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.

Interaction of Neighborhood and Genetic Risk on Waist Circumference in African-American Adults: A Longitudinal Study.

BACKGROUND: Understanding determinants of metabolic risk has become a national priority given the increasingly high prevalence rate of this condition among U.S. adults. PURPOSE: This study's aim was to assess the impact of gene-by-neighborhood social environment interactions on waist circumference (WC) as a primary marker of metabolic risk in underserved African-American adults. Based on a dual-risk model, it was hypothesized that those with the highest genetic risk and who experienced negative neighborhood environment conditions would demonstrate higher WC than those with fewer risk factors. METHODS: This study utilized a subsample of participants from the Positive Action for Today's Health environmental intervention to improve access and safety for walking in higher-crime neighborhoods, who were willing to provide buccal swab samples for genotyping stress-related genetic pathways. Assessments were conducted with 228 African-American adults at baseline, 12, 18, and 24 months. RESULTS: Analyses indicated three significant gene-by-environment interactions on WC outcomes within the sympathetic nervous system (SNS) genetic pathway. Two interactions supported the dual-risk hypotheses, including the SNS genetic risk-by-neighborhood social life interaction (b = -0.11, t(618) = -2.02, p = .04), and SNS genetic risk-by-informal social control interaction (b = -0.51, t(618) = -1.95, p = .05) on WC outcomes. These interactions indicated that higher genetic risk and lower social-environmental supports were associated with higher WC. There was also one significant SNS genetic risk-by-neighborhood satisfaction interaction (b = 1.48, t(618) = 2.23, p = .02) on WC that was inconsistent with the dual-risk pattern. CONCLUSIONS: Findings indicate that neighborhood and genetic factors dually influence metabolic risk and that these relations may be complex and warrant further study. TRIAL REGISTRATION: NCT01025726.

Describing associations between child maltreatment frequency and the frequency and timing of subsequent delinquent or criminal behaviors across development: variation by sex, sexual orientation, and race.

BACKGROUND: Child maltreatment has been linked to lower health, education, and income later in life, and is associated with increased engagement in delinquent or criminal behaviors. This paper explores trajectories of these behaviors from adolescence into early adulthood and tests maltreatment as a predictor, and whether observed patterns are consistent across different demographic groups. METHODS: Using data from the National Longitudinal Study of Adolescent to Adult Health, a longitudinal study of a nationally representative sample of U.S. adolescents (in grades 7-12 in the 1994-95 school year), we ran linear mixed effects models to estimate growth curves of two dependent variables: violent and nonviolent offending behavior. We tested if maltreatment altered the intercept or slope of the curves and how the curves of these behaviors and the associations between them and maltreatment varied by sex, race/ethnicity, and sexual orientation. RESULTS: The sample (n = 10,613) had equal proportions males and females, approximately one third identified as a race/ethnicity other than white, and over 10% were non-heterosexual. Experiences of maltreatment were highest for Native Americans and lowest for whites. Models indicated that males were more likely than females to engage in both violent and nonviolent offending and respondents who identified as non-heterosexual were more likely than their heterosexual peers to engage in nonviolent offending behavior. When maltreatment was included in models as a predictor, adolescents who experienced maltreatment had a more rapid increase in their non-violent offending behavior. For violent offending behavior, adolescents who experienced maltreatment had higher levels of offending and the levels progressively increased as maltreatment frequency did. Sex was a moderator; the relationship between maltreatment and predicted nonviolent offending was stronger for males than it was for females. Race/ethnicity and sexual orientation did not moderate the associations between maltreatment and offending behavior. CONCLUSIONS: This study provides insights from a nationally representative sample into the pattern of both delinquent and criminal behaviors in adolescence and young adulthood, describing not only how the pattern varies over time, but also by sociodemographics and offending type. Additionally, it highlights how the association between maltreatment and these behaviors varies by both offending type and sex.

Disrupting the link between maltreatment and delinquency: how school, family, and community factors can be protective.

BACKGROUND: Past experiences of childhood maltreatment are common for youth involved in the juvenile justice system. This paper explores potential protective factors at the peer, family, school, and neighborhood levels that disrupt the relationship between maltreatment and later non-violent and violent offending behavior and how these protective effects vary by a number of different sociodemographics. METHODS: We used data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative longitudinal study of adolescents who were in grades 7-12 in the 1994-95 school year. Pulling data from Add Health respondents from ages 13 to 30, we used linear mixed effects modeling to create growth curves of predicted violent and non-violent offending frequency from adolescence into young adulthood, with maltreatment frequency as a predictor. Next, we tested whether potential protective factors including time with friends, a high-quality relationship with a parent figure, school connection, or neighborhood collective efficacy moderated the intercept or slope of the growth curves. Finally, we tested if sex, race/ethnicity, or sexual orientation moderated these protective effects. RESULTS: For violent offending, school connection, high-quality relationships with mother or father figures, and neighborhood collective efficacy were all generally protective, meaning they were associated with lower levels and shallower slopes of predicted violent offending, but they were not more or less protective for those who experienced maltreatment. For non-violent offending, the same was true of school connection, high-quality relationships with a mother figure, and neighborhood collective efficacy, which were all generally protective. We found no evidence of a protective effect for time spent with friends, though this is likely due to measurement constraints, as simply measuring time spent with friends may have heterogeneous effects on delinquent behaviors. We found no evidence that any of these protective effects varied by sociodemographics. CONCLUSIONS: This paper identifies factors that teachers, juvenile corrections officers, policymakers and others can intervene on to prevent engagement (or re-engagement) in delinquency and offending among youth and young adults who experienced maltreatment. As they are also protective for youth who have not experienced maltreatment they also inform general delinquency prevention efforts.

Process Evaluation of the Project SHINE Intervention for African American Families: An Integrated Positive Parenting and Peer Monitoring Approach to Health Promotion.

This study describes the process evaluation of Project SHINE, a randomized family-based health promotion intervention that integrated parenting and peer monitoring for improving sedentary behavior, physical activity, and diet in African American families. Adolescent-parent dyads (n = 89) were randomized to a 6-week behavioral, positive parenting, and peer monitoring skills intervention or a general health education comparison condition. Process evaluation included observational ratings of fidelity, attendance records, psychosocial measures, and qualitative interviews. Results indicated that the intervention was delivered with high fidelity based on facilitator adherence (>98% of content delivered) and competent use of theoretically based behavior change and positive parenting skills (100% of ratings >3 on a 1-4 scale). Although only 43% of peers attended the "bring a friend" session, overall attendance was high (4.39 ± 1.51 sessions) as was the retention rate (88%). Parents in the intervention condition reported significant improvements in communication related to adolescents' engagement in health behaviors both on their own and with peers. These findings were supported by qualitative themes related to improvements in family communication and connectedness. This study provides an innovative example of how future family-based health promotion trials can expand their process evaluation approaches by assessing theoretically relevant positive parenting variables as part of ongoing monitoring.

Neighborhood Social Predictors of Weight-related Measures in Underserved African Americans in the PATH Trial.

African Americans have the highest rate of obesity in the United States relative to other ethnic minority groups. Bioecological factors including neighborhood social and physical environmental variables may be important predictors of weight-related measures specifically body mass index (BMI) in African American adults. Baseline data from the Positive Action for Today's Health (PATH) trial were collected from 417 African American adults. Overall a multiple regression model for BMI was significant, showing positive associations with average daily moderate-to-vigorous physical activity (MVPA) (B =-.21, P<.01) and neighborhood social interaction (B =-.13, P<.01). Consistent with previous literature, results show that neighborhood social interaction was associated with healthier BMI, highlighting it as a potential critical factor for future interventions in underserved, African American communities.

An overview of the Families Improving Together (FIT) for weight loss randomized controlled trial in African American families.

BACKGROUND: The Families Improving Together (FIT) randomized controlled trial tests the efficacy of integrating cultural tailoring, positive parenting, and motivational strategies into a comprehensive curriculum for weight loss in African American adolescents. The overall goal of the FIT trial is to test the effects of an integrated intervention curriculum and the added effects of a tailored web-based intervention on reducing z-BMI in overweight African American adolescents. DESIGN AND SETTING: The FIT trial is a randomized group cohort design the will involve 520 African American families with an overweight adolescent between the ages of 11-16 years. The trial tests the efficacy of an 8-week face-to-face group randomized program comparing M + FWL (Motivational Plus Family Weight Loss) to a comprehensive health education program (CHE) and re-randomizes participants to either an 8-week on-line tailored intervention or control on-line program resulting in a 2 (M + FWL vs. CHE group) × 2 (on-line intervention vs. control on-line program) factorial design to test the effects of the intervention on reducing z-BMI at post-treatment and at 6-month follow-up. INTERVENTION: The interventions for this trial are based on a theoretical framework that is novel and integrates elements from cultural tailoring, Family Systems Theory, Self-Determination Theory and Social Cognitive Theory. The intervention targets positive parenting skills (parenting style, monitoring, communication); cultural values; teaching parents to increase youth motivation by encouraging youth to have input and choice (autonomy-support); and provides a framework for building skills and self-efficacy through developing weight loss action plans that target goal setting, monitoring, and positive feedback.

Development of an innovative process evaluation approach for the Families Improving Together (FIT) for weight loss trial in African American adolescents.

UNLABELLED: This study demonstrates how a multi-theoretical, multilevel process evaluation was used to assess implementation of the Families Improving Together (FIT) for weight loss intervention. FIT is a randomized controlled trial evaluating a culturally tailored, motivational plus family-based program on weight loss in African American adolescents and their parents. Social Cognitive, Self Determination, Family Systems theories and cultural tailoring principles guided the conceptualization of essential elements across individual/family, facilitator, and group levels. Data collection included an observational rating tool, attendance records, and a validated psychosocial measure. RESULTS: Attendance records (0=absent, 1=present, criteria=≥70%) indicated that 71.5% of families attended each session. The survey (1=false, 6=true, criteria=≥4.5) indicated that participants perceived a positive group climate (M=5.16, SD=0.69). A trained evaluator reported that facilitator dose delivered (0=no, 1=yes, criteria=≥75%) was high (99.6%), and fidelity (1=none to 4=all, criteria=≥3) was adequate at facilitator (M=3.63, SD=0.41) and group levels (M=3.35, SD=0.49). Five cultural topics were raised by participants related to eating (n=3) and physical activity (n=2) behaviors and were integrated as part of the final curriculum. DISCUSSION: Results identify areas for program improvement related to delivery of multi-theoretical and cultural tailoring elements. Findings may inform future strategies for implementing effective weight loss programs for ethnic minority families.