Long-term population-level impact of a school-based parenting-focused intervention to prevent obesity among Black and Latinx children in historically disinvested neighborhoods

Project Summary/ Abstract Children with obesity are at increased risk of cardiovascular disease, type 2 diabetes, and premature death. Black and Latinx children are more likely than their white peers to experience overweight or obesity, in large part due to exposure to stressors and adverse experiences resulting from poverty, racism, and other social

determinants concentrated in historically disinvested neighborhoods. Predictable and nurturing parenting helps buffer children from the damaging impact of early life stress and supports self-regulation and healthy behaviors which contribute to healthy development. The onslaught of daily stressors in historically disinvested

neighborhoods, however, inevitably affects parents’ well-being and capacity to provide predictable and nurturing care. Parenting-focused interventions which provide meaningful social connection and support in the context of the tremendous challenges that families face, can effectively promote predictable and nurturing

parenting as well as child self-regulation, mental health, and academic outcomes in the context of adversity. Rigorous studies of several parenting programs find additional benefits for children’s physical health, suggesting that universal access to parenting-focused interventions may be key to achieving population-level

obesity prevention among Black and Latinx children living in stressful environments. Despite the potential of early childhood parenting-focused interventions to prevent obesity among Black and Latinx children from historically disinvested neighborhoods, the population-level impact remains unknown. We propose to study the

population-level impact on obesity in pre-adolescence from an evidence-based parenting-focused intervention offered to all families of pre-Kindergarten (pre-K) students in high-poverty schools. The current proposal leverages a large cRCT with 3,300 children (~75% Black and Latinx) to study intervention impact on BMI

trajectories from age 7 – 10-years. Using a mixed-methods sequential explanatory design, this study considers pre-intervention child characteristics and neighborhood environment as potential moderators to identify factors that may support or hinder prevention effectiveness at the level of the population. Aim 1 is to evaluate

preventive intervention impact on obesity (BMI) trajectories in pre-adolescence (at four time points at ages 7, 8, 9 and 10) and examine moderation by pre-intervention child self-regulation, race/ethnicity, and gender. Aim 2 is to identify neighborhood-level variation in intervention impact on BMI trajectories based on multiple

indicators of residential neighborhood context. Aim 3 is to understand how neighborhood context supports or hinders obesity prevention by learning from parents’ lived experiences through focus groups. In collaboration with a Community Advisory Board, we will integrate quantitative and qualitative findings from all aims and

provide recommendations to optimize prevention effectiveness. This project has the potential to exert a sustained, powerful influence on the field of obesity prevention and health equity.