Response to Transdermal Selegiline Smoking Cessation Therapy and Markers in the 15q24 Chromosomal Region.

INTRODUCTION: Current treatments for smoking cessation have limited efficacy. A potential pharmaceutical treatment for smoking cessation is selegiline, a selective and irreversible monoamine oxidase B inhibitor. A few clinical trials have been carried out using selegiline but the results have been mixed. We sought to determine if genetic markers in cholinergic loci in the 15q24 chromosomal region predict response to smoking cessation therapy with selegiline. METHODS: We performed an 8-week double-blind, placebo-controlled clinical trial of the selegiline transdermal system in heavy smokers, with follow-up at weeks 25 and 52. Eight single nucleotide polymorphisms (SNPs) in the 15q24 region, which contains the genes for the nicotinic acetylcholine receptor subunits CHRNA5, CHRNA3, and CHRNB4, were investigated for association with treatment response. RESULTS: The CHRNB4 promoter SNP rs3813567 was associated with both point prevalence abstinence and post-quit craving. Carriers of the minor C allele treated with selegiline showed lower rates of abstinence and higher levels of craving than selegiline-treated non-carriers, indicating that the rs3813567 C allele adversely affects abstinence in selegiline-treated smokers. This effect was not present among placebo-treated smokers. Selegiline-treated smokers with the CHRNA5 rs680244 GG genotype had lower post-quit craving, and unlike placebo-treated GG-carrying smokers, did not experience a post-quit increase in depressive symptoms. CONCLUSIONS: Variants in genes encoding cholinergic receptors affect abstinence, craving and mood in selegiline-treated smokers. Selegiline primarily affects dopamine levels in the brain, but cholinergic input affects nicotine-induced dopaminergic activity. These markers may have value in identifying those likely to respond to selegiline for smoking cessation.

A randomized clinical trial of the efficacy of extended smoking cessation treatment for adolescent smokers.

INTRODUCTION: Relatively few well-designed smoking cessation studies have been conducted with teen smokers. This study examined the efficacy of extended cognitive-behavioral treatment in promoting longer term smoking cessation among adolescents. METHODS: Open-label smoking cessation treatment consisted of 10 weeks of school-based, cognitive-behavioral group counseling along with 9 weeks of nicotine replacement (nicotine patch). A total of 141 adolescent smokers in continuation high schools in the San Francisco Bay Area were randomized to either 9 additional group sessions over a 14-week period (extended group) or 4 monthly smoking status calls (nonextended group). Intention-to-treat logistic regression analysis was used to assess the primary outcome of biologically confirmed (carbon monoxide < 9 ppm) point prevalence abstinence at Week 26 (6-month follow-up from baseline). RESULTS: At Week 26 follow-up, the extended treatment group had a significantly higher abstinence rate (21%) than the nonextended treatment (7%; OR = 4.24, 95% CI: 1.20-15.02). Females also were more likely to be abstinent at the follow-up than males (OR = 4.15, 95% CI: 1.17-14.71). CONCLUSIONS: The significantly higher abstinence rate at follow-up for the extended treatment group provides strong support for continued development of longer term interventions for adolescent smoking cessation.

Predicting successful 24-hr quit attempt in a smoking cessation intervention.

INTRODUCTION: The factors that influence the initial phase of quitting smoking have been understudied. Although maintenance of change is the ultimate test of the efficacy of treatment, maintenance is a nonissue for those who fail to manage even brief periods of abstinence. We examined factors associated with smokers' ability to achieve a targeted 24-hr quit during a smoking cessation program. As a comparison, we also examine whether predictors of an initial quit are different from factors that predict smoking abstinence at 52-week follow-up. METHODS: Using baseline data from a randomized clinical trial to examine the efficacy of selegiline for cigarette smoking cessation (n = 280), we conducted univariate analyses (analysis of variance or chi-square) to determine statistically significant predictors of a successful quit attempt (SQA) versus unsuccessful quit attempt. Multiple logistic regression was performed with significant predictors from the univariate analyses to determine main effects and interactions in a multivariate model. The same factors and analyses were used to examine predictors of 52-week point prevalence abstinence. RESULTS: Lower nicotine dependence (modified Fagerström Tolerance Questionnaire [mFTQ]), higher Behavioral Inhibition System score, and lower baseline heart rate were predictive of SQA in both the univariate and the multivariate models. Gender was the only predictor of 52-week smoking abstinence. CONCLUSIONS: Predictors of initial induction of change were not predictors of abstinence at the 1-year follow-up, suggesting that different factors mediate the different subprocesses of behavior change. Knowledge of these pretreatment factors that moderate a SQA could help clinicians target smokers who need more intensive therapy during the initial induction of cessation.

Markers in the 15q24 nicotinic receptor subunit gene cluster (CHRNA5-A3-B4) predict severity of nicotine addiction and response to smoking cessation therapy.

Stopping smoking is difficult even with treatment. Many patients prescribed pharmacologic treatments for smoking cessation experience side effects or lack of efficacy. We performed a pharmacogenetic study of the efficacy and tolerability of bupropion and transdermal nicotine (TN), two treatments for smoking cessation. Samples were drawn from two studies. In the first study (Maintenance 1, MT1), 301 smokers received bupropion plus TN for 11 weeks, followed by 14 weeks of placebo or bupropion. In the second study (MT2), 276 smokers received bupropion and TN for 8 weeks. We focused on eight SNPs in the 15q24 region, which contains the genes for the nicotinic cholinergic receptor subunits CHRNA5, CHRNA3, and CHRNB4, and has previously been implicated in nicotine addiction and smoking cessation. Analyses of baseline smoking quantity (SQ) identified an association between SQ and both the functional CHRNA5 SNP rs16969968 (D398N) and the CHRNA3 SNP rs1051730 (Y215Y) in a combined cohort containing MT1 and MT2. An association between SQ and ethnicity was also identified in the combined cohort. Pharmacogenetic analysis showed a significant association between rs8192475 (R37H) in CHRNA3 and both higher craving after quitting and increased withdrawal symptoms over time in MT2. Two markers for point prevalence abstinence, CHRNA5 SNP rs680244 and CHRNB4 SNP rs12914008, were also identified in MT2, with the strongest findings at week 52. These results provide further support for the role of the CHRNA5/A3/B4 subunits in determining number of cigarettes smoked and response to smoking cessation therapy.

Extended cognitive behavior therapy for cigarette smoking cessation.

UNLABELLED: PRIMARY AIM: Examine the effectiveness of extended cognitive behavior therapy (CBT) in promoting longer-term smoking abstinence. DESIGN: Open-label treatment phase followed by extended treatment phase. Randomization conducted prior to entry into open-label treatment phase; analysis based on intention-to-treat to avoid threat of selection bias. SETTING: Community smoking cessation clinic. PARTICIPANTS: A total of 304 adult smokers (> or = 18 years of age; > or = 10 cigarettes/day). INTERVENTION: Open-label (8 weeks): all participants received bupropion SR, nicotine patch, CBT. Extended treatment (12 weeks): participants received either CBT + voicemail monitoring and telephone counseling or telephone-based general support. MEASUREMENTS: Seven-day point prevalence abstinence, expired-air carbon monoxide. RESULTS: At week 20 follow-up, CBT produced a higher 7-day point prevalence abstinence rate: 45% versus 29%, P = 0.006; at 52 weeks the difference in abstinence rates (31% versus 27%) was not significant. History of depression was a moderator of treatment. Those with a positive history had a better treatment response at 20 weeks when assigned to the less intensive telephone support therapy (P < 0.05). CONCLUSION: The superiority of CBT to 20 weeks suggests that continued emphasis on the development of cognitive and behavioral strategies for maintaining non-smoking during an extended treatment phase may help smokers to maintain abstinence in the longer term. At present, the minimum duration of therapy is unknown.

Stanford GEMS phase 2 obesity prevention trial for low-income African-American girls: design and sample baseline characteristics.

OBJECTIVE: African-American girls and women are at high risk of obesity and its associated morbidities. Few studies have tested obesity prevention strategies specifically designed for African-American girls. This report describes the design and baseline findings of the Stanford GEMS (Girls health Enrichment Multi-site Studies) trial to test the effect of a two-year community- and family-based intervention to reduce weight gain in low-income, pre-adolescent African-American girls. DESIGN: Randomized controlled trial with measurements scheduled in girls' homes at baseline, 6, 12, 18 and 24 month post-randomization. SETTING: Low-income areas of Oakland, CA. PARTICIPANTS: Eight, nine and ten year old African-American girls and their parents/caregivers. INTERVENTIONS: Girls are randomized to a culturally-tailored after-school dance program and a home/family-based intervention to reduce screen media use versus an information-based community health education Active-Placebo Comparison intervention. Interventions last for 2 years for each participant. MAIN OUTCOME MEASURE: Change in body mass index over the two-year study. RESULTS: Recruitment and enrollment successfully produced a predominately low-socioeconomic status sample. Two-hundred sixty one (261) families were randomized. One girl per family is randomly chosen for the analysis sample. Randomization produced comparable experimental groups with only a few statistically significant differences. The sample had a mean body mass index (BMI) at the 74 th percentile on the 2000 CDC BMI reference, and one-third of the analysis sample had a BMI at the 95th percentile or above. Average fasting total cholesterol and LDL cholesterol were above NCEP thresholds for borderline high classifications. Girls averaged low levels of moderate to vigorous physical activity, more than 3 h per day of screen media use, and diets high in energy from fat. CONCLUSIONS: The Stanford GEMS trial is testing the benefits of culturally-tailored after-school dance and screen-time reduction interventions for obesity prevention in low-income, pre-adolescent African-American girls.

Extended treatment for cigarette smoking cessation: a randomized control trial.

AIM: To test the potential benefit of extending cognitive-behavioral therapy (CBT) relative to not extending CBT on long-term abstinence from smoking. DESIGN: Two-group parallel randomized controlled trial. Patients were randomized to receive non-extended CBT (n = 111) or extended CBT (n = 112) following a 26-week open-label treatment. SETTING: Community clinic in the United States. PARTICIPANTS: A total of 219 smokers (mean age: 43 years; mean cigarettes/day: 18). INTERVENTION: All participants received 10 weeks of combined CBT + bupropion sustained release (bupropion SR) + nicotine patch and were continued on CBT and either no medications if abstinent, continued bupropion + nicotine replacement therapy (NRT) if increased craving or depression scores, or varenicline if still smoking at 10 weeks. Half the participants were randomized at 26 weeks to extended CBT (E-CBT) to week 48 and half to non-extended CBT (no additional CBT sessions). MEASUREMENTS: The primary outcome was expired CO-confirmed, 7-day point-prevalence (PP) at 52- and 104-week follow-up. Analyses were based on intention-to-treat. FINDINGS: PP abstinence rates at the 52-week follow-up were comparable across non-extended CBT (40%) and E-CBT (39%) groups [odds ratio (OR) = 0.99; 95% confidence interval (CI) = 0.55, 1.78]. A similar pattern was observed across non-extended CBT (39%) and E-CBT (33%) groups at the 104-week follow-up (OR = 0.79; 95% CI= 0.44, 1.40). CONCLUSION: Prolonging cognitive-behavioral therapy from 26 to 48 weeks does not appear to improve long-term abstinence from smoking.

Extended treatment with bupropion SR for cigarette smoking cessation.

The authors present results of a randomized clinical trial of the efficacy of extended treatment with bupropion SR in producing longer term cigarette smoking cessation. Adult smokers (N = 362) received open-label treatment (11 weeks) that combined relapse prevention training, bupropion SR, and nicotine patch followed by extended treatment (14 weeks) with bupropion SR or matching placebo. Abstinence percentages were relatively high (week 11: 52%; week 25: bupropion, 42%; placebo, 38%; week 52: bupropion, 33%; placebo, 34%), but bupropion SR did not surpass placebo. Gender and baseline craving level were identified as significant, independent moderators of treatment response. Men were more likely to abstain than women (week 11: 59% vs. 43%, p = .001; week 25: 48% vs. 31%, p = .001; week 52: 39% vs. 27%, p = .01). Because most smokers suffer relapse with any current cessation treatment, the comparatively high abstinence percentages achieved in this trial are of interest.

Do Mexican-American mothers' food-related parenting practices influence their children's weight and dietary intake?

Food-related parenting attitudes are thought to influence children's dietary intake and weight. The objective of this study was to examine the associations between mothers' reports of food-related parenting and children's dietary intake and body mass index (BMI). A sample of 108 Mexican-American fifth-grade children and their mothers were surveyed. Children's height, weight, and three 24-hour dietary recalls were collected. Mothers reported household food insecurity status and food-related parenting attitudes. Correlational analyses were calculated among dietary intake variables, children's BMI percentiles, and food-parenting behaviors. Mothers' pressure on their children to eat was inversely correlated with children's BMI. In food-insecure families, attitudes toward making healthful foods available were inversely associated with children's daily energy intake and BMI. In contrast, in food-secure families, attitudes about making healthful foods available were positively associated with children's fruit intake and percentage energy from fat, and parental modeling of healthful food behaviors was inversely associated with the energy density. In our sample of Mexican-American families, mothers' food-related parenting was associated with their children's weight and dietary intake. These associations differed in food-secure and food-insecure households. Overall, pressure to eat was highly associated with children's weight, but the temporal nature of these relationships cannot be discerned.

Retrospective analysis of changing characteristics of treatment-seeking smokers: implications for further reducing smoking prevalence.

OBJECTIVE: The goal of the current study was to empirically compare successive cohorts of treatment-seeking smokers who enrolled in randomised clinical trials in a region of the USA characterised by strong tobacco control policies and low smoking prevalence, over the past three decades. DESIGN: Retrospective treatment cohort comparison. SETTING: Data were collected from 9 randomised clinical trials conducted at Stanford University and the University of California, San Francisco, between 1990 and 2013. PARTICIPANTS: Data from a total of 2083 participants were included (Stanford, n=1356; University of California San Francisco, n=727). PRIMARY AND SECONDARY OUTCOMES: One-way analysis of variance and covariance, χ(2) and logistic regression analyses were used to examine relations between nicotine dependence, cigarettes per day, depressive symptoms and demographic characteristics among study cohorts. RESULTS: Similar trends were observed at both settings. When compared to earlier trials, participants in more recent trials smoked fewer cigarettes, were less nicotine-dependent, reported more depressive symptoms, were more likely to be male and more likely to be from a minority ethnic/racial group, than those enrolled in initial trials (all p's<0.05). Analysis of covariances revealed that cigarettes per day, nicotine dependence and current depressive symptom scores were each significantly related to trial (all p's<0.001). CONCLUSIONS: Our findings suggest that more recent smoking cessation treatment-seeking cohorts in a low prevalence region were characterised by less smoking severity, more severe symptoms of depression and were more likely to be male and from a minority racial/ethnic group.

Household food security and nutritional status of Hispanic children in the fifth grade.

BACKGROUND: Food insecurity is a critical variable for understanding the nutritional status of low-income populations. However, limited research is available on the relation between household food insecurity and children's nutritional status. OBJECTIVE: Our objective was to examine the relations among household food insecurity, household food supplies, and school-age children's dietary intakes and body mass indexes (BMIs). DESIGN: A sample of 124 predominantly Hispanic, fifth-grade children and their mothers were surveyed as part of a school-based obesity-prevention program. Data on the children's weights and heights were collected and three 24-h dietary recalls were conducted. The mothers provided reports of household food insecurity and household food supplies. RESULTS: Food insecurity was negatively associated with the children's BMIs and household food supplies but not with the children's food intakes. However, a secondary analysis showed that as payday approached, children from the most food-insecure households had significant decreases in energy intakes and meat consumption. CONCLUSIONS: This is one of the first studies to report a significant association between food insecurity and children's nutritional status. The ages and sex-adjusted BMIs of the food-insecure children were lower than those of the food-secure children but were still within the normal range. The lower BMIs in the food-insecure children may have been due to short-term, yet periodic food restrictions that resulted as household food supplies diminished before payday. Future research is needed to assess the physiologic and psychological effects of periodic food restriction on children's health.

Children's food consumption during television viewing.

BACKGROUND: Television viewing is associated with childhood obesity. Eating during viewing and eating highly advertised foods are 2 of the hypothesized mechanisms through which television is thought to affect children's weight. OBJECTIVES: Our objectives were to describe the amounts and types of foods that children consume while watching television, compare those types with the types consumed at other times of the day, and examine the associations between children's body mass index (BMI) and the amounts and types of foods consumed during television viewing. DESIGN: Data were collected from 2 samples. The first sample consisted of ethnically diverse third-grade children, and the second consisted predominantly of Latino fifth-grade children. Three nonconsecutive 24-h dietary recalls were collected from each child. For each eating episode reported, children were asked whether they had been watching television. Height and weight were measured by using standard methods and were used to calculate BMI. RESULTS: On weekdays and weekend days, 17-18% and approximately 26% of total daily energy, respectively, were consumed during television viewing in the 2 samples. Although the fat content of the foods consumed during television viewing did not differ significantly from that of the foods consumed with the television off, less soda, fast food, fruit, and vegetables were consumed with the television on. The amount of food consumed during television viewing was not associated with children's BMI, but in the third-grade sample, the fat content of foods consumed during television viewing was associated with BMI. CONCLUSIONS: A significant proportion of children's daily energy intake is consumed during television viewing, and the consumption of high-fat foods on weekends may be associated with BMI in younger children.

Effects of an advocacy intervention to reduce smoking among teenagers.

OBJECTIVES: To test whether high school students' participation in advocacy activities related to the advertising, availability, and use of tobacco in their communities would prevent or reduce their own tobacco use. DESIGN: Ten continuation high schools in northern California, randomly assigned to a semester-long program in which students either carried out advocacy activities to counter environmental-level smoking influences in their communities (treatment) or learned about drug and alcohol abuse prevention (control). PARTICIPANTS: Eleventh and 12th grade high school students; 5 (advocacy) treatment and 5 control schools over 4 semesters from 2000 through 2002. MAIN OUTCOME MEASURES: Self-reported smoking defined as nonsmokers (those who had never smoked tobacco or those who were former smokers), light smokers (those who smoked <1 pack per week), or regular smokers (those who smoked >or=1 pack per week), and confirmed by carbon monoxide level readings. The following 3 constructs related to social cognitive theory- perceived incentive value, perceived self-efficacy, and outcome expectancies-were assessed. RESULTS: There was a significant net change from baseline to the end of the semester (after the intervention) between treatment and control schools for students who were regular smokers, but not for students who were nonsmokers or light smokers. Regular smoking decreased 3.8% in treatment schools and increased 1.5% in control schools (P<.001). Regular smoking continued to decrease at 6 months after the intervention in treatment schools, with a total change in prevalence from 25.1% to 20.3%. Involvement in community-advocacy activities and the 3 social constructs-perceived incentive value, perceived self-efficacy, and outcome expectancies-also showed significant net changes between treatment and control schools (all P values <.01). CONCLUSION: Student engagement in community-advocacy activities that addressed environmental influences of cigarette smoking resulted in significant decreases in regular smoking.

Parent-reported predictors of adolescent panic attacks.

OBJECTIVE: To identify parent-reported risk factors for adolescent panic attacks. METHOD: Structured diagnostic interviews were obtained from 770 parents of participants in a school-based risk factor study for adolescent panic. Parent-reported risk factors assessed included characteristics of the child (negative affect, separation anxiety disorder [SAD], childhood chronic illness, and childhood loss) as well as characteristics of the parent (parental panic disorder or agoraphobia [PDA], parental major depression, and parental chronic illness). RESULTS: Bivariate predictors of adolescent panic attacks included parent history of PDA, parent history of chronic illness, child negative affect, and child SAD. Using signal detection methods, three subgroups of participants at risk for panic attacks were identified. Fifty-eight percent of adolescents with panic attacks belonged to one of these high-risk groups. Adolescents with a positive parental history of PDA were at highest risk: 24% of this group experienced panic attacks. Among those without a positive parental history of PDA, those with high childhood negative affect or history of SAD were at increased risk for panic attacks (14% and 20%, respectively). CONCLUSIONS: The use of parent-reported data provides cross-validation for previously identified risk factors of adolescent panic attacks. Signal detection results suggest there are multiple paths (equifinality) to the development of adolescent panic attacks.

Randomized clinical trial of the efficacy of bupropion combined with nicotine patch in the treatment of adolescent smokers.

Adolescent smokers (N = 211) were randomized to 1 of 2 groups: (a) nicotine patch plus bupropion SR (sustained release; 150 mg per day) or (b) nicotine patch plus placebo. Group skills training sessions were conducted each week by research staff. Abstinence rates at Weeks 10 and 26 were as follows: (a) patch plus bupropion, 23% and 8%, (b) patch plus placebo, 28% and 7%. Despite the lack of a treatment effect, a large majority of adolescents in both treatment groups reduced their consumption to a few cigarettes per day or less and maintained this reduction over time. Similarly, an examination of survival curves revealed that by the end of treatment many had managed to avoid a return to daily smoking. These findings are encouraging and suggest new avenues for research. For example, treatments of the kind examined in this report, augmented by extended maintenance therapies, may yield higher long-term success rates.

Do men outperform women in smoking cessation trials? Maybe, but not by much.

Using data from 4 smoking cessation trials conducted from 1988 to 2000, the authors investigated whether men are more successful than women in quitting smoking. Odds ratios indicated that the abstinence rates were not significantly different for men and women. Thus, there may be little value to diverting research funds from efforts to develop more effective treatments for both men and women to efforts to explain a very small gender effect associated with existing treatments. However, it may be appropriate to make gender comparisons for new therapies for nicotine dependence. The authors recommend against analyses of gender differences in studies that do not account for gender in their research designs.

Associations among familism, language preference, and education in Mexican-American mothers and their children.

Latino families who express a higher degree of familism are characterized by positive interpersonal familial relationships, high family unity, social support, interdependence in the completion of daily activities, and close proximity with extended family members. Retention of cultural values, such as familism, may be linked to positive health outcomes; however, little is known about how families retain culture of origin values in the face of acculturation pressures. The current study explores acculturation influences as indexed by language preference and household education on maternal and child familism. Mothers and children of Mexican descent (fourth grade students) (n = 219) completed measures of demographics, household education, language preference, and familism. Three hypotheses were examined. First, we predicted that lower household education would be correlated with higher familism scores. However, contrary to our prediction, a higher familism score was significantly associated with a higher level of household education (p <.05). Second, we predicted that higher child familism would be associated with the preference for speaking Spanish. Children who preferred to use both English and Spanish (p <.01) or English alone (p <.05) had higher familism scores than those who preferred Spanish. Third, we predicted that lower child familism scores would be associated with greater differences in mother and child language preferences. There were no significant differences in child familism based on differences between parent and child language. Protective influences of cultural maintenance deserve further attention in longitudinal studies and in relation to the physical and mental health of youth.

Onset of major depression during treatment for nicotine dependence.

We monitored the emergence of major depression (MDD) during treatment for nicotine dependence among 224 smokers. MDD was assessed on three occasions during the course of treatment with the mood disorders portion of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (SCID), fourth edition (DSM-IV). Out of 224 participants, 20% had suffered a past episode of MDD, 18% of males and 22% of females. Four percent (n=10) experienced onset of MDD during the course of the study, four males and six females. Only 2 of the 10 cases managed to achieve abstinence at end of treatment. Those who reported large increases in depression symptoms between baseline and end of treatment (Week 10) were less likely to be abstinent at 26-week follow-up. The evidence indicates that those who treat nicotine dependence must be prepared to monitor and respond to the emergence of depression associated with treatment.

Major depression among adolescent smokers undergoing treatment for nicotine dependence.

This is the first study to examine the prevalence and effects of major depression (MDD) in a sample of adolescent smokers (N = 211) undergoing treatment for nicotine dependence. We assessed MDD at baseline and end of treatment with the mood disorders portion of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). Eleven percent of participants reported a history of MDD (6% of males and 21% of females). Study variables did not distinguish those with and without a history of MDD. End of treatment abstinence rates and relapse rates were similar in both groups. Two participants (1%), both female, experienced onset of MDD during the treatment. The findings provide further evidence that MDD is a comparatively common disorder among children and adolescents and that clinicians should monitor and be prepared to respond to depression that may emerge during the treatment of nicotine-dependent adolescents.

Dance and reducing television viewing to prevent weight gain in African-American girls: the Stanford GEMS pilot study.

OBJECTIVE: To test the feasibility, acceptability, and potential efficacy of after-school dance classes and a family-based intervention to reduce television viewing, thereby reducing weight gain, among African-American girls. DESIGN: Twelve-week, 2-arm parallel group, randomized controlled trial. SETTING: Low-income neighborhoods. PARTICIPANTS: Sixty-one 8-10-year-old African-American girls and their parents/guardians. INTERVENTIONS: The treatment intervention consisted of after-school dance classes at 3 community centers, and a 5-lesson intervention, delivered in participants' homes, and designed to reduce television, videotape, and video game use. The active control intervention consisted of disseminating newsletters and delivering health education lectures. MAIN OUTCOME MEASURES: Implementation and process measures, body mass index, waist circumference, physical activity measured by accelerometry, self-reported media use, and meals eaten with TV. RESULTS: Recruitment and retention goals were exceeded. High rates of participation were achieved for assessments and intervention activities, except where transportation was lacking. All interventions received high satisfaction ratings. At follow up, girls in the treatment group, as compared to the control group, exhibited trends toward lower body mass index (adjusted difference = -.32 kg/m2, 95% confidence interval [CI] -.77, .12; Cohen's d = .38 standard deviation units) and waist circumference (adjusted difference = -.63 cm, 95% CI -1.92, .67; d = .25); increased after-school physical activity (adjusted difference = 55.1 counts/minute, 95% CI -115.6, 225.8; d = .21); and reduced television, videotape, and video game use (adjusted difference = -4.96 hours/week, 95% CI -11.41, 1.49; d = .40). The treatment group reported significantly reduced household television viewing (d = .73, P = .007) and fewer dinners eaten while watching TV (adjusted difference = -1.60 meals/week, 95% CI -2.99, -.21; d = .59; P = .03). Treatment group girls also reported less concern about weight (d = .60; P = .03), and a trend toward improved school grades (d = .51; P = .07). CONCLUSIONS: This study confirmed the feasibility, acceptability, and potential efficacy of using dance classes and a family-based intervention to reduce television viewing, thereby reducing weight gain, in African-American girls.