Healthy Families DC: A Feasibility Pilot of a Family Centered Intervention to Improve Health Outcomes Among High-Risk Urban African-American Youth

Low income ethnic minority youth tend to be at greater risk for obesity, physical inactivity, high risk behaviors such as tobacco and substance use and resulting cardiovascular and chronic disease. In this study we modified an empirically validated tobacco and substance use risk prevention program, the Family Check-Up, to develop a tailored intervention (Healthy Families DC) that also included promotion of physical activity (PA) for DC middle-school students referred by school staff as over-weight and at risk for problem behaviors. The program included an initial family assessment, a family feedback session with family PA goal setting and 6 phone/text based booster sessions. A pilot study with 18 families, comprised of at least one caregiver and target child, was conducted to examine feasibility, acceptability, and trends in preliminary outcomes such as PA via self-report and accelerometry, health risk behaviors (e.g., tobacco use), health goal setting, and changes in family functioning (e.g., youth positive behaviors, parenting). All participating families were African American DC residents. The majority of students (avg age 13 years) came from single-caregiver households (2 male, 16 female).  Almost half of caregivers reported full-time employment (55%) and most reported financial difficulties (75%). On average, caregivers reported high sedentary behavior (10 hours/day) and only 15% were of normal weight range (objectively measured). The majority (75%) of students were also overweight/obese and only 11% reported engaging in recommended PA levels.  In terms of feasibility, 12 families completed the full program. On average, families engaged in only 1.67 calls and 1 text message session out of the six available. Text messaging (56% response) resulted in higher compliance than telephone-based (27%) attempts.  All families created a PA goal, and all families made some attempt to achieve the goal, though few met the goals as written.  Barriers to meeting PA goals included lack of nearby places to get exercise, lack of neighborhood safety, and parents’ work schedules. In terms of outcomes, post intervention means were slightly higher than baseline for some variables (e.g., positive youth behaviors, parenting behaviors, and exercise self-efficacy), however there were no significant changes in this small sample.  Finally, acceptability ratings were high: most (84%) parents and (93%) youth reported high levels of satisfaction. Rich feedback was received regarding ideas for future interventions (e.g., use of Fitbit for feedback, a field day for families to exercise together). Lessons learned from this pilot can inform development of prevention trials that can better meet the needs of high stressed urban families to promote healthy lifestyle behaviors.