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

Abstract

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.

Improving Consumption and Purchases of Healthier Foods in Retail Environments: A Systematic Review

“…Out of the 34 multi-component interventions, 13 interventions included two Ps [ 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ], 20 interventions included three Ps [ 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ], and one intervention included all four Ps [ 79 ]. All of the multi-component interventions included promotion.…”

“…All of the multi-component interventions included promotion. Overall, 8 had positive effects [ 57 , 58 , 65 , 66 , 71 , 73 , 75 , 76 ], 2 studies had mixed effects (positive + negative) [ 68 , 78 ], 13 had mixed effects (positive + null) [ 46 , 47 , 49 , 51 , 52 , 53 , 56 , 59 , 60 , 61 , 62 , 64 , 72 ], 4 had mixed effects, (positive + null + negative) [ 50 , 55 , 63 , 77 ], and 7 had null effects [ 48 , 54 , 67 , 69 , 70 , 74 , 79 ] (see Table 3 ).…”

“…All five studies utilized an experimental design [ 51 , 59 , 60 , 61 , 62 ] and included components related to increased stock of healthier items. Promotional strategies varied: One incorporated food demonstrations [ 47 ], one used social marketing campaigns [ 48 ], and all five used point-of-purchase promotions (e.g., taste testing, shelf labels, educational displays, food samples, and signage) [ 47 , 48 , 49 , 50 , 51 ].…”

“…Fifteen studies implemented interventions with promotion, product, and placement strategies [ 59 , 60 , 61 , 62 , 63 , 65 , 67 , 68 , 69 , 71 , 73 , 74 , 76 , 77 , 78 ]. Out of the 15, 2 had mixed effects (positive + negative) [ 68 , 78 ], 4 had mixed effects (positive + null) [ 59 , 60 , 61 , 62 ], 2 had mixed effects (positive + negative + null) [ 63 , 77 ], 3 had null effects [ 67 , 69 , 74 ], and 4 had positive effects [ 65 , 71 , 73 , 76 ].…”

“…Five studies were experimental [ 59 , 60 , 61 , 62 , 63 ]. The interventions included adding point-of-purchase promotions, changing the store structure and environment (e.g., adding a buffet bar or refrigerator, grouping products in a display), and altering the in-store location of products (e.g., multiple facings, prime placement, secondary placement, checkout aisle end-caps), and increased stocking of healthier products [ 59 , 60 , 61 , 62 , 63 ]. All five studies found mixed effects for improving the purchasing and consumption of healthy food.…”