Abstract
Purpose: To determine whether a lifestyle intervention embedded within Parents as Teachers (PAT), a national child development and parenting home visiting program, helped families make food-related home environment changes.Design: Secondary data analysis of a stratified randomized pragmatic trial. (Trial Registration: This study is registered at www.clinicaltrials.gov NCT01567033).Setting: Participant homes in St. Louis, Missouri.Subjects: Women (n = 179 with pre-post data, of 230 with baseline) participating in standard PAT, with overweight or obesity, and at least one preschool child with BMI percentile ≥60%.Intervention: PAT + Healthy Eating and Active Living Taught at Home (HEALTH), embedded elements of the Diabetes Prevention Program within the standard PAT curriculum. PAT + HEALTH addressed specific behaviors that impact caloric intake (e.g., sugar-sweetened beverages), focusing on behavioral and environmental strategies. Consistent with PAT practice, the frequency, number, and focus (i.e., time spent on intervention components) of home visits were determined by the family's needs; dose structure was flexible [on average intervention: 23 (SD = 9), usual care: 13 (SD = 6) visits].Measures: Food availability/accessibility and distractions in the home were assessed with items drawn largely from the HomeSTEAD Survey.Analysis: Generalized estimating equations (GEEs) were used to test equality of changes between baseline and 24 months in the intervention and usual care groups.Results: The only significant difference in the pattern of change between usual care and intervention was soda availability/accessibility (p = 0.013).Conclusion: This embedded intervention successfully reduced availability/accessibility of sugar-sweetened beverages in the home. However, given the limited impact on other food-related home environment factors, future interventions could seek to more effectively intervene on all aspects of the home environment.
Highlights
Obesity is prevalent in the United States and worldwide [1, 2], and is associated with diabetes and other acute and chronic conditions [2]
The data for this study are drawn from a pragmatic trial promoting lifestyle change to prevent weight gain in women [30], implemented within Parents as Teachers (PAT) affiliated programs located across eight St
There were no significant differences between usual care or intervention participants at baseline, with one exception: intervention participants were generally less educated than participants in the usual care group (Table 1)
Summary
Obesity is prevalent in the United States and worldwide [1, 2], and is associated with diabetes and other acute and chronic conditions [2]. Research on children and youth has indicated that the home environment and meal practices have important associations with dietary behaviors [4,5,6,7,8,9,10]. This includes negative associations between availability of unhealthy food choices, and intake of these foods [8, 9, 11,12,13]. This research has primarily drawn from observational studies, making it difficult to determine the direction of the associations
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