Progress 05/01/09 to 04/30/14
Outputs
Target Audience: Target Audience: Parents and 8-12 year old children participating in 4-H Youth Development programs and living in rural or frontier areas of Montana are the target audience. The 4-Health educational program provided parents with new knowledge about healthy-living in the areas of nutrition, physical activity, family communication/parenting, and body image. Participants learned how to apply this knowledge within their families and, particularly to their pre-teen children, in such a way as to prevent or reduce childhood obesity. Efforts: Curriculum materials for the 4-Health Educational Program (experimental) and Healthy Living Information Program (control) were developed, reviewed, pilot tested, modified as needed, and used statewide. Curricular materials have since been disseminated throughout the state. 6 trainings have been held across the state to train agents as facilitators, with a virtual training recorded and available for future use. Various statewide and national workshops, presentations, and outreach activities were completed over the last five years (see other products section for specific listing). Curricular materials were recognized as a 4-H Program of Distinction in 2014, and are available nationwide through the program website www.4health.org. Changes/Problems: In 2010, the proposed research design was revised based on focus group results, FSC/4-H Extension agent inputs, and curriculum revisions. The revised design included a two group (experimental and “best practices” control) intervention so that in the fall of 2010, pilot testing of all revised and expanded curriculum lessons began. In the summer of 2011, additional minor modifications were made as needed based on pilot results, those changes included minor modifications of the 4-Health (experimental) program and the associated parent and agent guides. Most of these changes were aimed at recognizing the wider ethnic and cultural diversity of potential participants in Montana, than was originally recognized in the guides developed for the pilot study. Most assessment instruments included in the pilot study and the basic assessment procedures were retained. As a result of the pilot pre-intervention results, however, two assessment changes were planned. The first involved having parents complete the full FHCRC food frequency questionnaire (FFQ) with regard to their child's dietary and nutrition/eating habits. In the pilot study we used only a selected part of this instrument. In the full study we asked them to complete the full FFQ. In addition to this change, we also decided to eliminate use of pedometers to assess physical activity (PA). Our experience in the pilot study suggested that the results obtained were too variable (and the cost too great) to warrant their use in the full study. Instead, we added self-assessment instruments for both parent and child that allowed reliable and valid assessment of PA. Although none of the other instruments used in the pilot study will be eliminated. Some additional instruments to assess important aspects of obesity risk were (e.g., assessment of child's sleep duration and assessment of child's goal-setting with regard to PA and nutritious eating). In 2012, a protocol for advising participants of potentially high blood pressure (BP) readings recorded during assessments that might require medical attention was added. The Montana State University IRB approved this modification on May 1, 2012. According to this protocol, participants whose BP is above the normal range, as determined by the American Heart Association norms, were sent a letter as soon as possible after the assessment session, advising them of the possible need to seek professional advice from their health care provider. In 2013, a year-5 no-cost extension was used to disseminate the 4-Health program to others and to write and publish additional manuscripts based on the results of this research. What opportunities for training and professional development has the project provided? Six agents received facilitator training in 2010, 21 agents received facilitator training in 2011, and 11 agents received facilitator training for the 2013 program year. 196 Parent/child dyads have participated in one of the two developed programs, either the 4-Health Educational Program, or the Healthy Living Information Program over the 5 year period, with 3 counties running the 4-Health Program this academic year. 4-Health team members attended and presented results, interactive workshops, research posters, and research and evaluation reports on a yearly basis at both statewide and national conferences in the last five years. Specific presentation information can be found in the products sections. How have the results been disseminated to communities of interest? After the completion of each program year, results from the research study and program evaluation were provided to the agents who taught the program, as well as all team members and collaborators on campus. The results were provided in the form of both quantitative and qualitative summary reports, and in a PowerPoint presentation format capable of being shared with county program participants. The 4-Health website (www.4health.org) has been continuously updated to include all materials and agent training information for national use. The curriculum includes both a Facilitator Guide for those interested in teaching the program and a Parent Guide for participants, PowerPoint slides for session by session use, and links to videos and other resources that are helpful for the use with the curriculum. Facilitators are encouraged to use the materials as a whole program encompassing ten sessions over their preferred time frame, but some session activities could be used individually if needed, and are provided separately for that purpose. Program evaluation materials are built into the program books, both in a post session format and a final evaluation format, and can be used to assess participant learning. For those interested in running the program, a virtual training webinar is available online, along with a training PowerPoint, a recruitment poster to assist in marketing, and all additional resources for facilitators. The 4-Health curriculum was selected as a 4-H National Program of Distinction in February of 2014. Project results have been presented statewide at Montana State University’s Annual Extension Conference, several statewide 4-H and Family and Consumer Science updates and meetings, Montana Dietetic Association gatherings, and to other groups including the Montana Extension Advisory Committee meeting, the Eat Right Montana Coalition, and the Montana Action for Healthy Kids Coalition. Presentations of results have also been made nationally at multiple Extension and food and nutrition conferences. Publications and specific presentations and workshops are listed under the “products” sections. After several years of targeted programming, the 4-Health Program has been disseminated across the state of Montana, with nine counties and two Native American reservations receiving training and materials in its dissemination year 2013-2014. The 4-Health program has become a statewide plan of work through the Extension system, allowing agents to continue to offer it in their communities in future years, with free downloading of curricular materials available nationwide. 4-Health has also been included as a program through the Office of Public Instruction’s statewide nutrition education directory, the Montana Rural Health Initiatives program page, and has been broadcast across the social media site for the statewide Eat Right Montana group, and the nationwide Society for Nutrition Education and Behavior. The curriculum is now being used by both 4-H and non 4-H groups across the state, program materials have been provided for use in 2014-2015. What do you plan to do during the next reporting period to accomplish the goals?
Nothing Reported
Impacts
What was accomplished under these goals?
Finalized budget plan Recruited and hired key staff members Carried out focus groups to assist in program development Pilot Study Developed 4-Health curriculum (experimental group) by revising and expanding existing curriculum (STEPS), adding lessons on parenting, family communication, and body image Developed Healthy Living Information program (control group) based on current USDA/MyPlate materials Revised research design plan, including delivery of a pilot study, based on childhood obesity prevention consultant recommendations Designed, revised, and finalized data collection plan and instruments Obtained IRB approval of assessment plans and consent form Designed 4-Health website and carried out website training of key personnel Marketed and recruited for study to selected Montana 4-H/FCS agents. Carried out daylong training session for participating agents. Carried out study in 6 rural MT counties, including pre- and post-intervention data collection Collected program evaluations from participants and agents After Pilot Study Analyzed assessment data, examining pre- and post-intervention differences between experimental and control groups. Revised 4-Health curriculum and republished program guides Revised assessment plan, protocols, and assessment packets and obtained IRB approval for revised plans Distributed agent recruitment information statewide Full Study Recruited 4-H/FCS agents who served as trainers for the experimental group or the point of contact for participants in the control group Recruited 150 parent-child dyads from 21 rural MT counties for semi-random assignment as research participants in experimental and control groups Conducted Full study pre-intervention assessments, delivered programs, and conducted post-intervention 6-month follow-up assessments Parent participants completed program evaluations Completed analysis of all research data (pre, post, and 6 month follow-up) After Full Study Completed data analysis Presented, published, and disseminated findings Disseminated program materials and training statewide Results of data analysis: This analysis presents data from the Full study and includes variables from each of the six health-related domains (physiologic, body image, food and nutrition, physical activity, family-related variables, and health-related quality of life). This analysis includes only participants who completed all three assessment sessions: Pre, Post, and 6-month follow-up. Child Age and Gender were entered as independent variables (IVs) and Age was dichotomized by median split. Age and Gender were included as IVs so that interactions with other IVs (Group and Time) could be assessed, since previous analyses indicated that many of the apparent Group (experimental/control) and Time (Pre/Post/6mo) effects or their interactions depended on child age and/or gender. Physical Assessments (BMIz, BP, and HR): BMIz scores did not show significant pre-post changes for either treatment group. This may be due to the fact that our treatments groups differed prior to intervention (perhaps due to non-random group assignment). BMIz scores pre-intervention, were significantly correlated with blood pressure (p<.01). Diastolic BP decreased significantly in both groups during the intervention (PrePost, p=.009); however, it increased in the control group during the follow-up (Post to 6mo.), resulting in a significant overall Group*Time interaction (p=.030). These effects must be interpreted with caution, however, because of significant Age and Gender interactions Body image improved for all 3 body image-related measures: These included body esteem, which improved during the intervention, body dissatisfaction, which decreased during the intervention, and sociocultural attitudes toward appearance, which indicated decreased awareness and internalization of pressures to be thin, following the intervention. Improvements in BD were somewhat greater in the experimental group than the control group (p=.059). However, these improvements depended on the age and gender of the child and all diminished or were reversed during the follow-up period. Food and nutrition: Children’s self-reported healthy eating self-efficacy increased for both groups during the intervention period (p=.028). Girls reported significantly greater healthy eating self-efficacy than boys overall (p=.002), across all 3 assessments. Parents reported on the availability of specific foods at home. These reports showed significant group differences across the 3 assessments, with those in the experimental group reporting greater improvements than those in the control group. These differences were significant for fruit availability at home (p=.022) and for green vegetable availability (p=.032). Again it must be noted, however, that the above results depended on participant Age and Gender. For instance, there was a significant (p=.032) 3-way interaction (Group*Gender*Assessment period) in the reported availability of Green Vegetables. Family communication & family mealtime: Family communication, as reported by parents, improved significantly for both groups during the intervention period (p=.027); however, there was no significant Group x Time (assessment period) interaction. Family mealtime priority, which assesses the child’s perception of the importance placed on family meals, showed a significant Group*Age interaction (p=.050), such that older children in the experimental group reported lower meal priority than younger children, whereas older children in the control group reported greater meal priority than younger children. Health-related quality of life: Child Self-esteem (SE) increased significantly for both groups and across all 3 assessments (p<.001). However, within-subjects contrasts revealed this improvement was statistically significant (p<.001) only during the follow-up period (post to 6mo.), not during the intervention period. There was also a main effect of Age (p=.013), with older children reporting significantly higher overall SE than younger children. There were few significant changes in well-being measures as assessed by the Kidscreen assessment instrument and most differences dependent on child Age or Gender. For example, psychological well-being involved a significant (p=.038) 3-way interaction (Age x Gender x Assessment period). Physical Activity (PA): There was a significant increase in children’s reported amount of physical activity in the past 7 days, for both groups during the intervention period. But this improvement returned to pre-intervention levels by the follow-up period. There was also a Gender*Age interaction (p=.049) with girls significantly more active than boys, although this gender difference was smaller for older children. Children’s self-estimated TV time (hours/school day) decreased significantly for both groups from Pre to Post intervention (p=.005). Although both groups increased again during the 6-month follow-up, this post-intervention increase was non-significant. Children also assessed their PA goals (e.g., How sure are you that you can set goals for yourself to be more physically active?). There was a significant overall increase (p<.001), with a large and significant increase from Pre to Post intervention (p=.001) and a further, but non-significant (p=.794), increase from Post to 6mo. As with other PA measures, there was a significant main effect of Age (p=.005) and a significant Group*Age interaction (p=.032) with older children expressing greater certainty about setting PA goals. Conclusions: This small parent-only eight month childhood obesity prevention program produced some significant program effects on selected aspects of healthy lifestyles affecting children including family diet and nutrition, child body image, child physical activity, and parenting styles.
Publications
- Type:
Journal Articles
Status:
Accepted
Year Published:
2014
Citation:
Benke, C., Bailey, S., Eldridge, G., Lynch, W., Martz, J., & Paul, L. (2014). 4-Health: A programmatic evaluation of a parent-based childhood obesity prevention program. Journal of Youth Development [In press].
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Progress 05/01/12 to 04/30/13
Outputs
Target Audience: Target Audience: Parents and 8-12 year old children participating in 4-H Youth Development programs and living in rural or frontier areas of Montana are the target audience. The 4-Health educational program provided parents with new knowledge about healthy-living in the areas of nutrition, physical activity, family communication/parenting, and body image. Participants learned how to apply this knowledge within their families and, particularly to their pre-teen children, in such a way as to prevent or reduce childhood obesity. Efforts: Curriculum materials for the 4-Health Educational Program (experimental) and Healthy Living Information Program (control) were developed, reviewed, pilot tested, modified as needed, and used statewide. Curricular materials have since been disseminated throughout the state. 6 trainings have been held across the state to train agents as facilitators, with a virtual training recorded and available for future use. Various statewide and national workshops, presentations, and outreach activities were completed over the last five years (see other products section for specific listing). Curricular materials were recognized as a 4-H Program of Distinction in 2014, and are available nationwide through the program website www.4health.org. Changes/Problems: A year-5 no-cost extension will be used to disseminate the 4-Health program to others and to write and publish additional manuscripts based on the results of this research. What opportunities for training and professional development has the project provided? Eleven agents received facilitator training for the 2013 program year, 9 counties and two Native American Reservations received full sets of 4-Health curriculum and materials in July 2013 for use in the upcoming year throughout their areas of the state. 4-Health team members attended and presented results at several national conferences in the past year for Extension and Food and Nutrition professionals. How have the results been disseminated to communities of interest? A summary of research and evaluation results was written and provided to the 21 participating sites from the full program year which included pre-post data as well as 6-month follow up findings. Two National presentations (below), and two (HHD-Sandy and Carrie, MTDA-Lynn, any others?) in state presentations were given in the past year to share program results and impacts. The 4-Health website (www.4health.org) was updated to include downloadable pdf’s of the curriculum materials as well as supplementary facilitator materials for national use. The 4-Health curriculum materials won the National Association of Family and Consumer Science Agents Western Region Award for a Family Health and Wellness program. What do you plan to do during the next reporting period to accomplish the goals? 4-Health team members have been accepted to present at four more National conferences throughout the fifth year no cost extension to the grant. 4-Health team members continue to work on manuscripts reporting project results.
Impacts
What was accomplished under these goals?
Preliminary results are as follows: Overview. Previous analyses, which included only the pre/post-intervention data, suggested the need for a revised approach that could help account for unavoidable problems of non-random sampling and apparent gender and age interactions. Thus, for the current analysis only data from the Full study (i.e., no Pilot study data) and selected variables from each of the six health-related domains were included (i.e., physiologic, body image, food and nutrition, physical activity, family-related variables, and health-related quality of life). These included physiological assessments as well as composite scores from various instruments previously validated for use with adults or children in the age range of children in the current study (8-12 yo at pre-intervention). As noted, the data were collected at three time-points, pre-intervention (October 2011), post-intervention (May 2012), and 6-month follow-up (November 2012). Thus, the current analyses included only participants who completed all three assessment sessions (Pre, Post, and 6mo). For this analysis, child Age and Gender were entered as independent variables (IVs) and Age was dichotomized by median split: younger ≤ 10.56 yo; older >10.56 yo. Both Age and Gender were included as IVs so that interactions with other IVs (Group and Time) could be assessed, since previous analyses had indicated that many of the apparent Group (Exp/Cont) and Time (Pre/Post/6mo) effects or their interactions depended on child age and/or gender.Physiologic Variables. In addition to height and weight (converted to BMIz), we assessed blood pressure (BP) and heart rate (HR) of children and their parents. Although our program was not directly aimed at decreasing child weight, we assumed that reductions in obesity risk factors such as blood pressure, might reflect progress toward a healthier lifestyle. Child BMIz scores decreased during the intervention and increased during follow-up, regardless of age or gender. However, this may have been due to season,fall to spring (Pre to Post) and spring to winter (Post to 6mo). Group x Age and Group x Gender interactions, which were apparent at the Pre assessment Group x Age (p=.028) and Group x Gender (p=.031), remained significant across all three assessment periods of the study Group x Age (p=.048) and Group x Gender (p=.005). Thus, girls had significantly lower BMIz scores at the start and throughout the entire study, although these differences decreased somewhat across the three assessment periods. Child BP measures (both systolic and diastolic) were lower in the Exp group than the Cont group Pre and generally remained lower (sBP: p=.021; dBP: p=.106) throughout the study. However, this picture was made more complex by significant age and gender interactions depending on the assessment period. For example in the case of sBP there was a highly significant Group x Time x Age interaction (p=.007). In part these interactions may have been due to initial group differences in children’s BMIz scores and the strong correlations between BMIz and cardiovascular measures.Body Image Aside from actual changes in physiologic risk factors for overweight, we proposed that improvements in children’s perception and acceptance of their own bodies would be positive signs of reduced risk for obesity and, perhaps, eating disorders. There were significant improvements in several body image (BI) measures including Body Esteem (BE), Body Dissatisfaction (BD) and Sociocultural Attitudes Toward Appearance (SATAQ). In most cases, positive changes occurred in both Exp and Cont groups. For example child BE improved significantly for both groups pre- to post-intervention. In the case of BD, there was a marginally significant Group x Time interaction (p=.059) during the intervention period (Pre to Post), such that BD decreased in the Exp group and increased in the Cont group. However, this difference was reversed in the follow-up period (Post to 6mo). As noted for the physiologic measures, there were also significant Age and Gender interactions.Food & Nutrition There was a statistically significant (p=.028) increase in children’s Healthy Eating Self-efficacy during the intervention period (Pre to Post). However, the Group x Time interaction was non-significant. Girls were significantly (p=.002) more confident in terms of their ability to make healthy food choices than boys overall. In this case there were no significant differences between groups or across the three assessment periods. However, there was a marginally significant Time x Age interaction (p=.083), with Older children decreasing breakfast frequency from Pre to Follow-up and Younger children increasing breakfast frequency over this same period. There was also a significant Group x Gender interaction (p=.034) with girls in the Exp group eating breakfast more frequently than girls in the Cont group.Physical Activity An activity total score derived from the Physical Activity Questionnaire for children showed a significant increase in activity Pre to Post for both groups. But this improvement reversed and returned to the Pre-intervention level (or below) at follow-up. Children were also asked to estimate the number of days per week that they were physically active for at least 60 minutes. Days of activity increased significantly overall across the three assessment periods but this increase was only significant during the intervention (Pre to Post) (p=.034) and did not depend on Group assignment. Children were also asked to estimate the average number of hours they watched TV each school day. Self-reported TV hours per school day decreased significantly from Pre to Post intervention (p=.005), but increased again Post-intervention to 6mo follow-up. There was also a significant Group x Gender interaction (p=.041), such that Cont group girls reported the fewest school-day hours of TV and less than girls in the Exp group, while Cont group boys reported the most hours of TV and more than boys in the Exp group. It is notable, however, that this Group x Gender interaction pattern was also significant at pre-intervention (p=.031). The Physical Activity Self-efficacy (PASE) questionnaire is an 18-item instrument designed to assess personal goal-setting for physical activity, as well as physical activity self-efficacy for children ages 8 to 10. .Family-related Variables. Family Meal Priority assesses the child’s perception of the importance/priority placed on family meals. The only significant effect was a Group x Age interaction (p=.050), such that Older children in the Exp group reported lower meal priority than Younger children, whereas in the Cont group Older children reported greater meal priority than Younger children. However, this was a complex interaction that also depended on the assessment period. Family Mealtime Rules assesses the child’s view of the importance of rules during family meals. In this case there was a single significant of Time x Gender interaction over the three assessment periods (p=.026), such that the importance of rules increased for girls but decreased for boys across the three assessment periods. Parents assessed the quality of family communication. Remarkably, despite the fact that no information about this topic was sent to parents in the Cont group, there was a significant Time effect (p=.027) during the pre- to post-intervention period with both groups reporting an increase in family communication effectiveness. Parents in both groups also reported improved stress management (p<.001), with the Exp group reporting somewhat greater improvement.
Publications
- Type:
Journal Articles
Status:
Accepted
Year Published:
2013
Citation:
Benke, C., Bailey, S., Martz, J., Paul, L., Lynch, W., & Eldridge, G. (2013). Developing a parent-centered obesity prevention program for 4-H families: Implications for extension family programming. Journal of Extension [On-line]. Available at: http://www.joe.org/joe/2013june/a8.php
- Type:
Book Chapters
Status:
Published
Year Published:
2013
Citation:
Paul, L., Benke, C. Martz, J. & Bailey, S. (2013). 4-Health Curriculum - Parent Guide. Bozeman: Montana State University.
- Type:
Book Chapters
Status:
Published
Year Published:
2013
Citation:
Paul, L., Benke, C. Martz, J. & Bailey, S. (2013). 4-Health Curriculum - Facilitator Guide. Bozeman: Montana State University.
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2012
Citation:
Benke, C., & Martz, J., Bailey, S., Lynch, W., Paul, L., & Eldridge, G. (October 2012). 4-Health: A Programmatic Evaluation of a Parent-Based Childhood Obesity Prevention Program. Evaluation Presentation. National Association of Extension 4-H Agents Conference, Orlando FL.
- Type:
Conference Papers and Presentations
Status:
Submitted
Year Published:
2013
Citation:
Benke, C., Bailey, S., Paul, L., Lynch, W., Martz, J., & Eldridge, G. (March 2013). 4-Health Research & Evaluation Results from a Parent-Centered Childhood Obesity Prevention Program. Research and Evaluation Presentation. Montana State University Health and Human Development Research Seminar, Bozeman, MT.
- Type:
Conference Papers and Presentations
Status:
Submitted
Year Published:
2013
Citation:
Bailey, S., Benke, C., Eldridge, G., Lynch, W., Martz, J., & Paul, L. (April 2013). Addressing Childhood Obesity in Rural Areas. Research Presentation. Priester National Extension Health Conference, Corvallis, OR.
- Type:
Conference Papers and Presentations
Status:
Accepted
Year Published:
2013
Citation:
Paul, L., Eldridge, G., Lynch, W., Bailey, S., Benke, C., Martz, J. (May 2013). Enhancing Body Image in Youth as Result of a Parent-Centered Childhood Obesity Prevention Program. Poster Presentation. Montana Dietetic Association, Bozeman, MT.
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Progress 05/01/11 to 04/30/12
Outputs
OUTPUTS: Completed post-intervention data collection for Pilot study in 6 MT counties. Conducted preliminary analysis of Pilot study assessment data, examining pre- and post-intervention differences between experimental (4-Health Educational Program) and control (Healthy Living Information, only) groups. Obtained feedback from Family and Consumer Science (FCS) agents and participant evaluations from parents on the effectiveness of the Pilot program. Revised 4-Health educational (experimental) program and republished Parent and Agent versions of the program guides. Revised the assessment plan as a result of feedback from parents, research assistants, and Pilot study results. Developed marketing brochures and recruitment materials for use in recruiting research participants. Presentations aimed at recruiting agents for year 3 were conducted at 4-H Institute meetings in Missoula, MT and Miles City, MT (in year 2) and at the MSU Extension Annual Conference in Bozeman, MT (Oct 18-20, 2011). Recruited 4-H/FCS agents from 11 rural MT counties, who served as trainers for the 4-Health Educational Program (experimental group). Recruited 4-H/FCS and county Extension Agents from another 10 rural MT counties to serve as the point of contact for participants in the Healthy Living Information (control) group. Carried out daylong agent training session for all 4-H/FCS agents participating in Pilot study. Created revised assessment protocols and assessment packets for use in 4-Health Full study. Obtained MSU IRB approval for revised assessment plans, including plans for advising participants of potentially high blood pressure. Recruited approximately 150 parent-child dyads from 21 rural MT counties for semi-random assignment as research participants for experimental and control groups for the Full study. Recruited and trained research assistants for assessment. Published Healthy Living Information (control group) packets, based on the CDC's "MyPlate" online information; first of 10 mail deliveries to participants began in 10 rural MT counties in Oct 2011. Conducted Full study pre-intervention assessments of all participants in 21 rural MT counties during the first 3 weeks of Sept 2011. Full study delivery of 4-Health Educational (experimental) program began in Oct 2011 in 11 rural MT counties and continued for 9 sessions through Apr. 2012. Created Full study SPSS data files based on pre-intervention assessment results and began preliminary descriptive analysis, comparing experimental and control groups, beginning in Jan 2012. Participated in the AFRI online meeting Nov. 14-15, 2011. Submitted Full study protocol manuscript to BioMed Central-Public Health in Jan 2012 (accepted Apr 2012). PARTICIPANTS: 4-Health Team Members: Douglas Steele, Project Manager and PI; Lynn C. Paul, Ed.D., coPI; Wesley C. Lynch, Ph.D., coPI; Jill Martz, Dir. Montana 4-H Youth Development Program, coPI; Sandy J. Bailey, Ph.D., Prof. HHD, Family and Human Development Specialist; Carrie Benke, MS, 4-Health Project Director; Galen Eldridge, MS, Research Associate; Elizabeth Bird, Grants Specialist; Tisha Stahly, MSU Extension Budget Management Specialist; Julie Heard, MSU Extension Human Resources Specialist; Montana County Extension and FCS/4-H Agents: 21 agents (collaborators) benefited from professional development through their involvement in training provided by 4-Health Program PIs and staff and were involved in participant recruiting and delivery of the program. Research Participants: One-hundred-fifty (150) rural Montana parents and 150 of their 8-12 year old children, who are involved in Montana's 4-H Youth Development Program, served as experimental or control group participants in a 9-month study. One-hundred-thirty-eight (138) parent-child dyads completed both the pre- and post-intervention assessment sessions. TARGET AUDIENCES: Parents and 8-12 year old children participating in 4-H Youth Development programs and living in rural or frontier areas of Montana are the target audience. The 4-Health educational programs provided 150 parents with new knowledge about healthy-living in the areas of nutrition, physical activity, family communication/parenting, and body image. Participants learned how to apply this knowledge within their families and, particularly to their preteen children, in such a way as to prevent or reduce childhood obesity. PROJECT MODIFICATIONS: Since the last annual report only two minor modifications have been made. The first is the addition of a change in the protocol for advising participants of potentially high blood pressure (BP) readings recorded during assessments that might require medical attention. The Montana State University IRB approved this modification on May 1, 2012. According to this protocol, participants whose BP is above the normal range, as determined by the American Heart Association norms, are sent a letter as soon as possible after the assessment session, advising them of the possible need to seek professional advice from their health care provider. The second change was the addition of a set of four questions for child participants to answer that were administered at the conclusion of the post-intervention assessment session. These questions were designed to ascertain the children's interest in a possible future "Healthy Living Program" designed specifically for them. Parent participant evaluation forms collected earlier, had indicated the interest of parents and children in direct participation of the children in such programs.
Impacts
Recruitment posters for experimental and control groups were designed and distributed to most 4-H and Family and Consumer Science agents in the state of Montana (May 2011). The result was successful recruitment of 150 parent-child dyads to serve as research participants.Participant debriefing forms were designed for use in each of the Full study assessment sessions (Jun. 2011).As a result, the efficiency and effectiveness of assessment data collection sessions was improved.New consent forms and other modifications of our MSU IRB proposal were approved for use in the Full study (July 2011).These changes improved assurance of participant confidentiality.In addition, providing unique consent forms for the two treatment groups reduced the likelihood of interaction of experimental and control participants during the Full study intervention period.An analysis of the participant evaluation forms completed during the Pilot study (Oct 2011)enhanced our understanding of how the program was perceived by participants, what problems or concerns they had, what knowledge, skills and abilities they felt they had acquired, and what lifestyle changes they reported making. This analysis also informed our decisions to make program and assessment changes needed for the Full study.An overview presentation of the Pilot study results (July 2011) provided information to all members of the research team on what aspects of participants' health were being affected.Small, even non-significant, changes suggested trends that might be anticipated in the Full study.This analysis also helped team members understand whether or not the assessment instruments selected for the Full study were appropriate for our rural population. As a result of this presentation some changes (see Project Modifications) were made subsequently in the assessment instrument packets (Aug 2011). Presentation also allowed opportunity to select what topics would be used for poster and oral presentation and research articles. An overview of the 4-Health study was presented at the 2011 NRI AFRI PD online meeting in Nov. 2011.This presentation allowed us to share information about our research project goals and preliminary results with other AFRI grantees.In preparation for publication of our protocol paper in BMC Public Health (see Publications), we completed a protocol registration entitled "Family Influences to Prevent Childhood Obesity" online at the Clinical Trials.gov website (Dec 2011).As a result other researchers interested in this field were made aware of the protocol for the 4-Health experimental study.A poster entitled "4-Health: Family Influences to Prevent Childhood Obesity, A Pilot Study in Six Rural Montana Communities" was presented at the 2012 Jeanne Priester Conference (Apr 2012).By summarizing the 4-Health Pilot study final results this poster educated conference participants on trends in the quantitative data and shared some of the qualitative results provided by program participants after completion of the Pilot study.This presentation shared potentially useful program results with other Extension specialists and enhanced their interest in the subsequent Full study, currently underway.
Publications
- Lynch W.C., Martz J., Eldridge G., Bailey S., Benke C., Paul L., (2012). Childhood Obesity Prevention in Rural Settings: Background, Rationale, and Study Design of '4-Health,' a Parent-only Intervention. BioMed Central Public Health, 12(1): 255.
- Steele, D., Paul, L., Lynch, W.C., Martz, J., Benke, C., Eldridge, G., & Bailey S., (2012). 4-Health: Family Influences to Prevent Childhood Obesity, A Pilot Study in Six Rural Montana Communities. Poster presented at Jeanne Priester Extension Health Conference, Washington DC. July 2012.
- Paul, L., Steele, D., Lynch, W.C., Martz, J., Benke, C., Eldridge, G., & Bailey, S. (2012). 4-Health: Family Influences to Prevent Childhood Obesity in Rural Montana. Poster presented at Montana Dietetic Association Annual Conference, Kalispell, Montana. May 2012.
- Paul, L., Eldridge, G., Lynch, W.C., Bailey, S., Benke, C., Martz, J., & Steele, D. (2012). Educating Parents about Preteen Body Image: A Topic Critical for Childhood Obesity Prevention in Rural Areas. Poster presented at Society for Nutrition Education and Behavior Annual Conference, Washington, DC. July 2012.
- Steele, D., Paul, L., Lynch, W.C., Martz, J., Benke, C., Eldridge, G., & Bailey, S. (July, 2012). 4-Health: Family Influences to Prevent Childhood Obesity, A Pilot Study in Six Rural Montana Communities. Poster presented at National Institute of Food & Agriculture Project Directors meeting, Washington, DC. July 2012.
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Progress 05/01/10 to 04/30/11
Outputs
OUTPUTS: Revised research design and delivery plan, including delivery of a pilot study beginning fall 2010 and delay of the originally proposed full study, now to begin fall 2011. Completed assessment plan and created assessment packets for pilot study (separate packets for parent and child). Established assessment timeline, completed data collection protocol, and purchased all necessary assessment equipment. Completed "4-Health" curriculum development (experimental group). Began marketing and recruitment for pilot study to selected Montana 4-H/FCS agents. Obtained MSU IRB approval of pilot study research and assessment plans and consent form. Attended AFRI meeting, Denver, CO (June 21-23, 2010) and presented poster on year 1 accomplishments. Completed hiring and training of data collection research assistants. Completed final design of 4-Health website and carried out website training of key personnel. Engaged four child obesity prevention consultants (Contento, Drewnowski, Glanz and Neumark-Sztainer) to review and advise on program development, research design, and assessment issues. Each consultant provided phone and written reviews. Printed and distributed parent and agent program guides to agents selected to deliver the experimental (pilot) program. Carried out daylong agent training session for all 4-H/FCS agents participating in pilot study. Finalized assessment instrument selection and revised parent and child assessment packets (for pilot study) based on consultant recommendations. Carried out pilot study, pre-intervention, assessments in 6 rural MT counties (N=44 parent-child dyads). Published control group information packets, based on "MyPyramid Healthy Living" information; first of 10 mail deliveries to participants began in 3 counties in Oct 2010. Pilot study delivery of experimental group (4-Health) program began in 3 counties (10 sessions delivered Oct. 2010 through Apr. 2011). Created pilot data (pre-intervention) SPSS files and began preliminary data analysis. Conducted a "diversity assessment" to determine special needs of potential Native American and rural MT participants. Selected 4-H/FCS agents completed the diversity assessment. Began 4-Health program revisions for year 3 (full experiment) based on participant, facilitator, and consultant feedback. Began Extension Agent recruitment for year 3 in all MT counties. Also began discussion of method of randomization of counties to experimental and control groups. Agent-training guides were revised and agent recruitment information packets for year 3 were distributed statewide. Presentations aimed at recruiting agents for year 3 were conducted at 4-H Institute meetings in Missoula and Miles City and at the MSU Extension Annual Conf. in Bozeman, MT. 4-Health curriculum revisions were completed and reviews by selected 4-H/FCS agents were solicited. Pre-intervention data analyses (pilot study) for children and parents were completed. Program evaluations (pilot study) were collected from all participants. Data collection research assistants were hired for post-intervention (pilot study) data collection sessions and May travel schedule to 6 counties was set. PARTICIPANTS: FCS/4-H Extension agents (collaborators) benefit from professional development through their involvement in training provided by 4-Health Program PIs and staff. 4-Health Team Members: Douglas Steele, Project Manager; Lynn C. Paul, Ph.D., PI; Wesley C. Lynch, Ph.D., coPI; Jill Martz, Dir. Montana 4-H Youth Development Program, coPI; Sandy J. Bailey, Ph.D., Assoc. Prof. HHD, Family and Human Development Specialist; Carrie Benke, MS, 4-Health Project Director; Galen Eldridge, MS, Research Associate; Elizabeth Bird, Grants Specialist; Jan Feist, Administrative Associate; Tisha Stahly, MSU Extension Budget Management Specialist; Julie Heard, MSU Extension Human Resources Specialist; Consultants: Adam Drewnowski, Ph.D., Director Center for Obesity Research, University of Washington, Seattle, WA; Karen Glanz, PhD, MPH, George A. Weiss University Professor, Schools of Medicine and Nursing, University of Pennsylvania, Philadelphia, PA; Dianne Neumark-Sztainer, PhD, MPH, RD, Professor, Division of Epidemiology and Community Health School of Public Health University of Minnesota, Minneapolis, MN; Isobel R. Contento, Ph.D., Mary Swartz Rose Professor of Nutrition and Education and Coordinator Program in Nutrition Department of Health and Behavior Studies Teachers College Columbia University, New York, NY; Collaborators: Montana County Extension and FCS Agents: 6 agents were involved in participant recruiting and delivery of the pilot program. 35 agents attended 4-H Institute meetings and invitations to participate in 4-Health were also emailed to all Cooperative Extension Agents in Montana and promoted at the MSU Extension Annual Conference with almost all MT Extension agents in attendance as well. As a result of the overall marketing campaign, 23 agents agreed to participate in the full study being planned for year 3; 3 agents reviewed the 4-Health curriculum and the participant and agent guides and provided feedback prior to beginning the pilot study; 2 agents who delivered the pilot program also reviewed these materials again after teaching the program 6 agents assessed the curriculum's applicability to diverse audiences. Research Participants: Forty-four (44) rural Montana parents and 44 of their 8-12 year old children, who are involved in Montana's 4-H Youth Development Program, served as experimental or control group participants in a 9-month pilot study. Thirty-nine (39) parent-child dyads completed both the pre- and post-intervention assessment sessions. TARGET AUDIENCES: Parents and 8-12 year old children participating in 4-H Youth Development programs and living in rural or frontier areas of Montana are the target audience. The 4-Health educational program will eventually provide parents with new knowledge about healthy-living in the areas of nutrition, physical activity, family communication/parenting, and body image. Participants will learn how to apply this knowledge within their families and, particularly to their pre-teen children, in such a way as to prevent or reduce childhood obesity. PROJECT MODIFICATIONS: Only minor modifications of the 4-Health (experimental) program and the associated parent and agent guides have been made since completing the pilot study. Most of these changes have been aimed at recognizing the wider ethnic and cultural diversity of potential participants in Montana, than was originally recognized in the guides developed for the pilot study. Most assessment instruments included in the pilot study and the basic assessment procedures will be retained. As a result of the pilot pre-intervention results, however, two assessment changes are planned. The first will involve having parents complete the full FHCRC food frequency questionnaire (FFQ) with regard to their child's dietary and nutrition/eating habits. In the pilot study we use only a selected part of this instrument and had parents complete it during the onsite assessment sessions. In the full study we will ask them to complete the full FFQ at home. In addition to this change, we have also decided to eliminate use of pedometers to assess physical activity (PA). Our experience in the pilot study suggested that the results obtained were too variable (and the cost too great) to warrant their use in the full study. Instead, we will add self-assessment instruments for both parent and child that will allow reliable and valid assessment of PA. Although none of the other instruments used in the pilot study will be eliminated. Some additional instruments to assess important aspects of obesity risk will be added (e.g., assessment of child's sleep duration and assessment of child's goal-setting with regard to PA and nutritious eating).
Impacts
1. Revised research design and delivery plan involving a pilot study in year 2 and the full study in year 3 solved several problems with the originally proposed 2-group delayed intervention control design. 2. Methods of marketing the intervention program to County Extension Agents throughout Montana were developed. 3. Four expert consultants in childhood obesity prevention provided advice on the appropriate control group conditions to use and evaluated the likely effectiveness of proposed assessment instruments. As a result some instruments were eliminated and others added to the final assessment package and a "best practices" information packet based on MyPyramid Healthy Living information, was developed and distributed to control group participants. 4. A package of assessment instruments was gathered and adapted for use with parents and children in the pilot study. The reliability and effectiveness of this package at assessing obesity risk factors in children and parents involved in 4-H youth development programs was determined. The ability of specific instruments to detect differences between experimental and control group participants will be determined based on pre-post difference score data from collected from pilot study participants. 5. Selected 4-H/FCS county agents were recruited and trained to deliver the 4-Health (experimental) program. They, in turn, recruited parent and child participants from among the 4-H youth development groups in each of their counties. 6. 4-Health program (experimental group intervention) was designed and delivered by selected 4-H/FCS agents in a pilot study involving 6 Montana counties and 44 parent-child dyads as participants. Participants in 3 counties served as an experimental group, which received the 4-Health program in 10 face-to-face meetings (90 min each) delivered over an 8-month period. Participants in the other 3 counties served as a control group, which received Healthy Living Information only via mail delivery at 5 times over 8 months. 7. Based on feedback and data collected in the pre-intervention phase of the pilot study, revisions of the 4-Health curriculum and the assessment package were completed during the winter and spring of 2010-11, resulting in a final plan for completion of the full experimental and control group research design beginning fall 2011. Thus far, 23 Cooperative Extension Agents representing 28 Montana counties have agreed to participate in the year 3 study. Of these, participants in 13 counties will serve as the experimental group, receiving the revised 4-Health program and participants in 10 counties serve as the control group and will receive Healthy Living Information by mail. The full study will begin in September 2011 with assessments of all participants to be carried out pre-intervention, post-intervention and at 6-month follow-up. Intervention program delivery for both groups will begin in October 2011.
Publications
- 3. Paul, L.C., Lynch, W.C, Martz, J., Benke, C., Eldridge, G., Bailey, S. & Taylor, K. (Jun 2010). Family Influences to Prevent Childhood Obesity (Focus Group Results). Poster presented at the NRI/AFRI Project Directors Meeting. Denver, CO.
- 4. Paul, L.C., Benke, C. Martz, J. & Bailey, S. (2010). 4-Health Curriculum - Parent Guide and Facilitator Guide. Bozeman: Montana State University.
- 1. Eldridge, G., Lynch, W.C., Bailey, S., Benke, C., Martz, J. & Paul, L.C. (2011). Parenting Practices that can Prevent or Reduce Childhood Obesity. Manuscript submitted to Journal of Youth Development.
- 2. Martz, J., Paul, L.C., Benke, C. Eldridge, G. & Lynch, W.C. (Jun 2010) Family Influences to Prevent Childhood Obesity: Stakeholder Input from Rural Montana Communities. Poster presented at the Children, Youth and Families at Risk (CYFAR) Annual Conference, San Francisco, CA.
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Progress 05/01/09 to 04/30/10
Outputs
OUTPUTS: 1. Completed NIFA and MSU, Office of Sponsored Programs, submissions and other requirements to initiate funding. 2. Received final Human Subjects approval (March 7, 2009). 3. Received final NIFA approval to begin project (May 1, 2009). 4. Finalized MSU budget allocation plan involving three co-PIs, two academic colleges, the MSU Extension Service. 5. Recruited, interviewed, and hired all key staff members. 6. Completed overall Plans of Work for the 4 year project for each of 5 project objectives: a) Design, develop, and deliver obesity prevention curriculum for parents of 4-H youth in rural Montana. b) Develop, test, revise and train for use of assessment instruments to evaluate project effectiveness. c) Market project plan and recruit Extension agents and 4-H families. d) Conduct formative evaluation of curriculum, curriculum delivery, and summative assessment. e) Insure appropriate project and grant management. 7. Carried out focus group interviews and summarized results re: participant's needs and interests in healthy lifestyles & obesity prevention programming and participant's perceived needs for program offerings. Fifty two Montana 4-H parents from 10 rural Montana counties participated in 11 focus groups, which began Sept. 21 and ended Oct. 29, 2009. All participating County Extension offices represented rural areas of the state. 8. Established the title as the "4-Health Program." 9. Began program promotion and recruitment of Family and Consumer Sciences (FCS) and 4-H county Extension agents to serve as participant recruitment representatives and trainers. 10. Began a formal promotional campaign for delivery of 4-Health Program. 11. Revised and expanded existing curriculum (STEPS), adding lessons focusing on parenting, family communication, role modeling, and body image. 12. Reviewed and revised assessment/data collection plan and instruments, including collection of all survey instruments and required publisher's permissions. 13. Revised research design based on focus group results, Extension agent inputs, and curriculum revisions. Revised design: Two group (experimental and "best practices" control) intervention. Year 2 (fall 2010): Begin pilot testing of all revised and expanded curriculum lessons, new assessment instruments and methods, and other methods details. Year 2 (summer 2011): Make additional modifications based on pilot results. Year 3 (fall 2011): Begin full program delivery. Year 4 (fall 2012): Data analysis and dissemination. 14. Began development of an web design for electronic program delivery and communication with participants. Obtained competitive bids for design, construction, delivery, and maintenance. A participant technology questionnaire was developed and distributed to selected rural 4-H families to determine their internet connectivity and speed capabilities (results pending). 15. Finalized list of counties and agents able and willing to participate in pilot program delivery beginning September 2010. 16. Began planning training protocol for FCS/4-H Extension agents (i.e., train-the-trainers). PARTICIPANTS: 4-Health Team Members: Lynn C. Paul, Ph.D., PI Wesley C. Lynch, Ph.D., coPI Jill Martz, Dir. Montana 4-H Youth Development Program, coPI Adam Drewnowski, Dir. UW Center for Obesity Research, consultant Sandy J. Bailey, Ph.D., Assoc. Prof. HHD, Family and Human Development Specialist Carrie Benke, MS, 4-Health Project Director Galen Eldridge, MS, Research Associate Katelyn Taylor, Graduate Research Assistant Elizabeth Bird, Grants Specialist Jan Feist, Administrative Associate Collaborators: Montana County Extension and FCS Agents: 10 agents hosted focus groups interviews. 16 agents attended our session at 4-H Update. The session covered focus group results, program plan modifications. These agents provided feedback on our plans during the meeting. 4 agents provided feedback, based on the session materials, via email. 6 agents are currently participating in our technology survey. Parent participants: Fifty two (52) rural Montana 4-H parents with one or more pre-teen children (8-12 y.o.) participated in the focus groups. Several additional community leaders participated in one-on-one discussions with the PIs regarding the program plans and goals. Focus group participants included: 50 mothers, 2 fathers. 50 Caucasians, 2 Native Americans TARGET AUDIENCES: Parents and 8-12 year old children participating in 4-H and living in rural or frontier areas of Montana are the target audience. The "4-Health" educational program will provide parents with new knowledge about healthy-living in the areas of nutrition, physical activity, family communication/parenting, and body image. Participants will learn how to apply this knowledge within their families and, particularly to their pre-teen children, in such a way as to prevent or reduce childhood obesity. Parents enrolled in "experimental" groups will receive this information and training in 10 face-to-face training sessions presented over a 9-month period. Parents enrolled in "control" groups will be provided with written information only on these same topics. PROJECT MODIFICATIONS: As originally proposed, the research study was designed as a 2-group (pretest x posttest) design with a delayed intervention control. However, two major concerns arose in year-1 that demanded a change to a 2-group simultaneous control design. One concern was that a pilot study was needed before full intervention could be initiated. This became apparent after the focus group study revealed a number of constraints on parents and extension agents that had not originally been anticipated. The second major concern was that the delayed control group would be disadvantaged by having to enroll in the study for 2 years in order to benefit from the program and that their year-2 data would be of little added benefit compared to the year-1, between-group data. As a result, it was decided that a pilot study should be run in 6 MT counties with parents in 3 counties serving as "experimental" participants and parents in the other 3 counties serving as "controls." Based on the results of the pilot and other information obtained (e.g., overcoming parent constraints, value of assessment instruments), a full between-groups (pretest x posttest) study would be carried out in year-3. This change of experimental design did not change the timeline of the overall project.
Impacts
1. Extension agents in all 56 Montana counties learned about the 4-Health Program, which would become available for delivery to rural 4-H parents via their county extension offices beginning in fall 2010. They learned this was both a research and outreach project and that, for research purposes, some parents would be enrolled in an experimental group, others in a control group. They learned about their potential roles in recruitment of participants and about the nature of their involvement and timeframe for delivery of the program. Interested agents were encouraged to consider the Program as a major item in their Plans of Work for 2010-11. 2. As a result of focus groups, PIs learned about the healthy-living knowledge base of rural 4-H parents of pre-teen children, their perceived need for additional information to better assist their children in making healthy-living choices and developing a positive body image. Major themes revealed were: a) Parents feel they are too busy to prepare healthier meals and snacks. b) Parents are concerned about low levels of physical activity by their children in the winter months or when they are not involved in seasonal sports activities. c) Parents worry about the negative effects of peer influence and media on their child's identity, self-esteem, body image, and health behaviors. d) Parents face challenges of effective communication as their pre-teens become increasingly independent. e) Parents understand the importance of modeling healthy behaviors for their children, but do not feel they are able or know how to be effective positive role models. 3. As a result of focus groups, PIs and staff learned about factors that might limit participation by rural 4-H parents in the Program, as originally conceived, particularly time constraints. Many other factors were identified that must be addressed in order to facilitate parent participation, including: a) Dealing with time constraints due to other activities and family commitments. b) Overcoming travel constraints and costs resulting from long distances required to participate in program activities. c) Potential participant's desire for financial incentives, including funds to offset travel costs. d) Parent's need for help with childcare during program activities. e) Desire for whole-family involvement in some aspects of the program. f) Need for the program to be fun and engaging. 4. PIs and staff evaluated available assessment instruments. As a result some instruments were replaced and others added. Key considerations included alignment of instruments with revised program goals and expected outcomes, whether instruments were sufficiently brief to allow parents and children to complete them in a reasonable time period and whether the instruments had adequate psychometric properties, relative to the age groups and rural families being assessed. 5. Based on the focus group results, an abstract was submitted to the 2010 meeting of the Children, Youth and Families at Risk (CYFAR) Conference, to be held in June. NIFA funding will cover travel by Dr. Martz (co-PI) and Ms. Benke (Project Director) to attend and present our poster.
Publications
- Martz, J., Paul, L.C., Benke, C. Eldridge, G., and Lynch, W.C. (2010, May) Family Influences to Prevent Childhood Obesity: Stakeholder Input from Rural Montana Communities. Children, Youth and Families at Risk Conference annual meeting, San Francisco, CA.
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