Online supplement: SCHOOL-WORKSITE WEIGHT CONTROL 1 ONLINE SUPPLEMENT. Brief Report. Promising partnerships:

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1 Online supplement: SCHOOL-WORKSITE WEIGHT CONTROL 1 ONLINE SUPPLEMENT Brief Report Promising partnerships: Randomized controlled trial of an integrative school-worksite obesity prevention program

2 Online supplement: SCHOOL-WORKSITE WEIGHT CONTROL 2 Part I. Supplemental Intervention Details PULSE Parent Healthy Weight Program (PHWP) Sessions were delivered by the first author and guided by a scripted protocol (i.e., see Table 1, Session Structure). Goals for the program included a systematic, phased restructuring of the home food environment as well as increases in self-monitoring and mindfulness. Parents were required to maintain energy balance logs documenting food intake, energy output, and use of self-regulatory skills. Each session began with up to 35 minutes of individualized social support and troubleshooting pertaining to parent self-monitoring and household food changes. It should be noted that field studies informed this portion of sessions: parents reported dissatisfaction with the impersonal nature of the original curriculum. The next portion of each weekly session Share, Target, Replace - emphasized the phased transformation of the home food environment. Activities were interactive and integrated technology. For example, during Share, two to three participants shared digital photographs depicting their home food contents in the target food group (See Table 1). A digital projector was used in order to facilitate the collaborative identification of foods that, based on well-established research, should likely be removed from the household (Epstein, McCurley, Wing, & Valoski, 1990; Epstein, Valoski, Koeske, & Wing, 1986; Epstein, Valoski, Wing, & McCurley, 1994). The stop light diet (Epstein et al., 1986) served as a conceptual guide and was introduced early in the program. Parents were instructed, whenever possible, to refer to foods based on stop light terminology (e.g., red, yellow, green). The Target activity then ensued. First, participants were encouraged to analyze the target food that should be replaced, as follows: (a) identification of food characteristics in terms of its

3 Online supplement: SCHOOL-WORKSITE WEIGHT CONTROL 3 meal category/placement (i.e., breakfast, lunch, dinner, snack, beverage, dessert) and preparation time, (b) identification of palatable or pleasant sensory features of the food (i.e., salty and crunchy), (c) estimation of cost of the food, and (d) identification of any cultural or psychological significance of the food. The Replace brainstorm followed. At this point, the group leader walked the group through the Target analysis (i.e., see a through d above) and generated ideas for replacement foods that would closely parallel characteristics of the target food(s). The final portion of the session involved goal-setting and homework assignments. All homework assignments addressed a specific food group or aspect of the home food environment as well as a self-regulatory or mindfulness skill. Again- with regard to self-monitoring,- parents were required to maintain energy balance logs documenting food intake, energy output, and use of self-regulatory skills. Sessions were held from 3:30 to 5:00 PM in a comfortable school/office lounge setting and occurred bi-weekly over a six-month period. The same group leader conducted all sessions using a scripted protocol. Fidelity was monitored via structured forms aligned with the treatment protocol. Content (i.e., troubleshooting and support, food group coverage, share, target, & replace), dose (e.g., number of minutes), and participant engagement (i.e., via number of contributions per session) were tracked. No deviations to intervention protocol were recorded, and 100% of participants in attendance at each session made at least two verbal contributions. Four groups of 9 or 10 parents each were implemented concurrently (i.e., a different group each afternoon, Monday through Thursday - Mon (PHWP), Tues (PHWP-W), Wed (PHWP), Thurs (PHWP-W)). Babysitting was available at each session. The school, in conjunction with the local grocery store, furnished $10 grocery gift cards per participant, per

4 Online supplement: SCHOOL-WORKSITE WEIGHT CONTROL 4 session attended. Process data were collected at each session. Any participants who did not attend sessions were sent session content summaries and homework assignments. Table 1 Program Structure Session # Target Home Food Topic Session Content Homework 1 Family Food Inventory Introductions; Breaking down barriers; Motivation to change; Rewarding yourself 2 Portion Control Energy balance basics; Budge calculations & selfmonitoring; Label reading; Portion management; Group FFI review & goals 3 Beverage targets Self-monitoring coping; Beverage substitutions; Child beverage monitoring 4 Dairy Self-monitoring coping; Dairy substitutions; Parent & child breakfasts 5 Snacks and convenience foods Self-monitoring coping; Snack substitutions; Preportioning snacks & snacks for school Family Food Inventory (FFI) EB Log & Beverage Targets EB Log & Dairy Targets EB Log & Snack targets EB Log & Protein/nut targets; Family activity brainstorm

5 Online supplement: SCHOOL-WORKSITE WEIGHT CONTROL 5 Session # Target Home Foods Session Content Homework 6 Proteins Self-monitoring coping; Protein substitutions; Weekly meal planning: Guest cooking demonstration 7 Carbohydrates and healthy grains 8 Social-cultural and restaurant food consumption 9 Responding to child and family behaviors 10 Future goals: Energy balance as a lifelong habit Self-monitoring coping; Carbohydrate substitutions; FFI reports & observations; Restaurant & social eating Self-monitoring coping; Restaurant analysis review & substitutions; Fueling family activity with energy & motivation Self-monitoring coping; Targets & collaborative suggestions for child behavior redirection Final session processing & buddy sign-up; Planning for ongoing contact with PULSE; Voluntary weight loss reports; Goals EB Log & Carbohydrate/grain targets; Updated FFI EB Log & Restaurant analysis EB Log & Child Observations EB Log & FFI

6 Online supplement: SCHOOL-WORKSITE WEIGHT CONTROL 6 Part II. Supplemental Results It should be noted that there were no missing data points for outcome measures of interest. For process measures, averages- based on attended sessions were utilized. Table 2 Statistics Before and After treatment & Sample Demographics Worksite-Inclusive Group (PHWP-W) (N=19) Standard Comparison Group (PHWP) (N=19) Main effect time Main effect group Time x group interaction Pre- M (s.d.) Post- M (s.d.) Pre- M (s.d.) Post- M (s.d.) F (η 2 p) F (η 2 p) F (η 2 p) Sessions attended ** -- (1.51) (1.52) Sessions with complete logs 7.79 (1.78) 4.32 (1.67) ** -- Parent BMI (3.50) (3.15) (3.25) (3.34) 20.29** (0.37) 0.64 (0.02) 8.92** (0.22) HFI Total OHFA (6.17) (3.70) (4.37) (2.23) 57.93*** (0.62) 7.80** (0.18) 5.47* (0.13) Child z-bmi 0.72 (0.77) 0.67 (0.64) 0.66 (0.70) 0.70 (0.69) 0.08 (0.002) (0) 3.91* (0.10) Parent Age (5.32) (5.07) Child Age 5.29 (0.28) 5.38 (0.39) Number Hours Employed Weekly (5.58) (5.43) Race (%) African American Latino *p <0.05 **p < 0.01 ***p <.001

7 Online supplement: SCHOOL-WORKSITE WEIGHT CONTROL 7 Table 3 Pre- and Post- Weight Classification Percentages for Parents & Children Parents (%) Children (%) Worksite-Inclusive Group (PHWP-W) (N=19) Standard Comparison Group (PHWP) (N=19) Healthy Overweight Obese Healthy Overweigh t Obese Pre Post Pre Post Note. Healthy weight = BMI percentile < 84.9; Overweight = BMI percentile ; Obese = BMI percentile 95+

8 Online supplement: SCHOOL-WORKSITE WEIGHT CONTROL 8 Table 4 Correlation Matrix for All Participants (N = 38) # Sessions Attended 1 2. # Energy Balance Logs.88** 1 3. Child zbmi Change a * 1 4. Parent BMI Change b -.52** -.48**.40* 1 5. Parent BMI Change a -.51** -.45**.20.75** 1 6. OHFA HFI Change a -.37* a Pre- to Follow-up (12-mos.) Pre- to Post- (6 mos.) ** = Correlation is significant at the 0.01 level (2-tailed) * = Correlation is significant at the 0.05 level (2-tailed) Table 5 Correlation Matrix for PHWP Group (N=19) # Sessions Attended 1 2. # Energy Balance Logs.76** 1 3. Child zbmi Change a Parent BMI Change b Parent BMI Change a *.45.53* 1 6. OHFA HFI Change a -.48* a Pre- to Follow-up (12-mos.) Pre- to Post- (6 mos.) ** = Correlation is significant at the 0.01 level (2-tailed) * = Correlation is significant at the 0.05 level (2-tailed)

9 Online supplement: SCHOOL-WORKSITE WEIGHT CONTROL 9 Table 6 Correlation Matrix for PHWP-W Group (N = 19) # Sessions Attended 1 2. # Energy Balance Logs.73** 1 3. Child zbmi Change a Parent BMI Change b Parent BMI Change a ** 1 6. OHFA HFI Change a * * 1 a Pre- to Follow-up (12-mos.) Pre- to Post- (6 mos.) ** = Correlation is significant at the 0.01 level (2-tailed) * = Correlation is significant at the 0.05 level (2-tailed)