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Healthy Schoolhouse 2.0 Health Promotion Intervention to Reduce Childhood Obesity in Washington, DC: A Feasibility Study.
Hawkins, M, Belson, SI, McClave, R, Kohls, L, Little, S, Snelling, A
Nutrients. 2021;(9)
Abstract
Childhood obesity prevalence trends involve complex societal and environmental factors as well as individual behaviors. The Healthy Schoolhouse 2.0 program seeks to improve nutrition literacy among elementary school students through an equity-focused intervention that supports the health of students, teachers, and the community. This five-year quasi-experimental study follows a baseline-post-test design. Research activities examine the feasibility and effectiveness of a professional development series in the first program year to improve teachers' self-efficacy and students' nutrition literacy. Four elementary schools in Washington, DC (two intervention, two comparison) enrolled in the program (N = 1302 students). Demographic and baseline assessments were similar between schools. Teacher participation in professional development sessions was positively correlated with implementing nutrition lessons (r = 0.6, p < 0.001, n = 55). Post-test student nutrition knowledge scores (W = 39985, p < 0.010, n = 659) and knowledge score changes (W = 17064, p < 0.010, n = 448) were higher among students in the intervention schools. Students who received three nutrition lessons had higher post knowledge scores than students who received fewer lessons (H(2) =22.75, p < 0.001, n = 659). Engaging teachers to implement nutrition curricula may support sustainable obesity prevention efforts in the elementary school environment.
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Effects of the Preschool-Based Family-Involving DAGIS Intervention Program on Children's Energy Balance-Related Behaviors and Self-Regulation Skills: A Clustered Randomized Controlled Trial.
Ray, C, Figuereido, R, Vepsäläinen, H, Lehto, R, Pajulahti, R, Skaffari, E, Sainio, T, Hiltunen, P, Lehto, E, Korkalo, L, et al
Nutrients. 2020;(9)
Abstract
The study examines the effects of a preschool-based family-involving multicomponent intervention on children's energy balance-related behaviors (EBRBs) such as food consumption, screen time and physical activity (PA), and self-regulation (SR) skills, and whether the intervention effects differed among children with low or high parental educational level (PEL) backgrounds. The Increased Health and Wellbeing in Preschools (DAGIS) intervention was conducted as a clustered randomized controlled trial, clustered at preschool level, over five months in 2017-2018. Altogether, 802 children aged 3-6 years in age participated. Parents reported children's consumption of sugary everyday foods and beverages, sugary treats, fruits, and vegetables by a food frequency questionnaire, and screen time by a 7-day diary. Physical activity was assessed by a hip-worn accelerometer. Cognitive and emotional SR was reported in a questionnaire by parents. General linear mixed models with and without repeated measures were used as statistical methods. At follow-up, no differences were detected in EBRBs or SR skills between the intervention and control group, nor did differences emerge in children's EBRBs between the intervention and the control groups when stratified by PEL. The improvement in cognitive SR skills among low PEL intervention children differed from low PEL control children, the significance being borderline. The DAGIS multicomponent intervention did not significantly affect children's EBRBs or SR. Further sub-analyses and a comprehensive process evaluation may shed light on the non-significant findings.
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3.
Parent Stress as a Consideration in Childhood Obesity Prevention: Results from the Guelph Family Health Study, a Pilot Randomized Controlled Trial.
Hruska, V, Darlington, G, Haines, J, Ma, DWL
Nutrients. 2020;(6)
Abstract
Parents' stress is independently associated with increased child adiposity, but parents' stress may also interfere with childhood obesity prevention programs. The disruptions to the family dynamic caused by participating in a behaviour change intervention may exacerbate parent stress and undermine overall intervention efficacy. This study explored how family stress levels were impacted by participation in a home-based obesity prevention intervention. Data were collected from 77 families (56 fathers, 77 mothers) participating in the Guelph Family Health Study (GFHS), a pilot randomized control trial of a home-based obesity prevention intervention. Four measures of stress were investigated: general life stress, parenting distress, depressive symptoms, and household chaos. Multiple linear regression was used to compare the level of stress between the intervention and control groups at post-intervention and 1-year follow-up, adjusted for baseline stress. Analyses for mothers and fathers were stratified, except for household chaos which was measured at the family level. Results indicate no significant differences between intervention and control groups for any stress measure at any time point, indicating a neutral effect of the GFHS intervention on family stress. Future work should investigate the components of family-based intervention protocols that make participation minimally burdensome and consider embedding specific stress-reduction messaging to promote family health and wellbeing.
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Who benefits from the intervention? Correlates of successful BMI reduction in the Texas Childhood Obesity Demonstration Project (TX-CORD).
Barlow, SE, Durand, C, Salahuddin, M, Pont, SJ, Butte, NF, Hoelscher, DM
Pediatric obesity. 2020;(5):e12609
Abstract
BACKGROUND Many childhood obesity intervention studies report mean outcomes but do not explore the variation in responses and the characteristics of those who respond well. OBJECTIVE To identify child and family characteristics associated with improvement in the primary outcome, %BMIp95 , of the Texas Childhood Obesity Research Demonstration project (TX-CORD). METHODS The 12-month TX-CORD secondary prevention study randomized 549 children, ages 2 to 12 years, with BMI ≥85th percentile to the intensive intervention vs. the comparison program, with measurements at baseline, 3-, and 12-months. A growth mixture model was used to identify mutually exclusive latent %BMIp95 trajectories. Latent class regression tested associations between baseline characteristics and latent class membership. RESULTS A 2-class solution emerged after accounting for the effect of intervention randomization. Latent Class 1 participants (86% of sample) were characterized by mild-to-moderate obesity and demonstrated a significantly greater response to the intensive intervention between 0 and 3 months (slope-on-group = -0.931, p = 0.03). A rebound between 3 and 12 months was not significantly different between arms. Latent Class 2 participants (14%), who had severe obesity, demonstrated no difference in response between intervention groups. Characteristics associated with Class 1 membership included younger age (2-5 years vs. 6-12 years: OR 3.70, p = .035) and lower maternal BMI category (< 35 kg/m2 vs. ≥ 35 kg/m2 : OR 7.14, p < .0001). CONCLUSIONS The optimal target population for the intensive intervention are children who have milder obesity, are younger, and do not have a mother with severe obesity. Children with severe obesity may require different approaches.
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Preventing eating disorders in young women: An RCT and mixed-methods evaluation of the peer-delivered Body Project.
Vanderkruik, R, Gist, D, Dimidjian, S
Journal of consulting and clinical psychology. 2020;(12):1105-1118
Abstract
OBJECTIVES Young women are at increased risk for eating disorders during adolescence (age range = 16-19), and there is the need for effective, sustainable prevention programs delivered during this critical window of development. The Body Project is a dissonance-based program that reduces key risk factors for disordered eating. Few studies have evaluated the program or the participant experience when peer-delivered at the high school level. The objective of this study was to evaluate using mixed-methods the Body Project program when peer-delivered among high school women. METHOD Three studies were conducted among young women in high school in the United States: (a) an open trial evaluation of a peer-delivered Body Project program (n = 112), (b) a pilot randomized controlled trial (RCT) comparing the Body Project with assessment-only control (n = 74), and (c) a qualitative investigation of participants' experiences (n = 131). RESULTS Open trial participants reported significant reductions in eating disorder risk factors and improvements in mood and self-attitude constructs over the intervention period (ds = .32-.77, ps < .01). Intervention effects for Body Project participants in the RCT compared with control were significant for body dissatisfaction, thin ideal internalization, dietary restraint, self-compassion, body surveillance, and loneliness (ds = .55-1.38, ps < .02). Thematic analyses of qualitative data highlight considerations for program delivery and engagement, including insights about why women join the program and perspectives on peer leaders. CONCLUSIONS Findings support the effectiveness of the peer-delivered Body Project with high school-aged women and highlight key recommendations for increasing engagement and strengthening prevention programs among young women. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Study protocol for a cluster randomized controlled trial to test "¡Míranos! Look at Us, We Are Healthy!" - an early childhood obesity prevention program.
Yin, Z, Ullevig, SL, Sosa, E, Liang, Y, Olmstead, T, Howard, JT, Errisuriz, VL, Estrada, VM, Martinez, CE, He, M, et al
BMC pediatrics. 2019;(1):190
Abstract
BACKGROUND One in three Head Start children is either overweight or obese. We will test the efficacy of an early childhood obesity prevention program, "¡Míranos! Look at Us, We Are Healthy!" (¡Míranos!), which promotes healthy growth and targets multiple energy balance-related behaviors in predominantly Latino children in Head Start. The ¡Míranos! intervention includes center-based (policy changes, staff development, gross motor program, and nutrition education) and home-based (parent engagement/education and home visits) interventions to address key enablers and barriers in obesity prevention in childcare. In partnership with Head Start, we have demonstrated the feasibility and acceptability of the proposed interventions to influence energy balance-related behaviors favorably in Head Start children. METHODS Using a three-arm cluster randomized controlled design, 12 Head Start centers will be randomly assigned in equal number to one of three conditions: 1) a combined center- and home-based intervention, 2) center-based intervention only, or 3) comparison. The interventions will be delivered by trained Head Start staff during the academic year. A total of 444 3-year-old children (52% females; n = 37 per center at baseline) in two cohorts will be enrolled in the study and followed prospectively 1 year post-intervention. Data collection will be conducted at baseline, immediately post-intervention, and at the one-year follow-up and will include height, weight, physical activity (PA) and sedentary behaviors, sleep duration and screen time, gross motor development, dietary intake and food and activity preferences. Information on family background, parental weight, PA- and nutrition-related practices and behaviors, PA and nutrition policy and environment at center and home, intervention program costs, and treatment fidelity will also be collected. DISCUSSION With endorsement and collaboration of two local Head Start administrators, ¡Míranos!, as a culturally tailored obesity prevention program, is poised to provide evidence of efficacy and cost-effectiveness of a policy and environmental approach to prevent early onset of obesity in low-income Latino preschool children. ¡Míranos! can be disseminated to various organized childcare settings, as it is built on the Head Start program and its infrastructure, which set a gold standard for early childhood education, as well as current PA and nutrition recommendations for preschool children. TRIAL REGISTRATION ClinicalTrials.Gov ( NCT03590834 ) July 18, 2018.
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Feasibility and implementation of a healthy lifestyles program in a community setting in Ontario, Canada: protocol for a pragmatic mixed methods pilot study.
Alvarez, E, Qutob, M, Mbuagbaw, L, Lavis, J, Lokker, C, Walli-Attaei, M, Samaan, Z, Sutton, A, Singh, J, Feeny, D, et al
BMJ open. 2019;(10):e031298
Abstract
INTRODUCTION Rates of chronic conditions, such as diabetes, cardiovascular disease and obesity are increasing in Canada and internationally. There are effective lifestyle interventions that are known to improve chronic conditions. However, there is often a gap in 'how to' make lifestyle changes. Mental health and other determinants of health play a role in the development and progression of chronic conditions. Changing habits takes time and requires the use of multiple techniques, including mental health and behavioural change strategies, based on a person's needs. A new, multidisciplinary, person-centred and evidence-based and practice-based programme has been created to address these needs. This proposal aims to evaluate the feasibility and implementation of this programme and to determine changes in participant-directed and clinical outcomes through a pilot study. METHODS AND ANALYSIS A pragmatic mixed methods design will be used to study multiple dimensions of the year-long healthy lifestyles programme. The pilot study includes a randomised controlled trial, with 30 participants randomised to either the programme or to a comparator arm, and qualitative components to determine the feasibility of the programme, including recruitment and retention, data missing rates and resources needed to run this programme. Changes in participant-directed and clinical outcomes will be measured. Descriptive statistics, t-tests and repeated measures analysis of variance (ANOVA) for within group comparisons and generalised estimating equations for between group analyses will be used. Qualitative interviews of programme staff and healthcare providers and family focus groups will be used to further enhance the findings and improve the programme. ETHICS AND DISSEMINATION Approval from the Hamilton Integrated Research Ethics Board (HiREB) has been obtained. Informed consent will be obtained prior to enrolling any participant into the study. Participant IDs will be used during data collection and entry. Peer-reviewed publications and presentations will target researchers, health professionals and stakeholders. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT03258138.HiREB project number: 3793.
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The impact of basic vs. enhanced Go NAPSACC on child care centers' healthy eating and physical activity practices: protocol for a type 3 hybrid effectiveness-implementation cluster-randomized trial.
Vaughn, AE, Studts, CR, Powell, BJ, Ammerman, AS, Trogdon, JG, Curran, GM, Hales, D, Willis, E, Ward, DS
Implementation science : IS. 2019;(1):101
Abstract
BACKGROUND To prevent childhood obesity and promote healthy development, health authorities recommend that child care programs use the evidence-based practices that foster healthy eating and physical habits in children. Go NAPSACC is an intervention shown to improve use of these recommended practices, but it is known to encounter barriers that limit its impact and widespread use. METHODS This study will use a type 3 hybrid effectiveness-implementation cluster-randomized trial to compare effectiveness and implementation outcomes achieved from Go NAPSACC delivered with a basic or enhanced implementation approach. Participants will include approximately 25 coaches from Child Care Aware of Kentucky (serving four geographic regions), 97 child care centers with a director and teacher from each and two cross-sectional samples of 485 3-4-year-old children (one recruitment at baseline, another at follow-up). Coaches will be randomly assigned to deliver Go NAPSACC using either the basic or enhanced implementation approach. "Basic Go NAPSACC" represents the traditional way of delivering Go NAPSACC. "Enhanced Go NAPSACC" incorporates preparatory and support activities before and during their Go NAPSACC work, which are guided by the Quality Implementation Framework and the Consolidated Framework for Implementation Research. Data will be collected primarily at baseline and post-intervention, with select measures continuing through 6, 12, and 24 months post-intervention. Guided largely by RE-AIM, outcomes will assess change in centers' use of evidence-based nutrition and physical activity practices (primary, measured via observation); centers' adoption, implementation, and maintenance of the Go NAPSACC program (assessed via website use); center directors', teachers', and coaches' perceptions of contextual factors (assessed via self-report surveys); children's eating and physical activity behaviors at child care (measured via observation and accelerometers); and cost-effectiveness (assessed via logs and expense tracking). The hypotheses anticipate that "Enhanced Go NAPSACC" will have greater effects than "Basic Go NAPSACC." DISCUSSION This study incorporates many lessons gleaned from the growing implementation science field, but also offers opportunities to address the field's research priorities, including applying a systematic method to tailor implementation strategies, examining the processes and mechanisms through which implementation strategies produce their effects, and conducting an economic evaluation of implementation strategies. TRIAL REGISTRATION ClinicalTrials.gov, NCT03938103, Registered April 8, 2019.
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Acute hepatitis B notification rates in Flanders, Belgium, 2009 to 2017.
Koc, Ö, Van Damme, P, Busschots, D, Bielen, R, Forier, A, Nevens, F, Robaeys, G
Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin. 2019;(30)
Abstract
BackgroundBelgium is a low-endemic country for hepatitis B. Universal hepatitis B vaccination in infants with catch-up in the age cohort of 10-13 year-olds began in 1999.AimsOur objective was to evaluate the effect of prevention and control strategies on acute hepatitis B notification rates in Flanders (Belgium) from 2009 to 2017.MethodsThis observational study collected demographic data and risk factors for acute hepatitis B from mandatory notifications to the Agency for Care and Health.ResultsIn Flanders, acute hepatitis B notification rates per 100,000 population decreased from 1.6 in 2009 to 0.7 in 2017. These rates declined in all age groups: 0-4-year-olds: 0.6 to 0.0, 5-14-year-olds: 0.2 to 0.0, 15-24-year-olds: 0.8 to 0.7, 25-34-year-olds: 3.4 to 1.1 and ≥ 35-year-olds: 1.59 to 0.7. There was also a downward trend in acute hepatitis B notification rates in native Belgians and first-generation migrants. Among 15-24-year-olds and 25-34-year-olds, a possible reversal of the decreasing trend was observed in 2016 and 2015, respectively. Among 548 acute hepatitis B cases, the main route of transmission was sexual activity (30.7%), and the pattern of transmission routes over time showed an increasing proportion of sexual transmission in men who have sex with men (MSM) after 2014. During the period from 2009 to 2017, five mother-to-child transmissions were reported.ConclusionsPrevention and control strategies were effective in reducing the acute hepatitis B notification rate. However, stronger prevention and control measures are needed in adult risk groups, particularly MSM.
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Determinants of successful lifestyle change during a 6-month preconception lifestyle intervention in women with obesity and infertility.
Karsten, MDA, van Oers, AM, Groen, H, Mutsaerts, MAQ, van Poppel, MNM, Geelen, A, van de Beek, C, Painter, RC, Mol, BWJ, Roseboom, TJ, et al
European journal of nutrition. 2019;(6):2463-2475
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Abstract
PURPOSE To identify demographic, (bio)physical, behavioral, and psychological determinants of successful lifestyle change and program completion by performing a secondary analysis of the intervention arm of a randomized-controlled trial, investigating a preconception lifestyle intervention. METHODS The 6-month lifestyle intervention consisted of dietary counseling, physical activity, and behavioral modification, and was aimed at 5-10% weight loss. We operationalized successful lifestyle change as successful weight loss (≥ 5% weight/BMI ≤ 29 kg/m2), weight loss in kilograms, a reduction in energy intake, and an increase in physical activity during the intervention program. We performed logistic and mixed-effect regression analyses to identify baseline factors that were associated with successful change or program completion. RESULTS Women with higher external eating behavior scores had higher odds of successful weight loss (OR 1.10, 95% CI 1.05-1.16). Women with the previous dietetic support lost 0.94 kg less during the intervention period (95% CI 0.01-1.87 kg). Women with higher self-efficacy reduced energy intake more than women with lower self-efficacy (p < 0.01). Women with an older partner had an increased energy intake (6 kcal/year older, 95% CI 3-13). A high stage of change towards physical activity was associated with a higher number of daily steps (p = 0.03). A high stage of change towards weight loss was associated with completion of the intervention (p = 0.04). CONCLUSIONS Determinants of lifestyle change and program completion were: higher external eating behavior, not having received previous dietetic support, high stage of change. This knowledge can be used to identify women likely to benefit from lifestyle interventions and develop new interventions for women requiring alternative support. TRIAL REGISTRATION The LIFEstyle study was registered at the Dutch trial registry (NTR 1530; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1530 ).