The family, being the first immediate surroundings of children, plays an important part in forming children's’ habits. The presence of at least one overweight parent triples the likelihood that a child will be overweight. Parents influence a child’s weight by modelling healthy behaviour and controlling food availability, feeding practices, and physical activity opportunities. For instance, higher parental TV viewing is associated with an increased risk of high levels of TV viewing for children, which in turn is positively correlated with adiposity. Women who live in rural areas and mothers in particular may be less likely to be physically active compared with other women. The current study uses data from ReadNPlay for a Bright Future, a primary care initiative with community linkages promoting healthy active living in families with young children being piloted in Appalachian Northeast Tennessee. Clinical counselling is being centred around novel tools provided to parents and discussed during each well child visit from birth through 18 months, the ReadNPlay Baby Book and Healthy Active Living Tips booklet. Provider training in brief motivational interviewing and behavioural counselling, use of social media, project posters placed in community settings, and participation incentives (e.g., free children’s books) are being used to promote healthy active living behaviours. The purpose of the current research is to describe baseline maternal reports of TV/screen time, fruit, vegetable, and sugar sweetened beverage (SSB) intake, and exercise and perceived barriers to exercise for this project. Forty mothers with infants aged 9-12 months (younger) and forty mothers with infants aged 13-24 months (older) attending well child visits at a paediatric clinic in Northeast Tennessee completed anonymous surveys. The participants of the study were primarily Caucasian families of lower socio-economic status, with 71% of participants receiving WIC. Over 80% of mothers of both younger and older infants reported that they wished that they could get more exercise. The most significant barriers to getting exercise in both samples were 1) Not having enough time to exercise and 2) The mother would rather spend the time with the child(ren) than exercise. The mean consumption of servings of fruit &/or vegetables was 3 servings per day for both samples; the previously reported average among US women is 3.5 servings per day. The mean consumption of SSB was 18 oz per day for mothers of younger babies & 22 oz per day for mothers of the older babies, amounting to approximately 250 calories per day, greater than the American Heart Association’s recommendation of a maximum daily intake of added sugars of 100 calories per day for women. This research adds to limited data on healthy active living behaviours of new mothers. Future work will examine how data may be used to drive and track improvements in counselling to promote healthy active living in new mothers and families with young children.

Purpose To describe: (1) development of ReadNPlay for a Bright Future with community stakeholders, (2) integration of a novel communicative tool, the ReadNPlay Baby Book, into infant-toddler well child visits, and (3) use of a quality improvement approach to monitor progress in promoting healthy active living in families with young children. Methods ReadNPlay for a Bright Future is funded by a grant from the American Academy of Pediatrics (AAP) and Metlife Foundation awarded to the East Tennessee State University Department of Pediatrics and Tennessee Chapter of the AAP. The setting for this project is in rural southern Appalachia, a U.S. region with a disproportionately high prevalence of obesity. During a community forum held in Northeast Tennessee in fall 2012, community stakeholders provided feedback to help finalize project materials and messages developed by the project team around four themes: Play More: Shut off the Screen, Play Together: Be Active as a Family, Fuel to Play: Eat Healthy, and Play Safely. A behavioral health consultant (BHC) assisted with provider training in brief motivational interviewing and behavioral counseling and project implementation in the clinic. An anonymous mothers' survey was designed to identify opportunities for improving behaviors and monitor progress in promoting healthy active living during well child visits. Process measures and feedback will be obtained from provider surveys and focus groups with parents and providers. Results As of February 2013, the ReadNPlay Baby Book is being provided to families starting at the newborn visit. The book contains age-appropriate guidance and areas for parents to record their baby's growth, milestones, eating habits, favorite books, and activities between birth and 18 months. Families are receiving small incentives for bringing it to each well child visit. A companion Healthy Active Living Tips booklet encourages healthy behaviors in the whole family. Use of social media, posters, and periodic community events provide reinforcement. A total of 80 mothers with infants 9-24 months of age are completing anonymous surveys during well child visits every 4-6 months (mostly Caucasian, 70% WIC recipients). Baseline surveys with mothers of younger infants (9-12 months of age) suggest: 60% of mothers are reading or looking at books with their infants on most days of the week; 80% of infants watch at least 30 minutes of television and 48.7% drink juice on a typical day; 82% of infants were ever-breastfed; 20% of mothers had sought care for their infants due to an injury; and 13.2% of infants routinely bed-share. Over 80% of all mothers wished that they themselves could get more exercise. Conclusion ReadNPlay for a Bright Future is using novel communication tools, community partnerships, and quality improvement methodology to encourage healthy active living during infant-toddler well child visits

The obesity problem in the U.S. is of epidemic proportions and affects even the youngest members of society. For instance, 10% percent of U.S. infants have excess weight for length, and early onset of obesity incites later risk. The American Academy of Pediatrics (AAP) Council on Communications and Media has linked media exposure to obesity as well as sleep, behavior issues, inattention, and decreased parent-child interaction in young children. Further, the AAP concludes that no known health benefits exist for media exposure in children under 2 and discourage use in this age range. Reading has been shown to increase secure attachment in infants and to increase the quality of parent-child interaction in addition to positive gains in child literacy. Additionally, two existing studies found that reading reduces screen time, thus serving as a healthy alternative to media exposure. Despite these findings, and the importance of anticipatory guidance in pediatric primary care for discussing shared reading, only 15% of pediatricians talk to families about media exposure. ReadNPlay for a Bright Future is a multi-disciplinary, multicomponent pilot study and healthy weight promotion initiative for families with infants aged birth to 24 months to create health-promoting home environments, set goals, and monitor progress regarding reading and active play. The setting for this study is an academic pediatric primary care practice serving a primarily Caucasian, socio-economically disadvantaged population in Southern Appalachia, with involvement from pediatricians, nurses, and a behavioral health consultant. A novel communicative tool, the ReadNPlay Baby Book, along with provider training in brief motivational interviewing, posters, social media, and participation incentives (e.g., free children’s books) are being used to improve counseling on healthy active living behaviors during infant well child visits. The current research endeavor is focused on the Play More: Shut Off the Screens aspect of the ReadNPlay initiative and utilizes data from a baseline survey completed by 40 mothers with infants aged 9-12 months and 40 mothers with infants aged 13-24 months to assess trends in one form of media exposure, television watching, and reading in this population. While the AAP recommends that children under 2 years do not watch TV, mothers in this study reported that 80% of infants 9-12 months and 87% of infants 13-24 months watched at least 30 minutes on a typical day. Sixty percent of mothers of infants 9-12 months and 82.5% of mothers of infants 13-24 months reported reading 2013 Appalachian Student Research Forum Page 71 or looking at books with their child on most days of a typical week, perhaps as a result of an existing Reach Out and Read Initiative in the practice. The current study adds to the dearth of research regarding risk factors during infancy for future development of obesity. Future research may examine whether increases in reading time may decrease time spent in media exposure.

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Purpose To describe: (1) development of ReadNPlay for a Bright Future with community stakeholders, (2) integration of a novel communicative tool, the ReadNPlay Baby Book, into infant-toddler well child visits, and (3) use of a quality improvement approach to monitor progress in promoting healthy active living in families with young children. Methods ReadNPlay for a Bright Future is funded by a grant from the American Academy of Pediatrics (AAP) and Metlife Foundation awarded to the East Tennessee State University Department of Pediatrics and Tennessee Chapter of the AAP. The setting for this project is in rural southern Appalachia, a U.S. region with a disproportionately high prevalence of obesity. During a community forum held in Northeast Tennessee in fall 2012, community stakeholders provided feedback to help finalize project materials and messages developed by the project team around four themes: Play More: Shut off the Screen, Play Together: Be Active as a Family, Fuel to Play: Eat Healthy, and Play Safely. A behavioral health consultant (BHC) assisted with provider training in brief motivational interviewing and behavioral counseling and project implementation in the clinic. An anonymous mothers’ survey was designed to identify opportunities for improving behaviors and monitor progress in promoting healthy active living during well child visits. Process measures and feedback will be obtained from provider surveys and focus groups with parents and providers. Results As of February 2013, the ReadNPlay Baby Book is being provided to families starting at the newborn visit. The book contains age-appropriate guidance and areas for parents to record their baby’s growth, milestones, eating habits, favorite books, and activities between birth and 18 months. Families are receiving small incentives for bringing it to each well child visit. A companion Healthy Active Living Tips booklet encourages healthy behaviors in the whole family. Use of social media, posters, and periodic community events provide reinforcement. A total of 80 mothers with infants 9-24 months of age are completing anonymous surveys during well child visits every 4-6 months (mostly Caucasian, 70% WIC recipients). Baseline surveys with mothers of younger infants (9-12 months of age) suggest: 60% of mothers are reading or looking at books with their infants on most days of the week; 80% of infants watch at least 30 minutes of television and 48.7% drink juice on a typical day; 82% of infants were ever-breastfed; 20% of mothers had sought care for their infants due to an injury; and 13.2% of infants routinely bed-share. Over 80% of all mothers wished that they themselves could get more exercise. Conclusion ReadNPlay for a Bright Future is using novel communication tools, community partnerships, and quality improvement methodology to encourage healthy active living during infant-toddler well child visits.

Purpose To describe outcomes of community partnerships for promoting healthy active living among families with young children in the ReadNPlay for a Bright Future Project. Methods ReadNPlay for a Bright Future was developed through grant support from the American Academy of Pediatrics (AAP) and Metlife Foundation awarded to the East Tennessee State University Department of Pediatrics and Tennessee AAP Chapter. ReadNPlay is a coordinated, multi-level, multi-component initiative promoting healthy active living among families with young children during infant-toddler health supervision visits and in childcare and other community settings. The project site is located in rural southern Appalachia, an area of the country with a high prevalence of obesity. Materials and messages developed by the project team were finalized during a community forum with stakeholders held in Northeast Tennessee in fall 2012. Four themes emerged as a focus for the initiative: Play More: Shut off the Screen, Play Together: Be Active as a Family, Fuel to Play: Eat Healthy, and Play Safely. Partnerships with the regional children's hospital, childcare providers, health department, public libraries, and farmers' markets were supported through on-going communication via email, social media, and individual meetings. Availability of two $750 pediatric resident mini-grants and structure afforded by the residency program's existing community pediatrics rotation facilitated development and implementation of community initiatives for this project. Results Project posters displayed in community settings, use of social media, and periodic community events are reinforcing efforts to promote healthy active living in the clinical setting. A new event for families with infants/toddlers was added to the children's hospital annual Kids Run, involving over 120 families during the first year. Walk N' Rollers received free Reach Out and Read books and were surprised at the sugar content of juice and other beverages displayed in sippy cups as part of a “Sugar Quiz.” Information disseminated through regional child care centers will promote participation in a summer Walk N' Roll program in addition to this annual event. At a regional childcare provider conference, ReadNPlay workshops with over 100 infant-toddler teachers and 40 families were conducted and information on Tennessee's “Gold Sneaker” designation for compliance with state nutrition and physical activity policies was shared (only 6% of local centers are designated). During summer 2013, 75 families are being provided with $10 farmers' market vouchers at their 12-15 month well child visit to encourage consumption of fruits and vegetables. 18-month statistics on social media reach, walking program participation, new Gold Sneaker designations, and farmers' market program participation will be presented. Conclusion This presentation will illustrate how pediatric residency programs and practitioners may partner with existing community organizations and initiatives to promote healthy active living in families with young children.