South Asians are the fastest growing immigrant community in the United States and experience high rates of health disparities. South Asian children are at high risk for the two most common diseases of early childhood: caries and obesity. This application uses the Common Risk/Health Factor Approach (CR/HFA) to target risk factors for childhood caries and obesity. Our study, CHALO! (Child Health Action to Lower Oral Health and Obesity Risk) comes from the Hindi word that means Let's go!. CHALO is a multi-level intervention (see figure) that includes a randomized controlled trial of a home visit intervention, and a Knowledge Translation campaign. The primary focus is behavioral change in bottle/'sippy' cup use and dietary intake-- factors that are common to both caries and obesity. Unique cariogenic and obesogenic behaviors are also targeted. Secondary outcomes include caries incidence and growth. Research assessments when children are 6 (baseline), 12, and 18 months of age will include novel techniques for assessing feeding practices (i.e., iPad assisted 24 hour dietary recall) and caries presence and severity (i.e., intra-oral cameras) that were developed by our team. CHALO will be conducted in the metro NY/NJ area, home to a large low-income high risk South Asian community. An RCT (Aim 1) will enroll 377 mothers of children 4-6 months old from New York City (n=3) and New Jersey (n=2) pediatric practices in our primary care research network SAPPHIRE (SA Practice Partnership for Health Improvement and Research). The intervention includes: a) home visits with mothers/families (n=6 visits over one year) and follow up phone support; b) patient navigation to make/keep timely dental visits (2x by 18 months). The Knowledge Translation component (Aim 2) will raise awareness of child health risks in South Asian communities and among professionals who provide their care. The campaign will include both traditional and social media components and will be evaluated using multiple metrics. Our multi-disciplinary team has expertise in cross-cultural psychology, clinical trials, child nutrition, health education and caries. CHALO builds upon the team's prior and on-going funded trials of caries and obesity interventions in young children. Innovations include: use of CR/HFA to target twin child health disparities; under-studied South Asian immigrant sample; intervention at multiple levels of the Social-Ecological model; cutting edge measurement technologies; and social marketing and evaluation. If successful, the CR/HFA offers an efficient and potentially cost-effective means of improving child health in at-risk populations.
This study employs a Common Risk/Health Factors Approach (CR/HFA) to the 2 most common health disparities of early childhood -dental caries and obesity-- in the nation's fast growing low-income South Asian immigrant community. It includes: a) an RCT- aimed at reducing feeding practices that increase caries and obesity risks (e.g., use of bottle/'sippy' cups) and increasing health-promoting behaviors (activity, dental visit) in young children, and b) a Knowledge Translation campaign to raise awareness among families, communities, and dental and pediatric providers. This study represents the first application of the CR/HFA in the nation, and only the second RCT of this efficient and potentially cost-effective approach worldwide.
| Karasz, Alison; Bonuck, Karen (2018) Reducing pediatric caries and obesity risk in South Asian immigrants: randomized controlled trial of common health/risk factor approach. BMC Public Health 18:680 |
