American Indian or Alaska Native
100%
Rosenstock, S., Ingalls, A., Cuddy, R. F., Neault, N., Littlepage, S., Cohoe, L., Nelson, L., Shephard-Yazzie, K., Yazzie, S., Alikhani, A., Reid, R., Kenney, A., & Barlow, A. (2021). Effect of a home-visiting intervention to reduce early childhood obesity among Native American children: A randomized clinical trial. JAMA Pediatrics, 175(2), 133–142. https://doi.org10.1001/jamapediatrics.2020.3557
Peer Reviewed
Model(s): Family Spirit®
Study Registration: ClinicalTrials.gov
This manuscript describes findings for an enhanced model, Family Spirit Nurture. For more information about Family Spirit Nurture, see the Tailored services and enhanced models section of Family Spirit's model page.
Child Health
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Statistical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| Age (in months) infant given first complementary food | 12 months old | High | 0.38 | Statistically significant, p= 0.04 | 126 children | Family Spirit Nurture vs. comparison, Shiprock, New Mexico, Navajo Nation, 2017-2019, full sample | |
| Age (months) when sugar-sweetened beverage first given | 12 months old | High | Not available | Not statistically significant, p= 0.59 | 122 children | Family Spirit Nurture vs. comparison, Shiprock, New Mexico, Navajo Nation, 2017-2019, full sample | |
| Ever introduced sugar-sweetened beverage | 6 months old | High | 0.03 | Not statistically significant, p= 0.94 | 128 children | Family Spirit Nurture vs. comparison, Shiprock, New Mexico, Navajo Nation, 2017-2019, full sample | |
| Ever introduced sugar-sweetened beverage | 9 months old | High | 0.08 | Not statistically significant, p= 0.67 | 128 children | Family Spirit Nurture vs. comparison, Shiprock, New Mexico, Navajo Nation, 2017-2019, full sample | |
| Ever introduced sugar-sweetened beverage | 12 months old | High | 0.14 | Not statistically significant, p= 0.34 | 128 children | Family Spirit Nurture vs. comparison, Shiprock, New Mexico, Navajo Nation, 2017-2019, full sample | |
| Infant sugar-sweetened beverage consumption, cups per week | 12 months old | High | 1.01 | Statistically significant, p< 0.01 | 122 children | Family Spirit Nurture vs. comparison, Shiprock, New Mexico, Navajo Nation, 2017-2019, full sample | |
| Introduced complementary food at 6 months postpartum or later | 12 months old | High | 0.48 | Statistically significant, p= 0.04 | 126 children | Family Spirit Nurture vs. comparison, Shiprock, New Mexico, Navajo Nation, 2017-2019, full sample |
This study included participants from the following locations:
- New Mexico
Study Participants
- Study participants were Navajo mothers ages 13 and older who had infants younger than 14 weeks. Researchers recruited participants through a pediatric clinic, the local Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and word of mouth.
- After the baseline assessment, 134 mothers were randomly assigned to the intervention group (68 mothers) or the comparison group (66 mothers).
- Outcomes were measured starting at six months postpartum and ending at 12 months postpartum.
- At enrollment, the average age of mothers was 27, and the average age of infants was around 2 months. About 84 percent of mothers were unemployed, and 81 percent were unmarried. In addition, about 35 percent of the families lacked reliable access to safe drinking water.
Setting
The study took place in Shiprock, New Mexico, on the Navajo Nation.
Intervention condition
Note: Navigate to the model page for more information about the home visiting model. See the source manuscript for more information about how the model was implemented in this study.
Comparison Conditions
- Families in the comparison group did not receive Family Spirit. Instead, they received three lessons at three, four, and five months after birth on injury prevention, including childproofing, safe travel with an infant, and preventing abuse and neglect.
- All families in both groups also received deliveries of safe drinking water for a period lasting from six to nine months after birth.
Funding Sources
This research was supported by Healthy Eating Research, a national program of the Robert Wood Johnson Foundation (grant 74132); the Navajo Area Indian Health Service (grants HHSI245201501072P and HHSI245201801201P); the Osprey Foundation (grant 132271); the McCune Charitable Foundation; and a private donor.
Study design characteristics contributing to rating
| Design | Random assignment compromised? | Attrition | Baseline equivalence | Confounding factors? | Valid, reliable measures? |
|---|---|---|---|---|---|
| Randomized controlled trial | No | Low |
Not assessed for randomized controlled trials with low attrition |
No |
Yes |
Notes from the review of this manuscript
Findings on infant body mass index (BMI) at ages 6, 9, and 12 months were not eligible for review because HomVEE does not review BMI outcomes measured before age 24 months. Findings on responsive feeding at ages 6, 9, and 12 months received a low rating because the measure did not meet HomVEE’s reliability standards. The internal consistency values reported for those time points were below HomVEE’s minimum threshold. Findings on infants’ sugar-sweetened drink intake at ages 6 and 9 months also received a low rating because they had high attrition and did not meet the baseline equivalence requirement. Information on measure reliability and baseline equivalence was obtained through correspondence with one of the study authors.