The CHALO ("Child Health Action to Lower Oral Caries and Obesity") -- from an Urdu word meaning "Let's go!"-is a multi-level strategy to reduce pediatric obesity and dental caries risk in South Asian (SA) children. Obesity and caries are the two most prominent health disparities of early childhood. Both caries and obesity: a) disproportionately impact low-income children of color, b) share common risk behaviors, i.e., feeding practices, and c) can most effectively be reduced or prevented prevention in infancy and early childhood. SA immigrant children are at high risk for both. CHALO includes both a randomized controlled trial (RCT) aimed at reducing risk behavior, and a Knowledge Translation project to raise awareness in SA lay and professional communities regarding child health risks.
CHALO builds upon the team's prior research re: cariogenic (R34-DE-022282) and obesogenic behaviors (10, 14, 15). CHALO's intervention components-- home visits, phone support, and "patient navigation" to dental visits-- proved to be feasible and acceptable. In the pilot R34, there were promising behavioral change on all measures. CHALO builds on this work, with the addition of: a) sippy cups as an intervention target, b) an iPad-based dietary recall tool, "MySmileBuddy," c) caries and obesity data, and; d) increased intervention contacts- consistent with recent child obesity and caries interventions (16, 17). An RCT (Aim 1) will enroll 360 mothers of children 4-6 month olds from New York City (n=3) and New Jersey (n=2) pediatric practices in SAPPHIRE ("SA Practice Partnership for Health Improvement and Research"). The Community Health Worker intervention includes: a) home visits with mothers/families (n=6 visits over one year) and follow up telephone support; b) patient navigation to make/keep timely dental visits (2x by 18 months). The Knowledge Translation component (Aim 2) will raise awareness of child health risks in SA communities and among professionals who provide their care. The campaign will include both traditional and social media components and will be evaluated using multiple metrics.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
380
Per Arm/Group Description, CHWs will provide a pamphlet and dental referral list to participants both groups.
Per Arm/Group Description, CHWs will a) conduct 6 home visits with mothers/families over a 12 month period along with follow-up phone support, and b) patient navigation support for child to receive 2 dental visits: one by 12 months of age and one by 18 months of age.
Healthy Kids Pediatric Group
East Windsor, New Jersey, United States
Robert Wood Johnson University Hospital
New Brunswick, New Jersey, United States
Smart Medical Care
Jamaica, New York, United States
Dr. Masub's Medical and Dental Office
Queens, New York, United States
Morris Heights Health Center
The Bronx, New York, United States
Jacobi Medical Center
The Bronx, New York, United States
Montefiore Medical Group
The Bronx, New York, United States
North Central Bronx Hospital
The Bronx, New York, United States
Quantity of (Combined) Sippy Cup and/or Bottles (Common Risk/Behavioral)
Number and amount of sippy cups + bottles/day consumed by child, obtained by RA assessment using MySmileBuddy
Time frame: 18 months of age (final follow-up [T2])
Added Sweeteners/Solids (Common Risk/Behavioral)
Number of sweeteners and/or solids/day added to child's sippy sups/bottles, obtained by RA
Time frame: 18 months of age (final follow-up [T2])
Fruits & Vegetables (Common Risk/Behavioral)
Frequency of servings/day obtained by RA assessment using MySmileBuddy
Time frame: 18 months of age (final follow-up [T2])
Juice & Sweet Drinks (Common Risk/Behavioral)
Frequency of servings/day obtained by RA assessment using MySmileBuddy
Time frame: 18 months of age (final follow-up [T2])
Use of Bottles/Sippy Cups at Nap or Bedtime (Common Risk/Behavioral)
Frequency of child drinking from a bottle or sippy cup/day when put down to bed or nap by RA assessment using MySmileBuddy
Time frame: 18 months of age (final follow-up [T2])
Sweet & Salty Snacks (Common Risk/Behavioral)
Frequency of servings obtained by RA assessment using MySmileBuddy
Time frame: 18 months of age (final follow-up [T2])
Physical Activity (Obesity/Behavioral)
Time child spent in active play, assessed by parent completed questionnaire
Time frame: 18 months of age (final follow-up [T2])
Screen Time (Obesity/Behavioral)
Time child spent in front of TV, computer, iPaD, or phone, assessed by parent completed questionnaire
Time frame: 18 months of age (final follow-up [T2])
Tooth Brushing (Caries/Behavioral)
Frequency of parent wiping/brushing teeth, assessed by parent completed questionnaire
Time frame: 18 months of age (final follow-up [T2])
Dental Visits (Caries/Behavioral)
Number of dental visits (child), assessed by parent completed questionnaire
Time frame: 18 months of age (final follow-up [T2])
Visible Caries
Any visible caries by intra-oral camera (yes/No)
Time frame: 18 months of age (T2).
Caries Severity
dfs index
Time frame: 18 months of age (T2)
Weight-for-length
BMI-for-age Z scores, standardized for sex and actual age at measurement at the baseline (T0), T1 (12 m.) and T2 (18 m.) interviews. We will categorize children as "overweight" and "obese" if their BMI-for-age Z-scores exceed +2 and +3, respectively, as recommended by the WHO
Time frame: 18 months of age (T2)
Change in Weight Velocity Z Scores
Weight velocity Z scores: for each 6 month period: 6 m.\>12 m. 12 m.\>18m
Time frame: see above
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