An annotation consists of three separate paragraphs that cover three respective components: summary, analysis, and application. These three components convey the relevance and value of the source. As such, an annotation demonstrates your critical thinking about, and authority on, the source. This weeks annotation is a precursor to the annotated bibliography assignment due in Week 10.An annotated bibliography is a document containing selected sources accompanied by a respective annotation of each source. In preparation for your own future research, an annotated bibliography provides a background for understanding a portion of the existing literature on a particular topic. It is also a useful first step in gathering sources in preparation for writing a subsequent literature review as part of a dissertation.With this in mind: Use the attached guidelines to annotate the research article titled Family-Based Childhood Obesity Prevention Interventions: A Systematic Review and Quantitative Content AnalysisProvide the reference list entry for this article in APA Style followed by a three-paragraph annotation that includes:A summaryAn analysisAn applicationFormat the annotation in Times New Roman, 12-point font, double-spaced. A separate References list page is not needed for this assignment.
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1-SUMMARY of the information you found in that specific source. The summary section gives your reader an overview of
the important information from that source. Remember that you are focusing on a source’s method and results, not
paraphrasing the article’s argument or evidence. The questions below can help you produce an appropriate, scholarly
? What is the topic of the source?
? What actions did the author perform within the study and why?
? What were the methods of the author?
? What was the theoretical basis for the study?
? What were the conclusions of the study?
Remember, a summary should be similar to an abstract of a source and written in past tense (e.g. “The authors found
that ” or “The studies showed ”), but it should not be the abstract, written in your own words.
2-CRITIQUE/ analysis of each source. In this section, you will want to focus on the strengths of the article or the study
(the things that would make your reader want to read this source), but do not be afraid to address any deficiencies or areas
that need improvement. The idea of a critique is that you act as a criticaddressing both the good and the bad.
In your critique/analysis, you will want to answer some or all of the following questions
Was the research question well framed and significant?
How well did the authors relate the research question to the existing body of knowledge?
Did the article make an original contribution to the existing body of knowledge?
Was the theoretical framework for the study adequate and appropriate?
Has the researcher communicated clearly and fully?
Was the research method appropriate?
Is there a better way to find answers to the research question?
Was the sample size sufficient?
Were there adequate controls for researcher bias?
Is the research replicable?
What were the limitations in this study?
How generalizable are the findings?
Are the conclusions justified by the results?
Did the writer take into account differing social and cultural contexts?
3-APPLICATION-justify the source’s use and address how the source might fit into your own research. Consider a few
? How is this source different than others in the same field or on the same topic?
? How does this source inform your future research?
? Does this article fill a gap in the literature?
? How would you be able to apply this method to your area of focus or project?
? Is the article universal?
Remember, annotated bibliographies do not use personal pronouns, so be sure to avoid using I, you, me, my, our, we, and
Ash et al. International Journal of Behavioral Nutrition and Physical Activity
Family-based childhood obesity prevention
interventions: a systematic review and
quantitative content analysis
Tayla Ash1,2* , Alen Agaronov1, TaLoria Young3, Alyssa Aftosmes-Tobio2 and Kirsten K. Davison1,2
Background: A wide range of interventions has been implemented and tested to prevent obesity in children.
Given parents influence and control over childrens energy-balance behaviors, including diet, physical activity,
media use, and sleep, family interventions are a key strategy in this effort. The objective of this study was to profile
the field of recent family-based childhood obesity prevention interventions by employing systematic review and
quantitative content analysis methods to identify gaps in the knowledge base.
Methods: Using a comprehensive search strategy, we searched the PubMed, PsycIFO, and CINAHL databases to
identify eligible interventions aimed at preventing childhood obesity with an active family component published
between 2008 and 2015. Characteristics of study design, behavioral domains targeted, and sample demographics
were extracted from eligible articles using a comprehensive codebook.
Results: More than 90% of the 119 eligible interventions were based in the United States, Europe, or Australia. Most
interventions targeted children 25 years of age (43%) or 610 years of age (35%), with few studies targeting the
prenatal period (8%) or children 1417 years of age (7%). The home (28%), primary health care (27%), and community
(33%) were the most common intervention settings. Diet (90%) and physical activity (82%) were more frequently
targeted in interventions than media use (55%) and sleep (20%). Only 16% of interventions targeted all four behavioral
domains. In addition to studies in developing countries, racial minorities and non-traditional families were also
underrepresented. Hispanic/Latino and families of low socioeconomic status were highly represented.
Conclusions: The limited number of interventions targeting diverse populations and obesity risk behaviors beyond
diet and physical activity inhibit the development of comprehensive, tailored interventions. To ensure a broad
evidence base, more interventions implemented in developing countries and targeting racial minorities, children at
both ends of the age spectrum, and media and sleep behaviors would be beneficial. This study can help inform future
decision-making around the design and funding of family-based interventions to prevent childhood obesity.
Keywords: Childhood obesity, Diet, Physical activity, Media use, Sedentary behavior, Sleep, Family-based
Childhood obesity continues to be a pervasive global
public health issue as children worldwide are significantly heavier than prior generations . Over the past
few decades, the prevalence of obesity among children
and adolescents has risen by 47% . Increases have
* Correspondence: Tra775@mail.harvard.edu
Harvard T.H. Chan School of Public Health, Department of Social and
Behavioral Sciences, SPH-2 655 Huntington Avenue, Boston 02115, USA
Harvard T.H. Chan School of Public Health, Department of Nutrition, Kresge
Building 677 Huntington Avenue, Boston 02115, USA
Full list of author information is available at the end of the article
been seen in both developed and developing countries,
with recent prevalence estimates of 23 and 13%, respectively . Despite evidence of a plateau in the rates of
obesity, at least among young children in developed
countries, current levels are still too high, posing shortand long-term impacts on childrens physical, psychological, social, and economic well-being . Of equal,
if not greater concern, racial/ethnic and socioeconomic disparities appear to be widening in some
countries . Given the extensive disease burden,
treatment resistance of obesity, and lack of signs of
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Ash et al. International Journal of Behavioral Nutrition and Physical Activity (2017) 14:113
attenuation for rates in the developing world, scientists, clinicians, and practitioners are working hard to
devise and test interventions to prevent childhood
obesity and reduce associated disparities [2, 9].
One category of interventions to prevent childhood
obesity that has grown considerably in recent years is
family-based interventions. This was in part due to a
number of key reports published in 2007, including an
Institute of Medicine (IOM) report on the recent progress of childhood obesity prevention  and a report
from a committee of experts representing 15 professional organizations appointed to make evidence-based
recommendations for the prevention, assessment, and
treatment of childhood obesity [11, 12]. In both reports,
parents are described as integral targets in interventions,
given their highly influential role in supporting and
managing the four behaviors that affect childrens energy
balance (diet, physical activity, media use, and sleep)
. This includes not only parenting practices and
rules, but also the environments to which children are
exposed, and the adoption of parents own behavioral
habits by children .
Since the release of these reports, there has been a
proliferation of family-based interventions to prevent
and treat childhood obesity as documented in at least
five published reviews of this literature in the past decade . While these reviews convey extensive information around intervention effectiveness, they cannot
reveal gaps in the knowledge base. Quantitative content
analysis  can be used to code intervention and
participant characteristics, and a review of the resulting
data can reveal areas and populations receiving a great
deal of attention, as well as those where few or no studies exist, thereby highlighting knowledge gaps. With a
focus on childhood obesity interventions, pertinent
questions to address include: whether interventions have
continued to focus primarily on diet and physical activity, neglecting the more recently established predictors
of media use and sleep ; whether some behaviors
are more likely to be targeted among certain age groups
or settings than others; and whether there are gaps with
regard to the populations targeted by interventions to
date, in particular, the representation of vulnerable populations (e.g. families living in developing countries, those
of low socioeconomic status, racial and ethnic minorities,
immigrants, and non-traditional families) [2, 3137]. In
addition to ethical reasons, from a pragmatic viewpoint, it
is difficult to identify best practices to prevent childhood
obesity in vulnerable populations when few interventions
have focused on that population [38, 39].
The goal of this study is to profile family-based interventions to prevent childhood obesity published since
2008 to identify gaps in intervention design and methodology. In particular, we use quantitative content analysis
Page 2 of 12
to systematically document intervention and sample
characteristics with the goal of directing future research
to address the identified knowledge gaps.
We used a multistage process informed by the Preferred
Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines to identify family-based
childhood obesity prevention interventions that were written in English and published between January 1, 2008 and
December 31, 2015 . Using an a priori defined protocol, we identified relevant articles and systematically
screened articles against inclusion and exclusion criteria.
The systematic review protocol was registered in the
PROSPERO database (CRD42016042009).
Following the identification of eligible studies, we conducted a quantitative content analysis to profile recent interventions for childhood obesity prevention. Content
analysis, originally used in communication sciences but
increasingly utilized in public health, is a research method
used to generate objective, systematic, and quantitative
descriptions of a topic of interest . Our research
team has previously employed this technique to survey
observational studies on parenting and childhood obesity
published between 2009 and 2015 [41, 42].
Search strategy and initial screening
With the help of a research librarian, two authors (TA,
AA) searched three databases (PubMed, PsycINFO, and
CINAHL) using individually tailored search strategies
most appropriate for each database. The selected databases are the three most common databases used in recent systematic reviews. Our search strategy consisted of
search strings composed of terms targeting four concepts: (1) family (e.g. family, mother, father, home), (2)
intervention (e.g. prevention, promotion), (3) children
(e.g. child, infant, youth), and (4) obesity (e.g. overweight, body mass) (see Additional file 1 for full search
strategy for one database). We searched title, abstract,
and medical subject headings (MeSH) or descriptor subjects (DE) term fields. Animal studies (e.g. rats), nonoriginal research articles (e.g. commentaries, editorials,
case reports), studies written in languages other than
English and studies focused on populations older than
18 years were excluded using search limits and NOT
terms. We restricted the search to articles published
since January 1, 2008, to capture interventions implemented after the release of the IOM and expert committee reports. Furthermore, a start point of January 2008
ensured the feasibility of this study given the labor and
time intensive process to screen and code studies. In a
recent systematic review of family-based interventions
for the treatment and prevention of childhood obesity,
more than 80% of eligible studies were published since
Ash et al. International Journal of Behavioral Nutrition and Physical Activity (2017) 14:113
2008 . Thus, a start date of 2008 appropriately
balances feasibility of implementation and the validity of
the resulting information. The search end date was
December 31, 2015.
The search yielded 12,274 hits, representing 9152
unique articles after removing duplicates (see Fig. 1).
Following a review of titles by three authors (TA, AA,
TY) and one research assistant, 7451 articles were
removed based on exclusion criteria, resulting in 1701
articles that proceeded to abstract review. Articles were
removed during title review if they were not written in
English or published in the designated time frame, were
not original research articles, did not include human
subjects, did not target children, were observational
studies, were not relevant to the topic of childhood
obesity (e.g. papers about Anorexia Nervosa), or included special clinical populations.
Application of eligibility criteria
Three authors (TA, AA, TY) and one research assistant
screened articles against the eligibility criteria during
abstract review, while two authors (TA, AA) screened
during full-text review, applying the aforementioned exclusion criteria. Eligible studies included family-based interventions for childhood obesity prevention published
Page 3 of 12
since 2008. We defined family-based interventions as
those involving active and repeated involvement in intervention activities from at least one parent or guardian
. Examples of intervention activities that qualify as
active parent involvement include workshops and counseling. Examples of passive involvement, which were
excluded, include sending home brochures for parents,
or simply inviting parents to a single event, but not involving them in the intervention in an integral way. We
defined obesity interventions as those that reported at
least one weight-related outcome (weight, body mass
index, etc.) or which self-identified as an obesity intervention. We defined interventions as preventive if they
did not explicitly focus on weight loss or management,
or if they did not recruit only children with obesity. The
final inclusion criterion was that the intervention was
designed with the intent of benefiting children (child
being defined as <18 years of age), excluded interventions in which the objective was to better parent health outcomes. Of the 1701 articles screened at the abstract level, 329 proceeded to full-text screening, of which 159 articles met the eligibility criteria and were included in the final pool of eligible papers (see Additional file 2 for a list of eligible articles). We examined intervention name, trial Fig. 1 PRISMA flow diagram for identifying and screening eligible family-based childhood obesity prevention interventions Ash et al. International Journal of Behavioral Nutrition and Physical Activity (2017) 14:113 number, the last name of the first author, and the last name of the last author to identify articles that originated from the same intervention. After collating, 119 unique interventions were identified, which included interventions with published outcome data, and interventions for which only a protocol was published. Percent agreement for all screening criteria ranged between 86 and 98%. Discrepancies were discussed and resolved. To ensure a fully inclusive search strategy, we also reviewed the references of a random subset of the articles meeting the inclusion criteria. A subset of 5% was chosen given the large sample size. No additional studies meeting the eligibility criteria were identified in the process, suggesting that the employed search was exhaustive. Data extraction For all eligible articles, we used conventional content analysis methodology  to extract and analyze article, intervention, and participant characteristics. We developed a comprehensive codebook to standardize the coding process. Multiple authors (TA, AA, AA-T) tested the codebook by coding five articles not included in the final pool of studies. An additional round of testing included 10 randomly selected articles from the study pool. After pilot testing the codebook and establishing reliability (see intercoder reliability), two trained coders (TA, AA) each coded half of the 159 eligible articles. Article characteristics We coded publication year, journal, funding sources, and type of paper. All specific funding sources for a given intervention were extracted and classified after web-based searching. Funding sources were categorized as federal, foundation, corporate, or university, and then further coded based on the specific federal, foundation or corporate agency. For type of paper, articles were coded as an intervention protocol or outcome evaluation. Articles that reported any intervention outcomes were coded as outcome evaluations; interventions that only described the intervention (or provided only baseline data) were coded as protocols. Because a seemingly large number of protocols were discovered among the final pool of articles, we elected to include them in the study. Interventions in which only a protocol has been published tend to represent the next generation of intervention studies and thus lend to a better understanding of the fields trajectory. Intervention characteristics We coded a wide range of intervention characteristics including geographic region of the study, age of target child, intervention setting, length of intervention, delivery mode, evaluation design, intervention recipient, Page 4 of 12 behavioral domains targeted, and theory used. Age of the target child at baseline was coded as prenatal (i.e., the intervention started before birth), 01 years, 2 5 years, 610 years, 1113 years, and 1417 years. If the age range fell predominantly into one category, any subsequent categories were only coded affirmative if the ages of participants crossed at least 2 years into a given range. Intervention setting was coded as home, primary care or health clinic, community-based, school, and childcare/preschool. Community-based interventions included those taking place in community gardens, parks, or recreational facilities. Interventions taking place at universities were also coded as community-based. In cases where intervention setting was ambiguous, or the intervention was not setting specific, we coded the intervention setting as unclear. Intervention length was coded as less than 13 weeks (3 months), 1351 weeks (311.9 months), or 52 weeks (12 months) or more. Two different types of intervention delivery modes were coded: in-person and technologybased. Technology-based approaches included those using computers, social media, text messages, or anything else involving the Internet. Evaluation design was coded as either randomized-controlled trial or quasi-experimental trial. We also ex ... Purchase answer to see full attachment
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