A community based prevention of weight gain intervention (Mothers In Motion) among young low-income overweight and obese mothers: design and rationale

Self-efficacy and autonomous motivation are associated with lower sugar-sweetened beverage consumption in low-income overweight and obese mothers of young children

Sugar-sweetened beverage (SSB) consumption is strongly associated with obesity. Autonomous motivation and self-efficacy, key concepts of self-determination theory, may influence SSB consumption. Low-income mothers of young children experience disproportionate rates of obesity. Whether autonomous motivation and self-efficacy are associated with SSB consumption in low-income mothers of young children is unknown. This exploratory secondary data analysis explored whether autonomous motivation or self-efficacy were associated with SBB consumption using data from a lifestyle intervention for low-income, overweight or obese mothers with young children. Participants (N = 311) completed surveys assessing autonomous motivation, self-efficacy, and SSB consumption at baseline, after the 16-week intervention, and at 3-month follow-up. Using baseline data, we performed linear regression models to explore associations of self-efficacy and autonomous motivation with SSB consumption. We also performed mixed effects models to explore whether autonomous motivation or self-efficacy were associated with SSB consumption over time. At baseline, a one-point increase in autonomous motivation and self-efficacy were associated with 4.36 (p < 0.001) and 6.43 (p = 0.025) fewer ounces of SSB consumption per day, respectively. In longitudinal models, SSB consumption decreased over time. Change in SSB consumption was associated with self-efficacy (B = -4.88; p = 0.015) and autonomous motivation (B = -2.29; p = 0.008). Our findings suggest self-efficacy and autonomous motivation may influence SSB consumption among mothers of young children with overweight and obesity. Further investigation should explore if self-efficacy and autonomous motivation have long-term effects on SSB consumption.

Mothers In Motion Program: Implementation Process and Acceptability by Community

BACKGROUND

Implementing lifestyle behavior programs in real-world settings challenges researchers. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has implemented and sustained Mothers In Motion (MIM)'s client videos for clients to promote healthy lifestyle behaviors, and train-the-trainer videos, for personnel to enhance motivational interviewing techniques since 2015 and 2016, respectively. This paper describes the implementation processes and the results of client video implementation acceptability by WIC personnel.

METHODS

To document the implementation process, we applied the Framework for Adaptation and Modifications to Evidence-Based Implementation Strategies (FRAME-IS). To evaluate implementation acceptability, we conducted semi-structured interviews with 15 WIC personnel. A qualitative analysis was conducted to identify the common themes.

RESULTS

The facilitators for client video implementation were the inclusion of the target audience and family members addressing daily challenges, easy implementation, and compatibility with daily practice. While videos online facilitated implementation, videos in DVD format could challenge implementation.

CONCLUSIONS

Future lifestyle intervention programs aimed for future implementation in community settings may consider the inclusion of the target audience and their family members and take into consideration easy implementation and compatibility.

Association between specific types of parent stressors and fast-food consumption among parents and children

INTRODUCTION

Although stress has been associated with eating behaviors, such as overeating and eating less healthy foods, the relationships between specific types of parent stressors and fast-food consumption in parents and young children have not been well studied. We hypothesized that parent perceived stress, parenting stress, and household chaos would be positively associated with fast-food consumption for parents and their young children.

METHODS

Parents of 2-5 year olds and with Body Mass Index >27 kg/m2 (N = 234, parent mean age: 34.3 (±5.7); child age: 44.9 (±13.8) months; 65.8 % from two parent households) completed surveys on parent perceived stress, parenting stress, household chaos, and their fast-food intake and that of their child.

RESULTS

In separate regression models, controlling for covariates, parent perceived stress (β = 0.21, p < 0.01; R2 = 0.10, p < 0.01), parenting stress (β = 0.26, p < 0.01; R2 = 0.13, p < 0.01), and household chaos (β = 0.25, p < 0.01; R2 = 0.12, p < 0.01) were each significantly associated with parent fast-food consumption, and separately with child fast-food consumption [Parent perceived stress (β = 0.05, p = 0.02; R2 = 0.14, p < 0.01); parenting stress (β = 0.14, p = 0.03; R2 = 0.14, p < 0.01); parent fast-food consumption (β = 0.40, p < 0.01; R2 = 0.27, p < 0.01)]. However, combined final models showed parenting stress (p < 0.01) as the only significant predictor of parent fast-food consumption, which in turn was the only significant predictor of child fast-food consumption (p < 0.01).

DISCUSSION

The findings support the inclusion of parenting stress interventions that target fast-food eating behaviors in parents, which may in turn, reduce fast-food intake in their young children.

Psychosocial Factors Associated With Physical Activity Among Low-Income Overweight or Obese Mothers with Young Children

PURPOSE

Investigate the associations between psychosocial factors and physical activity.

DESIGN

Secondary data analysis utilizing baseline data of a large-scale community-based randomized controlled lifestyle behavior intervention.

SETTING

The Special Supplemental Program for Women, Infants, and Children in Michigan, USA.

SUBJECTS

Low-income overweight or obese mothers with young children (N = 740, 65% response rate).

MEASURES

Survey data were collected via phone interview. Predictors included self-efficacy, autonomous motivation, emotional coping, and social support. Self-reported leisure physical activity was the outcome variable. Covariates were age, race, smoking, employment, education, body mass index, and postpartum status.

ANALYSIS

A multiple linear regression model was applied.

RESULTS

Self-efficacy (β = .32, 95% CI = .11, .52, P = .003) and autonomous motivation (β = .10, 95% CI = .03, .17, P = .005) were positively associated with physical activity. However, emotional coping and social support were not associated with physical activity.

CONCLUSION

Future research should examine the longitudinal association of key psychosocial factors with physical activity.

A Pilot Lifestyle Behavior Intervention for Overweight or Obese Pregnant Women: Results and Process Evaluation

Introduction

This paper presents a pilot lifestyle behavior intervention effect on gestational weight gain and maternal and neonatal outcomes and intervention acceptability.

Materials and Methods

Overweight or obese pregnant participants (N = 70) were randomized to the intervention or usual care group. The 20-week intervention integrated Hope theory and goal-oriented episodic future thinking (GoEFT) to prevent excessive gestational weight gain through stress and emotion management, healthy eating, and physical activity. Intervention participants completed a weekly web intervention module with 2 parts (I and II) and joined individual health coaching sessions (10 sessions). The primary outcome was gestational weight gain (GWG). Secondary outcomes included maternal and neonatal outcomes. Data were collected at 3 time points: baseline (< 17 weeks gestation, T1), 24-27 weeks gestation (T2), and 35-37 weeks gestation (T3). Intervention participants completed a semi-structured interview to evaluate the intervention. We compared GWG at T2 and T3 with T1 for intervention and usual care groups using t-tests and conducted content analysis to identify common themes for intervention acceptability.

Results

There were no significant group differences in GWG at T2 and T3. Maternal and neonatal outcomes were similar between groups. Common themes for intervention acceptability were disked web Part I intervention presented in text, the need for choosing a weekly intervention topic, raising awareness through GoEFT and self-evaluation, increased motivation through GoEFT, and usefulness of pre-written goals and goal progress evaluation.

Conclusions

Results of process evaluation are helpful for researchers to design a lifestyle intervention to prevent excessive gestational weight gain.

Cultural Sensitivity in Interventions Aiming to Reduce or Prevent Intimate Partner Violence During Pregnancy: A Scoping Review

Intimate partner violence (IPV) around the time of pregnancy is a recognized global health problem. Ethnic minorities and immigrant pregnant women experiencing IPV require culturally responsive health services. The aim of this scoping review was to identify aspects of cultural sensitivity in interventions to prevent or reduce IPV among ethnic minorities and immigrant pregnant women in high-income countries. Eight databases were searched in November 2019. Any type of scientific research, quantitative, qualitative, or mixed methods studies regarding interventions against IPV among pregnant women were considered for inclusion. Resnicow et al.'s definition of cultural sensitivity was used to identify aspects of cultural sensitivity. Ten papers relating to nine interventions/studies met our inclusion criteria. These studies, which included randomized controlled trials, a mixed methods study, a program evaluation, and a longitudinal study, were conducted in Australia, Belgium, Norway, and the United States. Aspects of surface cultural sensitivity, including the translation of intervention content into the language of the target group(s) and the involvement of bilingual staff to recruit participants, were identified in eight studies. Deep structure aspects of cultural sensitivity were identified in one study, where the intervention content was pretested among the target group(s). Results that could be related to the culture-sensitive adaptions included successful recruitment of the target population. Three studies were planning to investigate women's experiences of interventions, but no publications were yet available. This scoping review provides evidence that culturally sensitive interventions to reduce or prevent IPV among immigrant pregnant women are limited in number and detail.

Executive summary of evidence and consensus-based clinical practice guideline for management of obesity and overweight in postpartum women: An AIIMS-DST initiative

INTRODUCTION

Postpartum obesity is a public health concern. There is a need to counsel women about their postpartum weight management, accounting for various barriers they face. Limited literature in the Indian context underscored the need to develop the clinical practice guideline to be used by healthcare providers in Indian healthcare settings.

METHODS

The guideline was formulated by following the standardised methodology proposed by the National Health and Medical Research Council. Various steps such as identification of the patient population, assembly of the guideline development groups, identification of the key clinical questions, guideline development methods, grading the quality of evidence and recommendations and guideline translation were carried out to develop and validate the clinical practice recommendations.

RESULTS

The evidence and consensus-based clinical practice guideline has been developed, providing recommendations for key topics of interest for first-line treatment of obesity (lifestyle-related management). Recommendations focus on screening and initiating discussion with overweight and obese postpartum women as well as those who had normal pre-pregnancy body mass index but have retained excessive weight in the postpartum period. Recommendations highlight the evaluation and management of dietary, physical activity and breastfeeding behaviour. Recommendations also account for behavioural modification techniques to improve adherence to the prescribed weight management advice. Duration and frequency of follow-ups as well as the advice to be disseminated have also been discussed in the recommendations.

CONCLUSION

The guideline provides clinical practice points that can be used by healthcare providers, postpartum women and policymakers for opportunistic screening and management of postpartum obesity.

Perceived stress linking psychosocial factors and depressive symptoms in low-income mothers

Background

Little is known about associations between perceived stress, psychosocial factors (social support, emotional coping, coping self-efficacy, and autonomous motivation), and depressive symptoms in low-income overweight or obese mothers of young children. Using baseline data of a lifestyle intervention study, this secondary analysis investigates whether perceived stress might mediate the associations between the psychosocial factors and depressive symptoms.

Methods

Convenience sampling was applied. Low-income overweight or obese mothers of young children were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children in Michigan, US. Survey data were collected through phone interviews. Participants (N = 740) responded to valid surveys measuring perceived stress, social support, emotional coping, coping self-efficacy, autonomous motivation, and depressive symptoms. Composite indicator structural equation modeling was performed to test for potential mediation.

Results

When investigating the potential role of perceived stress as a mediator, the indirect effects of social support (b = − 2.10, p < 0.01), emotion coping (b = − 3.81, p < 0.05), and coping self-efficacy (b = − 7.53, p < 0.01) on depressive symptoms through perceived stress were significant, but the indirect effect of autonomous motivation was not.

Conclusion

Future intervention studies aiming to alleviate depressive symptoms in low-income overweight or obese mothers of young children might consider including practical strategies to promote social support, emotional coping, and coping self-efficacy to reduce perceived stress, which might potentially decrease depressive symptoms.

Trial registration

Clinical Trials NCT01839708; registered February 28, 2013.

Perceived Stress Can Mediate the Associations between a Lifestyle Intervention and Fat and Fast Food Intakes

This secondary analysis study addressed a gap of knowledge: whether perceived stress reduction created by a lifestyle intervention might serve as a mediator for reducing fat and fast food intakes in low-income overweight or obese mothers of young children. This analysis included 338 low-income overweight or obese mothers of young children who completed a phone interview immediately after the 16-week lifestyle intervention. Valid surveys were used to assess perceived stress and fat and fast food intakes. Composite indicator structural equation modeling was performed to test the mediation effects. The overall effect of the intervention was not significant for fat intake but was significant for fast food intake (B = −0.53, p < 0.05). When assessing the potential role of perceived stress as a mediator, the indirect effects of the intervention on fat (B = −0.39, p < 0.01) and fast food (B = −0.27, p < 0.01) intakes were both significant. Future dietary intervention studies aimed to reduce fat and fast food intakes in low-income overweight or obese mothers of young children might consider including practical strategies aimed at reducing perceived stress.

Multiple deprivation and other risk factors for maternal obesity in Portsmouth, UK

BACKGROUND

Maternal obesity is known to be associated with a range of adverse outcomes, both for the mothers and their children. It may be more prevalent in areas with higher deprivation as measured by the Index of Multiple Deprivation (IMD), but this has not been demonstrated consistently. This study focused primarily on the relationship between maternal obesity and deprivation in a setting where areas of significant deprivation are surrounded by the overall affluent South East England.

METHODS

The study used the records of 3830 women who delivered under the care of a Portsmouth hospital from 1 April 2013 to 31 March 2014. Logistic regression was used to analyse the association between national IMD quintiles and maternal obesity, accounting for the potential confounders of age, ethnic origin, smoking status and parity.

RESULTS

Following adjustment, women in the most deprived IMD quintile were 1.60 (95% CI: 1.13, 2.26) times more likely to be obese compared to those in the least deprived quintile. Maternal obesity was also found to be associated with ethnicity and parity, but not with age or smoking status.

CONCLUSIONS

Maternal obesity increased with increasing deprivation. IMD may be a useful group-level indicator when planning interventions aimed at tackling maternal obesity.

Mediators of intervention effects on dietary fat intake in low-income overweight or obese women with young children

PURPOSE

We investigated whether autonomous motivation and self-efficacy might mediate the association between a lifestyle behavior intervention and dietary fat intake in low-income overweight or obese women with young children.

METHODS

Participants were randomized to an intervention or comparison group. Intervention participants received a 16-week intervention aimed to prevent weight gain through promotion of stress management, healthy eating and physical activity. During the intervention phase, participants viewed a designated video lesson at home and dialed in a peer support group teleconference every week (weeks 1-4) then every other week (weeks 5-16). Potential mediation effects were analyzed using sequential mixed-effects linear models and path analysis.

RESULTS

The intervention led to increased autonomous motivation (β = 0.34, standard error [SE] = 0.15, P = 0.005), which subsequently increased self-efficacy (β = 0.18, SE = 0.35, P < 0.001), and higher levels of self-efficacy were associated with decreased dietary fat intake (β = -0.22, SE = 0.28, P < 0.001). In other words, autonomous motivation and self-efficacy mediated the association between the lifestyle behavior intervention and dietary fat intake.

CONCLUSION

To decrease dietary fat intake for low-income overweight or obese women with young children, strategies, such as those promoting peer encouragement, may be warranted in interventions to enhance autonomous motivation and/or practical skills for increasing self-efficacy.

Mediators affecting the association between a lifestyle behavior intervention and stress in low-income overweight or obese mothers of young children

Using data from a community-based lifestyle behavioral intervention study, this secondary data analysis investigated whether emotional coping, coping self-efficacy, and autonomous motivation mediated the association between the intervention and perceived stress in low-income overweight or obese mothers of young children. Results showed that coping self-efficacy significantly mediated the association between the intervention and perceived stress. However, emotional coping and autonomous motivation did not significantly mediate the association between intervention and perceived stress. Interventions may be more effective in helping the target audience reduce stress if they incorporate practical skills that can increase a sense of coping self-efficacy.

Mediation by self-efficacy in the relation between social support and dietary intake in low-income postpartum women who were overweight or obese

PURPOSE

Using baseline data from a prevention of weight gain intervention study, we investigated whether self-efficacy mediated the relations between social support and dietary intake of saturated fat, fast food, fruit and vegetable in low-income postpartum women who were overweight or obese.

METHODS

Participants (N = 740) completed validated measures of self-reported social support, self-efficacy, and dietary intake of saturated fat, fast food, fruit and vegetable. We performed composite indicator structural equation modeling to test the mediation effect. Effect size was calculated using proportion of maximum possible (POMP) scores in the endogenous variables (e.g., fast food) per unit change in the exogenous variable.

RESULTS

When including the influence of self-efficacy as a mediator, social support indirectly influenced dietary intake of saturated fat (p ≤ 0.001, POMP = -0.77%), fast food (p ≤ 0.001, POMP = -0.28%), and fruit and vegetable (p ≤ 0.001, POMP = 0.53%). Thus, these data are consistent with self-efficacy mediating the relations between social support and dietary intake of saturated fat, fast food, fruit and vegetable in low-income postpartum women who were overweight or obese.

CONCLUSION

Dietary interventions aiming to decrease saturated fat and fast food intake and increase fruit and vegetable intake for the target population may consider including practical skills for increasing social support and self-efficacy that can be implemented in daily life.

Sleep and weight loss in low-income overweight or obese postpartum women

Background

We conducted secondary data analyses to examine the associations between sleep duration, sleep quality, sleep disturbance and ≥ 5% of weight loss in low-income overweight or obese postpartum women enrolled in a community-based lifestyle behavior intervention study aimed at prevention of weight gain.

Methods

Participants were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children in Michigan. The Pittsburgh Sleep Quality Index was used to assess sleep duration, sleep quality, and sleep disturbance. All participants were assessed and weighed at baseline (T1, 569 participants), 4-month (T2, 367 participants), and 7-month from T1 (T3, 332 participants). Descriptive statistics and mixed-effects regression analysis were performed.

Results

Participants reported longer sleep duration (p = 0.048), better sleep quality (p = 0.003) and less sleep disturbance (p < 0.001) over time. There were no significant mean body weight changes at T2 and T3. However, a significantly higher proportion of women lost ≥5% of body weight at T3 (23.1%) than T2 (12.5%, p = 0.001). Sleep duration, quality, and disturbance were not significantly associated with ≥5% of weight loss.

Conclusion

Improvements in sleep duration, sleep quality and sleep disturbance over time were not associated with ≥5% of weight loss in low-income overweight or obese postpartum women.

Trial registration

Clinical Trials NCT01839708; retrospectively registered February 28, 2013.

Mothers In Motion intervention effect on psychosocial health in young, low-income women with overweight or obesity

BACKGROUND

Mothers in Motion (MIM), a community-based intervention program, was designed to help young, low-income women with overweight or obesity prevent further weight gain by promoting stress management, healthy eating, and physical activity. This paper presents the MIM's intervention effect on self-efficacy to cope with stress, emotional coping response, social support for stress management, stress, depressive symptoms, and positive and negative affect.

METHODS

Participants (N = 612) were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children in Michigan. They were randomly assigned to an intervention group (410 participants) or comparison group (202 participants). During the 16-week intervention, intervention participants watched ten video lessons at home and joined ten peer support group teleconferences. Surveys with established validity and reliability were used to measure self-efficacy to cope with stress, emotional coping response, and social support for stress management. The Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and Positive and Negative Affect Scale were used to measure stress, depressive symptoms, and positive and negative affect, respectively. A general linear mixed model was applied to test the intervention effect at the end of the 16-week intervention (T2, n = 338) and at three-month follow-up (T3, n = 311).

RESULTS

At T2, the intervention group reported significantly higher self-efficacy to cope with stress (effect size [Cohen's d] = 0.53), better emotional coping response (d = 0.38), less stress (d = 0.34), fewer depressive symptoms (d = - 0.27), and more positive affect (d = 0.31) than the comparison group. However, there were no significant differences in social support for stress management and negative affect between these two groups. At T3, the intervention group still reported significantly higher self-efficacy to cope with stress (d = 0.32) and better emotional coping response (d = 0.34) than the comparison group but did not report significantly higher social support for stress management, stress, depressive symptoms, and positive and negative affect.

CONCLUSIONS

To help young, low-income women with overweight or obesity manage stress, researchers and program planners may consider focusing on building self-efficacy to cope with stress.

TRIAL REGISTRATION

Clinical Trials NCT01839708 ; registered February 28, 2013.

A Community-Based Intervention Program's Effects on Dietary Intake Behaviors

OBJECTIVE

To evaluate the effect of a community-based lifestyle behavioral intervention on intakes of fat, fruits, vegetables, fast foods, and beverages in low-income young mothers with overweight or obesity.

METHODS

Participants were randomly assigned to an intervention (watching video lessons at home plus peer support group teleconferences) or a comparison group. General linear mixed model analyses were utilized to determine mean differences between the groups (212 intervention, 126 comparison) immediately following and 3 months (196 intervention, 115 comparison) after the intervention.

RESULTS

Immediately after the intervention, the intervention group had significantly lower mean scores in intakes of fat (effect size [d] = 0.24), fast foods (d = 0.33), and non-sugar-sweetened beverages (d = 0.27) than the comparison group. No significant group differences were observed for intakes of fruits, vegetables, or sugar-sweetened beverages. Three months after the intervention, no significant group differences were observed for intakes of fat, fruits, vegetables, fast foods, and both sugar- and non-sugar-sweetened beverages.

CONCLUSIONS

The intervention group improved dietary intakes of fat and fast foods but not fruits, vegetables, or beverages over the short term. Our intervention had no long-term effect on dietary intake behaviors.

Sex-dependent differences in voluntary physical activity

Numbers of overweight and obese individuals are increasing in the United States and globally, and, correspondingly, the associated health care costs are rising dramatically. More than one-third of children are currently considered obese with a predisposition to type 2 diabetes, and it is likely that their metabolic conditions will worsen with age. Physical inactivity has also risen to be the leading cause of many chronic, noncommunicable diseases (NCD). Children are more physically inactive now than they were in past decades, which may be due to intrinsic and extrinsic factors. In rodents, the amount of time engaged in spontaneous activity within the home cage is a strong predictor of later adiposity and weight gain. Thus, it is important to understand primary motivators stimulating physical activity (PA). There are normal sex differences in PA levels in rodents and humans. The perinatal environment can induce sex-dependent differences in PA disturbances. This Review considers the current evidence for sex differences in PA in rodents and humans. The rodent studies showing that early exposure to environmental chemicals can shape later adult PA responses are discussed. Next, whether there are different motivators stimulating exercise in male vs. female humans are examined. Finally, the brain regions, genes, and pathways that modulate PA in rodents, and possibly by translation in humans, are described. A better understanding of why each sex remains physically active through the life span could open new avenues for preventing and treating obesity in children and adults. © 2016 Wiley Periodicals, Inc.

Targeted mass media interventions promoting healthy behaviours to reduce risk of non-communicable diseases in adult, ethnic minorities

BACKGROUND

Physical activity, a balanced diet, avoidance of tobacco exposure, and limited alcohol consumption may reduce morbidity and mortality from non-communicable diseases (NCDs). Mass media interventions are commonly used to encourage healthier behaviours in population groups. It is unclear whether targeted mass media interventions for ethnic minority groups are more or less effective in changing behaviours than those developed for the general population.

OBJECTIVES

To determine the effects of mass media interventions targeting adult ethnic minorities with messages about physical activity, dietary patterns, tobacco use or alcohol consumption to reduce the risk of NCDs.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, ERIC, SweMed+, and ISI Web of Science until August 2016. We also searched for grey literature in OpenGrey, Grey Literature Report, Eldis, and two relevant websites until October 2016. The searches were not restricted by language.

SELECTION CRITERIA

We searched for individual and cluster-randomised controlled trials, controlled before-and-after studies (CBA) and interrupted time series studies (ITS). Relevant interventions promoted healthier behaviours related to physical activity, dietary patterns, tobacco use or alcohol consumption; were disseminated via mass media channels; and targeted ethnic minority groups. The population of interest comprised adults (≥ 18 years) from ethnic minority groups in the focal countries. Primary outcomes included indicators of behavioural change, self-reported behavioural change and knowledge and attitudes towards change. Secondary outcomes were the use of health promotion services and costs related to the project.

DATA COLLECTION AND ANALYSIS

Two authors independently reviewed the references to identify studies for inclusion. We extracted data and assessed the risk of bias in all included studies. We did not pool the results due to heterogeneity in comparisons made, outcomes, and study designs. We describe the results narratively and present them in 'Summary of findings' tables. We judged the quality of the evidence using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology.

MAIN RESULTS

Six studies met the inclusion criteria, including three RCTs, two cluster-RCTs and one ITS. All were conducted in the USA and comprised targeted mass media interventions for people of African descent (four studies), Spanish-language dominant Latino immigrants (one study), and Chinese immigrants (one study). The two latter studies offered the intervention in the participants' first language (Spanish, Cantonese, or Mandarin). Three interventions targeted towards women only, one pregnant women specifically. We judged all studies as being at unclear risk of bias in at least one domain and three studies as being at high risk of bias in at least one domain.We categorised the findings into three comparisons. The first comparison examined mass media interventions targeted at ethnic minorities versus an equivalent mass media intervention intended for the general population. The one study in this category (255 participants of African decent) found little or no difference in effect on self-reported behavioural change for smoking and only small differences in attitudes to change between participants who were given a culturally specific smoking cessation booklet versus a booklet intended for the general population. We are uncertain about the effect estimates, as assessed by the GRADE methodology (very low quality evidence of effect). No study provided data for indicators of behavioural change or adverse effects.The second comparison assessed targeted mass media interventions versus no intervention. One study (154 participants of African decent) reported effects for our primary outcomes. Participants in the intervention group had access to 12 one-hour live programmes on cable TV and received print material over three months regarding nutrition and physical activity to improve health and weight control. Change in body mass index (BMI) was comparable between groups 12 months after the baseline (low quality evidence). Scores on a food habits (fat behaviours) and total leisure activity scores changed favourably for the intervention group (very low quality evidence). Two other studies exposed entire populations in geographical areas to radio advertisements targeted towards African American communities. Authors presented effects on two of our secondary outcomes, use of health promotion services and project costs. The campaign message was to call smoking quit lines. The outcome was the number of calls received. After one year, one study reported 18 calls per estimated 10,000 targeted smokers from the intervention communities (estimated target population 310,500 persons), compared to 0.2 calls per estimated 10,000 targeted smokers from the control communities (estimated target population 331,400 persons) (moderate quality evidence). The ITS study also reported an increase in the number of calls from the target population during campaigns (low quality evidence). The proportion of African American callers increased in both studies (low to very low quality evidence). No study provided data on knowledge and attitudes for change and adverse effects. Information on costs were sparse.The third comparison assessed targeted mass media interventions versus a mass media intervention plus personalised content. Findings are based on three studies (1361 participants). Participants in these comparison groups received personal feedback. Two of the studies recorded weight changes over time. Neither found significant differences between the groups (low quality evidence). Evidence on behavioural changes, and knowledge and attitudes typically found some effects in favour of receiving personalised content or no significant differences between groups (very low quality evidence). No study provided data on adverse effects. Information on costs were sparse.

AUTHORS' CONCLUSIONS

The available evidence is inadequate for understanding whether mass media interventions targeted toward ethnic minority populations are more effective in changing health behaviours than mass media interventions intended for the population at large. When compared to no intervention, a targeted mass media intervention may increase the number of calls to smoking quit line, but the effect on health behaviours is unclear. These studies could not distinguish the impact of different components, for instance the effect of hearing a message regarding behavioural change, the cultural adaptation to the ethnic minority group, or increase reach to the target group through more appropriate mass media channels. New studies should explore targeted interventions for ethnic minorities with a first language other than the dominant language in their resident country, as well as directly compare targeted versus general population mass media interventions.

Results and lessons learned from a prevention of weight gain program for low-income overweight and obese young mothers: Mothers In Motion

Background

Mothers In Motion (MIM), a community-based lifestyle behavioral intervention, was designed and conducted to help low-income overweight and obese young mothers prevent further weight gain via promotion of stress management, healthy eating, and physical activity. This paper presents intervention effect on body weight (primary outcome) and summarizes lessons learned.

Methods

Participants (N = 612) were recruited from 7 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) offices in Michigan and were individually randomized to an intervention n= 410) or a comparison (n =202) group (2: 1 ratio). During the 16-week intervention, intervention participants watched theory-based culturally sensitive videos (in DVD format) featuring peers from the target audience to learn skills for managing stress, eating healthier, and being more physically active. They also dialed into peer support group teleconferences to enhance skills learned in the videos and increase motivation for lifestyle behavioral changes. Body weight, the primary outcome, was measured at baseline, immediately after the 16-week intervention, and 3 months after the 16-week intervention. Intervention effect was tested via general linear mixed model for repeated measures, using baseline measures as adjusting covariates.

Results

At baseline, the mean age of the participants was 28.5 ± 5.0 years (intervention: 28.4 ± 5.0, comparison: 28.9 ± 5.0); the mean body weight was 190.2 ± 1.4 lbs (intervention: 191.8 ± 30.0, comparison: 188.5 ± 29.1); and the mean body mass index (BMI) was 32.2 ± 4.4 (intervention: 32.2 ± 4.4, comparison: 31.7 ± 4.2). Of sample, 64.7% were obese. At 3 months after the 16-week intervention, no significant weight differences were found between the intervention (188.3 ± 10.6 lbs, BMI: 31.6 ± 1.8) and comparison groups (187.7 ± 10.6 lbs, BMI: 31.53 ± 1.8) when controlling for baseline body weight.

Conclusions

This lifestyle behavioral intervention that focused on stress management, healthy eating and physical activity was not effective in helping low-income overweight and obese young mothers prevent further weight gain.

Trial registration

Clinical Trials NCT01839708. This trial was registered retrospectively on February 28, 2013.

Recruitment Challenges and Enrollment Observations from a Community Based Intervention (Mothers In Motion) for Low-Income Overweight and Obese Women

BACKGROUND

Mothers In Motion (MIM), a randomized controlled trial, aimed to help young, low-income overweight and obese mothers prevent weight gain by promoting stress management, healthy eating, and physical activity. This paper describes MIM recruitment challenges and reports demographic characteristics affecting enrollment.

METHODS

Participants who were African American or Non-Hispanic White were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Michigan. We faced numerous recruitment challenges and learned that several strategies facilitated recruitment. Logistic regression analyses were performed to examine demographic characteristics that affect enrollment.

RESULTS

Women who had a higher body mass index (BMI, OR 1.06, 95% CI 1.02 - 1.10); were at late postpartum, (OR 1.24, 95% CI 1.10 - 1.40), were breastfeeding (OR 5.0, 95% CI 2.34 -10.65); or were at early postpartum and breastfeeding (OR 0.42, 95% CI 0.22 - 0.81) were more likely to enroll than their counterparts. Compared to African American women, Non-Hispanic White women were more likely to enroll (OR 1.77, 95% CI 1.29 - 2.42). Also, women who were non-smokers (OR 0.54, 95% CI 0.40 - 0.73) or had a higher education were more likely to enroll (OR 1.21, 95% CI 1.04 - 1.42) than those who smoked or had a lower education.

CONCLUSION

Future lifestyle behavioral intervention studies for similar target audiences may consider tailoring their recruitment messages based on relevant participant demographic characteristics identified as potential determinants of enrollment in this study.

Validation of PIN 3 physical activity survey in low-income overweight and obese young mothers

Background

Existing physical activity surveys have not been validated for use with low-income overweight and obese young mothers. This study aimed to validate the Pregnancy Infection and Nutrition 3 (PIN3) physical activity survey and to explore whether its validity varied by race/ethnicity and body mass index (BMI) category when including or excluding child and adult care activities in the target population.

Methods

Participants were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and were asked to fill out the PIN3 survey and wear an Actigraph accelerometer. Validity was assessed (N = 42) using Spearman correlation coefficient.

Results

Regardless of inclusion or exclusion of child and adult care activity, the PIN3 survey showed evidence of validity for moderate (correlation coefficients 0.33 [p = 0.03]; 0.40 [p = 0.08]) but not vigorous (−0.01 [p = 0.91]; −0.06 [p = 0.69]) physical activity. The mean minutes per week spent in moderate, vigorous and moderate-vigorous physical activity measured by the PIN3 were substantially higher than when measured by accelerometer, for example, 588 (PIN3) versus 148 (accelerometer) minutes per week. Also, correlations between self-reported and objective monitored activity varied substantially by race/ethnicity and BMI category, for example, 0.29 (p = 0.18) for overweight women versus 0.57 (p = 0.007) for obese women; 0.27 (p = 0.20) for African American versus 0.66 (p = 0.001) for white.

Conclusions

The PIN3 survey may be adequate for many applications where quick and practical assessments are needed for moderate physical activity data in low-income overweight and obese young mothers. The substantial differences in mean minutes per week between the PIN3 and accelerometer may be due to over-reported physical activity by the study participants.

Trial registration

Clinical Trials Number: NCT01839708