Skip to main content
Top
Published in: BMC Public Health 1/2012

Open Access 01-12-2012 | Study protocol

Childhood obesity prevention in rural settings: background, rationale, and study design of ‘4-Health,’ a parent-only intervention

Authors: Wesley C Lynch, Jill Martz, Galen Eldridge, Sandra J Bailey, Carrie Benke, Lynn Paul

Published in: BMC Public Health | Issue 1/2012

Login to get access

Abstract

Background

Childhood obesity in rural communities is a serious but understudied problem. The current experiment aims to assess a wide range of obesity risk factors among rural youth and to offer an 8-month intervention program for parents to reduce obesity risk in their preteen child.

Methods/Design

A two-group, repeated measures design is used to assess the effectiveness of the 4-Health intervention program. Assessments include anthropometric measures, child self-evaluations, parent self-evaluations, and parent evaluations of child. County Extension agents from 21 rural Montana counties recruit approximately 150 parent–child dyads and counties are semi-randomly assigned to the active intervention group (4-Health Educational Program) or a “best-practices” (Healthy Living Information) control group.

Discussion

This study will shed light on the effectiveness of this parent-only intervention strategy in reducing obesity risk factors among rural preteens. The 4-Health program is designed to provide information and skills development for busy rural parents that will increase healthy lifestyles of their preteen children and improve the parents’ ability to intervene effectively in the lives of their families during this critical developmental period.

Trial registration

ClinicalTrials.gov ID: NCT01510587
Appendix
Available only for authorised users
Literature
2.
go back to reference Matsushita Y, Yoshiike N, Kaneda F, Yoshita K, Takimoto H: Trends in childhood obesity in Japan over the last 25 years from the National Nutrition Survey. Obes Res. 2004, 12 (2): 205-214. 10.1038/oby.2004.27.CrossRefPubMed Matsushita Y, Yoshiike N, Kaneda F, Yoshita K, Takimoto H: Trends in childhood obesity in Japan over the last 25 years from the National Nutrition Survey. Obes Res. 2004, 12 (2): 205-214. 10.1038/oby.2004.27.CrossRefPubMed
3.
go back to reference McMurray RG, Harrell JS, Bangdiwala SI, Deng SB: Cardiovascular disease risk factors and obesity of rural and urban elementary school children. J Rural Health. 1999, 15 (4): 365-374. 10.1111/j.1748-0361.1999.tb00760.x.CrossRefPubMed McMurray RG, Harrell JS, Bangdiwala SI, Deng SB: Cardiovascular disease risk factors and obesity of rural and urban elementary school children. J Rural Health. 1999, 15 (4): 365-374. 10.1111/j.1748-0361.1999.tb00760.x.CrossRefPubMed
4.
go back to reference Rhee K: Childhood overweight and the relationship between parent behaviors, parenting style and family functioning. Ann Am Acad Pol Soc Sci. 2008, 615: 12-37.CrossRef Rhee K: Childhood overweight and the relationship between parent behaviors, parenting style and family functioning. Ann Am Acad Pol Soc Sci. 2008, 615: 12-37.CrossRef
5.
go back to reference Ostbye T, Zucker N, Krause KM, Lovelady CA, Evenson K, Peterson BL, Bastian LA, Swamy GK, West DJ, Brouwer RJ: Kids and adults now! Defeat obesity (KAN-DO): Rationale, design and baseline characteristics. Contemp Clin Trials. 2011, 32 (3): 461-469. 10.1016/j.cct.2011.01.017.CrossRefPubMedPubMedCentral Ostbye T, Zucker N, Krause KM, Lovelady CA, Evenson K, Peterson BL, Bastian LA, Swamy GK, West DJ, Brouwer RJ: Kids and adults now! Defeat obesity (KAN-DO): Rationale, design and baseline characteristics. Contemp Clin Trials. 2011, 32 (3): 461-469. 10.1016/j.cct.2011.01.017.CrossRefPubMedPubMedCentral
6.
go back to reference Golley RK, Perry RA, Magarey A, Daniels L: Family-focused weight management program for five- to nine-year-olds incorporating parenting skills training with healthy lifestyle information to support behaviour modification. Nutr Diet. 2007, 64 (3): 144-150. 10.1111/j.1747-0080.2007.00106.x.CrossRef Golley RK, Perry RA, Magarey A, Daniels L: Family-focused weight management program for five- to nine-year-olds incorporating parenting skills training with healthy lifestyle information to support behaviour modification. Nutr Diet. 2007, 64 (3): 144-150. 10.1111/j.1747-0080.2007.00106.x.CrossRef
7.
go back to reference Eisenmann JC, Gentile DA, Welk GJ, Callahan R, Strickland S, Walsh M, Walsh DA: SWITCH: rationale, design, and implementation of a community, school, and family-based intervention to modify behaviors related to childhood obesity. Bmc Public Health. 2008, 8: 223-10.1186/1471-2458-8-223.CrossRefPubMedPubMedCentral Eisenmann JC, Gentile DA, Welk GJ, Callahan R, Strickland S, Walsh M, Walsh DA: SWITCH: rationale, design, and implementation of a community, school, and family-based intervention to modify behaviors related to childhood obesity. Bmc Public Health. 2008, 8: 223-10.1186/1471-2458-8-223.CrossRefPubMedPubMedCentral
8.
go back to reference Janicke DM, Sallinen BJ, Perri MG, Lutes LD, Silverstein JH, Huerta MG, Guion LA: Sensible Treatment of Obesity in Rural Youth (STORY): design and methods. Contemp Clin Trials. 2008, 29 (2): 270-280. 10.1016/j.cct.2007.05.005.CrossRefPubMed Janicke DM, Sallinen BJ, Perri MG, Lutes LD, Silverstein JH, Huerta MG, Guion LA: Sensible Treatment of Obesity in Rural Youth (STORY): design and methods. Contemp Clin Trials. 2008, 29 (2): 270-280. 10.1016/j.cct.2007.05.005.CrossRefPubMed
9.
go back to reference Janicke DM, Sallinen BJ, Perri MG, Lutes LD, Huerta M, Silverstein JH, Brumback B: Comparison of parent-only vs family-based interventions for overweight children in underserved rural settings outcomes from project STORY. Arch Pediatr Adolesc Med. 2008, 162 (12): 1119-1125. 10.1001/archpedi.162.12.1119.CrossRefPubMedPubMedCentral Janicke DM, Sallinen BJ, Perri MG, Lutes LD, Huerta M, Silverstein JH, Brumback B: Comparison of parent-only vs family-based interventions for overweight children in underserved rural settings outcomes from project STORY. Arch Pediatr Adolesc Med. 2008, 162 (12): 1119-1125. 10.1001/archpedi.162.12.1119.CrossRefPubMedPubMedCentral
10.
go back to reference Janicke D, Sallinen B, Perri M, Silverstein J, Huerta M, Guion L: Preliminary findings from project STORY (Sensible Treatment of Obesity in Rural Youth). Ann Behav Med. 2007, 33: S22-10.1207/s15324796abm3301_3.CrossRef Janicke D, Sallinen B, Perri M, Silverstein J, Huerta M, Guion L: Preliminary findings from project STORY (Sensible Treatment of Obesity in Rural Youth). Ann Behav Med. 2007, 33: S22-10.1207/s15324796abm3301_3.CrossRef
11.
go back to reference Williamson DA, Champagne CM, Han H, Harsha D, Martin CK, Newton RL, Ryan DH, Sothern MS, Stewart TM, Webber LS: Increased obesity in children living in rural communities of Louisiana. Int J Pediatr Obes. 2009, 4 (3): 160-165. 10.1080/17477160802596148.CrossRefPubMedPubMedCentral Williamson DA, Champagne CM, Han H, Harsha D, Martin CK, Newton RL, Ryan DH, Sothern MS, Stewart TM, Webber LS: Increased obesity in children living in rural communities of Louisiana. Int J Pediatr Obes. 2009, 4 (3): 160-165. 10.1080/17477160802596148.CrossRefPubMedPubMedCentral
12.
go back to reference Wapner A, Bianco JA, Long M, Kushnick MR, Brannan G, Shubrook J: Take action: a multidisciplinary lifestyle intervention for families in a rural community. Childhood Obesity (Formerly Obesity and Weight Management). 2010, 6 (5): 270-276. 10.1089/chi.2010.0508. Wapner A, Bianco JA, Long M, Kushnick MR, Brannan G, Shubrook J: Take action: a multidisciplinary lifestyle intervention for families in a rural community. Childhood Obesity (Formerly Obesity and Weight Management). 2010, 6 (5): 270-276. 10.1089/chi.2010.0508.
13.
go back to reference Bandura A: Social cognitive theory: an agentic perspective. Annu Rev Psychol. 2001, 52: 1-26. 10.1146/annurev.psych.52.1.1.CrossRefPubMed Bandura A: Social cognitive theory: an agentic perspective. Annu Rev Psychol. 2001, 52: 1-26. 10.1146/annurev.psych.52.1.1.CrossRefPubMed
15.
go back to reference Baranowski T, Cullen K, Nicklas T, Thompson D, Baranowski J: Are current health behavioral change models helpful in guiding prevention of weight gain efforts?. Obes Res. 2003, 11: 23S-43S. 10.1038/oby.2003.222.CrossRefPubMed Baranowski T, Cullen K, Nicklas T, Thompson D, Baranowski J: Are current health behavioral change models helpful in guiding prevention of weight gain efforts?. Obes Res. 2003, 11: 23S-43S. 10.1038/oby.2003.222.CrossRefPubMed
16.
go back to reference Bacon L, Stern J, Van Loan M, Keim N: Size acceptance and intuitive eating improve health for obese, female chronic dieters. J Am Diet Assoc. 2005, 105 (6): 929-936. 10.1016/j.jada.2005.03.011.CrossRefPubMed Bacon L, Stern J, Van Loan M, Keim N: Size acceptance and intuitive eating improve health for obese, female chronic dieters. J Am Diet Assoc. 2005, 105 (6): 929-936. 10.1016/j.jada.2005.03.011.CrossRefPubMed
17.
go back to reference Glanz K, Rimer B: FM L: Health Behavior and Health Education: Theory, Research, and Practice. 2002, Jossey-Bass, San Francisco Glanz K, Rimer B: FM L: Health Behavior and Health Education: Theory, Research, and Practice. 2002, Jossey-Bass, San Francisco
18.
go back to reference Cowan PA, Cowan CP: Interventions as tests of family systems theories: marital and family relationships in children’s development and psychopathology. Dev Psychopathol. 2002, 14 (4): 731-759.CrossRefPubMed Cowan PA, Cowan CP: Interventions as tests of family systems theories: marital and family relationships in children’s development and psychopathology. Dev Psychopathol. 2002, 14 (4): 731-759.CrossRefPubMed
19.
go back to reference Whitchurch G, Constantine L: Systems Theory. Sourcebook of family theory and methods: A contextual approach. Edited by: PG Boss WD, LaRossa R, Schumm WR, Steinmetz SK. 1993, Plenum Press, New York, 325-352.CrossRef Whitchurch G, Constantine L: Systems Theory. Sourcebook of family theory and methods: A contextual approach. Edited by: PG Boss WD, LaRossa R, Schumm WR, Steinmetz SK. 1993, Plenum Press, New York, 325-352.CrossRef
20.
go back to reference Raidl M, Wittman G, Spencer M, Sant L, Lockard M, Peutz J: Steps To a New You: a health-centered program that helps adults change physical activity, eating habits, and body image perceptions. The Forum for Families and Consumer Issues. 2010, 15 (2): Raidl M, Wittman G, Spencer M, Sant L, Lockard M, Peutz J: Steps To a New You: a health-centered program that helps adults change physical activity, eating habits, and body image perceptions. The Forum for Families and Consumer Issues. 2010, 15 (2):
21.
go back to reference Kaplan M, Crago N, Herzog F, James L, Kiernan N, Middlemiss WN, Olte T, Weinreb-Welch L: FRIDGE (Food-Related Intergenerational Discussion Group Experiences). 2007, Penn State Cooperative Extension, University Park Kaplan M, Crago N, Herzog F, James L, Kiernan N, Middlemiss WN, Olte T, Weinreb-Welch L: FRIDGE (Food-Related Intergenerational Discussion Group Experiences). 2007, Penn State Cooperative Extension, University Park
22.
go back to reference National 4-H Council: Essential Elements for Positive Youth Development. 2009, National 4-H Council, USDA, Washington DC National 4-H Council: Essential Elements for Positive Youth Development. 2009, National 4-H Council, USDA, Washington DC
23.
go back to reference Lerner RM, Lerner JV, Almerigi JB, Theokas C, Phelps E, Gestsdottir S, Naudeau S, Jelicic H, Alberts A, Ma L, et al: Positive Youth Development, participation in community youth development programs, and community contributions of fifth-grade adolescents: findings from the first wave of the 4-H study of positive youth development. J Early Adolesc. 2005, 25 (1): 17-71. 10.1177/0272431604272461.CrossRef Lerner RM, Lerner JV, Almerigi JB, Theokas C, Phelps E, Gestsdottir S, Naudeau S, Jelicic H, Alberts A, Ma L, et al: Positive Youth Development, participation in community youth development programs, and community contributions of fifth-grade adolescents: findings from the first wave of the 4-H study of positive youth development. J Early Adolesc. 2005, 25 (1): 17-71. 10.1177/0272431604272461.CrossRef
24.
go back to reference Latham GP: Goal setting: a five-step approach to behavior change. Organ Dyn. 2003, 32 (3): 309-318. 10.1016/S0090-2616(03)00028-7.CrossRef Latham GP: Goal setting: a five-step approach to behavior change. Organ Dyn. 2003, 32 (3): 309-318. 10.1016/S0090-2616(03)00028-7.CrossRef
27.
go back to reference Centers for Disease Control and Prevention: National Health and Nutrition Examination Survey: Anthropometry Procedures Manual. 2007 Centers for Disease Control and Prevention: National Health and Nutrition Examination Survey: Anthropometry Procedures Manual. 2007
28.
go back to reference Perry CM, De Ayala RJ, Lebow R, Hayden E: A validation and reliability study of the Physical Activity and Healthy Food Efficacy scale for children (PAHFE). Health Educ Behav. 2008, 35 (3): 346-360.CrossRefPubMed Perry CM, De Ayala RJ, Lebow R, Hayden E: A validation and reliability study of the Physical Activity and Healthy Food Efficacy scale for children (PAHFE). Health Educ Behav. 2008, 35 (3): 346-360.CrossRefPubMed
29.
go back to reference Kowalski KC, Crocker PRE, Faulkner RA: Validation of the physical activity questionnaire for older children. Pediatr Exerc Sci. 1997, 9 (2): 174-186. Kowalski KC, Crocker PRE, Faulkner RA: Validation of the physical activity questionnaire for older children. Pediatr Exerc Sci. 1997, 9 (2): 174-186.
31.
go back to reference Edmundson E, Parcel GS, Feldman HA, Elder J, Perry CL, Johnson C, Williston BJ, Stone EJ, Yang MH, Lytle L, et al: The effects of the child and adolescent trial for cardiovascular health upon psychosocial determinants of diet and physical activity behavior. Prev Med. 1996, 25 (4): 442-454. 10.1006/pmed.1996.0076.CrossRefPubMed Edmundson E, Parcel GS, Feldman HA, Elder J, Perry CL, Johnson C, Williston BJ, Stone EJ, Yang MH, Lytle L, et al: The effects of the child and adolescent trial for cardiovascular health upon psychosocial determinants of diet and physical activity behavior. Prev Med. 1996, 25 (4): 442-454. 10.1006/pmed.1996.0076.CrossRefPubMed
32.
go back to reference Neumark-Sztainer D, Wall M, Story M, Fulkerson JA: Are family meal patterns associated with disordered eating behaviors among adolescents?. J Adolesc Health. 2004, 35 (5): 350-359.CrossRefPubMed Neumark-Sztainer D, Wall M, Story M, Fulkerson JA: Are family meal patterns associated with disordered eating behaviors among adolescents?. J Adolesc Health. 2004, 35 (5): 350-359.CrossRefPubMed
33.
go back to reference Truby H, Paxton SJ: Development of the children’s body image scale. Br J Clin Psychol. 2002, 41: 185-203. 10.1348/014466502163967.CrossRefPubMed Truby H, Paxton SJ: Development of the children’s body image scale. Br J Clin Psychol. 2002, 41: 185-203. 10.1348/014466502163967.CrossRefPubMed
34.
go back to reference Mendelson BK, White DR, Mendelson MJ: Self-esteem and body esteem: effects of gender, age, and weight. J Appl Dev Psychol. 1996, 17 (3): 321-346. 10.1016/S0193-3973(96)90030-1.CrossRef Mendelson BK, White DR, Mendelson MJ: Self-esteem and body esteem: effects of gender, age, and weight. J Appl Dev Psychol. 1996, 17 (3): 321-346. 10.1016/S0193-3973(96)90030-1.CrossRef
35.
go back to reference Heinberg LJ, Thompson JK, Stormer S: Development and validation of the socio-cultural attitudes towards appearance questionnaire. Int J Eat Disord. 1995, 17 (1): 81-89. 10.1002/1098-108X(199501)17:1<81::AID-EAT2260170111>3.0.CO;2-Y.CrossRefPubMed Heinberg LJ, Thompson JK, Stormer S: Development and validation of the socio-cultural attitudes towards appearance questionnaire. Int J Eat Disord. 1995, 17 (1): 81-89. 10.1002/1098-108X(199501)17:1<81::AID-EAT2260170111>3.0.CO;2-Y.CrossRefPubMed
36.
go back to reference Bedeian AG, Teague RJ, Zmud RW: Test-retest reliability and internal consistency of short-form of coopersmiths self-esteem inventory. Psychol Rep. 1977, 41 (3): 1041-1042. 10.2466/pr0.1977.41.3f.1041.CrossRefPubMed Bedeian AG, Teague RJ, Zmud RW: Test-retest reliability and internal consistency of short-form of coopersmiths self-esteem inventory. Psychol Rep. 1977, 41 (3): 1041-1042. 10.2466/pr0.1977.41.3f.1041.CrossRefPubMed
37.
go back to reference Ravens-Sieberer U, Gosch A, Rajmil L, Erhart M, Bruil J, Duer W, Auquier P, Power M, Abel T, Czemy L, et al: Kidscreen-52 quality-of-life measure for children and adolescents. Expert Rev Pharmacoecon Outcomes Res. 2005, 5 (3): 353-364. 10.1586/14737167.5.3.353.CrossRefPubMed Ravens-Sieberer U, Gosch A, Rajmil L, Erhart M, Bruil J, Duer W, Auquier P, Power M, Abel T, Czemy L, et al: Kidscreen-52 quality-of-life measure for children and adolescents. Expert Rev Pharmacoecon Outcomes Res. 2005, 5 (3): 353-364. 10.1586/14737167.5.3.353.CrossRefPubMed
38.
go back to reference Marcus BH, Selby VC, Niaura RS, Rossi JS: Self-efficacy and the stages of exercise behavior-change. Res Q Exerc Sport. 1992, 63 (1): 60-66.CrossRefPubMed Marcus BH, Selby VC, Niaura RS, Rossi JS: Self-efficacy and the stages of exercise behavior-change. Res Q Exerc Sport. 1992, 63 (1): 60-66.CrossRefPubMed
39.
go back to reference Godin G, Shephard RJ: A simple method to assess exercise behavior in the community. Can J Appl Sport Sci. 1985, 10 (3): 141-146.PubMed Godin G, Shephard RJ: A simple method to assess exercise behavior in the community. Can J Appl Sport Sci. 1985, 10 (3): 141-146.PubMed
40.
go back to reference Walker SN, Hill-Polerecky DM: Psychometric evaluation of Health-Promoting Lifestyle Profile II. 1996 Walker SN, Hill-Polerecky DM: Psychometric evaluation of Health-Promoting Lifestyle Profile II. 1996
41.
go back to reference Birch LL, Fisher JO, Grimm-Thomas K, Markey CN, Sawyer R, Johnson SL: Confirmatory factor analysis of the child feeding questionnaire: a measure of parental attitudes, beliefs and practices about child feeding and obesity proneness. Appetite. 2001, 36 (3): 201-210. 10.1006/appe.2001.0398.CrossRefPubMed Birch LL, Fisher JO, Grimm-Thomas K, Markey CN, Sawyer R, Johnson SL: Confirmatory factor analysis of the child feeding questionnaire: a measure of parental attitudes, beliefs and practices about child feeding and obesity proneness. Appetite. 2001, 36 (3): 201-210. 10.1006/appe.2001.0398.CrossRefPubMed
42.
go back to reference Centers for Disease Control and Prevention: National Health and Nutrition Examination Survey Questionnaire. (NHANES Flexible Consumer Behavior Module 2009–2010). 2009, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Hyattsville Centers for Disease Control and Prevention: National Health and Nutrition Examination Survey Questionnaire. (NHANES Flexible Consumer Behavior Module 2009–2010). 2009, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Hyattsville
43.
go back to reference Centers for Disease Control and Prevention: National Health and Nutrition Examination Survey Questionnaire 2009. (NHANES Consumer Behavior- Family Questionnaire). 2011, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Hyattsville Centers for Disease Control and Prevention: National Health and Nutrition Examination Survey Questionnaire 2009. (NHANES Consumer Behavior- Family Questionnaire). 2011, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Hyattsville
44.
go back to reference Cash TF, Melnyk SE, Hrabosky JI: The assessment of body image investment: an extensive revision of the appearance schemas inventory. Int J Eat Disord. 2004, 35 (3): 305-316. 10.1002/eat.10264.CrossRefPubMed Cash TF, Melnyk SE, Hrabosky JI: The assessment of body image investment: an extensive revision of the appearance schemas inventory. Int J Eat Disord. 2004, 35 (3): 305-316. 10.1002/eat.10264.CrossRefPubMed
45.
go back to reference Robinson C, Mandleco B, Frost Olsen S, Hart C: The parenting styles and dimensions questionnaire (PSDQ). Handbook of family measurement techniques Volume Vol. 2: Instruments and index. Edited by: Perlmutter B, Touliatos J, Holden G. 2001, Sage, Thousand Oaks, 190- Robinson C, Mandleco B, Frost Olsen S, Hart C: The parenting styles and dimensions questionnaire (PSDQ). Handbook of family measurement techniques Volume Vol. 2: Instruments and index. Edited by: Perlmutter B, Touliatos J, Holden G. 2001, Sage, Thousand Oaks, 190-
46.
go back to reference Olson D, Barnes H: Family Communication Manual. 2006, Life Innovations, Inc, Minneapolis Olson D, Barnes H: Family Communication Manual. 2006, Life Innovations, Inc, Minneapolis
47.
go back to reference Taveras EM, Mitchell K, Gortmaker SL: Parental confidence in making overweight-related behavior changes. Pediatrics. 2009, 124 (1): 151-158. 10.1542/peds.2008-2892.CrossRefPubMed Taveras EM, Mitchell K, Gortmaker SL: Parental confidence in making overweight-related behavior changes. Pediatrics. 2009, 124 (1): 151-158. 10.1542/peds.2008-2892.CrossRefPubMed
48.
go back to reference Hardy LL, Bass SL, Booth ML: Changes in sedentary behavior among adolescent girls: A 2.5-year prospective cohort study. J Adolesc Health. 2007, 40 (2): 158-165. 10.1016/j.jadohealth.2006.09.009.CrossRefPubMed Hardy LL, Bass SL, Booth ML: Changes in sedentary behavior among adolescent girls: A 2.5-year prospective cohort study. J Adolesc Health. 2007, 40 (2): 158-165. 10.1016/j.jadohealth.2006.09.009.CrossRefPubMed
Metadata
Title
Childhood obesity prevention in rural settings: background, rationale, and study design of ‘4-Health,’ a parent-only intervention
Authors
Wesley C Lynch
Jill Martz
Galen Eldridge
Sandra J Bailey
Carrie Benke
Lynn Paul
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2012
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-12-255

Other articles of this Issue 1/2012

BMC Public Health 1/2012 Go to the issue