eatgoodfeelgood

Background- The Problem

Childhood obesity affects 12.7% of children aged 2 to 5 years old and 20.7% of children aged 6 to 11 (Centers for Disease Control and Prevention, 2022). Between 1999 and 2018, childhood obesity rates in the United States rose by 4.5%; however, the weight of this increase is not equally distributed. Children from Spanish-speaking households are 24.4% more likely to be obese than their peers from English-speaking households (Tsoi et al., 2022).

There are many health consequences of childhood obesity including an increased likelihood of developing respiratory issues, such as asthma or sleep apnea, increased risk of type 2 diabetes, as well as advanced bone age, and altered blood lipid levels (Brown, 2018, p. 308). With this long list of potential comorbidities, childhood obesity ends up costing $14 billion in annual national health care expenses (Cawley, 2010). Beyond the physical health complications, childhood obesity has also been linked to severe mental health problems, including the cluster of adverse childhood experiences (ACE) that can exacerbate or cause additional diseases and illnesses (Schiff et al., 2021).

A major contributor to childhood obesity is excessive consumption of added sugars, particularly from sugar-sweetened beverages (SSBs). In fact, two-thirds of children drink at least one SSB on any given day. Consumption of SSBs, especially by children, is even higher in Latinx and Black populations. This is thought to be, in part, due to targeted marketing (Bleich et al., 2018).  Children of all ages and backgrounds are often exposed to food advertising, but children of color are more frequently exposed to advertisements for junk food and SSBs as food marketers of these products often target Latinx, Black, and low-income communities (Cannon et al., 2022). While Rhode Island passed a bill in 2018 to ban junk food marketing in its schools, children are still exposed to these advertisements in many other aspects of their lives (American Heart Association, n.d.).

A direct link can be drawn between these marketing tactics and a higher incidence of childhood obesity in children of color. While 16.6% of White children are obese, the numbers jump to 24.8% for Black children and 26.2% for Latinx children (Centers for Disease Control and Prevention, 2022).

Target Population- The Priority

Like these national trends, the highest rates of childhood overweight and obesity in Rhode Island (52% of children) can be seen in Central Falls- where 69.3% of residents are Latinx and 67% of households speak a language other than English at home. The high rates of childhood overweight/obesity in this primarily Latinx neighborhood is not just a statistical similarity- it is a prime example of targeted marketing by the food industry. 30% of Central Falls’ 22,593 residents are living in poverty and the median household income in 2020 dollars was below $35,000. As often seen in lower socioeconomic areas, the 1.19 square meters that make up the entirety of Central Falls, there are no full-sized grocery stores, but there are three burger restaurants, two convenience stores, two fried chicken spots, a pizza shop, and a Burger King (Rhode Island Kids COUNT, 2022; United States Census Bureau, 2021; Woolf et al., 2020).

Given that children are provided food primarily by the adults in their lives and also tend to model behaviors practiced and expressed by those same adults the EGFG program will target the primary caregivers of children aged 4 to 11 years old in Central Falls, Rhode Island. This target population will be identified through the Central Falls School District, which includes Captain Hunt Preschool, Ella Risk Elementary, and Veterans Memorial Elementary (Central Falls School District, n.d.).

Parental/guardian feeding and drinking habits can act either to increase or decrease a child’s risk of obesity (Niec et al., 2022). Childhood obesity interventions that have targeted parents and guardians have been successful in both improving the child’s weight and positive changes in social-emotional functioning (Li et al., 2020). Providing education and improving self-efficacy to parents and guardians in Rhode Island will create a ripple effect and improve the dietary habits and behaviors of their children, subsequently reducing rates of childhood obesity across the state.

Program Details- The Solution

Parents and guardians are often on the go between juggling their own work and their children’s school and extracurricular activities. Through the EatGoodFeelGood (EGFG) website, blog, and social media accounts, relevant and science-based information can be provided to any parent or guardian to be able to access whenever is most convenient for them. Connecting and meeting this target population presents its challenges in terms of space and time constraints. Virtual-based parent/guardian-focused nutrition interventions for childhood obesity have been previously found to increase the time study participants were willing to commit to taking part in the study (Boswell et al., 2019). Providing materials online also has the added benefit of being easily shared within and beyond the target audience. Additionally, these online platforms can easily gather, track, and report on data including the viewer’s age, gender, education level, relationship status-even their hobbies (Henström et al., 2022; Meta, n.d.).

All EGFG materials will also be available in both English and Spanish. The target audience is primarily Latinx and does not speak English at home, therefore providing materials that have been translated into Spanish by an individual with both a familiarity with the topic and the language is crucial to a culturally relevant and competent program (Hazard et al., 2021).

EGFG will consist of family-centered nutrition education information, practical implementation skills, and basic community resource referrals. With a focus on reducing consumption of SSBs, information will include how to identify SSBs using the nutrition facts label, how to talk about added sugars with kids, and recipes using natural sugars. Information will also be shared through EGFG on the importance of and specific advice on how individuals can advocate for related policy changes, such as how to contact local representatives in support of a proposed sugar-sweetened beverage tax (WPRI, 2021). Finally, as an attempt to increase access to healthier drink options, EGFG will also partner with local convenience stores and markets in Central Falls. In exchange for promoting the store on the EGFG blog and social media posts, stores will be asked to highlight beverages they sell that contain no added sugar through sales or signage. Most foods and beverages are bought as a direct result of advertising, so advertising options with no added sugars can influence consumers to opt for those instead of their sugar-sweetened counterparts

The Potential Impact & Stakeholders

Reducing consumption of sugar-sweetened beverages for children by way of increasing parent/guardian knowledge and self-efficacy has the potential to benefit many sectors of Rhode Island and involve many stakeholders. main caretakers of a child play a crucial role in the food their children have access to and the development of the child’s dietary attitudes and behaviors and are thus primary stakeholders. Many studies have found parent/guardian-focused interventions for childhood obesity to be successful at increasing both parent/guardian self-efficacy around nutritional habits and improving dietary behaviors, especially within Latinx populations (Hammersley et al., 2019; Parsons et al., 2018).

These healthier dietary behaviors will improve health outcomes cross-generationally in families and, because of this, stakeholders then expand to include healthcare providers and public health professionals. With improved dietary behaviors and health outcomes, decreases in chronic diseases and healthcare expenditures will be seen for both the family and the community at a relatively low cost, given that the intervention is online and, therefore, requires limited or no physical materials or incentives.

Educators and school professionals are also stakeholders in EGFG as reduced consumption of added sugars by way of reducing SSB intake and improved diet nutritional quality can also improve the academic performance of children (Faught et al., 2017). Academic outcomes impact a child’s future educational attainment, work performance and income, and other social determinants of health impacted by employment status such as socio-economic status. Additionally, providing bilingual materials and information to parents and guardians online can help a program be more easily available and, consequently, reach a wider audience. By ensuring program materials are relevant and accessible to the target population, EGFG can successfully and efficiently share knowledge, skills, and resources with Central Falls parents and guardians to reduce childhood consumption of SSBs.

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References

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Bleich, S. N., Vercammen, K. A., Koma, J. W., & Li, Z. (2018). Trends in beverage consumption among children and adults, 2003‐2014. Obesity, 26(2), 432–441. https://doi.org/10.1002/oby.22056

Boswell, N., Byrne, R., & Davies, P. S. W. (2019). Prospects for early childhood feeding interventions: An exploration of parent’s concerns and acceptability towards social media intervention opportunities. Nutrition & Dietetics, 76(4), 444–454. https://doi.org/10.1111/1747-0080.12502

Brown, J. E. (2018). Nutrition through the life cycle (7th ed.). Cengage Learning, Inc.

Cannon, J. S., Farkouh, E. K., Winett, L. B., Dorfman, L., Ramírez, A. S., Lazar, S., & Niederdeppe, J. (2022). Perceptions of arguments in support of policies to reduce sugary drink consumption among low-income white, black and Latinx parents of young children. American Journal of Health Promotion, 36(1), 84–93. https://doi.org/10.1177/08901171211030849

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Hazard, K., Lee, D., Ritchie, L., Rose, R., Rios, L. K. D., Plank, K., & Alkon, A. (2021). Development of an online curriculum for California early care and education providers on healthy beverages. BMC Public Health, 21(1), 1–1387. https://doi.org/10.1186/s12889-021-11428-x

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Tsoi, M. F., Li, H. L., Feng, Q., Cheung, C.-L., Cheung, T. T., & Cheung, B. M. (2022). Prevalence of childhood obesity in the United States 1999-2018: a 20-year analysis. Obesity Facts, 1–10. https://doi.org/10.1159/000524261

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Woolf, H. R., Fair, M., King, S. B., Dunn, C. G., & Kaczynski, A. T. (2020). Exploring dietary behavior differences among children by race/ethnicity and socioeconomic status. The Journal of School Health, 90(8), 658–664. https://doi.org/10.1111/josh.12915

WPRI. (2021, June 14). RI lawmakers at a standstill over bill that would tax sugary drinks. https://www.wpri.com/business-news/ri-lawmakers-at-a-standstill-over-bill-that-would-tax-sugary-drinks/#:~:text=The%20bill%2C%20introduced%20by%20Sen,or%20powders%20offered%20for%20sale.