January 2016  Volume 168 Copyright ª 2016 by Elsevier Inc.

Changes to The A s print-based publishing continues to evolve online, full-year indices are being
replaced by online searching tools and bound volume sets in libraries are nearing
Journal’s volume/ extinction. Therefore, the construct of a calendar year of issues being published in one
issue numbering or two volumes, paginated consecutively, is becoming outdated. As such, The Journal
has made the decision to change the volume/issue numbering system beginning with
scheme this January 2016 issue. In a nod to our increasingly electronic consumption of content,
— Monica L. Helton, BA numbering every issue separately as an independent volume unto itself (ie, each begin-
—William F. Balistreri, MD ning on page 1) is simpler for readers, especially those referencing content. Additionally,
such a numbering system allows our production team to assemble several issues concur-
rently, giving them the flexibility to move forward with production on future issues,
whereas they would otherwise be waiting for the final page number of the previous issue
before beginning the next one. This flexibility for production means faster publication
times for our authors and readers.

Using toy premiums

to target children
— Ivor D. Hill, MB, ChB, MD
E xcessive consumption of calorie-dense fast foods is in part responsible for the
growing number of people in the US who are overweight or obese. In order to
address the problem of obesity, it is necessary to understand the factors that influence
a family’s eating habits. Decisions to eat at fast food restaurants often are driven by
children, but it is not clear to what extent these decisions are influenced by child-
directed marketing. Each year in the US, hundreds of millions of dollars are spent
in child-directed marketing, most of which is in the form of TV advertising. Fast
food companies target children as a means of trying to influence selection of their
products by the family, and a strategy used by many of these companies is to feature
premiums such as toys in their child-directed advertising.
Emond et al hypothesized that greater commercial TV viewing by children would be
associated with greater frequency of visits to fast food restaurants, and that requests by
children to visit those restaurants are related to a desire to collect a toy premium. The
results of their study, published in this issue of The Journal, suggest a correlation be-
tween exposures to child-directed fast food advertising and frequency of visits by the
family to a particular fast food restaurant. In addition, the choice of restaurant appears
to be driven, in part, by the desire of the child to collect a toy. This study had some
limitations, including that it was conducted in a rural setting with a limited number
of fast food restaurants available to the participants. In addition, the precise role of
the toy premium in influencing the child’s decision to request a particular fast food
restaurant needs further clarification. Nevertheless, the results raise serious concerns
about the influence that child-directed marketing has on the eating habits of some
families and the potential role this plays in promoting excessive weight gain.
Article page 158<

Physical activity and

attention
A s parents, teachers, and policy makers have focused on increasing academic perfor-
mance in schools, school administrators have responded by increasing classroom
time in core subjects and decreasing time for physical education and other opportu-
nities for students to be active during the school day. During this same period of time,
— Stephen R. Daniels, MD, PhD
there has been an increase in the prevalence of obesity, as well as an increase in the

1
 prevalence of attention deficit disorder. Some have speculated that decreased time in
school for physical activity, and overall decreased physical activity in general, has actu-
ally decreased attention and performance in school.
In this issue of The Journal, Vanhelst et al report on the results of a cross-sectional
study designed to evaluate the relationship of physical activity and attention in
European adolescents. They found that increased moderate-to-vigorous physical
activity was associated with improved attention capacity after controlling for potential
confounding variables. Because this is a cross-sectional study, it is not possible to
determine if an intervention designed to increase physical activity would result in
increased attention. However, the results of this study suggest the need for such an
interventional study to test that hypothesis.
Article page 126<

BPD dodges multiple

bullets
E vidence-based, pharmacologic interventions to prevent bronchopulmonary
dysplasia (BPD) are limited to caffeine, postnatal steroids, and vitamin A. Of these,
only caffeine has gained wide acceptance, leaving practitioners searching for effective
— Clyde J. Wright, MD therapies to prevent BPD in at-risk infants. In this issue of The Journal, Ballard et al
report a study in which an extremely high-risk group of infants – extremely low gesta-
tional age newborns still requiring mechanical ventilation at 7-14 days of age – were
randomized to repeated doses of surfactant or sham instillation. Of note, all infants
in this trial were receiving inhaled nitric oxide. This trial is unique in that these inter-
ventions – inhaled nitric oxide and repeated surfactant dosing – aimed to address mul-
tiple biologically plausible contributors to the pathogenesis of BPD. These include, but
are not limited to, surfactant dysfuction, pulmonary inflammation, increased blood
vessel resistance, and abnormal endothelial function and lung growth. The authors
found that despite this combined approach, the combined primary outcome of sur-
vival at 36 weeks postmenstrual age without BPD was not different between the con-
trol and intervention groups (31.7 vs 31.3%, respectively). Importantly, the babies
enrolled in this trial are being followed and we await the findings from their neurode-
velopmental assessments in early childhood. The authors are to be congratulated for
taking the first steps towards evaluating in a multifaceted approach to prevent an all
too common, multifactorial disease in a randomized approach. To hit our target of
preventing BPD, it is likely that a similar approach addressing multiple contributing
pathologic factors will be necessary.
Article page 23<

Obesity and sleep

— Stephen R. Daniels, MD, PhD
T he association between sleep quality and duration and obesity is relatively well
known. Obesity is an important cause of obstructive sleep apnea, but disordered
sleep also may have an impact on diet and physical activity, making the inter-relation-
ship potentially complex. Many previous studies in this area have been cross-sectional,
which does not allow elucidation of the temporal relationships. In this issue of The
Journal, Halal et al report the results of a cohort study performed in Brazil in which
children were evaluated at birth and 1, 2, and 4 years of age. They found that sleep
duration of less than 10 hours per night at any follow-up visit was associated with
overweight or obesity at 4 years of age after adjustment for potential confounders.
These results suggest that short sleep duration precedes the abnormal weight gain
and could be causal. Better understanding of the mechanisms by which this relation-
ship may work is needed.
Article page 99<

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