July 11, 2016—(BRONX, NY)—More than one-third of Bronx residents are born outside of the United States. Often separated from family, challenged by language barriers, unfamiliar with health resources, and burdened by poverty, they are at high risk for health problems. And these risks extend to their young children.

Alison Karasz, Ph.D.Now, researchers at Albert Einstein College of Medicine and Montefiore have received a $3.7 million grant from the National Institutes of Health (NIH) to test a new intervention to improve the health outcomes of children of South Asian immigrants. South Asians are the fastest growing immigrant community in the United State and recent arrivals often lack access to good medical care.

Community health workers, who will also be South Asian women, will visit nearly 400 mothers with newborns in the Bronx and greater New York area to help them learn healthy feeding practices and improve oral hygiene for their children.

"We've found that many new mothers bottle-feed more frequently and delay weaning to a later age than is optimal for their children," said Alison Karasz, Ph.D., associate professor of family and social medicine at Einstein and principal investigator on the project.
Karen Bonuck, Ph.D."This can result from overcrowded homes, where mothers feel pressure to keep their children quiet, or concerns about children getting enough to eat. Based on our pilot program, we expect that when mothers are provided resources and support from someone they see as their peer, feeding practices will improve—and so will children's health."

The home-based intervention is titled Child Health Action to Lower Oral Health and Obesity Risk, or CHALO!, which means "Let's go!" in Hindi. It will target excess bottle-feeding and the extended use of bottles and "sippy" cups—the two most significant risk factors for childhood obesity and cavities.

"We know that health behaviors and eating patterns in the first few months of life can have an oversized impact on long-term health," said Dr. Karasz. "Obesity and caries, or tooth decay, are the two most common childhood diseases in the United States and impose a significant, lifelong burden."

Community health workers will visit 377 South Asian mothers of children aged 4 to 5 months and their families six times over the course of a year and will supplement with phone support. They will work with the mothers and their families to make concrete changes, such as:

• Listening and responding to children's cues about when they are hungry and when they are full
• Making and keeping dental visits
• Ending the common practice of using food to pacify children

"Based on our pilot program, we expect that when mothers are provided resources and support from someone they see as their peer, feeding practices will improve—and so will children’s health."

– Alison Karasz, Ph.D.

To evaluate the efficacy of the intervention, the health workers will assess the children's oral health and height and weight at 6, 12 and 18 months of age. They will use novel devices and techniques, including an inter-oral camera to capture images of the teeth. These images will be sent to the University of Rochester dental school for review. They'll also use an iPad program to assess children's feeding and oral health practices, in collaboration with Columbia University dental researchers.

Einstein researchers are partnering with a New York-based nonprofit organization, Sapna NYC, to deliver this home-based intervention. The mothers will be identified through Montefiore and the South Asian Practice Partnership for Health Improvement and Research, a practice-based research network for South Asian primary care practices. Dr. Karasz is executive director and co-founder of Sapna NYC, which started from a research project on women's depression funded by the NIH. Karen Bonuck, Ph.D., professor of family and social medicine at Einstein, is the project's co-principal investigator. Dr. Bonuck conducts research on early childhood feeding.

The title of the grant is "Obesity and Caries in Young South Asian Children: A Common Risk Factor Approach" (1R01MD010460).