Reducing pediatric caries and obesity risk in South Asian immigrants: randomized controlled trial of common health/risk factor approach

Alison Karasz, Karen Bonuck, Alison Karasz, Karen Bonuck

Abstract

Background: This paper describes the design and methods of a multi-phase study to reduce early childhood caries and obesity in vulnerable South Asian (SA) immigrants in the United States. Early childhood caries and obesity are the most common diseases of early childhood. Risk factors for both diseases are rooted in early childhood feeding practices such as bottle feeding and intake of sweets and sweetened beverages. The Common Health/Risk Factor Approach to addressing oral health is widely promoted by the WHO and other policy makers. This approach recognizes links between oral health and other diseases of modernity. Our CHALO! ("Child Health Action to Lower Obesity and Oral health risk"--from a Hindi word meaning "Let's go!") study targets SA families at high risk for early childhood caries and obesity. CHALO! addresses common risk factors associated with these two common diseases of childhood.

Methods: This two part project includes a randomized controlled trial, and a Knowledge Translation campaign. A randomized controlled trial will enroll n = 360 families from pediatric practices serving South Asians in the New York metro area. The intervention group will receive home visits by SA community health workers at 6, 8, 10, 12, 14, and 16 months of age. Controls will receive culturally tailored educational material. Primary outcomes-- cariogenic and obesogenic feeding practices at 6, 12, and 18 months-- will be assessed with the MySmileBuddy iPad based tool. Secondary outcomes include: oral hygiene practices, anthropometrics, and caries incidence at 18 months. A public education campaign will focus on both families and health care providers.

Discussion: There are few Common Health/Risk Factor Approach published studies on obesity and oral health risk in children, despite health morbidity and costs associated with both conditions. CHALO! comprises a multi-level interventions designed to promote culturally competent, sustainable change.

Trial registration: ClinicalTrials.gov NCT03077425 .

Keywords: Caries; Children; Common risk factor approach; Obesity; Oral health; South Asian.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Einstein Committee on Clinical Investigations, IRB # 2016–6156.

Consent for publication

NA

Competing interests

Dr. Karasz is the Executive Director of SAPNA, NYC. This community-based organization is a sub-contractor to the parent National Institutes of Health grant. The study’s community health workers are employed by SAPNA.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study flow

References

    1. Satia JA. Dietary acculturation and the nutrition transition: an overview. Appl Physiol Nutr Metab. 2010;35(2):219–223. doi: 10.1139/H10-007.
    1. Dye BA, Thornton-Evans G. Trends in oral health by poverty status as measured by healthy people 2010 objectives. Public Health Rep. 2010;125(6):817–830. doi: 10.1177/003335491012500609.
    1. DenBesten P, Berkowitz R. Early childhood caries: an overview with reference to our experience in California. J Calif Dent Assoc. 2003;31(2):139–143.
    1. Mouradian WE, Wehr E, Crall JJ. Disparities in children's oral health and access to dental care. JAMA : the journal of the American Medical Association. 2000;284(20):2625–2631. doi: 10.1001/jama.284.20.2625.
    1. United States Census B: American Community Survey. In., vol. 2010; 2009.
    1. Asian, Pacific Islanders Health F: South Asians in the United States. In.; 2006.
    1. Misra A, Misra R. Asian indians and insulin resistance syndrome: global perspective. Metab Syndr Relat Disord. 2003;1(4):277–283. doi: 10.1089/1540419031361390.
    1. Misra A, Singhal N, Sivakumar B, Bhagat N, Jaiswal A, Khurana L. Nutrition transition in India: secular trends in dietary intake and their relationship to diet-related non-communicable diseases. J Diabetes. 2011;3(4):278–292. doi: 10.1111/j.1753-0407.2011.00139.x.
    1. Pandit K, Goswami S, Ghosh S, Mukhopadhyay P, Chowdhury S. Metabolic syndrome in south Asians. Indian journal of endocrinology and metabolism. 2012;16(1):44–55. doi: 10.4103/2230-8210.91187.
    1. Misra A, Khurana L. The metabolic syndrome in south Asians: epidemiology, determinants, and prevention. Metab Syndr Relat Disord. 2009;7(6):497–514. doi: 10.1089/met.2009.0024.
    1. Whincup PH, Gilg JA, Owen CG, Odoki K, Alberti KG, Cook DG. British south Asians aged 13-16 years have higher fasting glucose and insulin levels than Europeans. Diabet Med. 2005;22(9):1275–1277. doi: 10.1111/j.1464-5491.2005.01587.x.
    1. Barnett AH, Dixon AN, Bellary S, Hanif MW, O'Hare JP, Raymond NT, Kumar S. Type 2 diabetes and cardiovascular risk in the UK south Asian community. Diabetologia. 2006;49(10):2234–2246. doi: 10.1007/s00125-006-0325-1.
    1. Bansal N, Ayoola OO, Gemmell I, Vyas A, Koudsi A, Oldroyd J, Clayton PE, Cruickshank JK. Effects of early growth on blood pressure of infants of British European and south Asian origin at one year of age: the Manchester children's growth and vascular health study. J Hypertens. 2008;26(3):412–418. doi: 10.1097/HJH.0b013e3282f3168e.
    1. Martinson ML, McLanahan S, Brooks-Gunn J. Variation in child body mass index patterns by race/ethnicity and maternal nativity status in the United States and England. Matern Child Health J. 2015;19(2):373–380. doi: 10.1007/s10995-014-1519-7.
    1. Bedi R, Uppal RD. The oral health of minority ethnic communities in the United Kingdom. Br Dent J. 1995;179(11–12):421–425. doi: 10.1038/sj.bdj.4808946.
    1. Wong F. Epidemiology: inequalities in oral health for deprived multiethnic communities. Br Dent J. 2000;189(2):84–4.
    1. Prendergast MJ, Beal JF, Williams SA. The relationship between deprivation, ethnicity and dental health in 5-year-old children in Leeds, UK. Community Dent Health. 1997;14(1):18.
    1. Gray M, Morris AJ, Davies J. The oral health of south Asian five-year-old children in deprived areas of Dudley compared with white children of equal deprivation and fluoridation status. Community Dent Health. 2000;17(4):243–245.
    1. Yin HS, Sanders LM, Rothman RL, Shustak R, Eden SK, Shintani A, Cerra ME, Cruzatte EF, Perrin EM. Parent health literacy and "obesogenic" feeding and physical activity-related infant care behaviors. J Pediatr. 2014;164(3):577–583. doi: 10.1016/j.jpeds.2013.11.014.
    1. Bonuck K, Kahn R, Schechter C. Is late bottle-weaning associated with overweight in young children? Analysis of NHANES III data. Clin Pediatr. 2004;43(6):535–540. doi: 10.1177/000992280404300605.
    1. Gooze RA, Anderson SE, Whitaker RC. Prolonged bottle use and obesity at 5.5 years of age in US children. J Pediatr. 2011;159(3):431–436. doi: 10.1016/j.jpeds.2011.02.037.
    1. Kimbro RT, Brooks-Gunn J, McLanahan S. Racial and ethnic differentials in overweight and obesity among 3-year-old children. Am J Public Health. 2007;97(2):298–305. doi: 10.2105/AJPH.2005.080812.
    1. Behrendt A, Sziegoleit F, Muler-Lessmann V, Ipek-Ozdemir G, Wetzel WE. Nursing-bottle syndrome caused by prolonged drinking from vessels with bill-shaped extensions. ASDC J Dent Child. 2001;68(1):47–50.
    1. Kaste LM, Gift HC. Inappropriate infant bottle feeding. Status of the Healthy People 2000 Objective. Arch Pediatr Adolesc Med. 1995;149(7):786–791. doi: 10.1001/archpedi.1995.02170200076012.
    1. Woo Baidal JA, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM. Risk factors for childhood obesity in the first 1,000 days: a systematic review. Am J Prev Med. 2016;50(6):761–779. doi: 10.1016/j.amepre.2015.11.012.
    1. Carvalho JC, Silva EF, Vieira EO, Pollaris A, Guillet A, Mestrinho HD. Oral health determinants and caries outcome among non-privileged children. Caries Res. 2014;48(6):515–523. doi: 10.1159/000360709.
    1. Almquist-Tangen G, Dahlgren J, Roswall J, Bergman S, Alm B. Milk cereal drink increases BMI risk at 12 and 18 months, but formula does not. Acta paediatrica. 2013;102(12):1174–1179. doi: 10.1111/apa.12418.
    1. Hyden CBK. Addition of solids and sweeteners in toddler bottles and sippy cups. ICAN: Infant, Child, & Adolescent Nutrition. 2014;6(4):205–210.
    1. Lumeng JC, Taveras EM, Birch L, Yanovski SZ. Prevention of obesity in infancy and early childhood: a National Institutes of Health workshop. JAMA Pediatr. 2015;169(5):484–490. doi: 10.1001/jamapediatrics.2014.3554.
    1. Li R, Scanlon KS, May A, Rose C, Birch L. Bottle-feeding practices during early infancy and eating behaviors at 6 years of age. Pediatrics. 2014;134(Suppl 1):S70–S77. doi: 10.1542/peds.2014-0646L.
    1. Dixon B, Pena MM, Taveras EM. Lifecourse approach to racial/ethnic disparities in childhood obesity. Adv Nutr. 2012;3(1):82–73. doi: 10.3945/an.111.000919.
    1. Li R, Magadia J, Fein SB, Grummer-Strawn LM. Risk of bottle-feeding for rapid weight gain during the first year of life. Arch Pediatr Adolesc Med. 2012;166(5):431–436. doi: 10.1001/archpediatrics.2011.1665.
    1. Faruque AS, Ahmed AM, Ahmed T, Islam MM, Hossain MI, Roy SK, Alam N, Kabir I, Sack DA. Nutrition: basis for healthy children and mothers in Bangladesh. J Health Popul Nutr. 2008;26(3):325–339.
    1. Godson JH, Williams SA. Oral health and health related behaviours among three-year-old children born to first and second generation Pakistani mothers in Bradford, UK. Community Dent Health. 1996;13(1):27.
    1. Watt RG. Oral health promotion: a national survey of infant feeding in Asian families: summary of findings relevant to oral health. Br Dent J. 2000;188(1):16–20.
    1. Watt RG. A national survey of infant feeding in Asian families: summary of findings relevant to oral health. Br Dent J. 2000;188(1):16–20.
    1. Williams SA, Hargreaves JA. An inquiry into the effects of health related behaviour on dental health among young Asian children resident in a fluoridated city in Canada. Community Dent Health. 1990;7:413–420.
    1. Engle PL, Pelto GH. Responsive feeding: implications for policy and program implementation. J Nutr. 2011;141(3):508–511. doi: 10.3945/jn.110.130039.
    1. Worobey J, Lopez MI, Hoffman DJ. Maternal behavior and infant weight gain in the first year. J Nutr Educ Behav. 2009;41(3):169–175. doi: 10.1016/j.jneb.2008.06.005.
    1. Farrow C, Blissett J. Does maternal control during feeding moderate early infant weight gain? Pediatrics. 2006;118(2):e293–e298. doi: 10.1542/peds.2005-2919.
    1. Hurley KM, Cross MB, Hughes SO. A systematic review of responsive feeding and child obesity in high-income countries. J Nutr. 2011;141(3):495–501. doi: 10.3945/jn.110.130047.
    1. Karasz A, Patel V, Ranasinghe S, Chaudhuri K, McKee MD. Preventing caries in young children of immigrant Bangladeshi families in New York: perspectives of mothers and paediatricians. Community Dent Health. 2014;31:1–5.
    1. Khunti K, Stone MA, Bankart J, Sinfield PK, Talbot D, Farooqi A, Davies MJ. Physical activity and sedentary behaviours of south Asian and white European children in inner city secondary schools in the UK. Fam Pract. 2007;24(3):237–244. doi: 10.1093/fampra/cmm013.
    1. Khunti K, Stone MA, Bankart J, Sinfield P, Pancholi A, Walker S, Talbot D, Farooqi A, Davies MJ. Primary prevention of type-2 diabetes and heart disease: action research in secondary schools serving an ethnically diverse UK population. J Public Health (Oxf) 2008;30(1):30–37. doi: 10.1093/pubmed/fdm078.
    1. Palaniappan L, Anthony MN, Mahesh C, Elliott M, Killeen A, Giacherio D, Rubenfire M. Cardiovascular risk factors in ethnic minority women aged < or =30 years. Am J Cardiol. 2002;89(5):524–529. doi: 10.1016/S0002-9149(01)02291-3.
    1. Lawton J, Ahmad N, Hanna L, Douglas M, Hallowell N. 'I can't do any serious exercise': barriers to physical activity amongst people of Pakistani and Indian origin with type 2 diabetes. Health Educ Res. 2006;21(1):43–54. doi: 10.1093/her/cyh042.
    1. Williams SA, Ahmed IA, Hussain P. Ethnicity, health and dental care--perspectives among British Asians: 1. Dental update. 1991;18(4):154–161.
    1. Williams SA, Ahmed IA, Hussain P. Ethnicity, health and dental care--perspectives among British Asians: 2. Dental update. 1991;18(5):205–207.
    1. Patel VV, Rajpathak S, Karasz A. Bangladeshi immigrants in New York City: a community based health needs assessment of a hard to reach population. J Immigr Minor Health. 2011;5:1–7.
    1. Hussain F, Cochrane R. Depression in south Asian women living in the UK: a review of the literature with implications for service provision. TranscultPsychiatry. 2004;41(1363–4615; 2):253–270.
    1. Karasz A. Cultural differences in conceptual models of depression. Soc Sci Med. 2005;60(7):1625–1635. doi: 10.1016/j.socscimed.2004.08.011.
    1. Hurley KM, Black MM, Papas MA, Caulfield LE. Maternal symptoms of stress, depression, and anxiety are related to nonresponsive feeding styles in a statewide sample of WIC participants. J Nutr. 2008;138(4):799–805. doi: 10.1093/jn/138.4.799.
    1. Goulding AN, Rosenblum KL, Miller AL, Peterson KE, Chen YP, Kaciroti N, Lumeng JC. Associations between maternal depressive symptoms and child feeding practices in a cross-sectional study of low-income mothers and their young children. The international journal of behavioral nutrition and physical activity. 2014;11:75. doi: 10.1186/1479-5868-11-75.
    1. Lumeng JC, Castle VP, Lumeng CN. The role of pediatricians in the coordinated national effort to address childhood obesity. Pediatrics. 2010;126(3):574–575. doi: 10.1542/peds.2010-1873.
    1. Henderson EJ. Acceptability of delivery of dietary advice in the dentistry setting to address obesity in pre-school children: a case study of the common risk factor approach. Public Health Nutr. 2014:1–6.
    1. Isong I, Dantas L, Gerard M, Kuhlthau K. Oral health disparities and unmet dental needs among preschool children in Chelsea, MA: exploring mechanisms, defining solutions. Journal of oral hygiene & health. 2014;2
    1. Long CM, Quinonez RB, Beil HA, Close K, Myers LP, Vann WF, Jr, Rozier RG. Pediatricians' assessments of caries risk and need for a dental evaluation in preschool aged children. BMC Pediatr. 2012;12:49.
    1. American Academy of Pediatrics: Bright futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, vol 3; 2008.
    1. Dentistry AAoP Guideline on periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents. Pediatr Dent. 2013;35(5):E148–E156.
    1. Section On oral H Maintaining and improving the oral health of young children. Pediatrics. 2014;134(6):1224–1229. doi: 10.1542/peds.2014-2984.
    1. Institute of M, National Research C . Improving access to oral health Care for Vulnerable and Underserved Populations. Washington DC: The National Academies Press; 2011.
    1. Hakim RB, Babish JD, Davis AC. State of dental care among Medicaid-enrolled children in the United States. Pediatrics. 2012;130(1):5–14. doi: 10.1542/peds.2011-2800.
    1. Peacock S, Konrad S, Watson E, Nickel D, Muhajarine N. Effectiveness of home visiting programs on child outcomes: a systematic review. BMC Public Health. 2013;13:17. doi: 10.1186/1471-2458-13-17.
    1. Bryans A, Cornish F, McIntosh J. The potential of ecological theory for building an integrated framework to develop the public health contribution of health visiting. Health Soc Care Community. 2009;17(6):564–572. doi: 10.1111/j.1365-2524.2009.00856.x.
    1. Peterson KE, Sorensen G, Pearson M, Hebert JR, Gottlieb BR, McCormick MC. Design of an intervention addressing multiple levels of influence on dietary and activity patterns of low-income, postpartum women. Health Educ Res. 2002;17(5):531–540. doi: 10.1093/her/17.5.531.
    1. Levine J, Wolf RL, Chinn C, Edelstein BL. MySmileBuddy: an iPad-based interactive program to assess dietary risk for early childhood caries. J Acad Nutr Diet. 2012;112(10):1539–1542. doi: 10.1016/j.jand.2012.06.010.
    1. Custodio-Lumsden CL, Wolf RL, Contento IR, Basch CE, Zybert PA, Koch PA, Edelstein BL. Validation of an early childhood caries risk assessment tool in a low-income Hispanic population. J Public Health Dent. 2016;76(2):136–142. doi: 10.1111/jphd.12122.
    1. Splieth CH, Nourallah AW. An occlusal plaque index. Measurements of repeatability, reproducibility, and sensitivity. Am J Dent. 2006;19(3):135–137.
    1. Kopycka-Kedzierawski DT, Billings RJ, McConnochie KM. Dental screening of preschool children using teledentistry: a feasibility study. Pediatr Dent. 2007;29(3):209–213.
    1. Kopycka-Kedzierawski DT, Billings RJ. Teledentistry in inner-city child-care centres. J Telemed Telecare. 2006;12(4):176–181. doi: 10.1258/135763306777488744.
    1. Kopycka-Kedzierawski DT, Bell CH, Billings RJ. Prevalence of dental caries in early head start children as diagnosed using teledentistry. Pediatr Dent. 2008;30(4):329–333.
    1. Elfrink ME, Veerkamp JS, Aartman IH, Moll HA, Ten Cate JM. Validity of scoring caries and primary molar hypomineralization (DMH) on intraoral photographs. Eur Arch Paediatr Dent. 2009;10(Suppl 1):5–10. doi: 10.1007/BF03262693.
    1. Boye U, Foster GR, Pretty IA, Tickle M. Children's views on the experience of a visual examination and intra-oral photographs to detect dental caries in epidemiological studies. Community Dent Health. 2012;29(4):284–288.
    1. Paulsell D, Boller K, Hallgren K, Esposito A. Zero to Three. Mathematical policy research. 2010. Assessing home visit quality: Dosage,content,and relationships; pp. 16–21.
    1. Barrett K, Zaveri H, Strong D: Fidelity data collection manual for the evidence-based home visiting to prevent child maltreatment cross-site evaluation. In. Edited by Children's Bureau AfCaF, US Department of Health and Human Services. Princeton, NJ: Mathematica Policy Research; 2010.
    1. Santos R. Development and validation of a revised short version of the working alliance inventory. Winnipeg, Manitoba: University of Manitoba; 2005.
    1. Group WHOMGRS WHO child growth standards based on length/height, weight and age. Acta Paediatr Suppl. 2006;450:76–85.
    1. Organization WH . WHO child growth standards: training course on child growth assessment. Geneva: WHO; 2008.
    1. White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med. 2011;30(4):377–399. doi: 10.1002/sim.4067.
    1. Karasz A, Patel VV, Chaudhury K, Kabita M, Jaiman A. The APPLE obesity project: using Community of Practice Theory to build a sustainable, community based Interventon (submitted) 2013.
    1. Karasz A, Raghavan S, Ranasinghe K, Kabita: The ASHA project: an innovative depression treatment intervention based on asset theory. In.
    1. Watt RG, Sheiham A. Integrating the common risk factor approach into a social determinants framework. Community Dent Oral Epidemiol. 2012;40(4):289–296. doi: 10.1111/j.1600-0528.2012.00680.x.
    1. Sheiham A, Watt RG. The common risk factor approach: a rational basis for promoting oral health. Community Dent Oral Epidemiol. 2000;28(6):399–406. doi: 10.1034/j.1600-0528.2000.028006399.x.
    1. Moynihan P, Makino Y, Petersen PE, Ogawa H. Implications of WHO guideline on sugars for dental health professionals. Community Dent Oral Epidemiol. 2017;46(1):1-7.
    1. Do LG, Scott JA, Thomson WM, Stamm JW, Rugg-Gunn AJ, Levy SM, Wong C, Devenish G, Ha DH, Spencer AJ. Common risk factor approach to address socioeconomic inequality in the oral health of preschool children--a prospective cohort study. BMC Public Health. 2014;14:429. doi: 10.1186/1471-2458-14-429.
    1. Arrow P, Raheb J, Miller M. Brief oral health promotion intervention among parents of young children to reduce early childhood dental decay. BMC Public Health. 2013;13:245. doi: 10.1186/1471-2458-13-245.
    1. Maupome G, Karanja N, Ritenbaugh C, Lutz T, Aickin M, Becker T. Dental caries in American Indian toddlers after a community-based beverage intervention. Ethn Dis. 2010;20(4):444–450.
    1. Karanja N, Lutz T, Ritenbaugh C, Maupome G, Jones J, Becker T, Aickin M. The TOTS community intervention to prevent overweight in American Indian toddlers beginning at birth: a feasibility and efficacy study. J Community Health. 2010;35(6):667–675. doi: 10.1007/s10900-010-9270-5.
    1. Green LW, Richard L, Potvin L. Ecological foundations of health promotion. American journal of health promotion : AJHP. 1996;10(4):270–281. doi: 10.4278/0890-1171-10.4.270.
    1. Stokols D. Social ecology and behavioral medicine: implications for training, practice, and policy. Behav Med. 2000;26(3):129–138. doi: 10.1080/08964280009595760.
    1. Pratt CA, Boyington J, Esposito L, Pemberton VL, Bonds D, Kelley M, Yang S, Murray D, Stevens J. Childhood obesity prevention and treatment research (COPTR): interventions addressing multiple influences in childhood and adolescent obesity. Contemp Clin Trials. 2013;36(2):406–413. doi: 10.1016/j.cct.2013.08.010.
    1. Penn S, Kerr J. Childhood obesity: the challenges for nurses. Nurs Child Young People. 2014;26(2):16. doi: 10.7748/ncyp2014.03.26.2.16.e398.
    1. Baur LA, O'Connor J. Special considerations in childhood and adolescent obesity. Clin Dermatol. 2004;22(4):338–344. doi: 10.1016/j.clindermatol.2004.01.005.
    1. Golden SD, Earp JA. Social ecological approaches to individuals and their contexts: twenty years of health education & behavior health promotion interventions. Health Educ Behav. 2012;39(3):364–372. doi: 10.1177/1090198111418634.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel