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Kaiser CK, Edwards Z, Austin EW. Media Literacy Practices to Prevent Obesity and Eating Disorders in Youth. Curr Obes Rep 2024; 13:186-194. [PMID: 38183580 DOI: 10.1007/s13679-023-00547-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE OF REVIEW Obesity and eating disorders share common issues related to media use and effects, especially in the USA. Current research increasingly demonstrates that media literacy can address this problem. This narrative review highlights current media literacy-based research for obesity and eating disorder prevention among youth. RECENT FINDINGS Current research using media literacy techniques to prevent obesity indicates that these interventions improve nutrition outcomes, improve family communication about food, improve critical thinking about food advertisements, reduce sugar and fat intake, and reduce screen use for parents and youth. In addition, eating disorder research reveals that media literacy techniques lead to higher scores of body satisfaction and self-esteem, with lower scores of perfectionism, thinness, and ideal masculinity. There is a need for media literacy-based interventions to focus on family communication to prevent obesity and eating disorders. Furthermore, there should be more focus on identified levels of prevention and specific clinical outcomes.
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Affiliation(s)
- Christopher Kit Kaiser
- Washington State Department of Social & Health Services, Behavioral Health Administration, Western State Hospital, 9601 Steilacoom Blvd SW, Building 8, Room 109, Lakewood, WA, USA.
| | - Zena Edwards
- Extension Youth & Families, Washington State University Extension, Vancouver, WA, USA
| | - Erica Weintraub Austin
- The Edward R. Murrow College of Communication, Washington State University, Pullman, WA, 99164-2520, USA
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Henes ST, Stotz SA, Riggs SE, Yang HM. eHealth, family-based interventions, and multilevel approaches to pediatric weight management: a scoping review. Nutr Rev 2024:nuad160. [PMID: 38269577 DOI: 10.1093/nutrit/nuad160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVE This scoping review examines the current literature on technology-based, eHealth interventions that integrate community and clinical approaches for family-based pediatric weight management. BACKGROUND Telehealth and eHealth interventions for weight management are increasingly commonplace; however, it is unclear in the current literature how family-based, pediatric, healthy-weight interventions integrate technology. Additionally, multilevel approaches to address childhood obesity, including working with clinical and community partners, are currently considered best practice and within the socioecological framework for sustainability of outcomes. Little is known how current family based pediatric healthy weight interventions integrate eHealth and multi-level approaches. METHODS Guided by Arksey and O'Malley's scoping review framework, a scoping literature review was conducted. Four databases were searched to identify studies conducted between 2010 and 2022 that addressed multilevel, family-based, pediatric weight management interventions that also integrated technology. Studies were excluded that did not include at least 2 of the 4 components and that did not include technology to some degree. RESULTS A total of 15 articles were included in the scoping review. All articles included some type of technology in the intervention. Twelve articles included a family-based approach, and only 1 article fully used a holistic approach to family-based, pediatric weight management that included technology and integrated clinical and community approaches to address the complexity of childhood obesity. CONCLUSIONS There are several family-based, pediatric weight management interventions that incorporate an eHealth component. There is a gap in the literature about programs that use both technology and integrate multilevel clinical and community approaches for treatment. Additionally, gaps exist in information about adolescent, family-based, weight management interventions, and there are opportunities for nutrition and dietetic professionals to become more involved with technological and multilevel approaches in family-based pediatric weight management.
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Affiliation(s)
- Sarah T Henes
- Department of Nutritional Sciences, University of Georgia, Athens, GA, USA
| | - Sarah A Stotz
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, USA
| | - Sandra E Riggs
- University Libraries, Research and Instruction, University of Georgia, Athens, GA, USA
| | - Hsuan-Mein Yang
- Department of Nutritional Sciences, University of Georgia, Athens, GA, USA
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Viera SB, Vivekanandan N, Cheney M, Le D, Lora KR. Hispanic caregivers' preferences for content, delivery methods, and sources of nutrition education from their child's preschool: Qualitative research findings. Nutr Health 2023:2601060221146321. [PMID: 36637248 DOI: 10.1177/02601060221146321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: With the obesity epidemic disproportionately affecting Hispanic children and preschool being a critical period when interventions may be effective to prevent it, nutrition education interventions in the preschool setting have the potential to stem obesity's spread. However, the nutrition education needs of low-income Hispanic populations and methods of delivery of that information require further exploration as culturally tailored approaches have seen limited reach to the target audience. Aim: To explore content, delivery methods, and sources of nutrition education that Hispanic caregivers prefer to receive from their child's preschool. Methods: Qualitative interviews with 25 self-identified Hispanic caregivers (≥18 years of age) of 3- to 5-year-old children at Head Start centers in the Washington, D.C., area. Caregivers were interviewed about preferred nutrition education topics, how nutrition education should be delivered, and by whom. Audio-recorded interviews were transcribed verbatim. Transcripts were analyzed using thematic analysis in NVivo v12. Results: Caregivers wanted to know about healthy foods and appropriate portion sizes to feed their children, fruit and vegetable feeding strategies, and how to incorporate Hispanic foods in healthy meals. Preferred delivery methods included receiving nutrition education and recipes in print and digital formats and in-person nutrition classes. Special Supplemental Nutrition Program for Women, Infants, and Children educators were regarded as trusted nutrition education sources. Conclusion: Tailored nutrition education messages combined with multiple delivery methods could be an effective way to reach Hispanic caregivers of preschoolers to increase their nutrition knowledge.
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Affiliation(s)
- Stacey B Viera
- Milken Institute School of Public Health, 8367The George Washington University, Washington, DC, USA
| | - Nikita Vivekanandan
- Milken Institute School of Public Health, 8367The George Washington University, Washington, DC, USA
| | - Marshall Cheney
- Department of Health and Exercise Science, 6187University of Oklahoma, Norman, OK, USA
| | - Daisy Le
- School of Nursing, Policy, Populations and Systems Community, 8367The George Washington University, Washington, DC, USA
| | - Karina R Lora
- Milken Institute School of Public Health, 8367The George Washington University, Washington, DC, USA
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Stark AL, Geukes C, Dockweiler C. Digital Health Promotion and Prevention in Settings: Scoping Review. J Med Internet Res 2022; 24:e21063. [PMID: 35089140 PMCID: PMC8838600 DOI: 10.2196/21063] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/16/2020] [Accepted: 12/02/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Digital technologies are increasingly integrating into people's daily living environments such as schools, sport clubs, and health care facilities. These settings play a crucial role for health promotion and prevention because they affect the health of their members, as the World Health Organization has declared. Implementing digital health promotion and prevention in settings offers the opportunity to reach specific target groups, lower the costs of implementation, and improve the health of the population. Currently, there is a lack of scientific evidence that reviews the research on digital health promotion and prevention in settings. OBJECTIVE This scoping review aims to provide an overview of research targeting digital health promotion and primary prevention in settings. It assesses the range of scientific literature regarding outcomes such as applied technology, targeted setting, and area of health promotion or prevention, as well as identifies research gaps. METHODS The scoping review was conducted following the Levac, Colquhoun, and O'Brien framework. We searched scientific databases and gray literature for articles on digital setting-based health promotion and prevention published from 2010 to January 2020. We included empirical and nonempirical publications in English or German and excluded secondary or tertiary prevention and health promotion at the workplace. RESULTS From 8888 records, the search resulted in 200 (2.25%) included publications. We identified a huge diversity of literature regarding digital setting-based health promotion and prevention. The variety of technology types extends from computer- and web-based programs to mobile devices (eg, smartphone apps) and telemonitoring devices (sensors). We found analog, digital, and blended settings in which digital health promotion and prevention takes place. The most frequent analog settings were schools (39/200, 19.5%) and neighborhoods or communities (24/200, 12%). Social media apps were also included because in some studies they were defined as a (digital) setting. They accounted for 31.5% (63/200) of the identified settings. The most commonly focused areas of health promotion and prevention were physical activity (81/200, 40.5%), nutrition (45/200, 22.5%), and sexual health (34/200, 17%). Most of the interventions combined several health promotion or prevention methods, including environmental change; providing information, social support, training, or incentives; and monitoring. Finally, we found that the articles mostly reported on behavioral rather than structural health promotion and prevention. CONCLUSIONS The research field of digital health promotion and prevention in settings is heterogeneous. At the same time, we identified research gaps regarding the absence of valid definitions of relevant terms (eg, digital settings) and the lack of literature on structural health promotion and prevention in settings. Therefore, it remains unclear how digital technologies can contribute to structural (or organizational) changes in settings. More research is needed to successfully implement digital technologies to achieve health promotion and prevention in settings.
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Affiliation(s)
- Anna Lea Stark
- School of Public Health, Centre for ePublic Health, Bielefeld University, Bielefeld, Germany
| | - Cornelia Geukes
- School of Public Health, Centre for ePublic Health, Bielefeld University, Bielefeld, Germany
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Gustafson A, Gillespie R, DeWitt E, Cox B, Dunaway B, Haynes-Maslow L, Steeves EA, Trude ACB. Online Pilot Grocery Intervention among Rural and Urban Residents Aimed to Improve Purchasing Habits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:871. [PMID: 35055688 PMCID: PMC8775883 DOI: 10.3390/ijerph19020871] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 02/05/2023]
Abstract
Online grocery shopping has the potential to improve access to food, particularly among low-income households located in urban food deserts and rural communities. The primary aim of this pilot intervention was to test whether a three-armed online grocery trial improved fruit and vegetable (F&V) purchases. Rural and urban adults across seven counties in Kentucky, Maryland, and North Carolina were recruited to participate in an 8-week intervention in fall 2021. A total of 184 adults were enrolled into the following groups: (1) brick-and-mortar "BM" (control participants only received reminders to submit weekly grocery shopping receipts); (2) online-only with no support "O" (participants received weekly reminders to grocery shop online and to submit itemized receipts); and (3) online shopping with intervention nudges "O+I" (participants received nudges three times per week to grocery shop online, meal ideas, recipes, Facebook group support, and weekly reminders to shop online and to submit itemized receipts). On average, reported food spending on F/V by the O+I participants was USD 6.84 more compared to the BM arm. Online shopping with behavioral nudges and nutrition information shows great promise for helping customers in diverse locations to navigate the increasing presence of online grocery shopping platforms and to improve F&V purchases.
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Affiliation(s)
- Alison Gustafson
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY 40506, USA; (B.C.); (B.D.)
| | - Rachel Gillespie
- Department of Family and Consumer Sciences Extension, University of Kentucky, Lexington, KY 40506, USA; (R.G.); (E.D.)
| | - Emily DeWitt
- Department of Family and Consumer Sciences Extension, University of Kentucky, Lexington, KY 40506, USA; (R.G.); (E.D.)
| | - Brittany Cox
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY 40506, USA; (B.C.); (B.D.)
| | - Brynnan Dunaway
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY 40506, USA; (B.C.); (B.D.)
| | - Lindsey Haynes-Maslow
- Agricultural & Human Sciences, North Carolina State University, Raleigh, NC 27695, USA;
| | | | - Angela C. B. Trude
- Department of Nutrition and Dietetics, Steinhardt School of Culture, Education, and Human Development, New York University, New York City, NY 10003, USA;
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Steeves EA, Trude ACB, Ruggiero CF, Ruiz MJM, Jones-Smith JC, Porter KP, Cheskin L, Hurley K, Hopkins L, Gittelsohn J. Perceptions and Impact of a Youth-led Childhood Obesity Prevention Intervention among Youth-leaders. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021; 16:213-234. [PMID: 34539947 DOI: 10.1080/19320248.2019.1649777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective To evaluate the impact of a youth-led nutrition intervention on youth-leaders themselves. Design Mixed methods, including: in-depth interviews and a quasi-experimental quantitative study comparing youth-leaders and nonparticipant comparison youth. Analysis Qualitative analysis using direct content analysis. Difference-in-differences analyses assessing quantitative program impact. Results Youth-leaders perceived that the intervention impacted themselves, the youth-participants, and their respective social networks. Youth-leaders experienced greater increases in intentions to eat healthfully (p=0.04), and greater decreases in support for healthy eating from their friends (p=0.01), than the comparison group. Conclusions/Implications Youth-leaders reported multiple levels of intervention impact, and increased intentions for healthy eating; however, additional research is needed to enhance impact on behavioral outcomes.
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Affiliation(s)
| | - Angela Cristina Bizzotto Trude
- Center for Human Nutrition and the Global Obesity Prevention Center at the Johns Hopkins Bloomberg School of Public Health
| | | | | | | | - Keshia Pollack Porter
- Department of Health Policy and Management and the Global Obesity Prevention Center at the Johns Hopkins Bloomberg School of Public Health
| | - Lawrence Cheskin
- Department of Health Behavior and Society and the Global Obesity Prevention Center at the Johns Hopkins Bloomberg School of Public Health
| | - Kristen Hurley
- Center for Human Nutrition and the Global Obesity Prevention Center at the Johns Hopkins Bloomberg School of Public Health
| | | | - Joel Gittelsohn
- Center for Human Nutrition and the Global Obesity Prevention Center at the Johns Hopkins Bloomberg School of Public Health
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Batra N, Colson CD, Alberto EC, Burd RS. Using Social Media for the Prevention of Pediatric Burn Injuries: Pilot Design and Usability Study. JMIR Form Res 2021; 5:e23242. [PMID: 34264194 PMCID: PMC8323015 DOI: 10.2196/23242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/12/2020] [Accepted: 05/17/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Most pediatric burn injuries are preventable. Social media is an effective method for delivering large-scale messaging and may be useful for injury prevention in this domain. OBJECTIVE This study evaluates the feasibility of creating a social media campaign for pediatric burn injury prevention. METHODS Ad spots containing a headline, short introduction, and video were created and posted on Facebook and Instagram over 4 months. Ad spots were targeted to parents and caregivers of children in our region with the highest number of burn injuries. We assessed the impact of each ad set using ThruPlays, reach, and video plays. RESULTS We created 55 ad spots, with an average length of 24.1 (range 10-44) seconds. We reached 26,496 people during the campaign. The total ThruPlays of the 55 ad spots were 14,460 at US $0.19 per ThruPlay. Ad spots related to home safety had a significantly higher daily ThruPlay rate than those related to fire safety (6.5 vs 0.5 per day; P<.001). CONCLUSIONS Social media is a feasible modality for delivering public health messages focused on preventing pediatric burn injuries. Engagement with these ads is influenced by ad presentation and the focus of the underlying injury prevention message.
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Affiliation(s)
- Nikita Batra
- Children's National Hospital, Washington, DC, United States
| | - Cindy D Colson
- Children's National Hospital, Washington, DC, United States
| | | | - Randall S Burd
- Children's National Hospital, Washington, DC, United States
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Fergus L, Roberts R, Holston D. Healthy Eating in Low-Income Rural Louisiana Parishes: Formative Research for Future Social Marketing Campaigns. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094745. [PMID: 33946825 PMCID: PMC8124262 DOI: 10.3390/ijerph18094745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/25/2021] [Accepted: 04/28/2021] [Indexed: 11/24/2022]
Abstract
High rates of obesity and chronic disease exist in the southeastern United States (US). Knowledge about the attitudes, beliefs, and barriers of the rural low-income Louisiana population regarding healthy eating is limited. Focus Group discussions based on the Theory of Planned Behavior (TPB) were conducted in rural parishes (N = 3) with low-income residents of Louisiana (N = 29). Grounded Theory methods and cross-case analysis were used. The participants were primarily single Black females of age 18–30 years who earned a high school diploma, were employed, and had children. Beliefs included healthy eating was physically beneficial, yet financial impacts and the low palatability of healthy foods were barriers. Professional resources for nutrition education were limited which led to reliance on friends, family, and the internet. Friends and family were positive and negative influences on eating choices. Control beliefs included the high prices and low palatability of healthy foods, the wide availability of Energy Dense Nutrient Poor (EDNP) foods, and low motivation to sustain eating behavior changes. Formative research to optimize campaign distribution channels may improve accessibility to social marketing support and healthy eating resources. Persuasive messages that address control beliefs are needed in social marketing campaigns for rural low-income Louisiana environments.
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Affiliation(s)
- Linda Fergus
- School of Nutrition and Food Sciences, Louisiana State University AgCenter, Baton Rouge, LA 70803, USA;
- Correspondence:
| | - Richie Roberts
- Department of Agricultural and Extension Education and Evaluation, Louisiana State University, Baton Rouge, LA 70803, USA;
| | - Denise Holston
- School of Nutrition and Food Sciences, Louisiana State University AgCenter, Baton Rouge, LA 70803, USA;
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9
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Li C, Ademiluyi A, Ge Y, Park A. Using Social Media to Understand Online Social Factors Concerning Obesity: A Systematic Review (Preprint). JMIR Public Health Surveill 2020; 8:e25552. [PMID: 35254279 PMCID: PMC8938846 DOI: 10.2196/25552] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/03/2021] [Accepted: 10/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background Evidence in the literature surrounding obesity suggests that social factors play a substantial role in the spread of obesity. Although social ties with a friend who is obese increase the probability of becoming obese, the role of social media in this dynamic remains underexplored in obesity research. Given the rapid proliferation of social media in recent years, individuals socialize through social media and share their health-related daily routines, including dieting and exercising. Thus, it is timely and imperative to review previous studies focused on social factors in social media and obesity. Objective This study aims to examine web-based social factors in relation to obesity research. Methods We conducted a systematic review. We searched PubMed, Association for Computing Machinery, and ScienceDirect for articles published by July 5, 2019. Web-based social factors that are related to obesity behaviors were studied and analyzed. Results In total, 1608 studies were identified from the selected databases. Of these 1608 studies, 50 (3.11%) studies met the eligibility criteria. In total, 10 types of web-based social factors were identified, and a socioecological model was adopted to explain their potential impact on an individual from varying levels of web-based social structure to social media users’ connection to the real world. Conclusions We found 4 levels of interaction in social media. Gender was the only factor found at the individual level, and it affects user’s web-based obesity-related behaviors. Social support was the predominant factor identified, which benefits users in their weight loss journey at the interpersonal level. Some factors, such as stigma were also found to be associated with a healthy web-based social environment. Understanding the effectiveness of these factors is essential to help users create and maintain a healthy lifestyle.
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Affiliation(s)
- Chuqin Li
- University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Adesoji Ademiluyi
- University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Yaorong Ge
- University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Albert Park
- University of North Carolina at Charlotte, Charlotte, NC, United States
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10
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Parra-Soto S, Ortega A, Celis-Morales C, Kain J. Perception that Mothers and / or Guardians of Overweight or Obese Preschool Children Have of a Text Messaging Program to Support Behaviour Change in their Children. Glob Pediatr Health 2020; 7:2333794X20961575. [PMID: 33110932 PMCID: PMC7555567 DOI: 10.1177/2333794x20961575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/02/2020] [Accepted: 08/04/2020] [Indexed: 11/13/2022] Open
Abstract
In most childhood obesity preventive programs, parents are targeted as they are key in achieving lifestyle behavior change in their children. Because their participation is generally low, new technologies, such as text messaging, are being tested to assess if their participation increases. The objective of this study was to determine the perception that mothers of overweight/ obese preschool children have of a textmessaging program developed to support their children’s lifestyle behavior change. Text messages were sent to 60 mothers twice a week for 12 weeks; 58 of them said they received all of them. During the process mothers were contacted twice regarding their opinion on all aspects related to the messages. At follow-up, we determined perception by in depth interviews administered to participants. Results show that text messaging implemented in a personalized manner was considered successful in regards to providing useful information to support their children’s behavior change.
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Affiliation(s)
- Solange Parra-Soto
- Institute of Nutrition and Food Technology (INTA), University of Chile.,Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Alejandra Ortega
- Institute of Nutrition and Food Technology (INTA), University of Chile
| | - Carlos Celis-Morales
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Grupo de Estudio en Educación, Actividad Física y Salud (GEEAFyS), Universidad Católica del Maule, Talca, Chile.,Centro de Investigaciones en Fisiología del Ejercicio (CIFE), Universidad Mayor, Santiago, Chile
| | - Juliana Kain
- Institute of Nutrition and Food Technology (INTA), University of Chile
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Gittelsohn J, Jock B, Poirier L, Wensel C, Pardilla M, Fleischhacker S, Bleich S, Swartz J, Trude ACB. Implementation of a multilevel, multicomponent intervention for obesity control in Native American communities (OPREVENT2): challenges and lessons learned. HEALTH EDUCATION RESEARCH 2020; 35:228-242. [PMID: 32413105 PMCID: PMC7243725 DOI: 10.1093/her/cyaa012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/20/2020] [Indexed: 05/03/2023]
Abstract
OPREVENT2 was a multilevel, multicomponent (MLMC) adult obesity prevention that sought to improve access and demand for healthier food and physical activity opportunities in six Native American communities in the Southwest and Midwest. OPREVENT2 worked with worksites, food stores, schools (grades 2-6), through social media and mailings, and with a local community action committee (CAC), in each of the three intervention communities, and was implemented in six phases. We conducted a process evaluation to assess implementation of each intervention component in terms of reach, dose delivered and fidelity. Implementation of each component was classified as high, medium or low according to set standards, and reported back at the end of each phase, allowing for improvements. The school and worksite components were implemented with high reach, dose delivered and fidelity, with improvement over time. The school program had only moderate reach and dose delivered, as did the social media component. The CAC achieved high reach and dose delivered. Overall, study reach and dose delivered reached a high implementation level, whereas fidelity was medium. Great challenges exist in the consistent implementation of MLMC interventions. The detailed process evaluation of the OPREVENT2 trial allowed us to carefully assess the relative strengths and limitations of each intervention component.
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Affiliation(s)
- J Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - B Jock
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - L Poirier
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - C Wensel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - M Pardilla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | | | - S Bleich
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - J Swartz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Angela C B Trude
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
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12
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Armstrong B, Trude ACB, Johnson C, Castelo RJ, Zemanick A, Haber-Sage S, Arbaiza R, Black MM. CHAMP: A cluster randomized-control trial to prevent obesity in child care centers. Contemp Clin Trials 2019; 86:105849. [PMID: 31525490 DOI: 10.1016/j.cct.2019.105849] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 02/06/2023]
Abstract
Foundational elements of lifelong health are formed during the preschool years. Child care attendance has nearly doubled in the past 5 years making child care centers an ideal setting to establish healthy habits that prevent pediatric obesity. Despite the promising evidence of efficacy of child care-based obesity prevention interventions, limited attention has been directed to criteria needed for implementation at scale. There is potential to improve children's dietary and physical activity behaviors in diverse communities through theory-based, culturally appropriate, manualized interventions, delivered by child care staff. CHAMP (Creating Healthy Habits Among Maryland Preschoolers) is a 3-arm cluster randomized controlled childhood obesity prevention trial, aiming to improve motor skills, physical activity and willingness to try new foods among 864 preschoolers (age 3-5 years) enrolled in 54 child care centers in 10 Maryland counties. CHAMP is informed by social-cognitive and bioecological theories and based on an evidence-based program, The Food Friends®. The two intervention arms include: 1) child care-center based lessons (18-week gross motor and 12-week nutrition) administered by trained child care staff, and 2) a web-based intervention for caregivers in addition to center-based lessons. Evaluations are conducted among children, caregivers, and child care staff at fall enrollment, midline, and spring, following intervention completion. Analyses include linear mixed-models, accounting for clustering and repeated measures, incorporating center-arms as moderators. CHAMP will provide evidence-based information to inform wellness guidelines and policies that can be disseminated broadly, to ensure that child care centers provide opportunities for children to develop healthy eating, and physical activity habits. Trial Registration: NCT03111264; https://clinicaltrials.gov/ct2/show/NCT03111264.
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Affiliation(s)
- Bridget Armstrong
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Angela C B Trude
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Candace Johnson
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Romulus J Castelo
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Amy Zemanick
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Sophie Haber-Sage
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Raquel Arbaiza
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Maureen M Black
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America; RTI International, Department of Pediatrics, United States of America.
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Chung A, Wallace B, Stanton-Koko M, Seixas A, Jean-Louis G. Feasibility and Acceptability of a Culturally Tailored Website to Increase Fruit and Vegetable Intake and Physical Activity Levels in African American Mother-Child Dyads: Observational Study. JMIR Pediatr Parent 2019; 2:e12501. [PMID: 31518320 PMCID: PMC6715398 DOI: 10.2196/12501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/31/2018] [Accepted: 12/31/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND African American youth (aged 8-14 years) do not adhere to national dietary and physical activity guidelines. Nonadherence to these recommendations contributes to disproportionate rates of obesity compared with their white counterparts. Culturally tailored electronic health (eHealth) solutions are needed to communicate nutrition and physical activity messages that resonate with this target population. OBJECTIVE This study aimed to identify the impact of exposure to a website hosting culturally tailored cartoons to inspire fruit and vegetable uptake and physical activity levels in African American mother-child dyads. METHODS Statistical analysis included paired sample t tests to evaluate knowledge gains, self-efficacy, and readiness to change. Adapted items from Prochaska's Stages of Change toward the following 4 behaviors were assessed with pre- and posttest surveys: (1) fruit and vegetable selection on my plate, (2) meal preparation, (3) fruit and vegetable selection outside of home, and (4) physical activity. Open-ended comments on videos from mother-child dyads were used to determine user acceptance. Observations of repeated responses during content analysis informed coding and development of key themes. RESULTS A final sample size of 93 mother-child dyads completed the study. Mothers reported significant improvement from precontemplation or contemplation stages to preparation or action stages for (1) fruit and vegetable selection on her plate (P=.03), (2) meal preparation for her family (P=.01), (3) fruit and vegetable selection outside the home (P<.001), and (4) physical activity (P<.001). Significant improvements were found in knowledge, stage of change, and self-efficacy for the 4 target behaviors of interest (P<.001). Children's open-ended commentary reported vicarious learning and positive character identification with brown-skinned cartoons exhibiting healthful food and exercise behaviors. Mothers commented on the lack of accessible produce in their neighborhoods not depicted in the cartoon videos. CONCLUSIONS Culturally adapted cartoons that incorporate tailored preferences by African American families, such as race or demography, may help increase adherence to target health behaviors when developing eHealth behavior solutions.
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Affiliation(s)
- Alicia Chung
- New York University School of Medicine, New York, NY, United States
| | - Barbara Wallace
- Teachers College, Columbia University, New York, NY, United States
| | | | - Azizi Seixas
- New York University School of Medicine, New York, NY, United States
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Gittelsohn J, Novotny R, Trude ACB, Butel J, Mikkelsen BE. Challenges and Lessons Learned from Multi-Level Multi-Component Interventions to Prevent and Reduce Childhood Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:ijerph16010030. [PMID: 30586845 PMCID: PMC6339209 DOI: 10.3390/ijerph16010030] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/10/2018] [Accepted: 12/20/2018] [Indexed: 12/12/2022]
Abstract
Multi-level multi-component (MLMC) strategies have been recommended to prevent and reduce childhood obesity, but results of such trials have been mixed. The present work discusses lessons learned from three recently completed MLMC interventions to inform future research and policy addressing childhood obesity. B’more Healthy Communities for Kids (BHCK), Children’s Healthy Living (CHL), and Health and Local Community (SoL) trials had distinct cultural contexts, global regions, and study designs, but intervened at multiple levels of the socioecological model with strategies that address multiple components of complex food and physical activity environments to prevent childhood obesity. We discuss four common themes: (i) How to engage with community partners and involve them in development of intervention and study design; (ii) build and maintain intervention intensity by creating mutual promotion and reinforcement of the intervention activities across the multiple levels and components; (iii) conduct process evaluation for monitoring, midcourse corrections, and to engage stakeholder groups; and (iv) sustaining MLMC interventions and its effect by developing enduring and systems focused collaborations. The paper expands on each of these themes with specific lessons learned and presents future directions for MLMC trials.
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Affiliation(s)
- Joel Gittelsohn
- Center for Human Nutrition, International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA.
| | - Rachel Novotny
- Children's Healthy Living Center of Excellence, College of Tropical Agriculture and Human Resources ⁻ University of Hawai'i at Mānoa, Honolulu, HI 96822, USA.
| | - Angela Cristina Bizzotto Trude
- Center for Human Nutrition, International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA.
| | - Jean Butel
- Children's Healthy Living Center of Excellence, College of Tropical Agriculture and Human Resources ⁻ University of Hawai'i at Mānoa, Honolulu, HI 96822, USA.
| | - Bent Egberg Mikkelsen
- Department of Learning & Philosophy, Aalborg University, A.C. Meyers Vænge 15, DK-2450 Copenhagen SV, Denmark.
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The impact of a multilevel childhood obesity prevention intervention on healthful food acquisition, preparation, and fruit and vegetable consumption on African-American adult caregivers. Public Health Nutr 2018; 22:1300-1315. [PMID: 30463637 DOI: 10.1017/s1368980018003038] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate the secondary impact of a multilevel, child-focused, obesity intervention on food-related behaviours (acquisition, preparation, fruit and vegetable (FV) consumption) on youths' primary caregivers. DESIGN B'More Healthy Communities for Kids (BHCK) group-randomized controlled trial promoted access to healthy foods and food-related behaviours through wholesaler and small store strategies, peer mentor-led nutrition education aimed at youths, and social media and text messaging targeting their adult caregivers. Measures included caregivers' (n 516) self-reported household food acquisition frequency for FV, snacks and grocery items over 30 d, and usual FV consumption in a sub-sample of 226 caregivers via the NCI FV Screener. Hierarchical models assessed average treatment effects (ATE). Treatment-on-the-treated-effect (TTE) analyses evaluated correlation between behavioural change and exposure to BHCK. Exposure scores at post-assessment were based on self-reported viewing of BHCK materials and participating in activities. SETTING Thirty Baltimore City low-income neighbourhoods, USA.ParticipantsAdult caregivers of youths aged 9-15 years. RESULTS Of caregivers, 90·89 % were female; mean age 39·31 (sd 9·31) years. Baseline mean (sd) intake (servings/d) was 1·30 (1·69) fruits and 1·35 (1·05) vegetables. In ATE, no significant intervention effect was found on caregivers' food-related behaviours. In TTE, each point increase in BHCK exposure score (range: 0-6·9) increased caregivers' daily fruit consumption by 0·2 servings (0·24 (se 0·11); 95 % CI 0·04, 0·47). Caregivers reporting greater social media exposure tripled their daily fruit intake (3·16 (se 0·92); 95 % CI 1·33, 4·99) and increased their frequency of unhealthy food purchasing v. baseline. CONCLUSIONS Child-focused community-based nutrition interventions may also benefit family members' fruit intake. Child-focused interventions should involve adult caregivers and intervention effects on family members should be assessed. Future multilevel studies should consider using social media to improve reach and engage caregiver participants.
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Trude ACB, Surkan PJ, Cheskin LJ, Gittelsohn J. A multilevel, multicomponent childhood obesity prevention group-randomized controlled trial improves healthier food purchasing and reduces sweet-snack consumption among low-income African-American youth. Nutr J 2018; 17:96. [PMID: 30373597 PMCID: PMC6206663 DOI: 10.1186/s12937-018-0406-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 10/17/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Consumption of foods and beverages rich in sugar remains high across all races and ages in the United States. Interventions to address childhood obesity and decrease sugar intake are needed, particularly in low-income settings. METHODS B'more Healthy Communities for Kids (BHCK) was a group-randomized, controlled trial implemented among 9-15-year olds in 30 low-income areas of Baltimore. We increased access to low-sugar foods and beverages at wholesalers and small food stores. Concurrently, we encouraged their purchase and consumption by children through youth-led nutrition education in recreation centers, in-store promotions, text messaging and a social media program directed at caregivers. Sugar consumption (sugar sweetened beverage (SSB), sweets) in youth was assessed pre- (n = 534) and post-intervention (n = 401) using the Block Kids Food Frequency Questionnaire. Purchasing of 38 healthier and 28 less healthier food/beverage varieties in the previous 7 days was assessed via self-report. Multilevel models at the community and individual levels were used. Analyses were stratified by age (younger: 9-12-year olds (n = 339) vs older: 13-15 (n = 170)). Models were controlled for child's sex, race, total daily caloric intake, and caregiver's age and sex. RESULTS Overall baseline mean healthier food purchasing was 2.5 (+ 3.6; min. 0, max. 34 items per week), and unhealthier food purchasing 4.6 (+ 3.7; 0-19 items per week). Mean intake at baseline for kcal from SSB was 176 (+ 189.1) and 153 (+ 142.5), and % of calories from sweets (i.e. cookies, cakes, pies, donuts, candy, ice cream, sweetened cereals, and chocolate beverages) was 15.9 (+ 9.7) and 15.9 (+ 7.7) in comparison and intervention youth, respectively. Intervention youth increased healthier foods and beverages purchases by 1.4 more items per week than comparison youth (β = 1.4; 95% CI: 0.1; 2.8). After the intervention, there was a 3.5% decrease in kcal from sweets for older intervention youth, compared to the control group (β = - 3.5; 95% CI: -7.76; - 0.05). No impact was seen on SSB consumption. CONCLUSION BHCK successfully increased healthier food purchasing variety in youth, and decreased % calories from sweet snacks in older youth. Multilevel, multicomponent environmental childhood obesity programs are a promising strategy to improve eating behaviors among low-income urban youth. TRIAL REGISTRATION NCT02181010 (July 2, 2014, retrospectively registered).
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Affiliation(s)
- Angela C. B. Trude
- Department of International Health, Global Obesity Prevention Center, and Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Pamela J. Surkan
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Lawrence J. Cheskin
- Department of Health Behavior and Society, and the Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, 550 N. Broadway, Baltimore, MD 21205 USA
| | - Joel Gittelsohn
- Department of International Health, Global Obesity Prevention Center, and Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
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