Nutrition Commons^™

Opportunities To Address Obesity Disparities Among High-Risk Latino Children And Adolescents, Erica G Soltero, Teresia M O'Connor, Deborah Thompson, Gabriel Q Shaibi

Children’s Nutrition Research Center Staff Publications

Purpose of review: This review highlights obesity-related disparities among Latino children and adolescents, discusses the social determinants of health (SDoH) that drive disparities, and presents case studies of strategies for reducing disparities and promoting health equity.

Recent findings: Recommended strategies for reducing obesity-related disparities include the use of culturally grounded programming, multi-sector collaborations, and technology. We present two exemplar studies that demonstrate that integrating cultural values and enhancing the overall cultural fit of prevention programs can increase engagement among high-risk Latino families. We also examine the use of multi-sector collaborations to build community capacity and address key SDoH that impact …

Theoretical Mediators Of Diabetes Risk And Quality Of Life Following A Diabetes Prevention Program For Latino Youth With Obesity, Erica G Soltero, Stephanie L Ayers, Marvyn A Avalos, Armando Peña, Allison N Williams, Micah L Olson, Yolanda P Konopken, Felipe G Castro, Kimberly J Arcoleo, Colleen S Keller, Donald L Patrick, Justin Jager, Gabriel Q Shaibi

Children’s Nutrition Research Center Staff Publications

Purpose: This study tested self-efficacy and social support for activity and dietary changes as mediators of changes in type 2 diabetes related outcomes following a lifestyle intervention among Latino youth.

Setting and intervention: Latino adolescents (14-16 years) with obesity (BMI% = 98.1 ± 1.4) were randomized to a 3-month intervention (n = 67) that fostered self-efficacy and social support through weekly, family-centered sessions or a comparison condition (n = 69).

Measures: Primary outcomes included insulin sensitivity and weight specific quality of life. Mediators included self-efficacy, friend, and family social support for health behaviors. Data was collected at baseline, 3-months, 6-months, …

Family-Based Obesity Prevention Interventions Among Hispanic Children And Families: A Scoping Review, Erica G Soltero, Armando Peña, Veronica Gonzalez, Edith Hernandez, Guisela Mackey, Chishinga Callender, Jayna M Dave, Debbe Thompson

Children’s Nutrition Research Center Staff Publications

This scoping review examined intervention and sample characteristics of family-based obesity prevention interventions among Hispanic youth. This review also examined the degree to which existing interventions were culturally-adapted, acknowledged social determinants of health (SDoH), and collaborated with community stakeholders. A comprehensive search across Medline Ovid, Embase, Scopus, PsycInfo, and Pubmed was used to identify 13 studies primarily based in the U.S. (92.3%). Data was extracted by two independent reviewers. Most used a randomized control trial design (69.2%), a behavior change theory (84.6%), and reported moderate to high (≥70%) retention (69.2%). Studies targeted improvements in physical activity (69.2%) and fruit and …

Menu Engineering And Dietary Behavior Impact On Young Adults’ Kilocalorie Choice, Christine Bergman, Yuan Tian, Andrew Moreo, Carola Raab

Hospitality Faculty Research

The obesity pandemic is associated with increased consumption of restaurant food. Labeling of menus is an intervention used to provide consumers with kilocalorie (calorie) information in hopes of them making healthier food choices. This study evaluated the relationship between young adults’ calorie choices on restaurant menus and menu design, dietary behaviors, and demographic characteristics. A 3 (fast-casual restaurants) × 4 (menu-designs based on menu engineering theories) between-subjects (n = 480, 18–24-year olds) experimental design was used. The relationship between the participants’ calorie choices (high versus low) and menu design, stage of change, gender, race, educational level and weight status was …

Reciprocal Control Of Obesity And Anxiety-Depressive Disorder Via A Gaba And Serotonin Neural Circuit, Guobin Xia, Yong Han, Fantao Meng, Yanlin He, Dollada Srisai, Monica Farias, Minghao Dang, Richard D Palmiter, Yong Xu, Qi Wu

Children’s Nutrition Research Center Staff Publications

The high comorbidity between obesity and mental disorders, such as depression and anxiety, often exacerbates metabolic and neurological symptoms significantly. However, neural mechanisms that underlie reciprocal control of feeding and mental states are largely elusive. Here we report that melanocortin 4 receptor (MC4R) neurons located in the dorsal bed nucleus of the stria terminus (dBNST) engage in the regulation of mentally associated weight gain by receiving GABAergic projections from hypothalamic AgRP neurons onto α5-containing GABA

Barbadin Potentiates Long-Term Effects Of Lorcaserin On Pomc Neurons And Weight Loss, Yang He, Hailan Liu, Na Yin, Yongjie Yang, Chunmei Wang, Meng Yu, Hesong Liu, Chen Liang, Julia Wang, Longlong Tu, Nan Zhang, Lina Wang, Yanlin He, Makoto Fukuda, Qi Wu, Zheng Sun, Qingchun Tong, Yong Xu

Children’s Nutrition Research Center Staff Publications

Obesity is a serious global health problem because of its increasing prevalence and comorbidities, but its treatments are limited. The serotonin 2C receptor (5-HT_2CR), a G-protein-coupled receptor, activates proopiomelanocortin (POMC) neurons in the arcuate nucleus of hypothalamus (ARH) to reduce appetite and weight gain. However, several 5-HT analogs targeting this receptor, e.g., lorcaserin (Lor), suffer from diminished efficacy to reduce weight after prolonged administration. Here, we show that barbadin (Bar), a novel β-arrestin/β2-adaptin inhibitor, can prevent 5-HT_2CR internalization in cells and potentiate long-term effects of Lor to reduce appetite and body weight in male mice. Mechanistically, …

The Shape Of The Oral Glucose Tolerance Test-Glucose Response Curve In Islet Cell Antibody-Positive Vs -Negative Obese Youth Clinically Diagnosed With Type 2 Diabetes, Joon Young Kim, Hala Tfayli, Fida Bacha, Silva Arslanian

Children’s Nutrition Research Center Staff Publications

BACKGROUND: The oral glucose tolerance test (OGTT)-glucose response curves (GRCs; incessant increase, monophasic, and biphasic) reflect insulin sensitivity and β-cell function, being worse in the former and superior in the latter. Here, we examined if the OGTT-GRC pattern is worse in obese antibody (glutamic acid decarboxylase 65-kDa [GAD65] and insulinoma-associated protein-2 [IA-2])-positive (Ab

METHODS: Forty-seven obese youth, 15 Ab

RESULTS: Incessant increase OGTT-GRC is the most frequent curve type and is three-fold higher in Ab

CONCLUSION: Severe insulin deficiency, a characteristic of type 1 diabetes, seems to be related to higher prevalence of incessant increase in Ab

Deciphering An Agrp-Serotoninergic Neural Circuit In Distinct Control Of Energy Metabolism From Feeding, Yong Han, Guobin Xia, Dollada Srisai, Fantao Meng, Yanlin He, Yali Ran, Yang He, Monica Farias, Giang Hoang, István Tóth, Marcelo O Dietrich, Miao-Hsueh Chen, Yong Xu, Qi Wu

Children’s Nutrition Research Center Staff Publications

Contrasting to the established role of the hypothalamic agouti-related protein (AgRP) neurons in feeding regulation, the neural circuit and signaling mechanisms by which they control energy expenditure remains unclear. Here, we report that energy expenditure is regulated by a subgroup of AgRP neurons that send non-collateral projections to neurons within the dorsal lateral part of dorsal raphe nucleus (dlDRN) expressing the melanocortin 4 receptor (MC4R), which in turn innervate nearby serotonergic (5-HT) neurons. Genetic manipulations reveal a bi-directional control of energy expenditure by this circuit without affecting food intake. Fiber photometry and electrophysiological results indicate that the thermo-sensing MC4RdlDRN neurons …

Obesity Prevention Toolkit To Combat Weight Gain Related To Sedentary Behavior And Dietary Habits In College Students: An Evidence-Based Project, Maria Amos, Martha Fuller

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Forty percent of the US population ages 20-39 are categorized as obese,

their BMI is over 30, and 35% of college age students are obese or overweight. Issues related to obesity cost the US $147 billion annually. Between 40%-50% of college students are reported to be inactive. Inactivity can lead to increased morbidity and mortality related to increased risks of cardiovascular disease, diabetes, hypertension, musculoskeletal issues, and depression. Providing dietary and physical activity education and access to nutritional information promotes behavior change in young adults.

Aims of Service Change: This evidence-based project proposal aims to provide a toolkit …

Thinking About Availability And Accessibility, Di Fang

Diet, Food, Exercise, and Nutrition (D-FEND)

Food environments are described, including food deserts and food access.

Dietary Strawberries Improve Cardiometabolic Risks In Adults With Obesity And Elevated Serum Ldl Cholesterol In A Randomized Controlled Crossover Trial, Arpita Basu, Kenneth Izuora, Nancy M. Betts, Jefferson W. Kinney, Arnold M. Salazar, Jeffrey L. Ebersole, R. Hal Scofield

Kinesiology and Nutrition Sciences Faculty Research

Background and aims: Dietary berries, such as strawberries, are rich in bioactive compounds and have been shown to lower cardiometabolic risk. We examined the effects of two dietary achievable doses of strawberries on glycemic control and lipid profiles in obese adults with elevated serum LDL cholesterol (LDL-C). Methods: In this 14-week randomized controlled crossover study, participants were assigned to one of the three arms for four weeks separated by a one-week washout period: control powder, one serving (low dose: 13 g strawberry powder/day), or two-and-a-half servings (high dose: 32 g strawberry powder/day). Participants were instructed to follow their usual diet …

Stakeholder Perspectives And Sustainability Of An Integrated Care Model For The Prevention And Management Of Obesity: The Childhood Obesity Research Demonstration (Cord) Project, Rebecca E Lee, Nathan H Parker, Allen M Hallett, Dennis Kao, Maria J Modelska, Hanadi S Rifai, Erica G Soltero, Daniel P O'Connor

Children’s Nutrition Research Center Staff Publications

Although reliable strategies exist to promote healthy habits that reduce childhood obesity, the sustainability of these strategies remains an ongoing public health challenge. This study aimed to identify factors experienced in a large, multisite project aimed at reducing childhood obesity that might contribute to project sustainability. Hypothesized constructs underpinning sustainability included replicability, continuation of benefits, institutionalization, and community capacity. Key informants (n = 27) completed 60 min, in-depth interviews, which were audio recorded and transcribed. Transcripts were first coded using a combined deductive and inductive approach. Four major themes emerged (with numerous subthemes): developing partnerships, challenges to the sustainability …

Metabolic Flexibility Across The Spectrum Of Glycemic Regulation In Youth, Fida Bacha, Sara Klinepeter Bartz, Maurice Puyau, Anne Adolph, Susan Sharma

Children’s Nutrition Research Center Staff Publications

BACKGROUNDMetabolic flexibility (MF) refers to the relative ability to utilize lipid and carbohydrate substrates and to transition between them. It is not clear whether MF is impaired in obese youth and what the determining factors are.METHODSWe investigated the determinants of MF (increased respiratory exchange ratio [ΔRER] under insulin-stimulated conditions) in pubertal youth (n = 104; 15.6 ± 1.8 years) with obesity across the spectrum of glucose tolerance compared with normal weight (NW) controls, including body composition (fat-free mass [FFM], %body fat), visceral adipose fat (VAT) (MRI), glycemia, and insulin sensitivity (IS) [3-hour hyperinsulinemic-euglycemic clamp with measurement of lipolysis ([2H5] glycerol), …

Rationale And Design Of The Baylor Infant Twin Study-A Study Assessing Obesity-Related Risk Factors From Infancy, Shabnam R Momin, Mackenzie K Senn, Scott Buckley, Neil R M Buist, Manisha Gandhi, Amy B Hair, Sheryl O Hughes, Kelly R Hodges, William C Lange, Maria A Papaioannou, Mimi Phan, Robert A Waterland, Alexis C Wood

Children’s Nutrition Research Center Staff Publications

Background: Early childhood (0-3 years) is a critical period for obesity prevention, when tendencies in eating behaviors and physical activity are established. Yet, little is understood about how the environment shapes children's genetic predisposition for these behaviors during this time. The Baylor Infant Twin Study (BITS) is a two phase study, initiated to study obesity risk factors from infancy. Data collection has been completed for Phase 1 in which three sub-studies pilot central measures for Phase 2. A novel infant temperament assessment, based on observations made by trained researchers was piloted in Behavior Observation Pilot Protocol (BOPP) study, a new …

Reducing The Obesity Epidemic Globally, Kimberli Pepper

Global Sustainable Development Projects

The consumption of high fructose corn syrup (HFCS) has caused a global obesity epidemic that has several health implications such as type two diabetes, fatty liver disease, kidney failure, oxidative stress, insulin resistance, multiple types of cancer, and pathogenesis of cardiometabolic diseases (Johnson et al., 2013; Malik and Hu, 2015; Romieu et al., 2017; Softic et al., 2016). The prevalence of obesity in the United States was evaluated by the Center for Disease Control (CDC) and reported that USA was at 39.8 percent, which is a significant risk factor for the development of type two diabetes mellitus (T2DM) (Mejia and …

Characterization Of Clostridium Cochlearium As A Potential Probiotic For Obesity Management, Paba Edirisuriya

Wayne State University Dissertations

ABSTRACTCHARACTERIZATION OF CLOSTRIDIUM COCHLEARIUM AS A POTENTIAL PROBIOTIC FOR OBESITY MANAGEMENT

ByPABA EDIRISURIYA MAY 2021 Advisor: Dr. Kequan Zhou Major: Nutrition and food science Degree: Doctor of Philosophy Emerging evidence indicates that manipulation of gut microflora is a potential therapeutic approach for managing obesity. Probiotic effects on host weight reduction have repeatedly been revealed through previous studies. Clostridium cochlearium is a butyrate-producing, spore-forming bacteria that have been reported to present in the mammalian gut. Our simulated Invitro digestion model revealed that C. cochlearium could survive in the unfavorable conditions of the human gastrointestinal tract, including low pH (pH2), high bile …

Take Charge, Mollie Bartles

All Student-Created Educational Resources

This educational handout highlights the benefits of a healthier lifestyle and how it is possible to eat on a budget.

Adolescent Obesity: Causes, Risks And Interventions, University Of New England Applied Nutrition Program

All Student-Created Educational Resources

To provide concise information about adolescent obesity to include the common causes, risk factors, immediate and long-term health risks. This handout also strives to deliver basic nutrition education and easy-to-access resources for more information.

Healthy Your Way, Susan Newkirk

All Student-Created Educational Resources

This handout depicts four lifestyle habits to integrate into everyday life to reduce your risk obesity and chronic diseases.

The Probiotic Effect Of Clostridium Cochlearium Is Associated With Significant Change In Short-Chain Fatty Acid Metabolism And Gut Microbiota, Qing Ai

Wayne State University Dissertations

The prevalence of obesity is rising steadily across the world, which increases the risk of many metabolic diseases and life-threatening illnesses. A specific strain, Clostridium cochlearium (C. cochlearium), reported as a butyrate producer, could have potential probiotic effects against obesity. The objective of this study was to evaluate the effects of dietary supplementation of C. cochlearium on a high-fat diet-induced obese (DIO) mouse model. The 16S rRNA sequencing of mice gut microbiome was performed at the end of the experimental period to identify the changes in gut microbial composition, investigate possible functional genes, and elucidate potential mechanisms. Thirty-six C57BL/6 6-8 …

Science Dialogue Mapping Of Knowledge And Knowledge Gaps Related To The Effects Of Dairy Intake On Human Cardiovascular Health And Disease, Andrew W Brown, Kathryn A Kaiser, Andrew Keitt, Kevin Fontaine, Madeline Gibson, Barbara A Gower, James M Shikany, Colby J Vorland, Donald C Beitz, Dennis M Bier, J Thomas Brenna, David R Jacobs, Penny Kris-Etherton, Kevin Maki, Michael Miller, Marie-Pierre St-Onge, Margarita Teran-Garcia, David B Allison

Children’s Nutrition Research Center Staff Publications

Dairy has been described as everything from a superfood to a poison; yet, arguments, assumptions, and data justifying these labels are not always clear. We used an issue-based information system, “dialogue mapping™,” to summarize scientific points of a live panel discussion on the putative effects of dairy on cardiovascular diseases (CVD) from a day-long session among experts in nutrition and CVD. Dialogue mapping captures relations among ideas to explicitly, logically, and visually connect issues/questions, ideas, pro/con arguments, and agreements, even if discussed at different times. Experts discussed two propositions: for CVD risk, consumption of full-fat dairy products, 1) should be …

Crucial Role Of Mammalian Glutaredoxin 3 In Cardiac Energy Metabolism In Diet-Induced Obese Mice Revealed By Transcriptome Analysis, Ninghui Cheng, Qianxing Mo, Jimmonique Donelson, Lingfei Wang, Ghislain Breton, George G Rodney, Jin Wang, Kendal D Hirschi, Xander H T Wehrens, Paul A Nakata

Children’s Nutrition Research Center Staff Publications

Obesity is often associated with metabolic dysregulation and oxidative stress with the latter serving as a possible unifying link between obesity and cardiovascular complications. Glutaredoxins (Grxs) comprise one of the major antioxidant systems in the heart. Although Grx3 has been shown to act as an endogenous negative regulator of cardiac hypertrophy and heart failure, its metabolic impact on cardiac function in diet-induced obese (DIO) mice remains largely unknown. In the present study, analysis of Grx3 expression indicated that Grx3 protein levels, but not mRNA levels, were significantly increased in the hearts of DIO mice. Cardiac-specific Grx3 deletion (Grx3 CKO) mice …

Wearable Activity Tracking Device Use In An Adolescent Weight Management Clinic: A Randomized Controlled Pilot Trial, Kanika Bowen-Jallow, Omar Nunez-Lopez, Alex Wright, Erika Fuchs, Mollie Ahn, Elizabeth Lyons, Daniel Jupiter, Lindsey Berry, Oscar Suman, Ravi S Radhakrishnan, Andrea M Glaser, Deborah I Thompson

Children’s Nutrition Research Center Staff Publications

Background: The use of physical activity tracker devices has increased within the general population. However, there is limited medical literature studying the efficacy of such devices in adolescents with obesity. In this study, we explored the feasibility of using wearable activity tracking devices as an adjunct intervention on adolescents with obesity.

Methods: Randomized controlled pilot trial evaluated the feasibility (attrition ≤50%) of an activity tracking intervention (ATI) and its effects on weight loss in adolescents with obesity enrolled in an adolescent weight management clinic (AWMC). Outcomes included feasibility (attrition rate) and absolute change in BMI. Differences between groups at 6, …

“We’Re, Like, The Most Unhealthy People In The Country”: Employing An Equity Lens To Reduce Barriers To Healthy Food Access In Rural Appalachia, Kathryn Cardarelli, Emily M. Dewitt, Rachel Gillespie, Heather Norman-Burgdolf, Natalie Jones, Janet Tietyen Mullins

Dietetics and Human Nutrition Faculty Publications

Introduction

Obesity disproportionately affects rural communities, and Appalachia has some of the highest obesity rates in the nation. Successful policy, systems, and environmental (PSE) interventions to reduce obesity must reflect the circumstances of the population. We used a health equity lens to identify barriers and facilitators for healthy food access in Martin County, Kentucky, to design interventions responsive to social, cultural, and historical contexts.

Methods

We conducted 5 focus groups in Martin County, Kentucky, in fall 2019 to obtain perspectives on the local food system and gauge acceptability of PSE interventions. We used grounded theory to identify perceived barriers and …

Effects Of Consuming Sugar-Sweetened Beverages For 2 Weeks On 24-H Circulating Leptin Profiles, Ad Libitum Food Intake And Body Weight In Young Adults, Desiree M. Sigala, Adrianne M. Widaman, Bettina Hieronimus, Marinelle V. Nunez, Vivien Lee, Yanet Benyam, Andrew A. Bremer, Valentina Medici, Peter J. Havel, Kimber L. Stanhope, Nancy L. Keim

Faculty Research, Scholarly, and Creative Activity

Sugar-sweetened beverage (sugar-SB) consumption is associated with body weight gain. We investigated whether the changes of (Δ) circulating leptin contribute to weight gain and ad libitum food intake in young adults consuming sugar-SB for two weeks. In a parallel, double-blinded, intervention study, participants (n = 131; BMI 18–35 kg/m2; 18–40 years) consumed three beverages/day containing aspartame or 25% energy requirement as glucose, fructose, high fructose corn syrup (HFCS) or sucrose (n = 23–28/group). Body weight, ad libitum food intake and 24-h leptin area under the curve (AUC) were assessed at Week 0 and at the end of Week …

How Minority Parents Could Help Children Develop Healthy Eating Behaviors: Parent And Child Perspectives, Chishinga Callender, Denisse Velazquez, Meheret Adera, Jayna M Dave, Norma Olvera, Tzu-An Chen, Shana Alford, Debbe Thompson

Children’s Nutrition Research Center Staff Publications

Minority children and children living in under-resourced households are at the greatest risk for obesity and diet-related disparities. Identifying effective strategies to reduce these risks is an important step in child obesity prevention. Parents influence the home environment and play a critical role in child obesity prevention. Eighteen parent–child dyads living in under-resourced Houston area communities participated in a mixed methods study (online surveys, telephone interviews). The purpose of the research reported here was to conduct a secondary analysis of the qualitative data to explore Black/African American and Hispanic parent and child perspectives of the ways in which parents could …

Obesity Indicators And C-Reactive Protein In Indonesian Adults (More Than Equal To 40 Years Old): The Indonesian Family Life Survey 5, Yeni Mahwati, Dieta Nurrika

Kesmas

C-reactive protein (CRP) is the best clinical marker for systemic inflammation. Obesity is associated with increased CRP levels. Systemic inflammation is present before morbidity occurs. Research reveals that the identification of obesity indicators and CRP levels is limited among Indonesians. The present study investigated the associations between obesity indicators (body mass index [BMI], waist circumference [WC], waist-to-hip ratio [WHR], waist-to-height ratio [WHtR]) and CRP levels among Indonesian adults. This cross-sectional study based on Indonesian Family Life Survey-5 2014–2015 was conducted among 3,386 adults (≥ 40 years) living in 13 provinces in Indonesia during the study period. All data were collected …

Evaluation Of The Attitudes Of Phytotherapists Towards The Herbal Treatment Of Obesity In The Light Of Ancient And Modern Theoretical Knowledge - Field Study In Tlemcen (Algeria), Chahrazed Bessenouci

Journal of the Arab American University مجلة الجامعة العربية الامريكية للبحوث

This research aimed to reveal the phytotherapists attitudes towards medicinal plants therapy used to treat obesity through identifying the nature of these attitudes and their degree of compatibility with what is in the ancient scientific manuscripts and the research publications in the modern chemistry. To do this, a choice was made of an intentional sample of 34 Herbalists-Phytotherapists (from several regions of the province of Tlemcen). Then the researchers used a face-to-face interview to survey the attitudes using a 27-item Likert-scale test. To determine the nature of the sample's attitudes and also the level of their knowledge, a descriptive analytical …

The Central Melanocortin System And Human Obesity, Yongjie Yang, Yong Xu

Children’s Nutrition Research Center Staff Publications

The prevalence of obesity and the associated comorbidities highlight the importance of understanding the regulation of energy homeostasis. The central melanocortin system plays a critical role in controlling body weight balance. Melanocortin neurons sense and integrate the neuronal and hormonal signals, and then send regulatory projections, releasing anorexigenic or orexigenic melanocortin neuropeptides, to downstream neurons to regulate the food intake and energy expenditure. This review summarizes the latest progress in our understanding of the role of the melanocortin pathway in energy homeostasis. We also review the advances in the identification of human genetic variants that cause obesity via mechanisms that …

The Impact Of Narratives And Active Video Games On Long-Term Moderate-To-Vigorous Physical Activity: A Randomized Controlled Trial Protocol, Dar Alon, Caio Victor Sousa, Tom Baranowski, Tiago V Barreira, Romina Cabrera-Perez, Kelly Chiu, Austin Fernandez, Amy Fleischman, Shirley Huang, Jungyun Hwang, Melanie C Green, I-Min Lee, Kelly Lee, Sarah Lessard, Lynne L Levitsky, Aika Misawa, Farzad Noubary, Ronald Samuels, Kyung Jin Sun, Debbe Thompson, Amy S Lu

Children’s Nutrition Research Center Staff Publications

Background: Although physical activity (PA) has been shown in helping prevent and treat obesity, current PA interventions are still not effective in ameliorating the obesity epidemic. Additional forms of PA need to be investigated to improve PA engagement and outcomes. We hypothesize that pairing a narrative (i.e., story) with an active video game (AVG), a less traditional form of PA, will increase participant engagement in PA. This paper presents the rationale, implementation, and pilot results of a study assessing the effect of narrative's impact on PA and a series of other health outcomes.

Objective: This paper presents the rationale, implementation, …