ANDALE Pittsburgh: A Family-Based Intervention to Prevent Obesity in Latino Preschool Children
by Sharon Ross
It is widespread knowledge that the U.S. has an obesity problem. Perhaps most concerning, though, are the rates of obesity affecting the most vulnerable: children. Latino preschool children have the highest rates of obesity compared with children of other racial and ethnic groups. Recent estimates report that 16.7 percent of Latino preschool children are considered obese compared with 3.5 percent of non-Latino white, 11.3 percent of non-Latino black, and 3.4 percent of non-Latino Asian children. Given that children of immigrants are the fastest growing segment of the U.S. child population, the majority of which are of Latino origin, there is a pressing public health need for effective programs that target obesity prevention in this group.
My research is committed to addressing the obesity disparity experienced by Latino children through culturally tailored home- and community-based prevention programs that target the entire family unit. In 2014, my research team and I received funding from the National Institutes of Health to develop and evaluate one such program. This program, ANDALE Pittsburgh, employed a mixed methods sequential research design to test the feasibility and acceptability of a promotora-delivered, family-based intervention to prevent obesity in Latino preschool children. Promotoras are peer health educators who are trusted individuals from the community and share common characteristics with the target population.
From a weekly meeting of the Latino family Health project to discuss ongoing research studies. From left to right: Project Coordinator Ivonne Smith-Tapia, co-Investigator Patricia Documet from the Graduate School of Public Health, student research assistant Neil Sharma, PI and Assistant Professor Sharon Ross, and student research assistant Jesse Dubin. The group is discussing the logo design for its new study, Raíces.
Participants included 49 Latino families with 2-5-year-old children living in Allegheny County, an Emerging Latino Community (ELC; areas with low (<5 percent) yet growing concentrations of Latinos). According to U.S. Census data, the Latino population in Allegheny County experienced a 71 percent increase between 2000-2010, estimating the population at 24,000. We know from our research that families living in this ELC face barriers to health care, legal, and social services, putting them at risk for poorer health outcomes.
To be most effective in meeting the needs of this small but growing population, it was important to us that our approach was participatory and grounded in the needs of the community. Intervention content was tailored based on findings from focus groups with 31 Latino parents with preschool-aged children living in Allegheny County, as well as interviews with key community stakeholders. We received guidance and feedback from both the Community Research Advisory Board (CRAB) at Pitt and the Latino Engagement Group for Salud (LEGS), a local coalition of community members, researchers, and health and social service providers. Furthermore, we recruited and trained six promotoras (i.e., peer health educators who are trusted individuals from the community and share common characteristics with the target population) to deliver the intervention.
Promotoras delivered 10, 90-minute, weekly, home-based sessions to families and focused on improving the home nutrition and physical activity environment through education, practice, and action (i.e., goal setting and problem solving). Intervention topics included family-focused healthy eating, active play, reducing sedentary time, and community resources, along with healthy recipe preparation and physical activity breaks. A key feature of the intervention was the use of promotora-guided but parent-derived goal setting activities to personalize the intervention approach to each family’s specific abilities, barriers, and environments.
To assess intervention feasibility and acceptability, we employed a mixed-methods process evaluation. Overall, we found that promotoras were able to deliver the intervention with fidelity and participants were extremely satisfied with the program. We also conducted pre- and post-assessments of key outcomes and found that the program was effective in improving child and parent nutrition and screen time, and parent physical activity.
Admittedly, the causes of childhood obesity are complex and interconnected, spanning across multiple, nested levels of the social ecological model (i.e., individual, family, community, society). While the program was short and only involved 49 families, the results were promising. I am currently developing a grant application to build on and extend these current findings in a large, multi-year trial. The goal of my overall research program is to build social support, empower communities, and ensure access to knowledge and environments to promote health and physical activity in Latino children of immigrants. It is my hope that this work will address, in a small way, the huge disparity experienced by Latino preschool children, and empower families to create and advocate for environments that promote a healthy weight in their children.
Sharon Ross is an assistant professor in the Department of Health and Physical Activity.