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Background: Behavioral interventions to prevent pediatric obesity have shown inconsistent results across the field. Studying what happens within the "black box" of these interventions and how differences in implementation lead to different outcomes will help researchers develop more effective interventions. Aim: To compare the implementation of three features of a phone-based intervention for parents (time spent discussing weight-related behaviors, behavior change techniques used in sessions, and intervention activities implemented by parents between sessions) with study outcomes. Methods: A random selection of 100 parent-child dyads in the intervention arm of a phone-based obesity prevention trial was included in this analysis. Sessions were coded for overall session length, length of time spent discussing specific weight-related behaviors, number of behavior change techniques used during the sessions, and number of intervention-recommended activities implemented by the parents between sessions (e.g., parent-reported implementation of behavioral practice/rehearsal between sessions). The primary study outcome, prevention of unhealthy increase in child body mass index (BMI) percentile, was measured at baseline and 12 months. Results: Overall session length was associated with decreases in child BMI percentile (b = -0.02, p = 0.01). There was no association between the number of behavior change techniques used in the sessions and decreases in child BMI percentile (b = -0.29, p = 0.27). The number of activities the parents reported implementing between sessions was associated with decreases in child BMI percentile (b = -1.25, p = 0.02). Discussion: To improve future interventions, greater attention should be paid to the intended and delivered session length, and efforts should be made to facilitate parents' implementation of intervention-recommended activities between sessions (ClinicalTrials.gov, No. NCT01084590).

Summary: Objective: To prospectively evaluate the relationship between cumulative environmental stress and cardiometabolic risk in middle childhood, and to examine whether hair cortisol, a measure of hypothalamic pituitary adrenal‐axis activity, mediates this relationship. Methods: In a cohort of children from low‐income households (n = 320; 59% Hispanic, 23% Black, body mass index (BMI) percentile >50th at enrollment), environmental stressors including family and neighbourhood factors representing disadvantage/deprivation, and cortisol concentrations from hair samples, were measured over five timepoints beginning when children were 2–4 years old. Cardiometabolic risk factors (i.e., BMI, blood pressure, lipids, blood sugar, C‐reactive protein) were measured at the final timepoint when children were 7–11 years of age. Results: In adjusted logistic regression models, greater cumulative environmental stress was associated with a higher likelihood of elevated cardiometabolic risk in middle childhood (p = 0.01). Children from minoritized racial/ethnic groups had a higher prevalence of both stressors and cardiometabolic risk factors. Cumulative environmental stress was associated with higher hair cortisol concentrations (p < 0.01). However, hair cortisol was not directly associated with cardiometabolic risk factors and did not explain the association between environmental stress and cardiometabolic risk in causal mediation analysis. Conclusions: The influence of cumulative stress on cardiometabolic health can be observed in middle childhood and may contribute to cardiometabolic health disparities, highlighting the importance of public health interventions to mitigate disadvantage. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate a multicomponent obesity prevention intervention among diverse, low-income preschoolers. Methods. Parent–child dyads (n = 534) were randomized to the Now Everybody Together for Amazing and Healthful Kids (NET-Works) intervention or usual care in Minneapolis, MN (2012–2017). The intervention consisted of home visits, parenting classes, and telephone check-ins. The primary outcomes were adjusted 24- and 36-month body mass index (BMI). Results. Compared with usual care, the NET-Works intervention showed no significant difference in BMI change at 24 (–0.12 kg/m2; 95% confidence interval [CI] = −0.44, 0.19) or 36 months (–0.19 kg/m2; 95% CI = −0.64, 0.26). Energy intake was significantly lower in the NET-Works group at 24 (–90 kcal/day; 95% CI = −164, −16) and 36 months (–101 kcal/day; 95% CI = −164, −37). Television viewing was significantly lower in the NET-Works group at 24 (rate ratio = 0.84; 95% CI = 0.75, 0.93) and 36 months (rate ratio = 0.88; 95% CI = 0.78, 0.99). Children with baseline overweight or obesity had lower BMI in the NET-Works group than those in usual care at 36 months (–0.71 kg/m2; 95% CI = −1.30, −0.12). Hispanic children had lower BMI in the NET-Works group than those in usual care at 36 months (–0.59 kg/m2; 95% CI = −1.14, −0.04). Conclusions. In secondary analyses, NET-Works significantly reduced BMI over 3 years among Hispanic children and children with baseline overweight or obesity. Trial Registration: ClinicalTrials.gov Identifier: NCT01606891. [ABSTRACT FROM AUTHOR]

Objective: Having frequent family dinners is associated with better diet quality in children; however, it is unknown whether the frequency of certain family meal types (i.e. dinner) is more strongly associated with better child weight and diet quality compared with other meal types (i.e. breakfast, lunch). Thus, the current study examined the frequency of eating breakfast, lunch or dinner family meals and associations with pre-school children's overall diet quality (HEI-2010) and BMI percentile.Design: Cross-sectional baseline data (2012-2014) from two randomized controlled childhood obesity prevention trials, NET-Works and GROW, were analysed together.Setting: Studies were carried out in community and in-home settings in urban areas of Minnesota and Tennessee, USA.Subjects: Parent-child (ages 2-5 years) pairs from Minnesota (n 222 non-Hispanics; n 312 Hispanics) and Tennessee (n 545 Hispanics; n 55 non-Hispanics) participated in the study.Results: Over 80 % of families ate breakfast or lunch family meals at least once per week. Over 65 % of families ate dinner family meals ≥5 times/week. Frequency of breakfast family meals and total weekly family meals were significantly associated with healthier diet quality for non-Hispanic pre-school children (P<0·05), but not for Hispanic children. Family meal frequency by meal type was not associated with BMI percentile for non-Hispanic or Hispanic pre-school children.Conclusions: Breakfast family meal frequency and total weekly family meal frequency were associated with healthier diet quality in non-Hispanic pre-school children but not in Hispanic children. Longitudinal research is needed to clarify the association between family meal type and child diet quality and BMI percentile. [ABSTRACT FROM AUTHOR]

Objective: To investigate the use of community-supported agriculture (CSA) as an employer-based health promotion intervention.Design: Quasi-experimental study using a convenience sample of employees at three employers.Setting: Participants and controls from three Minnesota employers completed baseline and follow-up health assessments and surveys about their experiences with CSA.Subjects: A total of 324 participants purchased a CSA share and were eligible for study inclusion. Study participants were matched by age, sex, employer and occupation to a non-randomized control group of individuals who did not purchase a CSA share but completed health assessments during the same time frame as the study participants.Results: The majority of participants were female, white, middle-aged and highly educated. The most common reason for purchasing a CSA share was a desire for fresh food, and the majority of participants were satisfied with their experience. Participants reported a significant increase in the number of vegetables present in the household and the frequency of family meals. The frequency of eating out decreased significantly, especially at fast-food restaurants. Participants also reported an increase in the amount and variety of produce consumed. However, health assessment data did not show significant changes in dietary intake, health status or BMI.Conclusions: CSA participation was associated with improvement in some aspects of the household environment and dietary behaviours. Further research is needed to determine whether employer-based CSA interventions may also lead to improvements in dietary intake and health. [ABSTRACT FROM AUTHOR]

The article reviews an investigation published in a 2015 issue of the "American Journal of Health Behavior" that examined whether regulatory focus and proximity to weight moderated the effectiveness of a weight-loss maintenance intervention. Topics include the finding that maintenance of weight loss may be enhanced by tailoring treatments to regulatory focus and goal weight. Also mentioned is regulatory focus theory proposing two self-regulatory orientations of promotion and prevention foci.

Background: Research suggests that the interaction between biological susceptibility and environmental risk is complex and that further study of behavioral typologies related to obesity and associated behaviors is important to further elucidate the nature of obesity risk and how to approach it for intervention. The current investigation aims to identify phenotypical lifestyle patterns that might begin to unify our understanding of obesity and obesity related behaviors. Methods: Individuals who had recently lost substantial weight of their own initiative completed measures of intentional weight control behaviors and lifestyle behaviors associated with eating. These behaviors were factor analyzed and the resulting factors were examined in relation to BMI, recent weight loss, diet, and physical activity. Results: Four meaningful lifestyle and weight control behavioral factors were identified--regularity of meals, TV related viewing and eating, intentional strategies for weight control, and eating away from home. Greater meal regularity was associated with greater recent weight loss and greater fruit and vegetable intake. Greater TV related viewing and eating was associated with greater BMI and greater fat and sugar intake. More eating away from home was related to greater fat and sugar intake, lower fruit and vegetable intake, and less physical activity. Greater use of weight control strategies was most consistently related to better weight, diet, and physical activity outcomes. Conclusions: Compared to the individual behavior variables, the identified lifestyle patterns appeared to be more reliably related to diet, physical activity, and weight (both BMI and recent weight loss). These findings add to the growing body of literature identifying behavioral patterns related to obesity and the overall weight control strategy of eating less and exercising more. In future research it will be important to replicate these behavioral factors (over time and in other samples) and to examine how changes in these factors relate to weight loss and weight maintenance over time. [ABSTRACT FROM AUTHOR]

Objectives: To assess the correlates of parental classification of adolescent weight status. Methods: Measured adolescent weight status was compared to parent self-report perception data (n=374 dyads) using multivariate analyses with interactions to identify characteristics associated with inaccurate parent classification of adolescent weight status. Results: Adolescent weight status was underestimated by 31% of parents. College-educated parents were more likely to underestimate the weight of their male adolescents (OR=1.95) and overweight adolescents (OR=4.0). Non-college-educated parents were 8.92 times as likely to misclassify overweight adolescents, regardless of the sex of the child. Conclusions: Parental perception may play a role in supporting adolescent's healthy weight-related behaviors. [ABSTRACT FROM AUTHOR]

Objectives: To build upon state-of- the-art theory and empirical data to estimate the strength of multiple mediators of the efficacious Keep Active Minnesota (KAM) physical activity (PA) maintenance intervention. Methods: The total, direct, and indirect effects through which KAM helped randomized participants (KAM n=523; UC n=526) maintain moderate or vigorous PA (MVPA) for up to 2 years were estimated using structural equation modeling. Results: Multiple mediators explained half (β=.052, P=.13) of the effect of KAM on MVPA (β=.105, P=.004). Self-efficacy was the upstream variable in 2 endogenously mediated effects, and the self-concept mediator emerged as the strongest predictor of MVPA. Conclusions: KAM positively impacted self-efficacy, which was associated with PA enjoyment, integration into the self-concept, and PA maintenance. Successful long-term PA maintenance appears to be influenced by multiple small interrelated mediational pathways. Future research evaluating maintenance models should specify recursive relationships among mediators and outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the efficacy at 6-, 12-, and 24-month follow-up of Keep Active Minnesota (KAM), a telephone and mail-based intervention designed to promote physical activity (PA) maintenance among currently active adults age 50 to 70. Method: Participants who reported having recently increased their MVPA to a minimum of 2d/wk, 30min/bout, (N =1049) were recruited in 2004 and 2005 from one large managed care organization in Minnesota, and randomly assigned to either treatment (KAM; N =523), or Usual Care (UC; N =526) with PA assessed using the CHAMPS questionnaire, and expressed as kcal/wk energy expenditure. Results: We find a sustained, significant benefit of the intervention at 6, 12 and 24months. kcal/wk expenditure in moderate or vigorous activities was higher at 6 (p <.03, Cohen''s d 6m =.16), 12 (p <.04, d 12m =.13) and 24months (p <.01, d 24m =.16) for KAM participants, compared to UC participants. Conclusions: The KAM telephone- and mail-based PA maintenance intervention was effective at maintaining PA in both the short-term (6months) and longer-term (12 and 24months) relative to usual care. [Copyright &y& Elsevier]

Although a considerable body of evidence supports telephone quit lines for smoking cessation, much less is known about the effectiveness of proactive Telephone Counseling with smokeless tobacco (ST) users. We conducted a randomized controlled trial comparing Telephone Counseling with the distribution of a self-help manual for ST cessation. We recruited 406 adult ST users throughout the state of Minnesota and randomized them to receive either: (a) a self-help manual (Manual only) or (b) a self-help manual plus proactive telephone-based cessation counseling (Telephone Counseling). The telephone-based treatment included up to four calls in support of quitting, and personalized various cognitive and behavioral strategies that are generally considered effective in tobacco cessation (such as setting a quit date, examining patterns of use, developing stress reduction skills, avoiding known triggers to use). Participants were surveyed by phone at 3 and 6 months to assess both point prevalence and continued abstinence. Prolonged abstinence from all tobacco was 6.8% and 30.9% (p<.001) at 3 months and 9.8% and 30.9% (p<.001) at 6 months in Manual only and Telephone Counseling, respectively. We found older age, lower dependency, and increased readiness predicted quitting success. Proactive telephone-based counseling is an effective strategy for improving cessation rates among ST users. Future research should determine the components contributing to the intervention success. [ABSTRACT FROM AUTHOR]

Background: Since many individuals who initiate physical activity programs are highly likely to return to a sedentary lifestyle, innovative strategies to efforts to increase the number of physically active older adults who successfully maintain beneficial levels of PA for a substantial length of time are needed. Methods/Design: The Keep Active Minnesota Trial is a randomized controlled trial of an interactive phone- and mail-based intervention to help 50-70 year old adults who have recently increased their physical activity level, maintain that activity level over a 24-month period in comparison to usual care. Baseline, 6, 12, and 24 month measurement occurred via phone surveys with kilocalories expended per week in total and moderate-to-vigorous physical activity (CHAMPS Questionnaire) as the primary outcome measures. Secondary outcomes include hypothesized mediators of physical activity change (e.g., physical activity enjoyment, self-efficacy, physical activity self-concept), body mass index, and depression. Seven day accelerometry data were collected on a sub-sample of participants at baseline and 24-month follow-up. Discussion: The Keep Active Minnesota study offers an innovative approach to the perennial problem of physical activity relapse; by focusing explicitly on physical activity maintenance, the intervention holds considerable promise for modifying the typical relapse curve. Moreover, if shown to be efficacious, the use of phone- and mail-based intervention delivery offers potential for widespread dissemination. Trial registration: ClinicalTrials.gov Identifier: NCT00283452. [ABSTRACT FROM AUTHOR]

Objective. To examine the beliefs, attitudes and health-seeking behavior surrounding the use of traditional medicine among the Karen (refugees from Burma). Methods. Three focus groups and two key-informant interviews were conducted with the Karen along with observations by researchers. Results. The Karen continue to use elements of their traditional healthcare system after resettling in the U.S. Accessibility and perceived efficacy of treatments influence their health-seeking behavior. The participants discussed beliefs about health and healing, spirituality, and their experience as refugees. Implications for improving the quality of healthcare for the Karen and recommendations for further research are discussed. [ABSTRACT FROM AUTHOR]

Abstract: Objective. : We evaluate the 6-month efficacy of Keep Active Minnesota, a phone- and mail-based physical activity maintenance intervention designed for use with adults age 50 to 70 years who have increased their physical activity within the past year. Method. : Participants (N =1049) recruited in 2004 and 2005 from one large managed-care organization in Minnesota were randomly assigned to either treatment (N =523) or usual care (N =526) with physical activity assessed using the Community Healthy Activities Model Program for Seniors questionnaire, and expressed as kcal/week expenditures. Results. : Total physical activity at baseline was similar for treatment and usual care participants (p <0.44) as was moderate/vigorous physical activity (p <0.21). Maintenance of physical activity was higher among treatment participants whose mean 6-month change in total kcal/week energy expenditure was −91, compared to −683 for usual care participants (p <0.002). Mean 6-month change in kcal/week expenditure in moderate or vigorous activities was −49 for treatment participants, compared to −612 for usual care participants (p <0.001). Conclusions. : This phone- and mail-based physical activity maintenance intervention is efficacious at maintaining physical activity at 6 months. [Copyright &y& Elsevier]

The article discusses the tool kit that enhances participants receive information regarding community-engaged pediatric research. Topics include concern on low health literacy skills which influence health related decisions, evaluation on behavior change in young children, and explanation guide regarding the research study.

Objective. To investigate the relationship between binge eating behavior and weight loss maintenance over a two-year period in adults. Design. Secondary data analysis using the Keep It Off study, a randomized trial evaluating an intervention to promote weight loss maintenance. Participants. 419 men and women (ages: 20 to 70 y; BMI: 20-44 kg/m2) who had intentionally lost ⩾10% of their weight during the previous year. Measurements. Body weight was measured and binge eating behavior over the past 6 months was reported at baseline, 12months and 24 months.Height was measured at baseline. Results. Prevalence of binge eating at baseline was 19.4% (n = 76). Prevalence of binge eating at any time point was 30.1% (n = 126). Although rate of weight regain did not differ significantly between those who did or did not report binge eating at baseline, binge eating behavior across the study period (additive value of presence or absence at each time point) was significantly associated with different rates of weight regain. Conclusion. Tailoring weight loss maintenance interventions to address binge eating behavior is warranted given the prevalence and the different rates of weight regain experienced by those reporting this behavior. [ABSTRACT FROM AUTHOR]