Kathryn Brogan Hartlieb

Sequential Multiple Assignment Randomized Trial (SMART) to Construct Weight Loss Interventions for African American Adolescents

The purpose of this study was to develop an adaptive behavioral treatment for African American adolescents with obesity. In a sequential multiple assignment randomized trial, 181 youth ages 12–16 years with primary obesity and their caregiver were first randomized to 3 months of home-based versus office-based delivery of motivational interviewing plus skills building. After 3 months, nonresponders to first phase treatment were rerandomized to continued home-based skills or contingency management. Primary outcome was percent overweight and hypothesized moderators were adolescent executive functioning and depression. There were no significant differences in primary outcome between home-based or office-based delivery or between continued home-based skills or contingency management for nonresponders to first-phase treatment. However, families receiving home-based treatment initially attended significantly more sessions in both phases of the trial, and families receiving contingency management attended more sessions in the second phase. Overall, participants demonstrated decreases in percent overweight over the course of the trial (3%), and adolescent executive functioning moderated this effect such that those with higher functioning lost more weight. More potent behavioral treatments to address the obesity epidemic are necessary, targeting new areas such as executive functioning. Delivering treatment in the home with contingency management may increase session attendance for this population.

Recruitment Strategies and the Retention of Obese Urban Racial/Ethnic Minority Adolescents in Clinical Trials: The FIT Families Project, Michigan, 2010-2014

Introduction The successful recruitment and retention of participants is integral to the translation of research findings. We examined the recruitment and retention rates of racial/ethnic minority adolescents at a center involved in the National Institutes of Health Obesity Research for Behavioral Intervention Trials (ORBIT) initiative by the 3 recruitment strategies used: clinic, informatics, and community. Methods During the 9-month study, 186 family dyads, each composed of an obese African American adolescent and a caregiver, enrolled in a 6-month weight-loss intervention, a sequential multiple assignment randomized trial. We compared recruitment and retention rates by recruitment strategy and examined whether recruitment strategy was related to dyad baseline characteristics. Results Of the 186 enrolled families, 110 (59.1%) were recruited through clinics, 53 (28.5%) through informatics, and 23 (12.4%) through community. Of those recruited through community, 40.4% enrolled in the study, compared with 32.7% through clinics and 8.2% through informatics. Active refusal rate was 3%. Of the 1,036 families identified for the study, 402 passively refused to participate: 290 (45.1%) identified through informatics, 17 (29.8%) through community, and 95 (28.3%) through clinics. Recruitment strategy was not related to the age of the adolescent, adolescent comorbidities, body mass index of the adolescent or caregiver, income or education of the caregiver, or retention rates at 3 months, 7 months, or 9 months. Study retention rate was 87.8%. Conclusion Using multiple recruitment strategies is beneficial when working with racial/ethnic minority adolescents, and each strategy can yield good retention. Research affiliated with health care systems would benefit from the continued specification, refinement, and dissemination of these strategies.

Effective Patient–Provider Communication in Pediatric Obesity

Effective patient-provider communication is not a primary focus of medical school curricula. Motivational interviewing (MI) is a patient-centered, directive communication framework appropriate for in health care. Research on MIs causal mechanisms has established patient change talk as a mediator of behavior change. Current MI research focuses on identifying which provider communication skills are responsible for evoking change talk. MI recommends informing, asking, and listening. Research provides evidence that asking for and reflecting patient change talk are effective communication strategies, but cautions providers to inform judiciously. Supporting a patients decision making autonomy is an important strategy to promote health behaviors.

Effectiveness of Nutrition Intervention in a Selected Group of Overweight and Obese African-American Preschoolers

High prevalence of childhood obesity persists as a public health concern in the USA. However, limited study has been conducted on the effectiveness of nutrition education focused on African-American (AA) preschoolers (PSLRs) in the preschool settings. The aim of this pilot study was to explore the effectiveness of nutrition education on AA PSLR’s health. A convenience sample of 164 PSLRs (95% AA, 44% female) from six Head Start (HS) centers in a Midwestern metropolitan area was randomly assigned to 3 groups: intervention group A, standard curriculum plus nutrition education for PSLRs; intervention group B, standard curriculum plus nutrition education for PSLRs and their caregivers (CGs); and control group, standard curriculum. Baseline and post-intervention differences within each group and differences among the three groups in body mass index (BMI) percentiles, blood lipid profile, and food preference/knowledge were analyzed. No significant changes in BMI percentiles among the three groups were observed. When only overweight and obese PSLRs were considered, there was a significant reduction in BMI percentile in group B (PSLR + CG) and control group. More PSLRs in all three groups had blood lipid levels in the acceptable with few in the high-risk levels. There were no changes in nutrition knowledge and healthy eating behavior post-intervention. This pilot study supports including both PSLRs and CGs in future preschool-based interventions and the need for more intense intervention to optimize healthy outcomes, especially for those AA PSLRs who are overweight or obese.

Correction to: Effectiveness of Nutrition Intervention in a Selected Group of Overweight and Obese African-American Preschoolers

Part of our original analyses was performed with overweight and obese preschoolers only. This procedure may have created a subgroup of individuals with extreme values at baseline and this may likely be inappropriate.