Dean Sidelinger, MD MSEd
Division of Community Pediatrics
University of California, San Diego
 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
 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
 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
 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
San Diego’s 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
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
Mildred A. Horodynski, PhD, RNC and
Manfred Stommel PhD
Improve eating habits in toddlers
through better parent-toddler
interaction during meal times
Christine Williams, MD, MPH
 Improve physical activity
and motor skills in children
(ages 3-4)
Curricula adapted to meet target
population’s needs:
 Translated into Spanish
 Adapted to meet various literacy levels
 Specific areas of focus within curricula:
• Recipes
• Music
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
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
 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
Focus on improving service delivery
Process
Evaluation
• Attendance sheets
• Parent exit survey
• Parent Educator feedback survey
Outcome
Evaluation
• Pretest/posttest/follow-up
• Diaries
424 families participated
334 offered at least 10
classes
223 completed ≥
7 classes
159 ≥ 1
home visit
143 attended ≥ 7 classes and
completed pre/post surveys
 383/424
primary children were 2–4 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)
Program start through 03-31-2008
Knowledge
Pre
Post
p-value
Food Guide Pyramid knowledge
score (9 possible)
3.01
5.86
< .001
Portion Size knowledge score (6
possible)
2.13
4.11
< .001
Health Facts knowledge score (12
possible)
9.35
10.74
< .001
143 completers with matched pre/post
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
< .001
143 completers with matched pre/post
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
< .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
143 completers with matched pre/post
Behavior
Pre
Post
p-value
Child TV Viewing
(hours per week)
18.03
12.03
< .001
Parent TV Viewing
(hours per week)
16.57
11.04
< .001
Television Viewing During Meals
(0 = never to 4 = all the time)
1.68
1.14
< .001
143 completers with matched pre/post
 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
210/334 eligible participants
 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
University of California, San Diego
Division Of Community Pediatrics
Join us in discovering new ways to
improve community health!
Dean Sidelinger
dsidelinger@ucsd.edu