Healthy Mothers-Healthy Children Nutrition and Physical Activity Intervention

Hispanic women and children who become overweight or obese are at risk for developing
prediabetes, type 2 diabetes, and cardiovascular disease later in life. To date, there have
been no interdisciplinary interventions that have targeted Hispanic women and their 3-4 year
old children to improve nutrition and physical activity behaviors to manage adiposity and
weight in mothers and prevent excessive adiposity and weight gain trajectory in their
children. Using a randomized two-group, repeated measures experimental design, the goal of
the proposed study is to investigate the efficacy of a 12-week nutrition and exercise
education, physical activity, coping skills training, and home-based physical activity
intervention in Hispanic women and their 3-4 year old children and 6 months of continued
monthly contact to help overweight and obese Hispanic mothers improve adiposity, weight,
health behaviors (nutrition and physical activity), and self-efficacy and their 3-4 year old
children improve their adiposity and weight gain trajectory and health behaviors (nutrition
and physical activity). The investigators will partner with two federally qualified health
departments in Durham and Chatham, North Carolina to enroll Hispanic women and their 3-4 year
old children and the investigators will partner with community centers to deliver the
intervention. A total of 294 Hispanic women with a BMI >25 kg/m² and 294 Hispanic 3-4 year
old children with a BMI percentile > 25 will be enrolled over 4 years and randomized to the
experimental or equal attention control group. Data will be collected at Time 1 (0 months
[baseline]) to Time 2 (9 months [completion of the intervention]) and Time 1 to Time 3 (15
months [after 6 months with no contact from the study staff]). Data collected will include
adiposity (primary outcomes: waist circumference, triceps and subscapular skinfolds) in
mothers and children and weight (primary outcomes: body mass index [BMI] in mothers and BMI
percentile in the children). Secondary outcomes will include health behaviors and
self-efficacy in the mothers (Adult Health Behavior Questionnaire, Lifestyle Health Promoting
Profile II, 3 day 24-Hour Food Recall, and 7 day Accelerometer, Eating Self-Efficacy Scale
and Exercise Self-Efficacy Scale) and in the children (7 day Accelerometer and 3 day 24-Hour
Food Recall). The investigators will also evaluate the cost of delivering the program for
public health departments. Data analysis will use general linear mixed models to test the
hypotheses. Decreasing overweight and obesity in Hispanic women and slowing adiposity and
weight gain trajectory in young Hispanic children is urgently needed to decrease morbidity,
mortality, and future health care costs. The knowledge to be gained from this study may
provide a foundation for extending this intervention to other Hispanic mothers and children
in other communities to assist mothers in managing their weight and preventing excessive
adiposity and weight gain in their children. This approach is translatable, real-world, and
could be replicated in other areas of the United States.

Inclusion criteria for mothers will be:

- age 18 years or older

- self-identification as Hispanic

- limited English proficiency; little acculturation, as measured by the Short
Acculturation Scale for Hispanics with a score from 1.00 to 2.99

- ability to understand spoken Spanish

- a BMI >25kg/m²

- residence with the child

- consent to join the study and consent for their child to join the study.

Inclusion criteria for children will be:

- age 3-4 years

- ability to understand spoken Spanish

- a BMI > 25th percentile for age and gender

Exclusion criteria for mothers will be:

- heart murmur

- congenital heart disease

- family history of sudden death

- difficulty exercising

- psychological problems