Testing a Multilevel, Multicomponent, Multigenerational Dietary Intervention to Improve Southeast Asian Children's Diets

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Background. Poor diet quality is a significant and critical problem for Southeast Asian (SEA) children whose families came to the US as refugees [e.g., Hmong, Cambodian, Laotian, Vietnamese]. SEA children are disproportionately burdened by higher rates of obesity and increased risk of other diet-related chronic diseases like type 2 diabetes relative to other Asian subgroups, Whites and “Other” races. Although dietary interventions have been shown to prevent/delay onset of diet-related chronic diseases, to our knowledge, there are no dietary interventions developed specifically for SEA children. Thus, there is an urgent need for dietary interventions that leverage state-of-the-art methods to address existing health disparities affecting SEA children and to advance scientific understanding of gaps in intervention research. Overview of Proposal. This proposal reflects our eight year (ongoing) academic-community research partnership with the Center for SEA in Rhode Island, formative work with SEA families, and our extensive experience conducting successful dietary interventions with underserved health disparity groups. The current study is a pilot feasibility study that tests an innovative multilevel, multicomponent, multigenerational dietary intervention to improve diet quality among SEA children. Conceptual Model. The Community Energy Balance and Family-Centered Action Model of Intervention Layout and Implementation frameworks provide the intervention rationale and structure. These frameworks propose that for disparity ethnic minority groups like SEA, multilevel, multicomponent, intergenerational interventions are the most effective intervention approach for changing and sustaining individual-level behavior change. Social cognitive theory and popular education philosophy inform the intervention content. Overview of Research Plan. 75 SEA families with children ages 6 to 11 years will be recruited from Providence County, Rhode Island. Adult-child pairs will be randomized to: (1) financial incentive only arm that will receive weekly $15 financial incentive coupons to subsidize purchase of healthy foods at a local SEA grocery store; or (2) financial incentive plus twice-monthly, family-based group nutrition education at the Center for SEA led by SEA community health workers; three motivational interviewing (MI) calls by trained community health workers; dietary norms messaging for adults (via weekly text messages) and for children (via Infographics at nutrition education sessions); and weekly $15 financial incentive coupons to subsidize purchase of healthy foods at SEA grocery stores; or (3) an Academic Engagement attention control arm that will follow the structure of the financial incentive plus nutrition education, MI and text messages and infographics arm. The primary outcomes are study feasibility and clinically meaningful improvement in child’s diet quality (measured by healthy eating index). Secondary outcomes are clinically meaningful changes in children’s body mass (~ 2kg weight loss or no weight gain), HbA1c (0.5%) and parent’s diet quality, HbA1c and the home food environment. These study findings will be used to inform a future, larger clinical trial.