28 results on '"Kathryn Brogan-Hartlieb"'
Search Results
2. Identifying Effective Motivational Interviewing Communication Sequences Using Automated Pattern Analysis.
- Author
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Mehedi Hasan, April Idalski Carcone, Sylvie Naar, Susan Eggly, Gwen L. Alexander, Kathryn Brogan Hartlieb, and Alexander Kotov 0001
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- 2019
- Full Text
- View/download PDF
3. A study of the effectiveness of machine learning methods for classification of clinical interview fragments into a large number of categories.
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Mehedi Hasan, Alexander Kotov 0001, April Idalski Carcone, Ming Dong 0001, Sylvie Naar, and Kathryn Brogan Hartlieb
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- 2016
- Full Text
- View/download PDF
4. Tailored motivational interviewing (TMI): Translating basic science in skills acquisition into a behavioral intervention to improve community health worker motivational interviewing competence for youth living with HIV
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J. Dennis Fortenberry, Amy L. Pennar, Bo Wang, Kathryn Brogan-Hartlieb, and Sylvie Naar
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Community Health Workers ,Gerontology ,Adolescent ,Multilevel model ,Psychological intervention ,Motivational interviewing ,MEDLINE ,HIV Infections ,Pilot Projects ,Motivational Interviewing ,PsycINFO ,Psychiatry and Mental health ,Behavior Therapy ,Intervention (counseling) ,Community health ,Humans ,Psychology ,Competence (human resources) ,Applied Psychology ,Aged - Abstract
Objective: Interventions to promote evidence-based practices are particularly needed for paraprofessional staff working with minority youth with HIV who have higher rates of HIV infection but lower rates of linkage and retention in care compared to older adults. Utilizing the ORBIT model for behavioral intervention development, we defined and refined a behavioral intervention for providers, Tailored Motivational Interviewing (TMI), to improve provider competence in previous studies (Phase 1a and 1b). The current study focuses on ORBIT Phase 2a-proof of concept. We hypothesized that TMI would be acceptable and feasible and would show a signal of efficacy of improving and maintaining community health worker (CHW) MI competence scores using an innovative statistical method for small N proof-of-concept studies. Method: Longitudinal data were collected from 19 CHWs at 16 youth HIV agencies. CHWs from 8 sites were assigned to the TMI group per the cofunders request. The remaining 8 sites were randomly assigned to TMI or services as usual. MI competence was assessed at baseline and up to 15 times over 2 years. Random coefficient models were utilized to examine time trajectories of competence scores and the impact of the intervention on competence trajectories. Semistructured interviews were conducted to determine barriers and facilitators of TMI. Results: Competence scores in the TMI group significantly increased while the scores of the control group significantly decreased. Further analysis of the intervention group demonstrated that scores significantly increased during the first 3 months after initial workshop and was sustained through the end of the study. Qualitative findings revealed insufficient time and competing priorities as perceived barriers whereas integrating MI into routine agency practices and ongoing training might facilitate implementation. Conclusions: Following a successful proof-of-concept, the next step is a fully randomized pilot study of TMI relative to a control condition in preparation for a stepped-wedge cluster randomized full scale trial. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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- 2021
5. Interpretable Probabilistic Latent Variable Models for Automatic Annotation of Clinical Text.
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Alexander Kotov 0001, Mehedi Hasan, April Idalski Carcone, Ming Dong 0001, Sylvie Naar-King, and Kathryn Brogan Hartlieb
- Published
- 2015
6. Advanced Patient-Centered Communication for Health Behavior Change: Motivational Interviewing Workshops for Medical Learners
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Kathryn Brogan Hartlieb, Brett Engle, Vivian Obeso, Maryse A. Pedoussaut, Lisa J. Merlo, and David R. Brown
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Motivational Interviewing ,Health Behavior Change Conversations ,Advanced Communication Skills ,Medicine (General) ,R5-920 ,Education - Abstract
Abstract Introduction Medical settings are critical access points for behavior change counseling, and lifestyle behavior change is considered a key component of chronic disease management. The Association of American Medical Colleges recommends that future physicians be competent in shared decision making and patient-centered behavioral guidance to prevent illness and improve patient self-management of chronic disease. Motivational interviewing (MI) is a patient-centered, directive method of communication to enhance behavior change. Specific teachable strategies underlie the collaborative MI communication style that aims to reduce discord and build motivation for change. Methods We present our three-session 12-hour MI curriculum as an advanced form of patient-centered communication. Each session includes presession assignment, large-group interactive lecture, and small-group activities for practice. An interdisciplinary team consisting of medical educators and health behavior change research-educators who are also members of the Motivational Interviewing Network of Trainers created the submission. The purpose of this resource is to provide medical educators with a short curriculum that incorporates materials and learning activities to promote skill in MI. Results In addition to positive feedback from student evaluations including the areas of relevance to training and self-rated skills improvement, preliminary pre- and posttraining scores from the medical students show significant improvement in expression of empathy and the ratio of reflections to questions. Discussion Implementation of the curriculum allows learners the opportunity to practice evidence-based communication that promotes intrinsic motivation for health behavior change in patients, a key treatment focus in chronic disease management.
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- 2016
- Full Text
- View/download PDF
7. Developing Machine Learning Models for Behavioral Coding
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Karen MacDonell, Mehedi Hasan, Alexander Kotov, Ming Dong, Sylvie Naar, Kathryn Brogan Hartlieb, Susan Eggly, April Idalski Carcone, and Gwen L. Alexander
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Male ,Support Vector Machine ,Adolescent ,Computer science ,Motivational interviewing ,Poison control ,Context (language use) ,Motivational Interviewing ,Machine learning ,computer.software_genre ,Session (web analytics) ,Machine Learning ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Developmental and Educational Psychology ,eHealth ,Humans ,0501 psychology and cognitive sciences ,mHealth ,Qualitative Research ,business.industry ,Communication ,05 social sciences ,Reproducibility of Results ,Professional-Patient Relations ,Support vector machine ,Statistical classification ,Pediatrics, Perinatology and Child Health ,Female ,Artificial intelligence ,business ,computer ,Behavioral Research ,Regular Articles ,050104 developmental & child psychology - Abstract
OBJECTIVE: The goal of this research is to develop a machine learning supervised classification model to automatically code clinical encounter transcripts using a behavioral code scheme. METHODS: We first evaluated the efficacy of eight state-of-the-art machine learning classification models to recognize patient–provider communication behaviors operationalized by the motivational interviewing framework. Data were collected during the course of a single weight loss intervention session with 37 African American adolescents and their caregivers. We then tested the transferability of the model to a novel treatment context, 80 patient–provider interactions during routine human immunodeficiency virus (HIV) clinic visits. RESULTS: Of the eight models tested, the support vector machine model demonstrated the best performance, achieving a .680 F1-score (a function of model precision and recall) in adolescent and .639 in caregiver sessions. Adding semantic and contextual features improved accuracy with 75.1% of utterances in adolescent and 73.8% in caregiver sessions correctly coded. With no modification, the model correctly classified 72.0% of patient–provider utterances in HIV clinical encounters with reliability comparable to human coders (k = .639). CONCLUSIONS: The development of a validated approach for automatic behavioral coding offers an efficient alternative to traditional, resource-intensive methods with the potential to dramatically accelerate the pace of outcomes-oriented behavioral research. The knowledge gained from computer-driven behavioral research can inform clinical practice by providing clinicians with empirically supported communication strategies to tailor their conversations with patients. Lastly, automatic behavioral coding is a critical first step toward fully automated eHealth/mHealth (electronic/mobile Health) behavioral interventions.
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- 2019
8. 'eatNplay' - a rurally-tailored, family-based, telehealth intervention for childhood obesity: Protocol for a mixed-methods randomized newsletter controlled pilot study
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Britney Arce, Allisandra G. Kummer, Lilian Golzarri-Arroyo, Stephanie L. Dickinson, Wasantha Jayawardene, Kathryn Brogan Hartlieb, Mary Lynn Davis-Ajami, Myles S. Faith, and Courtney O. Olcott
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medicine.medical_specialty ,Pediatric Obesity ,business.industry ,Motivational interviewing ,Peer group ,Pilot Projects ,General Medicine ,Telehealth ,medicine.disease ,Childhood obesity ,Telemedicine ,Family medicine ,Intervention (counseling) ,Child, Preschool ,Health care ,medicine ,Quality of Life ,Humans ,Pharmacology (medical) ,Thematic analysis ,business ,Child ,Curriculum ,Exercise ,Randomized Controlled Trials as Topic - Abstract
Background Childhood obesity disproportionately affects rural communities where access to pediatric weight control services is limited. Telehealth may facilitate access to these services. Objective This paper describes the rationale, curriculum, and methodology for conducting a randomized controlled pilot trial of a rural, family-based, telehealth intervention that aims to improve weight-related behaviors among children, compared to monthly newsletters. Methods A mixed-methods randomized design will randomly assign 44 rural families with one or more children aged 5 to 11 years identified as overweight or obese to an intervention or newsletter control group. The intervention group will attend ‘eatNplay’ group videoconferencing telehealth sessions, conducted weekly by a registered nurse and a motivational interviewing expert, to discuss diet, exercise, sleep, and peer group influences. The control group will receive newsletters covering these topics. Outcome measures at baseline, 12, and 26 weeks will assess 1) participant engagement and satisfaction with ‘eatNplay’; 2) child's BMI, dietary behavior, physical activity, and sleep behavior; and 3) parent/guardians' self-reported beliefs, behaviors, attitudes, perceived stress, and perceived quality of life. Analyses will employ 1) thematic analysis of semi-structured parent/guardian interviews after follow-up to help refine the intervention (e.g., curriculum), and 2) linear mixed models to compare outcomes between groups pre- and post-intervention and reduce bias from unobserved variables. Results of this pilot study could refine methodology for conducting telehealth studies, acceptability of healthcare provider-involved recruitment, interdisciplinary team approach, and addressing childhood obesity in rural communities through telehealth.
- Published
- 2021
9. African American Adolescent-Caregiver Relationships in a Weight Loss Trial
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Kai-Lin C Jen, Kathryn Brogan Hartlieb, Phillippe B. Cunningham, Deborah A. Ellis, Sylvie Naar-King, Kimberly Campbell-Voytal, and Angela J. Jacques-Tiura
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0301 basic medicine ,African american ,Persistence (psychology) ,030109 nutrition & dietetics ,media_common.quotation_subject ,Psychological intervention ,030209 endocrinology & metabolism ,Article ,Developmental psychology ,03 medical and health sciences ,0302 clinical medicine ,Weight loss ,Weight loss interventions ,Developmental and Educational Psychology ,medicine ,Behavioral interventions ,Thematic analysis ,medicine.symptom ,Life-span and Life-course Studies ,Psychology ,Autonomy ,media_common - Abstract
Successful family-based weight loss interventions for African American adolescents are rare. Parent-adolescent interactions supporting adoption of healthier nutrition and physical activity practices are not well understood. African American caregivers' and adolescents' perspectives on how they worked together to achieve weight loss need further exploration. This study describes the relationships experienced by adolescents and caregivers during the 6-month, evidence-based FIT Families weight loss trial and explores differences between families whose adolescents were successful and unsuccessful with weight loss. Exit interviews conducted with 136 adolescents (age 12–16 years; BMI percentile ≥95) and their caregivers (primarily mothers) were taped and transcribed verbatim. Content and thematic analysis was conducted to explore differences between groups stratified by weight loss. Five adolescent-caregiver relationship patterns emerged which describe dyads working together, working alone, working against each other; caregiver support and caregiver working on self. When relationship patterns were compared between groups stratified by weight loss, three themes emerged: motivation, support, and persistence. Families that achieved the greatest weight loss referred more often to working together to reach weight loss goals, attributed their success to adolescent self-motivation, with engaged caregiver support which allowed families to persist in change efforts. Family relationships involving adolescent autonomy, engaged parental support, and persistence despite challenges, clustered differently among adolescents who were successful at weight loss compared to those who were not. Interventionists trained to reinforce effective adolescent-parent interactions will advance behavioral interventions for families who have typically benefited least in prior interventions.
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- 2017
10. Individual, social and environmental predictors of physical activity in severe to morbid obese African American adolescents
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Deborah A. Ellis, Kathryn Brogan-Hartlieb, Sylvie Naar-King, Jeffrey J. Martin, Kai-Lin Catherine Jen, and Angela J. Jacques-Tiura
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African american ,self-esteem ,lcsh:Sports ,obesity ,minority ,Family support ,Physical activity ,Aerospace Engineering ,030209 endocrinology & metabolism ,health ,Variance (accounting) ,Developmental psychology ,03 medical and health sciences ,Social support ,lcsh:GV557-1198.995 ,0302 clinical medicine ,Walkability ,030212 general & internal medicine ,adolescents ,lcsh:Sports medicine ,Psychology ,lcsh:RC1200-1245 ,Value (mathematics) ,human activities ,Clinical psychology - Abstract
The purpose of this study was to predict low, moderate, hard and very hard physical activity (PA) and walking/biking/jogging based PA. One-hundred and fifty-nine severe to morbid obese African-American adolescents participated. We predicted 8% of the variance in hard PA largely due to family support and 10% of the variance in very hard PA due to other support (e.g. counselor) and having home PA equipment. We also predicted 10% of the variance in walking/biking/jogging due to the walkability of the neighborhood. Our findings support the value of social support and environmental supports in helping obese African American adolescents increase PA.
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- 2016
11. Motivational Interviewing to Increase Physical Activity in Underserved Women
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Ramona Benkert, Nancy George, Jean Cederna, Margaret L. Falahee, and Kathryn Brogan Hartlieb
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Advanced and Specialized Nursing ,Low income ,medicine.medical_specialty ,business.industry ,Physical activity ,Motivational interviewing ,Primary care ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Pulse rate ,Chronic disease ,Physical therapy ,Medicine ,030212 general & internal medicine ,business - Abstract
Regular physical activity (PA) has been shown to reduce the risk of chronic illness. Motivational Interviewing (MI) is an evidence-based practice known to improve PA in low-income women. In this project, 12 low-income women participated in 3 MI interviews oriented toward increasing PA. Of the women who consistently engaged in MI, 43% engaged in PA for 8 weeks. Women also demonstrated significant increases in confidence to engage in PA and a downward trend in pulse rate. MI offers an effective communication pattern for patients and providers interested in working together toward successful chronic disease management.
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- 2016
12. Outcomes From a Sequential Multiple Assignment Randomized Trial of Weight Loss Strategies for African American Adolescents With Obesity
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Kathryn Brogan Hartlieb, Angela J. Jacques-Tiura, April Idalski Carcone, Sylvie Naar, K-L Cathy Jen, Thomas N. Templin, Phillippe B. Cunningham, and Deborah A. Ellis
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Gerontology ,Male ,Pediatric Obesity ,Adolescent ,Psychological intervention ,Motivational interviewing ,Contingency management ,Motivational Interviewing ,Overweight ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Weight loss ,law ,Behavior Therapy ,030225 pediatrics ,Outcome Assessment, Health Care ,Weight Loss ,Medicine ,Humans ,030212 general & internal medicine ,Child ,General Psychology ,business.industry ,medicine.disease ,Obesity ,Clinical trial ,Black or African American ,Weight Reduction Programs ,Psychiatry and Mental health ,Female ,medicine.symptom ,business ,Regular Articles - Abstract
BackgroundMinority adolescents are at highest risk for obesity and extreme obesity; yet, there are few clinical trials targeting African American adolescents with obesity.PurposeThe purpose of the study was to develop an adaptive family-based behavioral obesity treatment for African American adolescents using a sequential multiple assignment randomized trial (SMART) design.MethodsFit Families was a SMART where 181 African American adolescents (67% female) aged 12–17 were first randomized to office-based versus home-based behavioral skills treatment delivered from a Motivational Interviewing foundation. After 3 months, nonresponders to first phase treatment were rerandomized to continued home-based behavioral skills treatment or contingency management with voucher-based reinforcement for adolescent weight loss and for caregiver adherence to the program. All interventions were delivered by community health workers. The primary outcome was treatment retention and percent overweight.ResultsAll adolescents reduced percent overweight by −3.20%; there were no significant differences in percent overweight based on treatment sequence. Adolescents receiving home-based delivery in Phase 1 and contingency management in Phase 2 completed significantly more sessions than those receiving office-based treatment and continued skills without CM (M = 8.03, SD = 3.24 and M = 6.62, SD = 2.95, respectively). The effect of contingency management was strongest among older and those with lower baseline confidence. Younger adolescents experienced greater weight reductions when receiving continued skills (−4.90% compared with −.02%).ConclusionsBehavioral skills training can be successfully delivered to African American adolescents with obesity and their caregivers by community health workers when using a home-based service model with incentives. More potent interventions are needed to increase reductions in percent overweight and may need to be developmentally tailored for younger and older adolescents.
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- 2019
13. Exploring ambivalence in motivational interviewing with obese African American adolescents and their caregivers: A mixed methods analysis
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Luke Thominet, Sylvie Naar, Ellen Barton, April Idalski Carcone, Kathryn Brogan Hartlieb, and Susan Eggly
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Male ,Adolescent ,media_common.quotation_subject ,Motivational interviewing ,Motivational Interviewing ,Ambivalence ,Article ,03 medical and health sciences ,0302 clinical medicine ,Weight loss ,030225 pediatrics ,Weight Loss ,medicine ,Humans ,Obesity ,030212 general & internal medicine ,media_common ,Self-efficacy ,Teamwork ,Behavior change ,General Medicine ,Self Efficacy ,Black or African American ,Weight Reduction Programs ,Caregivers ,Categorization ,Adolescent Behavior ,Content analysis ,Female ,medicine.symptom ,Psychology ,Clinical psychology - Abstract
Objective We conducted an exploratory mixed methods study to describe the ambivalence African-American adolescents and their caregivers expressed during motivational interviewing sessions targeting weight loss. Methods We extracted ambivalence statements from 37 previously coded counseling sessions. We used directed content analysis to categorize ambivalence related to the target behaviors of nutrition, activity, or weight. We compared adolescent-caregiver dyads’ ambivalence using the paired sample t -test and Wilcoxon signed-rank test. We then used conventional content analysis to compare the specific content of adolescents’ and caregivers’ ambivalence statements. Results Adolescents and caregivers expressed the same number of ambivalence statements overall, related to activity and weight, but caregivers expressed more statements about nutrition. Content analysis revealed convergences and divergences in caregivers’ and adolescents’ ambivalence about weight loss. Conclusion Understanding divergences in adolescent-caregiver ambivalence about the specific behaviors to target may partially explain the limited success of family-based weight loss interventions targeting African American families and provides a unique opportunity for providers to enhance family communication, foster teamwork, and build self-efficacy to promote behavior change. Practice implications Clinicians working in family contexts should explore how adolescents and caregivers converge and diverge in their ambivalence in order to recommend weight loss strategies that best meet families’ needs.
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- 2016
14. Identifying Effective Motivational Interviewing Communication Sequences Using Automated Pattern Analysis
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April Idalski Carcone, Mehedi Hasan, Susan Eggly, Gwen L. Alexander, Alexander Kotov, Kathryn Brogan Hartlieb, and Sylvie Naar
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Motivational interviewing ,Health Informatics ,Computational intelligence ,Context (language use) ,computer.software_genre ,Health informatics ,Article ,03 medical and health sciences ,0302 clinical medicine ,Artificial Intelligence ,030225 pediatrics ,0501 psychology and cognitive sciences ,Empirical evidence ,Hidden Markov model ,business.industry ,05 social sciences ,Behavior change ,Codebook ,Computer Science Applications ,Artificial intelligence ,business ,Psychology ,computer ,Natural language processing ,050104 developmental & child psychology ,Information Systems - Abstract
Motivational interviewing (MI) is an evidence-based strategy for communicating with patients about behavior change. Although there is strong empirical evidence linking “MI-consistent” counselor behaviors and patient motivational statements (i.e., “change talk”), the specific counselor communication behaviors effective for eliciting patient change talk vary by treatment context and, thus, are a subject of ongoing research. An integral part of this research is the sequential analysis of pre-coded MI transcripts. In this paper, we evaluate the empirical effectiveness of the Hidden Markov Model, a probabilistic generative model for sequence data, for modeling sequences of behavior codes and closed frequent pattern mining, a method to identify frequently occurring sequential patterns of behavior codes in MI communication sequences to inform MI practice. We conducted experiments with 1,360 communication sequences from 37 transcribed audio recordings of weight loss counseling sessions with African-American adolescents with obesity and their caregivers. Transcripts had been previously annotated with patient-counselor behavior codes using a specialized codebook. Empirical results indicate that Hidden Markov Model and closed frequent pattern mining techniques can identify counselor communication strategies that are effective at eliciting patients’ motivational statements to guide clinical practice.
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- 2018
15. African-American Adolescents' Weight Loss Skills Utilization: Effects on Weight Change in a Sequential Multiple Assignment Randomized Trial
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Angela J. Jacques-Tiura, Deborah A. Ellis, April Idalski Carcone, Sylvie Naar, Kathryn Brogan Hartlieb, Elizabeth K. Towner, Thomas N. Templin, and K.-L. Catherine Jen
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Male ,medicine.medical_specialty ,Adolescent ,education ,Motivational interviewing ,Psychological intervention ,Motivational Interviewing ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Weight loss ,Behavior Therapy ,030225 pediatrics ,Surveys and Questionnaires ,Weight Loss ,medicine ,Humans ,030212 general & internal medicine ,Obesity ,Goal setting ,business.industry ,Weight change ,Public Health, Environmental and Occupational Health ,Attendance ,medicine.disease ,Black or African American ,Psychiatry and Mental health ,Pediatrics, Perinatology and Child Health ,Physical therapy ,Female ,medicine.symptom ,business - Abstract
OBJECTIVE: Successful weight loss interventions for African-Americans adolescents are lacking. Cognitive-behavioral interventions seek to develop weight loss skills (e.g., counting calories, goal setting, managing one’s environment). Little is known about how well adolescents implement such skills in their daily lives. Study aims were to (1) examine weight loss skills utilization at midpoint and end of a 6-month cognitive-behavioral/motivational interviewing weight loss sequential multiple assignment randomized trial (SMART), and (2) determine if greater skill utilization predicted weight loss at treatment end and 3 months post-treatment. METHOD: One hundred and eighty six African-Americans adolescents with obesity and their caregiver were first randomly assigned to complete 3 months of cognitive-behavioral and motivational interviewing family-based weight loss treatment in their home or in the research office (Phase 1). Nonresponders (i.e., those who lost < 3% of initial weight, n = 161) were rerandomized to 3 months of continued skills training (n = 83) or contingency management (n = 78) for Phase 2; responders were allocated to 3 months of relapse prevention (n = 20). Adolescents’ frequency of weight loss skills utilization was assessed via questionnaire at treatment midpoint and end. RESULTS: Higher treatment attendance was associated with better skill utilization. Higher skill utilization was associated with more weight loss at treatment end, whereas higher baseline confidence was associated with more weight loss at follow-up. CONCLUSIONS: This study indicates the importance of attending weight loss intervention sessions to develop and strengthen weight loss skills in African-American adolescents with obesity, and strengthening confidence to use such skills for continued weight loss.
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- 2018
16. Motivational Interviewing in Adolescent Weight Management
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Ken Resnicow, Megan Ratcliff, and Kathryn Brogan Hartlieb
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Weight management ,Motivational interviewing ,Psychology ,Clinical psychology - Published
- 2017
17. Effectiveness of Nutrition Intervention in a Selected Group of Overweight and Obese African-American Preschoolers
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Kathryn Brogan Hartlieb, Yulyu Yeh, Cynthia A. Danford, and K-L. Catherine Jen
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Gerontology ,Dietary Fiber ,Male ,Parents ,medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,Pediatric Obesity ,Health (social science) ,Sociology and Political Science ,Nutrition Education ,Psychological intervention ,030209 endocrinology & metabolism ,Pilot Projects ,Overweight ,Childhood obesity ,Body Mass Index ,03 medical and health sciences ,Food Preferences ,0302 clinical medicine ,Patient Education as Topic ,medicine ,Early Intervention, Educational ,Humans ,030212 general & internal medicine ,Triglycerides ,Whole Grains ,business.industry ,Health Policy ,Public health ,Cholesterol, HDL ,Public Health, Environmental and Occupational Health ,Cholesterol, LDL ,medicine.disease ,Obesity ,Culturally Competent Care ,Black or African American ,Cholesterol ,Anthropology ,Head start ,Child, Preschool ,Female ,medicine.symptom ,business ,Body mass index - Abstract
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.
- Published
- 2017
18. From the Classroom to Entrustment - The Development of Motivational Interviewing Skills as an Entrustable Professional Activity
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Brett Engle, Kathryn Brogan-Hartlieb, Vivian T. Obeso, Maryse Pedoussaut, Michelle M. Hospital, Carla S. Lupi, Karin C. Esposito, and David R. Brown
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Medical education ,Motivational interviewing ,Psychology ,Professional activity - Abstract
This article was migrated. The article was marked as recommended. IntroductionThe move towards value-based care and population health has highlighted the prominent role of social and behavioral factors in determining health outcomes. Patient-centered behavioral guidance to improve patient self-management is recognized as an evidence-based intervention for a variety of chronic conditions but has yet to be adopted as a core competency or core entrustable professional activity (EPA). Motivational Interviewing (MI) is an evidence-based behavioral intervention involving an integrated set of competencies, featuring reflective listening, affirmation, evocation, and collaborative planning. An MI encounter is an observable, discrete task that can be framed as an EPA. Successful implementation of EPAs in the workplace requires institutional engagement, a thoughtful curricular approach, faculty development, and feasible, valid workplace-based assessment (WBA).MethodsWe implemented competency-based MI training and assessed competency outcomes for students and faculty. After joining the Association of American Medical Colleges Core EPA Pilot, we applied an iterative group process to develop an EPA and workplace-based assessment based on established MI competencies.ResultsDrawing upon nine years of developing MI curriculum, we present competency data for a student training study and a faculty coaching study, describe how we transitioned training from the classroom to the clinical setting employing an EPA framework, and present a one-page schematic and related WBA for an EPA based on MI.ConclusionWe propose that MI is a core EPA for future physicians practicing value-based care, and offer a roadmap for curriculum implementation.
- Published
- 2019
19. A comparison of snack serving sizes to USDA guidelines in healthy weight and overweight minority preschool children enrolled in Head Start
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Andrea Charvet, K.-L. Catherine Jen, Kathryn Brogan Hartlieb, and Yulyu Yeh
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0301 basic medicine ,medicine.medical_specialty ,Pediatrics ,Epidemiology ,Endocrinology, Diabetes and Metabolism ,Physical Therapy, Sports Therapy and Rehabilitation ,Overweight ,Food group ,03 medical and health sciences ,Serving size ,Environmental health ,medicine ,USDA ,Children ,2. Zero hunger ,Minority ,030109 nutrition & dietetics ,Snacking ,business.industry ,Health Policy ,Public health ,digestive, oral, and skin physiology ,Public Health, Environmental and Occupational Health ,food and beverages ,Secondary data ,Head Start ,medicine.disease ,Obesity ,Head start ,Snack ,medicine.symptom ,business ,Research Article - Abstract
Background Obesity disproportionately affects children from low-income families and those from racial and ethnic minorities. The relationship between snacking and weight status remains unclear, although snacking is known to be an important eating episode for energy and nutrient intake particularly in young children. The purpose of this pilot study was to examine the snack intake of minority preschool children enrolled in the Head Start Program in four centers in Detroit, Michigan, and investigate differences by child weight status. Methods This secondary data analysis used snack time food observation and anthropometric data from a convenience sample of 55 African American children (44 % girls, mean age = 3.8 years). Snack intake data was obtained over a mean of 5 days through direct observation of children by dietetic interns, and later converted into food group servings according to the United States Department of Agriculture (USDA) meal patterns and averaged for each child. Height and weight measurements were systematically collected and BMI-for-age percentiles were used to classify children into weight categories. One sample, paired samples and independent samples t-tests were performed to test for differences within and between means. Results Based on BMI-for-age percentiles, 72.7 % of the sample was under/healthy weight and 27.3 % was overweight/obese. Average (mean ± SD) intake of milk (0.76 ± 0.34) and overall fruits/vegetables (0.77 ± 0.34) was significantly lower than one USDA serving, while average intake of grains and breads (2.04 ± 0.89), meat/meat alternates (2.20 ± 1.89) and other foods (1.43 ± 1.08) was significantly higher than one USDA serving (p ≤ 0.05). Children ate more when offered canned versus fresh fruits (0.93 ± 0.57 vs. 0.65 ± 0.37, p = 0.007). Except for a significantly higher milk intake in the overweight/obese group compared to the under/healthy weight group (0.86 ± 0.48 vs. 0.72 ± 0.27, p = 0.021], no relationship was found between snack food intake and weight category. Only in the overweight/obese group was the intake of milk and fresh fruits not significantly different than one USDA serving. Conclusions Findings suggest that regardless of weight status low-income minority preschool children are consuming larger serving sizes when offered less healthy versus healthier snack foods. Continued efforts should be made to provide healthful snack foods at preschool settings to prevent obesity and promote healthier food habits.
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- 2016
20. Effective Patient-Provider Communication in Pediatric Obesity
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Kathryn Brogan Hartlieb, Tim Martin, April Idalski Carcone, Terrance L. Albrecht, and Angela J. Jacques-Tiura
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Counseling ,Male ,medicine.medical_specialty ,Pediatric Obesity ,Adolescent ,media_common.quotation_subject ,Motivational interviewing ,Child Welfare ,Motivational Interviewing ,Article ,03 medical and health sciences ,0302 clinical medicine ,Patient Education as Topic ,030225 pediatrics ,Health care ,medicine ,Humans ,Active listening ,030212 general & internal medicine ,skin and connective tissue diseases ,Child ,Curriculum ,media_common ,Medical education ,business.industry ,Behavior change ,Medical school ,Professional-Patient Relations ,Directive ,United States ,Pediatrics, Perinatology and Child Health ,Physical therapy ,Female ,sense organs ,business ,Autonomy ,Program Evaluation - Abstract
Effective patient-provider communication, although acknowledged as a key clinical skill and linked to better outcomes for patients, providers, and society as a whole, is not a primary focus of many medical schools’ curricula. Motivational Interviewing, or MI, is a patient-centered, directive communication framework appropriate for the health care setting with an ever growing empirical evidence base. Research on MI’s causal mechanisms has previously established patient change talk (motivational statements about behavior change) to be a mediator of behavior change. Current MI research is focused on identifying which provider communication skills are responsible for evoking change talk. MI recommends three core communication skills – informing, asking, and listening. A consistent evidence base is emerging for providers’ use of reflections (an active listening strategy). Our research provides evidence that asking for and reflecting patient change talk are effective communication strategies, but cautions providers to inform judiciously. In addition, our research indicates that supporting a patient's decision making autonomy is an important strategy to promote health behaviors.
- Published
- 2016
21. A study of the effectiveness of machine learning methods for classification of clinical interview fragments into a large number of categories
- Author
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Kathryn Brogan Hartlieb, Sylvie Naar, Alexander Kotov, Ming Dong, April Idalski Carcone, and Mehedi Hasan
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Conditional random field ,Support Vector Machine ,020205 medical informatics ,Computer science ,Word count ,Health Informatics ,02 engineering and technology ,Machine learning ,computer.software_genre ,Article ,Machine Learning ,03 medical and health sciences ,Naive Bayes classifier ,0302 clinical medicine ,0202 electrical engineering, electronic engineering, information engineering ,Feature (machine learning) ,030212 general & internal medicine ,AdaBoost ,Data Curation ,business.industry ,Deep learning ,Decision Trees ,Bayes Theorem ,Computer Science Applications ,Random forest ,Semantics ,Support vector machine ,ComputingMethodologies_PATTERNRECOGNITION ,Artificial intelligence ,business ,computer ,Natural language processing - Abstract
Display Omitted Feasibility assessment of automatic annotation of clinical text with large codebooks.Experiments with state-of-the-art classifiers and deep learning methods.Novel contextual and semantic features for annotation of clinical text.SVM with contextual and semantic features outperformed all other classifiers.Deep learning is not effective when the number of classes is large. This study examines the effectiveness of state-of-the-art supervised machine learning methods in conjunction with different feature types for the task of automatic annotation of fragments of clinical text based on codebooks with a large number of categories. We used a collection of motivational interview transcripts consisting of 11,353 utterances, which were manually annotated by two human coders as the gold standard, and experimented with state-of-art classifiers, including Naive Bayes, J48 Decision Tree, Support Vector Machine (SVM), Random Forest (RF), AdaBoost, DiscLDA, Conditional Random Fields (CRF) and Convolutional Neural Network (CNN) in conjunction with lexical, contextual (label of the previous utterance) and semantic (distribution of words in the utterance across the Linguistic Inquiry and Word Count dictionaries) features. We found out that, when the number of classes is large, the performance of CNN and CRF is inferior to SVM. When only lexical features were used, interview transcripts were automatically annotated by SVM with the highest classification accuracy among all classifiers of 70.8%, 61% and 53.7% based on the codebooks consisting of 17, 20 and 41 codes, respectively. Using contextual and semantic features, as well as their combination, in addition to lexical ones, improved the accuracy of SVM for annotation of utterances in motivational interview transcripts with a codebook consisting of 17 classes to 71.5%, 74.2%, and 75.1%, respectively. Our results demonstrate the potential of using machine learning methods in conjunction with lexical, semantic and contextual features for automatic annotation of clinical interview transcripts with near-human accuracy.
- Published
- 2016
22. Contingency management adapted for African-American adolescents with obesity enhances youth weight loss with caregiver participation: a multiple baseline pilot study
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Kathryn Brogan Hartlieb, Deborah A. Ellis, Sylvie Naar, Phillippe B. Cunningham, David M. Ledgerwood, Thomas Templin, and Bradley Donohue
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Gerontology ,030505 public health ,business.industry ,Public Health, Environmental and Occupational Health ,Psychological intervention ,Contingency management ,medicine.disease ,Affect (psychology) ,Obesity ,03 medical and health sciences ,0302 clinical medicine ,Multiple baseline design ,Weight loss ,Intervention (counseling) ,Pediatrics, Perinatology and Child Health ,medicine ,030212 general & internal medicine ,medicine.symptom ,0305 other medical science ,Baseline (configuration management) ,business - Abstract
Background:Contingency management (CM) interventions, which use operant conditioning principles to encourage completion of target behavioral goals, may be useful for improving adherence to behavioral skills training (BST). Research-to-date has yet to explore CM for weight loss in minority adolescents.Objective:To examine the effects of CM in improving adolescent weight loss when added to BST.Design:The study utilized an innovative experimental design that builds upon multiple baseline approaches as recommended by the National Institutes of Health.Participants/setting:Six obese African-American youth and their primary caregivers living in Detroit, Michigan, USA.Intervention:Adolescents received between 4 and 12 weeks of BST during a baseline period and subsequently received CM targeting weight loss.Main outcome measures:Youth weight.Statistical analysis performed:Linear mixed effects modeling was used in the analysis.Results:CM did not directly affect adolescent weight loss above that of BST (p=0.053). However, when caregivers were involved in CM session treatment, contingency management had a positive effect on adolescent weight loss. The estimated weight loss due to CM when caregivers also attended was 0.66 kg/week (pConclusion:This study demonstrates application of a novel experimental approach to intervention development and demonstrated the importance of parent involvement when delivering contingency management for minority youth weight loss. Lessons learned from contingency management program implementation are also discussed in order to inform practice.
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- 2015
23. Building Motivation in African American Caregivers of Adolescents With Obesity: Application of Sequential Analysis
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Ellen Barton, Angela J. Jacques-Tiura, Sylvie Naar, April Idalski Carcone, Kathryn Brogan Hartlieb, and Terrance L. Albrecht
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Counseling ,Male ,050103 clinical psychology ,Pediatric Obesity ,Adolescent ,media_common.quotation_subject ,education ,Motivational interviewing ,Medical classification ,Motivational Interviewing ,Sequential coding ,Overweight ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Developmental and Educational Psychology ,medicine ,Humans ,0501 psychology and cognitive sciences ,Child ,media_common ,African american ,05 social sciences ,medicine.disease ,Obesity ,Black or African American ,Caregivers ,Health Communication ,Pediatrics, Perinatology and Child Health ,Female ,medicine.symptom ,Psychology ,Social psychology ,Autonomy ,Regular Articles - Abstract
Objective We sought to examine communication between counselors and caregivers of adolescents with obesity to determine what types of counselor behaviors increased caregivers' motivational statements regarding supporting their child's weight loss. Methods We coded 20-min Motivational Interviewing sessions with 37 caregivers of African American 12-16-year-olds using the Minority Youth Sequential Coding for Observing Process Exchanges. We used sequential analysis to determine which counselor communication codes predicted caregiver motivational statements. Results Counselors' questions to elicit motivational statements and emphasis on autonomy increased the likelihood of both caregiver change talk and commitment language statements. Counselors' reflections of change talk predicted further change talk, and reflections of commitment language predicted more commitment language. Conclusions When working to increase motivation among caregivers of adolescents with overweight or obesity, providers should strive to reflect motivational statements, ask questions to elicit motivational statements, and emphasize caregivers' autonomy.
- Published
- 2015
24. Preference for Energy Dense Snack Foods in Healthy and Overweight Minority Preschool Children
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Andrea Charvet, Yulyu Yeh, Kathryn Brogan Hartlieb, and K-L. Catherine Jen
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Environmental health ,Energy (esotericism) ,Genetics ,medicine ,Food science ,Overweight ,medicine.symptom ,Psychology ,Molecular Biology ,Biochemistry ,Snack food ,Preference ,Biotechnology - Published
- 2015
25. Recruitment strategies and the retention of obese urban racial/ethnic minority adolescents in clinical trials: the FIT families project, Michigan, 2010-2014
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Deborah A. Ellis, Sharon Marshall, Kathryn Brogan Hartlieb, Angela J. Jacques-Tiura, Sylvie Naar-King, and Kai Lin Catherine Jen
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Gerontology ,Male ,medicine.medical_specialty ,Michigan ,Adolescent ,Urban Population ,Ethnic group ,Preventing Chronic Disease ,law.invention ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Weight Loss ,medicine ,Humans ,Family ,030212 general & internal medicine ,Obesity ,Minority Groups ,Retrospective Studies ,Original Research ,030505 public health ,Cognitive Behavioral Therapy ,business.industry ,4. Education ,Health Policy ,Public health ,Patient Selection ,Public Health, Environmental and Occupational Health ,Retention rate ,3. Good health ,Clinical trial ,Black or African American ,Informatics ,Income ,Female ,0305 other medical science ,business ,Body mass index ,Follow-Up Studies - Abstract
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.
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- 2015
26. Sequential Multiple Assignment Randomized Trial (SMART) to Construct Weight Loss Interventions for African American Adolescents
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Kai Lin Catherine Jen, Sylvie Naar-King, Kathryn Brogan Hartlieb, April Idalski Carcone, Deborah A. Ellis, Phillippe B. Cunningham, Angela J. Jacques-Tiura, and Thomas Templin
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Male ,Adolescent ,Population ,Motivational interviewing ,Contingency management ,Overweight ,Article ,law.invention ,03 medical and health sciences ,Executive Function ,0302 clinical medicine ,Randomized controlled trial ,law ,Behavior Therapy ,030225 pediatrics ,Weight Loss ,Developmental and Educational Psychology ,medicine ,Humans ,030212 general & internal medicine ,Obesity ,education ,Child ,Depression (differential diagnoses) ,education.field_of_study ,business.industry ,Depression ,Attendance ,medicine.disease ,Black or African American ,Clinical Psychology ,Caregivers ,Adolescent Behavior ,Female ,medicine.symptom ,business ,Clinical psychology - Abstract
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.
- Published
- 2015
27. Correction to: Effectiveness of Nutrition Intervention in a Selected Group of Overweight and Obese African-American Preschoolers
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Yulyu Yeh, Kathryn Brogan Hartlieb, Cynthia A. Danford, and K.-L. Catherine Jen
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0301 basic medicine ,Gerontology ,African american ,medicine.medical_specialty ,030109 nutrition & dietetics ,Health (social science) ,Sociology and Political Science ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,030209 endocrinology & metabolism ,Overweight ,03 medical and health sciences ,0302 clinical medicine ,Anthropology ,Intervention (counseling) ,Epidemiology ,Physical therapy ,Medicine ,medicine.symptom ,business ,Quality of Life Research - Abstract
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.
- Published
- 2017
28. Development and Formative Evaluation of the MENTOR Program for Preventing Childhood Obesity in School-Age Children
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Gwyn Senokossoff, Catherine Coccia, Fatma G. Huffman, Kathryn Brogan-Hartlieb, Adriana Campa, and Jessica Moya
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Gerontology ,Formative assessment ,Nutrition and Dietetics ,School age child ,medicine ,Medicine (miscellaneous) ,Psychology ,medicine.disease ,Childhood obesity - Published
- 2017
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