Developing an index of dose of exposure to early childhood obesity community interventions.

The recognition of the role of the environment in contributing to the obesity epidemic has led to increasing efforts to address obesity through environmental or place-based approaches in the past decade. This has challenged the use of the quasi-experimental design for evaluating community interventions. The objective of this study is to describe the development of an index of dose of exposure to community interventions that impact early childhood obesity. The goal is to provide an alternative means for evaluating the impact of multiple intervention strategies that target the same community at the same time. Two workgroups developed domains, constructs and protocols for estimating a "community intervention dose index" (CIDI). Information used to develop the protocol came from multiple sources including databases and reports of major funding organizations on obesity-related interventions implemented in Los Angeles County from 2005 to 2015, key informant interviews, and published literature. The workgroups identified five domains relevant to the consideration of dose of exposure to interventions: physical resources, social resources, context, capacity development, and programs and policies; developed a system for classifying programs and policies into macro- and micro-level intervention strategies; and sought ratings of strategy effectiveness from a panel of 13 experts using the Delphi technique, to develop an algorithm for calculating CIDI that considers intervention strength, reach and fidelity. This CIDI can be estimated for each community and used to evaluate the impact of multiple programs that use a myriad of intervention strategies for addressing a defined health outcome.

Patient's lung cancer diagnosis as a cue for relatives' smoking cessation: evaluating the constructs of the teachable moment.

BACKGROUND: To understand whether patient-reported experiences with lung cancer may create teachable moments (TM) for their relatives as evidenced by shifts in their risk perceptions, affective response, and self-image and in turn, motivation to quit smoking. METHODS: Patients at a comprehensive cancer center (n = 152) completed a survey within 6 months of lung cancer diagnosis to assess their cancer-related symptoms and openness and enumerated relatives who were smokers. Relative smokers (n = 218) then completed a survey assessing their risk perceptions, affective response, and self-image as a smoker related to the patient's diagnosis (TM mechanisms), and their motivation to quit smoking. Cross-sectional mediation and moderation analyses were conducted to explore the links between patient-reported experiences, and relatives' TM mechanisms, and motivation to quit smoking. RESULTS: Relative-reported affect was a significant mediator of the association between patient-reported symptoms and relative smoker's desire to quit. Relatives' self-image was a significant moderator of the association between patient-reported symptoms and relative smoker's desire to quit, such that patients' reported symptoms were associated with relatives' desire to quit only when the relative smoker reported a generally positive self-image as a smoker. No evidence was found for moderated mediation. However, the link between symptoms and negative affect was moderated by perceptions of risk. CONCLUSION: Whether smokers experience a family member's lung cancer as a TM is influenced by multiple interrelated cognitive and affective factors that warrant further exploration. Clearer understanding of these factors could inform how to re-invigorate and sustain this motivation to promote concrete actions toward smoking cessation. Copyright © 2015 John Wiley & Sons, Ltd.

Replicating Reducing the Risk: 12-Month Impacts of a Cluster Randomized Controlled Trial.

OBJECTIVES: To test the effectiveness of Reducing the Risk, an evidence-based sexual health curriculum designed to help prevent adolescent pregnancy and sexually transmitted infections, on youth sexual behavior and intermediate outcomes thought to lead to these behaviors. METHODS: Classes within schools in St. Louis, Missouri; Austin, Texas; and San Diego, California; were randomly assigned to receive Reducing the Risk or "business as usual." Youths completed Web-based surveys at baseline (preintervention, August 2012-January 2014) and 12 months later (August 2013-January 2015). Intent-to-treat analyses were conducted across sites; we tested for differences in impacts between sites and other subgroups. RESULTS: The program had no overall impact on sexual behaviors. However, at 1 site, program participants were significantly less likely to have engaged in recent sexual intercourse than were control group members. There were positive overall impacts on intermediate outcomes (e.g., knowledge, attitudes). CONCLUSIONS: After 12 months, Reducing the Risk was unsuccessful at changing sexual behaviors. Other results were mixed, but promising evidence (e.g., behavioral impacts at 1 site, impacts on intermediate outcomes) suggests potential for more widespread behavioral impacts over a longer term.

Replicating ¡Cuídate!: 6-Month Impact Findings of a Randomized Controlled Trial.

OBJECTIVES: To test whether ¡Cuídate!, a program culturally adapted for Hispanic youths, affects sexual risk behavior. METHODS: We evaluated 3 replications of ¡Cuídate! in California, Arizona, and Massachusetts in a randomized controlled trial (registry no. NCT02540304) in which 2169 primarily Hispanic participants were randomly assigned to an intervention (n = 1326) or a control (n = 870) group. Youths were surveyed at baseline (September 2012-April 2014) and 6 months postbaseline (March 2013-October 2014). We estimated pooled and subgroup impacts using a regression framework with baseline covariates to increase statistical precision (1216 youths analyzed in the treatment group, 806 analyzed in the control group). RESULTS: We found no impacts on the study's primary outcomes of recent sexual activity or recent unprotected sexual activity. However, ¡Cuídate! improved knowledge (10%-20% increase; P < .001), attitudes (effect size = .24; P < .001), and skills (effect size = .14; P = .002). Exploratory subgroup analyses suggest potentially problematic effects for some groups. CONCLUSIONS: Findings suggest that ¡Cuídate! was effective in improving youths' knowledge and attitudes. However, after 6 months, these changes did not translate to improvements in reported sexual risk behaviors.

The role of daily activities in youths' stress physiology.

PURPOSE: This study examined links between diurnal patterns of the stress hormone cortisol and time spent by adolescents in nine common daily activities. METHODS: During eight consecutive nightly telephone interviews, 28 youths (n = 12 girls), 10-18 years of age, reported their daily activities. On 4 days, four saliva samples were also collected and assayed for cortisol. Multilevel models assessed within- and between-person associations between time in each activity and cortisol area under the curve (AUC), cortisol awakening response (CAR), morning peak (30 minutes after wake up), and daily decline (morning peak to bedtime). RESULTS: Links with AUC were found for most activities; significant associations with cortisol rhythms suggested that most effects were due to anticipation of the day's activities. Specifically, on days when youths spent more time than usual on video games and television, they had lower AUCs, with lower morning peaks. Youths who spent more time reading (within-person) and in computer-related activities (between-person) had higher AUCs, with stronger CARs (within-person). Youths who slept more had lower AUCs, with lower morning peaks on both the between- and within-person levels. Amounts of time spent in clubs, and for older adolescents in sports, were also linked to lower AUCs. Finally, youths who spent more time in school/schoolwork had lower average AUCs, but on days when youths spent more time than usual in school, they had higher AUCs, stronger CARs, and steeper daily declines. CONCLUSION: Beyond their known implications for psychological adjustment, youths' everyday activities are linked to stress physiology.

Youth Supervision While Mothers Work: A Daily Diary Study of Maternal Worry.

Using data from a daily diary study of hourly hotel employees in the U.S. and their children, this study examined links between youth supervision arrangements and maternal worry while at work, examining both differences between individuals and day-to-day variation within individuals. Multilevel model analyses revealed both between- and within-person effects linking youth supervision to maternal worry. Mothers' partner status functioned as moderator, and maternal knowledge also emerged as a protective factor when youth were in self-care, highlighting a potential target for future work-family interventions, particularly those for hourly employees with limited access to family-friendly workplace policies.En utilisant les données d'une étude de journal quotidien des employés horaires de l'hôtel aux États-Unis et leurs enfants, cette étude a examiné les liens entre les modalités de supervision des jeunes et l'inquiétude maternelle pendant le travail, en examinant à la fois les différences inter individus et la variation intra individus au jour le jour. Analyses multi-niveaux ont révélé à la fois des effets inter et intra reliant la supervision des jeunes à l'inquiétude maternelle. Statut de partenaire des mères a fonctionné en tant que modérateur, et la connaissance maternelle est également apparue comme un facteur de protection lorsque les jeunes ont pris soins d'eux-mêmes, soulignant une cible potentielle pour des interventions de conciliation travail-famille, en particulier ceux conçus pour des employés horaires avec un accès limité à des politiques favorables à la famille.

Sources of Parental Knowledge in Mexican American Families.

We examined correlates of sources of parental knowledge of youths' experiences in Mexican American families, including child self-disclosure, parental solicitation, spouse, siblings, and individuals outside the family. Home and phone interviews were conducted with mothers, fathers, and their seventh-grade male and female offspring in 246 Mexican American families. Results indicated that mothers and fathers relied on different sources of knowledge; parent-child relationship quality and cultural orientations predicted parents' sources of knowledge; and different sources had different implications for youth adjustment. Specifically, child disclosure to mothers and fathers' reliance on their spouse were consistently linked to better youth outcomes. Moderation analyses revealed that correlates of parents' knowledge sources were not always uniform across mothers and fathers or daughters and sons.