Sylvie Naar1, Deborah Ellis2, April Idalski Carcone2, Angela J Jacques-Tiura2, Phillippe Cunningham3, Thomas Templin4, Kathryn Brogan Hartlieb5, K-L Cathy Jen6. 1. Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL. 2. Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI. 3. Department of Psychiatry, Medical University of South Carolina, Charleston, SC. 4. School of Nursing, Wayne State University, Detroit, MI. 5. Stempel College of Public Health and Social Work, Florida International University, Miami, FL. 6. Department of Nutrition and Food Science, Wayne State University, Detroit, MI.
Abstract
BACKGROUND:Minority adolescents are at highest risk for obesity and extreme obesity; yet, there are few clinical trials targeting African American adolescents with obesity. PURPOSE: The purpose of the study was to develop an adaptive family-based behavioral obesity treatment for African American adolescents using a sequential multiple assignment randomized trial (SMART) design. METHODS: Fit Families was a SMART where 181 African American adolescents (67% female) aged 12-17 were first randomized to office-based versus home-based behavioral skills treatment delivered from a Motivational Interviewing foundation. After 3 months, nonresponders to first phase treatment were rerandomized to continued home-based behavioral skills treatment or contingency management with voucher-based reinforcement for adolescent weight loss and for caregiver adherence to the program. All interventions were delivered by community health workers. The primary outcome was treatment retention and percent overweight. RESULTS: All adolescents reduced percent overweight by -3.20%; there were no significant differences in percent overweight based on treatment sequence. Adolescents receiving home-based delivery in Phase 1 and contingency management in Phase 2 completed significantly more sessions than those receiving office-based treatment and continued skills without CM (M = 8.03, SD = 3.24 and M = 6.62, SD = 2.95, respectively). The effect of contingency management was strongest among older and those with lower baseline confidence. Younger adolescents experienced greater weight reductions when receiving continued skills (-4.90% compared with -.02%). CONCLUSIONS:Behavioral skills training can be successfully delivered to African American adolescents with obesity and their caregivers by community health workers when using a home-based service model with incentives. More potent interventions are needed to increase reductions in percent overweight and may need to be developmentally tailored for younger and older adolescents.
RCT Entities:
BACKGROUND: Minority adolescents are at highest risk for obesity and extreme obesity; yet, there are few clinical trials targeting African American adolescents with obesity. PURPOSE: The purpose of the study was to develop an adaptive family-based behavioral obesity treatment for African American adolescents using a sequential multiple assignment randomized trial (SMART) design. METHODS: Fit Families was a SMART where 181 African American adolescents (67% female) aged 12-17 were first randomized to office-based versus home-based behavioral skills treatment delivered from a Motivational Interviewing foundation. After 3 months, nonresponders to first phase treatment were rerandomized to continued home-based behavioral skills treatment or contingency management with voucher-based reinforcement for adolescent weight loss and for caregiver adherence to the program. All interventions were delivered by community health workers. The primary outcome was treatment retention and percent overweight. RESULTS: All adolescents reduced percent overweight by -3.20%; there were no significant differences in percent overweight based on treatment sequence. Adolescents receiving home-based delivery in Phase 1 and contingency management in Phase 2 completed significantly more sessions than those receiving office-based treatment and continued skills without CM (M = 8.03, SD = 3.24 and M = 6.62, SD = 2.95, respectively). The effect of contingency management was strongest among older and those with lower baseline confidence. Younger adolescents experienced greater weight reductions when receiving continued skills (-4.90% compared with -.02%). CONCLUSIONS: Behavioral skills training can be successfully delivered to African American adolescents with obesity and their caregivers by community health workers when using a home-based service model with incentives. More potent interventions are needed to increase reductions in percent overweight and may need to be developmentally tailored for younger and older adolescents.
Authors: Donald A Williamson; Heather M Walden; Marney A White; Emily York-Crowe; Robert L Newton; Anthony Alfonso; Stewart Gordon; Donna Ryan Journal: Obesity (Silver Spring) Date: 2006-07 Impact factor: 5.002
Authors: Mary Savoye; Melissa Shaw; James Dziura; William V Tamborlane; Paulina Rose; Cindy Guandalini; Rachel Goldberg-Gell; Tania S Burgert; Anna M G Cali; Ram Weiss; Sonia Caprio Journal: JAMA Date: 2007-06-27 Impact factor: 56.272
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