The Impact of a Parenting Intervention on Latino Youth Health Behaviors

Study Overview
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Brief Summary
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The purpose of this study is to test if a parenting program can be used to prevent substance use among Latino youth and at the same time promote healthy eating. Pairs of 7th grade students and one of their parents will be enrolled in the study and randomly assigned to three groups: an existing parenting intervention focusing on substance use prevention (FPNG), the enhanced parenting intervention that also has nutrition content (FPNG+), and a comparison program focused on academic success. Only parents will attend intervention sessions. Data will be collected from the parent and their 7th grade student to see how these programs impacted substance use, nutrition, and parenting. The investigators hypothesize that families receiving the FPNG+ will have improved nutrition habits than the other conditions. Students in both FPNG and FPNG+ will have lower substance use rates as compared to the academic success program. In addition, the effects of parenting strategies and sociocultural factors on the FPNG and FPNG+ results will be studied.

Detailed Description
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Latino youth are a population at risk for chronic diseases because of their growing overweight and obesity rates, lack of adherence to nutrition and physical activity recommendations, and greater rates of tobacco, alcohol and other drugs use than youth of other ethnic groups. Parents are an important agent of change for youth due to their ability to create a home environment that promotes healthful behaviors (including substance use prevention and healthy nutrition), and parents' role as providers of resources to the family (including food). Parenting interventions are efficacious in preventing substance use among Latino youth, but few studies have used a family approach to promote healthy nutrition. Thus, the overall objective of the proposed project is to extend the scope of Families Preparing the New Generation (FPNG), an existing parenting program proven to help reduce substance use among Latino youth, to also promote healthy nutrition. The eco-developmental perspective will provide the theoretical foundation for the project for investigating risk and resiliency in Latino youth's drug use and nutrition behaviors. The main aims of the study are to (1) test the effects of a nutrition-enhanced parenting program (FPNG+) on substance use and nutrition among Latino youth, (2) explore how enhancing parenting skills impact the effects of the enhanced intervention, and (3) understand how social and cultural factors impact how the enhanced program works. The research team will first seek input from community members to create a nutrition-enhanced program that is acceptable to Latino parents of middle school students. The investigators will then collaborate with the American Dream Academy (ADA), an organization delivering an academic success program to families within middle schools throughout the Phoenix Area, to recruit 1,494 families who have a student in 7th grade to participate in the study. Parents from different schools will be offered one of three 10-week programs (assigned to each individual school): FPNG+ (substance use prevention and healthy nutrition), FPNG (substance use prevention only), and the ADA comparison program (focusing on academic success). Data will be collected from the 7th grade student and his/her participating parent before the start of the program, immediately after it ends, and 16 weeks later, to compare how the programs affect nutrition, substance use, and parenting. In a subgroup of 126 families (42 from each program), investigators will explore how the FPNG+ program affects diabetes and cardiovascular risk factors and whether the program induces changes in the types of foods available at participants' homes. For this, investigators will collect capillary blood samples from participants to measure glycosylated hemoglobin (a marker of diabetes risk) and cholesterol (a marker of cardiovascular risk), and blood pressure, as well as a list of foods that participants have at home. The long-term goal is to design and disseminate programs that contribute to helping parents assist their adolescent children develop and maintain long-lasting positive lifestyle behaviors in order to prevent substance use and chronic diseases.

Official Title
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Multi-level Effects of a Parenting Intervention for Enhancing Latino Youth Health Behaviors

Conditions
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Diet Modification, Substance Use Disorders, Diabetes Mellitus Risk, Cardiovascular Risk Factor, Lifestyle Risk Reduction, Parenting

Intervention / Treatment
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* Behavioral: Nutrition/substance use prevention
* Behavioral: Substance use prevention only
* Behavioral: Academic success program


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Youth: ages 12-14 Youth: Enrolled in 6th,7th, or 8th grade at the time of recruitment from the American Dream Academy (ADA) programs Adults: Age 18 or older Adults: Parent/caregiver/guardian of an eligible youth Exclusion Criteria: None

Ages Eligible for Study
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Minimum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Randomization to treatment conditions (FPNG+, FPNG, or comparison [RAD]) will occur at the school level. From the 18 participating schools, 6 each will be randomized into one of the three conditions.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Nutrition/substance use prevention<br>Parenting and nutrition curriculum targeting substance use prevention and diet improvement. | Behavioral: Nutrition/substance use prevention<br>* Parenting program focusing on diet improvement and substance use prevention<br>* Other names: FPNG+;|
| Active Comparator: Substance use prevention only<br>Parenting curriculum targeting substance use prevention only. | Behavioral: Substance use prevention only<br>* Parenting program focusing only on substance use prevention<br>* Other names: FPNG;|
| Sham Comparator: Academic success program<br>Control program focused only on academic success. | Behavioral: Academic success program<br>* Program focusing on academic success and college acceptance<br>* Other names: Realizing the American Dream (RAD);|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Recent use of substances | Survey questions: Changes in amount and frequency of alcohol, cigarettes, marijuana, and inhalants in the past 30 days. Scale ranges from 1 (no use of substance) to 7 (used 40 or more times). Higher score indicates more use. | Week 0, Week 10-12, Week 24-26 | 
| Drug resistance strategies | Survey questions: Change in youths' responses to substance use offers in the past 30 days and likely responses to hypothetical substance use offers. Scale ranges from 1 (never responded in this way) to 6 (responded this way more than 10 times). | Week 0, Week 10-12, Week 24-26 | 
| Nutrition outcomes | NCI Dietary Screener: Change in intake of fruit, vegetables, and sugar-laden foods | Week 0, Week 10-12, Week 24-26 | 
| Overall family functioning | Survey questions (parents) measuring: Change in family support, family conflict, parental monitoring, extent of involvement, and familism. | Week 0, Week 10-12, Week 24-26 | 
| Parents' social support | Social Support Questionnaire score. Scale from 1 (very dissatisfied with support) to 6 (very satisfied with support). Higher scores mean more social support. | Week 0, Week 10-12, Week 24-26 | 
| Acculturation | Acculturation Rating Scale for Mexican Americans-II (ARSMA-II) asks participants to indicate on a five point likert scale (Not at all (1) and Extremely often or almost always (5)) the extent to which they engage in 17 Mexican oriented behaviors. The Anglo Orientation Subscale (AOS) consists of 13 items, which asks participants to indicate on a five point likert scale (Not at all (1) and Extremely often or almost always (5)) the extent to which they engage in Anglo oriented behaviors. Means for each subscale are calculated, higher score means higher Mexican orientation and higher Anglo orientation. | Week 0, Week 10-12, Week 24-26 | 
| Food Insecurity | Assesses financially-based food insecurity and hunger in households. | Week 0, Week 10-12, Week 24-26 | 
| Self-efficacy for Parenting Index | A measure of parental beliefs that he/she is capable of performing parental roles/responsibilities | Week 0, Week 10-12, Week 24-26 | 
| Parent self-agency | Gauges the parent's sense of parenting competence and ability to positively influence the child's development | Week 0, Week 10-12, Week 24-26 | 
| Child Feeding Questionnaire | assesses parental attitudes, beliefs and practices about feeding | Week 0, Week 10-12, Week 24-26 | 
| Multidimensional Acculturative Stress Inventory | Measures how often a person experienced certain acculturation situations and how stressful they were. Scale ranges from 0 (No, did not happen to me) to 5 (Extremely stressful). Mean score is created, where higher values indicate more acculturative stress. | Week 0, Week 10-12, Week 24-26 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Body weight | Measured body weight for parents and youth. | Week 0, Week 10-12, Week 24-26 | 
| Height | Measured height for parents and youth. | Week 0, Week 10-12, Week 24-26 | 
| Body mass index | Calculated BMI for parents and youth estimated by dividing weight by height squared | Week 0, Week 10-12, Week 24-26 | 
| Systolic blood pressure | Measured systolic blood pressure using an automated blood pressure monitor | Week 0, Week 10-12, Week 24-26 | 
| Diastolic blood pressure | Measured diastolic blood pressure using an automated blood pressure monitor | Week 0, Week 10-12, Week 24-26 | 
| Total cholesterol | Total cholesterol measured via finger prick blood sample | Week 0, Week 10-12, Week 24-26 | 
| Glycosylated hemoglobin (HbA1c) | HbA1c measured via finger prick blood sample | Week 0, Week 10-12, Week 24-26 | 
| Diet of adolescents | 2004 Block Food Frequency Questionnaire | Week 0, Week 10-12, Week 24-26 | 
| Diet of the parents | Southwestern Food Frequency Questionnaire | Week 0, Week 10-12, Week 24-26 | 
| Home food environment | Modified version of the validated Home Food Inventory with cultural adaptations including foods commonly consumed by Latinos. | Week 0, Week 10-12, Week 24-26 |