EAL

NGHC: Childhood Nutrition and Lifestyle Factors (2013)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To assess the efficacy of a healthy lifestyle summer program called BOUNCE (Behavior Opportunities Uniting Nutrition Counseling and Exercise) in improving selected physical fitness measures (weight, BMI, BF%, waist circumference and aerobic fitness) and physical activity in minority girls.

Inclusion Criteria:

Both parents and daughters self-identified as Latino or African-American origin
Each daughter was required to be at risk for overweight (BMI from 85th to 94th percentile for age)
Each daughter was able to attend all three weeks of the intervention
The parent was able to attend three parent-group weekly sessions
Each daughter had to provide a medical history completed by the custodial parent and have a medical examination conducted by a medical professional indicating that daughter had no physical disability that could hinder her involvement in the BOUNCE study.

Exclusion Criteria:

Not described.

Description of Study Protocol:

Recruitment

Study families were recruited through flyers and brochures and referrals by counselors, nurses and school teachers from social service agencies and local elementary schools
Remaining families were recruited through the University of Houston BOUNCE Web site.

Design

Before and after study.

Blinding

Implied with measurements.

Intervention

A typical BOUNCE day consisted of exercise, nutrition education and behavioral counseling elements targeting daughters and their parents
The intervention was offered five days per week (Monday through-Friday) from 9 a.m. to 5 p.m. each day. Intervention sessions were delivered in four facilities at a university campus (gymnasium, dance studio, food science lab with four small kitchens and restaurant seating area and classroom) located within the target community.

Statistical Analysis

Descriptive statistics were calculated for the outcome variables
Data were inspected for missing or undefined values, and only subjects with pre- and post-intervention data were included in the final analysis
A repeated measures analysis of variance was then used to evaluate pre- and post-intervention differences in body weight, BMI, BF%, BP, waist circumference and aerobic fitness
Post-hoc analyses were conducted when appropriate
Additionally, two-tailed T-tests were conducted on the average number of minutes in moderate to vigorous physical activity over the three-week intervention.

Data Collection Summary:

Timing of Measurements

Trained data collectors conducted most of the study assessments at baseline and at the end of the three-week intervention.

Dependent Variables

Efficacy of the BOUNCE parent-daughter intervention in promoting selected physical fitness measures and activity:
- For the daughter assessments, anthropometric and clinical measures consisted of body height and weight measured to the nearest 0.1kg and 0.1cm respectively, using a stadiometer and a scale
- BMI was calculated using Quetelet's index and body fat percentage was obtained from a foot-to-foot bioelectrical impedance assessment using Tanita TBF 215 series scale
- Waist circumference measurements to the nearest 0.5cm were taken with a spring-guage loaded non-elastic flexible measuring tape at a point midway between the participants last rib of the rib cage to the top of the iliac crest at the end of a normal expiration
- Resting blood pressure of the participants was measured using a DINAMAP Vital Signs Monitor
- Actical accelerometers were used to objectively assess minute-to-minute physical activity during the intervention.
A BOUNCE project staff member collected textual data in the form of detailed notes and participant quotes
- The primary source of parental data for the study was qualitative: A trained moderator used a structured script/discussion guide to direct the sequence of questioning during two focus group sessions.

Independent Variables

BOUNCE intervention:

A typical BOUNCE day consisted of exercise, nutrition education and behavioral counseling elements targeting daughters and their parents
The intervention was offered five days per week (Monday to Friday) from 9 a.m. to 5 p.m. each day. Intervention sessions were delivered in four facilities at a university campus (gymnasium, dance studio, food science lab with four small kitchens and restaurant seating area and classroom) located within the target community.
Daughters attended daily session of exercise, nutrition education and behavioral counseling. Daughters engaged in three to four daily physical activity group sessions of varied intensity and the nutrition education component was conducted three times a day by a licensed and registered dietitian with the support of nutrition educators.
Parents participated in one two-hour session every week. During each session parents met with a dietitian, fitness instructor and counselor to teach them how to adapt family meals and activities to support their daughters' healthful food choices and enhance their physical activity and self-esteem.

Description of Actual Data Sample:

Initial N: 37 parent-daughter dyads (27 Latino and 10 African-American)
Attrition (final N): 37 parent-daughter dyads (27 Latino and 10 African-American)
Age: Daughters' mean age was 10.8±1.2 years and the parental mean age was 38.9±8.2 years
Ethnicity: Latino or African-American
Other relevant demographics: 51% of the parents either reported less than a high school education (26%) or completing of high school as their highest level of formal education
Location: Houston, Texas.

Summary of Results:

Key Findings

Mean intervention attendance was 92% for daughters and 59% for parents
Overall, the intervention produced significant results [F(4,26)=793.003], P<0.001
Post-hoc analyses demonstrated significant P<0.05 changes in daughters' body weight, BMI, waist circumference and aerobic fitness in the expected directions
No statistically significant P>0.05 changes were observed for BF% and BP
Daughters' average number of minutes engaged in moderate to vigorous physical activity improved each week (Week One, 60.47 minutes; Week Two, 70.32 minutes; Week Three, 74.70 minutes, respectively) as well as for the entire intervention
Improvements were significant for all three time periods (P<0.05).

Author Conclusion:

The BOUNCE intervention was effective in promoting fitness and activity in minority girls.

Funding Source:

Industry:

Aramark

Food Company:

University/Hospital:

University of Houston

Other:

St. Luke's Episcopal Health Charities Foundation, Oliver Foundation #OFGO40307

Reviewer Comments:

The authors identified three main limitations, including small sample size, the lack of control or comparison group and the lack of participants' dietary monitoring that occurred during this study.

Quality Criteria Checklist: Primary Research
Relevance Questions
	1.	Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)	Yes
	2.	Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?	Yes
	3.	Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?	Yes
	4.	Is the intervention or procedure feasible? (NA for some epidemiological studies)	Yes

Validity Questions
1.	Was the research question clearly stated?		Yes
	1.1.	Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?	Yes
	1.2.	Was (were) the outcome(s) [dependent variable(s)] clearly indicated?	Yes
	1.3.	Were the target population and setting specified?	Yes
2.	Was the selection of study subjects/patients free from bias?		No
	2.1.	Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?	Yes
	2.2.	Were criteria applied equally to all study groups?	Yes
	2.3.	Were health, demographics, and other characteristics of subjects described?	Yes
	2.4.	Were the subjects/patients a representative sample of the relevant population?	No
3.	Were study groups comparable?		N/A
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	N/A
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	N/A
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	N/A
	3.4.	If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?	N/A
	3.5.	If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)	N/A
	3.6.	If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?	N/A
4.	Was method of handling withdrawals described?		Yes
	4.1.	Were follow-up methods described and the same for all groups?	Yes
	4.2.	Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)	Yes
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	Yes
	4.4.	Were reasons for withdrawals similar across groups?	Yes
	4.5.	If diagnostic test, was decision to perform reference test not dependent on results of test under study?	N/A
5.	Was blinding used to prevent introduction of bias?		Yes
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	Yes
	5.2.	Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)	Yes
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	N/A
	5.4.	In case control study, was case definition explicit and case ascertainment not influenced by exposure status?	N/A
	5.5.	In diagnostic study, were test results blinded to patient history and other test results?	N/A
6.	Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?		Yes
	6.1.	In RCT or other intervention trial, were protocols described for all regimens studied?	Yes
	6.2.	In observational study, were interventions, study settings, and clinicians/provider described?	N/A
	6.3.	Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?	Yes
	6.4.	Was the amount of exposure and, if relevant, subject/patient compliance measured?	Yes
	6.5.	Were co-interventions (e.g., ancillary treatments, other therapies) described?	Yes
	6.6.	Were extra or unplanned treatments described?	Yes
	6.7.	Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?	Yes
	6.8.	In diagnostic study, were details of test administration and replication sufficient?	N/A
7.	Were outcomes clearly defined and the measurements valid and reliable?		Yes
	7.1.	Were primary and secondary endpoints described and relevant to the question?	Yes
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	Yes
	7.3.	Was the period of follow-up long enough for important outcome(s) to occur?	Yes
	7.4.	Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?	Yes
	7.5.	Was the measurement of effect at an appropriate level of precision?	Yes
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	Yes
	7.7.	Were the measurements conducted consistently across groups?	Yes
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		Yes
	8.1.	Were statistical analyses adequately described and the results reported appropriately?	Yes
	8.2.	Were correct statistical tests used and assumptions of test not violated?	Yes
	8.3.	Were statistics reported with levels of significance and/or confidence intervals?	Yes
	8.4.	Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?	N/A
	8.5.	Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?	N/A
	8.6.	Was clinical significance as well as statistical significance reported?	Yes
	8.7.	If negative findings, was a power calculation reported to address type 2 error?	No
9.	Are conclusions supported by results with biases and limitations taken into consideration?		Yes
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	Yes
10.	Is bias due to study's funding or sponsorship unlikely?		Yes
	10.1.	Were sources of funding and investigators' affiliations described?	Yes
	10.2.	Was the study free from apparent conflict of interest?	Yes