Impact of a Multi‐Level Multi‐Component Food Environment/Behavioral Intervention on Youth Leaders

Abstract

IntroductionPeer‐led interventions may be an effective means of addressing the childhood obesity epidemic, particularly as part of multi‐level interventions. Thus, we aimed to expand and sustain the youth‐leader program for the second wave of the B'more Healthy Communities for Kids (BHCK) trial using a combined policy, systems and environmental (PSE) approach.MethodsOur PSE approach targeted children (10–14 years old); and BHCK youth‐leaders (n=14) in low‐income, predominately African American neighborhoods in Baltimore City. The youth‐leaders delivered nutrition education in recreation centers, community corner stores and carryouts, acted as spokesperson in BHCK social media, and implemented environmental changes at food stores and recreation centers to improve healthy food access. Nutrition interactive sessions (n=98) were evaluated through multiple process measures to ensure adequate reach, dose delivered, fidelity, selected impact measures to plan (quality), and reproducibility for sustainability of the youth‐leader programing. Youth‐leader skills, dietary intake, and shopping behaviors were measured at pre‐ and post‐intervention and compared to a similar‐age sample of youth who were not selected to deliver the program thus assigned to the comparison group. A difference‐in‐difference analysis assessed the impact of the program on BHCK youth‐leaders and their counterparts (n=14 intervention, 11 comparison) on frequency of purchasing of specific promoted foods, overall energy intake, fat intake and other indicators of dietary quality (FV servings), and Body Mass Index. Difference‐in‐difference analysis was also conducted to determine the impact of the intervention on dietary factors of a subsample of child participants (n=93) receiving the intervention.ResultsThe wave 2 BHCK youth‐leader program was delivered with moderate to high reach, dose, and moderate fidelity. An average of 9.5 children (10–14 years old) participated in each nutrition session. Overall, we distributed 1018 handouts and 312 recipe cards. We conducted 98 nutrition sessions and distributed 1080 giveaways. We observed significant improvements in outcome expectancies and leadership skills in the most highly involved youth leaders (p<0.05). Analysis of available data indicated that children receiving the intervention from the youth‐leaders showed a trend in decreased total calorie intake and dietary fat compared to comparison, although not statistically significant.ConclusionsThe wave‐2 youth‐leader program was successfully implemented in low‐income areas of Baltimore. Youth‐leaders appeared to benefit as part of multi‐level programs, with improved psychosocial factors and leadership skills. Sustainability of such complex programs remains a challenge that must be addressed through strong partnerships established at the beginning of PSE projects.Support or Funding InformationResearch reported in this publication was supported by the Northeast ‐ Regional Nutrition Education Center of Excellence, and the Global Obesity Prevention Center (GOPC) at Johns Hopkins, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the Office of the Director, National Institutes of Health (OD) under award number U54HD070725. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. AT is supported by a doctoral fellowship from CNPq (GDE: 249316/2013‐7).