Longitudinal Intervention Effects on Parenting of the Aventuras para Niños Study

Background

Parenting interventions have achieved changes in factors associated with childhood obesity but few have tested the effects on multiple parental influences.

Purpose

This study examined the efficacy of an intervention aimed at improving several dimensions of parenting related to childhood obesity.

Design

The study used a 2 × 2 factorial design.

Setting/participants

In 2003, a sample of 13 Southern California schools was randomized to one of four conditions: micro-environment only, macro-environment only, micro-plus-macro–environment, and no treatment control condition. Participants included 811 predominantly Mexican immigrant/Mexican-American mothers with children in kindergarten through second grade.

Intervention

In both micro conditions, participants received monthly home visits by a promotora over a 7-month period plus monthly mailed newsletters.

Main outcome measures

In 2008, intervention effects were examined on (1) parenting strategies, including limit setting, monitoring, discipline, control, and reinforcement related to children's diet and physical activity; (2) parental support for physical activity; (3) parent-mediated family behaviors such as family meals eaten together and TV watching during family dinners; and (4) perceived barriers and other parent cognitions related to children's eating and activity.

Results

At the 2-year follow-up, significant improvements were observed in three of five parenting strategies, parental support, and two of four parent-mediated family behaviors among parents receiving the micro intervention (i.e., those who received promotora visits and monthly newsletters), as compared with those in the macro-only and control conditions.

Conclusions

Aspects of parenting related to children's risk for obesity and related health outcomes are modifiable with the support of a promotora and print media.

Introduction

The prevalence of overweight and obesity among U.S. children, especially pronounced among Mexican-American youth,¹ necessitates the implementation of interventions that target factors contributing to this epidemic. Socioecologic theory,² as well as frameworks presented by Rhee,³ Ventura and Birch,⁴ and Birch and Davison,⁵ indicate that parenting is among the most important family-level determinants of childhood obesity. At least five mechanisms by which Latino parents influence their children's risk for obesity have been identified: (1) parenting style (a more indulgent parenting style is associated with greater risk for obesity6, 7); (2) parenting strategies (parents who use more monitoring, more positive reinforcement, and less controlling parenting strategies have children who consume a healthier diet and are more physically active⁸); (3) provision of instrumental support (more instrumental support for physical activity is associated with normal weight⁹); (4) family behaviors (parents who purchase fast food for consumption at home at least once per week or more have children who consume more soda and more fat¹⁰); and (5) modeling of health behaviors (parents and children who eat away-from-home foods at least once per week are at greater risk for being overweight/obese¹¹). These family-level determinants demonstrate that health status is determined, in part, by social and structural aspects of the home and community environments.12, 13, 14, 15, 16

Several interventions have targeted parenting skills related to childhood obesity,17, 18, 19, 20, 21 yet few have examined changes in parenting18, 20, 22 and others did not target parenting explicitly although intervention activities were directed at the parents.23, 24, 25 One study determined that changes in childhood weight were explained, in part, by reductions in mothers' use of a permissive parenting style.¹⁸ Reductions have been noted in the use of restrictive child feeding practices subsequent to an intervention,²² although in another study no intervention effects were observed on parents' modeling of healthy behaviors.²⁰ Moreover, most of these parenting interventions were delivered by highly trained professionals (e.g., clinician dietitians and social workers,¹⁸ early-childhood specialist²⁰), making it difficult to conclude that similar results could be achieved with intervention agents that do not have such formal training.

The present study describes the implementation and long-term efficacy of a childhood obesity intervention targeting parental influences facilitated by promotoras. Specifically, this study examined the extent to which promotoras facilitate changes on four dimensions of parenting associated with childhood obesity risk: parenting strategies, parental support, parent-mediated family behaviors, and cognitive factors (i.e., perceptions). The promotora model involves community members who live among or at least are similar to the target population providing effective informational, instrumental, and emotional support for health behavior change.26, 27, 28, 29, 30, 31, 32, 33