Enhancing physical and social environments to reduce obesity among public housing residents: rationale, trial design, and baseline data for the Healthy Families study

Perceptions of dietary sugar consumption among public housing residents using a modified qualitative photovoice methodology

BACKGROUND

Consumption of dietary sugar (e.g. sugar-sweetened beverages and high sugar foods) is a predominant contributor to chronic health conditions, particularly in communities of low socio-economic position. Our objective was to explore social contextual influences on dietary sugar consumption among public housing residents in Boston, MA.

METHODS

This study employed the use of photovoice, a qualitative technique involving participant photography and narratives. Due to the COVID-19 pandemic, we conducted photovoice methods using Zoom. Adult residents of two public housing developments were invited to participate in pairs of online group sessions. The first session provided training on photovoice methodology and a discussion of example photographs and written narratives. Over the ensuing two weeks, participants took or identified stock photos as visual examples of personally-experienced barriers and facilitators of avoiding sugary foods and beverages. During the second session, study staff facilitated development of verbal narratives via group discussion. A total of 18 sessions were audio recorded, transcribed, and double-coded for themes.

RESULTS

Participants (n = 49) were predominantly women and identified as either Hispanic (61.2%) or non-Hispanic Black (30.6%). Approximately half of participants (51.1%) reported consuming sugar-sweetened beverages at least once per day. Qualitative analysis revealed participant-identified influences on dietary sugar consumption across multiple domains of influence, including individual preferences, beliefs, or circumstance, the social environment, the physical environment, and the macro environment.

CONCLUSIONS

The multiple social contextual influences on dietary sugar consumption identified in this study, particularly centrality of the home, cultural influences, individual-level sabotaging factors, may be useful for development of culturally tailored health promotion messaging and intervention through multiple channels.

General practitioner-centered rural obesity management: Design, protocol and baseline data of the German HAPpEN pragmatic trial

Objective

HAPpEN aims to implement and evaluate a holistic general practitioner-centered, interdisciplinary obesity management strategy in rural Germany, focusing on feasibility, health outcomes, and economic benefits.

Methods

HAPpEN is a 12-month, pragmatic single-arm, multicenter trial, informed by a formative survey, and initiated in April 2023 with 98 obese participants (body mass index, BMI ≥ 30 kg/m2) in Kulmbach, Germany. The program integrates nutritional counseling, physical activity, and behavior change techniques, including smartphone-based self-monitoring. Monthly consultations help set personalized goals using a multi-stage grading scale. Primary outcomes include BMI, body weight, waist circumference, heart rate, blood pressure and parameters, while secondary outcomes assess quality of life, wellbeing, health literacy, social interaction, and digital therapy support.

Results

The baseline cohort (mean age: 46.9 ± 11.8 years, 74.1 % female) exhibited high obesity rates (mean BMI: 40.1 ± 6.1 kg/m2), with 48.5 % classified as grade III obese. Common comorbidities were hypertension (51.8 %), dyslipidemia (30.5 %) and diabetes (21.8 %). Chronic joint paint, mainly in the knees and hips, affected up to 82.4 %. A familial aggregation of obesity, diabetes, and cardiovascular diseases was noted, alongside behavioral challenges such as lack of physical activity (81.8 %) and unhealthy eating habits (56.8 %).

Conclusion

HAPpEN addresses obesity's multifactorial nature through general practitioner-led, community-based, and digital strategies to promote sustainable lifestyle changes in rural areas. The trial aims to inform primary care obesity management guidelines, focusing on improving health literacy, patient engagement, and long-term clinical benefits. German Clinical Trials Register: DRKS00033916.

Interventions to prevent obesity in children aged 12 to 18 years old

BACKGROUND

Prevention of obesity in adolescents is an international public health priority. The prevalence of overweight and obesity is over 25% in North and South America, Australia, most of Europe, and the Gulf region. Interventions that aim to prevent obesity involve strategies that promote healthy diets or 'activity' levels (physical activity, sedentary behaviour and/or sleep) or both, and work by reducing energy intake and/or increasing energy expenditure, respectively. There is uncertainty over which approaches are more effective, and numerous new studies have been published over the last five years since the previous version of this Cochrane Review.

OBJECTIVES

To assess the effects of interventions that aim to prevent obesity in adolescents by modifying dietary intake or 'activity' levels, or a combination of both, on changes in BMI, zBMI score and serious adverse events.

SEARCH METHODS

We used standard, extensive Cochrane search methods. The latest search date was February 2023.

SELECTION CRITERIA

Randomised controlled trials in adolescents (mean age 12 years and above but less than 19 years), comparing diet or 'activity' interventions (or both) to prevent obesity with no intervention, usual care, or with another eligible intervention, in any setting. Studies had to measure outcomes at a minimum of 12 weeks post baseline. We excluded interventions designed primarily to improve sporting performance.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our outcomes were BMI, zBMI score and serious adverse events, assessed at short- (12 weeks to < 9 months from baseline), medium- (9 months to < 15 months) and long-term (≥ 15 months) follow-up. We used GRADE to assess the certainty of the evidence for each outcome.

MAIN RESULTS

This review includes 74 studies (83,407 participants); 54 studies (46,358 participants) were included in meta-analyses. Sixty studies were based in high-income countries. The main setting for intervention delivery was schools (57 studies), followed by home (nine studies), the community (five studies) and a primary care setting (three studies). Fifty-one interventions were implemented for less than nine months; the shortest was conducted over one visit and the longest over 28 months. Sixty-two studies declared non-industry funding; five were funded in part by industry. Dietary interventions versus control The evidence is very uncertain about the effects of dietary interventions on body mass index (BMI) at short-term follow-up (mean difference (MD) -0.18, 95% confidence interval (CI) -0.41 to 0.06; 3 studies, 605 participants), medium-term follow-up (MD -0.65, 95% CI -1.18 to -0.11; 3 studies, 900 participants), and standardised BMI (zBMI) at long-term follow-up (MD -0.14, 95% CI -0.38 to 0.10; 2 studies, 1089 participants); all very low-certainty evidence. Compared with control, dietary interventions may have little to no effect on BMI at long-term follow-up (MD -0.30, 95% CI -1.67 to 1.07; 1 study, 44 participants); zBMI at short-term (MD -0.06, 95% CI -0.12 to 0.01; 5 studies, 3154 participants); and zBMI at medium-term (MD 0.02, 95% CI -0.17 to 0.21; 1 study, 112 participants) follow-up; all low-certainty evidence. Dietary interventions may have little to no effect on serious adverse events (two studies, 377 participants; low-certainty evidence). Activity interventions versus control Compared with control, activity interventions do not reduce BMI at short-term follow-up (MD -0.64, 95% CI -1.86 to 0.58; 6 studies, 1780 participants; low-certainty evidence) and probably do not reduce zBMI at medium- (MD 0, 95% CI -0.04 to 0.05; 6 studies, 5335 participants) or long-term (MD -0.05, 95% CI -0.12 to 0.02; 1 study, 985 participants) follow-up; both moderate-certainty evidence. Activity interventions do not reduce zBMI at short-term follow-up (MD 0.02, 95% CI -0.01 to 0.05; 7 studies, 4718 participants; high-certainty evidence), but may reduce BMI slightly at medium-term (MD -0.32, 95% CI -0.53 to -0.11; 3 studies, 2143 participants) and long-term (MD -0.28, 95% CI -0.51 to -0.05; 1 study, 985 participants) follow-up; both low-certainty evidence. Seven studies (5428 participants; low-certainty evidence) reported data on serious adverse events: two reported injuries relating to the exercise component of the intervention and five reported no effect of intervention on reported serious adverse events. Dietary and activity interventions versus control Dietary and activity interventions, compared with control, do not reduce BMI at short-term follow-up (MD 0.03, 95% CI -0.07 to 0.13; 11 studies, 3429 participants; high-certainty evidence), and probably do not reduce BMI at medium-term (MD 0.01, 95% CI -0.09 to 0.11; 8 studies, 5612 participants; moderate-certainty evidence) or long-term (MD 0.06, 95% CI -0.04 to 0.16; 6 studies, 8736 participants; moderate-certainty evidence) follow-up. They may have little to no effect on zBMI in the short term, but the evidence is very uncertain (MD -0.09, 95% CI -0.2 to 0.02; 3 studies, 515 participants; very low-certainty evidence), and they may not reduce zBMI at medium-term (MD -0.05, 95% CI -0.1 to 0.01; 6 studies, 3511 participants; low-certainty evidence) or long-term (MD -0.02, 95% CI -0.05 to 0.01; 7 studies, 8430 participants; low-certainty evidence) follow-up. Four studies (2394 participants) reported data on serious adverse events (very low-certainty evidence): one reported an increase in weight concern in a few adolescents and three reported no effect.

AUTHORS' CONCLUSIONS

The evidence demonstrates that dietary interventions may have little to no effect on obesity in adolescents. There is low-certainty evidence that activity interventions may have a small beneficial effect on BMI at medium- and long-term follow-up. Diet plus activity interventions may result in little to no difference. Importantly, this updated review also suggests that interventions to prevent obesity in this age group may result in little to no difference in serious adverse effects. Limitations of the evidence include inconsistent results across studies, lack of methodological rigour in some studies and small sample sizes. Further research is justified to investigate the effects of diet and activity interventions to prevent childhood obesity in community settings, and in young people with disabilities, since very few ongoing studies are likely to address these. Further randomised trials to address the remaining uncertainty about the effects of diet, activity interventions, or both, to prevent childhood obesity in schools (ideally with zBMI as the measured outcome) would need to have larger samples.

A Scoping Review of the Community Health Worker Model Used for Food Systems Interventions Within the United States

OBJECTIVE

To document and analyze the food systems interventions delivered by community health workers (CHW) serving as educators within the United States (U.S.).

DATA SOURCE

Ten databases (ie, Agricola, CAB Abstracts, CINAHL, ERIC, Proquest Social Science and Education, Proquest Theses and Dissertations, PubMed, Scopus, SocIndex, Web of Science) and gray-literature repositories were searched for publications between 2005-2020.

STUDY INCLUSION AND EXCLUSION CRITERIA

English-language and U.S. studies included with CHW as educators or facilitators for food systems interventions. Food systems defined as processes of production, processing, distribution, marketing, access, preparation, consumption, and disposal of food products. Studies excluded for clinical settings; non-adult CHWs; CHWs with medical or public health credentials; and programming guides, reviews, and commentaries.

DATA EXTRACTION

Variables included CHW and intervention description, priority population, food system processes, and targeted and unexpected outcomes.

DATA SYNTHESIS

Data were analyzed by the lead investigator and described narratively.

RESULTS

Of 43 records, CHWs educated for consumption (n = 38), preparation (n = 33), and food access (n = 22) to improve health of priority populations. Community health workers educated for the highest number of food system processes in garden-based interventions. Programs reached many underserved racial and socioeconomic populations.

CONCLUSIONS

The CHW model has been used to educate in interventions for all food systems processes and reached many diverse underserved audiences. Future work must explore garden-based food systems education and CHWs as community change agents.

Predictive Utility of Alternate Measures of Physical Activity and Diet for Overweight and Obesity in Low-Income Minority Women

PURPOSE

The purpose is to compare the predictive utility of alternate measures of diet and physical activity for overweight and obesity among low-income minority women.

DESIGN

Cross-sectional analysis of baseline data from a cohort study.

SETTING

Three public housing developments in South Los Angeles.Subjects: Adult women (N = 425).

MEASURES

Primary outcome-weight status (normal BMI, overweight, or obese). Primary predictors- diet: 24-hour dietary recalls (Healthy Eating Index), dietary screener (intake of specific food groups), and single-item survey question (diet quality); physical activity: accelerometry (minutes/day of moderate-to-vigorous activity), short recall questionnaire (minutes/week of moderate and vigorous activity), and single-item questions (days per week did exercise; self-assessment of overall activity level).

ANALYSIS

Multinomial logistic regression models, controlling for socio-demographic covariates. Models are built up starting with least resource-intensive measures of diet and physical activity (single items) and sequentially adding more resource-intensive measures. Model performance is assessed via information-based model selection indices.

RESULTS

Adjusted relative risk for obesity for single-item measures ranged from .61 to .64 for diet (P < .01) and from .80 to .81 for physical activity (P <.05). The added value of resource-intensive measures was negligible for physical activity and at best small for diet.

CONCLUSION

Single-item questions for diet and physical activity can provide valuable information about risk for overweight and obesity in low-income minority women when more resource-intensive assessments are infeasible.

Public Rental Housing and Obesogenic Behaviors among Adults in Hong Kong: Mediator Role of Food and Physical Activity Environment

Public rental housing (PRH) for low-income families has been shown in several studies to be associated with poor health status and obesity. However, the causes of this health disparity are controversial, and the associations and pathways between PRH and obesogenic behaviors remain unknown. Using cross-sectional survey data of 1977 adults living in Hong Kong (aged or over 18) together with multi-source GIS-based environmental data, we examined the associations between PRH and obesogenic behaviors and the extent to which those associations can be explained by neighborhood food and physical environment. The unhealthy food environment, which relates with infrequent fruit and vegetables consumption, was calculated based on the relative density of fast food restaurants and convenience stores to grocery stores. The physical activity environment, which relates to physical inactivity and prolonged sitting, was assessed in terms of density of sports facilities and street greenery, separately. Regressions and mediation analyses show that PRH was negatively associated with physical inactivity directly and also indirectly via higher sports facilities density; however, PRH was positively associated with unhealthy diet largely directly and positively associated with prolonged sitting indirectly via less street greenery. We advanced the international literature of PRH health impact assessment and its environmental health pathways by providing evidence from the least housing-affordable city in the world. The findings provide planning implications in formulating a healthier PRH community for these low-income PRH households and mitigating health disparities induced by housing type.

Assessing impacts of redeveloping public housing communities on obesity in low-income minority residents: Rationale, study design, and baseline data from the Watts Neighborhood Health Study

INTRODUCTION

Obesogenic built- and social-environments in low-income and minority communities are often blamed for the higher rates of obesity in this population, but existing evidence is based largely on observational studies. This study leverages a natural experiment created by the redevelopment of a public housing community to examine the impact of major improvements to the housing, built, and social environments on obesity among residents.

METHODS/DESIGN

The study design is a natural experiment where residents from the redeveloped community (treatment group) will be compared to those from a similar community (control group) in terms of their pre/post changes in primary outcomes using annual longitudinal data on a cohort of residents. Quasi-experimental variation in the timing of exposure to various redevelopment components within the treated community will be further leveraged within a stepped-wedge research design to assess the impact of the redevelopment components. Primary outcome measures include body mass index, overweight, and obese status.

RESULTS

A cohort of 868 adults and 704 children (ages 2-17 years) was recruited during 2018-2019 with up to two waves of baseline data. At baseline, the prevalence of obesity (overweight or obesity) was 57.2% (81.3%) in adults and 33.1% (52.4%) among children, with no significant differences by treatment status. No differential trends in primary outcomes were observed by treatment status during the two years of baseline.

DISCUSSION

This natural experiment study offers a unique opportunity to assess whether improvements to housing, built, and social environment in low-income minority communities can lead to reductions in obesity.

Community health worker-delivered weight management intervention among public housing residents: A feasibility study

Community health worker-led interventions may be an optimal approach to promote behavior change among populations with low incomes due to the community health workers’ unique insights into participants’ social and environmental contexts and potential ability to deliver interventions widely. The objective was to determine the feasibility (implementation, acceptability, preliminary efficacy) of a weight management intervention for adults living in public housing developments. In 2016–2018, in Boston Massachusetts, we conducted a 3-month, two-group randomized trial comparing participants who received a tailored feedback report (control group) to participants who received the same report plus behavioral counseling. Community health workers provided up to 12 motivational interviewing-based counseling sessions in English or Spanish for diet and physical activity behaviors using a website designed to guide standardized content delivery. 102 participants enrolled; 8 (7.8%) were lost at 3-month follow up. Mean age was 46.5 (SD = 11.9) years; the majority were women (88%), Hispanic (67%), with ≤ high school degree (62%). For implementation, among intervention group participants (n = 50), 5 completed 0 sessions and 45 completed a mean of 4.6 (SD = 3.1) sessions. For acceptability, most indicated they would be very likely (79%) to participate again. For preliminary efficacy, adjusted linear regression models showed mean changes in weight (-0.94 kg, p = 0.31), moderate-to-vigorous physical activity (+11.7 min/day, p = 0.14), and fruit/vegetable intake (+2.30 servings/day, p < 0.0001) in the intervention vs. control group. Findings indicate a low-income public housing population was reached through a community health worker-led intervention with sufficient implementation and acceptability and promising beneficial changes in weight, nutrition, and physical activity outcomes.

Interventions for preventing obesity in children

EDITORIAL NOTE

This Cochrane review is now out of date and should not be used for reference. It has been split into four age groups and updated. Please refer to the 5‐11 and 12‐18 age group Cochrane reviews which were published in May 2024: https://doi.org/10.1002/14651858.CD015328.pub2 https://doi.org/10.1002/14651858.CD015330.pub2 The 2‐4 age group Cochrane review is planned for publication in September 2024.

BACKGROUND

Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies to prevent obesity is very large and is accumulating rapidly. This is an update of a previous review.

OBJECTIVES

To determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, PsychINFO and CINAHL in June 2015. We re-ran the search from June 2015 to January 2018 and included a search of trial registers.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of diet or physical activity interventions, or combined diet and physical activity interventions, for preventing overweight or obesity in children (0-17 years) that reported outcomes at a minimum of 12 weeks from baseline.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data, assessed risk-of-bias and evaluated overall certainty of the evidence using GRADE. We extracted data on adiposity outcomes, sociodemographic characteristics, adverse events, intervention process and costs. We meta-analysed data as guided by the Cochrane Handbook for Systematic Reviews of Interventions and presented separate meta-analyses by age group for child 0 to 5 years, 6 to 12 years, and 13 to 18 years for zBMI and BMI.

MAIN RESULTS

We included 153 RCTs, mostly from the USA or Europe. Thirteen studies were based in upper-middle-income countries (UMIC: Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, US-Mexico border), and one was based in a lower middle-income country (LMIC: Egypt). The majority (85) targeted children aged 6 to 12 years.Children aged 0-5 years: There is moderate-certainty evidence from 16 RCTs (n = 6261) that diet combined with physical activity interventions, compared with control, reduced BMI (mean difference (MD) -0.07 kg/m2, 95% confidence interval (CI) -0.14 to -0.01), and had a similar effect (11 RCTs, n = 5536) on zBMI (MD -0.11, 95% CI -0.21 to 0.01). Neither diet (moderate-certainty evidence) nor physical activity interventions alone (high-certainty evidence) compared with control reduced BMI (physical activity alone: MD -0.22 kg/m2, 95% CI -0.44 to 0.01) or zBMI (diet alone: MD -0.14, 95% CI -0.32 to 0.04; physical activity alone: MD 0.01, 95% CI -0.10 to 0.13) in children aged 0-5 years.Children aged 6 to 12 years: There is moderate-certainty evidence from 14 RCTs (n = 16,410) that physical activity interventions, compared with control, reduced BMI (MD -0.10 kg/m2, 95% CI -0.14 to -0.05). However, there is moderate-certainty evidence that they had little or no effect on zBMI (MD -0.02, 95% CI -0.06 to 0.02). There is low-certainty evidence from 20 RCTs (n = 24,043) that diet combined with physical activity interventions, compared with control, reduced zBMI (MD -0.05 kg/m2, 95% CI -0.10 to -0.01). There is high-certainty evidence that diet interventions, compared with control, had little impact on zBMI (MD -0.03, 95% CI -0.06 to 0.01) or BMI (-0.02 kg/m2, 95% CI -0.11 to 0.06).Children aged 13 to 18 years: There is very low-certainty evidence that physical activity interventions, compared with control reduced BMI (MD -1.53 kg/m2, 95% CI -2.67 to -0.39; 4 RCTs; n = 720); and low-certainty evidence for a reduction in zBMI (MD -0.2, 95% CI -0.3 to -0.1; 1 RCT; n = 100). There is low-certainty evidence from eight RCTs (n = 16,583) that diet combined with physical activity interventions, compared with control, had no effect on BMI (MD -0.02 kg/m2, 95% CI -0.10 to 0.05); or zBMI (MD 0.01, 95% CI -0.05 to 0.07; 6 RCTs; n = 16,543). Evidence from two RCTs (low-certainty evidence; n = 294) found no effect of diet interventions on BMI.Direct comparisons of interventions: Two RCTs reported data directly comparing diet with either physical activity or diet combined with physical activity interventions for children aged 6 to 12 years and reported no differences.Heterogeneity was apparent in the results from all three age groups, which could not be entirely explained by setting or duration of the interventions. Where reported, interventions did not appear to result in adverse effects (16 RCTs) or increase health inequalities (gender: 30 RCTs; socioeconomic status: 18 RCTs), although relatively few studies examined these factors.Re-running the searches in January 2018 identified 315 records with potential relevance to this review, which will be synthesised in the next update.

AUTHORS' CONCLUSIONS

Interventions that include diet combined with physical activity interventions can reduce the risk of obesity (zBMI and BMI) in young children aged 0 to 5 years. There is weaker evidence from a single study that dietary interventions may be beneficial.However, interventions that focus only on physical activity do not appear to be effective in children of this age. In contrast, interventions that only focus on physical activity can reduce the risk of obesity (BMI) in children aged 6 to 12 years, and adolescents aged 13 to 18 years. In these age groups, there is no evidence that interventions that only focus on diet are effective, and some evidence that diet combined with physical activity interventions may be effective. Importantly, this updated review also suggests that interventions to prevent childhood obesity do not appear to result in adverse effects or health inequalities.The review will not be updated in its current form. To manage the growth in RCTs of child obesity prevention interventions, in future, this review will be split into three separate reviews based on child age.

Community Needs Assessment among Latino Families in an Urban Public Housing Development

Studies examining the health of public housing residents are limited. In response, community-based participatory research principles were used to develop an intervention aimed at improving health outcomes related to multifactorial risk behaviors among Latino families living in a low-income neighborhood. A two-part needs assessment was completed to guide the intervention: interviews with parents ( n = 10) and a group model building (GMB) workshop with youth and parents ( n = 40) to explore the parent-youth dynamic. Interviews indicated that poverty, youth disobedience, and inadequate communication between parents and youth led to parental stress. During the workshop, balancing and reinforcing feedback loops involving Communication, Trust, and Respect between youth and parents were identified. Based on these findings and collaboration with a community advisory board, a bilingual, mindfulness-based meditation intervention was designed to address community needs: positive parent-child interaction emphasizing trust and communication, stress reduction, and family well-being.

Changing the housing environment to reduce obesity in public housing residents: a cluster randomized trial

BACKGROUND

Public housing residents face significant social, economic, and physical barriers to the practice of health behaviors for prevention of chronic disease. Research shows that public housing residents are more likely to report higher rates of obesity, current smoking, disability, and insufficient physical activity compared to individuals not living in public housing. Because these behaviors and conditions may be shaped by the built and social environments in which they live, we conducted a study to test an environmental level diet and physical activity intervention targeting obesity among urban public housing developments.

METHODS

This study was a cluster randomized controlled trial of public housing developments, the unit of analysis and randomization. A total of 10 public housing developments were recruited and subsequently randomized to either receive the intervention package or to serve as comparison sites. The year-long intervention included components to change the dietary and physical activity-related environments of the developments. Surveys at baseline and one-year follow-up provided data on changes in behaviors and weight from participants in both intervention and control developments.

RESULTS

Intervention participants significantly changed their eating and activity behaviors and body weight from baseline to one-year follow-up (p's < .05) while comparison participants reported no significant changes in any study variable.

CONCLUSIONS

These data provide initial support for the idea that interventions targeting the environment of public housing developments can assist residents to change unhealthy behaviors and can possibly reduce the high levels of chronic disease among public housing residents.

Evaluating Structural Change Approaches to Health Promotion: An Exploratory Scoping Review of a Decade of U.S. Progress

Structural change approaches-also known as policy and environmental changes-are becoming increasingly common in health promotion, yet our understanding of how to evaluate them is still limited. An exploratory scoping review of the literature was conducted to understand approaches and methods used to evaluate structural change interventions in health promotion and public health literature. Two analysts-along with health sciences librarian consultation-searched PubMed, Web of Science, and EMBASE for peer-reviewed U.S.-based, English language studies published between 2005 and 2016. Data were extracted on the use of evaluation frameworks, study designs, duration of evaluations, measurement levels, and measurement types. Forty-five articles were included for the review. Notably, the majority (73%) of studies did not report application of a specific evaluation framework. Studies used a wide range of designs, including process evaluations, quasi- or nonexperimental designs, and purely descriptive approaches. In addition, 15.6% of studies only measured outcomes at the individual level. Last, 60% of studies combined more than one measurement type (e.g., site observation + focus groups) to evaluate interventions. Future directions for evaluating structural change approaches to health promotion include more widespread use and reporting of evaluation frameworks, developing validated tools that measure structural change, and shifting the focus to health-directed approaches, including an expanded consideration for evaluation designs that address health inequities.

Feasibility and Acceptability of Dietary Intake Assessment Via 24-Hour Recall and Food Frequency Questionnaire among Women with Low Socioeconomic Status

BACKGROUND

Comprehensive evaluation of dietary interventions depends on effective and efficient measurement to quantify behavior change. To date, little is known regarding which self-reported measure of dietary intake is most feasible and acceptable for use in evaluation of the effectiveness of diet intervention studies among underserved populations.

OBJECTIVE

This research focused on evaluating feasibility and acceptability of two self-report measures of diet.

DESIGN

Cross-sectional.

PARTICIPANTS/SETTING

Two interviewer-administered 24-hour recalls and a 110-item food frequency questionnaire (FFQ) were administered to both English- and Spanish-speaking participants (n=36) by native English- and Spanish-speaking research assistants. On completion of both dietary assessments, participants were interviewed regarding their preference of measure.

MAIN OUTCOME MEASURES

Feasibility for completion of the dietary assessment measures was determined for contacts and retention. Acceptability of the measures was determined through responses to open- and closed-ended questions.

RESULTS

During the 5-month trial, 36 participants were enrolled; 29 completed both intake measures, and 26 completed both measures and the interview. Participants were mainly Hispanic/Latina (72%), with a mean age of 37.0 (±7.6) years. Feasibility targets were met for contacts (1.9, 1.6, 1.8 contact attempts to complete each diet assessment measure with a target of ≤2) and for retention with 89% and 91% completing two 24-hour recalls and the FFQ, respectively. Participants indicated both diet assessment methods were generally acceptable; both positive and negative comments were received for use of the FFQ.

CONCLUSION

Dietary assessment with the use of 24-hour recalls or an FFQ can be feasible and acceptable among women with low socioeconomic status, although care should be taken to address cultural appropriateness in the selection of the measurement method.

Collaborating with Public Housing Residents and Staff to Improve Health: A Mixed-Methods Analysis

This study described the health behaviors and barriers and facilitators of those behaviors in elderly and/or disabled residents of public housing. A mixed-methods design was used. Residents (N = 88) completed a survey with validated measures of health behaviors. A sub-sample (N = 16) participated in three focus groups. Residents scored worse than population norms on the majority of behaviors measured. Qualitative results framed in an ecological model indicated the majority of facilitators and barriers to health behaviors were perceived as occurring at the intrapersonal and interpersonal levels. Interventions to promote health should consider the unique barriers and facilitators to health behaviors among residents.

An intervention strategy for improving residential environment and positive mental health among public housing tenants: rationale, design and methods of Flash on my neighborhood!

BACKGROUND

In Canada, public housing programs are an important part of governmental strategies to fight poverty and public exclusion. The Flash on my neighborhood! project is a four-year multiphase community-based participatory action research strategy currently implemented in six public housing developments (n = 1009 households) across the province of Québec, Canada. The goal is to reduce the mental health disparities faced by these public housing tenants compared to the general population, while identifying which environmental and policy changes are needed to turn public housing settings into healthier environments.

METHODS

The protocol involves three successive, interconnected phases: 1) Strengths and needs assessment, including community outreach and recruitment of tenants to collaborate as peer researchers, an exploratory qualitative component (photovoice), a systematic neighborhood observation, and a household survey; 2) Action plan development, including a community forum and interactive capacity-building and discussion sessions; 3) Action plan implementation and monitoring. The entire intervention is evaluated using a mixed-method design, framed within a multiple case study perspective. Throughout the project and particularly in the evaluation phase, data will be collected to record a) contextual factors (tenants' previous experience of participation, history of public housing development, etc.); b) activities that took place and elements from the action plan that were implemented; and c) short- and medium-term outcomes (objective and perceived improvements in the quality of the residential setting, both physically and in terms of mental health and social capital).

DISCUSSION

The study will provide unprecedented evidence-based information on the key ingredients of a collective intervention process associated with the increased collective empowerment and positive mental health of public housing tenants.

[Electronic media in obesity prevention in childhood and adolescence]

BACKGROUND

The increasing prevalence of childhood obesity is - amongst other factors - due to changed leisure time habits with decreased physical activity and increased media consumption. However, electronic media such as tablets and smartphones might also provide a novel intervention approach to prevent obesity in childhood and adolescence.

OBJECTIVES

A summary of interventions applying electronic media to prevent childhood obesity is provided to investigate short term effects as well as long term results of these interventions.

METHODS

A systematic literature search was performed in PubMed/Web of Science to identify randomized and/or controlled studies that have investigated the efficacy of electronic media for obesity prevention below the age of 18.

RESULTS

A total of 909 studies were identified, and 88 studies were included in the analysis. Active video games did increase physical activity compared to inactive games when applied within a peer group. Interventions via telephone had positive effects on certain lifestyle-relevant behaviours. Interventions via mobile were shown to decrease dropout rates by sending regular SMS messages. To date, interventions via smartphones are scarce for adolescents; however, they might improve cardiorespiratory fitness. The results from internet-based interventions showed a trend towards positive effects on lifestyle-relevant behaviors. The combination of different electronic media did not show superior results compared to interventions with only one medium. Interventions via TV, DVD or video-based interventions may increase physical activity when offered as an incentive, however, effects on weight status were not observed.

DISCUSSION

Children and adolescents currently grow up in a technology- and media-rich society with computers, tablets, smartphones, etc. used daily. Thus, interventions applying electronic media to prevent childhood obesity are contemporary. Available studies applying electronic media are however heterogeneous in terms of applied medium and duration. Positive effects on body composition were not observed, but only on certain lifestyle-relevant behaviours. In addition, these effects could only be seen in the short term. Follow-up data are currently scarce.

A Place-Based Community Health Worker Program: Feasibility and Early Outcomes, New York City, 2015

INTRODUCTION

This study examined feasibility of a place-based community health worker (CHW) and health advocate (HA) initiative in five public housing developments selected for high chronic disease burden and described early outcomes.

METHODS

This intervention was informed by a mixed-method needs assessment performed December 2014-January 2015 (representative telephone survey, n=1,663; six focus groups, n=55). Evaluation design was a non-randomized, controlled quasi-experiment. Intake and 3-month follow-up data were collected February-December 2015 (follow-up response rate, 93%) on 224 intervention and 176 comparison participants, and analyzed in 2016. All participants self-reported diagnoses of hypertension, diabetes, or asthma. The intervention consisted of chronic disease self-management and goal setting through six individual CHW-led health coaching sessions, instrumental support, and facilitated access to insurance/clinical care navigation from community-based HAs. Feasibility measures included CHW service satisfaction and successful goal setting. Preliminary outcomes included clinical measures (blood pressure, BMI); disease management behaviors and self-efficacy; and preventive behaviors (physical activity).

RESULTS

At the 3-month follow-up, nearly all intervention participants reported high satisfaction with their CHW (90%) and HA (76%). Intervention participants showed significant improvements in self-reported physical activity (p=0.005) and, among hypertensive participants, self-reported routine blood pressure self-monitoring (p=0.013) compared with comparison participants. No improvements were observed in self-efficacy or clinical measures at the 3-month follow-up.

CONCLUSIONS

Housing-based initiatives involving CHW and HA teams are acceptable to public housing residents and can be effectively implemented to achieve rapid improvements in physical activity and chronic disease self-management. At 3-month assessment, additional time and efforts are required to improve clinical outcomes.

Information and communication technology use by female residents of public housing

BACKGROUND

Evidence suggests that Internet, mobile, or social media based-interventions may promote obesity-lowering behavior change, which has implications for cancer prevention and control interventions. However, the uptake of communication technologies among low socioeconomic status individuals, who need obesity management strategies most, is unclear.

METHODS

Using the baseline data from a cluster-randomized behavioral intervention trial, we examined the cross-sectional associations of frequency of information and communication technologies (ICT) use among female public housing residents, as well as the variation of ICT use across demographic and health-related variables.

RESULTS

ICT use was common among female public housing residents, with mobile use for calls and texts most prevalent (97% and 84%, respectively). Internet, social media, and health information users tended to be younger compared to non-users. Email, Internet, multimodal, and health information users were more likely to be born in the U.S. and be more highly educated than non-users. Social media and health information users were more likely to be Spanish speakers and people of Hispanic ethnicity compared to non-users, although this was not statistically significant. There were few differences according to obesity or physical activity level.

CONCLUSIONS

Our findings of differential socio-demographics between users vs. non-users suggests that future cancer prevention and control interventions among public housing residents should consider selecting ICT that are aligned with the usage patterns of different groups making up the intended audience.

"Whole-of-Community" Obesity Prevention: A Review of Challenges and Opportunities in Multilevel, Multicomponent Interventions

The causes of obesity worldwide are complex and multilevel, including changing food environments, physical activity levels, policies, and food production systems. This intricate context requires multilevel and multicomponent (MLMC) interventions to improve health outcomes. We conducted a literature review of MLMC interventions for obesity prevention and mitigation; 14 studies meeting search criteria were identified. We found examples of successes in preventing obesity, reducing overweight, improving healthful behaviors, and enhancing some psychosocial indicators. Of eight studies that reported health and behavioral results, five showed no significant impact and three showed reductions in obesity. Four studies showed significant improvement in dietary behavior, and five reported significant desirable effects in physical activity or screen time. Five studies reported psychosocial impacts, and three of these showed significant improvements. MLMC approaches show promising results, particularly when they are able to integrate components at the policy, community, and interpersonal levels.

The Use of Social Media for Health Promotion in Hispanic Populations: A Scoping Systematic Review

BACKGROUND

The Internet is an increasingly popular platform for public health interventions due to its distinct ability to communicate with, engage, and educate communities. Given the widespread use of the Internet, these interventions could be a means of equalizing access to information to address health disparities in minority populations, such as Hispanics. Hispanics are disproportionately affected by poor health outcomes, including obesity, diabetes, and human immunodeficiency virus/acquired immune deficiency syndrome. Although underserved and underrepresented, Hispanics are among the leading users of social media in the United States. Previous reviews have examined the use of social media in public health efforts, but, to our knowledge, none have focused on the Hispanic population.

OBJECTIVE

To conduct a scoping systematic review of the published literature to capture the ways social media has been used in health interventions aimed at Hispanic populations and identify gaps in existing knowledge to provide recommendations for future research.

METHODS

We performed a systematic review of the literature related to social media, public health, and Hispanics using the PubMed, PsycINFO, and EMBASE databases to locate peer-reviewed studies published between January 1, 2010, and December 31, 2015. Each article was reviewed for the following inclusion criteria: social media as a main component of study methodology or content; public health topic; majority Hispanic/Latino study population; English or Spanish language; and original research study. Relevant data were extracted from articles meeting inclusion criteria including publication year, location, study design, social media platform, use of social media, target population, and public health topic.

RESULTS

Of the 267 articles retrieved, a total of 27 unique articles met inclusion criteria. All were published in 2012 or later. The most common study design was a cross-sectional survey, which was featured in 10 of the 27 (37%) articles. All articles used social media for at least one of the following three purposes: recruiting study participants (14 of 27, 52%), promoting health education (12 of 27, 44%), and/or describing social media users (12 of 27, 44%). All but one article used multiple social media platforms, though Facebook was by far the most popular appearing in 24 of the 27 (89%). A diverse array of Hispanic populations was targeted, and health topics featured. Of these, the most highly represented were articles on sexual health directed toward Latino men who have sex with men (12 of 27, 44%). Healthy eating and active living received the second greatest focus (4 of 27, 15%).

CONCLUSIONS

Social media offers a potential accessible venue for health interventions aimed at Hispanics, a group at disproportionate risk for poor health outcomes. To date, most publications are descriptive in nature, with few indicating specific interventions and associated outcomes to improve health.