George SM, Prado G, Mauricio AM, Chiapa A, Bruening MM, Dishion TJ. The Family Check-Up 4 Health (FCU4Health): Applying Implementation Science Frameworks to the Process of Adapting an Evidence-Based Parenting Program for Prevention of Pediatric Obesity and Excess Weight Gain in Primary Care

Implementation experts have recently argued for a process of "scaling out" evidence-based interventions, programs, and practices (EBPs) to improve reach to new populations and new service delivery systems. A process of planned adaptation is typically required to integrate EBPs into new service delivery systems and address the needs of targeted populations while simultaneously maintaining fidelity to core components. This process-oriented paper describes the application of an implementation science framework and coding system to the adaptation of the Family Check-Up (FCU), for a new clinical target and service delivery system-prevention of obesity and excess weight game in primary care. The original FCU has demonstrated both short- and long-term effects on obesity with underserved families across a wide age range. The advantage of adapting such a program is the existing empirical evidence that the intervention improves the primary mediator of effects on the new target outcome. We offer a guide for determining the levels of evidence to undertake the adaptation of an existing EBP for a new clinical target. In this paper, adaptation included shifting the frame of the intervention from one of risk reduction to health promotion; adding health-specific assessments in the areas of nutrition, physical activity, sleep, and media parenting behaviors; family interaction tasks related to goals for health and health behaviors; and coordinating with community resources for physical health. We discuss the multi-year process of adaptation that began by engaging the FCU developer, community stakeholders, and families, which was then followed by a pilot feasibility study, and continues in an ongoing randomized effectiveness-implementation hybrid trial. The adapted program is called the Family Check-Up 4 Health (FCU4Health). We apply a comprehensive coding system for the adaptation of EBPs to our process and also provide a side-by-side comparison of behavior change techniques for obesity prevention and management used in the original FCU and in the FCU4Health. These provide a rigorous means of classification as well as a common language that can be used when adapting other EBPs for context, content, population, or clinical target. Limitations of such an approach to adaptation and future directions of this work are discussed.

George SM. A developmental cascade perspective of paediatric obesity: a conceptual model and scoping review

Considering the immense challenge of preventing obesity, the time has come to reconceptualise the way we study the obesity development in childhood. The developmental cascade model offers a longitudinal framework to elucidate the way cumulative consequences and spreading effects of risk and protective factors, across and within biopsychosocial spheres and phases of development, can propel individuals towards obesity. In this article, we use a theory-driven model-building approach and a scoping review that included 310 published studies to propose a developmental cascade model of paediatric obesity. The proposed model provides a basis for testing hypothesised cascades with multiple intervening variables and complex longitudinal processes. Moreover, the model informs future research by resolving seemingly contradictory findings on pathways to obesity previously thought to be distinct (low self-esteem, consuming sugary foods, and poor sleep cause obesity) that are actually processes working together over time (low self-esteem causes consumption of sugary foods which disrupts sleep quality and contributes to obesity). The findings of such inquiries can aid in identifying the timing and specific targets of preventive interventions across and within developmental phases. The implications of such a cascade model of paediatric obesity for health psychology and developmental and prevention sciences are discussed.

Predictors of Participant Attendance Patterns in a Family-Based Intervention for Overweight and Obese Hispanic Adolescents

This study examined participant attendance patterns and individual (e.g., income), family dynamics (e.g., communication), and cultural (i.e., Americanism, Hispanicism) predictors of these patterns among Hispanic families enrolled in a 12-week family-based intervention, Familias Unidas for Health and Wellness. Hispanic adolescents (n = 140, 49% female, 13.04 ± 0.87 years old, 36% overweight, 64% obese, 39% immigrants) and their parents (87% female, 42.09 ± 6.30 years old, BMI 30.99 ± 6.14 kg/m², 90% immigrants) were randomized to the intervention condition. A repeated measures latent class analysis that included 12 binary variables (yes/no) of attendance identified three subgroups of attendance patterns: consistently high, moderate and decreasing, and consistently low. An ANOVA was then conducted to examine whether the identified attendance patterns differed by individual, family dynamics, and cultural characteristics at baseline. Parents in the consistently high attendance group had lower Americanism than those in either of the other attendance groups. Adolescents in the consistently high attendance group had lower Hispanicism than those in either of the other attendance groups. No other variables significantly discriminated between attendance groups. Sustained attendance in the Familias Unidas for Health and Wellness intervention may be driven by Hispanic parents' desire to better understand their host culture, connect with other culturally similar parents, and reconnect adolescents with their heritage culture.

George SM, Brandt HM. African American Women's Perceived Influences on and Strategies to Reduce Sedentary Behavior

We conducted three focus groups to examine African American women's perceptions of factors influencing and proposed strategies for reducing sedentary behavior (SB). QSR NVivo 9 facilitated coding and organization of themes. Although participants ( n = 32, 53.6 ± 6.0 years, 75% obese) were unfamiliar with the term SB prior to focus groups, they described spending large amounts of time in SB at work and home. Participants viewed leisure-time SB as necessary and important but were amenable to decreasing SB at work. Participants also identified personal, social, and environmental factors contributing to SB as well as novel strategies for reducing SB. Results suggest that messages aimed at reducing SB in African American women should be positively framed, viewed within a socioecologic framework, and target nonleisure time SB. SB was viewed as a form of stress reduction; thus, future research might want to emphasize alternative stress management techniques that simultaneously reduce SB.

Effects of parent-adolescent reported family functioning discrepancy on physical activity and diet among Hispanic youth

Research has shown that family functioning has been positively associated with physical activity and dietary intake, both of which are obesity-related risk factors. The most widely practiced methodological approach to assessing this construct in empirical studies relies on either parent or adolescent report. Yet, discrepancy in parent and adolescent report of family functioning may provide a fuller understanding of the effects of this construct on obesity-related health outcomes. This is especially important among Hispanics, a population that suffers from disproportionately high rates of obesity and its health-related consequences. The purpose of this study was to examine whether, and to what extent, parent-adolescent discrepancies in family functioning are associated with physical activity, and fruit and vegetable and added sugar intake. We estimated discrepancy scores between parents and adolescents (n = 280 dyads) in family functioning. Then, using structural equation modeling, we tested the effect of family functioning discrepancy on adolescent reports of physical activity, fruits and vegetables intake, and added sugar intake. After controlling for adolescent's gender and BMI, family functioning discrepancy was significantly associated with reduced physical activity (β = -.14*, 95% CI ([-.26, -.05]) and fruits and vegetables intake (β = -.22*, 95% CI [-.38, -.09]) such that the larger the discrepancy between parent and youth reported family functioning, the fewer days of adolescent physical activity and the poorer the fruits and vegetables intake. Our findings provide insight for the role of the family in Hispanic adolescent health outcomes and rationale for capturing rich data to better understand that role. (PsycINFO Database Record

Clinic Personnel, Facilitator, and Parent Perspectives of eHealth Familias Unidas in Primary Care

INTRODUCTION

The purpose of this qualitative study was to understand the feasibility and acceptability of implementing eHealth Familias Unidas, an Internet-based, family-based, preventive intervention for Hispanic adolescents, in primary care.

METHODS

Semistructured individual interviews with clinic personnel and facilitators (i.e., physicians, nurse practitioners, administrators, and mental health workers; n = 9) and one focus group with parents (n = 6) were audiorecorded, transcribed verbatim, and analyzed using a general inductive approach.

RESULTS

Nine major themes emerged, including recommendations to minimize disruption to clinic flow, improve collaboration and training of clinic personnel and the research team, promote the clinic as a trusted setting for improving children's behavioral health, and highlight the flexibility and convenience of the eHealth format.

DISCUSSION

This study provides feasibility and acceptability findings, along with important considerations for researchers and primary care personnel interested in collaborating to implement an eHealth preventive intervention in pediatric primary care.

A Qualitative Study of Cognitive, Behavioral, and Psychosocial Challenges Associated With Pediatric Type 2 Diabetes in Ethnic Minority Parents and Adolescents

Purpose The purpose of this descriptive qualitative study was to explore cognitive, behavioral, and psychosocial challenges associated with having and/or parenting an adolescent with pediatric type 2 diabetes (T2D) from the perspectives of ethnic minority parents and adolescents. Methods Ethnic minority (79.2% non-Hispanic black, 29.6% Hispanic) adolescents (n = 14, 78.6% female, 14.7 ± 1.9 years) and their parents (n = 13, 100% female) participated in either individual family interviews or multifamily focus group sessions. Sessions were audio recorded, transcribed, and coded by a team of 4 raters. QSR NVivo 10 was used to perform a content analysis and to extract coded adolescent and parent responses. Results Six themes corresponding to 3 broad categories (cognitive, behavioral, and psychosocial challenges) emerged. Regarding cognitive challenges, families described difficulties learning about a new disease and managing youth knowledge deficits and/or superficial knowledge. In terms of behavioral challenges, parents and adolescents discussed ongoing difficulties with making and maintaining positive youth health behavior changes as well as with ensuring regimen adherence. Finally, managing youth emotions related to diabetes and navigating social relationships with peers and other family members around the disclosure of T2D were the primary psychosocial challenges to emerge. Conclusions Directions for future research include developing and evaluating brief family interventions and adolescent psychosocial screening measures. Recommendations for clinical practice include increasing family knowledge of T2D, enhancing parenting skills for managing youth behavior change, and conducting routine psychosocial screening during follow-up clinic visits.

Family-Centered Positive Behavior Support Interventions in Early Childhood To Prevent Obesity

Positive behavior support (PBS) strategies in early childhood, which include proactively structuring environments to support and positively reinforce healthy dietary and physical activity behaviors, are critical for preventing pediatric obesity, particularly among low-income, ethnic minority children. Existing evidence-based family-centered preventive interventions effectively impact parents' use of PBS strategies. Enhancing these programs to more directly target the key mechanisms of change specific to promoting children's healthy lifestyle behaviors could serve as the foundation for the next generation of effective protocols for preventing pediatric obesity. Two established programs that target PBS that can be feasibly implemented in a variety of service delivery systems using a multi-tiered, adaptive approach and the next steps of translation are discussed.

Factors associated with the implementation of the Familias Unidas intervention in a type 3 translational trial

This study highlights how Familias Unidas, a Hispanic-specific, evidence-based, family centered preventive intervention, progressed from intervention development (type 1 translation; T1) through rigorous evaluation (T2) and examines the role of intervention fidelity-adherence and competence-in a T3 trial. Effects of participant, provider, and organizational variables on direct (observational) and indirect (self-reported) fidelity were examined as were effects of fidelity. Two structural equation models were estimated using data from 367 Hispanic parent-adolescent dyads randomized to Familias Unidas. Facilitator perceptions of parental involvement in schools, school performance grade, and school socioeconomic status predicted indirect adherence ratings, which were positively related to adolescent substance use. Facilitator openness to evidence-based practices was associated with indirect competence ratings, school performance grade and size were associated with direct competence ratings, and direct competence ratings were negatively associated with substance use. Findings highlight unique contributions of direct and indirect fidelity ratings in the implementation of Familias Unidas.

Bayesian latent structure modeling of walking behavior in a physical activity intervention

The analysis of walking behavior in a physical activity intervention is considered. A Bayesian latent structure modeling approach is proposed whereby the ability and willingness of participants is modeled via latent effects. The dropout process is jointly modeled via a linked survival model. Computational issues are addressed via posterior sampling and a simulated evaluation of the longitudinal model's ability to recover latent structure and predictor effects is considered. We evaluate the effect of a variety of socio-psychological and spatial neighborhood predictors on the propensity to walk and the estimation of latent ability and willingness in the full study.

Behavioral and psychological aspects of exercise across stages of eating disorder recovery

This study examined the relationship between behavioral and psychological aspects of exercise and eating disorder recovery. Participants were categorized as having an eating disorder (n = 53), partially recovered (n = 15), fully recovered (n = 20), or non-eating disorder controls (n = 67). Groups did not differ significantly in time spent exercising, but did differ in exercise intensity, guilt-related exercise, obsessive exercise cognitions, and appearance/weight management and stress/mood management motivations for exercise. Results support the importance of measuring psychological aspects of exercise in particular across the course of an eating disorder.

Reliability of 24-Hour Dietary Recalls as a Measure of Diet in African-American Youth

BACKGROUND

Although it is a common practice to estimate dietary intake using three random 24-hour dietary recalls, some studies have suggested up to nine may be necessary to reliably estimate usual intake in youth. Given the resulting increase in resources and participant burden, more research is needed to determine whether this method is reliable, particularly in African-American youth at increased risk for obesity and other chronic diseases.

OBJECTIVE

This study estimated the reliability with which 24-hour dietary recalls measure energy, fat, fruit, and vegetable intake in African-American youth and examined how reliability changes as a function of the number of recalls.

DESIGN

This study used cross-sectional data collection across three studies.

PARTICIPANTS/SETTING

Participants were African-American youth (n=456, mean±standard deviation age 13.28±1.86 years, 64% were girls, mean±standard deviation body mass index [calculated as kg/m(2)] 31.45±7.94) who completed random 24-hour dietary recalls (67% completed three) conducted by research assistants using the Automated Self-Administered 24-Hour recall system (n=258) or registered dietitian nutritionists using the Nutrition Data System for Research (n=198).

MAIN OUTCOME MEASURES/STATISTICAL ANALYSES

Estimates provided by multilevel models were used to calculate the proportion of variance accounted for between individuals and the reliability of means within individuals as a function of the number of recalls.

RESULTS

Reliability estimates for assessing dietary outcomes using one to three recalls ranged from 11% to 62%. To achieve 80% reliability, the following number of recalls would need to be conducted: 8 for energy intake, 13 for fat intake, 21 to 32 for fruit intake, and 21 to 25 for vegetable intake.

CONCLUSIONS

The common practice of assessing dietary intake with three recalls does so with low reliability in African-American youth. Until more objective methods for reliably estimating usual intake are developed, researchers who choose to use 24-hour dietary recalls are encouraged to include estimates of the measure's reliability in a priori power calculations for improved decision making regarding the number of observations and/or sample size.

Process Evaluation of the Project SHINE Intervention for African American Families: An Integrated Positive Parenting and Peer Monitoring Approach to Health Promotion

This study describes the process evaluation of Project SHINE, a randomized family-based health promotion intervention that integrated parenting and peer monitoring for improving sedentary behavior, physical activity, and diet in African American families. Adolescent-parent dyads (n = 89) were randomized to a 6-week behavioral, positive parenting, and peer monitoring skills intervention or a general health education comparison condition. Process evaluation included observational ratings of fidelity, attendance records, psychosocial measures, and qualitative interviews. Results indicated that the intervention was delivered with high fidelity based on facilitator adherence (>98% of content delivered) and competent use of theoretically based behavior change and positive parenting skills (100% of ratings >3 on a 1-4 scale). Although only 43% of peers attended the "bring a friend" session, overall attendance was high (4.39 ± 1.51 sessions) as was the retention rate (88%). Parents in the intervention condition reported significant improvements in communication related to adolescents' engagement in health behaviors both on their own and with peers. These findings were supported by qualitative themes related to improvements in family communication and connectedness. This study provides an innovative example of how future family-based health promotion trials can expand their process evaluation approaches by assessing theoretically relevant positive parenting variables as part of ongoing monitoring.

Access to and Interest in Using Smartphone Technology for the Management of Type 1 Diabetes in Ethnic Minority Adolescents and Their Parents

BACKGROUND

A better understanding of parent and adolescent interest in using smartphone technology for type 1 diabetes (T1D) management is needed prior to developing technology-based interventions for ethnic minorities. This study examined access to and interest in technology-based programs for T1D in primarily Hispanic adolescents and their parents.

SUBJECTS AND METHODS

During a scheduled clinic visit, adolescents with T1D (n = 50; 52% female; 13.6 ± 2.0 years old; 74% Hispanic; hemoglobin A1c = 8.9 ± 1.7%) and their parents (n = 49; 54% household income <$49,000) completed brief self-report surveys.

RESULTS

Adolescents reported having access to the Internet (98%) and their own smartphones (86%). Thirty-seven percent reported using smartphone applications (apps) for their diabetes care, with 88% reporting carbohydrate counting as its primary function. Although most participants reported high/moderate interest in diabetes-specific apps, girls were more likely than boys to endorse high interest in apps to calculate and track insulin doses. A greater proportion of parents than of adolescents expressed high interest in apps to track glucose, count carbohydrates, calculate insulin doses, track insulin use, and receive diabetes-related reminders. A greater proportion of parents than of adolescents also endorsed interest in a program that combined Internet use with smartphone apps.

CONCLUSIONS

Results suggest ethnic minority adolescents with T1D across a range of income levels have access to smartphones. Although most parents expressed high interest in diabetes-specific apps, there was greater variability in adolescent interest. Understanding barriers and facilitators to the use of smartphone apps for diabetes care in ethnic minority adolescents may increase their interest in and ultimate adoption of this technology.

The Results of the "Positive Action for Today's Health" (PATH) Trial for Increasing Walking and Physical Activity in Underserved African-American Communities

BACKGROUND

The "Positive Action for Today's Health" (PATH) trial tested an environmental intervention to increase walking in underserved communities.

METHODS

Three matched communities were randomized to a police-patrolled walking plus social marketing, a police-patrolled walking-only, or a no-walking intervention. The 24-month intervention addressed safety and access for physical activity (PA) and utilized social marketing to enhance environmental supports for PA. African-Americans (N=434; 62% females; aged 51±16 years) provided accelerometry and psychosocial measures at baseline and 12, 18, and 24 months. Walking attendance and trail use were obtained over 24 months.

RESULTS

There were no significant differences across communities over 24 months for moderate-to-vigorous PA. Walking attendance in the social marketing community showed an increase from 40 to 400 walkers per month at 9 months and sustained ~200 walkers per month through 24 months. No change in attendance was observed in the walking-only community.

CONCLUSIONS

Findings support integrating social marketing strategies to increase walking in underserved African-Americans (ClinicalTrials.gov #NCT01025726).

Development of an innovative process evaluation approach for the Families Improving Together (FIT) for weight loss trial in African American adolescents

This study demonstrates how a multi-theoretical, multilevel process evaluation was used to assess implementation of the Families Improving Together (FIT) for weight loss intervention. FIT is a randomized controlled trial evaluating a culturally tailored, motivational plus family-based program on weight loss in African American adolescents and their parents. Social Cognitive, Self Determination, Family Systems theories and cultural tailoring principles guided the conceptualization of essential elements across individual/family, facilitator, and group levels. Data collection included an observational rating tool, attendance records, and a validated psychosocial measure.

RESULTS

Attendance records (0=absent, 1=present, criteria=≥70%) indicated that 71.5% of families attended each session. The survey (1=false, 6=true, criteria=≥4.5) indicated that participants perceived a positive group climate (M=5.16, SD=0.69). A trained evaluator reported that facilitator dose delivered (0=no, 1=yes, criteria=≥75%) was high (99.6%), and fidelity (1=none to 4=all, criteria=≥3) was adequate at facilitator (M=3.63, SD=0.41) and group levels (M=3.35, SD=0.49). Five cultural topics were raised by participants related to eating (n=3) and physical activity (n=2) behaviors and were integrated as part of the final curriculum.

DISCUSSION

Results identify areas for program improvement related to delivery of multi-theoretical and cultural tailoring elements. Findings may inform future strategies for implementing effective weight loss programs for ethnic minority families.

George SM. Contemporary research on parenting: conceptual, methodological, and translational issues

Researchers over the last decade have documented the association between general parenting style and numerous factors related to childhood obesity (e.g., children's eating behaviors, physical activity, and weight status). Many recent childhood obesity prevention programs are family focused and designed to modify parenting behaviors thought to contribute to childhood obesity risk. This article presents a brief consideration of conceptual, methodological, and translational issues that can inform future research on the role of parenting in childhood obesity. They include: (1) General versus domain specific parenting styles and practices; (2) the role of ethnicity and culture; (3) assessing bidirectional influences; (4) broadening assessments beyond the immediate family; (5) novel approaches to parenting measurement; and (6) designing effective interventions. Numerous directions for future research are offered.

Project SHINE: effects of parent-adolescent communication on sedentary behavior in African American adolescents

OBJECTIVE

This study examined parenting variables (communication, monitoring) as moderators of a family-based intervention for reducing sedentary behavior (SB) in African American adolescents. As a secondary aim, a similar model was tested using adolescent weight status as the outcome.

METHODS

African American adolescents (n = 73; 12.45 ± 1.45 years; 60% girls; 63% overweight/obese) and caregivers were randomized to a 6-week interactive, parent-based intervention or general health condition. Parent-adolescent communication and monitoring of health behaviors were self-reported by parents. Adolescent SB was self-reported by youth.

RESULTS

There was a significant intervention by communication interaction, such that intervention families with more positive communication showed lower adolescent SB than those with less positive communication or those in the comparison condition. No effects were found for monitoring on SB or for the model with weight status as the outcome.

CONCLUSIONS

Parent-adolescent communication may be an effective component to integrate into health promotion programs for African American adolescents.

Qualitative developmental research among low income African American adults to inform a social marketing campaign for walking

Background

This study describes the development of a social marketing campaign for increasing walking in a low income, high crime community as part of the Positive Action for Today’s Health (PATH) trial.

Methods

Focus groups were conducted with 52 African American adults (ages 18 to 65 yrs), from two underserved communities to develop themes for a social marketing campaign to promote walking. Participants responded to questions concerning social marketing principles related to product, price, place, promotion, and positioning for increasing neighbourhood walking.

Results

Focus group data informed the development of the campaign objectives that were derived from the “5 Ps” to promote physical and mental health, social connectedness, safety, and confidence in walking regularly. Focus group themes indicated that physical and mental health benefits of walking were important motivators. Walking for social reasons was also important for overcoming barriers to walking. Police support from trusted officers while walking was also essential to promoting safety for walking. Print materials were developed by the steering committee, with a 12-month calendar and door hangers delivered to residents’ homes to invite them to walk. Pride Stride walks empowered community walkers to serve as peer leaders for special walking events to engage new walkers.

Conclusions

Essential elements for developing culturally tailored social marketing interventions for promoting walking in underserved communities are outlined for future researchers.

Weight status as a moderator of the relationship between motivation, emotional social support, and physical activity in underserved adolescents

OBJECTIVE

This study examined weight status as a moderator of the relationship between motivation (controlled, autonomous, regulatory), emotional social support (parents, peers) and moderate-to-vigorous physical activity (MVPA) in underserved adolescents (ethnic minority, low-income).

METHODS

Participants from the Active by Choice Today Trial (n = 1,416; 54% girls, 73% African American, 52% overweight/obese) completed baseline measures, including height and weight, psychosocial surveys, and 7-day accelerometry estimates. Weight status was defined by body mass index z-score (zBMI).

RESULTS

Weight status moderated the effects of controlled, autonomous, and regulatory motivation on MVPA, such that these variables were more strongly associated with MVPA in adolescents with lower versus higher zBMI scores.

CONCLUSIONS

A better understanding of why motivation is not related to MVPA in underserved youth with a higher weight status is needed. Future pediatric obesity treatment in underserved youth may need to move beyond motivation into environmental factors associated with long-term behavior change.

The associations of parenting factors with adolescent body mass index in an underserved population

BACKGROUND

The current study examined parental factors related to risk of adolescent obesity within the context of a family systems framework.

METHODS

Seventy predominantly African American, low-income caregiver-adolescent dyads participated in the study. Validated measures of parental perceived child risk for development of type 2 diabetes mellitus, parental limit setting for sedentary behavior, and parental nurturance were evaluated as predictors of adolescent body mass index.

RESULTS

In this cross-sectional study, multiple linear regression demonstrated that parents of adolescents with higher zBMI reported worrying more about their child's risk of developing type 2 diabetes mellitus. Parent limit setting was also a significant predictor of adolescent zBMI. Contrary to expectations, higher levels of nurturance were associated with higher adolescent zBMI. Post hoc analyses revealed a trend towards a significant interaction between nurturance and limit setting, such that high levels of both parental nurturance and limit setting were associated with lower adolescent zBMI.

CONCLUSIONS

Current findings suggest the importance of authoritative parenting and monitoring of adolescent health behaviors in the treatment of obesity.

Effects of parenting style and parent-related weight and diet on adolescent weight status

OBJECTIVE

This study examined the interaction between parental limit setting of sedentary behaviors and health factors (weight status, physical activity [PA], fruit and vegetable [FV] intake) on standardized body mass index (zBMI) in African American adolescents.

METHODS

Data were from 67 parent-adolescent dyads. Parental limit setting, PA and FV intake were assessed via self-report, and objective height and weight measurements were collected.

RESULTS

Regressions examined the interaction between parental limit setting and BMI, PA, FV intake on adolescent zBMI. The model for parent BMI and FV intake accounted for 31% of the variance in adolescent zBMI. A significant interaction for parent BMI by limit setting showed that as parental BMI increased, higher (vs. lower) limit setting was associated with lower adolescent zBMI. Higher parent FV consumption was associated with lower adolescent zBMI.

CONCLUSION

Future interventions should integrate parent limit setting and target parent fruit and vegetable intake for obesity prevention in underserved adolescents.

Formative process evaluation for implementing a social marketing intervention to increase walking among African Americans in the Positive Action for Today's Health trial

OBJECTIVES

Evaluating programs targeting physical activity may help to reduce disparate rates of obesity among African Americans. We report formative process evaluation methods and implementation dose, fidelity, and reach in the Positive Action for Today's Health trial.

METHODS

We applied evaluation methods based on an ecological framework in 2 community-based police-patrolled walking programs targeting access and safety in underserved African American communities. One program also targeted social connectedness and motivation to walk using a social marketing approach. Process data were systematically collected from baseline to 12 months.

RESULTS

Adequate implementation dose was achieved, with fidelity achieved but less stable in both programs. Monthly walkers increased to 424 in the walking-plus-social marketing program, indicating expanding program reach, in contrast to no increase in the walking-only program. Increased reach was correlated with peer-led Pride Strides (r = .92; P < .001), a key social marketing component, and program social interaction was the primary reason for which walkers reported participating.

CONCLUSIONS

Formative process evaluation demonstrated that the walking programs were effectively implemented and that social marketing increased walking and perceived social connectedness in African American communities.

A qualitative study for understanding family and peer influences on obesity-related health behaviors in low-income African-American adolescents

BACKGROUND

Given the cultural and developmental relevance of family members and peers in the lives of African-American adolescents, the present study used a bioecological framework to qualitatively explore the parenting context as well as specific family factors (support, rules, monitoring) and peer factors (support) related to weight status, physical activity (PA), and healthy eating in low-income African-American boys versus girls.

METHODS

Qualitative data were obtained from African-American adolescents through focus groups. Adolescents (n = 45, 100% African American, 51% girls, 12.6 ± 1.2 years, 51% overweight/obese) were from two underserved communities in South Carolina (median income ≈$17,000-$22,000, high crime levels). Sessions were audiotaped, transcribed, and coded by independent pairs of raters (r = 0.75). QSR NVivo 8 was used to analyze data, and themes were categorized separately for boys and girls.

RESULTS

Adolescents reported themes of family warmth and control practices consistent with an authoritative style of parenting. Although adolescents wanted increased autonomy, they viewed parental monitoring as a favorable part of their relationship. Boys reported receiving more constructive feedback from parents about weight status and greater overall support for PA and diet than did girls. Girls reported more honest feedback from peers about weight status than did boys. Overall, adolescents acknowledged the unique opportunities of parents and peers in improving their health behaviors.

CONCLUSIONS

Findings suggest parents and peers interact in different ways with African-American boys and girls regarding their weight status and health behaviors. Future obesity prevention efforts in minority youth may need to target parenting skills that provide greater support to African-American girls. In addition, given peers influence PA and diet differently in boys and girls, interventions should strategically include parenting strategies that involve monitoring peer-adolescent interactions.