Community Health Worker Coaching, Food Insecurity, and Physical Activity in the Healthy Food First Trial: A Causal Mediation and Longitudinal Analysis.
7 affiliations
- 1Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel HIll, North Carolina, USA (R E. A), (C G. V), (L S T), (A S. A).
- 2Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel HIll, North Carolina, USA (R E. A), (L S T).
- 3Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel HIll, North Carolina, USA (S A. B).
- 4Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel HIll, North Carolina, USA (S A. B).
- 5Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA (K S. B).
- 6Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel HIll, North Carolina, USA (C G. V).
- 7Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel HIll, North Carolina, USA (A S. A).
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.
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BibTeX
@article{anderson2026community,
title = {{Community Health Worker Coaching, Food Insecurity, and Physical Activity in the Healthy Food First Trial: A Causal Mediation and Longitudinal Analysis.}},
author = {Robert E Anderson and Seth A Berkowitz and Kyle S Burger and Carmina G Valle and Lindsey Smith Taillie and Alice S Ammerman},
journal = {American journal of lifestyle medicine},
year = {2026},
month = oct,
doi = {10.1177/15598276261498203},
url = {https://europepmc.org/article/MED/42927090},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Community Health Worker Coaching, Food Insecurity, and Physical Activity in the Healthy Food First Trial: A Causal Mediation and Longitudinal Analysis.
AU - Robert E Anderson
AU - Seth A Berkowitz
AU - Kyle S Burger
AU - Carmina G Valle
AU - Lindsey Smith Taillie
AU - Alice S Ammerman
PY - 2026
DA - 2026/10/23
JO - American journal of lifestyle medicine
DO - 10.1177/15598276261498203
UR - https://europepmc.org/article/MED/42927090
AB - 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.
SN - 1559-8276
SN - 1559-8284
ER -