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There is an increased interest in the use of personalized medicine approaches in the prevention or treatment of obesity, however, few studies have used these approaches to identify individual differences in treatment effects. The current study demonstrates the use of the predicted individual treatment effects framework to test for individual differences in the effects of the ACTION-PAC intervention, which targeted the treatment and prevention of obesity in a high school setting. We show how methods for personalized medicine can be used to test for significant individual differences in responses to an intervention and we discuss the potential and limitations of these methods. In our example, 25% of students in the preventive intervention, were predicted to have their BMI z-score reduced by 0.39 or greater, while at other end of the spectrum, 25% were predicted to have their BMI z-score increased by 0.09 or more. In this paper, we demonstrate and discuss the process of using methods for personalized medicine with interventions targeting adiposity and discuss the lessons learned from this application. Ultimately, these methods have the potential to be useful for clinicians and clients in choosing between treatment options, however they are limited in their ability to help researchers understand the mechanisms underlying these predictions., Author(s): Alena Kuhlemeier [sup.1] , Thomas Jaki [sup.2] [sup.3] , Elizabeth Y. Jimenez [sup.4] , Alberta S. Kong [sup.4] , Hope Gill [sup.5] , Chi Chang [sup.6] , Ken Resnicow [...]

Background: In several countries worldwide, school-based human papillomavirus (HPV) vaccination programs have been successful; however, little research has explored US stakeholders' acceptance toward school-based HPV vaccination programs. Methods: A total of 13 focus groups and 12 key informant interviews (N?=?117; 85% females; 66% racial/ethnic minority) were conducted with 5 groups of stakeholders: parents of adolescent girls, parents of adolescent boys, adolescent girls, middle school nurses, and middle school administrators throughout the 5 public health regions of New Mexico. Results: All groups of stakeholders lacked knowledge on HPV and HPV vaccines. Stakeholders were interested in--but apprehensive about--the benefits of HPV vaccination. Despite previous literature showing the benefits of using middle schools as an HPV vaccination site, stakeholders did not deem middle schools as a viable site for vaccination. Nurses reported that using the school as an HPV vaccination site had not occurred to them; parents and adolescents stated they were uncertain about using this type of program. School administrators indicated that they lacked implementation authority. Conclusions: Our study uncovered barriers to using middle schools as a site of HPV vaccination. Resources should be directed toward increased support and education for middle school nurses who function as opinion leaders relevant to the uptake of HPV vaccination.

Background: In the emerging debate around obesity intervention in schools, recent calls have been made for researchers to include local community opinions in the design of interventions. Community-based participatory research (CBPR) is an effective approach for forming community partnerships and integrating local opinions. We used CBPR principles to conduct formative research in identifying acceptable and potentially sustainable obesity intervention strategies in 8 New Mexico school communities. Methods: We collected formative data from 8 high schools on areas of community interest for school health improvement through collaboration with local School Health Advisory Councils (SHACs) and interviews with students and parents. A survey based on formative results was created to assess acceptability of specific intervention strategies and was provided to SHACs. Quantitative data were analyzed using descriptive statistics while qualitative data were evaluated using an iterative analytic process for thematic identification. Results: Key themes identified through the formative process included lack of healthy food options, infrequent curricular/extracurricular physical activity opportunities, and inadequate exposure to health/nutritional information. Key strategies identified as most acceptable by SHAC members included healthier food options and preparation, a healthy foods marketing campaign, yearly taste tests, an after-school noncompetitive physical activity program, and community linkages to physical activity opportunities. Conclusion: An adaptive CBPR approach for formative assessment can be used to identify obesity intervention strategies that address community school health concerns. Eight high school SHACs identified 6 school-based strategies to address parental and student concerns related to obesity. (Contains 2 tables and 1 figure.)

Background: Obesity is rapidly becoming the most common chronic medical condition affecting children. To address this crisis, an Albuquerque, New Mexico, elementary school partnered with University of New Mexico researchers and conducted a Walking School Bus (WSB). The purpose of this article is to examine the feasibility of implementing a WSB. Methods: This pilot study featured 2 WSBs conducted for 10 weeks with kindergarten through fifth-grade students from a predominantly Hispanic elementary school. Qualitative and quantitative data, including coordinator field notes, attendance records, surveys of student and parent satisfaction, and a focus group, were used to evaluate feasibility. Results: Student and adult participants expressed a high degree of enthusiasm regarding their involvement in the WSB. Participants uniformly indicated that the WSB provided a supportive and safe environment to promote social interaction and physical activity. Conducting a WSB in an urban, underserved school district is feasible but requires attention to ensure participants' involvement and safety. In particular, it is recommended to begin the planning process early to enhance investment from key stakeholders. Conclusion: Effective, low-cost interventions are increasingly desired as solutions to the problem of obesity. The WSB has emerged as a promising strategy to address obesity and encourage partnerships across different social levels. Further research is necessary to assess the logistical challenges associated with conducting a large-scale WSB trial and whether such efforts lead to reductions in obesity risk factors. (Contains 3 tables.)

Background: Reports of physical activity (PA) measured via wrist-worn accelerometers in adolescents are limited. This study describes PA levels in adolescents at baseline of an obesity prevention and weight management trial. Methods: Adolescents (n = 930) at 8 high schools wore an accelerometer for 7 days, with average acceleration values of <50 mg, >150 mg, and >500 mg categorized as sedentary, moderate, and vigorous PA, respectively. In a 3-level mixed-effects generalized linear model, PA was regressed on sex, weight status, and day of week. Daily PA was nested within students, and students within schools, with random effects included for both. Results: Adolescents accumulated a median of 40 minutes daily of moderate to vigorous PA (MVPA). MVPA was significantly different for teens with obesity versus teens with normal weight (-5.4 min/d, P = .03); boys versus girls (16.3 min/d, P < .001); and Sundays versus midweek (-16.6 min/d, P < .001). Average sedentary time increased on weekends (Saturday: 19.1 min/d, P < .001; Sunday: 44.8 min, P < .001) relative to midweek but did not differ by sex or weight status. Conclusions: Interventions to increase PA in adolescents may benefit from focusing on increasing weekend PA and increasing MVPA in girls. [ABSTRACT FROM AUTHOR]

Objective. Human papillomavirus (HPV) vaccination rates in the United States have been lower than anticipated since the vaccine became widely available globally in 2006. Of particular concern are data that suggest disparities in vaccine receipt among US ethnic minority and health disparity populations such as Hispanics, who are disproportionately affected by cervical cancer. Given these trends, it is important to examine actual vaccination decision-making processes among clinicians, parents, and adolescents to identify strategies to enhance uptake. Design. We conducted a mixed-method study examining HPV vaccine decision-making, utilizing both structured questionnaires of primarily Hispanic mothers and daughters (aged 12-18) and semi-structured interviews with mothers, daughters, and health-care clinicians to more deeply investigate decision-making dynamics. Quant-itative analysis was used for descriptive purposes, while qualitative analysis featured an iterative process to examine factors related to decision-making surrounding the HPV vaccine. The study was conducted in two primary care clinics serving predominantly Hispanic patients in an urban New Mexico setting through Research Involving Outpatient Setting Network (RIOS Net), a primary care practice-based research network. Results. We administered 22 questionnaires and conducted 30 interviews. We identified three aspects of vaccine delivery that were similar across clinics: availability/supply of the vaccine, favorable clinician attitudes toward the vaccine, and clinicians' competing demands. We also identified three decision-making stages (pre-encounter, encounter, and post-encounter), though we found distinct differences in decision-making processes at the two sites. We describe the differences between an encounter-based and a process-based model of decision-making, and the ways in which explanatory factors might influence the decision-making process. Conclusion. Our findings suggest that factors other than race and ethnicity, such as education, socioeconomic status, and health-care access, play an important role in HPV vaccination decisions. Further research to elucidate the specific informational needs and communication strategies associated with these factors will be needed to enhance vaccine uptake. [ABSTRACT FROM AUTHOR]

The article discusses a study concerning acanthosis nigricans (AN) as a dermatological marker for the clustering of metabolic syndrome (MetS) components. The study involved 90 Hispanic school children who were tested for AN, family history of type 2 diabetes, body mass index (BMI) percentile and MetS components. Results of the study showed that children with AN are part of a very high risk sub-group for metabolic syndrome and can be subject to early preventive intervention.