A childhood obesity intervention developed by families for families: results from a pilot study

International Journal of Behavioral Nutrition and Physical Activity

Hal A Lawson³  Sibylle Kranz²  Kaigang Li⁴  Janine M Jurkowski¹  Kirsten K Davison⁵ 

[1] Department of Health Policy, Management and Behavior, School of Public Health, University at Albany, Albany, NY, USA;Department of Nutrition Sciences, College of Health and Human Services, Purdue University, West Lafayette, IL, USA;School of Social Welfare, University at Albany, Albany, NY, USA;Prevention Research Branch, National Institute of Child Health & Human Development, Bethesda, MD, USA;Department of Nutrition, Harvard School of Public Health, Harvard University, Boston, MA, USA

关键词: Family intervention;    Physical activity;    Diet;    Head Start;    Action research;    CBPR;    Community-based participatory research;   

Others  :  811022
DOI  :  10.1186/1479-5868-10-3

 received in 2012-06-01, accepted in 2012-12-19,  发布年份 2013

【 摘 要 】

Background

Ineffective family interventions for the prevention of childhood obesity have, in part, been attributed to the challenges of reaching and engaging parents. With a particular focus on parent engagement, this study utilized community-based participatory research to develop and pilot test a family-centered intervention for low-income families with preschool-aged children enrolled in Head Start.

Methods

During year 1 (2009–2010), parents played an active and equal role with the research team in planning and conducting a community assessment and using the results to design a family-centered childhood obesity intervention. During year 2 (2010–2011), parents played a leading role in implementing the intervention and worked with the research team to evaluate its results using a pre-post cohort design. Intervention components included: (1) revisions to letters sent home to families reporting child body mass index (BMI); (2) a communication campaign to raise parents’ awareness of their child’s weight status; (3) the integration of nutrition counseling into Head Start family engagement activities; and (4) a 6-week parent-led program to strengthen parents’ communication skills, conflict resolution, resource-related empowerment for healthy lifestyles, social networks, and media literacy. A total of 423 children ages 2–5 years, from five Head Start centers in upstate New York, and their families were exposed to the intervention and 154 families participated in its evaluation. Child outcome measures included BMI z-score, accelerometer-assessed physical activity, and dietary intake assessed using 24-hour recall. Parent outcomes included food-, physical activity- and media-related parenting practices and attitudes.

Results

Compared with pre intervention, children at post intervention exhibited significant improvements in their rate of obesity, light physical activity, daily TV viewing, and dietary intake (energy and macronutrient intake). Trends were observed for BMI z-score, sedentary activity and moderate activity. Parents at post intervention reported significantly greater self-efficacy to promote healthy eating in children and increased support for children’s physical activity. Dose effects were observed for most outcomes.

Conclusions

Empowering parents to play an equal role in intervention design and implementation is a promising approach to family-centered obesity prevention and merits further testing in a larger trial with a rigorous research design.

【 授权许可】

   
2013 Davison et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Ogden CL, Troiano RP, Briefel RR, Kuczmarski RJ, Flegal KM, Johnson CL: Prevalence of overweight among preschool children in the united states, 1971 through 1994. Pediatrics 1997., 99(4)
• [2]Ogden C, Carroll M, Flegal K: High body mass index for age among US children and adolescents, 2003–2006. J Am Med Assoc 2008, 299:2401-2405.
• [3]Daniels S: The consequences of childhood overweight and obesity. Future Child 2006, 16(1):47-67.
• [4]Olshansky J, Passaro D, Hershow R, et al.: A potential decline in life expectancy in the united states in the 21st century. N Engl J Med 2005, 352(March 17):1138-1145.
• [5]Anderson S, Whitaker R: Prevalence of obesity among US preschool children in different racial and ethnic groups. Arch Pediatr Adolesc Med 2009, 163(4):344-348.
• [6]Wang Y, Beydoun M: The obesity epidemic in the united states-gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiological Review. 2007, 29:6-28.
• [7]Davison K, Lawson H, Coatsworth J: The family-centered action model of intervention layout and implementation (FAMILI): the example of childhood obesity. Health Promot Pract 2012, 13(4):454-461.
• [8]Campbell K, Hesketh K: Strategies which aim to positively impact on weight, physical activity, diet and sedentary behaviours in children from zero to five years. A systematic review of the literature. Obes Rev 2007, 8:327-338.
• [9]Lindsay A, Sussner K, Kim J, Gortmaker S: The role of parents in preventing childhood obesity. Future Child 2006, 16(1):169-186.
• [10]Stice E, Shaw H, Marti C: A meta-analytic review of obesity prevention programs for children and adolescents: the skinny on interventions that work. Psychol Bull 2006, 132(5):667-691.
• [11]O'Connor T, Jago R, Baranowski T: Engaging parents to increase youth physical activity: a systematic review. Am J Prev Med 2009, 37(2):1410-1149.
• [12]Hingle M, O'Connor T, Dave J, Baranowski T: Parental involvement in interventions to improve child dietary intake: a systematic review. Prev Med 2010, 51:103-111.
• [13]Skelton J, Beech B: Attrition in paediatric weight management: a review of the literature and new directions. Obes Rev 2011, 12(5):e273-281.
• [14]Prinz R, Smith E, Dumas J, Laughlin J, White D, Barron R: Recruitment and retention of participants in prevention trials involving family-based interventions. Am J Prev Med 2001, 20(1):31-37.
• [15]Minkler M, Glover Blackwell A, Thompson M, Tamir H: Community-based participatory research: implications for public health funding. Am J Public Health 2003, 93(8):1210-1213.
• [16]Israel B, Parker E, Rowe Z, et al.: Community-based participatory research: lessons learned from the centers for Children's environmental health and disease prevention research. Environ Health Perspect 2005, 113(10):1463-1471.
• [17]Davison K, Campbell K: Opportunities to prevent obesity in children within families: an ecological approach. In Obesity prevention and public health. Edited by Crawford D, Jeffery R. Oxford: Oxford University Press; 2005:207-230.
• [18]Davison K, Jurkowski J, Lawson H: Family-centered obesity prevention redefined: the family ecological model. Public Health Nutrin press
• [19]Israel B, Checkoway B, Schulz A, Zimmerman M: Health education and community empowerment: conceptualizing and measuring perceptions of individual. Organizational, and Community Control Health Education and Behavior. 1994, 21(2):149-170.
• [20]Lawson H: Empowering people, faciliating community development, and contributing to sustainable development: the social work of sport, exercise, and physical education programs. Sport, Education and Society. 2005, 10(1):135-160.
• [21]Currie J, Duncan T: Does head start make a difference? Am Econ Rev 1995, 85(3):341-364.
• [22]Hoagwood K, Koretz D: Embedding prevention services within systems of care: strengthening the nexus for children. Appl Prev Psychol 1996, 5:225-234.
• [23]Jurkowski J, Greenpope L, Lawson H, Bovenzi M, Quartimon R, Davison K: Engaging low-income parents in childhood obesity prevention from start to finish: a case study. J Community Healthin press
• [24]Jurkowski J, Li K, Deanne G, Lawson H, Davison K: Measuring changes in empowerment among low-income parents participating in a CBPR project. APHA 139th Annual Meeting and Exposition. Washington, DC; 2011.
• [25]Wang C, Burris M: Photovoice: concept, methodology, and use for participatory needs assessment. Health Educ Behav 1997, 24:369-387.
• [26]Callan LB: Adapting the windshield survey model to community health education. HSMHA Health Rep 1971, 86(3):202-203.
• [27]Davison K, Jurkowski J, Gordon K, Li K, GreenPope L: An Obesity Awareness Social Marketing Campaign Targeting Head Start Families: Designed by Parents for Parents. Head Start’s 11th Conference. Research on Young Children and Families: Affective Practices in an Age of Diversity and Change. Washington, D.C; 2012.
• [28]Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, et al.: CDC growth charts: United States. Advance data from vital and health statistics. Hyattsville, Maryland: National Center for Health Statistics; 2000.
• [29]United States Department of Agriculture Agricultural Research Service: Design and Operation: The Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey, 1994–1996 and 1998–2000: USDA;1997. NFS Report No. 96–1.
• [30]Johnson R, Driscoll P, Goran M: Comparison of multiple-pass 24-hour recall estimates of energy intake with total energy expenditure determined by the doubly labelled water method in children. J Am Diet Assoc 1996, 96:1140-1144.
• [31]Pate R, Almeida M, McIver K, Pfeiffer K, Dowda M: Validation and calibration of an accelerometer in preschool children. Obesity 2006, 14(11):2000-2006.
• [32]Pfeiffer K, McIver K, Dowda M, Almeida M, Pate R: Validation and calibration of the actical accelerometer in preschool children. Medicine and Science in Sports and Exercise. 2006, 38(1):152-157.
• [33]Masse L, Fuemmeler B, Anderson C, et al.: Accelerometer data reduction: a comparison of four reduction algorithms on select outcome variables. Medicine and Science in Sports and Exercise. 2005, 37(11 Suppl):S544-554.
• [34]Trost S, McIver K, Pate R: Conducting accelerometer-based activity assessments in field-based research. Medicine and Science in Sports and Exercise. 2005, 37:S531-S543.
• [35]Pfeiffer K, Dowda M, McIver K, Pate R: Factors related to objectively measured physical activity in preschool children. Pediatr Exerc Sci 2009, 21(2):196-208.
• [36]Davison KK, Li K, Baskin ML, Cox T, Affuso O: Measuring parental support for children's physical activity in white and african american parents: the activity support scale for multiple groups (ACTS-MG). Prev Med 2011, 52(1):39-43.
• [37]Israel B, Coombe C, Cheezum R, et al.: Community-based participatory research: a capacity-building approach for policy advocacy aimed at eliminating health disparities. Am J Public Health 2010, 100(11):2094-2102.
• [38]Wallerstein N, Duran B: Community-based participatory research contributions to intervention research: the intersection of science and practice to improve health equity. Am J Public Health 2010, 100(1):S40-46. Apr 1
• [39]Economos C, Hyatt R, Goldberg J, et al.: A community intervention reduces BMI z-score in children: shape Up somerville first year results. Obesity 2007, 15:1325-1336.
• [40]Chomitz VR, McGowan RJ, Wendel JM, et al.: Healthy living cambridge kids: a community-based participatory effort to promote healthy weight and fitness. Obesity (Silver Spring) 2010, 18(Suppl 1):S45-53.
• [41]Choundhry S, McClinton-Powell L, Solomon M, et al.: POWER UP: A collaborative after-school program to prevent obesity in African American children. Prog Community Health Partnersh 2011, 5(4):363-373. Winter
• [42]Davis S, Goldmon M, Coker-Appiah D: Using a community-based participatory research approach to develop a faith-based obesity intervention for african american children. Health Promot Practin press
• [43]Hye-cheon Kim K, Linnan L, Campbell M, Brooks C, Koenig H, Wiesen C: The WORD (wholeness, oneness, righteousness, deliverance): a faith-based weight-loss program utilizing a community-based participatory research approach. Health Educ Behav 2008, 35(5):634-650.
• [44]Cook T, Campbell D: Quasi-Experimentation. Design and analysis issues for fields settings. Boston: Houghton Mifflin Company; 1979.
• [45]Matthews C, Freedson P, Hebert J, Stanek E: Seasonal variation in household, occupational, and leisure time physical activity: longitudinal analyses from the seasonal variation of blood cholesterol study. Am J Epidemiol 2001, 153(2):172-183.
• [46]Banks S: Children's Television viewing behavior. J Mark 1980, 44:48-55.
• [47]Hawe P, Shiell A, Riley T: Complex interventions: how "out of control" can a randomised controlled trial be? Br Med J 2004, 328(7455):1561-1563.
• [48]Trickett EJ, Beehler S, Deutsch C, et al.: Advancing the science of community-level interventions. Am J Public Health 2011, 101(8):1410-1419.