Family-Based Healthy Eating Interventions for Southeast Asian Children

Overseen By Akilah Dulin, PhD

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Brown University

Must not be taking: Weight, Metabolism

Disqualifiers: Type 2 diabetes, Disabilities, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 11

150 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to help Southeast Asian families improve their eating habits and overall health. It will test various approaches, including financial incentives, nutrition education, and motivational support, to determine their effectiveness in promoting healthy eating in children aged 6 to 11. Researchers seek to discover if these family-based methods can enhance children's diets, body weight, and blood sugar levels, while also positively affecting parents' diets and the home food environment. Southeast Asian families with children aged 6 to 11 who wish to improve their dietary habits may find this trial suitable. As an unphased trial, it offers families the chance to contribute to innovative research focused on enhancing children's health and nutrition.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, children on medications affecting weight or metabolism cannot participate.

What prior data suggests that these family-based healthy eating interventions are safe for Southeast Asian children?

In a previous study, family-based approaches to healthy eating improved children's eating habits and food choices. This suggests these programs are generally well-received. The research did not mention any negative effects, which is encouraging. Since this trial is in the early stages, it mainly focuses on assessing the program's feasibility and is not yet collecting extensive safety data. However, similar programs have not reported major safety issues, indicating the program is likely safe for families to try. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these approaches to improving healthy eating among Southeast Asian children because they focus on the whole family, not just the individual. The financial incentive arm offers families tangible support to buy healthier foods, which could make healthy eating more accessible. The combined approach of financial incentives with nutrition education, motivational interviewing, and dietary norms messages is particularly promising. This comprehensive method not only provides financial aid but also empowers families with knowledge and motivation to make lasting dietary changes, something current treatments often overlook.

What evidence suggests that this trial's treatments could be effective for improving healthy eating in Southeast Asian children?

This trial will compare different approaches to improving healthy eating among Southeast Asian children. One treatment arm combines financial rewards with nutrition education, motivational interviewing, and messages about healthy eating habits. Research has shown that these methods successfully increase the variety of foods children eat in places like rural Cambodia. Teaching families with tight budgets about nutrition effectively promotes healthy eating. Motivational interviewing, which involves guided conversations to boost motivation, has also shown promise in helping people make better food choices. Overall, these strategies work together to encourage families to choose healthier foods. Another arm will focus solely on financial incentives, while a third arm will serve as an attention control, focusing on academic engagement. ^{6 7 8 9 10}

Who Is on the Research Team?

Akilah Dulin, PhD

Principal Investigator

Brown University

Kim Gans, PhD, MPH, LDN

Principal Investigator

University of Connecticut

Are You a Good Fit for This Trial?

This trial is for Southeast Asian families with children aged 6-11, focusing on Hmong, Cambodian, Laotian or Vietnamese parents or grandparents who are involved in the child's diet and food preparation. Participants must be over 18, speak English or their native language, own a smartphone and shop at a specific SEA grocery store.

Inclusion Criteria

Adults: live with the child

Adults: Hmong, Cambodian, Laotian or Vietnamese

Adults: own a smartphone

Exclusion Criteria

My child is not on medication that affects weight or metabolism.

I have not participated in any weight-related studies in the past year.

I have not been hospitalized for conditions like type 2 diabetes in the past year.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive financial incentives, nutrition education, motivational interviewing, and dietary norms messaging

6 months

11 group sessions (in-person), 3 MI calls (virtual), weekly text messages

Follow-up

Participants are monitored for changes in diet quality, BMI, HbA1c, and home food environment

6 months

What Are the Treatments Tested in This Trial?

Interventions

• Family-Based Approaches to Improve Healthy Eating

Trial Overview

The study tests a family-based nutrition program that includes education, motivational interviews, text reminders and coupons for healthy foods to improve children’s eating habits. It aims to assess feasibility for larger trials by observing changes in kids' diets, BMI and HbA1c levels as well as parents’ diet quality.

How Is the Trial Designed?

Group I: Financial incentive only Experimental Treatment 1 Intervention

Participants will receive weekly financial incentive coupons to purchase eligible foods at the partnering Southeast Asian grocery store. Research Assistants will explain the coupon procedures during the randomization phone call. Research Assistants will mail the adult a schedule of coupon disbursement dates. RAs will mail one month's worth of coupons (4, $15 coupons) to each adult's home. Coupons will be used at point-of-sale. Participants' will receive an automated weekly text message via Qualtrics directing them to upload their photos to the system if they used coupons during that week.

Group II: Financial incentive + nutrition education, motivational interviewing, dietary norms messages Experimental Treatment 1 Intervention

The intervention consists of a) four $15 financial incentive coupons each month; b) twice-monthly group-based nutrition education at the Center for SEA; c) motivational interviewing (months 1, 3, 5); and d) weekly dietary norms text messages sent to adults and twice-monthly dietary norms infographics presented at nutrition education sessions for children. The research assistants will disburse one months' worth of the financial incentive coupon at the nutrition education sessions (or home mailings for absent participants). Families will attend 11 fortnightly, group-based nutrition education sessions lasting one hour. Southeast Asian community health workers will lead the sessions. Research assistants trained in motivational interviewing will call the adults. The calls will last 15-20 minutes. Adults will receive a series of weekly, interactive descriptive dietary norms text messages. Children will see descriptive dietary norms infographics at children's nutrition education sessions.

Group III: Attention control: Academic Engagement Experimental Treatment 1 Intervention

This intervention will be delivered using a similar format and schedule as the financial incentive+nutrition education, motivational interviewing and dietary norms intervention group (i.e., 11 community health worker led in-person group based sessions at the Center for Southeast Asians, 3 MI phone calls, and text messages). The content will focus on family-specific family engagement methods to improve children's academic outcomes.

Who Is Running the Clinical Trial?

Brown University

Lead Sponsor

Trials

480

Recruited

724,000+

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Collaborator

Trials

2,513

Recruited

4,366,000+

Center for Southeast Asians

Collaborator

Trials

1

Recruited

150+

National Institutes of Health (NIH)

Collaborator

Trials

2,896

Recruited

8,053,000+

University of Connecticut

Collaborator

Trials

194

Recruited

162,000+

Published Research Related to This Trial

The study involved 67 Chinese American children aged 8-10 and demonstrated that a family-based program effectively reduced body mass index and improved health behaviors over 8 months.

Participants showed significant improvements in dietary habits, such as increased fruit and vegetable intake, and enhanced physical activity levels, indicating the program's efficacy in promoting healthier lifestyles.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of a child-centred and family-based program in promoting healthy weight and healthy behaviors in Chinese American children: a randomized controlled study. Chen, JL., Weiss, S., Heyman, MB., et al.[2022]

Regular family meals are linked to healthier eating habits and reduced obesity risk in children and adolescents, highlighting their importance in health promotion efforts.

Four out of six reviewed interventions successfully increased family meal frequency, using strategies like goal setting and interactive activities, while also identifying barriers such as time constraints and food preferences that future programs should address.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Promoting family meals: a review of existing interventions and opportunities for future research. Dwyer, L., Oh, A., Patrick, H., et al.[2022]

The study identified 14 key themes related to family influences on healthy eating among adolescents, highlighting the importance of parental knowledge, attitudes, and food parenting practices in promoting better dietary habits.

Effective strategies for improving adolescent nutrition include empowering parents with practical cooking skills and nutrition knowledge, as well as involving children in food preparation and providing a variety of healthy food options at home.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Family Facilitators of, Barriers to and Strategies for Healthy Eating among Chinese Adolescents: Qualitative Interviews with Parent-Adolescent Dyads. Liu, KSN., Chen, JY., Sun, KS., et al.[2023]

In a study involving 71 parents of fourth-grade students, the availability of fruits and vegetables (FV) at home was found to significantly predict higher Healthy Eating Index (HEI) scores for total fruit and vegetables, indicating that access to healthy foods is crucial for improving dietary quality.

Parent modeling of FV eating behavior also positively influenced fruit HEI scores, suggesting that parents' eating habits can impact their children's dietary choices, while self-efficacy in preparing FV did not show a significant association with overall HEI scores.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Parent Food and Eating Behavior Assessments Predict Targeted Healthy Eating Index Components. Ruder, EH., Lohse, B., Mitchell, DC., et al.[2020]

A feasibility study involving 1,090 children aged 6-8 years in Birmingham showed that a culturally tailored intervention to prevent obesity was generally acceptable and feasible, with some components like physical activity opportunities and family cooking workshops being particularly effective.

Children who participated in the intervention were less likely to be obese and had a lower BMI z-score compared to the control group, indicating that the intervention had a positive impact on weight status and supports the need for a larger definitive trial.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preventing childhood obesity, phase II feasibility study focusing on South Asians: BEACHeS. Adab, P., Pallan, MJ., Cade, J., et al.[2022]

Parents define family meals as those that are homemade, prepared by caregivers, and enjoyed at home with most family members present, emphasizing conversation and a pleasant atmosphere.

In contrast, meals considered non-family meals often involve distractions like TV or tablets, include non-family members, and are characterized by a rushed or chaotic environment, highlighting the importance of meal context for family bonding.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exploration of parent-reported family meal dinner characteristics to inform a definition of family meals. Daragan, C., Tate, AD., Trofholz, AC., et al.[2023]

A review of eight randomized controlled trials found that family-based nutrition interventions can effectively improve dietary behaviors in children aged 5-18, highlighting the importance of setting family goals and modifying the home food environment.

Successful interventions often included hands-on teaching methods, such as games and group activities, as well as providing incentives like fruit and vegetable vouchers, although concerns about study quality, such as blinding and instrument reliability, were noted.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Family-based nutrition interventions for obesity prevention among school-aged children: a systematic review. Perdew, M., Liu, S., Naylor, PJ.[2021]

The 'Red Apple' intervention, which included multiple parental group sessions and activities, significantly improved healthy food intake in children compared to minimal intervention and control groups, indicating its effectiveness in promoting better eating habits.

Parents in the complete intervention group maintained their self-efficacy in regulating their children's eating behaviors, while those in the control group experienced a decrease, highlighting the positive impact of the intervention on parental confidence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of a parental school-based intervention to improve young children's eating patterns: a pilot study. Gomes, AI., Barros, L., Pereira, AI., et al.[2023]

In a study involving 34 children aged 7-11, it was found that while guardians contributed to the breadth of dietary data collected during recalls, the children themselves demonstrated significant knowledge about their own diets and sometimes rejected guardian input.

The interactions between guardians and children during dietary recalls revealed complex dynamics of power and cultural understandings, suggesting that relying solely on guardian presence may not always enhance data accuracy and that improvements in dietary recall methods are needed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"You ate all that!?": caretaker-child interaction during children's assisted dietary recall interviews. Sobo, EJ., Rock, CL.[2019]

A pilot study involving 45 mothers and their 4- to 6-year-old children showed that after receiving nutrition information and portion-related activities, both the calories served by mothers and the calories consumed by children significantly decreased, indicating a positive change in dietary habits.

The study suggests that interventions focusing on practical skills rather than just increasing nutrition knowledge may be more effective in changing children's dietary intake.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A parent-directed portion education intervention for young children: Be Beary Healthy. Small, L., Bonds-McClain, D., Vaughan, L., et al.[2016]

The study reviewed 49 articles on child dietary interventions involving parents, finding that effectiveness was the most reported aspect (72.5%), while maintenance was the least reported (2.5%), indicating a need for better reporting practices.

Only six studies directly compared the effectiveness of interventions with and without parental involvement, leaving the impact of parental participation on dietary outcomes unclear and highlighting the need for more focused research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A systematic review of children's dietary interventions with parents as change agents: Application of the RE-AIM framework. Schlechter, CR., Rosenkranz, RR., Guagliano, JM., et al.[2018]

The study developed the Family Mealtime Goals Questionnaire, which is a reliable tool for measuring parents' mealtime goals, based on responses from 1,140 parents of children aged 1 to 16 years.

The most commonly endorsed goal across all age groups was stress and conflict avoidance, highlighting the importance of understanding parents' motivations to improve children's eating behaviors and inform healthier eating interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development of a Parental Feeding Goal Measure: The Family Mealtime Goals Questionnaire. Snuggs, S., Houston-Price, C., Harvey, K.[2020]

A review of 14 observational studies found that non-responsive parental feeding practices and unhealthy eating behaviors in children are linked to an increased risk of overweight and obesity among Southeast Asian children aged 2-12 years.

The studies highlighted a need for more research across a broader range of Southeast Asian countries to better understand the factors contributing to childhood obesity and to develop targeted interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Non-Responsive Feeding Practices, Unhealthy Eating Behaviors, and Risk of Child Overweight and Obesity in Southeast Asia: A Systematic Review. Lindsay, AC., Sitthisongkram, S., Greaney, ML., et al.[2018]

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