Thirty to almost 50% of families in the COPTR trials reported food insecurity and high rates of participation in the Supplemental Nutrition Assistance Program. Nearly half of the Cleveland families moved once during the 3-year study, and 10% moved 3 or more times. The Stanford GEMS needed to change venues 6 times partly because of episodes of violent crime near the intervention sites. For example, 1 child in the Cleveland COPTR study was killed in a drive-by shooting, and several other participants knew a child who was shot and killed by the police. The social conditions in the communities in which these trials were conducted may help explain why the results of these trials were so disappointing. Retention rates in the treatment and control groups in both of these studies ranged from 89% to 96%. 4 Families in the intervention group were contacted 35 times over 3 years, with 15 contacts in the first year. 3 The second intervention, conducted in Minneapolis, Minnesota, consisted of efforts to integrate and synergize individually tailored home visits, community-based parenting classes, primary care provider support, and neighborhood connection strategies, which were compared with usual care. The control group received school readiness sessions over the 36 months of the study. One intervention, conducted in Nashville, Tennessee, was a family-based community-centered program designed to build skills over 12 weekly meetings followed by monthly coaching phone calls for 9 months and then a 24-month period of efforts to cue actions, including, for example, texts, letters, or telephone calls to promote playground use. In 2 other COPTR studies that included randomized intensive obesity interventions in low-income, predominantly Hispanic preschool-aged children aged 2 to 5 years, 3, 4 researchers also failed to find improvements in BMI trajectories compared with controls over a 3-year period of follow-up. Furthermore, no significant differences were observed in diet, physical activity measured by accelerometry, sleep, perceived stress, or cardiometabolic factors. No significant differences were observed in annual changes of BMI, waist circumference, or triceps skinfold thickness. At the end of the 3-year intervention, 90% of enrolled participants remained in the study. Both interventions included intensive engagement through 25 small-group sessions in the first year, alternating face-to-face and individualized phone sessions in year 2, and 4 face-to-face sessions and 8 individualized phone sessions in year 3. Both interventions focused on improving diet, physical activity, sleep and stress management, and reducing sedentary behavior. The control group was a SystemChange intervention that sought to establish family routines, restructured to develop new healthy habits. In this trial, 360 predominantly African American middle school children (mean age 11.6 years) and their parents were randomly assigned to a Healthåhange intervention, which relied on cognitive behavioral and motivational interviewing strategies that focused on goal setting, problem solving, self-monitoring, and relapse prevention. This study, conducted in Cleveland, Ohio, is 1 of 4 randomized controlled intervention trials, 2 of which have already been published. In this issue of Pediatrics, Moore et al 2 describe the most recent of the COPTR studies.
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