The Change Club intervention: 2-year impacts from a cluster-randomized trial in rural communities in New York and Texas

Introduction: Obesity and related chronic diseases in the U.S., particularly within rural communities and/or medically underserved areas, are a major societal and cost burden. Built environments with health-promoting attributes, which can be influenced through civic engagement, are a potential pathway to help address this substantial problem. Methods: We conducted a community-randomized delayed intervention trial in medically underserved rural communities (n = 12) in Texas and New York to evaluate the impacts of a civic engagement curriculum designed to create healthier physical activity and nutrition environments, called the Change Club, on individual measures of chronic disease risk and related behaviors and on collective and environmental outcomes 2 years after baseline. Residents within each community were recruited and enrolled to help lead community change activities; they are referred to as Change Club Members. Results: Using an intent-to-treat framework, no net effects were observed when comparing year-2 individual and collective outcomes for the intervention arm relative to the control arm, adjusting for baseline outcome values. Exploratory analyses compared attendees (61%) to non-attendees (39%) in the intervention group and found attendees had higher year-2 values than non-attendees (with baseline adjustment) on the primary outcome and two other individual measures: Life's Simple 7 composite cardiovascular risk score (+0.93, p = 0.006), World Cancer Research Fund/American Institute for Cancer Research composite cancer risk score (+0.54, p = 0.008), and healthy eating motivation (+0.27, p = 0.028). Discussion: This is among the first studies to evaluate how a civic engagement curriculum targeting built environment change may impact the health of residents who actively attend the Change Club meetings. While net impacts on the whole sample were not observed, exploratory analysis indicated that the approach holds promise when participants attend. Clinical trial registration: http://www.clinicaltrials.gov, identifier (NCT05002660).