Adolescent obesity is a multifaceted public health concern, particularly for Black and Hispanic adolescents who are disproportionately impacted by this epidemic. Research suggests that exposure to, and consumption of, foods prepared outside of the home contribute to having a high body mass index (BMI). On average, youth consume over one-third of their daily calories from meals prepared away from home (mainly from fast food). The majority of Black and Hispanic youth live in low-income families, often in communities with a high density of fast food restaurants. Ways to help adolescents make healthy choices in obesogenic settings are needed. Outcomes from the Michigan Pediatric Outpatient Weight Evaluation and Reduction (MPOWER) program suggested that adolescents? success with making healthy choices is greatly impacted by meals eaten outside of the home. In our MPOWERed Messages study we used tailored text messages (based on Self-Determination Theory and Motivational Interviewing) to help motivate adolescents to make healthy choices. This study revealed that adolescents welcomed health-related texts if they were personally relevant, but thought they would be most helpful if they were received at times when they faced dietary choices (i.e., in a restaurant). To address this need, MEI Research partnered with the PI on the Phase 1 STTR project to develop the Location Initiated Individualized Texts for African American Adolescent Health (LIITA3H) program that prompted healthy food choices at the point of purchase. LIITA3H succeeded in, 1) developing the technology to a) accurately identify when users were in their school cafeteria, or other eating venue, with the intent to eat, b) send a tailored text to prompt healthy choices, and c) submit an annotated photo of their food choice; 2) adapting message library (based on our previously tested MPOWERed messages) to be tailored to users? food preferences, school/restaurant menus, and to incorporate cultural tailoring with input from the target population; and 3) demonstrating feasibility via a 1-month pilot test and pre-post interviews with participants. The Phase 2 project will build on this success, and will enhance the program based on Phase 1 input to create the Location Initiated Individualized Texts for Adolescent Health (LIITAH) program. Content will be expanded to include messages tailored to Hispanic and White adolescents and to parents. The technology will be enhanced to work on all mobile operating systems; include a companion application for parents; link locations and menu data for food outlets nationwide; and allow automated message tailoring. We will test integration of the program into the Fruit Street platform. Fruit Street is a telehealth company that has raised $7 million in the past 2 years; its platform is licensed to hundreds of providers who treat obesity. Fruit Street will be the first licensee of LIITAH. We will conduct a trial of the integrated program to demonstrate the effect of LIITAH on decreasing the number of calories purchased from and visits to restaurants, and on lowering BMI.
This Phase 2 STTR project is to build upon the success of the Phase 1 study which combined the geo-location and mobile application expertise of MEI Research with the PI's clinical and research experience in text messaging, weight management, and cultural tailoring, to create a tailored intervention delivered via a mobile app, to help Black adolescents make healthy food choices at the point of purchase. This Phase 2 project will enhance the intervention to include greater automation and incorporate user requested components based on Phase 1 input; expand the tailoring to ensure relevance to Hispanic and White adolescents and to parents; demonstrate the impact on users' food purchases in restaurants; and integrate the program into the successful Fruit Street Telehealth Platform in preparation for commercialization and to make it widely available to those who might benefit. By helping adolescents make healthy choices when eating out, this product will promote the achievement of a healthy weight and a reduction in weight-related illnesses.
