Healthy Communities Study Research Articles

Associations of community programs and policies with children's dietary intakes: the Healthy Communities Study.

The impact of community-based obesity prevention efforts on child nutrition has not been adequately studied. Examine relationships between number, type and intensity of community programs and policies (CPPs) and child nutrition. An observational study of 5138 children (grades K-8) in 130 U.S. communities was conducted in 2013-2015. CPPs were identified by 10-14 key informant interviews per community. CPPs were characterized based on: count, intensity, number of different strategies used and number of different behaviours targeted. Scores for the prior 6years were calculated separately for CPPs that addressed primarily nutrition, primarily physical activity (PA) or total combined. Child intakes were calculated from a dietary screener and dietary behaviours were based on survey responses. Multi-level statistical models assessed associations between CPP indices and nutrition measures, adjusting for child and community-level covariates. Implementing more types of strategies across all CPPs was related to lower intakes of total added sugar (when CPPs addressed primarily PA), sugar-sweetened beverages (for nutrition and PA CPPs) and energy-dense foods of minimal nutritional value (for total CPPs). Addressing more behaviours was related to higher intakes of fruit and vegetables (for nutrition and total CPPs) and fibre (total CPPs). Higher count and intensity (PA and total CPPs) were related to more consumption of lower fat compared with higher fat milk. A higher count (PA CPPs) was related to fewer energy-dense foods and whole grains. No other relationships were significant at P<0.05. Multiple characteristics of CPPs to prevent obesity appear important to improve children's diets.

Community characteristics modify the relationship between obesity prevention efforts and dietary intake in children: the Healthy Communities Study.

The influence of community characteristics on the effectiveness of childhood obesity prevention efforts is not well understood. Examine the interaction of community characteristics with the relationship between community programmes and policies (CPPs) and dietary intake. An observational study of 5138 children in grades K-8 in 130 US communities was conducted in 2013-2015. Key informant interviews identified and characterized CPPs. CPP scores were generated for the number of target behaviours (CPP-Behav) and the number of behaviour change strategies (CPP-Strat) addressed by all CPPs and CPPs with nutrition goals over the prior 6years in each community. Dietary intake was assessed by dietary screener and included intake of sugar from sugar-sweetened beverages; energy-dense foods; fruits and vegetables; whole grains; and fibre. Multivariate statistical models assessed the interactions between US region, urbanicity, community-level income, and community-level race/ethnicity and CPP scores in relation to dietary intake. CPP-Strat was positively associated with healthier dietary intakes in the Northeast and West, and in high Hispanic communities; the reverse was true in the South, and in high African-American and low-income communities. The CPP-Behav was positively associated with healthier dietary intakes in the South and rural areas, and the reverse was true in the West. The relationships between CPP index scores and dietary intake were most strongly influenced by region and urbanicity and to a lesser extent by community-level race/ethnicity and income. Findings suggest that different considerations may be needed for childhood obesity prevention efforts in communities with different characteristics.

Association between community characteristics and implementation of community programmes and policies addressing childhood obesity: the Healthy Communities Study.

Little is known about whether characteristics of communities are associated with differential implementation of community programmes and policies to promote physical activity and healthy eating. This study examines associations between community characteristics (e.g. region and race/ethnicity) and the intensity of community programmes and policies implemented to prevent childhood obesity. It explores whether community characteristics moderate the intensity of community efforts to prevent childhood obesity. The objective of this study is to investigate associations between community characteristics and the intensity of community policies and programmes to prevent childhood obesity documented in the Healthy Communities Study that engaged a diverse sample of US communities. Programmes and policies were documented in 130 communities across the USA, reporting over 9000 different community programmes and policies to prevent obesity among children ages 4-15. We examined associations between community characteristics and the intensity of community programmes and policies implemented (i.e. their amount and reach, duration and strength of change strategy). Community characteristics explain 25% of the variability in the intensity of community programmes and policies implemented in communities. Particular characteristics - urbanicity, region, being a large county and the per cent of African-Americans in a community - contributed to more (over 18% of the 25%) of the observed variability.

Objectives of community policies and programs associated with more healthful dietary intakes among children: findings from the Healthy Communities Study.

Rational planning of community policies and programs (CPPs) to prevent obesity requires an understanding of CPP objectives associated with dietary behaviours. The objective of the study is to identify objectives of CPPs associated with healthful dietary behaviours. An observational study identified 4026 nutrition CPPs occurring in 130 communities in the prior 6years. Dietary intakes of fruits and vegetables, added sugar and sugar-sweetened beverages, among others, were reported among 5138 children 4-15years of age from the communities, using a Dietary Screener Questionnaire with children age 9 years and older (parent assisted) or parent proxies for younger children. CPPs were documented through key informant interviews and characterized by their intensity, count, and objectives including target dietary behaviour and food environment change strategy. Associations between dietary intakes and CPP objectives were assessed using hierarchical statistical models. CPPs with the highest intensity scores that targeted fast food or fat intake or provided smaller portions were associated with greater fruit and vegetable intake (0.21, 0.19, 0.23 cup equivalents/day respectively with p values <0.01, 0.04, 0.03). CPPs with the highest intensity scores that restricted the availability of less healthful foods were associated with lower child intakes of total added sugar (-1.08 tsp/day, p<0.01) and sugar from sugar-sweetened beverages (-1.63 tsp/day, p=0.04). Similar associations were observed between CPP count and dietary outcomes. No other significant associations were found between CPP target behaviours or environmental strategies and dietary intakes/behaviours. CPPs that targeted decreases in intakes of less healthful foods and/or aimed to modify the availability of less healthful foods and portions were associated with healthier child dietary behaviours.

Relationship of objective street quality attributes with youth physical activity: findings from the Healthy Communities Study.

Residential environments may significantly influence youth physical activity (PA). However, few studies have examined detailed street quality attributes via observational audits in relation to context-specific PA among youth. The objective of this study was to explore whether the overall quality of street environments, as well as specific attributes, was associated with neighbourhood-based and street-based PA within a national sample of youth in the Healthy Communities Study. Data were collected from 4616 youth from 130 communities across the USA. Youth PA in the neighbourhood and on the participant's street was captured using 7-d recall interviews. Windshield survey observational audits documented five street quality variables: burned, boarded up or abandoned residential units, litter, overall condition of residences, street type and presence of sidewalks in good condition. Youth with no litter on their street reported significantly lower neighbourhood-based PA and youth living on a side street, cul-de-sac, dead-end or one-way street reported greater neighbourhood-based PA. No significant associations were detected for the overall street quality index or with street-based PA. Specific street quality attributes may be associated with youth PA. Further research and collaboration between diverse disciplines and agencies should focus on understanding and improving street quality to promote youth PA and health.

Measuring the intensity of community programs and policies for preventing childhood obesity in a diverse sample of US communities: the Healthy Communities Study.

Efforts to address the critical public health problem of childhood obesity are occurring across the USA; however, little is known about how to characterize the intensity of these efforts. The purposes of this study are to describe the intensity of community programs and policies (CPPs) to address childhood obesity in 130 US communities and to examine the extent to which observed CPPs targeted multiple behaviours and employed a comprehensive array of strategies. To document CPPs occurring over a 10-year period, key informants were interviewed using a semi-structured interview protocol. Staff coded CPPs for key characteristics related to intensity, including reach, duration and strategy. Three types of CPP scores were calculated for intensity of CPPs, targeting of CPPs towards multiple behaviours and strategies used. Nine thousand six hundred eighty-one CPPs were identified. On average, communities had 74 different CPPs in place (standard deviation 30), with variation in documented CPPs (range 25-295). Most communities experienced a steady, modest increase in intensity scores over 10years. CPP targeting scores suggested that communities expanded the focus of their efforts over time to include more behaviours and strategies. Findings of this large-scale study indicate that great variation exists across communities in the intensity and focus of community interventions being implemented to address childhood obesity.

Regional comparisons of walking or bicycling for fun or exercise and for active transport in a nationally distributed sample of community‐based youth

Physical activity helps prevent excessive weight gain in youth. Few studies have examined regional variations in common activities, walking and bicycling. The primary aim was to examine participation in previous 7-day walking/bicycling for active transport and for fun/exercise by region, gender and age groups. Children (n=2693) from 130 diverse, geographically distributed US communities reported participation in previous 7-day walking/bicycling. Mixed model ANOVAs were used to compare walking/bicycling by region, gender and age groups using Healthy Communities Study data. Walking/bicycling for fun/exercise was higher in the Midwest, South and West compared with the Northeast, with the same regional patterns for boys, girls and 9-11-year olds. Walking/bicycling to non-school destinations was higher in the Midwest compared with the South and Northeast, with the same pattern for girls and 9-11-year olds. Walking/bicycling to school was higher Midwest, Northeast and West compared with the South, with similar patterns for girls and 12-15-year olds. Walking/bicycling for fun/exercise and to non-school destinations had higher prevalence than active transport to school. The Northeast reported lower walking/bicycling for fun/exercise; the South and Northeast reported lower walking/bicycling to non-school destinations. Program/policy initiatives should consider contextual demographic influences, as well as purpose/destination of walking/bicycling.

Associations between community programmes and policies and children's physical activity: the Healthy Communities Study.

Community initiatives to promote physical activity in children are common, but evidence supporting their effectiveness is limited. The objective of this study is to examine the relationships between community programmes and policies and children's physical activity in a large and diverse sample of US communities. Programmes and policies to promote children's physical activity were assessed in 130 communities by key informant interviews, and physical activity behaviours were measured by self-report and parental report in samples of children in each community (total n=5138). Associations between composite indices of community programmes and policies and indicators of total and moderate-to-vigorous physical activity were examined without and with adjustment for demographic factors. An index reflecting the 6-year history of the number of behaviour change strategies used in community programmes and policies was positively associated with children's moderate-to-vigorous physical activity. This association was attenuated with adjustment for demographic factors. Effect modification analyses found that the association was positive among non-Hispanic children but was negative for Hispanic children. Community initiatives to promote physical activity in children were positively associated with children's physical activity in non-Hispanic children. Such initiatives were negatively associated with physical activity in Hispanic children, suggesting that future research should consider unique cultural factors when designing community initiatives to promote activity in this population sub-group.

Eating School Meals Daily Is Associated with Healthier Dietary Intakes: The Healthy Communities Study

BackgroundResearch on the association between school meal consumption and overall dietary intake post-Healthy Hunger-Free Kids Act implementation is limited. ObjectiveThis study examines the association between frequency of participating in the National School Lunch and School Breakfast Programs and children’s dietary intakes. DesignThe Healthy Communities Study was a cross-sectional observational study conducted between 2013 and 2015. Participants and settingUS children aged 4 to 15 years (n=5,106) were included. Main outcome measuresDietary measures were assessed using the National Health and Nutrition Examination Survey Dietary Screener Questionnaire. Dietary intake included fruit and vegetables, fiber, whole grains, dairy, calcium, total added sugar, sugar-sweetened beverages, and energy-dense foods of minimal nutritional value. Statistical analysisMultivariate statistical models assessed associations between frequency of eating school breakfast or lunch (every day vs not every day) and dietary intake, adjusting for child- and community-level covariates. ResultsChildren who ate school breakfast every day compared with children who ate 0 to 4 days/wk, reported consuming more fruits and vegetables (0.1 cup/day, 95% CI: 0.01, 0.1), dietary fiber (0.4 g/day, 95% CI: 0.2, 0.7), whole grains (0.1 oz/day, 95% CI: 0.05, 0.1), dairy (0.1 cup/day, 95% CI: 0.05, 0.1), and calcium (34.5 mg/day, 95% CI: 19.1, 49.9). Children who ate school lunch every day, compared with those who ate less frequently, consumed more dairy (0.1 cup/day, 95% CI: 0.1, 0.2) and calcium (32.4 mg/day, 95% CI: 18.1, 46.6). No significant associations were observed between school meal consumption and energy-dense nutrient-poor foods or added sugars. ConclusionsEating school breakfast and school lunch every day by US schoolchildren was associated with modestly healthier dietary intakes. These findings suggest potential nutritional benefits of regularly consuming school meals.

The longitudinal relationship between community programmes and policies to prevent childhood obesity and BMI in children: the Healthy Communities Study.

Although a national epidemic of childhood obesity is apparent, how community-based programmes and policies (CPPs) affect this outcome is not well understood. This study examined the longitudinal relationship between the intensity of CPPs in 130 communities over 10years and body mass index (BMI) of resident children. We also examined whether these relationships differ by key family or community characteristics. Five thousand one hundred thirty-eight children in grades K-8 were recruited through 436 schools located within 130 diverse US communities. Measures of height, weight, nutrition, physical activity and behavioural and demographic family characteristics were obtained during in-home visits. A subsample of families consented to medical record review; these weight and height measures were used to calculate BMI over time for 3227 children. A total of 9681 CPPs were reported during structured interviews of 1421 community key informants, and used to calculate a time series of CPP intensity scores within each community over the previous decade. Linear mixed effect models were used to assess longitudinal relationships between childhood BMI and CPP intensity. An average BMI difference of 1.4kg/m2 (p-value<0.01) was observed between communities with the highest and lowest observed CPP intensity scores, after adjusting for community and child level covariates. BMI/CPP relationships differed significantly by child grade, race/ethnicity, family income and parental education; as well as community-level race/ethnicity. These results indicate that, over time, more intense CPP interventions are related to lower childhood BMI, and that there are disparities in this association by sociodemographic characteristics of families and communities.

Community Policies and Programs to Prevent Obesity and Child Adiposity

Evidence regarding impact of community policies and programs (CPPs) to prevent child obesity is limited, and which combinations of strategies and components are most important is not understood. The Healthy Communities Study was an observational study to assess relationships of characteristics and intensity of CPPs with adiposity, diet, and physical activity in children, taking advantage of variation across the U.S. in community actions to prevent child obesity. The study examined the association of CPPs to prevent child obesity with measured BMI and waist circumference, hypothesizing that communities with more-comprehensive CPPs would have children with lower adiposity. The study included 130 communities selected by probability-based sampling or because of known CPPs targeting child obesity. Data were collected at home visits on 5,138 children during 2013-2015. CPPs were scored for multiple attributes to create a CPP intensity score. A CPP target behavior score reflected the number of distinct target behaviors addressed. Scores were standardized with the smallest observed score across communities being 0 and the largest 1. Multilevel regression analysis in 2016 adjusted for community, household, and individual characteristics. Higher CPP target behavior score was significantly associated with lower BMI and waist circumference in a dose-response relationship, with magnitude for the past 3 years of CPPs of 0.843 (p=0.013) for BMI and 1.783 cm (p=0.020) for waist circumference. This study provides plausible evidence that comprehensive CPPs targeting a greater number of distinct physical activity and nutrition behaviors were associated with lower child adiposity.

School nutrition programs and policies, dietary intake, and obesity: The Healthy Communities Study

The study objective was to examine the association between the school nutrition environment and children's dietary intake and weight status in an observational sample of 5,138 U.S. children ages 4–15 years recruited from 130 communities in the Healthy Communities Study. The study includes information obtained on school characteristics (school participation in state and federal nutrition programs, school wellness committee and coordinator, and district food‐related school wellness policies), measurements of children's dietary practices (dietary screener and dietary behaviors related to child obesity), and measured child height and weight to calculate BMI z‐score. Hierarchical statistical models were generated to relate school nutrition policies and programs to dietary outcomes and BMI z‐score, adjusted for individual‐level covariates (e.g., child race/ethnicity, household income, maximum parent education, maximum parent employment), community covariates (e.g., region, minority status, urbanicity), and school and community level clustering. Children in schools where wellness committees were more active, i.e. met at least once in the past year, compared to children in schools where wellness committees were less active, i.e. met less than once per year, children had 0.10 lower BMI z‐scores (95% CI: −0.17, −0.02; P=0.02) and consumed breakfast on 0.14 more days/week (95% CI: 0.02, 0.25; P=0.02). Schools with farm to school programs compared to schools without such programs had children with a lower frequency of intake of energy dense foods by −0.19 times/day (95% CI: −0.33, −0.05; P=0.01). The presence of the USDA's Team Nutrition Initiative also was associated with an increase in children's intake of 0.14 servings/day of fruits and vegetables (95% CI: 0.00002, 0.14; P=0.05) compared to schools that did not have the program. In pair‐wise comparisons (at a 5% procedure‐wise error rate), schools with wellness committees that met more than once in the past year compared to schools with wellness committees that did not meet, children had significantly lower added sugar intake (−0.78 tsp/day) and significantly lower sugar intake from sugar‐sweetened beverages (−0.43 tsp/day). Overall, improved child diet and weight outcomes were found when schools had an active wellness committee, involvement in a farm to school program, and/or participated in the USDA's Team Nutrition Initiative.Support or Funding InformationSupported by: NHLBI #1K01HL131630 and RWJF HER #73272.

Operational Implementation of the Healthy Communities Study: How Communities Shape Children's Health.

The Healthy Communities Study (HCS) is examining how characteristics of community programs and policies targeting childhood obesity are related to childhood diet, physical activity, and obesity outcomes. The study involves selected districts and public schools in 130 communities; families recruited through schools; and data collected at the community, school, household, and child levels. Data collection took place in two waves-Wave 1 in Spring 2012 and Wave 2 from 2013 to 2015-with analysis to be completed by August 2016. This paper describes operational elements of the HCS, including recruitment activities, field operations, training of data collectors, human subjects protection, and quality assurance and quality control procedures. Experienced trainers oversaw and conducted all training, including training of (1) district and school recruitment staff; (2) telephone interviewers for household screening and recruitment; (3) field data collectors for conducting household data collection; and (4) community liaisons for conducting key informant interviews, document abstraction, and community observations. The study team developed quality assurance and quality control procedures that were implemented for all aspects of the study. Planning and operationalizing a study of this complexity and magnitude, with multiple functional teams, required frequent communication and strong collaboration among all study partners to ensure timely and effective decision making.

Physical Activity Measures in the Healthy Communities Study.

The risk of obesity is reduced when youth engage in recommended levels of physical activity (PA). For that reason, public health organizations in the U.S. have encouraged communities to implement programs and policies designed to increase PA in youth, and many communities have taken on that challenge. However, the long-term effects of those programs and policies on obesity are largely unknown. The Healthy Communities Study is a large-scale observational study of U.S. communities that is examining the characteristics of programs and policies designed to promote healthy behaviors (e.g., increase PA and improve diet) and determining their association with obesity-related outcomes. The purpose of this paper is to describe the methods used to measure PA in children and the personal and community factors that may influence it. The study used both self-reported and objective measures of PA, and measured personal, family, and home influences on PA via three constructs: (1) PA self-schema; (2) parental support; and (3) parental rules regarding PA. Neighborhood and community factors related to PA were assessed using three measures: (1) child perceptions of the neighborhood environment; (2) availability of PA equipment; and (3) attributes of the child's street segment via direct observation. School influences on children's PA were assessed via three constructs: (1) school PA policies; (2) child perceptions of the school PA environment; and (3) school outdoor PA environment. These measures will enable examination of the associations between characteristics of community PA programs and policies and obesity-related outcomes in children and youth.

The Healthy Communities Study: Its Rationale, Aims, and Approach.

Communities across the U.S. are implementing programs and policies designed to address the epidemic of childhood obesity. These programs vary widely in their approaches, including the intensity level, duration, funding, target population, and implementation techniques. However, no previous studies have examined these variations and determined how such aspects of community programs and policies are related to childhood obesity outcomes. The Healthy Communities Study is an observational study that is assessing the associations between characteristics of community programs and policies and BMI, nutrition, and physical activity in children. The Healthy Communities Study was funded in 2010, field data collection and medical record abstraction will be completed in 2015, and data cleaning and analyses will be completed by mid-year 2016. One-hundred and thirty communities (defined as a high school catchment area) and approximately 5,000 children in kindergarten through eighth grade and their parents have been recruited from public elementary and middle schools across the country. The study is examining quantitative and qualitative information obtained from community-based initiatives; measures of community characteristics (e.g., school environment); and child and parent measures, including children's physical activity levels and dietary practices and children's and parents' BMI. The Healthy Communities Study employs a complex study design that includes a diverse sample of communities across the country and combines current/cross-sectional and retrospective data (abstracted from children's medical records). This paper describes the rationale for the Healthy Communities Study, the study aims and logic model, and a brief overview of the study design.

Weight Status Measures Collected in the Healthy Communities Study: Protocols and Analyses.

The Healthy Communities Study is one of the largest studies to assess the relationship between characteristics of community programs and policies to prevent childhood obesity and obesity-related outcomes. The purpose of this paper is to describe the protocol that was developed for collecting the anthropometric data for the study and the procedures for analyzing the data. Data were collected from 2013 to 2015 and analyses will be completed by mid-2016. During in-home visits, Healthy Communities Study staff collected height, weight, and waist circumference measurements from child participants and height and weight measurements from adult participants. The protocol for obtaining these measurements was adapted from the protocol used by the National Health and Nutrition Examination Survey, with modifications to accommodate assessments conducted in homes rather than in a Mobile Examination Center. In addition to anthropometric data from in-home visits, the Healthy Communities Study collected retrospective height and weight measurements from the medical records of child participants. These data were used to calculate trajectories of BMI and BMI z-scores. The study implemented procedures for ensuring the accuracy of the in-home measurements and abstracted medical data. These procedures included automatically checking the ranges on entered data, reviewing data for end-digit patterns, and abstracting selected medical records using two independent abstractors to assess agreement. The collection of longitudinal height and weight measures will allow researchers to address several pressing questions related to how characteristics of community programs and policies are associated with obesity-related outcomes among children.

The Healthy Communities Study Nutrition Assessments: Child Diet and the School Nutrition Environment.

Multifaceted community interventions directed at improving food environments are emerging, but their impact on dietary change and obesity prevalence has not been adequately documented. The Healthy Communities Study (HCS) is seeking to identify characteristics and combinations of programs and policies that are associated with children's diets and obesity-related outcomes in various types of communities across the U.S. The purpose of this paper is to describe the methods used in 2013-2015 in the HCS to assess dietary intake, school nutrition environments, and other nutrition-related behaviors. The conceptual framework of the HCS is based on the socioecological model and behaviors shown in previous studies to be related to obesity in children guided selection of domains. Nine domains were identified as essential measures of nutrition in the HCS: (1) intake of selected foods and beverages; (2) food patterns and behaviors; (3) social support; (4) home environment; (5) school environment; (6) community environment; (7) breastfeeding history; (8) household food insecurity; and (9) dieting behaviors and body image. Children's dietary intake was assessed using a dietary screener and up to two automated 24-hour recalls. Dietary-related behaviors were assessed by a survey administered to the parent, child, or both, depending on child age. School nutrition measures were obtained from a combination of school staff surveys and researcher observations. Information from these measures is expected to contribute to a better understanding of "what is working" to improve the dietary behaviors that are likely to prevent obesity and improve health in children.

Measuring Community Programs and Policies in the Healthy Communities Study.

Childhood obesity is a challenging public health issue facing communities throughout the U.S. Local efforts are believed to be essential to assuring environments that support physical activity and healthy food/beverage consumption among children and their families. However, little is known about how broadly and intensively communities are implementing combinations of programs and policies that address childhood nutrition, physical activity, and weight control. The Healthy Communities Study is a nationwide scientific study in diverse communities to identify characteristics of communities and programs that may be associated with childhood obesity. Data collection occurred in 2013-2015; data analysis will be completed in 2016. As part of the Healthy Communities Study, researchers designed a measurement system to assess the number and scope of community programs and policies and to examine possible associations between calculated "intensity" scores for these programs and policies and behavioral and outcome measures related to healthy weight among children. This report describes the protocol used to capture and code instances of community programs and policies, to characterize attributes of community programs and policies related to study hypotheses, and to calculate the intensity of combinations of community programs and policies (i.e., using the attributes of change strategy, duration, and reach).

Statistical Design Features of the Healthy Communities Study.

The Healthy Communities Study is designed to assess relationships between characteristics of community programs and policies targeting childhood obesity and children's BMI, diet, and physical activity. The study involved a complex data collection protocol implemented over a 2-year period (2013-2015) across a diverse sample of 130 communities, defined as public high school catchment areas. The protocol involved baseline assessment within each community that included in-person or telephone interviews regarding community programs and policies and in-home collection of BMI, nutritional, and physical activity outcomes from a sample of up to 81 children enrolled in kindergarten through eighth grade in public schools. The protocol also involved medical record reviews to establish a longitudinal trajectory of BMI for an estimated 70% of participating children. Staged sampling was used to collect less detailed measures of physical activity and nutrition across the entire sample of children, with a subset assessed using more costly, burdensome, and detailed measures. Data from the Healthy Community Study will be analyzed using both cross-sectional and longitudinal models that account for the complex design and correct for measurement error and bias using a likelihood-based Markov-chain Monte Carlo methodology. This methods paper provides insights into the complex design features of the Healthy Communities Study and may serve as an example for future large-scale studies that assess the relationship between community-based programs and policies and health outcomes of community residents.

Reducing unhealthy weight gain in Fijian adolescents: results of the Healthy Youth Healthy Communities study

Obesity is a significant problem among adolescents in Pacific populations. This paper reports on the outcomes of a 3-year obesity prevention study, Healthy Youth Healthy Communities, which was part of the Pacific Obesity Prevention in Communities project, undertaken with Fijian adolescents. The intervention was developed with schools and comprised social marketing, nutrition and physical activity initiatives and capacity building designed to reduce unhealthy weight, and the individual exposure period was just over 2-year duration. The evaluation incorporated a quasi-experimental, longitudinal design in seven intervention secondary schools near Suva (n=874) and a matched sample of 11 comparison secondary schools from western Viti Levu (n=2,062). There were significant differences between groups at baseline; the intervention group was shorter, weighed less, had a higher proportion of underweight and lower proportion of overweight, and better quality of life (Pediatric Quality of Life Inventory only). At follow-up, the intervention group had lower percentage body fat (-1.17) but also a lower increase in quality of life (Assessment of Quality of Life instrument: -0.02; Pediatric Quality of Life Inventory: -1.94) than the comparison group. There were no other differences in anthropometry, and behaviours' changes showed a mixed pattern. In conclusion, this school-based health promotion programme lowered percentage body fat but did not reduce unhealthy weight gain or influence most obesity-promoting behaviours among Fijian adolescents. Despite growing evidence supporting the efficacy of community-based approaches to reduce obesity among children of European descent, findings from this study failed to demonstrate the efficacy of a community capacity-building approach among an adolescent sample drawn from a different sociocultural, economic and geographical context. Additional 'top-down' or other innovative approaches may be needed to reduce adolescent obesity in the Pacific.