ESPE Abstracts (2018) 89 P-P1-122

Determinants of Attrition from a Healthy Lifestyle Intervention: Experience from the CIRCUIT Program

Prince Kevin Danielsa,b, Marina Ybarrac,d, Andrea Van Hulstc,e, Tracie A Barnettc,f, Marie-Ève Mathieuc,g, Olivier Drouinc,g, Lisa Kakinamib, Jean-Luc Bigrasc,g & Mélanie Hendersonc,g


aRes, Montreal, Canada; bConcordia University, Montreal, Canada; cResearch Center of the Sainte-Justine University Hospital, Montreal, Canada; dArmand-Frap, Laval, Canada; eMcGill University, Montreal, Canada; fArmand-Frapier Institute, Laval, Canada; gUniversity of Montreal, Montreal, Canada


Introduction: Pediatric obesity is a global public health problem that is associated with severe cardiometabolic consequences. Weight management interventions focusing on lifestyles have shown some promising results, but attrition rates are often high and reasons for dropout are poorly understood.

Objectives: We aimed toestimate the prevalence, and identify the determinants of attrition among pediatric participants in the first year of a 2-year lifestyle intervention program.

Methods: The CIRCUIT (Centre Pédiatrique d’Intervention en Prévention et en Réadaptation Cardiovasculaires, Sainte-Justine Hospital University Center, Montreal, Canada) program is an ongoing lifestyle intervention program for youth aged 4–18 y at risk of cardiovascular disease (CVD). It consists of a personalized plan created by a clinical kinesiologist to increase physical activity and reduce sedentary behaviors by considering the specific needs and opportunities of each child and their living environment. Participants are contacted monthly by the kinesiologist and asked to return every 6 months for follow-up evaluations and further plan adjustments. We collected anthropometric and socioeconomic characteristics at baseline. Attrition was defined as having done the baseline visit but ceasing attendance prior to the 1-year follow-up. Differences in baseline characteristics between those who dropped out and those who did not (age, sex, body mass index z-score (zBMI), ethnicity, maternal and paternal education, living with both parents, estimated distance in time and distance in kilometers to the clinic) were analyzed using chi-square-, Fisher’s exact-, and t-tests. To determine predictors of drop-out, we used multivariable logistic regression models adjusted for age, sex, baseline zBMI, socio-demographic characteristics, and estimated driving time to the clinic.

Results: From 531 participants who started the program, 263 dropped out before the first year (attrition rate of 49.5%). Youth who dropped out were older (mean age 12.7y vs 11.3y; P<0.001) and less likely to live with both parents (58% vs. 68%, P=0.03). They were also less likely to have mothers who had completed high school (79% vs 90%, P=0.002). No group differences were observed for sex, ethnicity, baseline BMI z-score, fathers’ education, or driving time/distance to the clinic. In logistic regression models, only older age at initiation of the intervention (OR:1.2, CI: 1.1–1.3) and lower maternal education (OR: 2.3, CI: 1.3–4.3) were significant predictors of attrition.

Conclusion: Our program attrition rate was high, but comparable to other programs. Targeting a younger population and tailoring the program to parental level of education may improve retention to CIRCUIT and other lifestyle intervention programs.