Wednesday, November 11, 2020

The EAR-PC study findings encourages screening for hearing loss in older adults

Effective hearing loss screening in primary care: the early auditory referral-primary care study

AMERICAN ACADEMY OF FAMILY PHYSICIANS

Research News

Hearing loss is the second most common disability in the United States and comes with it a higher risk for being diagnosed with significant health conditions, such as hypertension, diabetes, dementia and depression, as well as higher health care cost and use. The Early Auditory Referral-Primary Care (EAR-PC) study was designed to address the lack of data about hearing loss screening. Implemented in real-world, community-based clinics, it evaluated the effect of a tailored electronic clinical alert appearing at all visits of patients 55 and older, to encourage clinicians to ask, "Do you have difficulty with your hearing?" The study's lead author is Philip Zazove, M.D., who is hearing impaired. He and his team of researchers evaluated a screening paradigm for identifying patients 55 years and older at risk of hearing loss from 10 family medicine clinics in two health systems for formal hearing evaluation and treatment. An electronic prompt alerted clinicians to screen for hearing loss during visits. About 25 percent of the patients had signs of hearing loss with the primary care screener (Hearing Handicap Inventory for the Elderly). Referral rates to audiology specialists increased from baseline rates of 3.2 percent to 14.4 percent at one health system and 0.7 percent to 4.7 percent at the other. Considering the high prevalence of hearing loss and the impact on quality of life, increasing referral rates for audiology testing may improve health outcomes.

Effective Hearing Loss Screening in Primary Care: The Early Auditory Referral-Primary Care Study
Philip Zazove, MD, MM, et al
University of Michigan, School of Medicine, Ann Arbor, Michigan
https://www.annfammed.org/content/18/6/520

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Six ways primary care "medical homes" are lowering health care spending

Patient-centered medical home activities associated with low medicare spending and utilization

AMERICAN ACADEMY OF FAMILY PHYSICIANS

Research News

Six Ways Primary Care "Medical Homes" Are Lowering Health Care Spending

New analysis of 394 U.S. primary care practices identifies the aspects of care delivery that are associated with lower health care spending and lower utilization of emergency care and hospital admissions. Researchers from the Urban Institute and RTI International analyzed health care cost data from a large group of Medicare patients and their primary care practices. Each practice previously took part in a 2011-2014 Centers for Medicare and Medicaid Services initiative to establish advanced primary care "medical homes," with improved and centralized care coordination.

What worked to reduce overall health care cost and utilization? At the top of the list: primary care practices that used patient clinical data to identify and remind patients due for preventive services saved, on average, about $70 per patient per month, lowered acute care hospital spending, and reduced hospitalizations and emergency department visits in their patient population.. Additionally, using their patient clinical records to initiate pre-visit planning, clinician reminders, targeted patient outreach, and population health monitoring were also linked to lower total Medicare spending. In short, practices that were able to leverage their patient data registry to anticipate need and target effective preventive services saved money.

Additional activities that were associated with fewer emergency department visits, reduced acute care spending and/or reduced hospital admissions include: offering targeted consultations for patients with chronic conditions to set health goals; following patients during hospital stays and supporting other specialists in patient care; establishing a protocol for sharing information in medical referrals; and adopting systematic approaches to quality improvement. Surprisingly, expanding access to care, such as expanded night and weekend hours, was not associated with lowered health care spending, utilization of emergency departments, nor reduced hospital readmissions.

Patient-Centered Medical Home Activities Associated With Low Medicare Spending and Utilization
Rachel A. Burton, MPP, et al
The Urban Institute, Washington, D.C.
https://www.annfammed.org/content/18/6/503

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Potentially preventable hospitalizations among older adults: 2010-2014

Older Americans who are Black, Hispanic, or Medicaid-eligible are more likely to experience preventable hospitalizations

AMERICAN ACADEMY OF FAMILY PHYSICIANS

Research News

Older Americans Who Are Black, Hispanic, or Medicaid-Eligible Are More Likely to Experience Preventable Hospitalizations

When complications due to diabetes, asthma, urinary tract infections, high blood pressure and other common conditions lead patients to visit the ER, researchers and health care quality administrators may label these visits as "potentially preventable hospitalizations." That is, with good outpatient care, these visits could have been potentially avoided. Potentially preventable hospitalizations are costly and can negatively impact the health and well-being of individuals, particularly if they are older. Researchers examined national trends in PPH to see differences across racial and socioeconomic subpopulations, as well as county-level differences, using 2010-2014 Medicare claims data. Overall, PPH rates consistently declined across all subpopulations. However, they found that Black and Hispanic Americans had higher PPH rates compared to Whites. Additionally, those who also had Medicaid insurance had higher rates than those with only Medicare coverage.

This examination of county-level potentially preventable hospitalization trends can inform health and social policies to support groups identified to be at-risk of PPH. The primary care system needs to be accessible and affordable, particularly for populations who are at higher risk of PPH. Policies with financial incentives to increase the number of primary care physicians, especially in rural and low-income areas, can potentially improve health care access and reduce PPH among vulnerable populations.

Potentially Preventable Hospitalizations Among Older Adults: 2010-2014
Elham Mahmoudi, PhD, et al
University of Michigan, School of Medicine, Ann Arbor, Michigan
https://www.annfammed.org/content/18/6/511




New analysis finds lung cancer screening reduces rates of lung cancer-specific death

Cancer-Specific Mortality, All-Cause Mortality, and Overdiagnosis in Lung Cancer Screening Trials: A Meta-Analysis

AMERICAN ACADEMY OF FAMILY PHYSICIANS

Research News

New Analysis Finds Lung Cancer Screening Reduces Rates of Lung Cancer-Specific Death

Low-dose CT screening methods may prevent one death per 250 at-risk adults screened, according to a meta-analysis of eight randomized controlled clinical trials of lung cancer screening. Researchers at the University of Georgia analyzed the health outcomes of 90,275 patients, comparing those who were screened versus those who received usual medical care or chest x-rays. Their analysis found a clinically and statistically significant 0.4 percent reduction in lung cancer-caused death long term, which translates into one preventable death per 250 at-risk adults screened. The authors recognize the important potential harm of overdiagnosis in cancer screening programs, and there was some evidence of overdiagnosis due to increased incidence in the screened group. However, based on the reduction in all-cause mortality being in the same direction and magnitude as lung cancer mortality, the authors interpret that the associated harms "do not appear to increase other causes of mortality," and the results of the study align with the U.S. Preventive Services Task Force recommendations for CT-based lung cancer screenings for adults age 55 to 80 who have a history of regular smoking.

Cancer-Specific Mortality, All-Cause Mortality, and Overdiagnosis in Lung Cancer Screening Trials: A Meta-Analysis
Mark H. Ebell MD, MS, et al
University of Georgia, College of Public Health, Athens, Georgia
https://www.annfammed.org/content/18/6/545

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Postpartum care fails to provide women with key recommended services

UMass Amherst researchers analyzed data from 20 million postpartum care visits

UNIVERSITY OF MASSACHUSETTS AMHERST

Research News

IMAGE

IMAGE: KIMBERLEY GEISSLER IS AN ASSISTANT PROFESSOR OF HEALTH POLICY AND MANAGEMENT IN THE UMASS AMHERST SCHOOL OF PUBLIC HEALTH AND HEALTH SCIENCES. view more 

CREDIT: UMASS AMHERST

Most women are receiving fewer than half the services recommended during their comprehensive postpartum medical checkup, according to a study by University of Massachusetts Amherst researchers.

"These findings underscore the importance of efforts to reconceptualize postpartum care to ensure women have access to a range of supports to manage their health during this sensitive period," concludes the study, published Nov. 10 in JAMA Network Open. "There is substantial room to improve the delivery of postpartum care."

Authors Kimberley Geissler and Laura Attanasio, both assistant professors of health policy and management in the School of Public Health and Health Sciences, were joined in the study by graduate student Brittany Ranchoff and undergraduate Michael Cooper. The study received funding from the National Heart, Lung and Blood Institute and the Agency for Healthcare Research and Quality.

"This research is very important because we were able to look at care that was actually provided and really understand what happened during health care visits, not just that the visits are happening. This information is critical for improving the quality of care," says Geissler.

The medical visits averaged about 17 minutes, the researchers found, which may help explain the incomplete postpartum care. "Is that enough time to provide these services? I don't know," Geissler says. "The pressure to see more patients in an increasingly short time is a known issue in the U.S. health care system, so it's not surprising we see that here, too."

In one of the most startling findings, despite an increased awareness of perinatal depression, only one in 11 patients received a screening for depression, part of the assessment of physical, social and psychological well-being recommended by the American College of Obstetricians and Gynecologists (ACOG).

"We need to look at why depression screening is not happening," Attanasio says. "This is an important factor in women's health for the rest of their lives. Even if you're missing some of the recommended services, this one should be universal among this population."

Previous studies have shown that women with Medicaid insurance receive fewer preventive services than women with private insurance, leading the UMass Amherst team to examine insurance type in their review. "We hypothesized recommended services would be less frequently provided during postpartum visits for women with Medicaid insurance compared to women with other coverage types," the researchers write.

However, Attanasio says, "we found that there were not significant differences in the services received between women with Medicaid coverage and private insurance. That could reflect the fact that a lot of these services were not provided to most of the women."

The researchers analyzed data from the National Ambulatory Medical Care Survey, which represented more than 20 million postpartum office visits to an ob-gyn or family medicine doctor from 2009 to 2016.

Recommended services include blood pressure screening; depression screening; pelvic exam; pap test; breast exam; blood glucose exam; contraceptive counseling or provision; counseling for weight reduction, exercise, stress management, diet/nutrition, and/or tobacco use; medication review; and referral to another physician, if needed.

The study calculated the percentage of visits during which the recommended postpartum care services were provided, including the following:

  • Blood pressure, 91.1%
  • Depression screening, 8.7%
  • Pelvic exam, 47.3%
  • Pap test, 15.9%
  • Breast exam, 21.9%
  • Contraceptive counseling or provision, 43.8%

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Diabetes epidemic detected among Xavante indigenous community in Central Brazil

Researchers examine retinas and find high prevalence of type 2 diabetes as well as ocular problems caused by the disease.

FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO

Research News

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IMAGE: RESEARCHERS EXAMINE RETINAS AND FIND HIGH PREVALENCE OF TYPE 2 DIABETES AS WELL AS OCULAR PROBLEMS CAUSED BY THE DISEASE view more 

CREDIT: FERNANDO KORN MALERBI

The Xavante, one of the indigenous communities most vulnerable to SARS-CoV-2 in Brazil, are suffering from an epidemic of diabetes, a "silent" disease considered a risk factor for severe COVID-19.

A group of researchers affiliated with the Federal University of São Paulo's Medical School (EPM-UNIFESP) and the University of São Paulo's Ribeirão Preto Medical School (FMRP-USP) examined the retinas of 157 individuals before the COVID-19 pandemic and found a high prevalence of type 2 diabetes and eye disorders caused by the disease.

The study was supported by São Paulo Research Foundation - FAPESP (https://bv.fapesp.br/en/auxilios/28693), and the results are published (https://www.sciencedirect.com/science/article/abs/pii/S0168822720306331) in Diabetes Research and Clinical Practice, the official journal of the International Diabetes Federation.

"Ninety-five of the 157 Xavante we examined [60.5%] were diagnosed with diabetes," Fernando Korn Malerbi (https://bv.fapesp.br/en/pesquisador/47115/fernando-korn-malerbi), a postdoctoral researcher in the Ophthalmology Department of EPM-UNIFESP and first author of the article published on the study.

According to Malerbi, diabetes can cause ocular problems such as retinopathy. Diabetic retinopathy develops when high blood sugar levels damage blood vessels in the retina, leading to vision loss if left untreated.

To diagnose cases of diabetic retinopathy and other possible eye disorders, the researchers examined members of the Xavante community on the Volta Grande and São Marcos Reservations in the state of Mato Grosso in Brazil's Center-West region. They used a smartphone-controlled retinal photography system developed by Phelcom Technologies (https://phelcom.com.br/en/company/) via a project (https://bv.fapesp.br/en/auxilios/105359) supported by FAPESP's Innovative Research in Small Business Program (PIPE (https://bv.fapesp.br/en/3/)).

Called the Eyer, the handheld retinograph is an optical device that produces precise images of the retina to detect back-of-the-eye (fundus) disease at a far lower cost than conventional methods. In addition, it has the advantage of being usable for remote diagnosis by an ophthalmologist via telemedicine.

The optical device is connected to a smartphone. It lights up and images the retina, and a specially written software application sends the images over the internet to Eyer Cloud, which stores and manages patient files.

In the absence of Wi-Fi or a 3G or 4G network, the images are stored in the smartphone and sent to the cloud when a broadband internet connection becomes available (read more at: agencia.fapesp.br/30784 (https://agencia.fapesp.br/portable-device-can-be-used-to-diagnose-eye-disease-remotely/30784/)).

Malerbi personally examined the Xavante volunteers and promptly gave them his diagnosis. "When retinal damage suggesting a risk of blindness was observed via the handheld retinograph, we informed the subjects via an interpreter and referred them to the local indigenous health service for follow-up and treatment," he said.

Of the 95 individuals with diabetes who underwent the complete ocular imaging protocol, 23 (24.2%) had ungradable images owing to cataract-caused media opacities that precluded evaluation of retinopathy in at least one eye.

Images from the remaining 72 subjects (75.8%) were good enough for diabetic retinopathy to be detected. The researchers found that 16 had the disease, and it was severe enough to be sight-threatening in seven.

"We proved that screening for diabetic retinopathy with a portable retinograph is feasible and economically viable because the technology is inexpensive and can be used in remote communities such as Indian reservations, where the population is usually dispersed in several villages," Malerbi said.

Deteriorating health

A previous study of eye problems among the Xavante reported diabetic retinopathy prevalence of 19.3% in the same locations. The higher level of prevalence found in this latest study may be due to the superior quality of the retinal camera images compared with the indirect ophthalmoscopy method used in the earlier study.

Another hypothesis is that the health of this indigenous population - one of the largest in Brazil, comprising some 17,000 Indians living on nine reservations - has deteriorated in the intervening years, the researchers surmised.

A previous study showed that 66.1% of 932 members of the Xavante community had metabolic syndrome, defined as a condition in which risk factors for cardiovascular disease and diabetes mellitus occur in the same individual.

For the researchers, the situation reflected changes in health profile and diet in recent decades, especially the consumption of industrialized foods and sedentary living (read more at: agencia.fapesp.br/22624 (https://agencia.fapesp.br/two-thirds-of-an-indigenous-community-have-metabolic-syndrome-and-are-obese/22624/)).

"The Xavante were traditionally hunter-gatherers but have become more sedentary. They've also changed their diet in recent decades, consuming new foodstuffs with high sugar content," Malerbi said.

Besides the Xavante, the researchers also examined the retinas of 33 Bororo - another community endangered by both COVID-19 and the bush fires that destroyed much of the Pantanal this year. Seven Bororo were found to have diabetes. One of these was diagnosed with severe diabetic retinopathy and referred to a health service for treatment.

CAPTION

Researchers examine retinas and find high prevalence of type 2 diabetes as well as ocular problems caused by the disease

About São Paulo Research Foundation (FAPESP)

The São Paulo Research Foundation (FAPESP) is a public institution with the mission of supporting scientific research in all fields of knowledge by awarding scholarships, fellowships and grants to investigators linked with higher education and research institutions in the State of São Paulo, Brazil. FAPESP is aware that the very best research can only be done by working with the best researchers internationally. Therefore, it has established partnerships with funding agencies, higher education, private companies, and research organizations in other countries known for the quality of their research and has been encouraging scientists funded by its grants to further develop their international collaboration. You can learn more about FAPESP at http://www.fapesp.br/en and visit FAPESP news agency at http://www.agencia.fapesp.br/en to keep updated with the latest scientific breakthroughs FAPESP helps achieve through its many programs, awards and research centers. You may also subscribe to FAPESP news agency at http://agencia.fapesp.br/subscribe.


Representation of female authors in family medicine academic journals is trending upward

Has female authorship distribution in family medicine research evolved over time?

AMERICAN ACADEMY OF FAMILY PHYSICIANS

Research News

Representation of Female Authors in Family Medicine Academic Journals is Trending Upward

After decades of underrepresentation in medicine, women are now entering many specialties in the United States, including family medicine, at higher rates than men. Despite the rising proportion of female physicians in family medicine, they continue to be underrepresented in the highest levels of professional attainment, particularly in academic settings. This study from the Robert Graham Center examines female authorship of research published in three leading U.S. family medicine journals over time. They found a statistically significant increase in female authorship of published research over time, with a 13-point jump in original research with female senior authors, from 29 percent in 2008 to 42 percent by 2017. In that same time period, the gender composition of the journals' editorial boards remained roughly the same. Published research was more likely to be male led if it did not have grant funding or if there were no other co-authors. This study's authors discuss the importance of increasing female representation in peer-reviewed publications, closing the gender gaps in the highest levels of academic medicine, and ensuring appropriate representation of thoughts and ideas in the field of family medicine.

Has Female Authorship Distribution in Family Medicine Research Evolved Over Time?
Yalda Jabbarpour, MD, et al
Robert Graham Center, Washington, D.C.
https://www.annfammed.org/content/18/6/496


Demolishing abandoned houses does not reduce nearby crime, study finds

Millions spent on efforts to curb illegal activity not effective

UNIVERSITY OF KANSAS

Research News

LAWRENCE -- Cities across the country have sought ways to improve neighborhood safety and in recent years have pointed to demolishing abandoned housing as a way to achieve the goal. While millions of dollars have been spent on the efforts, a recent University of Kansas study found a program demolishing more than 500 abandoned residential properties in Kansas City, Missouri, did not significantly reduce nearby violent or property crime.

Since the housing foreclosure crisis of 2007-08, the number of abandoned homes across the country has rapidly increased, drawing attention to dilapidated and abandoned residential properties and their effect on neighborhoods, including elevated crime rates. Hye-Sung Han, assistant professor of public affairs & administration at KU, conducted a study in which she examined 559 abandoned properties in Kansas City, Missouri, and nearby crime rates in the surrounding area. She found the demolition did not lead to a reduction in nearby crime and that localized socioeconomic and housing characteristics were much stronger predictors of any change in crime rates.

While scholars have long associated abandoned property and crime, there has been little research on whether demolishing abandoned properties reduces crime, even though police and city officials argue that demolition increases neighborhood safety and ease the burden on police by removing places for illegal activities.

"There is not much data out there on housing abandonment. Because of that, there aren't many studies done, and those that are, are mostly about how abandonment affects the neighborhood housing market," Han said. "But one other negative factor is crime and how it affects the quality of life it has for those still living in neighborhoods with abandoned housing. It has been pretty much proven that there is more crime where there is more abandoned housing."

Han said she decided to study the matter after hearing Kansas City's former police chief in 2016 touting a $10 million plan to demolish 800 dilapidated, abandoned homes to help reduce crime. The city has more than 10,000 abandoned properties, though not all have been deemed dangerous. Han identified 559 properties that were demolished between 2012 and 2016. Crime near the properties was compared to crime near another abandoned home that was not demolished. Her study, co-written with Scott Helm of the University of Missouri-Kansas City, was published in the journal Housing Policy Debate.

"I found out the crime around a property that was demolished did not change," Han said. "So, I looked at other explanations for crime going up or down. I think one of the reasons demolition doesn't make a difference is once you demolish the abandoned property, you are left a vacant lot. That is not necessarily better for neighborhood safety. In fact, I found that every single lot where the 559 properties were demolished was still vacant in 2020. Unkept vacant lots can encourage crime."

Han emphasized the study is not intended to criticize city officials or police but rather to shed light on whether programs using taxpayer funding to address crime are effective. Demolition is expensive, often costing $8,000 to $10,000 per home. The study focused on Kansas City, but similar demolition programs have taken place across the country, including cities such as Detroit, Philadelphia, Pittsburgh and Baltimore, some tearing down thousands of abandoned homes per year. One cannot assume the findings would be the same in other cities as they were in Kansas City, but Han said she feels similar results would be likely. There are differences among cities to consider, however, including types of properties being demolished, mostly single-family dwellings in Kansas City, while multiple-family rowhouses are more frequent targets for the wrecking ball in other cities, which carry a higher price tag.

The findings show that demolition of abandoned homes did not reduce nearby crime, which Han said indicates policymakers should consider holistic approaches to improve neighborhood safety. The focus should be on improving neighborhood social and physical characteristics, particularly in urban neighborhoods with high housing abandonment.

"In most cases, the very first thing that should happen is to get these houses and properties occupied," Han said. "So someone is at least living there and paying taxes, and so the city can provide more services."

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When kids watch a lot of TV, parents may end up more stressed

The more TV kids watch, the more ads they see and the more likely they are to ask for things on shopping trips, research shows

UNIVERSITY OF ARIZONA

Research News

There's bad news for parents who frequently plop their kids in front of the TV to give themselves a break: It might actually end up leaving moms and dads more stressed.

Why? Because the more television that kids watch, the more they're exposed to advertising messages. The more advertising they see, the more likely they are to insist on purchasing items when they go with their parents to the store - and perhaps make a fuss if told "no." All that, researchers say, may contribute to parents' overall stress levels, well beyond a single shopping trip.

The findings come from a University of Arizona-led study, published in the International Journal of Advertising, that explores the potential effects of children's television watching habits on their parents' stress levels.

"The more advertising children see, the more they ask for things and the more conflict is generated," said lead study author Matthew Lapierre, an assistant professor in the UArizona Department of Communication in the College of Social and Behavioral Sciences. "What we haven't looked at before is what the potential effect is on parents. We know kids ask for things, we know it leads to conflict, but we wanted to ask the next question: Could this be contributing to parents' overall stress?"

The study suggests that it could.

There are a few things parents can do, perhaps the most obvious of which is limiting screen time.

"Commercial content is there for a reason: to elicit purchasing behavior. So, if this is a problem, maybe shut off the TV," Lapierre said.

Of course, that can be easier said than done, he acknowledged.

Another thing parents can try, especially as advertising geared toward children ramps up around the holidays: Consider how they talk to their kids about consumerism.

The researchers looked at the effectiveness of three types of parent-child consumer-related communication:

--Collaborative communication is when a parent seeks child input on family purchasing decisions - for example, saying things such as, "I will listen to your advice on certain products or brands."
--Control communication is when a parent exhibits total control in parent-child consumer related interactions - for example, saying things such as, "Don't argue with me when I say no to your product request."
--Advertising communication is when parents talk to their children about advertising messages - for example, saying things such as, "Commercials will say anything to get you to buy something."

They found that, in general, collaborative communication is associated with less parent stress. However, the protective effect of collaborative communication decreases as children's purchase initiation and coercive behaviors - such as arguing, whining or throwing temper tantrums - increase.

Both control communication and advertising communication are associated with more purchase initiations and children's coercive behavior, the researchers found, suggesting that engaging less in those communication styles could be beneficial.

However, when children have higher levels of television exposure, the protective effect of engaging in less advertising communication decreases.

"Overall, we found that collaborative communication between parents and children was a better strategy for reducing stress in parents. However, this communicative strategy shows diminishing returns when children ask for more products or engage in more consumer conflict with parents," said study co-author Eunjoo Choi, a UArizona doctoral student in communication.

The study is based on survey data from 433 parents of children ages 2 to 12. The researchers focused on younger children because they have less independent purchasing power and spend more time shopping with their parents than older kids, Lapierre said.

In addition to answering questions about their communication styles, the parents in the study also responded to questions designed to measure:

--How much television their child watches in a day.
--How often their child ask for or demands a product during shopping trips, or touches a product without asking.
--How often their child engages in specific coercive behaviors during shopping trips.
--Parent stress levels.

Advertisers Find a Way

Lapierre acknowledged that the way people consume entertainment is changing. With the rise of the DVR and streaming services, many viewers are no longer being exposed to the traditional advertising of network or cable TV. However, advertisers are finding creative ways around that, through tactics such as product placement and integrated branding - incorporating product or company names into a show's narrative - Lapierre said. And advertising toward children remains a multibillion-dollar industry.

"In general, more television exposure means more exposure to commercialized content. Even if I'm streaming, if I I'm watching more of it, I'm likely seeing more integrated branding," Lapierre said.

Advertising aimed at children - which often features lots of bright colors, upbeat music and flashy characters - can be especially persuasive, since, developmentally, children aren't fully capable of understanding advertising's intent, Lapierre said.

"Advertising for kids is generated to makes them feel excited. They do a lot of things in kids' advertising to emotionally jack up the child," Lapierre said. "Children don't have the cognitive and emotional resources to pull themselves back, and that's why it's a particular issue for them."

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Weight loss shouldn't be the goal of PE

New study shows kids' physical fitness is more important than BMI

UNIVERSITY OF GEORGIA

Research News

IMAGE

IMAGE: CHILDREN GET ACTIVE OUTSIDE UGA'S MCPHAUL CHILD DEVELOPMENT LAB. view more 

CREDIT: ANDREW DAVIS TUCKER/UGA

For adults, the goal of exercise is often to shed some pounds, but new research from the University of Georgia suggests the objective should be different for kids.

Physical education should focus on improving students' physical skills, knowledge of the benefits of exercise and motivation to be active. The goal should be to build students' cardiorespiratory endurance, a measure of how well the body handles long periods of exercise--not to help them lose weight, according to the study's authors. Kids can be overweight (as measured by the Body Mass Index, or BMI) and still able to reach the recommended 60 minutes of moderate to vigorous physical activity each day. And students who are more active during PE, despite their weight, are more likely to stay active after school as well.

"Research has shown that even in young children, people who are fitter in terms of cardiorespiratory endurance participate in more intense physical activities," said lead author Sami Yli-Piipari, an associate professor in UGA's Mary Frances Early College of Education. "It's not really your weight that matters. Children can be a little bit overweight but still be relatively fit."

The study followed 450 children, ages 10 through 12, who took 90 minutes of mandatory PE every week. The students wore an accelerometer on their right hip during the day to track their total physical activity for a week, and simple tests--such as being able to do a regular or modified pushup or crunch-- were used to determine their mastery of physical skills. The researchers also explored whether students enjoyed PE or participated out of obligation.

"Physical education matters," Yli-Piipari said. "It's not only where students learn the skills, abilities and motivation to be active; it's where students are having to do something active at a higher intensity than they probably would after school."

The study took place in Finland, where children have more PE on average than American students, and the class also focuses on the importance of exercise and how to incorporate it into everyday life. In keeping with previous research, boys tended to be more active than girls. But surprisingly, muscle strength and motor skills didn't play a role in activity levels. Neither did motivation--whether the child wanted to participate in PE--nor enjoyment of PE classes.

The students who didn't participate in after-school sports were also typically less active during their down time. For many of these students, PE was the only time they exercised hard enough to work up a sweat, which makes it even more important to use class time effectively in a way that will get students moving and motivated to keep it up.

To help children learn to be physically literate, Yli-Piipari suggests teaching them in a way that gets students up and active.

  • Don't just lecture and tell kids to do something. Take them to places, get them moving, and let them try different things themselves.
  • Variety is key. Introduce children to multiple ways they can get their heart pumping and explain why it's important to stay active.
  • Finally, model lifestyle and behaviors that show that physical activity and exercise have an important value for you. Help connect the dots from exercising to the positive physical and mental health effects it can have on an individual.

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This study, done in partnership with the University of Jyväskylä in Finland, and the LIKES Research Centre for Physical Activity and Health, was published in the Journal of Teaching in Physical Education.