The prevalence of obesity in early life remains unacceptably high, especially among low-income children, most of whom are ethnic minorities. Marked ethnic disparities are evident by two years of age, which suggests that existing interventions are not adequate. Early prevention is critical, especially for low-income children. For example, among Latino children high body mass index during infancy renders them three times more likely than other children to be obese by age 6. The disparity observed at this young age presents a window of opportunity to intervene early through existing nutrition programs that foster healthful eating habits, which track into childhood and continue into adulthood. Yet, few prevention programs intervene during infancy, and those that do, do not incorporate feeding styles and practices into nutrition education, do not account for the involvement of caregivers other than parents in infant feeding, and/or 3) start too late. The proposed research addresses these gaps by moving beyond healthy eating to better understand and promote healthy feeding. Using a community-based participatory approach, the proposed research aims to 1): conduct a longitudinal study to characterize the caregiver context of infant feeding in low-income families and 2) develop and pilot test an enhanced intervention compared to EHS' existing nutrition education program.
For Aim 1, we will create a cohort of 300 mother-infant dyads who will participate in a longitudinal survey to examine the relation of infant feeding styles and practices to infant growth and obesity. A subsample of 36 mothers and 36 trusted other caregivers, identified by the mothers, will participate in longitudinal qualitative interviews (feeding data debriefings and dyadic interviews) to examine mothers' translation of nutrition education to practice in the context of multiple caregivers. Building on Aim 1, for Aim 2, we will engage EHS-enrolled mothers and other caregivers and EHS staff to develop and refine an enhanced intervention that will include new components on infant feeding styles and practices and the role of other caregivers in infant feeding. We will pilot test the enhanced intervention to produce information on its feasibility, acceptability and preliminary efficacy in promoting healthy feeding. Future research will involve an NIH R01 to test in a randomized controlled trial the effects of the enhanced nutrition education program, relative to those of the existing EHS nutrition education alone, on both mother and infant outcomes, specifically, the proximal outcomes of nutrition and feeding styles and practices and the distal outcomes of infant growth and obesity. This project, which focuses on an-at-risk child population, has great potential to address our nation's growing crisis of childhood obesity, which can dramatically improve the health of millions of Latino children, their families, and their future children.