The aims of the proposed research are to design and evaluate a low-cost, primary care-based intervention to prevent the onset of obesity in Latino infants. This proposal is relevant to public health because obesity often begins early in life and is associated with diabetes, heart disease, and numerous other comorbidities, and because Latino children in the United States experience disproportionately high rates of obesity. The goal of the proposed intervention is to promote infant feeding, nutrition and screen time practices that will be protective against obesity across the lifespan.

Primary Care Based Feeding and Screen Time Education to Prevent Obesity in Latino Infants Latino children experience higher rates of obesity than non-Hispanic white children, a disparity that emerges in infancy. Among Latino children, those with Spanish-speaking parents are at highest risk for obesity. Research has shown that optimal feeding strategies in early life and avoidance of screen time may lower the risk of childhood obesity, which in turn, reduces the risk of obesity and its comorbidities through adulthood. However, few interventions have sought to promote optimal infant feeding and screen time practices among Spanish-speaking Latino parents. In addition, most interventions in the literature that address infant obesity prevention have been conducted through home visits or special trips to the intervention site by parents, approaches that may not be sustainable in low-resource settings due to cost and the burden on participants. Given that infants are expected to have 7 well-child visits in the first year of life, primary care is an ideal setting in which to ofer parental education on infant feeding and screen time recommendations. The overall objective of this proposal is to design, pilot test, and refine a Spanish-language, culturally appropriate, primary care-based intervention to prevent obesity in Latino infants born to Spanish-speaking mothers. Our overarching hypothesis is that focused education on infant feeding and screen time avoidance will lead to use of optimal infant feeding and screen time practices among Spanish-speaking Latino mothers and result in less weight gain in the first year of life. In preparation for submitting an R01 application to test this hypothesis, we propose research with the following specific aims to be conducted at the San Francisco General Hospital (SFGH) outpatient pediatric clinic: Aim 1: Use the Information-Motivation-Behavioral Skills model to design 5 group educational modules that promote optimal infant feeding and screen time practices among Spanish-speaking Latino mothers; Aim 2: Use a pilot randomized-controlled trial (RCT) to test a yearlong intervention in which the 5 modules (Aim 1) are provided to Spanish-speaking Latino mothers just after well-child visits at ages 2 weeks, and 2, 4, 6, and 12 months (primary outcomes will include use of responsive feeding practices, infant dietary intake, and infant active and passive television viewing time; secondary outcomes will be infant anthropometrics); Aim 3: Use qualitative methods to assess how individual components of the intervention from Aim 2 affected feeding and screen time practices. By the conclusion of this award, we will have a scalable and potentially reproducible intervention for infant feeding and screen time practices, one that is linguistically and culturally appropriate for Spanish-speaking Latino parents and aims to reduce weight gain in the first year of life while promoting habits that protect against obesity across the lifespan. Dr. Amy Beck, PI for this mentored career development award, is a bilingual pediatrician with considerable clinical experience caring for low-income Latino children and a deep commitment to improving health outcomes in this population. Dr. Beck is a pediatric attending at SFGH (a public hospital affiliated with UCSF that serves a majority Latino population) where she provides both general pediatric care and also is the co-director of the pediatric obesity clinic. With respect to her research background, Dr. Beck holds a MPH and completed a General Pediatrics research fellowship at the University of California, San Francisco (UCSF). During her fellowship, Dr. Beck used both quantitative and qualitative methods to investigate risk factors for obesity among Latino children. She has 5 first-author publications, of which 4 directly inform this proposal. She is currently conducting two pilot intervention studies in obesity prevention and treatment for Latino children. Her long-term career goal is to be an independent investigator in the field of obesity prevention with a focus on improving preventive services for low-income Latino children. To accomplish this goal, Dr. Beck must strengthen her skills in biostatistics and qualitative methods and acquire new skills in dietary analysis and RCTs of behavioral interventions. Dr. Beck has formed an interdisciplinary team of faculty mentors and consultants with expertise in general pediatrics, nutrition, psychology, anthropology, Latino health, pediatric obesity, and health policy. Her primary mentor, Dr. Michael Cabana, is an internationally respected health services researcher and the Division Chief of General Pediatrics at UCSF. Dr. Cabana has extensive expertise in the design and conduct of RCTs in the ambulatory setting and a strong track record of mentorship. In addition to her mentored research plan and ongoing tutorials with her diverse mentorship team, Dr. Beck will take advantage of UCSF's numerous opportunities for research training. She will enroll in additional courses offered through the Training in Clinical Research Program that cover specific areas of her career development plan. She will also take a course at the UC Berkeley School of Public Health on dietary assessment. Finally, she will attend seminars offered by the Division of General Pediatrics and participate in the K scholars program offered by the Clinical and Translational Science Institute at UCSF. Dr. Beck has the full support of the UCSF Department of Pediatrics and the Division of General Pediatrics for this proposed award. By the conclusion of this award, Dr. Beck will be well positioned as an independent investigator in the field of childhood obesity prevention research.