Greenlight Plus Study: Approaches to Early Childhood Obesity Prevention

Study Overview
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Brief Summary
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A randomized controlled trial enrolling 900 parent-infant dyads (English and Spanish speaking) comparing Greenlight (control), a behavioral intervention focusing on nutrition, physical activity, media use, and sleep as compared to Greenlight Plus (intervention) which includes the above materials plus a health information technology (HIT) intervention aimed at supporting family goal-setting and behavior change during well-child checks throughout the first 2 years of life.

Detailed Description
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The investigators propose a randomized trial to compare the effectiveness of two different approaches to early childhood obesity prevention in children 0-2 years of age. The investigators will randomize 900 parent-infant dyads, recruited from six newborn nurseries/primary care clinics. The participating organizations are part of both CORNET, a national practice-based research network of pediatric residency primary care practices supported by the Academic Pediatric Association (APA), and PCORnet, the national research network supported by PCORI. In the nursery or at the first newborn clinic visit, eligible families will be consented and randomized to one of two arms. In Arm 1 (Greenlight), during each of the recommended well child visits from 0-24 months, pediatric residents, trained in clear health communication skills and shared goal-setting, will use the Greenlight Toolkit of low literacy, age-specific, parent education booklets to promote healthy family behaviors and obesity prevention. In Arm 2 (Greenlight Plus), families will receive the Greenlight intervention plus a health information technology (HIT) intervention aimed at supporting family goal-setting and behavior change. This design allows us to determine if HIT and the asynchronous support it provides between well-child visits can promote additional behavior change and obesity prevention. Specific Aims & Hypotheses (H) include: Aim 1: Compare the effectiveness of the 2 arms on weight-for-length and other weight measures through age 2. H1: Arm 2 will be significantly better than Arm 1 in supporting healthy child weight-for-length trajectory over 2 years; Aim 2: Compare the effectiveness of the two approaches on parent-reported outcomes, including child feeding and physical activity behaviors, parent feeding beliefs and behaviors, media use, and quality of doctor-patient communication. H2: Arm 2 will be significantly better at improving parent-reported health behaviors. Aim 3: Examine differences in main outcomes by social determinants, including race/ethnicity, language, health literacy. H3: A literacy- and culturally-sensitive approach to obesity prevention will result in equal subgroup improvements. Aim 4: To compare weight-for-length trajectory over 2 years in both intervention arms with a non-enrolled comparison group, using data from the PCORnet Common Data Model at participating sites. H4: PCORnet analysis will reveal the benefit of both Greenlight approaches (Arms 1 and 2) compared to before Greenlight intervention implementation and the added benefit of Arm 2 (Greenlight Plus) over other approaches.

Official Title
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Greenlight Plus Study: A Randomized Study of Approaches to Early Childhood Obesity Prevention

Conditions
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Behavior, Health, Child Obesity

Intervention / Treatment
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* Behavioral: Greenlight Plus
* Behavioral: Greenlight


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: For this study, eligible caregiver/infant dyads will be those with: an English- or Spanish-speaking parent/legal guardian, infant born in the newborn nursery with plans to have care in the local clinic OR presenting in that clinic for the first newborn visit (1-21 days of life), attendance at first newborn clinic visit no plans to leave the clinic within 2 years Completion of baseline data collection (survey data, child weight and length measures prior to randomization). Own a smartphone with access to data services Exclusion Criteria: Infant exclusion criteria: born prior to 34 weeks gestation or birth weight <1500 grams; weight <3rd %tile at enrollment (World Health Organization growth curves); or any chronic medical problem that may affect weight gain (e.g., metabolic disease, uncorrected congenital heart disease, renal disease, high-calorie formula; cleft palate; Down syndrome). Caregiver exclusion criteria include: <18 years old; serious mental or neurologic illness that impairs ability to consent/participate; poor visual acuity (corrected vision worse than 20/50 with Rosenbaum Screener). biological mother is HIV-positive

Ages Eligible for Study
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Maximum Age: 21 Days

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Greenlight Plus<br>Families will receive the Greenlight intervention plus a health information technology (HIT) intervention aimed at supporting family goal-setting and behavior change. This design allows us to determine if HIT and the asynchronous support it provides between well-child visits can promote additional behavior change and obesity prevention. | Behavioral: Greenlight Plus<br>* Families randomized to the Greenlight Plus arm will receive a HIT intervention starting at the newborn clinic visit. During the newborn visit, these families will receive basic instructions on how to access the Greenlight technology platform, which includes the iOTA text-messaging application and a website (usable on desktop or mobile platform). Families will receive text messages and goal-setting over the first 2 years of the child's life.<br>Behavioral: Greenlight<br>* All residents and families seen in the participating clinics will receive the basic Greenlight materials.<br>|
| Active Comparator: Greenlight<br>During each of the recommended well child visits from 0-24 months, pediatric residents, trained in clear health communication skills and shared goal-setting, will use the Greenlight Toolkit of low literacy, age- specific, parent education booklets to promote healthy family behaviors and obesity prevention. | Behavioral: Greenlight<br>* All residents and families seen in the participating clinics will receive the basic Greenlight materials.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Child weight for length trajectory |  | Baseline to 24 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Child BMI Z-score trajectory |  | Baseline to 24 months | 
| Child weight-for-length z-score trajectory |  | Baseline to 24 months | 
| Child overweight and/or obesity | Outcome defined by CDC or WHO standards | at 24 months |