Healthy Habits, Happy Homes: Randomized Trial to Improve Household Routines for Obesity Prevention Among Preschool-Aged Children

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1. Copyright restrictions may apply JAMA Pediatrics Journal Club Slides: Healthy Habits, Happy Homes Haines J, McDonald J, O’Brien A, et al. Healthy Habits, Happy Homes: randomized trial to improve household routines for obesity prevention among preschool-aged children. JAMA Pediatr. Published online September 9, 2013. doi:10.1001/jamapediatrics.2013.2356.
2. Copyright restrictions may apply • Background – Racial/ethnic minority children bear a disproportionate share of the burden of overweight status. – Previous observational research has shown that children who were exposed to 3 household routines (ie, eating family dinners, adequate nighttime sleep, and limiting screen time) had substantially lower obesity rates than children who were not exposed to those routines.1 • Study Objective – To examine the effectiveness of a home-based intervention to improve household routines known to be associated with childhood obesity among a sample of low-income, racial/ethnic minority families with young children. • Family routines: frequency of family meals, child sleep duration, time watching television (TV), and the presence of a TV in the room where the child slept. 1Anderson SE, Whitaker RC. Household routines and obesity in US preschool-aged children. Pediatrics. 2010;125(3):420-428. Introduction
3. Copyright restrictions may apply • Study Design – Randomized trial of a home-based intervention designed to improve household routines known to be associated with childhood obesity. • Intervention: Six-month intervention that promoted 4 household routines using the following: 1) Motivational coaching at home (4 visits) and by telephone (4 calls). 2) Mailed educational materials. 3) Text messages (2 times/week). • Control: Mailed materials focused on child development. • Setting – Delivered in families’ homes. • Participants – Total of 121 families with children aged 2 to 5 years who had a TV in the room where he or she slept. Methods
4. Copyright restrictions may apply Methods • Outcomes – Main Outcomes • Change in parent report of frequency of 4 household routines from baseline to 6-month follow-up: – Frequency of family meals (meals per week). – Child sleep duration (hours per day). – Time watching TV (hours per week). – Presence of TV in the room where the child slept. – Secondary Outcome • Change in age- and sex-adjusted body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) by 6-month follow-up.
5. Copyright restrictions may apply Results • Participant Characteristics at Baseline (n = 111) – Child Characteristics • Mean (SD) age: 4.1 (1.1) years. • Mean BMI: 17.4 (45% overweight or obese). • Sex: 47.7% female, 52.3% male. • Race: 33.3% black, 51.4% Hispanic, 15.3% white or other. – Maternal and Household Characteristics • Mean (SD) maternal BMI: 27.9 (6.1). • Education: 54.2% had obtained a high school diploma or less. • Marital status: 48.6% were married/cohabitating. • Household income: 55.1% earned ≤$20 000/year.
6. Copyright restrictions may apply Results • Compared with controls at 6-month follow-up, intervention participants had the following: – Longer sleep duration. • Difference of +0.75 h/d (P = .03). – Larger decrease in TV viewing on weekends. • Difference of -1.06 h/d (P = .02). – Lower BMI. • Difference of -0.40 (P = .05). • No significant intervention effect was found for the presence of a TV in the room where the child slept (P = .29) or for family meal frequency (P = .56).
7. Copyright restrictions may apply Comment • Healthy Habits, Happy Homes is the first home-based randomized trial to address key household routines related to obesity risk among young children. • This multicomponent intervention that used individually tailored counseling focused on improving household routines was found to increase children’s sleep duration and reduce children’s TV viewing on weekends and BMI compared with controls. • No significant effect on frequency of family meals was found. • Frequency at baseline was already high. • No significant effect on the presence of a TV in the room where the child slept was found. • The majority of children (80%) co-slept with their parents, who may have had a TV in their room.
8. Copyright restrictions may apply • The intervention was developed based on extensive formative research to ensure the intervention was contextually appropriate for the target population. • The use of mobile technology (text messaging) to encourage behavior change is novel. • Limitations – May not be generalizable to socioeconomically advantaged populations. – Low response rate. – Use of parental report measures. – Follow-up period was only 6 months long; a longer follow-up period would be needed to determine whether changes in BMI were sustained. Comment
9. Copyright restrictions may apply • If you have questions, please contact the corresponding author: – Elsie M. Taveras, MD, MPH, Division of General Pediatrics, Department of Pediatrics, Pediatric Population Health Management, Massachusetts General Hospital for Children, 100 Cambridge St, 15th Floor, Mail Code M100C1570, Boston, MA 02114 (etaveras@partners.org). Funding/Support • This work was supported by the Centers for Disease Control and Prevention and the National Center for Chronic Disease Prevention and Health Promotion (Prevention Research Centers grant 1U48DP00194). Conflict of Interest Disclosures • None reported. Contact Information