iAmHealthy Parents First

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Project Summary/Abstract Both children and adults in rural areas have higher obesity rates than their urban counterparts. With less access to evidence-based weight loss interventions, obesity poses a major risk factor contributing to elevated morbidity and mortality from cardiovascular disease, diabetes, and cancer among rural Americans. Obesity runs in families due to multiple factors including hereditary components, home environment, and behavioral modeling around dietary intake, physical activity, and screen time. Thus, targeting the rural family unit has the potential to enhance weight loss for adults and children simultaneously. Previous research from our team indicates that mHealth is feasible and acceptable for the delivery of obesity interventions to rural families as this type of intervention lowers child Body Mass Index z score (BMIz) and helps children and families to significantly change their health behaviors. The current application extends this work in a new and innovative direction, targeting parents first with an empirically supported obesity intervention, and then moving on to treat the family unit. In a randomized trial, we propose to compare a 4-month parent-only intervention followed by a 6-month family based behavioral group intervention (iAmHealthy-Parents First) to a parent wait-list control followed by the family based behavioral group intervention (iAmHealthy). Parent/child dyads will be recruited from both rural elementary schools and rural medical clinics in 8 towns. Each town will consist of a single site and will recruit 30 parent/child dyads, 15 of whom will be randomly assigned to iAmHealthy-Parents First and 15 to iAmHealthy, for a total of 240 parents and 240 children. Each rural town will have a population < 20,000 and/or the Rural Urban Commuting Area Codes of 4 or greater, and for the purposes of the study will include a nurse at a rural health clinic partnering with a nurse at a rural elementary school to make a single site. In Aim 1 we propose to study effectiveness through change in child BMIz and parent percent weight loss from baseline to month 10 (post-intervention), as well as through change in diet, change in physical activity and change in parent and child weight related quality of life. In Aim 2, we propose to assess mediators and moderators that we believe are specifically important to the treatment model and to the rural population. In Aim 3 we propose to explore the reach and representativeness of the intervention, and to explore a concept we have found key in both our adult and pediatric trials – nurse engagement. Our experience suggests that nurse engagement plays a key role in recruitment, retention, and engagement of the families, and here we propose to assess nurse engagement as well as foster it through the development of a Rural Nurse Engagement Collaborative. This exploratory aim will provide critical pragmatic data to inform future studies aimed at testing local implementation and dissemination strategies. The iAmHealthy Parents First intervention is an easily scalable, widely disseminable obesity intervention option which could significantly improve the way we treat obesity among rural families.