Abstract
Background: Contingency management (CM) interventions, which use operant conditioning principles to encourage completion of target behavioral goals, may be useful for improving adherence to behavioral skills training (BST). Research-to-date has yet to explore CM for weight loss in minority adolescents.
Objective: To examine the effects of CM in improving adolescent weight loss when added to BST.
Design: The study utilized an innovative experimental design that builds upon multiple baseline approaches as recommended by the National Institutes of Health.
Participants/setting: Six obese African-American youth and their primary caregivers living in Detroit, Michigan, USA.
Intervention: Adolescents received between 4 and 12 weeks of BST during a baseline period and subsequently received CM targeting weight loss.
Main outcome measures: Youth weight.
Statistical analysis performed: Linear mixed effects modeling was used in the analysis.
Results: CM did not directly affect adolescent weight loss above that of BST (p=0.053). However, when caregivers were involved in CM session treatment, contingency management had a positive effect on adolescent weight loss. The estimated weight loss due to CM when caregivers also attended was 0.66 kg/week (p<0.001, [95% CI; –1.96, –0.97]) relative to the baseline trajectory.
Conclusion: This study demonstrates application of a novel experimental approach to intervention development and demonstrated the importance of parent involvement when delivering contingency management for minority youth weight loss. Lessons learned from contingency management program implementation are also discussed in order to inform practice.
Acknowledgments
This study was funded by NHLBI 1U01HL097889. KBH, SN and DAE conceived and carried out experiments. TNT and DL conceived experiments and analyzed data. BD and PBC conceived experiments. All authors were involved in writing the paper and had final approval of the submitted and published versions. We thank Sarah Baker, Veronica Connors, Jessica Walker and Ashley Wiedemann for their role on this project.
Conflict of interest statement: The authors have no conflicts of interest statement to disclose.
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