Childhood obesity is on the rise throughout the world. Overweight/obesity in childhood is a major risk factor for serious health consequences (Patchucki, Lovenheim, Harding, 2014). The family unit can address childhood obesity when the family works together to support each other in physical activity (PA) and healthy eating decisions. Sibling support may be particularly important due to the amount of time siblings spend with each other. Siblings’ impact on informal social behavior may be a more powerful motivator compared to formal parenting norms (Patchucki, Lovenheim, Harding, 2014). Having an obese younger sibling creates a five times greater likelihood the older sibling will be obese (Patchucki, Lovenheim, Harding, 2014), thus, interventions aimed at siblings may be particularly effective. The literature suggests this is an understudied topic in need of attention.

During February 2015, 22 families from a Boys and Girls Club participated in a 2 week pilot study testing an intervention designed to improve PA and healthy eating within family units. Families were randomly assigned to a treatment group (n=12 families and 20 children) or a measurement-only control group (n=12 families and 15 children). Children in the treatment group participated in 40 minutes of PA and 20 minutes of nutrition education during after school time. Three times a week program staff distributed take home cards to parents that described an exercise or nutrition activity to complete as a family. Families also participated in family night and parents participated in a nutrition educational session.

Researchers developed a quantitative survey to assess sibling support by modifying the Coordinated Approach to Child Health questionnaire that was designed to measure parent and friend support for healthy eating and exercise (Nadar, Stone, Perry, Osganian, Kelder et al, 1999). The survey contained 10 questions on PA and nutrition by querying children about the support of other children in their household (i.e., “When I am active, other children in my house smile and cheer for me.”). The three response options were “almost never/never,” “sometimes,” and “almost always/ always.” Other children in the house were defined as brothers, sisters, stepbrothers, stepsisters, cousins or other children that live with the family. Child participants (age 6-11) completed the survey at baseline (pretest) and at the end of the 2-week intervention (posttest). Scores will be added to give an overall score. Changes from baseline to posttest will be compared across treatment groups.

Data are expected to be released for dissemination prior to the conference so that the results can be presented. In addition, the process of pilot testing this measure 68 times suggested changes that may improve future iterations of this assessment of sibling support. It would be beneficial to add a question asking if there are other children in the house. Assessing the quality of the sibling relationship could be considered using the Sibling Relationship Questionnaire (SRQ) (Leeuw, Snoek, Leeuwe, Strien, 2007), a higher SRQ score signifies better sibling relationship. The quality of the sibling’s relationship may impact how support for healthy choices is received within the sibling group. Children are prone to picking the extreme answer on a questionnaire based on their current emotional state (Chambers, Johnston, 2002). Thus, it may be beneficial to change the answer choices from “never or almost never” to “almost never” and “always or almost always” to “always” to avoid extreme answers.

Siblings participate in PA and mealtime together on a regular basis (Patchucki, Lovenheim, Harding, 2014). This new assessment provides a first step in measuring sibling support for PA and healthy eating. Understanding how siblings can positively influence one another to promote healthy choices may help reduce risk factors for childhood obesity.

Introduction

Dysphagia (swallowing impairment) is the most common side effect of radiation therapy (RT) in patients with head and neck cancer (HNC) (Greven et al., 2003; McColloch, Carroll, Magnuson, 2010). Dysphagia in this population is primarily a result of RT toxicity that includes mucositis (painful inflammation of the mucosal lining of the mouth, pharynx, and larynx), reduced taste, nausea, and dry mouth (Agarwala & Sbeitan, 2006; Gaziano, 2002; Groher & Crary, 2010; Sonis, 2004). Severe dysphagia necessitates the use of a feeding tube in many patients. Over 50% of patients remain dependent on a feeding tube at five months post RT and 10% to 30% continue to be dependent at one year (Greven et al., 2003; Ishiki et al., 2012; Paleri & Patterson; 2010, Rieger et al., 2006).

Persistent dysphagia in this population is primarily due to disuse atrophy of the swallowing muscles, reduced sensation, and chronic dry mouth (Gurney et al., 2008; Harrison, et al., 1997; Hutcheson et al., 2008; List et al., 1997; Maurer et al., 2011; Nguyen et al., 2006). Symptoms include difficulty eating dry foods, food sticking in the mouth or throat, and coughing on food or liquid secondary to food/liquid entering the airway. (Hutcheson et al., 2008; Langmore & Krisciunas, 2010; Logeman et al., 2008). These deficits contribute to reduced quality of life (QOL).

Several studies have shown that prophylactic swallowing exercises (PSE) for these patients minimizes dysphagia (Carnaby-Mann et al., 2011; Carroll et al., 2008; Kotz et al., 2012; van der Molen et al., 2011); however, compliance to PSE programs is often poor due to swallowing pain (Roe and Ashforth, 2011; van der Molen et al., 2011).

Specific Aims and Objectives

The specific aims of this study are: 1) determine the efficacy of a PSE protocol that consists solely of indirect swallowing exercises (swallowing exercises that do not require actual swallowing), and 2) determine if such a protocol minimizes patient discomfort, maximizes QOL, and improves exercise compliance. The study compares a PSE protocol consisting solely of indirect swallowing exercises to a PSE program similar to prior prophylactic studies that consists of both direct (exercises that require swallowing) and indirect swallowing exercises (Carnaby-Mann et al., 2011; Carroll et al., 2008; Kotz et al., 2012; Kulbersh, 2006; van der Molen et al., 2011).

Methods

Participants

Adult participants diagnosed with cancer of the tongue, palate, pharynx, or larynx, whose primary treatment is RT, qualify for the study. Participants are excluded if they have an existing diagnosis of dysphagia unrelated to their current HNC diagnosis, or if they are diagnosed with a progressive neurological disorder that could contribute to dysphagia.

Procedures

Participants are instructed in either the indirect or the combination PSE protocol prior to beginning RT. The exercises are prescribed three times per day, seven days per week throughout RT. Outcome measures are taken at baseline, three times during RT, and one month, three months, and six months post-RT.

Outcome Measures

An instrumental swallow study is administered to determine baseline swallowing function. The Eating Assessment Tool-20 (EAT-20), Functional Oral Intake Scale (FOIS), MD Anderson Dysphagia Inventory (MDADI), the European Organization for Research and Treatment of Cancer global QOL questionnaire (EORTC QLQ-C30), the EORTC Head and Neck module (EORTC H&N35), and a study-specific nutrition and pain questionnaire are used as outcome measures.

The EORTC QLQ-C30 is a validated measure of global QOL following treatment for cancer. The EAT-20, MDADI, and EORTC H&N35 are validated, self-administered, survey questionnaires designed to assess swallowing-related QOL. The FOIS is a validated 7-point scale of oral diet tolerance. It ranges from complete feeding tube dependence (level 1) to a full oral diet without restriction or compensation (level 7). The study-specific nutrition and pain questionnaire gathers information related to percent oral intake versus enteral nutrition, body mass index, and swallowing pain. The FOIS, MDADI, and EORTC questionnaires have been used in previous studies with similar populations and will allow for cross-study comparisons.

Anticipated Results

It is hypothesized that the indirect PSE protocol will be as effective as a combination PSE protocol for minimizing dysphagia, but the indirect PSE protocol will be more comfortable for patients, which will contribute to better compliance to the PSE exercises and better QOL.