Abstract 1. Describes the goals and methodology of a randomized, controlled trial comparing the e... more Abstract 1. Describes the goals and methodology of a randomized, controlled trial comparing the effects of standard medical care to two structured interventions: Family Learning Program and Behavioral Family Systems Therapy. The effects of these ...
Translational Issues in Psychological Science, 2015
This study evaluated the association of sleep duration and irregularity (shifts in sleep duration... more This study evaluated the association of sleep duration and irregularity (shifts in sleep duration and wake/bedtimes from weekday to weekend) with baseline level of obesity in youth enrolled in a weight management program. The 288 youth ranged in age from 6 to 18 years old; 61.1% were female, and 52.5% were Caucasian. In adjusted models, shorter sleep duration was significantly related to higher BMI z scores. Two measures of sleep irregularity, bedtime and wake-time shift, were also each related to baseline BMI z scores, but these relationships did not remain significant in adjusted models. In gender-stratified adjusted regression models, shorter sleep duration and greater wake-time shift for females were significantly associated with higher BMI z scores. None of the sleep variables were significantly related to BMI z scores for males in adjusted models. Taken together, the results of this study support the relationship between sleep duration and regularity with level of obesity in a racially diverse sample of predominantly obese, treatment-seeking youth.
Objective-To examine the relationship between stressful life events and physiological measures, m... more Objective-To examine the relationship between stressful life events and physiological measures, medication adherence, depressive symptoms, and impaired quality of life in adolescents with recent onset type 2 diabetes (T2D). Study design-Data were collected from 497 ethnically diverse participants (66% female) in the final year of the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) multi-center clinical trial. Exposure to 32 possible events over the prior year and rating of subsequent distress or upset were collected by self-report, and summarized in a major stressors score. The score was analyzed for relationship to glycemic control (HbA1c and treatment failure), BMI, diagnosis of hypertension or triglycerides dyslipidemia, oral medication adherence, presence of depressive symptoms, and impaired quality of life. Results-The total number of major stressful life events was calculated, with 33% of the sample reporting none, 67% at least one, 47% at least two, 33% at least three, and 20% reporting four or more. There were no associations between major stressors score and physiological measures or diagnosis of comorbidities. The odds of medication non-adherence increased significantly from those reporting at least one major stressor (odds ratio=1.58, p=0.0265) to those reporting at least 4 (odds ratio=2.70, p=0.0009). Significant odds of elevated depressive symptoms and impaired quality of life were also found with increased reporting of major stressors. Conclusions-Exposure to major stressful life events is association with lower adherence and impaired psychosocial functioning among adolescents with T2D. * Odds ratios (OR) and 95% confidence interval, and p-values from a model adjusted for sex. The reference category for number of upsetting events is combination of (a) event did not occur in past year and (b) event occurred but was rated not at all or a little upsetting. † Category ≥ 2 is a subset of category ≥ 1, and so on.
To examine moderating effects of family functioning and social support on the relationship of chi... more To examine moderating effects of family functioning and social support on the relationship of child-related stressors to caregivers' psychological adaptation in a sample of caregivers of children with a chronic illness. Method: Participants were 67 caregivers of children and adolescents with sickle cell syndromes. We conducted MANOVAs and subsequent effect size calculations to determine if family functioning would buffer the effects of caring for difficult-to-manage children with this illness. Results: Findings supported a moderator effect of family functioning on the association of children's externalizing behavioral problems to caregivers' symptoms of hostility. Greater levels of cohesive and adaptive family functioning buffered the potential detrimental effects of caring for children perceived as hard to manage. No significant associations were obtained between measures of caregivers' psychological adaptation and the severity of their children's disease. Conclusions: We make recommendations for family systems interventions, particularly for caregivers of children with behavior problems.
Journal of Developmental & Behavioral Pediatrics, 2008
Insufficient sleep may be a significant contributing factor to the increase in pediatric obesity ... more Insufficient sleep may be a significant contributing factor to the increase in pediatric obesity and thus may also contribute to adult obesity and chronic illness. Previous research has been based on large survey studies with consideration of demographics and lifestyle factors (e.g., snacking and TV watching) but not of child psychological/behavioral functioning and parenting factors. This study investigated the relationship of sleep duration to obesity status in 819 children ages 8 to 11 years old, with consideration of demographics, clinical elevations in child psychological/behavioral functioning, and parenting stress. In unadjusted and adjusted analyses, parent-reported child sleep duration was significantly associated with the odds of obesity with an increase of 41% for each 1-hour reduction in sleep duration. In addition to sleep duration, only median neighborhood income was significantly related to obesity status. Indices of child psychological/behavioral functioning and parenting stress were associated with sleep duration but not with obesity, and adjusting for these behavioral and parenting characteristics did not appreciably alter the relationship between sleep duration and obesity status. Exploratory gender-specific analyses found that mean sleep duration was significantly associated with the odds of obesity for boys but not for girls. These results show that the relationship of shorter sleep duration to a greater likelihood of being obese persists even after adjusting for potential confounders of child psychological/behavioral functioning and parenting stress. Gender-specific associations are similar to findings reported in samples that include adolescents.
Journal of Developmental & Behavioral Pediatrics, 2011
The objective of this study was to offer a practical demonstration of the use of bootstrapping in... more The objective of this study was to offer a practical demonstration of the use of bootstrapping in structural equation modeling (SEM) with smaller samples by evaluating family dinnertime rituals at the intersection between the family social environment and pediatric type 1 diabetes mellitus management. Method: Participants were 77 children and adolescents aged 6 to 18 years and their mothers from a larger study of child and parental challenges related to managing the treatment regimen and correlates of adherence. SEM was used to test a model of maternal reports of the family social environment as exogenous variables with mealtime rituals and child hemoglobin A1c levels as endogenous variables. The bootstrapping procedure and the Bollen-Stine bootstrapped 2 test were then applied to test the stability and appropriateness of this model. Results: Using SEM, the final model had robust goodness-of-fit indicators and revealed that the family social environment characteristics of control and cohesion were related to mealtime rituals, which was associated with hemoglobin A1c levels. The bootstrapping procedure indicated that the parameter estimates were very stable, thus lending greater credence to the model. The Bollen-Stine approach provided evidence that the entire hypothesized model was not significantly different from the model derived from bootstrapping. Conclusions: This investigation offers a practical demonstration of the bootstrapping technique and the Bollen-Stine approach for testing models on smaller samples in SEM. These techniques may be used with relatively small samples, which are common in developmental/behavioral pediatrics and pediatric psychology research.
Purpose-To compare two different parenting practices (parental monitoring and negotiated unsuperv... more Purpose-To compare two different parenting practices (parental monitoring and negotiated unsupervised time) and perceived parental trust in the reporting of health risk behaviors among adolescents. Methods-Data were derived from 692 adolescents in 9th and 10th grades (X̄ = 15.7 years) enrolled in health education classes in six urban high schools. Students completed a selfadministered paper-based survey that assessed adolescents' perceptions of the degree to which their parents monitor their whereabouts, are permitted to negotiate unsupervised time with their friends and trust them to make decisions. Using gender-specific multivariate logistic regression analyses, we examined the relative importance of parental monitoring, negotiated unsupervised time with peers, and parental trust in predicting reported sexual activity, sex-related protective actions (e.g., condom use, carrying protection) and substance use (alcohol, tobacco, and marijuana). Results-For males and females, increased negotiated unsupervised time was strongly associated with increased risk behavior (e.g., sexual activity, alcohol and marijuana use) but also sex-related protective actions. In males, high parental monitoring was associated with less alcohol use and consistent condom use. Parental monitoring had no affect on female behavior. Perceived parental trust served as a protective factor against sexual activity, tobacco, and marijuana use in females, and alcohol use in males. Conclusions-Although monitoring is an important practice for parents of older adolescents, managing their behavior through negotiation of unsupervised time may have mixed results leading to increased experimentation with sexuality and substances, but perhaps in a more responsible way. Trust established between an adolescent female and her parents continues to be a strong deterrent for risky behaviors but appears to have little effect on behaviors of adolescent males.
Defining the proper geographic scale for built environment exposures continues to present challen... more Defining the proper geographic scale for built environment exposures continues to present challenges. In this study, size attributes and exposure calculations from two commonly used neighborhood boundaries were compared to those from neighborhoods that were self-defined by a sample of 145 urban minority adolescents living in subsidized housing estates. Associations between five built environment exposures and physical activity, overweight and obesity were also examined across the three neighborhood definitions. Limited spatial overlap was observed across the various neighborhood definitions. Further, many places where adolescents were active were not within the participants' neighborhoods. No statistically significant associations were found between counts of facilities and the outcomes based on exposure calculations using the selfdefined boundaries; however, a few associations were evident for exposures using the 0.75 mile network buffer and census tract boundaries. Future investigation of the relationship between the built environment, physical activity and obesity will require practical and theoretically-based methods for capturing salient environmental exposures.
OBJECTIVE The current study examines the prevalence of binge eating and its association with adip... more OBJECTIVE The current study examines the prevalence of binge eating and its association with adiposity and psychosocial functioning in a large, diverse sample of youth with type 2 diabetes. RESEARCH DESIGN AND METHODS In the TODAY study, 678 (mean age 14.0 years; 64.9% girls) of the 704 youth randomized to the study completed a self-report measure of eating disorder symptoms and were categorized as nonovereaters, overeaters, subclinical binge eaters, or clinical binge eaters. RESULTS Youth with clinical (6%) and subclinical (20%) levels of binge eating had significantly higher levels and rates of extreme obesity, global eating disorder and depressive symptoms, and impaired quality of life. CONCLUSIONS These findings highlight the importance of evaluating youth with type 2 diabetes for the presence of binge eating. Future research is needed to determine the cumulative effects of disordered eating, obesity, and psychosocial distress on adherence to lifestyle change recommendations and...
Commentary: Introduction to the Special Issue on Pediatric Behavioral Sleep Medicine Carolyn E. I... more Commentary: Introduction to the Special Issue on Pediatric Behavioral Sleep Medicine Carolyn E. Ievers-Landis a & Brett R. Kuhn b c a Division of Developmental/Behavioral Pediatrics & Psychology, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH, USA b Department of Psychology, Munroe-Meyer Institute for Genetics and Rehabilitation, Omaha, NE, USA c Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
Objective To develop and test a model based on Bandura' s social cognitive theory to predict heal... more Objective To develop and test a model based on Bandura' s social cognitive theory to predict healthy lifestyle behaviors for the prevention of osteoporosis. Methods Participants were 354 girls, ages 8-11 years, recruited from area Girl Scout troops. Baseline data from a randomized trial of behavioral interventions are presented. Measures of social support, knowledge, self-efficacy, dietary calcium intake, and weight-bearing physical activity (WBPA) were obtained via interviews and self-administered questionnaires. Results A structural equation model was tested and fit the data well. Family social support, perceived self-efficacy for eating a calcium-rich diet, and knowledge of WBPA significantly predicted calcium intake. Friend and family support for exercise predicted WBPA. Self-efficacy partially mediated the relationship between family support and calcium intake, as confirmed by Holmbeck' s post-hoc probing strategy (2002). Conclusions Suggestions are made for primary prevention interventions such as parent and peer involvement, health education, and problem-solving training.
Diabetes research and clinical practice, Jan 13, 2017
The relationship between depressive symptoms and glycemic control in youth with type 2 diabetes w... more The relationship between depressive symptoms and glycemic control in youth with type 2 diabetes was assessed at baseline (n=682), 6, and/or 24 months (n=576). Neither baseline nor persistence of depressive symptoms was significantly associated with maintenance of glycemic control. Nevertheless, depressive symptoms were common, suggesting the importance of repeated screening.
Sleep Duration and Fat Intake-Weiss et al OVER THE PAST 40 YEARS, INSUFFICIENT SLEEP DURATION AMO... more Sleep Duration and Fat Intake-Weiss et al OVER THE PAST 40 YEARS, INSUFFICIENT SLEEP DURATION AMONG ADOLESCENTS HAS MARKEDLY INCREASED , WHEREBY TODAY ONLY ABOUT 33% OF teens are getting the recommended 9 hours of sleep. 1 Concurrent with this rise in short sleep duration is the epidemic of obesity. 2 Obesity in children and adolescents is a growing health concern because of its adverse impact on metabolism, blood pressure, respiratory disease, and quality of life, 3 as well as its association with adult obesity and chronic illnesses, including cardiovascular diseases, cancer, musculoskeletal disease, and gastrointestinal disease. 4,5,6 A number of studies have suggested that there is a link between sleep loss and weight gain in adults. 7-9 For children, this finding has been consistent across large samples studied in various countries 10,11 and in prospective studies. 12 Studies with older children or adolescents have found the relationship between short sleep duration and obesity for males but not for females. 13-15 Physiologic studies have shown that sleep deprivation may influence weight through effects on appetite, physical activity, and/or thermoregulation. 16,17 Experimental reductions in sleep duration have been hypothesized to alter metabolic rate or to affect the levels of appetite regulatory hormones, leptin and ghrelin. 16-21 An association between insufficient sleep and increased caloric intake has been demonstrated in some, 22 but not other, 23 studies. Differences in the literature may relate to differences in experiment design. Understanding the association between insufficient sleep and obesity in the population has been limited by a paucity of research that has quantified both energy intake and sleep duration in individuals studied in their native environments. Thus, it is unclear whether the mechanisms that mediate sleep loss and energy balance are through appetitive pathways, changes in energy expenditure, or altered metabolism. In this study, we examined the association between weekday sleep duration and energy consumption in adolescents aged 16 to 19 years studied in their natural environment. Using rigorously collected multiple-pass 24-hour food recalls and objectively measured sleep duration from wrist actigraphy, we tested the hypothesis that shorter sleep is associated with altered nutrient intake, including altered proportions of caloric intake from fats, carbohydrates, and snacks. METHODS Study Population The study sample comprised adolescents participating in the late-adolescent examination of the Cleveland Children's Sleep and Health Study, an ongoing longitudinal cohort study
Obesity is a serious health issue for American youth – especially youth from ethnic and racial mi... more Obesity is a serious health issue for American youth – especially youth from ethnic and racial minorities. Scholars have suggested media might put youth at risk for obesity-related issues. Research about media influence on health outcomes has relied on self-reporting of both media use and health behaviors. However, self-reports have limited validity. Youth learn about health through many media, but they might not be able to name health information sources. Studies show teens learn sexual health behaviors from magazines, TV, and music more than from parents or school and they learn smoking behaviors from commercial films. However, no research to date has examined weight-related content in entertainment media used by ethnic and racial minorities. It is the focus of our study. We present a content analysis of weight-related messages in magazines read by African American youth. We assess all information related to eating and physical activity in October 2008 and May 2009 issues of 12 po...
Objectives-To characterize, over a two-year period, the proportion of youth with type 2 diabetes ... more Objectives-To characterize, over a two-year period, the proportion of youth with type 2 diabetes (T2D) enrolled in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study that reported ever at least trying smoking cigarettes and/or drinking alcohol. Study design-Longitudinal data were examined for participants with T2D ages 10 to 18 years old at baseline. Youth psychosocial, parent/family, environmental, and biological correlates of trying health risk behaviors were tested via cross-sectional multivariate models at each time point. Longitudinal models were explored for selected factors. Results-Data were obtained from the TODAY study's ethnically diverse participants at baseline (N=644), 6-month (N=616), and 24-month (N=543) assessments. Percent of youth ever trying only smoking remained stable at 4%, only drinking alcohol increased from 17% to 26%, and both smoking and drinking increased from 10% to 18% over the two-year period. Factors related to trying health risk behaviors were older age, male sex, non-Hispanic White raceethnicity, lower grades, more depressive symptoms and stressful life events. Depressive symptoms, stressful life events, and BMI Z-score (the latter with smoking only) were related to engagement in health risk behaviors over time. Conclusions-Youth with T2D who are already at risk for health complications and who reported engaging in activities that further increase the likelihood of life-threatening morbidities were characterized. Although most correlates of trying these risk behaviors are non-modifiable, intervention efforts may need to focus on potentially modifiable factors, such as depressive symptoms and lower grades. Keywords Type 2 Diabetes; Alcohol; Smoking; Health Risk; Youth Youth with type 2 diabetes (T2D) may be at risk to develop comorbid complications, including hypertension, hyperlipidemia, and cancer, at an early age. 1,2 Progression of complications could be exacerbated by duration of diabetes and the obesity that contributed to the initial diagnosis. Engaging in health risk behaviors such as smoking cigarettes and drinking alcohol may further jeopardize their health. Early initiation of smoking and drinking in youth, even in some cases if "just trying," has been linked to later nicotine/ alcohol use disorders and other health conditions. 3-8 Published reports of smoking and alcohol use among youth with T2D are rare. 9 Knowledge of the correlates of these health risk behaviors is limited to predominantly physically healthy youth and youth with type 1 diabetes (T1D). Demographic variables, e.g., age, sex, race/ethnicity, and socioeconomic status, have been related to youth health risk behaviors. 9-12 Among psychosocial variables, lower grades, depressive symptomatology, stressful life events, and environmental factors are associated with youth substance use. 10-13 Biological correlates of substance use risk behaviors are elevated body mass index (BMI) in youth with T1D 14 and physically healthy * Variable not included in the multivariate model. ** Multivariate model adjusted for treatment assignment. * Variable not included in the multivariate model. ** Multivariate model adjusted for treatment assignment. *** Model evaluating relationship with outcome of drinking only (Drink, No Drink) All models adjusted for age, sex, race/ethnicity and treatment assignment.
Journal of Clinical Psychology in Medical Settings, 2000
Adherence to medical treatment is a significant problem for children and adolescents with chronic... more Adherence to medical treatment is a significant problem for children and adolescents with chronic conditions, such as asthma, diabetes, and cystic fibrosis. The consequences of nonadherence can be serious, contributing to increased symptoms, unnecessary hospitalizations, and declines in physical functioning. The quality of data obtained from clinical trials can also be affected by poor adherence, leading to erroneous conclusions concerning
Journal of Developmental & Behavioral Pediatrics, 2013
Carolyn E. Ievers-Landis, PhD,* Elissa Jelalian, PhD† It is with great pleasure that we present t... more Carolyn E. Ievers-Landis, PhD,* Elissa Jelalian, PhD† It is with great pleasure that we present the special issue on pediatric obesity of the Journal of Developmental and Behavioral Pediatrics (JDBP). This issue was intended to bring together, under the auspices of the Society of Developmental and Behavioral Pediatrics (SDBP), a collection of pediatric obesity-related research studies to further push this vital area of inquiry forward. Although the overall rates of obesity in youth seem to have leveled off, approximately 33% of children and adolescents in the United States remain overweight or obese.1 Pediatric obesity places children at risk for a number of negative health consequences, including obesity in adulthood,2,3 early onset type 2 diabetes,4 and cardiovascular disease.5,6 Children or adolescents who are obese also face a multitude of psychosocial challenges, including significant impairments in healthrelated quality of life (HRQOL),7,8 self-concept, and relationships with peers.9,10 It is incumbent on scientists and practitioners from pediatrics and psychology to come together to reverse the trend of this potentially preventable condition. This issue, entitled “Novel correlates, treatment or prevention of pediatric obesity in a developmental framework with a cultural or interdisciplinary context,” was conceived soon after a strategic planning meeting of SDBP’s Executive Committee and invited key members. The issue highlights the mission and vision statements and the core values of the Society. One major focus of SDBP is child development. As a result, we requested that each article within the “Call for Papers” be presented within a developmental framework for understanding pediatric obesity and informing interventions that work. We further recommended that the age range and developmental stages of the participants be thoughtfully considered for conceptualization of the model and hypotheses. The featured manuscripts cover a broad spectrum of development in our field from young childhood to emerging adult samples with coverage fairly evenly divided between 4 major developmental periods: early childhood, middle childhood, adolescence, and young adulthood. Within this developmental framework, we sought to highlight 2 perspectives: novel correlates/contributors for better understanding pediatric obesity (i.e., variables that are just beginning to emerge in this area or that have been the focus of studies predominantly in the adult literature within either cross-sectional or longitudinal designs) and treatment or prevention intervention studies. As featured in this special issue, novel correlates/ variables for furthering knowledge of pediatric obesity are (in order of appearance in this issue) as follows: parental U.S.-born status (Cespedes and colleagues, pages 541–548); cumulative social risk (Suglia, Duarte, Chambers, and Boynton-Jarrett, pages 549–556); emotional reactivity, emotional and external eating (Harrist, HubbsTait, Topham, Shriver, and Page, pages 557–565); attention deficit/hyperactivity disorder (Fliers and colleagues, pages 566–574); psychosocial profile subgroups relating to posttreatment HRQOL (Wu and Steele, pages 575–582); parental alliance (Mazzeschi and colleagues, pages 583–588); and discretionary time social context (Bohnert and colleagues, pages 589–598). Treatment or prevention intervention articles include a novel evaluation technique to determine which Motivational Interviewing communication strategies used by weight loss counselors predict black adolescents’ motivational statements (Carcone and colleagues, pages 599–608) and a pilot intervention that partnered with community organizations to target health knowledge and behavior of low-income adolescent mothers for improving parent/ child health behaviors and weight status (Davis and colleagues, pages 609–615). Finally, we chose to feature a promising experimental pilot study that tested acute exercise versus imposed sedentary behaviors on daily dietary intake and energy balance for adolescents who are obese (Thivel and co-authors, pages 616–622). Within these perspectives, we especially sought interdisciplinary research and studies with a cultural focus. The disciplines of the authors of this work are quite varied, including (but not limited to) the following: developmental/behavioral pediatrics; child development; clinical (pediatric) psychology; epidemiology; exercise, nutrition and health sciences; nutrition; public health; and social work. The cultural focus and context of the articles are also broad and include research participants residing within the United States who are African-American, American-Indian, white, and Hispanic. International contributions allow us to showcase From the *Division of Developmental/Behavioral Pediatrics and Psychology, Rainbow Babies & Children’s Hospital and University Hospitals Case Medical Center, Cleveland, OH; †Psychiatry and Human Behavior and Pediatrics at the Alpert Medical…
Abstract 1. Describes the goals and methodology of a randomized, controlled trial comparing the e... more Abstract 1. Describes the goals and methodology of a randomized, controlled trial comparing the effects of standard medical care to two structured interventions: Family Learning Program and Behavioral Family Systems Therapy. The effects of these ...
Translational Issues in Psychological Science, 2015
This study evaluated the association of sleep duration and irregularity (shifts in sleep duration... more This study evaluated the association of sleep duration and irregularity (shifts in sleep duration and wake/bedtimes from weekday to weekend) with baseline level of obesity in youth enrolled in a weight management program. The 288 youth ranged in age from 6 to 18 years old; 61.1% were female, and 52.5% were Caucasian. In adjusted models, shorter sleep duration was significantly related to higher BMI z scores. Two measures of sleep irregularity, bedtime and wake-time shift, were also each related to baseline BMI z scores, but these relationships did not remain significant in adjusted models. In gender-stratified adjusted regression models, shorter sleep duration and greater wake-time shift for females were significantly associated with higher BMI z scores. None of the sleep variables were significantly related to BMI z scores for males in adjusted models. Taken together, the results of this study support the relationship between sleep duration and regularity with level of obesity in a racially diverse sample of predominantly obese, treatment-seeking youth.
Objective-To examine the relationship between stressful life events and physiological measures, m... more Objective-To examine the relationship between stressful life events and physiological measures, medication adherence, depressive symptoms, and impaired quality of life in adolescents with recent onset type 2 diabetes (T2D). Study design-Data were collected from 497 ethnically diverse participants (66% female) in the final year of the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) multi-center clinical trial. Exposure to 32 possible events over the prior year and rating of subsequent distress or upset were collected by self-report, and summarized in a major stressors score. The score was analyzed for relationship to glycemic control (HbA1c and treatment failure), BMI, diagnosis of hypertension or triglycerides dyslipidemia, oral medication adherence, presence of depressive symptoms, and impaired quality of life. Results-The total number of major stressful life events was calculated, with 33% of the sample reporting none, 67% at least one, 47% at least two, 33% at least three, and 20% reporting four or more. There were no associations between major stressors score and physiological measures or diagnosis of comorbidities. The odds of medication non-adherence increased significantly from those reporting at least one major stressor (odds ratio=1.58, p=0.0265) to those reporting at least 4 (odds ratio=2.70, p=0.0009). Significant odds of elevated depressive symptoms and impaired quality of life were also found with increased reporting of major stressors. Conclusions-Exposure to major stressful life events is association with lower adherence and impaired psychosocial functioning among adolescents with T2D. * Odds ratios (OR) and 95% confidence interval, and p-values from a model adjusted for sex. The reference category for number of upsetting events is combination of (a) event did not occur in past year and (b) event occurred but was rated not at all or a little upsetting. † Category ≥ 2 is a subset of category ≥ 1, and so on.
To examine moderating effects of family functioning and social support on the relationship of chi... more To examine moderating effects of family functioning and social support on the relationship of child-related stressors to caregivers' psychological adaptation in a sample of caregivers of children with a chronic illness. Method: Participants were 67 caregivers of children and adolescents with sickle cell syndromes. We conducted MANOVAs and subsequent effect size calculations to determine if family functioning would buffer the effects of caring for difficult-to-manage children with this illness. Results: Findings supported a moderator effect of family functioning on the association of children's externalizing behavioral problems to caregivers' symptoms of hostility. Greater levels of cohesive and adaptive family functioning buffered the potential detrimental effects of caring for children perceived as hard to manage. No significant associations were obtained between measures of caregivers' psychological adaptation and the severity of their children's disease. Conclusions: We make recommendations for family systems interventions, particularly for caregivers of children with behavior problems.
Journal of Developmental & Behavioral Pediatrics, 2008
Insufficient sleep may be a significant contributing factor to the increase in pediatric obesity ... more Insufficient sleep may be a significant contributing factor to the increase in pediatric obesity and thus may also contribute to adult obesity and chronic illness. Previous research has been based on large survey studies with consideration of demographics and lifestyle factors (e.g., snacking and TV watching) but not of child psychological/behavioral functioning and parenting factors. This study investigated the relationship of sleep duration to obesity status in 819 children ages 8 to 11 years old, with consideration of demographics, clinical elevations in child psychological/behavioral functioning, and parenting stress. In unadjusted and adjusted analyses, parent-reported child sleep duration was significantly associated with the odds of obesity with an increase of 41% for each 1-hour reduction in sleep duration. In addition to sleep duration, only median neighborhood income was significantly related to obesity status. Indices of child psychological/behavioral functioning and parenting stress were associated with sleep duration but not with obesity, and adjusting for these behavioral and parenting characteristics did not appreciably alter the relationship between sleep duration and obesity status. Exploratory gender-specific analyses found that mean sleep duration was significantly associated with the odds of obesity for boys but not for girls. These results show that the relationship of shorter sleep duration to a greater likelihood of being obese persists even after adjusting for potential confounders of child psychological/behavioral functioning and parenting stress. Gender-specific associations are similar to findings reported in samples that include adolescents.
Journal of Developmental & Behavioral Pediatrics, 2011
The objective of this study was to offer a practical demonstration of the use of bootstrapping in... more The objective of this study was to offer a practical demonstration of the use of bootstrapping in structural equation modeling (SEM) with smaller samples by evaluating family dinnertime rituals at the intersection between the family social environment and pediatric type 1 diabetes mellitus management. Method: Participants were 77 children and adolescents aged 6 to 18 years and their mothers from a larger study of child and parental challenges related to managing the treatment regimen and correlates of adherence. SEM was used to test a model of maternal reports of the family social environment as exogenous variables with mealtime rituals and child hemoglobin A1c levels as endogenous variables. The bootstrapping procedure and the Bollen-Stine bootstrapped 2 test were then applied to test the stability and appropriateness of this model. Results: Using SEM, the final model had robust goodness-of-fit indicators and revealed that the family social environment characteristics of control and cohesion were related to mealtime rituals, which was associated with hemoglobin A1c levels. The bootstrapping procedure indicated that the parameter estimates were very stable, thus lending greater credence to the model. The Bollen-Stine approach provided evidence that the entire hypothesized model was not significantly different from the model derived from bootstrapping. Conclusions: This investigation offers a practical demonstration of the bootstrapping technique and the Bollen-Stine approach for testing models on smaller samples in SEM. These techniques may be used with relatively small samples, which are common in developmental/behavioral pediatrics and pediatric psychology research.
Purpose-To compare two different parenting practices (parental monitoring and negotiated unsuperv... more Purpose-To compare two different parenting practices (parental monitoring and negotiated unsupervised time) and perceived parental trust in the reporting of health risk behaviors among adolescents. Methods-Data were derived from 692 adolescents in 9th and 10th grades (X̄ = 15.7 years) enrolled in health education classes in six urban high schools. Students completed a selfadministered paper-based survey that assessed adolescents' perceptions of the degree to which their parents monitor their whereabouts, are permitted to negotiate unsupervised time with their friends and trust them to make decisions. Using gender-specific multivariate logistic regression analyses, we examined the relative importance of parental monitoring, negotiated unsupervised time with peers, and parental trust in predicting reported sexual activity, sex-related protective actions (e.g., condom use, carrying protection) and substance use (alcohol, tobacco, and marijuana). Results-For males and females, increased negotiated unsupervised time was strongly associated with increased risk behavior (e.g., sexual activity, alcohol and marijuana use) but also sex-related protective actions. In males, high parental monitoring was associated with less alcohol use and consistent condom use. Parental monitoring had no affect on female behavior. Perceived parental trust served as a protective factor against sexual activity, tobacco, and marijuana use in females, and alcohol use in males. Conclusions-Although monitoring is an important practice for parents of older adolescents, managing their behavior through negotiation of unsupervised time may have mixed results leading to increased experimentation with sexuality and substances, but perhaps in a more responsible way. Trust established between an adolescent female and her parents continues to be a strong deterrent for risky behaviors but appears to have little effect on behaviors of adolescent males.
Defining the proper geographic scale for built environment exposures continues to present challen... more Defining the proper geographic scale for built environment exposures continues to present challenges. In this study, size attributes and exposure calculations from two commonly used neighborhood boundaries were compared to those from neighborhoods that were self-defined by a sample of 145 urban minority adolescents living in subsidized housing estates. Associations between five built environment exposures and physical activity, overweight and obesity were also examined across the three neighborhood definitions. Limited spatial overlap was observed across the various neighborhood definitions. Further, many places where adolescents were active were not within the participants' neighborhoods. No statistically significant associations were found between counts of facilities and the outcomes based on exposure calculations using the selfdefined boundaries; however, a few associations were evident for exposures using the 0.75 mile network buffer and census tract boundaries. Future investigation of the relationship between the built environment, physical activity and obesity will require practical and theoretically-based methods for capturing salient environmental exposures.
OBJECTIVE The current study examines the prevalence of binge eating and its association with adip... more OBJECTIVE The current study examines the prevalence of binge eating and its association with adiposity and psychosocial functioning in a large, diverse sample of youth with type 2 diabetes. RESEARCH DESIGN AND METHODS In the TODAY study, 678 (mean age 14.0 years; 64.9% girls) of the 704 youth randomized to the study completed a self-report measure of eating disorder symptoms and were categorized as nonovereaters, overeaters, subclinical binge eaters, or clinical binge eaters. RESULTS Youth with clinical (6%) and subclinical (20%) levels of binge eating had significantly higher levels and rates of extreme obesity, global eating disorder and depressive symptoms, and impaired quality of life. CONCLUSIONS These findings highlight the importance of evaluating youth with type 2 diabetes for the presence of binge eating. Future research is needed to determine the cumulative effects of disordered eating, obesity, and psychosocial distress on adherence to lifestyle change recommendations and...
Commentary: Introduction to the Special Issue on Pediatric Behavioral Sleep Medicine Carolyn E. I... more Commentary: Introduction to the Special Issue on Pediatric Behavioral Sleep Medicine Carolyn E. Ievers-Landis a & Brett R. Kuhn b c a Division of Developmental/Behavioral Pediatrics & Psychology, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH, USA b Department of Psychology, Munroe-Meyer Institute for Genetics and Rehabilitation, Omaha, NE, USA c Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
Objective To develop and test a model based on Bandura' s social cognitive theory to predict heal... more Objective To develop and test a model based on Bandura' s social cognitive theory to predict healthy lifestyle behaviors for the prevention of osteoporosis. Methods Participants were 354 girls, ages 8-11 years, recruited from area Girl Scout troops. Baseline data from a randomized trial of behavioral interventions are presented. Measures of social support, knowledge, self-efficacy, dietary calcium intake, and weight-bearing physical activity (WBPA) were obtained via interviews and self-administered questionnaires. Results A structural equation model was tested and fit the data well. Family social support, perceived self-efficacy for eating a calcium-rich diet, and knowledge of WBPA significantly predicted calcium intake. Friend and family support for exercise predicted WBPA. Self-efficacy partially mediated the relationship between family support and calcium intake, as confirmed by Holmbeck' s post-hoc probing strategy (2002). Conclusions Suggestions are made for primary prevention interventions such as parent and peer involvement, health education, and problem-solving training.
Diabetes research and clinical practice, Jan 13, 2017
The relationship between depressive symptoms and glycemic control in youth with type 2 diabetes w... more The relationship between depressive symptoms and glycemic control in youth with type 2 diabetes was assessed at baseline (n=682), 6, and/or 24 months (n=576). Neither baseline nor persistence of depressive symptoms was significantly associated with maintenance of glycemic control. Nevertheless, depressive symptoms were common, suggesting the importance of repeated screening.
Sleep Duration and Fat Intake-Weiss et al OVER THE PAST 40 YEARS, INSUFFICIENT SLEEP DURATION AMO... more Sleep Duration and Fat Intake-Weiss et al OVER THE PAST 40 YEARS, INSUFFICIENT SLEEP DURATION AMONG ADOLESCENTS HAS MARKEDLY INCREASED , WHEREBY TODAY ONLY ABOUT 33% OF teens are getting the recommended 9 hours of sleep. 1 Concurrent with this rise in short sleep duration is the epidemic of obesity. 2 Obesity in children and adolescents is a growing health concern because of its adverse impact on metabolism, blood pressure, respiratory disease, and quality of life, 3 as well as its association with adult obesity and chronic illnesses, including cardiovascular diseases, cancer, musculoskeletal disease, and gastrointestinal disease. 4,5,6 A number of studies have suggested that there is a link between sleep loss and weight gain in adults. 7-9 For children, this finding has been consistent across large samples studied in various countries 10,11 and in prospective studies. 12 Studies with older children or adolescents have found the relationship between short sleep duration and obesity for males but not for females. 13-15 Physiologic studies have shown that sleep deprivation may influence weight through effects on appetite, physical activity, and/or thermoregulation. 16,17 Experimental reductions in sleep duration have been hypothesized to alter metabolic rate or to affect the levels of appetite regulatory hormones, leptin and ghrelin. 16-21 An association between insufficient sleep and increased caloric intake has been demonstrated in some, 22 but not other, 23 studies. Differences in the literature may relate to differences in experiment design. Understanding the association between insufficient sleep and obesity in the population has been limited by a paucity of research that has quantified both energy intake and sleep duration in individuals studied in their native environments. Thus, it is unclear whether the mechanisms that mediate sleep loss and energy balance are through appetitive pathways, changes in energy expenditure, or altered metabolism. In this study, we examined the association between weekday sleep duration and energy consumption in adolescents aged 16 to 19 years studied in their natural environment. Using rigorously collected multiple-pass 24-hour food recalls and objectively measured sleep duration from wrist actigraphy, we tested the hypothesis that shorter sleep is associated with altered nutrient intake, including altered proportions of caloric intake from fats, carbohydrates, and snacks. METHODS Study Population The study sample comprised adolescents participating in the late-adolescent examination of the Cleveland Children's Sleep and Health Study, an ongoing longitudinal cohort study
Obesity is a serious health issue for American youth – especially youth from ethnic and racial mi... more Obesity is a serious health issue for American youth – especially youth from ethnic and racial minorities. Scholars have suggested media might put youth at risk for obesity-related issues. Research about media influence on health outcomes has relied on self-reporting of both media use and health behaviors. However, self-reports have limited validity. Youth learn about health through many media, but they might not be able to name health information sources. Studies show teens learn sexual health behaviors from magazines, TV, and music more than from parents or school and they learn smoking behaviors from commercial films. However, no research to date has examined weight-related content in entertainment media used by ethnic and racial minorities. It is the focus of our study. We present a content analysis of weight-related messages in magazines read by African American youth. We assess all information related to eating and physical activity in October 2008 and May 2009 issues of 12 po...
Objectives-To characterize, over a two-year period, the proportion of youth with type 2 diabetes ... more Objectives-To characterize, over a two-year period, the proportion of youth with type 2 diabetes (T2D) enrolled in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study that reported ever at least trying smoking cigarettes and/or drinking alcohol. Study design-Longitudinal data were examined for participants with T2D ages 10 to 18 years old at baseline. Youth psychosocial, parent/family, environmental, and biological correlates of trying health risk behaviors were tested via cross-sectional multivariate models at each time point. Longitudinal models were explored for selected factors. Results-Data were obtained from the TODAY study's ethnically diverse participants at baseline (N=644), 6-month (N=616), and 24-month (N=543) assessments. Percent of youth ever trying only smoking remained stable at 4%, only drinking alcohol increased from 17% to 26%, and both smoking and drinking increased from 10% to 18% over the two-year period. Factors related to trying health risk behaviors were older age, male sex, non-Hispanic White raceethnicity, lower grades, more depressive symptoms and stressful life events. Depressive symptoms, stressful life events, and BMI Z-score (the latter with smoking only) were related to engagement in health risk behaviors over time. Conclusions-Youth with T2D who are already at risk for health complications and who reported engaging in activities that further increase the likelihood of life-threatening morbidities were characterized. Although most correlates of trying these risk behaviors are non-modifiable, intervention efforts may need to focus on potentially modifiable factors, such as depressive symptoms and lower grades. Keywords Type 2 Diabetes; Alcohol; Smoking; Health Risk; Youth Youth with type 2 diabetes (T2D) may be at risk to develop comorbid complications, including hypertension, hyperlipidemia, and cancer, at an early age. 1,2 Progression of complications could be exacerbated by duration of diabetes and the obesity that contributed to the initial diagnosis. Engaging in health risk behaviors such as smoking cigarettes and drinking alcohol may further jeopardize their health. Early initiation of smoking and drinking in youth, even in some cases if "just trying," has been linked to later nicotine/ alcohol use disorders and other health conditions. 3-8 Published reports of smoking and alcohol use among youth with T2D are rare. 9 Knowledge of the correlates of these health risk behaviors is limited to predominantly physically healthy youth and youth with type 1 diabetes (T1D). Demographic variables, e.g., age, sex, race/ethnicity, and socioeconomic status, have been related to youth health risk behaviors. 9-12 Among psychosocial variables, lower grades, depressive symptomatology, stressful life events, and environmental factors are associated with youth substance use. 10-13 Biological correlates of substance use risk behaviors are elevated body mass index (BMI) in youth with T1D 14 and physically healthy * Variable not included in the multivariate model. ** Multivariate model adjusted for treatment assignment. * Variable not included in the multivariate model. ** Multivariate model adjusted for treatment assignment. *** Model evaluating relationship with outcome of drinking only (Drink, No Drink) All models adjusted for age, sex, race/ethnicity and treatment assignment.
Journal of Clinical Psychology in Medical Settings, 2000
Adherence to medical treatment is a significant problem for children and adolescents with chronic... more Adherence to medical treatment is a significant problem for children and adolescents with chronic conditions, such as asthma, diabetes, and cystic fibrosis. The consequences of nonadherence can be serious, contributing to increased symptoms, unnecessary hospitalizations, and declines in physical functioning. The quality of data obtained from clinical trials can also be affected by poor adherence, leading to erroneous conclusions concerning
Journal of Developmental & Behavioral Pediatrics, 2013
Carolyn E. Ievers-Landis, PhD,* Elissa Jelalian, PhD† It is with great pleasure that we present t... more Carolyn E. Ievers-Landis, PhD,* Elissa Jelalian, PhD† It is with great pleasure that we present the special issue on pediatric obesity of the Journal of Developmental and Behavioral Pediatrics (JDBP). This issue was intended to bring together, under the auspices of the Society of Developmental and Behavioral Pediatrics (SDBP), a collection of pediatric obesity-related research studies to further push this vital area of inquiry forward. Although the overall rates of obesity in youth seem to have leveled off, approximately 33% of children and adolescents in the United States remain overweight or obese.1 Pediatric obesity places children at risk for a number of negative health consequences, including obesity in adulthood,2,3 early onset type 2 diabetes,4 and cardiovascular disease.5,6 Children or adolescents who are obese also face a multitude of psychosocial challenges, including significant impairments in healthrelated quality of life (HRQOL),7,8 self-concept, and relationships with peers.9,10 It is incumbent on scientists and practitioners from pediatrics and psychology to come together to reverse the trend of this potentially preventable condition. This issue, entitled “Novel correlates, treatment or prevention of pediatric obesity in a developmental framework with a cultural or interdisciplinary context,” was conceived soon after a strategic planning meeting of SDBP’s Executive Committee and invited key members. The issue highlights the mission and vision statements and the core values of the Society. One major focus of SDBP is child development. As a result, we requested that each article within the “Call for Papers” be presented within a developmental framework for understanding pediatric obesity and informing interventions that work. We further recommended that the age range and developmental stages of the participants be thoughtfully considered for conceptualization of the model and hypotheses. The featured manuscripts cover a broad spectrum of development in our field from young childhood to emerging adult samples with coverage fairly evenly divided between 4 major developmental periods: early childhood, middle childhood, adolescence, and young adulthood. Within this developmental framework, we sought to highlight 2 perspectives: novel correlates/contributors for better understanding pediatric obesity (i.e., variables that are just beginning to emerge in this area or that have been the focus of studies predominantly in the adult literature within either cross-sectional or longitudinal designs) and treatment or prevention intervention studies. As featured in this special issue, novel correlates/ variables for furthering knowledge of pediatric obesity are (in order of appearance in this issue) as follows: parental U.S.-born status (Cespedes and colleagues, pages 541–548); cumulative social risk (Suglia, Duarte, Chambers, and Boynton-Jarrett, pages 549–556); emotional reactivity, emotional and external eating (Harrist, HubbsTait, Topham, Shriver, and Page, pages 557–565); attention deficit/hyperactivity disorder (Fliers and colleagues, pages 566–574); psychosocial profile subgroups relating to posttreatment HRQOL (Wu and Steele, pages 575–582); parental alliance (Mazzeschi and colleagues, pages 583–588); and discretionary time social context (Bohnert and colleagues, pages 589–598). Treatment or prevention intervention articles include a novel evaluation technique to determine which Motivational Interviewing communication strategies used by weight loss counselors predict black adolescents’ motivational statements (Carcone and colleagues, pages 599–608) and a pilot intervention that partnered with community organizations to target health knowledge and behavior of low-income adolescent mothers for improving parent/ child health behaviors and weight status (Davis and colleagues, pages 609–615). Finally, we chose to feature a promising experimental pilot study that tested acute exercise versus imposed sedentary behaviors on daily dietary intake and energy balance for adolescents who are obese (Thivel and co-authors, pages 616–622). Within these perspectives, we especially sought interdisciplinary research and studies with a cultural focus. The disciplines of the authors of this work are quite varied, including (but not limited to) the following: developmental/behavioral pediatrics; child development; clinical (pediatric) psychology; epidemiology; exercise, nutrition and health sciences; nutrition; public health; and social work. The cultural focus and context of the articles are also broad and include research participants residing within the United States who are African-American, American-Indian, white, and Hispanic. International contributions allow us to showcase From the *Division of Developmental/Behavioral Pediatrics and Psychology, Rainbow Babies & Children’s Hospital and University Hospitals Case Medical Center, Cleveland, OH; †Psychiatry and Human Behavior and Pediatrics at the Alpert Medical…
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Papers by Carolyn Landis