Teen Mom 2: Improving Black Adolescent Maternal Cardiometabolic Health

Sponsor

University of Mississippi Medical Center (Other)

Overall Status

Not yet recruiting

CT.gov ID

NCT05843903

Collaborator

Mississippi State Department of Health (Other), Health Resources and Services Administration (HRSA) (U.S. Fed), National Institute of General Medical Sciences (NIGMS) (NIH)

Enrollment

Location

Arms

Anticipated Duration (Months)

1.2

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The proposed multicomponent digital health intervention has the potential to significantly impact the trajectory of maternal health in a rural, pregnant, Black adolescent population with the highest risks for cardiometabolic diseases worldwide. The proposed implementation strategy leverages mobile technologies which are ubiquitous across the socioeconomic gradient and proposes to train young adult WIC moms to deliver peer health coaching in a telehealth setting to address social barriers and support behavior change in pregnant, Black adolescent WIC clients in the Mississippi Delta - a rural region where the population is more than two-thirds percent Black and the teen birth rate is the highest in the United States. This is a scalable and sustainable approach to enhance WIC services and improve WIC's impact on population health and cardiometabolic health disparities in Black women.

Condition or Disease	Intervention/Treatment	Phase
Physical Activity Sedentary Behavior Gestational Weight Gain Social Determinants of Health	Behavioral: Peer Health Coaching Behavioral: #BabyLetsMove	N/A

Detailed Description

Teen Mom 2 will assess the feasibility, acceptability, and early efficacy of a 20-week multilevel, multicomponent digital health intervention, #BabyLetsMove, delivered through the University of Mississippi Medical Center's Telehealth Center for Excellence in partnership with the Special Supplemental Nutritional Program for Women, Infants, and Children (WIC) to increase physical activity (PA) and reduce sedentary behavior (SB) in pregnant, Black adolescent WIC clients in the Mississippi Delta. The Social Ecological Model and TElehealth in CHronic Disease Model provide an empirical framework for considering multiple determinants of health behavior and evaluating mechanisms of implementation and intervention impacts. At the person level, pregnant, Black adolescent (15- to 19-years) WIC clients (n=70) will be given three empirically supported behavior goals to (1) watch 2 hours or less of television per day, (2) take 10,000 steps or more per day, and (3) engage in 20 minutes or more of organized exercise like prenatal yoga or dance videos per day. The intervention is designed to build social cognition, affect, and skills using four intervention components including a Fitbit activity tracker, interactive self-monitoring text messages with tailored feedback, tailored skills training text messages and materials, and peer health coaching. At the systems-level, racially concordant young adult (20- to 25-years) WIC moms (n=8) will be hired and trained to deliver peer health coaching in a telehealth setting to first, address social needs and second, to provide support for achieving the three behavior goals. The specific aims are to: (1) assess the impact of #BabyLetsMove on objectively measured light-to-moderate PA and SB from baseline (<20-weeks' gestation) to 26- and 36-weeks' gestation in pregnant, Black adolescents; (2) use remote patient monitoring to objectively measure and characterize patterns of weight gain from baseline to 26- and 36-weeks' gestation; and (3) evaluate the feasibility and acceptability of training young adult WIC moms to provide health coaching in a telehealth setting. This study will advance public health and scientific knowledge in preparation for a future cluster randomized clinical trial by: training WIC moms to provide health coaching to pregnant, Black adolescents in a telehealth setting; developing an attention-control arm; assessing changes in adolescents' PA and SB throughout pregnancy in response to a 20-week intervention; characterizing patterns of weight gain throughout pregnancy in Black adolescents; comparing adolescents across counties and WIC providers; and evaluating an implementation partnership between WIC and the Telehealth Center of Excellence.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

78 participants

Allocation:

Non-Randomized

Intervention Model:

Single Group Assignment

Masking:

None (Open Label)

Primary Purpose:

Prevention

Official Title:

Teen Mom 2: A Multicomponent Digital Health Intervention to Improve Black Adolescent Maternal Cardiometabolic Health in Mississippi's WIC Community

Anticipated Study Start Date :

Jul 1, 2023

Anticipated Primary Completion Date :

Dec 31, 2027

Anticipated Study Completion Date :

Dec 31, 2028

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Peer Health Coaching Young adult (18- to 25-years), postpartum, Black women enrolled in WIC will undergo paid training in health coaching.	Behavioral: Peer Health Coaching Young adult, Black WIC moms will be trained as peer health coaches to first, address social needs and second, support health behavior change in pregnant, Black adolescents enrolled in WIC. Health coaching is a client-centered technique that leverages the power of lived experiences and motivational interviewing to strengthen one's drive for behavior change by linking personal goals with values. Training racially concordant health coaches will mitigate internalized and interpersonal racism, leverage moms' connection with WIC, and supplement WIC services by providing a scalable telehealth peer health coaching intervention.
Experimental: #BabyLetsMove There are four digital components to the intervention including Fitbit activity tracker, interactive self-monitoring and tailored feedback text messages, tailored skills training text messages and materials, and peer health coaching.	Behavioral: #BabyLetsMove The #BabyLetsMove digital health intervention uses a multi-level, systems-change approach. At the systems-level, racially concordant young adult WIC moms will be trained as health coaches. At the person level, adolescent WIC clients will be given empirically supported behavior goals, self-monitoring text messages with automated feedback, tailored skills training materials, a FitBit device, and tailored peer coaching support. The #BabyLetsMove intervention design is based on formative Teen Mom Study findings to build social cognition, affect, and skills to modify 3 concrete, achievable, and easily monitored behavioral targets: (1) Limit television viewing time to less than 2 hours per day; (2) Walk at least 10,000 steps per day; and (3) Do 20 minutes or more of exercise per day.

Arm

Intervention/Treatment

Experimental: Peer Health Coaching

Young adult (18- to 25-years), postpartum, Black women enrolled in WIC will undergo paid training in health coaching.

Behavioral: Peer Health Coaching

Young adult, Black WIC moms will be trained as peer health coaches to first, address social needs and second, support health behavior change in pregnant, Black adolescents enrolled in WIC. Health coaching is a client-centered technique that leverages the power of lived experiences and motivational interviewing to strengthen one's drive for behavior change by linking personal goals with values. Training racially concordant health coaches will mitigate internalized and interpersonal racism, leverage moms' connection with WIC, and supplement WIC services by providing a scalable telehealth peer health coaching intervention.

Experimental: #BabyLetsMove

There are four digital components to the intervention including Fitbit activity tracker, interactive self-monitoring and tailored feedback text messages, tailored skills training text messages and materials, and peer health coaching.

Behavioral: #BabyLetsMove

The #BabyLetsMove digital health intervention uses a multi-level, systems-change approach. At the systems-level, racially concordant young adult WIC moms will be trained as health coaches. At the person level, adolescent WIC clients will be given empirically supported behavior goals, self-monitoring text messages with automated feedback, tailored skills training materials, a FitBit device, and tailored peer coaching support. The #BabyLetsMove intervention design is based on formative Teen Mom Study findings to build social cognition, affect, and skills to modify 3 concrete, achievable, and easily monitored behavioral targets: (1) Limit television viewing time to less than 2 hours per day; (2) Walk at least 10,000 steps per day; and (3) Do 20 minutes or more of exercise per day.

Outcome Measures

Primary Outcome Measures

Moderate-to-vigorous physical activity (MVPA) [Change in MVPA from baseline (<20-weeks' gestation) to 26-weeks' gestation.]
GT9X ActiGraph accelerometer. Accelerometers will be worn on participants' non-dominant wrist for 7-days, 24-hours per day to record raw acceleration data using a sampling rate of 100 Hz that will be converted into objective measures. Counts will follow Hesketh et al. (2018) for moderate (1952 - 5724 counts per minute) and vigorous (>5724 counts per minute) PA. Wear-time compliance will include 20 hours per day, > 4 days per week including 1 weekend day.
Sedentary behavior (SB) [Change in SB from baseline (<20 weeks' gestation) to 26-weeks' gestation.]
GT9X ActiGraph accelerometer. Accelerometers will be worn on participants' non-dominant wrist for 7-days, 24-hours per day to record raw acceleration data using a sampling rate of 100 Hz that will be converted into objective measures. Counts will follow Clark et al. (2021) for SB (<100 counts per minute). Wear-time compliance will include 20 hours per day, > 4 days per week including 1 weekend day.
Moderate-to-vigorous physical activity (MVPA) [Change in MVPA from baseline (<20-weeks' gestation) to 36-weeks' gestation.]
GT9X ActiGraph accelerometer. Accelerometers will be worn on participants' non-dominant wrist for 7-days, 24-hours per day to record raw acceleration data using a sampling rate of 100 Hz that will be converted into objective measures. Counts will follow Hesketh et al. (2018) for moderate (1952 - 5724 counts per minute) and vigorous (>5724 counts per minute) PA. Wear-time compliance will include 20 hours per day, > 4 days per week including 1 weekend day.
Sedentary behavior (SB) [Change in SB from baseline (<20-weeks' gestation) to 36-weeks' gestation.]
GT9X ActiGraph accelerometer. Accelerometers will be worn on participants' non-dominant wrist for 7-days, 24-hours per day to record raw acceleration data using a sampling rate of 100 Hz that will be converted into objective measures. Counts will follow Clark et al. (2021) for SB (<100 counts per minute). Wear-time compliance will include 20 hours per day, > 4 days per week including 1 weekend day.

Eligibility Criteria

Criteria

Ages Eligible for Study:

15 Years to 25 Years

Sexes Eligible for Study:

Female

Accepts Healthy Volunteers:

Yes

Peer Health Coaches Inclusion Criteria:

18- to 15-years
Black or African American
6-months postpartum
Enrolled in WIC
English speaking
High school diploma or GED

Peer Health Coaches Exclusion Criteria:

Illiteracy

#BabyLetsMove Inclusion Criteria:

15- to 19-years
Black or African American
<20 weeks' gestation
Enrolled in WIC
Residing in 1 of 8 Mississippi Delta Counties
English speaking
Own or have personal use of a mobile smart phone
Singleton pregnancy
Plan to carry the fetus to term and keep the infant after birth
No history of chronic medical conditions in the past year that could influence weight loss or gain