Introduction
Hispanic adolescents in the U.S. are disproportionately affected by overweight and
obesity compared with their White, non-Hispanic counterparts. This study examines
the efficacy of an evidence-based family intervention adapted to target obesity-related
outcomes among Hispanic adolescents who were overweight/obese compared with prevention
as usual.
Study design
This study was an RCT.
Setting/participants
Participants were Hispanic adolescents who were overweight/obese (n=280, mean age=13.01 [SD=0.82] years) in the 7th/8th grade and their primary caregivers.
Primary caregivers were majority female legal guardians (88% female, mean age=41.88
[SD=6.50] years).
Intervention
Participants were randomized into the family-level obesity-targeted intervention or
referral to community services offered for overweight/obese adolescents and families
(condition). Data collection began in 2015.
Main outcome measures
Primary outcomes included dietary intake (e.g., reduction of sweetened beverages)
and past-month moderate-to-vigorous physical activity. Secondary outcomes were BMI
and family functioning assessed among adolescents and primary caregivers.
Results
Study analyses (2019) indicated no significant intervention effects for adolescents’
primary outcomes. Intervention effects were found for parents’ intake of fresh fruits
and vegetables (β=0.12, 95% CI=0.02, 0.23), added sugar (β= −0.11, 95% CI= −0.22,
−0.004), and sweetened beverages (β= −0.12, 95% CI=−0.23, −0.02), and parents showed
decreased BMI (β= −0.05, 95% CI= −0.11, −0.01) at 6 months after baseline compared
with usual prevention. Intervention effects were found for adolescent family communication
(β=0.13, 95% CI=0.02, 0.24), peer monitoring (β=0.12, 95% CI=0.01, 0.23), and parental
involvement (β=0.16, 95% CI=0.06, 0.26) at 6 months after baseline compared with prevention
as usual.
Conclusions
This intervention was not effective in improving overweight/obesity-related outcomes
in adolescents. The intervention was effective in improving parents’ dietary intake
and BMI; however, the effects were not sustained in the long term. Other intervention
strategies (e.g., booster sessions, increased nutritional information) may be necessary
to sustain beneficial effects and extend effects to adolescent participants.
Trial registration
This study is registered at www.clinicaltrials.gov NCT03943628.
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REFERENCES
- Differences in obesity prevalence by demographics and urbanization in U.S. children and adolescents, 2013-2016.JAMA. 2018; 319: 2410-2418
- Prevalence of obesity and severe obesity in U.S. children, 1999-2016.Pediatrics. 2018; 142e20173459https://doi.org/10.1542/peds.2017-3459
- Nutrient adequacy and diet quality in non-overweight and overweight Hispanic children of low socioeconomic status: the Viva la Familia Study.J Am Diet Assoc. 2009; 109: 1012-1021
- Youth risk behavior surveillance - United States, 2017.MMWR Surveill Summ. 2018; 67: 1-114
- A systematic analysis of childhood obesity prevention interventions targeting Hispanic children: lessons learned from the previous decade.Obes Rev. 2011; 12: e151-e158
- A systematic review of obesity prevention intervention studies among immigrant populations in the U.S.Curr Obes Rep. 2014; 3: 206-222
- Adolescence and the social determinants of health.Lancet. 2012; 379: 1641-1652
- Family functioning and parent support trajectories and substance use and misuse among minority urban adolescents: a latent class growth analysis.Subst Use Misuse. 2014; 49: 1908-1919
- A randomized controlled trial of a parent-centered intervention in preventing substance use and HIV risk behaviors in Hispanic adolescents.J Consult Clin Psychol. 2007; 75: 914-926
- Family functioning: associations with weight status, eating behaviors, and physical activity in adolescents.J Adolesc Health. 2013; 52: 351-357
- Family functioning and quality of parent-adolescent relationship: cross-sectional associations with adolescent weight-related behaviors and weight status.Int J Behav Nutr Phys Act. 2016; 13: 68
- Family functioning mediates the relationship between child behavior problems and parent feeding practices in youth with overweight or obesity.Transl Behav Med. 2019; 9: 431-439
- Parental influences on physical activity behavior in preschool children.Prev Med. 2010; 50: 129-133
- General parenting, childhood overweight and obesity-inducing behaviors: a review.Int J Pediatr Obes. 2011; 6: e12-e27
- Preventing weight gain and obesity: indirect effects of the family check-up in early childhood [published correction appears in Prev Sci. 2015;16(3):420].Prev Sci. 2015; 16: 408-419
- The Ecology of Human Development: Experiments by Nature and Design.Harvard University Press, Cambridge, MA1979
- Ecology of the family as a context for human development: research perspectives.Dev Psychol. 1986; 22: 723-742
- Family-based childhood obesity prevention interventions: a systematic review and quantitative content analysis.Int J Behav Nutr Phys Act. 2017; 14: 113
- The efficacy of Familias Unidas on drug and alcohol outcomes for Hispanic delinquent youth: main effects and interaction effects by parental stress and social support.Drug Alcohol Depend. 2012; 125: S18-S25
- Effects of a family intervention in reducing HIV risk behaviors among high-risk Hispanic adolescents: a randomized controlled trial.Arch Pediatr Adolesc Med. 2012; 166: 127-133
- Reducing substance use and HIV health disparities among Hispanic youth in the U.S.A.: the Familias Unidas program of research.Interv Psicosoc. 2011; 20: 63-73
- An ecodevelopmental framework for organizing the influences on drug abuse: a developmental model of risk and protection.in: Glantz MD Hartel CR Drug Abuse: Origins & Interventions. American Psychological Association, Washington, DC1999: 331-366
- Development of appetite self-regulation: integrating perspectives from attachment and family systems theory.Child Dev Perspect. 2018; 12: 51-57
- Family Therapy in Clinical Practice.Jason Aronson, Lanham, MD1993
- Effects of parent-adolescent reported family functioning discrepancy on physical activity and diet among Hispanic youth.J Fam Psychol. 2018; 32: 333-342
- Familias Unidas’ crossover effects on suicidal behaviors among Hispanic adolescents: results from an effectiveness trial.Suicide Life Threat Behav. 2016; 46: S8-S14
- Preventing internalizing symptoms among Hispanic adolescents: a synthesis across Familias Unidas trials.Prev Sci. 2014; 15: 917-928
- Familias Unidas for health and wellness: adapting an evidence-based substance use and sexual risk behavior intervention for obesity prevention in Hispanic adolescents.J Prim Prev. 2018; 39: 529-553
- Properties of the urn randomization in clinical trials [published correction appears in Controlled Clin Trials. 1989;10(1):following 126].Control Clin Trials. 1988; 9: 345-364
- The effects of a 2-year physical education program (SPARK) on physical activity and fitness in elementary school students. Sports, play and active recreation for kids.Am J Public Health. 1997; 87: 1328-1334
- Predictors of participant attendance patterns in a family-based intervention for overweight and obese Hispanic adolescents.Int J Environ Res Public Health. 2018; 15: 1482
- Development and evaluation of the National Cancer Institute's dietary screener questionnaire scoring algorithms.J Nutr. 2017; 147: 1226-1233
- SPSS for Windows Step by Step: A Simple Guide and Reference, 17.0 Update.10th ed. Allyn & Bacon, Boston, MA2010
- Association of physical activity with income, race/ethnicity, and sex among adolescents and young adults in the United States: findings from the National Health and Nutrition Examination Survey, 2007-2016.JAMA Pediatr. 2018; 172: 732-740
- The association between U.S. adolescents’ weight status, weight perception, weight satisfaction, and their physical activity and dietary behaviors.Int J Environ Res Public Health. 2018; 15: 1931
- 2000 CDC growth charts for the United States: methods and development.Vital Health Stat 11. 2002; 246: 1-190
- The relation of family functioning to violence among inner-city minority youths.J Fam Psychol. 1996; 10: 115-129
- Assessment of family relationship characteristics: a measure to explain risk for antisocial behavior and depression among urban youth.Psychol Assess. 1997; 9: 212-223
- Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses.Behav Res Methods. 2009; 41: 1149-1160
- How to use a Monte Carlo study to decide on sample size and determine power.Struct Equ Modeling. 2002; 9: 599-620
- Latent curve analysis.Psychometrika. 1990; 55: 107-122
- A longitudinal examination of positive parenting following an acceptance-based couple intervention.J Fam Psychol. 2016; 30: 104-113
- Meta-analysis of incidence rate data in the presence of zero events.BMC Med Res Methodol. 2015; 15: 42
- Analyzing longitudinal data with missing values.Rehabil Psychol. 2011; 56: 267-288
- Prevalence of obesity among adults and youth: United States, 2015-2016.NCHS Data Brief. 2017; (Accessed February 13, 2020): 1-8
- Family oriented care: opportunities for health promotion and disease prevention.J Fam Med Dis Prev. 2015; 1: 1-6
- Project SHINE: effects of a randomized family-based health promotion program on the physical activity of African American parents.J Behav Med. 2018; 41: 537-549
- Promoting exercise maintenance: how interventions with booster sessions improve long-term rehabilitation outcomes.Rehabil Psychol. 2013; 58: 323-333
- A pilot randomized controlled trial of a behavioral family-based intervention with and without home visits to decrease obesity in preschoolers.J Pediatr Psychol. 2014; 39: 1001-1012
- Long-term effect of lifestyle intervention on adiposity, metabolic parameters, inflammation and physical fitness in obese children: a randomized controlled trial.Nutr Diabetes. 2011; 1: e9
- Systematic review and meta-analysis of comprehensive behavioral family lifestyle interventions addressing pediatric obesity.J Pediatr Psychol. 2014; 39: 809-825
- Screening for obesity and intervention for weight management in children and adolescents: evidence report and systematic review for the U.S. Preventive Services Task Force.JAMA. 2017; 317: 2427-2444
- Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis.Pediatrics. 2012; 130: e1647-e1671
- Movement skills and physical activity in obese children: randomized controlled trial.Med Sci Sports Exerc. 2011; 43: 90-100
- Comparison of IPAQ-SF and two other physical activity questionnaires with accelerometer in adolescent boys.PLoS One. 2017; 12e0169527
- Early sexual maturation, body composition, and obesity in African‐American girls.Obes Res. 2004; 12: 64S-72S
Article Info
Publication History
Published online: October 01, 2020
Identification
Copyright
© 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
