Early Childhood Family Intervention and Long-Term Obesity Prevention Among Low-Income, Minority Youth

Introduction: Early childhood is a critical period to prevent obesity and reduce health disparities, yet, the evidence base for young children is extremely limited. The minimal impact of existing interventions may be due, in part, to the failure to promote key aspects of the early family environment that influence children’s health behaviors and risk for obesity. An emerging literature indicates that two fundamental aspects of parenting, responsiveness and control, contribute to the development of obesity. Racial and socioeconomic disparities in obesity may be understood in part via the impact of poverty-related stress on parenting and the subsequent disruptions to children’s acquisition of core self-regulatory skills. Indeed, an increasing number of studies document prospective links between early childhood stressors, child self-regulation, and obesity.

In two long-term follow-up studies with low-income families, we have previously shown that family intervention which strengthens parenting and behavioral regulation in early childhood (and does not address physical health) yields health benefits in pre-adolescence. Among youth who were at risk for behavior problems, those randomized to intervention had significantly lower BMI, lower levels of sedentary activity and higher levels of physical activity at follow-up, relative to controls. The current study extends this work by using the full sample in the 2^ndstudy (two additional cohorts; total of 4) to evaluate intervention impact on BMI, activity, diet and sleep. Further, moderation analyses consider multiple aspects of self-regulation in the context of identifying combinations of baseline factors that moderate intervention impact.

Method and Results. Participants were 559 ethnic minority youth who completed long-term follow-up assessments at age 8 after enrolling in an RCT of ParentCorps, a family-focused, school-based intervention in low-income, urban neighborhoods at age 4. BMI was measured by study staff and parents reported on children’s sleep, activity, and diet. At baseline, children’s self-regulation was rated by teachers and observed during standardized testing by study staff masked to intervention status. Preliminary analyses replicate previous findings of intervention impact on BMI at age 8, and indicate that the most efficient moderator of effect is a linear combination of teacher ratings of behavioral dysregulation (the single moderator tested previously), observed persistence, and school readiness test score (which includes motor/compliance tasks).

Conclusions: Efforts to strengthen parenting early in life may reduce obesity and health disparities, particularly for children who have not acquired adequate self-regulation skills.