Girls Health Enrichment Multisite Studies Research Articles

We Need a New Approach to Prevent Obesity in Low-Income Minority Populations.

* Abbreviations: COPTR — : Childhood Obesity Prevention and Treatment Research Consortium CPP — : community policy and program CPP-Strat — : community policy and program created to assess either nutrition or physical activity strategy GEMS — : Girls’ Health Enrichment Multi-site Studies HCS — : Healthy Communities Study In the last 2 decades, the National Institutes of Health invested in 2 major multicenter trials aimed at the prevention of obesity in high-risk populations of low-income Hispanic and African American children.1 The trials were the Childhood Obesity Prevention and Treatment Research Consortium (COPTR) and the Girls’ Health Enrichment Multi-site Studies (GEMS). Despite intensive, state-of-the-art, and often creative interventions conducted by seasoned investigators, all 5 of the studies considered below failed to alter the trajectory of weight gain in their participants compared with controls. In this issue of Pediatrics , Moore et al2 describe the most recent of the COPTR studies. This study, conducted in Cleveland, Ohio, is 1 of 4 randomized controlled intervention trials, 2 of which have already been published. In this trial, 360 predominantly African American middle school children (mean age 11.6 years) and their parents were randomly assigned to a HealthyChange intervention, which relied on cognitive behavioral and motivational interviewing strategies that focused on goal setting, problem solving, self-monitoring, and relapse prevention. The control group was a SystemChange intervention that sought to establish family routines, restructured to develop new healthy habits. Both interventions focused on improving diet, physical activity, sleep and stress management, and reducing sedentary behavior. Both interventions included intensive engagement through 25 small-group sessions in the first year, alternating face-to-face and individualized phone sessions in year 2, and 4 face-to-face sessions and 8 individualized phone sessions in year 3. At the end of the 3-year intervention, 90% of enrolled participants remained in the study. No significant differences were observed in annual changes of BMI, waist circumference, or triceps skinfold thickness. Furthermore, no significant differences were observed in diet, physical activity measured by accelerometry, sleep, perceived stress, or cardiometabolic factors. In 2 other COPTR studies that included randomized intensive obesity interventions in low-income, … Address correspondence to William H. Dietz, MD, PhD, Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, George Washington University, Room 319, 950 New Hampshire Ave NW, Washington, DC 20052. E-mail: bdietz{at}email.gwu.edu

Energy Underreporting in African-American Girls: A Longitudinal Analysis

The objective of this study was to determine the longitudinal prevalence and predictors of dietary underreporting in African-American preadolescent girls and the association of baseline dietary underreporting with changes in BMI over a 2-year period as part of the Girls health Enrichment Multi-site Studies (GEMS). Energy was summarized at baseline, 12 months, and 24 months and computed as a 3-day average of 24-hour dietary recalls. Physical activity was assessed by accelerometer, basal metabolic rate was estimated using the World Health Organization's prediction equation, and caloric underreporting was based on the Goldberg equation. We classified 48% of the girls at baseline as underreporters; with underreporting increasing over time (61% at 12 months; 66% at 24 months). Intervention treatment assignment did not affect the prevalence of underreporting over time. The consistency of underreporting (or not) stayed stable over time. Across all three time points, a higher BMI predicted underreporting. Baseline dietary underreporting and baseline BMI were found to be the major predictors of change in BMI, whereas baseline dietary variables did not predict change in BMI. Dietary underreporting was extremely common in this sample of AA preadolescent girls and predictive of change in BMI. Given the magnitude and consistency of dietary underreporting along with the fact that no dietary variables predicted change in BMI, measurement of dietary intake in preadolescents, even with sophisticated measurement methodologies, appears biased. The best use of dietary recalls may not be to estimate dietary intake but rather to determine underreporting.

Identification of facilitators and barriers to participation in weight gain prevention research by African American girls

Objective The purpose of the current study is to describe the development, implementation, and success of recruitment and adherence strategies of 303 African American preadolescent girls and their primary caregiver in the Girls health Enrichment Multi-site Studies (GEMS) program. Methods A socio-ecologic model was used to guide selection and implementation of recruitment and retention strategies which were continuously monitored and revised in response. Strategy mode and frequency associated with program enrollment, engagement, and retention were analyzed. Results Successful recruitment approaches included radio messages (23.1%), school fliers (20.1%), and friend referral (15%). Initially 463 potential participants responded, 320 girls were screened, and 303 enrolled. Significant increases in participant accrual were observed between Wave 4 (n = 28) and Wave 5 (n = 91) after using a team recruitment approach. Implementing case management strategies and providing make-up sessions also served to keep participants current and engaged in the program. In year 2, community field trips replaced the more structured sessions providing participants with experiential learning opportunities. Overall intervention attendance rates ranged from 79.7% to 90.5% among waves. Further, 75.9% and 80.2%, respectively, of participants attended 1-year and 2-year follow-ups. Conclusion Multiple recruitment strategies and flexible, responsive approaches to recruitment and retention guided by the socio-ecologic model facilitated optimal implementation of an intervention for preadolescent girls. Through the application of the socio-ecologic model researchers and program leaders will be able to identify strategies to enhance the probability of successful outcomes.

Family Context as It Relates to Weight-Related Behaviors in Preadolescent African American Girls

To examine family context in relation to body image, weight concerns, and weight control behaviors in preadolescent African American girls. Cross-sectional baseline data were analyzed from 303 African American girls 8 to 10 years old and a caregiver in the Girls health Enrichment Multi-site Studies Phase 2(GEMS), an obesity prevention intervention trial. Fruit, juice, and vegetable accessibility and family support for healthy eating and physical activity were significantly related to girls' body image and weight control behaviors. A comprehensive understanding of family factors may improve future programs aimed at preadolescent girls.

The Memphis Girls' health Enrichment Multi-site Studies (GEMS)

To determine the efficacy of a 2-year obesity prevention program in African American girls. Memphis GEMS (Girls' health Enrichment Multi-site Studies) was a controlled trial in which girls were randomly assigned to an obesity prevention program or alternative intervention. Local community centers and YWCAs (Young Women's Christian Associations) in Memphis, Tennessee. Girls aged 8 to 10 years (N = 303) who were identified by a parent or guardian as African American and who had a body mass index (BMI) at or higher than the 25th percentile for age or 1 parent with a BMI of 25 or higher. Group behavioral counseling to promote healthy eating and increased physical activity (obesity prevention program) or self-esteem and social efficacy (alternative intervention). The BMI at 2 years. The BMI increased in all girls with no treatment effect (obesity prevention minus alternative intervention) at 2 years (mean, 0.09; 95% confidence interval [CI], -0.40 to 0.58). Two-year treatment effects in the expected direction were observed for servings per day of sweetened beverages (mean, -0.19; 95% CI, -0.39 to 0.09), water (mean, 0.21; 95% CI, 0.03 to 0.40), and vegetables (mean, 0.15; 95% CI,-0.02 to 0.30), but there were no effects on physical activity. Post hoc analyses suggested a treatment effect in younger girls (P for interaction = .08). The mean BMI difference at 2 years was -2.41 (95% CI, -4.83 to 0.02) in girls initially aged 8 years and -1.02 (95% CI, -2.31 to 0.27) in those initially aged 10 years. The lack of significant BMI change at 2 years indicates that this intervention alone is insufficient for obesity prevention. Effectiveness may require more explicit behavior change goals and a stronger physical activity component as well as supportive changes in environmental contexts.

Defining Accelerometer Thresholds for Physical Activity in Girls Using ROC Analysis

Receiver operating characteristic (ROC) analysis is a common method used in diagnostic and screening tests to define thresholds levels of a factor that discriminates between 2 levels of another factor. The purpose of this analysis was to use ROC analysis to determine the optimal accelerometer-measured physical activity (PA) thresholds for predicting selective cardiovascular disease (CVD) risk factors. ROC was performed using data from Stanford Girls Health Enrichment Multisite Studies trial. PA was assessed for multiple days using accelerometers. CVD variables were overweight, elevated triglyceride, reduced HDL-C, hypertension, impaired fasting glucose, fasting insulin, and clustering of multiple CVD risk factors. A sample of 261 girls participated, of which 208 had complete CVD risk measures (mean +/- SD age = 9.4 +/- 0.9yrs, BMI = 20.7 +/- 4.8kg/m2). An average of > or =11.1 minutes/day at > or =2,600 counts/min was the maximally sensitive and specific threshold for discriminating girls who were overweight, > or =16.6 minutes/day at > or =2,000 counts/min for hyperinsulinemia or with > or =2 CVD risk factors. The Area Under the Curve for overweight, hyperinsulinemia, and > or =2 CVD risk factors was of 0.66, 0.58, and 0.60, respectively. The sensitivity and specificity associated with overweight, hyperinsulinemia, and > or =2 CVD risk factors were 60.3% and 72.9%, 53.3% and 83.9%, 44.0% and 84.7%, respectively. Empirically-derived thresholds of PA to optimally discriminate between girls with and without CVD risk were lower in this sample than generally recommended. This ROC approach should be repeated in other populations to determine optimal PA thresholds with clinical validity for research, surveillance and program evaluation.

A Randomized Controlled Trial of Culturally Tailored Dance and Reducing Screen Time to Prevent Weight Gain in Low-Income African American Girls

To test a 2-year community- and family-based obesity prevention program for low-income African American girls: Stanford GEMS (Girls' health Enrichment Multi-site Studies). Randomized controlled trial with follow-up measures scheduled at 6, 12, 18, and 24 months. Low-income areas of Oakland, California. African American girls aged 8 to 10 years (N=261) and their parents or guardians. Families were randomized to one of two 2-year, culturally tailored interventions: (1) after-school hip-hop, African, and step dance classes and a home/family-based intervention to reduce screen media use or (2) information-based health education. Changes in body mass index (BMI). Changes in BMI did not differ between groups (adjusted mean difference [95% confidence interval] = 0.04 [-0.18 to 0.27] per year). Among secondary outcomes, fasting total cholesterol level (adjusted mean difference, -3.49 [95% confidence interval, -5.28 to -1.70] mg/dL per year), low-density lipoprotein cholesterol level (-3.02 [-4.74 to -1.31] mg/dL per year), incidence of hyperinsulinemia (relative risk, 0.35 [0.13 to 0.93]), and depressive symptoms (-0.21 [-0.42 to -0.001] per year) decreased more among girls in the dance and screen time reduction intervention. In exploratory moderator analysis, the dance and screen time reduction intervention slowed BMI gain more than health education among girls who watched more television at baseline (P = .02) and/or those whose parents or guardians were unmarried (P = .01). A culturally tailored after-school dance and screen time reduction intervention for low-income, preadolescent African American girls did not significantly reduce BMI gain compared with health education but did produce potentially clinically important reductions in lipid levels, hyperinsulinemia, and depressive symptoms. There was also evidence for greater effectiveness in high-risk subgroups of girls.

Self-perception and Body Image Associations with Body Mass Index among 8-10-year-old African American Girls

The purpose of this study was to examine relationships among body mass index (BMI), self-perceptions, and body image discrepancy in African American (AA) girls. Baseline self-perception and BMI data were collected by trained staff from 303 preadolescent AA girls participating in the girls health enrichment multi-site studies. Correlations and multivariable logistic regression analyses were performed to identify relationships of BMI with self-perception factors. Girls with a BMI at or above the 85th percentile were more likely to have greater body image discrepancy and participate in weight control behaviors than girls with a BMI below the 85th percentile. Body image discrepancy was not related to self-esteem, but was positively correlated with physical activity self-concept and self-efficacy, and diet self-efficacy. Girls with higher BMI had greater body image discrepancy and were less confident in abilities to be active and eat healthy. Findings may inform the development of obesity interventions for preadolescents.

Prevalence and Characteristics of Energy Underreporting in African‐American Girls

To determine the frequency and characteristics of energy intake underreporting in African-American preadolescent girls as part of the Girls health Enrichment Multi-site Studies (GEMS). Energy intake was summarized using the Nutrition Data System for Research software and computed as a 3-day average of 24-h dietary recalls. Physical activity was assessed by an accelerometer, basal metabolic rate (BMR) was estimated using the World Health Organization's prediction equation, and underreporting of caloric intake was based on the Goldberg equation. Using a conservative criterion for determining energy underreporting, we classified 54.8% of the girls as underreporters; 45.2% were classified as plausible reporters. Factors related to underreporting included higher BMI (beta = -0.506, P < or = 0.001), older age (beta = -0.159, P = 0.001), greater unhealthy eating behaviors (beta = -0.118, P = 0.025), and higher self-efficacy for diet (beta = -0.098, P = 0.033). Underreporting of dietary intake, specifically energy, is common in African-American preadolescent girls and can be partially explained by weight status and psychosocial variables. The extent of dietary underreporting in specific and high-risk populations is largely unknown and could be evaluated by routinely including a report of such an index in future research studies.

Estimating Physical Activity From Incomplete Accelerometer Data in Field Studies

The purpose of this study was to develop a data-driven approach for analyzing incomplete accelerometer data from field-base studies. Multiple days of accelerometer data from the Stanford Girls health Enrichment Multi-site Studies (N = 294 African American girls) were summed across each minute of each day to produce a composite weekday and weekend day. Composite method estimates of physical activity were compared with those derived from methods typically described in the literature (comparison methods). The composite method retained 99.7% and 100% of participants in weekday and weekend-day analysis, respectively, versus 84.7% to 94.2% and 28.6% to 99.0% for the comparison methods. Average wearing times for the composite method for weekday and weekend day were 99.6% and 98.6%, respectively, 91.7% to 93.9% and 82.3% to 95.4% for the comparison methods. Composite-method physical activity estimates were similar to comparison-methods estimates. The composite method used more available accelerometer data than standard approaches, reducing the need to exclude periods within a day, entire days, and participants from analysis.

Abstract 3710: Stanford GEMS (Girls health Enrichment Multisite Studies): Long-Term Efficacy of After-School Dance and Screen Time Reduction in Low-Income African-American Girls

Objective: To test the efficacy of a 2-year, community- &amp; family-based intervention to reduce weight gain in low-income, preadolescent African-American girls Design: 2 arm, parallel group, randomized controlled trial Setting: Low-income areas of Oakland, CA Participants: 8 –10 year old African-American girls Interventions: Girls were randomized to a 2 year, culturally-tailored after school dance program and a home/family-based intervention to reduce screen media use (dance/TV) versus an information-based community health education (HE) active-placebo comparison intervention Primary Outcome: Change in body mass index measured up to 5 times over the course of the study Results: 261 girls were randomized (134 dance/TV, 127 HE) and 225 (86.2%) completed 1 or more follow-up measures (118 dance/TV, 107 HE; mean ± SD follow-up = 25.7 ± 8.5 mos and 25.2 ± 9.6 mos, respectively). Intent-to-treat analysis found no statistically significant differences between groups in BMI change (mean difference in changes= .04 kg/m2 per year, 95% confidence interval [95% CI] =−.19 to .27; P=.72). Similar results were found for waist circumference and triceps skinfold. Compared to girls in HE, girls in the dance/TV group significantly reduced fasting total cholesterol levels (difference in changes = −3.49 mg/dl per year, 95% CI −5.28 to −1.70; P&lt;.001), fasting LDL-cholesterol (−3.02, 95% CI −4.74 to −1.31; P&lt;.001) and depressive symptoms (P&lt;.05). Changes between groups were not statistically significant for HDL-cholesterol, triglycerides and insulin, resting blood pressure and heart rate, dietary energy and fat, accelerometer-measured physical activity, and screen time. Moderator analysis indicated the dance/TV reduction intervention was significantly more effective than HE in reducing BMI gain for girls with single parent families, more screen time and more depressive symptoms at baseline. Conclusions: A culturally-tailored after school dance and screen time reduction intervention did not slow BMI increases more than a health education intervention in low-income African-American girls. The dance/TV intervention resulted in greater reductions in fasting total and LDL-cholesterol and depressive symptoms, but not in other cardiovascular disease risk factors.

Stanford GEMS phase 2 obesity prevention trial for low-income African-American girls: Design and sample baseline characteristics

Objective African-American girls and women are at high risk of obesity and its associated morbidities. Few studies have tested obesity prevention strategies specifically designed for African-American girls. This report describes the design and baseline findings of the Stanford GEMS (Girls health Enrichment Multi-site Studies) trial to test the effect of a two-year community- and family-based intervention to reduce weight gain in low-income, pre-adolescent African-American girls. Design Randomized controlled trial with measurements scheduled in girls' homes at baseline, 6, 12, 18 and 24 month post-randomization. Setting Low-income areas of Oakland, CA. Participants Eight, nine and ten year old African-American girls and their parents/caregivers. Interventions Girls are randomized to a culturally-tailored after-school dance program and a home/family-based intervention to reduce screen media use versus an information-based community health education Active-Placebo Comparison intervention. Interventions last for 2 years for each participant. Main outcome measure Change in body mass index over the two-year study. Results Recruitment and enrollment successfully produced a predominately low-socioeconomic status sample. Two-hundred sixty one (261) families were randomized. One girl per family is randomly chosen for the analysis sample. Randomization produced comparable experimental groups with only a few statistically significant differences. The sample had a mean body mass index (BMI) at the 74th percentile on the 2000 CDC BMI reference, and one-third of the analysis sample had a BMI at the 95th percentile or above. Average fasting total cholesterol and LDL cholesterol were above NCEP thresholds for borderline high classifications. Girls averaged low levels of moderate to vigorous physical activity, more than 3 h per day of screen media use, and diets high in energy from fat. Conclusions The Stanford GEMS trial is testing the benefits of culturally-tailored after-school dance and screen-time reduction interventions for obesity prevention in low-income, pre-adolescent African-American girls.

Memphis Girls health Enrichment Multi-site Studies (GEMS): Phase 2: Design and baseline

Obesity prevalence is increasing in the U.S., especially among children and minority populations. This report describes the design and baseline data of the ongoing Girls health Enrichment Multi-site Studies (GEMS) trial (Memphis site), which is testing the efficacy of a 2-year family-based intervention to reduce excessive increase in body mass index (BMI). This randomized, controlled trial conducted at community centers in Memphis, Tennessee requires major measurements at baseline and at 12 and 24 months post-randomization. The participants are healthy African-American girls and one parent/caregiver of each girl. Participating girls are of ages 8–10 years, with BMI ≥ 25th percentile of the CDC 2000 growth charts or with one overweight or obese parent/caregiver (BMI ≥ 25 kg/m 2). The active intervention is designed to prevent excessive weight gain by promoting healthy eating habits and increasing physical activity. An alternative intervention (comparison group) promotes general self-esteem and social efficacy. The main outcome measure is the difference between the two treatment groups in the change in BMI at 2 years. Three hundred and three girls have been randomly assigned to receive the test intervention ( n = 153) or the alternative intervention ( n = 150). The two groups do not differ in baseline characteristics. At the time of enrollment, the mean age was 9 years, the mean BMI was 22 kg/m 2 (mean BMI percentile = 77th), and 41% were overweight (BMI ≥ 95th percentile using CDC 2000 growth charts). Participants' intake of fruits and vegetables (1.3 serving/day) and fats (36% kcal), and their participation in moderate-to-vigorous physical activity (20 min/day), did not meet national recommendations. The GEMS obesity prevention intervention targets improved diet and increased physical activity to reduce excessive weight gain in healthy African-American girls of ages 8–10.

Metabolic Syndrome in Preadolescent Girls

Endocrinology| November 01 2006 Metabolic Syndrome in Preadolescent Girls AAP Grand Rounds (2006) 16 (5): 54–55. https://doi.org/10.1542/gr.16-5-54 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Metabolic Syndrome in Preadolescent Girls. AAP Grand Rounds November 2006; 16 (5): 54–55. https://doi.org/10.1542/gr.16-5-54 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: metabolic syndrome x, pre-teen Source: Chi CH, Wang Y, Wilson DM, et al. Definition of metabolic syndrome in preadolescent girls. J Pediatr. 2006;148:788–792; doi:10.1016/j.jpeds.2006.01.048 The metabolic syndrome is a clustering of cardiovascular risk factors associated with insulin resistance such as obesity, hyperinsulinemia, dyslipidemia, and hypertension. There is no globally accepted definition of the metabolic syndrome in adults and even less agreement for pediatric patients, thus making it difficult to determine prevalence, compare results from different studies, or agree on screening tests. The purpose of this study was to determine the difference in prevalence rates when applying various published definitions of metabolic syndrome in preadolescent females. Two separate populations from other projects were used. The first was made up of low socioeconomic preadolescent black girls from Oakland, Calif who participated in the Stanford Girls Health Enrichment Multi-site Studies (Stanford GEMS). This was an obesity prevention study of preadolescent girls between the ages of 8 and 10 years with a body mass index (BMI) of ≥50th percentile for age or with a least 1 parent/guardian with a BMI of ≥25 kg/m2. The other population consisted of participants in the Stanford Girls Activity, Movement, and Environmental Strategy study (Stanford GAMES) in which preadolescent females, 7–10 years old, from 6 ethnically and socioeconomically diverse public elementary schools in South San Francisco, were enrolled for an obesity prevention study. Girls were ineligible in both studies if they had a prior diagnosis of diabetes mellitus, a chronic illness that affects growth or weight, or they received a medication potentially affecting growth or weight. Study parameters followed included weight, height, waist circumference, triceps skinfold, and resting systolic and diastolic blood pressure. Laboratory measurements included plasma glucose, insulin levels, HDL cholesterol, and triglyceride values. Investigators for studies on youth have used various sets of modified adult criteria to estimate the prevalence of metabolic syndrome in pediatric populations. Studies published in the past decade were reviewed to identify different sets of criteria for defining metabolic syndrome in children and adolescents. These studies were subsequently divided into projects using criteria adapted from the National Cholesterol Education Program Adult Treatment Panel III (ATP III)1 or World Health Organization (WHO)2 definitions of metabolic syndrome (6 and 8 projects, respectively). As an example of the range of definitions, one WHO-based definition requires BP ≥90% for age and sex, triglycerides or total cholesterol ≥90% for age and sex, and fasting glucose ≥90% for age and sex, while another requires insulin resistance (≥75% insulin for age and sex) plus 2 of these risk factors: systolic BP ≥75% for age and sex; HDL ≤25% for age and sex; glucose ≥110 mg/dL; and BMI ≥85% for age and sex. Prevalence of the metabolic syndrome ranged from 0.4% to 23% for GEMS and 2.0%–24.6% for GAMES using the definitions adapted from ATP III. There was a wide range of prevalence for metabolic syndrome, between 0%–15.3% for GEMS and 0.4%–15.8% for GAMES, when modified WHO criteria were used to define metabolic syndrome in the... You do not currently have access to this content.

Definition of metabolic syndrome in preadolescent girls

To compare and contrast proposed definitions of metabolic syndrome in pediatrics, and to determine prevalence of metabolic syndrome in preadolescent females when applying different criteria. A literature review on definitions of metabolic syndrome and cardiovascular "risk factor clustering" in children and adolescents published in the past decade. Pediatric definitions of metabolic syndrome were then applied to a community-based study of 261 black preadolescent females (Girls Health Enrichment MultiSite studies [GEMS]) and a school-based, cross-sectional study of 240 ethnically-diverse preadolescent females (Girls Activity, Movement and Environmental Strategy [GAMES]) who had a baseline physical examination and fasting morning blood sample. Agreement among pediatric definitions of metabolic syndrome was poor. The prevalence of MS and cardiovascular risk factor clustering ranged from 0.4% to 23.0% for GEMS and 2.0% to 24.6% for GAMES with definitions adapted from the National Cholesterol Education Program Adult Treatment Panel III, and 0% to 15.3% for GEMS and 0.4% to 15.8% for GAMES using modified criteria from the World Health Organization. The prevalence of metabolic syndrome in preadolescent girls varies widely because of disagreement among proposed definitions of metabolic syndrome in pediatrics. Further investigation is needed to determine which metabolic factors and their respective cut points should be used to identify children at risk for development of clinical disease.

The Relationship between Caffeine and Blood Pressure in Preadolescent African American Girls

While high caffeine consumption has been shown to be associated with increased blood pressure in controlled experiments, the relationship between caffeine consumption and blood pressure in preadolescent (ages 6-11 years) and adolescent (ages 12-19 years) children has not been well studied. The primary objective of this study was to assess the cross-sectional relationship between caffeine intake and blood pressure in 8- to 10-year-old African American girls who eat an unrestricted diet.Demographic, 24-hour dietary recall, and blood pressure data collected at baseline from 303 African American girls aged 8-10 years in the Girls health Enrichment Multisite Studies (GEMS) cohort were analyzed by using linear and multiple regression models.Dietary caffeine intake was not associated with either systolic or diastolic blood pressure (P=.33 and P=.36, respectively). However, consistent with the literature, height and body mass index were each positively and independently associated with systolic blood pressure (both P<.0001). Height and amount of sodium intake were positively associated with diastolic blood pressure (P=.01 and P=.02, respectively).Dietary caffeine intake in low amounts is not associated with elevated blood pressure in 8- to 10-year-old African American girls who eat an unrestricted diet.

Correlates of BMI, Body Fat, Dietary Intake, and Physical Activity among 8‐ to 10‐Year‐Old African‐American Girls: Girls Health Enrichment Multisite Studies Phase 1

In this supplement to Obesity Research, we present a series of articles examining correlates of BMI, body fat, dietary intake, and physical activity among 8to 10-yearold African-American girls who participated in Phase 1 of the National Heart, Lung, and Blood Institute (NHLBI)sponsored Girls Health Enrichment Multisite Studies (GEMS). The goal of Phase 1 of GEMS was to develop and pilot test culturally appropriate interventions to prevent excessive weight gain in 8to 10-year-old African-American girls. Phase 1 of GEMS was a 3-year development phase during which investigators from four field centers (University of Memphis, University of Minnesota, Baylor College of Medicine, and Stanford University) conducted formative evaluation including focus groups, interviews, and surveys to develop their respective intervention approaches. The field centers then independently developed and pilot tested their own interventions during a 12-week pilot study. Although the interventions were different at each field center, evaluation protocols with key commonalities were used. Girls were randomized to either an active intervention or control group on completion of a baseline clinic visit. After a 12-week intervention period, girls participated in a follow-up measurement visit. Two journal supplements, to date, were published. One described the genesis and rationale of GEMS, common design elements, recruitment strategies, and the outcomes of the four pilot studies (1). The second included empirical articles examining the measurement characteristics of the anthropometric, dietary intake, physical activity, and psychosocial variables collected as part of GEMS Phase 1 (2). This final supplement describes correlates of BMI, dietary intake, and physical activity among African-American girls. We include eight original empirical papers for this supplement and an introduction to the supplement that provides an overview of correlates of obesity among African-American preadolescent and adolescent girls and brief descriptions of each paper. In preparation for this supplement, we have taken steps to ensure rigorous peer review and critical input from knowledgeable colleagues with relevant expertise. To reflect the content of the papers, we identified reviewers with expertise in the following areas, both in general and specifically with African-American populations: pediatric obesity, nutrition, physical activity, behavioral interventions, and anthropometry. The process is described below. Each article was reviewed using a multistage process involving both internal and external review as follows. The guest editors initially critiqued submitted manuscripts and requested revisions before considering the papers ready for external review. Each manuscript was then sent to three external reviewers assigned by the guest editors based on the content of the papers and the expertise of the reviewers. Simultaneously, the paper was sent to two knowledgeable NHLBI staff scientists for content review as part of a standard NHLBI internal peer review process and then to a director for policy review. The identity of these reviewers was known only to the NHLBI guest editor (E.O.). All reviews were collated by the NHLBI guest editor and sent anonymously to the primary author, with a request to revise and provide written responses as to how each point raised by each reviewer was addressed. Authors’ responses and revised papers were then re-reviewed by the external reviewers and at least two of the guest editors, resulting in additional revisions. Several manuscripts were re-reviewed by external reviewers and the guest editors a second time to improve the quality of the papers. Final acceptance of the eight papers was determined by the guest editors. *Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota; †HealthPartners Research Foundation, Minneapolis, Minnesota; and ‡Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, National Institutes of Health, Rockville, Maryland. Copyright © 2004 NAASO

Parental Cultural Perspectives in Relation to Weight‐Related Behaviors and Concerns of African‐American Girls

To determine whether cultural perspectives of parents may influence children's eating and physical activity behaviors and patterns of weight gain. African-American girls (ages 8 to 10 years) and their parents (or caregivers) (n = 210) participated at one of four Girls Health Enrichment Multisite Studies Phase 1 Field Centers. At baseline, parents completed questionnaires adapted from the African-American Acculturation Scale (AAAS), the Multiethnic Identity Scale (MEIS), and an original question on Global Cultural Identity. Girls' baseline measures included physical activity assessment by accelerometer, 24-hour dietary recalls, and questionnaires about body image and weight concerns. Principal components analysis indicated the expected AAAS and MEIS factor structures, with moderate to good internal consistency (Cronbach's alpha = 0.61 to 0.82) and some intercorrelation among these measures (r = 0.17 to 0.57). Overall mean (SD) AAAS subscale scores of 4.1 (2.1) and 5.5 (1.8) of a possible 7 and 3.0 (0.9) of a possible 4 on the MEIS indicated, respectively, moderate to high levels of parental African-American cultural orientation and identity with moderate variability. Parental AAAS and MEIS scores were inversely correlated with girls' body image discrepancy and weight concern. One AAAS subscale was positively associated with total energy intake and percentage energy from fat. Overall, however, parental AAAS and MEIS scores were unrelated or inconsistently related to girls' physical activity and diet measures. The AAAS and MEIS measures had acceptable psychometric properties, except for weight concern, but did not give a consistent picture of how parental perspectives related to the girls' baseline attitudes and behaviors.

Correlates of obesity in African-American girls: an overview.

II (1976 to1980), the prevalence of overweight in children has doubledfrom 7% to 15% in children 6 to 11 years old and nearlytripled from 5% to 15% in adolescents 12 to 19 years old(1). Although childhood obesity is present across all demo-graphic and social classes, certain subgroups of the U.S.population are at increased risk. In particular, African-American preadolescent and adolescent girls show higherrates of overweight compared with their white counterparts.According to NHANES 1999 to 2000, African-Americangirls are twice as likely to be overweight as white girls at 6to 11 years old (22.2% vs. 11.6%, respectively) and 12 to 19years of age (26.6% vs. 12.4%, p 0.05) (1). Likewise,data from the National Heart, Lung, and Blood Institute(NHLBI) National Growth and Health Study (NGHS) (1987to 1997) on 9- to 10-year-old African-American and whitegirls show that African-American girls have significantlyhigher mean BMI than white girls at 9 years of age (18.5 vs.17.5, p 0.0001) and 10 years of age (19.8 vs. 18.4, p 0.0001) (2). Findings also indicate that by the age of 19,over one-half of the African-American girls in the NGHScohort were overweight, and more than one-third wereobese (3).Because childhood overweight has been increasingly rec-ognized as a public health problem, a considerable amountof research exploring the correlates of childhood overweighthas emerged. A large number of factors both proximal anddistal to the individual have been identified as contributingto the increasing prevalence of overweight among youth,including genetic, familial, socioeconomic, psychosocial,behavioral, and environmental factors (4). Although thiswork has begun to shed light on the complexity of theobesity epidemic and has been informative with respect totargeting prevention and treatment efforts, considerably lessinformation is available regarding determinants of over-weight among African-American girls in particular. TheNHLBI NGHS, a biracial observational cohort study, pro-vided a wealth of information about the development ofobesity among African-American and white girls (5,6).However, many questions remain unanswered.Phase 1 of the Girls Health Enrichment Multisite Studies(GEMS) program, which had the goal of developing andpilot testing culturally appropriate interventions to preventexcessive weight gain in 8- to 10-year-old African-Ameri-can girls, provides an additional important opportunity tobetter understand the correlates of obesity in this popula-tion. Phase 1 of GEMS was a 2.75-year development phaseduring which investigators from four field centers (Univer-sity of Memphis, University of Minnesota, Baylor Collegeof Medicine, and Stanford University) with the assistance ofa coordinating center (George Washington University) andparticipation by the NHLBI conducted formative evaluationto develop their individual obesity prevention approaches.The field centers then independently developed and pilottested their own interventions during a 12-week pilot study.Although the interventions were different at each field cen-ter, evaluation protocols with key commonalities were used,providing a rich data set to examine correlates of over-weight among a geographically diverse group of preadoles-cent African-American girls. Although not including anexhaustive list of all possible correlates of overweight, thepapers in this supplement are unique in their focus on a widerange of potential correlates of obesity, including psycho-social, diet, physical activity, biological, and maturationalfactors.Ethnic disparities in prevalence of overweight highlightthe importance of examining the cultural differences amongchildren from different racial/ethnic backgrounds and theirvaried effects on adiposity. For example, African-Americangirls and women experience less social pressure about theirweight, tend to be more satisfied with their bodies, and haveless negative attitudes about overweight compared withwhite girls and women (7–18). These cultural differences

Physical activity self-report and accelerometry measures from the Girls health Enrichment Multi-site Studies

Background. Valid and reliable physical activity checklists are needed to assess effectiveness of interventions. This study tested the validity and reliability of the Girls health Enrichment Multi-site Studies (GEMS) Activity Questionnaire. Methods. Two-hundred and ten African-American girls completed the GEMS Activity Questionnaire (GAQ), a checklist of 28 physical and 7 sedentary activities, including TV viewing, inquiring whether performed on the previous day (“yesterday”), and whether usually performed (“usual”). The girls wore an accelerometer (used as the criterion for validity) for three consecutive days at baseline and after a 12-week pilot intervention. Data from 172 girls at baseline and follow-up were usable for this report. Results. Girls were (mean ± SD) 8.8 ± 0.8 years old with a BMI of 22.3 ± 5.9 kg/m 2 . The intraclass correlation (ICC) examining reliability for the accelerometer across 3 days at baseline for the combined group was fair (ICC = 0.33, P < 0.21). The test–retest reliability coefficient for the 18-item MET-weighted GAQ yesterday scores for the comparison group of girls was 0.57 ( P < 0.001). At baseline and follow-up, nonsignificant correlations were observed between 3-day accelerometer counts/minute and GAQ 18-item usual score for both comparison and intervention groups. A significant correlation was found between change in accelerometer minutes of moderate-to-vigorous activity (MVPA) between 12 noon and 6 PM and change in GAQ physical activities in the comparison girls ( R = 0.35, P < 0.01). The TV-usual score was correlated with 3-day accelerometer counts/minute ( R = −0.19, P = 0.02) at baseline for the total sample. Conclusions. Correlations between the GAQ and accelerometer were low, indicating low validity. Although the GAQ may be helpful in describing types of physical activities performed, it needs further development to improve its psychometric properties.