A randomized controlled trial of culturally tailored dance and reducing screen time to prevent weight gain in low-income African American girls: Stanford GEMS.

OBJECTIVE: To test a 2-year community- and family-based obesity prevention program for low-income African American girls: Stanford GEMS (Girls' health Enrichment Multi-site Studies). DESIGN: Randomized controlled trial with follow-up measures scheduled at 6, 12, 18, and 24 months. SETTING: Low-income areas of Oakland, California. PARTICIPANTS: African American girls aged 8 to 10 years (N=261) and their parents or guardians. INTERVENTIONS: Families were randomized to one of two 2-year, culturally tailored interventions: (1) after-school hip-hop, African, and step dance classes and a home/family-based intervention to reduce screen media use or (2) information-based health education. MAIN OUTCOME MEASURE: Changes in body mass index (BMI). RESULTS: Changes in BMI did not differ between groups (adjusted mean difference [95% confidence interval] = 0.04 [-0.18 to 0.27] per year). Among secondary outcomes, fasting total cholesterol level (adjusted mean difference, -3.49 [95% confidence interval, -5.28 to -1.70] mg/dL per year), low-density lipoprotein cholesterol level (-3.02 [-4.74 to -1.31] mg/dL per year), incidence of hyperinsulinemia (relative risk, 0.35 [0.13 to 0.93]), and depressive symptoms (-0.21 [-0.42 to -0.001] per year) decreased more among girls in the dance and screen time reduction intervention. In exploratory moderator analysis, the dance and screen time reduction intervention slowed BMI gain more than health education among girls who watched more television at baseline (P = .02) and/or those whose parents or guardians were unmarried (P = .01). CONCLUSIONS: A culturally tailored after-school dance and screen time reduction intervention for low-income, preadolescent African American girls did not significantly reduce BMI gain compared with health education but did produce potentially clinically important reductions in lipid levels, hyperinsulinemia, and depressive symptoms. There was also evidence for greater effectiveness in high-risk subgroups of girls.

Stanford GEMS phase 2 obesity prevention trial for low-income African-American girls: design and sample baseline characteristics.

OBJECTIVE: African-American girls and women are at high risk of obesity and its associated morbidities. Few studies have tested obesity prevention strategies specifically designed for African-American girls. This report describes the design and baseline findings of the Stanford GEMS (Girls health Enrichment Multi-site Studies) trial to test the effect of a two-year community- and family-based intervention to reduce weight gain in low-income, pre-adolescent African-American girls. DESIGN: Randomized controlled trial with measurements scheduled in girls' homes at baseline, 6, 12, 18 and 24 month post-randomization. SETTING: Low-income areas of Oakland, CA. PARTICIPANTS: Eight, nine and ten year old African-American girls and their parents/caregivers. INTERVENTIONS: Girls are randomized to a culturally-tailored after-school dance program and a home/family-based intervention to reduce screen media use versus an information-based community health education Active-Placebo Comparison intervention. Interventions last for 2 years for each participant. MAIN OUTCOME MEASURE: Change in body mass index over the two-year study. RESULTS: Recruitment and enrollment successfully produced a predominately low-socioeconomic status sample. Two-hundred sixty one (261) families were randomized. One girl per family is randomly chosen for the analysis sample. Randomization produced comparable experimental groups with only a few statistically significant differences. The sample had a mean body mass index (BMI) at the 74 th percentile on the 2000 CDC BMI reference, and one-third of the analysis sample had a BMI at the 95th percentile or above. Average fasting total cholesterol and LDL cholesterol were above NCEP thresholds for borderline high classifications. Girls averaged low levels of moderate to vigorous physical activity, more than 3 h per day of screen media use, and diets high in energy from fat. CONCLUSIONS: The Stanford GEMS trial is testing the benefits of culturally-tailored after-school dance and screen-time reduction interventions for obesity prevention in low-income, pre-adolescent African-American girls.

Parental cultural perspectives in relation to weight-related behaviors and concerns of African-American girls.

OBJECTIVE: To determine whether cultural perspectives of parents may influence children's eating and physical activity behaviors and patterns of weight gain. RESEARCH METHODS AND PROCEDURES: African-American girls (ages 8 to 10 years) and their parents (or caregivers) (n = 210) participated at one of four Girls Health Enrichment Multisite Studies Phase 1 Field Centers. At baseline, parents completed questionnaires adapted from the African-American Acculturation Scale (AAAS), the Multiethnic Identity Scale (MEIS), and an original question on Global Cultural Identity. Girls' baseline measures included physical activity assessment by accelerometer, 24-hour dietary recalls, and questionnaires about body image and weight concerns. RESULTS: Principal components analysis indicated the expected AAAS and MEIS factor structures, with moderate to good internal consistency (Cronbach's alpha = 0.61 to 0.82) and some intercorrelation among these measures (r = 0.17 to 0.57). Overall mean (SD) AAAS subscale scores of 4.1 (2.1) and 5.5 (1.8) of a possible 7 and 3.0 (0.9) of a possible 4 on the MEIS indicated, respectively, moderate to high levels of parental African-American cultural orientation and identity with moderate variability. Parental AAAS and MEIS scores were inversely correlated with girls' body image discrepancy and weight concern. One AAAS subscale was positively associated with total energy intake and percentage energy from fat. Overall, however, parental AAAS and MEIS scores were unrelated or inconsistently related to girls' physical activity and diet measures. DISCUSSION: The AAAS and MEIS measures had acceptable psychometric properties, except for weight concern, but did not give a consistent picture of how parental perspectives related to the girls' baseline attitudes and behaviors.

Dance and reducing television viewing to prevent weight gain in African-American girls: the Stanford GEMS pilot study.

OBJECTIVE: To test the feasibility, acceptability, and potential efficacy of after-school dance classes and a family-based intervention to reduce television viewing, thereby reducing weight gain, among African-American girls. DESIGN: Twelve-week, 2-arm parallel group, randomized controlled trial. SETTING: Low-income neighborhoods. PARTICIPANTS: Sixty-one 8-10-year-old African-American girls and their parents/guardians. INTERVENTIONS: The treatment intervention consisted of after-school dance classes at 3 community centers, and a 5-lesson intervention, delivered in participants' homes, and designed to reduce television, videotape, and video game use. The active control intervention consisted of disseminating newsletters and delivering health education lectures. MAIN OUTCOME MEASURES: Implementation and process measures, body mass index, waist circumference, physical activity measured by accelerometry, self-reported media use, and meals eaten with TV. RESULTS: Recruitment and retention goals were exceeded. High rates of participation were achieved for assessments and intervention activities, except where transportation was lacking. All interventions received high satisfaction ratings. At follow up, girls in the treatment group, as compared to the control group, exhibited trends toward lower body mass index (adjusted difference = -.32 kg/m2, 95% confidence interval [CI] -.77, .12; Cohen's d = .38 standard deviation units) and waist circumference (adjusted difference = -.63 cm, 95% CI -1.92, .67; d = .25); increased after-school physical activity (adjusted difference = 55.1 counts/minute, 95% CI -115.6, 225.8; d = .21); and reduced television, videotape, and video game use (adjusted difference = -4.96 hours/week, 95% CI -11.41, 1.49; d = .40). The treatment group reported significantly reduced household television viewing (d = .73, P = .007) and fewer dinners eaten while watching TV (adjusted difference = -1.60 meals/week, 95% CI -2.99, -.21; d = .59; P = .03). Treatment group girls also reported less concern about weight (d = .60; P = .03), and a trend toward improved school grades (d = .51; P = .07). CONCLUSIONS: This study confirmed the feasibility, acceptability, and potential efficacy of using dance classes and a family-based intervention to reduce television viewing, thereby reducing weight gain, in African-American girls.

Recruitment of African-American pre-adolescent girls into an obesity prevention trial: the GEMS pilot studies.

OBJECTIVE: The objective of this report is to describe the methods used to recruit 8- to 10-year-old African-American girls into four 12-week randomized controlled pilot studies on obesity prevention. DESIGN: The Girls health Enrichment Multi-site Study (GEMS) involved 4 field centers which independently developed and tested interventions designed to prevent excess weight gain in African-American girls. Each field center developed its own recruitment plan, but used a standardized recruitment reporting form. The goal was to recruit 40-60 girls, depending on the center. MEASURES: Recruitment yields were computed at each site. Socio-demographic data and weight status were collected for 210 African-American girls who were randomized into the study, as well as for their parents/caregivers. Data were collected on the sources from which participants heard about the study, and the reasons for their interest in the project. RESULTS: The 4 field centers used multiple, but different, recruitment strategies. The most commonly used approaches were mailings, flyers, radio announcements, and group presentations. Caregivers were most likely to hear about the program from the radio (29%), a flyer from the school (23%), or from their child (18%). Among caregivers, the most common reasons for participating were: interest in health (56%), interest in diet/health (51%), and believing the program would be fun for their child (46%). The most frequent reason given by girls was that the program sounded like fun (70%). Three of the 4 field centers met their recruitment target goals. CONCLUSIONS: The GEMS experience demonstrates the feasibility of recruiting and enrolling African-American girls in short-term intervention studies of behavior change. The multiple recruitment strategies, which included developing trusting relationships in the respective communities, were considered critical to the success of recruitment.