The obesity epidemic continues to worsen, with low-income and rural populations as well as African American women disproportionately affected. Using community-based participatory research, the Emory Prevention Research Center has developed and rigorously tested an intervention to create home food environments that support healthy eating and weight gain prevention with partners in rural southwest Georgia (SW GA). The proposed core research is a hybrid effectiveness-implementation study of this intervention, called Healthy Homes/Healthy Families, delivered through a regional 2-1-1 system. 2-1-1 is a nationally designated 3-digit telephone exchange, similar to 9-1-1, that links callers to community-based health and social services. Our long-term goal is to leverage this collaborative infrastructure to address the obesity epidemic and scaling up of effective interventions through the national 2-1-1 system. Callers to 2-1-1 are disproportionately low-income, unemployed, uninsured, and have fewer years of education relative to the general population. Specifically, in collaboration with community partners in rural SW GA and four United Way 2-1-1 partners, we propose to conduct a hybrid effectiveness-implementation trial and scalability assessment to rigorously assess: a) the impact of a telephone-based home food environment intervention on weight-related dietary behaviors, b) implementation outcomes (i.e., reach, acceptability, barriers and facilitators), c) cost-effectiveness, and d) the scalability potential of a regional 2-1-1 system to deliver Healthy Homes/Healthy Families and other evidence-based cancer prevention interventions. We are uniquely positioned for this research given our long-standing track record in collaborating with 2-1-1s in disseminating research-tested interventions across multiple states and our expertise in implementation science. This novel approach to translational research, in combination with plans for broader faculty engagement across Emory through a multi-disciplinary Internal Advisory Board, a Stakeholder Advisory Board for Translation with nontraditional partners including United Way agencies and Cooperative Extension, and a deeply engaged Community Advisory Board in rural SW GA, position the EPRC to be a major player in prevention research with clear relevance for public health practice in Georgia and beyond. Nationally, we will establish a model for taking interventions developed through CBPR to scale through existing 2- 1-1 systems. This model of developing interventions locally in SW GA through CBPR and then scaling up with an innovative translation partner, such as 2-1-1, is a promising model with significant potential for translating public health interventions into practice for population-level impact.
Preventing weight gain in adults through modest changes in the home food environment has the potential to be an important strategy for addressing the obesity epidemic. This implementation research will establish a model for scaling up interventions developed through community-based participatory research through a regional 2-1- 1 system that reaches those most at risk for obesity.
