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Results of a Multi-level Intervention to Prevent and Control Childhood Obesity among Latino Children: The Aventuras Para Niños Study

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Community-based interventions are needed to reduce the burden of childhood obesity.

Purpose

To evaluate the impact of a multi-level promotora-based (Community Health Advisor) intervention to promote healthy eating and physical activity and prevent excess weight gain among Latino children.

Methods

Thirteen elementary schools were randomized to one of four intervention conditions: individual/family level (Family-only), school/community level (Community-only), combined (Family + Community), or a measurement-only condition. Participants were 808 Latino parents and their children enrolled in kindergarten through 2nd grade. Measures included parent and child body mass index (BMI) and a self-administered parent survey that assessed several parent and child behaviors.

Results

There were no significant intervention effects on children’s BMI z-score. The family intervention changed several obesity-related child behaviors (e.g., fruit/vegetable consumption) and these were mediated by changes in parenting variables (e.g., parent monitoring).

Conclusion

A promotora-based behavioral intervention was efficacious at changing parental factors and child obesity-related health behaviors.

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References

  1. Ogden C, Carroll M, Curtin L, Lamb M, Flegal K. Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA. 2010; 303: 242249.

    Article  PubMed  CAS  Google Scholar 

  2. Freedman D, Khan L, Serdula M, et al. The relation of childhood BMI to adult adiposity: The Bogalusa Heart Study. Pediatrics. 2005; 115: 2227.

    PubMed  Google Scholar 

  3. Narayan K, Boyle J, Thompson T, Sorensen S, Williamson D. Lifetime risk for diabetes mellitus in the United States. JAMA. 2003; 290: 18841890.

    Article  PubMed  CAS  Google Scholar 

  4. Stokols D. Translating social ecological theory into guidelines for community health promotion. Am J Health Promot. 1996; 10: 282298.

    Article  PubMed  CAS  Google Scholar 

  5. Elder J, Ayala G, Parra-Medina D, Talavera G. Health communication in the Latino community: Issues and approaches. Annu Rev Public Health. 2009; 30: 227251.

    Article  PubMed  Google Scholar 

  6. Bandura A. Social Foundations of Thought and Action. Englewood Cliffs, NJ: Prentice-Hall, 1986.

    Google Scholar 

  7. Janz NK, Becker M. The health belief model: A decade later. Health Educ Q 1984;11: 1–47.

    Article  PubMed  CAS  Google Scholar 

  8. Kreuter MW, McClure SM. The role of culture in health communication. Annu Rev Public Health. 2004; 25: 439–55

    Article  PubMed  Google Scholar 

  9. Ayala G X, Vaz L, Earp JA, Elder JP, Cherrington A. Outcome effectiveness of the lay health advisor model among Latinos in the United States: An examination by role type. Health Educ Res. 2010; 25: 815–40.

    Article  PubMed  Google Scholar 

  10. Troiano R, Berrigan D, Dodd K, et al. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008; 40: 181188.

    PubMed  Google Scholar 

  11. Crespo C, Smit E, Troiano R, et al. Television watching, energy intake, and obesity in US children: Results from the third National Health and Nutrition Examination Survey, 1988–1994. Arch Pediatr Adolesc Med. 2001; 155: 360365.

    PubMed  CAS  Google Scholar 

  12. Matheson D, Killen J, Wang Y, Varady A, Robinson T. Children’s food consumption during television viewing. Am J Clin Nutr. 2004; 79: 10881094.

    PubMed  CAS  Google Scholar 

  13. Marshall S, Biddle S, Gorely T, Cameron N, Murdey I. Relationships between media use, body fatness and physical activity in children and youth: A meta-analysis. Int J Obes Relat Metab Disord. 2004; 28: 12381246.

    Article  PubMed  CAS  Google Scholar 

  14. Moreno L, Rodríguez G. Dietary risk factors for development of childhood obesity. Curr Opin Clin Nutr Metab Care. 2007; 10: 336341.

    Article  PubMed  Google Scholar 

  15. Ludwig D, Peterson K, Gortmaker S. Relation between consumption of sugar-sweetened drinks and childhood obesity: A prospective, observational analysis. Lancet. 2001; 357: 505508.

    Article  PubMed  CAS  Google Scholar 

  16. Ayala G, Rogers M, Arredondo E, et al. Away-from-home food intake and risk for obesity: Examining the influence of context. Obesity. 2008; 16: 10021008.

    Article  PubMed  Google Scholar 

  17. Arredondo E, Elder J, Ayala G, et al. Is parenting style related to children’s healthy eating and physical activity in Latino families? Health Educ Res. 2006; 21: 862871.

    Article  PubMed  Google Scholar 

  18. Ventura A, Birch L. Does parenting affect children’s eating and weight status? Int J Behav Nutr Phys Act. 2008; 5: 15.

    Article  PubMed  Google Scholar 

  19. Kumanyika S, Grier S. Targeting interventions for ethnic minority and low-income populations. Future Child. 2006; 16: 187207.

    Article  PubMed  Google Scholar 

  20. Faith M, Scanlon K, Birch L, Francis L, Sherry B. Parent–child feeding strategies and their relationships to child eating and weight status. Obes Res. 2004; 12: 17111722.

    Article  PubMed  Google Scholar 

  21. Golan M, Crow S. Targeting parents exclusively in the treatment of childhood obesity: Long-term results. Obes Res. 2004; 12: 357361.

    Article  PubMed  Google Scholar 

  22. Black J, Macinko J. The changing distribution and determinants of obesity in the neighborhoods of New York City, 2003–2007. Am J Epidemiol. 2010; 171: 765775.

    Article  PubMed  Google Scholar 

  23. Luepker R, Perry C, McKinlay S, et al. Outcomes of a field trial to improve children’s dietary patterns and physical activity. The Child and Adolescent Trial for Cardiovascular Health. CATCH collaborative group. JAMA. 1996; 275: 768776.

    Article  PubMed  CAS  Google Scholar 

  24. Caballero B, Clay T, Davis S, et al. Pathways: A school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren. Am J Clin Nutr. 2003; 78: 10301038.

    PubMed  CAS  Google Scholar 

  25. Gentile D, Welk G, Eisenmann J, et al. Evaluation of a multiple ecological level child obesity prevention program: Switch what you Do, View, and Chew. BMC Med. 2009; 7: 49.

    Article  PubMed  Google Scholar 

  26. Spiegel S, Foulk D. Reducing overweight through a multidisciplinary school-based intervention. Obesity. 2006; 14: 8896.

    Article  PubMed  Google Scholar 

  27. Robinson T. Reducing children’s television viewing to prevent obesity: A randomized controlled trial. JAMA. 1999; 282: 15611567.

    Article  PubMed  CAS  Google Scholar 

  28. Gortmaker S, Peterson K, Wiecha J, et al. Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Arch Pediatr Adolesc Med. 1999; 153: 409418.

    PubMed  CAS  Google Scholar 

  29. Economos C, Hyatt R, Goldberg J, et al. A community intervention reduces BMI z-score in children: Shape up Somerville first year results. Obesity. 2007; 15: 13251336.

    Article  PubMed  Google Scholar 

  30. Kelly CM, Hoehner CM, Baker EA, Brennan Ramirez LK, Brownson RC. Promoting physical activity in communities: Approaches for successful evaluation of programs and policies. Eval and Progr Plan. 2006; 29: 280292.

    Article  Google Scholar 

  31. Wang S, Brownell K. Public policy and obesity: The need to marry science with advocacy. Psychiatr Clin North Am. 2005; 28: 235252.

    Article  PubMed  Google Scholar 

  32. Viswanathan M et al. Outcomes of community health worker interventions. In: Evidence report/technology assessment No. 181; AHRQ Publication No. 09-E014. 2009, Agency for Healthcare Research and Quality: Rockville, MD.

  33. Rhodes SD, Foley KL, Zometa CS, Bloom FR. Lay health advisor interventions among Hispanics/Latinos: A qualitative systematic review. Am J Prev Med. 2007; 33: 418–27.

    Article  PubMed  Google Scholar 

  34. Summerbell CD, Waters E, Edmunds L, Kelly SAM, Brown T, Campbell KJ. Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews. 2005, Issue 3.

  35. Elder J, Arredondo E, Campbell N, et al. Individual, family, and community environmental correlates of obesity in Latino elementary school children. J Sch Health. 2010; 80: 2030.

    Article  PubMed  Google Scholar 

  36. Duerksen SC, Campbell N, Arredondo EM, et al. Aventuras para Niños: Obesity prevention in the homes, schools, and neighborhoods of Mexican American children. In W.-D. Brettschneider and R. Naul (eds); Obesity in Europe: Young people’s physical activity and sedentary lifestyles. Frankfurt/M. u.a.: Peter Lang Publishing, 2007, 135–152.

  37. Elder J, Ayala G, Campbell N, et al. Interpersonal and print nutrition communication for a Spanish-dominant Latino population: Secretos de la Buena Vida. Health Psychol. 2005; 24: 4957.

    Article  PubMed  Google Scholar 

  38. Elder J, Campbell N, Candelaria J, et al. Project Salsa. Development and institutionalization of a nutritional health promotion project in a Latino community. Am J Health Promot. 1998; 12: 391401.

    Article  PubMed  CAS  Google Scholar 

  39. Baer D, Wolf M, Risley T. Some current dimensions of applied behavior analysis. J Appl Behav Anal. 1968; 1: 9197.

    Article  PubMed  CAS  Google Scholar 

  40. Cohen D, Scribner R, Farley T. A structural model of health behavior: A pragmatic approach to explain and influence health behaviors at the population level. Prev Med. 2000; 30: 146154.

    Article  PubMed  CAS  Google Scholar 

  41. Sallis J, McKenzie T, Kolody B, et al. Effects of health-related physical education on academic achievement: Project SPARK. Res Q Exerc Sport. 1999; 70: 127134.

    PubMed  CAS  Google Scholar 

  42. Stratton G, Mullan E. The effect of multicolor playground markings on children’s physical activity level during recess. Prev Med. 2005; 41: 828833.

    Article  PubMed  Google Scholar 

  43. Stewart J, Dennison D, Kohl H, Doyle J. Exercise level and energy expenditure in the TAKE 10! in-class physical activity program. J Sch Health. 2004; 74: 397400.

    Article  PubMed  Google Scholar 

  44. Tudor-Locke C, Ainsworth B, Popkin B. Active commuting to school: An overlooked source of childrens’ physical activity? Sports Med. 2001; 31: 309313.

    Article  PubMed  CAS  Google Scholar 

  45. CDC. National Health and Nutrition Examination Survey III Body Measurements (Anthropometry) Manual. In NCHS (ed). Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 1988.

  46. Kuczmarski R, Ogden C, Grummer-Strawn L, et al. CDC growth charts: United States. Adv Data. 2000:1–27.

  47. Weintraub D, tirumalai E, Haydel F, Fujimoto M, Fulton J, Robinson T. Team sports for overweight children: The Stanford Sports to Prevent Obesity Randomized Trial (SPORT). Arch Pediatr Adolesc Med. 2008; 162: 232–237.

    Article  PubMed  Google Scholar 

  48. Rosenberg D, Sallis J, Conway T, Cain K, McKenzie T. Active transportation to school over 2 years in relation to weight status and physical activity. Obesity. 2006; 14: 1771–1776.

    Article  PubMed  Google Scholar 

  49. Bower J, Hales D, Tate D, Rubin D, Benjamin S, Ward D. The childcare environment and children’s physical activity. Am J Prev Med. 2008; 34: 23–29.

    Article  PubMed  Google Scholar 

  50. Andaya A, Arredondo E, Alcaraz J, Lindsay S, Elder J. The Association between family meals, tv viewing during meals, and fruit, vegetables, soda, and chips intake among Latino children. J Nutr Educ Behav. 2010.

  51. Zive M, Frank-Spohrer G, Sallis J, et al. Determinants of dietary intake in a sample of white and Mexican-American children. J Am Diet Assoc. 1998; 98: 12821289.

    Article  PubMed  CAS  Google Scholar 

  52. Larios S, Ayala G, Arredondo E, Baquero B, Elder J. Development and validation of a scale to measure Latino parenting strategies related to children’s obesigenic behaviors. The parenting strategies for eating and activity scale (PEAS). Appetite. 2009; 52: 166172.

    Article  PubMed  Google Scholar 

  53. Elder J, Ayala G, Slymen D, Arredondo E, Campbell N. Evaluating psychosocial and behavioral mechanisms of change in a tailored communication intervention. Health Educ Behav. 2009; 36: 366380.

    Article  PubMed  Google Scholar 

  54. Ayala G, Baquero B, Arredondo E, Campbell N, Larios S, Elder J. Association between family variables and Mexican American children’s dietary behaviors. J Nutr Educ Behav. 2007; 39: 62–69.

    Article  PubMed  Google Scholar 

  55. Gable S, Chang Y, Krull J. Television watching and frequency of family meals are predictive of overweight onset and persistence in a national sample of school-aged children. J Am Diet Assoc. 2007; 107: 53–61.

    Article  PubMed  Google Scholar 

  56. Ayala G, Mueller K, Lopez-Madurga E, Campbell N, Elder J. Restaurant and food shopping selections among Latino women in Southern California. J Am Diet Assoc. 2005; 105: 3845.

    Article  PubMed  Google Scholar 

  57. Siddiqui O, Hedeker D, Flay B, Hu F. Intraclass correlation estimates in a school-based smoking prevention study. Am Journal Epi. 1996; 144: 425–33.

    CAS  Google Scholar 

  58. MacKinnon D, Fairchild A, Fritz M. Mediation analysis. Annu Rev Psychol. 2007; 58: 593614.

    Article  PubMed  Google Scholar 

  59. MacKinnon D, Fritz M, Williams J, Lockwood C. Distribution of the product confidence limits for the indirect effect: Program PRODCLIN. Behav Res Methods. 2007; 39: 384389.

    Article  PubMed  Google Scholar 

  60. Ayala G, Elder J, Campbell N, et al. Longitudinal intervention effects on parenting of the Aventuras para Niños study. Am J Prev Med. 2010; 38: 154162.

    Article  PubMed  Google Scholar 

  61. Rosner B, Prineas R, Loggie J, Daniels SR. Percentiles for body mass index in U.S. children 5 to 17 years of age. Pediatrics. 1998; 132: 211–22.

    Article  CAS  Google Scholar 

  62. Altman D, Schulz K, Moher D, Egger M, Davidoff F et al. The revised CONSORT statement for reporting randomized trials: Explanation and elaboration. Ann Intern Med. 2001; 134: 663–694.

    PubMed  CAS  Google Scholar 

  63. Kral T, Faith M. Influences on child eating and weight development from a behavioral genetics perspective. J Pediatr Psychol. 2009; 34: 596–605.

    Article  PubMed  Google Scholar 

  64. Foster G, Sherman S, Borradaile K, et al. A policy-based school intervention to prevent overweight and obesity. Pediatrics. 2008; 121: e794-802.

    Article  PubMed  Google Scholar 

  65. Israel B, Schulz A, Parker E, Becker A. Community-based participatory research: Policy recommendations for promoting a partnership approach in health research. Edu Health Change Learn Prac. 2001; 14: 182–197.

    Article  CAS  Google Scholar 

  66. Baranowski T, Cerin E, Baranowski J. Steps in the design, development and formative evaluation of obesity prevention-related behavior change trials. Int J Behav Nutr Phys Act. 2009; 6: 6.

    Article  PubMed  Google Scholar 

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Acknowledgments

The Aventuras para Niños study was funded by the National Heart, Lung and Blood Institute (5R01HL073776). Additional support was provided to Dr. Elder and Dr. Ayala by the Centers for Disease Control and Prevention (5U48DP000036), to Dr. Ayala by the American Cancer Society (RSGPB 113653), to Dr. Arredondo by the American Cancer Society (PFT-04-156-01), and to Dr. Crespo by the National Institute of Diabetes and Digestive and Kidney Diseases (F31DK079345) and the National Heart, Lung and Blood Institute (T32HL079891).

Conflict of Interest Statement

The authors have no conflicts of interest to disclose.

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Correspondence to Noe C. Crespo Ph.D., M.P.H., M.S..

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Crespo, N.C., Elder, J.P., Ayala, G.X. et al. Results of a Multi-level Intervention to Prevent and Control Childhood Obesity among Latino Children: The Aventuras Para Niños Study. ann. behav. med. 43, 84–100 (2012). https://doi.org/10.1007/s12160-011-9332-7

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  • DOI: https://doi.org/10.1007/s12160-011-9332-7

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