Effect of a Home-Visiting Intervention to Reduce Early Childhood Obesity Among Native American Children

Abstract

IMPORTANCEEarly childhood obesity disproportionately affects Native American communities. Home visiting is a promising strategy for promoting optimal infant growth in this population.OBJECTIVE To assess the impact of a brief home-visiting approach, Family Spirit Nurture (FSN), on sugar-sweetened beverage (SSB) consumption, responsive parenting and infant feeding practices, and optimal growth through 12 months post partum. DESIGN, SETTING, AND PARTICIPANTSThis study was a 1:1 randomized clinical trial comparing FSN with an injury prevention education control condition in a reservation-based community. Participants were Navajo mothers 13 years or older with infants younger than 14 weeks recruited between March 22, 2017, and May 18, 2018, and followed up through 12 months post partum. Intent-to-treat analyses were conducted. INTERVENTIONSThe 6-lesson FSN curriculum, delivered 3 to 6 months post partum by Navajo paraprofessionals, targeted optimal responsive and complementary feeding practices and avoidance of SSBs. The control group received 3 injury prevention lessons. MAIN OUTCOMES AND MEASURESPrimary outcomes established a priori were infant SSB consumption and responsive parenting and complementary feeding practices (responsive feeding scale, age at complementary food introduction, and percentage of mothers who introduced complementary food to infants at 6 months of age or older). The secondary outcome was the effect of the intervention on infant body mass index z scores (zBMIs).RESULTS A total of 134 Navajo mothers of infants younger than 14 weeks were enrolled in the randomized clinical trial, including 68 (mean [SD] maternal age at enrollment, 27.4 [6.4] years) in the intervention group and 66 (mean [SD] maternal age at enrollment, 27.5 [6.1] years) in the control group. Intervention participants reported statistically significantly lower infant SSB consumption through 12 months post partum (mean [SE], 0.56 [0.12] cups per week in the intervention group and 1.78 [0.18] cups per week in the control group; incidence rate ratio, 0.31; 95% CI, 0.19-0.50). Improvements in responsive feeding practices were observed through 9 months post partum (mean [SE], 3.48 [0.07] in the intervention group and 3.22 [0.08] in the control group) (difference, 0.26; 95% CI, 0.06-0.47); statistical significance was lost at 12 months post partum. Age at which the infant was given first food was younger in the intervention group (mean [SE] age, 4.61 [0.21] months in the intervention group and 5.28 [0.23] months in the control group) (difference, −0.67; 95% CI, −0.04 to −1.29). Infants in the intervention group had lower zBMI at 6 and 9 months compared with those in the control group (mean [SE] at 9 months, 0.27 [0.14] in the intervention group and 0.81 [0.14] in the control group; difference, −0.54; 95% CI, −0.94 to −0.14). The 12-month between-group difference was meaningful but not statistically significant (mean [SE], 0.61 [0.16] in the intervention group and 1.07 [0.20] in the control group; difference, −0.46; 95% CI, −0.92 to 0.0...

Dietary Transitions and Health Outcomes in Four Populations – Systematic Review

“…In 1956, the average Navajo BMI was 23.5 for men and for 22.9 women, when their saturated fat intake (mainly mutton and lard-fried bread) was as high or higher than White Americans ( 102 ). In 2020, average BMI for Navajo women was 31.2 ( 103 ).…”

Dietary Intake and Anthropometric Measurement at Age 36 Months Among Aboriginal and/or Torres Strait Islander Children in Australia

“…Our experience in the field when collecting dietary recalls at the 24-month follow-up posed a heavy burden on participants and meant that applying a more intensive dietary assessment tool at the 36-month follow-up was not possible. A longer period may need to pass among children in the delayed 21 Although the intervention attempted to improve early feeding practices, contrary to expectations, a higher proportion of infants in the intervention group were introduced to…”

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Home visitor perspectives on implementing a precision approach to home visiting in communities serving Native American families

“…Evidence‐based home visiting programs are recognized for their sustainable and positive impact as an early intervention strategy within community settings but face shared challenges in implementation. During research trials, home visiting programs have demonstrated significant impact in identifying and addressing child behavioral problems, child obesity, family nutrition, maternal depression, substance misuse, and intimate partner violence (Barlow et al., 2015; Dauber et al., 2017; Haroz et al., 2019; Rosenstock et al., 2021; Tandon et al., 2020). Family Spirit (FS), an evidence‐based, federally endorsed, culturally congruent home‐visiting intervention that is delivered by paraprofessionals, is a model program that holds the collective aims of improving parental competencies and children's and parent's social, emotional, and behavioral outcomes (Mullany et al., 2012).…”

“…The FS model demonstrates a strong foundation in terms of format and lesson delivery to address community‐specific needs. For example, the FS Nurture intervention study implemented the same format and delivery of lessons used in FS to deliver nutrition‐focused lessons to address childhood obesity and demonstrated post‐intervention protective effects against sugar‐sweetened beverages consumption, responsive feeding, and infant body mass index scores in a tribal community setting (Rosenstock et al., 2021). Secondary analysis of the FS intervention study (Barlow et al., 2015) revealed that children born to mothers with a history of alcohol, marijuana, or illicit substances demonstrated greater improvements in emotional and behavioral outcomes after receiving FS, which includes a substance use during pregnancy lesson, in comparison to their counterparts that did not receive the intervention (Haroz et al., 2019).…”