Míranos! Program, a Preschool Obesity Prevention RCT

NCT ID: NCT03590834

Last Updated: 2023-12-07

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

525 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-08-01

Study Completion Date

2023-08-31

Brief Summary

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The prevalence of obesity remains high in American children aged 2-5 while one in three Head Start children is overweight or obese. The proposed study is designed to test the efficacy of an early childhood obesity prevention program which promotes healthy growth in predominantly Latino children in Head Start.

The program is a group clustered randomized controlled trial in partnership with two local Head Start organizations to address key enablers and barriers in obesity prevention in young children. The study has three specific aims:

1. To test the efficacy of the Miranos! intervention on healthy weight growth (primary outcome) in normal weight, overweight, and obese children.
2. To test the impact of the Miranos! intervention on children's physical activity, sedentary behavior, sleep, and dietary behaviors (secondary outcomes).
3. To evaluate cost-effectiveness of the Miranos! intervention.

Miranos! will be delivered in Fall and Spring (8 months) and followed by a summer health campaign.

Detailed Description

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Using a three-arm design, 12 Head Start (HS) centers in equal number will be randomly assigned to one of three conditions: 1) a combined center- and home-based intervention, 2) center-based intervention only, or 3) active control. The interventions will be delivered during the academic year (an 8-month \[mo\] period). A total of 525 3-year-old children (52% females; in two cohorts) will be enrolled in the study at baseline and followed prospectively one-year post-intervention. The first cohort will be recruited in summer 2018. The second cohort will be recruited in summer 2019.

Data collection will be conducted at baseline (T0), immediate post-intervention (T1), and 1-year post-intervention follow-up (T2) and include children's height, weight, accelerometry-based PA and sedentary behavior, TV watching and sleep by parent reports, gross motor development, dietary intakes, food preference. Information on family background, parental PA- and nutrition-related practices, parental weight and health behaviors, PA and nutrition policies and environments at the center and home, and costs associated with intervention delivery will be collected. The primary endpoint for the study is the BMI at the posttest immediately following the completion of the intervention (T1).

Recruitment: Participant recruitment will take place during summer by sending a recruitment packet to child's home. This packet includes: study information sheet, recruitment flyer, informed consent form, a letter from center director and study PIs.

Process Evaluation: The process evaluation is informed by the NIH Behavior Change Consortium Treatment Fidelity Workgroup's best practice recommendations and recent multi-component RCTs. Míranos! has multiple components with multiple activities, the investigators will use many indicators to evaluate the fidelity and completeness of the implementation of all components and determine contribution of each component by linking it to the primary and secondary outcomes. The investigators will collect both quantitative/qualitative data to assess cross-site treatment consistency, non-treatment-related effects, and document protocol changes.

First, intervention dose delivered will be measured by: 1) pre-/post-study center environmental assessment by the Environment and Policy Assessment and Observations (EPAO) and auditing of meal menus; 2) completion of delivery schedule of staff, peer leader training, parent education sessions, home visits; 3) evaluation of staff, peer leader training; 4) monthly auditing of weekly lesson plans; and 5) monthly checklist of use of Míranos! Activity Cards, children's story books, HHL learning activities.

Second, the intervention dose received will be assessed by: 1) attendance records of staff, peer leader training, parent education sessions; 2) certification test of staff, peer leader training; 3) monthly staff evaluation (rating scale) of children's learning of HHL content, gross motor skills, eating behaviors; 4) post-study parent intercept interviews; and 5) post-study focus groups on program delivery process with staff (n=24) and parents (n=32).

Third, participants' responses to the intervention will be evaluated by: 1) random observations of staff behavior (rating scale) during outdoor play and lunch by research staff; 2) assessments on children's PA by the System for Observing Fitness Instruction Time for Preschoolers and diet by group plate waste test in 3 randomly selected centers; 3) in-depth interviews with staff (n=48) for program feedback; and 4) post-study staff and parent evaluation (rating scale) of satisfaction with intervention components/activities.

Conditions

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Obesity Healthy Eating Physical Activity Health Knowledge, Attitudes, Practice Gross Motor Development

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

The parents of the children were informed that their Head Start center will be randomly assigned to one of the three study groups.

Study Groups

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Center-based intervention

In-person, child-focused intervention taking place only at the Head Start centers

Group Type EXPERIMENTAL

Center-based Intervention

Intervention Type BEHAVIORAL

1. Center nutrition and physical activity policy modification to increase fruit and vegetable servings and more physical activity throughout the day
2. Staff training and technical assistance
3. Health education on healthy habits (diet, physical activity, sleep, screen time) using the Sesame Workshop Healthy Habits for Life (HHL) resource kit
4. Health contests
5. Gross motor and physical activity program
6. Miranos! activity cards based on children storybooks

Center-and-home-based intervention

In-person, child-focused intervention taking place only at the Head Start centers. Delivered in-person at Head Start centers and the family home.

Group Type EXPERIMENTAL

Home-based Intervention

Intervention Type BEHAVIORAL

1. Monthly interactive poster education sessions led by parent peer educators during child pick-up time. Held at Head Start Center. These sessions include family health challenges and take-home activities.
2. Three Home Visits delivered by Head Start staff. Obesity prevention goal-setting integrated into existing Head Start home visits
3. 16 semi-monthly, Family Newsletters with stories, tips, and strategies to promote healthy habits for preschool children
4. Incorporating activities related to PA, nutrition and sleep into existing Head Start Center Summer Calendars

Active Control

Active comparison group

Group Type ACTIVE_COMPARATOR

Active Control

Intervention Type BEHAVIORAL

Children will receive Head-Start-approved health education program for children: "I Am Moving, I Am Learning". In addition, the investigators will deliver an early childhood literacy program to all active control children to increase buy-in and retention.

Interventions

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Center-based Intervention

1. Center nutrition and physical activity policy modification to increase fruit and vegetable servings and more physical activity throughout the day
2. Staff training and technical assistance
3. Health education on healthy habits (diet, physical activity, sleep, screen time) using the Sesame Workshop Healthy Habits for Life (HHL) resource kit
4. Health contests
5. Gross motor and physical activity program
6. Miranos! activity cards based on children storybooks

Intervention Type BEHAVIORAL

Home-based Intervention

1. Monthly interactive poster education sessions led by parent peer educators during child pick-up time. Held at Head Start Center. These sessions include family health challenges and take-home activities.
2. Three Home Visits delivered by Head Start staff. Obesity prevention goal-setting integrated into existing Head Start home visits
3. 16 semi-monthly, Family Newsletters with stories, tips, and strategies to promote healthy habits for preschool children
4. Incorporating activities related to PA, nutrition and sleep into existing Head Start Center Summer Calendars

Intervention Type BEHAVIORAL

Active Control

Children will receive Head-Start-approved health education program for children: "I Am Moving, I Am Learning". In addition, the investigators will deliver an early childhood literacy program to all active control children to increase buy-in and retention.

Intervention Type BEHAVIORAL

Other Intervention Names

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CBI C+HBI

Eligibility Criteria

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Inclusion Criteria

* The child must be enrolled in a full-day Head Start center
* The child must be 3 years old at baseline, one child per family, parental consent

Exclusion Criteria

* N/A
Minimum Eligible Age

3 Years

Maximum Eligible Age

5 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of Texas at Austin

OTHER

Sponsor Role collaborator

University of Maryland

OTHER

Sponsor Role collaborator

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

NIH

Sponsor Role collaborator

Family Service Association of San Antonio Inc.

UNKNOWN

Sponsor Role collaborator

Parent/Child Incorporated (PCI) of San Antonio and Bexar County

UNKNOWN

Sponsor Role collaborator

The University of Texas at San Antonio

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Zenong Yin, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Texas at San Antonio

Deborah Parra-Medina, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Texas at Austin

Locations

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University of Texas at San Antonio

San Antonio, Texas, United States

Site Status

Countries

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United States

References

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Yin Z, Ullevig SL, Sosa E, Liang Y, Olmstead T, Howard JT, Errisuriz VL, Estrada VM, Martinez CE, He M, Small S, Schoenmakers C, Parra-Medina D. Study protocol for a cluster randomized controlled trial to test " inverted exclamation markMiranos! Look at Us, We Are Healthy!" - an early childhood obesity prevention program. BMC Pediatr. 2019 Jun 10;19(1):190. doi: 10.1186/s12887-019-1541-4.

Reference Type BACKGROUND
PMID: 31179916 (View on PubMed)

Ullevig SL, Parra-Medina D, Liang Y, Howard J, Sosa E, Estrada-Coats VM, Errisuriz V, Li S, Yin Z. Impact of inverted exclamation markMiranos! on parent-reported home-based healthy energy balance-related behaviors in low-income Latino preschool children: a clustered randomized controlled trial. Int J Behav Nutr Phys Act. 2023 Mar 21;20(1):33. doi: 10.1186/s12966-023-01427-z.

Reference Type BACKGROUND
PMID: 36944986 (View on PubMed)

Yin Z, Liang Y, Howard JT, Errisuriz V, Estrada VM, Martinez C, Li S, Ullevig SL, Sosa E, Olmstead T, Small S, Ward DS, Parra-Medina D. inverted exclamation markMiranos! a comprehensive preschool obesity prevention programme in low-income Latino children: 1-year results of a clustered randomised controlled trial. Public Health Nutr. 2023 Feb;26(2):476-487. doi: 10.1017/S1368980022002439. Epub 2022 Nov 11.

Reference Type BACKGROUND
PMID: 36357340 (View on PubMed)

Other Identifiers

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R01DK109323

Identifier Type: NIH

Identifier Source: secondary_id

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R01DK109323

Identifier Type: NIH

Identifier Source: org_study_id

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