Christopher CushingUniversity of Kansas | KU · Clinical Child Psychology Program and Life Span Institute
Christopher Cushing
Ph.D.
About
100
Publications
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Introduction
I am interested in using digital technology (e.g., smartphones and sensors) to help children and their families live healthier lives.
Additional affiliations
August 2012 - August 2014
Publications
Publications (100)
Objective
Although social media use, such as Instagram, has been associated with ED pathology, mechanisms connecting social media use to disordered eating behaviors (DEBs) remain largely unevaluated. Based on Dual Process, Tripartite, and Affect Regulation models of ED pathology, we proposed a moderated mediation model evaluating impacts of exposur...
Objective
ChatGPT and other large language models have the potential to transform the health information landscape online. However, lack of domain-specific expertise and known errors in large language models raise concerns about the widespread adoption of content generated by these tools for parents making healthcare decisions for their children. T...
Objective
The purpose of this systematic review and meta-analysis was to examine the effectiveness of psychological interventions at improving physical or mental health outcomes for youth living in rural communities who have, or are at-risk for, any chronic medical condition in comparison to control interventions conducted in rural communities.
Me...
BACKGROUND
Adolescent asthma is a significant contributor to youth morbidity and is known to be best managed through consistent medication use and symptom management. However, adolescents often struggle to accurately perceive their symptoms and consistently use their medication at the recommended rate, risking worsened symptoms and impaired quality...
BACKGROUND
Background: An adaptive text messaging intervention to promote adolescent physical activity has demonstrated encouraging feasibility, acceptability, and preliminary efficacy in a recent proof-of-concept study. To inform future intervention development, a secondary analysis of the data examined how physical activity is influenced by mood,...
Objective
To understand caregiver, healthcare professional and national expert perspectives on implementation of a just-in-time adaptive intervention, RE-PACT (Respiratory Exacerbation-Plans for Action and Care Transitions) to prevent respiratory crises in severe cerebral palsy.
Design
Qualitative research study.
Setting
Paediatric complex care p...
Objective:
Although a growing body of research has examined the impacts of ED-salient content, such as fitspiration and thinspiration, on eating disorder (ED) symptoms, there is less known about the characteristics of who may be at risk for accessing this content on Instagram. Current research is limited by cross-sectional and retrospective design...
BACKGROUND
This study will pilot test an innovative just-in-time adaptive intervention to reduce severe respiratory illness for children with severe cerebral palsy (CP). Our intervention program, RE-PACT (Respiratory Exacerbation – Plans for Action and Care Transitions), delivers timely, customized action planning and rapid clinical response when h...
Background
This study will pilot-test an innovative just-in-time adaptive intervention to reduce severe respiratory illness among children with severe cerebral palsy (CP). Our intervention program, Respiratory Exacerbation–Plans for Action and Care Transitions (RE-PACT), delivers timely customized action planning and rapid clinical response when ho...
Objective:
Parents of youth with type 1 diabetes (T1D) are fearful their children will experience nighttime hypoglycemia. Currently, the Hypoglycemia Fear Survey for Parents (HFS-P) lacks items that specifically assess parents' nighttime fear. This study aimed to fill this gap by rigorously identifying new items to specifically assess parent fear...
Objective. Youth with type 1 diabetes mellitus (T1D) are at risk for experiencing nighttime hypoglycemia, and many parents report significant anxiety at night regarding glucose management. Limited data exist examining continuous nighttime glucose levels as a predictor of parent fear of nighttime hypoglycemia. The present study aimed to examine the...
Objective:
Loss of control eating (LOC) is a dysregulated eating behavior relevant to eating disorders and weight-related health concerns. Hedonic appetite and affect (positive/negative) are dynamic microtemporal processes that influence LOC, but they have been studied predominantly in a static, macrotemporal manner. The present study examined ass...
Introduction:
Steeper delay discounting, or preference for small rewards sooner versus larger rewards later, has been linked to disinhibited eating and obesity. The overconsumption of food may also be motivated by hedonic hunger, or the drive to consume foods for pleasure rather than energy need. The present study hypothesized that hedonic hunger...
Background
Most adolescents with type 1 diabetes (T1D) do not achieve a glycated hemoglobin (HbA1c) <7.0%, which is the current clinical target. mHealth can offer a scalable and age-appropriate delivery method for behavioral interventions to lower adolescents' HbA1c levels, while applying established behavior change and behavioral economics theorie...
Background
A better understanding of the extent to which psychosocial and environmental correlates of physical activity are specific to locations would inform intervention optimization.
Purpose
To investigate cross-sectional associations of location-general and location-specific variables with physical activity and sedentary time in three common l...
Objectives:
Current literature in pediatric pain evaluates the Fear-Avoidance Model pathways at the trait (or macrotemporal) level, but it is unknown if these pathways also occur at the state (or microtemporal) level. Identifying microtemporal processes can improve our understanding of how the relationships within the Fear-Avoidance constructs var...
Executive function (EF) skills, parent–child conflict, and high blood glucose (BG) may impact child externalizing behaviors. We examined these child and parent factors in families of 5–9 year olds with recent-onset type 1 diabetes (T1D). Parents (N = 125) reported child EF, child externalizing behaviors, and conflict regarding T1D-specific tasks. W...
Objective
To test associations between parent-reported confidence to avoid hospitalization and caregiving strain, activation, and health-related quality of life (HRQOL).
Study Design
In this prospective cohort study, enrolled parents of (n=75) from three complex care programs received text messages (random times, every two weeks for three months)...
Purpose of Review
To introduce behavioral economics (BE), provide a description of how recent prevention and treatment interventions in persons with diabetes have incorporated BE in their intervention strategies, and discuss how BE could be used to inform new treatments for the clinical setting or research.
Recent Findings
In most of the trials de...
Adolescents with asthma endorse psychosocial difficulties as barriers to inhaled corticosteroid adherence. This study examined patterns of variability in adherence and within-person associations of psychosocial variables with adherence across days. Participants included twenty-five adolescents (Mage = 14.7, SD = 1.68; 48% male) with persistent asth...
This chapter focuses on aerobic activity levels and the effect of aerobic exercise on chronic pain intensity in youth. Youth with chronic pain do not engage in the recommended levels of aerobic activity. Thus, youth with chronic pain are more likely to have negative health-related outcomes, including obesity, diabetes, and heart disease. In additio...
Background
Youth with asthma commonly have suboptimal adherence to inhaled corticosteroids (ICS). It is critical to systematically evaluate the effectiveness of ICS adherence promotion interventions and discern which techniques are most effective.
Objective
This study aims to (1) quantify the extent to which interventions improve ICS adherence in...
Background
Severe fecal incontinence (FI) is common in patients both with and without anorectal malformations. Whether a formal bowel management program (BMP) has significant effects on FI, psychosocial development of the child, and caregiver stress is poorly understood. We hypothesize that BMP participation results in long-term clinical and qualit...
Objective: Pediatric diabetes healthcare providers and parents of youth with type 1 diabetes (T1D) described specific fears regarding nighttime hypoglycemia and behaviors parents engage in at night to avoid nighttime lows (i.e., blood glucose < 70mg/dL).
Methods: We completed semi-structured interviews with 10 diabetes providers (i.e., physicians,...
Introduction
Greater use of appearance‐focused social media, such as Instagram, is associated with increased body dissatisfaction and eating disorder (ED) symptoms; however, questions remain about the mechanism connecting social media use to disordered‐eating behaviors (DEBs). The proposed study evaluates how and for whom exposure to fitspiration o...
Objective
The present nonrandomized controlled trial aimed to evaluate feasibility, acceptability, and preliminary efficacy of a tailored text message intervention for increasing adolescent physical activity, as compared with passive monitoring.
Methods
Forty adolescents (13–18 years old) received either a tailored text messaging intervention (Net...
Background/Purpose
Most studies examining the components of the fear-avoidance model have examined processes at the group level. The current study used ecological momentary assessments to: (a) investigate the group and intraindividual relationships between pain fear, avoidance, and pain severity, (b) identify any heterogeneity between these relatio...
Background
Investigation of physical activity and dietary behaviors across locations can inform “setting-specific” health behavior interventions and improve understanding of contextual vulnerabilities to poor health. This study examined how physical activity, sedentary time, and dietary behaviors differed across home, school, and other locations in...
Background
Extant literature suggests that associations between aggression and substance use differ based on proactive and reactive functions of aggression and the specific substance use outcomes examined. To date, no research has examined links between these functions of aggression and e-cigarette use specifically, which could aid in developing pr...
Background: Current digital health interventions primarily use interventionist-defined rules to guide the timing of intervention delivery. As new temporally dense data sets become available, it is possible to make decisions about the intervention timing empirically.
Objective: This study aimed to explore the timing of physical activity among youth...
Background: Although research on adolescent e-cigarette use is growing, several questions remain unanswered, including the timing of initiation and the co-occurrence with initiation of other substances. The current study longitudinally evaluated the risk for initiation of e-cigarettes and examined associations with this risk and initiation of other...
In light of increasing rates of overweight and obesity worldwide, there is a critical need for accurate self-report measures of disinhibited and restrained eating behaviors across the weight spectrum. Item response theory was used to determine whether differences in disinhibited and restrained eating between healthy weight and overweight or obese i...
BACKGROUND
Adolescents diagnosed with persistent asthma commonly take less than 50% of their prescribed inhaled corticosteroids (ICS), placing them at-risk for asthma-related morbidity. Adolescents’ difficulties with adherence occur in the context of normative developmental changes (e.g., increased responsibility for disease management) and rely up...
Background:
Adolescents diagnosed with persistent asthma commonly take less than 50% of their prescribed inhaled corticosteroids (ICS), placing them at risk for asthma-related morbidity. Adolescents' difficulties with adherence occur in the context of normative developmental changes (eg, increased responsibility for disease management) and rely up...
Background: Middle school age youth are increasing their use of e-cigarettes, which creates a major public health concern. However, more research examining e-cigarette use in this age group is needed.
Methods: The current study examines trends in e-cigarette use, perceptions of parental attitudes regarding e-cigarettes, and sibling use over a three...
BACKGROUND
Current digital health interventions primarily use interventionist-defined rules to guide the timing of intervention delivery. As new temporally dense data sets become available, it is possible to make decisions about the intervention timing empirically.
OBJECTIVE
This study aimed to explore the timing of physical activity among youth t...
Objective:
Adolescents with chronic pain associated with functional gastrointestinal disorders (FGIDs) experience negative impacts on their health behaviors (i.e., sleep) and are at risk for a range of problems related to negative affect, which may serve to exacerbate one another in a reciprocal fashion. This study aimed to determine if the streng...
Introduction
Asthma is a leading cause of youth morbidity in the USA, affecting >8% of youth. Adherence to inhaled corticosteroids (ICS) can prevent asthma-related morbidity; however, the typical adolescent with asthma takes fewer than 50% of their prescribed doses. Adolescents are uniquely vulnerable to suboptimal asthma self-management due to sti...
Objective:
The current study aimed to determine if it was feasible and acceptable to use ecological momentary assessment (EMA) to assess individual associations between biopsychosocial contributors to chronic abdominal pain with two objective sensors and a mobile application. Specifically, we aimed to determine if it was possible to identify indiv...
Objective: The Institute of Medicine has called for greater integration of behavioral sciences in health care. Examining medical students’ exposure to and perceptions of a biopsychosocial approach to treating pediatric functional gastrointestinal disorders associated with pain (FGIDs-AP) may identify roles for pediatric psychologists. This study ex...
Background:
Mobile health (mHealth) apps have the potential to facilitate asthma self-management by including medication reminders, allowing self-monitoring of symptoms, improving access and quality of information communicated with provider, and providing educational resources to patients and parents. Many apps exist for asthma management; however...
Objectives:
The present study aimed to: (1) better understand physical activity levels in youth with chronic abdominal pain and (2) investigate the relationship between day-level physical activity related to next day pain intensity to identify any intraindividual heterogeneity.
Methods:
Seventy-one youth (M=13.34 y, SD=2.67 y) with chronic abdom...
Less is known about how neighborhood environments relate to sedentary time as compared to physical activity. This study examined relations of perceived and objective neighborhood environments with TV time, total screen time, total sedentary time, sedentary time at home, sedentary time in the home neighborhood, and time spent at home, in 524 12-16 y...
Background
Most pediatric studies do not include parent stakeholders in the design of the intervention itself and many pediatric mobile health (mHealth) interventions are not meaningfully disseminated after the trial period ends. Consequently, the consumer desire for mobile apps targeting pediatric health behavior is likely to be met by commercial...
This systematic review evaluates the effect of exercise on pediatric chronic pain in: (a) pre-post-test comparisons and RCTs, and (b) longitudinal actigraphy studies in children’s free-living environments. Following the PRISMA guidelines, 15 studies met inclusion criteria. Although preliminary results suggest exercise may be related to decreased pa...
To examine the bi-directional relationships between negative affectivity (i.e., depression, anxiety, and anger) and adolescents’ physical activity in nearly real time. Twenty-six adolescents (Mage = 15.67 ± 1.56 years; 57.7% male) were asked to complete 80 self-report measures of their negative affect (depression, anxiety, and anger) via a smartpho...
Objectives
This study examined contextual variables of location, vegetation, weather, safety, and traffic as predictors of affect, feeling states, and activity in order to gain preliminary understanding of relationships relevant to adolescent health.
Design
This is an ecological momentary assessment pilot study of adolescents.
Method
Twenty-six a...
Background/Purpose
Fecal incontinence is a prevalent pediatric condition with psychosocial impacts on both children and their caregivers. We sought to develop and validate the Cincinnati Fecal Incontinence Scale (CINCY-FIS) as a psychometrically valid measure to assess the quality of life and caregiver impacts of pediatric fecal incontinence.
Meth...
E-cigarette use among adolescents continues to rise. However, little research has examined factors that influence adolescent e-cigarette use. The goal of the current study was to better understand family influences (i.e., perceptions of parental attitudes and sibling use) of e-cigarette use and determine how these influences on e-cigarette use comp...
Background
Understanding interactions between stable characteristics and fluctuating states underlying youth’s food choices may inform methods for promoting more healthful food intake.
Purpose
This study examined dietary motivation and hedonic hunger as interacting predictors of adolescents’ consumption of palatable foods.
Methods
Intensive longi...
BACKGROUND
Most pediatric studies do not include parent stakeholders in the design of the intervention itself and many pediatric mobile health (mHealth) interventions are not meaningfully disseminated after the trial period ends. Consequently, the consumer desire for mobile apps targeting pediatric health behavior is likely to be met by commercial...
Objective: Adolescents are not meeting the recommended guidelines for physical activity. Social support and self-regulatory skills are two factors known to impact physical activity and sedentary behaviour. The study sought to examine how targeting feedback as part of a self-regulatory process could increase physical activity, and the individual who...
Ecological momentary assessment (EMA) studies typically rely on arbitrary decision rules for identifying and excluding invalid responses from the data. In addition, most studies treat independent variables as separate from each other even if their combinations might have importance above the independent contribution of each. Our study aimed to cond...
This article summarizes the utility of multiphase optimization strategy (MOST) and sequential multiple assignment randomized trial (SMART) processes in the development of empirically derived adaptive interventions (AIs). Recent empirical evidence suggests that SMART designs conducted within the context of a MOST framework can be used for building a...
Importance
Mobile health interventions are increasingly popular in pediatrics; however, it is unclear how effective these interventions are in changing health outcomes.
Objective
To determine the effectiveness of mobile health interventions for improving health outcomes in youth 18 years or younger.
Data Sources
Studies published through November...
Objective:
To understand the predictors and consequences of adolescent moderate-to-vigorous physical activity (MVPA) and sedentary behavior in nearly real-time.
Methods:
Participants were 26 adolescents (Mage = 15.96, SD = 1.56) who provided 80 self-reports of subjective states and continuous objective reports of MVPA and sedentary behavior over...
The current study examined the relationship between demographic variables, treatment factors, and perceived barriers-to-care to both caregiver distress and caregiver reported child health related quality of life in caregivers of children diagnosed with cancer utilizing path analysis. Parental distress is examined as a potential mediator between bar...
Intervention development can be accelerated by using wearable sensors and ecological momentary assessment (EMA) to study how behaviors change within a person. The purpose of this study was to determine the feasibility and acceptability of a novel, intensive EMA method for assessing physiology, behavior, and psychosocial variables utilizing two obje...
The Power of Food Scale (PFS) was developed to assess hedonic hunger, or how individuals think and feel about food and eating in the absence of metabolic need. The measure was originally developed and validated in two adult samples, and recent preliminary support has been provided for the validity in a sample of preadolescents. The aim of the curre...
Psychosocial distress is a salient construct experienced by families of children with newly diagnosed cancer, but little is known about parental appraisal of the child's illness and the subsequent impact this may have on child and parent functioning. The goal of the present study was to examine the interrelationships among multiple parent illness a...
Objective:
To describe the quality of life and parenting stress associated with a child with fecal incontinence (FI).
Methods:
Female caregivers (n = 170) of children aged 3-12 with FI completed a broad and general measure of quality of life and a measure of parenting stress. Results were compared to proxy reports for a normative sample of healt...
Objective:
Examine caregiver demand and general parent distress as mediators in the parent illness uncertainty-child depressive symptom association in youth with juvenile rheumatic diseases. METHODS: Children and adolescents completed the Child Depression Inventory; caregivers completed the Parent Perceptions of Uncertainty Scale, the Care for My...
Objective:
To investigate the relationship of illness uncertainty (IU) to global psychological distress (GPD) and posttraumatic stress symptomatology (PTSS) using a path analysis approach.
Methods:
Participants were 105 caregivers (MAge = 36.9 years, standard deviation [SD] = 8.7) of children (MAge = 8.6 years, SD = 5.0) with newly diagnosed can...
To examine the relationships between self-efficacy (SE) and social support (SS) for physical activity (PA), weekly moderate to vigorous PA (MVPA), and depression and anxiety in young adults (YAs) with asthma and allergies. Methods: Participants were 611 YAs (age M = 19.56 ± 3.28). YAs completed measures of SE for PA, SS for PA, depression, anxiety,...
Objective:
The purpose of the study was to investigate the relations between abuse types, non-maltreatment-related trauma, and health service utilization in a sample of youth in foster care with and without chronic medical conditions. METHOD: A total of 213 youth, aged 8-21 years, provided self-report of general trauma and abuse exposure. Medicaid...
Objective:
To summarize the guiding theoretical frameworks included in pediatric adherence-promotion interventions and characterize targeted domains using the theoretical domains framework (TDF), a standardized system developed by adult behavior change researchers.
Methods:
A systematic review of PubMed, PsycINFO, and CINAHL databases identifie...
Objective:
Systematically review and meta-analyze the pediatric literature on behavior-change techniques (BCT) as defined by Abraham & Michie (Health Psychology, 27, 379-387, 2008), and describe whether the most effective BCTs are incorporated in physical activity (PA) and dietary mobile apps.
Methods:
Randomized controlled trials (n = 74) targe...
The role of illness intrusiveness in the barriers to care -> depressive symptom association in youth with juvenile rheumatic diseases (JRDs) was examined. Sixty-six youth completed the Child Depression Inventory and the Illness Intrusiveness Scale-Child; parents completed the Barriers to Care Questionnaire and the Illness Intrusiveness Scale-Parent...
Objective: Stagnant effect sizes in controlled trials of treatment for pediatric obesity have led to calls for "more powerful" interventions. Multisystemic family therapy (MSFT), pharmacological interventions, bariatric surgery, eHealth, and residential treatments all show promise for extending the effectiveness of family-based programs. However, i...
Objective To evaluate and quantify the evidence for health promotion interventions in children and adolescents. Method 96 independent samples of smoking, physical activity, and diet studies were included. Outcomes included both objective and
self-reports of health behavior, as well as proxy measures such as fitness. Results The aggregated effect wa...
Background:
Food cravings are more prevalent and potentially problematic for many individuals with obesity. Initial evidence suggests that bariatric surgery has some short-term beneficial effects on cravings in adults, but little is known about the effect on adolescents or the trajectory beyond 6 months.
Methods:
The purpose of the present study...
Objective:
We sought to systematically review and meta-analyze the literature comparing motivational interviewing (MI) with a control condition for adolescent health behavior change. In the current article, we reviewed only studies targeting health behaviors other than substance use (e.g., sexual risk behavior, physical activity, diet).
Method:...
This study assessed longitudinal associations between preadolescent's physical activity engagement (PA), health-related quality of life (HRQOL), and teasing during physical activity (TDPA).
108 children completed measures of PA, HRQOL, and TDPA during fourth or fifth grade and 1 year later. Potential longitudinal associations between study variable...
Aggregated N-of-1 randomized controlled trials (RCTs) combined with multilevel modeling represent a methodological advancement that may help bridge science and practice in pediatric psychology. The purpose of this article is to offer a primer for pediatric psychologists interested in conducting aggregated N-of-1 RCTs.
An overview of N-of-1 RCT meth...
Initial outcome studies have reported that Roux-en-Y gastric bypass (RYGB) is safe and efficacious for adolescents with extreme obesity. Although rapid weight loss is seen initially, data also show that modest weight regain typically occurs as early as the second postoperative year. The contribution of various psychological factors, including hedon...
: To examine female caregiver and adolescent dyad characteristics that predict the female caregiver's concern about their adolescent's weight and the degree to which caregiver concern predicts desire for physician intervention.
: Fifty-three caregivers of adolescents with persistent obesity were asked to report on their adolescent's quality of life...
This article describes the use of the labyrinth for inquiry-based, hands-on activities suitable for a variety of psychology courses including learning, physiological psychology, clinical child psychology, and history of psychology. Two classroom examples that focus on psychology of learning and psychophysiology are presented. In general, students a...
Pediatric abdominal pain is a common childhood complaint. Available conceptualizations of the condition point toward an interdisciplinary approach to care as having the highest utility. The current study sets out to describe practice patterns among psychologists treating pediatric abdominal pain, the degree to which such practitioners engage in col...
To extend the health-related quality of life assessment literature by examining the reliability and validity of Sizing Me Up in a community sample of nontreatment-seeking overweight and obese children.
Participants included 302 students (M age = 10.34) recruited from 6 elementary schools, who completed self-report measures of health-related quality...
The goal of the current study was to assess the efficacy and acceptability of a web-based tutorial (Child Health Matters, CHM) designed to improve school nurses' communications with families about pediatric weight-related health issues. Using a randomized wait-list control design, a nationally representative sample of school nurses was assigned to...
This investigation examined the relations among parent/child decisional balance (perception of advantages/disadvantages), child weight status, and child outcomes. Thirty-seven parent–child dyads in a family-based weight management program participated in the study. Analyses indicated that children evidenced a more positive decisional balance profil...