B'More Healthy Communities for Kids, a multilevel obesity prevention program for African American children: Wave 1 process and impact results
Authors: Gittelsohn Joel , Trude Angela , Shipley Cara , Ruiz Maria Jose Mejia , Schwendler Teresa , Eckmann Thomas , Loh Ivory , Rapp Naomi 
Published: November 2023

Background

Limited research exists on the impact of multi‐level, multi‐component (MLMC) interventions. BHCK is an ongoing MLMC obesity prevention program, which targets multiple levels of the urban food environment, addressing child (via youth leaders), adult caregiver (via text messaging, social media), community (via corner store, carry‐out, wholesaler programs), and policy levels to increase healthy food access, purchasing, and consumption among low income African American (AA) youth between the ages of 10–14 in Baltimore City.

Methods

Wave 1 of BHCK was evaluated through a combination of process and impact measures at different levels. We observed small food stores/carryout to detect change in availability of BHCK healthy promoted products such as produce, whole grain products, lower fat snacks, and lower sugar beverages, low fat entrees/side dishes. In youth, we used the 2004 Block Kids FFQ to estimate impact on dietary intake. Our baseline sample was composed of 299 child‐caregiver dyads (pre‐intervention), with 70% assessed post‐intervention. Estimated difference in food group intake was calculated using the least‐squares mean regression, adjusted by child's age, sex, energy intake, baseline value of the dependent variable, BMI percentile, caregiver's income and education level. Analysis of covariance (ANCOVA) was used to assess difference in intake between intervention and control groups.

Results

Different components of the intervention were implemented with moderate to high reach, dose and fidelity observed. Twelve of our original sixteen youth‐leaders conducted a total of 98 nutrition sessions across seven intervention recreation centers, with an average of 10 low‐income AA children in our target age range (10–14) attending each session, and a total of 1600 child interactions in recreation centers and community venues combined. Educational sessions and promotional activities at stores reached 5–10 youth in our target age range per store session. 80% of study families received text‐messages during the program. We found an 8.6% increase in availability of whole wheat bread in intervention stores while control stores decreased 37.8% (p<0.01). FFQ data shows that youth in the intervention group increased consumption of whole grain foods from pre‐ to post‐intervention, whereas youth in the control group decreased. Intervention group had a 0.47 (± 0.04) adjusted mean intake of whole grains, whereas control group showed a 0.41 (±0.43) adjusted mean intake. Additional analyses will examine impact of the BHCK program on access, purchase, and consumption of healthier beverages and snacks.

Conclusions

This study is an example of a successful MLMC intervention. Findings will inform public health strategies to improve dietary quality and access to healthy food in low‐income urban settings. Future directions include scaling up to other cities and sustaining/institutionalizing successful strategies.

Support or Funding Information

Research reported in this work was supported by the Global Obesity Prevention Center (GOPC) at Johns Hopkins, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the Office of the Director, National Institutes of Health (OD) under award number U54HD070725. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.