Obesity is the single greatest health threat to today's children. Existing obesity prevention initiatives have had limited success. Our goal is to prevent the development of obesity in very young children by creating a multi-level intervention grounded in an ecological framework. This study is proposed on behalf of the Hartford Childhood Wellness Alliance, a 107 member, 35 group organization whose goal is to improve the health of children in Hartford, CT. In a randomized control trial, the primary aim of this stud is to test the initial efficacy of a program of enhanced home visitation with neighborhood and community support to change maternal behaviors related to infant nutrition (sweetened beverage/juice consumption, breastfeeding and introduction of solids), parenting skills (establishing routines around sleep, reading cues for hunger, satiety, TV time) and family wellness (improving the home food environment, enhancing physical activity). Mothers will be taught core behavioral skills (e.g., goal setting, self-monitoring, problem-solving and stimulus control) and participants will be linked to relevant community programs to support healthy behavior change. The study builds upon an existing home visiting program for newborns, utilizes Brighter Future Family (BFF) Centers to promote healthy cooking and shopping, to reduce sugar sweetened beverage/juice consumption and to increase physical activity, and is linked to a program in grocery/corner stores that promotes quality food choices including greater access to fresh fruits and vegetables. We hypothesize that at 12 months of age, infants in the intervention arm will drink less sugar sweetened beverages/juices, will have ingested solids at an older age, will have been breastfed longer and more exclusively than infants in the control arm and will have less TV viewing, more established sleep routines and greater soothability (primary outcomes). We further hypothesize that intervention families will purchase, cook and serve more fruits and vegetables, will demonstrate greater utilization of the BFF Centers and community resources around food, cooking and exercise and will have more infants with a weight for height <85th%. Results from this study have implications for the long-term maintenance of a healthy weight and for re-claiming the healthy family.

Public Health Relevance

Obesity occurs at an early age and is a national epidemic, especially in low socioeconomic, minority children. Culturally-sensitive, multi-level, multi-facete programs that are designed to prevent the development of obesity in children are needed. This project explores the use of multi-level behavior change interventions with skill building focused on mothers as the agents of change for their newborn infants with community support to prevent the development of obesity in children and improve the health of their families.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Exploratory/Developmental Grants (R21)
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Psychosocial Risk and Disease Prevention Study Section (PRDP)
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Esposito, Layla E
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Connecticut Children's Medical Center
United States
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