Overweight and Obesity
Conditions
Brief summary
The 1.2 million households living in public housing are disproportionately affected by obesity, where prevalence is estimated at 50%. An ecologic framework hypothesizes that this disparity is related, in part, to social and environmental factors within these neighborhoods that influence residents' lifestyles. Social networks and the built environment may work together to promote or inhibit lifestyle behaviors; however, combined social network-built environment interventions have not previously targeted changes in diet. Investigators hypothesize that an intervention that combines a social network approach with strategies that address public housing residents' challenges related to the built environment will improve dietary habits. The investigators' overall aim is to develop a combined social network-built environment intervention to reduce intake of beverages high in added sugars and to pilot test the intervention among residents of public housing developments in Baltimore, MD. The investigators' aim for this work is: 1) To develop a combined social network-built environment intervention to reduce intake of beverages high in added sugars and to pilot test the intervention among residents of public housing developments in Baltimore, MD. Investigators hypothesize that a social network intervention will be feasible and acceptable in promoting healthy lifestyle change, and that this intervention will alter lifestyle behaviors among public housing residents.
Detailed description
Investigators will conduct a 6-month non-randomized trial of the social network intervention described below. This will be a single arm trial in which investigators compare the outcomes of interest pre- and post- intervention. Investigators will adapt an HIV risk reduction social network intervention to create a new social network intervention targeting reduction in intake of sugar-sweetened beverages (SSB). The investigators' primary outcomes will be to test the acceptability and feasibility of the intervention and its components as well as estimate the likely effect of the intervention. In the intervention, individuals will be recruited and trained to be Peer Educators who will participate in group sessions and then communicate this information with members of participant's social network (Sidekick) and work to make changes to reduce intake of added sugars together. Given the frequent intake of SSB in this population, the intervention will focus on reducing added sugar intake through the reduced consumption of SSB. Peer Educators will participate in 6 core group sessions over a 6-week period as well as 3 additional booster sessions after completing the core curriculum. All sessions will be delivered by a facilitator and assistant facilitator using a guide. All groups will be held in a room in each public housing development's administrative building.
Interventions
BEHAVIORALSocial network intervention
The intervention combined a social network approach with strategies that address public housing residents' challenges related to the built environment to improve dietary habits. Given the frequent intake of sugar-sweetened beverages (SSB) in this population, the intervention focused on reducing added sugar intake through the reduced consumption of SSB.
Sponsors
National Heart, Lung, and Blood Institute (NHLBI)
Johns Hopkins University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* At least 18 years old * BMI≥25 kg/m2 * Must consume sugar-sweetened beverages at least twice daily * Peer Educators must identify one high-risk alter in the social network to enroll as Sidekick * Resides in select public housing developments in Baltimore, MD
Exclusion criteria
* Any underlying medical conditions that could seriously reduce life expectancy, ability to participate in the trial, or for which lifestyle change may be contraindicated and/or require medical supervision by a physician such as medication-dependent diabetes mellitus, cancer, lung disease requiring supplemental oxygen, dementia, angina, or diagnosis in the last 12 months of myocardial infarction, transient ischemic attack or stroke * Women who are pregnant or breastfeeding
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Sessions Attended | 3 months | Number of sessions attended calculated from attendance sign-in sheets. This is used for the assessment of program feasibility. |
| Participant Satisfaction as Assessed by 4-point Likert Scale | 6 months | Survey question assesses participant satisfaction with the intervention using a 4-point Likert scale (1 = Very satisfied; 2= Somewhat satisfied; 3 = Somewhat dissatisfied; 4 = Very dissatisfied). This is used for the assessment of program acceptability. |
| Participant's Likelihood to Recommend Program Assessed by 4-point Likert Scale | 6 months | Survey question assesses willingness to recommend that a friend participate using a 4-point Likert scale (1 = Very likely; 2= Somewhat likely; 3 = Somewhat unlikely; 4 = Very unlikely). This is used to assess the program acceptability. |
| Added Sugar Intake (Teaspoons/Day) Among Total Sample at Follow up | 6 months | Participants answered questions from the National Health Interview Survey (NHIS) 5-factor dietary screener, and relevant elements as recommended by NHIS were combined to estimate the daily added sugar intake (i.e.,soda, sugar-sweetened beverages, sweets and doughnuts). At 6 months, this measure ranged (min-max) from 9.1 to 56.0 teaspoons/day in this sample. The American Heart Association recommends that all adults limit their added sugar intake to no more than 9 teaspoons per day. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Added Sugar Intake (Teaspoons/Day) Among Egos (Peer Educators) at Follow up | 6 months | Participants answered questions from the National Health Interview Survey (NHIS) 5-factor dietary screener, and relevant elements as recommended by NHIS were combined to estimate the daily added sugar intake (i.e.,soda, sugar-sweetened beverages, sweets and doughnuts). The American Heart Association recommends that all adults limit their added sugar intake to no more than 9 teaspoons per day. |
| Median Weight at Follow up | 6 months | Weight (kg) measured using standard methods |
| Added Sugar Intake (Teaspoons/Day) Among Alters (Sidekicks) at Follow up | 6 months | Participants answered questions from the National Health Interview Survey (NHIS) 5-factor dietary screener, and relevant elements as recommended by NHIS were combined to estimate the daily added sugar intake (i.e.,soda, sugar-sweetened beverages, sweets and doughnuts). The American Heart Association recommends that all adults limit their added sugar intake to no more than 9 teaspoons per day. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Social Network Intervention Individuals will be recruited and trained to be Peer Educators who will participate in group sessions and then communicate this information with members of their social network (Sidekick) and work to make changes to reduce intake of sugar-sweetened beverages. Peer Educators will participate in 6 core group sessions over a 6-week period as well as 3 additional booster sessions over the subsequent 3 months after completing the core curriculum. All sessions will be delivered by a facilitator and assistant facilitator using a guide.
Social network intervention: The intervention combined a social network approach with strategies that address public housing residents' challenges related to the built environment to improve dietary habits. Given the frequent intake of sugar-sweetened beverages (SSB) in this population, the intervention focused on reducing added sugar intake through the reduced consumption of SSB. | 34 |
| Total | 34 |
Baseline characteristics
| Characteristic | Social Network Intervention |
|---|---|
| Added Sugar Intake among Peer Educators | 42.4 teaspoons/day |
| Added Sugar Intake among Sidekicks | 37.0 teaspoons/day |
| Added sugar intake total sample | 38.0 teaspoons/day |
| Age, Continuous | 45.7 years STANDARD_DEVIATION 12 |
| Body mass index, continuous | 32.1 kg/m^2 STANDARD_DEVIATION 6.7 |
| Race/Ethnicity, Customized African-American | 33 Participants |
| Race/Ethnicity, Customized Other | 1 Participants |
| Sex: Female, Male Female | 27 Participants |
| Sex: Female, Male Male | 7 Participants |
| Weight, continuous | 85.9 kg |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 34 |
| other Total, other adverse events | 0 / 34 |
| serious Total, serious adverse events | 0 / 34 |
Outcome results
Primary
Added Sugar Intake (Teaspoons/Day) Among Total Sample at Follow up
Participants answered questions from the National Health Interview Survey (NHIS) 5-factor dietary screener, and relevant elements as recommended by NHIS were combined to estimate the daily added sugar intake (i.e.,soda, sugar-sweetened beverages, sweets and doughnuts). At 6 months, this measure ranged (min-max) from 9.1 to 56.0 teaspoons/day in this sample. The American Heart Association recommends that all adults limit their added sugar intake to no more than 9 teaspoons per day.
Time frame: 6 months
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Social Network Intervention | Added Sugar Intake (Teaspoons/Day) Among Total Sample at Follow up | 17.2 teaspoons/day |
p-value: <0.001Wilcoxon signed rank sum
Primary
Number of Sessions Attended
Number of sessions attended calculated from attendance sign-in sheets. This is used for the assessment of program feasibility.
Time frame: 3 months
Population: Limited to Peer Educators who had the opportunity to attend the sessions.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Social Network Intervention | Number of Sessions Attended | 9 Number of sessions |
Primary
Participant Satisfaction as Assessed by 4-point Likert Scale
Survey question assesses participant satisfaction with the intervention using a 4-point Likert scale (1 = Very satisfied; 2= Somewhat satisfied; 3 = Somewhat dissatisfied; 4 = Very dissatisfied). This is used for the assessment of program acceptability.
Time frame: 6 months
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Social Network Intervention | Participant Satisfaction as Assessed by 4-point Likert Scale | Very satisfied | 30 Participants |
| Social Network Intervention | Participant Satisfaction as Assessed by 4-point Likert Scale | Somewhat satisfied | 4 Participants |
| Social Network Intervention | Participant Satisfaction as Assessed by 4-point Likert Scale | Somewhat dissatisfied | 0 Participants |
| Social Network Intervention | Participant Satisfaction as Assessed by 4-point Likert Scale | Very dissatisfied | 0 Participants |
Primary
Participant's Likelihood to Recommend Program Assessed by 4-point Likert Scale
Survey question assesses willingness to recommend that a friend participate using a 4-point Likert scale (1 = Very likely; 2= Somewhat likely; 3 = Somewhat unlikely; 4 = Very unlikely). This is used to assess the program acceptability.
Time frame: 6 months
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Social Network Intervention | Participant's Likelihood to Recommend Program Assessed by 4-point Likert Scale | Very likely | 31 Participants |
| Social Network Intervention | Participant's Likelihood to Recommend Program Assessed by 4-point Likert Scale | Somewhat likely | 3 Participants |
| Social Network Intervention | Participant's Likelihood to Recommend Program Assessed by 4-point Likert Scale | Somewhat unlikely | 0 Participants |
| Social Network Intervention | Participant's Likelihood to Recommend Program Assessed by 4-point Likert Scale | Very unlikely | 0 Participants |
Secondary
Added Sugar Intake (Teaspoons/Day) Among Alters (Sidekicks) at Follow up
Participants answered questions from the National Health Interview Survey (NHIS) 5-factor dietary screener, and relevant elements as recommended by NHIS were combined to estimate the daily added sugar intake (i.e.,soda, sugar-sweetened beverages, sweets and doughnuts). The American Heart Association recommends that all adults limit their added sugar intake to no more than 9 teaspoons per day.
Time frame: 6 months
Population: Limited to Sidekicks only
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Social Network Intervention | Added Sugar Intake (Teaspoons/Day) Among Alters (Sidekicks) at Follow up | 16.9 teaspoons/day |
Secondary
Added Sugar Intake (Teaspoons/Day) Among Egos (Peer Educators) at Follow up
Participants answered questions from the National Health Interview Survey (NHIS) 5-factor dietary screener, and relevant elements as recommended by NHIS were combined to estimate the daily added sugar intake (i.e.,soda, sugar-sweetened beverages, sweets and doughnuts). The American Heart Association recommends that all adults limit their added sugar intake to no more than 9 teaspoons per day.
Time frame: 6 months
Population: Limited to Peer Educators
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Social Network Intervention | Added Sugar Intake (Teaspoons/Day) Among Egos (Peer Educators) at Follow up | 17.4 teaspoons/day |
Secondary
Median Weight at Follow up
Weight (kg) measured using standard methods
Time frame: 6 months
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Social Network Intervention | Median Weight at Follow up | 84.3 kg |
p-value: 0.21Wilcoxon signed rank sum