Community Health Worker Coaching, Food Insecurity, and Physical Activity in the Healthy Food First Trial: A Causal Mediation and Longitudinal Analysis

To evaluate whether change in food insecurity (ΔFI) mediated the effect of a community health worker (CHW) intervention on physical activity (PA) among food insecure (FI) hypertensive adults, we conducted a secondary analysis of the Healthy Food First randomized clinical trial of food insecure adults with hypertension recruited from 364 North Carolina clinical sites. Participants were randomized to CHW coaching or no coaching within a 2 × 2 × 2 factorial design. FI was measured at baseline and 12 months; total PA (MET-min/week) at 12 and 18 months. Mediation models estimated indirect (ACME), direct (ADE), and total effects (ATE) of CHW assignment on 12-month PA through ΔFI. Generalized estimating equations evaluated repeated PA by CHW assignment. CHW assignment was not associated with PA, and ΔFI did not mediate the relationship. Effects were small (ACME = 16.2; 95% CI −62.6, 121.8; ADE = −214.1; 95% CI −871.7, 484.5; ATE = −197.9; 95% CI −855.6, 500.8 MET-min/week). The proportion mediated was near zero (−8.2%; 95% CI −142%, 124%). GEE analyses similarly showed no association (B = 363.7 MET-min/week; SE = 302.8; P = 0.23). Modest improvements in FI alone may be insufficient to increase PA without additional PA supports. ClinicalTrials.gov Identifier: NCT05048836.

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UNC Libraries
Published
2026-10-30
DOI
https://doi.org/10.17615/ask7-t014
Primary Topic
Food Security and Health in Diverse Populations
Type
article
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0.00

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article

Community Health Worker Coaching, Food Insecurity, and Physical Activity in the Healthy Food First Trial: A Causal Mediation and Longitudinal Analysis

Carmina G. Valle, Kyle Stanley Burger, Seth A. Berkowitz, Alice S. Ammerman et al.
3 links
UNC Libraries
Food Security and Health in Diverse Populations
article

Community Health Worker Coaching, Food Insecurity, and Physical Activity in the Healthy Food First Trial: A Causal Mediation and Longitudinal Analysis

Carmina G. Valle, Kyle Stanley Burger, Seth A. Berkowitz, Alice S. Ammerman, Lindsey Smith Taillie, Robert E. Anderson
article en

Abstract

To evaluate whether change in food insecurity (ΔFI) mediated the effect of a community health worker (CHW) intervention on physical activity (PA) among food insecure (FI) hypertensive adults, we conducted a secondary analysis of the Healthy Food First randomized clinical trial of food insecure adults with hypertension recruited from 364 North Carolina clinical sites. Participants were randomized to CHW coaching or no coaching within a 2 × 2 × 2 factorial design. FI was measured at baseline and 12 months; total PA (MET-min/week) at 12 and 18 months. Mediation models estimated indirect (ACME), direct (ADE), and total effects (ATE) of CHW assignment on 12-month PA through ΔFI. Generalized estimating equations evaluated repeated PA by CHW assignment. CHW assignment was not associated with PA, and ΔFI did not mediate the relationship. Effects were small (ACME = 16.2; 95% CI −62.6, 121.8; ADE = −214.1; 95% CI −871.7, 484.5; ATE = −197.9; 95% CI −855.6, 500.8 MET-min/week). The proportion mediated was near zero (−8.2%; 95% CI −142%, 124%). GEE analyses similarly showed no association (B = 363.7 MET-min/week; SE = 302.8; P = 0.23). Modest improvements in FI alone may be insufficient to increase PA without additional PA supports. ClinicalTrials.gov Identifier: NCT05048836.

UNC Libraries
University of North Carolina at Chapel Hill (US)
American Cancer Society, U.S. Environmental Protection Agency, New York State Department of Environmental Conservation, American Association of University Women, University of Akron, Sigma Xia, Instituto Tecnológico Vale, Walter Ehrströmin Säätiö, Cancer Research UK, Leverhulme Trust, Department for Environment, Food and Rural Affairs, UK Government, British Academy, Royal Society, University of Warwick, European Commission, Deutsche Forschungsgemeinschaft, Swedish Foundation for International Cooperation in Research and Higher Education, Fundação de Amparo à Pesquisa do Estado de São Paulo, National Natural Science Foundation of China, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Bayerische Forschungsstiftung, China Postdoctoral Science Foundation, Science and Technology Commission of Shanghai Municipality, Hungarian Scientific Research Fund, Lundbeckfonden, Conselho Nacional de Desenvolvimento Científico e Tecnológico, National Research Foundation of Korea, Hospital de Clínicas de Porto Alegre, Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul, Vetenskapsrådet, Instituto Mexicano del Seguro Social, Fundação de Amparo à Pesquisa do Estado de Goiás, Universiti Malaysia Pahang, Fundação de Amparo à Pesquisa e Inovação do Estado de Santa Catarina, Ministerstvo Zemědělství, Natural Science Foundation of Shandong Province, Suomen Eläinlääketieteen Säätiö, Svenska Läkaresällskapet, Internationale Stichting Alzheimer Onderzoek, Vaal University of Technology, EEA Grants/Norway Grants, Liaoning Revitalization Talents Program, Horizon 2020 Framework Programme, Engineering and Physical Sciences Research Council, Leibniz-Gemeinschaft, Fundação para a Ciência e a Tecnologia, Instituto de Salud Carlos III, European Regional Development Fund, National Heart, Lung, and Blood Institute, National Eye Institute, National Institute of Allergy and Infectious Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Division of Chemistry, Basic Energy Sciences, Core Research for Evolutional Science and Technology
Good health and well-being, No poverty, Reduced inequalities, Zero hunger
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