satisfied with their physical activity level than AG. AG more likely practised weight-loss management through diet and self-perceived overweight than AB. Mothers more likely identified AG's weight accurately but underestimated AB's weight. Stronger associations with risk of childhood OW/OB were found in boys than girls in dieting to lose weight (OR=6·7 in boys v. 2·6 in girls) and combined maternal and child perception of the child's overweight (OR=35·4 in boys v. 14·2 in girls).

Conclusions: Large sex differences in childhood obesity may be related to the sex disparities in weight-related beliefs and behaviours among children and their parents in China.
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http://dx.doi.org/10.1017/S1368980018000290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6062478PMC
August 2018

Obesity, body image, and its impact on children's eating and exercise behaviors in China: A nationwide longitudinal study.

Prev Med 2018 01 21;106:101-106. Epub 2017 Oct 21.

Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-Being, College of Health, Ball State University, USA; Department of Nutrition and Health Sciences, College of Health, Ball State University, USA. Electronic address:

Body image seems to mediate the association between obesity and health behaviors as well as weight control attempts. We examined the distribution of children's body image by demographic characteristics and their subsequent associations with eating, exercise, and weight change. Child body image and health behaviors from the China Health National Survey 2000-2011 were assessed at baseline and in follow-up for 6- to 17-year-old children during 2000-2011 using mixed models. There was a large discrepancy between children's actual weight status (overweight: 16.9%) vs. self-rated body image (fat: 2.4% in 2011). Less than 1% of children desired a fat body; girls were more likely to want to be thin (52.5% vs. 40.9%) than boys. About 11% of children needed to lose weight in order to be at their desired baseline. During follow-up, those needing weight loss to be as desired were more likely to attempt dieting to change their weight (OR, 95% CI=1.9, 1.1-3.5 in boys; 1.7, 1.1-2.5 in girls) and less likely to feel they had enough physical activity (OR, 95% CI=0.5, 0.4-0.7 in boys; 0.6, 0.5-0.9 in girls), although their weight gain had been significantly higher than those having consistent self and desired body images (β [SE]=0.4 [0.1] in boys; 0.2 [0.1] in girls, all p<0.05). However, no significant difference was shown in subsequent health behaviors among overweight children by body image discrepancy. The discrepancy in self vs. desired body image motivated children to change their obesity-related health behaviors among non-overweight children in China.
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http://dx.doi.org/10.1016/j.ypmed.2017.10.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5962018PMC
January 2018

Double burden of diseases worldwide: coexistence of undernutrition and overnutrition-related non-communicable chronic diseases.

Obes Rev 2018 Jan 22;19(1):49-61. Epub 2017 Sep 22.

Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-being, College of Health, Ball State University, Muncie, IN, USA.

Objective: This systematic examination and meta-analysis examined the scope and variation of the worldwide double burden of diseases and identified related socio-demographic factors.

Design: We searched PubMed for studies published in English from January 1, 2000, through September 28, 2016, that reported on double disease burden. Twenty-nine studies from 18 high-income, middle-income and low-income countries met inclusion criteria and provided 71 obesity-undernutrition ratios, which were included in meta-regression analysis.

Results: All high-income countries had a much higher prevalence of obesity than undernutrition (i.e. all the obesity/undernutrition ratios >1); 55% of the ratios in lower middle-income and low-income countries were <1, but only 28% in upper middle-income countries. Meta-analysis showed a pooled obesity-undernutrition ratio of 4.3 (95% CI = 3.1-5.5), which varied by country income level, subjects' age and over time. The average ratio was higher in high-income rather than that in lower middle-income and low-income countries (β [SE] = 10.8 [2.6]), in adults versus children (7.1 [2.2]) and in data collected since 2000 versus before 2000 (5.2 [1.5]; all P values < 0.05).

Conclusions: There are considerable differences in the obesity versus undernutrition ratios and in their prevalence by country income level, age groups and over time, which may be a consequence of the cumulative exposure to an obesogenic environment.
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http://dx.doi.org/10.1111/obr.12605DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5962023PMC
January 2018

Brain structural concomitants of resting state heart rate variability in the young and old: evidence from two independent samples.

Brain Struct Funct 2018 Mar 18;223(2):727-737. Epub 2017 Sep 18.

Department of Psychology, The Ohio State University, Columbus, OH, USA.

Previous research has shown associations between brain structure and resting state high-frequency heart rate variability (HF HRV). Age affects both brain structure and HF HRV. Therefore, we sought to examine the relationship between brain structure and HF HRV as a function of age. Data from two independent studies were used for the present analysis. Study 1 included 19 older adults (10 males, age range 62-78 years) and 19 younger adults (12 males, age range 19-37). Study 2 included 23 older adults (12 males; age range 55-75) and 27 younger adults (17 males; age range 18-34). The root-mean-square of successive R-R-interval differences (RMSSD) from ECG recordings was used as time-domain measure of HF HRV. MRI scans were performed on a 3.0-T Siemens Magnetom Trio scanner. Cortical reconstruction and volumetric segmentation were performed with the Freesurfer image analysis suite, including 12 regions as regions of interests (ROI). Zero-order and partial correlations were used to assess the correlation of RMSSD with cortical thickness in selected ROIs. Lateral orbitofrontal cortex (OFC) cortical thickness was significantly associated with RMSSD. Further, both studies, in line with previous research, showed correlations between RMSSD and anterior cingulate cortex (ACC) cortical thickness. Meta-analysis on adjusted correlation coefficients from individual studies confirmed an association of RMSSD with the left rostral ACC and the left lateral OFC. Future longitudinal studies are necessary to trace individual trajectories in the association of HRV and brain structure across aging.
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http://dx.doi.org/10.1007/s00429-017-1519-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5828882PMC
March 2018

Parenting practices and overweight status of junior high school students in China: A nationally representative study of 19,487 students from 112 schools.

Prev Med 2018 02 14;107:1-7. Epub 2017 Sep 14.

Systems-oriented Global Childhood Obesity Intervention Program, Department of Epidemiology and Environmental Health, The State University of New York at Buffalo, USA; Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-being, College of Health, Ball State University, USA; Department of Nutrition and Health Sciences, College of Health, Ball State University, USA. Electronic address:

The study aimed to examine the level of parental responsiveness and demandingness for junior high students in China and its association with child weight status; assess if it differs by student socio-demographic characteristics; and to test the association between parenting and child physical activity. Nationally representative survey data collected from 19,487 students in 112 middle schools across China in 2013-2014 academic year were analyzed in 2016. Children's anthropometrics and perceptions of parenting practices were accessed by self-administered questionnaire. Multilevel logistic regression models were fit to test the association controlling for child age, sex, school region, and parental education. The majority of adolescents reported their parents were highly responsive in terms of emotional support and involvement (high: 64.1% vs. low: 9.2%), although more parents were not perceived as highly demanding (high: 21.4% vs. low: 35.5%). Children were more likely to be overweight or obese if their parents were highly responsive (OR=1.4 [95%CI: 1.2,1.6]) and demanding (OR=1.1 [95%CI: 1.0,1.3]) compared to those with medium parenting scores. Older children, boys, children with highly educated parents, or in urban schools had greater odds of being overweight or obese by receiving highly responsive parenting compared to their counterparts. Children with highly demanding or responsive parenting had longer physical activity duration and higher physical activity participation rates than their counterparts. High responsiveness and demandingness among Chinese parents were associated with the risk of child overweight and obesity. Further research is needed to examine the causal relationship between parenting practices and childhood obesity in China.
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http://dx.doi.org/10.1016/j.ypmed.2017.09.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6752200PMC
February 2018

An Evaluation of the Effectiveness of the National Aeronautics and Space Administration Mission-X Child Health Promotion Program in the United States.

Am J Health Promot 2018 07 13;32(6):1333-1339. Epub 2017 Sep 13.

1 Systems-oriented Global Childhood Obesity Intervention Program, Department of Epidemiology and Environmental Health, The State University of New York at Buffalo, Buffalo, NY, USA.

Purpose: To examine the effects of the National Aeronautics and Space Administration Mission-X: Train Like an Astronaut program (MX) on children's health-related knowledge and behaviors of a sample of US participants.

Design: A nonexperimental pilot intervention study in 5 cities with a pre-post comparison of children's health-related knowledge and behaviors in the United States in 2014 and 2015.

Sample: Children (n = 409) with a mean age (standard deviation) of 10.1 (1.7) years.

Measures: Children answered pre- and postintervention questionnaires. We measured the differences in children's health knowledge on nutrition and physical fitness and behaviors on diet and physical activity as scores.

Intervention: A 6-week web- and school-based intervention for a healthier lifestyle by introducing physical fitness and science activities based on actual astronaut training under a teacher's supervision.

Analysis: Nonparametric analysis and logistic regression models.

Results: Participants significantly improved both of their health behaviors on physical activity ( P < .001) and diet ( P = .06) and their health knowledge regarding nutrition ( P < .001) and physical fitness ( P < .001) after the intervention. The improvement in children's behaviors ( P < .001), knowledge ( P < .001), and the total score ( P < .001) after intervention did not significantly vary by sex or age, after adjusting for year of participation and state of residency.

Discussion: The MX seems effective in improving health behaviors and health knowledge of participating children, which may serve as a model for sustainable global child health promotion program. Further research is needed to test its long-term effects on child health.
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http://dx.doi.org/10.1177/0890117117723959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6749986PMC
July 2018

Are single children more likely to be overweight or obese than those with siblings? The influence of China's one-child policy on childhood obesity.

Prev Med 2017 Oct 21;103:8-13. Epub 2017 Jul 21.

Systems-oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-being, College of Health, Ball State University, USA; Systems-oriented Global Childhood Obesity Intervention Program, Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY, USA; Department of Nutrition and Health Sciences, College of Health, Ball State Universty, USA. Electronic address:

China's one-child policy (1979-2015) has affected Chinese parenting practices and children's health behaviors and also may have contributed to increased childhood obesity. However, very limited research has investigated the association between one-child policy and childhood obesity. We examined characteristics of single-child families and the influence of one-child policy (indicated by single-child status) on children's weight status and related health behaviors. Data from children aged 6-18years old in the 2011 (n=1580) and 2000 (n=2317) China Health and Nutrition Survey were cross-sectionally analyzed with multilevel models. From 2000 to 2011, the rates about doubled for being a single-child (30.1% to 57.0%) and being overweight or obese (OWB, 6.6% to 16.5%) along with urbanization (27.5% to 37.1%). Single-child families had higher levels of parental education, household income and urban residence than families with ≥ two children (p<0.05). Compared to the children with siblings, single children were more likely to be OWB; the association became stronger over time (OR=4.5 (1.7-12.4) in 2011 and 1.7 (1.0-2.8) in 2000). Also, single children had less recreational screen time, but similar physical activity levels; however single urban children were more likely to have excess total energy intake (OR=5.70 (1.58-20.60)) than those with siblings. Being single-child is about four times more likely to be overweight/obesity than those having siblings, and the association became stronger over time in China. China's one-child policy might have contributed to its rising childhood obesity rates. Obesity intervention programs may need to account for the influence of the one-child policy in China.
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http://dx.doi.org/10.1016/j.ypmed.2017.07.018DOI Listing
October 2017

Maternal perception of child overweight status and its association with weight-related parenting practices, their children's health behaviours and weight change in China.

Public Health Nutr 2017 Aug 6;20(12):2096-2103. Epub 2017 Jun 6.

1Systems-oriented Global Childhood Obesity Intervention Program,Fisher Institute of Health and Well-Being,College of Health,Ball State University,HP 302C,Muncie,IN 47306,USA.

Objective: Childhood obesity has increased rapidly in China, but understanding is limited on how parents perceive their child's weight status and how this perception affects weight-related parenting practices. We examined maternal perception of her child's weight status and its association with demographics, subsequent weight-related parenting practices, the child's health behaviours and weight change. Design/Setting/Subjects Maternal perception of child's weight status and health behaviours from the China Health and Nutrition Surveys were assessed at baseline and in follow-up surveys for 816 children aged 6-18 years during 2004-2011. Associations were tested using mixed models.

Results: Overall, maternal and child perceptions of the child's weight status were fairly consistent (κ w=0·56), 63·8 % of mothers had correct perception. While 9·6 % of mothers perceived their child as overweight, 10·9 % of children did so, and 13·6 % of children were indeed overweight. Compared with mothers who viewed their children as normal weight, mothers who thought their children were overweight were more likely to encourage their children to increase their physical activity (OR; 95 % CI: 1·8; 1·0, 3·3) and to diet (4·3; 2·3, 7·8). Children perceived as overweight by their mothers were more likely to have insufficient physical activity (2·8; 1·6, 4·7) and gain more weight during follow-up (BMI Z-score, β (se): 1·0 (0·1); P<0·01) than children perceived by their mothers as normal weight.

Conclusions: In China, mothers who perceive their child as overweight are more likely to encourage their child to exercise and modify their diet for weight management, but this encouragement does not seem to improve the child's health behaviours and weight status.
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http://dx.doi.org/10.1017/S1368980017001033DOI Listing
August 2017

A Systematic Examination of the Association between Parental and Child Obesity across Countries.

Adv Nutr 2017 May 15;8(3):436-448. Epub 2017 May 15.

Systems-Oriented Global Childhood Obesity Intervention Program, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY; and.

Childhood obesity has become a global epidemic. Parents can have an important influence on their children's health behaviors and weight status. Many studies have examined the association between parental and childhood weight status. However, much heterogeneity between studies exists, and the parent-child (P-C) association in obesity has varied. The purpose of this systematic examination and meta-analysis was to examine the strength and variation of the P-C association in obesity and to identify factors (e.g., demographic characteristics and country's economic level) that may influence this association. PubMed was searched for relevant studies published between January 2000 and July 2015. Thirty-two studies from 21 countries met inclusion criteria; 27 reported ORs for the P-C obesity association and were included in a meta-analysis. The meta-analysis showed a strong P-C obesity association (pooled OR: 2.22; 95% CI: 2.09, 2.36), which varied by type of P-C pair (i.e., parents-child, father-child, and mother-child), child age, parent and child weight status, and the country's economic level. Stronger associations were shown in older children than in younger children (β ± SE: 0.02 ± 0.01), in both parents than in father only (β ± SE: 0.51 ± 0.11) or mother only (β ± SE: 0.38 ± 0.11), in parental obesity (β ± SE: 0.26 ± 0.10) and child obesity (β ± SE: 0.28 ± 0.12) than in parental and child overweight, and in high- than in middle-income countries (β ± SE: 0.23 ± 0.08). Thus, research from multiple countries shows significant P-C associations in weight status, but this association varies by child age, type of P-C pair, weight status, and the country's economic level. Results suggest that families and parents should be a key target for obesity intervention efforts.
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http://dx.doi.org/10.3945/an.116.013235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5421118PMC
May 2017