Introduction
Methods
Definition of Outcomes
Results
Interventions Targeting Adults
Study and Sample Characteristics
Author, year | Study design & sample size | Target population & characteristics | Study outcome measures | Attrition rates | Limitations |
---|---|---|---|---|---|
Elder et al., 2000 [42] | Quasi experimental, n = 732 from17 classes | 90 % Latino;51 % female;mean age = 31 yrs. |
Primary outcome(s): BP, WC, HC, and weight.Secondary: TC, HDL-C, knowledge, attitudes and diet. | 3 months (attrition not reported); 28 % for survey measures and 37 % for physiologic measures at 6 months; no differences by group. | Possible contamination between groups; significant weight gain over time; education-focused vs. behavioral approach, moderately high attrition rate. |
Harralson et al., 2007 [40] | Pre-post-test without control, n = 225 | 100 % Latino;100 % female;mean age = 44 yrs. |
Primary Outcome(s):BMI, BP, WHR.Secondary:Health knowledge, depression, psychosocial factors. | 48 % at 3 months to 4 months. | No control group, impact of cultural beliefs unclear, short follow-up period, high attrition rate. |
Cullen et al., 2009 [37] | Group randomized controlled trial, n = 1107a from 100 classes | 89 % Latino;97 % female;mean age = 35 yrs. |
Primary outcome(s):BMI, diet.Secondary:Dietary behaviors, psychosocial factors. | 26 % at 2 months and 45 % at 4 months; no differences by group at follow-up (data not presented). | Short follow-up period, high attrition rate at 4 months. |
Ayala et al., 2011 [38] | Pre-post-test without control n = 387b
| 100 % Latino;100 % female median age = 39 yrs. |
Primary outcomes(s):BMI, PA. Secondary:WC, BP, fitness, flexibility, depression, psychosocial factors. | 47 % at 6 months and 39 % at 12 months. | No control group, PA focus only, high attrition rate at 6 months. |
Novotny et al., 2012 [36] | Cluster randomized controlled trial, n = 4263c from 30 hotels | 42 % Filipino, 32 % Other Asian, 13 % Pacific Islander, 9 % White, 1 % African-American, 52 % female;mean age = 46 yrs. |
Primary outcome(s): BMI, Waist-to-height ratio.Secondary: PA and diet. | 17 % at 12 months and 30 % at 24 months; Rates by group not reported. | Unclear if control and intervention groups were similar at beginning of study, moderately high attrition rate at 24 months. |
Ziebarth et al, 2012 [41] | Pre-post-test without control, n = 47 families (57 adults and 54 children)d
| 100 % Latinos; 89 % female; mean age = 32 yrs. |
Primary outcome(s):BMI, WC, BP, blood lipids, glucose | 0 % at 2 months. | No control group, short follow-up period, small sample size. |
Schwartz et al., 2013 [39] | Pre-post-test without control, n = 477e
| “vast majority Latino”(% not reported);61 % female;mean age = 40 yrs. |
Primary outcome(s): BMI, WC, HC, BP, blood lipids, glucose, A1C Secondary: PA | 2 % at 2 months and 35 % at 12 months | No control group, moderately high attrition rate at 12 months. |
Summary of Interventions
Author, year | Setting | Delivery mode | No. of intervention components* | Planned dose and fidelity | Intervention effects | Major findings |
---|---|---|---|---|---|---|
Elder et al., 2000 [42] | ESL classes | ESL teachers | 1 component:
Intervention: Nutrition/heart health education integrated into ESL classes.
Control: Attention control on stress management. | Dose: Up to five 3-hr classes over a 1-to 2-week period over 3 months. Fidelity: ESL teachers received a half-day training however fidelity not reported. | X | Increase in HDL (p < 0.01) at 3 months vs. control, changes not maintained at 6 months. TC and BP decreased in both groups (p < 0.001). Increase in weight over time for both groups (p < 0.001). |
Harralson et al., 2007 [40] | Women’s wellness center | Not mentioned | 2 components:
Intervention: PA classes and health education sessions.
No control group. | Dose: Three 1-hour PA classes per week. One 30-minute health education class per week. First year: 12 weekly sessions. Second year: 16 weekly sessions. Fidelity: Not reported. | √ | 39 % of women BMI > 30 compared to 50 % at baseline. Decrease in BMI (p = 0.001), abdominal obesity (p < 0.001), and WHR (p = 0.04). |
Cullen et al., 2009 [37] | Texas EFNEP classes | 6 bilingual paraprofessionals plus separate EFNEP staff members for control group | 4 components:
Intervention: traditional EFNEP classes plus six videos, weekly goal setting and review, and intervention materials including recipes.
Control: traditional EFNEP classes. | Dose: 6 EFNEP class sessions. Fidelity: Selected paraprofessionals attended a 2-day training prior to intervention. 46 intervention sessions in 29 classes were observed, fidelity >80 %. | √ | Significant decrease in BMI in the intervention group at 2 months (p < 0.05), changes not maintained at 4 months. |
Ayala et al., 2011 [38] | Various community settings (i.e., schools, recreation centers, health centers) | Bilingual (Spanish and English) or monolingual Spanish speaking trained promotores | 1 component:
Intervention: group exercise classes delivered throughout the community.
No control group. | Dose: Mean attendance was 16 sessions per group exercise sign-in sheets. Fidelity: Promotores received an 8-session training, however fidelity not reported. | √ | No significant changes in BMI. Improved systolic BP, WC, and fitness indicators at 12 months (all p < 0.001). |
Novotny et al., 2012 [36] | Hotels | Research staff | 3 to 4 components:
Intervention: Hotel environmental changes (i.e., electronic sign messages, highlighting of healthy cafeteria and menu foods). Weekly group-based nutrition and PA classes held at work for all employees. Weekly group-based nutrition and PA outside of work hours for obese individuals only. Feedback on weight and WC measures.
Control: Only feedback on weight and WC measures. | Dose: Assessment and feedback on physical measurements and health behaviors at baseline, 12-, and 24-months (Up to three possible assessment and feedback sessions over 24-month period). Intervention group attended weekly 30 min sessions that incorporated PA and nutrition education for 24 months. Content of sessions was reinforced daily by the changes to the hotel environment. Fidelity: Not reported | X | No significant changes in BMI and WHR. |
Ziebarth et al., 2012 [41] | Community health center | Bilingual staff and certified bilingual exercise instructor | 3 components:
Intervention: We Can! curriculum (parents and children separately), PA sessions (together), and a family dinner.
No control group. | Dose: Eight weekly classroom (40 mins) and PA sessions (40 mins), followed by a family dinner. Education sessions conducted by bilingual health educator and registered nurse. PA sessions conducted by bilingual health promoter/certified exercise instructor. Fidelity: Not reported. | √ | Decrease in weight (p = 0.01), BMI (p = 0.01), reduction in sBP and dBP (p = 0.01, p = 0.05), decrease in blood glucose (p = 0.03) at 2 months. |
Schwartz et al., 2013 [39] | Community setting and home visits | Bilingual promotores | 4 components:
Intervention: Weekly group sessions that included a general family activity, PA, healthy meal or snack, discussion and wrap-up. Weekly family home visit. Review of baseline and post-assessment labs with clinicians.
No control group. | Dose: Eight two-hour group sessions and eight one-hour home visits over a 3 month period. Promotores selected from target communities were trained to conduct group-sessions and home visits. Fidelity: Promotores were trained to conduct family-meetings and home visits, however fidelity not reported. | √ | Significant reductions in all primary outcomes from baseline to 2 months (p < 0.000), and remained significant at 12 months (Weight, p = 0.001, BMI, WC, HC, WHR (p < 0.000), except for BP and blood lipids. |
Intervention Effects
Interventions Targeting Children
Study and Sample Characteristics
Author, year | Study-design and sample size | Target population & characteristics | Study outcome measures | Attrition rates | Limitations |
---|---|---|---|---|---|
Fitzgibbon et al., 2006 [45] | Group randomized controlled trial, n = 401 children from 12 Head Starts | 81 % Latino; 49 % female; mean age = 4.2 yrs. |
Primary outcome(s): BMI.
Secondary: dietary intake, and PA. | 3 % for intervention and control at 3.5 months, 11.9 % for intervention and 17 % for control at 12 months and 12.9 % for intervention and 17 % for control at 24 months. | Small sample size, lack of community engagement which could have enhanced cultural appropriateness of intervention, minimal parental engagement. |
Barkin et al., 2012 [46] | Parallel-group randomized controlled trial, n = 106a parent child-dyads | 95 % Latino; Parent: mean age = 31.3 yrs. Child: 50 % female; mean age = 4.2 yrs. |
Primary outcome(s): BMI, BMI percentile. | 35 % for intervention and 23 % for control at 3 months. | Short follow up period, small sample size, moderately high attrition in intervention versus control group. |
Yin et al., 2012 [44] | Pre-post with two treatment groups and a comparison n = 423b children from 4 Head Starts | 90 % Latino; 52 % female; mean age = 4.2 yrs. |
Primary outcome(s): BMI-z score. | Unknown by intervention and control; overall 12 % at 4.5 months. | Short follow up period, non-randomized, Not intending to stratify analyses by center & home based. |
Bellows et al, 2013 [43] | Group randomized controlled trial, n = 274c children from 8 Head Starts | 59 % Latino; 45 % female; mean age = 4.4 yrs. |
Primary outcome(s): PA
Secondary: BMI, BMI percentile and BMI-z score, fine and gross motor skills. | 26 % for intervention and 21 % for control at 4.5 months. | Short follow up period, no data on parental/household characteristics, dose of intervention may not have been adequate, no dose-response analysis; questionable use of nutrition education as control. |
Haines et al., 2013 [47] | Randomized controlled trial, n = 121d families | 51 % Latino; Child: 52 % female, mean age = 4.1 yrs. |
Primary outcome(s): change in eating meals together as a family, child's sleep duration, child's TV viewing time, and presence of TV in the room where child slept.
Secondary: child BMI. | 11.3 % for intervention and 5.1 % for control at 6 months. | Although formative work with population, no reported community engagement. |
Summary of Interventions
Author, year | Setting | Delivery mode | No. of intervention components* | Planned dose and fidelity | Intervention effect | Major findings |
---|---|---|---|---|---|---|
Fitzgibbon et al., 2006 [45] | Pre-schools through the Archdiocese of Chicago | Delivered to children by trained early childhood educators in both Spanish and English | 2 components delivered to children (with a parent component including newsletters):
Intervention: PA (20 min of aerobic activity) + Nutrition education (20 min of nutrition activity based on hand puppets reflecting food pyramid). Control: General health. | Dose: Intervention: 3 days/week for 3.5 months plus 12 weekly parent newsletters/homework assignments; Control: weekly 20 min sessions for 3.5 months. Fidelity: not reported. | X | No significant BMI differences between intervention and control schools. |
Barkin et al., 2012 [46] | Public community recreation center | Delivered by one trained facilitator in Spanish | 4 components delivered to parents:
Intervention: Group skill building sessions around nutrition, PA, sedentary behaviors, and building social networks. Control: school readiness activities. | Dose: Intervention: Weekly 90 min. sessions for 3 months; Control: Three 60 min. sessions over 3 months. Fidelity: Facilitator training and supervision; verification of essential treatment components by supervisor; controlling for differences between interventionists by having same administer each condition; collection of fidelity measures (e.g., length, #, frequency of sessions; participation rates). A study team member observed 3 sessions/condition (100 % of key messages discussed). | √ | Controlling for covariates, effect of treatment on post-intervention BMI was significant. Intervention effect strongest on obese children. |
Yin et al., 2012 [44] | Pre-school with parent involvement at school | Delivered by trained teachers in the pre-school centers, by peer-educators to parents | 3 components delivered to children, centre staff, and parents.
Intervention: PA (gross motor program + outdoor play), nutrition (healthy eating using Sesame Street characters), health literacy and capacity building
Control: Delayed intervention. | Dose: Center-based intervention: different modules, 2 weeks each, teachers needed to use all activities for each module at least once during 2 wks, integration of activity into daily routines (free play, healthy eating promotion). Home-based intervention: Center-based activities + 6 poster information sessions led by peer parent educators for 4.5 months (18 wks);
Control: Received intervention materials and training upon completion of study. Fidelity: levels of adherence to the protocol and its implementation, intervention exposure and program participation (e.g. teachers completed a biweekly report on supplemental classroom activities (frequency, time of the day, location of use, and problems) although results on fidelity measures not reported. | √ | Weight gain in weight z score for age and gender was significantly less in intervention (center + home based) vs. control but not just for center based. |
Bellows et al., 2013 [43] | Pre-schools (i.e. Classrooms) | Delivered by trained teachers in English | 2 components delivered to children:
Intervention: PA (focused on group of skills from one of the three gross motor skill categories) + nutrition (Food Friends program to increase willingness to try new foods).
Control: nutrition only. | Dose: Intervention: 4 days/wk. for 15-20 min in classrooms for 4.5 months (18 wks);
Control:12 week nutrition program Fidelity: Teachers trained on the study protocol before the study; program surveys for teachers every 3 weeks to ascertain activity completion; fidelity to lessons measured with Likert scale, although results of fidelity measures not reported. | X | Intervention had no effects on weight status. |
Haines et al., 2013 [47] | Home- based | Delivered by trained bilingual workers | 3 components delivered to parents
Intervention: Coaching, mail-based education, and text-based prompt targeting family functioning, nutrition and meal patterns, and PA and sedentary behaviours.
Control: Focused on healthful development. | Dose: Intervention: 4 home visits, 4 health coaching calls, mailed materials, twice weekly text messages for 4 months and then weekly for 2 months; Control: 4 monthly mailings Fidelity: Training of health educators on motivational interviewing; monthly coaching to reinforce messages, kept detailed records of completed home visits and calls although results of fidelity measures not reported. | √ | Intervention participants had significant decreases in BMI. |
Intervention Effects
Pilot Studies
Author, year | Study design & sample size | Target population & characteristics | Study outcome measures | Attrition rates | Limitations |
---|---|---|---|---|---|
Adult interventions | |||||
Keller and Cantue, 2008 [49] | Pre-post-test clinical trial, n = 18 | 100 % Latino; 100 % female; mean age = 55 yrs. |
Primary outcomes(s): Blood lipids, % and location of BF, BP, and adherence to PA. | Group I: 64 % Group II: 43 % at 9 months. | No control group, high attrition rate at 9 months. |
Millard et al., 2011 [48] | Pre-post-test with control, n = 91a
| 89 % Latino; 98 % female; mean age = 36 yrs. |
Primary outcome(s): BMI. | 21 % at 2 months; Rates by group not reported. | Short follow-up period, excluded 20 % of participants who attended less than half of sessions from analysis. |
Wieland et al., 2012 [50] | Pre-post-test without control, n = 45b
| 44 % Latina, 31 % Somalia, 18.7 % Cambodian, 6 % African-American; 100 % female; mean age = 40 yrs. |
Primary outcome(s): Weight, BMI, WC, and BP.
Secondary: QOL. | 29 % at 1.5 months. | No control group, short follow-up period. |
Child interventions | |||||
Olvera et al., 2010 [54] | Two-arm parallel group assignment; n = 46 mother-daughter dyads | 100 % Latino; 100 % female; Mother: mean age 35.8 yrs.; Daughter: mean age = 10.2 yrs. |
Primary outcome(s): Physical fitness and activity.
Secondary: Diet, BMI. | 31 % of dyads in intervention group versus 15 % of dyads in control group at 3 months. | No randomization, short follow-up period, moderately high attrition rate in the intervention group. |
Slusser et al., 2012 [51] | Randomized controlled trial; n = 160 families c
| 100 % Latino; Mothers: 100 % female mean age 31.6 yrs. Child: 56 % female |
Primary outcome(s): BMI. | *28 % in intervention group and 38 % in control group at 12 months. | Moderately high attrition in control group, sub-set analysis completed of those BMI >50 percentile is unclear, Time 2 for intervention not discussed, no community involvement reported. |
Castro et al., 2013 [52] | Pre-post-test without control; n = 120 children, 60 families | Child: 59 % Latino; 51 % female; mean age = 6 yrs. |
Primary outcome(s): BMI.
Secondary: Access to fruits and vegetables. | 20.8 % at 1.8 months (7 wks). | No control group, short follow-up period, non-independent observations. |
Bender et. al., 2013 [53] | Pre-post-test without control; n = 33 mother-child dyads | 100 % Latino dyads; Mothers: mean age = 27.0 yrs., Child: 52 % female; mean age = 3.6 yrs. |
Primary outcome(s): Children’s sugar sweetened beverage consumption and maternal walking.
Secondary: BMI. | 9 % at 6 months. | No control or randomization. |
Fitzgibbon et al., 2013 [55] | Randomized controlled trial; n = 146 children, 123 parents | 94 % Latino; Parent: 89 % female; mean age = 32.8 Child: 50 % female; mean age = 4.5 yrs. |
Primary outcome(s): BMI.
Secondary: PA, diet, screen time. | 1 % at 5.3 months (14 wks) and 15 % at 12 months for intervention and 3 % 5.3 months (14 wks) and 9 % at 12 months for control. | Homogenous group of low-acculturated and low-income Latinos. |
Author, year | Setting | Delivery mode | No. of intervention components | Planned dose and fidelity | Intervention effect | Major findings |
---|---|---|---|---|---|---|
Adult interventions | ||||||
Keller and Cantue, 2008 [49] |
Barrios (neighborhoods) and community centers | Promotoras | 1 component:Both treatment groups: PA intervention, different frequencies of walking. | Dose: Group I: 30 min for 3 days/wk of walkingGroup 2: 30 min for 5 days/wk of walking. Each participant walked at a 3.2-MET intensity for 9 months. Fidelity: Not reported | √ | BMI decreased over time for both groups; it decreased significantly at 9 months for group I but not for group II. |
Millard et al., 2011 [48] |
Colonias (social networks in low-income areas) | Promotores | 2 components: Intervention: PA (aerobics and stretching), chronic disease education. Control: No intervention. | Dose: Weekly group meetings (20 min of PA) over 1.8 months (7 wks) Fidelity: Training of Promotores but fidelity not reported. | √ | Significant decrease in BMI. |
Wieland et al. 2012 [50] | Different community settings (YMCA) worked with Rochester Healthy Community Partnership | Research staff | 2 components:Nutrition education (healthy food choices, portion sizes) and PA (dance and strength training). | Dose: Two 90 min classes (60 min PA and 30 min nutrition education) provided weekly for 1.5 months (6 wks) Fidelity: Not reported | X | Decreasing trend in biometric data but not statistically significant. |
Child Interventions | ||||||
Olvera et al., 2010 [54] | Various community settings (i.e. community centers, parks, grocery stores) and school setting (i.e. classroom, gym, playground, cafeteria) | Delivered by instructor | 3 components delivered to mothers and daughters: Intervention: Nutrition education, PA and behavioral counseling.Control: Educational material on nutrition and counseling plus light intensity PA. Control: Weekly meetings with instructor for 45 min + 45 min of light intensity aerobic or sports session. | Dose: Intervention: Over 3 months: 3 weekly structured group aerobic classes, 2 weekly nutrition sessions, and 1 weekly behavioral counseling session were provided. Each session included 45 min of exercise and 45 min of either nutrition education or counseling. Fidelity: Not reported. | X | No significant BMI differences between mothers and daughters of intervention and control. |
Slusser et al., 2012 [51] | Health clinics and Head Start programs and preschools | Trained bilingual social worker | 3 components delivered to mothers: Intervention: Parenting, nutrition (“Bright Futures in Practice Nutrition”) and physical activity (“Bright Futures in Practice PA”) Control: Wait list control (offered classes 1 yr. post). | Dose: Seven weekly 90-minute sessions plus two boosters delivered over 4 months. Fidelity: Not reported. | √ | Children in intervention decreased BMI-z scores significantly vs. controls at 12 months (among subset of children >50th percentile). |
Castro et al., 2013 [52] | Community gardens | Delivered by cooperative extension and research staff | 3 components delivered to families:Intervention: Gardening, cooking and nutrition, social events. No control group. | Dose: Weekly garden and cooking and nutrition sessions; 4 social events over 1.7 months (7 wks). Fidelity: Not reported. | √ | Of overweight and obese children (38 %), 17 %, achieved statistically significant improvements in BMI classification. |
Bender et. al., 2013 [53] | Urban Health Center | Delivered by trained Promotora | 3 components delivered to mothers:Intervention: Beverage consumption, physical activity, parental role modeling. No control group. | Dose: Phase 1: Four biweekly interactive group lessons delivered over 2 months. Phase 2: 2 hour lessons delivered by promotora. Six promotora led monthly group community. activities (i.e. grocery store field trips). Fidelity: Investigator supervision during group sessions but fidelity not reported. | X | Maternal BMI decreased significantly. Child BMI percentile did not decrease significantly. |
Fitzgibbon et al., 2013 [55] | Head Start Pre-schools | Delivered by trained early childhood educators and facilitators in both Spanish and English | 2 components delivered to children: Intervention: PA and Nutrition education. Control: General health. 3 components delivered to parents: Intervention: PA and Nutrition education, parenting. | Dose: Child intervention: 3 days/week for 40 minutes in classrooms (20 min of nutrition and 20 min of aerobic activity) for 14 wks + CD to supplement curriculum; Parent intervention: 6 weekly 90-minute classes + CD to reinforce materials. Control: Weekly newsletters about health and safety topics for 14 wks. Fidelity: Not reported. | X | Downward trend for BMI-z for both intervention and control. |