Together We STRIDE study is a community-based trial designed to test the effectiveness of a multi-level obesity prevention intervention in Hispanic children living in rural communities. The trial enrolled 653 children. Although this multi-level, community-based intervention did not show an overall intervention effect on BMI z-scores, greater engagement with the intervention components was associated with higher reductions in BMI z-scores.
ABSTRACT
Objectives
Pediatric obesity disproportionately affects children of lower socioeconomic status, racial and ethnic minorities, and rural communities, and is influenced by social and physical environments. Community-engaged interventions can address pediatric obesity and have been implemented in rural settings for other conditions, but few have specifically targeted rural childhood obesity. Together We STRIDE study is a community-based trial designed to test the effectiveness of a multi-level obesity prevention intervention in Hispanic children living in rural communities.
Methods
The trial enrolled 653 children (8–12 years old). The 13-month (March 2017–April 2018) multi-level intervention included comic books, nutrition and physical activity (PA) classes, media literacy education and PA breaks, and an open-street community program (Ciclovía). The primary outcome was between-group differences in BMI z-score, measured at baseline, 6 months, and 18 months.
Results
There were no significant between-group differences in BMI z-scores and BMI-for-age percentile relative to 95th percentile at 6 months or 18 months follow up. The mean difference in BMI z-score between intervention and comparison communities was −0.02 (95% CI −0.05, 0.02; p = 0.31) at 6 months and 0.03 (95% CI −0.03, 0.09; p = 0.32) at 18 months, respectively. BMI z-scores decreased progressively with increased exposure to intervention components (unadjusted p-trend = 0.008 and adjusted p-trend = 0.009).
Conclusions
Although this multi-level community-based intervention did not show an overall intervention effect on BMI z-scores, greater engagement with the intervention components was associated with higher reductions in BMI z-scores. The findings underscore both the promise and the challenges of community-based obesity prevention interventions in rural communities.
Trial Registration
NCT02982759 (Together We STRIDE) retrospectively registered during study recruitment