Validating the nonparental adult inventory (NPAI) for mental health assessment and research.

Survey data collected from 518 parent-adolescent dyads were used to examine the psychometric properties of the NonParental Adult Inventory (NPAI). Test-retest reliability, internal reliability, and factor structure were examined. Reliability analyses indicate adequate to good test-retest reliability and internal consistency. Exploratory and confirmatory factor analyses support three-factor models that differ for parent and adolescent samples, both of which explain approximately 54 % of the variance. The NPAI reveals a three-factor structure that clearly differentiates between related and nonrelated adults in both adolescent and parent samples. This scale may be useful to both practitioners in assessment procedures and researchers for use in multivariate analyses.

A confirmatory factor analysis of the metabolic syndrome in adolescents: an examination of sex and racial/ethnic differences.

OBJECTIVE: The metabolic syndrome (MetS) is a cluster of clinical indices that signals increased risk for cardiovascular disease and Type 2 diabetes. The diagnosis of MetS is typically based on cut-off points for various components, e.g. waist circumference and blood pressure. Because current MetS criteria result in racial/ethnic discrepancies, our goal was to use confirmatory factor analysis to delineate differential contributions to MetS by sub-group. RESEARCH DESIGN AND METHODS: Using 1999-2010 data from the National Health and Nutrition Examination Survey (NHANES), we performed a confirmatory factor analysis of a single MetS factor that allowed differential loadings across sex and race/ethnicity, resulting in a continuous MetS risk score that is sex and race/ethnicity-specific. RESULTS: Loadings to the MetS score differed by racial/ethnic and gender subgroup with respect to triglycerides and HDL-cholesterol. ROC-curve analysis revealed high area-under-the-curve concordance with MetS by traditional criteria (0.96), and with elevations in MetS-associated risk markers, including high-sensitivity C-reactive protein (0.71), uric acid (0.75) and fasting insulin (0.82). Using a cut off for this score derived from ROC-curve analysis, the MetS risk score exhibited increased sensitivity for predicting elevations in ≥2 of these risk markers as compared with traditional pediatric MetS criteria. CONCLUSIONS: The equations from this sex- and race/ethnicity-specific analysis provide a clinically-accessible and interpretable continuous measure of MetS that can be used to identify children at higher risk for developing adult diseases related to MetS, who could then be targeted for intervention. These equations also provide a powerful new outcome for use in childhood obesity and MetS research.

But I trust my teen: parents' attitudes and response to a parental monitoring intervention.

Parental knowledge gained from monitoring activities protects against adolescent risk involvement. Parental monitoring approaches are varied and may be modified with successful interventions but not all parents or adolescents respond to monitoring programs the same way. 339 parent-adolescent dyads randomized to receive a parental monitoring intervention and 169 parent-adolescent dyads in the control group were followed for one year over four measurement periods. Parent attitudes about the usefulness of monitoring, the importance of trust and respecting their teens' privacy, and the appropriateness of adolescent risk-taking behavior and experimentation were examined as predictors of longitudinal change in parental monitoring and open communication. Similar effects were found in both the intervention and control group models regarding open communication. Parental attitudes impacted longitudinal patterns of teen-reported parent monitoring, and these patterns differed across experimental groups. In the intervention group, parents' beliefs about the importance of trust and privacy were associated with a steeper decline in monitoring across time. Finally, parents' attitudes about the normative nature of teen experimentation were associated with a quadratic parental monitoring time trend in the intervention but not the control group. These findings suggest that parental attitudes may impact how families respond to an adolescent risk intervention.

Is parent and child weight status associated with decision making regarding nutrition and physical activity opportunities?

The objective of this study was to evaluate parents' versus children's level of decision making in regards to healthy eating and physical activity practices and how it relates to weight status. Cross-sectional parent responses to a series of visual analog items assessed the level of both parent and child involvement in decisions related to nutrition and physical activity. Participants included parent-kindergarten student cohorts in West Virginia from 2007 to 2009 (n=634). Mean nutrition and physical activity decision making scores were compared across four groups of parent and child weight status combinations. The results indicated that parents described equal involvement of the parent and child in nutrition and activity decisions within the home. Within families where the parent and/or the child were obese, parents reported more involvement of the child in nutritional decisions. Families with an obese parent and an obese child reported the highest level of child involvement in these types of decisions. In summary, this study found that families share involvement in decisions but greater child involvement may be associated with adult and/or child obesity. At least for younger children, decisions may prove healthier if parents have an equal or greater amount of input in the decisions related to healthy lifestyle choices.

Health behaviors of native Hawaiian and Pacific Islander adults in California.

Smoking, diet and physical activity are associated with chronic diseases, but representative prevalence data on these behaviors for Native Hawaiian and Pacific Islander (NHPI) adults are scarce. Data from the 2005 California Health Interview Survey were analyzed for self-identified NHPI and non-Hispanic white (NHW) adults. Ethnic and NHPI gender differences were examined for socio-demographic variables, obesity and health behaviors. Compared to NHW, NHPI displayed higher prevalence of obesity (p<0.001), smoking (p<0.05) and consumption of unhealthy foods and beverages (p<0.05). NHPI males were more likely than females to smoke (p<0.001). NHPI adults appear to be at higher risk for chronic disease than NHW due to obesity, smoking and intake of unhealthy foods and beverages. Culturally-specific health promotion interventions are needed to reduce risks among the underrepresented NHPI population.

Adaptation and cognitive testing of physical activity measures for use with young, school-aged children and their parents.

BACKGROUND: Increasing physical activity is one way to address the public health concern of childhood obesity. Physical activity measures for use with young, school-aged children are limited. METHODS: This study adapted two existing activity measures for young children, specifically self-efficacy and 7-day recall of physical activity. RESULTS: Through expert review and cognitive testing, the scales were adapted for use with young, school-aged children (ages 7-9). This article describes how the measures were adapted to insure comprehension of the child self-report measures. Reliability analyses provide support for their use in this population [Cronbach's alpha = 0.76 for the self-efficacy scale; moderate correlation between parent report and child report of child physical activity over the past week (rho = 0.52, P < 0.01]. CONCLUSIONS: Suggestions are offered for researchers interested in using similar methods when designing and adapting physical activity measures for new populations.

Metabolic abnormalities in children with asthma.

RATIONALE: Childhood asthma and obesity have reached epidemic proportions worldwide, and the latter is also contributing to increasing rates of related metabolic disorders, such as diabetes. Yet, the relationship between asthma, obesity, and abnormal lipid and glucose metabolism is not well understood, nor has it been adequately explored in children. OBJECTIVES: To analyze the relationship between asthma diagnosis and body mass in children across the entire range of weight percentile categories, and to test the hypothesis that early derangement in lipid and glucose metabolism is independently associated with increased risk for asthma. METHODS: Cross-sectional analysis of a representative sample of public school children from a statewide community-based screening program, including a total of 17,994 children, 4 to 12 years old, living in predominantly rural West Virginia, and enrolled in kindergarten, second, or fifth grade classrooms. MEASUREMENTS AND MAIN RESULTS: We analyzed demographics; family history; smoke exposure; parent-reported asthma diagnosis; body mass index; evidence of acanthosis nigricans as a marker for developing insulin resistance; and fasting serum lipid profile including total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. Regardless of their body mass index percentile, children diagnosed with asthma were more likely than children without asthma to have higher triglyceride levels and acanthosis nigricans after controlling for sex differences and smoke exposure. CONCLUSIONS: This study provides the first set of community-based data linking asthma, body mass, and metabolic variables in children. In particular, these findings uniquely describe a statistically significant association between asthma and abnormal lipid and glucose metabolism beyond body mass index associations.

Morbidly obese diagnosis as an indicator of cardiovascular disease risk in children: results from the CARDIAC Project.

OBJECTIVE: Obesity, an epidemic in children in the United States and abroad, is associated with risk factors for cardiovascular disease (CVD). Less is known about the consequences of morbid obesity in children. In the rural Appalachian population, obesity rates have reached such high proportions that it is difficult to target individual children. Consequently, there is a need to determine whether the morbid obesity category is useful for recommending comprehensive assessment and intervention for the highest risk children. Results from the Coronary Artery Risk Detection In Appalachian Communities (CARDIAC) program informed the use of the morbidly obese category of body mass index (BMI) as a surrogate measure of CVD risk. DESIGN: A total of 23 263 5th grade West Virginia students in the United States participated in a comprehensive risk factor screening between 2003 and 2008. METHODS: Screening included the calculation of BMI, resting blood pressure, presence of acanthosis nigricans, and fasting lipid profile (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides). RESULTS: Six percent of participants were morbidly obese (BMI >99%). The morbidly obese category provided additional risk factor information than that provided by typically given weight categories, in addition to being a highly specific indicator of additional CVD risk factors. CONCLUSION: These findings suggest that children diagnosed as morbidly obese have significantly greater chance of experiencing various CVD risk factors than those without morbid obesity diagnosis; these results suggest that the morbidly obese BMI category can be effectively used to target those children at greatest risk when resources are limited.

Physical activity correlates for Native Hawaiians and Pacific Islanders in the mainland United States.

Native Hawaiian and Pacific Islander (NHPI) people are an understudied population that demonstrates high obesity rates and low physical activity levels. This study's aim was to examine possible correlates of physical activity in NHPI adults. Height and weight were recorded in N=100 NHPIs (46.9±5.4 years; 56% males) following completion of an anonymous questionnaire addressing health behaviors (physical activity, smoking, diet), psychosocial characteristics (social support, barriers, stage of change), neighborhood environment attributes, and knowledge of physical activity recommendations. This study sample demonstrated low physical activity (20% met recommendations) and fruit and vegetable (F&V) consumption (1% met recommendations), and a high prevalence of overweight or obesity (94%). After adjusting for gender and education, F&V intake was the only significant correlate of physical activity (p<.001). Common correlates of physical activity did not generalize to NHPIs. Further investigations of culturally-specific correlates are needed so that physical activity interventions can be culturally tailored for NHPIs.

Universal versus targeted blood cholesterol screening among youth: The CARDIAC project.

OBJECTIVES: The goal was to determine the sensitivity and specificity of family history in identifying children with severe or genetic hyperlipidemias in a rural, predominantly white population. METHODS: A total of 20,266 fifth-grade children in West Virginia, from the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project, who completed a family history and fasting lipid profile were used in analyses. The relationship between hyperlipidemia and family history was determined, and the use of family history to predict the need for pharmacologic treatment among children with dyslipidemia was evaluated. RESULTS: A total of 71.4% of children met the National Cholesterol Education Program (NCEP) guidelines for cholesterol screening on the basis of positive family history. Of those, 1204 (8.3%) were considered to have dyslipidemia (low-density lipoprotein > or =130 mg/dL), and 1.2% of these children with dyslipidemia warranted possible pharmacologic treatment (low-density lipoprotein > or =160 mg/dL). Of the 28.6% who did not have a positive family history (did not meet NCEP guidelines), 548 (9.5%) had dyslipidemia, 1.7% of whom warranted pharmacologic treatment. Sensitivity and specificity data demonstrated that family history does not provide a strong indication as to whether pharmacologic treatment may be warranted. CONCLUSIONS: Results indicate that the use of family history to determine the need for cholesterol screening in children would have (1) missed many with moderate dyslipidemia and (2) failed to detect a substantial number with likely genetic dyslipidemias that would require pharmacologic treatment. The use of universal cholesterol screening would identify all children with severe dyslipidemia, allowing for proper intervention and follow-up and leading to the prevention of future atherosclerotic disease.

The effect of giving global coronary risk information to adults: a systematic review.

BACKGROUND: Global coronary heart disease (CHD) risk estimation (ie, a quantitative estimate of a patient's chances of CHD calculated by combining risk factors in an empirical equation) is recommended as a starting point for primary prevention efforts in all US adults. Whether it improves outcomes is currently unknown. METHODS: To assess the effect of providing global CHD risk information to adults, we performed a systematic evidence review. We searched MEDLINE for the years 1980 to 2008, Psych Info, CINAHL, and the Cochrane Database and included English-language articles that met prespecified inclusion criteria. Two reviewers independently reviewed titles, abstracts, and articles for inclusion and assessed study quality. RESULTS: We identified 20 articles, reporting on 18 unique fair or good quality studies (including 14 randomized controlled studies). These showed that global CHD risk information alone or with accompanying education increased the accuracy of perceived risk and probably increased intent to start therapy. Studies with repeated risk information or risk information and repeated doses of counseling showed small significant reductions in predicted CHD risk (absolute differences, -0.2% to -2% over 10 years in studies using risk estimates derived from Framingham equations). Studies providing global risk information at only 1 point in time seemed ineffective. CONCLUSIONS: Global CHD risk information seems to improve the accuracy of risk perception and may increase intent to initiate CHD prevention among individuals at moderate to high risk. The effect of global risk presentation on more distal outcomes is less clear and seems to be related to the intensity of accompanying interventions.

Body mass index as a surrogate measure of cardiovascular risk factor clustering in fifth-grade children: results from the coronary artery risk detection in the Appalachian Communities Project.

BACKGROUND: Obesity, an increasing problem in children in the United States and abroad, has been associated with risk factors for cardiovascular disease (CVD). Consequently, there is a need to determine body mass index (BMI) cut-off values for recommending comprehensive assessment and intervention for high-risk children. The objective of this study was to use results from a large-scale cross-sectional screening project, the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC), to derive BMI cut-off values that predict clustering of CVD risk factors. Design. 29 436 fifth grade West Virginia students in the United States participated in a comprehensive risk factor screening between 1997 and 2006. METHODS: Screening included the calculation of BMI, resting blood pressure, presence or absence of acanthosis nigricans, and a fasting lipid profile (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides). Factor analysis and receiver operating characteristic curves were used to examine BMI as a predictor for CVD risk factor clustering. RESULTS: BMI at the 95th percentile or higher were shown to be specific and sensitive predictors when three or more CVD risk factor clusters were present. CONCLUSION: These findings suggest that BMI, a cost-effective assessment tool, can be used to identify CVD risk-factor clustering at the 95th percentile.

Metabolic syndrome in fifth grade children with acanthosis nigricans: results from the CARDIAC project.

BACKGROUND: A number of cardiovascular disease (CVD) risk factors have been linked to obesity and associated negative health outcomes in children. However, no consistent definition of metabolic syndrome exists for children. In addition, research is needed to systematically examine the prevalence of metabolic syndrome in high-risk children, including those with insulin resistance. This study explores several definitions of metabolic syndrome and determines the prevalence of metabolic syndrome in a large sample of children with acanthosis nigricans (AN). METHODS: The study used results from a large-scale screening of fifth-grade students in West Virginia to explore the prevalence of metabolic syndrome among 676 male and female participants who had mild to severe AN. RESULTS: In this high-risk sample of students who had AN, 49% met the criteria, i.e., three risk factors including insulin resistance, high body-mass index, and elevated blood pressure or dyslipidemia, when tested for metabolic syndrome. Children with AN who were classified as obese or morbidly obese were at significantly increased odds of having metabolic syndrome. CONCLUSIONS: Results are discussed in terms of systematically defining metabolic syndrome for high-risk children, as well as public health and clinical interventions targeting children who are overweight or obese. The presence of AN and morbid obesity might be easily observed markers for metabolic syndrome.