Pilot Project to Integrate Community and Clinical Level Systems to Address Health Disparities in the Prevention and Treatment of Obesity among Ethnic Minority Inner-City Middle School Students: Lessons Learned

Abstract

Effective obesity prevention and treatment interventions are lacking in the United States, especially for impoverished minority youths at risk for health disparities, and especially in accessible community-based settings. We describe the launch and pilot implementation evaluation of the first year of the B'N Fit POWER initiative as a middle school-based comprehensive wellness program that integrates weight management programming into existing onsite preventive and clinical services. Consistent with the existing implementation science literature, we focused on both the organizational structures that facilitate communication and the development of trust among stakeholders, students, and families and the development of realistic and timely goals to implement and integrate all aspects of the program. New implementation and programming strategies were developed and tested to increase the proportion of students screened, support the linkage of students to care, and streamline the integration of program clinical and afterschool components into routine services already offered at the school. We report on our initial implementation activities using the Standards for Reporting Implementation Studies (StaRI) framework using hybrid outcomes combining the Reach element from the RE-AIM framework with a newly conceptualized Wellness Cascade.

Trends in health behavior and weight outcomes following enhanced afterschool programming participation

“…We piloted the B’N Fit POWER initiative, a middle school-based comprehensive wellness program for low-income minority urban youth in partnership with a school and its onsite stakeholders. This initiative integrates weight management programming into existing onsite school-based health center clinical services and after-school programming [ 27 ]. Our initial implementation strategies are reported elsewhere [ 27 ].…”

“…This initiative integrates weight management programming into existing onsite school-based health center clinical services and after-school programming [ 27 ]. Our initial implementation strategies are reported elsewhere [ 27 ]. This paper reports on the effectiveness of adding structured nutrition education and a minimum requirement for physical activity to standard middle school-based after-school programming.…”

Child health behaviour and parent priorities for a school-based healthy lifestyle programme

“…A cross-sectional study was conducted as part of a quasi-experimental evaluation of an existing youth-focused school-based healthy lifestyle programme in an urban school in The Bronx (Rieder et al, 2018). The community served by the school is 72% Hispanic, 16% Black and 7% White.…”

Trends in Health Behavior and Weight Outcomes Following Enhanced Afterschool Programming Participation: A Pragmatic Quasi-experimental Study

“…[36] 2)Target behavior attainment was assessed up to four times a year using a 14-item survey either by SBHC clinical staff during routine clinical assessments or by MMCC afterschool staff as part of afterschool health screening done annually. [21] Clinic data was obtained from the Epic EHR database, and attendance at afterschool sessions was monitored using the MMCC afterschool NYC DYCD database.…”

“…The initiative integrates weight management programming into existing onsite afterschool programming and school-based health center clinical services. [21] Our initial implementation strategies are reported elsewhere. [22] This paper reports on the effectiveness of adding structured nutrition education and a minimum requirement for physical activity to standard middle school-based afterschool programming.…”