Advisory Committee Chair
Advisory Committee Members
Date of Award
Degree Name by School
Doctor of Philosophy (PhD) College of Arts and Sciences
Pediatric chronic health conditions (CHCs) prevalence has increased post-COVID- 19, and CHCs affect children’s psychosocial development while representing significant family and societal financial burden. Interventions addressing CHC outcomes and psychosocial sequelae would benefit from examining and targeting biobehavioral and social-structural influences on such outcomes. Chronic inflammation and executive function (EF) deficits represent cross-cutting biobehavioral processes, promising novel targets, are vulnerable to social-structural influences, and common across CHC populations. Pediatric obesity represents a model CHC to examine, given its strong ties to chronic inflammation, EF deficits, health behavior, and SES, in addition to its increased prevalence in the wake of COVID-19. As such, this dissertation delineates and proposes a model of EF and inflammation across CHCs and evaluates the proposed model in the context of pediatric obesity. The biobehavioral and social-structural model of EF and inflammation in CHCs is delineated in the first paper, a conceptual review. The model posits that disease pathophysiology, including chronic inflammation, leads to EF deficits. EF deficits, in turn, hinder engagement in health-promoting behavior that would otherwise address disease pathophysiology and improve outcomes. At the same time, social-structural factors exacerbate outcomes at each step of this cycle. The second and third papers evaluate this iii model in children with and without overweight and obesity via a cross-sectional and pilot longitudinal study. Findings were limited for the influence of SES on biobehavioral processes and showed an unexpected pattern such that higher SES was linked with higher inflammation. When the biobehavioral cycle was evaluated, evidence supported expected links between adiposity and inflammation, and inflammation and EF, with some exceptions. EF was linked with food responsiveness, which was linked with adiposity, but minimal to no associations were observed with other health behaviors. Important findings that were opposite of predictions emerged and significant heterogeneity was observed in the strength of predicted associations, spurring additional research questions. Altogether, preliminary evidence was found for a modifiable biobehavioral cycle that may maintain or mitigate disease outcomes in pediatric obesity, and future research would benefit from reproducing the current pilot study and evaluating interventions designed to target this cycle.
King, Kathryn P., "Towards a Biobehavioral and Social-Structural Model of Inflammation and Executive Function in Pediatric Obesity: A Pilot Longitudinal Study" (2023). All ETDs from UAB. 416.