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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.

ABSTRACT: BACKGROUND:Consumption 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. METHODS:B'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. RESULTS:Overall 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 (??=?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 (??=?-?3.5; 95% CI: -7.76; -?0.05). No impact was seen on SSB consumption. CONCLUSION:BHCK 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 REGISTRATION:NCT02181010 (July 2, 2014, retrospectively registered).

SUBMITTER: Trude ACB

PROVIDER: S-EPMC6206663 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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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.

Trude Angela C B ACB Surkan Pamela J PJ Cheskin Lawrence J LJ Gittelsohn Joel J

Nutrition journal 20181029 1

<h4>Background</h4>Consumption 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.<h4>Methods</h4>B'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 s ...[more]

PMID: 30373597

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Project description:BackgroundPoint-of-sale is a potentially important opportunity to promote healthy eating through nutrition education and environment modification. The aim of this review was to describe and review the evidence of effectiveness of various types of interventions that have been used at point-of-sale to encourage purchase and/or eating of healthier food and to improve health outcomes, and the extent to which effectiveness was related to intensity, duration and intervention setting.MethodsRecords from searches in databases were screened and assessed against inclusion criteria. Included studies had risk of bias assessed. Intervention effectiveness was assessed for two outcomes: i) purchase and/or intake of healthier food options and/or nutrient intake; and ii) mediating factors that might effect the primary outcome.ResultsThe search identified 5635 references. Thirty-two papers met the inclusion criteria. Twelve studies had low risk of bias and were classified as strong, nine were moderate and 11 were weak. Six intervention types and a range of different outcome measures were described in these papers: i) nutrition education and promotion alone through supermarkets/stores; ii) nutrition education plus enhanced availability of healthy food; iii) monetary incentive alone; iv) nutrition education plus monetary incentives; v) nutrition intervention through vending machines; and vi) nutrition intervention through shopping online. The evidence of this review indicates that monetary incentives offered to customers for a short-term look promising in increasing purchase of healthier food options when the intervention is applied by itself in stores or supermarkets. There was a lack of good quality studies addressing all other types of relevant point-of-sale interventions examining change in purchase and/or intake of healthier food options. There were few studies that examined mediating factors that might mediate the effect on the primary outcomes of relevant interventions.ConclusionsA range of intervention types have been used at point-of-sale to encourage healthy purchasing and/or intake of healthier food options and to improve health outcomes. There is a need for more well designed studies on the effectiveness of a range of point-of-sale interventions to encourage healthier eating and improve health outcomes, and of the mediating factors that might impact these interventions.

Project description:The primary objective of this study was to explore views of dairy calf welfare and dairy product consumption habits among youth and adults. The secondary objective was to explore views of dairy calf welfare and dairy product consumption habits among a subset of parent-child pairs. Participants 5-17 years of age (n = 463) and 18 years old or greater (n = 1,310) completed an in-person survey at the Minnesota State Fair (St. Paul, MN, USA) in summer 2018. A subset of these data was comprised of parent-child pairs (n = 188). The survey was administered via Qualtrics using iPads and included multiple-choice questions about demographics and calf welfare, an open-ended question on "what dairy calves need to have a good life," and multiple-choice questions about participants' consumption of dairy products and nondairy alternative products. Content analysis was used for responses to the open-ended question, and concepts to describe dairy calf welfare views were identified. Fisher's exact test and Cohen's Kappa were used to investigate the relationships between parent-child pair responses about dairy calf welfare. In addition to these methods, prevalence-adjusted and bias-adjusted kappa (PABAK) were used to investigate the relationships between parent-child pair responses about consumption habits. The median age of all youth participants was 11 years and 61% were female, 82% were urban residents, and 63% did not have prior experience handling agricultural animals but 83% had visited a farm in the past. Most youth participants (94.4%) indicated that they consumed dairy products, while 47.1% consumed nondairy alternatives products. Median age range of all adult participants was 45-54 years, 65% were female, 82% urban residents, and 81% did not have prior experience handling agricultural animals but 63% had visited a farm in the past. Most adult participants (94%) indicated that they consumed dairy products and 47% indicated that they consumed nondairy alternative products. In response to "what dairy calves need to have a good life," youth and adults most commonly focused on issues related to biological functioning (82 and 70% of youth and adults mentioning this concept, respectively), followed by natural living (44 and 50%, respectively), humane care (30 and 20%, respectively), and affective states (5% of both youth and adults). For the natural living concept of animal welfare, parent and child responses were slightly associated (Kappa = 0.19; P = 0.01; overall agreement = 61%). Almost all participants reported consuming dairy products, therefore, the agreement is high between parents and children because in most households (90%), both parents and children consume dairy products. However, child consumption was observed to be lower (75%, 9/12) when parents do not consume dairy than when parents do consume dairy (95%, 167/176), leading to a Kappa of 0.20 (P = 0.006, PABAK = 0.81) and a slight association between parents and children. The results suggest that biological functioning is highly valued by the public and views of parents and their children related to natural living in dairy calves are slightly associated.

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Dataset Information

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.

Publications

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.

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