|dc.description.abstract||Background: Consumption of foods and beverages rich in sugar, fat, and salt remains high across all races and ages in the United States. In view of the multifactorial etiology of weight gain, efforts that simultaneously address multiple levels of the food system are recommended that will impact on food selection and consumption. Thus, multilevel multicomponent interventions to address childhood obesity and improve food-related behaviors and intake are needed, particularly in low-resource settings. It is also important to test whether community interventions are effective in ‘real-world’ conditions and in hard-to-reach populations, as participants need to have sufficient exposure to the intervention.
Objective: To evaluate how a multilevel multicomponent childhood obesity prevention intervention impacted the diet and food-related behaviors of low-income urban, predominantly African American families living in neighborhoods with low access to healthy foods in Baltimore City, and to evaluate the patterns of exposure to the different components of the intervention.
Methods: B’more Healthy Communities for Kids (BHCK) was a group-randomized controlled trial in 30 low-income areas in Baltimore for 534 African American youth aged 9-15 years old. BHCK components (policy, wholesaler, small stores, youth-mentor led nutrition education, and social media) simultaneously promoted purchase and consumption of low-sugar, low-fat foods/beverages. Exposure to the different intervention components was assessed via post-intervention interviews with 385 youths and their adult caregivers. Exposure scores were generated based on self-reported viewing of BHCK materials and participating in activities. Food consumption in youth (n=357) was assessed pre/post-intervention using the Block Kids Food Frequency Questionnaire. Analyses were stratified by age (school-age: 9-12; adolescent: 13-15). Additionally, caregivers’ (n=516) self-reported household food acquisition frequency for food items over 30 days, and usual consumption of fruit and vegetable (FV) was assessed in a sub-sample of 226 caregivers via the NCI FV Screener. Hierarchical multilevel models were conducted with random effects at the community and individual levels and assessed average-treatment-effects (ATE). Treatment-on-the-treated-effect (TTE) analyses evaluated the correlation between behavioral change and exposure to BHCK among adults.
Results: The BHCK intervention group was more exposed to the program components, and the comparison group also received some exposure, though to a lesser degree. In ATE analysis, youth in the intervention group purchased almost 1.5 more healthier food/beverage items per week, compared to their counterparts (β = 1.4; 95% CI: 0.1; 2.8). The age-stratified analysis demonstrated that BHCK decreased kcal intake from sweet snacks among intervention adolescents (13-15 years old) by 3.5% compared to their counterparts (β = -3.5; 95% CI: -7.76; -0.05). No significant effect of the intervention was found on caregiver food-related behaviors in the ATE analysis. However, the TTE showed a statistically significant increase in daily intake of fruits by 0.2 servings among adult participants who reported higher exposure to the intervention (0.2+0.1; 95% CI 0.1;0.5). Caregivers reporting greater exposure to social media tripled their daily fruit intake (3.1+0.9; 95% CI 1.3;4.9), compared to baseline.
Conclusions: Multilevel, multicomponent environmental childhood obesity programs are a promising strategy to improve eating behaviors among low-income urban youth. Child-focused community-based nutrition interventions may also benefit family members. Future community-based environmental intervention trials targeting low-income populations may consider enrolling larger sample sizes and improving program intensity, as the likelihood of low exposure is high. Future multilevel studies should consider using social media to improve reach and engage caregiver participants.||