Exposure to a Multilevel, Multicomponent Obesity Prevention Intervention (OPREVENT2) in Rural Native American Communities: Variability and Association with Change in Diet Quality.

Michelle Estradé,Leslie C Redmond,Sheila Fleischhacker,Marla Pardilla,Jacqueline Swartz,Ellen J I Van Dongen,Caroline R Wensel,Lisa Poirier,Angela C B Trude,Joel Gittelsohn,Margarita S Treuth

doi:10.3390/ijerph182212128

Abstract

The OPREVENT2 obesity prevention trial was a multilevel multicomponent (MLMC) intervention implemented in rural Native American communities in the Midwest and Southwest U.S. Intervention components were delivered through local food stores, worksites, schools, community action coalitions, and by social and community media. Due to the complex nature of MLMC intervention trials, it is useful to assess participants’ exposure to each component of the intervention in order to assess impact. In this paper, we present a detailed methodology for evaluating participant exposure to MLMC intervention, and we explore how exposure to the OPREVENT2 trial impacted participant diet quality. There were no significant differences in total exposure score by age group, sex, or geographic region, but exposure to sub-components of the intervention differed significantly by age group, sex, and geographical region. Participants with the highest overall exposure scores showed significantly more improvement in diet quality from baseline to follow up compared to those who were least exposed to the intervention. Improved diet quality was also significantly positively associated with several exposure sub-components. While evaluating exposure to an entire MLMC intervention is complex and imperfect, it can provide useful insight into an intervention’s impact on key outcome measures, and it can help identify which components of the intervention were most effective.

Highlights

IntroductionNative American peoples were prevented from practicing their traditional food cultures, characterized by predominantly plant-based diets supplemented with hunting, trapping, and fishing, and instead forced to adopt more sedentary agricultural practices and rely on government subsidies [1,2,3]
Since a primary focus of OPREVENT2 was on improving dietary quality [32], we examined whether exposure was associated with changes in Healthy Eating Index (HEI-2015)
Future intervention efforts should evaluate the balance between resources required for implementation and achieved exposure

Summary

Introduction

Native American peoples were prevented from practicing their traditional food cultures, characterized by predominantly plant-based diets supplemented with hunting, trapping, and fishing, and instead forced to adopt more sedentary agricultural practices and rely on government subsidies [1,2,3]. This transition resulted in a dietary pattern characterized by high intake of processed foods high in fat, sugar, and sodium, and low in fiber [4,5,6], Int. J.

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