In Texas, even the youngest children are affected by the obesity epidemic with 32% of 2 to 5 year old children overweight or obese before they enter school. The home environment and parenting skills and practices during the very early years of a child's life are critically important to establish obesity prevention behaviors such as healthy eating, physical activity, and adequate duration of sleep. However, parents lack these skills and interventions targeting the child's familiar environment, their home, are sparse. The overall aim of this study is to pilot test an integrated, culturally sensitive home-based program targeting predominantly low- income, African American and Hispanic parents to improve parenting skills for obesity prevention and control among toddlers ages 2 to 3 years. The program, PALS-CATCH, will integrate strategies from two research proven programs - Play and Learn Strategies (PALS) and the Coordinated Approach to Child Health (CATCH). This experimental study will target parents of toddlers in their home setting, teaching them how to be responsive and sensitive to their young child's cues, provide opportunities and assure consistency in young children's schedules for mealtime, activity, and sleep, thus facilitating child's development of self-regulation and other developmental outcomes to facilitate healthy eating, activity, and sleep patterns.
Our specific aims are:
Aim 1. To evaluate the feasibility and acceptability of PALS-CATCH among predominantly low-income, African American and Hispanic overweight or obese toddlers ages 2 to 3 years and their parents.
Aim 2. To determine the effect of PALS-CATCH on child energy balance-related behaviors. We will use a randomized controlled trial (RCT) design to pilot test PALS-CATCH among 60 low-income, African American and Hispanic parent-child dyads where the child is overweight or obese (BMI >85th percentile for age and gender). We hypothesize that post-intervention, as compared to those in the control group, children of parents receiving PALS-CATCH will decrease: a) BMI z-score, and b) ounces of sugar-sweetened beverages consumed per day, and increase: e) number of servings of fruits and vegetables consumed per day and, f) mean minutes of physical activity including moderate-to-vigorous physical activity per day. As part of our secondary aims, we will evaluate the effects of PALS-CATCH on parent and child psychosocial and behavioral outcomes including parenting skills, responsiveness, and child self-regulation behaviors related to diet, physical activity, screen time and sleep. We will also examine the extent to which these factors mediate the improvements in child BMI, dietary and physical activity behaviors. Pre and post-intervention measurements will be conducted using child anthropometric measurements, parent-reported 24-hour dietary recalls for child dietary intake, accelerometers for child physical activity, video observations measuring parent responsiveness behaviors and, parent surveys measuring home environmental, and psychosocial factors. Results from the pilot will be used obtain effect sizes to power a RO1 to determine the efficacy of PALS-CATCH for toddlers.
This study provides the potential for toddlers to derive the direct benefit of obesity prevention through a home- based, parent-centered program to improve parenting skills and practices to establish healthy nutrition, physical activity and sleep habits fr their child. In addition they may experience a wider variety of foods and opportunities to be physically active, develop eating, physical activity and sleep routines that support growth and, the acceptance of these healthy habits that will last a lifetime. Parents and other caregivers will receive information related to nutrition and physical activity that helps them make better lifestyl choices for themselves and their families.
