(View plain language abstract)
Obesity-promoting behaviours are established during early childhood and likely track. Parents are acknowledged as a key focus for lifestyle based interventions. Opportunities for obesity prevention, promotion of healthy eating, physical activity and reduced sedentary behaviours are poorly understood and urgently required. Preliminary results from the cluster-RCT known as the Infant Feeding Activity and Nutrition Trial (InFANT) shows many significant positive outcomes and holds promise as an approach that can be adopted successfully in existing public health services. The published protocol for the InFANT study can be found at http://www.biomedcentral.com/1471-2458/8/103. This application seeks funding to enhance an existing program of obesity-prevention research, which aims to describe how best to support families to promote obesity preventive behaviours from early infancy.
The study proposed will deliver an extended version of InFANT, a parent-focused intervention delivered to parents in their existing social networks until children are 18-months of age. This expanded intervention, known as InFANT- Extend speaks to data showing that parent's self-efficacy regarding promoting positive child health behaviours diminishes across early childhood and that this is associated with poor diet and sedentary behaviour outcomes. InFANT – Extend will comprise an individual-level assessment when the child is 18-months old. This will inform the subsequent delivery of tailored lifestyle behaviour support via the delivery of four tailored newsletters per annum for the subsequent two-years.
This study will assess the effectiveness of a 39-month parent-focused child obesity-prevention intervention (compared with a no-intervention control) and assess whether an extended intervention provides greater benefit than the established 15-month InFANT intervention.
This cluster RCT (InFANT-Extend) will replicate the InFANT study design and incorporate an additional iterative intervention delivered until child is aged 3.5 years. Recruitment will involve: randomly selecting local government districts in Melbourne, Australia from each of low, middle and high socio-economic areas; randomly selecting (proportionately) Maternal and Child Health Centres (MCHC) - the unit of randomisation; recruiting first-time parents of infants aged approximately three-months participating in MCHC initiated first-time parent's groups; randomly assigning groups to intervention or control.
Intervention will involve: delivery of six quarterly group-sessions (child aged 3-18 months); six between session mailed newsletters reinforcing session messages; purpose-designed InFANT DVD used in sessions and as take-home resource; control-group receive usual care plus quarterly generic child health newsletters. At 18-months of age intervention will involve, as noted above, individually tailored support for two years (until child is 3.5 years).
Published reviews of obesity-prevention interventions and the positive preliminary results arising from InFANT highlight that early childhood interventions are capable of influencing obesity-promoting behaviours. Such early intervention holds promise for prevention of obesity and the well documented associated health consequences, including cancer. This study will provide internationally unique data regarding promising and achievable public health interventions to prevent childhood adiposity.
Getting children's healthy eating and activity right from the start.
Many children are becoming overweight or obese and this will affect their health in the short and the longer terms. We know that from as young as 18 months of age children are adopting eating and activity behaviours that will promote weight gain. Given this, it is important that we seek to understand how best to prevent childhood obesity. As parents have great potential to influence children's health behaviours, parent-based programs that support parents to develop knowledge and skills likely to help their child achieve a healthy weight are important. It is also important that we understand how we can most cost-effectively prevent childhood obesity.
This study aims to assess the impact of a low-cost approach of supporting first time parents to develop knowledge and skills to promote healthy lifestyles in their growing children. This study builds on an existing and likely successful program which targeted first-time parents until infants reached 18 months of age. Given children's increased demandingness and independence at around age two, it is appropriate to find cost-effective ways to continue to support parents through a child's early life until a time when behaviours such as healthy eating and regular physical activity become established. This study will be run through existing first-time parent groups established in Melbourne, Australia by the Maternal and Child Health Services. It involves six quarterly group education sessions delivered over 15 months and will be followed up - at a time when many parents are returning to the work force and hence groups are no longer so accessible - with individually tailored advice to support parents with knowledge and skills to promote healthy eating and activity behaviours in their child.
It seems likely that we can improve children's eating and activity behaviours and hence reduce childhood fatness, by supporting parents with much needed knowledge and skills. One challenge remains; knowing how long and how intensively parents need such support to achieve these positive outcomes. This research will help to answer these important questions.