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BackgroundA high consumption of sugar-sweetened beverages (SSBs) poses significant health concerns, particularly for rural adults and adolescents. A manner in which the health of both caregivers and adolescents can be improved is by developing innovative strategies that target caregivers as the agents of change. Sending text messages through mobile phones has been cited as an effective way to improve behavioral outcomes, although little research has been conducted in rural areas, particularly focusing on SSB intake. ObjectiveBy targeting rural caregivers, this 2-phase study aimed to (1) understand caregivers’ perceptions and language preferences for SSB-related text messages to inform and refine message development and delivery and (2) evaluate the acceptability of text messages for SSB intake behavior change and examine short-term effects on SSB intake behavior. MethodsA convergent mixed methods design was used to systematically develop and pilot-test text messages with caregivers in Southwest Virginia. In phase 1, 5 focus groups that included a card-sorting activity were conducted to explore advantages/disadvantages, language preferences (ie, tone of voice, audience, and phrase preferences), and perceived use of text messages. In phase 2, caregivers participated in a 5-week text message pilot trial that included weekly educational and personalized strategy messages and SSB intake assessments at baseline and follow-up. Before the focus groups and after completing the pilot trial, caregivers also completed a pre-post survey that assessed SSB intake, SSB home availability, and caregivers’ SSB-related practices. Caregivers also completed individual follow-up telephone interviews following the pilot trial. ResultsIn phase 1, caregivers (N=33) reported that text messages were convenient, accessible, and easy to read. In addition, they preferred messages with empathetic and authoritative tones that provided useful strategies and stayed away from using absolute words (eg, always and never). In the phase 2 pilot trial (N=30), 87% of caregivers completed baseline and 77% completed follow-up assessment, suggesting a high utilization rate. Other ways in which caregivers reported benefiting from the text messages included sharing messages with family members and friends (80%), making mental notes (57%), and looking back at messages as reminders (50%). Caregivers reported significant improvements in home environment, parenting practices, and rulemaking around SSB (P=.003, P=.02, and P=.04, respectively). In addition, the frequency of SSB intake among caregivers and adolescents significantly decreased (P=.003 and P=.005, respectively). ConclusionsSpending time in the formative phases of text message development helped understand the unique perspectives and language preferences of the target population. Furthermore, delivering an intervention through text messages has the potential to improve caregiver behaviors and reduce SSB intake among rural caregivers and adolescents. Findings from this study were used to develop a larger bank of text messages, which would be used in a future study, testing the effectiveness of a text message intervention targeting SSB intake–related caregiver behaviors.

The implementation of school-based obesity-prevention programs is understudied. Kids SIP smart ER is a 6-month, school-based, behavioral intervention for Appalachian middle school students and includes a teacher implementation strategy. Kids SIP smart ER effectively reduced students' sugar-sweetened beverages (SSB) when Researcher-Led. However, Teacher-Led effectiveness and fidelity are unknown. To explore the relative SSB effects when Kids SIP smart ER was Researcher-Led versus Teacher-Led and to examine teacher fidelity. This study of secondary outcomes used a quasi-experimental analytic approach of a Hybrid Type 1 effectiveness–implementation and cluster randomized controlled tria (RCT) of Kids SIP smart ER. Student SSB behaviors and teacher self-rated fidelity were assessed, respectively, with the validated Beverage Intake Questionnaire (BEVQ-15) and lesson-specific checklists. Analyses included descriptive statistics and modified two-part models with time-fixed effects and school-year cohort cluster controls. The analytic sample included students from six control schools (n = 220), six Researcher-Led intervention schools (n = 306), and five Teacher-Led intervention schools (n = 218), as well as eight teachers. Teacher-Led intervention students decreased SSB by −14.3 ounces/day (95% confidence interval = −15.4, −13.2; P <.001). Relative to control and to Researcher-Led intervention, the Teacher-Led treatment effect among students was −11.6 ounces SSB/day (P <.001, effect size = 0.75) and −4.3 (P =.004, effect size = 0.25), respectively. Teachers returned fidelity checklists for 90% of planned lessons. Fidelity averaged 94% (SD = 4.0%) among returned forms and 85% (SD = 18.9%) when missing forms were counted as zeros. Teachers can implement Kids SIP smart ER with high fidelity and produce statistically and clinically meaningful improvements in students' SSB behaviors. Findings have implications for the sustained implementation of Kids SIP smart ER and other school-based obesity-prevention programs. Clinical Trial information : NCT03740113. [ABSTRACT FROM AUTHOR]

Kids SIP smart ER is a 6-month behavioral and health literacy intervention effective at reducing sugar-sweetened beverage (SSB) intake among middle school students and their caregivers in the rural Appalachian region. This exploratory mixed methods study utilized a convergent parallel design to assess participant acceptability of a school-based curriculum for students and a text messaging program for caregivers. Acceptability was assessed using surveys (873 students and 453 caregivers), five focus groups (34 students) and telephone interviews (22 caregivers). Quantitative data were analyzed descriptively, and qualitative data were content coded. On a 5-point scale, average quantitative survey acceptability ratings ranged from 2.7 to 3.3 among three student-rated questions and 4.1 to 4.2 among four caregiver-rated questions. Qualitative focus group findings suggested that students preferred curricular activities that were hands-on and involved social interaction, while caregiver interview results showed high acceptability of the text messaging program's design, including usability, content messages and personalization. Students and caregivers reported similar program benefits: increased knowledge of SSBs and health risks, increased awareness of SSB behaviors and support to make beverage behavior changes. Results from this study can be used to understand Kids SIP smart ER's effectiveness data, communicate the intervention's acceptability with stakeholders and plan for future implementation studies. [ABSTRACT FROM AUTHOR]

BACKGROUND: Adolescents with overweight or obesity are at greater risk of having physical and psychosocial consequences. With increased disparities and inadequate literature on prevalence of adolescent weight status in rural Appalachia, there is potential for further complications. Unfortunately, adolescent obesity treatment options are often limited, especially in medically underserved regions. METHODS: This cross‐sectional study of adolescents at eight rural Appalachian schools examined weight status among and associations between body mass index percentile (BMIp) categories and health‐related perceptions and weight‐control intentions. Previously validated instruments were utilized. Analyses included independent samples t‐tests, ANOVA tests, and chi‐squared tests. RESULTS: Of 814 adolescents (ages 11‐13; 55.0% girls), BMIp revealed 20.8% overweight, 22.7% obese, and 10.6% severely obese. Adolescents with higher BMIp categories reported poorer self‐rated health, inaccurate weight perceptions, and greater weight loss intentions (all p <.05). CONCLUSIONS: Findings, including high prevalence of adolescents with overweight and obesity, emphasize the need for more obesity prevention and treatment options. Schools may be an ideal setting to reach at‐risk adolescents and provide obesity prevention and treatment options, especially in medically underserved regions such as rural Appalachia. Opportunities and challenges to apply findings, including school‐based obesity programs, are discussed. [ABSTRACT FROM AUTHOR]

Although collaboration is recognized as an effective means to address multifaceted community issues, successful collaboration is difficult to achieve and failure is prevalent. To effectively collaborate, collaborators must recognize the strengths and weaknesses within their own efforts. Using Mattessich and colleagues' work as a springboard, a seven-factor model of effective collaboration is presented along with an accompanying evaluation tool, the Collaboration Assessment Tool (CAT). Confirmatory factor analysis of the CAT validated the proposed model with all seven collaboration factors demonstrating strong internal consistency. Concurrent validity was established through expected positive intercorrelations between the factors as well as strong positive correlations with the perceived success of collaborative efforts. As evaluators are increasingly asked to evaluate collaborations and coalitions, this conceptual model and tool can provide evaluators with a grounded, reliable, and valid assessment instrument to work with clients to build collaborative efforts in an intentional, comprehensive, and effective manner.

A hybrid Extension project is introduced that uses a traditional Extension delivery model without the complete infrastructure of Cooperative Extension Services. The absence of this local organizational support and infrastructure necessitates new thinking regarding how Information Technology (IT) can support this project and hybrid Extension projects in general. The reciprocal relationship between offline and online tasks and how an Internet portal can serve as a centralized location for project continuity is offered as one solution. How IT facilitates the implementation of hybrid Extension projects such as this one can further promote the interdisciplinary adoption of the Extension model. (Contains 1 table and 2 figures.)

Summary: Background: Access to evidence‐ and family‐based childhood obesity (FBCO) treatment interventions is a challenge, especially in underserved regions where childhood obesity disparities persist. Objective: Compare two 6‐month FBCO treatment interventions, iChoose (high intensity, parent–child dyads) and Family Connections (low intensity, parents only), in one underserved US region. Methods: This unblinded, RCT reports on effectiveness and implementation outcomes. Eligibility included children ages 5–12 with BMI ≥85th percentile. Analyses included descriptive statistics and intention‐to‐treat Heckman treatment effect models. Results: Enrolled children (n = 139, mean age 10.1 ± 1.7 years, 30% with overweight, 70% with obesity, 45% black, 63% Medicaid) were randomly assigned to iChoose (n = 70) or Family Connections (n = 69). Retention rates were 63% for iChoose and 84% for Family Connection. Among children, 6‐month BMI z‐score changes were not statistically significant within iChoose [BMI z‐score 0.03 (95% CI = −0.13, 0.19)] or Family Connections [BMI z‐score 0.00 (95% CI = −0.16, 0.16)]. Likewise, parents' BMI changes were not statistically significant. No adverse events were reported. Both programmes were delivered with high fidelity (77%–100%). Engagement in core components was 25%–36% for iChoose and 52%–61% for Family Connections. Implementation costs per child with improved BMI z‐score were $2841 for iChoose and $955 for Family Connections. Conclusions: Neither intervention yielded significant improvements in child BMI z‐score or parent BMI, yet both were delivered with high fidelity. Relative to iChoose, descriptive data indicated higher retention, better engagement, and lower costs for Family Connections—suggesting that a lower intensity and parent‐focused programme may better fit the intended audience's context. [ABSTRACT FROM AUTHOR]

Guided by community-based participatory research principles, this mixed-methods process evaluation explored the experience and capacity of a newly formed Parental Advisory Team (PAT) engaged in childhood obesity research in a medically underserved region. Following the successful completion of a 3-month evidence-based childhood obesity treatment program (iChoose), 13 parents/caregivers who completed iChoose consented to participate in the PAT. Between June 2015 and March 2016, the PAT had nine monthly meetings and completed mixed-methods capacity assessments. They engaged in activities related to understanding iChoose outcomes, defining their role and purpose as a partnership, initiating content development, and pilot testing maintenance intervention components for future iChoose efforts. Assessments included a quantitative survey administered at baseline and 9 months, and a qualitative interview completed at 9 months. Results indicated that PAT members' perceptions of the identified capacity dimensions were positive at baseline (3.8-4.3 on a 5-point scale) and remained positive at follow-up (3.9-4.4 on a 5-point scale); changes were not statistically significant. Qualitative data revealed that PAT members were satisfied with group participation and desired to enhance their role in subsequent iChoose research. Understanding and promoting parental engagement in the research process fills an important gap in childhood obesity literature. [ABSTRACT FROM AUTHOR]