Pilot Project to Integrate Community and Clinical Level Systems to Address Health Disparities in the Prevention and Treatment of Obesity among Ethnic Minority Inner-City Middle School Students: Lessons Learned

Jessica Rieder, Agnieszka Cain, Erica Carson, Andrea Benya, Paul Meissner, Carmen R Isasi, Judith Wylie-Rosett, Neal Hoffman, Colleen Kelly, Ellen J Silver, Laurie J Bauman, Jessica Rieder, Agnieszka Cain, Erica Carson, Andrea Benya, Paul Meissner, Carmen R Isasi, Judith Wylie-Rosett, Neal Hoffman, Colleen Kelly, Ellen J Silver, Laurie J Bauman

Abstract

Effective obesity prevention and treatment interventions are lacking in the United States, especially for impoverished minority youths at risk for health disparities, and especially in accessible community-based settings. We describe the launch and pilot implementation evaluation of the first year of the B'N Fit POWER initiative as a middle school-based comprehensive wellness program that integrates weight management programming into existing onsite preventive and clinical services. Consistent with the existing implementation science literature, we focused on both the organizational structures that facilitate communication and the development of trust among stakeholders, students, and families and the development of realistic and timely goals to implement and integrate all aspects of the program. New implementation and programming strategies were developed and tested to increase the proportion of students screened, support the linkage of students to care, and streamline the integration of program clinical and afterschool components into routine services already offered at the school. We report on our initial implementation activities using the Standards for Reporting Implementation Studies (StaRI) framework using hybrid outcomes combining the Reach element from the RE-AIM framework with a newly conceptualized Wellness Cascade.

Figures

Figure 1
Figure 1
The B'N Fit POWER clinical and community integration framework. Adapted from the Clinical–Community Integration Framework by Dietz et al. [31].
Figure 2
Figure 2
Implementation evaluation based on RE-AIM and Wellness Cascade.

References

    1. Ogden C. L., Carroll M. D., Lawman H. G., et al. Trends in obesity prevalence among children and adolescents in the United States, 1988–1994 through 2013-2014. JAMA. 2016;315(21):2292–2299. doi: 10.1001/jama.2016.6361.
    1. Skinner A. C., Skelton J. A. Prevalence and trends in obesity and severe obesity among children in the United States, 1999–2012. JAMA Pediatrics. 2014;168(6):561–566. doi: 10.1001/jamapediatrics.2014.21.
    1. Seo D. C., King M. H., Kim N., Sovinski D., Meade R., Lederer A. M. Predictors for persistent overweight, deteriorated weight status, and improved weight status during 18 months in a school-based longitudinal cohort. American Journal of Health Promotion. 2015;30(1):22–27. doi: 10.4278/ajhp.131118-quan-585.
    1. Watson K. B., Harris C. D., Carlson S. A., Dorn J. M., Fulton J. E. Disparities in adolescents’ residence in neighborhoods supportive of physical activity—United States, 2011-2012. Morbidity and Mortality Weekly Report. 2016;65(23):598–601. doi: 10.15585/mmwr.mm6523a2.
    1. Grossman D. C., Bibbins-Domingo K., Curry S. J., et al. Screening for obesity in children and adolescents: US preventive services task force recommendation statement. JAMA. 2017;317(23):p. 2417. doi: 10.1001/jama.2017.6803.
    1. Seo D.-C., Sa J. A meta-analysis of obesity interventions among US minority children. Journal of Adolescent Health. 2010;46(4):309–323. doi: 10.1016/j.jadohealth.2009.11.202.
    1. Wilson D. K. New perspectives on health disparities and obesity interventions in youth. Journal of Pediatric Psychology. 2009;34(3):231–244. doi: 10.1093/jpepsy/jsn137.
    1. Whitlock E. P. Screening and interventions for childhood overweight: a summary of evidence for the US preventive services task force. Pediatrics. 2005;116(1):e125–e144. doi: 10.1542/peds.2005-0242.
    1. Dao H. H., Frelut M. L., Oberlin F., Peres G., Bourgeois P., Navarro J. Effects of a multidisciplinary weight loss intervention on body composition in obese adolescents. International Journal of Obesity. 2004;28(2):290–299. doi: 10.1038/sj.ijo.0802542.
    1. Chehab L. G., Pfeffer B., Vargas I., Chen S., Irigoyen M. “Energy up”: a novel approach to the weight management of inner-city teens. Journal of Adolescent Health. 2007;40(5):474–476. doi: 10.1016/j.jadohealth.2006.12.009.
    1. Evans R. K., Franco R., Stern M., et al. Evaluation of a 6-month multi-disciplinary healthy weight management program targeting urban, overweight adolescents: effects on physical fitness, physical activity, and blood lipid profiles. Pediatric Obesity. 2009;4(3):130–133. doi: 10.1080/17477160802314997.
    1. Whitlock E. P., O’Connor E. A., Williams S. B., Beil T. L., Lutz K. W. Effectiveness of weight management interventions in children: a targeted systematic review for the USPSTF. Pediatrics. 2010;125(2):e396–e418. doi: 10.1542/peds.2009-1955.
    1. Laird Y., Fawkner S., Kelly P., McNamee L., Niven A. The role of social support on physical activity behaviour in adolescent girls: a systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity. 2016;13(1):p. 79. doi: 10.1186/s12966-016-0405-7.
    1. Woolford S. J., Sallinen B. J., Clark S. J., Freed G. L. Results from a clinical multidisciplinary weight management program. Clinical Pediatrics. 2011;50(3):187–191. doi: 10.1177/0009922810384845.
    1. Savoye M., Nowicka P., Shaw M., et al. Long-term results of an obesity program in an ethnically diverse pediatric population. Pediatrics. 2011;127(3):402–410. doi: 10.1542/peds.2010-0697d.
    1. DCCT. Lifetime benefits and costs of intensive therapy as practiced in the diabetes control and complications trial. JAMA. 1996;276(17):1409–1415. doi: 10.1001/jama.1996.03540170053032.
    1. Ickes M. J., McMullen J., Haider T., Sharma M. Global school-based childhood obesity interventions: a review. International Journal of Environmental Research and Public Health. 2014;11(9):8940–8961. doi: 10.3390/ijerph110908940.
    1. Belansky E. S., Cutforth N., Delong E., et al. Early impact of the federally mandated local wellness policy on physical activity in rural, low-income elementary schools in Colorado. Journal of Public Health Policy. 2009;30(1):S141–S160. doi: 10.1057/jphp.2008.50.
    1. Foster G. D., Sherman S., Borradaile K. E., et al. A policy-based school intervention to prevent overweight and obesity. Pediatrics. 2008;121(4):e794–e802. doi: 10.1542/peds.2007-1365.
    1. Gortmaker S. L., Peterson K., Wiecha J., et al. Reducing obesity via a school-based interdisciplinary intervention among youth: planet health. Archives of Pediatrics and Adolescent Medicine. 1999;153(4):409–418. doi: 10.1001/archpedi.153.4.409.
    1. Robinson T. N. Reducing children’s television viewing to prevent obesity: a randomized controlled trial. JAMA. 1999;282(16):1561–1567. doi: 10.1001/jama.282.16.1561.
    1. Rieder J., Khan U. I., Heo M., et al. Evaluation of a community-based weight management program for predominantly severely obese, difficult-to-reach, inner-city minority adolescents. Childhood Obesity. 2013;9(4):292–304. doi: 10.1089/chi.2012.0147.
    1. Peralta L. R., Jones R. A., Okely A. D. Promoting healthy lifestyles among adolescent boys: the fitness improvement and lifestyle awareness program RCT. Preventive Medicine. 2009;48(6):537–542. doi: 10.1016/j.ypmed.2009.04.007.
    1. Weintraub D. L., Tirumalai E. C., Haydel K. F., Fujimoto M., Fulton J. E., Robinson T. N. Team sports for overweight children: the stanford sports to prevent obesity randomized trial (SPORT) Archives of Pediatrics & Adolescent Medicine. 2008;162(3):232–237. doi: 10.1001/archpediatrics.2007.43.
    1. Dudley D. A., Okely A. D., Pearson P., Peat J. Engaging adolescent girls from linguistically diverse and low income backgrounds in school sport: a pilot randomised controlled trial. Journal of Science and Medicine in Sport. 2010;13(2):217–224. doi: 10.1016/j.jsams.2009.04.008.
    1. Eather N., Morgan P. J., Lubans D. R. Improving health-related fitness in adolescents: the CrossFit Teens™ randomised controlled trial. Journal of Sports Sciences. 2016;34(3):209–223. doi: 10.1080/02640414.2015.1045925.
    1. Christian D., Todd C., Hill R., et al. Active children through incentive vouchers—evaluation (ACTIVE): a mixed-method feasibility study. BMC Public Health. 2016;16(1):p. 890. doi: 10.1186/s12889-016-3381-6.
    1. Force C. P. S. T. Obesity Prevention and Control: School-Based Programs. 2017. .
    1. Pinnock H., Barwick M., Carpenter C. R., et al. Standards for reporting implementation studies (StaRI) statement. BMJ. 2017;356:p. i6795. doi: 10.1136/bmj.i6795.
    1. Hester J. A., Stange P. V., Seeff L. C., Davis J. B., Craft C. A. Toward Sustainable Improvements in Population Health: Overview of Community Integration Structures and Emerging Innovations in Financing. 2015. .
    1. Dietz W. H., Belay B., Bradley D., et al. A Model Framework that Integrates Community and Clinical Systems for the Prevention AND Management of Obesity and Other Chronic Diseases. 2017. .
    1. Roth J. L., Brooks-Gunn J. What exactly is a youth development program? Answers from research and practice. Applied Developmental Science. 2003;7(2):94–111. doi: 10.1207/s1532480xads0702_6.
    1. McKinney C., Bishop V., Cabrera K., et al. NuFit: nutrition and fitness CBPR program evaluation. Journal of Prevention and Intervention in the Community. 2014;42(2):112–124. doi: 10.1080/10852352.2014.881180.
    1. Stock S., Miranda C., Evans S., et al. Healthy buddies: a novel, peer-led health promotion program for the prevention of obesity and eating disorders in children in elementary school. Pediatrics. 2007;120(4):e1059–e1068. doi: 10.1542/peds.2006-3003.
    1. Kanyamee M., Fongkaew W., Chotibang J., Aree P., Kennedy C. An intervention study of changing eating behaviors and reducing weight in thai children aged 10–12. Pacific Rim International Journal of Nursing Research. 2013;17(4)
    1. Katz D. L., O’Connell M., Njike V. Y., Yeh M. C., Nawaz H. Strategies for the prevention and control of obesity in the school setting: systematic review and meta-analysis. International Journal of Obesity. 2008;32(12):1780–1789. doi: 10.1038/ijo.2008.158.
    1. Jelalian E., Mehlenbeck R., Lloyd-Richardson E. E., Birmaher V., Wing R. R. Adventure therapy’ combined with cognitive-behavioral treatment for overweight adolescents. International Journal of Obesity. 2006;30(1):31–39. doi: 10.1038/sj.ijo.0803069.
    1. Eskicioglu P., Halas J., Sénéchal M., et al. Peer mentoring for type 2 diabetes prevention in first nations children. Pediatrics. 2014;133(6):e1624–e1631. doi: 10.1542/peds.2013-2621.
    1. Story M. School-based approaches for preventing and treating obesity. International Journal of Obesity and Related Metabolic Disorders. 1999;23(2):43–51. doi: 10.1038/sj.ijo.0800859.
    1. Foundation R. W. J. Health Outcomes: Overall Rank. 2017. t.
    1. Egger J. R., Bartley K. F., Benson L., Bellino D., Kerker B. Childhood obesity is a serious concern in New York City: higher levels of fitness associated with better academic performance. NYC Vital Signs. 2009;8(1):1–4.
    1. Public School 95 Sheila Mencher in Bronx, New York. 2017. .
    1. da Costa Nunez R., Adams M., Gleason A., Harris S. Failures and solutions: New Yorkers’ views on homelessness. Proceedings from an ICPH Public Opinion Poll; 2011; New York, NY, USA.
    1. Atkiss K., Moyer M., Desai M., Roland M. Positive youth development: an integration of the developmental assets theory and the socio-ecological model. American Journal of Health Education. 2011;42(3):171–180.
    1. Education, N. Y. C. D. O. NYC Fitnessgram. .
    1. Barlow S. E. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120(4):S164–S192. doi: 10.1542/peds.2007-2329C.
    1. Service U. S. D. A. F. A. N. MyPlate. 2017. .
    1. Institute N. I. H. N. H. L. A. B. How Much Sleep is Enough? 2017. .
    1. Glasgow R. E., Vogt T. M., Boles S. M. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. American Journal of Public Health. 1999;89(9):1322–1327. doi: 10.2105/ajph.89.9.1322.
    1. McGoey T., Root Z., Bruner M. W., Law B. Evaluation of physical activity interventions in children via the reach, efficacy/effectiveness, adoption, implementation, and maintenance (RE-AIM) framework: a systematic review of randomized and non-randomized trials. Preventive Medicine. 2016;82:8–19. doi: 10.1016/j.ypmed.2015.11.004.
    1. Kessler R. S., Purcell E. P., Glasgow R. E., Klesges L. M., Benkeser R. M., Peek C. J. What does it mean to “employ” the RE-AIM model. Evaluation & the Health Professions. 2013;36(1):44–66. doi: 10.1177/0163278712446066.
    1. Gaglio B., Shoup J. A., Glasgow R. E. The RE-AIM framework: a systematic review of use over time. American Journal of Public Health. 2013;103(6):e38–e46. doi: 10.2105/ajph.2013.301299.
    1. Mugavero M. J., Amico K. R., Horn T., Thompson M. A. The state of engagement in HIV care in the United States: from cascade to continuum to control. Clinical Infectious Diseases. 2013;57(8):1164–1171. doi: 10.1093/cid/cit420.
    1. O’Connor E. A., Evans C. V., Burda B. U., Walsh E. S., Eder M., Lozano P. Screening for obesity and intervention for weight management in children and adolescents: evidence report and systematic review for the US preventive services task force. JAMA. 2017;317(23):p. 2427. doi: 10.1001/jama.2017.0332.
    1. Epic. 2017. .
    1. Plan-Do-Study-Act (PDSA) Cycle. 2017. .
    1. Kaplan S. A., Calman N. S., Golub M., Davis J. H., Ruddock C., Billings J. Racial and ethnic disparities in health: a view from the South Bronx. Journal of Health Care for the Poor and Underserved. 2006;17(1):116–127. doi: 10.1353/hpu.2006.0026.
    1. McKee M. D., O’Sullivan L. F., Weber C. M. Perspectives on confidential care for adolescent girls. Annals of Family Medicine. 2006;4(6):519–526. doi: 10.1370/afm.601.
    1. Education N. Y. C. D. O. STEM. 2017. .
    1. Doran G. T. There’s a S.M.A.R.T. way to write management’s goals and objectives. Management Review. 1981;70(11):35–36.
    1. Cason-Wilkerson R., Goldberg S., Albright K., Allison M., Haemer M. Factors influencing healthy lifestyle changes: a qualitative look at low-income families engaged in treatment for overweight children. Childhood Obesity. 2015;11(2):170–176. doi: 10.1089/chi.2014.0147.
    1. Sallinen B. J., Schaffer S., Woolford S. J. In their own words: learning from families attending a multidisciplinary pediatric weight management program at the YMCA. Childhood Obesity. 2013;9(3):200–207. doi: 10.1089/chi.2012.0106.
    1. Puhl R. M., Peterson J. L., Luedicke J. Weight-based victimization: bullying experiences of weight loss treatment-seeking youth. Pediatrics. 2013;131(1):e1–e9. doi: 10.1542/peds.2012-1106.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться