Skip to main content

Advertisement

SpringerLink
Log in

Baseline Targeted Moderation in a Trial of the Family Check-Up 4 Health: Potential Explanations for Finding Few Practical Effects

  • Published:
Prevention Science Aims and scope Submit manuscript

Abstract

Not all participants will benefit equally from even well-established, evidence-based prevention programs. For this reason, the field of prevention science is beginning to embrace individual tailoring of interventions. The Family Check-Up was among the first prevention programs to tailor at the family level as opposed to the more prevalent focus on adapting programs for different cultures, genders, and other immutable participant characteristics. Despite tailoring, families with lower levels of stress and parental mental health issues, children with lower baseline conduct problems, and families living in an extremely deprived neighborhood benefitted less from the Family Check-Up. This study examined baseline targeted moderation (BTM) within a trial of the Family Check-Up 4 Health (FCU4Health) program, an adaptation of the Family Check-Up for primary care delivery and explicit targeting of obesogenic behaviors. Ethnically diverse, low-income families (N = 240) with children ages 5.5 to 12 years identified in pediatric primary care with elevated body mass index (BMI) were enrolled and randomized to FCU4Health or usual care. Few BTM effects were found using single-variable-as-moderator and latent-class-as-moderator analytic approaches across the primary (child BMI, body composition) and secondary outcomes (family health routines; child eating behaviors, food choices, emotional problems, problem behaviors, quality of life; caregiver BMI and body composition), as well as hypothesized mediators (child self-regulation, parenting skills). The high-risk nature of the sample and the FCU4Health being individually tailored might have mitigated finding BTM effects. This trial was prospectively registered (NCT03013309 ClinicalTrials.gov).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Allen, J. P., & Philliber, S. (2001). Who benefits most from a broadly targeted prevention program? Differential efficacy across populations in the Teen Outreach program. Journal of Community Psychology, 29, 637–655. https://doi.org/10.1002/jcop.1040.

    Article  PubMed  PubMed Central  Google Scholar 

  • Baydar, N., Reid, M. J., & Webster-Stratton, C. (2003). The role of mental health factors and program engagement in the effectiveness of a preventive parenting program for head start mothers. Child Development, 74, 1433–1453. https://doi.org/10.1111/1467-8624.00616.

    Article  PubMed  Google Scholar 

  • Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107, 238–246.

    Article  CAS  PubMed  Google Scholar 

  • Bentler, P. M. (1995). EQS structural equations program manual. Encino, CA: Multivariate Software.

  • Berkel, C., Fu, E., Carroll, A. J., Wilson, C., Tovar-Huffman, A., Mauricio, A. M., & Smith, J. D. (2021). Effects of the Family Check-Up 4 Health on parenting and child behavioral health: A randomized hybrid effectiveness-implementation trial in primary care. Prevention Science, 22, 464–474. https://doi.org/10.1007/s11121-021-01213-y

    Article  PubMed  Google Scholar 

  • Berkel, C., Mauricio, A. M., Rudo-Stern, J., Dishion, T. J., & Smith, J. D. (2020a). Motivational interviewing and caregiver engagement in the Family Check-Up 4 Health. Prevention Science : THe Official Journal of the Society for Prevention Research. https://doi.org/10.1007/s11121-020-01112-8

    Article  Google Scholar 

  • Berkel, C., Rudo-Stern, J., Abraczinskas, M., Wilson, C., Lokey, F., Flanigan, E., & Smith, J. D. (2020). Translating evidence-based parenting programs for primary care: Stakeholder recommendations for sustainable implementation. Journal of Community Psychology, 48, 1178–1193. https://doi.org/10.1002/jcop.22317.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bíró, K., Dombrádi, V., Jani, A., Boruzs, K., & Gray, M. (2018). Creating a common language: Defining individualized, personalized and precision prevention in public health. Journal of Public Health, 40, e552–e559. https://doi.org/10.1093/pubmed/fdy066.

    Article  PubMed  Google Scholar 

  • Byrne, B. M. (1994). Structural equation modeling with EQS and EQS/Windows: Basic concepts, applications, and programming. Sage.

    Google Scholar 

  • CDC/NCHS. (2000). CDC growth charts: United States. http://www.cdc.gov/growthcharts. Posted May 30, 2000.

  • Cooper, B. R., & Lanza, S. T. (2014). Who benefits most from Head Start? Using latent class moderation to examine differential treatment effects. Child development, 85(6), 2317-2338. https://doi.org/10.1111/cdev.12278

  • Dishion, T. J., & Patterson, G. R. (2016). The development and ecology of antisocial behavior: Linking etiology, prevention, and treatment. In D. Cicchetti (Ed.), Developmental Psychopathology. New York, NY: John Wiley & Sons, Inc.

  • Dishion, T. J., Shaw, D. S., Connell, A., Gardner, F. E. M., Weaver, C., & Wilson, M. (2008). The Family Check-Up with high-risk indigent families: Preventing problem behavior by increasing parents’ positive behavior support in early childhood. Child Development, 79, 1395–1414. https://doi.org/10.1111/j.1467-8624.2008.01195.x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Dishion, T. J., & Stormshak, E. A. (2007). Intervening in children’s lives: An ecological, family-centered approach to mental health care. American Psychological Association.

    Book  Google Scholar 

  • Dishion, T. J., Stormshak, E. A., & Kavanagh, K. (2011). Everyday parenting: A professional’s guide to building family management skills. Research Press.

    Google Scholar 

  • Ellis, L. K., & Rothbart, M. K. (2001). Revision of the Early Adolescent Temperament Questionnaire. Paper presented at the Biennial Meeting of the Society for Research in Child Development, Minneapolis, Minnesota.

  • Enders, C. K., & Bandalos, D. L. (2001). The relative performance of full information maximum likelihood estimation for missing data in structural equation models. Structural equation modeling, 8(3), 430-457. https://doi.org/10.1207/S15328007SEM0803_5

  • Fu, E., Grimm, K. J., Berkel, C., & Smith, J. D. (2020). Parenting and social-ecological correlates with children’s health behaviours: A latent profile analysis. Pediatric Obesity, 15.

  • Gerards, S. M. P. L., Sleddens, E. F. C., Dagnelie, P. C., de Vries, N. K., & Kremers, S. P. J. (2011). Interventions addressing general parenting to prevent or treat childhood obesity. International Journal of Pediatric Obesity, 6, e28-e45. https://doi.org/10.3109/17477166.2011.575147

  • Goodman, R. (1997). The Strengths and Difficulties Questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38, 581–586. https://doi.org/10.1111/j.1469-7610.1997.tb01545.x.

  • Hales, C. M., Fryar, C. D., Carroll, M. D., Freedman, D. S., & Ogden, C. L. (2018). Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007–2008 to 2015–2016. JAMA, 319, 1723–1725. https://doi.org/10.1001/jama.2018.3060.

    Article  PubMed  PubMed Central  Google Scholar 

  • Harrison, K., Bost, K. K., McBride, B. A., Donovan, S. M., Grigsby-Toussaint, D. S., Kim, J., & Jacobsohn, G. C. (2011). Toward a developmental conceptualization of contributors to overweight and obesity in childhood: The Six-Cs model. Child Development Perspectives, 5, 50–58. https://doi.org/10.1111/j.1750-8606.2010.00150.x.

    Article  Google Scholar 

  • Howe, G. W. (2019). Using baseline target moderation to guide decisions on adapting prevention programs. Development and Psychopathology, 31, 1777–1788. https://doi.org/10.1017/S0954579419001044.

    Article  PubMed  Google Scholar 

  • Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6, 1–55. https://doi.org/10.1080/10705519909540118.

    Article  Google Scholar 

  • Insel, T. R. (2007). The arrival of preemptive psychiatry. Early Intervention in Psychiatry, 1, 5–6. https://doi.org/10.1111/j.1751-7893.2007.00017.x.

    Article  PubMed  Google Scholar 

  • Jago, R., Edwards, M. J., Urbanski, C. R., & Sebire, S. J. (2013). General and specific approaches to media parenting: A systematic review of current measures, associations with screen-viewing, and measurement implications. Childhood Obesity, 9, S51-S72. https://doi.org/10.1089/chi.2013.0031

  • Koskinen, J., Magnussen, C. G., Sinaiko, A., Woo, J., Urbina, E., Jacobs, D. R., & Juonala, M. (2017). Childhood age and associations between childhood metabolic syndrome and adult risk for metabolic syndrome, type 2 diabetes mellitus and carotid intima media thickness: The International Childhood Cardiovascular Cohort Consortium. Journal of the American Heart Association, 6.

  • LeBourgeois, M. K., & Harsh, J. R. (2016). Development and psychometric evaluation of the Children’s Sleep-Wake Scale. Sleep Health, 2, 198–204. https://doi.org/10.1016/j.sleh.2016.04.001.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lloyd-Jones, D. M., Hong, Y., Labarthe, D., Mozaffarian, D., Appel, L. J., Van Horn, L., & and on behalf of the American Heart Association Strategic Planning Task Force Statistics Committee. (2010). Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association’s strategic impact goal through 2020 and beyond. Circulation, 121, 586–613. https://doi.org/10.1161/circulationaha.109.192703.

    Article  Google Scholar 

  • McEachern, A., Dishion, T. J., Weaver, C. M., Shaw, D. S., Wilson, M. N., & Gardner, F. E. M. (2012). Parenting Young Children (PARYC): Validation of a self-report parenting measure. Journal of Child and Family Studies, 21, 498–511.

    Article  PubMed  PubMed Central  Google Scholar 

  • Metzler, C. W., Biglan, A., Ary, D. V., & Li, F. (1998). The stability and validity of early adolescents’ reports of parenting constructs. Journal of Family Psychology, 12, 600–619. https://doi.org/10.1037/0893-3200.12.4.600.

    Article  Google Scholar 

  • Moreno, J. P., Kelley, M. L., Landry, D. N., Paasch, V., Terlecki, M. A., Johnston, C. A., & Foreyt, J. P. (2011). Development and validation of the Family Health Behavior Scale. International Journal of Pediatric Obesity, 6, e480-486. https://doi.org/10.3109/17477166.2011.575148.

    Article  PubMed  Google Scholar 

  • Munthali, R. J., Kagura, J., Lombard, Z., & Norris, S. A. (2016). Childhood adiposity trajectories are associated with late adolescent blood pressure: Birth to twenty cohort. BMC Public Health, 16, 665. https://doi.org/10.1186/s12889-016-3337-x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Muthén, B. O., & Muthén, L. K. (2019). Mplus, Version 8.4. Los Angeles, CA: Muthén & Muthén.

  • National Cancer Institute, D. o. C. C. a. P. S., Applied Research Program Short Dietary Assessment Instruments,. (2013). Dietary Screener Questionnaire in the NHANES 2009–2010. [http://appliedresearch.cancer.gov/diet/screeners/] (Accessed June 12, 2016).

  • National Research Council. (2011). Toward precision medicine: Building a knowledge network for biomedical research and a new taxonomy of disease. National Academies Press.

    Google Scholar 

  • National Research Council and Institute of Medicine. (2011). Early childhood obesity prevention policies. The National Academies Press.

    Google Scholar 

  • O’Connor, E. A., Evans, C. V., Burda, B. U., Walsh, E. S., Eder, M., & Lozano, P. (2017). Screening for obesity and intervention for weight management in children and adolescents: Evidence Report and Systematic review for the US Preventive Services Task Force. JAMA, 317, 2427–2444. https://doi.org/10.1001/jama.2017.0332.

    Article  PubMed  Google Scholar 

  • Pelham, W. E., Dishion, T. J., Tein, J. Y., Shaw, D. S., & Wilson, M. N. (2017). What doesn’t work for whom? Exploring heterogeneity in responsiveness to the family check-up in early childhood using a mixture model approach. Prevention Science, 18, 911–922. https://doi.org/10.1007/s11121-017-0805-1.

    Article  PubMed  PubMed Central  Google Scholar 

  • Perrino, T., Pantin, H., Prado, G., Huang, S., Brincks, A., Howe, G., & Brown, C. H. (2014). Preventing internalizing symptoms among Hispanic adolescents: a synthesis across Familias Unidas trials. Prevention Science, 15. https://doi.org/10.1007/s11121-013-0448-9

  • Peter, H., Westfall, R., Rom, D., Wolfinger, R., & Hochberg, Y. (2000). Multiple comparisons and multiple tests: Using the SAS system. SAS Institute.

    Google Scholar 

  • Prado, G., Pantin, H., Briones, E., Schwartz, S. J., Feaster, D., Huang, S., & Szapocznik, J. (2007). A randomized controlled trial of a parent-centered intervention in preventing substance use and HIV risk behaviors in Hispanic adolescents. Journal of Consulting & Clinical Psychology, 75, 914–926. https://doi.org/10.1037/0022-006X.75.6.914.

    Article  Google Scholar 

  • Reuben, J. D., Shaw, D. S., Brennan, L. M., Dishion, T. J., & Wilson, M. N. (2015). A family-based intervention for improving children’s emotional problems through effects on maternal depressive symptoms. Journal of Consulting and Clinical Psychology, 83, 1142.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rothbart, M. K., Ahadi, S. A., Hershey, K. L., & Fisher, P. (2001). Investigations of temperament at three to seven years: The Children’s Behavior Questionnaire. Child Development, 72, 1394–1408. https://doi.org/10.1111/1467-8624.00355.

    Article  CAS  PubMed  Google Scholar 

  • Sadeh, A., Mindell, J. A., Luedtke, K., & Wiegand, B. (2009). Sleep and sleep ecology in the first 3 years: A web-based study. Journal of Sleep Research, 18, 60–73. https://doi.org/10.1111/j.1365-2869.2008.00699.x.

    Article  PubMed  Google Scholar 

  • Seburg, E. M., Olson-Bullis, B. A., Bredeson, D. M., Hayes, M. G., & Sherwood, N. E. (2015). A review of primary care-based childhood obesity prevention and treatment interventions. Current Obesity Reports, 4, 157–173. https://doi.org/10.1007/s13679-015-0160-0.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shaw, D. S., Sitnick, S. L., Brennan, L. M., Choe, D. E., Dishion, T. J., Wilson, M. N., & Gardner, F. (2016). The long-term effectiveness of the Family Check-Up on school-age conduct problems: Moderation by neighborhood deprivation. Development and Psychopathology, 28, 1471–1486. https://doi.org/10.1017/S0954579415001212

  • Shelleby, E. C., & Shaw, D. S. (2014). Outcomes of parenting interventions for child conduct problems: A review of differential effectiveness. Child Psychiatry & Human Development, 45, 628–645. https://doi.org/10.1007/s10578-013-0431-5.

    Article  Google Scholar 

  • Smith, J. D., Berkel, C., Carroll, A. J., Fu, E., Grimm, K. J., Mauricio, A. M., & Samaddar, K. (2021). Health behaviour outcomes of a family based intervention for paediatric obesity in primary care: A randomized type II hybrid effectiveness-implementation trial. Pediatric Obesity, e12780. https://doi.org/10.1111/ijpo.12780

  • Smith, J. D., Berkel, C., Hails, K. A., Dishion, T. J., Shaw, D. S., & Wilson, M. N. (2018). Predictors of participation in the Family Check-Up program: A randomized trial of yearly services from age 2 to 10 years. Prevention Science, 19, 652–662. https://doi.org/10.1007/s11121-016-0679-7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Smith, J. D., Berkel, C., Jordan, N., Atkins, D. C., Narayanan, S. S., Gallo, C., & Bruening, M. M. (2018). An individually tailored family-centered intervention for pediatric obesity in primary care: Study protocol of a randomized type II hybrid implementation-effectiveness trial (Raising Healthy Children study). Implementation Science, 13, 1–15. https://doi.org/10.1186/s13012-017-0697-2.

    Article  Google Scholar 

  • Smith, J. D., Berkel, C., Rudo-Stern, J., Montaño, Z., St George, S. M., Prado, G., & Dishion, T. J. (2018c). The Family Check-Up 4 Health (FCU4Health): Applying implementation science frameworks to the process of adapting an evidence-based parenting program for prevention of pediatric obesity and excess weight gain in primary care. Frontiers in Public Health, 6, 293. https://doi.org/10.3389/fpubh.2018.00293

    Article  PubMed  PubMed Central  Google Scholar 

  • Smith, J. D., Egan, K. N., Montaño, Z., Dawson-McClure, S., Jake-Schoffman, D. E., Larson, M., & St. George, S. M. (2018). A developmental cascade perspective of paediatric obesity: Conceptual model and scoping review. Health Psychology Review, 12, 271–293. https://doi.org/10.1080/17437199.2018.1457450.

    Article  PubMed  PubMed Central  Google Scholar 

  • Smith, J. D., & St. George, S. M., & Prado, G. (2017). Family-centered positive behavior support interventions in early childhood to prevent obesity. Child Development, 88, 427–435. https://doi.org/10.1111/cdev.12738.

    Article  PubMed  PubMed Central  Google Scholar 

  • Smith, J. D., Montaño, Z., Dishion, T. J., Shaw, D. S., & Wilson, M. N. (2015). Preventing weight gain and obesity: indirect effects of the family check-up in early childhood. Prevention Science, 16(3), 408-419. https://doi.org/10.1007/s11121-014-0505-z

  • St. George, S. M., Agosto, Y., Rojas, L. M., Soares, M., Bahamon, M., Prado, G., & Smith, J. D. (2020). A developmental cascade perspective of paediatric obesity: A systematic review of preventive interventions from infancy through late adolescence. Obesity Reviews, 21.

  • Swinburn, B. A., Sacks, G., Hall, K. D., McPherson, K., Finegood, D. T., Moodie, M. L., & Gortmaker, S. L. (2011). The global obesity pandemic: Shaped by global drivers and local environments. The Lancet, 378, 804–814. https://doi.org/10.1016/S0140-6736(11)60813-1.

    Article  Google Scholar 

  • US Preventive Services Task Force. (2017). Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA, 317, 2417–2426. https://doi.org/10.1001/jama.2017.6803.

    Article  Google Scholar 

  • Van Ryzin, M. J., & Nowicka, P. (2013). Direct and indirect effects of a family-based intervention in early adolescence on parent−youth relationship quality, late adolescent health, and early adult obesity. Journal of Family Psychology, 27(1), 106-116. https://doi.org/10.1037/a0031428

  • Varni, J. W., Seid, M., & Kurtin, P. S. (2001). PedsQL™ 4.0: Reliability and Validity of the Pediatric Quality of Life Inventory™ version 4.0 generic core scales in healthy and patient populations. Medical Care, 39, 800–812.

  • Walton, K., Simpson, J. R., Darlington, G., & Haines, J. (2014). Parenting stress: A cross-sectional analysis of associations with childhood obesity, physical activity, and TV viewing. BMC Pediatrics, 14, 244.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This study was supported by the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control & Prevention (U18 DP006255; Berkel & Smith).

Author information

Authors and Affiliations

  1. Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City, Utah, USA

    Justin D. Smith

  2. Center for Prevention Implementation Methodology for Drug Abuse and HIV, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Allison J. Carroll & Emily Fu

  3. Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Allison J. Carroll

  4. Program in Integrated Behavioral Health, College of Health Solutions, Arizona State University, Tempe, AZ, USA

    Cady Berkel

  5. Phoenix Children’s Hospital, Phoenix, AZ, USA

    Cady Berkel

Authors
  1. Justin D. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Allison J. Carroll
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emily Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cady Berkel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Justin D. Smith.

Ethics declarations

Ethics Approval

This trial was designed in accordance with the basic ethical principles of autonomy, beneficence, justice, and non-maleficence and conducted in accordance with the rules of Good Clinical Practice outlined in the most recent Declaration of Helsinki. The project was approved by the Institutional Review Boards of Arizona State University (Protocol 00004530) and Phoenix Children’s Hospital (Protocol 17–001). All other institutions participating in this research provided signed reliance agreements ceding to the IRB of Arizona State University.

Informed Consent

Consent and assent were obtained from all participants included in the study.

Conflict of Interest

Berkel and Smith co-developed the Family Check-Up 4 Health program with Thomas Dishion, developer of the original Family Check-Up.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Smith, J.D., Carroll, A.J., Fu, E. et al. Baseline Targeted Moderation in a Trial of the Family Check-Up 4 Health: Potential Explanations for Finding Few Practical Effects. Prev Sci 24, 226–236 (2023). https://doi.org/10.1007/s11121-021-01266-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11121-021-01266-z

Keywords

Search

Navigation