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Original Investigation | Journal Club

Healthy Habits, Happy Homes:  Randomized Trial to Improve Household Routines for Obesity Prevention Among Preschool-Aged Children

Jess Haines, PhD, MHSc, RD3; Julia McDonald, MS, MPH1; Ashley O’Brien, LCSW, MPH1; Bettylou Sherry, PhD, RD4; Clement J. Bottino, MD5; Marie Evans Schmidt, PhD5,6; Elsie M. Taveras, MD, MPH1,2
[+] Author Affiliations
1Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
2Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
3Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
4Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
5Division of General Pediatrics, Children’s Hospital Boston, Boston, Massachusetts
6Center on Media and Child Health, Children’s Hospital Boston, Boston, Massachusetts
JAMA Pediatr. 2013;167(11):1072-1079. doi:10.1001/jamapediatrics.2013.2356.
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Importance  Racial/ethnic and socioeconomic disparities exist across risk factors for childhood obesity.

Objective  To examine the effectiveness of a home-based intervention to improve household routines known to be associated with childhood obesity among a sample of low-income, racial/ethnic minority families with young children.

Design  Randomized trial.

Setting  The intervention was delivered in the families’ homes.

Participants  The study involved 121 families with children aged 2 to 5 years who had a television (TV) in the room where he or she slept; 111 (92%) had 6-month outcome data (55 intervention and 56 control). The mean (SD) age of the children was 4.0 (1.1) years; 45% were overweight/obese. Fifty-two percent of the children were Hispanic, 34% were black, and 14% were white/other. Nearly 60% of the families had household incomes of $20 000 or less.

Interventions  The 6-month intervention promoted 4 household routines, family meals, adequate sleep, limiting TV time, and removing the TV from the child’s bedroom, using (1) motivational coaching at home and by phone, (2) mailed educational materials, and (3) text messages. Control subjects were mailed materials focused on child development.

Main Outcomes and Measures  Change in parent report of frequency of family meals (times/wk), child sleep duration (hours/d), child weekday and weekend day TV viewing (hours/d), and the presence of a TV in the room where the child slept from baseline to 6 months. A secondary outcome was change in age- and sex-adjusted body mass index (calculated as weight in kilograms divided by height in meters squared).

Results  Compared with control subjects, intervention participants had increased sleep duration (0.75 hours/d; 95% CI, 0.06 to 1.44; P = .03), greater decreases in TV viewing on weekend days (−1.06 hours/d; 95% CI, −1.97 to −0.15; P = .02), and decreased body mass index (−0.40; 95% CI, −0.79 to 0.00; P = .05). No significant intervention effect was found for the presence of a TV in the room where the child slept or family meal frequency.

Conclusions and Relevance  Our results suggest that promoting household routines, particularly increasing sleep duration and reducing TV viewing, may be an effective approach to reduce body mass index among low-income, racial/ethnic minority children. Longer-term studies are needed to determine maintenance of behavior change.

Trial Registration  clinicaltrials.gov Identifier: NCT01565161

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Figure.
Participant Flow for the Healthy Habits, Happy Homes Study

TV indicates television.

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