A true challenge for any superhero: The impact of a comic book child obesity prevention program

This study evaluated the Comics for Health program, a childhood obesity prevention intervention based on social cognitive theory (SCT), and compared it to a similar knowledge-based intervention. Third, fourth and fifth grade children from twelve afterschool programs were randomly assigned into either a theory-based (n=37), or knowledge-based (n=34) group. For the theory-based intervention, various pedagogical techniques (e.g. role-play, modeling) were used to mediate changes in key SCT constructs, while the knowledge-based intervention focused solely on learning facts related to health. Both programs also helped children learn aspects of comic book creation, and culminated with each child creating their own original comic-book or strip. A pretest, post-test and three-month follow-up test were conducted to evaluate the programmatic effects on BMI-percentile, four obesity-related behaviors (e.g. fruit & vegetable consumption), and three constructs of social cognitive theory (e.g. self-efficacy) related to each behavior. Using a nested-design, separate repeated-measures ANOVAs were used and improvements in the main effect over time were found for fruit and vegetable consumption (p<0.005), physical activities (p<0.004), water and sugar-free beverage consumption (p<0.001) and self-efficacy for fruit and vegetable consumption (p<0.015) and physical activities (p<0.009), however there were no significant interaction (group x time) effects found. Effect sizes (as measured by Cohen's f) were also mostly medium, ranging from 0.17 to 0.31. Process evaluations were used to aid in the interpretation of the results. This intervention may be a viable prevention program for use in multi-component intervention efforts in the future.