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Adaptation and Dissemination of an Evidence-based Obesity Prevention Intervention


<p>We propose to adapt, implement, and disseminate this evidence-based obesity prevention intervention through an existing partnership of the University of Illinois Extension-Cook County, the University of Illinois at Chicago (UIC) Partnership for Health Promotion (a program that delivers SNAP-Ed, the Supplemental Nutritional Assistance Program Education), and UIC's Departments of Kinesiology & Nutrition and Medicine. </p>
<p>Goal 1. Utilize formative research to adapt the Hip-Hop to Health intervention for delivery through the Expanded Food and Nutrition Education Program (EFNEP) and similar programs that deliver SNAP-Ed. Objective 1.1 Convene an advisory group and conduct key informant interviews of relevant stakeholders and obesity prevention experts to adapt the intervention for delivery by EFNEP and SNAP-Ed staff. Objective 1.2 Conduct focus groups with staff from the University of Illinois Extension EFNEP-Cook County and Chicago Partnership for Health Promotion to examine knowledge, attitudes, behaviors, feelings, experiences, and needs relevant to adapting an obesity prevention intervention in diverse settings. Objective 1.3 Review the adapted intervention with EFNEP and SNAP-Ed staff. </p>
<p>Goal 2. Train University of Illinois Extension EFNEP-Cook County and Chicago Partnership for Health Promotion staff to deliver the adapted intervention. Objective 2.1 Develop training protocols and train staff on the adapted Hip-Hop to Health intervention. Objective 2.2 Pilot training protocols and conduct a training session with staff. Objective 2.3 Evaluate paraprofessional staff on knowledge and competency and assess cost of training. </p>
<p>Goal 3. Work with University of Illinois EFNEP Cook County and the Chicago Partnership for Health Promotion to conduct a randomized comparative effectiveness study. Objective 3.1 Randomize preschool programs to receive the adapted Hip-Hop to Health (HH) or a Standard General Nutrition Intervention (GN). Objective 3.2 Conduct HH and GN in six sessions over 12 weeks. </p>
<p>Goal 4. Evaluate diet, learning, and lifestyle outcomes of the adapted intervention. Objective 4.1 Compare changes in dietary intake (i.e., fat, fruit and vegetable intake) at 13 weeks between children and parents who received HH and those who received GN. Objective 4.2 Compare change in nutrition knowledge at 13 weeks between children and parents who received HH and those who received GN. Objective 4.3 Compare changes in physical activity and television viewing at 13 weeks between children and parents who received HH and those who received GN. Objective 4.4 Compare BMI trajectory at 13 weeks between children who received HH and those who received GN. </p>
<p>Goal 5. Document the adapted intervention and disseminate it on a larger scale. Objective 5.1 Disseminate intervention delivery manual for HH that can be used by EFNEP and related agencies that deliver SNAP-Ed to successfully implement HH in diverse settings. Objective 5.2 Disseminate the HH manual to EFNEP and SNAP-Ed staff and provide advisory support for implementation at other locations. Objective 5.3 Track implementation, sustainability, and dissemination through a process evaluation using the RE-AIM model.</p>

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<p>NON-TECHNICAL SUMMARY: <br/>This proposal addresses the AFRI priority area of Food Safety, Nutrition and Health, the FY 2010 RFA of Childhood Obesity Prevention and a single-function Extension Project. Obesity has become epidemic in the US. Socioeconomic status and race/ethnicity are associated with disparities in health outcomes and these associations are evident with obesity in families from low-income populations. Recent data suggest that the prevalence of obesity is even higher among low-income, preschool children. Thus, the preschool years may represent a critical period for addressing weight-related behaviors among these at-risk children. Poor diet quality and inactivity are known to increase the risk for obesity. To improve diet and activity in minority, low income children and their parent/caregivers, we developed "Hip Hop to Health," a nutrition and physical
activity obesity prevention program. We evaluated the intervention by comparing changes in body mass index (BMI) in 3-5 year old minority, low income children randomized to either Hip Hop to Health (HH) or a general health intervention (GH). Results at follow-up showed that children in HH had smaller changes in BMI compared to children in the GH control group. HH was the first efficacy trial to document positive effects on BMI in low-income, preschool children. We propose to adapt, implement, and disseminate this evidence-based obesity prevention intervention through a partnership with the University of Illinois Extension Cook County, the Chicago Partnership for Health Promotion (a program that delivers Supplemental Nutritional Assistance Programs Education (SNAP-Ed), and faculty at UIC.
APPROACH:<br/>This study is a randomized comparative effectiveness trial comparing our Hip-Hop intervention (HH) to a general nutrition control intervention (GN) designed for low-income children and their parents. The study will be conducted in three successive cohorts of 3 schools each with 2 HH and 1 GN in each cohort. Therefore, we will randomize 9 classes from EFNEP or SNAP-Ed programs in Chicago to either HH or GN. Paraprofessionals that are taught the HH curriculum will work in different sites than paraprofessionals that are taught the GN curriculum, which eliminates most concerns about cross-intervention contamination. All children and parents who are recipients of EFENP and SNAP-Ed services are eligible to participate. Parents will be recruited to sign an informed consent for themselves and their children. Inclusion criteria include 1) agree to give informed
consent, 2) agree to give demographic data and have anthropometric data collection, and 3) agree to have food intake and activity assessed. Parent/child dyads in HH will receive a six-session obesity prevention intervention that is delivered over 12 weeks. GN parent/child dyads will receive a general nutrition intervention including information on general nutrition that is also delivered in six-sessions over 12 weeks. We will collect data on BMI, nutrition knowledge, diet intake, and physical activity post-intervention to assess the effects of the intervention on these endpoints. We will also collect information on potential mediators of diet and physical activity behavior change, including stress, social support, food insecurity, and barriers to healthy food preparation. Study Design Analysis. The study is a 2 Group (HH, GN) X 2 Times (Baseline, End of Program) repeated measures design
with subject and school clustering. We will employ PROC MIXED in SAS version 9.2 or later and conduct the analysis within the linear mixed models framework with random effects to represent within-subjects and within-schools similarity. We will transform outlying data as warranted. We will analyze discrete outcomes using the companion PROC GLIMMIX for generalized linear mixed models. Note that mixed models accommodate both time-invariant and time-varying covariates and make best use of incomplete data under plausible missing at random missing data assumptions. Analyses of mediation effects will be carried out using version 6 of the M-plus program. The design of the study affords purchase on important theoretical and practical issues. First, five outcome measures (i.e., food and vegetable intake, percentage of fat in diet, physical activity, television viewing, and nutrition knowledge) are
obtained at two time points (i.e., baseline and end of program). With appropriate scaling (transformation) it should be possible to regard the vector of five measures as approximately multivariate normal and to study the pattern of inter-correlations (as in factor analysis). Second, the outcomes describe the behaviors of both children and their parents, and owing to the fact that parents report on their children, a positive child-parent correlation is to be expected and cannot be taken to indicate parental sway.

<p>PROGRESS: 2011/02 TO 2012/01
<p>OUTPUTS: <br/>Activities: We have conducted 6 key informant interviews to gain feedback and recommendations regarding curriculum content, barriers to curriculum adaptation, and ways to modify delivery format. We used the information collected in the informant interviews were used to inform the protocol for a series of five focus groups with a total of 19 people that included nutrition educators from EFNEP and Snap-en , as well as parents of preschool age children. Both the interviews and the focus groups have been transcribed, analyzed and used in the development of the nutrition and exercise curriculum for preschool aged children and their families. We have conducted three conferences with our community partners, during which we have received valuable feedback on our existing health education curriculum, as well as early drafts of the
curriculum we have created. We have created an 8-unit healthy eating and exercise curriculum for preschool aged children. We have also created a complimentary 8-unit curriculum for parents of pre-school aged children to teach them about healthy eating and exercise in a framework of empowerment and parenting tips to encourage healthy habits and lifestyle for the whole family.
<p>PARTICIPANTS: Principal Investigator: Marian Fitzgibbon, Ph.D. oversaw curriculum adaptation and implementation efforts, worked closely with Drs. Odom-Young, Braunschweig, Stolley, and other leadership in EFENP and SNAP-Ed to plan and implement different phases of the study, and worked with Dr. Berbaum on study design. Co-Principal Investigator: Angela Odoms-Young, Ph.D. oversaw and implemented the qualitative aspects of the project, particularly the focus groups and key informant interviews, analyze the data in
order to inform the adaptation of the Hip Hop curriculum, worked closely with Dr. Fitzgibbon and the other investigators to evaluate the qualitative data. Co-Investigator: Melinda Stolley, Ph.D. is the creator of the Hip-Hop to Health curriculum, and also developed the training protocol for public school teachers to implement Hip-Hop to Health within their classrooms. She worked with the other investigators and Advisory Group to adapt the intervention. Co-Investigator: Michael Berbaum, Ph.D., has primary responsibility for guiding the randomization and statistical analyses. Co-Investigator: Carol Braunschweig, Ph.D., R.D. Dr. Braunschweig has worked with the Co-PI's and other investigators to insure that the dietary aspects of the Hip-Hop to Health curriculum reflect state of the art dietary information and nutritional recommendations. Project Coordinator: Lara Blumstein oversaw and
coordinated all of the components of the study to date. Specifically she maintained and update IRB approval process, supervised focus groups and data collector hiring, assisted with data collection and consent process, coordinated all team and community partner meetings, developed policies and procedures for recruitment, data collection, and intervention, along with the Co-PIs, co-investigators, and research staff and developed necessary procedural modifications. Lara has also played a key role in the adaptation of the Hip Hop to Health curriculum Intervention Coordinator: Rebeccah Michaelis has assisted in the development and adaptaion of the Hip Hop to Health curriculum. Data Manager/Analyst: Linda Schiffer, MS, MPH, This year she designed and developed the study data base and design scannable forms for the project's data collection. Data Coordinator: Leo Restrepo, MS,. This year he
has assisted in creating scannable forms for data collection. Data Collector: Sylvia Muralles is a Data Collector. This year she has recruited and consented study participants in focus groups and transcribed collected focus group data. Community Partners: Jennifer McCarthy and Jacqueline Wilson from the Expanded Food and Nutrition Education Program (EFNEP) in Chicago and Anastasia McGee from the Chicago Partner Health Promotion (CPHP) have attended three Community Partners planning and adaptation meetings in the first year of the project. TARGET AUDIENCES: Nothing significant to report during this reporting period. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Fitzgibbon, Marian L; Odoms-Young, Angela; Stolley, Melinda R; Berbaum, Michael L; Braunschweig, Carol L
University of Illinois - Chicago
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