1
|
Noriega Esquives BS, St George SM, Moreno PI, Lee TK, Munoz E, Lad T, Pollack A, Hollowell CMP, Ramirez AG, Penedo FJ. A latent class analysis of health behavior changes after cancer diagnosis among Hispanic/Latino cancer survivors. J Cancer Surviv 2024; 18:739-749. [PMID: 36459380 PMCID: PMC10441686 DOI: 10.1007/s11764-022-01300-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/10/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE We aimed to identify subgroups of Hispanic/Latino (H/L) cancer survivors with distinct health behavior patterns and their associated sociodemographic, medical, and psychosocial characteristics. METHODS Baseline data were used from a randomized clinical trial evaluating the efficacy of an enhanced patient navigation intervention in H/L cancer survivors. Participants (n = 278) completed the Lifestyle Behavior Scale and validated questionnaires on health-related quality of life (HRQOL), supportive care needs, distress, and satisfaction with cancer care. Latent class analysis was used to determine the latent classes and associated characteristics. RESULTS Three latent classes emerged: class 1 (survivors who increased health behaviors [e.g., exercising and eating healthy] since diagnosis); class 2 (no changes in health behaviors since diagnosis); and class 3 (a "mixed class," with a higher or lower engagement across various health behaviors since diagnosis). Participants in class 1 were significantly more educated and less likely to be foreign born. Participants in class 2 were significantly older and more likely to have prostate cancer. H/L cancer survivors in class 3 had a significantly lower income, were less educated, and reported greater unmet supportive care needs, more distress, and poorer HRQOL. CONCLUSIONS Survivors who report engaging in health behaviors less frequently since diagnosis may be experiencing psychosocial challenges and health disparities. IMPLICATIONS FOR CANCER SURVIVORS Hispanic/Latino cancer survivors may benefit from screening for social determinants of health and mental health needs, prompt referral to supportive care services, community resources, and public services, and participating in culturally informed psychosocial interventions to address their unique needs.
Collapse
Affiliation(s)
| | - Sara M St George
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Patricia I Moreno
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Tae Kyoung Lee
- Department of Child Psychology and Education, Sungkyunkwan University, Seoul, South Korea
| | - Edgar Munoz
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, USA
| | - Thomas Lad
- Department of Oncology, Cook County Health and Hospital Systems, Chicago, USA
| | - Alan Pollack
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, USA
| | | | - Amelie G Ramirez
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, USA
| | - Frank J Penedo
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, USA.
- Department of Psychology, University of Miami, Coral Gables, USA.
- Department of Medicine, University of Miami Miller School of Medicine, Miami, USA.
- University of Miami Don Soffer Clinical Research Center, 1120 NW 14Th Street, 15th Floor, Miami, FL, 33136, USA.
| |
Collapse
|
2
|
Figueroa G, Castañeda S, McLean H, Dukandar J, Wilson S, Martin P, St George SM, Araya-Acero L, Jones PD. Low Health Literacy, Lack of Knowledge, and Self-Control Hinder Healthy Lifestyles in Diverse Patients with Steatotic Liver Disease. Dig Dis Sci 2024; 69:384-398. [PMID: 38112835 DOI: 10.1007/s10620-023-08212-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/24/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION In parallel with the obesity and diabetes epidemics, steatotic liver disease (SLD) has emerged as a major global public health concern. The mainstay of therapy is counseling on weight loss and increased exercise. However, such lifestyle modifications infrequently lead to success. We aimed to identify barriers to diet and lifestyle modification in patients with SLD. METHODS Patients with SLD completed a 14-item questionnaire that assigned barriers to healthy eating to three categories: lack of knowledge, lack of self-control, and lack of time, with a higher summary score indicating more perceived barriers. We administered assessments of health literacy and physical activity. We analyzed the data using descriptive statistics and ordinal regression analysis. RESULTS We included 151 participants with a median age of 64; 54% were female and 68.2% were Hispanic. Median BMI was 31.9 kg/m2. Most respondents, 68.2%, had low health literacy and were either underactive, 29.1% or sedentary, 23.2%. Lack of self-control was the strongest barrier to achieving a healthy lifestyle, followed by lack of knowledge. Lack of time was not significant barrier. Patients with the most significant barriers were more likely to have obesity, low health literacy, and be sedentary. DISCUSSION Lack of self-control and knowledge are the greatest barriers to adopting a healthy lifestyle in patients with SLD. Future clinical interventions should integrate education that targets various health literacy levels with behavioral approaches to improve a sense of agency.
Collapse
Affiliation(s)
- Gloria Figueroa
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14Th Street, Miami, FL, 33136, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephanie Castañeda
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14Th Street, Miami, FL, 33136, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hayley McLean
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14Th Street, Miami, FL, 33136, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jasmine Dukandar
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14Th Street, Miami, FL, 33136, USA
| | - Shanique Wilson
- University of Miami/Jackson Memorial Hospital Internal Medicine Residency, Miami, FL, USA
| | - Paul Martin
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14Th Street, Miami, FL, 33136, USA
| | - Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Luis Araya-Acero
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14Th Street, Miami, FL, 33136, USA
| | - Patricia D Jones
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 NW 14Th Street, Miami, FL, 33136, USA.
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
| |
Collapse
|
3
|
Lopez-Pentecost M, Perkin S, Freylersythe S, Rossi P, Rolle LD, St. George SM, Crane TE. Feasibility and Acceptability of a Text Message Intervention to Promote Adherence to Nutrition and Physical Activity Guidelines in a Predominantly Hispanic Sample of Cancer Survivors and Their Informal Caregivers: Results from a Pilot Intervention Trial. Nutrients 2023; 15:4799. [PMID: 38004192 PMCID: PMC10675593 DOI: 10.3390/nu15224799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/02/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Hispanic cancer survivors face unique barriers to meeting American Cancer Society (ACS) nutrition and physical activity guidelines, which reduce the risk of cancer recurrence and mortality and improve quality of life. This pilot intervention trial evaluated the feasibility and acceptability of a two-week ACS guideline-based nutrition and physical activity text message intervention in a predominantly Hispanic sample of cancer survivors and their informal caregivers. A mixed methods approach was used to assess feasibility and acceptability of the intervention. Feasibility and acceptability were measured by meeting a-priori cut-offs of >80% for recruitment, retention, and text message response rate. Participants also completed a semi-structured exit interview by telephone that assessed intervention components. Thirteen cancer survivors and six caregivers (n = 19) participated in this pilot study; 78% self-identified as Hispanic. Mean time since treatment completion for survivors was 11.9 years (SD 8.4), and 67% had breast cancer. Cancer survivors had a higher acceptability rate for physical activity (94%) compared to nutrition messages (86%), whereas equal acceptability rates were observed for both types of messages among caregivers (91%). Texting interventions are a feasible, acceptable, and a cost-effective strategy that have the potential to promote lifestyle behavior change among Hispanic cancer survivors and caregivers.
Collapse
Affiliation(s)
- Melissa Lopez-Pentecost
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Sophia Perkin
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
| | - Sarah Freylersythe
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Paola Rossi
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - LaShae D. Rolle
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Sara M. St. George
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Tracy E. Crane
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Medical Oncology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| |
Collapse
|
4
|
St Fleur RG, St George SM, Feaster DJ, Lee TK, Antoni MH. Functions of Resiliency Traits and Processes in Differential Effects of CBSM on Quality of Life in Breast Cancer Survivors: A Moderated Mediation Model. Int J Behav Med 2023:10.1007/s12529-023-10194-x. [PMID: 37389777 DOI: 10.1007/s12529-023-10194-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Although there is evidence that cognitive behavioral therapy (CBT)-based group interventions can improve quality of life (QoL) in women undergoing treatment for breast cancer (BC) little is known about factors that mediate and moderate these effects. We examined a) the mediating role of benefit finding on QoL changes after a Cognitive Behavioral Stress Management (CBSM) intervention, and b) whether this mediation effect differed based on baseline optimism in the first year following surgery for BC. METHODS We used data from a prior CBSM trial in 240 women with stage 0-3 BC who completed measures of benefit finding (Benefit Finding Scale, BFS), QoL (Functional Assessment of Cancer Treatment, FACT-G), and optimism (Life Orientation Test-Revised) at baseline (2 - 10 weeks post-surgery), 6-months and 12-months after randomization. CBSM-related changes and mediation and moderation effects were assessed using latent growth curve models. RESULTS We found CBSM increased benefit finding (b = 2.65, p < 0.01), emotional (b = 0.53, p < 0.01), and functional QoL (b = 0.71, p < 0.05) over time. CBSM-related changes in emotional QoL were mediated by increased benefit finding (indirect effect = 0.68, 95% bootstrapped CI: 0.17, 1.56) but only among participants with low to moderate optimism at baseline. CONCLUSION CBSM intervention improved emotional QoL over the first year of breast cancer treatment by increasing benefit finding among women who reported low trait optimism suggesting those who will most likely benefit from improving benefit finding during this stressful period.
Collapse
Affiliation(s)
- Ruth G St Fleur
- Department of Epidemiology, Brown University School of Public Health, Rhode Island, Providence, USA.
| | - Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tae Kyoung Lee
- Department of Child Psychology and Education/Social Innovation Program, Sungkyunkwan University, Seoul, South Korea
| | - Michael H Antoni
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| |
Collapse
|
5
|
Benzo RM, St George SM, Messiah SE, Lovan P, Leite R, Patel A, Lee TK, Prado GJ. Physical Fitness Among Adolescents Who are Hispanic With Overweight or Obesity. Pediatr Phys Ther 2023; 35:252-258. [PMID: 36722880 PMCID: PMC10065889 DOI: 10.1097/pep.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe cardiorespiratory, strength, muscular endurance, and flexibility fitness outcomes in a sample of adolescents who are Hispanic aged 11 to 15 years with overweight or obesity, stratified by age and sex. METHODS The sample included 280 adolescents (mean age: 13.0 ± 0.83 years, mean body mass index percentile: 94.6). Anthropometric measures included height, weight, body mass index percentile, and waist and hip circumference. Fitness measures included handgrip strength, sit-ups in 60 seconds, sit-and-reach test, and 6-minute walk test. We report mean scores for each fitness outcome measure and correlation coefficients with anthropometric measures. RESULTS Mean handgrip was 23.7 ± 6.48 kg, sit-and-reach test was 25.3 ± 8.13 cm, average sit-ups in 60 seconds were 19.4 ± 9.28, and 6-minute walk distance was 1960 ± 271 ft. Males outperformed females in all tests except sit-and-reach test. DISCUSSION Compared with published fitness values of healthy weight adolescents, our sample of adolescents who are Hispanic with overweight/obesity living in southern Florida is unconditioned in terms of cardiorespiratory fitness, strength, muscular endurance, and flexibility.
Collapse
Affiliation(s)
- Roberto M Benzo
- Departments of Psychology (Drs Benzo and Lovan) and Public Health Sciences (Drs St. George and Lee and Mr Leite) and School of Medicine (Ms Patel), University of Miami, Miami, Florida; The University of Texas Health Science Center at Houston, School of Public Health, Dallas Campus (Dr Messiah); Center for Pediatric Population Health (Dr Messiah), University of Texas Health Science at Houston, School of Public Health and Children's Health System of Texas, Dallas; School of Nursing and Health Studies (Dr Prado), University of Miami, Coral Gables, Florida
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Leite RO, Pavia V, Kobayashi MA, Kyoung Lee T, Prado G, Messiah SE, St. George SM. The Effects of Parent-Adolescent Acculturation Gaps on Adolescent Lifestyle Behaviors: Moderating Role of Family Communication. J Lat Psychol 2023; 11:21-39. [PMID: 37519909 PMCID: PMC10374166 DOI: 10.1037/lat0000215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Objectives This study examined 1) associations between parent-adolescent acculturation gaps in Americanism and Hispanicism and adolescents' lifestyle behaviors (fruit and vegetable intake and physical activity), and 2) the moderating roles of adolescent- and parent-reported family communication on these associations. Methods Hispanic adolescents who have overweight or obesity (n=280; 52% female, 13.0±0.8 years old) and their parents (88% female, 44.9±6.5 years old) completed baseline measures on acculturation, family communication, weekly physical activity, and daily fruit and vegetable intake as part of their participation in a family-based health promotion efficacy trial. Acculturation gaps were calculated by taking the product of adolescent and parent scores for each subscale (Americanism and Hispanicism). We conducted multiple linear regression analyses with three-way interaction terms (e.g., parent Americanism x adolescent Americanism x family communication) to assess for moderation. Results Family communication significantly moderated the association between parent-adolescent acculturation gaps in Americanism and adolescent fruit and vegetable intake. For families with low adolescent-reported family communication, parent-adolescent discrepancies in Americanism were associated with lower adolescent fruit and vegetable intake whereas there were no significant associations for families with high family communication. There were no effects on weekly minutes of physical activity. Acculturation gaps in Hispanicism were not significantly associated with either outcome. Conclusions Findings highlight the importance of parent-adolescent acculturation gaps and family communication on fruit and vegetable intake for Hispanic adolescents. Targeting parent-adolescent acculturation gaps for families with low levels of communication may be important to improve dietary behaviors in Hispanic adolescents, who are already disproportionately affected by obesity.
Collapse
Affiliation(s)
- Rafael O. Leite
- Department of Psychology, University of Miami, Coral Gables, FL
| | - Vanina Pavia
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | | | - Tae Kyoung Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Guillermo Prado
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL
| | - Sarah E. Messiah
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center, School of Public Health, Dallas Campus, Dallas, TX
- Center for Pediatric Population Health, UTHealth School of Public Health and Children’s Health System of Texas, Dallas, TX
| | - Sara M. St. George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| |
Collapse
|
7
|
St. George SM, Harkness AR, Rodriguez-Diaz CE, Weinstein ER, Pavia V, Hamilton AB. Applying Rapid Qualitative Analysis for Health Equity: Lessons Learned Using "EARS" With Latino Communities. Int J Qual Methods 2023; 22:10.1177/16094069231164938. [PMID: 38463016 PMCID: PMC10923582 DOI: 10.1177/16094069231164938] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Qualitative research amplifies the voices of marginalized communities and thus plays a critical role in shaping our understanding of health inequities and their social determinants. Traditional qualitative approaches, such as grounded theory or thematic analysis, require extensive training and are time- and labor-intensive; as such, they may not be adequately suited to address healthy equity issues that require a swift response. Rapid qualitative analysis (RQA) is an action-oriented approach to qualitative data analysis that may be used when findings are needed to quickly inform practice. RQA capitalizes on using a team to summarize key points from qualitative data into matrices to explore relevant themes efficiently and systematically. In this paper, we provide case examples from our work applying RQA to health equity research with Latino communities to address community needs, such as responses to public health emergencies and the development of service delivery and technology interventions for infectious and chronic diseases. We draw from our collective experiences to share lessons learned and provide the following specific recommendations ("EARS") to researchers interested in applying RQA for health equity research: (1) Employ RQA to address rapidly evolving, urgent, health equity challenges; (2) Assure quality and rigor throughout the RQA process; (3) Respond to barriers and problem-solve as needed; and (4) Strengthen community relationships before, during, and after using RQA. Overall, we advocate for the use of RQA to promote health equity due to its ability to integrate the vital perspectives of marginalized communities and efficiently respond to their needs.
Collapse
Affiliation(s)
- Sara M. St. George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Audrey R. Harkness
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Carlos E. Rodriguez-Diaz
- Department of Prevention and Community Health and Gill-Lebovic Center for Community Health in the Caribbean and Latin America, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | | | - Vanina Pavia
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alison B. Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
8
|
Natale R, Agosto Y, Bulotsky Shearer RJ, St George SM, Jent J. Designing a virtual mental health consultation program to support and strengthen childcare centers impacted by COVID-19: A randomized controlled trial protocol. Contemp Clin Trials 2023; 124:107022. [PMID: 36442806 PMCID: PMC9694403 DOI: 10.1016/j.cct.2022.107022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The COVID-19 pandemic has had negative psychosocial impacts on young children; teachers in childcare centers continue to be overwhelmed by how to address the downstream psychological effects children are experiencing. This randomized controlled trial will study the role of a community-based, childcare center-support system in improving resilience and mitigating the long-term impacts of COVID-19 on children's development. METHODS This study will be modeled on a successful Early Childhood Mental Health Consultation (ECMHC) intervention which utilizes mental health consultants to deliver a Jump Start+: COVID 19 Support (JS + CS) virtual toolkit to childcare centers in Miami-Dade County via a Kubi robot. The toolkit comprises four strength-based strategies likely to be effective in improving resiliency following disasters: Safety Planning, Effective Communication, Adult Self-Care, and Trauma-Informed Behavior Support. Our first aim will utilize a cluster randomized trial to examine the effectiveness of JS + CS on improving the psychosocial functioning of young children, as compared to an obesity prevention intervention control group. Children will be followed at 6, 12, 18, and 24 months. The second aim will examine the mechanisms that contribute to effective uptake by teachers of the JS + CS support strategies on child outcomes. The third aim will explore implementation barriers/facilitators as well as potential societal contextual factors (e.g., vaccine uptake) to help centers serving disproportionately affected minority communities recover from and prepare for future crises. CONCLUSION This design will inform the refinement and scaling of JS + CS and generalize impacts to other childcare center interventions in the context of disasters.
Collapse
Affiliation(s)
- Ruby Natale
- University of Miami Miller School of Medicine, Department of Pediatrics, 1601 NW 12(th) Ave, Miami, Florida 33136, USA.
| | - Yaray Agosto
- University of Miami Miller School of Medicine, Department of Pediatrics, 1601 NW 12(th) Ave, Miami, Florida 33136, USA.
| | - Rebecca J Bulotsky Shearer
- University of Miami, Department of Psychology, 5665 Ponce de Leon Blvd, Coral Gables, Florida 33146, USA.
| | - Sara M St George
- University of Miami Miller School of Medicine, Department of Public Health Sciences, 1120 NW 14(th) St, Miami, Florida 33136, USA.
| | - Jason Jent
- University of Miami Miller School of Medicine, Department of Pediatrics, 1601 NW 12(th) Ave, Miami, Florida 33136, USA.
| |
Collapse
|
9
|
St Fleur RG, St. George SM, Ream M, Antoni MH. A latent profile analysis to assess physical, cognitive and emotional symptom clusters in women with breast cancer. Psychol Health 2022; 37:1253-1269. [PMID: 34187253 PMCID: PMC10068690 DOI: 10.1080/08870446.2021.1941960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/24/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Current research on the physical and psychological functioning of breast cancer survivors often takes an approach where symptoms are studied independently even though they often occur in clusters This paper aims to identify physical and psychological symptom clusters among breast cancer survivors while assessing clinical, psychosocial and demographic characteristics that predict subgroup membership. DESIGN Using post-surgical data collected from 240 women with stage 0-III breast cancer, symptom clusters were identified using latent profile analysis of patient-reported symptoms. MAIN OUTCOME MEASURES Baseline measures included the Pittsburg Sleep Quality Index, the Fatigue Symptom Inventory, the Hamilton Rating Scales for depression and anxiety and the Impact of Event Scale. RESULTS Three distinct classes were identified: (1) mild physical, cognitive and emotional symptoms, (2) moderate across all domains and (3) high levels of all symptoms. Lower socio-economic status, minority ethnicity, younger age, advanced disease stage along with lower self-efficacy and less internal locus of control were significantly associated with a higher likelihood of class 3 membership. CONCLUSION By identifying those most at risk for severe physical and psychological symptoms in the post-surgical period, our results can guide the development of tailored interventions to optimise quality of life during breast cancer treatment.
Collapse
Affiliation(s)
- Ruth G. St Fleur
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sara M. St. George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Molly Ream
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Michael H. Antoni
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| |
Collapse
|
10
|
Kobayashi MA, Benzo RM, Lee TK, George SMS. Intergenerational Determinants of Weight Status Concordance and Discordance in Parent/Adolescent Dyads from the Family Life, Activity, Sun, Health, and Eating Study. Child Obes 2022; 18:454-465. [PMID: 35049335 DOI: 10.1089/chi.2021.0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Studies have shown that obesity (OB) has strong intergenerational linkages and tends to cluster in families, but there is a dearth of research examining the socioecological factors predictive of weight status concordance and discordance among parents and adolescents. Methods: We ran a stepwise multinomial logistic regression to assess for sociodemographic, individual-, and family-level predictors of four dyadic weight status groups using data from 1516 parent/adolescent dyads from the National Cancer Institute's Family Life, Activity, Sun, Health, and Eating Study. We categorized parent/adolescent dyads into one of four groups based on their BMI: (1) Healthy Weight Concordance (i.e., both parent and adolescent in the normal weight range); (2) overweight (OW)/OB Concordance (i.e., both parent and adolescent with OW or OB); (3) Discordance-Parent OW/OB (i.e., parent with OW/OB and adolescent in the normal weight range); or (4) Discordance-Adolescent OW/OB (i.e., adolescent with OW/OB and parent in the normal weight range). Results: There were 475 parent/adolescent dyads (31.3%) in the Healthy Weight Concordance group, 351 (23.2%) in the OW/OB Concordance group, 604 (39.8%) in the Discordance-Parent OW/OB group, and 86 (5.7%) in the Discordance-Adolescent OW/OB group. Being from a low socioeconomic family, identifying as a minority, and identifying as a male parent were associated with an OW/OB dyadic BMI. Higher levels of adolescent and parent emotional eating were significantly associated with parent/adolescent dyads being in the OW/OB Concordance group. Parent emotional eating was also associated with Discordance-Parent OW/OB. In contrast, parents' and adolescents' physical activity self-efficacy was associated with a Healthy Weight dyadic BMI vs. OW/OB Concordance or Discordance-Parent OW/OB. Conclusions: Our findings highlight the strength of OW/OB concordance in families, especially among lower socioeconomic and ethnic minority families and the significance of emotional eating and physical activity self-efficacy in contributing to BMI patterns among parents and adolescents.
Collapse
Affiliation(s)
- Marissa A Kobayashi
- Department of Psychology, University of Miami, Miami, FL, USA.,Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Roberto M Benzo
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Tae Kyoung Lee
- Convergence for Social Innovation/Child Psychology and Education, Sungkyunkwan University, Seoul, Korea
| | - Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
11
|
Kobayashi MA, Lee TK, St George SM, Lebron C, Dorcius D, Prado G, Messiah SE. Intergenerational cardiovascular disease risks among Hispanics living in the United States. Pediatr Obes 2022; 17:e12870. [PMID: 34751514 DOI: 10.1111/ijpo.12870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/02/2021] [Accepted: 09/20/2021] [Indexed: 12/01/2022]
Abstract
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.
Collapse
Affiliation(s)
- Marissa A Kobayashi
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, Florida, USA.,Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Tae K Lee
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Sara M St George
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Cynthia Lebron
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, Florida, USA.,School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| | - David Dorcius
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, Florida, USA.,School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| | - Sarah E Messiah
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, Florida, USA.,Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center, School of Public Health, Dallas, Texas, USA.,Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, Texas, USA
| |
Collapse
|
12
|
St George SM, Kobayashi MA, Noriega Esquives BS, Ocasio MA, Wagstaff RG, Dorcius DP. Pediatric Obesity Prevention and Treatment Among Hispanics: A Systematic Review and Meta-Analysis. Am J Prev Med 2022; 62:438-449. [PMID: 35190103 PMCID: PMC8864167 DOI: 10.1016/j.amepre.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The rates of pediatric obesity in the U.S. are highest among Hispanics. There is no existing meta-analysis of the effects of obesity interventions among Hispanic youth. This systematic review and meta-analysis assesses the effects of obesity prevention and treatment interventions on Hispanic youth's weight status and lifestyle behaviors. METHODS PubMed, PsycINFO, and Scopus were searched between January 1, 2000 and October 30, 2020. Interventions with ≥50% Hispanic youth aged 0-18 years were included. Using a weighted inverse-variance procedure, fixed-effects and random-effects models were run for an overall effect size on the basis of the Qtotal test statistic. Hedges' g was calculated for outcomes of interest between baseline and postintervention separately for studies with multiple versus single conditions. Continuous and categorical moderators were also examined. RESULTS A total of 1,103 articles were screened, of which 117 were included in the narrative synthesis and 105 in the meta-analysis (n=49,276 youth). The overall effects for RCT/quasi-experimental studies on BMI status (g= -0.15, SE=0.03, 95% CI= -0.20, -0.10), waist circumference (g= -0.15, SE=0.10, 95% CI= -0.35, -0.05), physical activity (g=0.12, SE=0.05, 95% CI=0.03, 0.22), fruit and vegetable intake (g=0.08, SE=0.02, 95% CI=0.03, 0.12), and sugar-sweetened beverage intake (g= -0.07, SE= 0.03, 95% CI= -0.13, -0.01) were small. Intervention effects varied by participant developmental stage, SES, study setting, and lifestyle behavior target. DISCUSSION Beyond developing more impactful interventions to address obesity among Hispanic youth, findings highlight the need for targeted policies and more easily disseminable interventions that can spread small effects across a population for maximal public health impact.
Collapse
Affiliation(s)
- Sara M St George
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida.
| | - Marissa A Kobayashi
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Blanca S Noriega Esquives
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Manuel A Ocasio
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida; Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana
| | - Rachel G Wagstaff
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida; School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - David P Dorcius
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| |
Collapse
|
13
|
Kane N, Neutzling M, St. George SM. Development of Brief Video Intervention to Promote Physical Activity among Children during the COVID-19 Pandemic and Beyond. American Journal of Health Education 2022. [DOI: 10.1080/19325037.2021.2019626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
14
|
Law LH, Wilson DK, St George SM, Kitzman H, Kipp CJ. Families Improving Together (FIT) for weight loss: a resource for translation of a positive climate-based intervention into community settings. Transl Behav Med 2021; 10:1064-1069. [PMID: 31167022 DOI: 10.1093/tbm/ibz020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Climate-based weight loss interventions, or those that foster a nurturing family environment, address important ecological influences typically ignored by the traditional biomedical treatments. Promoting a climate characterized by positive communication, autonomy support, and parental warmth supports adolescents in making healthy behavioral changes. In addition, encouraging these skills within the family may have additional benefits of improved family functioning and other mental and physical health outcomes. Although several programs have identified essential elements and established the evidence base for the efficacy of these interventions, few have offered resources for the translation of these constructs from theoretical concepts to tangible practice. This paper provides strategies and resources utilized in the Families Improving Together (FIT) for weight loss randomized controlled trial to create a warm, supportive climate characterized by positive communication within the parent-child relationship. Detailed descriptions of how Project FIT emphasized these constructs through facilitator training, intervention curriculum, and process evaluation are provided as a resource for clinical and community interventions. Researchers are encouraged to provide resources to promote translation of evidence-based interventions for programs aiming to utilize a positive climate-based family approach for lifestyle modification.
Collapse
Affiliation(s)
- Lauren H Law
- Department of Psychology, University of South Carolina, Columbia, SC
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC
| | - Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Heather Kitzman
- Baylor Scott and White Health and Wellness Center, Dallas, TX
| | - Colby J Kipp
- Department of Psychology, University of South Carolina, Columbia, SC
| |
Collapse
|
15
|
Lebron CN, Agosto Y, Guzman T, Sutton D, Stoutenberg M, Messiah SE, George SMS. A qualitative study of cognitive, behavioral, and environmental influences on Hispanic mothers' early childhood feeding practices. Appetite 2021; 164:105268. [PMID: 33864860 DOI: 10.1016/j.appet.2021.105268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/12/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
Young children's lifestyle behaviors are largely shaped by their parents. There are socioeconomic risk factors particular to Hispanic populations that influence the way parents feed their children. As obesity continues to be a public health issue with substantial inequities across race and ethnicity, it is critical to understand Hispanic parents' food choices and feeding practices. The objective of this qualitative study is to identify the behavioral, environmental, and cognitive factors that influence the parental food choices and feeding behaviors of Hispanic mothers of children ages 0-5 years. Snowball sampling was used to recruit participants from the community (n = 30) who were 1) female; 2) Hispanic; 3) over the age of 18; and 4) a mother to child(ren) between the ages zero and five. Each interview consisted of a brief demographic survey and a set of open-ended questions based on Social Cognitive Theory constructs. A thematic analysis using a combined deductive and inductive approach was used to analyze transcriptions. Results indicated that mothers' attitudes around breastfeeding were connected with their challenges, while their attitudes around solid foods were expressed in their feeding strategies. Mothers used strategies of modeling, repeated exposure, and practices of "sneaking" in healthy foods and bribing to promote healthy eating. Mothers were most likely to seek out information from (1) pediatricians, (2) female family members, and (3) the internet. Hispanic mothers actively seek out information from many different sources that impact how they feed their young children. Understanding their trusted sources and how it influences the SCT constructs is an important step in preventing early childhood obesity.
Collapse
Affiliation(s)
- Cynthia N Lebron
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA.
| | - Yaray Agosto
- Florida International University, Robert Stempel College of Public Health & Social Work, Miami, FL, USA
| | - Tamisha Guzman
- Florida International University, Robert Stempel College of Public Health & Social Work, Miami, FL, USA
| | - Danielle Sutton
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mark Stoutenberg
- College of Public Health, Temple University, Philadelphia, PA, USA
| | - Sarah E Messiah
- University of Texas Health Science Center School of Public Health, Dallas Campus, Dallas, TX, USA; Center for Pediatric Population Health, Children's Health System of Texas and UTHealth School of Public Health, Dallas, TX, USA
| | - Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
16
|
Prado G, Fernandez A, St George SM, Lee TK, Lebron C, Tapia MI, Velazquez MR, Messiah SE. Results of a Family-Based Intervention Promoting Healthy Weight Strategies in Overweight Hispanic Adolescents and Parents: An RCT. Am J Prev Med 2020; 59:658-668. [PMID: 33011010 PMCID: PMC7577952 DOI: 10.1016/j.amepre.2020.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 02/07/2023]
Abstract
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.
Collapse
Affiliation(s)
- Guillermo Prado
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida.
| | - Alejandra Fernandez
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida
| | - Sara M St George
- Department of Public Health Sciences, University of Miami, Miami, Florida
| | - Tae K Lee
- Department of Public Health Sciences, University of Miami, Miami, Florida
| | - Cynthia Lebron
- Department of Public Health Sciences, University of Miami, Miami, Florida
| | - Maria I Tapia
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida
| | - Maria Rosa Velazquez
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida
| | - Sarah E Messiah
- Department of Public Health Sciences, University of Miami, Miami, Florida; Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida; University of Texas Health Science Center, School of Public Health, Dallas, Texas; Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, Texas
| |
Collapse
|
17
|
Lebron CN, Agosto Y, Lee TK, Prado G, George SMS, Pantin H, Messiah SE. Family Mealtime Communication in Single- and Dual-Headed Households Among Hispanic Adolescents With Overweight and Obesity. J Nutr Educ Behav 2020; 52:840-849. [PMID: 32595083 PMCID: PMC7492453 DOI: 10.1016/j.jneb.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 02/24/2020] [Accepted: 03/08/2020] [Indexed: 06/11/2023]
Abstract
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.
Collapse
Affiliation(s)
- Cynthia N Lebron
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL.
| | - Yaray Agosto
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
| | - Tae K Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Hilda Pantin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Sarah E Messiah
- University of Texas Health Science Center, School of Public Health, Dallas, TX; Center for Pediatric Population Health, Children's Health System of Texas and UTHealth School of Public Health, Dallas, TX
| |
Collapse
|
18
|
St George SM, Agosto Y, Rojas LM, Soares M, Bahamon M, Prado G, Smith JD. A developmental cascade perspective of paediatric obesity: A systematic review of preventive interventions from infancy through late adolescence. Obes Rev 2020; 21:e12939. [PMID: 31808277 PMCID: PMC6980892 DOI: 10.1111/obr.12939] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 01/03/2023]
Abstract
The goals of this systematic review were to identify and describe paediatric obesity prevention interventions from infancy to late adolescence and to provide recommendations for future intervention research in light of a recently proposed developmental cascade (DC) model of paediatric obesity. We conducted an electronic search of randomized controlled trials with a minimum 6-month postintervention follow-up published between 1995 and 2019. We included 74 interventions: prenatal/infancy (n = 4), early childhood (n = 11), childhood (n = 38), early to mid-adolescence (n = 18), and late adolescence (n = 3). Infancy and early childhood trials targeted early feeding and positive parenting skills. Half of the childhood and adolescence trials were school based and used universal prevention strategies; those classified as selective or indicated prevention tended to involve the family for more intensive lifestyle modification. Less than 10% of studies followed participants over long periods of time (greater than or equal to 5 years), and only 16% and 31% of studies assessed intervention mediators and moderators, respectively. We recommend that future interventions focus on early prevention, assess long-term intervention effects, use a standardized taxonomy for defining intervention behavioural strategies, assess underlying mechanisms of action and intervention moderators, target parent and family management strategies across development, and increase scientific equity. We also provide specific recommendations regarding intervention targets for each developmental stage.
Collapse
Affiliation(s)
- Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Yaray Agosto
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida
| | - Lourdes M Rojas
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Mary Soares
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Monica Bahamon
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Justin D Smith
- Department of Psychiatry and Behavioral Sciences, Department of Preventive Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
19
|
St. George SM, Noriega Esquives B, Agosto Y, Kobayashi M, Leite R, Vanegas D, Perez AT, Calfa C, Schlumbrecht M, Slingerland J, Penedo FJ. Development of a multigenerational digital lifestyle intervention for women cancer survivors and their families. Psychooncology 2019; 29:182-194. [DOI: 10.1002/pon.5236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/28/2019] [Accepted: 09/07/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Sara M. St. George
- Department of Public Health SciencesUniversity of Miami Miller School of Medicine Florida
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of Medicine Miami Florida
| | | | - Yaray Agosto
- Department of Public Health SciencesUniversity of Miami Miller School of Medicine Florida
| | - Marissa Kobayashi
- Department of Public Health SciencesUniversity of Miami Miller School of Medicine Florida
| | - Rafael Leite
- Department of Public Health SciencesUniversity of Miami Miller School of Medicine Florida
| | - Dario Vanegas
- Department of Public Health SciencesUniversity of Miami Miller School of Medicine Florida
| | - Alejandra T. Perez
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of Medicine Miami Florida
| | - Carmen Calfa
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of Medicine Miami Florida
| | - Matthew Schlumbrecht
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of Medicine Miami Florida
| | - Joyce Slingerland
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of Medicine Miami Florida
| | - Frank J. Penedo
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of Medicine Miami Florida
| |
Collapse
|
20
|
Kobayashi M, Leite RO, Lugo I, Wetstone R, Vanegas D, George SMS, Czaja SJ. GRANDPARENTS’ PERSPECTIVES ON A MULTIGENERATIONAL DIGITAL HEALTH PHYSICAL ACTIVITY INTERVENTION. Innov Aging 2019. [PMCID: PMC6846194 DOI: 10.1093/geroni/igz038.2487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Studies examining associations among grandparents’ involvement and grandchildren’s lifestyle behaviors have been largely mixed or negative highlighting the need for interventions that help grandparents promote grandchildren’s healthy behaviors. The current study explored older adults’ interest in participating in a digital intervention with their grandchildren. As part of the intervention, grandparents and grandchildren would engage in weekly walks and use a mobile application to track their steps, photos and conversations. Twelve grandparents (63±6.5yrs; 75% female; 50% Hispanic) participated in qualitative interviews. Researchers asked open-ended questions to assess grandparents’ relationships with their grandchildren, motivation to participate, and feedback on prototypes. A 10-item systems usability questionnaire was also administered. Three researchers independently analyzed interview transcripts using a rapid assessment approach and reached consensus on key themes. Grandparents described having positive relationships with their grandchildren and used texts to schedule time with them; family dynamics (conflicts, divorce) influenced the amount of time they spent together. Grandparents’ motivation for participating in the intervention included the opportunity to enhance their relationship with their grandchild and improve their own health. Grandparents noted weekly walks would feasibly occur on the weekends given their grandchildren’s competing activities. They were receptive to proposed weekly session topics (e.g., sports/hobbies, ancestry, humor) and suggested other topics to discuss during weekly walks, such as faith/religion, morality, safety, and nutrition. They strongly agreed or agreed that they would use the prototypes frequently and found them easy to use (83% and 92%, respectively). Results from this study will inform the next iteration of intervention prototypes.
Collapse
Affiliation(s)
| | | | | | | | | | - Sara M St George
- University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Sara J Czaja
- Weill Cornell Medicine, New York, New York, United States
| |
Collapse
|
21
|
Lebron CN, St George SM, Eckembrecher DG, Alvarez LM. "Am I doing this wrong?" Breastfeeding mothers' use of an online forum. Matern Child Nutr 2019; 16:e12890. [PMID: 31568669 PMCID: PMC6937377 DOI: 10.1111/mcn.12890] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 01/06/2023]
Abstract
As mothers seek out information around breastfeeding, many are turning to online message boards, listservs, or social media for advice. Babycenter.com, a parenting website with widespread use, hosts a Breastfeeding Support and Help community forum with over 140,000 users and more than one million conversation threads. The purpose of this study is to examine this online support forum to understand the information seeking and sharing practices of its users. We extracted a total of 258 original posts and 1,445 corresponding comments from Babycenter.com's breastfeeding forum posted over a 10-day period. Using content analysis, we coded the posts into 15 categories reflective of the types of information users were seeking. We then randomly selected 45 conversation threads across the most popular categories to further understand how users were sharing information. The most popular breastfeeding topics for which users sought out information included feeding challenges, supply issues, feeding schedule and duration, pumping, physical health, excretion issues, storing milk, nipple issues, and general breastfeeding questions. Participants elicited information from others using interviewing questions and built consensus around issues by agreeing with previous posts. They shared their knowledge and personal breastfeeding experiences and also provided encouragement to continue breastfeeding and overcome challenges. Online support forums are actively being used by breastfeeding mothers seeking information from others with similar experiences. This presents an important resource for breastfeeding mothers and may, therefore, be an important component of future breastfeeding interventions.
Collapse
Affiliation(s)
- Cynthia N Lebron
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Daphne G Eckembrecher
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lucia M Alvarez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
22
|
Lebron CN, Lee TK, Prado G, St George SM, Pantin H, Messiah SE. Psychometric properties of an abbreviated Childhood Family Mealtime Questionnaire among overweight and obese Hispanic adolescents. Appetite 2019; 140:169-179. [PMID: 31075325 PMCID: PMC6639035 DOI: 10.1016/j.appet.2019.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 12/17/2022]
Abstract
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.
Collapse
Affiliation(s)
- Cynthia N Lebron
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Tae K Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hilda Pantin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sarah E Messiah
- School of Public Health Dallas, University of Texas, Dallas, TX, USA
| |
Collapse
|
23
|
Rojas LM, Bahamón M, Wagstaff R, Ferre I, Perrino T, Estrada Y, St George SM, Pantin H, Prado G. Evidence-based prevention programs targeting youth mental and behavioral health in primary care: A systematic review. Prev Med 2019; 120:85-99. [PMID: 30610888 DOI: 10.1016/j.ypmed.2018.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 12/07/2018] [Accepted: 12/16/2018] [Indexed: 01/05/2023]
Abstract
The objectives of this systematic review were to: 1) identify evidence-based youth (i.e., infancy, pre-school age, school age, and adolescence) mental and behavioral health disorder preventive interventions conducted in or offered by primary care settings, and 2) describe these interventions' characteristics, efficacy, and clinical involvement. Randomized controlled trials that targeted the prevention of mental or behavioral health outcomes for youth and had a connection to primary care were included. The PRISMA guidelines were utilized for two phases: 1) searching PubMed, EMBASE, PsycInfo, CINAHL, and Cochrane databases in January 2017; and 2) searching United States Preventive Services Task Force (USPSTF) Systematic Reviews in November 2017. The two phases revealed 504 and 58 potential articles, respectively. After removal of duplicates, screening of abstracts, and full-text reviews, 19 interventions (infancy: n = 2, pre-school age: n = 3, school age: n = 6, adolescence: n = 8) were included: 1) 10 interventions described in 17 articles from the databases, and 2) 9 interventions described in 11 articles from the USPSTF reviews. The included interventions capitalized on primary care settings as a natural entry point to engage youth and families into interventions without requiring a large amount of clinic involvement. Commonalities of efficacious interventions and recommendations for future research are discussed. The authors encourage primary care providers, mental and behavioral health providers, and/or public health researchers to continue developing and testing preventive interventions, or adapting existing interventions, to be implemented in primary care.
Collapse
Affiliation(s)
- Lourdes M Rojas
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1007a, Miami, FL 33136, USA.
| | - Mónica Bahamón
- Emergency Department, Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL 33136, USA
| | - Rachel Wagstaff
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1007a, Miami, FL 33136, USA
| | - Isabella Ferre
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1007a, Miami, FL 33136, USA
| | - Tatiana Perrino
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1007a, Miami, FL 33136, USA
| | - Yannine Estrada
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1007a, Miami, FL 33136, USA
| | - Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1007a, Miami, FL 33136, USA
| | - Hilda Pantin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1007a, Miami, FL 33136, USA
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1007a, Miami, FL 33136, USA
| |
Collapse
|
24
|
St George SM, Messiah SE, Sardinas KM, Poma S, Lebron C, Tapia MI, Velazquez MR, Pantin H, Prado G. Familias Unidas for Health and Wellness: Adapting an Evidence-Based Substance Use and Sexual Risk Behavior Intervention for Obesity Prevention in Hispanic Adolescents. J Prim Prev 2018; 39:529-553. [PMID: 30291486 PMCID: PMC6585459 DOI: 10.1007/s10935-018-0524-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We describe the adaptation of Familias Unidas, an evidence-based substance use and sexual risk behavior intervention, for obesity prevention in Hispanic adolescents. Intervention developers and experts in pediatric obesity, exercise physiology, dietetics, and the local parks system provided input for changes. Hispanic families also provided input through a series of 21 focus groups conducted before, during, and after an initial pilot test of the adapted intervention. After transcribing audiotaped sessions, we used a general inductive approach and Dedoose qualitative software to derive themes. Results indicated the need for improved health-related family functioning, enhanced nutrition education and skill building, increased family engagement in physical activity, and stronger links between family and environmental supports. Parents who participated in the pilot test expressed high enthusiasm for hands-on nutrition training and reported improvements in family functioning. Adolescents liked outdoor physical activities but wanted parents to be more engaged in joint physical activity sessions. The adapted intervention maintains fidelity to Familias Unidas' core theoretical elements and overall structure, but also includes content focused on physical activity and nutrition, adolescent participation in physical activity sessions led by park coaches, and joint parent-adolescent participation in physical activity and nutrition skill-building activities.
Collapse
Affiliation(s)
- Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1009, Miami, FL, 33136, USA.
| | - Sarah E Messiah
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1009, Miami, FL, 33136, USA
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Krystal M Sardinas
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sofia Poma
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1009, Miami, FL, 33136, USA
| | - Cynthia Lebron
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1009, Miami, FL, 33136, USA
| | - Maria I Tapia
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1009, Miami, FL, 33136, USA
| | - Maria Rosa Velazquez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1009, Miami, FL, 33136, USA
| | - Hilda Pantin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1009, Miami, FL, 33136, USA
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 1009, Miami, FL, 33136, USA
| |
Collapse
|
25
|
Portacio FG, Botero P, St George SM, Stoutenberg M. Informing the Adaptation and Implementation of a Lifestyle Modification Program in Hispanics: A Qualitative Study Among Low-Income Hispanic Adults. Hisp Health Care Int 2018; 16:204-212. [PMID: 30426783 DOI: 10.1177/1540415318808831] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low-income Hispanics are a hard to reach population that face unique challenges in achieving behavior change. Understanding such challenges can inform the adaptation of lifestyle behavioral interventions and increase participant engagement. This descriptive qualitative study aimed to (1) inform lifestyle modification programs focused on improving the physical activity and healthy eating of low-income Hispanic adults and (2) explore potential gender differences necessary for consideration. Five gender-specific focus groups were conducted with Hispanic adults from a free community clinic (n = 45, 64% women, 53.1 ± 10.1 years). Sessions were audio-recorded, transcribed, and coded using a general inductive approach. The qualitative software program Dedoose was used to perform a content analysis. Emergent themes included topics of interest, methods of increasing engagement in healthy behaviors, and the delivery of lifestyle modification programs. Men expressed greater interest in physical activity, while women desired to learn about healthy eating. Men described the importance of physician communication, while women focused on the role of social support as facilitators for participating in such programs. Both genders described education as key to behavior change and viewed text messaging as a valuable complement. Results from this study can inform the adaptation of lifestyle modification programs and increase the engagement of low-income Hispanic populations.
Collapse
Affiliation(s)
- Francia G Portacio
- University of Miami, Miami, FL, USA.,University of Tennessee at Chattanooga, TN, USA
| | | | | | - Mark Stoutenberg
- University of Miami, Miami, FL, USA.,University of Tennessee at Chattanooga, TN, USA
| |
Collapse
|
26
|
Smith JD, Berkel C, Rudo-Stern J, Montaño Z, St. George SM, Prado G, Mauricio AM, Chiapa A, Bruening MM, Dishion TJ. The Family Check-Up 4 Health (FCU4Health): Applying Implementation Science Frameworks to the Process of Adapting an Evidence-Based Parenting Program for Prevention of Pediatric Obesity and Excess Weight Gain in Primary Care. Front Public Health 2018; 6:293. [PMID: 30374436 PMCID: PMC6196330 DOI: 10.3389/fpubh.2018.00293] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 09/24/2018] [Indexed: 02/04/2023] Open
Abstract
Implementation experts have recently argued for a process of "scaling out" evidence-based interventions, programs, and practices (EBPs) to improve reach to new populations and new service delivery systems. A process of planned adaptation is typically required to integrate EBPs into new service delivery systems and address the needs of targeted populations while simultaneously maintaining fidelity to core components. This process-oriented paper describes the application of an implementation science framework and coding system to the adaptation of the Family Check-Up (FCU), for a new clinical target and service delivery system-prevention of obesity and excess weight game in primary care. The original FCU has demonstrated both short- and long-term effects on obesity with underserved families across a wide age range. The advantage of adapting such a program is the existing empirical evidence that the intervention improves the primary mediator of effects on the new target outcome. We offer a guide for determining the levels of evidence to undertake the adaptation of an existing EBP for a new clinical target. In this paper, adaptation included shifting the frame of the intervention from one of risk reduction to health promotion; adding health-specific assessments in the areas of nutrition, physical activity, sleep, and media parenting behaviors; family interaction tasks related to goals for health and health behaviors; and coordinating with community resources for physical health. We discuss the multi-year process of adaptation that began by engaging the FCU developer, community stakeholders, and families, which was then followed by a pilot feasibility study, and continues in an ongoing randomized effectiveness-implementation hybrid trial. The adapted program is called the Family Check-Up 4 Health (FCU4Health). We apply a comprehensive coding system for the adaptation of EBPs to our process and also provide a side-by-side comparison of behavior change techniques for obesity prevention and management used in the original FCU and in the FCU4Health. These provide a rigorous means of classification as well as a common language that can be used when adapting other EBPs for context, content, population, or clinical target. Limitations of such an approach to adaptation and future directions of this work are discussed.
Collapse
Affiliation(s)
- Justin D. Smith
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Cady Berkel
- REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ, United States
- Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Jenna Rudo-Stern
- REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ, United States
| | - Zorash Montaño
- Children's Hospital of Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Sara M. St. George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Anne M. Mauricio
- REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ, United States
| | - Amanda Chiapa
- Yale Child Study Center, New Haven, CT, United States
| | - Meg M. Bruening
- Department of Nutrition, Arizona State University, Tempe, AZ, United States
| | - Thomas J. Dishion
- REACH Institute, Department of Psychology, Arizona State University, Tempe, AZ, United States
- Oregon Research Institute, Eugene, OR, United States
| |
Collapse
|
27
|
Smith JD, Egan KN, Montaño Z, Dawson-McClure S, Jake-Schoffman DE, Larson M, St. George SM. A developmental cascade perspective of paediatric obesity: a conceptual model and scoping review. Health Psychol Rev 2018; 12:271-293. [PMID: 29583070 PMCID: PMC6324843 DOI: 10.1080/17437199.2018.1457450] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/22/2018] [Indexed: 12/12/2022]
Abstract
Considering the immense challenge of preventing obesity, the time has come to reconceptualise the way we study the obesity development in childhood. The developmental cascade model offers a longitudinal framework to elucidate the way cumulative consequences and spreading effects of risk and protective factors, across and within biopsychosocial spheres and phases of development, can propel individuals towards obesity. In this article, we use a theory-driven model-building approach and a scoping review that included 310 published studies to propose a developmental cascade model of paediatric obesity. The proposed model provides a basis for testing hypothesised cascades with multiple intervening variables and complex longitudinal processes. Moreover, the model informs future research by resolving seemingly contradictory findings on pathways to obesity previously thought to be distinct (low self-esteem, consuming sugary foods, and poor sleep cause obesity) that are actually processes working together over time (low self-esteem causes consumption of sugary foods which disrupts sleep quality and contributes to obesity). The findings of such inquiries can aid in identifying the timing and specific targets of preventive interventions across and within developmental phases. The implications of such a cascade model of paediatric obesity for health psychology and developmental and prevention sciences are discussed.
Collapse
Affiliation(s)
- Justin D. Smith
- Department of Psychiatry and Behavioral Sciences, Department of Preventive Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA, (312)503-4041.
| | - Kaitlyn N. Egan
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA, (619)733-3977.
| | - Zorash Montaño
- Children’s Hospital of Los Angeles, University of Southern California, Los Angeles, California, USA, (323)804-6666.
| | - Spring Dawson-McClure
- Center for Early Childhood Health & Development, New York University Langone Medical Center, New York, New York, USA, (919)930-7240.
| | - Danielle E. Jake-Schoffman
- Division of Preventive & Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA, (508)856-6517.
| | - Madeline Larson
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA, (253)225-0119.
| | - Sara M. St. George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA, (305)243-0726.
| |
Collapse
|
28
|
St George SM, Petrova M, Kyoung Lee T, Sardinas KM, Kobayashi MA, Messiah SE, Prado G. Predictors of Participant Attendance Patterns in a Family-Based Intervention for Overweight and Obese Hispanic Adolescents. Int J Environ Res Public Health 2018; 15:E1482. [PMID: 30011798 PMCID: PMC6068939 DOI: 10.3390/ijerph15071482] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/28/2018] [Accepted: 07/05/2018] [Indexed: 02/01/2023]
Abstract
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.
Collapse
Affiliation(s)
- Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | - Mariya Petrova
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | - Tae Kyoung Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | - Krystal M Sardinas
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | - Marissa A Kobayashi
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | - Sarah E Messiah
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| |
Collapse
|
29
|
Warren TY, Wilcox S, St. George SM, Brandt HM. African American Women's Perceived Influences on and Strategies to Reduce Sedentary Behavior. Qual Health Res 2018; 28:1112-1122. [PMID: 29291686 PMCID: PMC6204229 DOI: 10.1177/1049732317748605] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
We conducted three focus groups to examine African American women's perceptions of factors influencing and proposed strategies for reducing sedentary behavior (SB). QSR NVivo 9 facilitated coding and organization of themes. Although participants ( n = 32, 53.6 ± 6.0 years, 75% obese) were unfamiliar with the term SB prior to focus groups, they described spending large amounts of time in SB at work and home. Participants viewed leisure-time SB as necessary and important but were amenable to decreasing SB at work. Participants also identified personal, social, and environmental factors contributing to SB as well as novel strategies for reducing SB. Results suggest that messages aimed at reducing SB in African American women should be positively framed, viewed within a socioecologic framework, and target nonleisure time SB. SB was viewed as a form of stress reduction; thus, future research might want to emphasize alternative stress management techniques that simultaneously reduce SB.
Collapse
Affiliation(s)
| | - Sara Wilcox
- University of South Carolina, Columbia, South Carolina, USA
| | | | | |
Collapse
|
30
|
Lebron CN, Lee TK, Park SE, St George SM, Messiah SE, Prado G. Effects of parent-adolescent reported family functioning discrepancy on physical activity and diet among Hispanic youth. J Fam Psychol 2018; 32:333-342. [PMID: 29698007 PMCID: PMC5922788 DOI: 10.1037/fam0000386] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Research has shown that family functioning has been positively associated with physical activity and dietary intake, both of which are obesity-related risk factors. The most widely practiced methodological approach to assessing this construct in empirical studies relies on either parent or adolescent report. Yet, discrepancy in parent and adolescent report of family functioning may provide a fuller understanding of the effects of this construct on obesity-related health outcomes. This is especially important among Hispanics, a population that suffers from disproportionately high rates of obesity and its health-related consequences. The purpose of this study was to examine whether, and to what extent, parent-adolescent discrepancies in family functioning are associated with physical activity, and fruit and vegetable and added sugar intake. We estimated discrepancy scores between parents and adolescents (n = 280 dyads) in family functioning. Then, using structural equation modeling, we tested the effect of family functioning discrepancy on adolescent reports of physical activity, fruits and vegetables intake, and added sugar intake. After controlling for adolescent's gender and BMI, family functioning discrepancy was significantly associated with reduced physical activity (β = -.14*, 95% CI ([-.26, -.05]) and fruits and vegetables intake (β = -.22*, 95% CI [-.38, -.09]) such that the larger the discrepancy between parent and youth reported family functioning, the fewer days of adolescent physical activity and the poorer the fruits and vegetables intake. Our findings provide insight for the role of the family in Hispanic adolescent health outcomes and rationale for capturing rich data to better understand that role. (PsycINFO Database Record
Collapse
Affiliation(s)
- Cynthia N Lebron
- Department of Public Health Sciences, University of Miami Miller School of Medicine
| | - Tae Kyoung Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine
| | - Sung Eun Park
- School of Education and Human Development, University of Miami
| | - Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine
| | - Sarah E Messiah
- Messiah, Mailman Center for Child Development, University of Miami Miller School of Medicine
| | - Guillermo Prado
- Division of Prevention Science and Community Health, University of Miami
| |
Collapse
|
31
|
Molleda L, Bahamon M, St George SM, Perrino T, Estrada Y, Correa Herrera D, Pantin H, Prado G. Clinic Personnel, Facilitator, and Parent Perspectives of eHealth Familias Unidas in Primary Care. J Pediatr Health Care 2017; 31:350-361. [PMID: 28012799 PMCID: PMC5903564 DOI: 10.1016/j.pedhc.2016.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The purpose of this qualitative study was to understand the feasibility and acceptability of implementing eHealth Familias Unidas, an Internet-based, family-based, preventive intervention for Hispanic adolescents, in primary care. METHODS Semistructured individual interviews with clinic personnel and facilitators (i.e., physicians, nurse practitioners, administrators, and mental health workers; n = 9) and one focus group with parents (n = 6) were audiorecorded, transcribed verbatim, and analyzed using a general inductive approach. RESULTS Nine major themes emerged, including recommendations to minimize disruption to clinic flow, improve collaboration and training of clinic personnel and the research team, promote the clinic as a trusted setting for improving children's behavioral health, and highlight the flexibility and convenience of the eHealth format. DISCUSSION This study provides feasibility and acceptability findings, along with important considerations for researchers and primary care personnel interested in collaborating to implement an eHealth preventive intervention in pediatric primary care.
Collapse
|
32
|
St George SM, Pulgarón ER, Ferranti D, Agosto Y, Toro MI, Ramseur KC, Delamater AM. A Qualitative Study of Cognitive, Behavioral, and Psychosocial Challenges Associated With Pediatric Type 2 Diabetes in Ethnic Minority Parents and Adolescents. Diabetes Educ 2017; 43:180-189. [PMID: 28340546 DOI: 10.1177/0145721717691146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose The purpose of this descriptive qualitative study was to explore cognitive, behavioral, and psychosocial challenges associated with having and/or parenting an adolescent with pediatric type 2 diabetes (T2D) from the perspectives of ethnic minority parents and adolescents. Methods Ethnic minority (79.2% non-Hispanic black, 29.6% Hispanic) adolescents (n = 14, 78.6% female, 14.7 ± 1.9 years) and their parents (n = 13, 100% female) participated in either individual family interviews or multifamily focus group sessions. Sessions were audio recorded, transcribed, and coded by a team of 4 raters. QSR NVivo 10 was used to perform a content analysis and to extract coded adolescent and parent responses. Results Six themes corresponding to 3 broad categories (cognitive, behavioral, and psychosocial challenges) emerged. Regarding cognitive challenges, families described difficulties learning about a new disease and managing youth knowledge deficits and/or superficial knowledge. In terms of behavioral challenges, parents and adolescents discussed ongoing difficulties with making and maintaining positive youth health behavior changes as well as with ensuring regimen adherence. Finally, managing youth emotions related to diabetes and navigating social relationships with peers and other family members around the disclosure of T2D were the primary psychosocial challenges to emerge. Conclusions Directions for future research include developing and evaluating brief family interventions and adolescent psychosocial screening measures. Recommendations for clinical practice include increasing family knowledge of T2D, enhancing parenting skills for managing youth behavior change, and conducting routine psychosocial screening during follow-up clinic visits.
Collapse
Affiliation(s)
- Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida (Dr St. George)
| | - Elizabeth R Pulgarón
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida (Dr Pulgarón, Ms Agosto, Ms Toro, Mr Ramseur, Dr Delamater)
| | - Dina Ferranti
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida (Ms Ferranti)
| | - Yaray Agosto
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida (Dr Pulgarón, Ms Agosto, Ms Toro, Mr Ramseur, Dr Delamater)
| | - Maria I Toro
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida (Dr Pulgarón, Ms Agosto, Ms Toro, Mr Ramseur, Dr Delamater)
| | - Kevin C Ramseur
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida (Dr Pulgarón, Ms Agosto, Ms Toro, Mr Ramseur, Dr Delamater)
| | - Alan M Delamater
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida (Dr Pulgarón, Ms Agosto, Ms Toro, Mr Ramseur, Dr Delamater)
| |
Collapse
|
33
|
Abstract
Positive behavior support (PBS) strategies in early childhood, which include proactively structuring environments to support and positively reinforce healthy dietary and physical activity behaviors, are critical for preventing pediatric obesity, particularly among low-income, ethnic minority children. Existing evidence-based family-centered preventive interventions effectively impact parents' use of PBS strategies. Enhancing these programs to more directly target the key mechanisms of change specific to promoting children's healthy lifestyle behaviors could serve as the foundation for the next generation of effective protocols for preventing pediatric obesity. Two established programs that target PBS that can be feasibly implemented in a variety of service delivery systems using a multi-tiered, adaptive approach and the next steps of translation are discussed.
Collapse
|
34
|
St George SM, Huang S, Vidot DC, Smith JD, Brown CH, Prado G. Factors associated with the implementation of the Familias Unidas intervention in a type 3 translational trial. Transl Behav Med 2016; 6:105-14. [PMID: 27012258 DOI: 10.1007/s13142-015-0344-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
This study highlights how Familias Unidas, a Hispanic-specific, evidence-based, family centered preventive intervention, progressed from intervention development (type 1 translation; T1) through rigorous evaluation (T2) and examines the role of intervention fidelity-adherence and competence-in a T3 trial. Effects of participant, provider, and organizational variables on direct (observational) and indirect (self-reported) fidelity were examined as were effects of fidelity. Two structural equation models were estimated using data from 367 Hispanic parent-adolescent dyads randomized to Familias Unidas. Facilitator perceptions of parental involvement in schools, school performance grade, and school socioeconomic status predicted indirect adherence ratings, which were positively related to adolescent substance use. Facilitator openness to evidence-based practices was associated with indirect competence ratings, school performance grade and size were associated with direct competence ratings, and direct competence ratings were negatively associated with substance use. Findings highlight unique contributions of direct and indirect fidelity ratings in the implementation of Familias Unidas.
Collapse
Affiliation(s)
- Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.
| | - Shi Huang
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Denise C Vidot
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Justin D Smith
- Center for Prevention Implementation Methodology, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - C Hendricks Brown
- Center for Prevention Implementation Methodology, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| |
Collapse
|
35
|
Lawson AB, Ellerbe C, Carroll R, Alia K, Coulon S, Wilson DK, VanHorn ML, George SMS. Bayesian latent structure modeling of walking behavior in a physical activity intervention. Stat Methods Med Res 2016; 25:2634-2649. [PMID: 24741000 PMCID: PMC5388556 DOI: 10.1177/0962280214529932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The analysis of walking behavior in a physical activity intervention is considered. A Bayesian latent structure modeling approach is proposed whereby the ability and willingness of participants is modeled via latent effects. The dropout process is jointly modeled via a linked survival model. Computational issues are addressed via posterior sampling and a simulated evaluation of the longitudinal model's ability to recover latent structure and predictor effects is considered. We evaluate the effect of a variety of socio-psychological and spatial neighborhood predictors on the propensity to walk and the estimation of latent ability and willingness in the full study.
Collapse
Affiliation(s)
- Andrew B Lawson
- Division of Biostatistics, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Caitlyn Ellerbe
- Division of Biostatistics, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Rachel Carroll
- Division of Biostatistics, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kassandra Alia
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Sandra Coulon
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - M Lee VanHorn
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Sara M St George
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| |
Collapse
|
36
|
Bardone-Cone AM, Higgins MK, St George SM, Rosenzweig I, Schaefer LM, Fitzsimmons-Craft EE, Henning TM, Preston BF. Behavioral and psychological aspects of exercise across stages of eating disorder recovery. Eat Disord 2016; 24:424-39. [PMID: 27463591 PMCID: PMC5055812 DOI: 10.1080/10640266.2016.1207452] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examined the relationship between behavioral and psychological aspects of exercise and eating disorder recovery. Participants were categorized as having an eating disorder (n = 53), partially recovered (n = 15), fully recovered (n = 20), or non-eating disorder controls (n = 67). Groups did not differ significantly in time spent exercising, but did differ in exercise intensity, guilt-related exercise, obsessive exercise cognitions, and appearance/weight management and stress/mood management motivations for exercise. Results support the importance of measuring psychological aspects of exercise in particular across the course of an eating disorder.
Collapse
Affiliation(s)
- Anna M Bardone-Cone
- a Department of Psychology and Neuroscience , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - M K Higgins
- a Department of Psychology and Neuroscience , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Sara M St George
- b Department of Public Health Sciences , University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Ilyssa Rosenzweig
- a Department of Psychology and Neuroscience , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Lauren M Schaefer
- c Department of Psychology , University of South Florida , Tampa , Florida , USA
| | | | - Taylor M Henning
- a Department of Psychology and Neuroscience , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Brittany F Preston
- e Department of Psychological Sciences , University of Missouri-St. Louis , St. Louis , Missouri , USA
| |
Collapse
|
37
|
Buscemi J, Janke EA, Kugler KC, Duffecy J, Mielenz TJ, St. George SM, Sheinfeld Gorin SN. Increasing the public health impact of evidence-based interventions in behavioral medicine: new approaches and future directions. J Behav Med 2016; 40:203-213. [DOI: 10.1007/s10865-016-9773-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 07/14/2016] [Indexed: 12/27/2022]
|
38
|
St George SM, Van Horn ML, Lawman HG, Wilson DK. Reliability of 24-Hour Dietary Recalls as a Measure of Diet in African-American Youth. J Acad Nutr Diet 2016; 116:1551-1559. [PMID: 27394936 DOI: 10.1016/j.jand.2016.05.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although it is a common practice to estimate dietary intake using three random 24-hour dietary recalls, some studies have suggested up to nine may be necessary to reliably estimate usual intake in youth. Given the resulting increase in resources and participant burden, more research is needed to determine whether this method is reliable, particularly in African-American youth at increased risk for obesity and other chronic diseases. OBJECTIVE This study estimated the reliability with which 24-hour dietary recalls measure energy, fat, fruit, and vegetable intake in African-American youth and examined how reliability changes as a function of the number of recalls. DESIGN This study used cross-sectional data collection across three studies. PARTICIPANTS/SETTING Participants were African-American youth (n=456, mean±standard deviation age 13.28±1.86 years, 64% were girls, mean±standard deviation body mass index [calculated as kg/m(2)] 31.45±7.94) who completed random 24-hour dietary recalls (67% completed three) conducted by research assistants using the Automated Self-Administered 24-Hour recall system (n=258) or registered dietitian nutritionists using the Nutrition Data System for Research (n=198). MAIN OUTCOME MEASURES/STATISTICAL ANALYSES Estimates provided by multilevel models were used to calculate the proportion of variance accounted for between individuals and the reliability of means within individuals as a function of the number of recalls. RESULTS Reliability estimates for assessing dietary outcomes using one to three recalls ranged from 11% to 62%. To achieve 80% reliability, the following number of recalls would need to be conducted: 8 for energy intake, 13 for fat intake, 21 to 32 for fruit intake, and 21 to 25 for vegetable intake. CONCLUSIONS The common practice of assessing dietary intake with three recalls does so with low reliability in African-American youth. Until more objective methods for reliably estimating usual intake are developed, researchers who choose to use 24-hour dietary recalls are encouraged to include estimates of the measure's reliability in a priori power calculations for improved decision making regarding the number of observations and/or sample size.
Collapse
|
39
|
St George SM, Wilson DK, McDaniel T, Alia KA. Process Evaluation of the Project SHINE Intervention for African American Families: An Integrated Positive Parenting and Peer Monitoring Approach to Health Promotion. Health Promot Pract 2016; 17:557-68. [PMID: 27084025 DOI: 10.1177/1524839916635977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study describes the process evaluation of Project SHINE, a randomized family-based health promotion intervention that integrated parenting and peer monitoring for improving sedentary behavior, physical activity, and diet in African American families. Adolescent-parent dyads (n = 89) were randomized to a 6-week behavioral, positive parenting, and peer monitoring skills intervention or a general health education comparison condition. Process evaluation included observational ratings of fidelity, attendance records, psychosocial measures, and qualitative interviews. Results indicated that the intervention was delivered with high fidelity based on facilitator adherence (>98% of content delivered) and competent use of theoretically based behavior change and positive parenting skills (100% of ratings >3 on a 1-4 scale). Although only 43% of peers attended the "bring a friend" session, overall attendance was high (4.39 ± 1.51 sessions) as was the retention rate (88%). Parents in the intervention condition reported significant improvements in communication related to adolescents' engagement in health behaviors both on their own and with peers. These findings were supported by qualitative themes related to improvements in family communication and connectedness. This study provides an innovative example of how future family-based health promotion trials can expand their process evaluation approaches by assessing theoretically relevant positive parenting variables as part of ongoing monitoring.
Collapse
|
40
|
St George SM, Delamater AM, Pulgaron ER, Daigre A, Sanchez J. Access to and Interest in Using Smartphone Technology for the Management of Type 1 Diabetes in Ethnic Minority Adolescents and Their Parents. Diabetes Technol Ther 2016; 18:104-9. [PMID: 26840496 DOI: 10.1089/dia.2015.0086] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND A better understanding of parent and adolescent interest in using smartphone technology for type 1 diabetes (T1D) management is needed prior to developing technology-based interventions for ethnic minorities. This study examined access to and interest in technology-based programs for T1D in primarily Hispanic adolescents and their parents. SUBJECTS AND METHODS During a scheduled clinic visit, adolescents with T1D (n = 50; 52% female; 13.6 ± 2.0 years old; 74% Hispanic; hemoglobin A1c = 8.9 ± 1.7%) and their parents (n = 49; 54% household income <$49,000) completed brief self-report surveys. RESULTS Adolescents reported having access to the Internet (98%) and their own smartphones (86%). Thirty-seven percent reported using smartphone applications (apps) for their diabetes care, with 88% reporting carbohydrate counting as its primary function. Although most participants reported high/moderate interest in diabetes-specific apps, girls were more likely than boys to endorse high interest in apps to calculate and track insulin doses. A greater proportion of parents than of adolescents expressed high interest in apps to track glucose, count carbohydrates, calculate insulin doses, track insulin use, and receive diabetes-related reminders. A greater proportion of parents than of adolescents also endorsed interest in a program that combined Internet use with smartphone apps. CONCLUSIONS Results suggest ethnic minority adolescents with T1D across a range of income levels have access to smartphones. Although most parents expressed high interest in diabetes-specific apps, there was greater variability in adolescent interest. Understanding barriers and facilitators to the use of smartphone apps for diabetes care in ethnic minority adolescents may increase their interest in and ultimate adoption of this technology.
Collapse
Affiliation(s)
- Sara M St George
- 1 Department of Public Health Sciences, University of Miami Miller School of Medicine , Miami, Florida
| | - Alan M Delamater
- 2 Department of Pediatrics, University of Miami Miller School of Medicine , Miami, Florida
| | - Elizabeth R Pulgaron
- 2 Department of Pediatrics, University of Miami Miller School of Medicine , Miami, Florida
| | - Amber Daigre
- 2 Department of Pediatrics, University of Miami Miller School of Medicine , Miami, Florida
| | - Janine Sanchez
- 2 Department of Pediatrics, University of Miami Miller School of Medicine , Miami, Florida
| |
Collapse
|
41
|
Wilson DK, Van Horn ML, Siceloff ER, Alia KA, St George SM, Lawman HG, Trumpeter NN, Coulon SM, Griffin SF, Wandersman A, Egan B, Colabianchi N, Forthofer M, Gadson B. The Results of the "Positive Action for Today's Health" (PATH) Trial for Increasing Walking and Physical Activity in Underserved African-American Communities. Ann Behav Med 2016; 49:398-410. [PMID: 25385203 DOI: 10.1007/s12160-014-9664-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The "Positive Action for Today's Health" (PATH) trial tested an environmental intervention to increase walking in underserved communities. METHODS Three matched communities were randomized to a police-patrolled walking plus social marketing, a police-patrolled walking-only, or a no-walking intervention. The 24-month intervention addressed safety and access for physical activity (PA) and utilized social marketing to enhance environmental supports for PA. African-Americans (N=434; 62% females; aged 51±16 years) provided accelerometry and psychosocial measures at baseline and 12, 18, and 24 months. Walking attendance and trail use were obtained over 24 months. RESULTS There were no significant differences across communities over 24 months for moderate-to-vigorous PA. Walking attendance in the social marketing community showed an increase from 40 to 400 walkers per month at 9 months and sustained ~200 walkers per month through 24 months. No change in attendance was observed in the walking-only community. CONCLUSIONS Findings support integrating social marketing strategies to increase walking in underserved African-Americans (ClinicalTrials.gov #NCT01025726).
Collapse
Affiliation(s)
- Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, 29208, USA,
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Alia KA, Wilson DK, McDaniel T, St George SM, Kitzman-Ulrich H, Smith K, Heatley V, Wise C. Development of an innovative process evaluation approach for the Families Improving Together (FIT) for weight loss trial in African American adolescents. Eval Program Plann 2015; 49:106-16. [PMID: 25614139 PMCID: PMC4372476 DOI: 10.1016/j.evalprogplan.2014.12.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 12/15/2014] [Accepted: 12/21/2014] [Indexed: 05/12/2023]
Abstract
UNLABELLED This study demonstrates how a multi-theoretical, multilevel process evaluation was used to assess implementation of the Families Improving Together (FIT) for weight loss intervention. FIT is a randomized controlled trial evaluating a culturally tailored, motivational plus family-based program on weight loss in African American adolescents and their parents. Social Cognitive, Self Determination, Family Systems theories and cultural tailoring principles guided the conceptualization of essential elements across individual/family, facilitator, and group levels. Data collection included an observational rating tool, attendance records, and a validated psychosocial measure. RESULTS Attendance records (0=absent, 1=present, criteria=≥70%) indicated that 71.5% of families attended each session. The survey (1=false, 6=true, criteria=≥4.5) indicated that participants perceived a positive group climate (M=5.16, SD=0.69). A trained evaluator reported that facilitator dose delivered (0=no, 1=yes, criteria=≥75%) was high (99.6%), and fidelity (1=none to 4=all, criteria=≥3) was adequate at facilitator (M=3.63, SD=0.41) and group levels (M=3.35, SD=0.49). Five cultural topics were raised by participants related to eating (n=3) and physical activity (n=2) behaviors and were integrated as part of the final curriculum. DISCUSSION Results identify areas for program improvement related to delivery of multi-theoretical and cultural tailoring elements. Findings may inform future strategies for implementing effective weight loss programs for ethnic minority families.
Collapse
Affiliation(s)
- Kassandra A Alia
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, USA.
| | - Tyler McDaniel
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Heather Kitzman-Ulrich
- Department of Behavioral and Community Health, University of North Texas, Fort Worth, TX, USA
| | - Kelsey Smith
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - VaShawn Heatley
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Courtney Wise
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| |
Collapse
|
43
|
Power TG, Sleddens EFC, Berge J, Connell L, Govig B, Hennessy E, Liggett L, Mallan K, Santa Maria D, Odoms-Young A, St. George SM. Contemporary research on parenting: conceptual, methodological, and translational issues. Child Obes 2013; 9 Suppl:S87-94. [PMID: 23944927 PMCID: PMC3746214 DOI: 10.1089/chi.2013.0038] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Researchers over the last decade have documented the association between general parenting style and numerous factors related to childhood obesity (e.g., children's eating behaviors, physical activity, and weight status). Many recent childhood obesity prevention programs are family focused and designed to modify parenting behaviors thought to contribute to childhood obesity risk. This article presents a brief consideration of conceptual, methodological, and translational issues that can inform future research on the role of parenting in childhood obesity. They include: (1) General versus domain specific parenting styles and practices; (2) the role of ethnicity and culture; (3) assessing bidirectional influences; (4) broadening assessments beyond the immediate family; (5) novel approaches to parenting measurement; and (6) designing effective interventions. Numerous directions for future research are offered.
Collapse
Affiliation(s)
- Thomas G. Power
- Department of Human Development, Washington State University, Pullman, WA
| | - Ester F. C. Sleddens
- Department of Health Promotion, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jerica Berge
- Department of Family and Community Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Lauren Connell
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA
| | - Bert Govig
- Faculty of Medicine, McGill University, Montreal, Québec, Canada
| | - Erin Hennessy
- Cancer Prevention Fellowship Program, National Cancer Institute, Rockville, MD
| | - Leanne Liggett
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Kimberley Mallan
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia
| | | | - Angela Odoms-Young
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL
| | | |
Collapse
|
44
|
St George SM, Wilson DK, Schneider EM, Alia KA. Project SHINE: effects of parent-adolescent communication on sedentary behavior in African American adolescents. J Pediatr Psychol 2013; 38:997-1009. [PMID: 23685450 DOI: 10.1093/jpepsy/jst027] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study examined parenting variables (communication, monitoring) as moderators of a family-based intervention for reducing sedentary behavior (SB) in African American adolescents. As a secondary aim, a similar model was tested using adolescent weight status as the outcome. METHODS African American adolescents (n = 73; 12.45 ± 1.45 years; 60% girls; 63% overweight/obese) and caregivers were randomized to a 6-week interactive, parent-based intervention or general health condition. Parent-adolescent communication and monitoring of health behaviors were self-reported by parents. Adolescent SB was self-reported by youth. RESULTS There was a significant intervention by communication interaction, such that intervention families with more positive communication showed lower adolescent SB than those with less positive communication or those in the comparison condition. No effects were found for monitoring on SB or for the model with weight status as the outcome. CONCLUSIONS Parent-adolescent communication may be an effective component to integrate into health promotion programs for African American adolescents.
Collapse
Affiliation(s)
- Sara M St George
- MA, Department of Psychology, Barnwell College, University of South Carolina, Columbia, SC 29208, USA.
| | | | | | | |
Collapse
|
45
|
Wilson DK, St George SM, Trumpeter NN, Coulon SM, Griffin SF, Wandersman A, Forthofer M, Gadson B, Brown PV. Qualitative developmental research among low income African American adults to inform a social marketing campaign for walking. Int J Behav Nutr Phys Act 2013; 10:33. [PMID: 23497164 PMCID: PMC3610237 DOI: 10.1186/1479-5868-10-33] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 02/20/2013] [Indexed: 11/25/2022] Open
Abstract
Background This study describes the development of a social marketing campaign for increasing walking in a low income, high crime community as part of the Positive Action for Today’s Health (PATH) trial. Methods Focus groups were conducted with 52 African American adults (ages 18 to 65 yrs), from two underserved communities to develop themes for a social marketing campaign to promote walking. Participants responded to questions concerning social marketing principles related to product, price, place, promotion, and positioning for increasing neighbourhood walking. Results Focus group data informed the development of the campaign objectives that were derived from the “5 Ps” to promote physical and mental health, social connectedness, safety, and confidence in walking regularly. Focus group themes indicated that physical and mental health benefits of walking were important motivators. Walking for social reasons was also important for overcoming barriers to walking. Police support from trusted officers while walking was also essential to promoting safety for walking. Print materials were developed by the steering committee, with a 12-month calendar and door hangers delivered to residents’ homes to invite them to walk. Pride Stride walks empowered community walkers to serve as peer leaders for special walking events to engage new walkers. Conclusions Essential elements for developing culturally tailored social marketing interventions for promoting walking in underserved communities are outlined for future researchers.
Collapse
Affiliation(s)
- Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC 29208, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
St George SM, Wilson DK, Lawman HG, Van Horn ML. Weight status as a moderator of the relationship between motivation, emotional social support, and physical activity in underserved adolescents. J Pediatr Psychol 2013; 38:387-97. [PMID: 23378172 DOI: 10.1093/jpepsy/jss178] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study examined weight status as a moderator of the relationship between motivation (controlled, autonomous, regulatory), emotional social support (parents, peers) and moderate-to-vigorous physical activity (MVPA) in underserved adolescents (ethnic minority, low-income). METHODS Participants from the Active by Choice Today Trial (n = 1,416; 54% girls, 73% African American, 52% overweight/obese) completed baseline measures, including height and weight, psychosocial surveys, and 7-day accelerometry estimates. Weight status was defined by body mass index z-score (zBMI). RESULTS Weight status moderated the effects of controlled, autonomous, and regulatory motivation on MVPA, such that these variables were more strongly associated with MVPA in adolescents with lower versus higher zBMI scores. CONCLUSIONS A better understanding of why motivation is not related to MVPA in underserved youth with a higher weight status is needed. Future pediatric obesity treatment in underserved youth may need to move beyond motivation into environmental factors associated with long-term behavior change.
Collapse
Affiliation(s)
- Sara M St George
- Department of Psychology, Barnwell College, University of South Carolina, Columbia, SC 29208, USA.
| | | | | | | |
Collapse
|
47
|
Schneider EM, Wilson DK, Kitzman-Ulrich H, St George SM, Alia KA. The associations of parenting factors with adolescent body mass index in an underserved population. J Obes 2013; 2013:715618. [PMID: 23762540 PMCID: PMC3671295 DOI: 10.1155/2013/715618] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 04/06/2013] [Accepted: 04/22/2013] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The current study examined parental factors related to risk of adolescent obesity within the context of a family systems framework. METHODS Seventy predominantly African American, low-income caregiver-adolescent dyads participated in the study. Validated measures of parental perceived child risk for development of type 2 diabetes mellitus, parental limit setting for sedentary behavior, and parental nurturance were evaluated as predictors of adolescent body mass index. RESULTS In this cross-sectional study, multiple linear regression demonstrated that parents of adolescents with higher zBMI reported worrying more about their child's risk of developing type 2 diabetes mellitus. Parent limit setting was also a significant predictor of adolescent zBMI. Contrary to expectations, higher levels of nurturance were associated with higher adolescent zBMI. Post hoc analyses revealed a trend towards a significant interaction between nurturance and limit setting, such that high levels of both parental nurturance and limit setting were associated with lower adolescent zBMI. CONCLUSIONS Current findings suggest the importance of authoritative parenting and monitoring of adolescent health behaviors in the treatment of obesity.
Collapse
Affiliation(s)
- Elizabeth M Schneider
- Department of Clinical & Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL 32610, USA.
| | | | | | | | | |
Collapse
|
48
|
Alia KA, Wilson DK, St George SM, Schneider E, Kitzman-Ulrich H. Effects of parenting style and parent-related weight and diet on adolescent weight status. J Pediatr Psychol 2012; 38:321-9. [PMID: 23248345 DOI: 10.1093/jpepsy/jss127] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study examined the interaction between parental limit setting of sedentary behaviors and health factors (weight status, physical activity [PA], fruit and vegetable [FV] intake) on standardized body mass index (zBMI) in African American adolescents. METHODS Data were from 67 parent-adolescent dyads. Parental limit setting, PA and FV intake were assessed via self-report, and objective height and weight measurements were collected. RESULTS Regressions examined the interaction between parental limit setting and BMI, PA, FV intake on adolescent zBMI. The model for parent BMI and FV intake accounted for 31% of the variance in adolescent zBMI. A significant interaction for parent BMI by limit setting showed that as parental BMI increased, higher (vs. lower) limit setting was associated with lower adolescent zBMI. Higher parent FV consumption was associated with lower adolescent zBMI. CONCLUSION Future interventions should integrate parent limit setting and target parent fruit and vegetable intake for obesity prevention in underserved adolescents.
Collapse
Affiliation(s)
- Kassandra A Alia
- Department of Psychology, Barnwell College, University of South Carolina, Columbia, SC 29208, USA.
| | | | | | | | | |
Collapse
|
49
|
Coulon SM, Wilson DK, Griffin S, St George SM, Alia KA, Trumpeter NN, Wandersman AK, Forthofer M, Robinson S, Gadson B. Formative process evaluation for implementing a social marketing intervention to increase walking among African Americans in the Positive Action for Today's Health trial. Am J Public Health 2012; 102:2315-21. [PMID: 23078486 DOI: 10.2105/ajph.2012.300758] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Evaluating programs targeting physical activity may help to reduce disparate rates of obesity among African Americans. We report formative process evaluation methods and implementation dose, fidelity, and reach in the Positive Action for Today's Health trial. METHODS We applied evaluation methods based on an ecological framework in 2 community-based police-patrolled walking programs targeting access and safety in underserved African American communities. One program also targeted social connectedness and motivation to walk using a social marketing approach. Process data were systematically collected from baseline to 12 months. RESULTS Adequate implementation dose was achieved, with fidelity achieved but less stable in both programs. Monthly walkers increased to 424 in the walking-plus-social marketing program, indicating expanding program reach, in contrast to no increase in the walking-only program. Increased reach was correlated with peer-led Pride Strides (r = .92; P < .001), a key social marketing component, and program social interaction was the primary reason for which walkers reported participating. CONCLUSIONS Formative process evaluation demonstrated that the walking programs were effectively implemented and that social marketing increased walking and perceived social connectedness in African American communities.
Collapse
Affiliation(s)
- Sandra M Coulon
- Department of Psychology, Barnwell College, University of South Carolina, Columbia, SC 29208, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
St. George SM, Wilson DK. A qualitative study for understanding family and peer influences on obesity-related health behaviors in low-income African-American adolescents. Child Obes 2012; 8:466-76. [PMID: 23061501 PMCID: PMC3647590 DOI: 10.1089/chi.2012.0067] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Given the cultural and developmental relevance of family members and peers in the lives of African-American adolescents, the present study used a bioecological framework to qualitatively explore the parenting context as well as specific family factors (support, rules, monitoring) and peer factors (support) related to weight status, physical activity (PA), and healthy eating in low-income African-American boys versus girls. METHODS Qualitative data were obtained from African-American adolescents through focus groups. Adolescents (n = 45, 100% African American, 51% girls, 12.6 ± 1.2 years, 51% overweight/obese) were from two underserved communities in South Carolina (median income ≈$17,000-$22,000, high crime levels). Sessions were audiotaped, transcribed, and coded by independent pairs of raters (r = 0.75). QSR NVivo 8 was used to analyze data, and themes were categorized separately for boys and girls. RESULTS Adolescents reported themes of family warmth and control practices consistent with an authoritative style of parenting. Although adolescents wanted increased autonomy, they viewed parental monitoring as a favorable part of their relationship. Boys reported receiving more constructive feedback from parents about weight status and greater overall support for PA and diet than did girls. Girls reported more honest feedback from peers about weight status than did boys. Overall, adolescents acknowledged the unique opportunities of parents and peers in improving their health behaviors. CONCLUSIONS Findings suggest parents and peers interact in different ways with African-American boys and girls regarding their weight status and health behaviors. Future obesity prevention efforts in minority youth may need to target parenting skills that provide greater support to African-American girls. In addition, given peers influence PA and diet differently in boys and girls, interventions should strategically include parenting strategies that involve monitoring peer-adolescent interactions.
Collapse
Affiliation(s)
| | - Dawn K. Wilson
- Department of Psychology, University of South Carolina, Columbia, SC
| |
Collapse
|