Research Project #1

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The Acres Homes region in Houston, TX, is a predominantly African American and Hispanic community, a persistent poverty area with 69% of the residents living in food desert areas, and over 40% of the adult residents reportedly being obese. Ours is a cluster-randomized trial to assess the impact of Brighter Bites (BB), a school-based intervention improving access to fresh produce and nutrition education, on obesity and metabolic outcomes among children enrolled across 12 elementary schools serving the Acres Homes community and their parents. BB is proven to be effective at engaging parents, improving healthy dietary behaviors, reducing food insecurity, in low-income elementary school children in the short and long term. However, the impact of the program on obesity and metabolic measures in children or parents is unknown. Using an interweaving approach, BB will be integrated into Be Well Acres Homes, a place-based cancer prevention initiative. Elementary schools will be randomized to the BB intervention or waitlisted control condition (12 schools, 720 parent-child dyads). At BB schools, families will receive 16 distributions of 20-25 lbs. (~50 servings) of fresh produce to take home, recipe tastings, and hands-on, robust nutrition education in school, and for parents, access to the BB mobile app during one school year, with the option to continue participation in the BB program for two subsequent school years. Children and parents will be assessed at baseline, post-intervention (~9 months) and 21-months follow-up for the following outcomes: height, weight, glycosylated hemoglobin (HbA1c) via finger stick, blood pressure (BP), dietary intake via screener, child skin carotenoid levels, diet-related behaviors, home availability/access to FV and food insecurity status via questionnaires. Aim 1: Our primary aim is to examine the effects of the BB intervention compared to wait-list control at post-intervention on changes in primary child outcomes (BMI z-score, HbA1c, and vegetable intake) Aim 2: To examine the effects of the BB intervention compared to wait-list control at 9-month post intervention on changes in secondary outcomes (household food security status, parent BMI, HbA1c, BP, parent and child dietary behaviors, and home access/availability of FV). Aim 3: To examine the mediational influence of changes in food security status, parent outcomes, and home environment measures on changes in child outcomes at 9-month post-intervention. Aim 4: Using within-subject analyses, examine and compare the long-term and dose-response effects of the BB intervention strategies on diet, adiposity, and metabolic outcomes at 21-mos follow-up in the children. Aim 5: Explore the moderating effects of social (financial distress, experiences of discrimination, health literacy, and social connectedness), and environmental variables (proximity to food access sources, food environment, and neighborhood social vulnerability) on program effectiveness. This project will inform the translation and scaling efforts of BB, a highly successful natural experiment. It also advances dissemination and implementation science by studying and improving upon implementation to increase program reach and impact in persistent poverty areas such as Acres Homes.