Adolescent Mothers, Infant Obesity
Conditions
Keywords
Infant, Obesity, Adolescent, Social media, Prevention
Brief summary
The purpose of this social media group randomized trial (GRT) is to test the feasibility of our Baby Dayr for Teen Moms intervention to increase maternal responsiveness to infant cues and implement healthy feeding practices through development of a healthy feeding style. Aim 1: Evaluate the feasibility and acceptability of the Baby Dayr intervention administered to the target population as it relates to their acceptance and satisfaction with the content, format, delivery, and use of social media. Aim 2: Explore efficacy of the Baby Dayr intervention administered to adolescent mothers of infants 4 months of age or less as assessed by maternal responsiveness, feeding style, and feeding practices evaluated at the completion of the intervention using self-report methods.
Detailed description
Rapid weight gain during infancy is one of the strongest risk factors for obesity later in childhood. Weight gain in infancy is closely linked with feeding practices. Unhealthy mother-infant feeding practices contribute to rapid and/or excessive infant weight gain. Lower-income, adolescent, first-time mothers are less likely to engage in infant-centered feeding (ICF) which is characterized by maternal responsiveness (MR), healthy feeding styles (FS), and healthy feeding practices (FP). ICF is needed to reduce rapid/excessive weight gain during the first six months of life and to foster infant feeding self-regulation that is associated with healthy growth. ICF is a critical factor in reducing infant obesity risk and later adverse health conditions. Practical early intervention strategies are necessary to promote ICF among adolescent mothers to reduce obesity risk. We propose Baby Dayr, a novel social media intervention platform designed by the investigators which includes cell phone text message reminders, an infant feeding website, and Facebook to increase ICF through daily behavioral challenge activities (challenges) for this population. Because cell phones permit natural, frequent and non-intrusive contact as they are not time-or-place-dependent, they offer an innovative strategy for intervening with adolescent mothers. However, this approach is untested for its feasibility with this population regarding infant feeding practices. We propose an exploratory, longitudinal, randomized, two-group study design. The three specific aims are: 1) to establish preliminary efficacy of the intervention as assessed by infant growth evaluated pre-intervention, immediately post intervention, and when the infant is six months old; 2) establish preliminary efficacy of the Baby Dayr plus Maternal-Infant Health Program (MIHP) care vs. MIHP care only on infant-centered feeding (MR, FS, and FP) mediated by maternal knowledge and self-efficacy; and 3) establish the feasibility, acceptability, and satisfaction of a social media intervention (Baby Dayr) for low-income adolescent, first-time mothers by assessing: 1) rates of enrollment and completion of daily challenges, 2) acceptability ratings of Baby Dayr; and 3) satisfaction with Baby Dayr. Participants will be randomly assigned to the intervention (Baby Dayr and MIHP) (n = 40) or control group (MIHP care only) (n = 40). The intervention consists of six weeks of daily challenges and will be delivered starting when the infant is four to six weeks old. The study is innovative in its: 1) assessment of ICF to reduce rapid/excessive infant weight gain in the first six months of life with low-income, adolescent, first-time mother-infant dyads, and 2) combination of an infant-centered skill-building, educational, and coaching approach using social media that is accessible and suitable for adolescents. The proposed research is significant in that it will contribute to the science related to ICF and knowledge regarding use of a social media platform in an at-risk population that can lead to reducing the risk of infant obesity. Information gained from this study will be used to refine the intervention for use in a larger-scale, longitudinal, randomized, controlled trial to reduce obesity risk in infants of low-income, adolescent mothers.
Interventions
The Tools for Teen Moms intervention is a novel social media intervention platform designed by the investigators which includes cell phone text message reminders, and infant feeding website, and Facebook to increase infant-centered feeding through daily behavioral challenge activities (challenges) for this population. The intervention consists of 6 weeks of daily challenges and will be delivered within the infant's first 6 months of life.
Sponsors
Study design
Eligibility
Inclusion criteria
* Self-identified, English-speaking * Low-income, adolescent * First-time mothers between the ages of 14 and 19 * With daily web access and access to a cell phone that includes text messaging capabilities * Family income ≤ 185% of federal poverty * Term birth (37≤42 weeks, 2500≤3750 grams birth weight) * Mothers and infants with no special nutrients or feeding needs * Infants less than six weeks old at study enrollment who have not started eating solid foods * Adolescent mothers must be a primary caretaker of the infant who feeds her infant at least once a day, and who is willing to participate in a six-week intervention with data collection at three defined time points (T1, T2, and T3)
Exclusion criteria
* Male caregivers * Mothers and infants with diagnosed feeding/eating disorders * Significant perinatal or postnatal complications * Post partum depression or other mental health problems * Adolescent mothers who do not share in the feeding responsibility of their infants * Adolescents without daily web access nor a cell phone with text messaging capabilities
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Infant Growth | Baby is less than 2 months; baby is 3 months; baby is 6 months | Recumbent infant length (inches) and weight (pounds/ounces) measured at three separate time points. While recumbent infant length was collected in inches and weight collected in pounds/ounces, these measures were converted into z-score measurements for the outcome measurement of change in infant growth. Standardized weight scores are measures of relative weight adjusted for child age and sex. The z-score indicates the number of standard deviations away from a reference population in the same age range and with the same sex. A z-score of 0 is equal to the mean. Negative numbers indicated weight values lower than the mean and the positive numbers indicate weight values higher than the mean. |
Countries
United States
Participant flow
Recruitment details
Teen mothers of infants were recruited. Teen mothers participated in the intervention. Infants were included for collection of demographic and weight data. Thus the actual number of participants is doubled to account for both the mothers and infants as participants. Protocol Enrollment number then is 164 ( 82 teen mothers and 82 infants).
Participants by arm
| Arm | Count |
|---|---|
| Tools for Teen Moms Intervention Group Tools for Teen Moms intervention group will receive daily challenges focusing on: 1) Maternal-Infant Feeding Interaction; and 2) Feeding Practices Challenges. | 102 |
| MIHP Standard Care MIHP care consists of voluntary home visits: one week postpartum, at six weeks, and six months, and on-going as needed provided by a RN, licensed social worker, RD, infant mental health specialist and/or paraprofessional. Content includes a flexible plan of care with visits based on identified domains for both the mother and the infant. | 62 |
| Total | 164 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 20 | 10 |
Baseline characteristics
| Characteristic | Tools for Teen Moms Intervention Group | MIHP Standard Care | Total |
|---|---|---|---|
| Age, Continuous | 17.53 years STANDARD_DEVIATION 1.3 | 17.61 years STANDARD_DEVIATION 1.41 | 17.56 years STANDARD_DEVIATION 1.33 |
| Birth length (cm) | 50.98 cm STANDARD_DEVIATION 2.71 | 50.70 cm STANDARD_DEVIATION 2.88 | 50.88 cm STANDARD_DEVIATION 2.77 |
| Birth weight (kg) | 3.21 kg STANDARD_DEVIATION 0.4 | 3.21 kg STANDARD_DEVIATION 0.43 | 3.21 kg STANDARD_DEVIATION 0.41 |
| Breastfeeding status at baseline Breastfed in the past | 15 Participants | 9 Participants | 24 Participants |
| Breastfeeding status at baseline Currently Breastfeeding | 18 Participants | 16 Participants | 34 Participants |
| Breastfeeding status at baseline Never Breastfed | 18 Participants | 6 Participants | 24 Participants |
| Employment Status Full time (at least 35 hours/week) | 3 Participants | 0 Participants | 3 Participants |
| Employment Status Not working | 45 Participants | 27 Participants | 72 Participants |
| Employment Status Working part-time | 3 Participants | 4 Participants | 7 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 18 Participants | 14 Participants | 32 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 33 Participants | 17 Participants | 50 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Highest level of education completed 10th grade | 11 Participants | 0 Participants | 11 Participants |
| Highest level of education completed 11th grade | 16 Participants | 13 Participants | 29 Participants |
| Highest level of education completed 12th grade | 6 Participants | 2 Participants | 8 Participants |
| Highest level of education completed 6th grade | 0 Participants | 0 Participants | 0 Participants |
| Highest level of education completed 7th grade | 2 Participants | 1 Participants | 3 Participants |
| Highest level of education completed 8th grade | 2 Participants | 2 Participants | 4 Participants |
| Highest level of education completed 9th grade | 2 Participants | 2 Participants | 4 Participants |
| Highest level of education completed Completed some college credits | 1 Participants | 3 Participants | 4 Participants |
| Highest level of education completed High school diploma or GED | 11 Participants | 7 Participants | 18 Participants |
| Highest level of education completed Missing | 0 Participants | 1 Participants | 1 Participants |
| Infant age at enrollment | 1.21 months STANDARD_DEVIATION 0.48 | 1.18 months STANDARD_DEVIATION 0.54 | 1.20 months STANDARD_DEVIATION 0.5 |
| Infant Baseline length (cm) | 54.75 cm STANDARD_DEVIATION 2.99 | 55.05 cm STANDARD_DEVIATION 3.61 | 54.86 cm STANDARD_DEVIATION 3.22 |
| Infant Baseline weight (kg) | 4.30 kg STANDARD_DEVIATION 0.75 | 4.27 kg STANDARD_DEVIATION 0.78 | 4.29 kg STANDARD_DEVIATION 0.76 |
| Infant sex Female | 25 Participants | 14 Participants | 39 Participants |
| Infant sex Male | 26 Participants | 17 Participants | 43 Participants |
| Marital Status In a Relationship | 29 Participants | 17 Participants | 46 Participants |
| Marital Status Married | 4 Participants | 3 Participants | 7 Participants |
| Marital Status Not in a Relationship | 18 Participants | 11 Participants | 29 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Asian | 2 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) Black or African American | 22 Participants | 12 Participants | 34 Participants |
| Race (NIH/OMB) More than one race | 2 Participants | 2 Participants | 4 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 24 Participants | 17 Participants | 41 Participants |
| Region of Enrollment United States | 51 teen mother participants | 31 teen mother participants | 82 teen mother participants |
| Sex: Female, Male Female | 51 Participants | 31 Participants | 82 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants |
| Solid feeding status at baseline Fed anything other than breastmilk or formula Missing | 0 Participants | 0 Participants | 0 Participants |
| Solid feeding status at baseline Fed anything other than breastmilk or formula No | 51 Participants | 30 Participants | 81 Participants |
| Solid feeding status at baseline Fed anything other than breastmilk or formula Yes | 0 Participants | 1 Participants | 1 Participants |
| Solid feeding status at baseline Given tastes of solid food from mother's finger Missing | 1 Participants | 0 Participants | 1 Participants |
| Solid feeding status at baseline Given tastes of solid food from mother's finger No | 49 Participants | 29 Participants | 78 Participants |
| Solid feeding status at baseline Given tastes of solid food from mother's finger Yes | 1 Participants | 2 Participants | 3 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 102 | 0 / 62 |
| serious Total, serious adverse events | 0 / 102 | 0 / 62 |
Outcome results
Change in Infant Growth
Recumbent infant length (inches) and weight (pounds/ounces) measured at three separate time points. While recumbent infant length was collected in inches and weight collected in pounds/ounces, these measures were converted into z-score measurements for the outcome measurement of change in infant growth. Standardized weight scores are measures of relative weight adjusted for child age and sex. The z-score indicates the number of standard deviations away from a reference population in the same age range and with the same sex. A z-score of 0 is equal to the mean. Negative numbers indicated weight values lower than the mean and the positive numbers indicate weight values higher than the mean.
Time frame: Baby is less than 2 months; baby is 3 months; baby is 6 months
Population: 82 participants were included in analysis at Time 1, 79 at Time 2, and 67 at Time 3. This is due to participants lost to follow-up.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Tools for Teen Moms Intervention Group | Change in Infant Growth | Time 1 (infant 2-8 weeks of age) | -0.46 Weight for age Z-score | Standard Deviation 0.9 |
| Tools for Teen Moms Intervention Group | Change in Infant Growth | Time 2 (infant about 3 months) | -0.33 Weight for age Z-score | Standard Deviation 0.95 |
| Tools for Teen Moms Intervention Group | Change in Infant Growth | Time 3 (infant about 6 months) | -0.22 Weight for age Z-score | Standard Deviation 1.17 |
| MIHP Standard Care | Change in Infant Growth | Time 1 (infant 2-8 weeks of age) | -0.44 Weight for age Z-score | Standard Deviation 0.86 |
| MIHP Standard Care | Change in Infant Growth | Time 2 (infant about 3 months) | -0.46 Weight for age Z-score | Standard Deviation 0.93 |
| MIHP Standard Care | Change in Infant Growth | Time 3 (infant about 6 months) | -0.21 Weight for age Z-score | Standard Deviation 0.83 |