Impact of a Community-Wide Multi-Level Obesity Prevention Intervention for Children in Rural Communities

Thesis (Master's)--University of Washington, 2018Childhood overweight and obesity are serious public health concerns in the US. Certain populations are disproportionately affected based on race/ethnicity and geographic area (HRSA, 2015). Multiple components constitute a child’s obesogenic environment, but there is inadequate research on obesity prevention interventions to address these multiple facets, especially in rural settings. The purpose of this paper is to examine the preliminary effectiveness of Together We STRIDE, a multi-level intervention on nutrition and physical activity behaviors among 3rd to 5th graders in a rural community of Eastern Washington. The intervention community received multi-level intervention activities at the individual, family, school, and community levels. Anthropometric measurements were collected at baseline and 6-month follow up, and a subgroup of participants provided information on nutrition and physical activity behaviors. Changes in the subgroup’s consumption of fruit, vegetables, and sugar from sugar sweetened beverages (SSBs); physical activity (PA); and sedentary behaviors (including screen time) were analyzed for differences within and between intervention and comparison groups, and by gender. Fruit intake increased for both groups, with the intervention group consuming slightly more. Vegetable consumption decreased for both groups, but the intervention group showed a smaller decrease compared to the intervention group. The intervention group decreased, while the comparison group significantly increased (p=0.002), sugar intake from SSBs. The intervention group reported a significant increase in light PA (p=0.007), an increase in moderate PA, and a decrease in vigorous PA, while the comparison group reported a decrease at all three levels, revealing a significant difference between intervention and comparison groups at all three levels (p=0.009, 0.012, 0.032, respectively). Weekend sedentary behavior increased in the intervention group, while it decreased in the comparison group. Weekend screen time increased for both groups. Differences by gender showed: intervention boys consumed significantly less sugar than their comparison group counterparts (p=0.019); vigorous PA between intervention and comparison groups of boys was significant (p=0.028), while light PA between intervention and comparison groups of girls was significant (p=0.030); and no significant differences by gender on sedentary behavior. The intervention had a significant effect on increasing PA, and revealed small but meaningful improvements in fruit consumption and sugar intake from SSBs. Vegetable consumption decreased slightly, but the trend for the intervention group may be less solidified as children had not received all of the intervention components during the preliminary assessment. These preliminary results show intervention effectiveness in addressing fruit and sugar consumption, as well as physical activity behaviors at the midpoint assessment. Thus, it is anticipated that a larger magnitude of difference will be seen at 18-month follow up