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1.
J Nutr Educ Behav ; 2020 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-32595083

RESUMO

OBJECTIVE: To investigate the association of adolescent self-report of family mealtime communication on obesity-related behaviors in single- and dual-parent households and by sex in a sample of overweight and obese Hispanic adolescents. DESIGN: Cross-sectional analysis of a randomized control trial SETTING: Eighteen middle schools in Miami-Dade County, Florida. PARTICIPANTS: Two-hundred and eighty Hispanic seventh- and eighth-grade students MAIN OUTCOME MEASURES: Physical activity, fruit and vegetable intake, and added sugar intake. ANALYSIS: Structural equation modeling. RESULTS: The findings indicate that mealtime communication was associated with fruit and vegetable consumption in boys (ß = .30; P = .001; 95% confidence interval [CI], 0.52-2.68) and physical activity in girls (ß = .26; P = .010; 95% CI, 0.16-1.30). Moreover, a single-parent household was associated with dietary consumption in boys (fruit and vegetable intake [ß= .18; P = .039; 95% CI, 0.02-2.60] but had a moderating effect on fruit and vegetable consumption in girls (ß = .21; P = .015; 95% CI, 0.14-2.19). CONCLUSIONS AND IMPLICATIONS: Family mealtime communication may impact dietary and physical activity outcomes in Hispanic adolescents with overweight and obesity, but differentially across gender and household parent makeup. These findings, together with the prevalence of single parents, point to the importance of targeting Hispanic single parents as agents of change to promote healthy lifestyle behaviors in their children via positive mealtime interactions.

2.
Health Promot Pract ; : 1524839919900765, 2020 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-32081063

RESUMO

In Latin America, there is an increasing interest in the implementation and dissemination of evidence-based, family-centered interventions to prevent youth behavioral problems. While families' participation in interventions is integral to achieving the interventions' desired impact, little is known about what predicts Latin American families' attendance. The current study provides a unique opportunity to explore the participation of families living in the United States, Ecuador, and Chile in an evidence-based intervention, Familias Unidas. We tested for differences in attendance rates, family functioning variables, and adolescent behavioral problem variables, then applied a hierarchical multiple regression to (a) identify which variables significantly predicted program attendance and (b) assess whether the country in which the intervention was implemented in moderated the relationship between predictors and program attendance. On average, Chilean and Ecuadorian parents were more engaged and attended more sessions than parents living in the United States. Across samples, there was significant differences in family functioning and adolescent behavioral problem variables. However, effective parent-adolescent communication was the only significant predictor of lower program attendance. A significant interaction effect revealed that even though Chilean parents had high parent-adolescent communication, they were more likely to attend sessions, compared to parents living in the United States. We highlight the promise of engaging and retaining families, across U.S. and Latin American samples, into a culturally syntonic, family-based intervention, and discuss potential explanations for success in Chile and Ecuador. Researchers interested in implementing interventions in Latin America could utilize these findings to better target participants and intervention efforts.

3.
Behav Med ; : 1-13, 2020 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-31935162

RESUMO

Emerging adulthood has been described as a difficult stage in life and may be particularly stressful for Hispanic emerging adults who are disproportionately exposed to adversity and chronic sociocultural stressors. To better prevent and treat depressive disorders among Hispanic emerging adults, more research is needed to identify and understand modifiable determinants that can help this population enhance their capacity to offset and recover from adversity and sociocultural stressors. As such, this study aimed to (1) examine the association between resilience and depressive symptoms among Hispanic emerging adults, and (2) examine the extent to which intrapersonal resources (e.g., mindfulness, distress tolerance, emotion regulation strategies) and interpersonal resources (e.g., family cohesion, social support) moderate the association between resilience and depressive symptoms. To examine these aims, 200 Hispanic emerging adults (ages 18-25) from Arizona (n = 99) and Florida (n = 101) completed a cross-sectional survey, and data were analyzed using hierarchical multiple regression and moderation analyses. Findings from the hierarchical multiple regression indicate that higher resilience was associated with lower depressive symptoms. Findings from the moderation analyses indicate that family cohesion, social support, and emotion regulation strategies (e.g., cognitive reappraisal and expressive suppression) functioned as moderators; however, mindfulness and distress tolerance were not significant moderators. Findings from this study add to the limited literature on resilience among Hispanics that have used validated measures of resilience. Furthermore, we advance our understanding of who may benefit most from higher resilience based on levels of intrapersonal and interpersonal resources.

4.
Obes Rev ; 21(2): e12939, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31808277

RESUMO

The goals of this systematic review were to identify and describe paediatric obesity prevention interventions from infancy to late adolescence and to provide recommendations for future intervention research in light of a recently proposed developmental cascade (DC) model of paediatric obesity. We conducted an electronic search of randomized controlled trials with a minimum 6-month postintervention follow-up published between 1995 and 2019. We included 74 interventions: prenatal/infancy (n = 4), early childhood (n = 11), childhood (n = 38), early to mid-adolescence (n = 18), and late adolescence (n = 3). Infancy and early childhood trials targeted early feeding and positive parenting skills. Half of the childhood and adolescence trials were school based and used universal prevention strategies; those classified as selective or indicated prevention tended to involve the family for more intensive lifestyle modification. Less than 10% of studies followed participants over long periods of time (greater than or equal to 5 years), and only 16% and 31% of studies assessed intervention mediators and moderators, respectively. We recommend that future interventions focus on early prevention, assess long-term intervention effects, use a standardized taxonomy for defining intervention behavioural strategies, assess underlying mechanisms of action and intervention moderators, target parent and family management strategies across development, and increase scientific equity. We also provide specific recommendations regarding intervention targets for each developmental stage.

5.
Int J Ment Health Addict ; 17(3): 467-478, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31814808

RESUMO

College drinking is a serious health concern. Few studies have examined screening measures and methods of administration. This study compares two alcohol screens (NIAAA 5/4 binge drinking question or Alcohol Use Disorders Identification Test (AUDIT)) in a college student health clinic waiting room and two modes of administration (self-administered either on a computer kiosk or on a tablet computer). Participants were 259 undergraduates from the University of Miami. Most (78-98%) students completed screening. More students were identified with risky alcohol use with the 5/4 (49%) than AUDIT (14%). On the 5/4, administration method was not linked to completion, 93% kiosk vs. 95% tablet, p = .554, but was related to identification as a risky alcohol user, 42% kiosk vs. 56% tablet, p = .033. On the AUDIT, administration method was significantly related to completion, 73% kiosk vs. 98% tablet, p < .001, and identification, 8% kiosk vs. 23% tablet, p = .003. Method of administration of the single item 5/4 binge drinking question was related to the a higher proportion of students identified with risky alcohol use when screened by a computer tablet, but not completion rates; the AUDIT method of administration was related to both completion and identification rates (higher rates with the tablet in both cases). Education of student health providers who make decisions about what screening tools to use in their centers and who interpret the results of alcohol screening in college health centers should consider the potential influence of administration method. Future research should examine the reasons that method of administration might influence screening results.

6.
Artigo em Inglês | MEDLINE | ID: mdl-31731821

RESUMO

BACKGROUND: Miami-Dade County, where many Latina seasonal workers reside and work, has the highest incidence of the human immunodeficiency virus (HIV) in the US: a rate four times the national average. Despite this disproportionate risk for HIV, there are no HIV prevention interventions that aim to decrease HIV among Latina seasonal workers. METHODS: The PROGRESO EN SALUD study compared the outcomes of two interventions adapted to include a social network component (VOICES and HEALTHY). Recruitment used a social network respondent-driven sampling design in which each seed was asked to recruit three friends, and those friends were asked to recruit three friends, for a total of twenty groups of 13 friends. We collected data at baseline, and 6 months and 12 months post intervention completion. We used generalized estimating equation models, properly adjusted for non-independent contributions of both social network interventions, to estimate the effects. Gaussian family multivariate models were calculated, addressing exchangeable working correlations, including both individual-level and cluster-level covariates in these models. RESULTS: A total of 261 Latina seasonal workers participated in either the HEALTHY or the VOICES intervention. There were significant changes over time in cognitive factors (HIV knowledge, condom use self-efficacy, and adequate knowledge of condom use), behavioral factors (condom use, female condom use, and HIV testing), and communication factors (talking with friends about HIV prevention and intention to negotiate safe sex with male partners). DISCUSSION: This study supports the literature suggesting that interventions incorporating social networks can have positive effects on HIV prevention and treatment outcomes, including sustained benefits beyond study periods.


Assuntos
Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Educação em Saúde/métodos , Hispano-Americanos , Adulto , Comunicação , Preservativos/estatística & dados numéricos , Feminino , Florida , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Comportamento de Redução do Risco , Sexo Seguro , Autoeficácia , Comportamento Sexual
7.
J Phys Act Health ; 16(11): 952-961, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31557723

RESUMO

BACKGROUND: Previous literature has shown a negative relationship between parental stress and youth moderate to vigorous physical activity (MVPA). This study examined (1) the relationship between parental stress and adolescent MVPA, (2) the moderating role of family communication on this relationship, and (3) gender differences in these effects among overweight and obese Hispanic adolescents. METHODS: Hispanic adolescents (N = 280, 52% female, 13.0 [0.8] y old, 44% obese, 12% severely obese) and their parents (88% female, 44.9 [6.5] y old) completed baseline measures for an efficacy trial. Adolescents self-reported MVPA in minutes per week for work, transportation, and recreation using a validated measure. Multiple regression analyses with interaction terms and multigroup methods were conducted. RESULTS: There was a negative effect of parental stress on adolescent MVPA (ß = -0.15, t = -2.018, P ≤ .05). This effect was moderated by family communication (ß = 0.20, t = 2.471, P = .01), such that the association between parental stress and youth MVPA was stronger for adolescents with low levels of family communication. Furthermore, a multiple group model showed that the interaction was significant for boys (ß = 0.27, t = 2.185, P = .03), but not for girls. CONCLUSIONS: Findings provide support that addressing parental stress and family communication may help facilitate MVPA among Hispanic boys, the most at-risk group for pediatric obesity.

8.
Prev Sci ; 20(7): 1114-1124, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31140021

RESUMO

In this article, we highlight the urgent public health need for prevention of heavy episodic drinking among underage Hispanic emerging adults in the USA. We outline the current state of binge drinking prevention programming and contrast it with the unique cultural, social, and developmental realities of this population using an ecodevelopmental framework (Szapocznik and Coatsworth 1999). Finally, we advance specific recommendations for the development and delivery of culturally tailored, multisystemic binge drinking prevention programs for underage Hispanic emerging adults.

9.
Appetite ; 140: 169-179, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31075325

RESUMO

The current family mealtime literature shows that assessments of the mealtime environment are typically self-report, yet few studies discuss validation techniques or report using validated scales. As such, the current analysis was conducted to validate one of the only published measures to assess the mealtime environment from the adolescent perspective. Specifically, the Childhood Family Mealtime Questionnaire (CFMQ) was evaluated in a sample of 280 overweight and obese Hispanic adolescents to address the need for a validated measure of the family mealtime environment in a demographic that is disproportionately affected by the current obesity epidemic. Results of exploratory and confirmatory factor analyses to evaluate the optimal factor structure, reliability, and validity for a revised, abbreviated CFMQ are presented here. The concurrent validity of the CFMQ was evaluated using correlations between the factor structures and the previously used, culturally appropriate comparable measure of family functioning. Correlations were also computed between factor scores and obesogenic outcomes (fruit and vegetable intake, added sugar intake, and physical activity). Analyses produced a revised, abbreviated version that includes 22 items (reduced from a total of 69 items) and consists of the following 4 factors: family mealtime communication (5 items), family mealtime stress (7 items), appearance weight control (5 items), and mealtime structure (6 items). Cronbach's alphas are reported for reliability. When examining CFMQ concurrent validity with the family functioning latent variable, results showed the family mealtime communication subscale ranked highest. Additionally, the family mealtime communication subscale was associated with all three obesogenic outcomes. This abbreviated CFMQ may be a useful tool for those studying family mealtime environments and their influence on obesity and its associated lifestyle behaviors.

10.
J Adolesc ; 72: 91-100, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30877842

RESUMO

INTRODUCTION: The pervasive use of technology has raised concerns about its association with adolescent mental health, including internalizing symptoms. Existing studies have not always had consistent findings. Longitudinal research with diverse subgroups is needed. METHODS: This study examines the relationship between screen-based sedentary (SBS) behaviors and internalizing symptoms among 370 Hispanic adolescents living in Miami, Florida- United States, who were followed for 2 ½ years and assessed at baseline, 6, 18 and 30 months post-baseline between the years 2010 and 2014. Approximately 48% were girls, and 44% were foreign-born, most of these youth being from Cuba. Mean age at baseline was 13.4 years, while at the last time-point it was 15.9 years. RESULTS: Findings show that girls had higher internalizing symptoms and different patterns of screen use compared to boys, including higher phone, email, and text use. SBS behaviors and internalizing symptoms cooccurred at each time-point, and their trajectories were significantly related (r = 0.45, p < .001). Cross-lagged panel analyses found that SBS behaviors were not associated with subsequent internalizing symptoms. Among girls, however, internalizing symptoms were associated with subsequent SBS behaviors during later adolescence, with internalizing symptoms at the 18-month assessment (almost 15 years old) associated with subsequent SBS behaviors at the 30-month assessment (almost 16 years old; ß = 0.20, p < .01). CONCLUSIONS: Continued research and monitoring of internalizing symptoms and screen use among adolescents is important, especially among girls. This includes assessments that capture quantity, context, and content of screen time.


Assuntos
Mecanismos de Defesa , Tempo de Tela , Comportamento Sedentário , Adolescente , Comportamento do Adolescente , Feminino , Florida , Hispano-Americanos/psicologia , Humanos , Estudos Longitudinais , Masculino , Estados Unidos
11.
LGBT Health ; 6(4): 139-145, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30844341

RESUMO

Lesbian, gay, bisexual, transgender, queer, questioning, and other sexual and gender minority youth (LGBTQ) experience myriad health inequities relative to their cisgender heterosexual peers. Families have a profound impact on adolescent health, but little is known about this influence on LGBTQ youth specifically. We draw on work presented at a public symposium that aimed to characterize existing scientific evidence, identify gaps in knowledge, and set priority areas for future research on the influence of family factors on LGBTQ youth health. We review the evidence in each identified priority area and propose promising avenues for future research and opportunities for innovation.

12.
Subst Abuse Treat Prev Policy ; 14(1): 1, 2019 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-30606266

RESUMO

BACKGROUND: Behavioral Interventions are needed to prevent HIV in substance users, which is associated with higher risk for contracting HIV via unprotected sexual intercourse or syringe-based exposure. We reviewed universal HIV prevention interventions targeting intravenous drug users (IDUs) and non-IDUs (NIDUs) to identify which prevention interventions are the most effective at reducing HIV transmission risk among IDU's and NIDU's and identify gaps in the literature. METHODS: A PubMed literature review (1998-2017), limiting studies to universal HIV prevention interventions targeting adult HIV-negative substance users. Interventions were compared across sample sizes, sociodemographic, intervention setting, study design, use of theoretical models, and intervention effects. RESULTS: Of 1455 studies identified, 19 targeted IDUs (n = 9) and NIDUs (n = 10). Both IDU and NIDU studies were conducted in substance use treatment centers and included both group (44% vs. 73%) and individual-based (56% vs. 27%) methods; only one NIDU study used a couple-based intervention. All IDU, and 89% of NIDU, studies used explanatory and behavior-change theoretical models to guide selection of intervention mechanisms. Reduction in frequency of risky sexual behaviors were observed in 33% IDU and 64% NIDU studies, where 56% of IDU studies effectively increased drug use-related hygiene and 67% decreased frequency of injections. Eight studies included start-of-study HIV testing and five examined HIV seroconversion. CONCLUSION: The interventions reviewed demonstrate promising results for decreasing risky sexual practices for NIDUs and reducing high-risk drug practices for IDUs, thereby reducing HIV transmission risk. Future studies should include HIV testing and measurement of HIV seroconversion to fully elucidate intervention effects.


Assuntos
Usuários de Drogas/psicologia , Infecções por HIV/prevenção & controle , Comportamento de Redução do Risco , Abuso de Substâncias por Via Intravenosa/terapia , Sexo sem Proteção/prevenção & controle , Humanos
13.
Prev Med ; 120: 85-99, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30610888

RESUMO

The objectives of this systematic review were to: 1) identify evidence-based youth (i.e., infancy, pre-school age, school age, and adolescence) mental and behavioral health disorder preventive interventions conducted in or offered by primary care settings, and 2) describe these interventions' characteristics, efficacy, and clinical involvement. Randomized controlled trials that targeted the prevention of mental or behavioral health outcomes for youth and had a connection to primary care were included. The PRISMA guidelines were utilized for two phases: 1) searching PubMed, EMBASE, PsycInfo, CINAHL, and Cochrane databases in January 2017; and 2) searching United States Preventive Services Task Force (USPSTF) Systematic Reviews in November 2017. The two phases revealed 504 and 58 potential articles, respectively. After removal of duplicates, screening of abstracts, and full-text reviews, 19 interventions (infancy: n = 2, pre-school age: n = 3, school age: n = 6, adolescence: n = 8) were included: 1) 10 interventions described in 17 articles from the databases, and 2) 9 interventions described in 11 articles from the USPSTF reviews. The included interventions capitalized on primary care settings as a natural entry point to engage youth and families into interventions without requiring a large amount of clinic involvement. Commonalities of efficacious interventions and recommendations for future research are discussed. The authors encourage primary care providers, mental and behavioral health providers, and/or public health researchers to continue developing and testing preventive interventions, or adapting existing interventions, to be implemented in primary care.


Assuntos
Transtornos Mentais/prevenção & controle , Saúde Mental , Serviços Preventivos de Saúde/organização & administração , Prevenção Primária/organização & administração , Adolescente , Criança , Pré-Escolar , Medicina Baseada em Evidências , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Transtornos Mentais/epidemiologia , Avaliação de Programas e Projetos de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Estados Unidos , Adulto Jovem
14.
J Adolesc Health ; 64(4): 494-501, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30514652

RESUMO

PURPOSE: The research literature shows that discrepancies in positive parenting between parent and adolescent represents maladaptive parent-adolescent relationships, which are in turn positively linked to later substance use in Hispanic youth. However, questions remain about for whom interventions work and by what mechanisms they work to prevent discrepancies in positive parenting. The current study investigated the moderating and mediating roles of positive parenting discrepancy trajectories on the association between condition effect (i.e., a family-based intervention vs. prevention as usual condition) and substance use among Hispanic youth. METHODS: Eigth grade Hispanic adolescents (mean age = 13.86) and their primary caregivers (mean age = 42.32) were randomly assigned to two conditions: Familias Unidas (n = 376) or prevention as usual (n = 370). Participants were assessed at baseline and at 6, 18, and 30 months postbaseline. Using structural equation modeling, moderated mediation analyses were conducted to test whether the relationship between condition and past 90-day substance use at 30 months was mediated by discrepancy trajectories in positive parenting and whether direct and indirect relationships between condition and substance use were moderated by positive parenting discrepancies at baseline. RESULTS: The results showed that, relative to prevention as usual, Familias Unidas reduced positive parenting discrepancies across time, when parent reports were higher than adolescent reports at baseline; this in turn, predicted substance use at 30 months postbaseline. CONCLUSIONS: The findings provide important evidence supporting the need to collect multiple informant reports on positive parenting and examining the directionality of these reports among Hispanic families.

15.
Contemp Clin Trials ; 76: 64-71, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30453076

RESUMO

Family-based behavioral interventions are efficacious and effective in preventing drug use and sexual risk behaviors; unfortunately, they have not been evaluated and disseminated in pediatric primary care practice, where they can have a significant impact. There is an increased focus on integrating parenting interventions into primary care to reduce health disparities among ethnic minorities such as Hispanics. Although Hispanic youth demonstrate higher levels of drug use and sexual risk behaviors than their non-Hispanic counterparts, few parenting interventions are available for Hispanic youth, and none have been delivered specifically to Hispanic adolescents in primary care. Therefore, this manuscript describes the rationale and design of an Internet-based, family-centered, Hispanic-specific, evidence-based prevention intervention, eHealth Familias Unidas Primary Care. Hispanic adolescents (n = 456) and their care givers will be recruited from pediatric primary care clinics in South Florida and randomized to: eHealth Familias Unidas Primary Care or prevention as usual. The intervention will be delivered by trained interns, clinic volunteers, social workers, mental health counselors, students, and nurses. Outcomes will be measured at baseline and 6, 12, 24, and 36 months post-baseline. This study will determine whether the intervention, compared to prevention as usual, is effective in reducing drug use, unprotected sex, and STI incidence in Hispanic youth through the improvement of family functioning. Additionally, we will determine the cost effectiveness of delivering eHealth Familias Unidas within primary care settings. The effectiveness of eHealth Familias Unidas Primary Care will further inform the need to integrate effective behavioral health interventions into primary care settings.


Assuntos
Saúde da Família , Hispano-Americanos , Atenção Primária à Saúde , Doenças Sexualmente Transmissíveis/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Telemedicina/métodos , Sexo sem Proteção/prevenção & controle , Adolescente , Criança , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pediatria , Assunção de Riscos , Comportamento Sexual , Telemedicina/economia
16.
Prev Sci ; 20(1): 68-77, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29748900

RESUMO

While substance use and sexual risk behaviors among Hispanic youth continue to be public health concerns, few evidence-based preventive interventions are developed for and implemented with Hispanic/Latino youth. The objective of this study was to evaluate the efficacy of eHealth Familias Unidas, an Internet adaptation of an evidence-based family intervention for Hispanics. A randomized controlled trial design (n = 230) was used to evaluate intervention effects on substance use and condomless sex among a sample of Hispanic eighth graders with behavioral problems. Participants were randomized to eHealth Familias Unidas (n = 113) or prevention as usual (n = 117) and assessed at baseline and 3 and 12 months post baseline. We trained mental health school personnel and community mental health professionals to recruit and deliver the Internet-based intervention with Hispanic families. It was hypothesized that, over time, eHealth Familias Unidas would be more efficacious than prevention as usual in reducing drug use (marijuana, cocaine, inhalants, and other drugs), prescription drug use, cigarette use, alcohol use, and condomless sex and that these changes would be mediated by family functioning. Significant intervention effects were found across time for drug use, prescription drug use, and cigarette use. While eHealth Familias Unidas positively affected family functioning, mediation effects were not found. This study demonstrated that family-based eHealth interventions can be efficacious among Hispanic populations when delivered in community settings.


Assuntos
Família , Hispano-Americanos , Medicina Preventiva , Telemedicina , Adolescente , Criança , Prática Clínica Baseada em Evidências , Estudos de Viabilidade , Feminino , Humanos , Internet , Masculino , Avaliação de Resultados em Cuidados de Saúde , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle
17.
Front Public Health ; 6: 293, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30374436

RESUMO

Implementation experts have recently argued for a process of "scaling out" evidence-based interventions, programs, and practices (EBPs) to improve reach to new populations and new service delivery systems. A process of planned adaptation is typically required to integrate EBPs into new service delivery systems and address the needs of targeted populations while simultaneously maintaining fidelity to core components. This process-oriented paper describes the application of an implementation science framework and coding system to the adaptation of the Family Check-Up (FCU), for a new clinical target and service delivery system-prevention of obesity and excess weight game in primary care. The original FCU has demonstrated both short- and long-term effects on obesity with underserved families across a wide age range. The advantage of adapting such a program is the existing empirical evidence that the intervention improves the primary mediator of effects on the new target outcome. We offer a guide for determining the levels of evidence to undertake the adaptation of an existing EBP for a new clinical target. In this paper, adaptation included shifting the frame of the intervention from one of risk reduction to health promotion; adding health-specific assessments in the areas of nutrition, physical activity, sleep, and media parenting behaviors; family interaction tasks related to goals for health and health behaviors; and coordinating with community resources for physical health. We discuss the multi-year process of adaptation that began by engaging the FCU developer, community stakeholders, and families, which was then followed by a pilot feasibility study, and continues in an ongoing randomized effectiveness-implementation hybrid trial. The adapted program is called the Family Check-Up 4 Health (FCU4Health). We apply a comprehensive coding system for the adaptation of EBPs to our process and also provide a side-by-side comparison of behavior change techniques for obesity prevention and management used in the original FCU and in the FCU4Health. These provide a rigorous means of classification as well as a common language that can be used when adapting other EBPs for context, content, population, or clinical target. Limitations of such an approach to adaptation and future directions of this work are discussed.

18.
J Prim Prev ; 39(6): 529-553, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30291486

RESUMO

We describe the adaptation of Familias Unidas, an evidence-based substance use and sexual risk behavior intervention, for obesity prevention in Hispanic adolescents. Intervention developers and experts in pediatric obesity, exercise physiology, dietetics, and the local parks system provided input for changes. Hispanic families also provided input through a series of 21 focus groups conducted before, during, and after an initial pilot test of the adapted intervention. After transcribing audiotaped sessions, we used a general inductive approach and Dedoose qualitative software to derive themes. Results indicated the need for improved health-related family functioning, enhanced nutrition education and skill building, increased family engagement in physical activity, and stronger links between family and environmental supports. Parents who participated in the pilot test expressed high enthusiasm for hands-on nutrition training and reported improvements in family functioning. Adolescents liked outdoor physical activities but wanted parents to be more engaged in joint physical activity sessions. The adapted intervention maintains fidelity to Familias Unidas' core theoretical elements and overall structure, but also includes content focused on physical activity and nutrition, adolescent participation in physical activity sessions led by park coaches, and joint parent-adolescent participation in physical activity and nutrition skill-building activities.


Assuntos
Promoção da Saúde/métodos , Hispano-Americanos , Obesidade Pediátrica/prevenção & controle , Adolescente , Adulto , Prática Clínica Baseada em Evidências/métodos , Família/etnologia , Família/psicologia , Feminino , Grupos Focais , Educação em Saúde/métodos , Humanos , Masculino , Ciências da Nutrição/educação , Pais , Obesidade Pediátrica/etnologia , Projetos Piloto , Transtornos Relacionados ao Uso de Substâncias/etnologia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Sexo sem Proteção/etnologia , Sexo sem Proteção/prevenção & controle
19.
Artigo em Inglês | MEDLINE | ID: mdl-30011798

RESUMO

This study examined participant attendance patterns and individual (e.g., income), family dynamics (e.g., communication), and cultural (i.e., Americanism, Hispanicism) predictors of these patterns among Hispanic families enrolled in a 12-week family-based intervention, Familias Unidas for Health and Wellness. Hispanic adolescents (n = 140, 49% female, 13.04 ± 0.87 years old, 36% overweight, 64% obese, 39% immigrants) and their parents (87% female, 42.09 ± 6.30 years old, BMI 30.99 ± 6.14 kg/m², 90% immigrants) were randomized to the intervention condition. A repeated measures latent class analysis that included 12 binary variables (yes/no) of attendance identified three subgroups of attendance patterns: consistently high, moderate and decreasing, and consistently low. An ANOVA was then conducted to examine whether the identified attendance patterns differed by individual, family dynamics, and cultural characteristics at baseline. Parents in the consistently high attendance group had lower Americanism than those in either of the other attendance groups. Adolescents in the consistently high attendance group had lower Hispanicism than those in either of the other attendance groups. No other variables significantly discriminated between attendance groups. Sustained attendance in the Familias Unidas for Health and Wellness intervention may be driven by Hispanic parents' desire to better understand their host culture, connect with other culturally similar parents, and reconnect adolescents with their heritage culture.


Assuntos
Hispano-Americanos , Sobrepeso/etnologia , Participação do Paciente/estatística & dados numéricos , Adolescente , Adulto , Comunicação , Características Culturais , Família , Relações Familiares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sobrepeso/terapia
20.
Account Res ; 25(5): 259-272, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29717898

RESUMO

The informed consent comprehension process is key to engaging potential research subject participation. The aim of this study is to compare informed consent comprehension between two methods: standard and video-delivered. We compared the in-person and video-delivered informed consent process in the Familias Unidas intervention. We evaluated comprehension using a 7-item true/false questionnaire. There were a total of 152 participants in the control group and 87 in the experimental. General characteristics were similar between both groups (p > 0.05). First-attempt informed consent comprehension was higher in the intervention group but was not statistically significant (80% and 78% respectively p = 0.44). A video-delivered informed consent process did not differ from the standard method of informed consent in a low educational and socioeconomic environment.


Assuntos
Compreensão , Família/psicologia , Consentimento Livre e Esclarecido/normas , Populações Vulneráveis/psicologia , Adolescente , Adulto , Equador , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sujeitos da Pesquisa/psicologia , Características de Residência , Fatores Socioeconômicos , Gravação de Videoteipe
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