MAP for Child Health: Using Social Networks to Improve child health and oral health

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Early Childhood Caries, along with obesity, are the most prevalent health disparities of childhood in the west. Both are closely associated with maternal feeding behaviors and cognitions. Educational and behavioral interventions—most directed at individual mothers—have shown disappointing results in recent decades, showing limited impact on child health and nutrition. Social-contextual features of the environment--community, neighborhood and household—are known to profoundly impact child feeding and other risk/protection behaviors. Working with low income immigrant families at high risk of child caries and obesity, this application will develop a neighbor-based social network intervention designed to reduce oral caries and obesity by modifying the social context in which child feeding and oral hygiene behaviors are embedded. MAP (“Mothers Action Project”) for Child Health—is a 12-month group intervention designed to decrease the risk of early childhood caries and other nutrition-related disease, among South Asian (SA) toddler and preschool (TP) children aged 1-5. Research from our team and others finds low income immigrant SA mothers to be highly vulnerable to influences from the social sphere which increase risks to child health. Many experience social pressure from elders in their social networks to feed TP children a diet heavy in milk, milk additives, sweets, and refined carbohydrates— all of which adversely impact oral and metabolic health. Accordingly, MAP-CH is a novel strategy to modify mothers’ social environment by creating new, health promoting social networks. During the UH3 Phase of the project, 126 clusters of mothers living in close physical proximity (12 per cluster, 1512 total) will be randomized 1:1 into intervention and control arms. Controls will receive health and parenting education materials. The intervention group will participate in a 12- month, group-based “Mothers’ Club.” Led by a skilled peer facilitator, each mothers’ club will receive an intervention designed to: 1) build close social ties, social support, and a sense of group identity among group members; 2) improve knowledge, attitudes and parenting skills related to feeding. The goal is to transform each ‘Mothers’ Club” club into a meaningful—and lasting-- social network that will support healthy behaviors at least 12 months beyond the end of the intervention. Network formation and social processes will be monitored in the pilot phase and throughout the trial using a network diagnostics framework to assess social integration and network cohesion. MAP-CH is the first child oral health intervention using a social network approach.