Abstract
BackgroundChildren living in rural areas are at higher risk for obesity compared to urban children, and Native American (NA) children have the highest prevalence of overweight/obesity for all races combined. Out-of-school programs (OOSPs) are a promising setting to improve children’s health. Parents are important in supporting their child’s obesity-related behaviors, yet it remains unclear what combination and dose of parent engagement strategies is feasible and optimal. This study’s primary objective was to assess the feasibility of an OOSP and home-based obesity prevention intervention for rural NA and non-NA children.MethodsThis was an 11-week, two group, randomized feasibility study. Participants were children and their parents at one OOSP on a rural American Indian reservation. Children, ages 6–9, were randomized to receive the Generations Health (GH) intervention or comparison condition. The GH group received daily activities focused on physical activity (PA), nutrition, sleep, and reducing TV/screen time, and frequently engaged parents. The comparison group received usual OOSP activities. To assess intervention feasibility, we measured recruitment and participation rates and program satisfaction. We assessed pre- to posttest changes in body composition, PA and sleep patterns, dietary intake and Healthy Eating Index-2010 (HEI-2010) scores, TV/screen time, and nutrition knowledge. We report recruitment and participation rates as percentages and participants’ program satisfaction as means. Two-tailed paired t tests and 95% confidence intervals were used to detect changes in behavioral and health outcome variables.ResultsForty-six children met age eligibility criteria; following screening, 52% (24/46) met the inclusion criteria and 96% (23/24) were randomized to the study. Overall, 91% of the children participated in the intervention and 100% participated in at least some of the posttest assessments. Parents reported high program satisfaction (mean rating of 4, on a 1–5 scale). Our outcome measure for child adiposity, zBMI, was reduced by 0.15 in the GH group, but increased by 0.13 in the comparison condition. Meaningful changes were evident for total kilocalories, HEI-2010 scores, PA, TV/screen time, and nutrition knowledge.ConclusionsHigh recruitment, participation and program satisfaction and positive health and behavioral outcomes at 11 weeks provide encouraging indications of the feasibility and potential effectiveness of the intervention.Trial registrationISRCTN24274245
Highlights
Children living in rural areas are at higher risk for obesity compared to urban children, and Native American (NA) children have the highest prevalence of overweight/obesity for all races combined
Each Generations Health Out-of-school programs (OOSPs) session begins with 40 min of moderate-to vigorous physical activity (MVPA) that is followed by 20 min of nutrition, reducing sedentary behaviors including TV/screen time, and improving sleep activities
We focused on the 6–9 years old age group because they comprise most of the children regularly attending OOSPs [49] and the literature shows a paucity of interventions targeting 1st, 2nd, and 3rd graders
Summary
Children living in rural areas are at higher risk for obesity compared to urban children, and Native American (NA) children have the highest prevalence of overweight/obesity for all races combined. This study’s primary objective was to assess the feasibility of an OOSP and home-based obesity prevention intervention for rural NA and non-NA children. The nearly 12 million children living in rural areas in the USA have 26% greater odds of obesity compared to urban children [1], even after controlling for sociodemographics [2,3,4,5]. Recent studies suggest that preadolescent children ages 6–11 years are most likely to experience acceleration of weight gain during childhood [8], suggesting it may be especially important to provide effective health promotion programs during the early elementary school years. A recent review of obesity disparities research targeting children and minority populations in underserved communities shows that very few trials intervene at multiple levels or intervene on multiple factors (e.g., home, school, afterschool, local organization policies) [12, 13]. A recent multilevel intervention that improved fruit and vegetable consumption in mostly Black and Hispanic children living in Southern and Pacific Coast rural communities [14] shows that a multilevel approach can be successfully implemented in diverse rural communities, but implementation and rigorous evaluation of such interventions is rare
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
