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Title: Enhanced vs standard Parents as Teacher curriculum on factors related to infant feeding among African American women

Author
item TUSSING-HUMPHREYS, LISA - University Of Illinois
item Thomson, Jessica
item Goodman, Melissa
item LANDRY, ALICIA - University Of Central Arkansas

Submitted to: Southern Medical Journal
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 7/16/2019
Publication Date: 10/5/2019
Citation: Tussing-Humphreys, L.M., Thomson, J.L., Goodman, M.H., Landry, A.S. 2019. Enhanced vs standard Parents as Teacher curriculum on factors related to infant feeding among African American women. Southern Medical Journal. 112(10):512-519. https://doi.org/10.14423/SMJ.0000000000001024.
DOI: https://doi.org/10.14423/SMJ.0000000000001024

Interpretive Summary: Childhood obesity affects approximately 15% of children 2 to 4 years of age in Mississippi as compared to 9% among children 2 to 5 years of age in the general United States population. Thus there is a need for interventions that effectively prevent the development of excess adiposity from an early age, particularly in Mississippi. The primary purpose of this paper was to determine if compliance with the American Academy of Pediatrics infant feeding recommendations concerning the timing of solid food introduction and exposure to foods that can cause excessive weight gain differed between treatment groups in a maternal, infant and early childhood home visiting project. Pregnant women at least 18 years of age, less than 19 weeks pregnant, and residing in a lower Mississippi Delta county were recruited for this project. Infant dietary intake and maternal knowledge, beliefs, and practices about infant feeding were collected from 24 experimental and 30 control participants between September 2013 and May 2016. Compliance with infant feeding recommendations ranged from approximately 20% (no sugar sweetened beverages before 12 months of age) to approximately 80% (no fruit juice until after 6 months of age). On average, infants were fed sugar sweetened beverages at approximately 10 months of age in both treatment groups. Significant differences in compliance between groups was not found. Participants’ knowledge and beliefs about infant feeding practices were generally in agreement with the expert recommendations at baseline with few changes over time. In conclusion, an educational curriculum that included anticipatory messaging regarding expert infant feeding recommendations was not effective at improving compliance as compared to a standard educational curriculum. Interventions that translate maternal knowledge about infant feeding recommendations into action are necessary for improving the diets of weaning infants in this region of the U.S.

Technical Abstract: Purpose: To determine the comparative impact of the standard Parents as Teachers® (PAT) to an enhanced version (PATE) of the perinatal educational curriculum on compliance with infant feeding recommendations and changes in maternal infant feeding knowledge and beliefs. Methods: Women at least 18 years of age, less than 19 weeks pregnant, and residing in three Mississippi counties were randomized to standard Parents as Teachers® (PAT) or a nutrition and physical activity enhanced (PATE) version of the perinatal educational curriculum. Infant diets were assessed via 24-hour diet recall at postnatal months 1 - 12. Maternal knowledge and beliefs about infant feeding were assessed via survey at baseline and postnatal month 12. Compliance with infant feeding recommendations and differences in compliance between treatment arms, were assessed with Kaplan-Meier survival curves. Longitudinal changes in maternal knowledge and beliefs were assessed with McNemar’s tests of symmetry. Results: Postnatal retention for the PAT and PATE arms were 83% (25/30) and 88% (21/24). Compliance with feeding recommendations for PAT and PATE participants, respectively, was 40% and 63% for no solid foods before 6 months, 23% and 21% for no sugar sweetened beverages (SSBs) before 12 months, 100% (both) for no fruit juice before 6 months, and 43% and 46% for no snack chips, French fries and other fried foods and candy before 12 months. Median times to feeding SSBs were 10.1 and 9.6 months in PAT and PATE arms. Significant differences in compliance between arms were not found (p > 0.05). Participants’ knowledge and beliefs about infant feeding were generally in agreement with expert recommendations at baseline with few changes over time or between arms. Conclusion: Findings suggest the need for further intervention focused on translating knowledge into action to improve diets of weaning infants in this region of the U.S.