A community-randomized controlled trial against sugary snacking among infants and toddlers
Objectives: We evaluated the impact of educational interventions on sugary snacking in infants and toddlers in Tehran, Iran.
Methods: A 6-month intervention was integrated into health staff duties. We assigned 12- to 15-month-olds (n = 242) and their mothers attending the vaccination offices of 18 randomly selected public health centers into the following groups: pamphlet and reminder (A), pamphlet only (B), and one control group (C). The mothers were interviewed at baseline and after follow-up. We recorded the frequency of sugary snacking for both the children and their mothers and calculated changes over 6 months. A reduction in the children's snacking frequency indicated a positive outcome. The family's residential area (affluent/nonaffluent) indicated its socioeconomic level. Associations between the children's and their mothers' snacking frequency were assessed by means of Spearman correlation. The outcomes of each intervention group were compared separately to those of the control group by means of the Mann-Whitney test. In addition, we performed intention to treat analysis. Factors related to a positive outcome were explained by means of logistic regression models.
Results: In all groups, the child's and mother's snacking at baseline correlated (r = 0.4). A positive outcome was found for 62% of the children in group A and for 49% and 32% in groups B and C, respectively. In group A, a reduction in the children's snacking frequency was found despite their residential area (P < 0.05). Controlling for intervention effects, the logistic regression model showed that residential area was unrelated to the positive outcome.
Conclusions: Oral health education with reminders provided to mothers by general health staff is a valuable tool for reducing sugary snacking in infants and toddlers in a country with developing oral health systems.