Adverse Childhood Experiences Are Associated with Cardiometabolic Risk among Hispanic American Adolescents.

OBJECTIVE: To assess the relationship between adverse childhood experiences (ACEs) and cardiometabolic risk among Hispanic adolescents. STUDY DESIGN: This cross-sectional study was conducted at an academic research center in Gainesville, Florida. Participants were locally recruited, and data were collected from June 2016 to July 2018. Participants (n = 133, 60.2% female) were healthy adolescents aged 15-21 years who self-identified as Hispanic, were born in the US, and had a body mass index (BMI) between ≥18.5 and ≤40 kg/m2. Primary outcomes were BMI, body fat percentage, waist circumference, and resting blood pressure. Associations between ACEs and cardiometabolic measures were assessed by multivariable logistic regression models, which controlled for sex, age, parental education, and food insecurity. Results were sex-stratified to assess potential variations. RESULTS: Reporting ≥4 ACEs (28.6%) was significantly associated with a greater BMI (P = .004), body fat percentage (P = .02), and diastolic blood pressure (P = .05) compared with reporting <4 ACEs. Female participants reporting ≥4 ACEs were significantly more likely to have a greater BMI (P = .04) and body fat percentage (P = .03) whereas male participants reporting ≥4 ACEs were significantly more likely to have a greater BMI (P = .04), systolic blood pressure (P = .03), and diastolic blood pressure (P = .03). CONCLUSIONS: Hispanic adolescent participants who experienced ≥4 ACEs were more likely to have elevated risk markers of obesity and cardiometabolic disease. Further research is needed to elucidate the physiological mechanisms driving these relationships.

Feasibility/acceptability of an acceptance-based therapy intervention for diverse adolescent girls with overweight/obesity.

BACKGROUND: Behavioral obesity interventions using an acceptance-based therapy (ABT) approach have demonstrated efficacy for adults, yet feasibility and acceptability of tailoring an ABT intervention for adolescents remains unknown. OBJECTIVE: This study assessed the feasibility and acceptability of an ABT healthy lifestyle intervention among diverse adolescent cisgender girls with overweight/obesity (OW/OB). METHODS: Adolescent cisgender girls aged 14-19 with a BMI of ≥85th percentile-for-sex-and-age were recruited for participation in a single-arm feasibility study. The primary outcomes were recruitment and retention while the secondary outcome was change in BMI Z-score over the 6-month intervention. Exploratory outcomes included obesity-related factors, health-related behaviors, and psychological factors. RESULTS: Recruitment goals were achieved; 13 adolescents (>60% racial/ethnic minorities) participated in the intervention, and 11 completed the intervention (85% retention). In completers (n = 11), a mean decrease in BMI Z-score of -0.15 (SD = 0.34, Cohen's d = -0.44) was observed. Improvements were also noted for change in percentage of 95th percentile (d = -0.35), percent body fat (d = -0.35), quality of life (d = 0.71), psychological flexibility (d = -0.86), and depression (d = -0.86). CONCLUSIONS: These preliminary findings suggest an ABT healthy lifestyle intervention tailored for adolescent cisgender girls with OW/OB may be an acceptable treatment that could lead to improvements in BMI Z-score, obesity-related measures, and psychological outcomes.

Acceptability of Research and Health Care Visits During the COVID-19 Pandemic: Cross-sectional Survey Study.

BACKGROUND: The COVID-19 pandemic has had a widespread impact on attendance in biomedical research and health care visits. OBJECTIVE: This study aimed to identify when and how American adults might feel comfortable about resuming in-person research and health care visits. METHODS: Cross-sectional questionnaire data were collected from 135 adults (age: median 48 years; women: n=113, 83.7%; White participants: n=92, 68.2%) who were engaged in health-related research. RESULTS: More than half of the respondents (65/122, 53.3%) felt that the COVID-19 pandemic positively affected their desire to participate in research. Although 73.6% (95/129) of respondents also indicated a willingness to attend in-person health care visits while Centers for Disease Control and Prevention (CDC) guidelines are implemented, 85.8% (109/127) indicated a willingness to attend in-person, outdoor visits, and 92.2% (118/128) reported a willingness to attend drive-through visits (with CDC guidelines implemented during both visit types). Videoconferencing was the most preferred format for intervention visits; however, adults over the age of 65 years preferred this format less than younger adults (P=.001). CONCLUSIONS: Researchers and clinicians should continue to provide opportunities for continuing the conduction of remote-based interventions while enforcing CDC guidelines during in-person visits.

Behavioral Weight Loss Intervention Preferences of Adolescents with Overweight/Obesity.

Background: Behavioral lifestyle interventions are the foundation of adolescent obesity treatment. Tailoring an intervention using adolescent stakeholder engagement during the development process could improve intervention effectiveness. Methods: Adolescents with overweight/obesity ages 14-19 (n = 41) participated in 11 sex-specific focus groups (girls = 6, boys = 5) and were asked their preferences regarding who should lead the intervention and be involved, what the messaging of the program should be, how to make the program engaging and maintain participation, and how to best measure nutrition intake and activity. Transcripts were coded and analyzed for emergent themes. Results: Mean age was 16.0 ± 1.8 years and participants were racially/ethnically diverse. Adolescents preferred interventions that avoid a focus on "weight loss," and instead emphasize "healthy lifestyle," which represents a more comprehensive goal of targeting physical and mental well-being. Most participants indicated preferences for a relatable instructor with prior weight loss experience. Both sexes preferred optional parental involvement, as some parents were described as helpful, while others were perceived as a hindrance to success. Boys and girls identified incentives, engaging activities, and electronic communication as core components for engagement and retention, with girls emphasizing socialization and building relationships. Sex differences in preferences were observed. Girls had more concerns about intervention participation and preferred interventions to be sex stratified. Conclusions: Behavioral interventions to treat adolescent obesity should focus messaging/content on healthy lifestyles, rather than weight loss, and be sex stratified. Development and implementation of future behavioral interventions for adolescent obesity should consider tailoring to adolescent preferences when possible to improve feasibility, acceptability, and effectiveness.

Perceived barriers/facilitators to a healthy lifestyle among diverse adolescents with overweight/obesity: A qualitative study.

Objective: Effectiveness of behavioural obesity treatments in adolescents is modest. Thus, incorporating participant feedback may lead to improvement of intervention acceptability. This qualitative study's objective was to assess perceived barriers/facilitators to weight loss and healthy lifestyles among diverse adolescents with overweight/obesity (OW/OB). Methods: Adolescents ages 14-19 with BMI ≥ 85th percentile participated in focus groups and identified perceived barriers/facilitators to weight loss and healthy lifestyles. Results: Ten sex-stratified focus groups (n = 41; n = 13 males, n = 28 females) were conducted in 2018 and 2019. Females reported experiencing weight struggles, whereas males often stated no struggles with weight, despite all participants meeting criterion for OW/OB. Barriers included eating behaviours, family members and internal motivation, with additional barriers of physical activity, friends, time and support cited in females. Facilitators included parental, familial and peer support of healthy eating and exercise, modelling behaviours, internal motivation and organized sports. Two additional findings regarding adolescents' perceived barriers/facilitators include substantial overlap and sex differences of perceived barriers/facilitators. Conclusions: Adolescent males and females with OW/OB experience weight status differently, affecting their perceived barriers/facilitators to weight loss and healthy lifestyles. Tailoring weight management interventions to the unique needs of adolescent females versus adolescent males has the potential to improve intervention quality and effectiveness.

COVID-19 Impacts Mental Health Outcomes and Ability/Desire to Participate in Research Among Current Research Participants.

OBJECTIVE: This study aimed to examine the impact of coronavirus disease 2019 (COVID-19) on current research participants' mental health outcomes, ability to adhere to behavioral intervention recommendations, and desire to participate in research. METHODS: A quantitative/qualitative cross-sectional survey was used among adults currently enrolled in health-related research (N = 250; 85% women; > 50% currently enrolled in behavioral weight loss intervention). RESULTS: COVID-19 was perceived as a severe threat by most (62.3%). Related to COVID-19, 29.6% of participants reported moderate/severe symptoms of anxiety/depression, and 68.4% reported moderate/severe posttraumatic stress disorder (PTSD) symptomatology, with women more likely to demonstrate moderate/severe anxiety/depression (P = 0.047) and PTSD symptomatology (P = 0.028) relative to men. Those with moderate/severe levels of anxiety/depression (P = 0.0154) and distress (P = 0.0330) were more likely to report a decreased desire to participate in research. Among those in behavioral interventions, individuals perceiving COVID-19 as a moderate/severe threat or experiencing moderate/severe depression or PTSD symptomatology were 4 to 19 times more likely to report that COVID-19 affected their ability to adhere to behavioral recommendations. Qualitative analysis identified four themes describing COVID-19's impact on research experiences: transition, remote intervention delivery, ability to adhere to program goals, and research participation interest. CONCLUSIONS: These data suggest that participants engaged in health-related research perceive COVID-19 as a significant threat, affecting mental health, desire to participate in research, and ability to adhere to intervention recommendations.

Accuracy of weight loss information in Spanish search engine results on the internet.

OBJECTIVE: To systematically assess the quality of online information related to weight loss that Spanish speakers in the U.S. are likely to access. METHODS: This study evaluated the accessibility and quality of information for websites that were identified from weight loss queries in Spanish and compared this with previously published results in English. The content was scored with respect to five dimensions: nutrition, physical activity, behavior, pharmacotherapy, and surgical recommendations. RESULTS: Sixty-six websites met eligibility criteria (21 commercial, 24 news/media, 10 blogs, 0 medical/government/university, 11 unclassified sites). Of 16 possible points, mean content quality score was 3.4 (SD = 2.0). Approximately 1.5% of sites scored greater than 8 (out of 12) on nutrition, physical activity, and behavior. Unsubstantiated claims were made on 94% of the websites. Content quality scores varied significantly by type of website (P < 0.0001) with unclassified websites scoring the highest (mean = 6.3, SD = 1.4) and blogs scoring the lowest (mean = 2.2, SD = 1.2). All content quality scores were lower for Spanish websites relative to English websites. CONCLUSIONS: Weight loss information accessed in Spanish Web searches is suboptimal and relatively worse than weight loss information accessed in English, suggesting that U.S. Spanish speakers accessing weight loss information online may be provided with incomplete and inaccurate information.