Implementation of Text-Messaging and Social Media Strategies in a Multilevel Childhood Obesity Prevention Intervention: Process Evaluation Results

Surkan

Cheskin

et al. 2018

Nutr J

Self Cite

137

BackgroundConsumption 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.MethodsB’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.ResultsOverall 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.ConclusionBHCK 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 registrationNCT02181010 (July 2, 2014, retrospectively registered).Electronic supplementary materialThe online version of this article (10.1186/s12937-018-0406-2) contains supplementary material, which is available to authorized users.

Section: Resultsmentioning

confidence: 99%

“…Social media (Facebook, Instagram, and Twitter) was used to integrate all levels of BHCK and targeted caregivers [ 35 ]. Recipes, news, and BHCK-specific activities related to healthier beverages and snacks were featured daily.…”

Section: Methodsmentioning

confidence: 99%

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

Surkan

Cheskin

et al. 2018

Nutr J

Self Cite

137

“…Implementation of each component of the BHCK intervention was evaluated through detailed process evaluation reported elsewhere. (40; 41; 42; 43; 44) Table 1 illustrates implementation quality of each BHCK component. The intervention was implemented with overall moderate- to high-reach, dose delivered, and fidelity.…”

Section: Resultsmentioning

confidence: 99%

The impact of a multilevel childhood obesity prevention intervention on healthful food acquisition, preparation, and fruit and vegetable consumption on African-American adult caregivers

Surkan

Steeves

et al. 2018

Public Health Nutr.

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Objectives: To evaluate the secondary impact of a multilevel, child-focused, obesity intervention on food-related behaviors (acquisition, preparation, and 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 food and food-related behaviors through wholesaler and small store strategies, peer-mentor led nutrition education aimed at youth, 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 days, and usual consumption of FV 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 the correlation between behavioral change and exposure to BHCK. Exposure scores at post-assessment were based on self-reported viewing of BHCK materials and participating in activities. Setting: 30 Baltimore City low-income neighborhoods Subjects: Adult caregivers of youth ages 9–15 years. Results: 90.89% of caregivers were female, average 39.31(± 9.31) years. Baseline mean fruit intake (servings/day) was 1.30(± 1.69) and vegetable was 1.35(± 1.05). In ATE, no significant effect of the intervention was found on caregiver food-related behaviors. In TTE, for each point increase in the BHCK exposure score (range 0–6.9), caregivers increased daily consumption of fruits by 0.2 servings (0.24± 0.11; 95%CI 0.04; 0.47). Caregivers reporting greater exposure to social media tripled their daily fruit intake (3.16± 0.92; 95%CI 1.33; 4.99) and increased frequency of unhealthy food purchasing, compared to 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.

“…Perhaps the most formal version was employed by BHCK [18]. In BHCK, each intervention component had multiple measures for reach, dose delivered and fidelity [31,34,35,36,37]. Each of these measures had a minimum high standard for delivery, based on previous work, the literature, and/or specific resource constraints.…”

Section: Resultsmentioning

confidence: 99%

Challenges and Lessons Learned from Multi-Level Multi-Component Interventions to Prevent and Reduce Childhood Obesity

Gittelsohn

Novotny

et al. 2018

IJERPH

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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.