A practical model for preventing type 2 diabetes in minority youth

A Pilot Study to Examine the Feasibility and Acceptability of a Virtual Adaptation of an In-Person Adolescent Diabetes Prevention Program

BACKGROUND

Rates of prediabetes and type 2 diabetes are alarmingly high among racial/ethnic minority youth. The current study examines the virtual adaptation of an in-person peer-led youth diabetes prevention program.

METHODS

The initial phase involved the study team adapting workshop sessions from an in-person to a virtual format (Zoom). We conducted a 2-h feasibility pilot in December 2020 and implemented the full 12 session pilot program from June to September 2021 with 14 prediabetic adolescents recruited from our hospital-based general pediatric clinic. Weekly sessions were led by trained peer educators and focused on promoting healthy eating and physical activity using behavioral techniques (e.g., goal setting, brainstorming, and problem solving).

RESULTS

The virtual adaptation of our program was shown to be feasible and acceptable among our pilot participants. We were able to deliver the same workshop content and behavioral skills development as the in-person workshop using a variety of Zoom features.

CONCLUSIONS

Our peer-led youth diabetes prevention program was successfully adapted and implemented in a virtual format and was well accepted by at-risk youth. Future research is needed to examine the impact of virtual youth lifestyle interventions on behavioral and clinical outcomes such as weight and diabetes risk.

The "great live and move challenge": a program to promote physical activity among children aged 7-11 years. Design and implementation of a cluster-randomized controlled trial

BACKGROUND

Recent population-based surveys have reported that large majorities of children in France, Europe and in the US are not complying with international physical activity (PA) guidelines. There is, therefore, a need to find programs that will improve children's PA habits from an early age. Theory-based interventions that include school, family, and community involvement have the potential to generate a considerable increase in the PA level of children. The theory of planned behavior (TPB) is one of the most widely tested models of the factors influencing health-related behaviors. The Great Live and Move Challenge (GLMC) is an extended TPB-based intervention designed to promote PA in French primary school children aged 7-11 years. The objective of this paper is to describe the protocol of a randomized controlled trial to evaluate the effectiveness of the GLMC on the PA level of children.

METHODS

This is a two-year cluster-randomized controlled trial comparing an intervention group to a control group, randomized into clusters (community of communes) and stratified by department (Hérault, Gard, Aude) and residential environment (urban, rural). The goal is to recruit 4000 children. The GLMC involves children and their parents, and multiple local grassroots partners, such as school teachers, municipal officials and policy stakeholders. The intervention will be delivered over 3.5 months per year for a two-year period. Pre- and post-intervention, children and parents will be asked to fulfill a questionnaire concerning current PA level, TPB variables (i.e., intentions, attitudes, subjective norms, perceived behavioral control) and other psychosocial variables (e.g., perceptions of activity opportunities). A subsample of 400 children will be proposed to wear an accelerometer (i.e., the Actigraph GT3X+). The primary hypothesis is that the GLMC intervention will increase the proportion of children achieving the World Health Organization's recommended 60 min of moderate to vigorous PA per day by 15%.

DISCUSSION

This study will evaluate the effectiveness of a multilevel, theory-based PA program and potentially provide valuable information for schools and public health officers looking for innovative PA programs.

TRIAL REGISTRATION

ISRCTN:61116221 , 19/06/2018.

Type 2 Diabetes in Latino Youth: A Clinical Update and Current Challenges

Latino youth have the highest prevalence of overweight and obesity among all ethnic groups and are disproportionally affected by pre diabetes and type 2 diabetes (T2DM). Interventions that effectively reduce the risk of pre diabetes and T2DM in this population are urgently needed. Studies have shown that without any change, 50% of Latino children and adolescents will develop T2DM. This has important public health implications. Few pharmacologic options are approved for use in the pediatric population. The largest clinical trial to date did include a significant sample of Latinos, however the intervention used metformin or rosiglitazone in addition to lifestyle management and did not show meaningful weight loss, with around half of the participants meeting criteria for treatment failure. On the other hand, a smaller trial on surgical treatment of adolescents with severe obesity and T2DM resulted in superior glycemic control, reduced weight, and improvement of other co-morbidities of T2DM in youth. Lastly, culturally tailored programs that focus on building healthy communities appear to be a promising intervention to reduce diabetes risk in Latino youth. This review provides an update on the clinical aspects of T2DM in Latino youth and focuses on management and prevention strategies.

"Sacbe", a Comprehensive Intervention to Decrease Body Mass Index in Children with Adiposity: A Pilot Study

Interventions in children with adiposity decrease less than 0.2 the body mass index (BMI) z-score less than 0.2 and only in 21⁻23% of cases. Experts recommend focusing on the habits of a healthy lifestyle (HLS) but considering the sociocultural context of children and their parents. Our objective was to achieve a higher percentage of success in lowering the BMI z-score in children with adiposity and their parents through a pilot program "Sacbe" based on HLS, sensitive to the sociocultural context previously explored and with the active participation of parents. This is a pilot study in children aged 8 to 18 years with adiposity according to the BMI z-score. The program consisted of two workshops on HLS and nutrition given by the pediatric endocrinologist in group sessions with 3⁻5 families and reinforcements in each visit by registered dietitians. We recorded lifestyle habits and anthropometric characteristics of children and their parents at the baseline visit and every month for 3⁻4 months. Forty-nine families, 55 children and 64 parents participated, 60% of the children were female, the average age was 13.95 ± 3.3 years, 72.7% and 86.7% lowered the z score of the BMI due to intention to treat and protocol analysis (p < 0.001), respectively; BMI z-score decreased by 0.22 ± 0.21, from 2.13 ± 0.57 to 1.91 ± 0.58 (p < 0.001). In total, 83% of the parents involved were mothers, the average age was 45.8 ± 9.4 years, 77% lost weight and body fat (p < 0.001), the frequency of unhealthy habits decreased. The results of "Sacbe" exceeded expectations by combining the active participation of parents, sessions in groups, and the education on various components of an HLS inside sociocultural context. The main challenge will be to standardize and reproduce this type of complex interventions, as well as to assure long-term success.

Impact and Moderating Variables of an Intervention Promoting Physical Activity Among Children: Results From a Pilot Study

This pilot study pursued three objectives: to assess the effect of a 1-month multilevel intervention on the PA of children, to assess the impact of the intervention on the theory of planned behavior (TPB) variables, and to evaluate the extent to which the impact of the intervention on PA and TPB variables varied according to personal (i.e., gender and age) and situational (i.e., class and school) moderating variables. Children were aged 7 to 11 years ( n = 306). Analyses revealed a significant increase of PA practice and TPB variables ( ps < .001). Age (i.e., being a younger child) was associated with a higher increase on attitude and perceived control ( ps < .01). The class or the school levels explained a meaningful variance in the evolution of PA or TPB variables (intraclass correlation coefficients > .10). The present study reports the interest and feasibility of a multilevel intervention to increase PA and TPB variables in children.

Prevention of Type 2 Diabetes in U.S. Hispanic Youth: A Systematic Review of Lifestyle Interventions

CONTEXT

Prevalence of type 2 diabetes mellitus (T2DM) in youth has increased rapidly in recent decades along with rises in childhood obesity. Disparities in risk and prevalence of T2DM are evident in Hispanic youth when compared with non-Hispanic whites. Targeted diabetes prevention programs have been recommended to reduce risk prior to adulthood in this population. This systematic review explores the effectiveness of lifestyle-based diabetes prevention interventions for Hispanic youth.

EVIDENCE ACQUISITION

PubMed, PsycINFO, Web of Science, and CENTRAL were searched from database inception to March 1, 2017, for studies that evaluated lifestyle-focused prevention trials targeting U.S. Hispanic youth under age 18 years. Fifteen publications met criteria for inclusion.

EVIDENCE SYNTHESIS

Of the 15 studies, 11 were RCTs; four were uncontrolled. Interventions were heterogeneous in intensity, content, and setting. Duration of most trials was 12-16 weeks. Mean age of participants ranged from 9.8 to 15.8 years, sample sizes were generally small, and the majority of participants were overweight (BMI ≥85th percentile). Three studies reported statistically significant reductions in mean BMI, four in BMI z-score, and six in fasting glucose/insulin. Study quality was moderate to high. Effect sizes were generally small to medium.

CONCLUSIONS

Evidence for the impact of lifestyle-based diabetes prevention interventions targeting U.S. Hispanic youth remains limited. Few interventions demonstrated success in reducing BMI and glucose regulation and follow-up times were brief. More studies are needed that recruit larger samples sizes, extend follow-up times, explore innovative delivery modalities, and examine effectiveness across sex and age.

Use of Focus Groups to Inform a Youth Diabetes Prevention Model

OBJECTIVE

To explore minority adolescents' perceptions of their diabetes risk, barriers and facilitators to adopting lifestyle changes, and ideas for adapting a youth diabetes prevention model.

METHODS

The study was conducted at collaborating community sites in East Harlem, NY. Trained moderators facilitated focus groups, which were audio taped and transcribed. Participants were 21 Latino and African American adolescents aged 14-18 years with a family history of diabetes and no reported personal history of diabetes. The phenomenon of interest was youth input in adapting a diabetes prevention model. Two researchers independently coded transcripts, identified major themes, compared findings, and resolved differences through discussion and consensus.

RESULTS

Dominant themes included (1) the impact of diabetes on quality of life within adolescents' personal networks; (2) conflict between changing diet and activity and their current lifestyle; (3) lifestyle choices being dictated by cost, mood, body image, and environment, not health; and (4) family, social, and environmental pressures reinforcing sedentary behaviors and unhealthy diets.

CONCLUSIONS AND IMPLICATIONS

Themes from youth focus groups were framed in the context of an existing youth diabetes prevention conceptual model, with results informing expansion of the model and identification and organization of potential intervention components.

Models accounting for intention-behavior discordance in the physical activity domain: a user's guide, content overview, and review of current evidence

There is a growing concern among researchers with the limited effectiveness and yet subsequent stagnation of theories applied to physical activity (PA). One of the most highlighted areas of concern is the established gap between intention and PA, yet the considerable use of models that assume intention is the proximal antecedent of PA. The objective of this review was to: 1) provide a guide and thematic analysis of the available models that include constructs that address intention-behavior discordance and 2) highlight the evidence for these structures in the PA domain. A literature search was conducted among 13 major databases to locate relevant models and PA studies published before August 2014. Sixteen models were identified and nine overall themes for post-intentional constructs were created. Of the 16 models, eight were applied to 36 PA studies. Early evidence supported maintenance self-efficacy, behavioral regulation strategies, affective judgments, perceived control/opportunity, habit, and extraversion as reliable predictors of post-intention PA. Several intention-behavior discordance models exist within the literature, but are not used frequently. Further efforts are needed to test these models, preferably with experimental designs.

Adapting health promotion interventions for ethnic minority groups: a qualitative study

Adaptation of health interventions has garnered international support across academic disciplines and among various health organizations. Through semi-structured interviews, we sought to explore and understand the perspectives of 26 health researchers and promoters located in the USA, UK, Australia, New Zealand and Norway, working with ethnic minority populations, specifically African-, South Asian- and Chinese-origin populations in the areas of smoking cessation, increasing physical activity and healthy eating, to better understand how adaptation works in practice. We drew on the concepts of intersectionality, representation and context from feminist, sociology and human geography literature, respectively, to help us understand how adaptations for ethnic groups approach the variable of ethnicity. Findings include (i) the intersections of ethnicity and demographic variables such as age and gender highlight the different ways in which people interact, interpret and participate in adapted interventions; (ii) the representational elements of ethnicity such as ancestry or religion are more complexly lived than they are defined in adapted interventions and (iii) the contextual experiences surrounding ethnicity considerations shape the receptivity, durability and continuity of adapted interventions. In conclusion, leveraging the experience and expertise of health researchers and promoters in light of three social science concepts has deepened our understanding of how adaptation works in principle and in practice for ethnic minority populations.

The Healthy Children, Strong Families intervention: design and community participation

Healthy Children, Strong Families (HCSF) is a 2-year, community-driven, family-based randomized controlled trial of a healthy lifestyles intervention conducted in partnership with four Wisconsin American Indian tribes. HCSF is composed of 1 year of targeted home visits to deliver nutritional and physical activity curricula. During Year 1, trained community mentors work with 2-5-year-old American Indian children and their primary caregivers to promote goal-based behavior change. During Year 2, intervention families receive monthly newsletters and attend monthly group meetings to participate in activities designed to reinforce and sustain changes made in Year 1. Control families receive only curricula materials during Year 1 and monthly newsletters during Year 2. Each of the two arms of the study comprises 60 families. Primary outcomes are decreased child body mass index (BMI) z-score and decreased primary caregiver BMI. Secondary outcomes include: increased fruit/vegetable consumption, decreased TV viewing, increased physical activity, decreased soda/sweetened drink consumption, improved primary caregiver biochemical indices, and increased primary caregiver self-efficacy to adopt healthy behaviors. Using community-based participatory research and our history of university-tribal partnerships, the community and academic researchers jointly designed this randomized trial. This article describes the study design and data collection strategies, including outcome measures, with emphasis on the communities' input in all aspects of the research.

Family-focused physical activity, diet and obesity interventions in African-American girls: a systematic review

Obesity interventions that involve family members may be effective with racial/ethnic minority youth. This review assessed the nature and effectiveness of family involvement in obesity interventions among African-American girls aged 5-18 years, a population group with high rates of obesity. Twenty-six databases were searched between January 2011 and March 2012, yielding 27 obesity pilot or full-length prevention or treatment studies with some degree of family involvement and data specific to African-American girls. Interventions varied in type and level of family involvement, cultural adaptation, delivery format and behaviour change intervention strategies; most targeted parent-child dyads. Some similarities in approach based on family involvement were identified. The use of theoretical perspectives specific to African-American family dynamics was absent. Across all studies, effects on weight-related behaviours were generally promising but often non-significant. Similar conclusions were drawn for weight-related outcomes among the full-length randomized controlled trials. Many strategies appeared promising on face value, but available data did not permit inferences about whether or how best to involve family members in obesity prevention and treatment interventions with African-American girls. Study designs that directly compare different types and levels of family involvement and incorporate relevant theoretical elements may be an important next step.

Patient trust in physicians and shared decision-making among African-Americans with diabetes

This study explores patient trust in physicians and its relationship to shared decision-making (SDM) among African-Americans with diabetes (types 1 and 2). We conducted a series of focus groups (n = 27) and in-depth interviews (n = 24). Topic guides were developed utilizing theoretical constructs. Each interview was audiotaped and transcribed verbatim. Each transcript was independently coded by two randomly assigned members of the research team; codes and themes were identified in an iterative fashion utilizing Atlas.ti software. The mean age of study participants was 62 years and 85% were female. We found that (1) race as a social construct has the potential to influence key domains of patient trust (interpersonal/relationship aspects and medical skills/technical competence), (2) the relationship between patient trust and shared decision-making is bidirectional in nature, and (3) enhancing patient trust may potentially increase or decrease SDM among African-Americans with diabetes. Mistrust of physicians among African-Americans with diabetes may partially be addressed through (1) patient education efforts, (2) physician training in interpersonal skills and cultural competence, and (3) physician efforts to engage patients in SDM. To help enhance patient outcomes among African-Americans with diabetes, physicians might consider incorporating strategies to simultaneously engender their patients' trust and encourage shared decision-making.

3-Self behavior modification programs base on the PROMISE Model for clients at metabolic risk

The objectives of this mixed methods research were 1) to study effects of the health behavior modification program (HBMP) conducted under the principles of the PROMISE Model and the CIPP Model and 2) to compare the 3-self health behaviors and the biomedical indicators before with after the program completion. During the program, three sample groups including 30 program leaders, 30 commanders and 120 clients were assessed, and there were assessments taken on 4,649 volunteers who were at risk of metabolic syndrome before and after the program conducted in 17 hospitals. The collected data were analyzed by the t-test and the path analysis. The research instruments were questionnaires used for program evaluation, structuralized interview forms, and questionnaires used for 3-self health behavior assessment. The findings were as follows: 1) During the program, the assessment result deriving from comparing the overall opinions toward the program among the three sample groups showed no difference (F=2.219), 2) The program management factors based on the PROMISE Model (positive reinforcement, optimism, context, and process or activity provision) had an overall influence on the product or success of the HBMP (p< 0.05) with size effects at 0.37, 0.13, 0.31 and 0.88 respectively. All of the factors could predict the product of the program by 69%. 3) After participating in the program, the clients’ 3-self health behaviors (self-efficacy, self-regulation, and self-care) were significantly higher than those appeared before the participation (p< 0.05), and their biomedical indicators (BMI, blood pressure, waistline, blood glucose, lipid profiles, cholesterol, and HbA1c) were significantly lower than those measured before the program (p< 0.05).

Reach-out: a family-based diabetes prevention program for African American youth

OBJECTIVE

To pilot test and assess the feasibility of a culturally grounded approach to adolescent overweight and diabetes prevention.

STUDY DESIGN

Reach-Out, a family-based nutrition and exercise program for overweight African American youth aged 9 to 12 years and their families, is led by lay health leaders and conducted in a community setting on Chicago's south side (Illinois). Age-appropriate interactive sessions focus on skills building, problem solving, and setting goals during 14 weekly sessions, with monthly meetings thereafter. Pre-post comparisons were made for 29 families (62 subjects) using physical (body mass index [BMI], blood pressure, waist circumference), biochemical (glucose, insulin, lipid levels) and behavioral data. Statistical analyses included mixed-effects linear models and logistic regression.

RESULTS

Children's mean BMI z score fell from 2.46 at baseline to 2.38 at 14 weeks and 2.39 at 1 year (p=.02), while parents' BMI remained stable. Children reported increased walking (p=0.07) and exhibited a corresponding rise in mean serum high-density lipoprotein cholesterol from 49.4 to 54.2 (p<.001). Qualitative assessment showed that participants enjoyed the program but felt the program could be improved by making the sessions even more interactive.

CONCLUSION

A community-based program for overweight minority youth and families can successfully address overweight, with the potential to decrease diabetes risk in youth.

Outcomes From a Culturally Tailored Diabetes Prevention Program in Hispanic Families From a Low-Income School

Purpose

The purpose of this study was to test the effectiveness of a minimal, tailored diabetes prevention program for families that could be delivered in elementary school settings.

Methods

Families were eligible for the program if they had at least one child aged 8 to 12 years old attending the elementary school who was at high risk of developing type 2 diabetes mellitus. Families attended ten 90-minute sessions with exercise, cooking demonstrations, and healthy life-style lessons. Height, weight, and self-reported behavior were assessed in parents and height and weight in children before and after classes.

Results

A total of 82 parents (2% men, 98% women) and 62 children (47% boys and 53% girls) enrolled in the program across 3 replications. Parents had an average weight loss from baseline to the end of the program of 1.5 lb (P = .05). There was a large increase in the number of parents who self-reported engaging in leisure-time physical activity as a result of participating in the program (14% vs 64%; P < .01). There were no changes in children’s body mass index percentile or z score as a result of the program.

Conclusions

Delivering a diabetes prevention program in an elementary school setting was effective for increasing diabetes-related knowledge, chronic disease awareness, and self-reported healthy behavior in low-income Spanish-speaking families.

Camp jump start: effects of a residential summer weight-loss camp for older children and adolescents

OBJECTIVE

Residential weight-loss camps offer an opportunity for overweight and obese children to lose weight in a medically safe, supervised, supportive environment. The purpose of this report is to describe short-term outcomes in 76 children participating in a 4- or 8-week residential weight-loss camp for children and adolescents.

PATIENTS AND METHODS

The camp program enrolled obese 10- to 18-year-old adolescents. The program consisted of structured and nonstructured physical activities and group educational sessions covering nutrition, physical fitness, and self-esteem. A diet plan of 3 balanced meals and 2 snacks per day was prepared under the supervision of a registered dietitian. Participants had height, weight, and blood pressure measured and performed a 1-mile run at maximum effort on an outdoor track.

RESULTS

For all campers, statistically significant (P < .0001) reductions were observed for BMI, BMI z score, systolic blood pressure, body weight, and 1-mile run times. Compared with campers in the 4-week session, campers in the 8-week session had greater reductions in BMI, BMI z score, body weight, and systolic blood pressure. Multivariate analysis revealed that gender was a significant predictor for reduction in body weight, BMI, and BMI z score, all of which decreased more in boys than in girls.

CONCLUSIONS

This report adds to the evidence that residential weight-loss camps are highly effective in improving measures of health and fitness among overweight and obese children and adolescents. Additional study is needed on the long-term effects of such camps in terms of weight maintenance, behavior change, and metabolic and health outcomes.

Determinants of the use of a diabetes risk-screening test

A study was designed to investigate why people do or do not make use of a diabetes risk test developed to facilitate the timely diagnosis of diabetes. Data were collected using a web-based questionnaire, which was based on the Health Belief Model, the Theory of Planned Behavior, and the Threatening Medical Situations Inventory. People who had and had not used the risk test were recruited to complete the survey. The sample consisted of 205 respondents: 44% who had used the test and 56% who had not. The hypothesized relationships between the dependent variable (diabetes risk test use) and the determinants used in this study were tested using logistic regression analysis. Only two significant predictors of diabetes risk test use were found: gender and barriers. More women than men use the test. Furthermore, people who experience more barriers will be less inclined to use the test. The contribution of diabetes screening tests fully depends on people's willingness to use them. To optimize the usage of such test, it is especially important to address the barriers as perceived by the public. Two types of barriers must be addressed: practical barriers (time to take the test, fear of complexity of the test), and consequential barriers (fear of the disease and treatment, uncertainties about where to go in the case of an increased risk of diabetes).

Communicating with older diabetes patients: self-management and social comparison

OBJECTIVE

The health status and life experiences of older diabetes patients may be highly heterogeneous, thus making their perspectives particularly relevant for developing individualized self-management plans for this population. Our earlier research showed older diabetes patients' healthcare goals and self-management behaviors are frequently shaped through social comparisons with peers/family members. The present paper explores this role of social comparison in their self-management practices and develops a conceptual model depicting the process.

METHODS

Data were collected using open-ended, semi-structured interviews to elicit 28 older, type 2 diabetes patients' healthcare goals and self-management practices. Qualitative techniques were used to extract salient themes.

RESULTS

Social comparison plays a salient role in routinizing older patients' self-management practices. Almost all patients assess their self-management by making "downward" comparisons with individuals doing worse than them; "upward" comparisons are rarely invoked. Occasionally patients' social comparisons lead them to adopt "normalizing" behaviors resulting in deviations from medically recommended self-care.

CONCLUSION

The findings formed the basis for developing a conceptual model delineating the role of social comparison in self-management that can be beneficial for providers in tailoring educational interventions for self-management.

PRACTICE IMPLICATIONS

Fostering these comparisons can help providers enhance communication on initiating and sustaining self-management practices.

Baseline correlates of insulin resistance in inner city high-BMI African-American children

To characterize the influence of diet-, physical activity-, and self-esteem-related factors on insulin resistance in 8- 10-year-old African-American (AA) children with BMI greater than the 85th percentile who were screened to participate in a community-based type 2 diabetes mellitus (T2DM) prevention trial. In 165 subjects, fasting glucose- and insulin-derived values for homeostasis model assessment of insulin resistance (HOMA-IR) assessed insulin resistance. Body fatness was calculated following bioelectrical impedance analysis, and fitness was measured using laps from a 20-m shuttle run. Child questionnaires assessed physical activity, dietary habits, and self-esteem. Pubertal staging was assessed using serum levels of sex hormones. Parent questionnaires assessed family demographics, family health, and family food and physical activity habits. Girls had significantly higher percent body fat but similar anthropometric measures compared with boys, whereas boys spent more time in high-intensity activities than girls. Scores for self-perceived behavior were higher for girls than for boys; and girls desired a more slender body. Girls had significantly higher insulin resistance (HOMA-IR), compared with boys (P < 0.01). Adjusting for age, sex, pubertal stage, socioeconomic index (SE index), and family history of diabetes, multivariate regression analysis showed that children with higher waist circumference (WC) (P < 0.001) and lower Harter's scholastic competence (SC) scale (P = 0.044) had higher insulin resistance. WC and selected self-esteem parameters predicted insulin resistance in high-BMI AA children. The risk of T2DM may be reduced in these children by targeting these factors.

How is shared decision-making defined among African-Americans with diabetes?

OBJECTIVE

This study investigates how shared decision-making (SDM) is defined by African-American patients with diabetes, and compares patients' conceptualization of SDM with the Charles model.

METHODS

We utilized race-concordant interviewers/moderators to conduct in-depth interviews and focus groups among a purposeful sample of African-American patients with diabetes. Each interview/focus group was audio-taped, transcribed verbatim and imported into Atlas.ti software. Coding was done using an iterative process and each transcription was independently coded by two members of the research team.

RESULTS

Although the conceptual domains were similar, patient definitions of what it means to "share" in the decision-making process differed significantly from the Charles model of SDM. Patients stressed the value of being able to "tell their story and be heard" by physicians, emphasized the importance of information sharing rather than decision-making sharing, and included an acceptable role for non-adherence as a mechanism to express control and act on treatment preferences.

CONCLUSION

Current instruments may not accurately measure decision-making preferences of African-American patients with diabetes.

PRACTICE IMPLICATIONS

Future research should develop instruments to effectively measure decision-making preferences within this population. Emphasizing information-sharing that validates patients' experiences may be particularly meaningful to African-Americans with diabetes.

Constructs of health and environment inform child obesity prevention in American Indian communities

OBJECTIVE

Obesity prevention efforts have had limited success in American Indian (AI) populations. More effective prevention programs might be designed using insights into linkages between parental health beliefs, environmental constraints and healthy lifestyle choices.

METHODS AND PROCEDURES

Focus group sessions (n = 42 participants) were conducted to explore parental perspectives on children's health, diet and physical activity in three Wisconsin Tribal communities. Focus group questions were derived from preliminary interviews and observations on environmental barriers surrounding nutrition and physical activity.

RESULTS

Two broad thematic areas emerged from the focus groups: child health themes and environmental themes. Health themes included views of child health (emphasizing emotional health), views on parenting, and assessment of risks to child safety. Environmental (social and physical) themes included assessments of personal support networks, assessments of local facilities and programs, and values regarding household relationships. A provisional model of family behaviors related to child nutrition and physical activity was developed to better understand these themes and the potential tensions among them.

DISCUSSION

Understanding the unique cultural constructs of health and environment of AI communities can inform decision making in community-level prevention research. The proposed model served as a useful starting point for designing healthy lifestyle interventions in these AI communities. This model may also be applicable to other minority communities.

Community and family perspectives on addressing overweight in urban, African-American youth

OBJECTIVE

To assess weight-related beliefs and concerns of overweight urban, African-American children, their parents, and community leaders before developing a family-based intervention to reduce childhood overweight and diabetes risk.

DESIGN

We conducted 13 focus groups with overweight children and their parents and eight semistructured interviews with community leaders.

PARTICIPANTS AND SETTING

Focus group participants (N = 67) from Chicago's South Side were recruited through flyers in community sites. Interview participants (N = 9) were recruited to sample perspectives from health, fitness, education, civics, and faith leaders.

RESULTS

Community leaders felt awareness was higher for acute health conditions than for obesity. Parents were concerned about their children's health, but felt stressed by competing priorities and constrained by lack of knowledge, parenting skills, time, and financial resources. Parents defined overweight in functional terms, whereas children relied upon physical appearances. Children perceived negative social consequences of overweight. Parents and children expressed interest in family-based interventions to improve nutrition and physical activity and offered suggestions for making programs interesting.

CONCLUSIONS

This study provides insights into the perspectives of urban, African-American overweight children, their parents, and community leaders regarding nutrition and physical activity. The specific beliefs of these respondents can become potential leverage points in interventions.

Models and theories in studies on educating and counseling children about physical health: a systematic review

The aim of this review is to gain a comprehensive view on the theories and models referred to in studies on educating and counseling children about physical health. A computer search was conducted using PubMed Medline, and Silverplatter Webspirs Psycinfo. Original studies, reviews, and theoretical papers published between 1992-2003 were included. The review presents the results of the 35 studies in which the majority of the subjects were between 0 and 12 years of age. A classification system is proposed that helped grouping the models, and the interrelationship between this classification and the characteristics of the reviewed studies is explored. The classification could function as an introductory guide and help to select appropriate theories and models when defining future research agenda's. The results of this review may attribute to the refinement of the theoretical underpinning of child education and counseling in physical health.