One-third of children in the U.S. are overweight or obese, with disproportionately higher rates among underserved populations, including low socio-economic status (SES) and/or racial/ethnic minority households. High sugar-sweetened beverage (SSB) intake is a major contributor to the energy imbalance leading to childhood obesity, with children from low SES and minority racial/ethnic backgrounds more likely to be heavy consumers of SSBs than higher SES and White populations. As the majority of SSBs consumed by children take place at home, parental collaboration is critical to reduce children's SSB intake. Narrative-based approaches, in which key health messages are created and presented within the context of a story by children, can be used to develop culturally-tailored, family-specific messages that appeal to parents'emotions and thus facilitate greater likelihood of behavior change compared to traditional didactic, educational approaches. To address health disparities in SSB intake as well as childhood obesity, we propose a culturally-tailored intervention targeting underserved children and parents'SSB intake in which youth are actively engaged and empowered to be key behavior change agents within their families. Youth will design creative, narrative-based materials through print, audio, and film projects, highlighting key behavioral messages on SSBs that will be shared with their parents. As children heavily influence parental purchasing decisions, we proposed that these messages will reduce parental purchase of SSBs and subsequently decrease SSB availability in the home environment. The intervention will be delivered through the Boys and Girls Clubs of America, a youth-based community setting that serves an ethnically diverse and predominantly low SES population. Intervention pre- testing and refinement will be based on focus group input;intervention feasibility, acceptability, and preliminary efficacy on children and parents'SSB intake and children's body mass index (BMI) will be assessed through a site-matched, randomized controlled trial with 54 parent-child pairs (N=108) per site. Building upon Dr. Wang's prior pilot work on reducing SSB intake among inner-city youth, this award will provide her with training in developing behavioral interventions and conducting randomized controlled trials in community settings. The proposal will contribute to Dr. Wang's long-term goal of designing and evaluating family-based obesity prevention programs that can be sustained and disseminated in community settings. In addition to the highly supportive research environment at the University of Massachusetts Medical School and the local Boys and Girls Clubs, Dr. Wang's multidisciplinary team of mentors is highly experienced and committed to provide her with the support needed to achieve the proposed training and research goals.

Public Health Relevance

The health and economic costs associated with the ongoing childhood obesity epidemic are staggering, with the current generation of children at greater risk for experiencing less healthy lives and shorter life expectancies than their parents. Sugar-sweetened beverages (SSBs) are aggressively marketed to children and comprise the leading source of added sugars to children's diet. Interventions that target children's SSB consumption through empowering children as behavior change agents within their families can enhance childhood obesity prevention efforts. We propose to implement and evaluate a family-based program, in which youth are trained in media literacy, health literacy, and health communication and create messages that are delivered to parents, to reduce SSB intake and obesity risk among underserved children and families.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Scientist Development Award - Research & Training (K01)
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Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
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Podskalny, Judith M,
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Boston University
Public Health & Prev Medicine
Schools of Public Health
United States
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Haughton, Christina F; Waring, Molly E; Wang, Monica L et al. (2018) Home Matters: Adolescents Drink More Sugar-Sweetened Beverages When Available at Home. J Pediatr 202:121-128
Pagoto, Sherry; Tulu, Bengisu; Agu, Emmanuel et al. (2018) Using the Habit App for Weight Loss Problem Solving: Development and Feasibility Study. JMIR Mhealth Uhealth 6:e145
Haughton, Christina F; Silfee, Valerie J; Wang, Monica L et al. (2018) Racial/ethnic representation in lifestyle weight loss intervention studies in the United States: A systematic review. Prev Med Rep 9:131-137
Kozak, Andrea T; Buscemi, Joanna; Hawkins, Misty A W et al. (2017) Technology-based interventions for weight management: current randomized controlled trial evidence and future directions. J Behav Med 40:99-111
Wang, Monica L; Waring, Molly E; Jake-Schoffman, Danielle E et al. (2017) Clinic Versus Online Social Network-Delivered Lifestyle Interventions: Protocol for the Get Social Noninferiority Randomized Controlled Trial. JMIR Res Protoc 6:e243
Wang, Monica L; Haughton, Christina F; Frisard, Christine et al. (2017) Perceived weight status and weight change among a U.S. adult sample. Obesity (Silver Spring) 25:223-228
Morgan, Philip J; Young, Myles D; Lloyd, Adam B et al. (2017) Involvement of Fathers in Pediatric Obesity Treatment and Prevention Trials: A Systematic Review. Pediatrics 139:
Fitzpatrick, Stephanie L; Wischenka, Danielle; Appelhans, Bradley M et al. (2016) An Evidence-based Guide for Obesity Treatment in Primary Care. Am J Med 129:115.e1-7
Haughton, Christina F; Wang, Monica L; Lemon, Stephenie C (2016) Racial/Ethnic Disparities in Meeting 5-2-1-0 Recommendations among Children and Adolescents in the United States. J Pediatr 175:188-194.e1
Wang, Monica L; Lemon, Stephenie C; Clausen, Kristian et al. (2016) Design and methods for a community-based intervention to reduce sugar-sweetened beverage consumption among youth: H2GO! study. BMC Public Health 16:1150

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