The promotion of physical activity and healthy eating to prevent obesity among youth is a pressing challenge. The current study examined the feasibility of community health workers (CHWs) conducting a physical activity (PA) and healthy eating intervention strategy with links to community supports and programs. Youth aged 10 - 18 years were recruited from three clinical sites serving inner-city families. Trained CHWs conducted assessment and counseling for PA and healthy eating among youth and their families and provided customized plans and navigation to neighborhood PA and nutrition programs. Measures of daily PA by self-report, weekday and weekend day sedentary behaviors, fruit and vegetable intake, avoidance of fatty foods, and avoidance of sugary drinks were assessed at baseline and follow-up. Twenty-five patients (mean age = 12.9 years) were exposed to ~9 months of intervention from baseline. Pre- and post-assessments revealed significant changes in reported PA, sedentary behaviors on weekdays, sedentary behaviors on weekend days, fruit and vegetable intake, avoidance of fatty foods, and avoidance of sugary drinks. Results demonstrated the feasibility of having CHWs effectively influenced the PA and eating behaviors of inner-city youth. Greater success was evident when assessment and counseling for PA and healthy eating were accompanied by navigation to neighborhood resources. The use of CHWs may be a cost-effective approach impacting the PA, sedentary, and dietary behaviors of youth.
The important influence of physical activity (PA) on reducing the burden of chronic diseases and enhancing quality of life is well established [
This nine month feasibility project used a multi-component translational intervention study design and focused on primary prevention of the behavioral metabolic disease risk factors of poor dietary habits, physical inactivity, sedentary behaviors, and access to primary health care. The primary intervention sites were a community-based primary care pediatric clinic, and two high-risk pediatric subspecialty practices associated with an academic health center. These three sites are staffed by the academic health center’s affiliated faculty. The clinic-based portion of the intervention consisted of assessment and counseling protocols designed to determine youth PA and eating behaviors and to provide customized PA and dietary recommendations.
The targeted behaviors of PA and healthy eating were directed towards a total of 70 boys and girls who were 10 through 18 years of age along with their families and lived and received their education and health care in several lower income inner-city areas of the Chattanooga, Tennessee region of the United States. Trained CHWs administered all physical activity and dietary assessment tools and provided summary information to primary care providers responsible for each patient (
yes, but less than 6 months, 5 = yes, greater than 6 months). These health behaviors were assessed at baseline and approximately ~9 months at follow-up. Each patient’s initial assessment and counseling session conducted by the CHWs provided navigational information about environmental and program supports for physical activity and healthy eating in community neighborhoods. The CHWs used a commercially available online tool, Walk- score.com™, to accomplish this goal. Through the use of this tool, the CHWs provided walking maps, directions to fitness facilities and programs for children and adolescents, healthy eating establishments and markets to all patients undergoing the assessment and counseling.
Intervention strategies included navigating participants to physical activity and nutrition programs offered through local community organizations, for example, local schools, local parks and recreation facilities, faith- based organizations, and other voluntary health organizations. As a result, each patient’s physical activity and dietary plan, as detailed in the assessment program by the CHW, was tailored to individual patients not only by using personal behavioral characteristics and strategies, but also by utilizing place of residence, neighborhood resources, and access to facilities, affordability of programming, and other supportive environmental moderators.
Each child’s weight and calculated body mass index (BMI) was assessed at baseline and follow-up using clinic charts and/or an electronic health record. Self-reported sedentary behavior (e.g., TV watching, computer gaming, and video watching), physical activity, fruit and vegetable intake, avoidance of fatty foods, and avoidance of sugary drinks was also assessed at baseline and periodically throughout the follow-up period. Human subjects’ protection: All patients and their families were provided information about the study. Among families agreeing to participation, adults and children/youth provided informed consent/ascent, respectively. Study protocols and informed/ascent consent forms were approved by the University of Tennessee: College of Medicine Chattanooga/Erlanger Health System Institutional Review Board.
All clinical and health behavior data were entered into an Excel spreadsheet and kept secure either in a password protected laptop and/or flash drive. Data were imported into IBM SPSS version 21 for data analysis. Summary statistics, means, standard deviation, standard error were calculated for both baseline and follow-up measures. Paired t tests were conducted among all pairs of patient data—(baseline, follow-up). Stratification of data by age and sex were also conducted. Comparisons of baseline measures of age, weight, and BMI among patients completing the intervention trial with 45 patients who elected not to participate in the intervention were conducted and were shown to differ in terms of weight, BMI, and health behaviors (results not shown).
The mean period of follow-up was 8.6 months and was marked by a repeating of the behavioral assessments, anthropometric and usual care biomedical measures when available. Baseline patient characteristics for 25 patients who participated in the 9 month intervention program are displayed in
Characteristic | Mean | Standard Deviation ± |
---|---|---|
Age (years) | 12.9 | 2.85 |
Weight (Kg) | 51.72 | 21.12 |
BMI (Kg/m2) | 23.34 | 6.52 |
Number | Proportion (%) | |
Female | 17 | 60% |
Male | 8 | 40% |
Latino/Hispanic Race/Ethnicity | 19 | 76% |
African-American Race/Ethnicity | 4 | 16% |
Caucasian/White Race/Ethnicity | 2 | 8% |
The results from this feasibility study suggest that trained CHWs can influence the physical activity and eating behaviors of inner-city youth when assessment and counseling for physical activity and healthy eating is accompanied by navigation to neighborhood resources. The use of CHWs may be a cost-effective approach impacting the physical activity, sedentary, and dietary behaviors of youth. Our results appear to be quite timely since the rate of overweight and obese children and adolescents in the United States continues to increase. The increase in the prevalence of overweight and obesity among children and adolescents is similar to estimates among adults, and has been increasing disproportionately among African-American and Latino children and adolescents. Sixteen percent (16%) of African-American children are overweight, and an additional 15% are at risk for overweight or becoming obese. Latino children are the most overweight ethnic group of US children, with 22% overweight and 40% at risk for overweight or obesity, compared with 14% and 28% for white children, and 21% and 35% for African-American children, respectively [
Our study demonstrated that the innovative use of enhanced follow-up methods, such as implementing a patient navigation system that directs participants to environmental supports within their communities for active living and healthy eating, increasing the likelihood of translating and sustaining these important health behaviors which may be linked to the effective prevention and management of obesity and associated co-morbidities.
We wish to thank our Community Health Workers, Eunice Mendoza and Elizabeth Tenley, for their diligent and faithful work among our patients, their families, and community partners.