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NCT04164277

FirstStep2Health Intervention

Completed NA Results posted Last updated 2 August 2024
What this trial tests

NA trial testing Caregiver Component. in Pediatric Obesity in 95 participants. Completed in 31 August 2023.

Timeline
20 September 2021
Primary endpoint
31 August 2023
31 August 2023

Quick facts

Lead sponsorMichigan State University
PhaseNA
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingsingle
Primary purposeprevention
Enrollment95
Start date20 September 2021
Primary completion31 August 2023
Estimated completion31 August 2023
Sites1 location across United States

Drugs / interventions tested

Conditions studied

Sponsor

Michigan State University

Who can join

Adults 3 to 5, any sex, with Pediatric Obesity or Risk Reduction Behavior. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Moderate-to-vigorous Physical Activity (MVPA; Preschoolers)-AIM 1 Primary · Moderate-to-vigorous physical activity at 17 weeks

The ActiGraph GT3X accelerometer (www.theactigraph.com) will record acceleration counts from which minutes of MVPA per day will be estimated (analysis software available). Each caregiver-preschooler dyad will receive the accelerometers at the same time and data collectors will explain to both caregiver and preschooler how to wear the accelerometers. Preschoolers' caregivers will be instructed to return monitors either at the Head Start center or via mail using using the provided prepaid envelope after the seventh day. Data will be downloaded to the same computer used to initialize monitors. In

GroupValue95% CI
Intervention7.51± 3
Control7.46± 2.17
Fruit/Vegetable Intake (Preschoolers)-AIM 1 Secondary · Fruit/vegetable intake at 17 weeks

Preschoolers' fruit/vegetable intake (servings/day) at home will be assessed by three non-consecutive 24-hour dietary recalls (one weekend day; two weekdays; randomly selected) with their caregivers over 2-3 weeks. The Project Manager will be trained at the University of Minnesota Nutrition Coordinating Center for two days and certified. The Project Manager will train interviewers to collect data individually from each caregiver via telephone. To aid in assessment of portion sizes, two-dimensional food models and measuring guides will be provided to caregivers at Head Start centers. Preschoole

GroupValue95% CI
Intervention3.60± 2.01
Control3.61± 2.68
Screen Time (Preschoolers)-AIM 1 Secondary · Screen time at 17 weeks

Preschoolers' screen time will be assessed by two questions from the National Health and Nutrition Examination Survey (NHANES)-Physical Activity and Physical Fitness Survey. The two questions ask caregivers about the number of hours per day their preschooler watches television or videos and uses a computer or plays games. The scale has good reliability with coefficients ranging from 0.63 to 0.84. The sum score of the two questions (min-max: 0-24 hours/day) will be used to describe preschoolers' screen time, with a higher score indicating more screen time. Caregivers will complete the survey.

GroupValue95% CI
Intervention3.70± 2.99
Control3.58± 2.71
Number of Preschoolers Who Are Overweight or Obese-AIM 1 Secondary · Proportion of overweight and obesity at 17 weeks

Data collectors will measure each preschooler (bulky clothing, shoes, and things in pockets removed) in a private room. In accordance with NHANES measurement protocol, height without shoes will be measured to the nearest 0.1 cm. with a Shorr Board (Weigh and Measure, LLC, Olney, MD), and weight in kg. will be measured to the nearest 0.1 kg. using a Seca model 874 portable electronic scale (Seca Corp., Columbia, MD). Two measurements will be taken for height and weight. If the two differ by \< 0.5 cm. and \< 0.5 kg., they will be averaged to determine the final height and weight, respectively.

GroupValue95% CI
Intervention14
Control12
Moderate-to-vigorous Physical Activity (MVPA; Caregivers)-AIM 2 Secondary · Moderate-to-vigorous physical activity at 17 weeks

The ActiGraph GT3X-plus accelerometer (www.theactigraph.com) will record acceleration counts from which minutes of MVPA per day will be estimated (analysis software available). Data collection procedure for caregivers will be similar to those employed for preschoolers, but different count thresholds will be used: moderate (2690-6166 counts/60 seconds) and vigorous PA (≥ 6167 counts/60 seconds). Sixty-second increments with counts ≥ 2690 will be summed to determine minutes of MVPA.

GroupValue95% CI
Intervention8.25± 6.75
Control10.14± 9.77
Fruit/Vegetable Intake (Caregivers)-AIM 2: Block Fruit-Vegetable-Fiber Screener Secondary · Diet quality at 17 weeks

The ten-item Block Fruit-Vegetable-Fiber Screener will assess the caregivers' fruit/vegetable intake (servings/day). This survey provides estimates for intake of food groups including total fruit/vegetable servings, dietary fiber (mg), Vitamin C (mg), magnesium (mg), and potassium (mg). The scale is significantly correlated with the full Block survey (r = 0.71). The established scoring equation will be used to calculate the number of servings of fruit/vegetable each participant consumes per day.

GroupValue95% CI
Intervention4.52± 2.46
Control3.44± 1.58
Screen Time (Caregivers)-AIM 2 Secondary · Screen time at 17 weeks

Caregivers' screen time will also be assessed by two questions from the National Health and Nutrition Examination Survey (NHANES)-Physical Activity and Physical Fitness Survey. The sum of the two questions (min-max: 0-24 hours/day) will be used to describe preschoolers' screen time, with a higher score indicating more screen time.

GroupValue95% CI
Intervention4.93± 4.71
Control5.93± 5.67
Number of Caregivers Who Are Overweight or Obese-AIM 2 Secondary · Proportion of overweight and obesity at 17 weeks

BMI will be calculated based on weight (kg)/height (m2) and used to determine caregivers' weight status. Data collection procedures for caregivers will be similar to those employed for preschoolers.

GroupValue95% CI
Intervention23
Control16
Knowledge (Caregivers)-AIM 2 Secondary · Knowledge at 17 weeks

The 25-item Parental Knowledge Scale will be used to assess parental knowledge on preschoolers' dietary intake and physical activity. The 2-point Likert scale has been used with low-income parents. It has two subscales: nutrition knowledge (score range 0-10), and physical activity knowledge (score range 0-15), with a higher sum score indicating greater knowledge on healthy eating or physical activity.

Nutrition knowledge
GroupValue95% CI
Intervention7.45± 1.27
Control6.68± 1.87
Physical activity knowledge
GroupValue95% CI
Intervention12.53± 1.64
Control11.58± 8.18
Feeding Practice Skill (Caregivers)-AIM 2 Secondary · Feeding practice skill at 17 weeks

Parent feeding practice skill will be assessed by the 33-item Child Feeding Questionnaire. The Child Feeding Questionnaire was developed to evaluate parental beliefs, attitudes, and practices regarding child feeding, with a focus on obesity proneness in children aged 2-11 years old. The 5-point Likert questionnaire, with good reliability and validity, includes seven factors: perceived responsibility, perceived caregiver weight, perceived child weight, concerns about child weight, pressure to eat, restriction, and monitoring. The mean score of the items for each factor, with a range from 1 to 5

Feeding responsibility
GroupValue95% CI
Intervention4.65± 0.71
Control4.58± 0.64
Perceived parent weight
GroupValue95% CI
Intervention3.11± 0.43
Control3.31± 0.46
Perceived child weight
GroupValue95% CI
Intervention2.95± 0.32
Control2.88± 0.29
Concern about child weight
GroupValue95% CI
Intervention1.46± 1.05
Control1.13± 0.26
Restriction
GroupValue95% CI
Intervention3.33± 0.86
Control3.37± 0.87
Pressure to eat
GroupValue95% CI
Intervention2.86± 0.99
Control2.68± 0.80
Monitoring
GroupValue95% CI
Intervention4.04± 1.10
Control4.13± 0.83
Self-efficacy (Caregivers)-AIM 2 Secondary · Self-efficacy at 17 weeks

The 20-item Parental Self-Efficacy Scale, measuring caregivers' confidence to support their preschoolers' healthy eating and physical activity, will assess caregiver self-efficacy. The 10-point Likert scale has shown good reliability with Cronbach's alphas ranging from 0.72 to 0.94. It has two subscales: nutrition self-efficacy (12 items) and physical activity self-efficacy (8 items). The mean score, with a range from 0 to 10, will be calculated for each subscale, with a higher mean score indicating greater self-efficacy.

Nutrition self-efficacy
GroupValue95% CI
Intervention8.95± 1.35
Control8.18± 1.68
Physical activity self-efficacy
GroupValue95% CI
Intervention9.27± 1.12
Control8.38± 1.70
Parental Support (Caregivers)-AIM 2 Secondary · Parental support at 17 weeks

The 12-item Parental Support Scale for Eating Habits and Physical Activity will measure support for the child. The 6-point Likert scale has very good reliability with Cronbach's alphas ranging from 0.83 to 0.87. It has two subscales: nutrition support (7 items) and physical activity support (5 items). The mean score, with a range from 1 to 6, will be calculated for each subscale, with a higher mean score indicating greater parental support.

Nutrition support
GroupValue95% CI
Intervention4.52± 0.80
Control4.39± 0.71
Physical activity support
GroupValue95% CI
Intervention5.15± 1.05
Control4.64± 1.25

Sponsor's own description

This project will determine the preliminary efficacy of an innovative intergenerational intervention among Head Start preschoolers, aged 3-5 years, and their caregivers. A two-group cluster randomized controlled trial will be conducted. Six Head Start centers will be randomly assigned to the intervention (n=3) or control group (n=3), and an average of 6 caregiver-preschooler dyads will be recruited from each class (N=144 dyads from 16 classes). Grounded in an Actor-Partner Interdependence Model, the 16-week intervention has 3 components: 1) a caregiver component, including 1a) a Facebook-based program with weekly electronic retrievable flyers providing health information and behavioral change strategies and 4 weekly habit-formation tasks to improve parenting practices and home environment for preschoolers; and 1b) 3 face-to-face or virtual meetings (weeks 1, 8, \& 16) to establish personal connections and communication networks among caregivers, discuss strategies, and share community resources to support preschoolers' behavioral changes at home; 2) a caregiver-preschooler learning component via Facebook messenger to send preschooler letters to each caregiver privately by the research team twice per week to 2a) share the preschooler's experiences of learning at school and his/her interests for a healthy diet and physical activity at home, and 2b) elicit caregivers' response to the letters; and 3) a Head Start center-based preschooler component to help preschoolers establish healthy habits via weekly healthy diet and physical activity participatory learning.

Publications & conference data

6 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Healthy eating interventions delivered in early childhood education and care settings for improving the diet of children aged six months to six years.
    Yoong SL, Lum M, Wolfenden L, Jackson J, et al · · 2023 · cited 29× · PMID 37306513 · DOI 10.1002/14651858.cd013862.pub2
  2. Healthy eating interventions delivered in early childhood education and care settings for improving the diet of children aged six months to six years.
    Yoong SL, Lum M, Wolfenden L, Jackson J, et al · · 2023 · cited 12× · PMID 37606067 · DOI 10.1002/14651858.cd013862.pub3
  3. FirstStep2Health: A cluster randomised trial to promote healthy behaviours and prevent obesity amongst low-income preschoolers.
    Ling J, Suriyawong W, Robbins LB, Zhang N, et al · · 2024 · cited 10× · PMID 38622494 · DOI 10.1111/ijpo.13122
  4. Interventions to prevent obesity in children aged 2 to 4 years old.
    Phillips SM, Spiga F, Moore TH, Dawson S, et al · · 2025 · cited 3× · PMID 40494564 · DOI 10.1002/14651858.cd015326.pub2
  5. Effects of the dyadic FirstStep2Health intervention on parents' behaviour and anthropometric outcomes: a secondary analysis of a cluster randomised trial.
    Ling J, Kao TA, Robbins LB, Kerver JM, et al · · 2024 · PMID 39638602 · DOI 10.1136/bmjopen-2023-081578
  6. Baseline higher hair cortisol moderated some effects in a healthy lifestyle intervention.
    Ling J, Ordway MR, Zhang N. · · 2024 · PMID 38636353 · DOI 10.1016/j.psyneuen.2024.107058

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Drug Landscape aggregates and links these public records for informational use only. Always verify against the primary source before clinical or regulatory decisions. Canonical URL: https://druglandscape.com/trial/NCT04164277.

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