Compounding effects of stress on diet, physical activity, and wellbeing among African American parents: a qualitative study to inform the LEADS health promotion trial.

The purpose of the study was to conduct in-depth qualitative interviews to understand the lived experiences of African American parents of overweight adolescents who had previously participated in a family-based weight loss program and to utilize these insights to inform the essential elements of the LEADS trial, an integrated resilience stress management and health promotion intervention. Participants (N = 30) were African American parents and/or caregivers (96.7% female; Mage = 49.73, SD = 10.88; MBMI = 37.63, SD = 8.21) of adolescents with overweight and/or obesity. Interviews were transcribed and coded using inductive and deductive approaches for themes by two independent coders. Inter-rater reliability was acceptable (r = 0.70-0.80) and discrepancies were resolved to 100% agreement. Prominent stress themes included caregiver responsibilities, work, interpersonal family conflict, and physical and emotional consequences of chronic stress. Participants also noted decreases in physical activity and poor food choices due to stress. Coping mechanisms included prayer/meditation, church social support, and talking with family/partner. Results highlight the importance of mitigating stress among African American parents through stress management and cultural/familial resilience approaches to increase the likelihood of engagement in behavioral strategies in health promotion programs. Future studies should assess the utility of incorporating stress management components and health promotion techniques to improve health outcomes among African American families.

The Results of the Families Improving Together (FIT) for Weight Loss Randomized Trial in Overweight African American Adolescents.

BACKGROUND: Few intervention studies have integrated cultural tailoring, parenting, behavioral, and motivational strategies to address African American adolescent weight loss. PURPOSE: The Families Improving Together (FIT) for Weight Loss trial was a randomized group cohort study testing the efficacy of a cultural tailoring, positive parenting, and motivational intervention for weight loss in overweight African American adolescents (N = 241 adolescent/caregiver dyads). METHODS: The trial tested an 8-week face-to-face group motivational plus family weight loss program (M + FWL) compared with a comprehensive health education control program. Participants were then rerandomized to an 8-week tailored or control online program to test the added effects of the online intervention on reducing body mass index and improving physical activity (moderate-to-vigorous physical activity [MVPA], light physical activity [LPA]), and diet. RESULTS: There were no significant intervention effects for body mass index or diet. There was a significant effect of the group M + FWL intervention on parent LPA at 16 weeks (B = 33.017, SE = 13.115, p = .012). Parents in the group M + FWL intervention showed an increase in LPA, whereas parents in the comprehensive health education group showed a decrease in LPA. Secondary analyses using complier average causal effects showed a significant intervention effect at 16 weeks for parents on MVPA and a similar trend for adolescents. CONCLUSIONS: While the intervention showed some impact on physical activity, additional strategies are needed to impact weight loss among overweight African American adolescents.

Effects of Parenting and Perceived Stress on BMI in African American Adolescents.

OBJECTIVE: This study set out to examine the role of parenting practices in protecting or exacerbating the negative effects of parent and adolescent stress on adolescent body mass index (BMI) over time. Separate longitudinal models were conducted to evaluate how parenting practices interacted with parental perceived stress and adolescent perceived stress in predicting adolescent BMI. METHODS: Baseline data were collected from 148 African American adolescents (Mage = 12.93, SD = 1.75; Mz-BMI = 0.78, SD = 0.50; MBMI%-ile = 96.7, SD = 3.90) and their caregivers (Mage = 44.45, SD = 8.65; MBMI = 37.63, SD = 8.21) enrolled in the Families Improving Together for Weight Loss trial. Adolescents self-reported their perceptions of caregiver parenting style and feeding practices. Both caregivers and adolescents self-reported their perceptions of chronic stress. BMI for parents and adolescents was assessed objectively at baseline and 16 weeks post-intervention. RESULTS: Hierarchical regression models predicting adolescent BMI z-score (z-BMI) indicated a significant interaction between parental perceived stress and parental pressure to eat. Simple slopes analyses demonstrated that for those parents that exhibit higher pressure to eat, parent stress was positively associated with adolescent z-BMI. CONCLUSIONS: These findings provide preliminary support suggesting that certain parenting practices interact with chronic stress on adolescent weight-related outcomes and that future interventions may consider integrating these factors.

Who declines to respond to the reactions to race module?: findings from the South Carolina Behavioral Risk Factor Surveillance System, 2016-2017.

BACKGROUND: The inclusion of self-reported differential treatment by race/ethnicity in population-based public health surveillance and monitoring systems may provide an opportunity to address long-standing health inequalities. While there is a growing trend towards decreasing response rates and selective non-response in health surveys, research examining the magnitude of non-response related to self-reported discrimination warrants greater attention. This study examined the distribution of sociodemographic variables among respondents and non-respondents to the South Carolina Behavioral Risk Factor Surveillance System (SC-BRFSS) Reactions to Race module (6-question optional module capturing reports of race-based treatment). METHODS: Using data from SC-BRFSS (2016, 2017), we examined patterns of non-response to the Reactions to Race module and individual items in the module. Logistic regression models were employed to examine sociodemographic factors associated with non-response and weighted to account for complex sampling design. RESULTS: Among 21,847 respondents, 15.3% were non-responders. Significant differences in RTRM non-response were observed by key sociodemographic variables (e.g., age, race/ethnicity, labor market participation, and health insurance status). Individuals who were younger, Hispanic, homemakers/students, unreported income, and uninsured were over-represented among non-respondents. In adjusted analyses, Hispanics and individuals with unreported income were more likely to be non-responders in RTRM and across item, while retirees were less likely to be non-responders. Heterogeneity in levels of non-responses were observed across RTRM questions, with the highest level of non-response for questions assessing differential treatment in work (54.8%) and healthcare settings (26.9%). CONCLUSIONS: Non-responders differed from responders according to some key sociodemographic variables, which could contribute to the underestimation of self-reported discrimination and race-related differential treatment and health outcomes. While we advocate for the use of population-based measures of self-reported racial discrimination to monitor and track state-level progress towards health equity, future efforts to estimate, assess, and address non-response variations by sociodemographic factors are warranted to improve understanding of lived experiences impacted by race-based differential treatment.

Moderating the Effects of Adverse Childhood Experiences to Address Inequities in Tobacco-Related Risk Behaviors.

Adverse childhood experiences (ACEs) can increase the risk of engagement in unhealthy behaviors including tobacco use. Protective factors, such as safe, stable, and nurturing relationships (SSNRs) can potentially moderate the long-term impact of ACEs by helping children build resilience. However, there is limited research on whether the impact of these factors is stronger among Black children and families, who face disproportionately poorer health outcomes compared to their White counterparts. This study examined the relationships among protective factors in childhood, ACEs (one or more vs. none), and tobacco use (smoking tobacco, e-cigarette use) in adulthood, including whether these relationships differed by race. Data were obtained from the 2016 South Carolina administration of the Behavioral Risk Factor Surveillance System (n = 7,014). Using stratified, multivariate logistic regression, the presence of an SSNR in childhood (whether participants' basic needs were met and whether they felt safe and protected during childhood) was assessed as a potential moderator of the association between ACEs (one or more vs. none) and smoking tobacco or e-cigarettes stratified by race (Black and White). Control variables included sex, age, educational attainment, and income. Statistically significant moderating effects of an SSNR was present for White adults only: The relationship between ACEs and risk behaviors was weakened when an SSNR was present in childhood. Although SSNRs appear to prevent some risk behavior consequences from ACEs among some groups, additional research is needed to understand their potential utility across population subgroups.

The Moderating Effects of the Families Improving Together (FIT) for Weight Loss Intervention and Parenting Factors on Family Mealtime in Overweight and Obese African American Adolescents.

Few studies have integrated positive parenting and motivational strategies to address dietary outcomes such as frequency of family mealtime. The Families Improving Together (FIT) for Weight Loss trial was a randomized group cohort trial (n = 241 dyads) testing the efficacy of integrating a motivational plus family weight loss (M + FWL) intervention for healthy eating and weight loss in overweight and obese African American adolescents. The current study tested the interaction of parenting styles (responsiveness, demandingness) and parental feeding practices (restriction, concern about child's weight, pressure to eat) and the FIT intervention on frequency of family mealtime over 16 weeks. Multilevel modeling demonstrated significant interactions between the group-based treatment and responsiveness (p = 0.018) and demandingness (p = 0.010) on family mealtime. For the group-based M + FWL intervention, increased responsiveness and reduced demandingness were associated with increased frequency of family mealtime from baseline to 16 weeks. There was also a negative association between parental restriction and frequency of family mealtime, but a positive association between parental concerns about their adolescent's weight and frequency of mealtime. These findings are the first to demonstrate that an authoritative or nurturing parenting style moderated intervention effects for improving the frequency of family mealtime in overweight and obese African American adolescents.

A Qualitative Study of Stress and Coping to Inform the LEADS Health Promotion Trial for African American Adolescents with Overweight and Obesity.

The purpose of this study was to conduct in-depth individual interviews with 30 African American adolescents with overweight and obesity and their families (caregiver/adolescent dyads) to gain a better understanding of how to integrate stress and coping essential elements into an existing family-based health promotion program for weight loss. Interview data from 30 African American adolescents with overweight and obesity (Mage = 15.30 ± 2.18; MBMI%-ile = 96.7 ± 3.90) were transcribed and coded for themes using inductive and deductive approaches by two independent coders. Inter-rater reliability was acceptable (r = 0.70-0.80) and discrepancies were resolved to 100% agreement. The themes were guided by the Relapse Prevention Model, which focuses on assessing barriers of overall coping capacity in high stress situations that may undermine health behavior change (physical activity, diet, weight loss). Prominent themes included feeling stressed primarily in response to relationship conflicts within the family and among peers, school responsibilities, and negative emotions (anxiety, depression, anger). A mix of themes emerged related to coping strategies ranging from cognitive reframing and distraction to avoidant coping. Recommendations for future programs include addressing sources of stress and providing supportive resources, as well as embracing broader systems such as neighborhoods and communities. Implications for future intervention studies are discussed.

Racial/Ethnic Disparities in Health Care Access Are Associated with Adverse Childhood Experiences.

There is a growing body of research documenting racial/ethnic differences in the relationship between adverse childhood experiences (ACEs) and negative health outcomes in adulthood. However, few studies have examined racial/ethnic differences in the association between ACEs and health care access. Cross-sectional data collected from South Carolina's Behavioral Risk Factor Surveillance System (2014-2016; n = 15,436) was used to examine associations among ACEs, race/ethnicity, and health care access among South Carolina adults. Specifically, logistic regression models were used to estimate the odds ratio (OR) and 95% confidence intervals (CI) for three health care access outcomes: having a personal doctor, routine checkup in the last 2 years, and delay in seeking medical care due to cost. Without adjusting for any covariates, in the overall population, the odds of having no personal doctor, no checkup in the last 2 years, and delay in medical care due to cost was significantly higher among those with at least one ACE, compared with those with no ACEs; and health care access varied by race, with significant relationships detected among Whites and Blacks. Among White adults, the odds of having no checkup in the last 2 years and delay in medical care due to cost was significantly higher among those with at least one ACE, compared with those with no ACEs. Among Black adults, a delay in medical care due to cost was significantly higher among those who reported ACEs compared with their counterparts. The results from this study suggest that ACEs may be an underrecognized barrier to health care for adults. Investing in strategies to mitigate ACEs may help improve health care access among adults.

Families Improving Together (FIT) for weight loss: a resource for translation of a positive climate-based intervention into community settings.

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.