Parent participation in weight-related health interventions for children and adolescents: a systematic review and meta-analysis

Objective

To review child and adolescent weight-related health intervention characteristics, with a particular focus on levels of parental participation, and examine differences in intervention effectiveness.

Methods

Multiple social science, health, and medical databases were searched, and experimental randomized controlled studies of child and adolescent weight‐related health interventions, reported in January 2004 through December 2010, were collected. Intervention characteristics were reviewed, and pre- and post-measurement data, including body mass index, were extracted for analyses. Differences in effect sizes of experimental and control groups were used to evaluate effectiveness of interventions.

Results

Reports of 42 interventions were included. Intervention activities consisted of nutrition education, physical activity education, physical activity sessions, behavior education, behavior therapy, or a combination of these activities. Significant differences existed among levels of parent participation, p < 0.05. In addition, intervention duration positively predicted intervention effectiveness, p = 0.006, and the linear combination of parent participation and intervention duration significantly predicted intervention effectiveness, p = 0.001.

Conclusions

This study suggests that weight‐related health interventions that require parent participation more effectively reduce body mass indexes of child and adolescent participants. In addition, longer interventions that include parent participation appear to have greater success. Suggestions for future research and related interventions are provided.     

Lessons Learned About Adolescent Nutrition from the Minnesota Adolescent Health Survey

In 1986–1987, more than 30,000 adolescents completed the Minnesota Adolescent Health Survey, a comprehensive assessment of adolescent health status, health behaviors, and psychosocial factors. Although the survey included relatively few items on nutrition-related issues, a wealth of knowledge about adolescent nutrition was gained. Lessons learned from a decade of subsequent analyses of data collected in the survey and implications for working with youth are summarized in this article. Major concerns identified included high prevalence rates of inadequate intake of fruits, vegetables, and dairy products; unhealthful weight-control practices; and overweight status. For example, inadequate fruit intake was reported by 28% of the adolescents and inadequate vegetable intake was reported by 36%. Among female adolescents, 12% reported chronic dieting, 30% reported binge eating, 12% reported self-induced vomiting, and 2% reported using diuretics or laxatives. Some of the risk factors for inadequate food intake patterns or unhealthful weight-control practices included low socioeconomic status, minority status, chronic illness, poor school achievement, low family connectedness, weight dissatisfaction, overweight, homosexual orientation among male adolescents, and use of health-compromising behaviors. To improve adolescent eating behaviors, the results suggest a need for innovative outreach strategies that include educational and environmental approaches. Dietitians play a key role in developing interventions and promoting research in the field of adolescent nutrition. J Am Diet Assoc. 1998;98:1449–1456.     

深圳市医疗保险管理的探讨与实践

该回顾总结了深圳市实施职工基本医疗保险制度的实践经验,主要内容包括：建立医疗保险社会化服务网络;不断探索和改进医疗费用结算办法;建立对医患双方的制约机制;加强对特殊人群医疗费用的管理工作;加强各有关部门的协调配合;建立健全医疗保险管理专业队伍。     

Were the mental health benefits of a housing mobility intervention larger for adolescents in higher socioeconomic status families?

Moving to Opportunity (MTO) was a social experiment to test how relocation to lower poverty neighborhoods influences low-income families. Using adolescent data from 4 to 7 year evaluations (aged 12–19, n=2829), we applied gender-stratified intent-to-treat and adherence-adjusted linear regression models, to test effect modification of MTO intervention effects on adolescent mental health. Low parental education, welfare receipt, unemployment and never-married status were not significant effect modifiers. Tailoring mobility interventions by these characteristics may not be necessary to alter impact on adolescent mental health. Because parental enrollment in school and teen parent status adversely modified MTO intervention effects on youth mental health, post-move services that increase guidance and supervision of adolescents may help support post-move adjustment.     

全球开始关注卫生体系加强

在过去很长一段时间内,某一具体疾病是主要研究对象,但近几十年特别是2005年以来,许多组织开始参与全球卫生研究并关注卫生体系加强。本文对这一关注产生的原因及方式展开研究。研究采用了过程追踪的定性方法,并对政治层面引发和限制其关注的因素进行分析。研究发现加强卫生体系之所以得到广泛关注,主要是因为：全球卫生的参与者担心卫生体系方面的问题会影响千年发展目标的实现,并担心全球卫生行动可能会给国家卫生体系带来负面影响。此外,许多全球卫生组织已经意识到,薄弱的卫生体系会成为实现组织既定目标的瓶颈。尽管目前有众多的参与者支持加强卫生体系,但这些行动者还未形成有凝聚力的政策联盟。此外,加强卫生体系的概念不清晰,而且加强卫生体系的证据很薄弱。由于全球金融危机、全球卫生政策的不确定性以及一些行动者暂时性地支持等,对加强卫生体系的关注是否具有可持续性,目前尚未有定论。     

Social and Ecological Structures Supporting Adolescent Connectedness to School: A Theoretical Model

BACKGROUND: Adolescence is a time of great change. For most young people, this is a healthy and happy experience; however, for some it is characterized by many health, social, and academic challenges. A student's feeling of connectedness to school helps meet these challenges. Little is known, however, about the school characteristics that promote this connection and, more importantly, how this connection occurs. This article reviews the connectedness literature and integrates health promotion, adolescent development, and ecological frameworks to describe how a school context fosters this connection.
METHOD: A systematic search and review process was used to retrieve scholarly articles pertaining to the research topic.
RESULTS: Each retrieved article was summarized, and a subsequent model was developed to define a school ecology and describe how this ecology influences a student's need to feel connected to school and the positive influence this connection has on adolescent health and well-being.
CONCLUSIONS: Integrating developmental, ecological, and health promotion intervention theories and frameworks assists in the identification of interpersonal and organizational aspects of a school environment, which satisfy an individual's needs to feel autonomous, competent, and connected, and to improve health and well-being outcomes for adolescents.     

Parenting Practices and Adolescent Internalizing Symptoms in the United States, 1991–2019

PurposeAdolescent internalizing symptoms are increasing in the United States. Changes in parenting practices, including monitoring and communication, have been hypothesized to contribute to these increases. We aimed to estimate trends in parenting practices and understand whether shifts in such practices explain increases in internalizing symptoms.MethodsUsing 1991–2019 Monitoring the Future data (N = 933,645), we examined trends in five parental practices (i.e., knowledge [three combined indicators], monitoring [four combined indicators], communication, weekend curfew, social permission) with ordinal regressions. We tested associations between parental practices and indicators of being in the top decile of depressive affect, low self-esteem, and self-derogation using survey-weighted logistic regressions, adjusted for gender, race/ethnicity, grade, and parental education.ResultsThe prevalences of parental practices have not changed over time, with the exception of increases in parental knowledge, specifically parents knowing where an adolescent is after school (1999–2019 mean increase: 4.34 to 4.61 out of 5) and knowing an adolescent's location (4.16–4.49) and company at night (4.26–4.51). Higher levels of each practice were associated with lower internalizing symptoms (e.g., adjusted odds ratio for a high depressive affect based on a one-unit increase in parental knowledge: 0.89, 95% confidence interval: 0.88, 0.90). Patterns were consistent across internalizing outcomes and decade.DiscussionParental knowledge, monitoring, and other practices are stable protective factors for adolescent mental health. These factors are not changing in a manner that would plausibly underlie increases in internalizing symptoms. Future interventions should provide resources that support these parental practices which are tied to adolescent internalizing symptoms.     

Parenting for the promotion of adolescent mental health: a scoping review of programmes targeting ethnoculturally diverse families

A scoping review of the literature on parenting programmes that target the promotion of adolescent mental health was conducted to examine the quality of the studies and unique content of programmes for parents from ethnoculturally diverse communities. PsycINFO and Web of Science were searched in April, 2011 (for all publications prior to that date) and again in August, 2015 (for publications from April, 2011 to August, 2015) using specific keywords and inclusion criteria. A hand search was also conducted. Overall, 107 studies met inclusion criteria for final data extraction and included evaluations of interventions targeted at substance use, early/risky sexual activity and behavioural problems. Eighteen of the 107 studies described programmes targeting parents of adolescents from diverse ethnocultural communities; the quality of these 18 studies was assessed using a marginally modified version of the Downs and Black Checklist (Downs & Black 1998). Their average quality assessment score was 16 out of 28. In addition, two key themes reflected in successful interventions emerged: strengthening parent–adolescent relationship through communication, and importance of community engagement in designing and implementing the intervention. Findings indicate gaps in service delivery to parents of adolescents from ethnoculturally diverse communities; there are a limited number of studies on programmes targeting ethnoculturally diverse parents of adolescents, and the quality of studies that do exist is overall low. Given increasing diversity, more emphasis should be placed on developing and modifying programmes to meet the needs of ethnoculturally diverse communities. More rigorous, standardised efforts should be made to evaluate programmes that do exist.     

Perceived financial status,health, and maladjustment in adolescence

This study examines the relationship between adolescent perception of family financial status and diverse aspects of health and maladjustment. Data were derived from the 2005 Ontario Student Drug Use Survey of 7th–12th grade students in ontario, Canada. This biennial survey monitors mental and physical health, substance use, and delinquent behavior in adolescent students. Results indicate that the significance of perceived financial status varies across adolescent outcomes. Greater emotional distress and lower self-rated health are associated with a perception of below average financial status. The associations of illicit drug use and hazardous and harmful drinking with perceived financial status vary for younger and older adolescents. Adjustments for parental education highlight differences in the influences of perceived financial status and parental education on health and behavior. Results highlight the utility of perceived family financial status in examinations of adolescent health and behavior, and the importance of examining diverse aspects of health and maladjustment.     

社会资本举办民营医疗机构的困境与对策——以浙江省温州市为例

在总结温州市鼓励社会资本办医政策的基础上,对温州社会资本办医现状进行调查后发现,社会资本办医在项目落地、医保定点、奖补基金兑现、融资、机构待遇、人才队伍建设、管理和社会美誉度等方面仍面临着诸多困难。进一步推进社会办医还需从政策落实、配套改革、融资及人才扶持和强化监管等方面全面推进。     

四川省民族地区卫生发展状况研究

文章采用社会调查及统计分析方法,分析四川省少数民族地区卫生发展的现状与特点,阐明其自然环境因素、社会经济文化因素、卫生服务因素、卫生政策因素对农村卫生发展和居民健康状况带来的影响,由此提出通过文化渗透、卫生资源合理布局、加强卫生投入、建立以健康问题为中心的疾病防控体系、发展远程医疗等策略促进民族卫生发展。     

父母教育方式对青少年心理健康影响的研究

作用应从EMBU和SCL－90对842名高中学生进行了父母教育方式及心理健康调查，并探讨了父母教育方式对青少年心理健康的影响，结果表明．不同家庭的教育方式存在较大差异。父母对男孩和女孩的教育方式有一定区别：父母职业好、文化程度高的家庭对子女的教育方式优于父母职业差、文化程度低者。相关和逐步回归分析均表明，父母教育方式与子女心理健康关系密切．不良的教育方式（加偏受被试、惩罚、拒绝、否认、过度保护等）是促使青少年产生心理问题的重要危险因素。     

Rural Mexican-American Adolescent Sexual Risk Behavior

CONTEXT: There is a need for community-based, culturally sensitive, cognitive-behavioral interventions to reduce sexual risk behavior among minority adolescents. Studies of adolescent risk and protective behaviors have focused on identifying modifiable psychosocial variables that predict differential outcomes for subsequent intervention efforts. Research has been scarce in studies of rural minority adolescent women. PURPOSE: To examine the protective and risk behaviors of these rural Mexican-American adolescent women and their relationship to physical or sexual abuse. METHODS: Mexican-American adolescent women aged 14-19 years were recruited through a rural health clinic and administered a self-report assessment for protective and risk behavior and sexual, physical, and psychological abuse. FINDINGS: Rural minority adolescent women endured high levels of psychological distress and many risk behaviors yet experienced few protective behaviors. Barriers to health care included access and confidentiality. Physically or sexually abused adolescents endured relatively greater risk and fewer protective behaviors than nonabused. CONCLUSIONS: Rural Mexican-American adolescent women may benefit from confidential identification and assessment of abuse history and risk and protective behaviors so that appropriate psychological treatment can accompany accessible medical treatment. The prevalence of risk behaviors and abuse among these women presents a need for development of behavioral interventions for risk reduction and promotion of health protective behaviors.     

Rural mental health: neither romanticism nor despair

ABSTRACT: This paper explores the relationship between rural places and mental health. It begins with a definition of mental health and an outline of the data that have led to the current concern with promoting positive mental health. We then consider aspects of rural life and place that contribute to positive mental health or increase the likelihood of mental health problems. Issues identified include environment, place, gender identity, violence and dispossession and the influence of the effects of structural changes in rural communities. The paper concludes with a discussion of some of the determinants of resilience in rural places, including social connectedness, valuing diversity and economic participation.     

Evidence-based public health: what does it offer developing countries?

The global burden of disease and illness is primarily situated in developing countries. As developing countries have limited resources, it is particularly important to invest in public health and health promotion strategies that are effective. Systematic reviews are central to evidence-based public health and health promotion practice and policy. This paper discusses issues surrounding the relevance of evidence-based public health and systematic reviews to the health of developing countries. It argues that there is a lack of systematic reviews relevant to the health priorities of developing countries; many interventions reviewed can not be implemented in resource-poor situations; and, a limited amount of primary research is conducted in developing countries. The paper further argues that improvements in public health are determined not only by effective health services and interventions, but through an approach that includes other sectors and influences broader structural and systematic barriers to health. Given the social complexity of human development, and the inter-sections amongst different development goals, there is no question that gains in developing country public health are unlikely to emerge from systematic reviews alone, but will require decisions about inter-sectoral collaboration and social policy initiatives. Nonetheless, evidence around intervention effectiveness has an important role to play in addressing health priorities in developing countries and resource-poor areas. The public health evidence base urgently needs strengthening, with dedicated effort towards increasing the relevance of primary evidence and systematic reviews.     

Physical Activity Behaviors and Emotional Self‐Efficacy: Is There a Relationship for Adolescents?

BACKGROUND: This study explored relationships between physical activity (PA) behaviors and emotional self-efficacy (ESE) in a statewide sample of public high school adolescents in South Carolina (n=3836). METHODS: The Center for Disease Control Youth Risk Behavior Survey PA items and an adolescent ESE scale were used. Logistic regression analyses and multivariate models constructed separately, revealed significant race by gender findings. RESULTS: Results suggest that reduced vigorous PA (past 7 days), moderate PA (past 7 days), strengthening/toning exercises (past 7 days), and playing on sport teams (past 12 months) were associated (p相似文献   

Family structure and sexual and reproductive health outcomes among adolescents in rural Sierra Leone

Orphanhood is common in sub-Saharan Africa, and is a critical issue shaping global assistance for children. Care arrangements for children are often fluid, and many ‘orphaned’ children have a surviving biological parent. This study examines the protective effects of family-level factors on early sex and pregnancy in rural Sierra Leone. A survey of 530 adolescents in 2 districts in Sierra Leone was analysed to evaluate associations between living arrangement and orphanhood on recent sexual activity and pregnancies out of wedlock. After controlling for confounders, living with one's mother (AOR = 0.46, 95% CI: 0.22–1.00) and living with both parents (AOR = 0.36, 95% CI: 0.17–0.73) were protective against recent sexual activity. Orphan status was not significantly associated with recent sexual activity. Among 164 sexually active adolescents, neither living arrangement nor orphanhood was associated with pregnancy. This study demonstrates the protective effect of living with a surviving biological parent to delay early sexual debut. Once an adolescent becomes sexually active; however, living arrangement is not associated with the risk of pregnancy out of wedlock. The findings suggest that supporting family connectedness and preventing unnecessary family separation may benefit at least some aspects of adolescent sexual and reproductive health in Sierra Leone.     

论职业化卫生管理队伍建设的法规与制度保证

本文探讨职业化卫生管理队伍建设的法规与制度保证，首先阐述了法规制度保证的必要性，是依法管理的需要，强制执行的需要，稳定实施的需要和规范化管理的需要，其次阐述了所需的法规制度保证，主要包括：专业化制度、志职化制度、任职资格制度和专业技术职称制度；再次，阐述了法规制度保证的可行性，专业化制度具备了一定的教育培训条件，志职化制度具有一定的认识和规章基础任职资格制度正在酝酿之中，技术职称虽无规范性制度，但是不少卫生机构都在评定，急需制度规范。     

Does socioeconomic status moderate the relationships between school connectedness with psychological distress,suicidal ideation and attempts in adolescents?

ObjectiveResearch has indicated that school connectedness acts as a buffer against depressive symptoms and suicidality. However, little is known about the role of socioeconomic status (SES) on these links. The present study examined the moderating role of subjective SES and parental education on the relationships between school connectedness and psychological distress, suicidal ideation and suicide attempts.MethodsData were gathered from 4955 participants within the 2013 cycle of the Ontario Students Drug Use and Health Survey, a province-wide repeated school-based survey of students in grade 7 to 12 across Ontario, Canada.ResultsResults indicated that higher subjective SES is associated with high levels of school connectedness. Subjective SES is also a significant moderator of the association between school connectedness and psychological distress, but not between school connectedness and suicidal ideation or attempts. At low subjective SES, there was no difference in risk of psychological distress between students with high and low levels of school connectedness. However, at higher subjective SES, students with high levels of school connectedness have lower odds of psychological distress than those with low levels of school connectedness. The associations between school connectedness and each of the mental health outcomes did not significantly vary with parental education.ConclusionsThese findings suggest that the beneficial effects of school connectedness on mental health problems may be more strongly related to adolescents' status beliefs rather than parental education. Future research is needed to better understand the mechanism through which subjective SES and school connectedness influence psychological distress.