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1.
Pediatr Obes ; : e12870, 2021 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-34751514

RESUMO

BACKGROUND: Few studies have assessed intergenerational associations of obesity and cardiovascular disease risks from parents to their children among Hispanic Americans. OBJECTIVES: To assess intergenerational cardiovascular associations among Hispanic families. METHODS: Using baseline data from an obesity-focused efficacy trial targeting Hispanic adolescents (n = 280) and their parents, we conducted a series of logistic regression analyses to investigate the effects of parental BMI and blood pressure on adolescents' BMI and blood pressure, respectively. RESULTS: After adjusting for significant socio-demographic variables and adolescents' lifestyle behaviours, adolescents were more than twice as likely to be in the severely obese versus overweight range when their parents had obesity (vs. non-obese; OR = 2.55, 95% CI = 1.20, 5.39) and more than twice as likely to be in the severely obese versus obese weight range (OR = 2.44, 95% CI = 1.22, 4.87) when their parents had obesity. When compared to those with normal blood pressure, adolescents who had parents with elevated blood pressure/hypertension were more than twice as likely to have elevated blood pressure (OR = 2.05, 95% CI = 1.04, 4.00) or be classified as hypertensive stage 1/2 (OR = 2.81, 95% CI = 1.31, 6.01). CONCLUSIONS: Both severe obesity and elevated blood pressure are highly associated among Hispanic parent-child dyads. Findings underscore the potential benefits of intervening with the family system.

2.
J Aging Phys Act ; : 1-13, 2021 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-34611054

RESUMO

Physical inactivity is a major public health issue among older adults and children. This study presents preliminary results that will inform the development of a technology-based physical activity intervention for grandparents and grandchildren (ages 6-12 years old). The authors used an iterative user-centered design framework to gather quantitative data from grandparents (n = 35) and subsequently invited a subset of 12 of them to engage in qualitative interviews. Participants were 63.1 ± 9.8 years old, 80% female, 64% U.S.-born, 43% Hispanic, 66% single, and 40% <$15K income. The majority of grandparents reported mobile device proficiency, very close relationships with their grandchildren, and interest in participating in an intergenerational intervention. Four key themes related to family closeness, dynamics, routines, and technology informed intervention development. Next steps involved a pilot trial using Fitbits and a fully functioning technology-based prototype. Grandparents are uniquely positioned within their families to serve as agents of change in health-promoting interventions.

3.
Psychol Health ; : 1-17, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34187253

RESUMO

OBJECTIVE: Current research on the physical and psychological functioning of breast cancer survivors often takes an approach where symptoms are studied independently even though they often occur in clusters This paper aims to identify physical and psychological symptom clusters among breast cancer survivors while assessing clinical, psychosocial and demographic characteristics that predict subgroup membership. DESIGN: Using post-surgical data collected from 240 women with stage 0-III breast cancer, symptom clusters were identified using latent profile analysis of patient-reported symptoms. MAIN OUTCOME MEASURES: Baseline measures included the Pittsburg Sleep Quality Index, the Fatigue Symptom Inventory, the Hamilton Rating Scales for depression and anxiety and the Impact of Event Scale. RESULTS: Three distinct classes were identified: (1) mild physical, cognitive and emotional symptoms, (2) moderate across all domains and (3) high levels of all symptoms. Lower socio-economic status, minority ethnicity, younger age, advanced disease stage along with lower self-efficacy and less internal locus of control were significantly associated with a higher likelihood of class 3 membership. CONCLUSION: By identifying those most at risk for severe physical and psychological symptoms in the post-surgical period, our results can guide the development of tailored interventions to optimise quality of life during breast cancer treatment.

4.
Am J Prev Med ; 59(5): 658-668, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33011010

RESUMO

INTRODUCTION: Hispanic adolescents in the U.S. are disproportionately affected by overweight and obesity compared with their White, non-Hispanic counterparts. This study examines the efficacy of an evidence-based family intervention adapted to target obesity-related outcomes among Hispanic adolescents who were overweight/obese compared with prevention as usual. STUDY DESIGN: This study was an RCT. SETTING/PARTICIPANTS: Participants were Hispanic adolescents who were overweight/obese (n=280, mean age=13.01 [SD=0.82] years) in the 7th/8th grade and their primary caregivers. Primary caregivers were majority female legal guardians (88% female, mean age=41.88 [SD=6.50] years). INTERVENTION: Participants were randomized into the family-level obesity-targeted intervention or referral to community services offered for overweight/obese adolescents and families (condition). Data collection began in 2015. MAIN OUTCOME MEASURES: Primary outcomes included dietary intake (e.g., reduction of sweetened beverages) and past-month moderate-to-vigorous physical activity. Secondary outcomes were BMI and family functioning assessed among adolescents and primary caregivers. RESULTS: Study analyses (2019) indicated no significant intervention effects for adolescents' primary outcomes. Intervention effects were found for parents' intake of fresh fruits and vegetables (ß=0.12, 95% CI=0.02, 0.23), added sugar (ß= -0.11, 95% CI= -0.22, -0.004), and sweetened beverages (ß= -0.12, 95% CI=-0.23, -0.02), and parents showed decreased BMI (ß= -0.05, 95% CI= -0.11, -0.01) at 6 months after baseline compared with usual prevention. Intervention effects were found for adolescent family communication (ß=0.13, 95% CI=0.02, 0.24), peer monitoring (ß=0.12, 95% CI=0.01, 0.23), and parental involvement (ß=0.16, 95% CI=0.06, 0.26) at 6 months after baseline compared with prevention as usual. CONCLUSIONS: This intervention was not effective in improving overweight/obesity-related outcomes in adolescents. The intervention was effective in improving parents' dietary intake and BMI; however, the effects were not sustained in the long term. Other intervention strategies (e.g., booster sessions, increased nutritional information) may be necessary to sustain beneficial effects and extend effects to adolescent participants. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT03943628.


Assuntos
Sobrepeso , Bebidas Adoçadas com Açúcar , Adolescente , Adulto , Peso Corporal , Feminino , Humanos , Masculino , Obesidade , Sobrepeso/prevenção & controle , Pais
5.
BMC Public Health ; 20(1): 852, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493280

RESUMO

BACKGROUND: Social connectedness is an important predictor of health outcomes and plays a large role in the physical and mental health of an individual and a community. The presence of a functioning health clinic with a community health worker program may indirectly improve health outcomes by increasing the social connectedness of the community in addition to providing direct patient care. This study examines the social connectedness of the inhabitants of three Mexican towns within the catchment area of a healthcare Non-Government Organization (NGO) through a qualitative analysis. METHODS: Willing participants were videotaped answering open-ended questions about their community and use of healthcare resources. Interviews were then coded for relevant themes and analyzed for content relating to social connectedness, social isolation, and health. RESULTS: Respondents reported that having a functioning community clinic had improved their lives significantly through direct provision of care and by reducing the financial burden of travel to seek medical care elsewhere. Respondents from each town differed slightly in their primary means of social support. One town relied more heavily on organized groups (i.e., religious groups) for their support system. Social isolation was reported most frequently by housewives who felt isolated in the home and by respondents that had to deal with personal illness. Respondents that self-identified as Community Health Workers (CHWs) in their respective communities acknowledged that their roles bestowed physical and psychological health benefits upon themselves and their families. CONCLUSIONS: Overall, a long-term health intervention may directly impact the relative social isolation and social connectedness of a community's inhabitants. The social connectedness of the community is an important quality that must be considered when evaluating and planning health interventions.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , População Rural/estatística & dados numéricos , Comportamento Social , Apoio Social , Adulto , Integração Comunitária/psicologia , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Organizações , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Isolamento Social
6.
Matern Child Nutr ; 16(1): e12890, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31568669

RESUMO

As mothers seek out information around breastfeeding, many are turning to online message boards, listservs, or social media for advice. Babycenter.com, a parenting website with widespread use, hosts a Breastfeeding Support and Help community forum with over 140,000 users and more than one million conversation threads. The purpose of this study is to examine this online support forum to understand the information seeking and sharing practices of its users. We extracted a total of 258 original posts and 1,445 corresponding comments from Babycenter.com's breastfeeding forum posted over a 10-day period. Using content analysis, we coded the posts into 15 categories reflective of the types of information users were seeking. We then randomly selected 45 conversation threads across the most popular categories to further understand how users were sharing information. The most popular breastfeeding topics for which users sought out information included feeding challenges, supply issues, feeding schedule and duration, pumping, physical health, excretion issues, storing milk, nipple issues, and general breastfeeding questions. Participants elicited information from others using interviewing questions and built consensus around issues by agreeing with previous posts. They shared their knowledge and personal breastfeeding experiences and also provided encouragement to continue breastfeeding and overcome challenges. Online support forums are actively being used by breastfeeding mothers seeking information from others with similar experiences. This presents an important resource for breastfeeding mothers and may, therefore, be an important component of future breastfeeding interventions.


Assuntos
Aleitamento Materno/psicologia , Disseminação de Informação , Comportamento de Busca de Informação , Internet , Mães/psicologia , Redes Sociais Online , Apoio Social , Feminino , Humanos
7.
Psychooncology ; 29(1): 182-194, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31600424

RESUMO

OBJECTIVES: This paper presents the results of a study developed to inform the design of a multigenerational digital lifestyle intervention for overweight/obese women cancer survivors and their families. We followed the first six phases of the Integrate, Design, Assess, and Share (IDEAS) framework. METHODS: Grandmothers with breast, endometrial, or ovarian cancers (n = 46; 66.1 ± 0.9 years old; 34% Hispanic, 33% non-Hispanic black, 33% non-Hispanic white) self-reported their lifestyle behaviors, family structure, mobile device use, and interest in a family-based lifestyle intervention. A randomly selected subset of 21 participants subsequently completed qualitative interviews to understand their family relationships, weight-related challenges, and feedback on intervention prototypes. RESULTS: Participants reported low fruit intake (0.9 ± 0.1 servings/day), moderate vegetable intake (3.0 ± 0.2 servings/day), and high levels of moderate physical activity (990 ± 234 MET-minutes/week). The majority owned a smartphone (93%) and expressed interest in family-based programs (80%) that focused on weight management (91%). Qualitative data were collapsed into seven intervention considerations, including: capitalizing on existing familial support, involving local family who need lifestyle change, tapping into survivors' internal strengths, validating prior weight loss, overcoming barriers to sustained lifestyle change, providing information on cancer risk, and motivating families through reinforcing activities. CONCLUSIONS: Following the IDEAS framework, our next steps are to develop a fully-functioning prototype and conduct a randomized pilot trial to test the feasibility and effects of a digital intervention that empowers racially/ethnically diverse overweight/obese women cancer survivors to improve their physical activity and dietary intake and to lose weight by encouraging healthy lifestyle behaviors in their children and grandchildren.


Assuntos
Sobreviventes de Câncer/psicologia , Aconselhamento/métodos , Relações Familiares , Educação em Saúde/métodos , Estilo de Vida Saudável , Obesidade/psicologia , Adulto , Idoso , Exercício Físico , Feminino , Promoção da Saúde/métodos , Humanos , Pessoa de Meia-Idade , Obesidade/complicações , Cooperação do Paciente , Perda de Peso
8.
Transl Behav Med ; 10(4): 1064-1069, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-31167022

RESUMO

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.


Assuntos
Relações Pais-Filho , Perda de Peso , Adolescente , Comunicação , Humanos , Estilo de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Traduções
9.
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.


Assuntos
Comportamentos Relacionados com a Saúde , Estilo de Vida , Obesidade Pediátrica/prevenção & controle , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Instituições Acadêmicas
10.
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.


Assuntos
Comportamento do Adolescente/psicologia , Pais/psicologia , Obesidade Pediátrica/complicações , Adolescente , Comunicação , Feminino , Identidade de Gênero , Hispano-Americanos , Humanos , Masculino , Inquéritos e Questionários
11.
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.


Assuntos
Comportamento Alimentar/psicologia , Hispano-Americanos/psicologia , Obesidade/psicologia , Sobrepeso/psicologia , Inquéritos e Questionários/normas , Adolescente , Criança , Análise Fatorial , Comportamento Alimentar/etnologia , Feminino , Humanos , Masculino , Refeições/psicologia , Psicometria , Reprodutibilidade dos Testes
12.
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
13.
Hisp Health Care Int ; 16(4): 204-212, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30426783

RESUMO

Low-income Hispanics are a hard to reach population that face unique challenges in achieving behavior change. Understanding such challenges can inform the adaptation of lifestyle behavioral interventions and increase participant engagement. This descriptive qualitative study aimed to (1) inform lifestyle modification programs focused on improving the physical activity and healthy eating of low-income Hispanic adults and (2) explore potential gender differences necessary for consideration. Five gender-specific focus groups were conducted with Hispanic adults from a free community clinic (n = 45, 64% women, 53.1 ± 10.1 years). Sessions were audio-recorded, transcribed, and coded using a general inductive approach. The qualitative software program Dedoose was used to perform a content analysis. Emergent themes included topics of interest, methods of increasing engagement in healthy behaviors, and the delivery of lifestyle modification programs. Men expressed greater interest in physical activity, while women desired to learn about healthy eating. Men described the importance of physician communication, while women focused on the role of social support as facilitators for participating in such programs. Both genders described education as key to behavior change and viewed text messaging as a valuable complement. Results from this study can inform the adaptation of lifestyle modification programs and increase the engagement of low-income Hispanic populations.


Assuntos
Promoção da Saúde/organização & administração , Hispano-Americanos , Estilo de Vida , Pobreza , Adulto , Idoso , Índice de Massa Corporal , Comunicação , Dieta Saudável/métodos , Exercício Físico , Feminino , Comportamentos Relacionados com a Saúde , Educação em Saúde/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Fatores Sexuais , Apoio Social , Fatores Socioeconômicos , Envio de Mensagens de Texto
14.
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
15.
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.

16.
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
17.
J Behav Med ; 41(4): 537-549, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29705935

RESUMO

This study examined the effects of a family-based health promotion intervention on the moderate-to-vigorous physical activity (MVPA), light physical activity, sedentary behavior, and fruit and vegetable intake of African American parents. Eighty-nine African American parents (41.5 ± 8.5 years; 92% females; 74% obese; 64% < $40 K income) and adolescents (12.5 ± 1.4 years; 61% girls; 48% obese) were randomized to a 6-week behavioral skills plus positive parenting and peer monitoring intervention grounded in social cognitive, self-determination, and family systems theories or a general health comparison program. Parents wore accelerometers for 7 days and completed three 24-h dietary recalls at baseline and post-intervention. Multilevel regression models (controlling for baseline variables) demonstrated a significantly greater increase in parent MVPA for those in the intervention versus comparison condition (b = 9.44, SE = 4.26, p < 0.05). There were no other significant effects. Family-based approaches that include African American parents and youth may increase parent MVPA and hold promise for preventing chronic diseases.


Assuntos
Afro-Americanos/psicologia , Exercício Físico/psicologia , Terapia Familiar , Promoção da Saúde/métodos , Pais/psicologia , Adolescente , Adulto , Criança , Feminino , Alimentos , Humanos , Masculino , Obesidade , Poder Familiar , Grupo Associado , Comportamento Sedentário
18.
J Fam Psychol ; 32(3): 333-342, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29698007

RESUMO

Research has shown that family functioning has been positively associated with physical activity and dietary intake, both of which are obesity-related risk factors. The most widely practiced methodological approach to assessing this construct in empirical studies relies on either parent or adolescent report. Yet, discrepancy in parent and adolescent report of family functioning may provide a fuller understanding of the effects of this construct on obesity-related health outcomes. This is especially important among Hispanics, a population that suffers from disproportionately high rates of obesity and its health-related consequences. The purpose of this study was to examine whether, and to what extent, parent-adolescent discrepancies in family functioning are associated with physical activity, and fruit and vegetable and added sugar intake. We estimated discrepancy scores between parents and adolescents (n = 280 dyads) in family functioning. Then, using structural equation modeling, we tested the effect of family functioning discrepancy on adolescent reports of physical activity, fruits and vegetables intake, and added sugar intake. After controlling for adolescent's gender and BMI, family functioning discrepancy was significantly associated with reduced physical activity (ß = -.14*, 95% CI ([-.26, -.05]) and fruits and vegetables intake (ß = -.22*, 95% CI [-.38, -.09]) such that the larger the discrepancy between parent and youth reported family functioning, the fewer days of adolescent physical activity and the poorer the fruits and vegetables intake. Our findings provide insight for the role of the family in Hispanic adolescent health outcomes and rationale for capturing rich data to better understand that role. (PsycINFO Database Record


Assuntos
Dieta/métodos , Exercício Físico/psicologia , Relações Familiares/psicologia , Hispano-Americanos/psicologia , Pais/psicologia , Autorrelato , Adolescente , Adulto , Criança , Dieta/psicologia , Dieta/estatística & dados numéricos , Feminino , Frutas , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade , Verduras , Adulto Jovem
19.
Health Psychol Rev ; 12(3): 271-293, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29583070

RESUMO

Considering the immense challenge of preventing obesity, the time has come to reconceptualise the way we study the obesity development in childhood. The developmental cascade model offers a longitudinal framework to elucidate the way cumulative consequences and spreading effects of risk and protective factors, across and within biopsychosocial spheres and phases of development, can propel individuals towards obesity. In this article, we use a theory-driven model-building approach and a scoping review that included 310 published studies to propose a developmental cascade model of paediatric obesity. The proposed model provides a basis for testing hypothesised cascades with multiple intervening variables and complex longitudinal processes. Moreover, the model informs future research by resolving seemingly contradictory findings on pathways to obesity previously thought to be distinct (low self-esteem, consuming sugary foods, and poor sleep cause obesity) that are actually processes working together over time (low self-esteem causes consumption of sugary foods which disrupts sleep quality and contributes to obesity). The findings of such inquiries can aid in identifying the timing and specific targets of preventive interventions across and within developmental phases. The implications of such a cascade model of paediatric obesity for health psychology and developmental and prevention sciences are discussed.


Assuntos
Desenvolvimento Infantil/fisiologia , Modelos Teóricos , Obesidade Pediátrica , Criança , Humanos , Obesidade Pediátrica/etiologia , Obesidade Pediátrica/metabolismo , Obesidade Pediátrica/fisiopatologia , Obesidade Pediátrica/psicologia
20.
Qual Health Res ; 28(7): 1112-1122, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29291686

RESUMO

We conducted three focus groups to examine African American women's perceptions of factors influencing and proposed strategies for reducing sedentary behavior (SB). QSR NVivo 9 facilitated coding and organization of themes. Although participants ( n = 32, 53.6 ± 6.0 years, 75% obese) were unfamiliar with the term SB prior to focus groups, they described spending large amounts of time in SB at work and home. Participants viewed leisure-time SB as necessary and important but were amenable to decreasing SB at work. Participants also identified personal, social, and environmental factors contributing to SB as well as novel strategies for reducing SB. Results suggest that messages aimed at reducing SB in African American women should be positively framed, viewed within a socioecologic framework, and target nonleisure time SB. SB was viewed as a form of stress reduction; thus, future research might want to emphasize alternative stress management techniques that simultaneously reduce SB.


Assuntos
Afro-Americanos/psicologia , Meio Ambiente , Exercício Físico , Comportamento Sedentário/etnologia , Idoso , Feminino , Grupos Focais , Humanos , Atividades de Lazer , Pessoa de Meia-Idade , Percepção , Meio Social , Fatores Socioeconômicos , Estresse Psicológico/terapia
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