Using a Community-Based Participatory Process in Creating a School-Based Health Center Obesity Intervention for Multi-ethnic Teens Andrew Sussman, PhD, MCRP Alberta Kong, MD, MPH Jose Canaca, MD Rachel Mittleman, MEd Sally Davis, PhD Nina Wallerstein, DrPH 1st Annual UNM National Health Disparities Conference May 24, 2011

Background Overweight (BMI 85th-95th percentile) and obesity (BMI 95th percentile) disproportionately affect certain racial and ethnic populations. Nationally, Hispanic boys and non-Hispanic Black girls experience significantly higher BMI rates than their non-Hispanic White counterparts. In New Mexico, American Indian youth have the highest rate of obesity (17.8%), double that of White youth (8.7%); Black (13.5%) and Hispanic (12.8%) youth also have high rates, about one - third higher than White youth.

Background Promising strategies for intervention with teens include: Targeting locations (e.g., school) where adolescents spend the majority of their time Motivational interviewing Use of media Intervention is based on the Transtheoretical Model or Stages of Change Progress through a series of stages

Adolescents Committed to Improvement of Nutrition and Physical Activity (ACTION) Phase 1: Use an adaptive community-based participatory research approach to develop a school-based health center intervention for overweight teens Create DVD and clinician tool kit Phase 2: Feasibility testing of the school-based health center intervention against standard care for weight loss R21 HL NIH/NHLBI

Methods (Phase 1: Formative Research) Create strategies for DVD and provider toolkit. Semi-structured interviews with OW/OB teens (N=7) and with parents (N=8) of OW/OB teens from two participating high schools ACTION Advisory Council meetings: 7 OW/OB teens and 5 parents of OW/OB teens Feedback from 2 school-based health center providers and program manager +

Parent and Student Interviews Purposeformative data collection to help guide intervention development Served as basis for ACTION Advisory Council Creation of DVD and provider toolkit Methodsemi-structured qualitative interviews with purposefully selected adolescent and parents

Parent and Student Interviews: Demographics

Parent and Student Interviews Interview Domains: Teen/Parent views on: Typical daily routines (focus on nutrition and physical activity) Use of media (cell phones, music, computers, TV/movies, etc.) Perspectives on health and obesity (barriers and facilitators to being healthy; change motivators) Intervention Development (DVD content, group vs. individual, etc.)

Parent and Student Results Parent themes: Difficult to motivate kids Kids not worried about obesity and consequences Emphasize importance of parents as role models Schools as unhealthy environments food, lack of PE and health classes

Parent and Student Results Adolescent themes: Less concerned about long term problems Adolescents busyschool, activities and work Define health more as functional (what can I do) than illness status Receptive to working with SBHC provider; need social network support

1) Translation of Themes to DVD Challenge of motivation Teens: tap into internal motivation Functional health status

2) Translation of Themes to DVD Inadequate exposure to health/nutritional information (no PE or health classes) Navigating unhealthy environments

3) Translation of Themes to DVD Adolescents busy (school, activities and work) Feasible, accessible options needed

DVDStyle and Content Hire a Pro: Chris Schueler (Christopher Productions) Make it HOT, HIP and COOL Kids like us, problems like ours (sources of internal motivation) DVD not meant as full solution but catalyst

Provider Toolkit Content Weight loss guidelines Motivational interviewing Parent publication: supporting teens, stocking the refrigerator, cheaper food choices, recipes Displays for clinic Session tools: weight history assessment diet/physical activity assessment goal setting MyPyramid.gov activity/food journal label reading portion tips breakfast fast food eating at school drinks snacks local physical activity resources

Conclusions Conducting formative assessment research using an adaptive participatory process was an effective way to develop culturally appropriate and tailored intervention materials in multiethnic school settings. Our experience demonstrates the importance of partnership formation in the creation of contextually sensitive interventions.

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