Implementation of an early childhood obesity prevention intervention and physical activity- and screen time-related practices of Chinese-American parents of 6-month and 12-month old infants
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BACKGROUND: Obesity is an understudied, but important issue for Chinese-American children. While overall rates of child obesity among Chinese-Americans are lower than in other racial/ethnic minority populations, about 1 in 4 low-income school-aged Chinese-American children are classified as overweight or obese, with the prevalence among male children as high as 40%. Despite the need to address obesity prevention, especially among younger, pre-school-aged Chinese-American children, strategies to prevent obesity early in life have not been well-studied for this population. OBJECTIVE: To examine activity and screen time related behaviors in a low-income Chinese-American population, before and after implementation of an early childhood obesity prevention intervention (Greenlight) in a primary care setting serving predominantly low income families. METHODS: This was a pre-, post-intervention analysis of physical activity- and screen time- related outcomes associated with the implementation of the Greenlight intervention, a health literacy-informed early child obesity prevention program, which was culturally adapted for low-income Chinese-Americans, and implemented in a federally qualified health center in New York City’s Chinatown. Greenlight consists of: 1) low literacy handouts and “tangible tools” (e.g. portion size bowls) given at each well-child check (WCC), 2) physician communication training (e.g. use of written handouts to support verbal counseling, teach-back, goal-setting), and 3) 1:1 health educator encounters in waiting room. Pre-implementation parent-child dyads were consecutively enrolled at their 6- or 12-month well-child check (WCC) (n=70 and n=74 respectively). The cohort of post-implementation parent-child dyads was consecutively enrolled between 0-3 months of age (n=200) and followed at their 6-month (n=159) and 12-month (n=146) WCCs. Inclusion criteria for the dyads included: parent spoke Cantonese, Mandarin or English; parent/child of Chinese descent; and child born full term (≥37 weeks gestation). Primary outcome variables were: 1) meeting physical activity recommendations (>30 minutes of tummy time at 6 months of age; >60 minutes of active time (crawling, scooting, active play) at 12 months of age; based on American Academy of Pediatrics (AAP) recommendations), 2) meeting screen time recommendations (0 minutes of screen time, based on AAP recommendations at 6 and 12 months of age). Multiple logistic regression analysis was performed, adjusting for child age, child gender, use of out of home daycare, parent age, primary language at home, and education. RESULTS: Six-month olds in the post-implementation period had a 5-fold increased odds of meeting the physical activity recommendation compared to pre-implementation (pre vs. post: 30.3 vs. 63.0%, p<0.001; AOR=5.0[2.5-10.1]. Twelve-month olds in the post-Greenlight implementation period had a nearly 20-fold increased odds of meeting the physical activity recommendation compared to pre-implementation (pre vs. post: 76.5 vs. 98.6%, p<0.001; AOR=19.4 [4.1-91.7]). Overall, screen time minutes were low in the pre- and post-implementation periods, with median television screen time <5 minutes at 6 months and <10-15 minutes at 12 months. There were no statistically significant differences by pre- vs. post-implementation status related to meeting the AAPs screen time recommendation of no screen time, in both unadjusted and adjusted analyses. CONCLUSION: At 6 and 12 months, implementation of Greenlight was associated with parent ability to meet physical activity-related recommendations. Overall use of screen time was low, and no differences were seen in parent ability to meet screen time recommendations. Further study is needed to identify additional strategies to address screen time use in infants.