Project GAME ON!: Empowering urban children to engage in healthy behaviors to reduce obesity risk through an interactive digital comic tool

PopCom Health seeks to design and develop an interactive, customizable digital health promotion comic tool for Black/African American (AA) and Latino preadolescents to reduce childhood obesity (OB) risk. Childhood OB continues to be a serious public health issue in the US, with economic, physical, and psychosocial consequences. Over the last three decades, the rate of childhood OB has tripled, with more than one-third of 6 to 19-year old children now considered having overweight or OB, with high rates in low-income groups. This epidemic has profound consequences leading to adverse health outcomes, such as type 2 diabetes, cancer, and increased risk of adult morbidity and mortality. OB can detrimentally impact children’s social and emotional well-being and has been associated with poor academic performance. To help improve the health of future generations, effective and engaging interventions are needed to capture children’s attention in a multi-media environment. We have created a family-centered, interactive, web-based health promotion comic tool focused on reducing childhood OB risk in low-income Black/AA and Latino pre-adolescents under an R21 study funded by the Agency for Healthcare Research and Quality (AHRQ). Results of a 6-week intervention pilot feasibility study were encouraging: the tool was feasible to deliver and acceptable to the child and parent populations, and children receiving the comic tool demonstrated more significant improvements (p<0.05) in vegetable, water, and sugar intake compared to the control group, from pre- to post-intervention. While these results are promising, we found that engagement with the tool diminished over time and improvements in psychosocial variables related to dietary behaviors (i.e., attitudes, behavioral intention, self-efficacy, outcome expectations) diminished at the 3-month follow-up. Building on our previous work, PopCom Health seeks to design an enhanced interactive, culturally relevant and customizable health promotion comic tool for Black/AA and Latino children ages 8 to 12, in which children’s choices affect the storyline and health content. We predict this format will lead to increased engagement with the tool and thus, empower children and improve their attitudes and beliefs related to dietary and physical activity (PA) behaviors. Recognizing caregivers’ role on children’s habits, parents will also receive newsletters reinforcing healthy dietary and PA behaviors at home, which had been developed during the R21 study. The tool will be evaluated remotely through the following Phase I Specific Aims: 1) Design, develop and evaluate the usability of a customizable, 6-week interactive comic structure; 2) Using a three-group pilot randomized controlled trial: a) assess engagement and acceptability of the new comic structure, and b) explore the association between engagement and self-efficacy related to dietary and PA behaviors. Validation of tool engagement will lay the groundwork for Phase II studies to evaluate longer- term effects and the ability of our tool to reduce childhood OB risk and improve dietary and PA behaviors in our target populations.