Targeting self-regulation to promote health behaviors in children

Abstract

Poor self-regulation (i.e., inability to harness cognitive, emotional, motivational resources to achieve goals) is hypothesized to contribute to unhealthy behaviors across the lifespan. Enhancing early self-regulation may increase positive health outcomes. Obesity is a major public health concern with early-emerging precursors related to self-regulation; it is therefore a good model for understanding self-regulation and health behavior. Preadolescence is a transition when children increase autonomy in health behaviors (e.g., eating, exercise habits), many of which involve self-regulation. This paper presents the scientific rationale for examining self-regulation mechanisms that are hypothesized to relate to health behaviors, specifically obesogenic eating, that have not been examined in children. We describe novel intervention protocols designed to enhance self-regulation skills, specifically executive functioning, emotion regulation, future-oriented thinking, and approach bias. Interventions are delivered via home visits. Assays of self-regulation and obesogenic eating behaviors using behavioral tasks and self-reports are implemented and evaluated to determine feasibility and psychometrics and to test intervention effects. Participants are low-income 9-12 year-old children who have been phenotyped for self-regulation, stress, eating behavior and adiposity through early childhood. Study goals are to examine intervention effects on self-regulation and whether change in self-regulation improves obesogenic eating.

Adolescent Interventions to Manage Self-Regulation in Type 1 Diabetes (AIMS-T1D): randomized control trial study protocol

“…The AIMS-T1D intervention is based on prior work that used a multiphase optimization strategy design [51] framework to test different intervention strategies on SR targets among youth, specifically EF, ER, and FO [4]. Intervention activities, which are manualized, will be introduced to participants in person after randomization by trained interventionists.…”

“…Measures of all primary and secondary outcomes will be conducted at baseline and again 8 weeks later in order to evaluate change in each outcome among participants in the intervention versus control groups (see Table 1 for list of measures and assessment method). Staff are extensively trained in both questionnaire and behavioral task administration using manuals developed in prior work that used similar assessment strategies [4].…”

“…Primary study outcomes include FO, ER, and EF as indicators of SR. Where appropriate, SR is assessed using a combination of direct assessment (behavioral tasks completed by the participant) plus adolescent self-report and parent-report on standard questionnaires that have been found to be reliable in prior work [4]. Task and questionnaire-based assessments will be analyzed separately as such measurement approaches may represent different aspects of SR. [60] Future Orientation (FO)…”

“…We based our power analysis on prior work detecting change in SR targets [4] and T1D medication adherence literature [10,11]. We anticipate medium effect sizes of 0.6 with the bundled interventions, so our proposed sample size of 94 (47 per group) should result in sufficient statistical Power of 82% to detect such effects using a two-sided Type I error alpha of 0.05.…”

“…Decades of research have demonstrated the importance of self-regulation (SR), or the capacity to control one's thoughts, emotions, and behaviors in order to achieve a desired goal, in shaping individuals' health outcomes [1,2]. SR capacity has been conceptualized as including three component processes: executive functioning skills; emotion regulation strategies; and ability to delay gratification in service of achieving future goals [3,4]. Low SR capacity has been shown to interfere with individuals' engagement in a variety of health maintenance behaviors including engaging in regular physical activity [5], consuming a healthy diet [6][7][8], and adhering to medical treatment regimens [9][10][11].…”