A Community-Academic Partnership to Improve Access to Healthy Foods in Low-Income Communities

Purpose: Access to healthy foods is often limited in low-income communities and prevents the adoption of a healthy diet needed to meet national dietary recommendations, reduce chronic disease, and prevent obesity. The Healthy Harvest Community Gardening Partnership is a community-based participatory research program between faith-based organizations, academic institutions, local philanthropy, and other non-profit institutions, created in 2009 for improving access to healthy foods and quality of life through a community garden network. Methods: Healthy Harvest uses a social ecological framework combining individual, interpersonal, and community level influences into a single program, and employs a train-the-trainer approach for providing expertise in gardening and community-capacity building to low-income, predominately African American communities. Results: To date, garden sites have been constructed at 4 churches (average church size N=353, 98% African American) and one school (287 students, 98% African American) in an inner city, low-income community. Liaisons from each garden site have attended six monthly trainings on gardening and community-capacity building. Monthly evaluations of gardening activity indicate that a total of 139 individual garden plots have been constructed of which 101 show signs of use, 79 have visible plants, 31 have visible produce of which approximately 300 lbs have been donated to local food pantries. A total of 53 community garden volunteer workdays have been conducted with over 90 volunteers participating in garden maintenance and community outreach. Initial data demonstrate the feasibility of this approach for increasing access to fruits and vegetables in low-income communities. Qualitative data is being collected to evaluate the effect of Healthy Harvest on lifestyle (physical activity and diet) and social (perceptions of neighborhood, feelings of connectedness) variables. Furthermore, Healthy Harvest plans to develop a system for distributing produce, therefore providing access to healthy foods on a broader scale. Conclusions: Overall, this novel community-academic partnership has demonstrated initial feasibility to improve access to healthy foods in low-income communities and could provide a model for other communities to prevent obesity

A Pilot Study of the Effects of a Tailored Web-Based Intervention on Promoting Fruit and Vegetable Intake in African American Families

Background: The current study examined the effects of a Web-based tailored parenting intervention on increasing fruit and vegetable intake in African American families. Methods: Forty-seven African American parents (mean age, 41.32±7.30; 93.6% female) with an adolescent (mean age, 13.32±1.46; 59.6% female) participated in a Web-based autonomy-support parenting tailored intervention session to increase both parent and youth fruit and vegetable (F a Web-based information phase, and a goal-setting and action plan phase. Self-reported measures of parenting skills [based on autonomy (choice), support, and communication] and FandV intake (assessed as average daily intake) were assessed at baseline and at a 1-week follow-up session. Results: There was a significant increase in parents' self-reports of daily fruit intake from pretest to the 1-week follow-up. Parent and adolescent combined FandV intake also significantly increased from pretest to 1-week follow-up. Overall, parents reported that the program was easy to navigate and that they enjoyed participating in the Web-based online program. Conclusions: Current findings provide preliminary support for an autonomy-support parent tailored Web-based program for improving dietary intake in African American families.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140334/1/chi.2013.0070.pd

Using process evaluation for program improvement in dose, fidelity and reach: the ACT trial experience

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to demonstrate how formative program process evaluation was used to improve dose and fidelity of implementation, as well as reach of the intervention into the target population, in the "Active by Choice Today" (ACT) randomized school-based trial from years 1 to 3 of implementation.</p> <p>Methods</p> <p>The intervention integrated constructs from Self-Determination Theory and Social Cognitive Theory to enhance intrinsic motivation and behavioral skills for increasing long-term physical activity (PA) behavior in underserved adolescents (low income, minorities). ACT formative process data were examined at the end of each year to provide timely, corrective feedback to keep the intervention "on track".</p> <p>Results</p> <p>Between years 1 and 2 and years 2 and 3, three significant changes were made to attempt to increase dose and fidelity rates in the program delivery and participant attendance (reach). These changes included expanding the staff training, reformatting the intervention manual, and developing a tracking system for contacting parents of students who were not attending the after-school programs regularly. Process outcomes suggest that these efforts resulted in notable improvements in attendance, dose, and fidelity of intervention implementation from years 1 to 2 and 2 to 3 of the ACT trial.</p> <p>Conclusion</p> <p>Process evaluation methods, particularly implementation monitoring, are useful tools to ensure fidelity in intervention trials and for identifying key best practices for intervention delivery.</p

Results of the Active by Choice Today (ACT) Randomized Trial for Increasing Physical Activity in Low-Income and Minority Adolescents

Objective - This study reports the results of the Active by Choice Today (ACT) trial for increasing moderate-to-vigorous physical activity (MVPA) in low-income and minority adolescents. Design - The ACT program was a randomized controlled school-based trial testing the efficacy of a motivational plus behavioral skills intervention on increasing MVPA in underserved adolescents. Twenty-four middle schools were matched on school size, percentage minorities, percentage free or reduced lunch, and urban or rural setting before randomization. A total of 1,563 6th grade students (mean age, 11.3 years, 73% African American, 71% free or reduced lunch, 55% female) participated in either a 17-week (over one academic year) intervention or comparison after-school program. Main Outcome Measure - The primary outcome measure was MVPA based on 7-day accelerometry estimates at 2-weeks postintervention and an intermediate outcome was MVPA at midintervention. Results - At midintervention students in the intervention condition engaged in 4.87 greater minutes of MVPA per day (95% CI: 1.18 to 8.57) than control students. Students in intervention schools engaged in 9.11 min (95% CI: 5.73 to 12.48) more of MVPA per day than those in control schools during the program time periods; indicating a 27 min per week increase in MVPA. No significant effect of the ACT intervention was found outside of school times or for MVPA at 2-weeks postintervention. Conclusions - Motivational and behavioral skills programs are effective at increasing MVPA in low-income and minority adolescents during program hours, but further research is needed to address home barriers to youth MVPA

Computerized Self-Monitoring and Email Feedback for Weight Loss

Objective The purpose of this study was to develop and evaluate a 12-week weight management intervention involving computerized self-monitoring and technology-assisted feedback with and without an enhanced behavioral component. Methods 120 overweight (30.5 ± 2.6 kg/m2) adults (45.0 ± 10.3 years) were randomized to one of three groups: computerized self-monitoring with Basic feedback (n = 45), Enhanced behavioral feedback (n = 45), or wait-list control (n = 30). Intervention participants used a computer software program to record dietary and physical activity information. Weekly e-mail feedback was based on computer-generated reports, and participants attended monthly measurement visits. Results The Basic and Enhanced groups experienced significant weight reduction (−2.7 ± 3.3 kg and −2.5 ± 3.1 kg) in comparison to the Control group (0.3 ± 2.2; p \u3c 0.05). Waist circumference and systolic blood pressure also decreased in intervention groups compared to Control (p \u3c 0.01). Conclusions A program using computerized self-monitoring, technology-assisted feedback, and monthly measurement visits produced significant weight loss after 12 weeks. However, the addition of an enhanced behavioral component did not improve the effectiveness of the program. Practice implications This study suggests that healthcare professionals can effectively deliver a weight management intervention using technology-assisted strategies in a format that may complement and reduce face-to-face sessions

Computerized Self-Monitoring and Email Feedback for Weight Loss

Objective The purpose of this study was to develop and evaluate a 12-week weight management intervention involving computerized self-monitoring and technology-assisted feedback with and without an enhanced behavioral component. Methods 120 overweight (30.5 ± 2.6 kg/m2) adults (45.0 ± 10.3 years) were randomized to one of three groups: computerized self-monitoring with Basic feedback (n = 45), Enhanced behavioral feedback (n = 45), or wait-list control (n = 30). Intervention participants used a computer software program to record dietary and physical activity information. Weekly e-mail feedback was based on computer-generated reports, and participants attended monthly measurement visits. Results The Basic and Enhanced groups experienced significant weight reduction (−2.7 ± 3.3 kg and −2.5 ± 3.1 kg) in comparison to the Control group (0.3 ± 2.2; p \u3c 0.05). Waist circumference and systolic blood pressure also decreased in intervention groups compared to Control (p \u3c 0.01). Conclusions A program using computerized self-monitoring, technology-assisted feedback, and monthly measurement visits produced significant weight loss after 12 weeks. However, the addition of an enhanced behavioral component did not improve the effectiveness of the program. Practice implications This study suggests that healthcare professionals can effectively deliver a weight management intervention using technology-assisted strategies in a format that may complement and reduce face-to-face sessions

Promoting Social Nurturance and Positive Social Environments to Reduce Obesity in High-Risk Youth

Nurturing environments within the context of families, schools, and communities all play an important role in enhancing youth's behavioral choices and health outcomes. The increasing prevalence rates of obesity among youth, especially among low income and ethnic minorities, highlight the need to develop effective and innovative intervention approaches that promote positive supportive environments across different contexts for at-risk youth. We propose that the integration of Social Cognitive Theory, Family Systems Theory, and Self-Determination Theory offers a useful framework for understanding how individual, family, and social-environmental-level factors contribute to the development of nurturing environments. In this paper, we summarize evidence-based randomized controlled trials that integrate positive parenting, motivational, and behavioral skills strategies in different contexts, including primary care, home, community, and school-based settings. Taken together, these studies suggest that youth and parents are most likely to benefit when youth receive individual-level behavioral skills, family-level support and communication, and autonomous motivational support from the broader social environment. Future investigators and healthcare providers should consider integrating these evidence-based approaches that support the effects of positive social climate-based interventions on promoting healthy eating, physical activity, and weight management in youth

The Associations of Parenting Factors with Adolescent Body Mass Index in an Underserved Population

Background. The current study examined parental factors related to risk of adolescent obesity within the context of a family systems framework. Methods. Seventy predominantly African American, low-income caregiver-adolescent dyads participated in the study. Validated measures of parental perceived child risk for development of type 2 diabetes mellitus, parental limit setting for sedentary behavior, and parental nurturance were evaluated as predictors of adolescent body mass index. Results. In this cross-sectional study, multiple linear regression demonstrated that parents of adolescents with higher zBMI reported worrying more about their child's risk of developing type 2 diabetes mellitus. Parent limit setting was also a significant predictor of adolescent zBMI. Contrary to expectations, higher levels of nurturance were associated with higher adolescent zBMI. Post hoc analyses revealed a trend towards a significant interaction between nurturance and limit setting, such that high levels of both parental nurturance and limit setting were associated with lower adolescent zBMI. Conclusions. Current findings suggest the importance of authoritative parenting and monitoring of adolescent health behaviors in the treatment of obesity