Asian
3.20%
Source
Peer reviewed?
Yes
Paul, I. M., Savage, J. S., Anzman-Frasca, S., Marini, M. E., Beiler, J. S., Hess, L. B., ... & Birch, L. L. (2018). Effect of a responsive parenting educational intervention on childhood weight outcomes at 3 years of age: the INSIGHT randomized clinical trial. JAMA, 320(5), 461-468. https://doi.org/10.1001/jama.2018.9432
Study Registration
Funding Sources
This research was supported by Award Numbers R01DK088244 and UL1TR000127 from the National Institutes of Health and 2011-67001-30117 from the U.S. Department of Agriculture. The research was also supported by the Children’s Miracle Network at Penn State Health Children's Hospital and the Penn State Clinical and Translational Science Institute.
Study Design
| Design | Attrition | Baseline equivalence | Confounding factors | Valid, reliable measures? |
|---|---|---|---|---|
| Randomized controlled trial | Low | Not assessed for randomized controlled trials with low attrition |
No |
Yes, details reported below for findings on valid, reliable outcomes that otherwise rate at least moderate |
Notes
Information on sample sizes and details about findings on body-mass index were based on correspondence with the author. The authors reported several findings that are not eligible for review because they do not examine the impact of the intervention on an eligible outcome.
Study Participants
Study participants were mother and infant dyads recruited after delivery in one Pennsylvania hospital. To be eligible, dyads had to include full-term, singleton births, with infants of normal birth weight. Mothers were English-speaking, primiparous, and at least 20 years old. A total of 291 dyads were randomly assigned to either the Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) intervention (145 dyads) or a comparison intervention (146 dyads). Mother–infant dyads were randomly assigned to the INSIGHT intervention or the comparison intervention two weeks after birth, and outcomes were measured until the children’s third birthday. In the study, 89 percent of mothers were White, 6 percent were Black, 3 percent were Asian, and 1 percent reported another race. Seven percent of mothers reported Hispanic ethnicity.
Setting
The study took place in Hershey, Pennsylvania.
Home Visiting Services
INSIGHT consisted of home visits conducted when infants were 3 to 4, 16, 28, and 40 weeks old, followed by annual clinic-based visits at 1, 2, and 3 years old. The curriculum taught parents to respond promptly and in developmentally appropriate ways to infant cues across four behavioral states (drowsy, sleepy, fussy, and alert/calm). Research nurses provided parents with developmentally appropriate sleep guidance during each visit. The guidance addressed bedtime routines, sleep location, and night waking. During and between visits, caregivers were provided with information and resources on responsive feeding, lactation support, soothing practices, and home safety (including crib safety and choking hazards). When infants were 2 weeks old, participants received a mailed packet with information on infant feeding.
Comparison Conditions
Families assigned to the comparison condition were not eligible to receive intervention services through the INSIGHT program. However, these families received a similar number of home visits as the INSIGHT group (when infants were 3 to 4, 16, 28, and 40 weeks old) and annual clinic-based visits at 1, 2, and 3 years old. The home visits focused solely on home safety topics, including crib safety. When infants were 2 weeks old, participants received a mailed packet with information on infant feeding.
Were any subgroups examined?
No
Subgroups examined
• Boys • Girls • Intended feeding mode (breastfeeding) • Intended feeding mode (formula)
Findings that rate moderate or high in this manuscript
| Outcome measure | Timing of follow-up | Rating | Effect size | Stastical significance | Sample size | Sample description |
|---|---|---|---|---|---|---|
BMI (in standardized units) |
3 years old |
High | -0.28 | Statistically significant, p= 0.04 |
232 children | INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample |
BMI percentile |
3 years old |
High | -0.24 | Not statistically significant, p= 0.07 |
232 children | INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample |
Percent overweight |
3 years old |
High | -0.41 | Not statistically significant, p= 0.07 |
232 children | INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample |
Percent obese |
3 years old |
High | -0.70 | Not statistically significant, p= 0.08 |
232 children | INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample |
BMI (in standardized units) |
2 years old |
High | -0.21 | Not statistically significant, p= 0.10 |
243 children | INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample |
BMI percentile |
2 years old |
High | -0.15 | Not statistically significant, p= 0.26 |
243 children | INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample |
Percent overweight |
2 years old |
High | -0.43 | Statistically significant, p= 0.04 |
243 children | INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample |
Percent obese |
2 years old |
High | -1.47 | Statistically significant, p= 0.01 |
243 children | INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample |
Accelerated weight gain |
16 weeks old |
High | -0.19 | Not statistically significant, p= 0.44 |
269 infants | INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample |
Accelerated weight gain |
1 year old |
High | -0.05 | Not statistically significant, p= 0.97 |
253 children | INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample |
Conditional weight gain |
28 weeks old |
High | Statistically significant, p <.01 |
262 children | INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample |
|
Weight-for-age below 5th percentile |
3 years old |
High | 0.39 | Not statistically significant, p = 0.22 |
279 children | INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample |
Downward crossing of 2 major percentile lines for height and weight |
3 years old |
High | -0.32 | Not statistically significant, p = 0.47 |
279 children | INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample |
BMI |
4 weeks old |
High | -0.43 | Statistically significant, p <.01 |
279 children | INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample |
BMI |
16 weeks old |
High | -0.27 | Statistically significant, p = 0.03 |
269 children | INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample |
BMI |
28 weeks old |
High | -0.39 | Statistically significant, p <.01 |
262 children | INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample |
BMI |
40 weeks old |
High | -0.33 | Statistically significant, p = 0.01 |
259 children | INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample |
BMI |
1 year old |
High | -0.28 | Statistically significant, p = 0.02 |
253 children | INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample |
BMI |
2 years old |
High | -0.21 | Not statistically significant, p = 0.10 |
243 children | INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample |
BMI |
3 years old |
High | -0.32 | Statistically significant, p = 0.02 |
232 children | INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample |
This study included participants with the following characteristics at enrollment:
Race/Ethnicity
Maternal Education
Other Characteristics
This study included participants from the following locations:
- Pennsylvania