Adaptations of an Effective Evidence-Based Pediatric Weight Management Intervention.

Current childhood obesity treatment programs do not address medically underserved populations or settings where all members of an interdisciplinary team may not exist-either within one organization or within the community. In this paper, we describe the use of a community-academic partnership to iteratively adapt Epstein's Traffic Light Diet (TLD), into Building Healthy Families (BHF), a community-placed evidence-based pediatric weight management intervention (PWMI) and evaluate its effectiveness in reducing BMI z scores. Nine cohorts of families completed BHF. Participants included children aged 6-12 years with obesity (M = 9.46, SD = 1.74). The Framework for Reporting Adaptations and Modifications-Expanded guided our classification of modifications across BHF cohorts. Using the FRAME reporting structure, the changes that were documented were (1) planned and occurred pre-implementation, (2) based on decisions from local stakeholders (e.g., school administrator, members of the implementation team), and (3) specific to changes in content and context-with a focus on implementation and potential for local scale-up. The nature of the adaptations included adding elements (whole of family approach), removing elements (calorie counting), and substituting elements (steps for minutes of physical activity). Across 9 cohorts, 84 families initiated the BHF program, 69 families successfully completed the 12-week program, and 45 families returned for 6-month follow-up assessments. Results indicated that the BMI z score in children was reduced by 0.31 ± 0.17 at 6 months across all cohorts. Reduction in BMI z score ranged from 0.41 in cohort 4 to 0.13 in cohort 5. Iterative adaptations to BHF were completed to improve the fit of BHF to the setting and participants and have contributed to a sustained community PWMI that adheres to the underlying principles and core elements of other evidence-based PWMIs. Monitoring adaptations and related changes to outcomes can play a role in long-term sustainability and effectiveness.

Understanding implementation costs of a pediatric weight management intervention: an economic evaluation protocol.

BACKGROUND: Understanding the cost and/or cost-effectiveness of implementation strategies is crucial for organizations to make informed decisions about the resources needed to implement and sustain evidence-based interventions (EBIs). This economic evaluation protocol describes the methods and processes that will be used to assess costs and cost-effectiveness across implementation strategies used to improve the reach, adoption, implementation, and organizational maintenance of an evidence-based pediatric weight management intervention- Building Health Families (BHF). METHODS: A within-trial cost and cost-effectiveness analysis (CEA) will be completed as part of a hybrid type III effectiveness-implementation trial (HEI) designed to examine the impact of an action Learning Collaborative (LC) strategy consisting of network weaving, consultee-centered training, goal-setting and feedback, and sustainability action planning to improve the adoption, implementation, organizational maintenance, and program reach of BHF in micropolitan and surrounding rural communities in the USA, over a 12-month period. We discuss key features of implementation strategy components and the associated cost collection and outcome measures and present brief examples on what will be included in the CEA for each discrete implementation strategy and how the results will be interpreted. The cost data will be collected by identifying implementation activities associated with each strategy and using a digital-based time tracking tool to capture the time associated with each activity. Costs will be assessed relative to the BHF program implementation and the multicomponent implementation strategy, included within and external to a LC designed to improve reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) of BHF. The CEA results will be reported by RE-AIM outcomes, using the average cost-effectiveness ratio or incremental cost-effectiveness ratio. All the CEAs will be performed from the community perspective. DISCUSSION: The proposed costing approach and economic evaluation framework for dissemination and implementation strategies and EBI implementation will contribute to the evolving but still scant literature on economic evaluation of implementation and strategies used and facilitate the comparative economic analysis. TRIAL REGISTRATION: ClinicalTrials.gov NCT04719442 . Registered on January 22, 2021.

A Type III Hybrid Effectiveness-Implementation Pilot Trial Testing Dissemination and Implementation Strategies for a Pediatric Weight Management Intervention: The Nebraska Childhood Obesity Research Demonstration Project.

Background: Several family-based efficacious pediatric weight management interventions (PWMIs) have been developed to reduce child weight status. These programs are typically based in larger cities delivered by an interdisciplinary team in a hospital or medical center. The degree to which these efficacious PWMIs have been translated to, and are feasible in, rural or micropolitan areas is unclear. This study protocol describes a pilot Type III hybrid effectiveness-implementation (T3HEI) trial testing a multilevel strategy that focuses on the adoption, implementation, and sustainability of a PWMI online training program and resource package designed for implementation in micropolitan and rural areas. Methods: The trial design employed the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate outcomes and the Promoting Action on Research Implementation in Health Services framework to specify potential mechanisms of adoption, implementation, and sustainability. The study will test the feasibility of a fund and contract dissemination strategy in the adoption of a PWMI in four to eight rural communities, compare a learning collaborative implementation strategy including embedded training and sustainability action planning with communities who receive the PWMI online program and resources alone, and determine whether the PWMI reach, effectiveness, and maintenance are of magnitude similar to previous effectiveness trials. The dissemination and implementation process focused on an integrated research-practice partnership process model that includes a systems-based approach with multiple sectors and vertical decision-making representation. Conclusions: Our pilot T3HEI study has the potential to inform how best to move and sustain evidence-based PWMIs into practice. The findings will inform larger scale dissemination, implementation, and sustainability efforts in medically underserved areas across the country. Trial registration: This protocol is registered with clinicaltrials.gov (NCT04719442).

Combined influence of physical activity and television viewing on the risk of overweight in US youth.

OBJECTIVE: The purpose of this study was to examine the combined influence of physical activity (PA) and television viewing (TV) on the risk of overweight in US youth ages 14-18 years. RESEARCH DESIGN AND METHODS: Cross-sectional data from a nationally representative sample of approximately 13,600 US high school students participating in the 2001 Centers for Disease Control and Prevention Youth Risk Behavior Survey (YRBS) were examined. Participants were cross-tabulated into nine PA-TV groups according to the level of moderate (MPA) or vigorous PA (VPA) (low: < or = 2 days per week; moderate: 3-5 days per week; high: 6-7 days per week) and TV (low: < or = 1 h per day; moderate: 2-3 h per day; high: > or = 4 h per day). The referent group was the low TV/high PA group. The body mass index was used to determine overweight and obesity based on the International Obesity Task Force reference values. Logistic regression was used to examine the influence of TV and PA on the odds of overweight in boys and girls, while controlling for age and ethnicity. RESULTS: Boys and girls watching low levels of TV did not have increased odds of overweight regardless of PA level with the exception of girls with low TV/low VPA (odds ratio (OR)=1.48). Girls who watched moderate and high levels of TV had increased odds of overweight at any level of MPA or VPA (OR 1.24-3.11). In girls, the odds of overweight increased in a graded manner across PA levels for both the moderate and high levels of TV. Girls with high TV/low VPA had the highest odds of overweight (OR=3.11). In general, most of the associations were stronger in girls compared to boys. CONCLUSION: The results highlight the importance of considering both PA and TV as risk factors for overweight in adolescents.

The influence of significant others on attitudes, subjective norms and intentions regarding dietary supplement use among adolescent athletes.

Dietary supplement use has increased significantly over the past decade. The use of supplements among adolescents seems to be influenced by their beliefs and attitudes. The influence of coaches, parents, and athletic trainers also may be important. The purpose of this study was (1) to determine whether attitudes are a better predictor of adolescents' intentions to use dietary supplements than are subjective norms, and (2) to assess the influence of significant others (coaches, parents, and trainers) on attitudes, subjective norms, and intentions among adolescent athletes. Adolescents (N = 1,626) who were enrolled in grades six through twelve in nine public schools completed a self-report questionnaire that measured attitudes, subjective norms, and intentions regarding dietary supplement use. Results indicated that attitudes were a better predictor of intentions to use dietary supplements than were subjective norms. It was also found that trainers had more influence on the attitudes, subjective norms, and intentions of adolescents regarding supplement use than did parents and coaches. Implications for prevention are addressed.