Daniel P O'Connor

University of Houston, Houston, Texas, United States

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Publications (125)299.29 Total impact

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    Full-text · Dataset · Dec 2015
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    ABSTRACT: Analysis of electromyography (EMG) data has been shown to be valuable in biomedical and clinical research. However, most analysis tools do not consider the non-linearity of EMG data or the synergistic effects of multiple neuromuscular activities. The SYNERGOS algorithm was developed to assess a single index based on non-linear analysis of multiple neuromuscular activation (MNA) of different muscles. This index has shown promising results in Parkinsonian gait, but it was yet to be explored whether the SYNERGOS index is generalizable. In this study, we evaluated generalizability of the SYNERGOS index over the course of several trials and over separate days with different walking speeds. Ten healthy adults aged from 18 to 40 years walked on a treadmill on two different days, while EMG data was collected from the upper and lower right leg. SYNERGOS indices were obtained and a generalizability analysis was conducted. The algorithm detected changes in MNA in response to altering gait speed and depicted a high generalizability coefficient ( ρ^2 ${\hat \rho ^2}$ ) of 0.823 with a standard error of 5.117 with nominal inter-trial or inter-day effects. We concluded SYNERGOS may be a valuable tool in EMG analysis due to its generalizability and its sensitivity to task modifications and associated neuromotor changes.
    No preview · Article · Dec 2015 · Biomedizinische Technik/Biomedical Engineering
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    Full-text · Article · Oct 2015
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    ABSTRACT: Continuous monitoring technologies such as accelerometers and pedometers are the gold standard for physical activity (PA) measurement. However, inconsistencies in use, analysis, and reporting limit the understanding of dose–response relationships involving PA and the ability to make comparisons across studies and population subgroups. These issues are particularly detrimental to the study of PA across different ethnicities with different PA habits. This systematic review examined the inclusion of published guidelines involving data collection, processing, and reporting among articles using accelerometers or pedometers in Hispanic or Latino populations. English (PubMed; EbscoHost) and Spanish (SCIELO; Biblioteca Virtual en Salud) articles published between 2000 and 2013 using accelerometers or pedometers to measure PA among Hispanics or Latinos were identified through systematic literature searches. Of the 253 abstracts which were initially reviewed, 57 met eligibility criteria (44 accelerometer, 13 pedometer). Articles were coded and reviewed to evaluate compliance with recommended guidelines (N = 20), and the percentage of accelerometer and pedometer articles following each guideline were computed and reported. On average, 57.1 % of accelerometer and 62.2 % of pedometer articles reported each recommended guideline for data collection. Device manufacturer and model were reported most frequently, and provision of instructions for device wear in Spanish was reported least frequently. On average, 29.6 % of accelerometer articles reported each guideline for data processing. Definitions of an acceptable day for inclusion in analyses were reported most frequently, and definitions of an acceptable hour for inclusion in analyses were reported least frequently. On average, 18.8 % of accelerometer and 85.7 % of pedometer articles included each guideline for data reporting. Accelerometer articles most frequently included average number of valid days and least frequently included percentage of wear time. Inclusion of standard collection and reporting procedures in studies using continuous monitoring devices in Hispanic or Latino population is generally low. Lack of reporting consistency in continuous monitoring studies limits researchers' ability to compare studies or draw meaningful conclusions concerning amounts, quality, and benefits of PA among Hispanic or Latino populations. Reporting data collection, computation, and decision-making standards should be required. Improved interpretability would allow practitioners and researchers to apply scientific findings to promote PA.
    Full-text · Article · Sep 2015 · BMC Public Health
  • Patrick C Schottel · Daniel P O'Connor · Mark R Brinker
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    ABSTRACT: Long bone nonunions have an important impact on a patient's quality of life. The purpose of this study was to compare long bone nonunions with use of the Time Trade-Off direct measure to compute utility scores and to determine which nonunion anatomic location had the lowest health-related quality of life. The Time Trade-Off assesses the percentage of a patient's remaining life that the patient would be willing to trade for perfect health. Eight hundred and thirty-two consecutive long bone nonunions with Time Trade-Off data were identified and were retrospectively studied from a prospectively collected patient database. Nonunions with infections and those involving the articular portion of the bone were recorded. Time Trade-Off utility scores were obtained for all nonunion cases upon their initial clinical evaluation by a single surgeon specializing in reconstructive trauma. The mean utility score of our nonunion cohort was 0.68 and it differed significantly by long bone (p = 0.037). Nonunions of the forearm had the lowest utility score (0.54), followed by the clavicle (0.59), femur (0.68), tibia or fibula (0.68), and humerus (0.71). Post hoc tests showed that patients with nonunions of the forearm had significantly lower utility scores (p = 0.031) compared with all other bones. Patients diagnosed with a long bone nonunion have a very low health-related quality of life. We found that this single cohort's mean utility score was 0.68. This result is well below that of illnesses such as type-I diabetes mellitus (0.88), stroke (0.81), and acquired immunodeficiency syndrome (0.79). We found that patients with forearm nonunions had the lowest utility scores. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.
    No preview · Article · Sep 2015 · The Journal of Bone and Joint Surgery
  • Tracey Ledoux · J. Robinson · T. Baranowski · D. O'Connor

    No preview · Article · Aug 2015
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    ABSTRACT: The cross-site process evaluation plan for the Childhood Obesity Research Demonstration (CORD) project is described here. The CORD project comprises 3 unique demonstration projects designed to integrate multi-level, multi-setting health care and public health interventions over a 4-year funding period. Three different communities in California, Massachusetts, and Texas. All CORD demonstration projects targeted 2-12-year-old children whose families are eligible for benefits under Title XXI (CHIP) or Title XIX (Medicaid). The CORD projects were developed independently and consisted of evidence-based interventions that aim to prevent childhood obesity. The interventions promote healthy behaviors in children by applying strategies in 4 key settings (primary care clinics, early care and education centers, public schools, and community institutions). The CORD process evaluation outlined 3 main outcome measures: reach, dose, and fidelity, on 2 levels (researcher to provider, and provider to participant). The plan described here provides insight into the complex nature of process evaluation for consortia of independently designed multi-level, multi-setting intervention studies. The process evaluation results will provide contextual information about intervention implementation and delivery with which to interpret other aspects of the program. Copyright © 2015 Society for Nutrition Education and Behavior. Published by Elsevier, Inc. All rights reserved. All rights reserved.
    No preview · Article · Aug 2015
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    ABSTRACT: Lifestyle interventions that promote physical activity and healthy dietary habits may reduce binge eating symptoms and be more feasible and sustainable among ethnic minority women, who are less likely to seek clinical treatment for eating disorders. The purpose of this study was to investigate (1) whether participating in a lifestyle intervention is a feasible way to decrease binge eating symptoms (BES) and (2) whether changes in BES differed by intervention (physical activity vs. dietary habits) and binge eating status at baseline (binger eater vs. non-binge eater) in African American and Hispanic women. Health Is Power (HIP) was a longitudinal randomized controlled trial to promote physical activity and improve dietary habits. Women (N=180) who completed anthropometric measures and questionnaires assessing fruit and vegetable and dietary fat intake, BES and demographics at baseline and post-intervention six months later were included in the current study. Over one-fourth (27.8%) of participants were categorized as binge-eaters. Repeated measures ANOVA demonstrated significant two- and three-way interactions. Decreases in BES over time were greater in binge eaters than in non-binge eaters (F(1,164)=33.253, p<.001), and women classified as binge eaters who participated in the physical activity intervention reported greater decreases in BES than non-binge eaters in the dietary habits intervention (F(1,157)=5.170, p=.024). Findings suggest behavioral interventions to increase physical activity may lead to reductions in BES among ethnic minority women and ultimately reduce the prevalence of binge eating disorder and health disparities in this population. Copyright © 2015. Published by Elsevier Ltd.
    No preview · Article · Jul 2015 · Appetite
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    ABSTRACT: Objectives : In this paper we develop the Policy Indicator Checklist-Physical Activity (PIC-PA) to evaluate PA policies across settings (community, school, early care and education) in Childhood Obesity Research Demonstration (CORD) communities. Methods : The PIC-PA was developed through comprehensive reviews of existing policies and recommendations. Raters identified and coded policies in CORD communities. Principal components analysis (PCA) identified key PA policy environment components. Results : PCA results suggest 5 major policy components: “Standards and Guidelines for Physical Education and Outdoor Play,” “Assessment and Planning of Physical Activity Programs,” “Safety and Design of Active Transportation Networks,” “Increasing Public Access to Outdoor Recreation Opportunities,” and “Infrastructure to Promote Walking and Bicycling to School.” Conclusions : The PIC captures PA policy environments, highlighting important needs for improvements.
    No preview · Article · Jul 2015
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    ABSTRACT: The ex vivo expansion of tumor-associated-antigen (TAA)- specific cytotoxic T-cells (CTLs) from healthy donors for adoptive transfer to cancer patients is now providing additional treatment options for patients. Many studies have shown that adoptive transfer of expanded CTLs can reduce the risk of relapse in cancer patients following hematopoietic stem cell transplantation (HSCT). However, the procedure can be limited by difficulties in priming and expanding sufficient numbers of TAA-specific-CTLs. Because acute dynamic exercise mobilizes large numbers of T-cells to peripheral blood, we hypothesized that a single bout of exercise would augment the ex vivo expansion of TAA-specific-CTLs.We therefore collected lymphocytes from blood donated by healthy adults at rest and after brief maximal dynamic exercise. TAA-specific CTLs were expanded using autologous monocyte-derived-dendritic cells pulsed with melanoma-associated antigen 4 (MAGE-A4), with preferentially expressed antigen in melanoma (PRAME), and with Wilms' tumor protein (WT-1). Post exercise, 84% of the participants had a greater number of CTLs specific for at least one of the three TAA.Cells expanded from post exercise blood yielded a greater number of MAGE-A4 and PRAME-specific-cells in 70% and 61% of participants, respectively. In the 'exercise-responsive' participants (defined as participants with at least a 10% increase in TAA-specific-CTLs post-exercise), MAGEA4- and PRAME-specific-CTLs increased 3.4-fold and 6.2- fold respectively. Moreover, expanded TAA-specific CTLs retained their antigen-specific cytotoxic activity. No phenotype differences were observed between expanded cells donated at rest and postexercise. We conclude that exercise can enhance the ex vivo expansion of TAA-specific-CTLs from healthy adults without compromising cytotoxic function. Hence, this study has implications for immunotherapy using adoptive T-cell transfer of donor-derived T-cells after allogeneic HSCT.
    Full-text · Article · Apr 2015 · Exercise immunology review
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    ABSTRACT: We developed the policy indicator checklist (PIC) to identify and measure policies for calorie-dense foods and sugar-sweetened beverages to determine how policies are clustered across multiple settings. In 2012 and 2013 we used existing literature, policy documents, government recommendations, and instruments to identify key policies. We then developed the PIC to examine the policy environments across 3 settings (communities, schools, and early care and education centers) in 8 communities participating in the Childhood Obesity Research Demonstration Project. Principal components analysis revealed 5 components related to calorie-dense food policies and 4 components related to sugar-sweetened beverage policies. Communities with higher youth and racial/ethnic minority populations tended to have fewer and weaker policy environments concerning calorie-dense foods and healthy foods and beverages. The PIC was a helpful tool to identify policies that promote healthy food environments across multiple settings and to measure and compare the overall policy environments across communities. There is need for improved coordination across settings, particularly in areas with greater concentration of youths and racial/ethnic minority populations. Policies to support healthy eating are not equally distributed across communities, and disparities continue to exist in nutrition policies. (Am J Public Health. Published online ahead of print March 19, 2015: e1-e8. doi:10.2105/AJPH.2015.302559).
    No preview · Article · Mar 2015 · American Journal of Public Health
  • Daniel P O'Connor · Heather J Leach · Scherezade K Mama · Rebecca E Lee
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    ABSTRACT: Purpose: Individual perceptions of one's neighborhood environment influence decisions about physical activity participation. Differences between single-family housing neighborhoods versus multi-family housing neighborhoods may affect perceptions and lead to varying responses on surveys designed to assess perceptions of the neighborhood environment for physical activity. This study tested the factorial invariance for the Physical Activity Neighborhood Environment Survey (PANES) between residents of single-family versus multi-family housing neighborhoods. Method: This study was a secondary data analysis of PANES ratings from African American and Hispanic or Latina women (n = 324) who participated in the Health Is Power study (NCI R01CA109403), a multi-site, community-based trial to investigate the relationship between neighborhood factors and physical activity adoption and maintenance. Factorial invariance was tested using a series of nested confirmatory factor analysis models. Results: The final model was a 2nd-order factor structure with partial invariance of item intercepts. The 2nd-order factor structure and the relationships of the PANES items to the 1st-order factors (amenable, unsafe, and walkable) and of the 1st-order factors to the 2nd-order factor (environment) were invariant between the single-family and multi-family housing neighborhood groups. Conclusion: These findings support the construct validity of PANES, which can be considered valid for measuring neighborhood perceptions among residents of neighborhoods with different housing types.
    No preview · Article · Mar 2015 · Research quarterly for exercise and sport
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    ABSTRACT: The ex vivo generation of monocyte-derived-dendritic cells (mo-DCs) has facilitated the use of DCs in immunotherapy research. However, low blood monocyte numbers frequently limit the manufacture of sufficient numbers of mo-DCs for subsequent experimental and clinical procedures. Because exercise mobilizes monocytes to the blood, we tested if acute dynamic exercise by healthy adults would augment the generation of mo-DCs without compromising their differentiation or function. We compared mo-DC generation from before- and after-exercise blood over 8-days of culture. Function was assessed by FITC-dextran uptake and the stimulation of autologous cytomegalovirus (pp65)-specific-T-cells. Supporting the hypothesis, we found a near fourfold increase in number of mo-DCs generated after-exercise. Furthermore, relative FITC-dextran uptake, differentiation rate, and stimulation of pp65-specific-T-cells did not differ between before- and after-exercise mo-DCs. We conclude that exercise enhances the ex vivo generation of mo-DCs without compromising their function, and so may overcome some limitations associated with manufacturing these cells for immunotherapy. Copyright © 2015 Elsevier Inc. All rights reserved.
    Full-text · Article · Feb 2015 · Cellular Immunology
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    ABSTRACT: Introduction: The Childhood Obesity Research Demonstration (CORD) project links public health and primary care interventions in three projects described in detail in accompanying articles in this issue of Childhood Obesity. This article describes a comprehensive evaluation plan to determine the extent to which the CORD model is associated with changes in behavior, body weight, BMI, quality of life, and healthcare satisfaction in children 2-12 years of age. Design/methods: The CORD Evaluation Center (EC-CORD) will analyze the pooled data from three independent demonstration projects that each integrate public health and primary care childhood obesity interventions. An extensive set of common measures at the family, facility, and community levels were defined by consensus among the CORD projects and EC-CORD. Process evaluation will assess reach, dose delivered, and fidelity of intervention components. Impact evaluation will use a mixed linear models approach to account for heterogeneity among project-site populations and interventions. Sustainability evaluation will assess the potential for replicability, continuation of benefits beyond the funding period, institutionalization of the intervention activities, and community capacity to support ongoing program delivery. Finally, cost analyses will assess how much benefit can potentially be gained per dollar invested in programs based on the CORD model. Conclusions: The keys to combining and analyzing data across multiple projects include the CORD model framework and common measures for the behavioral and health outcomes along with important covariates at the individual, setting, and community levels. The overall objective of the comprehensive evaluation will develop evidence-based recommendations for replicating and disseminating community-wide, integrated public health and primary care programs based on the CORD model.
    Full-text · Article · Feb 2015 · Childhood Obesity
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    ABSTRACT: Objectives: To evaluate the radiographic and clinical outcomes of a systematic approach to exchange nailing for the treatment of aseptic femoral nonunions previously treated with an intramedullary nail. Design: Retrospective cohort. Setting: Tertiary referral center. Patients: Fifty aseptic femoral nonunions in 49 patients who presented with an intramedullary nail in situ an average of 25 months after the initial fracture nailing were evaluated. Intervention: Our systematic approach includes inserting an exchange nail at least 2 mm larger in diameter than the in situ nail, using a different manufacturer’s nail, static interlocking, correction of any metabolic and endocrine abnormalities, and secondary nail dynamization in cases showing slow progression toward healing. Main Outcomes Measurements: The outcome measures were radiographic and clinical evidence of nonunion healing and time to union. Results: All 50 femoral nonunions (100%) healed after this systematic approach to exchange nailing. The average time to achieve union was 7 months (range, 3–26 months). Conclusions: Utilization of this systematic approach of exchange nailing for the treatment of aseptic femoral nonunions resulted in a 100% healing rate. Key Words: fracture, ununited, intramedullary nail, femur, aseptic nonunion
    No preview · Article · Jan 2015 · Journal of Orthopaedic Trauma
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    ABSTRACT: The GoWoman project is developing and pilot testing the first small group weight management program designed to meet the unique needs of women with mobility impairments, a significantly underserved health disparity population. The project is conducted by a consortium of investigators at five universities in partnership with a Community Advisory Board of five women with mobility impairments. In adapting existing curriculum from the Diabetes Prevention Program, we added content related to the association between disability and weight gain, adaptive cooking, accessible kitchen design, an expanded range of physical activities, precautions against excessive activities and exercises, disability-related stress, and examples that reflect the life situation of women with disabilities. Participants track their progress through MyFitnessPal. Offering this intervention in the online virtual world of Second Life allows us to circumvent many of the geographic, transportation, logistic, disability, and personal barriers that women with mobility impairments face when attempting to participate in public weight loss programs. Our simulated accessible kitchen, caf, and physical activity venues also provide congenial and stigma-free environments for offering social interaction opportunities to reinforce the weight loss programming. The intervention consists of facilitated groups of 8-10 women who gather using their avatar and communicate using voice or text. Sessions last two hours and convene once a week for 16 weeks. We will demonstrate this virtual venue and present the results of the beta-test. We will discuss advantages and technical challenges of implementing interventions in virtual environments, and the implications of this study for mainstream weight loss programs.
    No preview · Conference Paper · Nov 2014
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    ABSTRACT: The purpose of this study was to evaluate outcomes in patients with rotator cuff tear arthropathy after staged bilateral reverse shoulder arthroplasties (RSAs) and to compare them with an age-, gender-, and diagnosis-matched control group with a unilateral RSA. We identified 11 patients with bilateral RSAs for rotator cuff tear arthropathy with a minimum of 2-year follow-up in a prospective shoulder arthroplasty registry. The bilateral group was matched to a control group of 19 patients with a unilateral RSA. Shoulder function scores, mobility, patient satisfaction, and activities of daily living were assessed preoperatively and at final follow-up. There was no statistical difference between the first RSA or second RSA and the control group regarding age, gender, or follow-up. No group differences were noted preoperatively for shoulder function scores or mobility (P > .10). All groups significantly improved on all shoulder function scores (Constant score, American Shoulder and Elbow Surgeons score, Western Ontario Osteoarthritis of the Shoulder index, Single Assessment Numeric Evaluation score) and mobility at final follow-up (all P < .01). There were no significant differences in shoulder function scores or mobility between the first and second RSA in the bilateral group or between either shoulder in the bilateral group and the unilateral group (all P > .10). Patient satisfaction improved and patients were successfully able to perform many important activities of daily living after bilateral RSAs. Patients with bilateral rotator cuff tear arthropathy can be advised that staged bilateral RSAs can be successful when indicated. Improvements in shoulder function scores, patient satisfaction, and mobility are possible for both the first RSA and the second RSA. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Oct 2014 · Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]
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    ABSTRACT: Background: Management of periprosthetic infection after reverse shoulder arthroplasty (RSA) remains a challenge. Whereas the infection rate after RSA has improved, more information would be helpful to identify patient risk factors for infection after RSA. The purpose of this study was to evaluate risk factors for infection after RSA. Methods: We identified 301 primary RSAs with a minimum of 1-year follow-up in a prospectively collected shoulder arthroplasty registry. We performed bivariate and multivariable logistic regression analyses to assess the association between patient demographic and clinical characteristics (age, sex, smoking, diabetes, rheumatoid arthritis, body mass index, and history of prior failed hemiarthroplasty or total shoulder arthroplasty) and periprosthetic infection after RSA. Results: There were 15 periprosthetic infections after RSA (5.0%). Patients with a history of RSA for failed arthroplasty (odds ratio, 5.75; 95% confidence interval, 2.01-16.43; P = .001) and patients younger than 65 years had an increased risk for development of an infection (odds ratio, 4.0; 95% confidence interval, 1.21-15.35; P = .021). History of smoking, diabetes, rheumatoid arthritis, or obesity did not contribute to an increased risk of infection after RSA. Conclusions: This is the first study evaluating risk factors for infection after RSA while controlling for confounding variables with multivariable analysis. The greatest risk factors for infection after RSA were history of a prior failed arthroplasty and age younger than 65 years. Patients with these clinical characteristics should be counseled preoperatively about the increased risk for development of infection after RSA.
    Full-text · Article · Aug 2014 · Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]
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    ABSTRACT: Blood flow restricted resistance exercise improves muscle strength; however, the cardiovascular response is not well understood. This investigation measured local vascular responses, tissue oxygen saturation (StO2), and cardiovascular responses during supine unilateral leg press and heel raise exercise in four conditions: high load with no occlusion cuff (HL), low load with no occlusion cuff (LL), and low load with occlusion cuff pressure set at 1.3 times resting diastolic blood pressure (BFRDBP) or at 1.3 times resting systolic blood pressure (BFRSBP). Subjects (N=13) (men/women 5/8, 31.8±12.5 yr, 68.3±12.1 kg, mean±SD) performed 3 sets of leg press and heel raise to fatigue with 90-s rest. Artery diameter, velocity time integral (VTI), and stroke volume (SV) were measured using two-dimensional and Doppler ultrasound at rest and immediately after exercise. Heart rate (HR) was monitored using a 3-lead ECG. Finger blood pressure (BP) was acquired by photoplethysmography. Vastus lateralis StO2 was measured using near-infrared spectroscopy (NIRS). A repeated-measures ANOVA was used to analyze exercise work and StO2. Multi-level modeling was used to evaluate the effect of exercise condition on vascular and cardiovascular variables. Statistical significance was set a priori at P<0.05. Artery diameter did not change from baseline during any of the exercise conditions. Blood flow increased after exercise in each condition except BFRSBP. StO2 decreased during exercise and recovered to baseline levels during rest only in LL and HL. HR, SV, and cardiac output (Q) responses to exercise were blunted in BFR. BP was elevated during rest intervals in BFR. Our results demonstrate that cuff pressure alters the hemodynamic responses to resistance exercise. These findings warrant further evaluations in individuals presenting cardiovascular risk factors.
    No preview · Article · Aug 2014 · Medicine and science in sports and exercise
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    ABSTRACT: The purpose of this study was to determine whether self-regulation of eating in minority preschool-aged children mediates the relationship between parent feeding practices and child weight. Participants were 299 low-income African American and Hispanic parents and their preschool-aged children who participated in Head Start. Parents completed questionnaires about controlling feeding practices (pressure to eat, restriction) and children's appetitive characteristics (enjoyment of food, food responsiveness, satiety responsiveness). Path analyses were used to determine whether children's self-regulation of eating mediated the relationship between feeding practices and child weight. Greater satiety responsiveness in African American preschool-age children partially mediated the inverse association between pressure to eat and children's weight, B (SE) = -0.073 (0.036), p < .05. Enjoyment of food and food responsiveness did not mediate the relationship between pressure to eat and weight in the African American sample, ps > .05, nor did appetitive characteristics mediate the relationship between restriction and child weight, ps > .05. Appetitive characteristics did not mediate the relationship between controlling feeding practices and child weight in the Hispanic sample, ps >.05. Implications include the need for culturally sensitive self-report measures and for researchers to account for the possible effects of racial/ethnic differences when designing interventions.
    Full-text · Article · Jun 2014 · Appetite

Publication Stats

2k Citations
299.29 Total Impact Points

Institutions

  • 2009-2015
    • University of Houston
      • Department of Health and Human Performance
      Houston, Texas, United States
  • 2011
    • University of Alabama at Birmingham
      • Department of Epidemiology
      Birmingham, AL, United States
  • 2005-2007
    • Clinique Sainte Anne
      Strasburg, Alsace, France
    • University of Texas Medical School
      • Department of Orthopaedic Surgery
      Houston, Texas, United States
    • University of Pécs
      Fuenfkirchen, Baranya, Hungary
  • 2004
    • University of Texas Health Science Center at Houston
      • Department of Orthopaedic Surgery
      Houston, Texas, United States