Crystal S Lim's research while affiliated with University of Missouri and other places

Publications (57)

Article
Limited research has examined a comprehensive set of predictors when evaluating discharge placement decisions for infants exposed to substances prenatally. Using a previously validated medical record data extraction tool, the current study examined prenatal substance exposure, infant intervention (i.e., pharmacologic, or non-pharmacologic), and dem...
Article
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Background: Pediatric obesity is common and a significant burden. Supplementing pediatric obesity treatment with technology is needed. This manuscript examines the usability and satisfaction, as well as explores initial effectiveness, of a remote patient monitoring system (RPMS) designed for youth presenting for pediatric weight management treatme...
Article
Objective: The COVID-19 pandemic has exacerbated differences related to employment and family psychological health. However, empirical evidence examining COVID-19-linked differences concerning children and families remains scant. This study addresses this gap by examining sociodemographic differences associated with COVID-19 on family access to re...
Article
Objective: The objective of this review was to examine existing literature and conceptually map the evidence for school-based obesity prevention programs implemented in rural communities, as well as identify current gaps in the literature. Introduction: Pediatric obesity is a significant public health condition worldwide. Rural residency places...
Article
Importance To our knowledge, there are no published randomized clinical trials of recruitment strategies. Rigorously evaluated successful recruitment strategies for children are needed. Objective To evaluate the feasibility of 2 recruitment methods for enrolling rural children through primary care clinics to assess whether either or both methods a...
Article
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Background/Objective Prior to the COVID-19 pandemic, our research group initiated a pediatric practice-based randomized trial for the treatment of childhood obesity in rural communities. Approximately 6 weeks into the originally planned 10-week enrollment period, the trial was forced to pause all study activity due to the COVID-19 pandemic. This pa...
Article
Aim: Children with sickle cell disease (SCD) have historically weighed less than their healthy peers. More recently, a retrospective chart review from six institutions in New England reported nearly one-quarter of children and adolescents with SCD had raised body mass index (BMI). This study aimed to examine rates of children with SCD with raised...
Article
This study investigated whether emergency department (ED) visits for mental health concerns increased during the COVID-19 pandemic, taking a health disparities lens. ED encounters from the only academic medical center in Mississippi were extracted from March-December 2019 and 2020, totaling 2842 pediatric (ages 4-17) and 17887 adult (ages 18-89) pa...
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Children in rural settings are underrepresented in clinical trials, potentially contributing to rural health disparities. We performed a scoping review describing available literature on barriers and facilitators impacting participation in pediatric clinical trials in rural and community-based (non-clinical) settings. Articles identified via PubMed...
Article
Previous research has shown that food parenting practices, which vary within the context of sociocultural factors, are associated with child weight, eating behaviors, and body dissatisfaction. While parents typically engage in multiple food parenting practices, few studies have examined what subgroups or combinations of food parenting practices are...
Preprint
BACKGROUND Pediatric obesity is a critical public health issue. Augmenting care in multidisciplinary pediatric obesity clinics with innovative evidence-based technology to improve weight status and health outcomes is needed. OBJECTIVE This study describes the design and methods of an open trial pilot study to examine a remote patient monitoring sy...
Article
Background Pediatric obesity is a critical public health issue. Augmenting care in multidisciplinary pediatric obesity clinics with innovative evidence-based technology to improve weight status and health outcomes is needed. Objective This study describes the design and methods of an open trial pilot study to examine a remote patient monitoring sy...
Article
Objective: Attention-deficit hyperactivity disorder (ADHD) and obesity are highly prevalent, impairing, and costly conditions, affecting about 10% of children each. Research indicates heightened prevalence of childhood obesity among youth with ADHD. However, more research is needed, examining comorbid ADHD among youth with overweight/obesity (OV/O...
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Background In 1999, type 2 diabetes mellitus (T2DM) was identified as an emerging epidemic in youth, and racial and ethnic minority youth were identified with high risk. Two decades later, no gold standard T2DM prevention intervention has been established for this population. Objective This study tests the efficacy of a telehealth diabetes preventi...
Preprint
BACKGROUND In 1999, type 2 diabetes (T2DM) was labeled an emerging epidemic in youth and racial and ethnic minority youth were identified at highest risk. Two decades later, there remains no gold standard T2DM prevention intervention for youth. OBJECTIVE This research protocol aims to test the efficacy of a telehealth diabetes prevention intervent...
Article
Objective: The objectives were to identify profiles of school-age children with overweight and obesity (OW/OB) from rural counties based on patterns of diet, activity, and sleep, to examine demographic predictors, and to examine whether profiles were differentially associated with psychosocial functioning. Methods: Participants included 163 chil...
Article
Objective To comprehensively examine the behavioral phenotypes of children with and without executive function (EF) impairments in a clinical sample of youth with obesity. Methods Youth aged 8 to 17 years (Mean age = 12.97) attending a medical clinic for obesity and their caregivers (N = 195 dyads) completed a battery of behavioral questionnaires....
Article
Participants (N = 1050; ages 1–19) were from a multidisciplinary pediatric obesity clinic. There were no significant associations between patient characteristics and attrition from the initial visit to the first follow-up. Multiple linear regressions revealed race and the approximate distance traveled to the clinic was associated with the number of...
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Purpose: Children with obesity demonstrate increased risk for eating disorders and internalizing psychopathology. Research in adults indicates unique facets of social anxiety differentially relate to eating pathology. These associations remain understudied in pediatric samples. The current study evaluated associations between social anxiety and di...
Article
Objective: To assess the effectiveness of behavioral parent-only (PO) and family-based (FB) interventions on child weight, dietary intake, glycated hemoglobin, and quality of life in rural settings. Methods: This study was a three-armed, randomized controlled trial. Participants were children (age 8-12 years) with overweight or obesity and their...
Article
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Objective: The objective of this scoping review is to map the available literature on school-based obesity prevention programs in rural communities. Introduction: Significant health disparities are associated with childhood obesity, and these disparities disproportionately affect children in disadvantaged communities, such as rural areas. Youth...
Article
Objectives: Examine racial differences in disordered eating and parental feeding in youth with obesity. Methods: A diverse sample of 131 treatment-seeking youth (Mage = 12.84 years; Rangeage = 8-18 years; 65.6% African American, 34.4% Caucasian) with obesity (MBMIz = 2.60) completed a disordered eating questionnaire; parents completed a question...
Article
Sickle cell disease (SCD) is associated with pain and decreased health-related quality of life (HRQOL). Coping strategies influence pain but have not been evaluated as mediating the relation between pain and HRQOL in pediatric SCD. The current study examined whether pain-related coping mediates the association between pain and HRQOL in children and...
Conference Paper
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Background Children who are obese are at increased risk for numerous medical, psychological, and reproductive comorbidities. Poly cystic ovary syndrome (PCOS) is one of the common conditions seen in females who are obese but little is known regarding the prevalence in adolescents. The purpose of this project was to examine the prevalence of PCOS in...
Preprint
Objective: Disordered eating attitudes and behaviors play a critical role in pediatric overweight and obesity and are important to measure in research and practice with this population. Disordered eating attitudes and behaviors in youth are commonly measured using the Children's Eating Attitudes Test (ChEAT), which has not been psychometrically eva...
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Objective: To examine initial outcomes of an 8-week Healthy-Lifestyle Intervention Program (HIP) which included children's participation in a daily summer camp along with parents' participation in a parenting program focused on overweight/obesity. Methods: Using a nonrandomized pilot trial design, 16 children (M child age = 6.42 yr; 81% male; 10...
Article
Objective : To examine the association between caregiver proxy report of executive function (EF) and dysregulated eating behavior in children with obesity. Participants were 195 youth with obesity aged 8-17 years, and their legal guardians. Youth height, weight, demographics, depressive symptoms, eating behaviors, and EF were assessed cross-sectio...
Article
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Purpose: Examine whether unhealthy and extreme weight control behaviors (WCBs) mediate the relationship between youth weight status and disease-specific health-related quality of life (HRQOL) in treatment-seeking youth who are overweight and obese (OV/OB). Method: 82 youth 10-17 years of age who were OV/OB and attending an outpatient obesity-rel...
Article
Objective: This study compared child weight status, social skills, body dissatisfaction, and health-related quality of life (HRQOL), as well as parent distress and family functioning in youth who are overweight or obese (OV/OB) with versus without clinical anxiety symptoms. Method: Participants included 199 children 7 to 12 years of age (mean ag...
Article
Background: Identifying factors linked to disordered eating in overweight and obesity (OV/OB) may provide a better understanding of youth at risk for disordered eating. This project examined whether ADHD symptoms and body dissatisfaction were associated with disordered eating. Methods: ADHD symptoms, disordered eating, and body dissatisfaction w...
Article
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Currently, over 30% of youth are overweight or obese. Limited access to parks and recreational facilities is related to physical inactivity and obesity. Environmental factors may also impact the effectiveness of pediatric weight management interventions. Most research concerning the built environment and child weight status has been conducted in ur...
Article
Objective Examine relations between depressive symptoms, ethnic identity, and health-related quality of life (HRQOL) in overweight or obese (OV/OB) children. Methods A total of 166 OV/OB 8- to 17-year-olds (M = 12.94 years; 86.7% obese; 50.6% racial/ethnic minority) attending an outpatient pediatric obesity medical clinic participated. Children com...
Article
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Objective To examine a computerized parent training program, “Bear Essentials,” to improve parents’ knowledge and coaching to help relieve preschoolers’ immunization distress. Method In a randomized controlled trial, 90 parent–child dyads received Bear Essentials parent training plus distraction, distraction only, or control. Outcomes were parent k...
Article
The purpose of this case study is to describe the application and challenges of utilizing a manualized behavioral parent group intervention to address pediatric obesity in a community-based rural setting. Treatment included 21 group sessions, which focused on nutritional and physical activity education, gradual changes to healthy lifestyle behavior...
Article
This study examined associations between pain, physical activity, physical fitness, and health-related quality of life (HRQOL) in overweight and obese children. Participants were 270 overweight and obese children 8-12 years of age and their parents. Children were separated into No Pain Frequency, Low Pain Frequency, and High Pain Frequency groups....
Article
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Purpose To conduct a meta-analysis of randomized controlled trials examining the efficacy of comprehensive behavioral family lifestyle interventions (CBFLI) for pediatric obesity. Method Common research databases were searched for articles through April 1, 2013. 20 different studies (42 effect sizes and 1,671 participants) met inclusion criteria. R...
Article
To examine disordered eating and associations with health-related quality of life (HRQOL) in rural overweight/obese (OW/OB) children. Cross-sectional analyses were conducted with 272 rural OW/OB children aged 8-12 years (M = 10.36; SD = 1.39). Child anthropometrics, demographics, disordered eating attitudes, unhealthy weight control behaviors (UWCB...
Article
Objective: Compare youth with comorbid asthma and obesity to youth with obesity only to determine if differences exist in body mass index, dietary intake, levels of physical activity, sleep duration and health-related quality of life. Levels of parent distress were also compared. Methods: Participants included 248 children (n = 175 in Obesity gr...
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Background: Sagittal abdominal diameter (SAD) is a novel anthropometric that correlates more strongly with visceral adipose tissue (VAT) and cardiometabolic disease risk in adults compared with body mass index (BMI). However, little research has evaluated this measurement in children. Objective: To evaluate SAD as a measure of cardiometabolic ri...
Article
Rates of obesity are higher for children and adults living in rural areas relative to non-rural settings. As a result, there is an immense need for pediatric weight management programs focused on children and families living in rural areas. However, clinicians and families in rural communities experience numerous barriers when participating in thes...
Article
The CHIRP Study is a two-arm, pilot randomized controlled trial assessing the effectiveness of a behavioral family weight management intervention in an important and at-risk population, overweight young children, 3 to 6years of age, and their parents from underserved rural counties. Participants will include 96 parent-child dyads living in rural co...
Article
Background: This study examined agreement and disagreement between child and caregiver reports of healthy, unhealthy, and extreme weight control behaviors (WCBs) in overweight and obese children. Methods: Participants were 93 youth 10-17 years old [M = 12.9; standard deviation (SD) = 2.1] attending an outpatient pediatric obesity clinic and thei...
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This study examined whether racial identity moderates the relation between pain and quality of life (QOL) in children with sickle cell disease (SCD). 100 children 8-18 years of age with SCD participated during a regularly scheduled medical visit. Children completed questionnaires assessing pain, QOL, and regard racial identity, which evaluates raci...
Article
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This pilot study examined the efficacy of a behavioral family intervention (BFI) to address weight management in obese children from economically disadvantaged backgrounds. Forty children, ages 6 to 12, and their parents enrolled in Medicaid were assigned to a BFI or an individual standard of care condition. Assessments were completed at baseline,...
Article
Pediatric treatment outcome research focusing on the physical and mental health of children living in rural areas is limited, despite the immense need. Participant recruitment is a significant barrier faced by pediatric researchers working in rural communities. The purpose of this article is to review challenges recruiting children and families to...
Article
The Extension Family Lifestyle Intervention Project (E-FLIP for Kids) is a three-arm, randomized controlled trial assessing the effectiveness of two behavioral weight management interventions in an important and at-risk population, overweight and obese children and their parents in rural counties. Participants will include 240 parent-child dyads fr...
Article
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This study examined whether social support moderates the relation between peer victimization and depressive symptoms in children who are obese. Participants were 96 children 8 to 17 years of age (M = 12.8, SD = 1.8) attending a pediatric obesity clinic. Children completed self-report measures. Results indicated that for obese girls peer social supp...
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Intravenous (IV) antibiotic therapy for pulmonary exacerbations (PE) has been shown to improve pulmonary functioning for patients with cystic fibrosis (CF); however, little is known about its effects on pediatric health-related quality of life (HRQOL). This prospective study assessed the impact of IV treatment of a PE on generic and CF-specific HRQ...
Article
The purpose of this study was to evaluate the effectiveness of vapocoolant for preschoolers' immunization injection pain relief. Fifty-seven 4 to 6-year-old children were randomized into vapocoolant alone or typical care conditions. Pain was measured at the baseline and at injection via self-report, caregiver report, nurse report, and by an observa...
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To conduct an evidence-based review of pediatric pain measures. Seventeen measures were examined, spanning pain intensity self-report, questionnaires and diaries, and behavioral observations. Measures were classified as "Well-established," "Approaching well-established," or "Promising" according to established criteria. Information was highlighted...
Article
Distraction has been shown to be an effective technique for managing pain in children; however, few investigations have examined the utility of this technique with infants. The goal of the current study was to investigate the effectiveness of movie distraction in reducing infants' immunization distress. Participants were 136 infants (range=1-21 mon...
Article
Adherence rates for chronic pediatric conditions are approximately 50%. The primary objective of the study was to assess rates of adherence using four different measurement methods for children with cystic fibrosis (CF). Participants included 37 children with CF between 6 and 13 years of age and their primary caregivers. Adherence measures included...
Article
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Relations between general behavior, temperament, and procedure-related behavior and distress were examined in children receiving intramuscular injections before undergoing restorative dental procedures. Younger children are likely to benefit the most from interventions prior to and during dental procedures. Children's anxiety before dental procedur...
Article
Occulocerebrocutaneous syndrome is a rare condition characterized by orbital cysts and skin tags. The presence of supernumerary teeth has not previously been associated with this syndrome. A primary supernumerary tooth with a permanent supernumerary successor was found in this case. This highlights the importance of very careful examination when as...

Citations

... In a post-COVID-19 scenario, virtual care provides accessibility, flexibility, and convenience to patients, families, and providers. Future virtual care models may look to incorporate tools such as video consultations, mobile phone applications, online educational resources, and remote monitoring devices [44][45][46]. These tools can facilitate communication between healthcare professionals and patients, allowing providers to monitor treatment progress and adjust treatment plans as needed. ...
... Roberts et al. from the Medical University of South Carolina [6] describe their experience of conducting a pediatric randomized clinical trial during the COVID-19 pandemic and their shift to virtual procedures. The authors developed a process by which clinical sites could transition to a virtual approach to complete all aspects of a trial safely and effectively. ...
... School education needs to reflect the value demands of "students" selfgrowth. e Internet is an educational tool and educational carrier [24,25]. At the same time, the Internet is also a living and educational environment that supports the growth of college students. ...
... The same applies for studies in developing countries [26]. RCT recruitment in rural areas is also lacking, as most of the research occurs in the academic health centers typically located in large urban areas [27]. The lack of inclusion of these groups poses harm to participants and raises concerns about justice and lack of generalizability [28]. ...
... Pediatric obesity is a burden on health care systems [3]; for example, it is estimated to account for over USD 14 billion a year in health care costs [4]. There is a need for treatments focused on pediatric obesity in order to reduce the development of comorbidities and lower health care costs [5]. ...
... A growing body of research suggests an association between ADHD and OW/OB status in children and adults (Cortese, 2019;Merrill et al., 2021), and that both inattentive and hyperactive/impulsive ADHD symptoms may contribute to increased BMI (Cortese et al., 2016;Graziano et al., 2010). Proposed plausible explanations for their association include genetic factors , abnormal eating patterns (Egbert et al., 2018), executive function de cits (Fang et al., 2019), and alterations in sleep patterns (Türkoğlu & Çetin, 2019). ...
... Therefore, recent perspectives suggest that adolescents with overweight and obese can have different standards of lifestyle and behaviors, compared to a normal-weight a adolescents [21]. In particular, there may be differences related to HQOL, PA volume a week, and 24 h movement behavior sleeping time, SED, MVPA, and LPA [21]. ...
... Dentro de los hallazgos clínicos que pudieran hacernos sospechar de una resistencia a la insulina los podemos hallar durante la exploración física, en los cuales se incluyen: acantosis nigricans, marcas cutáneas e hiperpigmentación en axilas, ombligo, ingle y fosas poplíteas (Gowey, et al, 2020). ...
... Unfortunately, many tertiary care clinics are unable to meet the overwhelming demand due to limited capacity and difficulty engaging patients and their families in treatment [25]. While a number of pediatric weight management clinics have attempted to address logistical concerns and demographic characteristics that predict engagement and attendance patterns [26][27][28], the present study examined a clinic initiative to triage patient referrals while prioritizing limited clinic slots for patients and families demonstrating interest and readiness to engage in lifestyle changes to address excess weight. Results indicate that efforts to address a backlog of patient referrals were efficacious and efficient. ...