Essay strucutred with an appraissal tool

 

OPTION 1: Individual submission (begin with this template and submit a draft)
Structured 3,500 word essay maximum excluding the 1,129 words of these questions and your list of references. Expand the explanation boxes as required.
You must use this worksheet to complete the assessment and submit it through Turnitin.
Pair number
Name and student number Hui Jun Serene Huang
Second reviewer, name and student number
Date draft submitted through TurnitIn. Word count (not including the 1,129 for the form and the references):
Date of exchange individual work and discussion with partner
Study assessed: New Moves – Preventing weight-related problems in adolescent girls Nequmark-Sztainer 2010
QUALITY ASSESSMENT TOOL FOR QUANTITATIVE STUDIES
Please complete these the questions presented as structured paragraphs as you would in an essay. Highlight your selection or cross-out the choice not applicable. Demonstrate your knowledge of epidemiological principles within each section and support your statements.
Show the structured PICO question of the study
Population: adolescent girls with weight problems aged 13-19 years, those in high school, Americans
Intervention: New Moves, a school-based health intervention program targeting overweight adolescent girls
Comparison: To those girls that are not attending ‘New Moves’ program
Outcome: percentage body fat, physical activities, BMI, dietary intake, unhealthy weight control behaviours, eating patterns and body/self-image

Statement of the problem: Is the school-based program ‘New Moves’ effective in preventing obesity/ weight problems in adolescent girls?
Question type: Therapy
The best study type for this kind of questions is randomised control trial, summarised with a systematic review.
COMPONENT RATINGS
A) SELECTION BIAS
(Q1) Are the individuals selected to participate in the study likely to be representative of the target population?
1. Very likely
2. Somewhat likely
3.Not likely
4. Can’t tell

Provide your explanation:
I chose no 3- not likely because
• the sample size (stated in the settings/participants column) is too small (356 girls) to represent the target population (p. 1, paragraph 4).
• 75% of the participants were from ethnic/racial minority groups (p.2, paragraph 2) but this study was conducted in the Minneapolis/St. Paul metropolitan area of Minnesota (p.2, paragraph 4) where majority of the population are white Americans.
• The authors did not specify which type of weight related problems as being underweight and overweight could fit into this category. Assuming that this study is aimed at issues of obesity, then they would have to recruit only obese/overweight participants instead of just 46% of overweight/obese girls (p.1, paragraph 4).
At such, the samples used in this study are not representative of the target population because this study is about weight issues in adolescents in Minneapolis, America. If this study were to attain generalizability, it has to model America’s population where majority of the population are whites and include only adolescents who are overweight so as to attain generalizability. This is especially when the research question did not specifically mention about looking at weight issues among the adolescents in minority groups in America.

(Q2) What percentage of selected individuals agreed to participate?
1. 80 – 100% agreement
2. 60 – 79% agreement
3. less than 60% agreement
4. Not applicable
5. Can’t tell

Provide your explanation:
I chose no. 5- can’t tell because there was no clear description of the selection process. At such, the number of participants were enrolled in the beginning becomes quite uncertain. Moreover, the only information given was 433 participants consented after which 77 of them dropped out due to various reasons leaving 356 participants who went on to enrol in the program. No information was given on how many participants were recruited the beginning. At such, 433 participants could represent any percentage of those initially recruited. According to the QA dictionary, if Q1 is 3 and Q2 is 5, the rating for this column is WEAK.

RATE THIS SECTION STRONG MODERATE WEAK
See dictionary 1 2 3
Provide your explanation:
According to Gordis (2013), selection bias is the choosing of participants in such a manner that an obvious association occur between the outcome of interest and the participants thus opposing reality. However, the method of selecting the participants for this study raises the issue of selection bias because The number of participants from the control and intervention group who agreed to participate in the program before they were assigned to receive control or intervention is unknown even though 356 out of 433 girls (82%) participated in the program hence the selection bias in this study is weak.
B) STUDY DESIGN
Indicate the study design
1. Randomized controlled trial
2. Controlled clinical trial
3. Cohort analytic (two group pre + post)
4. Case-control
5. Cohort (one group pre + post (before and after))
6. Interrupted time series
7.Other, please specify:
8. Can’t tell

Was the study described as randomized? If NO, go to Component C.
No Yes
If Yes, was the method of randomization described? (See dictionary)
No Yes
If Yes, was the method appropriate? (See dictionary)
No Yes

Provide your explanation:
According to Gordis (2013), the purpose of randomisation is to ensure that the next assignment cannot be predicted. Hence if a study states that it is a randomised controlled trial, it must
1) use methods such as computerised randomisation
2) clearly state the method of randomisation before the actual randomisation process takes place (Gordis, 2013).

In this case, although the literature did mention that this study was a randomised controlled trial (p. 2, paragraph 4), it offers no description of the process of randomisation such as using tossing a coin to determine which schools would be the control or intervention.

What literature did mention was:
1) the study was conducted over a period of one year from each group (the first group being studied in 2007-2008 and the second group in 2008-2009) (p. 2, paragraph 4)
2) a cohort of girls were measured (p.5 paragraph 2)- which indicated that observations were made on the same group of participants)
3) evaluation assessments were made thrice- at baseline (prior to commencing the fall PE lesson), post class (immediately after the completion of the fall PE class) and at follow-up (nine months after intervention started, when school year ended) (p.3, paragraph 3).
4) The intervention spanned over a period of 9 months – between the fall (September) in 2007 to nine months later, which is May of 2008) (p.3, paragraph 3).

It is also not a
– controlled clinical trial because the method of allocation is not transparent due to the lack of description of the randomisation process (EPHPP, 2009).
– cohort-analytic because it the exposure of the intervention is controlled by the investigators (EPHPP, 2009).
– Case-control study because the study provides the intervention hence there is no need to examine whether or not the participants were exposed to the intervention (EPHPP, 2009)

At such, this description seemed to have fitted that of an interrupted time series where multiple observations were made over time, observation are made on the same units and have a specific point in the series where the intervention started (EPHPP, 2009).
RATE THIS SECTION STRONG MODERATE WEAK
See dictionary 1 2 3
Provide your explanation:
As mentioned above, the study design was originally intended be a group RCT (p. 2, paragraph 4). However, the literature offers no description of the process of randomisation of schools hence raising some uncertainties of its status as an RCT. Instead, the description seemed to fit that of an interrupted times series. According to the EPHPP dictionary, if the study description fits an interrupted time series, the rating for this column is MODERATE.

C) CONFOUNDERS
(Q1) Were there important differences between groups prior to the intervention?
1.Yes
2. No
3. Can’t tell

The following are examples of confounders:
1. Race
2. Sex
3. Marital status/family
4. Age
5. SES (income or class)
6. Education
7. Health status
8. Pre-intervention score on outcome measure

Provide your explanation:
Yes, but not all – gender is not a confounder in this study because all the participants are females (p.3 paragraph 1), which otherwise there would be difference in genders in terms of level of physical activity and food intake (Halliday, Palma, Mellor, Green & Renzaho, 2014).
Otherwise all other factors are confounders in this study because
– this study involved different races (p. 14, table 1). At such, different races might have its own risks for certain diseases, such as high blood pressure and diabetes (Halliday, Palma, Mellor, Green & Renzaho, 2014).
– Marital status/ family is a confounder because even though there are limited evidences to support that parental involvement is effective in managing childhood obesity (Upton, Taylor, Erol & Upton, 2015; van Slujis, Kriemler & McMinn, 2011), poor family function was found to be positively associated with increased risk of obesity (Halliday, Palma, Mellor, Green & Renzaho, 2014). As this study involved obese participants (p.3, paragraph 2), there is likelihood that poor family functioning is a contributing factor towards their obesity.
– Age is a confounder because the literature stated under the setting/participants column that the participants’ ages are between 14.5 yrs old to 17 years old (p.1, paragraph 4). At such, the differences in age might also indicate the differences in the stage of development (such as puberty), which were found to have effects on eating behaviours (Halliday, Palma, Mellor, Green & Renzaho, 2014). One example is weight gain due to increased energy requirements during their growth period (Bornhorst, Huybrechts, Ahrens, Eiben & Michels, 2013).
– Socioeconomic status was also found to have effects an individual’s ability to purchase and stock up healthy food (Halliday, Palma, Mellor, Green & Renzaho, 2014). Other than that, Dinsa, Goryakin, Fumagalli & Suhrcke (2012) also found that obesity is positively associated with higher SES and education levels.
– Education is also a confounder because the study conducted by Rutkowski & Connelly (2011) on obesity risk knowledge and the level of physical activity in adolescents found that parents were less educated were more likely to accept “junk foods” in their childrens’ diets.
– As for health status, literatures found that obesity have higher prevalence in youth with asthma because of the increased use of oral and inhaled steroids (Black, Smith, Porter, Jacobsen, Steven & Koebnick, 2012; Sutherland, 2014). Although the literature did not mention about the participants’ health status, having health conditions such asthma would contribute towards obesity.
(Q2) If yes, indicate the percentage of relevant confounders that were controlled (either in the design (e.g. stratification, matching) or analysis)?
1. 80 – 100% (most)
2. 60 – 79% (some)
3. Less than 60% (few or none)
4. Can’t Tell
RATE THIS SECTION STRONG MODERATE WEAK
See dictionary 1 2 3
Provide your explanation:
According to the EPHPP dictionary, confounding factor is described as the variable that is not only associated with the intervention/exposure but also has the potential to influence study outcomes (EPHPP, 2009). At such, these factors must be either stratified or matched in the study design or in the analysis so as to achieve a balance in these variables between groups (EPHPP, 2009).
In this case, the literature did not mention that confounders were balanced at base line. It also did not mention how many percentages of the variables had been stratified or not stratified. What it did mention was that the participants’ age, ethnicity/race, baseline measures were being adjusted during the statistical analysis (p. 5, paragraph 2). At such, this study appears to have provided insufficient information on this area. According to the QA dictionary, a combination of (1) for Q1 and (3) for Q2 gives a WEAK rating for this column.
D) BLINDING
(Q1) Was (were) the outcome assessor(s) aware of the intervention or exposure status of participants?
1. Yes
2. No
3. Can’t tell

Provide your explanation:
I chose can’t tell because the literature only stated that the assessors who did the participants’ measurements and collection of data were trained research staff but did not mention that the assessors were independent or blinded in such a way that they did not know which group’s data they were handling. Moreover, it was stated in their website (www.newmovesonline.com) that they had a separate team for intervention and evaluation. However, it was not written in this literature. At such, it could be argued that if they also had separate team for this particular study, they would have written it in their literature. At such, there is a possibility of them using the same team throughout the process thus increasing the risk of the assessors knowing about the intervention or the exposure.
(Q2) Were the study participants aware of the research question?
1. Yes
2. No
3. Can’t tell

Provide your explanation:
The literature mentioned about putting up posters and flyers at schools so the students must have been aware of the program when they signed up for it. However, no information was given on whether or not the participants were informed about the research. The only information given was that the participants were required to choose either one or two PE classes in order to graduate (p.3 paragraph 4) and answer the questionnaires at a later part. At such, there is a likelihood that they might be aware of the research question in the process of carrying out the intervention or evaluation.
RATE THIS SECTION STRONG MODERATE WEAK
See dictionary 1 2 3

Provide your explanation:
Blinding refers to the process of ensuring that the participants are unaware of the research question so as to prevent reporting bias (EPHPP, 2009). In this case, the literature did not mention about blinding process hence there is likelihood that the participants are aware of the research question and the intervention in addition to the lack of description on how blinding was undertaken. Due to this, it would seem that the risk of bias here is quite high. According to the EPHPP dictionary, if the answers for both Q1 & 2 were YES, this column would be rated as WEAK.
E) DATA COLLECTION METHODS
(Q1) Were data collection tools shown to be valid?
1. Yes
2. No
3. Can’t tell

Provide your explanation:
According to Gordis (2013), the validity of a test refers to its ability to recognise who has a disease (sensitivity) and who does not have it (specificity).
In this case study, the participants’ body fat percentages were measured using the dual-energy x-ray absorptiometry (DXA) (p.4 paragraph 7). According to the validation studies of the DXA undertaken by Glickman, Marn, Supiano, Dengel (2004), results showed that the DXA measured visceral adiposity accurately when compared against the volumetric CT scans results with reproducible results.
-A second tool used in this study was BMI, a commonly used validated tool which measures the degree of obesity in a person by dividing the weight against the height multiplied by height (Estes, Calleja, Theobald & Harvey, 2012).
– This study also measured physical activities using the 3-DPAR, which was validated by Han & Dinger (2009) in a study comparing the 3-DPAR and the 7-DPAR with the accelerometer. Results showed that the 3-DPAR was more accurate in measuring adolescents’ levels of physical activity.
– The 24 hr dietary recall (p.5, paragraph 1) is a validated tool as found by a systematic review undertaken by (Tabacchi, Amodio, Pasquale, Bianco, Jemni & Mammina, 2014) on the validation and reproducibility of dietary assessment methods in high school children.
-As for the New Move survey, the author stated that it has been pilot-tested by the author on 48 adolescents. At such, a literature search was conducted in a bid to search for its validation study but to no avail. Given that no validation study was found for the New Moves survey, it is quite likely that this tool is not valid.
(Q2) Were data collection tools shown to be reliable?
1. Yes
2. No
3. Can’t tell

Provide your explanation:
Reliability refers the reproducibility of the results that does not take its specificity and sensitivity into account (Gordis, 2013). In this case, the BMI, 3-DPAR, 24 HR dietary recall and the New Moves survey are all measuring what they seek to measure hence if properly undertaken, the results would be replicable. However, Gordis (2013) stated that it is important to consider intrasubject variability (variables that are caused by human characteristics), intraobserver variation (differences as a result of subjectivity) and interobserver variation (no two examiners can obtain exactly the same results).
In this case, the calculation for BMI is weight divided by height multiplied by height (in meters).
In this case study, the validity of the calculations for BMI is dependent on
– whether or not the height and weight was measured accurately – is it weighing scale caliberated to zero to prevent errors? Have they ensured that they measured the participants without shoes and items in pockets?
– the condition in which weight was measured – was measurements taken before or after meal time, pre or post exercise?
– What time of the day were the measurements taken (such as early morning or noon time)(Gordis, 2013)?
The literature also stated that the study spanned from the autumn in 2007 to the following spring (p.3, paragraph 3) hence there would be thick clothing worn by participants, which could affect the accuracy of the weight measurement thus also affecting the accuracy of the BMI. At such, have they included the thick clothings in the weight measurement? As this study did not offer a clear description about the conditions in which the participants’ weight was measured, the accuracy of the height, weight and BMI cannot be ascertained.

Another assessment tool used in this study is the 3-DPAR is a survey that requires participants to self-report their physical activities (p.5, paragraph 1). Due to this, the reliability of the results could be affected by
• difficulties in differentiating the intensity of the activities,
• difficulties in recalling the duration of each activity,
• the survey involving some days that are more structured than others (such as a schooling day) and when more activities are undertaken on certain days of the week (such as weekends) as these are suggested to be easier to recall (Han & Dinger, 2009).

As for the 24hr dietary recall method (p. 5, paragraph 1), it is also a survey that relies on self-reporting hence it is also prone to
– misreporting and under-reporting because of underestimating energy intake (Poslusna, Ruprich, de Vries, Jakubikova & van’t Veer, 2009; Bornhorst, Huybrechts, Ahrens, Eiben & Michels, 2013).
– Not taking into consideration the times where intake is significantly higher or lower due, such as when they are unwell (Bornhorst et al., 2013).

– As for the New Moves survey, it is a set of questionnaires on food intake, level of physical activity and sedentary lifestyle and self-perception that also requires self-reporting and recalling (Nequmark-Sztainer, Story, Flattum, Friend, Hannan. Bauer,…& Petrich, 2009). At such, it is also at risk of recall and reporting bias as with the above-mentioned surveys.
RATE THIS SECTION STRONG MODERATE WEAK
See dictionary 1 2 3
Provide your explanation:
According to the EPHPP dictionary, an assessment tool must have both validity and reliability. In this case, the New moves survey does not seem valid even though the rest were validated. In addition, the reliability of the tools was also fraught with risks of recall biases and human variables (as mentioned above). At such, it appears that both the validity and reliability were not achieved in the study. According to the dictionary, if the answer to Q1 is No, then the rating for data validity is Weak.

F) WITHDRAWALS AND DROP-OUTS
(Q1) Were withdrawals and drop-outs reported in terms of numbers and/or reasons per group?
1. Yes
2. No
3. Can’t tell
4. Not Applicable (i.e. one time surveys or interviews)

(Q2) Indicate the percentage of participants completing the study. (If the percentage differs by groups, record the lowest).
1. 80 -100%
2. 60 – 79%
3. less than 60%
4. Can’t tell
5. Not Applicable (i.e. Retrospective case-control)

RATE THIS SECTION STRONG MODERATE WEAK
See dictionary 1 2 3 Not Applicable
Provide your explanation:
The answer for question 1 is yes but only partial dropouts were accounted for (p. 12) because the literature clearly gave the reasons as to why 433 participants consented but only 356 were enrolled into the study. However, the dropouts that occurred after the enrolment (20 participants) were not clearly accounted for (p. 12). The only information given by the author regarding these portion of dropouts were “concerns due to doing a required urine test and logistic difficulties in getting to the clinic (e.g moved, did not want to miss class)”. At such, we do not know the exact reasons for dropout for these 20 participants, which might have significant impact on the study results because we do not know how many of dropouts were ‘missing in random’ or ‘not missing in random’ (Higgins & Green, 2011). If the reasons were due to ‘missing in random’, at least we know that these data may not be not be important and that the analysis made based on the rest of the available data would tend to have reliability despite having a smaller sample size (Higgins & Green, 2011). However, this information was not given hence there are uncertainties.

As for question 2, the literature stated that 177 from the intervention group and 159 from the control group completed the follow-up evaluation. This gives us a total of 336 participants. 336/433 x 100% = 77.5% therefore the answer is 60-79%.

As this study had a small sample size, dropouts were not totally accounted for and the completion rate is 77.5%, the reliability of the data becomes questionable.
According to the EPHPP dictionary, if the response for question 1 is Yes and question 2 is 60-79%, the total rating for this column would be Moderate.

G) INTERVENTION INTEGRITY
(Q1) What percentage of participants received the allocated intervention or exposure of interest?
1. 80 -100%
2. 60 – 79%
3. less than 60%
4. Can’t tell

Provide your explanation:
The answer is 100% because the literature stated “girls in both the intervention and control schools participated in an all-girls physical education class during the first semester of the school year” (p. 3, paragraph 1). This sentence also indicated that the normal physical education classes in the participating schools were not an all-girls’ class to begin with. At such, giving the all–girls physical education class to the control schools counted as an intervention.
(Q2) Was the consistency of the intervention measured?
1. Yes
2. No
3. Can’t tell

Provide your explanation:
Yes, because the study used Cronbach alpha, a tool for measuring internal consistency and correlation among answers in the assessment tool as well as the correlation between items using a scale from 0 to 1(Connelly, 2011). The closer a Cronbach alpha value is to 1, the more it reflects consistency between items and low errors in measurements (Connelly, 2011).

(Q3) Is it likely that subjects received an unintended intervention (contamination or co-intervention) that may influence the results?
1. Yes
2. No
3. Can’t tell

Provide your explanation:
Yes, because the control group also received an all-girls physical education class as evidenced by the statement: “the control group also received an intervention (ie. an all girls’ class composed of girls with sedentary lifestyles)” (p7, paragraph 3). This sentence suggested that there was an intention to affect the study results in such a way that it favours the intervention over control.
H) ANALYSES
(Q1) Indicate the unit of allocation (circle one)
community organization / institution practice / office individual
(Q2) Indicate the unit of analysis (circle one)
community organization / institution practice / office individual

Provide your explanation to Q1 & Q2:
For Q1, the unit of allocation is institution practice because the participants are group of girls which are randomized in term of schools and not individually (p. 2, paragraph 4). According to Higgins et al. (2011), cluster randomised trials are used to randomised schools, villages or families with the intention of analysing the group effects of the intervention. This intention could be reflected through the authors stating that randomisation of the schools into control and intervention group allows the New Moves program to be evaluated (p. 3, paragraph 1).
As for Q2, the unit of analysis is office individual as outcome measures such as percentage body fats, BMI, physical activities (p.1, paragraph 6) has to be measured individually, in which the participants’ measurements were taken at baseline, post-class and at follow-up (p5, paragraph 2).
(Q3) Are the statistical methods appropriate for the study design?
1. Yes
2. No
3. Can’t tell

Provide your explanation:
According to Centre for Evidence-based Medicine (2014), the results for therapy studies are often presented as dichotomous results (either it happen or not happen, yes or no), which are measureable by relative risk (RR), absolute risk reduction (ARR), relative risk reduction (RRR) and Numbers needed to treat (NNT). However, the literature did not explain which method of calculation was employed hence it is uncertain which one of the above calculations were being made.
However, the literature mentioned about measuring p-values (p.5, paragraph 2), which was used calculate the effect of intervention and to prove against a null hypothesis (Higgins & Green, 2012). According to Higgins & Green (2012), the confidence intervals (CI) must also be calculated because the statistical analysis consists of the CI and the P-values, which are interpreted together. However, the literature did not mention about the CI for each of its interventions as well. As the study results appeared to be ambiguous, the statistical methods could not be ascertained.
(Q4) Is the analysis performed by intervention allocation status (i.e. intention to treat) rather than the actual intervention received?
1. Yes
2. No
3. Can’t tell

Provide your explanation:
Can’t tell, because while there is no evidence that the study was calculating NNT due to the study results being expressed as decimals instead of whole numbers (Higgins & Green, 2011), the study also suggested that it factored in those participants who were lost to follow-up. This is evidenced by the statement “ n=182 girls in the intervention condition and 174 girls in the control condition, although numbers may vary for individual analyses due to missing values” (p.18), in which the diagram in p. 12 showed that these were the number of participants who were enrolled into the class. If they were not factored in, the numbers used should be 177 from the intervention group and 159 from the control group (p.12).

GLOBAL RATING
COMPONENT RATINGS
Please transcribe the information from the gray boxes on pages 1-4 onto this page. See dictionary on how to rate this section.

A SELECTION BIAS STRONG MODERATE WEAK
1 2 3
B STUDY DESIGN STRONG MODERATE WEAK
1 2 3
C CONFOUNDERS STRONG MODERATE WEAK
1 2 3
D BLINDING STRONG MODERATE WEAK
1 2 3
E DATA COLLECTION METHOD STRONG MODERATE WEAK
1 2 3
F WITHDRAWALS AND DROPOUTS STRONG MODERATE WEAK
1 2 3 Not Applicable

GLOBAL RATING FOR THIS PAPER (circle one):
1 STRONG (no WEAK ratings)
2 MODERATE (one WEAK rating)
3 WEAK (two or more WEAK ratings)
Discuss now your report with your partner working through each item and the epidemiological principles.

With both reviewers discussing the ratings:
Is there a discrepancy between the two reviewers with respect to the component (A-F) ratings?
No Yes
If yes, indicate the reason for the discrepancy
1. Oversight
2. Differences in interpretation of criteria
3. Differences in interpretation of study

Describe what happened when you exchanged your drafts and the describe outcome of the discussion (you may describe what you learned during the process):

If you were unable to complete the above comparison, please describe the reason and state the risk of failing to undertake a comparative assessment after initial independent assessment.
Final decision of both reviewers (circle one):
1 STRONG
2 MODERATE
3 WEAK
Provide your explanation:
Results:
How large was the effect of the intervention? (consider the outcomes measured, whether the primary outcome is clearly specified, and the key results for each outcome)

Provide your explanation:
Your overall conclusions about this study:
Considering both the trustworthiness and outcomes of the study, make a brief overall conclusion.
Provide your explanation:

References: (may be in addition to the 3,500 word limit

Black, M. H., Smith, N., Porter, A. H., Jacobsen, S. J., & Koebnick, C. (2012). Higher prevalence of obesity among children with asthma. Obesity, 20(5), 1041-1047. doi:10.1038/oby.2012.5

Börnhorst, C., Huybrechts, I., Hebestreit, A., Krogh, V., De Decker, A., Barba, G., . . . IDEFICS and the I.Family consortia. (2014). Usual energy and macronutrient intakes in 2-9-year-old european children. International Journal of Obesity (2005), 38 Suppl 2(S2), S115. doi:10.1038/ijo.2014.142

Centre for Evidenced-based Medicine. (2014). Therapy/RCT: critical appraisal sheet. Retrieved from http://www.cebm.net/critical-appraisal/

Connelly, L. M. (2011). Cronbach’s alpha. Medsurg Nursing, 20(1), 45-45, 44. Retrieved from http://search.proquest.com/docview/851871291?accountid=13380

Dinsa, G. D., Goryakin, Y., Fumagalli, E., & Suhrcke, M. (2012). Obesity and socioeconomic status in developing countries: A systematic review. Obesity Reviews, 13(11), 1067-1079. doi:10.1111/j.1467-789X.2012.01017.x
Effective Public Health Practice Project. (2009). Quality Assessment tool for quantitative studies dictionary. Retrieved from www.ephpp.ca/PDF/QADictionary_dec2009.pdf

Estes, M. E. Z., Calleja, P., Theobald, K., & Harvey, T. (2013). Health assessment and physical examination. South Melbourne, Vic: Cengage Learning Australia.

Glickman, S. G., Marn, C. S., Supiano, M. A., & Dengel, D. R. (2004). Validity and reliability of dual-energy X-ray absorptiometry for the assessment of abdominal adiposity. Journal of Applied Physiology, 97(2), 509-514. doi:10.1152/japplphysiol.01234.2003

Gordis, L. (2013). Epidemiology. London: Saunders.

Halliday, J., Palma, C., Mellor, D., Green, J., & Renzaho, A. (2014; 2013). The relationship between family functioning and child and adolescent overweight and obesity: A systematic review. International Journal of Obesity, 38(4), 480-493. doi:10.1038/ijo.2013.213

Han, J. L., & Dinger, M. K. (2009). Validity of a self-administered 3-day physical activity recall in young adults. American Journal of Health Education, 40(1), 5-13. doi:10.1080/19325037.2009.10599073

Higgins J. P. T & Green S. (2011). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration. Retrieved from www.cochrane-handbook.org.

Nequmark-Sztainer, D., Story, M., Flattum, C., Friend, S., Hannan. ., Bauer, K., …& Petrich, C. (2009). New Moves: an alternative physical education just for girls. Retrieved from http://www.newmovesonline.com/index.html

Poslusna, K., Ruprich, J., de Vries, J. H. M., Jakubikova, M., & van’t Veer, P. (2009). Misreporting of energy and micronutrient intake estimated by food records and 24 hour recalls, control and adjustment methods in practice. British Journal of Nutrition, 101(S2), S73-S85. doi:10.1017/S0007114509990602

Rutkowski, E. M., & Connelly, C. D. (2011). Obesity risk knowledge and physical activity in families of adolescents. Journal of Pediatric Nursing, 26(1), 51-57. doi:10.1016/j.pedn.2009.12.069

Sutherland, E. R. (2014). Linking obesity and asthma. Annals of the New York Academy of Sciences, 1311(1), 31-41. doi:10.1111/nyas.12357

Tabacchi, G., Amodio, E., Di Pasquale, M., Bianco, A., Jemni, M., & Mammina, C. (2014; 2013). Validation and reproducibility of dietary assessment methods in adolescents: A systematic literature review. Public Health Nutrition, 17(12), 2700-2714. doi:10.1017/S1368980013003157

Upton, P., Taylor, C., Erol, R., & Upton, D. (2014). Family-based childhood obesity interventions in the UK: A systematic review of published studies. Community Practitioner : The Journal of the Community Practitioners’ & Health Visitors’ Association, 87(5), 25-29.

Van Sluijs, E. M. F., Kriemler, S., & McMinn, A. M. (2011). The effect of community and family interventions on young people’s physical activity levels: A review of reviews and updated systematic review. British Journal of Sports Medicine, 45(11), 914-922. doi:10.1136/bjsports-2011-090187

This worksheet is based upon the EPHPP “Qualitative Assessment Tool for Quantitative Studies” and with permission was modified for teaching purposes.

References
Oxford English Dictonary (n.d). Retreived from: http://www.oxforddictionaries.com/definition/english/institution

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