Advertisement

Results of a Family-Based Intervention Promoting Healthy Weight Strategies in Overweight Hispanic Adolescents and Parents: An RCT

Published:October 01, 2020DOI:https://doi.org/10.1016/j.amepre.2020.06.010

      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Ogden CL
        • Fryar CD
        • Hales CM
        • Carroll MD
        • Aoki Y
        • Freedman DS
        Differences in obesity prevalence by demographics and urbanization in U.S. children and adolescents, 2013-2016.
        JAMA. 2018; 319: 2410-2418
        • Skinner AC
        • Ravanbakht SN
        • Skelton JA
        • Perrin EM
        • Armstrong SC
        Prevalence of obesity and severe obesity in U.S. children, 1999-2016.
        Pediatrics. 2018; 142e20173459https://doi.org/10.1542/peds.2017-3459
        • Wilson TA
        • Adolph AL
        • Butte NF
        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
        • Kann L
        • McManus T
        • Harris WA
        • et al.
        Youth risk behavior surveillance - United States, 2017.
        MMWR Surveill Summ. 2018; 67: 1-114
        • Branscum P
        • Sharma M
        A systematic analysis of childhood obesity prevention interventions targeting Hispanic children: lessons learned from the previous decade.
        Obes Rev. 2011; 12: e151-e158
        • Tovar A
        • Renzaho AM
        • Guerrero AD
        • Mena N
        • Ayala GX
        A systematic review of obesity prevention intervention studies among immigrant populations in the U.S.
        Curr Obes Rep. 2014; 3: 206-222
        • Viner RM
        • Ozer EM
        • Denny S
        • et al.
        Adolescence and the social determinants of health.
        Lancet. 2012; 379: 1641-1652
        • Cordova D
        • Heinze J
        • Mistry R
        • et al.
        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
        • Prado G
        • Pantin H
        • Briones E
        • et al.
        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
        • Berge JM
        • Wall M
        • Larson N
        • Loth KA
        • Neumark-Sztainer D
        Family functioning: associations with weight status, eating behaviors, and physical activity in adolescents.
        J Adolesc Health. 2013; 52: 351-357
        • Haines J
        • Rifas-Shiman SL
        • Horton NJ
        • et al.
        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
        • Warnick JL
        • Stromberg SE
        • Krietsch KM
        • Janicke DM
        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
        • Loprinzi PD
        • Trost SG
        Parental influences on physical activity behavior in preschool children.
        Prev Med. 2010; 50: 129-133
        • Sleddens EF
        • Gerards SM
        • Thijs C
        • De Vries NK
        • Kremers SP
        General parenting, childhood overweight and obesity-inducing behaviors: a review.
        Int J Pediatr Obes. 2011; 6: e12-e27
        • Smith JD
        • Montaño Z
        • Dishion TJ
        • Shaw DS
        • Wilson MN
        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
        • Bronfenbrenner U
        The Ecology of Human Development: Experiments by Nature and Design.
        Harvard University Press, Cambridge, MA1979
        • Bronfenbrenner U
        Ecology of the family as a context for human development: research perspectives.
        Dev Psychol. 1986; 22: 723-742
        • Ash T
        • Agaronov A
        • Young T
        • Aftosmes-Tobio A
        • Davison KK
        Family-based childhood obesity prevention interventions: a systematic review and quantitative content analysis.
        Int J Behav Nutr Phys Act. 2017; 14: 113
        • Prado G
        • Cordova D
        • Huang S
        • et al.
        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
        • Prado G
        • Pantin H
        • Huang S
        • et al.
        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
        • Prado G
        • Pantin H.
        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
        • Szapocznik J
        • Coatsworth JD
        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
        • Saltzman JA
        • Fiese BH
        • Bost KK
        • McBride BA
        Development of appetite self-regulation: integrating perspectives from attachment and family systems theory.
        Child Dev Perspect. 2018; 12: 51-57
        • Bowen M
        Family Therapy in Clinical Practice.
        Jason Aronson, Lanham, MD1993
        • Lebron CN
        • Lee TK
        • Park SE
        • St George SM
        • Messiah SE
        • Prado G
        Effects of parent-adolescent reported family functioning discrepancy on physical activity and diet among Hispanic youth.
        J Fam Psychol. 2018; 32: 333-342
        • Vidot DC
        • Huang S
        • Poma S
        • Estrada Y
        • Lee TK
        • Prado G
        Familias Unidas’ crossover effects on suicidal behaviors among Hispanic adolescents: results from an effectiveness trial.
        Suicide Life Threat Behav. 2016; 46: S8-S14
        • Perrino T
        • Pantin H
        • Prado G
        • et al.
        Preventing internalizing symptoms among Hispanic adolescents: a synthesis across Familias Unidas trials.
        Prev Sci. 2014; 15: 917-928
        • St George SM
        • Messiah SE
        • Sardinas KM
        • et al.
        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
        • Wei LJ
        • Lachin JM
        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
        • Sallis JF
        • McKenzie TL
        • Alcaraz JE
        • Kolody B
        • Faucette N
        • Hovell MF
        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
        • St George SM
        • Petrova M
        • Kyoung Lee T
        • et al.
        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
        • Thompson FE
        • Midthune D
        • Kahle L
        • Dodd KW
        Development and evaluation of the National Cancer Institute's dietary screener questionnaire scoring algorithms.
        J Nutr. 2017; 147: 1226-1233
        • George D
        • Mallery M.
        SPSS for Windows Step by Step: A Simple Guide and Reference, 17.0 Update.
        10th ed. Allyn & Bacon, Boston, MA2010
        • Armstrong S
        • Wong CA
        • Perrin E
        • Page S
        • Sibley L
        • Skinner A
        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
        • Xu F
        • Cohen SA
        • Greaney ML
        • Greene GW
        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
        • Kuczmarski RJ
        • Ogden CL
        • Guo SS
        • et al.
        2000 CDC growth charts for the United States: methods and development.
        Vital Health Stat 11. 2002; 246: 1-190
        • Gorman-Smith D
        • Tolan PH
        • Zelli A
        • Huesmann LR
        The relation of family functioning to violence among inner-city minority youths.
        J Fam Psychol. 1996; 10: 115-129
        • Tolan PH
        • Gorman-Smith D
        • Huesmann LR
        • Zelli A
        Assessment of family relationship characteristics: a measure to explain risk for antisocial behavior and depression among urban youth.
        Psychol Assess. 1997; 9: 212-223
        • Faul F
        • Erdfelder E
        • Buchner A
        • Lang AG
        Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses.
        Behav Res Methods. 2009; 41: 1149-1160
        • Muthén LK
        • Muthén BO
        How to use a Monte Carlo study to decide on sample size and determine power.
        Struct Equ Modeling. 2002; 9: 599-620
        • Meredith W
        • Tisak J
        Latent curve analysis.
        Psychometrika. 1990; 55: 107-122
        • Morrill MI
        • Hawrilenko M
        • Córdova JV
        A longitudinal examination of positive parenting following an acceptance-based couple intervention.
        J Fam Psychol. 2016; 30: 104-113
        • Spittal MJ
        • Pirkis J
        • Gurrin LC
        Meta-analysis of incidence rate data in the presence of zero events.
        BMC Med Res Methodol. 2015; 15: 42
        • Enders CK
        Analyzing longitudinal data with missing values.
        Rehabil Psychol. 2011; 56: 267-288
        • Hales CM
        • Carroll MD
        • Fryar CD
        • Ogden CL
        Prevalence of obesity among adults and youth: United States, 2015-2016.
        NCHS Data Brief. 2017; (Accessed February 13, 2020): 1-8
        • Garcia-Huidobro D
        • Mendenhall T
        Family oriented care: opportunities for health promotion and disease prevention.
        J Fam Med Dis Prev. 2015; 1: 1-6
        • St George SM
        • Wilson DK
        • Van Horn ML
        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
        • Fleig L
        • Pomp S
        • Schwarzer R
        • Lippke S
        Promoting exercise maintenance: how interventions with booster sessions improve long-term rehabilitation outcomes.
        Rehabil Psychol. 2013; 58: 323-333
        • Stark LJ
        • Clifford LM
        • Towner EK
        • et al.
        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
        • Vos RC
        • Wit JM
        • Pijl H
        • Houdijk EC
        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
        • Janicke DM
        • Steele RG
        • Gayes LA
        • et al.
        Systematic review and meta-analysis of comprehensive behavioral family lifestyle interventions addressing pediatric obesity.
        J Pediatr Psychol. 2014; 39: 809-825
        • O'Connor EA
        • Evans CV
        • Burda BU
        • Walsh ES
        • Eder M
        • Lozano P
        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
        • Ho M
        • Garnett SP
        • Baur L
        • et al.
        Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis.
        Pediatrics. 2012; 130: e1647-e1671
        • Cliff DP
        • Okely AD
        • Morgan PJ
        • et al.
        Movement skills and physical activity in obese children: randomized controlled trial.
        Med Sci Sports Exerc. 2011; 43: 90-100
        • Rääsk T
        • Mäestu J
        • Lätt E
        • et al.
        Comparison of IPAQ-SF and two other physical activity questionnaires with accelerometer in adolescent boys.
        PLoS One. 2017; 12e0169527
        • Himes JH
        • Obarzanek E
        • Baranowski T
        • Wilson DM
        • Rochon J
        • McClanahan BS
        Early sexual maturation, body composition, and obesity in African‐American girls.
        Obes Res. 2004; 12: 64S-72S