NEAT AT2

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NEAT AT2

• Dean Sidelinger, MD MSEd
• Division of Community Pediatrics
• University of California, San Diego

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Nutrition Education Aimed at Toddlers and Animal
Trackers for ages 2 4

• Funding First 5 Commission of San Diego
• Duration 3 years (2006 2009)
• Investigators
• P.I. Shelia Broyles
• Former Co-P.I. Dean Sidelinger
• Co-Director Howard Taras
• Partners
• South Bay Union School District
• Chula Vista Elementary School District
• National City School District
• South Bay Community Services Agency

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History

• Proposition 10
• Fifty cents/pack tobacco tax in California
• Funds programs for children 0 5
• First 5 for Parents - RFA for evidence-based
• Nutrition and physical activity training,
• Literacy programs, and/or
• Parent education
• South Region of San Diego
• Partners met to strategize response
• UCSD Comm Peds chosen as the lead organization

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South Region of San Diego
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Goals

• Adapt existing curricula for use with parents
• Educate parents on the importance of nutrition
  exercise
• Provide parents with skills resources needed to
  ensure a healthy, nurturing environment for their
  children
• Evaluate the curricula the feasibility of its
  use

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Community Assets

• High rates of breastfeeding protective against
  obesity
• Several preschool programs in place (i.e.
  Preschool for All)
• Greater resources and more obesity prevention
  programs are available to kids in elementary
  higher grade levels
• Long history of community-wide collaboration

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Community Needs

• San Diegos South Region
• Population 68 Hispanic (33 foreign born),
  predominantly Spanish speaking
• Percentage of overweight children higher than
  state averages
• Significant barriers to accessing preventive
  health care and quality nutrition

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Target Population

• Parents of children aged 2-4
• English language learners
• Low literacy parents
• Target -1038 families over 3 years
• Special Populations
• Teen parents
• Families living in shelters

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NEAT

• Mildred A. Horodynski, PhD, RNC and Manfred
  Stommel PhD
• Improve eating habits in toddlers through better
  parent-toddler interaction during meal times

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Animal Trackers (AT)

• Christine Williams, MD, MPH
• Improve physical activity and motor skills in
  children (ages 3-4)

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Adaptation Cultural Sensitivity

• Curricula adapted to meet target populations
  needs
• Translated into Spanish
• Adapted to meet various literacy levels
• Specific areas of focus within curricula
• Recipes
• Music

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Adaptation Age level

• NEAT
• Originally designed for 1-3 yo
• Utilized in house pediatric expertise
• AT
• Originally designed for 3-5 yo
• Collaborated with developer
• Designed new activities
• Music an ongoing project

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Logistics

• Parent Educators
• Bilingual (English and Spanish)
• Outreach Recruitment
• Conduct classes, home visits, data collection
• Activities
• 10 classes alternating between physical activity
  nutrition lessons
• 4 home visits after program completion

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Timeline

• Ten 90 minute classes
• AT one week (with PA activity for parents)
• NEAT the following week
• One focused on food labels healthy choices
• 4 Home Visits after program completion
• 1, 2, 3, 6 months post
• Survey administration
• Reinforcement and booster lessons
• Review diaries

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Evaluation

• Focus on improving service delivery
• Process Evaluation
• Attendance sheets
• Parent exit survey
• Parent Educator feedback survey
• Outcome Evaluation
• Pretest/posttest/follow-up
• Diaries

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Families to Date (03-31-2008)
143 attended 7 classes and completed pre/post
surveys
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Preliminary Demographics

• 383/424 primary children were 24 yo
• Approximately half were male 201/424
• Majority of families had a mother (or stepmother)
  participating (391/424)
• Most parents self-identified as Latino (395/424)
• 351/424 reporting Spanish as their primary
  language spoken at home
• Almost 2/3 of caregivers reported their highest
  education was in Mexico (269/424)

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Preliminary Results - Knowledge
Knowledge Pre Post p-value
Food Guide Pyramid knowledge score (9 possible) 3.01 5.86 lt .001
Portion Size knowledge score (6 possible) 2.13 4.11 lt .001
Health Facts knowledge score (12 possible) 9.35 10.74 lt .001
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Preliminary Results - Dietary
Behavior Pre Post p-value
Estimated portions of fruits and vegetables per day 4.27 4.56 .156
Fiber frequency score (0 less to 20 more frequent) 8.24 8.79 .060
Fat frequency score (0 less to 64 more frequent) 26.36 21.98 lt .001
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Preliminary Results PA
Behavior ( days in a typical week) Pre Post p-value
How often does child participate in PA for at least 10 minutes at a time 2.98 3.41 lt .001
How often does parent take child outside for a walk or to play 2.13 2.46 .006
Number of days of parent physical activity for at least 20 minutes that makes you sweat or breathe hard 2.92 3.67 .001
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Preliminary Results - TV Viewing
Behavior Pre Post p-value
Child TV Viewing (hours per week) 18.03 12.03 lt .001
Parent TV Viewing (hours per week) 16.57 11.04 lt .001
Television Viewing During Meals (0 never to 4 all the time) 1.68 1.14 lt .001
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Parent Exit Surveys

• Enjoyment of NEAT AT2 4.94
• 1 less to 5 more positive evaluation
• Helpfulness of NEAT AT2 4.96
• 1 less to 5 more positive evaluation
• Recommendation to a friend 4.95
• 1 strongly disagree to 5 strongly agree

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Some Limitations

• The teachers serve as the evaluators
• We are seeing variations among parent educators
• Some have higher retention
• Location and timing of classes
• All outcome measures are self-report
• Some measures are not full validated instruments

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University of California, San DiegoDivision Of
Community Pediatrics
Join us in discovering new ways to improve
community health!

• Dean Sidelinger
• dsidelinger_at_ucsd.edu