Promotoras providing health education to prevent childhood obesity

Aims: The goal of the study presented in this paper (title blinded) is to examine the effect that confounding factors such as mode of delivery, length of time breastfeeding, maternal obesity, and pacifier use has on the outcomes of health teaching specifically on nutrition of infants by promotoras. Additional factors such as mothers’ education, employment history as well as rates and types of food insecurity are also investigated to determine their influence on growth outcomes. Case studies of successful outcomes as well as unsuccessful outcomes will be presented with details about the processes that influence the outcomes.

Background: Among racial and ethnic groups, the Hispanic population has rates of 24.3% and 21.2%, for overweight and obesity respectively. The rate for the Hispanic populations was about one and a half times the rate for the white non-Hispanic population. The National Council of La Raza reports that one out of two Latino children born in the Year 2000 will develop diabetes. Early and rapid growth in infants, denoted by the upward crossing of growth centiles, is strongly associated with early development and persistence of obesity in young children. Substantial research has linked child obesity/overweight to increased risks for serious health outcomes, which include adverse physical, psychological/behavioral, or social consequences.

Methods: Data were extracted from clinical notes made by the promotoras after each visit to the family. The notes were organized in a Subjective, Objective, Assessment, Plan (SOAP) format along with clinical measures of weight, height, and 24 hour diet assessment. There were 279 clinical notes from 2-3 promotoras covering 12 months of visits to 66 subjects analyzed for this paper. 

Results: There is a high rate of food insecurity among the sample with 100% using WIC, 50% receiving SNAP (food stamps), 15% using food banks, 5% skipping meals due to no food, and 89% running out of money to buy food weekly/biweekly. Rates of cesarean delivery are high at 44%, with 8% having gestational diabetes, and a mean postpartum BMI of 33. Normal weight infants have a longer duration of breastfeeding than do overweight or obese children.

Implications: Social issues frequently create a lot of stress in the families with interest in child feeding taking lesser importance than securing food for family. Overall, breastfeeding history was not associated with weight/L status at the most recent visit although prolonged breastfeeding in conjunction with counseling by promotoras may promote healthy weight status. Delivery status, C-section versus vaginal, did not appear to be associated with W/L status at most recent visit. In a subgroup of engaged mothers, targeted counseling appeared to reverse unhealthy weight gain trends. Further analysis needed to determine if the engagement is a result of the education provided only or if the positive outcome is a result of an effective working relationship established by the promotora with the families. Some families appear to be resistant to counseling on infant nutrition in spite of culturally appropriate education provided in a manner congruent with the education and language of the subjects.