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Hip-Hop to Health Jr. Randomized Effectiveness Trial: 1-Year Follow-up Results
Angela Kong1, Joanna Buscemi2, Melinda R Stolley3
1Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois; University of Illinois Cancer Center, Chicago, Illinois; Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois.
Insights
This preschool obesity prevention trial showed modest improvements in diet quality but did not significantly affect BMI or screen time. Real-world implementation yielded fewer benefits than efficacy trials.
Area of Science:
- Childhood Obesity Prevention
- Public Health Interventions
- Lifestyle Behavior Modification
Background:
- Preschool years are critical for addressing obesity-related lifestyle factors.
- Effectiveness of early childhood obesity prevention programs requires evaluation.
- This study assessed a preschool-based intervention's 1-year impact.
Purpose of the Study:
- To evaluate the 1-year effectiveness of a preschool-based obesity prevention trial.
- To assess the impact of a healthy lifestyle intervention on diet, BMI, and screen time in preschoolers.
- To compare a teacher-delivered intervention with a general health curriculum.
Main Methods:
- Randomized controlled trial (RCT) involving 618 African American children (aged 3-5) in Head Start programs.
- Eighteen preschools were assigned to either a 14-week healthy lifestyle intervention or a control curriculum.
- Primary outcome: Body Mass Index (BMI) z-score; secondary outcomes: diet quality and screen time, measured at baseline, postintervention, and 1-year follow-up.
Main Results:
- Significant improvements in diet quality, including overall quality and fruit intake, were observed in the intervention group (p=0.02).
- No significant differences were found in BMI z-score or screen time between groups at 1-year follow-up.
- Diet quality declined more in the control group compared to the intervention group over the follow-up period.
Conclusions:
- The adapted "Hip-Hop to Health Jr." program demonstrated modest benefits in diet quality but did not significantly alter weight gain trajectory.
- Real-world delivery by Head Start teachers resulted in fewer benefits compared to a rigorous efficacy trial.
- Lessons learned are crucial for designing, implementing, and disseminating effective evidence-based obesity prevention programs for wider reach.
Introduction:
The preschool years provide a unique window of opportunity to intervene on obesity-related lifestyle risk factors during the formative years of a child's life. The purpose of this study was to assess the impact of a preschool-based obesity prevention effectiveness trial at 1-year follow-up.
Design:
RCT.
Settings/Participants:
Primarily African American children (aged 3-5 years, N=618) attending Head Start preschool programs administered by Chicago Public Schools.
Methods:
Eighteen preschools were randomly assigned in 2007-2008 to receive either (1) a 14-week teacher-delivered intervention focused on healthy lifestyle behaviors or (2) a 14-week teacher-delivered general health curriculum (control group).
Main Outcome Measures:
The primary outcome, BMI, was measured at baseline, postintervention, and 1-year follow-up. Diet and screen time behaviors were also assessed at these time points. Multilevel mixed effects models were used to test for between-group differences. Data were analyzed in 2014.
Results:
Significant between-group differences were observed in diet, but not in BMI z-score or screen time at 1-year follow-up. Diet differences favored the intervention arm over controls in overall diet quality (p=0.02) and in subcomponents of diet quality, as measured by the Healthy Eating Index-2005, and in fruit intake (servings/day, excludes juice) (p=0.02). Diet quality worsened more among controls than the intervention group at 1-year follow-up.
Conclusions:
The adaptation of Hip-Hop to Health Jr. produced modest benefits in diet quality but did not significantly impact weight gain trajectory. Not unlike other effectiveness trials, this real-world version delivered by Head Start teachers produced fewer benefits than the more rigorous efficacy trial. It is important to understand and build upon the lessons learned from these types of trials so that we can design, implement, and disseminate successful evidence-based programs more widely and effectively.
Trial Registration:
This study is registered at www.clinicaltrials.gov NCT00241878.
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