Tools for Teen Moms: An Intervention to Reduce Infant Obesity
Horodynski, Mildred A.
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Session presented on Saturday, July 25, 2015: Purpose: Rapid weight gain in the first six months of life is associated with a sharply increased risk of obesity later in life and subsequent health consequences. Unhealthy mother-infant feeding practices contribute to rapid/excessive infant weight gain Lower-income, adolescent, first-time mothers are also less likely to engage in infant-centered feeding (shared regulation of feeding within the mother-infant dyad) characterized by Maternal responsiveness (positive Maternal recognition and responses to infant cues), positive feeding styles (Maternal guided approach to infant feeding), and healthy feeding practices as recommended by the American Academy of Pediatrics. Infant-centered feeding is needed to reduce rapid/excessive gain in the first six months of life. Infant-centered feeding fosters infant feeding self-regulation, which is associated with healthy growth (weight and length) and is crucial in reducing childhood obesity risk and adverse health conditions later in life. Few published intervention studies on the prevention or reduction of obesity in infants exist. Practical early intervention strategies must be developed to promote infant-centered feeding among adolescent mothers. The proposed intervention addresses a deficit in the literature on infant-centered feeding to reduce rapid/excessive infant weight gain that exists for this high-risk population. Adolescent mothers' feeding behaviors are most directly related to infant weight gain in the first year of life. Compared to adult mothers, adolescent mothers are less knowledgeable, less responsive, more controlling, and less skilled in infant feeding, which interferes with infants' self-regulation, natural weight trajectory, and healthy growth during the first year of life. The purpose of this study is to test a new social media intervention (Tools 4 Teen Moms [T4TM]) and to determine the preliminary efficacy and the feasibility, acceptability, and satisfaction of T4TM. This poster presents data on website usage, as means of acceptability and satisfaction with the social media intervention. Methods: A two-group randomized control trial is being implemented with a targeted sample of 100 low-income, first-time adolescent mothers with infants (0 to 6 months of age) to obtain evidence for efficacy, feasibility, acceptability, and satisfaction related to T4TM. Infant-centered feeding to reduce rapid/excessive infant weight gain, which provides the basis for the behaviors targeted in the Tools 4 Teen Moms intervention, is derived from theories and empirical studies of mother-infant interaction. The infant-centered feeding experience comprises Maternal responsiveness, feeding styles, and feeding practices. Maternal responsiveness is the sensitivity of the behaviors of a mother to her infant's cues through expert judgment of what her infant needs. These behaviors comprise a relationship-skill set promoting mothers' accurate recognition and response to infants' feeding cues. Feeding style expresses the mother's beliefs about and approach to guiding her infant's feeding behaviors. It also describes how (style) mothers feed their infants (authoritative, authoritarian, permissive, and uninvolved). Feeding practices are Maternal behaviors relating to what is fed, where, how, and how often; they are essential for ensuring healthy eating habits throughout childhood. Maternal behaviors affect infant growth over time and are the focus within the Maternal-infant feeding interaction. Several background factors also affect infant growth, such as Maternal knowledge, self-efficacy, infant temperament, and demographic characteristics, (Maternal age, education, marital status, employment, race, infant birth weight, and type of feeding). This proposal focuses on some of the major background factors that affect infant growth. Participants will be randomly assigned to the intervention group (n = 50) or control group (n = 50). Inclusion criteria: Self-identified, English-speaking, low-income, adolescent, first-time mothers between the ages of 15 and 19, with daily web access and access to a cell phone that includes text messaging capabilities, will be eligible to participate. Other criteria include: family income - 185% of federal poverty; term birth (37-42 weeks, 2500-3750 grams birth weight); mothers and infants with no special nutrients or feeding needs; and infants less than six weeks old at study enrollment who have not started eating solid foods. Adolescent mothers must be a primary caretaker of the infant who feeds her infant at least once a day. Adolescent mothers are recruited from Maternal Infant Health Programs, a program for pregnant women and infants who are Medicaid-eligible, promotes healthy pregnancies, positive birth outcomes, and healthy infants through home and office visits during the first year of life. Tools4Teen Moms, developed to promote mother-infant feeding interaction, integrates a parent-infant interaction model, self-determination theory, and goal setting theory to address infant-centered feeding. The intervention consists of six weeks of daily challenges via the T4TM website within four urban, Michigan counties. Tools4Teen Moms challenges will be delivered for six weeks starting when the infant is four to six weeks old. T4TM includes cell phone text message reminders, an infant feeding website, and a Facebook interface to increase infant-centered feeding. Participants perform daily behavioral challenge activities, which consist of daily challenges for six weeks via the T4TM website. Daily challenges focus on promoting Maternal-infant feeding interaction and healthy feeding practices. Data are collected at three time points (baseline, when the infant is 10-12 weeks old, and six months old), using self-report and anthropometric measures. Data analysis for challenge feasibility: For those in the intervention group, the number and percent of participants who completed all the challenges will be determined. Acceptability and Satisfaction: The results of the satisfaction survey will be summarized and evaluated for overall satisfaction. Open-ended questions will be transcribed to identify key reasons for satisfaction levels and suggestions for improvement. Results: (Preliminary): Currently, the participant age range is 16 to 19 years with a mean of 18 years; 33% of participants identify themselves as Hispanic/Latina, 27%, identify as Black/African American, 20% White, 7% Asian, and 13% as multiracial. Most participants (87%) are not currently employed. At the time of data collection 33% of participants were currently breastfeeding, while 67% were not; of the 67% who were not currently breastfeeding, 50% had breastfed their baby at some point. Birth weight of babies in the study ranges from 5.58-9.19 lbs (mean = 7.29 lbs). Preliminary results indicate engagement with the T4TM website and challenges. Participants visited the website an average of 28/42 days. Many participants have retroactively completed challenges; meaning they visited the 'Past Challenges' to complete challenges that had been posted earlier that week. The average minimum challenge exposure for completed participants thus far is 31/42. Preliminary results show that participants engage with quizzes available on the T4TM website; participants have completed an average of 3/4 quizzes. Feedback from participants indicates enjoyment of the intervention. All participants agreed that they found the website helpful, they learned a lot about infant feeding from this program, and they would recommend T4TM to a friend for infant feeding advice. Participants agreed that they were satisfied with the challenges presented in the T4TM intervention. One participant expressed her opinion of the program: 'It's a good program; I like it because it teaches me new things about becoming a great mother, and I really appreciate this program. Thank you so much!' Conclusion: This study is in progress. Preliminary evidence supports use of text messaging and daily challenges to engage adolescent mothers in healthy infant feeding practices. Nursing can augment education with skill application via social media.