Obesity in the U.S. has disproportionately affected African American (AA) adolescents who have almost twice the prevalence of obesity than their Caucasian peers. This is due in part to greater exposure to, and higher consumption of, 'fast'and calorie dense foods among minority vs. majority populations. Finding effective ways to address dietary habits among AA adolescents is vital to avert the myriad illnesses related to obesity and the associated costs that are likely to cloud their future. Youth consume a significant proportion of their calories during school hours, often from two sources: 1) school meals and 2) fast food restaurants /convenience stores. For AA adolescents, school- related food choices are uniquely impacted by economic and environmental factors. Specifically, many are recipients of free/reduced meals, thus packing a lunch is less realistic. Furthermore, AA adolescents live and attend school in low-income communities with a disproportionally high number of fast food venues and convenience shops. Finding ways to help AA adolescents make healthy choices in these obesogenic environments is essential to reduce the disparity with their age peers. Based on our clinical and research experience we believe that an intervention incorporating location-based tailored texts has great potential to impact dietary choices. Our clinical work in the Michigan Pediatric Outpatient Weight Evaluation and Reduction (MPOWER) program suggests that adolescents'success with making healthy choices is greatly impacted by their school environment. Our preliminary research with the MPOWERed Messages weight-loss intervention indicated that adolescents welcomed health-related texts if they viewed them as personally relevant. Further, they believed the texts helped them make healthy choices but suggested it would be better if they were sent at times when they faced dietary choices. The goal of the proposed study is to develop and pilot test the Location Initiated Individualized Texts for African American Adolescent Health (LIITA3H) mobile application to aid healthy food choices. The study has 3 Aims: 1) Develop a mobile application that will a) accurately identify when students are in their school cafeteria or other eating venue with the intent to eat, b) automatically send a tailored text to prompt healthy choices, and c) convey an annotated photo response about their choice;2) Develop a message library (adapted from our messages tested previously) tailored to students'food preferences, school /restaurant menus, and incorporate cultural tailoring with input from the target population;3) Conduct a 1-month pilot, to test the acceptability, feasibilit and use of the intervention via data collected automatically by the app along with semi-structured interviews with adolescents in the pilot and with school personnel to explore whether use of the app influenced school functioning.
The project will combine our clinical and research experience of text messaging, weight management, and cultural tailoring, in a personalized geo-location and mobile application to create an intervention to help African American adolescents make healthy dietary choices.