Niños Sanos, Familia Sana: A Multi-Component Intervention to Prevent Obesity in Mexican-Heritage Children in Rural California

Adela de la Torre, Lucia Kaiser, Banafsheh Sadeghi, Yvette Flores, Richard Green, Ulfat Shaikh, Meagan Hanbury, Alberto Aguilera, Linda Whent

Abstract #NP31

Methods

Discussion and Conclusion Objectives: To fill a gap in knowledge related to effective interventions in Mexican-heritage populations, this study had four aims: 1) slow down the rate of weight gain among intervention children compared to controls; 2) identify mediating factors related to economic and nutrition education intervention components; 3) develop a culturally-adapted nutrition and physical activity curriculum for families; and 4) increase cultural competency of university students.

Description: In 2012, the Niños Sanos, Familia Sana study began a three-year community-based intervention that provided a monthly voucher to buy fruits and vegetables; an enhanced, school-based, physical activity program; and nutrition and physical activity education targeting Mexican-heritage families with children ages 3-8 years. A comparison community received family educational programs (not nutrition-related).

Evaluation: Follow-up anthropometric measures were analyzed for 387 intervention and 313 comparison children. After three years, obese boys and girls had a significantly lower rate of body mass index gain in the intervention group compared to controls (interaction obesity status by treatment, p=0.05). Household purchases included a wide variety of produce, with bananas, apples, tomatoes, avocadoes, mangoes, strawberries, pineapples, cucumbers, limes, and oranges being most frequently selected (n=227). Frequency of consuming energy-dense foods decreased significantly in the intervention children over three years compared to controls (n=175, p=0.008).

Conclusion and Implications: This study will yield insights to guide government nutrition and food assistance programs in promoting behavioral change and preventing obesity in similar high-risk populations.

Text Introduction

Funding This project was supported by Agriculture and Food Research Initiative Competitive Grant no. 2011-68001-30167 from the USDA National Institute of Food and Agriculture. UC ANR provided support for the extension specialists and advisors who designed the nutrition education components.

References

Prevalence of childhood obesity is higher (22.4%) in Latino children ages 2-19 years than in non-Latino white children (14%). Though obesity rates have decreased among 2-5 year olds nationwide, racial and ethnic health disparities persist and indicate the urgency of early prevention efforts in high-risk communities. In 2012, University of California (UC) Davis faculty and students and UC Cooperative Extension specialists and advisors collaborated in conducting a five-year study (with three years of active intervention) to prevent childhood obesity in a Mexican-origin, rural farmworker community in California’s Central Valley. The Niños Sanos, Familia Sana (NSFS, Healthy Children, Healthy Family) was a community-based intervention that provided a monthly voucher to buy fruits and vegetables, an enhanced physical activity school-based program, and nutrition education to parents and their children ages 3-8 y in 2012. A comparison community received non-nutrition related educational programs and art projects. The three main goals of this integrated project were to: 1) Slow the rate of weight gain among intervention children, as compared to non-intervention children (research); 2) adapt UC Cooperative Extension science-based nutrition curricula for cultural propriety (extension); and 3) strengthen and increase the number of culturally competent UC Davis students (education).

Results

Research: During the five-year study, we followed 563 families with 700 eligible children (313 comparison and 387 intervention children) (1). Research staff recorded weight, height, and waist circumference of the children at baseline and every six months in the follow-up years from 2012-2015. Bilingual staff and college students interviewed the parents or primary caregivers yearly to collect data on household income, expenditures, child’s frequency of consuming 26 foods or beverages (2), food insecurity, food assistance participation, and other household information. Twice a year (winter and summer), we collected a month of food receipt data to complement scanner data on fruit and vegetable purchases from the local store that accepted the vouchers. Using an intent-to-treat analyses and repeated measures (Statistical software R , version 3.2.2), we examined log-transformed changes in body mass index (BMI) in a linear mixed effect model with random intercept and slope. We adjusted for the clustering effect of more than one child per household; child’s age and obesity status at baseline; and duration of exposure to the intervention. Sex-specific models were estimated. Similarly, a mixed model repeated measures analysis was used to examine the differences in children’s vegetable and fast food dietary patterns, adjusting for child gender, child age, child weight status, maternal acculturation, maternal years of education, household monthly income. Extension: The extension-led nutrition team developed culturally-adapted nutrition and physical activity lessons in collaboration with the community and provided oversight of the nutrition education delivery to parents over the three years (3). Each one-hour lesson included discussion, hands-on activities, and a cooking demonstration. UC CalFresh (SNAP-Ed) and the Expanded Food and Nutrition Education Program (EFNEP) provided school-based nutrition education to intervention children.

Education: We developed a new graduate-level course on Community-based Participatory Research at UC Davis every year since 2012. The project also provided opportunities for graduate students completing their masters or doctorate research.

1) De la Torre A, Sadeghi B, Green R, Kaiser LL, Flores Y, Jackson CF, Shaikh U, Whent L, Schaefer S. Niños Sanos, Familia Sana: Mexican immigrant study protocol for a multifaceted CBPR intervention to combat childhood obesity in two rural California towns. BMC 2013 Oct 31:13 1033 doi 10.1186/1471-2458-13-1033. 2) Kaiser LL, Aguilera A, Horowitz M, Lamp C, Johns M, Gomez-Camacho, Ontai, de la Torre. Correlates of food patterns in young Latino children at high-risk of obesity. Public Health Nutrition. 2015; 18(16):3042-3050. 3) Kaiser LL; Martinez J, Horowitz M, Lamp C, Johns M, Espinoza D, Byrnes M, Muñoz Gomez M, Aguilera A, Adela de la Torre, Adaptation of a culturally-relevant nutrition and physical activity program for low-income, Mexican-origin parents with young children. Prev Chronic Dis 2015;12:140591. DOI: http://dx.doi.org/10.5888/pcd12.140591 4) Sadeghi B, Kaiser LL, Schaefer S, Tseregounis IE, Martinez L, Gomez-Camacho R, et al. Multifaceted community-based intervention reduces rate of BMI growth in obese Mexican-origin boys. Pediatric obesity. 2016. Epub 2016/04/14.

Research

Table 1: Description of participants (n=700)

Figure 1: Mean BMI over time in intervention (n=387) and comparison (n=313) children

Figure 2: Children’s food patterns over time (intervention n=100; comparison n=75)

Extension Research: The results of the research study show that a multifaceted three-year community-based intervention can be effective in slowing weight gains among rural Mexican-heritage children (Sadeghi et al 2016). After controlling for age, obesity status at the time of joining the study, time-interval from baseline to measurement, and duration of participation in the study, the intervention was inversely associated with log-transformed BMI in obese boys (β = -0.063 +_ 0.021, P = 0.003) and girls (β = -0.046 +_ 0.021, P = 0.028). At the end of the second year of follow-up, we did not observe significant differences in children’s vegetable consumption (F=0.31, p=0.579) or total fruit and vegetable consumption (F= 0.79, p=0.375) between groups. A significant decrease was observed in fast and convenience foods among intervention children, compared to the control community by the end of year 2 (F=10.46, p=0.001). Extension: University and community partnerships can guide development of culturally-tailored, obesity prevention programs, suitable for use in high-risk, Mexican-origin audiences through community programs (3). Focus group feedback highlighted an immediate need to reach other household members and for environmental improvements at the school and community levels. With these improvements, a curriculum for parents, focused on physical activity and nutrition, can contribute to childhood obesity prevention. Education: In 2016, the Chichano(a) Studies Department at UC Davis agreed to continue offering the new course in Community-based Participatory Research methods to graduate students. This course has attracted graduate students from diverse disciplines including nutrition, nursing, education, international agricultural development, and public health. Course evaluations for 2013-2015 ranged from 4.7-4.8 (out of 5.0 points).

Education

Awarded Degrees: Nutrition and Public

Health Alberto Aguilera, PhD Michelle Byrnes, MPH

Mayra Muñoz Gomez, MS Lizette Rodriguez, MS Kristal Sheldon, MPH

Awarded Degrees: Agricultural and

Resource Economics Meagan Hanbury, PhD

Awarded Degrees: Education

Rosa Manzo, PhD Rosa Camacho-Gomez, PhD

Awarded Degrees: Nursing

Lisa Martinez, PhD Christy Solorio, MS

Degrees In Progress

Araceli Gonzalez (Education, PhD) Iraklis Tsereounis (Epidemiology, PhD)