Familias Unidas for Health and Wellness: Adapting an Evidence-Based Substance Use and Sexual Risk Behavior Intervention for Obesity Prevention in Hispanic Adolescents

The Role of Intervention Fidelity, Culture, and Individual-Level Factors on Health-Related Outcomes Among Hispanic Adolescents with Unhealthy Weight: Findings from a Longitudinal Intervention Trial

Previous studies have suggested the impact of intervention fidelity on the management and prevention of chronic diseases; however, little is known about the effect of the contributing determinants (at multiple levels of influence) that can impact health-related interventions intending to improve the health status of Hispanic adolescents with overweight or obesity. The current study aimed to assess whether fidelity (i.e., dosage and quality of the program delivery), acculturation (i.e., orientation to the American culture, retention of Hispanic cultural values), and individual-level socio-demographic characteristics (i.e., income, education) predict changes in family processes (e.g., parent control), which in turn may affect adolescent health-related outcomes including body mass index (BMI), physical activity, dietary intake, and adolescents' health-related quality of life. A pathway analysis model was utilized to explore the study variables among 140 Hispanic parent-adolescent dyads randomized to Familias Unidas Health and Wellness (FUHW) intervention. Results indicated that fidelity was significantly associated with changes in parent-adolescent communication, parent monitoring, limit-setting, and control. Parents' education was associated with changes in parent limit-setting, and parent Hispanicism was associated with changes in parent limit-setting and discipline. The examination between family processes and adolescent health outcomes revealed that parents' higher discipline and improved communication with their adolescents were significantly associated with improved adolescents' quality of life, and parent control was positively associated with physical activity and negatively associated with BMI in adolescents. Our findings demonstrated the significant contribution of intervention fidelity and participants' characteristics in parenting strategies leading to adolescents' health outcomes to prevent obesity-related chronic diseases. Future research is needed to investigate the effect of environmental and organizational factors on the delivery of the intervention materials.

Factors Associated with Fathers' Attendance in a Latino Family Obesity Prevention Program

Community-based programs may contribute to Latino pediatric obesity prevention; however, attendance remains low. This study aimed to identify factors associated with Latino father/male caregiver attendance in family-based adolescent obesity prevention programs conducted as part of a randomized controlled trial. The study used cross-sectional data from 137 fathers in the program, involving eight weekly sessions to improve their children's energy balance-related behaviors. Evaluation data were collected at baseline and post-intervention. Fathers in a waitlisted control group attended sessions after post-intervention data collection. Attendance patterns were identified using cluster analysis: consistently high attendance (50% of fathers), declining attendance (19%), and non-attendance (31%) clusters. Multinomial logistic regression was used to examine associations between attendance patterns and variables. Compared to consistently high attendance, fathers in the non-attendance cluster were more likely to have been assigned to the control group (odds ratio [OR] = 7.86, p < 0.001), tended to have lower household income (OR = 2.50, p = 0.098), and attended the program at a site where the program occurred weekdays (OR = 0.35, p = 0.094). Maintaining contact during waiting periods and providing sessions online or during weekends could reduce non-attendance by enhancing convenience for low-income fathers working multiple jobs.

Reducing Screen-Based Sedentary Behavior Among Overweight and Obese Hispanic Adolescents Through a Family-Based Intervention

BACKGROUND

Sedentary behaviors, including screen-based activities, are associated with obesity, cardiovascular, and mental health risks. In the US, minority and socioeconomically disadvantaged youth engage in substantial sedentariness, requiring targeted interventions. Familias Unidas for Health and Wellness (FUHW) is a family intervention to reduce risks among Hispanic youth with overweight and obesity. Analyses examined (1) FUHW's impact on parent and adolescent screen-based sedentary behavior and (2) differential intervention effects by adolescent gender, internalizing symptoms, and body mass index.

METHODS

A total of 280 overweight/obese Hispanic middle schoolers and parents were randomized to FUHW or control and assessed at baseline, 6, 12, and 24 months between 2015 and 2019.

RESULTS

Linear growth models showed that exposure to FUHW was not associated with parent sedentary behavior over time (b = -0.11, P = .32) but was associated with decreases in adolescent sedentary behavior (b = -0.27, P = .03). Neither gender nor internalizing symptoms moderated intervention effects, but there were differential effects by body mass index. Compared to controls, FUHW showed significant decreases in sedentary behavior among overweight (b = -0.85, P < .01) and obese (b = -0.79, P < .01) youth but not severely obese youth.

CONCLUSIONS

FUHW reduced youth screen-based sedentary behavior. Youth with severe obesity require additional intervention.

Intergenerational cardiovascular disease risks among Hispanics living in the United States

BACKGROUND

Few studies have assessed intergenerational associations of obesity and cardiovascular disease risks from parents to their children among Hispanic Americans.

OBJECTIVES

To assess intergenerational cardiovascular associations among Hispanic families.

METHODS

Using baseline data from an obesity-focused efficacy trial targeting Hispanic adolescents (n = 280) and their parents, we conducted a series of logistic regression analyses to investigate the effects of parental BMI and blood pressure on adolescents' BMI and blood pressure, respectively.

RESULTS

After adjusting for significant socio-demographic variables and adolescents' lifestyle behaviours, adolescents were more than twice as likely to be in the severely obese versus overweight range when their parents had obesity (vs. non-obese; OR = 2.55, 95% CI = 1.20, 5.39) and more than twice as likely to be in the severely obese versus obese weight range (OR = 2.44, 95% CI = 1.22, 4.87) when their parents had obesity. When compared to those with normal blood pressure, adolescents who had parents with elevated blood pressure/hypertension were more than twice as likely to have elevated blood pressure (OR = 2.05, 95% CI = 1.04, 4.00) or be classified as hypertensive stage 1/2 (OR = 2.81, 95% CI = 1.31, 6.01).

CONCLUSIONS

Both severe obesity and elevated blood pressure are highly associated among Hispanic parent-child dyads. Findings underscore the potential benefits of intervening with the family system.

A Healthy Lifestyle Intervention for Hispanic Families: Moderating Effects of Education, Income, Nativity

OBJECTIVE

To explore the moderation effect of parental social determinant factors-educational attainment, income, and nativity-on intervention effects of a family-based lifestyle intervention, Familias Unidas for Health and Wellness (FUHW).

DESIGN

Longitudinal analysis across 6- and 24-months postbaseline of a randomized controlled trial.

PARTICIPANTS

Two-hundred and eighty primary caregivers.

ANALYSIS

Moderation analysis was used to examine the interactive effects between intervention effects and social determinant factors.

MAIN OUTCOME MEASURES

Parental body mass index, added sugar intake, sugar-sweetened beverage intake, and fruits and vegetable intake.

RESULTS

Findings indicated that FUHW effects on added sugar intake were moderated by educational attainment (P = 0.006), income (P = 0.023), and nativity (P = 0.024). In addition, FUHW effects on sugar-sweetened beverage intake were moderated by parent education (P = 0.042).

CONCLUSIONS AND IMPLICATIONS

This study suggests that FUHW may be helpful in reducing added sugar and sugar-sweetened beverage intake for Hispanic parents who face social determinant factors-educational attainment, income, and foreign-born status-that may influence their dietary behaviors. By including demographic information in intervention development, effects may be enhanced by ensuring that considerations related to participants' socioeconomic and cultural status are incorporated into intervention components and help reduce overweight and obesity.

A Family-Based Healthy Lifestyle Intervention: Crossover Effects on Substance Use and Sexual Risk Behaviors

This study examined the efficacy of a healthy lifestyle family-based intervention in reducing substance use and sexual risk behaviors compared with prevention as usual over 24 months in Hispanic adolescents. Participants were overweight/obese Hispanic adolescents (N = 280; M age 13.01; SD = .82) in the 7th/8th grade and their primary caregivers. Participants were randomized to either the healthy lifestyle family-based intervention or to the control condition (i.e., referral to community services offered for overweight and/or obese adolescents and their families). Outcomes included adolescent substance use and sexual risk behaviors among adolescents. Intervention effects were found for adolescent alcohol (b = - 0.37, 95% CI = [- 0.49, - 0.26]), marijuana (b = - 1.00, CI = [- 1.22, - 0.78]), and non-prescription drug use (b = - 3.77, CI = [- 6.49, - 1.05]) over 24 months. No significant intervention effects were found for adolescent sexual risk behaviors. Findings suggest that Familias Unidas for Health and Wellness reduces adolescent alcohol, marijuana, and non-prescription drug use across time. ClinicalTrials.gov Identifier: NCT03943628.

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

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.

Family Mealtime Communication in Single- and Dual-Headed Households Among Hispanic Adolescents With Overweight and Obesity

OBJECTIVE

To investigate the association of adolescent self-report of family mealtime communication on obesity-related behaviors in single- and dual-parent households and by sex in a sample of overweight and obese Hispanic adolescents.

DESIGN

Cross-sectional analysis of a randomized control trial SETTING: Eighteen middle schools in Miami-Dade County, Florida.

PARTICIPANTS

Two-hundred and eighty Hispanic seventh- and eighth-grade students MAIN OUTCOME MEASURES: Physical activity, fruit and vegetable intake, and added sugar intake.

ANALYSIS

Structural equation modeling.

RESULTS

The findings indicate that mealtime communication was associated with fruit and vegetable consumption in boys (β = .30; P = .001; 95% confidence interval [CI], 0.52-2.68) and physical activity in girls (β = .26; P = .010; 95% CI, 0.16-1.30). Moreover, a single-parent household was associated with dietary consumption in boys (fruit and vegetable intake [β= .18; P = .039; 95% CI, 0.02-2.60] but had a moderating effect on fruit and vegetable consumption in girls (β = .21; P = .015; 95% CI, 0.14-2.19).

CONCLUSIONS AND IMPLICATIONS

Family mealtime communication may impact dietary and physical activity outcomes in Hispanic adolescents with overweight and obesity, but differentially across gender and household parent makeup. These findings, together with the prevalence of single parents, point to the importance of targeting Hispanic single parents as agents of change to promote healthy lifestyle behaviors in their children via positive mealtime interactions.

The Effects of Parental Stress on Physical Activity Among Overweight and Obese Hispanic Adolescents: Moderating Role of Family Communication and Gender

BACKGROUND

Previous literature has shown a negative relationship between parental stress and youth moderate to vigorous physical activity (MVPA). This study examined (1) the relationship between parental stress and adolescent MVPA, (2) the moderating role of family communication on this relationship, and (3) gender differences in these effects among overweight and obese Hispanic adolescents.

METHODS

Hispanic adolescents (N = 280, 52% female, 13.0 [0.8] y old, 44% obese, 12% severely obese) and their parents (88% female, 44.9 [6.5] y old) completed baseline measures for an efficacy trial. Adolescents self-reported MVPA in minutes per week for work, transportation, and recreation using a validated measure. Multiple regression analyses with interaction terms and multigroup methods were conducted.

RESULTS

There was a negative effect of parental stress on adolescent MVPA (β = -0.15, t = -2.018, P ≤ .05). This effect was moderated by family communication (β = 0.20, t = 2.471, P = .01), such that the association between parental stress and youth MVPA was stronger for adolescents with low levels of family communication. Furthermore, a multiple group model showed that the interaction was significant for boys (β = 0.27, t = 2.185, P = .03), but not for girls.

CONCLUSIONS

Findings provide support that addressing parental stress and family communication may help facilitate MVPA among Hispanic boys, the most at-risk group for pediatric obesity.

Psychometric properties of an abbreviated Childhood Family Mealtime Questionnaire among overweight and obese Hispanic adolescents

The current family mealtime literature shows that assessments of the mealtime environment are typically self-report, yet few studies discuss validation techniques or report using validated scales. As such, the current analysis was conducted to validate one of the only published measures to assess the mealtime environment from the adolescent perspective. Specifically, the Childhood Family Mealtime Questionnaire (CFMQ) was evaluated in a sample of 280 overweight and obese Hispanic adolescents to address the need for a validated measure of the family mealtime environment in a demographic that is disproportionately affected by the current obesity epidemic. Results of exploratory and confirmatory factor analyses to evaluate the optimal factor structure, reliability, and validity for a revised, abbreviated CFMQ are presented here. The concurrent validity of the CFMQ was evaluated using correlations between the factor structures and the previously used, culturally appropriate comparable measure of family functioning. Correlations were also computed between factor scores and obesogenic outcomes (fruit and vegetable intake, added sugar intake, and physical activity). Analyses produced a revised, abbreviated version that includes 22 items (reduced from a total of 69 items) and consists of the following 4 factors: family mealtime communication (5 items), family mealtime stress (7 items), appearance weight control (5 items), and mealtime structure (6 items). Cronbach's alphas are reported for reliability. When examining CFMQ concurrent validity with the family functioning latent variable, results showed the family mealtime communication subscale ranked highest. Additionally, the family mealtime communication subscale was associated with all three obesogenic outcomes. This abbreviated CFMQ may be a useful tool for those studying family mealtime environments and their influence on obesity and its associated lifestyle behaviors.

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.