In collaboration with Boston (Action for Boston Community Development, ABCD) and Cambridge/Somerville (Community Action Agency of Somerville, CAAS) Head Start programs, and with funding from the National Institutes of Health, the Communities for Healthy Living (CHL) program is a family-centered obesity prevention program for low income families enrolled in Head Start. Grounded in family and empowerment theories and developed in collaboration with Head Start staff and low-income parents using community-based participatory research, CHL engages parents as co-leaders and addresses life challenges beyond those typically targeted in obesity interventions. More specifically, in addition to child diet and physical activity behaviors, CHL targets areas such as parent and child behavioral health, food insecurity and housing insecurity through skill building in positive communication, developing and leveraging social networks, and advocating for access to health resources. Figure 1 illustrates CHL’s theory of change is summarized.
To ensure broad reach at low cost, CHL integrates systems-level changes into the Head Start setting including modified health status letters, links with nutrition specialists, and tailored communication materials. These activities are coupled with a more intensive peer-led parent empowerment program (Parents Connect for Healthy Living, or PConnect) focusing on the development of life skills to promote family health.
The efficacy of CHL will be rigorously tested using a cluster-randomized controlled trial with Head Start centers randomized to an intervention start date (i.e., a stepped wedge design). Primary outcomes, including children’s Body Mass Index and diet, physical activity, media and sleep behaviors will be measured for all children ages 3 to 5 years enrolled in participating centers and extracted from Head Start records. This information will be supplemented with measures of parent empowerment and parenting practices which will be collected from a subsample of families. Neighborhood-level socioeconomic, food, and PA environments will also be explored as potential moderators of the effect of CHL.