Linking Primary Care, Communities, and Families to Prevent Obesity Among Preschool Children

1. Linking Primary Care, Communities, and Families to Prevent Obesity Among Preschool Children Jerica M. Berge, PhD, MPH, LMFT Session #F5b October 29, 2011 Collaborative Family Healthcare Association 13th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

2. Faculty Disclosure Presenters are required to disclose to the audience any relevant financial relationships during the past 12 months.

3. Linking Primary Care, Communities, and Families to Prevent Obesity Among Preschool Children

4. Childhood Obesity and Primary Care Prevalence of childhood obesity has almost tripled in the last two decades Multi-level, multi-setting interventions are needed to address this complex problem NIH and other expert committees have recommended using primary care as an entry point for family-based interventions

5. Specific Aims: Net-WORKS Evaluate three-year parent-targeted intervention for preschool children Primary outcome change in child BMI z-score Randomized two-group design (N = 500)

6. CHILD ACTIVITY LEVEL & PATTERNS ↑Moderate-to-Vigorous Physical Activity ↓ Screen Time • PEDIATRIC PRIMARY CARE • raise awareness re: obesity risk • brief guidance • reinforcement of parent change HOME ENVIRONMENT ↑ Availability fruits & vegetables ↑ Availability healthy snack & meals ↑ Family Meals ↑ Physical Activity Opportunities ↓ Sedentary Activity Opportunities ↓Availability sweetened beverages ↓High fat/calorie snack foods PARENT Parental Knowledge Behavioral Intentions Self-efficacy Parenting support for PA and healthy eating Parent feeding practices Parenting style Parent modeling of PA and healthy eating • EARLY CHILD & FAMILY EDUCATION (ECFE) • Promoteobesity-prevention & positive parenting practices • Provide social support • Modify social norms re: healthy eating & PA • FAMILY ADVOCATE • links parents & each intervention level • provides phone coaching support to parents CHILD BMI Z-SCORE • COMMUNITY FOOD & PA PARTNERSHIPS • YWCA Partnership: Increase access to PA opportunities and resources • IATP partnership: Increase access to affordable healthful food CHILD DIETARY INTAKE ↓ Sweetened beverage consumption ↓ High fat/high calorie snacks and meals ↑ Fruits and vegetables

7. Phase 1: Pilot Trial; Years 1-2 Phase 2: Randomized Controlled Trial; Years 3-5 Phase 3: Dissemination and Sustainability; Years 6-7 Phases of Net-WORKS

8. Intervention N=500 families (10 community clinics) Somali Hispanic Hmong African American White Randomized two-group design (N = 500) • Standard Care Control Group (safety message) • Experimental Group 3 year duration

9. Intervention Components • Primary care message • Family advocate (9 home visits per year) • Parenting class (12 weeks x 2 semesters) • Community food retail and recreation

10. Evaluation Components Child • BMI z-score (weight, height) • Body composition (pilot) • Dietary intake (1 24-hour recall) • PA (accelerometry) Parent • Feeding behaviors • Parenting style • Demographic and family variables Home • Food purchase and availability • TV and PA environment

11. Pilot Results • Feasibility • Primary care • Home visits • Phone coaching • Parenting classes • Community resources • BMI changes in the right direction • Challenges

12. Anticipated Challenges • Timely achievement of recruitment goals • Retention for both groups • Long-term engagement in the intervention • Intervention translation to optimal energy balance for kids? • Study populations