Factors predicting parent engagement in a family-based childhood obesity prevention and control program.

BACKGROUND: Family-based interventions are efficacious at preventing and controlling childhood overweight and obesity; however, implementation is often hindered by low parent engagement. The purpose of this study was to evaluate predictors of parent engagement in a family-based childhood obesity prevention and control intervention. METHODS: Predictors were assessed in a clinic-based community health worker (CHW)-led Family Wellness Program consisting of in-person educational workshops attended by parents and children. This program was part of a larger effort known as the Childhood Obesity Research Demonstration projects. Participants included 128 adult caretakers of children ages 2-11 (98% female). Predictors of parent engagement (e.g., anthropometric, sociodemographic, psychosocial variables) were assessed prior to the intervention. Attendance at intervention activities was recorded by the CHW. Zero-inflated Poisson regression was used to determine predictors of non-attendance and degree of attendance. RESULTS: Parents' lower readiness to make behavioral and parenting changes related to their child's health was the sole predictor of non-attendance at planned intervention activities in adjusted models (OR = 0.41, p < .05). Higher levels of family functioning predicted degree of attendance (RR = 1.25, p < .01). CONCLUSIONS: To improve engagement in family-based childhood obesity prevention interventions, researchers should consider assessing and tailoring intervention strategies to align with the family's readiness to change and promote family functioning. TRIAL REGISTRATION: NCT02197390, 22/07/2014.

Process Evaluation of an Early Care and Education Intervention: The California Childhood Obesity Research Demonstration Study (CA-CORD).

Given the widespread use of out-of-home child care in the United States, early care and education (ECE) providers offer ideal settings to promote health behaviors among Hispanic/Latino children whose obesity prevalence remains high. This study details the process evaluation of ECE intervention strategies of a childhood obesity research demonstration study (California Childhood Obesity Research Demonstration [CA-CORD]) to prevent and control obesity among Hispanic/Latino children aged 2 to 12 years. Participating ECE providers received the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) materials and action planning sessions with a trained interventionist; Sports, Play, and Active Recreation for Kids (SPARK) physical activity (PA), health behavior, and body mass index assessment trainings; and health behavior toolkit, cooking kit, water dispensers, and posters to promote healthy eating, PA, water consumption, and quality sleep. Intervention logs and director/lead teacher interviews evaluated how well 14 center-based and 9 private ECE providers implemented policy, system, and environmental changes. NAP SACC was implemented with higher fidelity than other strategies, and participation in SPARK trainings was lower than health behavior trainings. ECE directors/lead teachers reported that the intervention activities and materials helped them promote the targeted behaviors, especially PA. Results demonstrated that the use of NAP SACC, trainings, and toolkit had high fidelity and were potentially replicable for implementation in ECE settings among Hispanic/Latino communities.

A Qualitative Examination of Parent Engagement in a Family-Based Childhood Obesity Program.

Low parent engagement is frequently identified as a barrier to effective implementation of family-based childhood obesity prevention and control programs. A more nuanced understanding of factors affecting parent engagement is important for improving implementation and, ultimately, program efficacy. This qualitative study examined factors influencing parent engagement in a family-based childhood obesity prevention and control program. Semistructured interviews informed by the health belief model and the transtheoretical model were conducted with 22 predominantly Latina mothers following the scheduled conclusion of program activities. Spanish- and English-language interviews were transcribed, translated into English (if Spanish), coded, and summarized using established protocols. Differences between parents who attended at least two thirds of program activities and those who did not were examined. There were no significant demographic differences between parents who did and did not complete two thirds of program activities. Findings indicated that differences in parent engagement may be at least partially explained by differences in parental motivations for participating and in barriers and facilitators, such as children's level of support and enthusiasm for the program. Parents were highly satisfied with the program content and the community health workers who delivered the program. This study adds to emergent literature regarding parents' experiences in family-based childhood obesity prevention and control programs. Potential targets for improving program engagement are discussed.

Factors Affecting Implementation of the California Childhood Obesity Research Demonstration (CA-CORD) Project, 2013.

INTRODUCTION: Ecological approaches to health behavior change require effective engagement from and coordination of activities among diverse community stakeholders. We identified facilitators of and barriers to implementation experienced by project leaders and key stakeholders involved in the Imperial County, California, Childhood Obesity Research Demonstration project, a multilevel, multisector intervention to prevent and control childhood obesity. METHODS: A total of 74 semistructured interviews were conducted with project leaders (n = 6) and key stakeholders (n = 68) representing multiple levels of influence in the health care, early care and education, and school sectors. Interviews, informed by the Multilevel Implementation Framework, were conducted in 2013, approximately 12 months after year-one project implementation, and were transcribed, coded, and summarized. RESULTS: Respondents emphasized the importance of engaging parents and of ensuring support from senior leaders of participating organizations. In schools, obtaining teacher buy-in was described as particularly important, given lower perceived compatibility of the intervention with organizational priorities. From a program planning perspective, key facilitators of implementation in all 3 sectors included taking a participatory approach to the development of program materials, gradually introducing intervention activities, and minimizing staff burden. Barriers to implementation were staff turnover, limited local control over food provided by external vendors or school district policies, and limited availability of supportive resources within the broader community. CONCLUSION: Project leaders and stakeholders in all sectors reported similar facilitators of and barriers to implementation, suggesting the possibility for synergy in intervention planning efforts.

Predictors of change in sports participation in Latino and non-Latino children.

BACKGROUND: Few prospective studies have examined predictors of change in specific physical activity (PA) behaviours in different ethnic groups. PURPOSE: To assess predictors of change in sports participation in Latino and non-Latino 5-8 year-old children in San Diego, California. METHODS: Average sports participation frequency (days/week) was assessed by validated parent-report at baseline (Nov 2006-May 2008) and 1 year later in 541 children (45.0% male, 41.1% Latino; mean ± SD age: 6.6 ± 0.7 years) taking part in an obesity prevention study (Project MOVE). Biological (sex, age, Body Mass Index z-score), socio-cultural (ethnicity, income, care giver education), parental (PA rules, PA encouragement) and environmental factors (home PA equipment, PA location) were assessed at baseline. Associations between change in sports participation and potential predictors were studied using multilevel linear regression stratified by Latino ethnicity, adjusted for sex, baseline sport participation, study condition and recruitment area. RESULTS: Sports participation increased over 1 year (mean change: +0.5 days; p<0.001) and change was similar for boys and girls (p=0.95), but Latino children showed a greater increase (p=0.03). The number of locations used for PA (p=0.024) and the total frequency of PA location use (p=0.018) were positively associated with increased sports participation among Latinos. No predictors were identified for non-Latino children. CONCLUSIONS: Only factors relating to PA location were identified as predictors of change in sports participation for Latino children. Interventions targeting specific PA behaviours such as sports participation may need to consider PA locations for Latino children and be tailored for specific ethnic groups.

Mediators affecting girls' levels of physical activity outside of school: findings from the trial of activity in adolescent girls.

BACKGROUND: Providing after school activities is a community level approach for reducing the decline in physical activity of girls as they reach early adolescence. PURPOSE: The purpose of this study was to examine psychosocial, environmental, and behavioral factors as potential mediators of after school physical activity in adolescent girls. METHODS: We assessed objectively measured levels of physical activity occurring outside of school and potential predictors and mediators of activity in girls participating in the Trial of Activity in Adolescent Girls (TAAG). RESULTS: We found that the TAAG intervention had a statistically significant and positive effect on out of school activity in the 2006 cohort. Self-efficacy, friends' social support, total social support, and difficulty getting to and from community activities mediated the level of moderate to vigorous physical activity in girls. CONCLUSIONS: Parents, communities, and schools should provide and enhance opportunities outside of the school day for adolescents to be active. Reducing transportation barriers and enlisting social support appear to be key.

Community agency survey formative research results from the TAAG study.

School and community agency collaboration can potentially increase physical activity opportunities for youth. Few studies have examined the role of community agencies in promoting physical activity, much less in collaboration with schools. This article describes formative research data collection from community agencies to inform the development of the Trial of Activity for Adolescent Girls (TAAG) intervention to provide out-of-school physical activity programs for girls. The community agency survey is designed to assess agency capacity to provide physical activity programs for girls, including resources, programs, and partnerships. Most agency respondents (n = 138) report operations during after-school hours, adequate facilities, and program options for girls, although most are sport oriented. Agency resources and programming vary considerably across the six TAAG field sites. Many agencies report partnerships, some involving schools, although not necessarily related to physical activity. Implications for the TAAG intervention are presented.

Physical activity attitudes, preferences, and practices in African American, Hispanic, and Caucasian girls.

Physical activity levels in girls decline dramatically during adolescence, most profoundly among minorities. To explore ethnic and racial variation in attitudes toward physical activity, semistructured interviews (n = 80) and physical activity checklists (n = 130) are conducted with African American, Hispanic, and Caucasian middle school girls in six locations across the United States. Girls from all groups have similar perceptions of the benefits of physical activity, with staying in shape as the most important. Girls have similar negative perceptions of physical activity, including getting hurt, sweating, aggressive players, and embarrassment. Chores, running or jogging, exercises, and dance are common activities for girls regardless of ethnicity. Basketball, swimming, running, and dance are commonly cited favorite activities, although there are slight differences between ethnic groups. The results suggest that factors other than ethnicity contribute to girls' physical activity preferences and that distinct interventions may not be needed for each ethnic group.

Our Choice/Nuestra Opción: the Imperial County, California, Childhood Obesity Research Demonstration study (CA-CORD).

BACKGROUND: Despite recent declines among young children, obesity remains a public health burden in the United States, including among Latino/Hispanic children. The determining factors are many and are too complex to fully address with interventions that focus on single factors, such as parenting behaviors or school policies. In this article, we describe a multisector, multilevel intervention to prevent and control childhood obesity in predominantly Mexican-origin communities in Southern California, one of three sites of the CDC-funded Childhood Obesity Research Demonstration (CA-CORD) study. METHODS: CA-CORD is a partnership between a university-affiliated research institute, a federally qualified health center, and a county public health department. We used formative research, advisory committee members' recommendations, and previous research to inform the development of the CA-CORD project. Our theory-informed multisector, multilevel intervention targets improvements in four health behaviors: fruit, vegetable, and water consumption; physical activity; and quality sleep. Intervention partners include 1200 families, a federally qualified health center (including three clinics), 26 early care and education centers, two elementary school districts (and 20 elementary schools), three community recreation centers, and three restaurants. Intervention components in these sectors target changes in behaviors, policies, systems, and the social and physical environment. Evaluation activities include assessment of the primary outcome, BMI z-score, at baseline, 12-, and 18-months post-baseline, and sector evaluations at baseline, 12, and 24 months. CONCLUSIONS: Identifying feasible and effective strategies to prevent and control childhood obesity has the potential to effect real changes in children's current and future health status.

Viability of parks and recreation centers as sites for youth physical activity promotion.

This descriptive study explored the potential for public parks and recreation centers as intervention sites for promoting physical activity among youth. Directors (55% women) of 44 recreation centers in San Diego County completed a survey of their centers' physical activity programming for youths ages 3 to 17 years (response rate = 60%). On an average weekday, 373 (SD = 782) youths participated in physical activity at a center. More boys attended than girls (p <.05). Some centers sponsored after-school programs at elementary (41%) and middle (11%) schools but not at high schools (0%). Primary barriers to providing physical activity programs were inadequate staffing (54%), funding (39%), and facilities (32%). Girls and low-income youth were identified as the most difficult populations to reach. Directors reported considerable interest in collaborating on interventions to improve youth activity programs. Public parks and recreation centers are understudied settings with the potential for substantial involvement in efforts to promote youth physical activity.

Neighborhood Income Matters: Disparities in Community Recreation Facilities, Amenities, and Programs.

EXECUTIVE SUMMARY: Physical activity is important for children's development and their current and future health; national recommendations are for them to engage in at least 60 minutes of moderate to vigorous physical activity daily. Most of children's physical activity occurs outside of school hours; thus, access to and the quality of community recreation facilities and programming are particularly relevant. Researchers have identified strong links among socioeconomic disparities, physical inactivity, and poor health, but a limited number of studies have examined how access to community recreation facilities and physical activity programming are affected by local socioeconomic conditions. In many low-income communities, park and recreation facilities may be the only place for children to be physically active outside of school; thus, it is important to understand the connection between community environmental characteristics and child use of facilities. We were interested in determining whether the characteristics of community recreation center environments would be associated with neighborhood income and children's use of the centers. To do this we designed a study to identify whether neighborhood income disparities were associated with recreation center environmental characteristics and whether those characteristics were associated with young children's use of the center. We believed that findings to these questions could inform policy decisions within recreation centers and recreation departments to improve equity, facility use, and levels of physical activity. Thirty community recreation centers and 541 nearby families with children aged 5-8 years in five cities in Southern California participated in the study. To generate data we used multiple research instrumentation including (a) a structured physical activity survey of program offerings and barriers to children's participation in physical activity at the center [completed by recreation center supervisors], (b) direct observation of the presence and condition of recreation center facilities and amenities by trained assessors, and (c) a parent questionnaire on child use of the center. Results indicated that the condition of the community center facilities and amenities, but not their number, was positively related to neighborhood income (p < .05). As well, the number of cost-free, but not total, youth physical activity programs was inversely associated with neighborhood income (p < .05). Parent's report of their children using centers was positively associated with the number of amenities observed there (p < .05). The results suggest that policy makers and community recreation center staff should consider both neighborhood economic issues and environmental characteristics in their efforts to promote children's physical activity at recreation centers.

Association between school- and nonschool-based activity programs and physical activity in adolescent girls.

BACKGROUND: Some researchers have questioned if activity programs would be more effective if based outside school (eg, community leagues) rather than within schools. This study compared participation in activity programs based within and outside of school, and estimated the associations between participation and moderate-vigorous physical activity (MVPA) among adolescent girls. METHODS: Within the Trial of Activity for Adolescent Girls, independent samples of 1559 6th-grade girls (age 11 to 12) and 3282 8th-grade girls (age 13 to 14) reported program participation using questionnaires. MVPA was measured using accelerometers. Linear mixed models accounted for school and site clustering. RESULTS: Sixth-grade girls reported 5 times as many programs outside school as within school (4.1 vs. 0.8); daily MVPA was 0.29 minutes higher (1.2% of the mean) for each additional program outside school. Compared with 6th-grade girls, 8th-grade girls participated in 1.3 fewer programs outside school, while programs' association with MVPA was unchanged. Conversely, school programs' association with MVPA was greater in 8th grade. Daily MVPA was 1.33 minutes higher per school program, and participation declined 0.13. CONCLUSION: Programs within and outside schools can both increase activity among adolescent girls. Intervention research should focus on increasing participation in school programs, and increasing movement during programs outside school.