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A group randomized controlled trial integrating obesity prevention and control for postpartum adolescents in a home visiting program.

Haire-Joshu DL, Schwarz CD, Peskoe SB, Budd EL, Brownson RC, Joshu CE - Int J Behav Nutr Phys Act (2015)

Bottom Line: This risk is significantly heightened for adolescents that become pregnant, many of whom experience postpartum weight retention.When compared to the control group, BALANCE adolescents significantly improved fruit and vegetable intake (p = .03).There were no significant differences between groups in sweetened drink and snack consumption or walking.

View Article: PubMed Central - PubMed

Affiliation: Washington University in St. Louis, The Brown School of Social Work and Public Health, and The School of Medicine, 1 Brookings Dr, St. Louis, MO, 63130, USA. djoshu@wustl.edu.

ABSTRACT

Background: Adolescence represents a critical period for the development of overweight that tracks into adulthood. This risk is significantly heightened for adolescents that become pregnant, many of whom experience postpartum weight retention. The aim of this study was to evaluate Balance Adolescent Lifestyle Activities and Nutrition Choices for Energy (BALANCE), a multicomponent obesity prevention intervention targeting postpartum adolescents participating in a national home visiting child development-parent education program.

Methods: A group randomized, nested cohort design was used with 1325 adolescents, 694 intervention and 490 control, (mean age = 17.8 years, 52 % underrepresented minorities) located across 30 states. Participatory methods were used to integrate lifestyle behavior change strategies within standard parent education practice. Content targeted replacement of high-risk obesogenic patterns (e.g. sweetened drink and high fat snack consumption, sedentary activity) with positive behaviors (e.g. water intake, fruit and vegetables, increased walking). Parent educators delivered BALANCE through home visits, school based classroom-group meetings, and website activities. Control adolescents received standard child development information. Phase I included baseline to posttest (12 months); Phase II included baseline to follow-up (24 months).

Results: When compared to the control group, BALANCE adolescents who were ≥12 weeks postpartum were 89 % more likely (p = 0.02) to maintain a normal BMI or improve an overweight/obese BMI by 12 months; this change was not sustained at 24 months. When compared to the control group, BALANCE adolescents significantly improved fruit and vegetable intake (p = .03). In stratified analyses, water intake improved among younger BALANCE teens (p = .001) and overweight/obese BALANCE teens (p = .05) when compared to control counterparts. There were no significant differences between groups in sweetened drink and snack consumption or walking.

Conclusion: Prevention of postpartum weight retention yields immediate health benefits for the adolescent mother and may prevent the early development or progression of maternal obesity, which contributes to the intergenerational transmission of obesity to her offspring. Implementing BALANCE through a national home visiting organization may hold promise for promoting positive lifestyle behaviors associated with interruption of the progression of maternal obesity.

Trial registration: Clinical Trials Registry NCT01617486 .

No MeSH data available.


Related in: MedlinePlus

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Fig1: Consolidated standards of reporting diagram

Mentions: BALANCE used a group randomized, nested cohort design using communities as the unit of allocation while the analysis is conducted at the level of the individual, controlling for the effect of secular trends on behavioral outcomes [32, 33]. Sample size calculations for 90 % statistical power were based on methods focused on nested cohort designs [34]. PAT affiliated adolescent programs across 30 states were divided into 3 strata based on number of adolescent parents expected in the state followed by random assignment. Other stratification criteria were not used since the demographics are similar for teen parents. Adolescents were eligible to participate if they were enrolled in the PAT Teen Program, were less than one year postpartum, and were not pregnant or planning to become pregnant. Eligibility and willingness to participate were assessed at the sites by the parent educator. Study staff followed up with interested adolescents to formally recruit and obtain consent. Across these sites, 1325 adolescents mothers were eligible to participate (774 randomized to intervention, 551 randomized to control) (Fig. 1). However, 141 of the 1325 participants randomized did not complete the baseline assessment, and 55 were pregnant at posttest. Of the 1129 participants that completed the baseline assessment and did not become pregnant, 905 participants completed a post and/or follow-up assessment. Among BALANCE participants with baseline assessments, those lost to follow-up were more likely to report their race/ethnicity as “Other” when compared with those who completed a post and/or follow-up assessments; there were no other significant differences in baseline characteristics. Among control participants with baseline assessments, there were no significant differences between those with and without post and/or follow-up assessments. The Institutional Review Board of Saint Louis University and Washington University in St. Louis approved this study. Informed consent was obtained from all participants in this study.Fig. 1


A group randomized controlled trial integrating obesity prevention and control for postpartum adolescents in a home visiting program.

Haire-Joshu DL, Schwarz CD, Peskoe SB, Budd EL, Brownson RC, Joshu CE - Int J Behav Nutr Phys Act (2015)

Consolidated standards of reporting diagram
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4499890&req=5

Fig1: Consolidated standards of reporting diagram
Mentions: BALANCE used a group randomized, nested cohort design using communities as the unit of allocation while the analysis is conducted at the level of the individual, controlling for the effect of secular trends on behavioral outcomes [32, 33]. Sample size calculations for 90 % statistical power were based on methods focused on nested cohort designs [34]. PAT affiliated adolescent programs across 30 states were divided into 3 strata based on number of adolescent parents expected in the state followed by random assignment. Other stratification criteria were not used since the demographics are similar for teen parents. Adolescents were eligible to participate if they were enrolled in the PAT Teen Program, were less than one year postpartum, and were not pregnant or planning to become pregnant. Eligibility and willingness to participate were assessed at the sites by the parent educator. Study staff followed up with interested adolescents to formally recruit and obtain consent. Across these sites, 1325 adolescents mothers were eligible to participate (774 randomized to intervention, 551 randomized to control) (Fig. 1). However, 141 of the 1325 participants randomized did not complete the baseline assessment, and 55 were pregnant at posttest. Of the 1129 participants that completed the baseline assessment and did not become pregnant, 905 participants completed a post and/or follow-up assessment. Among BALANCE participants with baseline assessments, those lost to follow-up were more likely to report their race/ethnicity as “Other” when compared with those who completed a post and/or follow-up assessments; there were no other significant differences in baseline characteristics. Among control participants with baseline assessments, there were no significant differences between those with and without post and/or follow-up assessments. The Institutional Review Board of Saint Louis University and Washington University in St. Louis approved this study. Informed consent was obtained from all participants in this study.Fig. 1

Bottom Line: This risk is significantly heightened for adolescents that become pregnant, many of whom experience postpartum weight retention.When compared to the control group, BALANCE adolescents significantly improved fruit and vegetable intake (p = .03).There were no significant differences between groups in sweetened drink and snack consumption or walking.

View Article: PubMed Central - PubMed

Affiliation: Washington University in St. Louis, The Brown School of Social Work and Public Health, and The School of Medicine, 1 Brookings Dr, St. Louis, MO, 63130, USA. djoshu@wustl.edu.

ABSTRACT

Background: Adolescence represents a critical period for the development of overweight that tracks into adulthood. This risk is significantly heightened for adolescents that become pregnant, many of whom experience postpartum weight retention. The aim of this study was to evaluate Balance Adolescent Lifestyle Activities and Nutrition Choices for Energy (BALANCE), a multicomponent obesity prevention intervention targeting postpartum adolescents participating in a national home visiting child development-parent education program.

Methods: A group randomized, nested cohort design was used with 1325 adolescents, 694 intervention and 490 control, (mean age = 17.8 years, 52 % underrepresented minorities) located across 30 states. Participatory methods were used to integrate lifestyle behavior change strategies within standard parent education practice. Content targeted replacement of high-risk obesogenic patterns (e.g. sweetened drink and high fat snack consumption, sedentary activity) with positive behaviors (e.g. water intake, fruit and vegetables, increased walking). Parent educators delivered BALANCE through home visits, school based classroom-group meetings, and website activities. Control adolescents received standard child development information. Phase I included baseline to posttest (12 months); Phase II included baseline to follow-up (24 months).

Results: When compared to the control group, BALANCE adolescents who were ≥12 weeks postpartum were 89 % more likely (p = 0.02) to maintain a normal BMI or improve an overweight/obese BMI by 12 months; this change was not sustained at 24 months. When compared to the control group, BALANCE adolescents significantly improved fruit and vegetable intake (p = .03). In stratified analyses, water intake improved among younger BALANCE teens (p = .001) and overweight/obese BALANCE teens (p = .05) when compared to control counterparts. There were no significant differences between groups in sweetened drink and snack consumption or walking.

Conclusion: Prevention of postpartum weight retention yields immediate health benefits for the adolescent mother and may prevent the early development or progression of maternal obesity, which contributes to the intergenerational transmission of obesity to her offspring. Implementing BALANCE through a national home visiting organization may hold promise for promoting positive lifestyle behaviors associated with interruption of the progression of maternal obesity.

Trial registration: Clinical Trials Registry NCT01617486 .

No MeSH data available.


Related in: MedlinePlus