Aviva Must | Tufts University School of Medicine (original) (raw)

Papers by Aviva Must

Disability and Health Journal, 2019

Background: The prevalence of obesity in children with autism spectrum disorder (ASD) exceeds tha... more Background: The prevalence of obesity in children with autism spectrum disorder (ASD) exceeds that of the general population, but the level of parental concern about obesity in these children is unexplored. Objective: We estimate the prevalence of obesity in children 10-17 years in the redesigned National Survey of Children's Health (NSCH) 2016, and compare parental concern about obesity between parents of children with and without ASD. Methods: The nationally representative NSCH 2016 oversampled parents of children with parent-report of special health care needs, including ASD. Parents opted to complete the survey via the web or surface mail. Following report of their child's height and weight, parents were asked "Are you concerned about their weight?" Response options included: "Yes, it's too high," "Yes, it's too low," or "No, I am not concerned." Obesity (>95th percentile BMI) was defined using the 2000 CDC growth reference. We used logistic regression to compare odds of obesity, and odds of parental concern, between children with and without ASD. Results: In 24,251 children, ASD (n=699) increased obesity risk after adjusting for age, sex, and race/ethnicity (OR=1.54, 95%CI: 1.11, 2.14). ASD medication did not significantly affect obesity. ASD increased obesity concern (OR=2.17, 95%CI: 1.53, 4.81) among parents with obese children. Parents of boys with obesity and ASD had less obesity concern if he was taking medication for ASD (OR=0.258, 95%CI: 0.09, 0.78). Conclusion: While the prevalence of obesity is elevated in children with ASD, parental obesity concern is high, suggesting opportunities for the development of parent-focused obesity prevention and treatment interventions for this population.

Appetite, 2016

Cancer treatment can impact the hypothalamic-pituitary region of the developing brain, impairing ... more Cancer treatment can impact the hypothalamic-pituitary region of the developing brain, impairing appetite regulation and causing food craving in children who have survived cancer. We assessed food craving using a modified Food Craving Inventory in 22 survivors of pediatric acute lymphoblastic leukemia (ALL) and lymphoma (median age = 11.7 years) and evaluated its association with treatment exposure and changes in weight status over a one-year period. Mean total craving score was 2.1 (SD=0.7). Survivors reported significantly higher mean craving score for fast-foods [2.6 (SD=0.9)] than for sweets [2.1 (SD=0.8)], carbohydrates [2.0 (SD=0.6)], and fats [1.8 (SD=0.7)] (all P values<0.05). Results from multivariate linear regression indicated that survivors diagnosed at an older age (≥4.5 years) experienced higher frequencies of food craving than those diagnosed at a younger age (<4.5 years) (β=0.88, 95% CI: 0.42, 1.34). Food craving, however, was not significantly associated with survivors' weight status over 12 months of followup. Food craving alone does not appear to explain the obesity risk in this sample of childhood

Journal of the Academy of Nutrition and Dietetics, Feb 1, 2012

Mealtimes in families with young children are increasingly of interest to nutrition and public he... more Mealtimes in families with young children are increasingly of interest to nutrition and public health researchers, yet assessment tools are limited. Meals in our Household is a new parent-report questionnaire that measures six domains: 1) structure of family meals, 2) problematic child mealtime behaviors, 3) use of food as reward, 4) parental concern about child diet, 5) spousal stress related to child's mealtime behavior, and 6) influence of child's food preferences on what other family members eat. Reliability and initial face, construct, and discriminant validity of the questionnaire were evaluated between January 2007 and December 2009 in two cross-sectional studies comprising a total of 305 parents of three-to eleven-year-old children (including 53 children with autism spectrum disorders). Internal consistencies (Cronbach's alpha) for the six domains averaged 0.77 across both studies. Test-retest reliability, assessed among a subsample of 44 parents who repeated the questionnaire after between 10 and 30 days, was excellent (Spearman correlations for the domain scores between two administrations ranged from 0.80 to 0.95). Initial construct validity of the instrument was supported by observation of hypothesized interrelationships between domain scores which were of the same direction and similar magnitude in both studies. Consistent with discriminant validity, children with autism spectrum disorders had significantly higher domain scores for problematic child mealtime behaviors, use of food as

Journal of Autism and Developmental Disorders, Jun 13, 2015

Mealtime behavior problems and family stress occur frequently among families of children with aut... more Mealtime behavior problems and family stress occur frequently among families of children with autism spectrum disorder (ASD). However, it is unknown whether food selectivity is an associated factor. The associations of high food selectivity with mealtime behavior problems, spousal stress, and influence on family members were assessed among 53 children with ASD and 58 typically developing (TD) children ages 3-11 years. Compared to TD children, children with ASD were more likely to have high food selectivity, and their parents reported more mealtime behavior problems, higher spousal stress, and influence on what other family members ate. High food selectivity was associated with mealtime behavior problems in both groups. Interventions to reduce food selectivity may lead to decreases in mealtime behavior problems.

BMC Pediatrics, Dec 1, 2005

Background: The condition of obesity has become a significant public health problem in the United... more Background: The condition of obesity has become a significant public health problem in the United States. In children and adolescents, the prevalence of overweight has tripled in the last 20 years, with approximately 16.0% of children ages 6-19, and 10.3% of 2-5 year olds being considered overweight. Considerable research is underway to understand obesity in the general pediatric population, however little research is available on the prevalence of obesity in children with developmental disorders. The purpose of our study was to determine the prevalence of overweight among a clinical population of children diagnosed with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASD). Methods: Retrospective chart review of 140 charts of children ages 3-18 years seen between 1992 and 2003 at a tertiary care clinic that specializes in the evaluation and treatment of children with developmental, behavioral, and cognitive disorders. Diagnostic, medical, and demographic information was extracted from the charts. Primary diagnoses of either ADHD or ASD were recorded, as was information on race/ethnicity, age, gender, height, and weight. Information was also collected on medications that the child was taking. Body mass index (BMI) was calculated from measures of height and weight recorded in the child's chart. The Center for Disease Control's BMI growth reference was used to determine an ageand gender-specific BMI z-score for the children. Results: The prevalence of at-risk-for-overweight (BMI >85th%ile) and overweight (BMI > 95th%ile) was 29% and 17.3% respectively in children with ADHD. Although the prevalence appeared highest in the 2-5 year old group (42.9%ile), differences among age groups were not statistically significant. Prevalence did not differ between boys and girls or across age groups (all p > 0.05). For children with ASD, the overall prevalence of at-risk-for-overweight was 35.7% and prevalence of overweight was 19%. Conclusion: When compared to an age-matched reference population (NHANES 1999-2002), our estimates indicate that children with ADHD and with ASD have a prevalence of overweight that is similar to children in the general population.

Journal of the American Dental Association, 2012

Introduccion. Dos informes del surgeon general de los EE. UU. llaman la atencion sobre el desprop... more Introduccion. Dos informes del surgeon general de los EE. UU. llaman la atencion sobre el desproporcionado efecto que la enfermedad oral tiene en las personas con discapacidades, y la falta de informacion sobre salud oral de estas personas. Metodos. En este estudio retrospectivo, los autores han utilizado datos clinicos y demograficos (desde el 1 de abril de 2009 hasta el 31 de marzo de 2010) extraidos de las historias clinicas electronicas de 4.732 adultos con discapacidades intelectuales y del desarrollo (DID) que recibian tratamiento dental a traves del sistema de clinicas dentales financiado por el estado. Los autores utilizaron estos datos para investigar la salud oral y los factores de riesgo asociados de estos adultos con DID. Resultados. La prevalencia de caries no tratada en la muestra del estudio fue del 32,2%, la de la periodontitis fue del 80,3% y la del edentulismo total fue del 10,9%. El numero promedio (desviacion estandar) de dientes con caries, dientes perdidos y de dientes con caries, perdidos y obturados fue 1 (2,2), 6,7 (7) y 13,9 (7,7), respectivamente. Conclusiones. El tratamiento dental del adulto con DID presenta serias dificultades. La edad, la capacidad de cooperacion con el dentista y el tipo de resistencia son factores importantes a tener en cuenta para planificar estrategias preventivas. Implicaciones clinicas. Se demuestra una elevada carga de enfermedad dental en la muestra de este estudio. Se requiere mas investigacion para identificar intervenciones eficaces en la mejora de la salud oral del adulto con DID.

Pediatric obesity, Feb 24, 2016

The Healthy Weight Research Network (HWRN) for children with autism and developmental disabilitie... more The Healthy Weight Research Network (HWRN) for children with autism and developmental disabilities (ASD/DD) is an interdisciplinary network with national representation. This paper discusses the modified Delphi procedure that was used to develop the HWRN's research agenda to address the problem of obesity in children with ASD/DD. The five research areas identified for priority included: 1) Family practices around food/mealtimes; 2) Physical activity and sedentary behaviors in relation to weight; 3) Relationship between food patterns, behavior, and weight gain; 4) Program-adaption and delivery; and 5) Influence of school and community-based organizations on food intake and physical activity. The goals and agenda of the HWRN hold promise for making progress toward the prevention and successful treatment of obesity in this population.

Journal of the Academy of Nutrition and Dietetics, Nov 1, 2012

Dietary factors vary widely among ethnic groups. However, the effect of specific nutrients on car... more Dietary factors vary widely among ethnic groups. However, the effect of specific nutrients on cardiometabolic risk is not well understood, especially in children. Four dietary factors known to influence cardiometabolic risk (ie, carbohydrate, saturated, monounsaturated, and polyunsaturated fat intake) were assessed by the Block Kids 2004 Food Frequency Questionnaire in a crosssectional sample of racially diverse fourth-through eighth-grade students (n=148) in a Boston-area school district studied between January and April 2010. Fasting total cholesterol, low-density lipoprotein, high-density lipoprotein (HDL) cholesterol, triglyceride, C-reactive protein (CRP), and interleukin-6 (IL-6) levels, and body mass index z scores were measured. Differences

Public Health Nutrition, Aug 3, 2012

Objective: Low serum vitamin D, which largely affects ethnic minorities, is associated with obesi... more Objective: Low serum vitamin D, which largely affects ethnic minorities, is associated with obesity and other chronic diseases. Little is known about racial/ ethnic differences in intake, particularly in children, or if any differences are associated with differences in serum 25-hydroxyvitamin D (25(OH)D). The objective of the present study was to determine whether racial/ethnic differences in dietary vitamin D intake exist and whether they explain differences in 25(OH)D. Design: Vitamin D intakes (Block Kids 2004 FFQ) and 25(OH)D were measured. Race/ethnicity was parent-reported (white (37?9 %), Hispanic (32?4 %), black (8?3 %), Asian (10?3 %), multi-racial/other (11?0 %)). Multivariable analyses were conducted to examine the associations among dietary vitamin D and race/ethnicity, as well as 25(OH)D, independent of BMI Z-score and other covariates. Setting: Elementary/middle schools in Somerville, MA, USA, during January-April 2010. Subjects: Schoolchildren (n 145) in 4th-8th grade. Results: Only 2?1 % met the 2011 RDA (15 mg/d (600 IU/d)). Average dietary intake was 3.5 (SD 2.2) mg/d (140 (SD 89?0) IU/d). No racial/ethnic differences in intake were evident. Most (83?4 %) were 25(OH)D deficient (,20 ng/ml; 16?0 (SD 6?5) ng/ml). In ANOVA post hoc analyses, 25(OH)D levels were lower in Hispanics than whites (14?6 (SD 6?1) ng/ml v. 17?9 (SD 4?6) ng/ml; P , 0?01). Dietary vitamin D was associated with 25(OH)D overall (P , 0?05), but did not explain the racial/ethnic differences in 25(OH)D. Conclusions: Most children in this northeast US sample did not meet dietary recommendations for vitamin D and were vitamin D deficient. Dietary vitamin D did not explain the difference in 25(OH)D between Hispanic and white children. Further research is needed to determine if changes in dietary vitamin D by race/ethnicity can impact 25(OH)D levels.

Appetite, Apr 1, 2015

Employment is a major factor underlying im/migration patterns. Unfortunately, lower diet quality ... more Employment is a major factor underlying im/migration patterns. Unfortunately, lower diet quality and higher rates of obesity appear to be unintended consequences of moving to the US. Changes in food preparation practices may be a factor underlying dietary acculturation. The relationships between employment, acculturation, and food-related time use in Hispanic families have received relatively little attention. We used cross-sectional data collected from Hispanic mothers (ages 18-65) with at least one child <13 years old participating in the 2003-2011 American Time Use Survey (n = 3622) to estimate the relationship between employment, acculturation (US-born vs. im/migrant), and time spent in food preparation and family dinner. Regression models were estimated separately for the employed and the non-working and were adjusted for Hispanic origin group, socio-demographic and household characteristics. Working an eight-hour day was associated with spending 38 fewer minutes in food preparation (−38.0 ± SE 4.8, p < 001). Although being US-born was associated with spending fewer minutes in food preparation, this relationship varied by origin group. Acculturation did not appear to modify the relationship between hours worked and time spent in food preparation or family dinner. Mothers who worked late hours spent less time eating the evening meal with their families (−9.8 ± SE 1.3). Although an eight-hour workday was associated with a significant reduction in food preparation time, an unexpected result is that, for working mothers, additional time spent in paid work is not associated with the duration of family dinner later that day.

BMC Public Health, Oct 22, 2008

Background: The high prevalence of childhood obesity underscores the importance of monitoring pop... more Background: The high prevalence of childhood obesity underscores the importance of monitoring population trends in children's activity and screen time, and describing associations with child age, gender, race/ethnicity, and weight status. Our objective was to estimate the proportion of young children in the US who have low levels of active play or high levels of screen time, or who have both these behaviors, and to describe associations with age, gender, race/ethnicity, and weight status. Methods: We analyzed data collected during the National Health and Nutrition Examination Surveys 2001-2004, a US nationally representative cross-sectional study. We studied 2964 children aged 4.00 to 11.99 years. Our main outcomes were reported weekly times that the child played or exercised hard enough to sweat or breathe hard (active play), daily hours the child watched television/videos, used computers, or played computer games (screen time), and the combination of low active play and high screen time. Low active play was defined as active play 6 times or less per week. High screen time was defined as more than 2 hours per day. We accounted for the complex survey design in analyses and report proportions and 95% confidence intervals. We used Wald Chi-square to test for differences between proportions. To identify factors associated with low active play and high screen time, we used multivariate logistic regression. Results: Of US children aged 4 to 11 years, 37.3% (95% confidence interval, 34.1% to 40.4%) had low levels of active play, 65.0% (95% CI, 61.4% to 68.5%) had high screen time, and 26.3% (95% CI, 23.8% to 28.9%) had both these behaviors. Characteristics associated with a higher probability of simultaneously having low active play and high screen time were older age, female gender, non-Hispanic black race/ethnicity, and having a BMI-forage ≥95 th percentile of the CDC growth reference. Conclusion: Many young children in the US are reported to have physical activity and screen time behaviors that are inconsistent with recommendations for healthy pediatric development. Children who are overweight, approaching adolescence, girls, and non-Hispanic blacks may benefit most from public health policies and programs aimed at these behaviors.

The Journal of Pediatrics, Nov 1, 2013

Objective-To assess whether parent training in behavioral intervention, combined with a 16session... more Objective-To assess whether parent training in behavioral intervention, combined with a 16session nutrition and activity education program, would improve weight loss relative to nutrition and activity education alone in adolescents and young adults with Down syndrome. Study design-21 youth with Down syndrome aged 13-26 with a BMI ≥85 th percentile were enrolled and randomized to a 6-month nutrition and activity education intervention (n=10) or to nutrition and activity education+behaviorial intervention (n=11), and followed for 6 months after the active intervention period (1-year follow-up). The primary outcome measure was body weight; secondary outcomes included percentage body fat (%fat) by bioelectric impedance; intake of fruits, vegetables, and energy-dense low-nutrient snack food (treats) by 3-day food record; and moderate/vigorous physical activity by accelerometry. Results-At 6 months, mean body weight in the nutrition and activity education+behaviorial intervention group was 3.2kg lower than in the nutrition and activity education group (95%CI: 1.0, 5.5, p=0.005). Mean group differences were sustained at 1 year (3.6kg 95%CI: 1.4, 5.9, p=0.002). At 6 months, moderate/vigorous physical activity time averaged 18 minutes/day more in nutrition and activity education+behaviorial intervention than at baseline (p=0.01); in nutrition and activity education, moderate/vigorous physical activity declined by 7 minutes/day (p=0.30); these changes were largely maintained at 1 year, but were not statistically significant. Vegetable intake in nutrition and activity education+behaviorial intervention exceeded intake in nutrition and activity education by a mean of 1.6 servings at 1 year (p=0.009), but not at 6 months. No group differences were observed for %fat or consumption of fruits or treats.

Background: The prevalence of neurodevelopmental and psychiatric diagnoses (NPDs) in youth is inc... more Background: The prevalence of neurodevelopmental and psychiatric diagnoses (NPDs) in youth is increasing, and unhealthy physical activity (PA), diet, screen time, and sleep habits contribute to the chronic disease disparities and behavioral challenges this population experiences. Objective: This pilot study aims to adapt a proven exergaming and telehealth PA coaching intervention for typically developing youth with overweight or obesity; expand it to address diet, screen, and sleep behaviors; and then test its feasibility and acceptability, including PA engagement, among youth with NPDs. Methods: Participants (N=23; mean age 15.1 years, SD 1.5; 17 males, 9 people of color) recruited in person from clinic and special education settings were randomized to the Adaptive GameSquad (AGS) intervention or wait-list control. The 10-week adapted intervention included 3 exergaming sessions per week and 6 real-time telehealth coaching sessions. The primary outcomes included feasibility (adherence to planned sessions), engagement (uptake and acceptability as reported on process questionnaires), and PA level (combined light, moderate, and vigorous as measured by accelerometer). Descriptive statistics summarized feasibility and engagement data, whereas paired, two-tailed t tests assessed group differences in pre-post PA. Results: Of the 6 coaching sessions, AGS participants (n=11; mean age 15.3 years, SD 1.2; 7 males, 4 people of color) completed an average of 5 (83%), averaging 81.2 minutes per week of exergaming. Of 9 participants who completed the exit questionnaire, 6 (67%) reported intention to continue, and 8 (89%) reported feeling that the coaching sessions were helpful. PA and sleep appeared to increase during the course of the intervention over baseline, video game use appeared to decrease, and pre-post intervention PA per day significantly decreased for the control (−58.8 min; P=.04) but not for the intervention group (−5.3 min; P=.77), despite potential seasonality effects. However, beta testers and some intervention participants indicated a need for reduced complexity of technology and more choice in exergames.

The FASEB Journal, Apr 1, 2014

A large proportion of cancer patients gain weight following cancer diagnosis and treatment, and t... more A large proportion of cancer patients gain weight following cancer diagnosis and treatment, and tend to maintain an undesirable weight years after treatment completion. Undesirable weight gain has been shown to contribute to poor survival outcomes in several cancers. However, cancer survivors may not perceive weight status as important and thus may not be motivated to manage their weight. We conducted a survey to understand attitudes towards weight management in cancer patients and survivors who attended oncology outpatient clinics at Tufts Medical Center between July and November 2012. Over a half (56.5%) of the 209 subjects (mean age=58.3 years; mean BMI=27.9 kg/m2) indicated that they would like to lose weight, followed by those (34.4%) who would like to gain or maintain weight, and those (9.1%) who did not think about their weight. Old age was negatively associated with the attitudes towards weight loss (OR=0.8, 95% CI: 0.6-0.9 for five-year increase in age) while being long-term survivors (off-treatm...

International Journal of Environmental Research and Public Health, Apr 12, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Medicine and Science in Sports and Exercise, May 1, 2010

who met the MSA recommendations were numerically stronger on all 5 strength measures and signific... more who met the MSA recommendations were numerically stronger on all 5 strength measures and significantly stronger on hip abduction (p<.03), knee extension (p<.01), and knee flexion (p<.01). Women who met the MSA recommendations had lower percent body fat (p<.001). Logistic regression, controlling for age and race, indicated that women who did not meet the MSA recommendations demonstrated a 150% increase in the odds (OR = 2.5, .95CI = 1.8 to 3.5) of being classified as obese (BMI ≥30). CONCLUSIONS: The results provide support for the recommendation of 2+ days of MSA per week. Women who met the MSA recommendation were stronger, leaner, and less likely to be obese. Future research should investigate the specific type, time, and intensity of MSA and relate those variables to health outcomes.

Journal of the American Dental Association, Aug 1, 2012

Reproduction or republication strictly prohibited without prior written permission of the America... more Reproduction or republication strictly prohibited without prior written permission of the American Dental Association.

Archives of pediatrics & adolescent medicine, Mar 1, 2006

Eight hundred twenty individuals (403 females and 417 males) assessed at 4 time points: in 1983 w... more Eight hundred twenty individuals (403 females and 417 males) assessed at 4 time points: in 1983 when they were 9 to 18 years old (n = 776), in 1985 to 1986 when they were 11 to 22 years old (n=775), in 1991 to 1994 when they were 17 to 28 years old (n=776), and in 2001 to 2003 when they were 28 to 40 years old (n=661). Main Exposures: Anxiety disorders and depression assessed by structured diagnostic interview. Main Outcome Measures: Centers for Disease Control and Prevention body mass index z score (BMIz), a measure of weight status; and association of anxiety and depression with BMIz level and annual change. Results: In females, anxiety disorders were associated with higher weight status, a BMIz of 0.13 (95% confidence interval, 0.01-0.25) units higher compared with females without anxiety disorders. Female depression was associated with a gain in BMIz of 0.09 units/y (95% confidence interval, 0.03-0.15 units/y), modified by the age when depression was first observed, such that early depression onset was associated with a higher subsequent BMIz than depression onset at older ages. In males, childhood depression was associated with a lower BMIz (−0.46; 95% confidence interval, −0.93 to 0.02 units lower at the age of 9 years), but BMIz trajectories for males with or without depression converged in adulthood; male anxiety disorders were not substantively associated with weight status. Conclusions: Anxiety disorders and depression were associated with a higher BMIz in females, whereas these disorders in males were not associated with a higher BMIz. These results, if causal and confirmed in other prospective studies, support treating female anxiety and depression as part of comprehensive obesity prevention efforts.

Archives of pediatrics & adolescent medicine, Apr 1, 1996

The prevalence of obesity among children and adolescents has increased, and television viewing ha... more The prevalence of obesity among children and adolescents has increased, and television viewing has been suggested as a cause. We examined the relation between hours of television viewed and the prevalence of overweight in 1990, and the incidence and remission of overweight from 1986 to 1990 in a nationally representative cohort of 746 youths aged 10 to 15 years in 1990 whose mothers were 25 to 32 years old. Overweight was defined as a body mass index higher than the 85th percentile for age and gender. We observed a strong dose-response relationship between the prevalence of overweight in 1990 and hours of television viewed. The odds of being overweight were 4.6 (95% confidence interval, 2.2 to 9.6) times greater for youth watching more than 5 hours of television per day compared with those watching 0 to 2 hours. When adjustments were made for previous overweight (in 1986), baseline maternal overweight, socioeconomic status, household structure, ethnicity, and maternal and child aptitude test scores, results were similar (odds ratio, 5.3; 95% confidence interval, 2.3 to 12.1). We also found significant relations between television viewing and increased incidence and decreased remission of overweight during this 4-year period, adjusted for baseline covariates. The adjusted odds of incidence were 8.3 (95% confidence interval, 2.6 to 26.5) times greater for youth watching more than 5 hours of television per day compared with those watching for 0 to 2 hours. Estimates of attributable risk indicate that more than 60% of overweight incidence in this population can be linked to excess television viewing time. Television viewing affects overweight among youth, and reductions in viewing time could help prevent this increasingly common chronic health condition.