The Role of Acculturation in Predicting Participant Attendance Patterns in a Family-Centered Obesity Prevention Intervention for Hispanic Youth

Introduction: Childhood obesity is one of the most significant preventable public health problems in the U.S. and is particularly pronounced in Hispanic youth. Family-based interventions have been identified as a promising approach to obesity prevention for Hispanic adolescents. The public health impact of family-centered and pediatric obesity-related interventions, however, has been historically challenged by low engagement/attendance. To effectively address childhood obesity, it is imperative to not only examine attendance rates but also participants’ attendance patterns over the intervention course. The purpose of this study was to investigate the presence of distinct temporal attendance patterns of Hispanic families involved in a family-centered obesity prevention intervention. Because previous literature has indicated that acculturation strongly influences the health outcomes of Hispanics, we additionally examined the potential role of acculturation as a predictor of the anticipated heterogeneous patterns of attendance.

Methods: A total of 280 Hispanic adolescents in the overweight or obese weight ranges and their primary caregiver(s) participated in a randomized controlled trial evaluating the efficacy of a family-centered obesity prevention intervention for Hispanic youth. Participants were recruited from middle schools in Miami-Dade County and randomized to either Familias Unidas (intervention) or a community practice comparison condition. Intervention families participated in eight group sessions and four family visits; attendance was recorded for all 12 sessions. Acculturation was assessed at baseline using the Bicultural Involvement Questionnaire. Latent class analyses (LCA) were used to investigate participant attendance patterns and the role of acculturation as a predictor of attendance patterns.

Results: The fit indices showed that a model with three patterns of participant attendance across both group and family sessions was the most appropriate for the data (BIC: 1431.58, SSABIC: 1311.35, Entropy: 0.97, Adj. LMR-LRT:61.82, p < .05). The majority of participating families (n=101, 72.2%) belonged to a “chronically high” attendance pattern. The remaining families were part of either (a) a moderate and decreasing attendance pattern (n=21, 15.05%) sessions or (b) a consistently low attendance pattern (n=18, 12.8%). ANOVA results showed that parents in the chronically high attendance group had significantly lower levels of orientation towards the American culture (M[SD]= 35.54[11.78]) compared to those in the other two attendance patterns (M[SD]= 43.42[10.73] / (M[SD]= 27.08[12.70])), suggesting that the less parents were identifying with American culture, the more likely they were to participate in group and family sessions.

Conclusions: These findings highlight the importance of examining distinct attendance patterns over the course of an intervention as well as factors that impact these patterns. The findings have implications for the methods used for recruitment and retention of study participants, especially in the field of child obesity prevention for Hispanic families.