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Lin SF, Zive MM, Schmied E, Helm J, Ayala GX. The Effects of a Multisector, Multilevel Intervention on Child Dietary Intake: California Childhood Obesity Research Demonstration Study. Nutrients 2023; 15:4449. [PMID: 37892523 PMCID: PMC10610147 DOI: 10.3390/nu15204449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
Consuming too few fruits and vegetables and excess fat can increase the risk of childhood obesity. Interventions which target mediators such as caregivers' dietary intake, parenting strategies, and the family meal context can improve children's diets. A quasi-experimental, pre-post intervention with four conditions (healthcare (HC-only), public health (PH-only), HC + PH, and control) was implemented to assess the effects of the interventions and the effects of the mediators. HC (implemented with the Obesity Care Model) and PH interventions entailed capacity building; policy, system, and environment changes; and a small-scale media campaign to promote healthy eating. Linear mixed models were used to assess intervention effects and the mediation analysis was performed. Predominantly Hispanic/Latino children and caregivers from rural communities in Imperial County, California, were measured at baseline (N = 1186 children/848 caregivers) and 12 months post-baseline (N = 985/706, respectively). Children who were overweight/obese in the HC-only condition (M = 1.32) consumed more cups of fruits at the 12-month follow-up than those in the control condition (M = 1.09; p = 0.04). No significant mediation was observed. Children in the PH-only condition consumed a significantly higher percentage of energy from fat (M = 36.01) at the follow-up than those in the control condition (M = 34.94, p < 0.01). An obesity intervention delivered through healthcare settings slightly improved fruit intake among at-risk children, but the mechanisms of effect remain unclear.
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Affiliation(s)
- Shih-Fan Lin
- Institute for Behavioral and Community Health (IBACH), San Diego, CA 92123, USA; (E.S.); (G.X.A.)
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, San Diego, CA 92182, USA
| | - Michelle Murphy Zive
- Herbert Wertheim School of Public Health, University of California, San Diego, CA 92093, USA;
| | - Emily Schmied
- Institute for Behavioral and Community Health (IBACH), San Diego, CA 92123, USA; (E.S.); (G.X.A.)
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, San Diego, CA 92182, USA
| | - Jonathan Helm
- Department of Psychology, San Diego State University, San Diego, CA 92182, USA;
| | - Guadalupe X. Ayala
- Institute for Behavioral and Community Health (IBACH), San Diego, CA 92123, USA; (E.S.); (G.X.A.)
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, San Diego, CA 92182, USA
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Blaychfeld Magnazi M, Gesser-Edelsburg A, Itzhaky Y, Endevelt R, Fliss Isakov N. Children in the Anthroposophical Education System Have Lower Rates of Obesity, and Higher Rates of Health Promoting Behaviors. Nutrients 2023; 15:3088. [PMID: 37513506 PMCID: PMC10386373 DOI: 10.3390/nu15143088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The anthroposophical philosophy is a holistic educational and lifestyle approach. Limited information exists on the health-promoting behavioral norms and obesity rates among children living anthroposophical vs. conventional lifestyles. AIMS This study aims to compare the prevalence of childhood obesity, and parents' perceptions of their children's food environment, between anthroposophical and conventional education systems. METHODS We performed a cross-sectional analysis of the National Anthropometric Measurement Survey for first grade students in Israel, comparing anthroposophical schools with matched conventional schools. Additionally, an online survey was distributed among parents of children in both school systems, assessing children's eating norms and dietary intake. RESULTS Overweight and obesity rates were higher among students in conventional schools (n = 205,500) compared to anthroposophical schools (n = 2247) (11.2% vs. 9.6%, and 7.8% vs. 4.8%, respectively; Pv < 0.001). Anthroposophical schools were perceived by more parents to have health-promoting curricula, health promoting teacher behavior, and health promoting social dietary norms, while their children's dietary intake was perceived as healthier both in school and in the after-school, social, and familial environment (Pv < 0.001). CONCLUSIONS Children in anthroposophical education exhibited lower overweight and obesity rates, and engaged in more health-promoting behaviors. Further research is needed to explore the relationship between the anthroposophical lifestyle and childhood obesity, and to identify effective anthroposophical strategies for health promotion among children.
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Affiliation(s)
- Moran Blaychfeld Magnazi
- Nutrition Division, Public Health Services, Ministry of Health, Jerusalem 9101002, Israel
- School of Public Health, the Health and Risk Communication Laboratory, University of Haifa, Haifa 3498838, Israel
| | - Anat Gesser-Edelsburg
- School of Public Health, the Health and Risk Communication Laboratory, University of Haifa, Haifa 3498838, Israel
| | - Yafit Itzhaky
- Department of Public Health Nursing, Public Health Services, Ministry of Health, Jerusalem 9101002, Israel
| | - Ronit Endevelt
- Nutrition Division, Public Health Services, Ministry of Health, Jerusalem 9101002, Israel
- School of Public Health, the Health and Risk Communication Laboratory, University of Haifa, Haifa 3498838, Israel
| | - Naomi Fliss Isakov
- Nutrition Division, Public Health Services, Ministry of Health, Jerusalem 9101002, Israel
- School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Schmied EA, Madanat H, Chuang E, Moody J, Ibarra L, Cervantes G, Strong D, Boutelle K, Ayala GX. Factors predicting parent engagement in a family-based childhood obesity prevention and control program. BMC Public Health 2023; 23:457. [PMID: 36890461 PMCID: PMC9996842 DOI: 10.1186/s12889-023-15359-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 03/02/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Family-based interventions are efficacious at preventing and controlling childhood overweight and obesity; however, implementation is often hindered by low parent engagement. The purpose of this study was to evaluate predictors of parent engagement in a family-based childhood obesity prevention and control intervention. METHODS Predictors were assessed in a clinic-based community health worker (CHW)-led Family Wellness Program consisting of in-person educational workshops attended by parents and children. This program was part of a larger effort known as the Childhood Obesity Research Demonstration projects. Participants included 128 adult caretakers of children ages 2-11 (98% female). Predictors of parent engagement (e.g., anthropometric, sociodemographic, psychosocial variables) were assessed prior to the intervention. Attendance at intervention activities was recorded by the CHW. Zero-inflated Poisson regression was used to determine predictors of non-attendance and degree of attendance. RESULTS Parents' lower readiness to make behavioral and parenting changes related to their child's health was the sole predictor of non-attendance at planned intervention activities in adjusted models (OR = 0.41, p < .05). Higher levels of family functioning predicted degree of attendance (RR = 1.25, p < .01). CONCLUSIONS To improve engagement in family-based childhood obesity prevention interventions, researchers should consider assessing and tailoring intervention strategies to align with the family's readiness to change and promote family functioning. TRIAL REGISTRATION NCT02197390, 22/07/2014.
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Affiliation(s)
- Emily A Schmied
- School of Public Health, San Diego State University, San Diego, 92182, USA. .,Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, USA.
| | - Hala Madanat
- Division of Research and Innovation, San Diego State University, San Diego, 92182, USA
| | - Emmeline Chuang
- School of Social Welfare, University of California Berkeley, Berkeley, 94720, USA
| | - Jamie Moody
- San Diego State University Research Foundation, San Diego, 92182, USA
| | - Leticia Ibarra
- School of Public Health, San Diego State University, San Diego, 92182, USA
| | | | - David Strong
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, San Diego, 92093, USA
| | - Kerri Boutelle
- Department of Pediatrics, University of California San Diego, San Diego, 92161, USA
| | - Guadalupe X Ayala
- School of Public Health, San Diego State University, San Diego, 92182, USA.,Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, USA
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Schmied EA, Full KM, Lin SF, Gregorio-Pascual P, Ayala GX. Sleep health among U.S. Hispanic/Latinx children: An examination of correlates of meeting sleep duration recommendations. Sleep Health 2022; 8:615-619. [PMID: 36055935 DOI: 10.1016/j.sleh.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/06/2022] [Accepted: 07/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The objective of this study was to examine the association between sociodemographic, behavioral, and environmental factors and adherence to sleep duration recommendations among 1165 U.S. Hispanic/Latinx children. METHODS In this cross-sectional study, the following parent-reported variables were examined as correlates of whether children met age-appropriate nightly sleep duration recommendations: caretaker and child demographics (eg, gender, age, poverty level), presence of TV in child's bedroom, child's daily screen time and bedtime. RESULTS Most (61.4%) children (mean age: 6.39 years, SD = 2.66) met sleep duration guidelines. Multivariable regression results revealed the odds of meeting recommendations were significantly higher among children 6-12 years old living above the poverty threshold (odds ratio [OR] = 1.57; 95% confidence interval [95%CI]: 1.08, 2.31) and those with a regular bedtime ("Some of the time:" OR = 2.05; 95%CI: 1.07, 3.92; "Most of the time:" OR = 3.19; 95%CI: 1.77, 5.74; "Always:" OR = 4.46; 95%CI: 2.43, 8.13). CONCLUSIONS Sleep health disparities must be addressed through culturally and contextually appropriate interventions that combine individual-level strategies with those that address social and environmental factors.
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Affiliation(s)
- Emily A Schmied
- School of Public Health, San Diego State University, and Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California, USA.
| | - Kelsie M Full
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Shih-Fan Lin
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California, USA
| | - Petrona Gregorio-Pascual
- San Diego State University & University of California, San Diego Joint Doctoral Program in Public Health, and Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California, USA
| | - Guadalupe X Ayala
- School of Public Health, San Diego State University, and Institute for Behavioral and Community Health and SDSU HealthLINK Center, San Diego State University Research Foundation, San Diego, California, USA
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Ayala GX, Monge-Rojas R, King AC, Hunter R, Berge JM. [Entorno social y obesidad infantil: implicaciones para la investigación y la práctica en Estados Unidos y en los países latinoamericanos]. Obes Rev 2021; 22 Suppl 5:e13350. [PMID: 34708540 PMCID: PMC9138052 DOI: 10.1111/obr.13350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/02/2022]
Abstract
The environments of children influence their risk for childhood obesity through, among other factors, a child's weight-related behaviors (i.e., diet and physical activity). In this article, we present evidence on social environmental factors associated with a child's diet and physical activity, and more generally, the prevention and control of childhood obesity among Hispanic/Latinx children in the United States and children from countries in Latin America. Using a socio-ecologic lens, we present evidence from cross-sectional and longitudinal studies conducted in the United States involving Hispanic/Latinx children, and evidence from studies involving children in Latin America. Studies examining parenting factors in the home environment (e.g., parenting strategies) are especially emphasized, with more limited evidence on social environmental factors in other lived contexts (e.g., school). The influence of acculturation on social relationships cuts across levels of the socio-ecological framework. Intervention research identified strategies and research gaps for intervening on social factors to promote healthy behaviors and reduce risk for childhood obesity. Community health workers and others forms of peer support were identified as relevant approaches at multiple levels of the socio-ecological framework. This article concludes with directions for future research to further understand the environment using newer information and communication technologies.
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Affiliation(s)
- Guadalupe X Ayala
- School of Public Health, San Diego State University, the Institute for Behavioral and Community Health, and the SDSU HealthLINK Center, San Diego, California, EE. UU
| | - Rafael Monge-Rojas
- Unidad de Salud y Nutrición, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica
| | - Abby C King
- Departments of Epidemiology & Population Health and Medicine (Stanford Prevention Research Center), Stanford University School of Medicine, Stanford, California, EE. UU
| | - Ruth Hunter
- Centre for Public Health, Queen's University Belfast, Irlanda del Norte, Belfast, Reino Unido
| | - Jerica M Berge
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, Mineápolis, Minesota, EE. UU
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Lee RE, Parker NH, Hallett AM, Kao D, Modelska MJ, Rifai HS, Soltero EG, O'Connor DP. Stakeholder perspectives and sustainability of an integrated care model for the prevention and management of obesity: the Childhood Obesity Research Demonstration (CORD) project. Transl Behav Med 2021; 11:393-407. [PMID: 32667038 DOI: 10.1093/tbm/ibaa058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although reliable strategies exist to promote healthy habits that reduce childhood obesity, the sustainability of these strategies remains an ongoing public health challenge. This study aimed to identify factors experienced in a large, multisite project aimed at reducing childhood obesity that might contribute to project sustainability. Hypothesized constructs underpinning sustainability included replicability, continuation of benefits, institutionalization, and community capacity. Key informants (n = 27) completed 60 min, in-depth interviews, which were audio recorded and transcribed. Transcripts were first coded using a combined deductive and inductive approach. Four major themes emerged (with numerous subthemes): developing partnerships, challenges to the sustainability of implemented programming, the importance of intervening in multiple settings, and ongoing implementation and evaluation strategies. Replicability of complex childhood obesity interventions is possible when there are strong partnerships. Benefits can continue to be conferred from programming, particularly when evidence-based strategies are used that employ best practices. Implementation is facilitated by institutionalization and policies that buffer challenges, such as staffing or leadership changes. Community capacity both enhances the sustainability of interventions and develops as a result of strengthening partnerships and policies that support childhood obesity programming.
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Affiliation(s)
- Rebecca E Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Nathan H Parker
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Allen M Hallett
- Department of Epidemiology, Human Genetics and Environmental Sciences, Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX, USA
| | - Dennis Kao
- School of Social Work, Carleton University, Ottawa, Ontario, Canada
| | - Maria J Modelska
- Department of Civil and Environmental Engineering, Cullen College of Engineering, University of Houston, Houston, TX, USA
| | - Hanadi S Rifai
- Department of Civil and Environmental Engineering, Cullen College of Engineering, University of Houston, Houston, TX, USA
| | - Erica G Soltero
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, USA
| | - Daniel P O'Connor
- Department of Health and Human Performance, HEALTH Research Institute, University of Houston, Houston, TX, USA
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Ayala GX, Monge‐Rojas R, King AC, Hunter R, Berge JM. The social environment and childhood obesity: Implications for research and practice in the United States and countries in Latin America. Obes Rev 2021; 22 Suppl 3:e13246. [PMID: 33951272 PMCID: PMC8365653 DOI: 10.1111/obr.13246] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/17/2022]
Abstract
The environments of children influence their risk for childhood obesity through, among other factors, a child's weight-related behaviors (i.e., diet and physical activity). In this article, we present evidence on social environmental factors associated with a child's diet and physical activity, and more generally, the prevention and control of childhood obesity among Hispanic/Latinx children in the United States and children from countries in Latin America. Using a socio-ecologic lens, we present evidence from cross-sectional and longitudinal studies conducted in the United States involving Hispanic/Latinx children, and evidence from studies involving children in Latin America. Studies examining parenting factors in the home environment (e.g., parenting strategies) are especially emphasized, with more limited evidence on social environmental factors in other lived contexts (e.g., school). The influence of acculturation on social relationships cuts across levels of the socio-ecological framework. Intervention research identified strategies and research gaps for intervening on social factors to promote healthy behaviors and reduce risk for childhood obesity. Community health workers and others forms of peer support were identified as relevant approaches at multiple levels of the socio-ecological framework. This article concludes with directions for future research to further understand the environment using newer information and communication technologies.
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Affiliation(s)
- Guadalupe X. Ayala
- School of Public HealthSan Diego State University, the Institute for Behavioral and Community Health, and the SDSU HealthLINK CenterSan DiegoCaliforniaUSA
| | - Rafael Monge‐Rojas
- Health and Nutrition UnitCosta Rican Institute for Research and Education on Nutrition and Health (INCIENSA)CartagoCosta Rica
| | - Abby C. King
- Departments of Epidemiology & Population Health and Medicine (Stanford Prevention Research Center)Stanford University School of MedicineStanfordCaliforniaUSA
| | - Ruth Hunter
- Centre for Public HealthQueen's University Belfast, North IrelandBelfastUK
| | - Jerica M. Berge
- Department of Family Medicine and Community Health, Medical SchoolUniversity of MinnesotaMinneapolisMinnesotaUSA
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Ledoux T, Thompson D, O'Connor T, Avery D, Kochi C, O'Connor DP, Lin SF, Binggeli-Vallarta A, Blaine RE, Sharma S, Hoelscher DM. Cross-Site Process Evaluation Results for the Early Childhood Education Center Setting: CORD Study. Child Obes 2020; 16:350-357. [PMID: 32471316 DOI: 10.1089/chi.2019.0314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: The Childhood Obesity Research Demonstration project aimed to deliver evidence-based obesity prevention interventions to at-risk families at three demonstration sites. The interventions were delivered in multiple settings, including early childhood education centers (ECECs), public schools, and primary care clinics. An evaluation center conducted cross-site process, impact, and sustainability evaluations. Results of the cross-site process evaluation for the ECECs will be described. Methods: Reach (proportion of the target population who participated), dose delivered (materials and interventions that were distributed), and fidelity (proportion of planned intervention components delivered) were assessed at two levels (researcher-to-provider and provider-to-family levels). Standardized data forms were completed by research team members at each demonstration site with assistance from the evaluation center. Results: The Childhood Obesity Research Demonstration project reached 5174 children and 390 teachers in 58 ECECs. The centers delivered an average of 3.9 hours of training to teachers. A total of 1382 different types of materials were distributed to providers, and from 1.3 to 4.3 hours of technical support were delivered to centers monthly. For fidelity at the researcher-to-provider level, 49.5% (n = 370) of eligible teachers completed all training sessions. Considerable variations across demonstration sites in reach, dose delivered, and fidelity across were observed. Conclusion: The Childhood Obesity Research Demonstration project reached large numbers of children, families, teachers, and ECECs. Maintaining intervention fidelity while reaching large numbers of at-risk individuals proved to be a challenge.
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Affiliation(s)
- Tracey Ledoux
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Teresia O'Connor
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Dana Avery
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Camila Kochi
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Daniel P O'Connor
- Department of Health and Human Performance, HEALTH Research Institute, University of Houston, Houston, TX, USA
| | - Shih-Fan Lin
- Institute for Behavioral and Community Health, San Diego State University, San Diego, CA, USA
| | | | - Rachel E Blaine
- Department of Family and Consumer Sciences, California State University, Long Beach, CA, USA
| | - Shreela Sharma
- Michael & Susan Dell Center for Health Living, University of Texas Health Science Center, School of Public Health, Houston, TX, USA
| | - Deanna M Hoelscher
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Austin Campus, Austin, TX, USA
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Lee RE, Kao D, Parker NH, Hallett AM, Kochi CY, Modelska MJ, Rifai HS, O'Connor DP. Evaluating sustainability in the Childhood Obesity Research Demonstration project: the model and process. ACTA ACUST UNITED AC 2020; 78:13. [PMID: 32082567 PMCID: PMC7017491 DOI: 10.1186/s13690-020-0397-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/30/2020] [Indexed: 02/08/2023]
Abstract
Background In the context of health-related interventions, sustainability is the capacity to maintain the changes resulting from the intervention. These can be improved policies, practices or trends intended to improve population health. The Childhood Obesity Research Demonstration (CORD) project was a multi-site, multi-intervention collaboration testing the Obesity Chronic Care Model with interventions for childhood obesity prevention and management. We present the model, definitions and methodology used for the cross-site sustainability evaluation of CORD. Methods We applied the Ecologic Model of Obesity to childhood obesity interventions to operationalize four sustainability constructs: replicability, continuation of benefits, institutionalization, and community capacity. We used a triangulation approach and employed mixed methods to assess sustainability constructs at each level of the Ecologic Model of Obesity: Micro, Meso, Exo and Macro. We constructed checklists to count and code intervention activities, use of evidence-based practices among providers, and environmental factors and policies hypothesized to influence intervention sustainability. We developed in-depth interviews for principal investigators and project leads. We applied the Wilder Collaboration Factors Inventory with key stakeholders. Results Lessons learned suggested that sustainability constructs should be clearly identified and operationalized a priori. Constructs must be flexible to account for differences between intervention plans and implementation to obtain robust and informative data. Conclusion Strong links are needed among researchers, program implementers and communities to accomplish consistent, robust and valuable data collection efforts to assure sustainable and healthy communities.
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Affiliation(s)
- Rebecca E Lee
- 1Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 N. 3rd St, Phoenix, AZ 85004 USA
| | - Dennis Kao
- 2School of Social Work, Carleton University, 509 Dunton Tower, 1125 Colonel By Drive, Ottawa, ON K1S 5B6 Canada
| | - Nathan H Parker
- 3Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Unit 1330, CPB3.3278, PO Box 301439, Houston, TX 77230 USA
| | - Allen M Hallett
- 4Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, 1616 Guadalupe St, Ste 6.300, Austin, TX 78701 USA
| | - Camila Y Kochi
- 5Department of Pharmacological & Pharmaceutical Sciences, University of Houston, 4849 Calhoun Rd. #5007A, Houston, TX 77204 USA
| | - Maria J Modelska
- 6Department of Civil and Environmental Engineering, Cullen College of Engineering, University of Houston, 4726 Calhoun, N107 Engineering Bldg 1, Houston, TX 77204 USA
| | - Hanadi S Rifai
- 6Department of Civil and Environmental Engineering, Cullen College of Engineering, University of Houston, 4726 Calhoun, N107 Engineering Bldg 1, Houston, TX 77204 USA
| | - Daniel P O'Connor
- 7Department of Health and Human Performance, HEALTH Research Institute, University of Houston, 3875 Holman St. Rm. 104 Garrison, Houston, TX 77204 USA
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Borg A, Haughton CF, Sawyer M, Lemon SC, Kane K, Pbert L, Li W, Rosal MC. Design and methods of the Healthy Kids & Families study: a parent-focused community health worker-delivered childhood obesity prevention intervention. BMC OBESITY 2019; 6:19. [PMID: 31171975 PMCID: PMC6545743 DOI: 10.1186/s40608-019-0240-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 03/14/2019] [Indexed: 11/22/2022]
Abstract
Background One third of U.S. children and two thirds of adults are overweight or obese. Interventions to prevent obesity and thus avert threats to public health are needed. This paper describes the design and methods of the Healthy Kids & Families study, which tested the effect of a parent-focused community health worker (CHW)-delivered lifestyle intervention to prevent childhood obesity. Methods Participants were English or Spanish-speaking parent-child dyads (n = 247) from nine elementary schools (grades K-6) located in racial/ethnically diverse low-income communities in Worcester, Massachusetts. Using a quasi-experimental design with the school as the level of allocation, the study compared the lifestyle intervention vs. an attention-control comparison condition. The lifestyle intervention was guided by social cognitive theory and social ecological principles. It targeted the child’s social and physical home environment by intervening with parental weight-related knowledge, beliefs, and skills for managing child obesogenic behaviors; and addressed families’ needs for community resources supportive of a healthy lifestyle. The two-year CHW-delivered intervention was structured based on the 5As model (Agenda, Assess, Advise, Assist, Arrange follow up) and included two in person sessions and two telephone follow-ups per year with the parent, with a personalized letter and print materials sent after each contact. Parents also received quarterly newsletters, Facebook messages, and invitations to community events. The attention-control comparison condition used the same format and contact time as the intervention condition, but targeted positive parenting skills. Measurements occurred at baseline, and at 6-, 12-, 18- and 24-month follow-up. Assessments included anthropometrics, accelerometry, global positioning system (GPS), and self-report surveys. The primary outcome was child body mass index (BMI) z score. Secondary outcomes were parent BMI; and parent and child diet, physical activity, sedentariness, and utilization of community resources supportive of a healthy lifestyle. Discussion A CHW-delivered parent-focused lifestyle intervention may provide a translatable model for targeting the high priority public health problem of childhood obesity among low-income diverse communities. If demonstrated effective, this intervention has potential for high impact. Trial registration ClinicalTrials NCT03028233. Registered January 23,2017. The trial was retrospectively registered.
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Affiliation(s)
- Amy Borg
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Christina F Haughton
- Oak Hill Community Development Corporation, 74 Providence Street, Worcester, MA 01604 USA
| | - Mullen Sawyer
- 3Tufts University Friedman School of Nutrition and Policy, 150 Harrison Avenue, Boston, MA 02111 USA
| | - Stephenie C Lemon
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Kevin Kane
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Lori Pbert
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Wenjun Li
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
| | - Milagros C Rosal
- 1Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA
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Rodríguez-Pérez R, Correa-Matos N, Valdés-Valderrama A, Rodríguez-Cruz LA, Rodríguez MC. A Qualitative Study of Puerto Rican Parent and ChildPerceptions Regarding Eating Patterns. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:608-615. [PMID: 30509552 DOI: 10.1016/j.jneb.2018.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 09/13/2018] [Accepted: 10/08/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To identify barriers that prevent healthy eating practices in Puerto Rican early adolescents (EAs). DESIGN Qualitative data collected via focus groups. A total of 7 focus groups were conducted: 5 with EAs and 2 with parents and caregivers (PCs). SETTING Urban and rural Puerto Rico. PARTICIPANTS Early adolescents aged 12-14years (n = 52) and PCs (n = 17). PHENOMENON OF INTEREST Factors that prevent healthy eating behavior in EAs in Puerto Rico. ANALYSIS Verbatim transcripts from focus group interviews were coded for concept frequency, extension, and content analysis. RESULTS The 3 main factors that influenced participants' eating habits, according to EAs' and PCs' answers, were stores that sold less healthful foods on or near school and the community, parental influence in the development of unhealthy eating habits, and the low cost of unhealthy foods. CONCLUSIONS AND IMPLICATIONS When EAs chose what to eat, primary food choices were based on taste preferences, physical access, economic cost, and influence of PCs, whereas health effects had little consideration. Nutrition education programs have to meet taste preferences and provide eating options that are affordable, accessible, and easy to prepare to achieve healthy food practices among EAs.
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Affiliation(s)
- Robinson Rodríguez-Pérez
- Department of Agricultural Economics and Rural Sociology, College of Agricultural Sciences,University of Puerto Rico, Mayagüez Campus, Mayagüez, Puerto Rico.
| | - Nancy Correa-Matos
- Nutrition and Dietetics Program, College of Natural Sciences, University of Puerto Rico, Río Piedras Campus, Río Piedras, Puerto Rico
| | - Angélica Valdés-Valderrama
- Department of Agricultural Economics and Rural Sociology, College of Agricultural Sciences,University of Puerto Rico, Mayagüez Campus, Mayagüez, Puerto Rico
| | - Luis Alexis Rodríguez-Cruz
- Department of Food Science and Technology, College of Agricultural Sciences, University of Puerto Rico, Mayagüez Campus, Mayagüez, Puerto Rico
| | - María C Rodríguez
- Department of Agricultural Education, College of Agricultural Sciences, University of Puerto Rico, Mayagüez Campus, Mayagüez, Puerto Rico
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12
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Agaronov A, Ash T, Sepulveda M, Taveras EM, Davison KK. Inclusion of Sleep Promotion in Family-Based Interventions To Prevent Childhood Obesity. Child Obes 2018; 14:485-500. [PMID: 30109955 PMCID: PMC6422003 DOI: 10.1089/chi.2017.0235] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Sleep promotion in childhood may reduce the risk of obesity, but little is known of its inclusion in family-based interventions. This study examines the proportion and context of family-based interventions to prevent childhood obesity that promote child sleep. We drew on data from a recent systematic review and content analysis of family-based interventions for childhood obesity prevention published between 2008 and 2015, coupled with new data on sleep promotion strategies, designs, and measures. Out of 119 eligible family-based interventions to prevent childhood obesity, 24 (20%) promoted child sleep. In contrast, 106 (89%) interventions targeted diet, 97 (82%) targeted physical activity, and 63 (53%) targeted media use in children. Most interventions that promoted sleep were implemented in clinics (50%) and home-based settings (38%), conducted in the United States (57%), and included children 2-5 years of age (75%). While most interventions utilized a randomized controlled design (70%), only two examined the promotion of sleep independent of other energy-balance behaviors in a separate study arm. Sleep was predominately promoted by educating parents on sleep hygiene (e.g., age-appropriate sleep duration), followed by instructing parents on responsive feeding practices and limiting media use. One intervention promoted sleep by way of physical activity. A large number promoted sleep by way of bedtime routines. Most interventions measured children's sleep by parent report. Results demonstrate that sleep promotion is underrepresented and variable in family-based childhood obesity interventions. While opportunities exist for increasing its integration, researchers should consider harmonizing and being more explicit about their approach to sleep promotion.
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Affiliation(s)
- Alen Agaronov
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA.,Address correspondence to: Alen Agaronov, MS, RDN, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115
| | - Tayla Ash
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Martina Sepulveda
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ
| | - Elsie M. Taveras
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA.,Division of General Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Kirsten K. Davison
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
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13
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Hull PC, Buchowski M, Canedo JR, Beech BM, Du L, Koyama T, Zoorob R. Childhood obesity prevention cluster randomized trial for Hispanic families: outcomes of the healthy families study. Pediatr Obes 2018; 13:686-696. [PMID: 27884047 PMCID: PMC5443700 DOI: 10.1111/ijpo.12197] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/25/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Obesity prevalence is disproportionately high among Hispanic children. OBJECTIVES The Healthy Families Study assessed the efficacy of a culturally targeted, family-based weight gain prevention intervention for Hispanic immigrant families with children ages 5-7 years. METHODS The study used a two-group, cluster randomized trial design, assigning 136 families (clusters) to the active intervention (weight gain prevention) and 136 families to attention control (oral health). The active intervention included a 4-month intensive phase (eight classes) and an 8-month reinforcement phase (monthly mail/telephone contact). Children's body mass index z-score (BMI-Z) was the primary outcome. RESULTS The BMI-Z growth rate of the active intervention group did not differ from the attention control group at short-term follow-up (median 6 months; 168 families, 206 children) or long-term follow-up (median 16 months; 142 families, 169 children). Dose response analyses indicated a slower increase in BMI-Z at short term among overweight/obese children who attended more intervention classes. Moderate physical activity on weekends increased at short term. Weekend screen time decreased at short term among those attending at least one class session. CONCLUSION Low class attendance likely impacted intention-to-treat results. Future interventions targeting this population should test innovative strategies to maximize intervention engagement to produce and sustain effects on weight gain prevention.
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Affiliation(s)
- Pamela C. Hull
- Vanderbilt University Medical Center, Department of Medicine, Division of Epidemiology, Nashville, TN, USA
| | - Maciej Buchowski
- Vanderbilt University Medical Center, Department of Medicine, Division of Gastroenterology, Hepatology, & Nutrition, Nashville, TN, USA
| | | | - Bettina M. Beech
- University of Mississippi Medical Center, Department of Pediatrics, Jackson, MS, USA
| | - Liping Du
- Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN, USA
| | - Tatsuki Koyama
- Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN, USA
| | - Roger Zoorob
- Baylor College of Medicine, Department of Family and Community Medicine, Houston, TX, USA
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14
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Stang J, Bonilla Z. Factors Affecting Nutrition and Physical Activity Behaviors of Hispanic Families With Young Children: Implications for Obesity Policies and Programs. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:959-967. [PMID: 28969899 DOI: 10.1016/j.jneb.2017.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/14/2017] [Accepted: 08/14/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine preferred policies and programs to prevent obesity and diabetes as identified by parents and caregivers of 3- to 5-year-old Latino children. DESIGN Constructs from the Social Ecological Model were used to develop 10 focus group and key informant interview questions. SETTING Community venues and schools in St Paul, MN. PARTICIPANTS A total of 64 parents and caregivers and 20 key informants provided comments. INTERVENTION(S) Community-based participatory research methods were used to gather opinions regarding appropriate and preferred methods to prevent obesity and diabetes among Latino youth. Native Spanish-speaking investigators who were members of the community conducted 7 focus groups (60-90 minutes each) and 20 key informant interviews. MAIN OUTCOME MEASURES Themes and subthemes of preferences based on participant comments. ANALYSIS Transcript-based, long-table qualitative analysis. RESULTS Five themes were identified: (1) cultural beliefs and practices are inconsistent with obesity prevention; (2) cost and convenience; (3) positive parenting practices; (4) we want to learn more about being healthy; and (5) gardens, parks, gyms, and school meals. At least 1 theme fell within each of the Social Ecological Model domains. CONCLUSIONS AND IMPLICATIONS Our results suggest that parents of young Hispanic children prefer that obesity and diabetes prevention programs address multiple levels of influence.
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Affiliation(s)
- Jamie Stang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
| | - Zobeida Bonilla
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
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15
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Lin SF, Binggeli-Vallarta A, Cervantes G, Angulo J, Moody JS, McKenzie TL, Horton LA, Ayala GX. Process Evaluation of an Early Care and Education Intervention: The California Childhood Obesity Research Demonstration Study (CA-CORD). Health Promot Pract 2018; 21:298-307. [PMID: 30051727 DOI: 10.1177/1524839918786953] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Given the widespread use of out-of-home child care in the United States, early care and education (ECE) providers offer ideal settings to promote health behaviors among Hispanic/Latino children whose obesity prevalence remains high. This study details the process evaluation of ECE intervention strategies of a childhood obesity research demonstration study (California Childhood Obesity Research Demonstration [CA-CORD]) to prevent and control obesity among Hispanic/Latino children aged 2 to 12 years. Participating ECE providers received the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) materials and action planning sessions with a trained interventionist; Sports, Play, and Active Recreation for Kids (SPARK) physical activity (PA), health behavior, and body mass index assessment trainings; and health behavior toolkit, cooking kit, water dispensers, and posters to promote healthy eating, PA, water consumption, and quality sleep. Intervention logs and director/lead teacher interviews evaluated how well 14 center-based and 9 private ECE providers implemented policy, system, and environmental changes. NAP SACC was implemented with higher fidelity than other strategies, and participation in SPARK trainings was lower than health behavior trainings. ECE directors/lead teachers reported that the intervention activities and materials helped them promote the targeted behaviors, especially PA. Results demonstrated that the use of NAP SACC, trainings, and toolkit had high fidelity and were potentially replicable for implementation in ECE settings among Hispanic/Latino communities.
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Affiliation(s)
| | | | | | - Janette Angulo
- Imperial County Public Health Department, El Centro, CA, USA
| | - Jamie S Moody
- University of California, San Diego, San Diego, CA, USA
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16
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Somali, Latino and Hmong parents' perceptions and approaches about raising healthy-weight children: a community-based participatory research study. Public Health Nutr 2018; 21:1079-1093. [PMID: 28803597 PMCID: PMC9931373 DOI: 10.1017/s1368980017001719] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Immigrants in the USA are confronted with health disparities, including childhood obesity and obesity-related chronic diseases. We aimed to identify perceptions of childhood body weight, approaches to raising healthy children and desires for supportive programmes of Somali, Latino and Hmong (SLM) parents in the Twin Cities, Minnesota, USA. DESIGN Using community-based participatory research, ten focus groups (FG) were conducted with sixty-seven parents (n 28 Somali, three FG; n 19 Latino, four FG; n 20 Hmong, three FG) of 3-12-year-old children in their native language. Demographic information was collected. RESULTS SLM parents perceived that health is not necessarily weight-based; childhood obesity is caused by overeating, eating unhealthy foods and sedentary activities; traditional foods are generally healthy while American foods are generally unhealthy; and healthy children are inherently physically active. Parents identified their goals as feeding children so they would be healthy and happy, helping them be active and safe, and teaching them to cook traditional foods to be self-sufficient and maintain their cultural identity. Parents were challenged by children's unhealthy food and sedentary preferences, their own uncertainties about healthy foods and behaviours, and structural factors. Parents thought interventions could help them with these challenges, including information about healthy foods, age-appropriate portion sizes, safe places to be active and strategies tailored to their cultural norms. CONCLUSIONS SLM parents are trying to raise healthy-weight children based on their understanding of children's health, weight, diet and physical activity, while dealing with social, economic and environmental challenges and trying to maintain cultural identity and traditions.
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17
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Schmied EA, Chuang E, Madanat H, Moody J, Ibarra L, Ortiz K, Macias K, Ayala GX. A Qualitative Examination of Parent Engagement in a Family-Based Childhood Obesity Program. Health Promot Pract 2018; 19:905-914. [PMID: 29448812 DOI: 10.1177/1524839918757487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Low parent engagement is frequently identified as a barrier to effective implementation of family-based childhood obesity prevention and control programs. A more nuanced understanding of factors affecting parent engagement is important for improving implementation and, ultimately, program efficacy. This qualitative study examined factors influencing parent engagement in a family-based childhood obesity prevention and control program. Semistructured interviews informed by the health belief model and the transtheoretical model were conducted with 22 predominantly Latina mothers following the scheduled conclusion of program activities. Spanish- and English-language interviews were transcribed, translated into English (if Spanish), coded, and summarized using established protocols. Differences between parents who attended at least two thirds of program activities and those who did not were examined. There were no significant demographic differences between parents who did and did not complete two thirds of program activities. Findings indicated that differences in parent engagement may be at least partially explained by differences in parental motivations for participating and in barriers and facilitators, such as children's level of support and enthusiasm for the program. Parents were highly satisfied with the program content and the community health workers who delivered the program. This study adds to emergent literature regarding parents' experiences in family-based childhood obesity prevention and control programs. Potential targets for improving program engagement are discussed.
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Affiliation(s)
- Emily A Schmied
- 1 San Diego State University, San Diego, CA, USA.,2 Institute for Behavioral and Community Health, San Diego, CA, USA
| | | | - Hala Madanat
- 1 San Diego State University, San Diego, CA, USA.,2 Institute for Behavioral and Community Health, San Diego, CA, USA
| | - Jamie Moody
- 4 University of California, San Diego, La Jolla, CA, USA
| | | | - Kenia Ortiz
- 2 Institute for Behavioral and Community Health, San Diego, CA, USA
| | - Karla Macias
- 2 Institute for Behavioral and Community Health, San Diego, CA, USA
| | - Guadalupe X Ayala
- 1 San Diego State University, San Diego, CA, USA.,2 Institute for Behavioral and Community Health, San Diego, CA, USA
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18
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Mantziki K, Renders CM, Westerman MJ, Mayer J, Borys JM, Seidell JC. Tools for a systematic appraisal of integrated community-based approaches to prevent childhood obesity. BMC Public Health 2018; 18:189. [PMID: 29378550 PMCID: PMC5789618 DOI: 10.1186/s12889-018-5042-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 01/05/2018] [Indexed: 01/04/2023] Open
Abstract
Background Evaluation and monitoring methods are often unable to identify crucial elements of success or failure of integrated community-wide approaches aiming to tackle childhood overweight and obesity, yet difficult to determine in complex programmes. Therefore, we aimed to systematically appraise strengths and weaknesses of such programmes and to assess the usefulness of the appraisal tools used. Methods To identify strengths and weaknesses of the integrated community-based approaches two tools were used: the Good Practice Appraisal tool for obesity prevention programmes, projects, initiatives and intervention (GPAT), a self-administered questionnaire developed by the WHO; and the OPEN tool, a structured list of questions based on the EPODE theory, to assist face-to-face interviews with the principle programme coordinators. The strengths and weaknesses of these tools were assessed with regard to practicalities, quality of acquired data and the appraisal process, criteria and scoring. Results Several strengths and weaknesses were identified in all the assessed integrated community-based approaches, different for each of them. The GPAT provided information mostly on intervention elements whereas through the OPEN tool information on both the programme and intervention levels were acquired. Conclusion Large variability between integrated community-wide approaches preventing childhood obesity in the European region was identified and therefore each of them has different needs. Both tools used in combination seem to facilitate comprehensive assessment of integrated community-wide approaches in a systematic manner, which is rarely conducted. Nonetheless, the tools should be improved in line to their limitations as recommended in this manuscript. Electronic supplementary material The online version of this article (10.1186/s12889-018-5042-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K Mantziki
- Department of Health Sciences, VU University of Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands.
| | - C M Renders
- Department of Health Sciences, VU University of Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands
| | - M J Westerman
- Department of Health Sciences, VU University of Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands
| | - J Mayer
- EPODE International Network, 109-111 Rue Royale, 1000, Brussels, Belgium
| | - J M Borys
- EPODE International Network, 109-111 Rue Royale, 1000, Brussels, Belgium
| | - J C Seidell
- Department of Health Sciences, VU University of Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands
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19
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Ayala GX, Castro IA, Pickrel JL, Lin SF, Williams CB, Madanat H, Jun HJ, Zive M. A Cluster Randomized Trial to Promote Healthy Menu Items for Children: The Kids' Choice Restaurant Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1494. [PMID: 29194392 PMCID: PMC5750912 DOI: 10.3390/ijerph14121494] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/20/2017] [Accepted: 11/20/2017] [Indexed: 01/01/2023]
Abstract
Evidence indicates that restaurant-based interventions have the potential to promote healthier purchasing and improve the nutrients consumed. This study adds to this body of research by reporting the results of a trial focused on promoting the sale of healthy child menu items in independently owned restaurants. Eight pair-matched restaurants that met the eligibility criteria were randomized to a menu-only versus a menu-plus intervention condition. Both of the conditions implemented new healthy child menu items and received support for implementation for eight weeks. The menu-plus condition also conducted a marketing campaign involving employee trainings and promotional materials. Process evaluation data captured intervention implementation. Sales of new and existing child menu items were tracked for 16 weeks. Results indicated that the interventions were implemented with moderate to high fidelity depending on the component. Sales of new healthy child menu items occurred immediately, but decreased during the post-intervention period in both conditions. Sales of existing child menu items demonstrated a time by condition effect with restaurants in the menu-plus condition observing significant decreases and menu-only restaurants observing significant increases in sales of existing child menu items. Additional efforts are needed to inform sustainable methods for improving access to healthy foods and beverages in restaurants.
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Affiliation(s)
- Guadalupe X Ayala
- Graduate School of Public Health and the Institute for Behavioral and Community Health (IBACH), San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA.
| | - Iana A Castro
- Marketing Department, Fowler College of Business and IBACH, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA.
| | - Julie L Pickrel
- IBACH, San Diego State University Research Foundation, 9245 Sky Park Court, Suite 220, San Diego, CA 92123, USA.
| | - Shih-Fan Lin
- IBACH, San Diego State University Research Foundation, 9245 Sky Park Court, Suite 220, San Diego, CA 92123, USA.
| | - Christine B Williams
- Department of Pediatrics, University of California, San Diego, Family Medicine and Public Health, 9500 Gilman Drive, #0725, La Jolla, CA 92093, USA.
| | - Hala Madanat
- Graduate School of Public Health and the Institute for Behavioral and Community Health (IBACH), San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA.
| | - Hee-Jin Jun
- IBACH, San Diego State University Research Foundation, 9245 Sky Park Court, Suite 220, San Diego, CA 92123, USA.
| | - Michelle Zive
- Department of Pediatrics, University of California, San Diego, Family Medicine and Public Health, 9500 Gilman Drive, #0725, La Jolla, CA 92093, USA.
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20
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Avilés-Santa ML, Colón-Ramos U, Lindberg NM, Mattei J, Pasquel FJ, Pérez CM. From Sea to Shining Sea and the Great Plains to Patagonia: A Review on Current Knowledge of Diabetes Mellitus in Hispanics/Latinos in the US and Latin America. Front Endocrinol (Lausanne) 2017; 8:298. [PMID: 29176960 PMCID: PMC5687125 DOI: 10.3389/fendo.2017.00298] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/16/2017] [Indexed: 12/13/2022] Open
Abstract
The past two decades have witnessed many advances in the prevention, treatment, and control of diabetes mellitus (DM) and its complications. Increased screening has led to a greater recognition of type 2 diabetes mellitus (type 2 DM) and prediabetes; however, Hispanics/Latinos, the largest minority group in the US, have not fully benefited from these advances. The Hispanic/Latino population is highly diverse in ancestries, birth places, cultures, languages, and socioeconomic backgrounds, and it populates most of the Western Hemisphere. In the US, the prevalence of DM varies among Hispanic/Latino heritage groups, being higher among Mexicans, Puerto Ricans, and Dominicans, and lower among South Americans. The risk and prevalence of diabetes among Hispanics/Latinos are significantly higher than in non-Hispanic Whites, and nearly 40% of Hispanics/Latinos with diabetes have not been formally diagnosed. Despite these striking facts, the representation of Hispanics/Latinos in pharmacological and non-pharmacological clinical trials has been suboptimal, while the prevalence of diabetes in these populations continues to rise. This review will focus on the epidemiology, etiology and prevention of type 2 DM in populations of Latin American origin. We will set the stage by defining the terms Hispanic, Latino, and Latin American, explaining the challenges identifying Hispanics/Latinos in the scientific literature and databases, describing the epidemiology of diabetes-including type 2 DM and gestational diabetes mellitus (GDM)-and cardiovascular risk factors in Hispanics/Latinos in the US and Latin America, and discussing trends, and commonalities and differences across studies and populations, including methodology to ascertain diabetes. We will discuss studies on mechanisms of disease, and research on prevention of type 2 DM in Hispanics/Latinos, including women with GDM, youth and adults; and finalize with a discussion on lessons learned and opportunities to enhance research, and, consequently, clinical care oriented toward preventing type 2 DM in Hispanics/Latinos in the US and Latin America.
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Affiliation(s)
- M. Larissa Avilés-Santa
- National Heart, Lung, and Blood Institute at the National Institutes of Health, Bethesda, MD, United States
| | - Uriyoán Colón-Ramos
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Nangel M. Lindberg
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Josiemer Mattei
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Francisco J. Pasquel
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Cynthia M. Pérez
- University of Puerto Rico Graduate School of Public Health, San Juan, Puerto Rico
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21
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Abstract
The National Heart, Lung, and Blood Institute and the National Institutes of Health Office of Disease Prevention convened a meeting on August 29-30, 2013 entitled "Obesity Intervention Taxonomy and Pooled Analysis." The overarching goals of the meeting were to understand how to decompose interventions targeting behavior change, and in particular, those that focus on obesity and to combine data from groups of related intervention studies to supplement what can be learned from the individual studies. This paper summarizes the workshop recommendations and provides an overview of the two other papers that originated from the workshop and that address decomposition of behavioral change interventions and pooling of data across diverse studies within a consortium.
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22
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Saelens BE, Scholz K, Walters K, Simoni JM, Wright DR. Two Pilot Randomized Trials To Examine Feasibility and Impact of Treated Parents as Peer Interventionists in Family-Based Pediatric Weight Management. Child Obes 2017; 13:314-323. [PMID: 28398852 PMCID: PMC5549807 DOI: 10.1089/chi.2016.0233] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND To examine feasibility and initial efficacy of having previously treated parents serve as peer interventionists in family-based behavioral weight management treatment (FBT). METHODS Children aged 7-11 years with overweight/obesity and parents (n = 59 families) were enrolled in one of two pilot trials, the EPICH (Engaging Parents in Child Health) randomized trial comparing professional versus peer FBT delivery or the Parent Partnership trial, which provided professionally delivered FBT to families (first generation) and then randomly assigned first generation parents to either be or not be peer interventionists for subsequent families (second generation). Efficacy (child zBMI change), feasibility, and costs for delivering FBT, and impacts of being a peer interventionist were examined. RESULTS In EPICH, families receiving professional versus peer intervention had similar decreases in child zBMI and parent BMI, with markedly lower costs for peer versus professional delivery. In Parent Partnership, families receiving peer intervention significantly decreased weight status, with very preliminary evidence suggesting better maintenance of child zBMI changes if parents served as peer interventionists. Previously treated parents were willing, highly confident, and able to serve as peer interventionists in FBT. CONCLUSIONS Two pilot randomized clinical trials suggest parents-as-peer interventionists in FBT may be feasible, efficacious, and delivered at lower costs, with perhaps some additional benefits to serving as a peer interventionist. More robust investigation is warranted of peer treatment delivery models for pediatric weight management.
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Affiliation(s)
- Brian E. Saelens
- Seattle Children's Research Institute, Seattle, WA.,Department of Pediatrics, University of Washington, Seattle, WA
| | | | | | - Jane M. Simoni
- Department of Psychology, University of Washington, Seattle, WA
| | - Davene R. Wright
- Seattle Children's Research Institute, Seattle, WA.,Department of Pediatrics, University of Washington, Seattle, WA
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23
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Visioning Report 2017: A Preferred Path Forward for the Nutrition and Dietetics Profession. J Acad Nutr Diet 2017; 117:110-127. [DOI: 10.1016/j.jand.2016.09.027] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Indexed: 01/17/2023]
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24
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Chuang E, Brunner J, Moody J, Ibarra L, Hoyt H, McKenzie TL, Binggeli-Vallarta A, Cervantes G, Finlayson TL, Ayala GX. Factors Affecting Implementation of the California Childhood Obesity Research Demonstration (CA-CORD) Project, 2013. Prev Chronic Dis 2016; 13:E147. [PMID: 27763831 PMCID: PMC5072750 DOI: 10.5888/pcd13.160238] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Ecological approaches to health behavior change require effective engagement from and coordination of activities among diverse community stakeholders. We identified facilitators of and barriers to implementation experienced by project leaders and key stakeholders involved in the Imperial County, California, Childhood Obesity Research Demonstration project, a multilevel, multisector intervention to prevent and control childhood obesity. Methods A total of 74 semistructured interviews were conducted with project leaders (n = 6) and key stakeholders (n = 68) representing multiple levels of influence in the health care, early care and education, and school sectors. Interviews, informed by the Multilevel Implementation Framework, were conducted in 2013, approximately 12 months after year-one project implementation, and were transcribed, coded, and summarized. Results Respondents emphasized the importance of engaging parents and of ensuring support from senior leaders of participating organizations. In schools, obtaining teacher buy-in was described as particularly important, given lower perceived compatibility of the intervention with organizational priorities. From a program planning perspective, key facilitators of implementation in all 3 sectors included taking a participatory approach to the development of program materials, gradually introducing intervention activities, and minimizing staff burden. Barriers to implementation were staff turnover, limited local control over food provided by external vendors or school district policies, and limited availability of supportive resources within the broader community. Conclusion Project leaders and stakeholders in all sectors reported similar facilitators of and barriers to implementation, suggesting the possibility for synergy in intervention planning efforts.
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Affiliation(s)
- Emmeline Chuang
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E. Young Dr South, Los Angeles, California 90095-1772.
| | - Julian Brunner
- Los Angeles, Fielding School of Public Health, Los Angeles, California
| | - Jamie Moody
- San Diego State University Research Foundation, Institute for Behavioral and Community Health, San Diego, California
| | | | - Helina Hoyt
- San Diego State University Research Foundation, Institute for Behavioral and Community Health, San Diego, California
| | - Thomas L McKenzie
- San Diego State University Research Foundation, Institute for Behavioral and Community Health, San Diego, California
| | | | - Griselda Cervantes
- San Diego State University Research Foundation, Institute for Behavioral and Community Health, San Diego, California
| | - Tracy L Finlayson
- San Diego State University Research Foundation, Institute for Behavioral and Community Health, and San Diego State University, Graduate School of Public Health, San Diego, California
| | - Guadalupe X Ayala
- San Diego State University Research Foundation, Institute for Behavioral and Community Health, and San Diego State University, College of Health and Human Services, San Diego, California
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Ewart-Pierce E, Mejía Ruiz MJ, Gittelsohn J. "Whole-of-Community" Obesity Prevention: A Review of Challenges and Opportunities in Multilevel, Multicomponent Interventions. Curr Obes Rep 2016; 5:361-74. [PMID: 27379620 PMCID: PMC5962013 DOI: 10.1007/s13679-016-0226-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The causes of obesity worldwide are complex and multilevel, including changing food environments, physical activity levels, policies, and food production systems. This intricate context requires multilevel and multicomponent (MLMC) interventions to improve health outcomes. We conducted a literature review of MLMC interventions for obesity prevention and mitigation; 14 studies meeting search criteria were identified. We found examples of successes in preventing obesity, reducing overweight, improving healthful behaviors, and enhancing some psychosocial indicators. Of eight studies that reported health and behavioral results, five showed no significant impact and three showed reductions in obesity. Four studies showed significant improvement in dietary behavior, and five reported significant desirable effects in physical activity or screen time. Five studies reported psychosocial impacts, and three of these showed significant improvements. MLMC approaches show promising results, particularly when they are able to integrate components at the policy, community, and interpersonal levels.
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Affiliation(s)
- Ella Ewart-Pierce
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
| | - María José Mejía Ruiz
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Joel Gittelsohn
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
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Pierro J, Abulaimoun B, Roth P, Blau J. Factors Associated with Supplemental Formula Feeding of Breastfeeding Infants During Postpartum Hospital Stay. Breastfeed Med 2016; 11:196-202. [PMID: 27027901 DOI: 10.1089/bfm.2015.0091] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine reasons potentially amenable to interventions that mothers choose to supplement breastfeeding with formula in the immediate postpartum period. STUDY DESIGN We distributed surveys to all mothers in the postpartum unit who delivered a live newborn on day of maternal discharge to assess feeding behaviors during their inpatient admission. We evaluated, when applicable, their reasons for supplementation and examined cultural and demographic information to uncover trends for formula use and potential areas for provider intervention. RESULTS Seven hundred twelve of 1,400 mothers responded, of which 478 (65%) reported supplementing breastfeeding with formula (BF+F). The most common reasons for formula supplementation were perception of inadequate milk supply (36.4%), desire for sleep (35.4%), and a plan to breast and bottle feed (35.2%). Exclusive breastfeeding (EBF) was associated with primiparous status (OR 1.95; 95% CI 1.3-3.0), higher education level (OR 2.6; 95% CI 1.7-3.9), and having been breastfed as an infant (OR 1.54; 95% CI 1-2.37). Mothers who experienced skin-to-skin contact also had higher rates of EBF (29.5% versus 19.9%). Factors associated with exclusive formula feeding included single marital status, birth of mother in the United States, Catholic religion, multiparity, and cesarean delivery. Religious and cultural factors also played important roles in maternal feeding behaviors. CONCLUSION Clinicians can anticipate risk factors for formula use in mothers who plan to breastfeed and tailor counseling appropriately to increase EBF rates.
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Affiliation(s)
- Joanna Pierro
- Division of Neonatology, Department of Pediatrics, Staten Island University Hospital , Staten Island, New York
| | - Bdair Abulaimoun
- Division of Neonatology, Department of Pediatrics, Staten Island University Hospital , Staten Island, New York
| | - Philip Roth
- Division of Neonatology, Department of Pediatrics, Staten Island University Hospital , Staten Island, New York
| | - Jonathan Blau
- Division of Neonatology, Department of Pediatrics, Staten Island University Hospital , Staten Island, New York
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Ayala GX, Castro IA, Pickrel JL, Williams CB, Lin SF, Madanat H, Jun HJ, Zive M. A restaurant-based intervention to promote sales of healthy children's menu items: the Kids' Choice Restaurant Program cluster randomized trial. BMC Public Health 2016; 16:250. [PMID: 26965639 PMCID: PMC4785671 DOI: 10.1186/s12889-016-2892-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 02/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Away-from-home eating is an important dietary behavior with implications on diet quality. Thus, it is an important behavior to target to prevent and control childhood obesity and other chronic health conditions. Numerous studies have been conducted to improve children's dietary intake at home, in early care and education, and in schools; however, few studies have sought to modify the restaurant food environment for children. This study adds to this body of research by describing the development and launch of an innovative intervention to promote sales of healthy children's menu items in independent restaurants in Southern California, United States. METHODS This is a cluster randomized trial with eight pair-matched restaurants in San Diego, California. Restaurants were randomized to a menu-only versus menu-plus intervention condition. The menu-only intervention condition involves manager/owner collaboration on the addition of pre-determined healthy children's menu items and kitchen manager/owner collaboration to prepare and plate these items and train kitchen staff. The menu-plus intervention condition involves more extensive manager/owner collaboration and kitchen staff training to select, prepare, and plate new healthy children's menu items, and a healthy children's menu campaign that includes marketing materials and server training to promote the items. The primary outcome is sales of healthy children's menu items over an 18-week period. In addition, dining parties consisting of adults with children under 18 years of age are being observed unobtrusively while ordering and then interviewed throughout the 18-week study period to determine the impact of the intervention on ordering behaviors. Manager/owner interviews and restaurant audits provide additional evidence of impact on customers, employees, and the restaurant environment. Our process evaluation assesses dose delivered, dose received, and intervention fidelity. DISCUSSION Successful recruitment of the restaurants has been completed, providing evidence that the restaurant industry is open to working on the public health challenge of childhood obesity. Determining whether a restaurant intervention can promote sales of healthy children's menu items will provide evidence for how to create environments that support the healthy choices needed to prevent and control obesity. Despite these strengths, collection of sales data that will allow comprehensive analysis of intervention effects remains a challenge. TRIAL REGISTRATION NCT02511938.
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Affiliation(s)
- Guadalupe X Ayala
- San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA. .,Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221, San Diego, CA, 92123, USA.
| | - Iana A Castro
- San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA.,Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221, San Diego, CA, 92123, USA
| | - Julie L Pickrel
- Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221, San Diego, CA, 92123, USA
| | - Christine B Williams
- Department of Pediatrics, Center for Community Health, University of California at San Diego, 9500 Gilman Drive, #0927, La Jolla, CA, 92093, USA
| | - Shih-Fan Lin
- San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA.,Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221, San Diego, CA, 92123, USA
| | - Hala Madanat
- San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA.,Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221, San Diego, CA, 92123, USA
| | - Hee-Jin Jun
- San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA.,Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221, San Diego, CA, 92123, USA
| | - Michelle Zive
- Department of Pediatrics, Center for Community Health, University of California at San Diego, 9500 Gilman Drive, #0927, La Jolla, CA, 92093, USA
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Joseph S, Stevens AM, Ledoux T, O'Connor TM, O'Connor DP, Thompson D. Rationale, Design, and Methods for Process Evaluation in the Childhood Obesity Research Demonstration Project. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2015; 47:560-565.e1. [PMID: 26298514 DOI: 10.1016/j.jneb.2015.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/26/2015] [Accepted: 07/19/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The cross-site process evaluation plan for the Childhood Obesity Research Demonstration (CORD) project is described here. DESIGN The CORD project comprises 3 unique demonstration projects designed to integrate multi-level, multi-setting health care and public health interventions over a 4-year funding period. SETTING Three different communities in California, Massachusetts, and Texas. PARTICIPANTS All CORD demonstration projects targeted 2-12-year-old children whose families are eligible for benefits under Title XXI (CHIP) or Title XIX (Medicaid). INTERVENTION(S) The CORD projects were developed independently and consisted of evidence-based interventions that aim to prevent childhood obesity. The interventions promote healthy behaviors in children by applying strategies in 4 key settings (primary care clinics, early care and education centers, public schools, and community institutions). MAIN OUTCOME MEASURE(S) The CORD process evaluation outlined 3 main outcome measures: reach, dose, and fidelity, on 2 levels (researcher to provider, and provider to participant). ANALYSIS The plan described here provides insight into the complex nature of process evaluation for consortia of independently designed multi-level, multi-setting intervention studies. The process evaluation results will provide contextual information about intervention implementation and delivery with which to interpret other aspects of the program.
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Affiliation(s)
- Sitara Joseph
- Center on Research and Evaluation, Simmons School of Education and Human Development, Southern Methodist University, Dallas, TX
| | - Andria M Stevens
- Texas Obesity Research Center, University of Houston, Houston, TX
| | - Tracey Ledoux
- Texas Obesity Research Center, University of Houston, Houston, TX
| | - Teresia M O'Connor
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | | | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX.
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Ayala GX, Ibarra L, Cherrington AL, Parada H, Horton L, Ji M, Elder JP. Puentes hacia una mejor vida (Bridges to a Better Life): Outcome of a Diabetes Control Peer Support Intervention. Ann Fam Med 2015; 13 Suppl 1:S9-17. [PMID: 26304977 PMCID: PMC4648133 DOI: 10.1370/afm.1807] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Peer support can promote diabetes control, yet research on feasible and effective peer support models is lacking. This randomized controlled trial tested a volunteer-based model of peer support for diabetes control. METHODS Thirty-four volunteer peer leaders were recruited and trained to provide support to 5 to 8 patients each through telephone contact, in-person, individual, and group support. Planned dose was 8 contacts, preferably in the first 6 months. Patients with uncontrolled diabetes were randomly sampled from the medical records of 3 community clinics. After a baseline interview and medical records review to obtain baseline values for the primary outcome, HbA1c, 336 patient participants were randomly assigned to a 12-month peer support intervention or usual care. The assessment protocol was repeated at 6 and 12 months after baseline. RESULTS Thirty peer leaders delivered an average of 4 contacts each per assigned participant (range 1-24). Despite the lack of intervention fidelity, the intervention was effective at reducing glycated hemoglobin (HbA1c) among intervention as compared with usual care participants (P=0.05). Similar trends were observed in frequency of meeting fruit and vegetable guidelines (P =0.09), a secondary outcome. Counterintuitively, usual care participants reported checking their feet more days out of 7 than intervention participants (P =0.03). CONCLUSIONS Given the modest changes we observed, combined with other evidence for peer support to promote diabetes control, additional research is needed on how to modify the system of care to increase the level of peer support delivered by volunteers.
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Affiliation(s)
- Guadalupe X Ayala
- San Diego State University College of Health and Human Services and Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California
| | | | - Andrea L Cherrington
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Lucy Horton
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California
| | - Ming Ji
- University of South Florida College of Nursing, Tampa, Florida
| | - John P Elder
- San Diego State University College of Health and Human Services and Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California
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Schmied E, Parada H, Horton L, Ibarra L, Ayala G. A Process Evaluation of an Efficacious Family-Based Intervention to Promote Healthy Eating. HEALTH EDUCATION & BEHAVIOR 2015; 42:583-92. [DOI: 10.1177/1090198115577375] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Entre Familia: Reflejos de Salud was a successful family-based randomized controlled trial designed to improve dietary behaviors and intake among U.S. Latino families, specifically fruit and vegetable intake. The novel intervention design merged a community health worker ( promotora) model with an entertainment-education component. This process evaluation examined intervention implementation and assessed relationships between implementation factors and dietary change. Participants included 180 mothers randomized to an intervention condition. Process evaluation measures were obtained from participant interviews and promotora notes and included fidelity, dose delivered (i.e., minutes of promotora in-person contact with families, number of promotora home visits), and dose received (i.e., participant use of and satisfaction with intervention materials). Outcome variables included changes in vegetable intake and the use of behavioral strategies to increase dietary fiber and decrease dietary fat intake. Participant satisfaction was high, and fidelity was achieved; 87.5% of families received the planned number of promotora home visits. In the multivariable model, satisfaction with intervention materials predicted more frequent use of strategies to increase dietary fiber ( p ≤ .01). Trends suggested that keeping families in the prescribed intervention timeline and obtaining support from other social network members through sharing of program materials may improve changes. Study findings elucidate the relationship between specific intervention processes and dietary changes.
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Affiliation(s)
- Emily Schmied
- San Diego State University, San Diego, CA, USA
- Institute for Behavioral and Community Health, San Diego, CA, USA
| | | | - Lucy Horton
- Institute for Behavioral and Community Health, San Diego, CA, USA
| | | | - Guadalupe Ayala
- San Diego State University, San Diego, CA, USA
- Institute for Behavioral and Community Health, San Diego, CA, USA
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Blanck HM, Collins JL. The Childhood Obesity Research Demonstration project: linking public health initiatives and primary care interventions community-wide to prevent and reduce childhood obesity. Child Obes 2015; 11:1-3. [PMID: 25679058 DOI: 10.1089/chi.2014.0122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Heidi M Blanck
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion , Centers for Disease Control and Prevention, Atlanta, GA
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O'Connor DP, Lee RE, Mehta P, Thompson D, Bhargava A, Carlson C, Kao D, Layne CS, Ledoux T, O'Connor T, Rifai H, Gulley L, Hallett AM, Kudia O, Joseph S, Modelska M, Ortega D, Parker N, Stevens A. Childhood Obesity Research Demonstration project: cross-site evaluation methods. Child Obes 2015; 11:92-103. [PMID: 25679060 PMCID: PMC4323026 DOI: 10.1089/chi.2014.0061] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The Childhood Obesity Research Demonstration (CORD) project links public health and primary care interventions in three projects described in detail in accompanying articles in this issue of Childhood Obesity. This article describes a comprehensive evaluation plan to determine the extent to which the CORD model is associated with changes in behavior, body weight, BMI, quality of life, and healthcare satisfaction in children 2-12 years of age. DESIGN/METHODS The CORD Evaluation Center (EC-CORD) will analyze the pooled data from three independent demonstration projects that each integrate public health and primary care childhood obesity interventions. An extensive set of common measures at the family, facility, and community levels were defined by consensus among the CORD projects and EC-CORD. Process evaluation will assess reach, dose delivered, and fidelity of intervention components. Impact evaluation will use a mixed linear models approach to account for heterogeneity among project-site populations and interventions. Sustainability evaluation will assess the potential for replicability, continuation of benefits beyond the funding period, institutionalization of the intervention activities, and community capacity to support ongoing program delivery. Finally, cost analyses will assess how much benefit can potentially be gained per dollar invested in programs based on the CORD model. CONCLUSIONS The keys to combining and analyzing data across multiple projects include the CORD model framework and common measures for the behavioral and health outcomes along with important covariates at the individual, setting, and community levels. The overall objective of the comprehensive evaluation will develop evidence-based recommendations for replicating and disseminating community-wide, integrated public health and primary care programs based on the CORD model.
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Affiliation(s)
- Daniel P. O'Connor
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, Houston, TX
| | - Rebecca E. Lee
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Paras Mehta
- Department of Psychology, Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - Alok Bhargava
- School of Public Policy, University of Maryland, College Park, MD
| | - Coleen Carlson
- Department of Psychology, Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX
| | - Dennis Kao
- Graduate College of Social Work, University of Houston, Houston, TX
| | - Charles S. Layne
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, Houston, TX
| | - Tracey Ledoux
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, Houston, TX
| | - Teresia O'Connor
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - Hanadi Rifai
- Department of Civil and Environmental Engineering, University of Houston, Houston, TX
| | - Lauren Gulley
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, Houston, TX
| | - Allen M. Hallett
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, Houston, TX
| | - Ousswa Kudia
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, Houston, TX
| | - Sitara Joseph
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, Houston, TX
| | - Maria Modelska
- Department of Civil and Environmental Engineering, University of Houston, Houston, TX
| | - Dana Ortega
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, Houston, TX
| | - Nathan Parker
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, Houston, TX
| | - Andria Stevens
- Department of Health and Human Performance, Texas Obesity Research Center, University of Houston, Houston, TX
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Foltz JL, Belay B, Dooyema CA, Williams N, Blanck HM. Childhood Obesity Research Demonstration (CORD): the cross-site overview and opportunities for interventions addressing obesity community-wide. Child Obes 2015; 11:4-10. [PMID: 25679059 PMCID: PMC4322789 DOI: 10.1089/chi.2014.0159] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This is the first of a set of articles in this issue on the Childhood Obesity Research Demonstration (CORD) project and provides an overview of the multisite approach and community-wide interventions. Innovative multisetting, multilevel approaches that integrate primary healthcare and public health interventions to improve outcomes for children with obesity need to be evaluated. The CORD project aims to improve BMI and obesity-related behaviors among underserved 2- to 12-year-old children by utilizing these approaches. METHODS The CORD consortium, structure, model terminology and key components, and common measures were solidified in year 1 of the CORD project. Demonstration sites applied the CORD model across communities in years 2 and 3. Evaluation plans for year 4 include site-specific analyses as well as cross-site impact, process, and sustainability evaluations. RESULTS The CORD approach resulted in commonalities and differences in participant, intervention, comparison, and outcome elements across sites. Products are to include analytic results as well as cost assessment, lessons learned, tools, and materials. DISCUSSION Foreseen opportunities and challenges arise from the similarities and unique aspects across sites. Communities adapted interventions to fit their local context and build on strengths, but, in turn, this flexibility makes cross-site evaluation challenging. CONCLUSION The CORD project represents an evidence-based approach that integrates primary care and public health strategies and evaluates multisetting multilevel interventions, thus adding to the limited research in this field. CORD products will be disseminated to a variety of stakeholders to aid the understanding, prevention, and management of childhood obesity.
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Affiliation(s)
- Jennifer L. Foltz
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
- U.S. Public Health Service Commissioned Corps, Atlanta, GA
| | - Brook Belay
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Carrie A. Dooyema
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Nancy Williams
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
- U.S. Public Health Service Commissioned Corps, Atlanta, GA
| | - Heidi M. Blanck
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
- U.S. Public Health Service Commissioned Corps, Atlanta, GA
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Chuang E, Ayala GX, Schmied E, Ganter C, Gittelsohn J, Davison KK. Evaluation protocol to assess an integrated framework for the implementation of the Childhood Obesity Research Demonstration project at the California (CA-CORD) and Massachusetts (MA-CORD) sites. Child Obes 2015; 11:48-57. [PMID: 25423618 PMCID: PMC4323117 DOI: 10.1089/chi.2014.0049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The long-term success of child obesity prevention and control efforts depends not only on the efficacy of the approaches selected, but also on the strategies through which they are implemented and sustained. This study introduces the Multilevel Implementation Framework (MIF), a conceptual model of factors affecting the implementation of multilevel, multisector interventions, and describes its application to the evaluation of two of three state sites (CA and MA) participating in the Childhood Obesity Research Demonstration (CORD) project. METHODS/DESIGN A convergent mixed-methods design is used to document intervention activities and identify determinants of implementation effectiveness at the CA-CORD and MA-CORD sites. Data will be collected from multiple sectors and at multiple levels of influence (e.g., delivery system, academic-community partnership, and coalition). Quantitative surveys will be administered to coalition members and staff in participating delivery systems. Qualitative, semistructured interviews will be conducted with project leaders and key informants at multiple levels (e.g., leaders and frontline staff) within each delivery system. Document analysis of project-related materials and in vivo observations of training sessions will occur on an ongoing basis. Specific constructs assessed will be informed by the MIF. Results will be shared with project leaders and key stakeholders for the purposes of improving processes and informing sustainability discussions and will be used to test and refine the MIF. CONCLUSIONS Study findings will contribute to knowledge about how to coordinate and implement change strategies within and across sectors in ways that effectively engage diverse stakeholders, minimize policy resistance, and maximize desired intervention outcomes.
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Affiliation(s)
- Emmeline Chuang
- Department of Health Policy and Management, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA
- Division of Health Promotion and Behavioral Sciences, San Diego State University Graduate School of Public Health, San Diego, CA
| | - Guadalupe X. Ayala
- Division of Health Promotion and Behavioral Sciences, San Diego State University Graduate School of Public Health, San Diego, CA
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, CA
| | - Emily Schmied
- Division of Health Promotion and Behavioral Sciences, San Diego State University Graduate School of Public Health, San Diego, CA
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, CA
- Department of Family and Preventive Medicine, University of California at San Diego School of Medicine, San Diego, CA
| | - Claudia Ganter
- Departments of Nutrition and of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| | - Joel Gittelsohn
- Bloomberg School of Public Health and the Global Obesity Prevention Center, Johns Hopkins University, Baltimore, MD
| | - Kirsten K. Davison
- Departments of Nutrition and of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
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