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Intervention IP-128: Children’s Healthy Living Program - CHL
Summary
This intervention was a community-wide program in Alaska, American Samoa, the Northern Mariana Islands, Guam, and Hawaii that aimed to help young children live healthier lives. Over two years, communities worked on 19 activities that promoted better sleep, less screen time, more physical activity, more fruits and vegetables, more water, and fewer sugary drinks, while also making changes to policies, child care settings, local environments, and health education. The study suggests that an integrated approach engaging the entire community can improve children's health.
Overview
The intervention's purpose is to prevent overweight and obesity in young children (ages 2–8y) and improve related health outcomes in communities across the US‑Affiliated Pacific region.
Research-Tested — Interventions with strong methodological rigor that have demonstrated short-term or long-term positive effects on one or more targeted health outcomes to improve minority health and/or health disparities through quantitative measures; Studies have a control or comparison group and are published in a peer-review journal; No pilot, demonstration or feasibility studies.
Intervention Details
Both Community and Academic/Clinical Researchers
Citations:
-
Novotny R, Davis J, Butel J, Boushey CJ, Fialkowski MK, Nigg CR, Braun KL, Leon Guerrero RT, Coleman P, Bersamin A, Areta AAR, Barber LR Jr, Belyeu-Camacho T, Greenberg J, Fleming T, Dela Cruz-Talbert E, Yamanaka A, Wilkens LR. Effect of the Children's Healthy Living Program on Young Child Overweight, Obesity, and Acanthosis Nigricans in the US-Affiliated Pacific Region: A Randomized Clinical Trial. JAMA network open. 2018 Oct 5;1(6):e183896. PubMed
PubMed Central DOI
Relevance: Main Intervention -
Novotny R, Yamanaka AB, Butel J, Boushey CJ, Dela Cruz R, Aflague T, Coleman P, Shallcross L, Fleming T, Wilkens LR. Maintenance Outcomes of the Children's Healthy Living Program on Overweight, Obesity, and Acanthosis Nigricans Among Young Children in the US-Affiliated Pacific Region: A Randomized Clinical Trial. JAMA network open. 2022 Jun 1;5(6):e2214802. PubMed PubMed Central DOI
Relevance: Post-Intervention Outcomes
No
Contact Information
University of Hawaiʻi at Mānoa
https://www.chl-pacific.org/
Results
Improve minority health or the health of other populations with health disparities (e.g. rural populations, populations with low SES)
The primary outcomes were body size measurements.
Secondary outcomes were acanthosis nigricans, sleep quality and duration, dietary intake, physical activity, and other questionnaire responses.
The intervention communities showed significant improvement compared with control communities in overweight and obesity prevalence (p=0.02) and waist circumference (p=0.02). Acanthosis nigricans prevalence was reduced (P<0.001) in intervention communities.
Within-group changes over time and the between-group difference in changes were assessed using a Wald test, with degrees of freedom based on the number of communities. Subgroup models were run by age and sex to test effect differences via Wald tests of interaction terms. Two-sided P<0.05 was considered statistically significant.
Evaluations and Assessments
No
Demographic and Implementation Description
Obesity
American Indian or Alaska Native, Native Hawaiian or other Pacific Islander
People with Lower Socioeconomic Status (SES), Racial and Ethnic Minority Populations, Underserved Rural Communities
Children (1 - 9 years)
Socio-demographics / Population Characteristics
Rural, Urban / Inner City
Unspecified
Alaska Boroughs and Census Areas, Anchorage, Fairbanks North Star, Kenai Peninsula, Matanuska-Susitna, Hawaii, Hawaii, Honolulu, Kalawao, Kauai, Maui, American Samoa, Guam, Northern Mariana Islands
Low SES, Middle SES
Minority Health and Health Disparities Research Framework
| Levels of Influence | |||||
|---|---|---|---|---|---|
| Individual | Interpersonal | Community | Societal | ||
| Determinant Types | Biological | ✔ | |||
| Behavioral | ✔ | ✔ | ✔ | ✔ | |
| Physical / Built Environment | ✔ | ✔ | ✔ | ✔ | |
| Sociocultural Environment | ✔ | ✔ | ✔ | ✔ | |
| Health Care System | ✔ | ✔ | |||
Community Involvement
The community's role in different areas of the Intervention (Choices are "No Role", "Participation", and "Leadership"):
Participation
Leadership
Participation
Leadership
Participation
Participation
Participation
Leadership
Characteristics and Implementation
Behavior Change, Physical Environmental Change, Policy Change, Quality Improvement or Organizational Change, Social/Societal Change
Primary Prevention
Business / Retail, Clinic / Health Care Facility, Daycare / Preschool, Home, Local Community (e.g. Barbershops, Beauty / Hair Salon, Laundromats, Food Markets, Community Centers), Parks and Recreation, Houses of Worship, Schools / Colleges
In-person, Online/e-Health
Community Health Worker/Promoters, Healthcare Professional (Physician, Nurse, Technician), Care Providers, Teachers
Conceptual Framework
Diffusion of Innovation Theory, Social Cognitive / Social Learning Theory, Social Marketing, Theories of Organization Change (e.g. Dimensions of Organizational Change, Stage Theory, Interorganization Relations Theory, Community Coalition Action Theory)
Community Organization / Community Building, Social Determinants of Health Conceptual Framework, Social Ecological Model, Analysis Grid for Elements Linked to Obesity (ANGELO) Framework
Implementation
Cluster Randomized Controlled Trial
4333
4042
2012
2015
Intervention Exposures
2-3 years
Varies per community
More than 10 Sessions
1-2 Hours
Dyad/Group of two (e.g. participant & partner; mother & child), Group (e.g. Community leaders)
Grade 8-9
Impact, Lessons, Components
Yes
The intervention had a number of important unanticipated positive effects that demonstrated sustainability and long-term change, which were tracked and examined in further study and analysis. These positive effects included creation of coalitions and ongoing professional development among individuals involved in the intervention.
The use of a common intervention template derived from a blend of community and evidence-based approaches and actions provided flexibility for each community to localize and tailor the intervention to build on and strengthen local initiatives, circumstances, and indigenous culture.
Lessons Learned
The measured effect of the intervention may have been dampened by intervention activities like messaging and advertising affecting control communities. The use of wrist accelerometers to measure activity needs further evaluation to determine if the measurements are effective in capturing the movements of young children.
Insights Gained During Implementation
| Insight Category | Insight Description |
|---|---|
| Cost of Implementing or Sustaining | Training of community members, including degree training, was vital for sustaining the intervention. |
| Logistics | The common US land grant college structure was key to the success of the intervention across diverse communities and political systems. |
| Administrative Resources | A high degree of administrative support was needed for contracting multiple communities. |
| Training / Technical Assistance | Training and leadership of community members was key to success. |
| Staffing | Local leadership and role modelling of various behaviors and activities in local settings was essential. |
| Recruitment | Embedding recruitment into local community organizations, such as Headstart, was effective. |
Intervention Components
Yes
Yes
Products, Materials, and Funding
| Used for Implementation | Needed for Sustainability | |
|---|---|---|
| Expertise | ||
|
Community mobilization, community organization/coalition building |
Yes | Yes |
|
Health Education / Health Literacy |
Yes | Yes |
|
Health communication, health marketing/publicity |
Yes | Yes |
|
Key informants, Tribal leaders, Community gatekeepers |
Yes | Yes |
| Partnerships | ||
|
Health care facilities (local clinics) |
Yes | Yes |
|
School system (e.g. school administrators, health educators, daycares, preschools, private & public schools) |
Yes | Yes |
|
Universities |
Yes | Yes |
|
Community groups (e.g. faith-based organizations, barbershops, beauty-salons, laundromats, food markets, community centers, cultural associations, tribal groups) |
Yes | Yes |
| Funding Sources | ||
|
Public funding (e.g., federal, state or local government) |
Yes | Yes |
Product/Material/Tools
| Tailored For Language | Language(s) if other than English | Material | |
|---|---|---|---|
| Outreach/Recruitment Tools | |||
|
Publicity Materials (e.g. Posters, Flyers, Press Releases) |
No |
https://www.chl-pacific.org/extension-and-outreach-center/chl-food-systems__trashed/resource-materials/
|
|
| Participant Educational Tools | |||
|
Brochures/Factsheets/Pamphlets |
Yes |
Samoan |
https://www.chl-pacific.org/extension-and-outreach-center/chl-food-systems__trashed/resource-materials/
|
| Measurement Tools | |||
|
Standardized Instrument/Measures |
Yes |
Samoan |
https://www.chl-pacific.org/chl-data-center/research-requests/data-resources/
|
Implementation Materials and Products
| Material | |
|---|---|
| Implementation/Delivery Materials | |
| No Implementation/Delivery Materials provided. | |
| Implementation/Output Materials | |
| No Implementation/Output Materials provided. | |
Articles Related to Submitted Intervention
| Article | |
|---|---|
| Reports/Monographs | |
| No Reports/Monographs provided. | |
| Additional Articles | |
|
Methodology |
https://pubmed.ncbi.nlm.nih.gov/24043557/
|