Introduction:Mothers have increased risk for insufficient physical activity and face various barriers to engaging in physical activity. Youth sports have been examined as a setting for health-promotion interventions for children but not for parents. The authors conducted a 6-week single-arm open pilot trial of a physical activity intervention delivered to mothers in Rhode Island, U.S. during children's sports practices. Methods:The authors partnered with a youth football organization to deliver the intervention, which consisted of group physical activity sessions during practice. Feasibility was determined on the basis of whether enrollment (i.e., ≥8 participants per week), retention (i.e., ≥80% of participants through 6 weeks), and assessment (i.e., obtaining usable physical activity data from ≥80% of participants) targets were met. Acceptability was determined on the basis of participant responses to a consumer satisfaction questionnaire (with the intervention deemed satisfactory if ≥80% of participants were satisfied with the intervention) and engagement (i.e., intervention session attendance). Preliminary efficacy was determined on the basis of whether participants experienced increases in moderate-to-vigorous physical activity, assessed through 7-day physical activity recall, or physical activity self-efficacy, assessed through the self-efficacy for physical activity measure, at 3 and 6 weeks relative to baseline. The authors descriptively analyzed postintervention feasibility, acceptability, sociodemographic characteristics, and preliminary efficacy outcomes. To explore preliminary efficacy estimates, the authors ran a series of unadjusted paired t-tests to compare baseline moderate-to-vigorous physical activity and self-efficacy with moderate-to-vigorous physical activity and self-efficacy at 3 and 6 weeks. Results:The authors met recruitment (n=26) and retention (85%) targets but only collected follow-up data from 12 participants (aged 30-62 years). Twelve of 18 planned intervention sessions were offered owing to practice cancellations; participant attendance ranged from 0 to 12 sessions (mean=3.52, SD=4.07). All participants (100%) were satisfied with the intervention, and significant increases in moderate-to-vigorous physical activity and physical activity self-efficacy were observed. Specifically, an increase in moderate-to-vigorous physical activity from baseline to 3 weeks of 114.5 minutes was observed (Cohen's d=0.75), whereas self-efficacy scores increased by 0.98 (Cohen's d=0.97). Self-efficacy scores were increased by 1.07 (Cohen's d=0.91) at 6 weeks. Conclusions:This study demonstrated the feasibility of delivering a physical activity intervention to mothers during youth sports practices, although the authors did not reach the assessment target. Participants were satisfied with the intervention, and increases in physical activity outcomes were observed. However, studies examining strategies to increase engagement and maximize benefits, particularly among insufficiently active mothers, would be beneficial. Nonetheless, this is the first study to demonstrate the potential of youth sports practices as a setting for delivering health promotion interventions to parents.

Importance Family-based behavioral treatment (FBT) is recommended for childhood obesity treatment; however, it is not effective for all families. Since parenting training (PT) has been associated with healthy weight and eating behaviors, intensive PT may augment delivery of behavior change strategies and improve child weight loss outcomes. Objective To compare the efficacy of child overweight or obesity treatment that adds intensive PT to standard FBT with the efficacy of FBT alone. Design, Setting, and Participants This 2-arm randomized clinical trial (Reinforced, Enhanced, Families, Responsibility, Education, Support, and Health [ReFRESH]) conducted from April 2017 to November 2022 at an academic center in San Diego, California, included children aged 7 to 12 years with overweight or obesity (body mass index [BMI]>= 85th to <99.9th percentile) and one of their parents. Interventions Parent-child dyads were randomized 1:1 to the intervention group, which received FBT plus PT, or the control group, which received FBT alone. Both groups received twenty 60-minute sessions over 6 months with separate parent and child groups led by staff and nine 20-minute behavior change coaching sessions. The FBT plus PT group sessions incorporated additional intensive parenting skills training in an interactive format. Main Outcomes and Measures The primary outcome was change from baseline in child BMI z score and BMI as a percentage of the 95th BMI percentile (BMIp95) after treatment (month 6) and at 6- and 12-month follow-up. Secondary outcomes included the proportion of children who attained clinically meaningful weight loss (ie, reduction of >= 0.20 BMI z score units) and intervention dropout rates. Intention-to-treat analysis was conducted using linear mixed models and logistic regression. Results A total of 140 parent-child dyads were included, with 70 in each treatment arm. Mean (SD) child age was 9.91 (1.54) years, and baseline BMI z score was 2.28 (0.80); 71 children (50.7%) were female. There were no significant between-group differences in BMI z score or BMIp95 after treatment or at the follow-up time points. Both groups had significant decreases in weight status after treatment (combined BMI z score: beta, -0.14 [95% CI, -0.21 to -0.07]; P < .001; combined BMIp95: beta, -3.46 [95% CI, -5.41 to -1.51]; P < .001). More children in the FBT plus PT arm compared with the FBT arm had a reduction of at least 0.20 BMI z score units (34 [48.6%] vs 22 [31.4%]; P = .01) after treatment (adjusted odds ratio, 2.10 [95% CI, 1.01-4.47]). Both treatments were well accepted, with no between-group differences in risk of dropout (hazard ratio, 1.01 [95% CI, 0.72-1.43]). Conclusions and Relevance In this randomized clinical trial examining the effect of parenting training on child weight status, there were no significant differences in weight status between groups; children in both groups had a significant reduction in weight status. However, more children had clinically meaningful weight loss in the FBT plus PT group. Further work is needed to determine factors associated with treatment response and changes in parenting skills. Trial Registration ClinicalTrials.gov Identifier: NCT02976636

Family-based behavioral treatment (FBT) is recommended for childhood obesity treatment; however, it is not effective for all families. Since parenting training (PT) has been associated with healthy weight and eating behaviors, intensive PT may augment delivery of behavior change strategies and improve child weight loss outcomes. To compare the efficacy of child overweight or obesity treatment that adds intensive PT to standard FBT with the efficacy of FBT alone. This 2-arm randomized clinical trial (Reinforced, Enhanced, Families, Responsibility, Education, Support, and Health [ReFRESH]) conducted from April 2017 to November 2022 at an academic center in San Diego, California, included children aged 7 to 12 years with overweight or obesity (body mass index [BMI]≥85th to <99.9th percentile) and one of their parents. Parent-child dyads were randomized 1:1 to the intervention group, which received FBT plus PT, or the control group, which received FBT alone. Both groups received twenty 60-minute sessions over 6 months with separate parent and child groups led by staff and nine 20-minute behavior change coaching sessions. The FBT plus PT group sessions incorporated additional intensive parenting skills training in an interactive format. The primary outcome was change from baseline in child BMI z score and BMI as a percentage of the 95th BMI percentile (BMIp95) after treatment (month 6) and at 6- and 12-month follow-up. Secondary outcomes included the proportion of children who attained clinically meaningful weight loss (ie, reduction of ≥0.20 BMI z score units) and intervention dropout rates. Intention-to-treat analysis was conducted using linear mixed models and logistic regression. A total of 140 parent-child dyads were included, with 70 in each treatment arm. Mean (SD) child age was 9.91 (1.54) years, and baseline BMI z score was 2.28 (0.80); 71 children (50.7%) were female. There were no significant between-group differences in BMI z score or BMIp95 after treatment or at the follow-up time points. Both groups had significant decreases in weight status after treatment (combined BMI z score: β, −0.14 [95% CI, −0.21 to −0.07]; P < .001; combined BMIp95: β, −3.46 [95% CI, −5.41 to −1.51]; P < .001). More children in the FBT plus PT arm compared with the FBT arm had a reduction of at least 0.20 BMI z score units (34 [48.6%] vs 22 [31.4%]; P = .01) after treatment (adjusted odds ratio, 2.10 [95% CI, 1.01-4.47]). Both treatments were well accepted, with no between-group differences in risk of dropout (hazard ratio, 1.01 [95% CI, 0.72-1.43]). In this randomized clinical trial examining the effect of parenting training on child weight status, there were no significant differences in weight status between groups; children in both groups had a significant reduction in weight status. However, more children had clinically meaningful weight loss in the FBT plus PT group. Further work is needed to determine factors associated with treatment response and changes in parenting skills. ClinicalTrials.gov Identifier: NCT02976636

BACKGROUND AND OBJECTIVES Family-based behavioral treatment (FBT) for children with obesity is provided in weekly parent and child groups over 6 months. A guided self-help FBT program (gshFBT) is provided to the dyad in short meetings. Both interventions provide the same content; however, gshFBT provides this content in less time (FBT = 23 hours, gshFBT = 5.3 hours). This study aimed to evaluate whether gshFBT is noninferior to FBT on child weight loss and cost-effectiveness. METHODS 150 children aged between 7.0 and 12.9 years with a BMI between the 85th and 99.9th percentile and their parent were recruited and randomized to a 6-month program of gshFBT (n = 75) or FBT (n = 75) and were followed 12 months post-treatment. RESULTS A total of 150 children (mean age = 10.1 years, 49% female, mean BMIz = 2.09) and their parent (mean age = 41.5 years, 87% female, 45% Hispanic, 37% White non-Hispanic, 9.7% Asian, 4.8% Black, 7.3% other) were recruited from the San Diego Metropolitan area. Joint LME models showed that gshFBT was noninferior to FBT on child weight loss (ΔBMIz = −0.02 [90% credible interval [CI] −0.08–0.05, P = .65]; ΔBMIp95% = −1.57 [90% CI –4.46–1.31, P = .28]) and cost less (cost/dyad gshFBT = $1498; FBT = $2775). CONCLUSION The gshFBT program provided similar weight losses for children with less contact hours and with lower cost than FBT. The reduced time and ease of scheduling for the family in gshFBT will allow for an increased reach of treatment to a greater proportion of families in need.

IntroductionLatinas face increased risk for chronic diseases associated with insufficient physical activity (PA). The researchers previously showed that a website-based intervention could increase PA among insufficiently active Latinas, yet rates of meeting national PA guidelines were low. The original intervention was enhanced by adding additional features, content, and points of contact, including via text messaging. This study tests the efficacy of the enhanced intervention compared with the original, aimed at maximizing and sustaining PA gains across 24 months. It also examines if increases in PA differed by baseline PA.Study designThe researchers conducted a superiority randomized controlled trial (data collected 2018-2022, analyzed 2023).Setting/participantsParticipants were 195 Spanish-speaking Latinas ages 18-65 in the Providence, RI area.InterventionThe original intervention is an empirically supported Spanish-language, individually-tailored, website-delivered PA intervention. The enhanced intervention includes text messaging and additional data-driven content and interactive features.Main outcome measuresTotal weekly minutes of moderate to vigorous PA (MVPA) was measured via accelerometry and self-report at 6, 12, 18, and 24 months.ResultsParticipants in both groups increased their MVPA over 24 months. There were no significant between-group differences at 6 or 12 months; at 18 months the enhanced intervention group had higher levels of self-reported (mean (sd): 90.35 (43.55) vs. 70.18 (9.99)) and accelerometer-measured (66.21 (18.26) vs. 60.27 (16.00)) MVPA compared to the original intervention group. They also had higher levels of self-reported (111.17 (23.35) vs. 81.44 (1.82)) and accelerometer-measured (63.76 (15.12) vs. 54.86 (14.59)) MVPA at 24 months. Baseline PA moderated the intervention effect.ConclusionsThis study demonstrates the potential to enhance the efficacy of website-based PA interventions by utilizing text messaging, and adding more interactive features, content, and phone support. These enhancements may be particularly beneficial in supporting long-term PA maintenance.Trial registrationThis study is registered at www.clinicaltrial.gov (NCT03491592).

Women with negative body image engage in less physical activity. The purpose of this study is to examine the relationship between body image and physical activity in Latinas participating in a lifestyle program. Participants (age 43.8 ± 10.1 years and BMI 30.4 ± 5.2 kg/m 2 ) were enrolled in a 12-month culturally and linguistically adapted, individually tailored, intervention focused on increasing moderate-to-vigorous intensity physical activity (MVPA). Longitudinal assessments were conducted on body image dissatisfaction (BID) using the Figure Rating Scale, MVPA using the 7-day PAR interview, and objectively measured body weight. Pre-intervention BID did not significantly predict MVPA change. Participants experienced considerable reduction in BID. Greater MVPA engagement and weight loss were independently related to BID reduction. Acculturation did not moderate these relationships. Body image improved in Latinas participating in a cognitive and behavioral physical activity intervention regardless of weight loss and acculturation level.

Latina and Black/African American (AA) women report disproportionately low levels of muscle-strengthening activities (MSA) and high rates of related chronic health conditions. Despite the health benefits of MSA, physical activity intervention research in these populations has focused mostly on increasing aerobic physical activity. The purpose of this review was to describe the current state of scientific literature on MSA interventions among Latina and Black/AA women. Two electronic databases, CINAHL and PubMed, were searched for studies published during the past 10 years. Studies were included in this review if they reported promotion of MSA, included at least 50% Latina and/or Black/AA women in their samples, and used an interventional design. Search procedures identified 8 unique interventions targeting MSA in Latina (n = 3) and Black/AA women (n = 5). Results revealed there is limited published research on MSA promotion among Latina and Black/AA women, especially on theory-based interventions that address psychosocial and behavioral influences of MSA, as well as assessment of MSA outcomes in these populations. This review highlights a critical need for research on culturally tailored behavioral interventions to reduce the low MSA in Latina and Black/AA women and provides future research directions on this topic.

Maternal overweight or obesity has been associated with metabolic syndrome through 1 year postpartum, but it remains unknown whether a culturally-modified, motivationally-targeted, and individually-tailored Lifestyle Intervention could improve postpartum cardiometabolic health among Hispanic women with overweight or obesity. Proyecto Mamá was a randomized controlled trial conducted in Western Massachusetts from 2014 to 2020 in which Hispanic women with overweight/obesity were randomized to a Lifestyle Intervention (LI) involving diet and exercise or to a comparison Health and Wellness Intervention (HW). Biomarkers of cardiovascular risk (i.e., lipids, C-reactive protein) and insulin resistance (fasting insulin, glucose, HbA1c, homeostasis model assessment [HOMA-IR], leptin, adiponectin) were measured at baseline (early pregnancy), mid-pregnancy, and 6 weeks, 6 months, and 12 months postpartum. Generalized linear mixed effect models were used to evaluate differences in the change in biomarkers over the course of postpartum follow-up time. In intent-to-treat analyses among eligible women (LI; n=51, HW; n=58) there were no significant differences in changes in biomarkers of CVD risk or insulin resistance over the postpartum year; for example, the intervention effect for total cholesterol was 6.98 (SE: 6.36, p=0.27) and for HbA1c was −0.01 (SE: 0.4, p=0.85). In pooled analyses, regardless of intervention arm, women who participated in any vigorous activity had less of an increase in HbA1c (intervention effect = −0.17, SE: 0.05, p=0.002) compared to those with no vigorous activity, and similarly beneficial associations with other cardiovascular risk biomarkers (p<0.05). Women who participated in vigorous activity, regardless of their assigned intervention arm, had more favorable changes in biomarkers of insulin resistance. Women with overweight/obesity during pregnancy are at an increased risk of adverse cardiometabolic profiles and future development of type 2 diabetes and cardiovascular disease. Hispanic women are disproportionately affected by cardiometabolic disorders but have largely been excluded from lifestyle intervention studies. Although providing a lifestyle intervention to Hispanic women with overweight/obesity resulted in no significant differences in postpartum cardiometabolic biomarkers, women who articipated in vigorous activity, regardless of their assigned intervention arm, had favorable changes in insulin resistance biomarkers. These findings suggest that the intensity of physical activity may be important for improving postpartum cardiometabolic biomarkers among high-risk, Hispanic women.

Family-based behavioral treatment (FBT) is one of the most effective treatments for childhood obesity. These programs include behavior change strategies and basic parenting training to help parents make healthy diet and physical activity changes for their children. While effective, not all families respond to this program. Additional training on how to effectively deliver these behavior change strategies may improve outcomes. The authoritative parenting style is associated with many positive academic and socio-emotional outcomes in children, and is characterized by displays of warmth and support while also being consistent with setting limits and boundaries. This parenting style has also been associated with normal weight status. Furthermore, parenting training programs that promote this parenting style for children with behavioral issues have shown unintended effects on decreasing child weight status. Therefore, our goal was to examine the effect of adding more intensive parenting training to FBT on child weight status. We randomized 140 children and their parent to either FBT or FBT + Parenting Training (FBT + PT). Assessments were conducted at baseline, mid-treatment (month 3), post-treatment (month 6), 6-month follow-up (month 12), and 12-month follow-up (month 18). Primary outcome was change in child weight status. Secondary outcomes were rates of drop-out, treatment adherence, and acceptability. If effective, this program may provide another alternative for families to help improve outcomes in childhood obesity management.

BackgroundMore than half (55%) of Latina women do not meet aerobic physical activity (PA) guidelines, and frequently cite time, childcare, and transportation as barriers to PA. In addition to linguistic adaptations for this population, successful PA interventions for Latina women addressed these barriers through remote intervention delivery approaches (eg, mail, phone, or web delivery). ObjectiveWe aimed to evaluate 6-month outcomes of a randomized trial comparing a Spanish-language, individually tailored, web-delivered PA intervention (original) to an enhanced version with text messages and additional features (enhanced). Further, we evaluated if increases in PA at 6 months were moderated by baseline activity status. MethodsIn total, 195 Latina women aged 18-65 years participated in a trial comparing the efficacy of the enhanced versus original interventions at initiating PA behavior change. We examined minutes per week of accelerometer-measured PA in the enhanced versus original arms, and the proportion of each arm meeting aerobic PA guidelines (150 min/wk at 6 mo). For moderator analyses, participants were classified as inactive (0 min/wk) or low active (1-90 min/wk) at baseline, measured via the 7 Day Physical Activity Recall interview. ResultsPA increased from 19.7 (SD 47.9) minutes per week at baseline to 46.9 (SD 66.2) minutes per week at 6 months in the enhanced arm versus 20.6 (SD 42.7) minutes per week to 42.9 (SD 78.2) minutes per week in the original arm (P=.78). Overall, 30% (31/103) of the enhanced group met aerobic PA guidelines at 6 months, compared to 21% (19/92) of the original group (odds ratio [OR] 1.75, 95% CI 0.87-3.55). Baseline PA (inactive vs low active) moderated treatment effects on PA. For inactive participants, there were no group differences at 6 months (b=7.1; SE 22.8; P=.75), while low-active participants increased more in enhanced than original (b=72.5; SE 27.9; P=.01). For low-active participants, 45% (46/103) of the enhanced group met PA guidelines at 6 months, versus 20% (18/92) of the original arm (OR 3.29, 95% CI 1.05-11.31). For inactive participants, there were no group differences (25/103, 24% vs n=19/92, 21% for enhanced vs original, respectively; OR 1.28, 95% CI 0.54-3.06). ConclusionsIntervention effects were conditional on baseline PA. For low-active Latina women, the enhanced intervention was more effective at increasing PA. Additional tailored intervention enhancements may be necessary to increase PA for inactive Latina women. Trial RegistrationClinicalTrials.gov NCT03491592; https://www.clinicaltrials.gov/study/NCT03491592 International Registered Report Identifier (IRRID)RR2-10.1186/s13063-022-06575-4

High levels of stress and inactivity likely contribute to chronic disease disparities among Latinas in the U.S. and call for intervention. To inform such efforts, the current study examined the relationships among changes (over time) in physical activity, stress, and related cardiometabolic biomarkers among sedentary (mostly) first generation Latinas. Data are taken from a randomized controlled trial (N = 199 Latinas) of two home-based physical activity interventions (Original vs. theory- and technology- Enhanced versions). Physical activity and perceived stress were assessed at baseline and 6 and 12 months. Blood draws occurred at baseline and 6 months in a random subsample (N = 153). The participants were underactive (<60/min week of moderate-to-vigorous physical activity) Mexican American (89%) women with moderate perceived stress scores (M = 21.49, SD = 8.55, range = 0-40) and excess weight (M BMI = 30.6) at baseline. Overall, participants reported decreases in stress after 6 months enroled in the physical activity programs. The odds of a reduction in perceived stress were 11% higher among Enhanced versus Original Intervention participants (OR = 1.11, 95% CI: 1.05-2.27). Those who met physical activity guidelines were significantly more likely to report reductions in perceived stress over 6 months (OR = 1.92, 95% CI: 1.08-4.16). Furthermore, those who reported reductions in perceived stress over 6 months reported significantly more moderate-to-vigorous physical activity at 12 months (+69 min/week, SE = 27.98, p = 0.01) compared to those who did not. Greater reductions in perceived stress over 6 months were associated with greater improvements in cardiometabolic biomarkers (HbA1c, triglycerides, p's < 0.05). These results support a bidirectional relationship between improvements in stress and physical activity among Latinas. Future implications include using physical activity to address stress management and health disparities in this community.

Current U.S. guidelines recommend that adults obtain 150 min per week of moderate intensity physical activity (PA), 75 min of vigorous intensity PA, or some equivalent combination. However, less than half of U.S. adults reach this goal, with the proportion even smaller among adults with overweight or obesity. Moreover, regular PA declines after age 45-50. Previous research suggests a shift in national guidelines to emphasize PA of a self-selected intensity (i.e., self-paced), instead of prescribed moderate intensity PA, may result in better adher-ence to PA programs, particularly among midlife adults with overweight or obesity. The present paper presents the protocol for a field-based RCT testing the hypothesis that adherence to PA programs is improved when PA is explicitly recommended to be self-paced rather than prescribed at moderate intensity among midlife (ages 50-64) adults (N = 240) with overweight or obesity. All participants receive a 12-month intervention designed to help them overcome barriers to regular PA and are randomly assigned to either self-paced or prescribed mod-erate intensity PA. The primary outcome is total volume of PA (minutes by intensity) as measured by accel-erometry. Secondary outcomes include self-reported min/week of PA and changes in bodyweight. Additionally, using ecological momentary assessment, we examine putative mediators of treatment effects. We hypothesize self-paced PA will lead to a more positive affective response to PA, more perceived autonomy, and lower perceived exertion during PA, and thus greater increases in PA behavior. Findings will have direct implications for PA intensity recommendations among midlife adults with overweight or obesity.

BackgroundOwing to structural-level, interpersonal-level, and individual-level barriers, Latino men have disproportionately high rates of physical inactivity and experience related chronic diseases. Despite these disparities, few physical activity (PA) interventions are culturally targeted for Latino men. ObjectiveThis study reported the feasibility and acceptability of Hombres Saludables PA intervention for Latino men. We also reported the preliminary efficacy of the intervention on PA change and provided the results of the exploratory moderator and mediator analysis. MethodsWe completed a 6-month, single-blind, pilot randomized controlled trial of Hombres Saludables with Latino men aged between 18 and 65 years. Men were randomized to either (1) a theory-driven, individually tailored, internet-based and SMS text message–based, Spanish-language PA intervention arm or (2) a nutrition and wellness attention contact control arm that was also delivered via the web and SMS text message. We assessed the primary study outcomes of feasibility using participant retention and acceptability using postintervention survey and open-ended interview questions. We measured the preliminary efficacy via change in minutes of moderate to vigorous PA per week using ActiGraph wGT3X-BT accelerometry (primary measure) and self-reported minutes per week using 7-day Physical Activity Recall. Participants completed the assessments at study enrollment and after 6 months. ResultsThe 38 participants were predominantly Dominican (n=8, 21%) or Guatemalan (n=5, 13%), and the mean age was 38.6 (SD 12.43) years. Retention rates were 91% (21/23) for the PA intervention arm and 100% (15/15) for the control arm. Overall, 95% (19/20) of the intervention arm participants reported that the Hombres study was somewhat to very helpful in getting them to be more physically active. Accelerometry results indicated that participants in the intervention group increased their PA from a median of 13 minutes per week at study enrollment to 34 minutes per week at 6 months, whereas the control group participants showed no increases. On the basis of self-reports, the intervention group was more likely to meet the US PA guidelines of 150 minutes per week of moderate to vigorous PA at 6-month follow-up, with 42% (8/19) of the intervention participants meeting the PA guidelines versus 27% (4/15) of the control participants (odds ratio 3.22, 95% CI 0.95-13.69). Exploratory analyses suggested conditional effects on PA outcomes based on baseline stage of motivational readiness, employment, and neighborhood safety. ConclusionsThe PA intervention demonstrated feasibility and acceptability. Results of this pilot study indicate that the Hombres Saludables intervention is promising for increasing PA in Latino men and suggest that a fully powered trial is warranted. Our technology-based PA intervention provides a potentially scalable approach that can improve health in a population that is disproportionately affected by low PA and related chronic disease. Trial RegistrationClinicalTrials.gov NCT03196570; https://classic.clinicaltrials.gov/ct2/show/NCT03196570 International Registered Report Identifier (IRRID)RR2-10.2196/23690

Overweight and obesity affect 45% of children and increases the risk for several negative health sequelae. Family-Based Behavioral Treatment (FBT) is the most efficacious treatment for child weight management and consists of nutrition and physical activity education, behavior change skills and parenting skills training. FBT is time and staff intensive and can include 20, 60-min separate groups for parents and children, as well as 20-min behavior coaching sessions to help problem solve barriers to implementing the skills learned and individualize the program. Guided self-help (GSH) therapies involve providing families a manual to review independently and brief coaching sessions by an interventionist to facilitate adherence. We developed a GSH version of FBT (gshFBT) which provides a manual to both parents and children and includes 14, 20-min coaching sessions over 6-months. The current study randomized 150 children (mean age = 10.1 years (SD =1.38); mean BMI% = 97.3% (SD = 2.84); mean BMIz = 2.09 (SD = 0.40); 49% female; 43% Hispanic) and one of their parents (mean age = 41.8 years (SD = 6.52); mean BMI = 32.0 (SD = 7.24); 87.3% female; 43% Hispanic) to either a group-based FBT program or a gshFBT program. Assessments are conducted at baseline, post-treatment (6 months), 6-month follow-up (12 months) and 12-month follow-up (18 months). Primary outcomes are child weight change (BMIz) and cost effectiveness. Recruitment occurred between May 2017 and October 2021 and follow-up assessments are underway. Given the public health concern for children with obesity and the low level of access to FBT, gshFBT could prove extremely useful to provide intervention to a greater proportion of the population.

Latinas are disproportionately affected by low physical activity (PA) levels and related health conditions (e.g., diabetes, obesity). Few Latinas in the U.S. (17

Latinas report low levels of physical activity (PA) and disproportionate risk of lifestyle-related diseases. Enhancements to evidence-based PA interventions may increase efficacy; however, uptake of interventions will likely depend on costs. To describe costs and examine the cost-effectiveness of two interventions for helping Latinas reach national aerobic PA guidelines. Adult Latinas (N = 199) were randomly assigned to an Original theory-based mail-delivered intervention or an Enhanced version with texting and additional calls and materials. Meeting PA guidelines was measured by the 7-Day PA Recall interview at baseline, 6 and 12 months. Intervention costs were estimated from a payer perspective. Incremental cost-effectiveness ratios (ICERs) were calculated as the additional cost per participant meeting guidelines in the Enhanced versus Original intervention. At baseline, no participants met guidelines. After 6 months, 57% and 44% in the Enhanced and Original arms met guidelines, respectively; at 12 months, rates fell to 46% and 36%. Cost per person of the Enhanced and Original interventions were $184 and $173 at 6 months, respectively, and $234 and $203 at 12 months. The primary additional expense in the Enhanced arm was staff time. ICERs were $87 per additional person meeting guidelines at 6 months (per sensitivity analysis, $26 if delivered by volunteers and $114 by medical assistants), and $317 at 12 months (sensitivity analysis: $57 and $434). Incremental costs per person meeting guidelines in the Enhanced arm were modest and could be warranted given the potential health benefits of meeting PA guidelines.

BACKGROUND:Women with abnormal glucose tolerance during pregnancy are at risk for cardiovascular disease (CVD), with higher rates among Hispanics. However, studies on the impact of lifestyle interventions on postpartum CVD profiles are sparse. METHODS:This is a secondary analysis of a controlled trial among a subsample of Hispanic women with abnormal glucose tolerance participating in Estudió PARTO (Project Aiming to Reduce Type twO diabetes; mean age = 28.2 y, SD: 5.8) who were randomized to a culturally modified Lifestyle intervention (n = 45) or a comparison Health and Wellness intervention (n = 55). Primary endpoints were biomarkers of cardiovascular risk (lipids, C-reactive protein, fetuin-A, and albumin-to-creatinine ratio) and insulin resistance (fasting insulin, glucose, HbA1c, homeostasis model assessment, leptin, tumor necrosis factor-alpha, and adiponectin) measured at baseline (6-wk postpartum) and 6 and 12 months. RESULTS:In intent-to-treat analyses, there were no significant differences in changes in biomarkers of CVD risk or insulin resistance over the postpartum year. In prespecified sensitivity analyses, women adherent with the Lifestyle Intervention had more favorable improvements in insulin (intervention effect = -4.87, SE: 1.93, P = .01) and HOMA-IR (intervention effect = -1.15, SE: 0.53, P = .03) compared with the Health and Wellness arm. In pooled analyses, regardless of intervention arm, women with higher postpartum sports/exercise had greater increase in HDL-cholesterol (intervention effect = 6.99, SE: 1.72, P = .0001). CONCLUSIONS:In this randomized controlled trial among Hispanic women with abnormal glucose tolerance, we did not observe a significant effect on postpartum biomarkers of CVD risk or insulin resistance. Women adherent to the intervention had more favorable changes in insulin and HOMA-IR.

Supplemental digital content is available in the text. ABSTRACT Introduction Few studies have focused on physical activity (PA) maintenance, particularly among minority populations; smartphone apps could provide valuable tools. This study aimed to 1) assess and understand PA maintenance among Latinas who completed a PA intervention, and 2) evaluate the feasibility, acceptability, and preliminary efficacy of commercial smartphone apps as tools for PA maintenance. Methods For this feasibility study, 27 Latinas who completed a PA intervention and increased their PA were randomly assigned to enhanced maintenance (i.e., taught to use commercial smartphone apps, n = 14) or regular maintenance (i.e., no additional treatment, n = 13). After 3 months, the feasibility and acceptability of using apps for PA maintenance was assessed via survey questions, analyzed using descriptive statistics. PA was reassessed via the 7-d PA recall and analyzed using longitudinal mixed effects regression models. Qualitative data were collected via open-ended interview questions and analyzed using thematic analysis. Results Forty-three percent of enhanced maintenance participants reported using study apps at least “a little” and 21% using them “a lot.” Although not statistically significant, enhanced maintenance participants reported a smaller drop in PA from postintervention to postmaintenance, compared with regular maintenance participants. Several participants expressed approval of the apps, whereas others reported on factors that kept them from using the apps for PA maintenance. Conclusions Incorporating lessons learned from this study, larger randomized trials are warranted to evaluate the efficacy of using smartphone apps to support PA maintenance. The widespread use of apps could make them ideal tools to support PA maintenance after interventions in different settings.