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.

[1]  Jacob Cohen.  Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[2]  A. Bandura.  Self-Efficacy: The Exercise of Control , 1997, Journal of Cognitive Psychotherapy.

[3]  A. Kazdin,et al.  Systematic desensitization and nonspecific treatment effects: a methodological evaluation. , 1976, Psychological bulletin.

[4]  T. Robinson,et al.  Primary care interventions to reduce television viewing in African-American children. , 2002, American journal of preventive medicine.

[5]  T. Robinson,et al.  Phase 1 of the Girls health Enrichment Multi-site Studies (GEMS): conclusion. , 2003, Ethnicity & disease.

[6]  H. Kraemer.  To increase power in randomized clinical trials without increasing sample size. , 1991, Psychopharmacology bulletin.

[7]  E. Klonoff,et al.  Revising and Improving the African American Acculturation Scale , 2000 .

[8]  Thomas N. Robinson,et al.  Overweight Children and Adolescents , 2005 .

[9]  Melvin N Wilson,et al.  Family Ecologies of Ethnic Minority Children. , 1990 .

[10]  T. Robinson,et al.  Use of the body mass index (BMI) as a measure of overweight in children and adolescents. , 1998, The Journal of pediatrics.

[11]  David Rogosa,et al.  Comparing nonparallel regression lines. , 1980 .

[12]  Clark C. Presson,et al.  Multivariate applications in substance use research : new methods for new questions , 2000 .

[13]  Dawn K. Wilson,et al.  Health-Promoting and Health-Compromising Behaviors among Minority Adolescents. , 1997 .

[14]  Darrell M. Wilson,et al.  Dance and reducing television viewing to prevent weight gain in African-American girls: the Stanford GEMS pilot study. , 2003, Ethnicity & disease.

[15]  A. Bandura.  Social Foundations of Thought and Action , 1986 .

[16]  H. Kraemer,et al.  Are certain multicenter randomized clinical trial structures misleading clinical and policy decisions? , 2005, Contemporary clinical trials.

[17]  T. Robinson,et al.  Parental cultural perspectives in relation to weight-related behaviors and concerns of African-American girls. , 2004, Obesity research.

[18]  Janice C Baranowski,et al.  Collaborative planning for formative assessment and cultural appropriateness in the Girls health Enrichment Multi-site Studies (GEMS): a retrospection. , 2003, Ethnicity & disease.

[19]  Tom Baranowski,et al.  The Fun, Food, and Fitness Project (FFFP): the Baylor GEMS pilot study. , 2003, Ethnicity & disease.

[20]  T. Baranowski,et al.  Cultural sensitivity in public health: defined and demystified. , 1999, Ethnicity & disease.

[21]  John E. Overall,et al.  Comparison of two strategies for analysis of variance in nonorthogonal designs. , 1981 .

[22]  Paul Elliott,et al.  Coronary heart disease epidemiology : from aetiology to public health , 1992 .

[23]  Windy Dryden,et al.  Handbook of Psychotherapy and Behavior Change , 1987, Journal of Cognitive Psychotherapy.

[24]  G. Rose,et al.  Strategies of prevention: the individual and the population , 2005 .

[25]  T. Cook,et al.  Quasi-experimentation: Design & analysis issues for field settings , 1979 .

[26]  D. Jacobs,et al.  An after-school obesity prevention program for African-American girls: the Minnesota GEMS pilot study. , 2003, Ethnicity & disease.

[27]  T. Robinson,et al.  School-based cardiovascular disease prevention studies: Review and synthesis , 1997 .

[28]  L. Anderson.  Acculturative stress: A theory of relevance to black Americans , 1991 .

[29]  H. Kraemer,et al.  Mediators and moderators of treatment effects in randomized clinical trials. , 2002, Archives of general psychiatry.

[30]  Donald F. Roberts,et al.  Kids and media in America , 2003 .

[31]  T. Robinson,et al.  Measurement characteristics of activity-related psychosocial measures in 8- to 10-year-old African-American girls in the Girls Health Enrichment Multisite Study (GEMS). , 2004, Preventive medicine.

[32]  T N Robinson,et al.  Reducing children's television viewing to prevent obesity: a randomized controlled trial. , 1999, JAMA.

[33]  F Vinicor,et al.  The continuing epidemics of obesity and diabetes in the United States. , 2001, JAMA.

[34]  H. Kraemer,et al.  How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. , 2001, The American journal of psychiatry.

[35]  F. Johnston,et al.  Obesity, growth and development , 2001 .

[36]  S. Kumanyika,et al.  Child- and parent-targeted interventions: the Memphis GEMS pilot study. , 2003, Ethnicity & disease.

[37]  Elliott A. Medrich,et al.  Constant Television: A Background to Daily Life. , 1979 .

[38]  M. Rosenberg.  Society and the adolescent self-image , 1966 .

[39]  T. Robinson,et al.  Preventing childhood obesity: a solution-oriented research paradigm. , 2005, American journal of preventive medicine.

[40]  Dina L. G. Borzekowski,et al.  Viewing the viewers: Ten video cases of children's television viewing behaviors , 1999 .

[41]  K. Flegal,et al.  Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. , 2004, JAMA.

[42]  Obesity in Adults,et al.  Identification, Evaluation, and Treatment of Overweight and Obesity , 2021, Obesity Prevention and Treatment.

[43]  T. Robinson,et al.  Obesity prevention for children and adolescents. , 2001 .

[44]  M. Rosenberg.  Conceiving the self , 1979 .

[45]  T. Robinson,et al.  Physical activity self-report and accelerometry measures from the Girls health Enrichment Multi-site Studies. , 2004, Preventive medicine.

[46]  Ellen Frank,et al.  Moderators of treatment outcomes: clinical, research, and policy importance. , 2006, JAMA.

[47]  T. Robinson,et al.  Evaluation of quality control procedures for 24-h dietary recalls: results from the Girls Health Enrichment Multisite Studies. , 2004, Preventive medicine.

[48]  B. Efron.  Forcing a sequential experiment to be balanced , 1971 .

[49]  S. Going,et al.  Defining accelerometer thresholds for activity intensities in adolescent girls. , 2004, Medicine and science in sports and exercise.

[50]  T. Lohman,et al.  Anthropometric Standardization Reference Manual , 1988 .

[51]  T. Robinson,et al.  Measurement characteristics of weight concern and dieting measures in 8-10-year-old African-American girls from GEMS pilot studies. , 2004, Preventive Medicine.

[52]  Ncep Expert Panel on Blood Cholesterol Levels in Childr Adolescents.  National Cholesterol Education Program (NCEP): highlights of the report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. , 1992, Pediatrics.

[53]  J. Phinney.  The Multigroup Ethnic Identity Measure , 1992 .

[54]  K. Flegal,et al.  Overweight children and adolescents: description, epidemiology, and demographics. , 1998, Pediatrics.

[55]  R. Moos,et al.  Methodological issues in estimating main and interactive effects: examples from coping/social support and stress field. , 1984, Journal of health and social behavior.

[56]  L. Cronbach,et al.  Aptitudes and instructional methods: A handbook for research on interactions , 1977 .

[57]  Katrina L. Bledsoe,et al.  Links between race/ethnicity and cultural values as mediated by racial/ethnic identity and moderated by gender. , 1997, Journal of personality and social psychology.

[58]  H. Kraemer,et al.  Methodological Difficulties in Studies of Obesity. I. Measurement Issues , 1990 .

[59]  Catharyn T. Liverman,et al.  Preventing Childhood Obesity: Health in the Balance , 2005 .

[60]  Helena Chmura Kraemer,et al.  How Many Subjects? Statistical Power Analysis in Research , 1987 .

[61]  S D Imber,et al.  Some conceptual and statistical issues in analysis of longitudinal psychiatric data. Application to the NIMH treatment of Depression Collaborative Research Program dataset. , 1993, Archives of general psychiatry.

[62]  N. M. Morris,et al.  Validation of a self-administered instrument to assess stage of adolescent development , 1980, Journal of youth and adolescence.

[63]  Helena C Kraemer,et al.  Centring in regression analyses: a strategy to prevent errors in statistical inference , 2004, International journal of methods in psychiatric research.

[64]  G. Rose,et al.  Strategy of prevention: lessons from cardiovascular disease. , 1981, British medical journal.

[65]  E. Obarzanek,et al.  Girls health Enrichment Multi-site Studies (GEMS): new approaches to obesity prevention among young African-American girls. , 2003, Ethnicity & disease.

[66]  K. Resnicow,et al.  Interpersonal interventions for minority adolescents. , 1997 .

[67]  R. Renger,et al.  Development and evaluation of the McKnight Risk Factor Survey for assessing potential risk and protective factors for disordered eating in preadolescent and adolescent girls. , 1999, The International journal of eating disorders.

[68]  H. Kraemer,et al.  Ethnic variation in cardiovascular disease risk factors among children and young adults: findings from the Third National Health and Nutrition Examination Survey, 1988-1994. , 1999, JAMA.