title: Shift-and-persist: a protective factor for elevated BMI among low-socioeconomic-status children.
abstract: OBJECTIVE
  Low socioeconomic status (SES) is associated with many adverse health outcomes, including childhood overweight and obesity. However, little is understood about why some children defy this trend by maintaining a healthy weight despite living in obesogenic environments. The objective of this study is to test the hypothesis that the psychological strategy of "shift-and-persist" protects low-SES children from overweight and obesity. Shift-and-persist involves dealing with stressors by reframing them more positively while at the same time persisting in optimistic thoughts about the future.
  
  
  METHODS
  Middle school children (N = 1,523, ages 9-15) enrolled in a school-based obesity prevention trial completed health surveys and physical assessments. Multiple linear regression analysis was used to examine the role of SES, shift-and-persist strategies, and their interaction on BMI z-scores, while controlling for student race/ethnicity, gender, and reported diet and physical activity.
  
  
  RESULTS
  Among children reporting engaging in less frequent shift-and-persist strategies, lower SES was associated with significantly higher BMI z-scores (P < 0.05). However, among children reporting engaging in more frequent shift-and-persist strategies, there was no association of SES with BMI z-score (P = 0.16), suggesting that shift-and-persist strategies may be protective against the association between SES and BMI.
  
  
  CONCLUSIONS
  Interventions aimed at improving psychological resilience among children of low SES may provide a complementary approach to prevent childhood overweight and obesity among at-risk populations.
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut, USA; CARE: Community Alliance for Research and Engagement, New Haven, Connecticut, USA.
authors.forename: Stacey
authors.initials: S
authors.lastname: Kallem
authors.forename: Amy
authors.initials: A
authors.lastname: Carroll-Scott
authors.forename: Lisa
authors.initials: L
authors.lastname: Rosenthal
authors.forename: Edith
authors.initials: E
authors.lastname: Chen
authors.forename: Susan M
authors.initials: SM
authors.lastname: Peters
authors.forename: Catherine
authors.initials: C
authors.lastname: McCaslin
authors.forename: Jeannette R
authors.initials: JR
authors.lastname: Ickovics
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D005260:Female; D006306:Health Surveys; D006801:Humans; D016014:Linear Models; D008297:Male; D063766:Pediatric Obesity / Q000517:prevention & control / Q000523:psychology*; D011203:Poverty; D012574:Schools; D012923:Social Class; D013315:Stress, Psychological