Source: CHILDREN'S NUTRITION RES CENTER BAYLOR COLL OF MED submitted to
PROMOTING THE SELF-REGULATION OF ENERGY INTAKE ON AFRICAN AMERICAN AND LATINO PRESCHOOLERS:A FAMILY FOCUSED OBESITY PREVENTION PROGRAM
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
COMPLETE
Funding Source
Reporting Frequency
Annual
Accession No.
0224301
Grant No.
2011-68001-30009
Cumulative Award Amt.
$4,194,606.00
Proposal No.
2010-04615
Multistate No.
(N/A)
Project Start Date
Feb 1, 2011
Project End Date
Jan 31, 2018
Grant Year
2011
Program Code
[A2101]- Childhood Obesity Prevention: Integrated Research, Education, and Extension to Prevent Childhood Obesity
Recipient Organization
CHILDREN'S NUTRITION RES CENTER BAYLOR COLL OF MED
1100 BATES STREET
HOUSTON,TX 77030
Performing Department
(N/A)
Non Technical Summary
Overweight and obesity are well-known risk factors for disease in children and adolescents. One factor contributing to child obesity is the poor self-regulation of energy intake. To date, no obesity prevention program has been developed to target this risk factor. We propose to develop a scientifically-validated, family-focused, culturally competent, obesity prevention program focusing on this issue by pursuing four specific objectives. First, additional insight into parental influences on children?s self-regulation of energy intake will be gained through the detailed observational coding and analysis of a unique set of 425 videotapes of mother-child interactions at dinnertime. Second, we will develop and pilot test a six-session parent-focused obesity prevention program informed by the results of our observational analysis, focus group data, and previous research on the determinants of childhood obesity. Third, we will conduct a randomized control trial of the completed program at locations in Texas and Washington. Finally, we will disseminate the materials nationally and locally through national organizations and Washington State University Extension.
Animal Health Component
80%
Research Effort Categories
Basic
(N/A)
Applied
80%
Developmental
20%
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
7036010101050%
8026020302050%
Goals / Objectives
No comprehensive, scientifically-validated, family-focused, obesity prevention program currently exists for parents of preschoolers. Only one current family program exists that specifically addresses the needs of low-income, minority parents and no programs focus on the important role that parents play in the development of children's food preferences, food selection, and self-regulation of energy intake. The objectives of this multisite, integrated research-extension project are to develop, evaluate, and to begin dissemination of a scientifically-validated, family-focused, culturally competent, obesity prevention program to promote healthy food preferences and the self-regulation of eating via a four-step process: The first objective is to examine how mothers influence their children's self-regulation of energy intake by conducting detailed, observational coding and analysis of a unique set of 425 previously collected videotapes of mother-child interactions at mealtime in low-income African American and Latina mothers (Research). The second objective is to develop and pilot test a scientifically-based, culturally competent six-session parent directed, obesity prevention program focused on parental feeding strategies that support young children's self-regulation. This program is informed by the results of our observational analyses, focus group data, and previous research on the determinants of childhood obesity. (Extension). The third objective is to test the efficacy of this program by conducting a randomized controlled trial of the completed program at three locations (two in Washington state and one in Houston), Texas. (Research and Extension). The fourth objective is to begin dissemination of the materials through WSU Extension and national organizations (Extension). These objectives will be accomplished through a collaboration between a multidisciplinary team of researchers and extension faculty at the Children's Nutrition Research Center at Baylor College of Medicine, the Children's Eating Laboratory of the University of Colorado Denver, and Washington State University.
Project Methods
During Phase I, we will complete observational analyses of previously recorded videotapes of 143 low-income Head Start African American (AA) and Latino (L) families at dinner (3 separate mealtime recordings per family). Focus group data will be collected to provide further insight into the results. Both simple frequency and lag sequential analyses will examine the feeding practices. It is expected that child obesity will be positively associated with prompts to eat, directiveness of influence attempts, conflict, threats, restriction and maternal responses that invalidate child fullness cues. Using these results, during Phase II we will develop, pilot test, and refine a family-based, culturally competent, obesity prevention program targeting low-income AA and L families with preschoolers in Houston, Texas and Washington state. Focus groups will examine cultural issues to ensure that the prevention program meets the needs of the target population. When analyses of observational and focus group data are complete, the team will meet with the writer/producer to develop and refine learning objectives of the program including helping parents to encourage their child to 1) develop self-regulation of energy intake, 2) try new foods, and 3) prefer fruit and vegetables, low-fat, low-sugar foods, and whole grains. We will develop six 90 minute parenting sessions which include DVDs with parenting vignettes illustrating food strategies that reinforce main messages, photo novellas for parents, picture books for children, handouts, six-ingredient menus, and other items such as mugs and refrigerator magnets. Versions in English and in Spanish will be produced. Materials will be evaluated using focus groups and external reviewers. Materials will be piloted in Houston, TX and Washington state. During Phase III, a formal randomized controlled trial will be implemented. Five programs will be implemented per site for each of two years, yielding a total of 40 programs (5 programs per year X 2 years X 4 sites with 2 in TX and 2 in WA). Twenty programs will be intervention (self-regulation) and twenty will be control (food safety). To test the efficacy of the program, a series of measures will be collected including information on feeding styles, feeding practices, knowledge and attitudes about food, self-regulation of energy intake, dietary quality and intake, and body mass index. We will conduct outcome analyses using multi-level growth modeling. It is expected that parents in the intervention group will use more child-centered and less parent-centered feeding directives, be less likely to show indulgent and more likely to show authoritative feeding styles, show lower scores on restriction and pressure to eat feeding practices, and demonstrate higher levels of food knowledge. During Phase IV, the program will be disseminated through eXtension website. Members of the WSU extension parenting team will package the intervention for use by parent and nutrition educators.

Progress 02/01/11 to 01/31/18

Outputs
Target Audience:The target audiences for the intervention progect were low-income Hispanic and African American families in Washington State and Houston, TX. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Several of the research staff members that workedon this project at both site locations, Houston, TX and Pullman, WA were also attending undegraduate or graduate programs. The project offered training opportunities to these staff members under the supervision and mentorship of the study researachers, Sheryl O. Hughes, PhD, Thomas G. Power, PhD, and Louise Parker, PhD. Staff members obtained or are completing degrees in prevention science, human development, counseling psychology, dietetics, public health, and education. Training activities complemented the degree programs of the staff members. Specifically, activities included completing dissertations for doctoral programs by examining various contructs as part of the project. Additionally, staff members were trained on facilitating and leading the 7-lesson sessions, including discussions and educational activities regarding promotion of healthy food preferences and eating self-regulation with preschool children and their families, as well as theories of adult education. How have the results been disseminated to communities of interest?Dissemination has proceeded in two ways. First, weselected specificmaterialssuccessful to the program (e.g., manuals, curriculum, accompanying videos, successful parent and child activities, etc.) to include in the Baylor College of Medicine website. Second, members of the WSU Extension teamare in the process ofpromoting the program to nutrition educators, acrossstate and region. The extension team plans to promote the program nationally through established Extension networks for EFNEP, SNAP-Ed and the Children Youth and Families at Risk programs. Dr. Parker,through her role on the national SNAP-Ed Program Development Team,is promoting the program through the professional development system for educators. Investigators and extension team members have already presented information on the prevention program at various national and international conferences as outlined below. WSU Extension's long-term intent is to create a dissemination model with options for both face-to- face and distance training, and to include a field-based evaluation protocol that can be used by any partners who adopt the program. A related goal is to develop an ongoing learning community among implementers (facilitated by technology) to insure fidelity to the tested model and monitoring of program impacts across states and communities. Results of this study have been presented at the following scientific conferences and meetings, and lectures: 1. Hughes SO, Power TG, Johnson SL, Goodell LS, Parker S, Beck AE. Development of a family focused child obesity prevention program. Presentation at the Society of Nutrition Education and Behavior, Pittsburgh, Pennsylvania, July 25-28, 2015. 2. Hughes SO, Power TG, Micheli N, Papaioannou MA, Johnson SL, Goodel LS, Parker L, Beck A. Development of a family focused child obesity prevention program. Presentation at the Society of Nutrition Education and Behavior, San Diego, California, July 30-August 2, 2016. 3. Hughes SO, Power TG, Johnson SL, Parker L, Lanigan J, Beck A, Betz D, Martinez A. Development of a family focused child obesity prevention program for preschoolers. Presentation at the annual meeting of the Society for Prevention Research, Washington, DC, May 30-June 2, 2017. 4. Hughes, SO, Power, TG, Johnson, SL, Parker, L, Lanigan, J, Beck, A, Betz, D, Martinez, A. Preventing Childhood Obesity through a Family Based Program--SEEDS. Presentation at the annual meeting of the International Society for Behavioral Nutrition and Physical Activity, Victoria, Canada, June 7-10, 2017. 5. Hughes SO, Power TG, Johnson SL, Parker L, Lanigan J, Beck A, Betz D, Martinez A, Micheli N, Papaioannou M. Preliminary results from a childhood obesity family-based prevention program. Presentation at the annual conference of the National Council of Family Relations, Orlando, Florida, November 15-18, 2017. 6. Parker L. Exploring parental feeding styles and food media as contributors to childhood obesity: preliminary data from two family interventions in the U.S. Public lecture at the University of Newcastle, Callaghan, Australia, November 20, 2017. 7. Lanigan J, Hughes SO, Power TG, Parker L. Establishing healthy weight trajectories in early childhood. Symposium presentation at the National Research Conference on Early Childhood, Washington DC, June 25-27, 2018. 8. Lanigan J, Hughes SO, Power TG, Parker L, Beck A, Johnson S. SEEDS preschool eating curriculum development and evaluation poster presentation at the National Research Conference on Early Childhood, Washington DC, June 25-27, 2018. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? The efficacy of the prevention program is supported by preliminary data. Pre- to post-assessment showed that parents in the prevention program used more responsive feeding practices, provided more meal structure by serving appropriate portion sizes, promoted novel foods, and encouraged exploration more than control parents. Regarding the child outcomes of eating self-regulation, no differences were found from pre- to post-assessment between prevention and control participants. Further analyses arecurrently being conducted to include all follow-up data. Portions of thisprogram are currently beingused in combination with the Eating Smart • Being Active curriculum of the Expanded Food and Nutrition Education Program (EFNEP). One of the goals of the Eating Smart • Being Active EFNEP program is to addportions of theSEEDS parent feeding content and the videos created in the SEEDS project to the Eating Smart • Being Active curriculum. The objective is to further increase the impact of the Eating Smart • Being Active curriculum by teaching parents responsive feeding resulting in healthier child eating behaviors and food intake.

Publications

  • Type: Journal Articles Status: Published Year Published: 2016 Citation: Hughes SO, Power TG, Beck A, Betz D, Calodich S, Goodell LS, Hill LG, Hill R, Jaramillo JA, Johnson SL, Lanigan J, Lawrence A, Martinez AD, Nesbitt M, Overath I, Parker L, Ullrich-French S. Strategies for Effective Eating Development-SEEDS: Design of an Obesity Prevention Program to Promote Healthy Food Preferences and Eating Self-Regulation in Children From Low-Income Families. J Nutr Educ Behav. 2016 Jun;48(6):405-418.e1.


Progress 02/01/15 to 01/31/16

Outputs
Target Audience:The target audiences for the intervention progect are African-American and Hispanic low-income families in Washington state and Houston, TX. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Trainings were conducted in Seattle, WA for all assessment personel on the project. How have the results been disseminated to communities of interest?Results of the RCT will be disseminated in Year 6 of the project. What do you plan to do during the next reporting period to accomplish the goals?We plan to continue with the RCT in Washington state and Houston, TX.

Impacts
What was accomplished under these goals? We are continuing to implement the intervention programs the states of Washington and Texas by trained parent and child facilitators. A total of 6 to 8 parent-child dyads are enrolled in each intervention arm and 6-8 parent-child dyads are enrolled in each control arm receiving no intervention. Recruitment is taking place in Head Start and low-income nutrition programs in each state. Eleven programs have been completed to date with a total of 204 parent-child dyads having completed the program (105 in the intervention groups and 99 in the control groups). The programs will continue in each state for the coming year.

Publications


    Progress 02/01/14 to 01/31/15

    Outputs
    Target Audience: The target audiences for the intervention progect are African-American and Hispanic low-income families in Washington state and Houston, TX. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Training was conducted in Seattle, WA for all assessment personel on the project. How have the results been disseminated to communities of interest? Results of the RCT will be disseminated in Year 5 of the project. What do you plan to do during the next reporting period to accomplish the goals? We plan to continue with the RCT in Washington state and Houston, TX.

    Impacts
    What was accomplished under these goals? Currently the intervention programs are being implemented in the states of Washington and Texas by trained parent and child facilitators. A total of 6 to 8 parent-child dyads are enrolled in each intervention arm and 6-8 parent-child dyads are enrolled in each control arm receiving no intervention. Recruitment is taking placein Head Startand low-income nutrition programs in each state, Five programs have been completed to date with a total of 79 parent-child dyads having completed the program (42 in the intervention groups and 37 in the control groups). The programs will continue in each state for the coming year.

    Publications


      Progress 02/01/13 to 01/31/14

      Outputs
      Target Audience: We conducted pilot testing of the developed intervention program with low-income African-American and Hispanic families with preschoolers. The pilot testing was conducted in Washington State and Houston, Texas. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Training was conducted in Seattle, WA for parent and child intervention facilitators. This included staff members from Washington State University and Baylor College ofMedicine. How have the results been disseminated to communities of interest? Results of the RCT will be disseminated in Year 5 of the project once the RCT has been completed. What do you plan to do during the next reporting period to accomplish the goals? Our plan is to modify the parent, child, and family sessions based on information derived from the pilot testing. The RCT will begin in the next reporting period.

      Impacts
      What was accomplished under these goals? Goals for this project included the following: 1) completing observational coding and analyses of 425 videotapes of family meals, 2) conducting focus groups to better understand factors that impact parent feeding at mealtime and their influence on child eating self-regulation, 3) developing curriculum for parent, child, and family sessions to be used in the intervention, 4) conducting pilot testing of the curriculum and modifying based on feedback, and 5) conducting a RCT of the intervention in the states of Washington and Texas. Focus groups and observational coding were completed and used to inform the development of intervention curriculum for seven sessions (parent, child, and family) to be used across a seven week intervention program. The seven parent sessions included: Introduction, Trying New Foods (how do children develop preferences), Internal Cues of Hunger and Fullness (how do children decide when they've had enough to eat; how do parents know when their child has had enough to eat), Portion Sizes (how do parents decide what is an appropriate portion for preschoolers) Structure of the Environment (outside influences), Structure of the Home Environment (structure of the home meal), and Review (responsive feeding). Extensive curriculum was developed for each of the seven sessions and included fun and engaging videos incorporated into the content. The seven child sessions included activities targeting trying new foods and identifying internal cues similar to the content in the parent sessions. Fun and engaging dolls were crafted to help teach children to identify and describe cues of hunger and fullness. Family sessions were developed as well with the parents and children focusing on what they learned in their individual sessions. Pilot testing was conducted on the curriculum in Washington state and Houston, TX.

      Publications


        Progress 02/01/12 to 01/31/13

        Outputs
        Target Audience: Nothing Reported Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals? Continued to devel ope the program and pilot the program prior to the RCT.

        Impacts
        What was accomplished under these goals? Continued development of the intervention program.

        Publications


          Progress 02/01/11 to 01/31/12

          Outputs
          OUTPUTS: Goals for first two years of this project included 1) completing the detailed observational coding and analysis of 425 videotapes of mother-child interactions during the dinner meal, 2) conducting focus groups to gain additional insight into the factors that impact parental feeding decisions at mealtime and their influence on childrens self-regulation of energy intake, and 3) to develop parent, child, and family sessions to be used in the intervention. To date, we have completed coding of 240 videotapes and inter-rater reliability has been established. Coding of the remaining 185 videotapes is ongoing and will be completed by July, 2013. Extensive training for focus group staff was completed during the first year. Eight focus group discussions with 98 low-income mothers (4 with Latina mothers; 4 with Black mothers) were completed in Houston, TX, and Tacoma and Yakima, WA. Themes included Determining Fullness (for parent and child), Portion Sizes (what is the right amount to serve), Mealtime Distractions, Choice versus Rules, Accepting Foods, and Behavior Change. Information from the focus groups was used to inform the development of seven parent sessions to be used in the intervention. These seven sessions are as follows: Introduction, Picky Eating (how do children develop preferences; i.e. how do children decide what they want to eat), Internal Cues (how do children develop self-regulation; i.e. how do they decide when theyve had enough to eat), Structure of the Environment, Structure of the Meal, Portion Sizes, and Responsive Feeding. Extensive curriculum has been developed for each of the seven sessions. The corresponding child sessions are under development as well as the family sessions (parent and child will together focus on what they learned in their individual sessions). The intervention will be piloted in Year 3. The pilot will involve two 7-week sessions conducted at each site. Houston will have two "sites" (one Black and one Latina); WSU will have two sites (Tacoma and Yakima). At each site, the program will be implemented by a trained parent educator and a trained early childhood specialist from the local community. These professionals will be of the same ethnicity as the program assistants and extensively trained by the project staff in the intervention before the initiation of any programs. Six to ten parents will be recruited for each session through either Head Start or Extensions low-income nutrition programs. PARTICIPANTS: Susan L. Johnson at the University of Colorado Denver Thomas G. Power at Washington State University Louise Parker at Washington State University Jane Lanigan at Washington State University Laura Hill at Washington State University Drew Betz at Washington State University Sarah Ullrich-French at Washington State University Irene Overath at Washington State University Shirley Broughton at Washington State University Suzie Goodell at North Carolina State University TARGET AUDIENCES: Nothing significant to report during this reporting period. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

          Impacts
          None at this time.

          Publications

          • Power TG, Hughes SO, Goodell LS, Johnson SL, Duran JAJ, Williams K, Eaton AD, Frankel LA. (2013). Mother-child interactions at dinner: a descriptive study of low-income African American and Latino mothers. (under review)