Impact of ¡Míranos! on parent-reported home-based healthy energy balance-related behaviors in low-income Latino preschool children: a clustered randomized controlled trial

Sarah L Ullevig, Deborah Parra-Medina, Yuanyuan Liang, Jeffrey Howard, Erica Sosa, Vanessa M Estrada-Coats, Vanessa Errisuriz, Shiyu Li, Zenong Yin, Sarah L Ullevig, Deborah Parra-Medina, Yuanyuan Liang, Jeffrey Howard, Erica Sosa, Vanessa M Estrada-Coats, Vanessa Errisuriz, Shiyu Li, Zenong Yin

Abstract

Background: Widespread establishment of home-based healthy energy balance-related behaviors (EBRBs), like diet, physical activity, sedentary behavior, screen time, and sleep, among low-income preschool-aged children could curb the childhood obesity epidemic. We examined the effect of an 8-month multicomponent intervention on changes in EBRBs among preschool children enrolled in 12 Head Start centers.

Methods: The Head Start (HS) centers were randomly assigned to one of three treatment arms: center-based intervention group (CBI), center-based plus home-based intervention group (CBI + HBI), or control. Before and following the intervention, parents of 3-year-olds enrolled in participating HS centers completed questionnaires about their child's at-home EBRBs. Adult-facilitated physical activity (PA) was measured by an index based on questions assessing the child's level of PA participation at home, with or facilitated by an adult. Fruit, vegetable, and added sugar intake were measured via a short food frequency questionnaire, and sleep time and screen time were measured using 7-day logs. A linear mixed effects model examined the intervention's effect on post-intervention changes in PA, intake of fruit, vegetable, and added sugar, sleep time, and screen time from baseline to post-intervention.

Results: A total of 325 parents participated in the study (CBI n = 101; CBI + HBI n = 101; and control n = 123). Compared to control children, CBI and CBI + HBI parents reported decreases in children's intake of added sugar from sugar-sweetened beverages. Both CBI and CBI + HBI parents also reported smaller increases in children's average weekday screen time relative to controls. In addition, CBI + HBI parents reported CBI + HBI parents reported increases in children's adult-facilitated PA, fruit and vegetable intake, and daily sleep time during weekdays (excluding weekends) and the total week from baseline to post-intervention, while children in the CBI increased sleep time over the total week compared to the children in the control group.

Conclusions: Parent engagement strengthened the improvement in parent-reported EBRBs at home in young children participating in an evidence-based obesity prevention program in a childcare setting. Future studies should investigate equity-related contextual factors that influence the impact of obesity prevention in health-disparity populations.

Trial registration: ClinicalTrials.gov, NCT03590834. Registered July 18, 2018, https://ichgcp.net/clinical-trials-registry/NCT03590834.

Keywords: Intervention; Nutrition; Preschool children; Screen time; Sleep.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2023. The Author(s).

Figures

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Fig. 1
Data Flow Diagram

References

    1. Reilly JJ. Physical activity, sedentary behaviour and energy balance in the preschool child: opportunities for early obesity prevention. Proc Nutr Soc. 2008;67(3):317–325. doi: 10.1017/S0029665108008604.
    1. De Craemer M, De Decker E, De Bourdeaudhuij I, Vereecken C, Deforche B, Manios Y, et al. Correlates of energy balance-related behaviours in preschool children: a systematic review. Obes Rev. 2012;13:13–28. doi: 10.1111/j.1467-789X.2011.00941.x.
    1. Hesketh KD, Campbell KJ. Interventions to prevent obesity in 0–5 year olds: an updated systematic review of the literature. Obesity. 2010;18(S1):S27–S35. doi: 10.1038/oby.2009.429.
    1. McGinty SM, Osganian SK, Feldman HA, Milliren CE, Field AE, Richmond TK. BMI trajectories from birth to young adulthood. Obesity (Silver Spring) 2018;26(6):1043–1049. doi: 10.1002/oby.22176.
    1. Simmonds M, Burch J, Llewellyn A, Griffiths C, Yang H, Owen C, et al. The use of measures of obesity in childhood for predicting obesity and the development of obesity-related diseases in adulthood: a systematic review and meta-analysis. Health Technol Assess. 2015;19(43):1–336. doi: 10.3310/hta19430.
    1. Swinburn B, Caterson I, Seidell J, James W. Diet, nutrition and the prevention of excess weight gain and obesity. Public Health Nutr. 2004;7(1a):123–146. doi: 10.1079/PHN2003585.
    1. Wang YC, Bleich SN, Gortmaker SL. Increasing caloric contribution from sugar-sweetened beverages and 100% fruit juices among US children and adolescents, 1988–2004. Pediatrics. 2008;121(6):e1604–e1614. doi: 10.1542/peds.2007-2834.
    1. Reilly JJ. Physical activity, sedentary behaviour and energy balance in the preschool child: opportunities for early obesity prevention. Proc Nutr Soc. 2008;67(03):317–325. doi: 10.1017/S0029665108008604.
    1. LeBlanc AG, Spence JC, Carson V, Connor Gorber S, Dillman C, Janssen I, et al. Systematic review of sedentary behaviour and health indicators in the early years (aged 0–4 years) Appl Physiol Nutr Metab. 2012;37(4):753–772. doi: 10.1139/h2012-063.
    1. St-Onge MP. The role of sleep duration in the regulation of energy balance: effects on energy intakes and expenditure. J Clin Sleep Med JCSM Publ Am Acad Sleep Med. 2013;9(1):73–80. doi: 10.5664/jcsm.2348.
    1. Birch LL, Fisher JO. Development of eating behaviors among children and adolescents. Pediatrics. 1998;101(Supplement 2):539–549. doi: 10.1542/peds.101.S2.539.
    1. Birch LL, Davison KK. Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight. Pediatr Clin North Am. 2001;48(4):893–907. doi: 10.1016/S0031-3955(05)70347-3.
    1. Story M, Kaphingst K, French S. The role of child care settings in obesity prevention. Future Child Center Future Chil David Lucile Packard Found. 2006;16(1):143–168. doi: 10.1353/foc.2006.0010.
    1. Clark HR, Goyder E, Bissell P, Blank L, Peters J. How do parents’ child-feeding behaviours influence child weight? Implications for childhood obesity policy. J Public Health. 2007;29(2):132–41.
    1. Murashima M, Hoerr SL, Hughes SO, Kaplowitz SA. Feeding behaviors of low-income mothers: directive control relates to a lower BMI in children, and a nondirective control relates to a healthier diet in preschoolers. Am J Clin Nutr. 2012;95(5):1031–1037. doi: 10.3945/ajcn.111.024257.
    1. Birch LL. Development of food acceptance patterns in the first years of life. Proc Nutr Soc. 1998;57(04):617–624. doi: 10.1079/PNS19980090.
    1. Pope ML, Liu T, Getchell N. Object-control skills in Hispanic preschool children enrolled in head start. Percept Mot Skills. 2011;112(1):193–200. doi: 10.2466/10.11.17.24.PMS.112.1.193-200.
    1. Singh GK, Siahpush M, Kogan MD. Rising social inequalities in US childhood obesity, 2003–2007. Ann Epidemiol. 2010;20(1):40–52. doi: 10.1016/j.annepidem.2009.09.008.
    1. Volger S, Rigassio Radler D, Rothpletz-Puglia P. Early childhood obesity prevention efforts through a life course health development perspective: a scoping review. PLoS ONE. 2018;13(12):e0209787. doi: 10.1371/journal.pone.0209787.
    1. Reilly JJ, Hughes AR, Gillespie J, Malden S, Martin A. Physical activity interventions in early life aimed at reducing later risk of obesity and related non-communicable diseases: a rapid review of systematic reviews. Obes Rev. 2019;20(Suppl 1):61–73. doi: 10.1111/obr.12773.
    1. Kerr JA, Loughman A, Knox A, Koplin JJ, Allen KJ, Wake M. Nutrition-related interventions targeting childhood overweight and obesity: a narrative review. Obes Rev. 2019;20(Suppl 1):45–60. doi: 10.1111/obr.12768.
    1. Jones RA, Sousa-Sá E, Peden M, Okely AD. Childcare physical activity interventions: a discussion of similarities and differences and trends, issues, and recommendations. Int J Environ Res Public Health. 2019;16(23):4836. doi: 10.3390/ijerph16234836.
    1. Ward DS, Welker E, Choate A, Henderson KE, Lott M, Tovar A, et al. Strength of obesity prevention interventions in early care and education settings: a systematic review. Prev Med. 2017;95:S37–S52. doi: 10.1016/j.ypmed.2016.09.033.
    1. Lewis L, Povey R, Rose S, Cowap L, Semper H, Carey A, et al. What behavior change techniques are associated with effective interventions to reduce screen time in 0–5 year olds? A narrative systematic review. Prev Med Rep. 2021;23:101429. doi: 10.1016/j.pmedr.2021.101429.
    1. Miller MA, Bates S, Ji C, Cappuccio FP. Systematic review and meta-analyses of the relationship between short sleep and incidence of obesity and effectiveness of sleep interventions on weight gain in preschool children. Obes Rev. 2021;22(2):e13113. doi: 10.1111/obr.13113.
    1. Morris H, Skouteris H, Edwards S, Rutherford L. Obesity prevention interventions in early childhood education and care settings with parental involvement: a systematic review. Early Child Dev Care. 2015;185(8):1283–1313. doi: 10.1080/03004430.2014.991723.
    1. Tomayko EJ, Tovar A, Fitzgerald N, Howe CL, Hingle MD, Murphy MP, et al. Parent involvement in diet or physical activity interventions to treat or prevent childhood obesity: an umbrella review. Nutrients. 2021;13(9):3227. doi: 10.3390/nu13093227.
    1. Tamayo MC, Dobbs PD, Pincu Y. Family-centered interventions for treatment and prevention of childhood obesity in hispanic families: a systematic review. J Community Health. 2021;46(3):635–643. doi: 10.1007/s10900-020-00897-7.
    1. Wang X, Ammerman A, Orr CJ. Family-based interventions for preventing overweight or obesity among preschoolers from racial/ethnic minority groups: a scoping review. Obes Sci Pract. 2022;8(3):371–386. doi: 10.1002/osp4.578.
    1. National Center for Health Statistics. (2021). National Health and Nutrition Examination Survey 2017–March 2020 Prepandemic Data Files Development of Files and Prevalence Estimates for Selected Health Outcomes. Hyattsville, MD Retrieved from .
    1. Yin Z, Parra-Medina D, Cordova A, He M, Trummer V, Sosa E, et al. Miranos! Look at us, we are healthy! An environmental approach to early childhood obesity prevention. Child Obes (Print) 2012;8(5):429–439. doi: 10.1089/chi.2011.0125.
    1. Yin Z, Ullevig SL, Sosa E, Liang Y, Olmstead T, Howard JT, et al. Study protocol for a cluster randomized controlled trial to test “¡ Míranos! Look at us, We are healthy!”–an early childhood obesity prevention program. BMC Pediatr. 2019;19(1):1–17. doi: 10.1186/s12887-019-1541-4.
    1. Office of Head Start. Head Start Program Performance Standards. US Department of Health and Human Services Administration for Children and Families. Washington, DC. 2016.
    1. Brown CL, Perrin EM. Obesity prevention and treatment in primary care. Acad Pediatr. 2018;18(7):736–745. doi: 10.1016/j.acap.2018.05.004.
    1. Hewawitharana SC, Thompson FE, Loria CM, Strauss W, Nagaraja J, Ritchie L, et al. Comparison of the NHANES dietary screener questionnaire to the automated self-administered 24-hour recall for children in the healthy communities study. Nutr J. 2018;17(1):111. doi: 10.1186/s12937-018-0415-1.
    1. Haines J, McDonald J, O’Brien A, Sherry B, Bottino CJ, Schmidt ME, et al. Healthy habits, happy homes: randomized trial to improve household routines for obesity prevention among preschool-aged children. JAMA Pediatr. 2013;167(11):1072–1079. doi: 10.1001/jamapediatrics.2013.2356.
    1. National Cancer Institute. Data Processing & Scoring Procedures Using Current Methods Bethesda, Maryland: U.S. Department of Health and Human Services National Institutes of Health; 2020 [May 5, 2021]. Available from: .
    1. National Cancer Institute. Identifying Extreme Exposure Values Bethesda, Maryland: U.S. Department of Health and Human Services National Institutes of Health; 2020 [May 5, 2021]. Available from: .
    1. van de Kolk I, Goossens AJM, Gerards SMPL, Kremers SPJ, Manders RMP, Gubbels JS. Healthy nutrition and physical activity in childcare: views from childcare managers, childcare workers and parents on influential factors. Int J Environ Res Public Health. 2018;15(12):2909. doi: 10.3390/ijerph15122909.
    1. Nicklas T, Lopez S, Liu Y, Saab R, Reiher R. Motivational theater to increase consumption of vegetable dishes by preschool children. Int J Behav Nutr Phys Act. 2017;14(1):16. doi: 10.1186/s12966-017-0468-0.
    1. Benjamin-Neelon SE. Position of the academy of nutrition and dietetics: benchmarks for nutrition in child care. J Acad Nutr Diet. 2018;118(7):1291–1300. doi: 10.1016/j.jand.2018.05.001.
    1. Ward S, Bélanger M, Donovan D, Carrier N. Systematic review of the relationship between childcare educators’ practices and preschoolers’ physical activity and eating behaviours. Obes Rev. 2015;16(12):1055–70.
    1. Cronk CE, Hoffmann RG, Mueller MJ, Zerpa-Uriona V, Dasgupta M, Enriquez F. Effects of a culturally tailored intervention on changes in body mass index and health-related quality of life of Latino children and their parents. Am J Health Promot: AJHP. 2011;25(4):e1–11.
    1. Fitzgibbon ML, Stolley MR, Schiffer L, Van Horn L, KauferChristoffel K, Dyer A. Hip-hop to health Jr. for Latino preschool children. Obesity. 2006;14(9):1616–1625. doi: 10.1038/oby.2006.186.
    1. Barkin SL, Heerman WJ, Sommer EC, Martin NC, Buchowski MS, Schlundt D, et al. Effect of a behavioral intervention for underserved preschool-age children on change in body mass index: a randomized clinical trial. JAMA. 2018;320(5):450–460. doi: 10.1001/jama.2018.9128.
    1. Seburg EM, Olson-Bullis BA, Bredeson DM, Hayes MG, Sherwood NE. A review of primary care-based childhood obesity prevention and treatment interventions. Curr Obes Rep. 2015;4(2):157–173. doi: 10.1007/s13679-015-0160-0.
    1. Strauss WJ, Nagaraja J, Landgraf AJ, Arteaga SS, Fawcett SB, Ritchie LD, et al. The longitudinal relationship between community programmes and policies to prevent childhood obesity and BMI in children: the healthy communities study. Pediatr Obes. 2018;13(S1):82–92. doi: 10.1111/ijpo.12266.
    1. Mehdizadeh A, Nematy M, Vatanparast H, Khadem-Rezaiyan M, Emadzadeh M. Impact of parent engagement in childhood obesity prevention interventions on anthropometric indices among preschool children: a systematic review. Child Obes. 2019;16(1):3–19. doi: 10.1089/chi.2019.0103.
    1. Demmer E, Cifelli CJ, Houchins JA, Fulgoni VL. The pattern of complementary foods in American infants and children aged 0–5 Years Old—A cross-sectional analysis of data from the NHANES 2011–2014. Nutrients. 2018;10(7):827. doi: 10.3390/nu10070827.
    1. Lee R, Zhai F, Han W-J, Brooks-Gunn J, Waldfogel J. Head Start and children’s nutrition, weight, and health care receipt. Early Child Res Quar. 2013;28(4):723–33.
    1. Erinosho T, Vaughn A, Hales D, Mazzucca S, Gizlice Z, Treadway C, et al. The quality of nutrition and physical activity environments of child-care centers across three states in the southern U.S. Prev Med. 2018;113:95–101. doi: 10.1016/j.ypmed.2018.04.029.
    1. Williams PA, Cates SC, Blitstein JL, Hersey J, Gabor V, Ball M, et al. Nutrition-education program improves preschoolers’ at-home diet: a group randomized trial. J Acad Nutr Diet. 2014;114(7):1001–8.
    1. Welsh JA, Wang Y, Figueroa J, Brumme C. Sugar intake by type (added vs. naturally occurring) and physical form (liquid vs. solid) and its varying association with children’s body weight, NHANES 2009–2014. Pediatr Obes. 2018;13(4):213–21.
    1. Wang Y, Guglielmo D, Welsh JA. Consumption of sugars, saturated fat, and sodium among US children from infancy through preschool age, NHANES 2009–2014. Am J Clin Nutr. 2018;108(4):868–877. doi: 10.1093/ajcn/nqy168.
    1. World Health Organization. Guideline: sugars intake for adults and children Geneva, Switzerland: World Health Organization; 2015 [cited 2021 May]. Available from: .
    1. Mehdizadeh A, Nematy M, Vatanparast H, Khadem-Rezaiyan M, Emadzadeh M. Impact of parent engagement in childhood obesity prevention interventions on anthropometric indices among preschool children: a systematic review. Child Obes (Print) 2020;16(1):3–19. doi: 10.1089/chi.2019.0103.
    1. Vos MB, Kaar JL, Welsh JA, Horn LVV, Feig DI, Anderson CAM, et al. Added sugars and cardiovascular disease risk in children: a scientific statement from the American heart association. Circulation. 2017;135(19):e1017–e1034. doi: 10.1161/CIR.0000000000000439.
    1. Woo Baidal JA, Nelson CC, Perkins M, Colchamiro R, Leung-Strle P, Kwass J-A, et al. Childhood obesity prevention in the Women, Infants, and children program: outcomes of the MA-CORD study. Obesity. 2017;25(7):1167–1174. doi: 10.1002/oby.21865.
    1. Walton K, Filion AJ, Gross D, Morrongiello B, Darlington G, Simpson JR, et al. Parents and tots together: pilot randomized controlled trial of a family-based obesity prevention intervention in Canada. Can J Public Health. 2015;106(8):e555–e562. doi: 10.17269/CJPH.106.5224.
    1. Downing KL, Hnatiuk JA, Hinkley T, Salmon J, Hesketh KD. Interventions to reduce sedentary behaviour in 0-5-year-olds: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2018;52(5):314–321. doi: 10.1136/bjsports-2016-096634.
    1. Common Sense Media. The Common Sense census: media use by kids age zero to eight 2017. Common Sense Media 2017 [October 28, 2022]. Available from: . Accessed 28 Oct 2022.
    1. Anderson SE, Whitaker RC. Household routines and obesity in US preschool-aged children. Pediatrics. 2010;125(3):420–428. doi: 10.1542/peds.2009-0417.
    1. Scott-Sheldon LAJ, Hedges LV, Cyr C, Young-Hyman D, Khan LK, Magnus M, et al. Childhood obesity evidence base project: a systematic review and meta-analysis of a new taxonomy of intervention components to improve weight status in children 2–5 years of age, 2005–2019. Child Obes. 2020;16(S2):S221–S248. doi: 10.1089/chi.2020.0139.
    1. Jones A, Armstrong B, Weaver RG, Parker H, von Klinggraeff L, Beets MW. Identifying effective intervention strategies to reduce children’s screen time: a systematic review and meta-analysis. Int J Behav Nutr Phys Act. 2021;18(1):126.
    1. Tandon PS, Zhou C, Sallis JF, Cain KL, Frank LD, Saelens BE. Home environment relationships with children’s physical activity, sedentary time, and screen time by socioeconomic status. Int J Behav Nutr Phys Act. 2012;9(1):88. doi: 10.1186/1479-5868-9-88.
    1. Njoroge WFM, Elenbaas LM, Garrison MM, Myaing M, Christakis DA. Parental cultural attitudes and beliefs regarding young children and television. JAMA Pediatr. 2013;167(8):739–745. doi: 10.1001/jamapediatrics.2013.75.
    1. Waller NA, Zhang N, Cocci AH, D’Agostino C, Wesolek-Greenson S, Wheelock K, et al. Screen time use impacts low-income preschool children’s sleep quality, tiredness, and ability to fall asleep. Child Care Health Dev. 2021;47(5):618–26. doi: 10.1111/cch.12869.
    1. Lan Q-Y, Chan KC, Yu KN, Chan NY, Wing YK, Li AM, et al. Sleep duration in preschool children and impact of screen time. Sleep Med. 2020;76:48–54. doi: 10.1016/j.sleep.2020.09.024.
    1. Perrin EM, Howard JB, Ward DS. In the absence of clear causation, casting a wider net for prevention. Pediatrics. 2016;138(5):e20162895. doi: 10.1542/peds.2016-2895.
    1. Hämäläinen RM, Sandu P, Syed AM, Jakobsen MW. An evaluation of equity and equality in physical activity policies in four European countries. Int J Equity Health. 2016;15(1):191. doi: 10.1186/s12939-016-0481-y.
    1. Kumanyika SK. A Framework for increasing equity impact in obesity prevention. Am J Public Health. 2019;109(10):1350–1357. doi: 10.2105/AJPH.2019.305221.
    1. Maitland C, Stratton G, Foster S, Braham R, Rosenberg M. A place for play? The influence of the home physical environment on children’s physical activity and sedentary behaviour. Int J Behav Nutr Phys Act. 2013;10(1):99. doi: 10.1186/1479-5868-10-99.
    1. Carey G, Crammond B, De Leeuw E. Towards health equity: a framework for the application of proportionate universalism. Int J Equity Health. 2015;14:81. doi: 10.1186/s12939-015-0207-6.
    1. Amaro H. The action is upstream: place-based approaches for achieving population health and health equity. Am J Public Health. 2014;104(6):964. doi: 10.2105/AJPH.2014.302032.
    1. Kumanyika SK. Getting to equity in obesity prevention: A new framework. Washington, DC: National Academy of Medicine; 2017.
    1. Macdiarmid J, Blundell J. Assessing dietary intake: Who, what and why of under-reporting. Nutr Res Rev. 1998;11(2):231–253. doi: 10.1079/NRR19980017.

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