Project SHINE: Effects of Parent–Adolescent Communication on Sedentary Behavior in African American Adolescents

Currently 41% of African American adolescents in the United States between the ages of 12 and 19 years are overweight or obese (Ogden, Carroll, Kit, & Flegal, 2012). Research has shown that adolescent obesity tracks into adulthood (Kvaavik, Tell, & Klepp, 2003; Power, Lake, & Cole, 1997), making adolescence an important developmental period for effective health promotion interventions. Previous positive associations between youth sedentary behavior (SB; e.g., screen time, sitting) and weight status (Epstein et al., 2008; Gortmaker et al., 1996; Laurson et al., 2008; Robinson, 1999, 2001) have made decreasing SB a recommended strategy for reducing pediatric obesity (Davis et al., 2007). Still, recent national estimates show a high proportion of ethnic minorities are not meeting recommendations to limit screen time to <2 hr daily, with 54% of African American adolescents watching ≥3 hr/day of television compared with 34% of adolescents overall (Eaton et al., 2012). Given ongoing social transitions during adolescence (e.g., need for autonomy support from families, increased involvement with peers), developing more integrated intervention approaches that target relevant social contexts (e.g., parents, peers) may lead to improvements in health behaviors, including SB, in ethnic minority adolescents (St. George & Wilson, 2012; Wilson, 2009). Family-based interventions have received increased attention in the prevention and treatment of pediatric obesity (Epstein, Paluch, Roemmich, & Beecher, 2007; Golley, Hendrie, Slater, & Corsini, 2011; McLean, Griffin, Toney, & Hardeman, 2003). Family Systems Theory (FST; Broderick, 1993) provides a framework for developing effective interventions that integrate dynamic interactions within the family system to improve health behaviors in children and adolescents (Kitzman-Ulrich et al., 2010). Recent FST-based interventions (e.g., positive parenting practices, authoritative parenting style) have been shown to be effective in promoting positive obesity-related health behaviors (Brotman et al., 2012; Kitzman-Ulrich et al., 2011). For ethnic minority youth in particular, it has been suggested that family-based interventions to improve health behaviors should include family support and parent involvement as key conceptual factors (Wilson, 2009). However, despite previous literature suggesting ethnic minority parents may operate within unique ethnocultural, economic, and social contexts (e.g., having a different cultural background and parenting customs than the majority culture, living under economic hardship, being “the other” group; Coll & Pachter, 2002), few health promotion programs focused on parenting have exclusively targeted this high-risk population. In the present study, African American families participated in an interactive, parent-based intervention known as Project SHINE (“Supporting Health Interactively through Nutrition and Exercise”), which targeted various FST variables, including autonomy-supportive communication and parental monitoring specific to activity and dietary behaviors. Cultural targeting strategies (e.g., peripheral, evidential, constituent-involving) were used to enhance intervention relevance for African American families (Kreuter, Lukwago, Bucholtz, Clark, & Sanders-Thompson, 2003). The moderating effects of parent–adolescent communication and parental monitoring on the relationship between the intervention and adolescent SB were tested. A challenge parents often face during the adolescent developmental period is balancing the adolescent’s growing need for autonomy and increased peer involvement with the parents’ desire to protect the adolescent from negative experiences (Eccles et al., 1991). One way to facilitate this balance is through engaging in positive communication, which may foster an adolescent’s sense of autonomy by including them in the decision-making process (Grolnick, 2003). Communication, defined as an exchange in which individuals openly express and receive ideas (Robin, 1979), is an important feature of evolving parent–adolescent relationships (Laursen & Collins, 2004; Robin & Foster, 2002). Family health communication has been shown to reduce child health risk factors (Hutchinson, Jemmott, Sweet Jemmott, Braverman, & Fong, 2003; Marta, 1997; Reimuller, Hussong, & Ennett, 2011; Whitaker & Miller, 2000). For example, parent–adolescent communication around risk-taking behaviors has not only reduced these behaviors (e.g., alcohol use, sex) (Hutchinson et al., 2003; Reimuller et al., 2011), it has also influenced the effect of peers on adolescent risk-taking (Whitaker & Miller, 2000). Few studies outside of those on adolescent risk-behaviors, however, have directly tested communication-centered approaches for improving obesity-related behaviors in African American families. Furthermore, few have extended parent–adolescent communication into adolescent–peer relationships specific to obesity-related behaviors, making the current intervention unique from previous approaches. The present study examines the interaction between parent–adolescent communication and participation in the Project SHINE intervention on adolescent SB. Beyond parent–adolescent communication, studies have shown that when parents monitor and set rules around adolescent SB, adolescents are less likely to engage in these behaviors (Ramirez et al., 2011; Salmon, Timperio, Telford, Carver, & Crawford, 2012; Zabinski, Norman, Sallis, Calfas, & Patrick, 2007). Previous interventions that have included a monitoring component related to SB for African American adolescents have found significant decreases in screen time (Ford, McDonald, Owens, & Robinson, 2002; Robinson et al., 2003). For example, Robinson and colleagues (2003) randomized African American girls to either dance classes plus a family-based intervention to reduce screen time or a health education comparison group. Caregivers received electronic television time managers (i.e., devices to budget viewing time) to monitor screen time for each member of the household. The intervention resulted in greater reductions of household TV viewing than did the comparison condition; however, little focus was given to targeting family communication or relationships. In the present study, parental monitoring is specifically examined as a moderator of the relationship between participation in Project SHINE and weekly hours of adolescent SB. In summary, the purpose of this study was to test the moderating effects of parenting variables (parent–adolescent communication, monitoring) on a family-based intervention for reducing SB in African American adolescents. It was hypothesized that the family-based intervention would interact with both communication and monitoring, such that more positive parent–adolescent communication (defined in terms of frequency and quality) and greater parental monitoring of health behaviors would be associated with less weekly hours of SB for those in the intervention versus comparison condition. As a secondary aim, and although weight loss was not a targeted intervention outcome, this study explored the moderating effects of parenting variables (parent–adolescent communication, monitoring) on the intervention predicting adolescent age- and sex-standardized body mass index (zBMI) at post-intervention.