Please select the eligibility criteria that correspond to the clinical trial below.
Title: Preventing Early Childhood Obesity, Part 2: Family Spirit Nurture, Prenatal - 18 Months
Brief Summary: This study aims to assess the impact of a home-visiting program, called "Family Spirit Nurture" (FSN), on reducing early childhood obesity in American Indian (AI) children. The FSN intervention targets parent feeding practices, young children's diet and physical activity (PA) and early childhood (0-2 years of age) weight status, all associated with risk for early childhood obesity and, consequently, risk for obesity over the life course. The investigators will also explore whether maternal psychosocial factors (stress, depression and substance use), household food/water security and/or constrained physical activity environments moderate FSN intervention impacts on: mother's feeding behaviors for infants and toddlers; and, children's diets, PA patterns, and weight status. Finally, the investigators will examine how maternal/infant characteristics, diet and behaviors impact the underlying biologic mechanisms of early childhood obesity and whether social and behavioral interventions can impact infant metabolic health. The investigators evaluation will employ a randomized controlled design, in which both the intervention and comparison condition receive assisted transportation to prenatal and well-baby visits (called "Optimized Standard Care"), and the comparison condition also receives potentially beneficial injury prevention education at 8 assessment visits.

Primary Aims:

Efficacy of Family Spirit Nurture (FSN) + Optimized Standard Care (OSC) versus Injury Prevention Education (IPE) + OSC will be assessed for each of the following from birth to 24 months postpartum:

Aim 1. Mothers' implementation of recommended feeding behaviors. Hypothesis 1. FSN + OSC mothers will be more likely to meet breastfeeding and complementary feeding recommendations and engage in responsive parenting/feeding behaviors compared to IPE + OSC mothers.

Aim 2. Children's consumption of healthy diet and physical activity engagement. Hypothesis 2. FSN + OSC children will consume more fruits and vegetables and fewer calories from sugar sweetened beverages (SSB), snacks and desserts, and they will have higher physical activity and reduced screen time/other sedentary activities compared to IPE + OSC children.

Aim 3. Children's weight status. Hypothesis 3. Mean BMI z-scores for FSN + OSC children will be closer to zero (the mean age- and sex- specific BMI z-score for the World Health Organization standard reference population) compared to IPE + OSC children.


Options:
A: Inclusion Criteria:

* Self identifies as non-Hispanic, African-American
* Less than 28 weeks pregnant at time of screening and recruitment
* Expecting a singleton birth
* Maternal age at time of birth will be at 18-39 years
* Lives within specified distance of study site
* Not intending to leave study area before expectant child's 15th month of life
* Agreeable to referring another family member/caregiver to participate in the study

Exclusion Criteria:

* Pre-term birth (\<= 36 weeks gestation)
* Less than 18 years at time of delivery
* Delivers infant with a congenital anomaly or medical condition that significantly affects feeding (e.g., cleft lip and/or palate, metabolic disease)
* Delivers multiples
* Newborn nursery, neonatal intensive care unit (NICU), or maternity floor stay for 7 or more days after the delivery
B: Inclusion Criteria:

* Mothers with a child 0-23 months of age
* Children 0-23 months of age
* Currently pregnant women
* Resides in the program or control area

Exclusion Criteria:

-
C: Inclusion Criteria:

1. Willingness to participate
2. 14 to 24 years old at the time of conception
3. \< 32 weeks gestation at the time of enrollment
4. Reside within 1 hour (50 miles) of local Indian Health Service medical facility
5. Willingness to undergo random assignment and participate in all aspects of the study

Exclusion Criteria:

1. Inability to participate in full intervention or evaluation (e.g., planned move, residential treatment, etc.)
D: Inclusion Criteria:

* Adolescent mothers
* Mothers living in the city of Porto Alegre
* Healthy nontwin newborns with birth weight equal or greater than 2500g

Exclusion Criteria:

* Mothers living with mother-in-law
* Mother-infant pairs that were unable to stay together due to a health concern in either the mother or infant
* Mammaplasty reductive

Answer: C