Many behaviors that can be a cause of obesity begin early in infancy. At 2 months of age:
The Greenlight Study
Greenlight is being evaluated as part of a study funded by the National Institutes of Health.
The Greenlight study has allowed the research team to look at feeding and activity-related parenting practices in the families who participated, as well as issues such as health literacy.
In the cluster randomized trial, 865 parent-child pairs were enrolled at the 2 month well-child check-up and are being followed through their 5 year old check-up. The families are mostly Hispanic and African-American, from low income backgrounds.
Read published paper describing the Greenlight study.
Study Details
The multi-site NIH-funded Greenlight study will help researchers understand why obesity develops in young children and strategies to address childhood obesity.
1 The Greenlight Study Pediatric Resident Clinic Sites
The Greenlight Study is a cluster randomized study, involving 4 university-affiliated pediatric resident clinic sites.
Two sites were randomized to receive the Greenlight intervention:
- NYU School of Medicine / Bellevue Hospital Center
- Vanderbilt University
Two clinic sites were randomized to receive an injury prevention intervention based on the American Academy of Pediatrics’ TIPP program (The Injury Prevention Program) [active control group]:
- University of Miami
- University of North Carolina at Chapel Hill
2 Greenlight Intervention Components
Greenlight parents received:
- Age-specific core Greenlight booklets (English or Spanish) at each well-child check-up from 2 months through 2 years of life (2, 4, 6, 9, 12, 15-18 months)
- Clear communication techniques used by providers trained in health literacy-informed counseling strategies, including teachback and goal-setting
- Topic booklets, if needed, exploring additional issues such as breastfeeding and sleep
- Tangible tools to reinforce Greenlight messages
- — 2 month check-up - onesie with message “I’m sweet enough. Please no juice.”
- — 9 month check-up - sippy cup to promote transition to cup by 1 year
- — 12 month check-up - portion size snack cups to promote portion size knowledge and healthy snacks outside of the home
- — 15-18 month check-up - placemat to show how to divide plate to include ½ fruits/ vegetables
3 Injury Prevention Intervention Components (based on AAP TIPP Program)
Parents at the injury prevention sites received:
- Age-specific AAP TIPP handouts (English or Spanish) at each well-child check-up from 2 months through 2 years of life (2, 4, 6, 9, 12, 15-18 months)
- Tangible tools to reinforce AAP TIPP messages
- — 2 month check-up - onesie with message “This side up for sleep”
- — 9 month check-up - bath duck with thermometer
- — 12 month check-up - cabinet locks
- — 15-18 month check-up - placemat showing car seat recommendations
4 Parent/Child Inclusion Criteria
Parent/child pairs were given the opportunity to enroll in the study if the following inclusion criteria were met:
- Primary caregiver (parent or legal guardian)
- Caregiver English or Spanish-speaking
- Infant presenting for 2 month well-child check-up, between 6-12 weeks of age
- Caregiver agrees to bring child to well-child visits through 2 years of life
5 Parent/Child Exclusion Criteria
Parent/child pairs were not asked to enroll in the study if the following exclusion criteria were present:
- Child born before 32 weeks gestational age or with a birth weight of less than 1500 grams
- Child with weight/length less than 3rd percentile at 2 months of age
- Child with diagnosis of failure to thrive, or with weight that dropped more than 2 percentile curves since prior check-up
- Child with known medical problems that may affect their ability to thrive or requires a special diet (e.g. metabolic disease, uncorrected congenital heart disease, renal disease, lung disease)
- Caregiver with significant mental or neurologic illness likely to affect their ability to participate
- Caregiver age less than 18 years
- Caregiver with known plans to move out of the area during the study period
6 Pediatric Resident Physicians Inclusion Criteria
Pediatric resident physicians were given the opportunity to enroll in the study if the following inclusion criteria were met:
- Participation in the medical center’s pediatric residency program
- Provision of regular care in the pediatric resident primary care clinic
Pediatric residents were not offered enrollment if they had known plans to leave the training program during the following 6 months.
Publications
Greenlight is informed by the extensive, ongoing research of our team of primary investigators. Here is a selection of publications.