Futuros Fuertes 2.0: A primary care-based intervention to prevent obesity in low-income Latino children

PROJECT SUMMARY Futuros Fuertes 2.0: A primary care-based intervention to prevent obesity in low-income Latino children Latino children are at higher risk of obesity and obesity sequelae relative to non-Hispanic white children. Poverty also increases obesity risk. Disparities in obesity for Latino children emerge in early childhood; and feeding and sedentary behaviors that increase obesity risk begin in the first two years of life. Consequently, it is critical to develop and test interventions to prevent obesity among low-income Latino children beginning in infancy. Primary care provides an ideal setting for obesity prevention among infants and toddlers given frequent visits in the first two years of life. Incorporating culturally concordant lay health educators into primary care settings serving diverse, low-income populations is a strategic approach for leveraging primary care visits to promote healthy behaviors. Furthermore, the use of text messages is a promising strategy for extending the reach of primary care-based interventions and engaging family members who do not attend in-person visits. Our team developed and successfully pilot tested Futuros Fuertes 1.0 (Strong Futures), a culturally tailored, primary care-based intervention to prevent obesity in Latino infants and toddlers. A pilot trial of Futuros Fuertes 1.0 found impact on child health behaviors and BMI z-score and informed modifications and enhancements leading to Futuros Fuertes 2.0. Parents/caregivers receive Futuros Fuertes 2.0 intervention content through: health education and coaching sessions from a lay health educator, two text messages per week, and environmental prompts. Text messages are also sent to up to 2 additional family members. Through Futuros Fuertes 2.0, parents are coached on responsive feeding techniques, foods and beverages that are healthy for their child and those to avoid, screen time guidelines, and strategies to enhance sleep duration. Our central hypothesis is that a culturally tailored, primary care-based intervention for low-income Latino parents/caregivers delivered via health education and coaching sessions in the infant and toddler period and reinforced through text messages to multiple family caregivers will result in lower BMI at age 2. In Aim 1, we will determine the impact of Futuros Fuertes 2.0 on children’s BMI and on feeding, screen time and sleep. Low-income Latino infant- parent/caregiver dyads (n=576) will be recruited from birth to 1 month at two health centers in Northern California and randomized to: Futuros Fuertes 2.0 or a control intervention. In Aim 2, we will assess mediators and moderators of intervention effect. In Aim 3, we will use a qualitative approach (semi-structured interviews) to understand parent and provider experiences with the Futuros Fuertes 2.0 intervention. The Futuros Fuertes 2.0 model may improve feeding, screen time and sleep behaviors among low-income Latino children and therefore has the potential for lowering their lifetime risk of obesity and metabolic complications.