Examining the effects of ADAPT+: An Intervention to Promote Healthy Behaviors in Youth with Obesity and their Parents living in Rural/Agricultural Communities - Project Summary/Abstract Section Youth living in rural/agricultural areas are a group at high health-risk, with 90% projected to be overweight or obese (OW/OB) by 2030. These youth are more likely to have obesity-related complications in adulthood, particularly cancer and heart disease. Living in rural areas is associated with geographical isolation, limited access to affordable healthy foods, and access to healthcare and economic instability. Targeted lifestyle interventions emphasizing parental behaviors to improve diet and physical activity (PA) show the most consistent success. We tailored our evidence-informed, theory-based, multi-family intervention, ADAPT+ (ADAPT+ Mindfulness), to our target population – OW/OB youth (8-12 years old) and their families, many of whom are Latinos, living in rural communities. Based on our R34 which demonstrated strong feasibility and acceptability (R34AT010661; Stern & Redwine, MPIs), our fully powered multi-site trial now tests the efficacy of ADAPT+. Our central hypothesis is that incorporating mindfulness strategies will help manage parental stress, thereby increasing receptivity to ADAPT+ and thus promoting lifestyle health behavior change. To test the efficacy of ADAPT+ (ORBIT Phase 3), we partner with a statewide community organization serving 6500+ low-income, rural youth and their families living in agricultural communities. Our longitudinal randomized controlled trial targets 224 dyads in two geographic regions, allowing us to assess the preliminary generalizability of ADAPT+. Aim 1: To test the efficacy of ADAPT+ compared with Enhanced Usual Care (EUC) on primary outcomes: a) lowering parental stress, increasing parental mindfulness and b) improving youth eating and (e.g., more fruits and vegetables, less sugary beverages) PA behaviors, and anthropometric indicators (BMI, Waist-Hip ratio). Aim 2: Evaluate the impact of ADAPT+ compared with EUC on secondary outcomes, including parental diet quality/eating (e.g., more fruits and vegetables, less sugary beverages), PA behaviors, and anthropometric indicators (BMI, Waist-Hip ratio). Exploratory Aim 1: To evaluate: a) indirect relationships (mediators) of parental stress and mindfulness on parent receptivity to intervention content (e.g., intention to and confidence to change) and parent/youth health behaviors; b) Social and contextual factors (moderators), e.g., food access, built environment via geocoding (rurality), stress, health literacy, social support, education and income. Exploratory Aim 2: To explore maintenance of effects and factors related to attrition of ADAPT+ vs. EUC through 12-mos., contacted via phone/WhatsApp to complete a battery of self-report study measures. The aims of the study are significant, as they address an urgent public health epidemic among a high- risk population of youth and their families; innovative, as they implement a unique intervention that addresses many limitations in current approaches to obesity prevention; and employ a rigorous scientific approach, setting the stage for a larger scale dissemination application.
