Childhood obesity prevention in rural settings: background, rationale, and study design of '4-Health,' a parent-only intervention

Wesley C Lynch, Jill Martz, Galen Eldridge, Sandra J Bailey, Carrie Benke, Lynn Paul, Wesley C Lynch, Jill Martz, Galen Eldridge, Sandra J Bailey, Carrie Benke, Lynn Paul

Abstract

Background: Childhood obesity in rural communities is a serious but understudied problem. The current experiment aims to assess a wide range of obesity risk factors among rural youth and to offer an 8-month intervention program for parents to reduce obesity risk in their preteen child.

Methods/design: A two-group, repeated measures design is used to assess the effectiveness of the 4-Health intervention program. Assessments include anthropometric measures, child self-evaluations, parent self-evaluations, and parent evaluations of child. County Extension agents from 21 rural Montana counties recruit approximately 150 parent-child dyads and counties are semi-randomly assigned to the active intervention group (4-Health Educational Program) or a "best-practices" (Healthy Living Information) control group.

Discussion: This study will shed light on the effectiveness of this parent-only intervention strategy in reducing obesity risk factors among rural preteens. The 4-Health program is designed to provide information and skills development for busy rural parents that will increase healthy lifestyles of their preteen children and improve the parents' ability to intervene effectively in the lives of their families during this critical developmental period.

Trial registration: ClinicalTrials.gov ID: NCT01510587.

Figures

Figure 1
Figure 1
Participant recruitment, assignment, and data collection flow chart.

References

    1. Childhood Obesity Facts.
    1. Matsushita Y, Yoshiike N, Kaneda F, Yoshita K, Takimoto H. Trends in childhood obesity in Japan over the last 25 years from the National Nutrition Survey. Obes Res. 2004;12(2):205–214. doi: 10.1038/oby.2004.27.
    1. McMurray RG, Harrell JS, Bangdiwala SI, Deng SB. Cardiovascular disease risk factors and obesity of rural and urban elementary school children. J Rural Health. 1999;15(4):365–374. doi: 10.1111/j.1748-0361.1999.tb00760.x.
    1. Rhee K. Childhood overweight and the relationship between parent behaviors, parenting style and family functioning. Ann Am Acad Pol Soc Sci. 2008;615:12–37.
    1. Ostbye T, Zucker N, Krause KM, Lovelady CA, Evenson K, Peterson BL, Bastian LA, Swamy GK, West DJ, Brouwer RJ. Kids and adults now! Defeat obesity (KAN-DO): Rationale, design and baseline characteristics. Contemp Clin Trials. 2011;32(3):461–469. doi: 10.1016/j.cct.2011.01.017.
    1. Golley RK, Perry RA, Magarey A, Daniels L. Family-focused weight management program for five- to nine-year-olds incorporating parenting skills training with healthy lifestyle information to support behaviour modification. Nutr Diet. 2007;64(3):144–150. doi: 10.1111/j.1747-0080.2007.00106.x.
    1. Eisenmann JC, Gentile DA, Welk GJ, Callahan R, Strickland S, Walsh M, Walsh DA. SWITCH: rationale, design, and implementation of a community, school, and family-based intervention to modify behaviors related to childhood obesity. Bmc Public Health. 2008;8:223. doi: 10.1186/1471-2458-8-223.
    1. Janicke DM, Sallinen BJ, Perri MG, Lutes LD, Silverstein JH, Huerta MG, Guion LA. Sensible Treatment of Obesity in Rural Youth (STORY): design and methods. Contemp Clin Trials. 2008;29(2):270–280. doi: 10.1016/j.cct.2007.05.005.
    1. Janicke DM, Sallinen BJ, Perri MG, Lutes LD, Huerta M, Silverstein JH, Brumback B. Comparison of parent-only vs family-based interventions for overweight children in underserved rural settings outcomes from project STORY. Arch Pediatr Adolesc Med. 2008;162(12):1119–1125. doi: 10.1001/archpedi.162.12.1119.
    1. Janicke D, Sallinen B, Perri M, Silverstein J, Huerta M, Guion L. Preliminary findings from project STORY (Sensible Treatment of Obesity in Rural Youth) Ann Behav Med. 2007;33:S22. doi: 10.1207/s15324796abm3301_3.
    1. Williamson DA, Champagne CM, Han H, Harsha D, Martin CK, Newton RL, Ryan DH, Sothern MS, Stewart TM, Webber LS. Increased obesity in children living in rural communities of Louisiana. Int J Pediatr Obes. 2009;4(3):160–165. doi: 10.1080/17477160802596148.
    1. Wapner A, Bianco JA, Long M, Kushnick MR, Brannan G, Shubrook J. Take action: a multidisciplinary lifestyle intervention for families in a rural community. Childhood Obesity (Formerly Obesity and Weight Management) 2010;6(5):270–276. doi: 10.1089/chi.2010.0508.
    1. Bandura A. Social cognitive theory: an agentic perspective. Annu Rev Psychol. 2001;52:1–26. doi: 10.1146/annurev.psych.52.1.1.
    1. Robison J. Health at every size: toward a new paradigm of weight and health. MedGenMed. 2005;7(3):13.
    1. Baranowski T, Cullen K, Nicklas T, Thompson D, Baranowski J. Are current health behavioral change models helpful in guiding prevention of weight gain efforts? Obes Res. 2003;11:23S–43S. doi: 10.1038/oby.2003.222.
    1. Bacon L, Stern J, Van Loan M, Keim N. Size acceptance and intuitive eating improve health for obese, female chronic dieters. J Am Diet Assoc. 2005;105(6):929–936. doi: 10.1016/j.jada.2005.03.011.
    1. Glanz K, Rimer B. FM L: Health Behavior and Health Education: Theory, Research, and Practice. Jossey-Bass, San Francisco; 2002.
    1. Cowan PA, Cowan CP. Interventions as tests of family systems theories: marital and family relationships in children’s development and psychopathology. Dev Psychopathol. 2002;14(4):731–759.
    1. Whitchurch G, Constantine L. In: Sourcebook of family theory and methods: A contextual approach. PG Boss WD, LaRossa R, Schumm WR, Steinmetz SK, editor. Plenum Press, New York; 1993. Systems Theory; pp. 325–352.
    1. Raidl M, Wittman G, Spencer M, Sant L, Lockard M, Peutz J. Steps To a New You: a health-centered program that helps adults change physical activity, eating habits, and body image perceptions. The Forum for Families and Consumer Issues. 2010;15(2)
    1. Kaplan M, Crago N, Herzog F, James L, Kiernan N, Middlemiss WN, Olte T, Weinreb-Welch L. FRIDGE (Food-Related Intergenerational Discussion Group Experiences) Penn State Cooperative Extension, University Park; 2007.
    1. National 4-H Council. Essential Elements for Positive Youth Development. National 4-H Council, USDA, Washington DC; 2009.
    1. Lerner RM, Lerner JV, Almerigi JB, Theokas C, Phelps E, Gestsdottir S, Naudeau S, Jelicic H, Alberts A, Ma L. et al.Positive Youth Development, participation in community youth development programs, and community contributions of fifth-grade adolescents: findings from the first wave of the 4-H study of positive youth development. J Early Adolesc. 2005;25(1):17–71. doi: 10.1177/0272431604272461.
    1. Latham GP. Goal setting: a five-step approach to behavior change. Organ Dyn. 2003;32(3):309–318. doi: 10.1016/S0090-2616(03)00028-7.
    1. .
    1. .
    1. Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey: Anthropometry Procedures Manual. 2007.
    1. Perry CM, De Ayala RJ, Lebow R, Hayden E. A validation and reliability study of the Physical Activity and Healthy Food Efficacy scale for children (PAHFE) Health Educ Behav. 2008;35(3):346–360.
    1. Kowalski KC, Crocker PRE, Faulkner RA. Validation of the physical activity questionnaire for older children. Pediatr Exerc Sci. 1997;9(2):174–186.
    1. Youth Risk Behavior Survey. 2010. .
    1. Edmundson E, Parcel GS, Feldman HA, Elder J, Perry CL, Johnson C, Williston BJ, Stone EJ, Yang MH, Lytle L. et al.The effects of the child and adolescent trial for cardiovascular health upon psychosocial determinants of diet and physical activity behavior. Prev Med. 1996;25(4):442–454. doi: 10.1006/pmed.1996.0076.
    1. Neumark-Sztainer D, Wall M, Story M, Fulkerson JA. Are family meal patterns associated with disordered eating behaviors among adolescents? J Adolesc Health. 2004;35(5):350–359.
    1. Truby H, Paxton SJ. Development of the children’s body image scale. Br J Clin Psychol. 2002;41:185–203. doi: 10.1348/014466502163967.
    1. Mendelson BK, White DR, Mendelson MJ. Self-esteem and body esteem: effects of gender, age, and weight. J Appl Dev Psychol. 1996;17(3):321–346. doi: 10.1016/S0193-3973(96)90030-1.
    1. Heinberg LJ, Thompson JK, Stormer S. Development and validation of the socio-cultural attitudes towards appearance questionnaire. Int J Eat Disord. 1995;17(1):81–89. doi: 10.1002/1098-108X(199501)17:1<81::AID-EAT2260170111>;2-Y.
    1. Bedeian AG, Teague RJ, Zmud RW. Test-retest reliability and internal consistency of short-form of coopersmiths self-esteem inventory. Psychol Rep. 1977;41(3):1041–1042. doi: 10.2466/pr0.1977.41.3f.1041.
    1. Ravens-Sieberer U, Gosch A, Rajmil L, Erhart M, Bruil J, Duer W, Auquier P, Power M, Abel T, Czemy L. et al.Kidscreen-52 quality-of-life measure for children and adolescents. Expert Rev Pharmacoecon Outcomes Res. 2005;5(3):353–364. doi: 10.1586/14737167.5.3.353.
    1. Marcus BH, Selby VC, Niaura RS, Rossi JS. Self-efficacy and the stages of exercise behavior-change. Res Q Exerc Sport. 1992;63(1):60–66.
    1. Godin G, Shephard RJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci. 1985;10(3):141–146.
    1. Walker SN, Hill-Polerecky DM. Psychometric evaluation of Health-Promoting Lifestyle Profile II. 1996.
    1. Birch LL, Fisher JO, Grimm-Thomas K, Markey CN, Sawyer R, Johnson SL. Confirmatory factor analysis of the child feeding questionnaire: a measure of parental attitudes, beliefs and practices about child feeding and obesity proneness. Appetite. 2001;36(3):201–210. doi: 10.1006/appe.2001.0398.
    1. Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey Questionnaire. (NHANES Flexible Consumer Behavior Module 2009–2010) U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Hyattsville; 2009.
    1. Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey Questionnaire 2009. (NHANES Consumer Behavior- Family Questionnaire) U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Hyattsville; 2011.
    1. Cash TF, Melnyk SE, Hrabosky JI. The assessment of body image investment: an extensive revision of the appearance schemas inventory. Int J Eat Disord. 2004;35(3):305–316. doi: 10.1002/eat.10264.
    1. Robinson C, Mandleco B, Frost Olsen S, Hart C. In: Handbook of family measurement techniques Volume Vol. 2: Instruments and index. Perlmutter B, Touliatos J, Holden G, editor. Sage, Thousand Oaks; 2001. The parenting styles and dimensions questionnaire (PSDQ) p. 190.
    1. Olson D, Barnes H. Family Communication Manual. Life Innovations, Inc, Minneapolis; 2006.
    1. Taveras EM, Mitchell K, Gortmaker SL. Parental confidence in making overweight-related behavior changes. Pediatrics. 2009;124(1):151–158. doi: 10.1542/peds.2008-2892.
    1. Hardy LL, Bass SL, Booth ML. Changes in sedentary behavior among adolescent girls: A 2.5-year prospective cohort study. J Adolesc Health. 2007;40(2):158–165. doi: 10.1016/j.jadohealth.2006.09.009.
    1. Fred Hutchinson Cancer Research Center Food Frequency Questionnaire. .

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