Hurricane Maria hit Puerto Rico September 20, 2017, which is the same day Marshfield Clinic Research Institute researcher Jeremy Pomeroy, Ph.D. received funding for his new study that aims to curb childhood obesity in families that use the Women, Infants and Children (WIC) Food and Nutrition program in Puerto Rico.

The Baby Act Trial is a collaboration between Dr. Maribel Campos at the University of Puerto Rico, Cristina Palacios, Ph.D., at Florida International University and Pomeroy with the Center for Clinical Epidemiology and Population Health at the Research Institute.

“We didn’t know we were awarded for three weeks after the hurricane,” Pomeroy said. “That obviously threw a significant wrench into a lot of the things because what we were counting on for Wi-Fi changed.”

Before Hurricane Maria, free public Wi-Fi was available in San Juan and most women had smartphones, so a portion of the intervention was intended to be delivered online.

The lack of infrastructure after Maria forced the researchers to request additional funding to purchase solar chargers for participant’s phones, help improve Wi-Fi at the WIC offices, work with huge lapses in power and change some of the WIC locations.

“One of the other impacts of the hurricane is a lot of people have left the island, which means that the population using the WIC clinics has changed a bit. Some clinics have seen increased use, while others saw less use,” Pomeroy said.

Studying obesity in children

With the study set to open recruitment at the end of May, the group is using a past study in Puerto Rico to improve this one.

“We learned quite a bit about challenges and barriers, so ultimately that whole study was not very successful,” Pomeroy said. The group has found that the families did not reliably come to appointments to receive the interventions, which is why more cellphone technology was used in this study.

The group chose Puerto Rico because 85 percent of Puerto Rican women are on WIC and the island has high rates of obesity.

“Obesity is an issue all over the U.S., but Puerto Rico has particularly high rates of adult and childhood obesity,” Pomeroy said. Research shows that socioeconomic issues and access to healthy nutrition play a role in obesity rates.

The intervention initially focused on promoting breast feeding; when and how to initiate solid foods; limiting the intake of sugar and sweetened drinks; and infant activation. Hurricane Maria prompted the researchers to add self-care as a fifth element to the intervention, which aims to help the families through the stressful time.

Tracking infant activation

According to Pomeroy, infant activation is a relatively new idea that encourages motor development and learning at an earlier age using interventions like tummy time, grasping exercises and working on age-appropriate motor development.

“The idea of infant activation is priming for the promotion of movement throughout the child’s lifespan,” Pomeroy said.

The research is actively tracking the infant behavior through accelerometers, which is a device similar to a Fitbit.

“The goal of that is to better understand what it is about this intervention that might be having an effect,” Pomeroy said. Infant movement is difficult to track because they move, but also are moved by adults.

This is why the researchers are placing two accelerometers on each child – one on their leg and the other on their waist.

The accelerometer on the leg will analyze the child’s movement while the one on their waist will be used to subtract the movement from the child being carried.

Using WIC to drive the intervention

While many families use WIC in Puerto Rico, the group also sought WIC participants because WIC provides access to better food while providing vouchers for very specific choices.

This allows the researchers to teach participants how to prepare the food they are given and to make it as nutritious as possible.

“You can take very similar ingredients such as eggs, but how you prepare eggs can change the quality,” Pomeroy said.

If the intervention is successful, Pomeroy anticipates it will be available across the U.S. after the materials are linguistically and culturally translated.

“If this is successful, the first thing we will be looking to do is integrate it into normal practice in WIC,” Pomeroy said.