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- Title
Effect of a Home-Visiting Intervention to Reduce Early Childhood Obesity Among Native American Children: A Randomized Clinical Trial.
- Authors
Rosenstock, Summer; Ingalls, Allison; Foy Cuddy, Reese; Neault, Nicole; Littlepage, Shea; Cohoe, Lisa; Nelson, Leonela; Shephard-Yazzie, Kimberlyn; Yazzie, Shaneyka; Alikhani, Anna; Reid, Raymond; Kenney, Anne; Barlow, Allison
- Abstract
This randomized clinical trial assesses the impact of a brief home-visiting approach, Family Spirit Nurture, on sugar-sweetened beverage consumption, responsive parenting and infant feeding practices, and optimal infant growth through 12 months post partum. Key Points: Question: What is the impact of a nutrition-focused home-visiting intervention on early childhood obesity and associated risk factors? Findings: In this randomized clinical trial of 134 Navajo mothers and their infants enrolled 3 to 12 months post partum, mothers who received the Family Spirit Nurture infant nutrition and responsive feeding home-visiting intervention vs those who did not reported feeding children substantially fewer sugar-sweetened beverages and having better responsive feeding practices. In turn, their infants had lower body mass index z scores. Meaning: Results of this trial suggest that a home-visiting intervention created in partnership with and for Native American individuals is an effective strategy for promoting healthy infant feeding and growth in the first year of life. Importance: Early childhood obesity disproportionately affects Native American communities. Home visiting is a promising strategy for promoting optimal infant growth in this population. Objective: To assess the impact of a brief home-visiting approach, Family Spirit Nurture (FSN), on sugar-sweetened beverage (SSB) consumption, responsive parenting and infant feeding practices, and optimal growth through 12 months post partum. Design, Setting, and Participants: This study was a 1:1 randomized clinical trial comparing FSN with an injury prevention education control condition in a reservation-based community. Participants were Navajo mothers 13 years or older with infants younger than 14 weeks recruited between March 22, 2017, and May 18, 2018, and followed up through 12 months post partum. Intent-to-treat analyses were conducted. Interventions: The 6-lesson FSN curriculum, delivered 3 to 6 months post partum by Navajo paraprofessionals, targeted optimal responsive and complementary feeding practices and avoidance of SSBs. The control group received 3 injury prevention lessons. Main Outcomes and Measures: Primary outcomes established a priori were infant SSB consumption and responsive parenting and complementary feeding practices (responsive feeding scale, age at complementary food introduction, and percentage of mothers who introduced complementary food to infants at 6 months of age or older). The secondary outcome was the effect of the intervention on infant body mass index z scores (zBMIs). Results: A total of 134 Navajo mothers of infants younger than 14 weeks were enrolled in the randomized clinical trial, including 68 (mean [SD] maternal age at enrollment, 27.4 [6.4] years) in the intervention group and 66 (mean [SD] maternal age at enrollment, 27.5 [6.1] years) in the control group. Intervention participants reported statistically significantly lower infant SSB consumption through 12 months post partum (mean [SE], 0.56 [0.12] cups per week in the intervention group and 1.78 [0.18] cups per week in the control group; incidence rate ratio, 0.31; 95% CI, 0.19-0.50). Improvements in responsive feeding practices were observed through 9 months post partum (mean [SE], 3.48 [0.07] in the intervention group and 3.22 [0.08] in the control group) (difference, 0.26; 95% CI, 0.06-0.47); statistical significance was lost at 12 months post partum. Age at which the infant was given first food was younger in the intervention group (mean [SE] age, 4.61 [0.21] months in the intervention group and 5.28 [0.23] months in the control group) (difference, −0.67; 95% CI, −0.04 to −1.29). Infants in the intervention group had lower zBMI at 6 and 9 months compared with those in the control group (mean [SE] at 9 months, 0.27 [0.14] in the intervention group and 0.81 [0.14] in the control group; difference, −0.54; 95% CI, −0.94 to −0.14). The 12-month between-group difference was meaningful but not statistically significant (mean [SE], 0.61 [0.16] in the intervention group and 1.07 [0.20] in the control group; difference, −0.46; 95% CI, −0.92 to 0.01). Conclusions and Relevance: Infants of Native American mothers who participated in a home-visiting intervention had substantially lower SSB consumption and improvements in responsive feeding practices and infant zBMI scores, suggesting the intervention is effective for promoting healthy infant feeding and growth. Trial Registration: ClinicalTrials.gov Identifier: NCT03101943
- Subjects
UNITED States; NATIVE American children; BEVERAGES; CONFIDENCE intervals; CURRICULUM; HOME care services; INFANT development; INFANT nutrition; CHILDHOOD obesity; PARENTING; PUERPERIUM; RESEARCH funding; STATISTICAL sampling; EARLY intervention (Education); RANDOMIZED controlled trials; DATA analysis software; DESCRIPTIVE statistics
- Publication
JAMA Pediatrics, 2021, Vol 175, Issue 2, p133
- ISSN
2168-6203
- Publication type
Article
- DOI
10.1001/jamapediatrics.2020.3557