title: Sequential Multiple Assignment Randomized Trial (SMART) to Construct Weight Loss Interventions for African American Adolescents.
abstract: The purpose of this study was to develop an adaptive behavioral treatment for African American adolescents with obesity. In a sequential multiple assignment randomized trial, 181 youth ages 12-16 years with primary obesity and their caregiver were first randomized to 3 months of home-based versus office-based delivery of motivational interviewing plus skills building. After 3 months, nonresponders to first phase treatment were rerandomized to continued home-based skills or contingency management. Primary outcome was percent overweight and hypothesized moderators were adolescent executive functioning and depression. There were no significant differences in primary outcome between home-based or office-based delivery or between continued home-based skills or contingency management for nonresponders to first-phase treatment. However, families receiving home-based treatment initially attended significantly more sessions in both phases of the trial, and families receiving contingency management attended more sessions in the second phase. Overall, participants demonstrated decreases in percent overweight over the course of the trial (3%), and adolescent executive functioning moderated this effect such that those with higher functioning lost more weight. More potent behavioral treatments to address the obesity epidemic are necessary, targeting new areas such as executive functioning. Delivering treatment in the home with contingency management may increase session attendance for this population.
authors: a Department of Pediatrics, Wayne State University.
authors: Sylvie
authors: S
authors: Naar-King
authors: a Department of Pediatrics, Wayne State University.
authors: Deborah A
authors: DA
authors: Ellis
authors: a Department of Pediatrics, Wayne State University.
authors: April
authors: A
authors: Idalski Carcone
authors: b College of Nursing , Wayne State University.
authors: Thomas
authors: T
authors: Templin
authors: a Department of Pediatrics, Wayne State University.
authors: Angela J
authors: AJ
authors: Jacques-Tiura
authors: a Department of Pediatrics, Wayne State University.
authors: Kathryn
authors: K
authors: Brogan Hartlieb
authors: c Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina.
authors: Phillippe
authors: P
authors: Cunningham
authors: d Department of Nutrition and Food Science, Wayne State University.
authors: Kai-Lin Catherine
authors: KL
authors: Jen
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000208:ethnology / Q000523:psychology*; D001741:Black or African American / Q000208:ethnology / Q000523:psychology*; D001521:Behavior Therapy / Q000379:methods*; D017028:Caregivers / Q000523:psychology*; D002648:Child; D003863:Depression / Q000208:ethnology / Q000523:psychology / Q000628:therapy; D056344:Executive Function / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000208:ethnology / Q000523:psychology* / Q000628:therapy; D015431:Weight Loss / Q000208:ethnology / Q000502:physiology