Dean Sidelinger, MD MSEd Division of Community Pediatrics University of California, San Diego

 Funding: First 5 Commission of San Diego  Duration: 3 years (2006 – 2009)  Investigators: P.I. Shelia Broyles Former Co-P.I. Dean Sidelinger Co-Director Howard Taras  Partners: South Bay Union School District Chula Vista Elementary School District National City School District South Bay Community Services Agency

 Proposition 10: Fifty cents/pack tobacco tax in California Funds programs for children 0 – 5  First 5 for Parents - RFA for evidence-based: Nutrition and physical activity training, Literacy programs, and/or Parent education  South Region of San Diego Partners met to strategize response UCSD Comm Peds chosen as the lead organization

 Adapt existing curricula for use with parents  Educate parents on the importance of nutrition & exercise  Provide parents with skills & resources needed to ensure a healthy, nurturing environment for their children  Evaluate the curricula & the feasibility of its use

 High rates of breastfeeding – protective against obesity  Several preschool programs in place (i.e. “Preschool for All”)  Greater resources and more obesity prevention programs are available to kids in elementary & higher grade levels  Long history of community-wide collaboration

San Diego’s South Region  Population 68% Hispanic (33% foreign born), predominantly Spanish speaking  Percentage of overweight children higher than state averages  Significant barriers to accessing preventive health care and quality nutrition

 Parents of children aged 2-4  English language learners  Low literacy parents  Target families over 3 years  Special Populations: Teen parents Families living in shelters

Mildred A. Horodynski, PhD, RNC and Manfred Stommel PhD  Improve eating habits in toddlers through better parent-toddler interaction during meal times

Christine Williams, MD, MPH  Improve physical activity and motor skills in children (ages 3-4)

Curricula adapted to meet target population’s needs:  Translated into Spanish  Adapted to meet various literacy levels  Specific areas of focus within curricula: Recipes Music

 NEAT Originally designed for 1-3 yo Utilized in house pediatric expertise  AT Originally designed for 3-5 yo Collaborated with developer Designed new activities Music an ongoing project

 Parent Educators Bilingual (English and Spanish) Outreach & Recruitment Conduct classes, home visits, data collection  Activities 10 classes alternating between physical activity & nutrition lessons 4 home visits after program completion

 Ten 90 minute classes AT one week (with PA activity for parents) NEAT the following week One focused on food labels & healthy choices  4 Home Visits after program completion 1, 2, 3, & 6 months post Survey administration Reinforcement and booster lessons Review diaries

Focus on improving service delivery  Process Evaluation Attendance sheets Parent exit survey Parent Educator feedback survey  Outcome Evaluation Pretest/posttest/follow-up Diaries

424 families participated 334 offered at least 10 classes 223 completed ≥ 7 classes 159 ≥ 1 home visit 143 attended ≥ 7 classes and completed pre/post surveys

 383/424 primary children were 2–4 yo  Approximately half were male – 201/424  Majority of families had a mother (or stepmother) participating (391/424)  Most parents self-identified as Latino (395/424) 351/424 reporting Spanish as their primary language spoken at home  Almost 2/3 of caregivers reported their highest education was in Mexico (269/424) Program start through

KnowledgePrePostp-value Food Guide Pyramid knowledge score (9 possible) <.001 Portion Size knowledge score (6 possible) <.001 Health Facts knowledge score (12 possible) < completers with matched pre/post

BehaviorPrePostp-value Estimated portions of fruits and vegetables per day Fiber frequency score (0 = less to 20 = more frequent) Fat frequency score (0 = less to 64 = more frequent) < completers with matched pre/post

Behavior (# days in a typical week) PrePostp-value How often does child participate in PA for at least 10 minutes at a time <.001 How often does parent take child outside for a walk or to play Number of days of parent physical activity for at least 20 minutes that makes you sweat or breathe hard completers with matched pre/post

BehaviorPrePostp-value Child TV Viewing (hours per week) <.001 Parent TV Viewing (hours per week) <.001 Television Viewing During Meals (0 = never to 4 = all the time) < completers with matched pre/post

 Enjoyment of NEAT AT2 – = less to 5 = more positive evaluation  Helpfulness of NEAT AT2 – = less to 5 = more positive evaluation  Recommendation to a friend – = strongly disagree to 5 = strongly agree 210/334 eligible participants

 The teachers serve as the evaluators  We are seeing variations among parent educators Some have higher retention  Location and timing of classes  All outcome measures are self-report  Some measures are not full validated instruments

Dean Sidelinger University of California, San Diego Division Of Community Pediatrics Join us in discovering new ways to improve community health!