BACKGROUND: Contingency management (CM) interventions, which use operant conditioning principles to encourage completion of target behavioral goals, may be useful for improving adherence to behavioral skills training (BST). Research-to-date has yet to explore CM for weight loss in minority adolescents. OBJECTIVE: To examine the effects of CM in improving adolescent weight loss when added to BST. DESIGN: The study utilized an innovative experimental design that builds upon multiple baseline approaches as recommended by the National Institutes of Health. PARTICIPANTS/ SETTING: Six obese African-American youth and their primary caregivers living in Detroit, Michigan, USA. INTERVENTION: Adolescents received between 4 and 12 weeks of BST during a baseline period and subsequently received CM targeting weight loss. MAIN OUTCOME MEASURES: Youth weight. STATISTICAL ANALYSIS PERFORMED: Linear mixed effects modeling was used in the analysis. RESULTS: CM did not directly affect adolescent weight loss above that of BST (p=0.053). However, when caregivers were involved in CM session treatment, contingency management had a positive effect on adolescent weight loss. The estimated weight loss due to CM when caregivers also attended was 0.66 kg/week (p<0.001, [95% CI; -1.96, -0.97]) relative to the baseline trajectory. CONCLUSION: This study demonstrates application of a novel experimental approach to intervention development and demonstrated the importance of parent involvement when delivering contingency management for minority youth weight loss. Lessons learned from contingency management program implementation are also discussed in order to inform practice.
BACKGROUND: Contingency management (CM) interventions, which use operant conditioning principles to encourage completion of target behavioral goals, may be useful for improving adherence to behavioral skills training (BST). Research-to-date has yet to explore CM for weight loss in minority adolescents. OBJECTIVE: To examine the effects of CM in improving adolescent weight loss when added to BST. DESIGN: The study utilized an innovative experimental design that builds upon multiple baseline approaches as recommended by the National Institutes of Health. PARTICIPANTS/ SETTING: Six obese African-American youth and their primary caregivers living in Detroit, Michigan, USA. INTERVENTION: Adolescents received between 4 and 12 weeks of BST during a baseline period and subsequently received CM targeting weight loss. MAIN OUTCOME MEASURES: Youth weight. STATISTICAL ANALYSIS PERFORMED: Linear mixed effects modeling was used in the analysis. RESULTS: CM did not directly affect adolescent weight loss above that of BST (p=0.053). However, when caregivers were involved in CM session treatment, contingency management had a positive effect on adolescent weight loss. The estimated weight loss due to CM when caregivers also attended was 0.66 kg/week (p<0.001, [95% CI; -1.96, -0.97]) relative to the baseline trajectory. CONCLUSION: This study demonstrates application of a novel experimental approach to intervention development and demonstrated the importance of parent involvement when delivering contingency management for minority youth weight loss. Lessons learned from contingency management program implementation are also discussed in order to inform practice.
Authors: Angela J Jacques-Tiura; Deborah A Ellis; April Idalski Carcone; Sylvie Naar; Kathryn Brogan Hartlieb; Elizabeth K Towner; Thomas N Templin; K-L Catherine Jen Journal: J Adolesc Health Date: 2018-11-02 Impact factor: 5.012