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Haemer M, Tong S, Bracamontes P, Gritz M, Osborn B, Perez-Jolles M, Shomaker L, Steen E, Studts C, Boles R. Randomized-controlled trial of a whole-family obesity prevention and treatment intervention designed for low-income Hispanic families: HeLP the healthy living program. Contemp Clin Trials 2023; 135:107359. [PMID: 37852530 PMCID: PMC10842075 DOI: 10.1016/j.cct.2023.107359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/06/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Low-income Hispanic families face marked disparities in obesity, but interventions for obesity prevention and treatment have rarely been designed with this population as a focus. Hispanic culture is characterized by Familism, a value that prioritizes familial respect, cooperation, and togetherness. We describe the rationale and design of a trial of the Healthy Living Program (HeLP), a bilingual whole-family behavioral obesity prevention and treatment intervention designed around the value Familism and addressing food insecurity. METHODS/DESIGN This two-group randomized comparative effectiveness trial will compare the effects of HeLP versus a primary care counseling intervention (Recommended Treatment of Obesity in Primary Care, or RTOP) on decreasing body mass index (BMI; kg/m2) in Hispanic children 2-16 years of age with obesity and preventing BMI increase among siblings without obesity. 164 families per arm will be recruited from primary care practices. Families randomized to HeLP will participate in 12 two-hour sessions, followed by booster sessions. HeLP sessions include family meals and instruction in parenting skills, nutrition, culinary skills, fitness, and mindfulness delivered at community recreation centers by bilingual health educators and athletic trainers. Families randomized to RTOP will be offered individual visits in primary care every 3 months throughout the 18-month follow-up period. Secondary outcomes include changes to objectively measured child fitness, the home environment related to nutrition, physical activity, and media usage, food insecurity, child eating behaviors, quality of life, parent BMI and waist circumference, and implementation outcomes. DISCUSSION This protocol paper describes the rationale and planned methods for the comparative effectiveness trial. TRIAL REGISTRATION Clinicaltrials.gov Identifier NCT05041855 (6/13/2023).
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Affiliation(s)
- Matthew Haemer
- University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA.
| | - Suhong Tong
- University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Perla Bracamontes
- University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Mark Gritz
- University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA; University of Colorado Anschutz Medical Campus, Adult and Child Center for Outcomes Research and Delivery Science, 1890 N Revere Ct, Aurora, CO 80045, USA
| | - Brandon Osborn
- University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Monica Perez-Jolles
- University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA; University of Colorado Anschutz Medical Campus, Adult and Child Center for Outcomes Research and Delivery Science, 1890 N Revere Ct, Aurora, CO 80045, USA
| | - Lauren Shomaker
- University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA; Colorado State University, Department of Human Development and Family Studies, 410 Pitkin St., Fort Collins, Co 80523, USA
| | - Emily Steen
- University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Christina Studts
- University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA; University of Colorado Anschutz Medical Campus, Adult and Child Center for Outcomes Research and Delivery Science, 1890 N Revere Ct, Aurora, CO 80045, USA
| | - Richard Boles
- University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA
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Thompson DA, Haemer MA, Krebs NF, Pereira RI, Moss A, Furniss AL, Bonczynski J, Nicklas JM. A WIC-Based Behavior Change Intervention for Postpartum Women With Overweight and Obesity: A Pilot Feasibility Randomized Trial. Health Promot Pract 2023:15248399231173704. [PMID: 37226873 PMCID: PMC10674029 DOI: 10.1177/15248399231173704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Background. Postpartum weight retention is a risk factor for obesity and is particularly important among Hispanic women who have an increased rate of obesity. Given its broad reach, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program provides an ideal setting to implement community-based interventions for low-income postpartum women. Purpose. To examine the feasibility, acceptability, and preliminary efficacy of a multicomponent intervention delivered by staff within the WIC program designed to promote behavior changes in urban, postpartum women with overweight/obesity. Method. This was a 12-week pilot trial randomizing participants to a health behavior change (Intervention) or control (Observation) group. The Intervention included monthly visits with trained WIC staff providing patient-centered behavior change counseling, with multiple touchpoints between visits promoting self-monitoring and offering health behavior change support. Results. Participants (n = 41), who were mainly Hispanic (n = 37, 90%) and Spanish-speaking (n = 33, 81%), were randomized to the Intervention (n = 19) or Observation (n = 22) group. In the Intervention group, 79% (n = 15) of eligible participants were retained for the study duration. All Intervention participants endorsed that they would participate again. Regarding physical activity, participant readiness to change and self-efficacy improved for Intervention participants. About one-quarter of women in the Intervention group (27%, n = 4) had a 5% weight loss compared with one woman (5%) in the Observation group; this difference was not statistically significant (p = .10). Conclusions. This pilot demonstrated the feasibility and acceptability of delivering a low-intensity behavior change intervention within the WIC setting for postpartum women with overweight/obesity. Findings support the role of WIC in addressing postpartum obesity.
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Affiliation(s)
- Darcy A Thompson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Matthew A Haemer
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Nancy F Krebs
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Rocio I Pereira
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Angela Moss
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Anna L Furniss
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Jacinda M Nicklas
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
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Muramatsu N, Yin L, Berbaum ML, Marquez DX, Walton SM, Caceres M, Cruz Madrid KY, Zanoni JP. Protocol for a randomized controlled trial of low-intensity physical activity for frail older adults: Promoting seniors' health with home care aides (Pro-Home). Contemp Clin Trials 2021; 104:106362. [PMID: 33737196 DOI: 10.1016/j.cct.2021.106362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
Regular participation in physical activity benefits older adults physically and mentally. However, the availability and assessment of physical activity programs that are safe and appropriate for homebound older adults at risk for nursing home admission are limited. Here we describe the protocol for a randomized controlled trial that examines the effectiveness of a gentle physical activity program. Delivered by home care aides who regularly help hard-to-reach older home care clients with housekeeping and routine personal care services in the home, this program is implemented in a real-world context of caregiver-client dyads in a Medicaid-funded home care program. The trial uses a two-group repeated measures design (baseline, Month 4, and Month 8) with 300 pairs of eligible home care clients and their home care aides. The results from this trial could provide evidence and guidelines for a new model of home care, which would facilitate the working together of older home care clients and their home care aides to maintain or improve the functional status of nursing home-eligible older adults.
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Affiliation(s)
- Naoko Muramatsu
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, USA; Institute for Health Research and Policy, University of Illinois Chicago, USA.
| | - Lijuan Yin
- Institute for Health Research and Policy, University of Illinois Chicago, USA
| | - Michael L Berbaum
- Institute for Health Research and Policy, University of Illinois Chicago, USA
| | - David X Marquez
- Department of Kinesiology and Nutrition, University of Illinois Chicago, USA
| | - Surrey M Walton
- Department of Pharmacy Systems Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, USA
| | - Maria Caceres
- Institute for Health Research and Policy, University of Illinois Chicago, USA
| | - Katya Y Cruz Madrid
- Division of Academic Internal Medicine and Geriatrics, University of Illinois Chicago, USA; Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Joseph P Zanoni
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, USA
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Muramatsu N, Yin L, Berbaum ML, Marquez DX, Jurivich DA, Zanoni JP, Cruz Madrid KY, Walton SM. Promoting Seniors' Health With Home Care Aides: A Pilot. THE GERONTOLOGIST 2018; 58:779-788. [PMID: 28633502 PMCID: PMC6044396 DOI: 10.1093/geront/gnx101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Indexed: 11/13/2022] Open
Abstract
Purpose Regular physical activity (PA) benefits older adults. However, frail older adults lack opportunities to be physically active. This pilot study aimed to test and enhance the feasibility of a PA program delivered by home care aides (HCAs) for community-dwelling older adults in a Medicaid-funded home care setting and to generate preliminary efficacy and cost data. Design and Methods HCAs were trained to deliver a brief motivational enhancement and three chair-bound movements to motivate their older clients to do PA daily and to help maintain their independence in the community. Mixed methods were used to evaluate clients' function and health before and after the 4-month intervention. Results Clients' daily activity function and health outcomes (physical fitness, self-rated health, pain interference, and fear of falling) improved significantly. The program was well-received by clients (N = 54) and their HCAs (N = 46) as indicated by high retention rates among client participants (93%) and remarks provided by clients. Implications Building PA into the everyday care of older adults and the routine work of HCAs is feasible. The intervention has the potential for further implementation and dissemination.
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Affiliation(s)
- Naoko Muramatsu
- School of Public Health, University of Illinois at Chicago
- Institute for Health Research and Policy, University of Illinois at Chicago
| | - Lijuan Yin
- School of Public Health, University of Illinois at Chicago
- Institute for Health Research and Policy, University of Illinois at Chicago
| | - Michael L Berbaum
- Institute for Health Research and Policy, University of Illinois at Chicago
| | - David X Marquez
- Institute for Health Research and Policy, University of Illinois at Chicago
- Department of Kinesiology and Nutrition, University of Illinois at Chicago
| | - Donald A Jurivich
- Section of Geriatrics, School of Medicine and Health Sciences, University of North Dakota, Grand Forks
| | | | - Katya Y Cruz Madrid
- Division of Academic Internal Medicine and Geriatrics, University of Illinois at Chicago and Jesse Brown VA Health Care System
| | - Surrey M Walton
- Institute for Health Research and Policy, University of Illinois at Chicago
- College of Pharmacy, University of Illinois at Chicago
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Yan T, Wilber KH, Simmons WJ. Motivating High-Risk Older Adults to Exercise: Does Coaching Matter? Home Health Care Serv Q 2011; 30:84-95. [DOI: 10.1080/01621424.2011.569670] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Tingjian Yan
- a University of California at Los Angeles , Los Angeles, California, USA
| | | | - W. June Simmons
- c Partners in Care Foundation , Los Angeles, California, USA
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Yan T, Wilber KH, Wieckowski J, Simmons WJ. Results from the Healthy Moves for Aging Well program: changes of the health outcomes. Home Health Care Serv Q 2010; 28:100-11. [PMID: 20182959 DOI: 10.1080/01621420903176136] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The Healthy Moves for Aging Well program piloted a home-based, low-intensity strength exercise program that targeted a nursing home certifiable, ethnically diverse sample of community-residing adults aged 65 and older. This study examined the effectiveness of the Healthy Moves program in reducing participants' number of falls, fear of falling, depression, and pain. Results indicated that participants (n = 338) had statistically significant declines in the number of falls and level of pain. These declines were found among participants who improved their exercise performance. This pilot suggests that a modest intervention that couples behavior change with seated exercise can have a positive outcome on a sample of older adults who have high levels of functional impairment and lack a regular exercise regime.
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Affiliation(s)
- Tingjian Yan
- Davis School of Gerontology, University of Southern California, Los Angeles, California 90089-0191, USA.
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Amy NK, Aalborg A, Lyons P, Keranen L. Barriers to routine gynecological cancer screening for White and African-American obese women. Int J Obes (Lond) 2005; 30:147-55. [PMID: 16231037 DOI: 10.1038/sj.ijo.0803105] [Citation(s) in RCA: 228] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Obese women are reported to be at higher risk from gynecological cancers than nonobese women, yet these women are less likely to get cancer-screening tests. The specific factors that contribute to obese women not obtaining timely cancer screening have not been identified. OBJECTIVE To investigate the factors that contribute to lower rates of gynecological cancer screening as related to women's body size. DESIGN A purposeful sample of 498 White and African-American women with body mass index (BMI) from 25 to 122 kg/m(2), including 60 women with BMI > 55 kg/m(2), was surveyed concerning access to gynecological cancer screening and potential barriers that could cause delay. Health care providers (N = 129) were surveyed concerning their education, practices, and attitudes about providing care and gynecological cancer-screening tests for obese women. RESULTS Obese women reported that they delay cancer-screening tests and perceive that their weight is a barrier to obtaining appropriate health care. The percent of women reporting these statements increased significantly as the women's BMI increased. Women with BMI > 55 kg/m(2) had a significantly lower rate (68%) of Papanicolaou (Pap) tests compared to others (86%). The lower screening rate was not a result of lack of available health care since more than 90% of the women had health insurance. Women report that barriers related to their weight contribute to delay of health care. These barriers include disrespectful treatment, embarrassment at being weighed, negative attitudes of providers, unsolicited advice to lose weight, and medical equipment that was too small to be functional. The percentage of women who reported these barriers increased as the women's BMI increased. Women who delay were significantly less likely to have timely pelvic examinations, Pap tests, and mammograms than the comparison group, even though they reported that they were 'moderately' or 'very concerned' about cancer symptoms. The women who delay care were also more likely to have been on weight-loss programs five or more times. Many health care providers reported that they had little specific education concerning care of obese women, found that examining and providing care for large patients was more difficult than for other patients, and were not satisfied with the resources and referrals available to provide care for them. CONCLUSION Since the goal of preventive cancer screening is to improve health outcomes for all women and since obese women are at greater risk, strategies must be designed to reduce the weight barriers to these tests and improve the quality of the health care experience. Providers should receive specific training related to care of large women.
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Affiliation(s)
- N K Amy
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, 94720, USA.
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Boise R, Petersen R, Curtis KM, Aalborg A, Yoshida CK, Cabral R, Ballentine JM. Reproductive health counseling at pregnancy testing: a pilot study. Contraception 2004; 68:377-83. [PMID: 14636943 DOI: 10.1016/j.contraception.2003.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To pilot brief reproductive health counseling for women obtaining pregnancy testing in a managed-care setting who did not desire pregnancy. METHODS Women received counseling, access to contraception and a booster call at 2 weeks. Changes in contraceptive behavior were evaluated. RESULTS Of 85 women who completed counseling, 58 (68%) completed follow-up. Participants reported that counseling was useful at baseline (94%) and follow-up (83%). The staff found the intervention important (100%) and implementation feasible (100%). Forty-one percent of participants improved their use of contraception (from no use or from less effective use to more effective use). Twenty-nine percent continued highly effective use and 9% recessed from highly effective use. Of 22 participants with risk of sexually transmitted disease, 3 (14%) began using condoms consistently, while 1 (5%) continued using condoms consistently. CONCLUSIONS Counseling at pregnancy testing was well accepted by the staff and participants. Observed behavioral changes suggest that this intervention may be effective in increasing effective use of contraception.
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Affiliation(s)
- Richard Boise
- Adolescent Medicine, The Permanente Medical Group, 3400 Delta Fair Boulevard, Antioch, CA, USA.
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