An Application of the Complier Average Causal Effect Analysis to Examine the Effects of a Family Intervention in Reducing Illicit Drug Use among High‐Risk Hispanic Adolescents

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107494/1/famp12068.pd

The Impact of Socio-Ecological Risk Factor Clustering on Mental, Emotional, and Behavioral Problems in Hispanic Adolescents

Hispanic youth are often at greater risk for developing mental, emotional, and behavioral (MEB) problems, such as substance use, sexual risk behaviors, and internalizing and externalizing symptoms, compared to non-Hispanic white youth. Socio-ecological risk and protective factors, including family, school, peer, and acculturation factors, have been shown to be associated individually with a variety of MEB problems. This study examines the clustering of these risk and protective factors and evaluates whether there are specific subgroups of Hispanic adolescents, who are at greater risk for a variety of MEB problems. Data come from two randomized controlled trials, and were collected at baseline, when adolescents were in eighth grade, and then 6, 18, and 30 months post-baseline. Cross-sectional analyses included 959 participants, whereas longitudinal analyses utilized the 474 control group participants to evaluate associations in the absence of intervention. Using latent class analysis, three subgroups (Low, Medium, and High Socio-Ecological Risk) were identified based on socio-ecological risk and protective factors. Results indicated that adolescents in the higher socio-ecological risk subgroups reported significantly higher MEB problems at both baseline and 30 months post-baseline. Furthermore, the majority of adolescents remained in the same socio-ecological risk group across time points. Those who remained in the Low Socio-Ecological Risk group reported significantly lower MEB problems at 30 months post-baseline compared to those who remained in the High or Medium Socio-Ecological Risk groups. These results highlight the stability and impact of the clustering of socio-ecological risk and protective factors on MEB problems and support previous literature in finding the importance of these factors during early adolescence. Implications include the importance of screening youth for multiple risk and protective factors during early adolescence, as well as examining similar socio-ecological risk subgroups as potential moderators of the effects of preventive interventions

The association of organized and unorganized physical activity and sedentary behavior with internalizing and externalizing symptoms in Hispanic adolescents

Background Literature suggests that physical activity (PA) and sedentary behavior may be associated with adolescent mental health symptoms. A gap in the literature is whether different types of PA have unique impacts on internalizing and externalizing symptoms. This study separately assesses the association of organized PA, unorganized PA, and sedentary behavior with internalizing and externalizing symptoms. Method This study analyzed baseline data from a randomized controlled trial of a preventive intervention with 575 Hispanic adolescents. Using separate multivariable linear mixed models, the relationship between the independent variables of PA and sedentary behavior and the dependent variables of internalizing and externalizing symptoms was evaluated. Results Organized PA was not associated with internalizing or externalizing symptoms; however, higher levels of unorganized PA were associated with greater internalizing and externalizing symptoms. Increased sedentary behavior was also associated with higher levels of externalizing symptoms, but not internalizing symptoms. Conclusions Implications of this study highlight the need to examine types of PA separately as they may differentially influence adolescent mental health symptoms. Potential explanations for these findings and suggested further analyses are discussed

The Role of Physical Activity and Sedentary Behavior in Substance Use and Risky Sex Behaviors in Hispanic Adolescents

The purpose of our study was to investigate the potential relationships in Hispanic adolescents ( n = 575) between substance use and/or risky sexual behaviors and (a) physical activity (PA) and (b) sedentary time and (c) the moderating effect of gender. PA levels and sedentary behaviors were assessed using the PA Questionnaire for Adolescents, while risky behaviors were assessed using items similar to those used in the national epidemiological study, Monitoring the Future. We found significant, positive associations between PA and smoking, drug use, and risky sex measures. Similar positive associations existed between sedentary time and risky behaviors. However, after stratifying by gender, most of the relationships remained significant only for males. Our study is among the first to examine these relationships in Hispanic adolescents. Given the emphasis on increasing PA and decreasing sedentary behavior in adolescents, more efforts should be dedicated to understanding the effect of these lifestyle habits on risky behaviors. </jats:p

Effect of a child care center-based obesity prevention program on body mass index and nutrition practices among preschool-aged children

This study examined the effect of an early childhood obesity prevention program on changes in Body Mass Index (BMI) z-score and nutrition practices. Eight child care centers were randomly assigned to an intervention or attention control arm. Participants were a multiethnic sample of children aged 2 to 5 years old (N = 307). Intervention centers received healthy menu changes and family-based education focused on increased physical activity and fresh produce intake, decreased intake of simple carbohydrate snacks, and decreased screen time. Control centers received an attention control program. Height, weight, and nutrition data were collected at baseline and at 3, 6, and 12 months. Analysis examined height, weight, and BMI z-score change by intervention condition (at baseline and at 3, 6, and 12 months). Pearson correlation analysis examined relationships among BMI z-scores and home activities and nutrition patterns in the intervention group. Child BMI z-score was significantly negatively correlated with the number of home activities completed at 6-month post intervention among intervention participants. Similarly, intervention children consumed less junk food, ate more fresh fruits and vegetables, drank less juice, and drank more 1% milk compared to children at control sites at 6 months post baseline. Ninety-seven percent of those children who were normal weight at baseline were still normal weight 12 months later. Findings support child care centers as a promising setting to implement childhood obesity prevention programs in this age group

Role modeling as an early childhood obesity prevention strategy: effect of parents and teachers on preschool children's healthy lifestyle habits

To assess the effectiveness of a child care center-based parent and teacher healthy lifestyle role-modeling program on child nutrition and physical activity outcomes. Child care centers (N = 28) serving low-income families were randomized to intervention or control arms. Intervention centers (N = 12) implemented (1) menu modifications, (2) a child's healthy lifestyle curriculum, and (3) an adult (teacher- and parent-focused) healthy lifestyle role-modeling curriculum. Control centers (N = 16) received an attention control safety curriculum. Nutrition and physical activity data were collected at the beginning (T1) and at the end (T2) of the school year. Exploratory factor analysis identified positive and negative nutrition and physical activity practices by children, parents, and teachers. Intervention parents' baseline (β = .52, p < .0001) and school year consumption (β = .47, p < .0001) of fruits/vegetables significantly increased their children's consumption of fruits/vegetables from T1 to T2. Intervention parents significantly influenced a decrease in children's junk food consumption (β = -.04, p < .05), whereas control parents significantly influenced an increase in their children's junk food consumption (β = .60, p < .001) from T1 to T2. Control children showed a significant increase in junk food consumption (β = .11, p = .01) and sedentary behavior (β = .09, p < .005) from T1 to T2. Teachers did not significantly influence preschool-age children's nutrition or physical activity patterns from T1 to T2. Parent nutrition and physical activity patterns significantly influence their preschool-age children's consumption of fruits/vegetables, junk food, and level of sedentary behavior. Future obesity prevention intervention efforts targeting this age group should include parents as healthy lifestyle role models for their children

Obesity Prevention Program in Childcare Centers: Two-Year Follow-Up

To assess the impact of an early childhood obesity prevention intervention "Healthy Caregivers-Healthy Children" (HC2) on dietary patterns and body mass index percentile (PBMI) over 2 school years. Randomized controlled trial. Childcare centers. Low-income families. Intervention centers (N = 12) received HC2 which consisted of (1) menu modifications, (2) a healthy eating and physical activity curriculum for children, and (3) a parent curriculum for healthy meal preparation, reinforced through a role-modeling curriculum. Control centers (N = 16) received an injury prevention/safety intervention. Child PBMI and parent report of child's consumption of fruits/vegetables and unhealthy food. Confirmatory factor analysis verified the psychometric properties of factor scores for children's consumption of fruits/vegetables and unhealthy food. Growth curve analysis assessed the impact of HC2 on change in consumption of fruits/vegetables and unhealthy food and PBMI over 2 school years. Children in the intervention group (n = 754) had a negative slope (β = -1.95, standard error [SE] = 0.97, P = .04), indicating less increase in PBMI versus control children (n = 457). Stratified analyses showed that obese children in the intervention arm had a significantly higher increase in fruit/vegetable consumption versus control group obese children (β = 0.24, SE = 0.08, P = .003). The HC2 intervention resulted in the maintenance of healthy PBMI over 2 preschool years among low-income multiethnic children. These findings support efforts to implement healthy weight programs in the childcare setting

Association between Socio-Ecological Risk Factor Clustering and Mental, Emotional, and Behavioral Problems in Hispanic Adolescents

Compared to non-Hispanic whites, Hispanic adolescents in the U.S. report higher rates of several mental, emotional, and behavioral (MEB) problems such as substance use, sexual risk behaviors, and internalizing and externalizing problems. There is evidence of common pathways in the development of MEB problems with certain subgroups of Hispanic adolescents being at greater risk. In the present article, we report analysis of baseline data for 959 Hispanic adolescents who participated in one of two randomized controlled trials evaluating a family-based preventive intervention. Utilizing latent class analysis, we identified subgroups of Hispanic adolescents based on socio-ecological risk and protective factors (e.g., parent-adolescent communication, parental involvement in school). Three distinct socio-ecological risk subgroups (high, medium, and low risk) were identified and exhibited significant differences from each other across a majority of socio-ecological risk and protective factors. Adolescents in higher socio-ecological risk subgroups reported greater MEB problems across all outcomes. Individual comparisons revealed significant differences between the low socio-ecological risk group and both the medium and high socio-ecological risk group in lifetime alcohol use, smoking, and sex, as well as internalizing and externalizing problems. Implications for intervention include focusing on specific risk subgroups and targeting shared risk and protective factors rather than specific MEB outcomes