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Citation:

Olvera N, Bush JA, Sharma SV, Knox BB, Scherer RL, Butte NF. BOUNCE: A community-based mother-daughter healthy lifestyle intervention for low-income Latino families. Obesity (Silver Spring). 2010 Feb;18 Suppl 1: S102-S104.


PubMed ID: 20107454
Study Design:
Non-Randomized Controlled Trial
Class:
C - Click here for explanation of classification scheme.
NEUTRAL: See Research Design and Implementation Criteria Checklist below.
Research Purpose:

To assess the efficacy of the BOUNCE (Behavior Opportunities Uniting Nutrition, Counseling, and Exercise) intervention for improving physical fitness and activity in Latino mother-daughter pairs in community and school settings.

Inclusion Criteria:
  • Latino mother and daughter pairs
  • Daughter assent
  • Mother consent.
Exclusion Criteria:
  • Dietary restrictions (not defined)
  • Medical conditions (not defined).
Description of Study Protocol:

Recruitment

Flyers mailed to homes of Latino families. 

Design

Non-randomized intervention; two-arm parallel study with Experimental Group (EG) and Comparison Group (CG).

Dietary Intake/Dietary Assessment Methodology

Daughters' dietary intakes were assessed using the School Physical Activity and Nutrition (SPAN) survey developed by Hoelscher and colleagues

Blinding Used 

Not applicable.

Intervention 

  • 12-week intervention
  • Delivered in community settings (e.g., park centers, park playgrounds and grocery stores) and schools (e.g., classroom, gym, cafeteria and playground) 
  • EG intervention: Three weekly structured group exercise sessions or free play recreational activities (45 minutes each), two weekly nutrition sessions (45 minutes each) and one weekly behavioral counseling session (45 minutes each)
  • CG group: Met with an instructor once a week for 45 minutes; received educational materials on nutrition and counseling topics and participated in light intensity activity.

Statistical Analysis

  • Repeated measures ANCOVA measured differences between groups (two-sided tests, level of significance =0.05); adjusted covariates were age and body mass index
  • Cohen's d was calculated to demonstrate effect size and allow for comparisons across different measures between EG and CG.
Data Collection Summary:

Timing of Measurements

  • Baseline
    • Demographics
    • Acculturation (daughters: Short Acculturation Scale for Latino Youth; maternal: Preferred language)
    • Body height, measured by stadiometer
    • Body weight, measured by Tanita scale
    • Physical fitness (aerobic)
    • Activity level
    • Dietary intake, daughter only
  • Post-intervention
    • Physical fitness (aerobic)
    • Activity level
    • Dietary intake, daughter only.

Dependent Variables

  • Physical fitness, daughter
    • 20-Meter Endurance Shuttle Run Test
  • Physical fitness, mother
    • Rockport Walk Test was used to estimate peak oxygen consumption (VO2 peak)
  • Activity level, daughter
    • Accelerometers assessed duration and intensity (via activity counts per minute) for two continuous days (Monday and Tuesday) at the start and end of the intervention
      • Moderate-vigorous: 1,500 counts or higher per minute
  • Activity level, mother
    • University of Houston Non-Exercise Physical Activity Rating
      • Zero (sedentary) to seven (vigorous)
  • Dietary intake, daughter: SPAN survey.

Independent Variables

  • obese status, daughter: Age- and gender-specific body mass index (BMI) percentiles (Centers for Disease Control and Prevention)
  • normal weight: Between 5th and 84th percentile
  • overweight: 85th percentile or higher
  • Obesity status, mother: body mass index (kg/m2
    • Normal weight: 25 or less
    • Overweight: Higher than 25
  • Acculturation and demographics.

Control Variables

Not applicable, other than variables controlled for statistically.

Description of Actual Data Sample:
  • Initial N:
    • 77% of interested pairs (from recruitment flyers) enrolled in the study
    • 46 pairs were enrolled (EG=26, CG=20)
  • Attrition (final N):
    • 11 pairs dropped (24%)
      • Two pairs due to religious reasons
      • Three pairs for health reasons
      • Six pairs due to conflicts with job schedule
    • Final sample: 35 pairs (EG=18, CG=17)
    • Participants who dropped out did not differ from other participants in baseline traits 
  • Age:
    • Mothers EG mean±standard deviation, 33.3±4.6 years
    • Mothers CG 38.2±10.6 years
    • Daughters (age seven to 13 years)
  • Ethnicity: Latino, 82% of daughters were born in US but all mothers were born in Mexico or Central America
  • Other relevant demographics:
    • 68% of mothers had less than eight years of education and 75% were unemployed
    • No significant (NS) differences in body mass index between EG (23.6±4.2) and CG daughters (21.8±3.2) or between EG (31.0±6.7) and CG mothers (32.3±7.0) at baseline
    • Two-thirds of daughters and 88% of mothers were overweight
  • Anthropometrics: Mother's in EG were younger than mothers in CG (P<0.05)
  • Location: Houston, TX.
Summary of Results:

 Main Findings

  • After the intervention, EG daughters showed higher levels of physical fitness than CG daughters (P<0.05)
  • There were NS differences in the average daily counts per minute of daughters in the EB and CG post-intervention
  • Post-intervention, neither EG or CG mothers reported changes in physical fitness or self-reported physical activity levels
  • Trends in dietary intake indicated that EG daughters tended to report reduced high-fat foods intake and sweetened beverages and an increase in fruits and vegetables, but these trends were not statistically significant
  • There were NS differences in body mass index between EG and CG mothers post-intervention after controlling for baseline BMI.

 Other Findings

Variables

Treatment Group
Mean±SD

Control Group
Mean±SD

Effect Size (Cohen's d)

Large >0.75

Physical fitness, daughter (number of laps on 20-Meter Shuttle)

14.2±4.9 pre

20.7±8.4 post

11.2+5.3 pre

13.1+5.5 post

0.78

Physical activity, daughter (MVPA)

64.3±23.9 pre

70.7±31.5 post

35.4±21.9 pre

38.0±13.1 post

0.75

Dietary intake, daughter (times per day)

   High fat foods

   Sweetened beverages

   Fruit or vegetable

2.2±1.4 pre, 1.9±1.6 post

2.0±1.3 pre, 1.1±1.4 post

3.1±1.6 pre, 4.1±2.6 post

1.9±1.9 pre, 2.6±1.9 post

1.1±1.1 pre, 1.7±1.0 post

3.1±2.0 pre, 2.9±2.3 post

0.40

0.36

 

0.34

Physical fitness, mother (VO2 peak)

36.4±8.1 pre, 36.9±5.1 post

42.9±9.0 pre, 42.9±6.7 post 0.40
Physical activity rating, mother 1.4±0.9 pre, 2.1±1.6 post 1.2±1.5 pre, 1.2±0.9 post 0.40

 

Author Conclusion:
  • The BOUNCE intervention had a significant effect on EG Latino daughters’ aerobic capacity compared to CG daughters
  • No changes in physical activity or body mass index were observed between EG and CG mother-daughter dyads.

 

Reviewer Comments:
  • Sample size is small; exploratory study with larger clinical trials needed to test BOUNCE
  • The authors report that EG mothers reported more strategies to increase fruit and vegetable consumption and reduce fat intake compared to CG mothers, but it is not reported how these strategies were collected or analyzed.

 

 


Research Design and Implementation 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 nutrition or dietetics practice?
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?
No
  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?
No
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)
No
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?
Yes
  3.3. Were concurrent controls used? (Concurrent preferred over historical controls.)
Yes
  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 or cross-sectional 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. Criterion may not be applicable in some cross-sectional studies.)
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?
???
  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?
No
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?
No
  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.)
No
  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?
N/A
  6.6. Were extra or unplanned treatments described?
N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?
N/A
  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?
No
  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)?
No
  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