Strong Families Start at Home/Familias Fuertes Comienzan en Casa: A novel Video and Motivational Interviewing Intervention to improve diet quality of low-income, ethnically diverse children

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The diets of US children are suboptimal and effective primary prevention interventions are urgently needed to shape dietary behaviors early in life, especially among Latinx families, who experience higher prevalence of obesity and cardiovascular disease. The community energy balance framework suggests the need to intervene at multiple levels, while addressing cultural and contextual factors, to effectively impact diet quality for disease prevention including: 1) Child level, including appetitive traits (satiety responsiveness (sensitivity to internal satiety signals), food responsiveness (sensitivity to external food cues), and food fussiness; 2) Parent level including the food parenting practices they use to feed children; 3) Home level including the availability and accessibility of food, and; 4) Broader context including social determinants, food security/access to healthy foods. While there have been several interventions aimed at improving the diet quality of young children, few have targeted more than one of these levels and almost none are tailored to a child’s appetitive traits, culturally appropriate, and convenient for busy, working Latinx families. Further, most have only focused on what parents should not be doing, rather than supporting what they should be doing. This proposal will build on our recently completed R34 pilot feasibility trial (R34HL140229-01A1) to test the efficacy of a novel home-based intervention with 257 Latinx families of preschool children. The proposed 6-month intervention will include: 1) Three home visits by a community health worker (CHW) trained in brief motivational interviewing that include in-home cooking demonstrations to prepare a meal involving the child; using a family meal-time video to provide feedback on food parenting; 2) Screening for social-determinants of health and connecting families to federal/state/local resources; 3)Text-messages (2x/wk); 4) Tailored materials/messages; and 5) Three CHW phone calls to reinforce food parenting, food resource management and healthy eating. Specific Aims are to: Improve quality of the dietary intakes of 2–5-year-old children (Aim 1); Improve food parenting practices (Aim 2); and Improve the home availability of healthy foods (Aim 3). Exploratory aims will assess: the relationship between outcome measures and intervention dose; the relationship between outcome measures and potential mediators and moderators and the intervention’s effect on child BMI. This study fills an important research gap by targeting the home food environment with positive food parenting while acknowledging a child’s appetitive traits. It also meets the NIH call for needed research to reduce health disparities among Latinx populations and has the potential for high public health impact.