生活品質(quality of life, QoL)是一個多向度的健康指標，並且能有效地幫助健康照護專業人員瞭解個人的整體健康狀況。除了「生活品質」之外，另一個健康照護專業人員關切的議題是「過重」。因此，現在有愈來愈多的文獻探討生活品質和過重之間的關係。然而，縱使現在有許多文獻探討過重孩童的生活品質，目前仍未有研究針對台灣過重孩童的生活品質進行探討。所以，本論文欲用三個研究探討台灣孩童其生活品質和過重之間的相關議題。
研究一評估了一個常用的一般兒童生活品質問卷(Pediatric Quality of Life Inventory 4.0, PedsQL)的心理計量表現。透過方便取樣的方式，共有479位八至十二歲的兒童參與此研究。結果顯示兒童自評的PedsQL在各個分量表以及總量表皆具有良好的內在一致性(Cronbach’s α =.62-.90)、再測信度(intraclass correlation coefficient =.67-.84)。更甚者，經由驗證性因素分析(confirmatory factor analysis, CFA)，兒童自評PedsQL被發現具有良好的建構效度(GFI =.905-.938, TLI =.910-.932, CFI =.921-.944, IFI =.922-.945, RMSEA =.056-.059)。因此，我們認為兒童自評PedsQL是一個具有良好信效度的工具，並適用於之後的研究。
在PedsQL的信效度建立後，研究二使用PedsQL測量過重男孩的生活品質。除此之外，研究二也測量了過重男孩的活動量(physical activity, PA)以及生活品質和活動量之間的關係。十八個過重男孩和十八個正常體重男孩參與研究二。每個男孩均填寫PedsQL並於他們的腰際佩戴加速規(accelerometer)。加速規是用來測量男孩在一周間進行多少分鐘的中強度活動(moderate-to-vigorous PA, MVPA)。結果顯示過重男孩的生活品質(81.04±10.85 vs. 89.67±8.40, p =.012)和中強度活動量分鐘數(735.15±270.32 vs. 938.71±214.65, p =.02)顯著地低於正常體重男孩。除此之外，過重男孩單一周末天的中強度活動量分鐘數顯著地低於其單一周間天的中強度活動量分鐘數(113.19±38.46 vs. 84.61±54.67, p =.016)。而且，過重男孩的周末活動量和其生活品質間有一正向的邊緣顯著相關(r =.47, p =.06)。經由上述結果，我們建議健康照護專業人員可以設計相關的活動量計畫給過重孩童以增進其周末活動量。
研究三瞭解家長和兒童間對兒童生活品質感受的差異。共有187對八至十二歲孩童和其家長參與研究三，每位孩童和每位家長都填寫PedsQL。和研究二相同的結果是，肥胖孩童的自評生活品質低於正常體重孩童(82.95±14.80 vs. 87.60±10.29, p <.05)。除此之外，研究三更發現肥胖孩童的自評生活品質低於家長代評的生活品質(82.95±14.80 vs. 86.35±10.91, p <.05)。此項結果顯示肥胖孩童的家長對於其孩童面臨的生活品質困境並不是很瞭解。
總結以上結果，台灣肥胖孩童如同其他國家的肥胖孩童一般，有生活品質低落的情形。而活動量似乎是益於生活品質的因素，健康照護專業人員應鼓勵過重孩童增加活動量以促進其生活品質表現。另一方面，尤於肥胖孩童的家長對於其孩童的生活品質表現瞭解不深，因此有必要協助家長的瞭解，以益於肥胖孩童的生活品質表現。

Quality of life (QoL), a multi-dimensional health index, is important to health professionals for understanding a person’s overall health status. Another important issue for health professionals is the risk factors for being overweight. Therefore, more and more studies examine the relationship between QoL and being overweight. However, although many studies discuss the QoL of overweight children, no studies have been done in Taiwan. Therefore, this dissertation, which includes three studies on the QoL of overweight children, aimed to probe the information of QoL and being overweight in Taiwanese children.
The first study evaluated the psychometric properties of one broadly used generic pediatric QoL instrument, the Pediatric Quality of Life Inventory 4.0 (PedsQL). A convenience sample of 8- to 12-year-old children was recruited (n = 479). The results showed that the internal consistency of child-reported PedsQL was satisfactory for all subscales and for the total score (Cronbach’s α =.62-.90), and had acceptable test-retest reliability (intraclass correlation coefficient =.67-.84). Moreover, the result of confirmatory factor analysis (GFI =.905-.938, TLI =.910-.932, CFI =.921-.944, IFI =.922-.945, RMSEA =.056-.059) confirmed the construct validity for child-reported PedsQL. Therefore, I conclude that child-reported PedsQL is a reliable and valid instrument for measuring children’s QoL.
After the PedsQL was validated, the second study used it to measure QoL for overweight boys in Taiwan. The physical activity (PA) level and the association between QoL and PA were also examined. Eighteen overweight boys and 18 of their normal-weight counterparts were recruited. Each boy filled out the PedsQL and wore an accelerometer on his waist. The accelerometers were used to measure how many minutes of moderate-to-vigorous PA (MVPA) the participants engaged in for one whole week. The results showed that overweight boys reported significantly lower QoL (81.04 ± 10.85 vs. 89.67 ± 8.40, p =.012) and significantly less MVPA (735.15 ± 270.32 minutes vs. 938.71 ± 214.65, p =.02) than normal-weight boys did. In addition, overweight boys reported significantly more MVPA on weekdays than on weekend days (113.19 ± 38.46 vs. 84.61 ± 54.67, p =.016). Moreover, a positive and marginally significant correlation (r =.47, p =.06) was found between QoL and weekend PA in overweight boys. Therefore, health professionals should consider designing PA programs for overweight children to engage in more PA on weekends.
The third study was done to further understand the differences between child-reported and parent-reported QoL in obese children. One hundred eighty-seven dyads of 8- to 12-year old children (60 obese and 127 normal-weight) completed child-reported PedsQL and one of their parents completed a parent-reported PedsQL. In agreement with the second study, the obese children rated their QoL lower than their normal-weight counterparts did (82.95 ± 14.80 vs. 87.60 ± 10.29, p <.05). Moreover, the obese children also rated their QoL lower than their parents did (82.95 ± 14.80 vs. 86.35 ± 10.91, p <.05). The results suggest that parents of obese children were insensitive to their children’s QoL difficulties.
In summary, overweight children in Taiwan say that their QoL is lower than that of normal-weight children. In addition, PA is a potential positive factor related to overweight children’s QoL, and health professionals should encourage overweight children to engage in more PA. In addition, parents of obese children seemed not to be aware of the effects of obese on their children’s QoL. Therefore, helping parents to understand their obese children’s difficulties may also be beneficial for obese children.

Alder, P. A., Kless, S., & Adler, P. (1992). Socialization to gender roles: Popularity among elementary school boys and girls. Sociology of Education, 65(3), 169-188.
Anastasi, A. (1982). Psychological testing (5th ed.). New York, NY: Macmillan.
American Educational Research Association, American Psychological Association, and the National Council on Measurement in Education (1999). Standards for Educational and Psychological Testing. Washington, DC: APA.
American Occupation Therapy Association. (2002). Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 56, 609-639.
Basu, D. (2004). Quality-Of-Life Issues in Mental Health Care: Past, Present, and Future. The German Journal of Psychiatry, 7(3), 35-43.
Blanchard, S. A. (2006). AOTA's statement on obesity. American Journal of Occupational Therapy, 60(6), 680.
Bowling, A. (1996). The effects of illness on quality of life: findings from a survey of household in Great Britain. Journal of Epidemiology and Community Health, 50(2), 149-155.
Chan, K. S., Mangione-Smith, R., Burwinkle, T. M., Rosen, M., & Varni, J. W. (2005). The PedsQL: Reliability and validity of the short-form generic core scales and Asthma Module. Medical Care, 43, 256-265.
Chan, L. F. P., Chow, S. M. K., & Lo, S. K. (2005). Preliminary validation of the Chinese version of the Pediatric Quality of Life Inventory. International Journal of Rehabilitation Research, 28, 219-227.
Chao, C. C., Chen, S. H., Wang, C. Y., Wu, Y. C., & Yeh, C. H. (2003). Psychological adjustment among pediatric cancer patients and their parents. Psychiatry and Clinical Neurosciences, 57, 75-81.
Chang, H. J., Lin, M. F., & Lin, K. C. (2007). The mediating and moderating roles of the cognitive triad on adolescent suicidal ideation. Nursing Research, 56, 252-259.
Chen, J.-L., & Kennedy, C. (2005). Cultural variations in children’s coping behaviour, TV viewing time, and family functioning. International Nursing Review, 52, 186-195.
Chen, W., Lin, C. C., Peng, C. T., Li, C. I., Wu, H. C., Chiang, J., et al. (2002). Approaching healthy body mass index norms for children and adolescents from health-related physical fitness. Obesity Review, 3(3), 225-232.
Chen, X., Sekine, M., Hamanishi, S., Wang, H., Gaina, A., Yamagami, T., et al. (2005). Lifestyles and health-related quality of life in Japanese school children: A cross-sectional study. Preventive Medicine, 40(6), 668-678.
Child Welfare League Foundation. (2011). [Love children 333: A survey of children perceived family warmth.]. [Article in Chinese]. Child Welfare League Foundation Bimonthly Journal, 108, 4-5. http://www.children.org.tw/upload/doc/138.pdf
Chu, N.-F. (2001). Prevalence and trends of obesity among school children in Taiwan--the Taipei Children Heart Study. International Journal of Obesity, 25(2), 170-176.
Chu, N.-F., & Pan, W.-H. (2007). Prevalence of obesity and its comorbidities among schoolchildren in Taiwan. Asia Pacific Journal of Clinical Nutrition, 16(S2), 601-607.
Chuh, A. A. T. (2003). Validation of a Cantonese version of the Children's Dermatology Life Quality Index. Pediatric Dermatology, 20, 479-481.
Clark, F., Reingold, F. S., & Salles-Jordan, K. (2007). Obesity and occupational therapy (position paper). American Journal of Occupational Therapy, 61(6), 701-703.
Cole, T. J., Bellizzi, M. C., Flegal, K. M., & Dietz, W. Z. (2000). Establishing a standard definition for child overweight and obesity worldwide: international survey. British Medical Journal, 320(7244), 1240-1243.
Corder, K., Brage, S., Ramachandran, A., Snehalatha, C., Wareham, N., & Ekelund, U. (2007). Comparison of two Actigraph models for assessing free-living physical activity in Indian adolescents. Journal of Sports Sciences, 25(14), 1607-1611.
Davis, S. N. (2003). Sex stereotypes in commercials targeted toward children: A content analysis. Sociological Spectrum, 23, 407-424.
Deforche, B., De Bourdeaudhuij, I., D’hondt, E., & Cardon, G. (2009). Objectively measured physical physical activity, physical activity related personality and body mass index in 6- to 10-yr-old children: A cross-sectional study. International Journal of Behavioral Nutrition and Physical Activity, 6, 25.
Eiser, C., & Morse, R. (2001). Can parents rate their child’s health-related quality of life? Resutls of a systematic review. Quality of Life Research, 10(4), 347-357.
Ekelund, U., Åman, J., Yngve, A., Renman, C., Westerterp, K., & Sjöström, M. (2002). Physical activity but not energy expenditure is reduced in obese adolescents: A case-control study. American Journal of Clinical Nutrition, 76, 935-941.
Erhart, M., Ellert, U., Kurth, B. M., & Ravens-Sieberer, U. (2009). Measuring adolescents' HRQoL via self reports and parent proxy reports: An evaluation of the psychometric properties of both versions of the KINDL-R instrument. Health and Quality of Life Outcomes, 7:77.
European Medicines Agency. (2005). Committee for Medicinal Products for Human Use (CHMP). Reflection Paper on the Regulatory Guidance for the Use of Health-Related Quality of Life (HRQL) Measures in the Evaluation of Medicinal Products. Retrieved June 4th, 2012, from http://www.emea.europa.eu/docs/en_GB/document_library/Scientific_guideline/2009/09/WC500003637.pdf
Freedson, P., Pober, D., & Janz, K. F. (2005). Calibration of accelerometer output for children. Medicine & Science in Sports & Exercise, 37(11 Suppl), S523-530.
Friedlander, S. L., Larkin, E. K., Rosen, C. L., Palermo, T. M., & Redline, S. (2003). Decreased quality of life associated with obesity in school-aged children. Archives of Pediatric & Adolescent Medicine, 157(12), 1206-1211.
Hartmann, T., Zahner, L., Puhse, U., Puder, J. J., & Kriemler, S. (2010). Effects of a school-based physical activity program on physical and psychosocial quality of life in elementary school children: A cluster-randomized trial. Pediatric Exercise Science,22, 511-522.
Holm, M. B., Rogers, J. C., & Stone, R. G. (2008). Person-task-environment interventions: A decision-making guide. In E. B. Crepeau, E. S. Cohn, & B. A. Boyt Schell (Eds.), Willard & Spackman’s Occupational Therapy (10th ed., pp. 460-490). Philadelphia, PA: Lippincott Williams & Wilkins.
Hoyle, R. H., & Panter, A. T. (1995). Writing about structural equation modeling. In R. H. Hoyle (Ed.), Structural equation modeling: Concepts, issues, and application. Thousand Oaks, CA: Sage.
Hughes, A. R., Farewell, K., Harris, D., & Reilly, J. J. (2007). Quality of life in a clinical sample of obese children. International Journal of Obesity, 31(1), 39-44.
Hughes, A. R., Henderson, A., Ortiz-Rodriguez, V., Artinou, M. L., & Reilly, J. J. (2006). Habitual physical activity and sedentary behaviour in a clinical sample of obese children. International Journal of Obesity, 30(10), 1494-1500.
Ingerski, L. M., Janicke, D. M, & Silverstein, J. H. (2007). Brief report: quality of life in overweight youth - the role of multiple informants and perceived social support. Journal of Pediatric Psychology, 32(7), 869-874.
Janicke, D. M., Marciel, K. K., Ingerski, L. M., Novoa, W., Lowry, K. W., Sallinen, B. J., et al. (2007). Impact of psychosocial factors on quality of life in overweight youth. Obesity, 15(7), 1799-1807.
Kim, C., Laroche, M., & Tomiuk, M. A. (2004). The Chinese in Canada: A study in ethnic change with emphasis on gender roles. Journal of Social Psychology, 144, 5-29.
Kline, R. B. (1998). Principles and practice of structural equation modeling. New York, NY: Guilford Press.
Kobayashi, K., & Kamibeppu, K. (2010). Measuring quality of life in Japanese children: Development of the Japanese version of the PedsQL. Pediatrics International, 52, 80-88.
Kolotkin, R. L., Zeller, M., Modi, A. C., Samsa, G. P., Quinlan, N. P., Yanovski, J. A., et al. (2006). Assessing weight-related quality of life in adolescents. Obesity, 14(3), 448-457.
Lazzer, S., Boirie, Y., Bitar, A., Montaurier, C., Vernet, J., Meyer, M., et al. (2003). Assessment of energy expenditure associated with physical activities in free-living obese and nonobese adolescents. American Journal of Clinical Nutrition, 78(3), 471-479.
Lee, C.-F., Chien, L.-Y., Ko, Y.-L., Chou, Y.-H., Tai, C.-J., & Liou, Y.-M. (2005). Development and psychometric properties of the Chinese language version of the TAPQOL: A health-related quality of life instrument for preschool children. International Journal of Nursing Studies, 42, 457-465.
Lee, P.-H., Chang, L.-I., & Ravens-Sieberer, U. (2008). Psychometric evaluation of the Taiwanese version of the Kiddo-KINDL generic children’s health-related quality of life instrument. Quality of Life Research, 17, 603-611.
Lee, P.-H., Chang, W.-Y., Liou, T.-H., & Chang, P.-C. (2006). Stage of exercise and health-related quality of life among overweight and obese adults. Journal of Advanced Nursing, 53(3), 295-303.
Limbers, C. A., Newman, D. A., & Varni, J. W. (2009). Factorial invariance of child self-report across race/ethnicity groups: A multigroup confirmatory factor analysis approach utilizing the PedsQL 4.0 generic core scales. Annals of Epidemiology, 19, 575-581.
Limbers, C. A., Newman, D. A., & Varni, J. W. (2008). Factorial invariance of child self-report across age subgroups: a confirmatory factor analysis of ages 5 to 16 years utilizing the PedsQL 4.0 generic core scales. Value in Health, 11, 659-668.
Lin, C.-C., & Huang, T.-C. (2009). [Cram culture]. [Article in Chinese.] Ren Wen Ji She Hui Ke Xue Ji Kan [Journal of Social Sciences and Philosophy], 21(4), 587-643.
Lin, C.-Y., Luh, W.-M., Yang, A.-L., Su, C.-T, Wang, J.-D., & Ma, H.-I. (2012a). Psychometric properties and gender invariance of the Chinese version of the self-report Pediatric Quality of Life Inventory Version 4.0: Short form is acceptable. Quality of Life Research, 21(1), 177-182.
Lin, C.-Y., Su, C.-T., & Ma, H.-I. (2012b). Physical activity patterns and quality of life of overweight boys: A preliminary study: A Preliminary Study. Hong Kong Journal of Occupational Therapy,22(1), 31-37.
Liu, Y.-H. (2008). [Domestic study on private supplementary tutoring during the past decade: Review and outlook]. [Article in Chinese.] Wei Lai Yu Fa Zhan [Future and Development], 9, 45-48.
Modi, A. C., & Zeller, M. H. (2008). Validation of a parent-proxy, obesity-specific quality-of-life measure: Sizing them up. Obesity, 16(12), 2624-2633.
Miró, A. H. a. J. (2008). Development and psychometric evaluation of a Catalan self- and interviewer-administered version of the Pediatric Quality of Life Inventory Version 4.0. Journal of Pediatric Psychology, 33, 63-79.
Mosley, L. J., Jedlicka, J. S., Lequieu, E., & Taylor, F. D. (2008). Obesity and occupational therapy practice. OT practice, 13(7), 8-15.
Nader, P. R., Bradley, R. H., Houts, R. M., McRitchie, S. L., & O'Brien, M. (2008). Moderate-to-vigorous physical activity from ages 9 to 15 years. Journal of American Medical Association, 300(3), 295-305.
Neumark-Sztainer, D. (2011). Obesity and body image in youth. In T. F. Cash & L. Smolak (Eds). Body image: A handbook of science, practice, and prevention (2nd ed., pp. 180-188). New York, NY: Guilford Press.
Ng, J. Y. Y., Landgraf, J. M., Chiu, C. S. W., Cheng, N. L., & Cheung, Y. F. (2005). Preliminary evidence on the measurement properties of the Chinese version of the Child Health Questionnaire, parent form (CHQ-pF50) and child form (CHQ-CF87). Quality of Life Research, 14, 1775-1781.
Nunnally, J. (1978). Psychometric theory (2nd ed.). New York: McGraw-Hill.
Ogden, C. L., Carroll, M. D., Curtin, L. R., Lamb, M. M., & Flegal, K. M. (2010). Prevalence of high mass index in US children and adolescents, 2007-2008. Journal of the American Medical Association, 303(3), 242-249.
Oliver, M., Schofield, G., & McEvoym, E. (2006). An integrated curriculum approach to increasing habitual physical activity in children: A feasibility study. Journal of School Health, 76(2), 74-79.
Patrick, K., Norman, G. J., Calfas, K. J., Sallis, J. F., Zabinski, M. F., Rupp, J., et al. (2004). Diet, physical activity, and sedentary behaviors as risk factors for overweight in adolescence. Archives of Pediatrics & Adolescent Medicine, 158(4), 385-390.
Petersen, S., Hagglof, B., Stenlund, H., & Bergstrom, E. (2009). Psychometric properties of the Swedish PedsQL, Pediatric Quality of Life Inventory 4.0 generic core scales. Acta Paediatrica, 98, 1504-1512.
Pinhas-Hamiel, O., Singer, S., Pilpel, N., Fradkin, A., Modan, D., & Reichman, B. (2006). Health-related quality of life among children and adolescents: Associations with obesity. International Journal of Obesity, 30(2), 267-272.
Puyau, M. R., Adolph, A. L., Vohra, F. A., & Butte, N. F. (2002). Validation and calibration of physical activity monitors in children. Obesity Research, 10(3), 150-157.
Puhl, R. M., & Latner, J. D. (2007). Stigma, obesity, and the health of the nation’s children. Psychological Bulletin, 133(4), 557-580.
Portney, L. G., & Watkins, M. P. (2000). Foundations of Clinical Research: Applications to Practice, 2nd ed. Upper Saddle River, NJ: Prentice Hall Health.
Ravens-Sieberer, U., & Bullinger, M. (2000). KINDL-Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents Revised Version Manual.
Ravens-Sieberer, U., Erhart, M., Wille, N., Wetzel, R., Nickel, J., & Bullinger, M. (2006). Generic health-related quality-of-life assessment in children and adolescents: Methodological considerations. Pharmacoeconomics, 24(12), 1199-1220.
Ricciardelli, L. A., & McCabe, M. P. (2011). Body image development in adolescent boys. In T. F. Cash & L. Smolak (Eds). Body image: A handbook of science, practice, and prevention (2nd ed., pp. 85-92). New York, NY: Guilford Press.
Riddoch, C. J., Bo Andersen, L., Wedderkopp, N., Harro, M., Klasson-Heggebo, L., Sardinha, L. B., et al. (2004). Physical activity levels and patterns of 9- and 15-yr-old European children. Medicine & Science in Sports & Exercise, 36(1), 86-92.
Robitail, S., Simeoni, M. C., Ravens-Sieberer, U., Bruil, J., & Auquier, P. (2007). Children proxies' quality-of-life agreement depended on the country using the European KIDSCREEN-52 questionnaire. Journal of Clinical Epidemiology,60(5), 469-478.
Rosner, B. (2006). Fundamentals of Biostatistics, 6th ed. Belmont, CA: Thomson Books/Cole; pp. 613-617.
Salek, S. (1998). Compendium of quality of life instruments. Chichester, NY: John Wiley & Sons.
Saw, S. M., Nieto, F. J., Katz, J., & Chew, S. J. (1999). Estimating the magnitude of close-up work in school-age children: a comparison of questionnaire and diary instruments. Ophthalmic Epidemiology, 6(4), 291-301.
Schwimmer, J. B., Burwinkle, T. M., & Varni, J. W. (2003). Health-related quality of life of severely obese children and adolescents. Journal of the American Medical Association, 289(14), 1813-1819.
Shaya, F. T., Flores, D., Gbarayor, C. M., & Wang, J. (2008). School-based obesity interventions: A literature review. Journal of School Health, 78(4), 189-196.
Shoup, J. A., Gattshall, M., Dandamudi, P., & Estabrooks, P. (2008). Physical activity, quality of life, and weight status in overweight children. Quality of Life Research, 17(3), 407-412.
Stevanovic, D. (2009). Serbian KINDL questionnaire for quality of life assessments in healthy children and adolescents: Reproducibility and construct validity. Health and Quality of Life Outcomes, 7:79.
Swallen, K. C., Reither, E. N., Haas, S. A., & Meier, A. M. (2005). Overweight, obesity and health-related quality of life among adolescents: The national longitudinal study of adolescent health. Pediatrics, 155(2), 340-347.
Sweeting, H. N. (2008). Gendered dimensions of obesity in childhood and adolescence. Nutrition Journal, 7, 1.
Treuth, M. S., Catellier, D. J., Schmitz, K. H., Pate, R. R., Elder, J. P., McMurray, R. G., et al. (2007). Weekend and weekday patterns of physical activity in overweight and normal-weight adolescent girls. Obesity, 15(7), 1782-1788.
Treuth, M. S., Hou, N., Young, D. R., & Maynard, L. M. (2005). Accelerometry-measured activity or sedentary time and overweight in rural boys and girls. Obesity Research, 13(9), 1606-1614.
Trost, S. G., Kerr, L. M., Ward, D. S., & Pate, R. R. (2001). Physical activity and determinants of physical activity in obese and non-obese children. International Journal of Obesity, 25(6), 822-829.
Trost, S. G., Pate, R. R., Freedson, P. S., Sallis, J. F., & Taylor, W. C. (2000). Using objective physical activity measures with youth: How many days of monitoring are needed? Medicine & Science in Sports & Exercise, 32(2), 426-431.
Trost, S. G., Ward, D. S., Moorehead, S. M., Watson, P. D., Riner, W., & Burke, J. R. (1998). Validity of the computer science and applications (CSA) activity monitor in children. Medicine & Science in Sports & Exercise, 30(4), 629-633.
Upton, P., Lawford, J., & Eiser, C. (2008). Parent-child agreement across child health-related quality of life instruments: A review of the literature. Quality of Life Research, 17(6), 895-913.
U.S. Department of Health and Human Services. (2008). 2008 Physical Activity Guidelines for Americans. Retrieved June 4th, 2012, from http://www.health.gov/paguidelines
U. S. Food and Drug Administration. (2009). Guidance for industry. Patient-Reported Outcome Measures: Use in Medical Product Development. Retrieved June 4th, 2012, from http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM193282.pdf
Vandenberg, R. J., & Lance, C. E. (2000). A review and synthesis of the measurement invariance literature: Suggestions, practices, and recommendations for organizational research. Organizational Research Methods, 3, 4-70.
Varni, J. W., Burwinkle, T. M., Seid, M., & Skarr, D. (2003). The PedsQL 4.0 as a pediatric population health measure: Feasibility, reliability, and validity. Ambulatory Pediatrics, 3(6), 329-341.
Varni, J. W., Seid, M., Knight, T. S., Uzark, K., & Szer, I. S. (2002). The PedsQL 4.0 Generic Core Scales: sensitivity, responsiveness, and impact on clinical decision-making. Journal of Behavioral Medicine, 25(2), 175-193.
Varni, J. W., Seid, M., & Kurtin, P. S. (2001). PedsQL 4.0: Reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Medical Care,39(8), 800-812.
Varni, J. W., Seid, M., & Rode, C. A. (1999). The PedsQL: Measurement model for the pediatric quality of life inventory. Medical Care, 37, 126-139.
Wang, H.-Y., Cheng, C.-C., Hung, J.-W., Ju, Y.-H., Lin, J.-H., & Lo, S.-K. (2010). Validating the Cerebral Palsy Quality of Life for Children (CP QOL-Child) questionnaire for use in Chinese populations. Neuropsychological Rehabilitation, 20(6), 883-898.
Wertheim, E. H., & Paxton, S. J. (2011). Body image development in adolescent girls. In T. F. Cash & L. Smolak (Eds). Body image: A handbook of science, practice, and prevention (2nd ed., pp. 76-84). New York, NY: Guilford Press.
Wilcock, A. A. (1998). An Occupational Perspective on Health. Thorofare, NJ: Slack.
Williams, J., Wake, M., Hesketh, K., Maher, E., & Waters, E. (2005). Health-related quality of life of overweight and obese children. Journal of the American Medical Association, 293(1), 70-76.
World Health Organization. (1993). Study protocol for the World Health Organization project to develop a Quality of Life assessment instrument (WHOQOL). Quality of Life Research, 2(2), 153-159.
Xu, T., Wu, Z., Yan, Z., Rou, K., & Duan, S. (2010). Measuring health-related quality of life in children living in HIV/AIDS-affected families in rural areas in Yunnan, China: Preliminary reliability and validity of the Chinese version of PedsQL 4.0 generic core scales. Journal of Acquired Immune Deficiency Syndromes, 53 Supplement 1, S111-S115.
Yam, W. K. L., Chow, S. M. K., & Ronen, G. M. (2005). Chinese version of the parent-proxy health-related quality of life measure for children with epilepsy: Translation, cross-cultural adaptation, and reliability studies. Epilepsy & Behavior, 7, 697-707.
Yeh, C.-H., Chang, C.-W., & Chang, P.-C. (2005). Evaluating quality of life in children with cancer using children's self-reports and parent-proxy reports. Nursing Research, 54, 354-362.
Yeh, C.-H., Chao, K.-Y., & Hung, L.-C. (2004). The quality of life for cancer children (QOLCC) in Taiwan (part I): Reliability and construct validity by confirmatory factor analysis. Psycho-Oncology, 13, 161-170.
Yerxa, E. J. (2002). Habits in context: A synthesis, with implications for research in occupational science. OTJR: Occupational, Participation, and Health, 22, 104-110.
Zeller, M. H., & Modi, A. C. (2006). Predictors of health-related quality of life in obese youth. Obesity, 14(1), 122-130.
Zeller, M. H., & Modi, A. C. (2009). Development and initial validation of an obesity-specific quality-of-life measure for children: sizing me up. Obesity, 17(6), 1171-1177.