Maternal-infant feeding style, defined as a mother's approach to regulating infant feeding, is a critical, potentially modifiable mediator linking povery and child obesity. Evidence has documented that poverty-related risks directly impact feeding styles and create barriers to intervention engagement. This suggests the need to address both risks and barriers to improve intervention impact. Pediatric platforms represent an opportunity to address these risks and barriers due to their ability to access low-income families with poverty-related risks beginning in early infancy. The candidate proposes a mentored support period of five years to acquire expertise in developing strategies to improve obesity prevention in the context of poverty beginning during infancy. The candidate is an Assistant Professor of Pediatrics with the long-term goal of becoming an independent clinical research investigator. This goal will be achieved through training from expert multidisciplinary mentors from the fields of developmental-behavioral pediatrics, applied developmental psychology, nutrition science and biostatistics, formal coursework and other career development activities. She will gain advanced skills in: 1) applying theoretical frameworks from developmental psychology to patient-oriented research addressing poverty-related risks;2) state-of-the-art methodologies for assessing maternal-infant feeding interactions;3) complex quantitative longitudinal data analysis with repeated measures;4) qualitative research methodologies to identify barriers and facilitators of intervention engagement with low-income families;5) intervention development and evaluation;and 6) grant writing. The practical application of these goals will be accomplished through three study aims.
In Aim 1, Dr. Gross will conduct a secondary analysis of longitudinal data from a large ongoing study of an early obesity prevention intervention to systematically describe the relationships between poverty-related risks and maternal-infant feeding styles and the degree to which these styles impact caloric intake and infant weight trajectories.
In Aim 2, Dr. Gross will use qualitative methodologies to inform the conceptualization and development of strategies to address poverty-related risks and barriers that can be incorporated into a behavior change intervention and integrated into a population-scalable primary care-based platform.
In Aim 3, Dr. Gross will pilot test these strategies for feasibility of implementation and obtaining preliminary estimates of effect size. The successful execution of this proposal will lead to an R01 application to test the efficacy of an obesity prevention intervention that addresses poverty-related risks and barriers using a population-scalable primary care-based platform to increase responsive maternal-infant feeding styles and reduce early child obesity.

Public Health Relevance

Poverty-related disparities in child obesity begin early in life and have significant public health implications, including adverse impacts on child health and increased risk of obesity across the life-course. Poverty-related risks, such as financial difficulties, low educational attainment and psychosocial stressors, impact infant feeding and may create barriers to the success of interventions designed to prevent early child obesity. This study will advance the science of obesity prevention by developing strategies to address both poverty-related risks and barriers using a pre-existing, low cost pediatric primary care-based platform to access low-income families with young infants.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Mentored Patient-Oriented Research Career Development Award (K23)
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Developmental Biology Subcommittee (CHHD)
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Haverkos, Lynne
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Albert Einstein College of Medicine
Schools of Medicine
United States
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Berman, Rachel Stein; Patel, Milani R; Belamarich, Peter F et al. (2018) Screening for Poverty and Poverty-Related Social Determinants of Health. Pediatr Rev 39:235-246
Gross, Rachel S; Mendelsohn, Alan L; Messito, Mary Jo (2018) Prenatal Material Hardship and the Internal Locus of Control Over the Prevention of Child Obesity: Progress Report. Acad Pediatr 18:603-604
Fuller, Anne; Messito, Mary Jo; Mendelsohn, Alan L et al. (2018) Prenatal Material Hardships and Infant Regulatory Capacity at 10 Months Old in Low-Income Hispanic Mother-Infant Pairs. Acad Pediatr 18:897-904
Gross, Rachel S; Mendelsohn, Alan L; Yin, H Shonna et al. (2017) Randomized controlled trial of an early child obesity prevention intervention: Impacts on infant tummy time. Obesity (Silver Spring) 25:920-927
Gross, Rachel S; Mendelsohn, Alan L; Gross, Michelle B et al. (2016) Randomized Controlled Trial of a Primary Care-Based Child Obesity Prevention Intervention on Infant Feeding Practices. J Pediatr 174:171-177.e2
Gross, Rachel S; Mendelsohn, Alan L; Gross, Michelle B et al. (2016) Material Hardship and Internal Locus of Control Over the Prevention of Child Obesity in Low-Income Hispanic Pregnant Women. Acad Pediatr 16:468-474