Physical Activity Behaviors of Female Adolescents in Saudi Arabia.

BACKGROUND: Saudi Arabia has one of the highest childhood obesity rates worldwide. The primary factor associated with the high prevalence of obesity among adolescents is a lack of physical activity (PA). Compared to male adolescents, very few Saudi female adolescents meet the World Health Organization recommendation of achieving 60 min of moderate to vigorous PA per day, putting them at a higher risk of overweight and obesity. OBJECTIVE: This cross-sectional study aimed to examine the relationship between the theory of planned behavior and psychosocial factors, including attitude toward PA, subjective norms, perceived behavioral control (PBC), PA intention, and self-reported PA among Saudi female adolescents. METHODS: A convenience sample of 329 Saudi female adolescents was recruited from all-female public intermediate and high schools in the Eastern Region of Saudi Arabia. Data were collected using online self-administered questionnaires. The theoretical model was examined using structural equation modeling. RESULTS: The findings revealed a higher prevalence of overweight compared to obesity among participants. About half the participants were from families with a medium monthly income. The mean PA score indicated a low level of PA. The model demonstrated significant explanatory power for both PA intention and PA behavior, respectively. The strongest predictor of adolescents' intention was attitude, followed PBC.Moreover, the female adolescents' attitudes and PBC had significant indirect effects on self-reported PA through intention, while intention had a direct effect on PA. The model did not support a direct or indirect relationship between subjective norms and PA. DISCUSSION: The findings provide essential support for targeting attitude and perceived behavior control of female adolescents in order to enhance their PA intention. This theoretical understanding can help design effective theory-based interventions that promote PA among Saudi female adolescents.

Stress Management Interventions Among U.S. High School Adolescents: A Meta-Analysis.

BACKGROUND: Adolescent ineffective stress management has been associated with negative health outcomes, such as anxiety and depression. Comprehensively evaluating the effects of stress management interventions is needed. AIMS: The aim of this study was to quantitatively evaluate the effects of stress management interventions on mental health outcomes (stress, anxiety, depression, and positive and negative affect) and perform moderation analysis to identify moderators of intervention effects on stress, anxiety, and depression among U.S. high school adolescents. METHODS: Four databases (CINAHL, ERIC, PubMed, and PsycINFO) were searched. After literature screening, 24 articles describing 25 studies were retained. Hedge's g was calculated using random-effects models. Exploratory moderation analyses were performed to identify moderators. RESULTS: The pooled effects on reducing stress were -0.36. The interventions had small effects on decreasing anxiety (g = -0.31) and depression (g = -0.23). Long-term follow-up effects were -0.77 on perceived stress, -0.08 on anxiety, and -0.19 on depression. Mind-body and cognitive-behavioral interventions had moderate effects on reducing anxiety (g = -0.51). Interventions with longer duration (>8 weeks) were more effective in reducing anxiety (-0.39 vs. -0.26) and depression (-0.36 vs. -0.17). CONCLUSIONS: These findings support the short-term effectiveness of stress management interventions in improving mental health among high school adolescents in the United States. Subsequent research efforts should focus on sustaining long-term effects.

The role of psychosocial factors and biological sex on rural Thai adolescents' drinking intention and behaviours: A structural equation model.

AIMS: To examine the contributions of psychosocial factors (attitude towards drinking, perceived drinking norms [PDNs], perceived behavioural control [PBC]), and biological sex on drinking intention and behaviours among rural Thai adolescents. DESIGN: A cross-sectional study design. METHODS: In 2022, stratified by sex and grade, we randomly selected 474 rural Thai adolescents (Mage = 14.5 years; SD = 0.92; 50.6% male) from eight public district schools in Chiang Mai Province, Thailand, to complete a self-administered questionnaire. Structural equation modelling with the weighted least square mean and variance adjusted was used for data analysis. RESULTS: All adolescents' psychosocial factors contributed significantly to the prediction of drinking intention, which subsequently influenced their drinking onset, current drinking and binge drinking pattern in the past 30 days. PDNs emerged as the strongest psychosocial predictor of drinking intention, followed by PBC. Rural adolescents' drinking intention significantly mediated the relationship between all psychosocial factors and drinking behaviours either fully or partially. The path coefficient between drinking attitude and drinking intention was significantly different between males and females. CONCLUSION: Different from previous studies focus on adolescents' drinking attitude, rural Thai adolescents' PDNs play a significant role on their drinking intention and subsequently their drinking onset and patterns. This nuanced understanding supports a paradigm shift to target adolescents' perceived drinking norms as a means to delay their drinking onset and problematic drinking behaviours. IMPACT: Higher levels of perceived drinking norms significantly led to the increase in drinking intention among adolescents. Minimizing adolescents' perceptions of favourable drinking norms and promoting their capacity to resist drinking, especially due to peer pressure, are recommended for nursing roles as essential components of health education campaigns and future efforts to prevent underage drinking. PATIENT OR PUBLIC CONTRIBUTION: In this study, there was no public or patient involvement.

Effects of mindfulness-based interventions on anthropometric outcomes: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: The effects of mindfulness-based interventions (MBIs) on anthropometrics remain obscure. This review quantitatively synthesizes the effects of MBIs on decreasing body mass index (BMI), waist circumference (WC), weight, and percent body fat (%BF). METHODS: Seven databases, including CINAHL Plus with Full Text, PubMed, PsycINFO, Cochrane, Web of Science Core Collection, Embase, and Sociological Abstracts were searched; studies with a comparison group were selected. Random-effects models were then applied to estimate the pooled effects (Hedge's g), while exploratory moderation analyses with mixed-effects models were performed to explore potential moderators of MBIs on anthropometrics. RESULTS: The pooled effect size was -0.36 (p < .001) on BMI, -0.52 (p < .001) on WC, -1.20 (p < .004) on weight loss, and -0.43 (p = .389) on %BF. The long-term effects from baseline to follow-up and from post-intervention to follow-up were sustained on BMI (-0.37, p = .027; -.24, p = .065) and weight loss (-1.91, p = .027; -0.74, p = .011) respectively. For weight loss, adding mindful movement had greater effects than those without (-2.65 vs -0.39, p < .001). CONCLUSION: Our findings support the short-term MBI effects on BMI reduction, WC, weight, and %BF, and long-term effects on reducing BMI and weight. Future efforts should focus on sustaining effects on reducing WC and %BF.

Motivational Interviewing in Pediatric Obesity: A Meta-analysis of the Effects on Behavioral Outcomes.

BACKGROUND: Currently, the effects of motivational interviewing (MI) on children's behavioral changes remain obscure. PURPOSE: This systematic review and meta-analysis examined the effects of MI on children's lifestyle behavioral changes (fruits and vegetables [F/V], dairy, sugary beverages, calories, snacks, fat intake, moderate vigorous physical activity [MVPA], and screen time). METHODS: Six databases (CINAHL, Cochrane, Embase, PsycINFO, PubMed, and Web of Sciences) from 2005 to 2022 were searched. Thirty-one intervention studies with a comparison group met the criteria. Random-effects models were performed to estimate the pooled effects; exploratory moderation analyses with mixed-effects models were used to explore potential intervention moderators. RESULTS: The pooled effect size was 0.10 (p = .334) on ↑F/V, 0.02 (p = .724) on ↑dairy, -0.29 (p < .001) on ↓calories, -0.16 (p = .054) on ↓sugary beverages, -0.22 (p = .002) on ↓snacks, -0.20 (p = .044) on ↓fat, 0.22 (p = .001) on ↑MVPA, and -0.06 (p = .176) on ↓screen time. The effects of MIs were moderated by ↑MI sessions regarding ↓snacks (B = -0.04, p = .010). Multicomponent and clinical programs had greater effects on dairy intake than their counterparts (0.09 vs. -0.21, p = .034; 0.12 vs. -0.14, p = .027, respectively). Similarly, interventions with a fidelity check resulted in greater dairy intake than those without a check (0.29 vs. -0.15, p = .014). A few long-term follow-up assessments revealed effects on ↓F/V (-0.18; p = .143, k = 2), ↓dairy (-0.13, p = .399, k = 4), ↓MVPA (-0.04; p = .611, k = 6), and ↑screen time (0.12; p = .242, k = 4). CONCLUSIONS: Our findings support the short-term effects of MI on improving children's lifestyle behaviors. Additional investigations are needed to better sustain children's long-term behavioral changes.

Although motivational interviewing (MI) techniques are often recommended and used by clinicians to promote healthy behaviors, their effects on children's behavioral changes are not clear. This systematic review and meta-analysis examined the effects of MI on children's lifestyle behavioral changes particularly in children's intakes in fruits and vegetables, dairy, sugary drinks, calories, snacks, and high-fat diet, as well as children's physical activity and screen time. A total of 957 articles from six databases were screened for eligibility. Among them, 31 eligible articles were retrieved for knowledge synthesis. This review found that MI techniques were effective in lowering children's intakes in calories, sugary drinks, snacks, high-fat diets. In addition, MI techniques were also effective in promoting children's moderate to vigorous physical activities. It seemed that more MI sessions were more likely to decrease children's snacks intakes. Taken together, our findings support the short-term effects of MI on improving children's lifestyle behaviors. Additional investigations are needed to better sustain children's long-term behavioral changes.

Psychosocial Determinants of Recommended Lifestyle Behaviors among Hypertensive Patients: An Integrative Literature Review.

Healthy lifestyle levels are low among adults with hypertension (HTN). Unfortunately, psychosocial factors contributing to patients' inability to meet healthy lifestyle recommendations are not well-understood. This integrative review examined the relationships of three psychosocial factors (self-efficacy, outcome expectancy, and social support) with dietary adherence (DA) and physical activity (PA) among adults with HTN. In total, 24 peer-reviewed studies were assessed. Results showed self-efficacy had small-to-large relationships with PA (r = 0.02-0.46) and DA (r = 0.06-0.79), with the strength of the associations varying by the assessed domain and country of origin. However, few studies reported a small relationship between the remaining factors (outcome expectancy and social support) and PA and DA. Thus, more efforts are needed to delineate the contributions of social support and outcome expectancies on DA or PA. When designing an intervention that focuses on improving PA or DA among adults with HTN, these psychosocial factors should be targeted.

Economic burden of childhood overweight and obesity: A systematic review and meta-analysis.

To update existing literature and fill the gap in meta-analyses, this meta-analysis quantitatively evaluated the worldwide economic burden (in 2022 US $) of childhood overweight and obesity in comparison with healthy weight. The literature search in eight databases produced 7756 records. After literature screening, 48 articles met the eligibility criteria. The increased annual total medical costs were $237.55 per capita attributable to childhood overweight and obesity. Overweight and obesity caused a per capita increase of $56.52, $14.27, $46.38, and $1975.06 for costs in nonhospital healthcare, outpatient visits, medication, and hospitalization, respectively. Length of hospital stays increased by 0.28 days. Annual direct and indirect costs were projected to be $13.62 billion and $49.02 billion by 2050. Childhood obesity ascribed to much higher increased healthcare costs than overweight. During childhood, the direct medical expenditures were higher for males than for females, but, once reaching adulthood, the expenditures were higher for females. Overall, the lifetime costs attributable to childhood overweight and obesity were higher in males than in females, and childhood overweight and obesity resulted in much higher indirect costs than direct healthcare costs. Given the increased economic burden, additional efforts and resources should be allocated to support sustainable and scalable childhood obesity programs.

Family lifestyle is related to low-income preschoolers' emotional well-being during COVID-19 pandemic.

PROBLEM: COVID-19 has profoundly impacted children's behavioral and psychosocial development, especially young children from low-income families. This study examined how caregivers' and preschoolers' lifestyle behaviors (sleep, screen time, physical activity, eating behavior) were related to preschoolers' emotional well-being (sadness, fear, anger, and positive affect). METHODS: Using a cross-sectional design, we recruited low-income caregivers from Head Start organizations and the Qualtrics panel. Participants provided consent and completed an online survey. FINDINGS: A total of 408 caregivers (mean age = 31) participated: 17% Hispanic, 21% Black, 49% separated/single, 44% unemployed, and 39% with ≤high school education. After adjusting for demographics and preschoolers' lifestyle behaviors, caregivers' sleep disturbance was positively correlated with preschoolers' anger, fear, and sadness, while negatively related to positive affect. Similarly, caregivers' sleep time was positively correlated with preschoolers' sadness and negatively related to positive affect. Preschoolers' sleep time was negatively related to fear and positively related to positive affect. Likewise, preschoolers' physical activity was negatively correlated with fear, sadness, and positively correlated with positive affect. Additionally, preschoolers' fruit/vegetable intake was negatively associated with anger, fear, sadness, and positively associated with positive affect. CONCLUSIONS: The identified behavior-emotion connection provides a foundation for developing family-based lifestyle interventions in promoting mental health among preschoolers.

Motivational Interviewing Conversational Agent for Parents as Proxies for Their Children in Healthy Eating: Development and User Testing.

BACKGROUND: Increased adoption of off-the-shelf conversational agents (CAs) brings opportunities to integrate therapeutic interventions. Motivational Interviewing (MI) can then be integrated with CAs for cost-effective access to it. MI can be especially beneficial for parents who often have low motivation because of limited time and resources to eat healthy together with their children. OBJECTIVE: We developed a Motivational Interviewing Conversational Agent (MICA) to improve healthy eating in parents who serve as a proxy for health behavior change in their children. Proxy relationships involve a person serving as a catalyst for behavior change in another person. Parents, serving as proxies, can bring about behavior change in their children. METHODS: We conducted user test sessions of the MICA prototype to understand the perceived acceptability and usefulness of the MICA prototype by parents. A total of 24 parents of young children participated in 2 user test sessions with MICA, approximately 2 weeks apart. After parents' interaction with the MICA prototype in each user test session, we used qualitative interviews to understand parents' perceptions and suggestions for improvements in MICA. RESULTS: Findings showed participants' perceived usefulness of MICAs for helping them self-reflect and motivating them to adopt healthier eating habits together with their children. Participants further suggested various ways in which MICA can help them safely manage their children's eating behaviors and provide customized support for their proxy needs and goals. CONCLUSIONS: We have discussed how the user experience of CAs can be improved to uniquely offer support to parents who serve as proxies in changing the behavior of their children. We have concluded with implications for a larger context of designing MI-based CAs for supporting proxy relationships for health behavior change.

Adolescents' Perceived Drinking Norms Toward Alcohol Misuse: An Integrative Review.

The purpose of this integrative review is to synthesize prior research on the relationship between adolescents' perceived subjective and descriptive drinking norms and their drinking intention and behaviors. Four databases (CINAHL, PubMed, Cochrane, and Sociological Abstracts) were searched to identify relevant articles. Thirty-one peer-reviewed articles published from 2010 to 2020 were reviewed. The results highlight that adolescents' perceived drinking norms derived from their parents and peers, such as approving or disapproving attitudes, significantly influence adolescents' drinking intention and behaviors. Moreover, pro-drinking messages, advertisements, and postings from electronic media (i.e., TV, movies, and the Internet) and online social networks (e.g., Facebook, Instagram, and Twitter) shape adolescents' drinking intention and encourage adolescents to initiate alcohol consumption early and/or escalate their drinking. Thus, future interventions should focus on subjective drinking norms that stem from interpersonal relationships in combination with perceived descriptive drinking norms derived from various media exposure.

The effects of motivational interviewing on children's body mass index and fat distributions: A systematic review and meta-analysis.

Currently, the effects of motivational interviewing (MI) on children's anthropometric changes remain unclear. This systematic review and meta-analysis examined the effects of MI on children's anthropometric changes (body mass index [BMI], waist circumference [WC], and body fat percentage [BF%]). We also assessed potential moderators of MI on children's BMI changes. This systematic review searched five databases (CINAHL, Cochrane, PsycINFO, PubMed, and Web of Sciences) from 2005 to 2020 to evaluate the effects of MI interventions that had a comparison group on children's anthropometric change as outcomes (BMI, WC, or BF%). Thirty-three articles met the inclusion criteria. We performed random-effects models and exploratory moderation analyses with mixed-effects models. The pooled effect size of MI was -0.18 (p = 0.002) on BMI, -0.65 (p < 0.001) on WC, and -0.44 (p = 0.005) on children's BF%. The relationship between MI and BMI changes was significantly moderated by the types of intervener (Q = 9.71, p = 0.021) and the existence of supplemental intervention activities (Q = 9.21, p = 0.002). Other potential moderators included children's age, weight status, intervention setting, and targeted behaviors (eating and/or physical activity). Our findings support the effectiveness of MI interventions on improving children's anthropometric outcomes (i.e., BMI, WC, and BF%).

FOCUS Program: Treating Patients With Cancer and Family Caregivers as a Unit of Care.

BACKGROUND: Studies indicate that patients' and caregivers' responses to illness are interdependent; each person affects the other. Existing evidence reinforces the need to recognize family caregivers as equal recipients of care and support. OBJECTIVES: This evidence-based pilot study evaluated the feasibility and preliminary efficacy of the nurse-guided, psychoeducational, family-based FOCUS program intervention at a local oncology outpatient clinic. METHODS: 30 patient-caregiver dyads were recruited from a local oncology clinic. Intervention delivery occurred using home visits and telephone calls. Self-administered questionnaires were used to assess participants' self-efficacy, quality of life (QOL), and coping pre- and postintervention, and intervention satisfaction postintervention. Three tailored psychosocial education sessions were held during a 6- to 9-week period. FINDINGS: Significant changes in outcomes were found, including increased self-efficacy in both patients and caregivers, higher QOL in caregivers, and decreased use of substances for coping in patients. There was a trend for patients' emotional well-being to improve over time; other aspects of QOL showed little change. There were no significant changes in caregivers' coping.

Parent-Adolescent Dyads' Efficacy, Coping, Depression, and Adolescent Health Risks.

BACKGROUND: Efficacy beliefs have been suggested to protect children from many risky health behaviors. However, the relationships between parent-child dyads' coping and efficacy beliefs are not clear. Therefore, this study examined the relationships between parent-child dyads' coping patterns and their association with collective family efficacy, adolescent filial efficacy, parenting efficacy, family satisfaction, depressive symptoms, and parents' perceived adolescent health risks. METHODS: Guided by the Bandura's efficacy framework, we surveyed 158 parent-adolescent dyads from the midwestern U.S. on coping, collective family efficacy, adolescent filial efficacy, family satisfaction, parenting efficacy, depressive symptoms, and parent perceived adolescent health risks. Descriptive statistics, bivariate correlations, multiple regression, and path modeling were performed. FINDINGS: Parent-adolescent dyads spiritual coping was positively correlated, but other coping subscales were not. The path models revealed that adolescents collective family and filial efficacy were positively related to their overall coping. Adolescent family satisfaction both directly and indirectly protected adolescents from depressive symptoms. Parents' parenting efficacy and family satisfaction were directly and indirectly associated with lower parents' perceived adolescent health risks. DISCUSSION: It seems that parents' constructive coping mechanisms were more collective-focused, while adolescents' coping strategies were more individual-focused (venting and humor). Promoting parent-adolescent dyads' efficacy beliefs could enhance their coping strategies and minimize depressive symptoms and adolescent health risks. APPLICATION TO PRACTICE: adolescents' collective coping mechanisms (self-reliance and family problem solving) can be promoted within the family context. In fact, when helping adolescents develop family problem solving skills, it is important to consider parents' ability/efficacy and their emotional status.

Parent-Child Dyad's Collective Family Efficacy and Risky Adolescent Health Behaviors.

BACKGROUND: Parents play an influential role in their children's health behaviors. Research has shown that individuals' efficacy beliefs (personal and collective efficacy) are closely related to their behaviors and can be modified to improve health outcomes. Existing evidence confirms the effect of self-efficacy on various health outcomes. However, the effects of parent-child dyads' collective efficacy beliefs on adolescents' health outcomes are less clear. Bandura and his colleagues postulated that family members' perceived collective family efficacy plays an important role in their psychological well-being and possibly their health behaviors. However, few study results have delineated the relationship between collective family efficacy and risky adolescent health behaviors. OBJECTIVES: This study was conducted to examine the relationships among parent-adolescent dyads' collective family efficacy, satisfaction with family functioning, depressive symptoms, personal efficacy beliefs, and adolescent risky health behaviors. METHODS: This cross-sectional study surveyed 158 parent-adolescent dyads from the Midwestern region of the United States. Linear regression and path modeling were conducted to examine the influences of dyads' personal and collective efficacy beliefs on the adolescents' negative attitudes toward healthy lifestyle practices, injury prevention, safe sex practices, substance use prevention, and depressive symptoms. RESULTS: Risky adolescent health behaviors were strongly correlated with higher depressive symptoms. The dyads' personal and collective efficacy beliefs emerged as protective factors for adolescent health risks directly and indirectly through depressive symptoms. Both adolescents' and parents' perceived collective family efficacy buffered the effect of parent-adolescent dyads' depressive symptoms on adolescent risky health behaviors with significant direct and indirect effects. Adolescents' family efficacy, satisfaction with family functioning, and filial efficacy significantly mediated the relationship between depressive symptoms and risky health behaviors. DISCUSSION: Parent-adolescent dyads' perceived collective family efficacy buffers adolescents from depressive symptoms and risky health behaviors. This finding suggests that family interventions should not only address adolescents' personal-level efficacy but also their collective aspects of efficacy beliefs within the family context.

Obesity and Hair Cortisol: Relationships Varied Between Low-Income Preschoolers and Mothers.

PURPOSE: Literature on the relationship between hair cortisol concentration (HCC) and body mass index (BMI) is scarce and inconsistent in both preschoolers and parents. Thus, the study aimed to examine the relationships among HCC, perceived distress, coping, and BMI among low-income Head Start preschoolers and mothers. METHODS: A cross-sectional, correlational study was conducted with a non-random sample of 35 mother-preschooler dyads. Height and weight were measured using a ShorrBoard Stadiometer and a Seca portable electronic scale, respectively. HCC was extracted using the enzyme immunoassay approach. Mothers' perceived distress and coping were assessed by Cohen's Perceived Stress Scale. RESULTS: Mothers' mean age was 29.74 years, and preschoolers' mean age was 4.69 years. The sample included 17% Hispanic, 54% Black, and 60% single mothers; and 23% Hispanic and 60% Black preschoolers. Compared to mothers in low HCC group (< 4.1 pg/mg), mothers in high HCC group (≥ 4.1 pg/mg) had lower BMI (B = - 4.62, p = .049). The indirect effects of mothers' HCC on BMI via perceived distress and coping was 15% of the total effects. Preschoolers with mothers in high HCC group had significantly lower BMI z-score than those with mothers in low HCC group (B = - 0.94, p = .043). Preschoolers' HCC had a small positive correlation with their BMI z-score (B = 0.01, p = .112). CONCLUSIONS: Relationships between HCC and BMI varied between low-income mothers and preschoolers. A stress management component may need to be integrated into future obesity interventions. Given the limitation of small sample size and cross-sectional study design, the findings need to be interpreted with caution, and further investigation is warranted.

Concept Analysis of Relatedness in Physical Activity Among Adolescents.

AIM: This analysis seeks to clarify the concept of relatedness in physical activity (PA) among adolescents. BACKGROUND: Health-related behavior research highlights the importance of focusing on individual psychological needs such as relatedness in PA to improve adolescents' motivation toward PA. Although relatedness in PA has been associated with PA participation among adolescents, a thorough analysis of the concept is lacking. Conceptual clarification of relatedness in the context of PA is needed for promoting consistency between conceptual and operational definitions and refining empirical measurement. DESIGN: The 6-steps of Rodgers' (2000) evolutionary method of concept analysis was used to analyze the data and identify attributes, surrogate/related terms, antecedents, and consequences of the relatedness concept. METHOD: Several databases were used to extract relevant articles. A total of 113 were identified. Forty articles met the inclusion criteria. In addition, twenty-six articles were included through other sources. The review process yielded a final set of 66 articles. RESULT: A refined definition of relatedness in PA is an adolescent's perception of feeling socially connected with significant people in a reciprocal, caring, and trusting relationship that is a self-system process and promotes a sense of belonging and internalization within PA contexts. Attributes, surrogate/related terms, antecedents and consequences of relatedness in PA were identified from extant literature. CONCLUSION: This comprehensive analysis provides a clarification of the conceptual definition of relatedness in PA among adolescents. The concept can guide nurses in designing interventions to improve health behavior or promoting changes in health policy. Future research is needed to refine operational definitions of relatedness so that they represent the defining attributes of the concept.

Body mass index, waist circumference and body fat are positively correlated with hair cortisol in children: A systematic review and meta-analysis.

The current body of research lacks a meta-analysis of the relationship between hair cortisol concentration (HCC) and anthropometry in children. Therefore, this systematic review and meta-analysis was conducted to examine this relationship and explore possible moderators between HCC and body mass index (BMI/BMI z-score). Eleven databases were searched: CINAHL, Cochrane, Embase, PsycEXTRA, Psychology and Behavioral Sciences, PsycINFO, PubMed, Scopus, Social Sciences Full Text, Sociological Abstracts and Web of Sciences. Random-effects models and exploratory moderator analyses with mixed-effects models were performed using the Comprehensive Meta-Analysis software. The meta-analysis showed small positive correlations between HCC and BMI (r = 0.08, 95% confidence interval [CI]: 0.02, 0.14, n = 18, p = .009), BMI z-score (r = 0.10, 95% CI: 0.03, 0.16, n = 12, p = .003), waist circumference (r = 0.10, 95% CI: 0.04, 0.17, n = 10, p = .001) and body fat including fat mass index (r = 0.06, 95% CI: 0.02, 0.11, n = 3, p = .005). The relationship between HCC and BMI/BMI z-score was significantly moderated by children's sex. Results from this meta-analysis provide initial objective support for a small positive relationship between HCC and anthropometric factors.

Adolescent Autonomous Motivation for Physical Activity: A Concept Analysis.

PURPOSE: The purpose of this concept analysis is to develop a clear definition of adolescent autonomous motivation for physical activity (PA) based on all existing theoretical and operational definitions of autonomous motivation noted in the literature. For providers, understanding this is essential to elucidate why some adolescents choose to participate in a health-promoting behavior like PA. Researchers need to identify if they are evaluating autonomous motivation or a different type. METHODS: Rodgers' Evolutionary Method of concept analysis was used. PubMed, CINAHL, ERIC, PsychInfo, and Sport Discus were searched. RESULTS: No concept analysis of adolescent autonomous motivation for PA was found. Autonomous motivation may include intrinsic motivation and two forms of extrinsic motivation, integrated and identified behavioral regulations. Defining attributes include being: 1) dynamic and 2) on a continuum. Adolescent autonomous motivation for PA is a personal desire to attain PA because the behavior is fun and enjoyable, or it is an important part of how the adolescent self-identifies. The adolescent views the self as being healthy so maintains a healthy lifestyle; or views the self as athletic so needs to attain adequate MVPA. CONCLUSION: Findings are that an autonomy-supportive environment and positive perceptions of PA are needed in order to have the outcome of increased PA. The information may be helpful for promoting consistency of measurement across disciplines. Future research with adolescents is warranted to examine underlying differences between males and females, by age, weight status, and developmental stage. PRACTICE IMPLICATIONS: An in-depth understanding is needed for providers who are interested in developing interventions to assist adolescents in regularly attaining adequate PA.

Predictors of quality of life and depression among Korean-American cancer patients and their family caregivers.

OBJECTIVE: This study examined social, cultural, and appraisal factors associated with Korean-American cancer patients' and their family caregivers' quality of life (QOL) and depression. METHODS: Data were from Korean-American cancer patients and their family caregivers (N = 60 dyads) living in the United States. Study aims were examined using descriptive statistics and multiple regression. RESULTS: For patients, higher social support and lower negative appraisal of illness predicted higher patient QOL; negative appraisal of illness also predicted higher patient depression. For caregivers, older age, having fewer traditional Korean values, and more modern (individualistic) values predicted higher caregiver QOL. Caregivers who held more modern values also had less depression. CONCLUSIONS: Higher support and less negative appraisal predicted better QOL in patients. For caregivers however, the type of cultural values they held (tradition or modern) was a key factor that predicted level of QOL and depression. Assessment of support and appraisal as well as attention to cultural values may enhance their QOL and reduce depression.

Family Efficacy within Ethnically Diverse Families: A Qualitative Study.

Family efficacy, which refers to a family's belief in its ability to produce a desired outcome, has been shown to protect adolescents from risky health behaviors. Few studies have examined family efficacy within diverse populations, however, and understanding of how efficacy is framed and formed within the context of cultural and familial values is limited. This descriptive qualitative study examined sources of family efficacy within ethnically and socioeconomically diverse families, evaluating how such families develop and exercise family efficacy with the intent to protect adolescents from risky health behaviors (i.e., marijuana and alcohol use and early sexual activity). We collected qualitative data via two semi-structured interviews, 4-6 months apart, with 31 adolescents (ages 12-14) and their parent/s, for total of 148 one-on-one interviews. Thematic analysis identified three distinct domains of family efficacy: relational, pragmatic, and value-laden. Prior experiences and cultural background influenced the domain/s utilized by families. Significantly, families that consistently tapped into all three domains were able to effectively manage personal and family difficulties; these families also had family strategies in place to prevent adolescents from risky behaviors. Health professionals could utilize this concept of multidimensional family efficacy to promote health within culturally diverse families.