Appalachians Together Restoring the Eating Environment: Improving Healthy Diet in Rural Appalachian Kentucky

Study Overview
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Brief Summary
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Most of the nation's serious chronic health challenges and causes of death, including diabetes, heart disease, cancer, and obesity, are directly linked to sub-optimal diet. Both poor diets and associated disease are disproportionately common in the Appalachian counties of eastern Kentucky, a region with stark health inequities, including elevated rates of obesity, overweight, and premature mortality. The purpose of this study is to evaluate a multi-component intervention developed through community-based participatory research methods for improving access to healthy foods and enhancing dietary intake in eastern Kentucky. The intervention components evaluated in this study consist of: 1) a school-based campaign to promote water consumption in middle and high schools and 2) a series of group cooking classes for adults.

Official Title
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Appalachians Together Restoring the Eating Environment (Appal-TREE): Advancing Sustainable CBPR Interventions to Improve Healthy Diet in Rural Appalachian Children

Conditions
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Feeding Behavior, Drinking Behavior

Intervention / Treatment
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* Behavioral: School-based water campaign
* Behavioral: Community cooking classes


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: For school-based component: Student in selected middle or high school classroom in a participating school in intervention or comparison counties (6th to 12th grades) For cooking classes: adult aged 18 years or older and residing in intervention county who have at least one dependent child attending middle or high school in the participating school districts Exclusion Criteria: Unable to speak or read English, as all materials will be presented in English

Ages Eligible for Study
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Minimum Age: 10 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: School-based water campaign<br>Students who attend middle and high schools in the intervention counties will receive a school-based water campaign. A sample of students from each school will complete surveys before and after the installation of the water refilling stations to measure beverage consumption, knowledge, attitudes, and self-efficacy. | Behavioral: School-based water campaign<br>* Includes: 1) the installation of filtered water bottle refilling stations, 2) the distribution of reusable water bottles to all students and teachers, and 3) a social marketing campaign to support the increase of water consumption among students.<br>|
| No Intervention: Comparison schools<br>A sample of students who attend middle and high schools in the comparison county, which does not receive any intervention components, will complete surveys to measure beverage consumption, knowledge, attitudes, and self-efficacy. | |
| Experimental: Community cooking classes<br>Adults in the same intervention counties as the school-based water campaign will enroll in group cooking classes. They will complete a baseline and two follow-up surveys to measure changes in fruit and vegetable consumption, attitudes, and self-efficacy. | Behavioral: Community cooking classes<br>* Cooking classes will be delivered to groups of 8-12 adult participants as a series of 8 weekly classes in community venues. The content of each class is driven by topics and themes identified and prioritized by community members, namely cooking healthy on tight budget.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in beverage consumption (students) | Survey items address frequency and quantity of beverages consumed in past month. Includes water, pop/soda, diet pop/soda, sports drinks, energy drinks, sweetened tea, 100% fruit juice, and milk. | Baseline, 6 months, 12 months, 18 months, 24 months, 30 months | 
| Change in fruit and vegetable consumption (adults) | Survey items address frequency and quantity of consumption of fruits and vegetables in the past month. | Baseline to 8 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in attitudes and preferences about beverages (students) | Survey items address taste preferences, attitudes about eating/drinking behavior and body image, and self-efficacy. | Baseline, 6 months, 12 months, 18 months, 24 months, 30 months | 
| Change in purchasing of drinks (students) | Survey items will address frequency of purchasing beverages at fast food restaurants, convenience stores, and school venues and events. | Baseline, 6 months, 12 months, 18 months, 24 months, 30 months | 
| Change in food preparation habits (adults) | Survey items address meal planning and preparation | Baseline to 8 weeks | 
| Change in food purchasing habits (adults) | Survey items address frequency of purchasing food at work, grocery/convenience stores, restaurants and produce stands | Baseline to 8 weeks | 
| Change in perceptions of availability of health foods (adults) | Survey items address availability of high quality fruits and vegetables and low-fat foods | Baseline to 8 weeks | 
| Change in barriers to health eating (adults) | Survey items address physical, psychosocial, emotional, and financial barriers to healthy eating | Baseline to 8 weeks |