Prenatal and Pediatric Primary Care-Based Child Obesity Prevention: Effects of Adverse Social Determinants of Health on Intervention Attendance and Impact.
Prenatal and Pediatric Primary Care-Based Child Obesity Prevention: Effects of Adverse Social Determinants of Health on Intervention Attendance and Impact.
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基于产前和儿科初级保健的儿童肥胖预防：健康的不利社会决定因素对干预出勤率和影响的影响。
DOI：
10.1089/chi.2023.0149
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Gross,RachelS
中科院分区：
文献类型：
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作者：
Duh-Leong,Carol;Messito,MaryJo;Katzow,MichelleW;Kim,ChristinaN;Mendelsohn,AlanL;Scott,MarcA;Gross,RachelS
背景：健康的不良社会决定因素（SDoHs），特别是社会心理压力源和物质困难，与儿童早期肥胖有关。对于不良的SDoHs是否会改变早期儿童肥胖预防计划的效果，我们知之甚少。方法：我们对有公共保险的拉丁裔背景的生育亲子二人组进行了二次分析，他们参加了一项从怀孕开始的儿童肥胖预防计划“早期开始计划”（StEP）的随机对照试验。我们测量了基线不良sdoh，分类为心理社会压力源（低社会支持、单身婚姻状况和母亲抑郁症状）和物质困难（食品不安全、住房失修和经济困难），并在妊娠晚期单独和累计测量。Logistic回归模型检验了不良SDoHs对StEP出勤率的影响。然后，我们测试了不良的SDoHs是否会减缓干预对2岁儿童体重的影响。结果：我们观察到不良SDoHs对358对亲子对结局的异质性影响。虽然房屋失修降低了较高出勤率的几率[调整比值比（aOR） 0.52, 95%可信区间（CI）： 0.29-0.94]，但高水平的心理社会压力源使较高出勤率的几率增加了一倍（aOR 2.36, 95% CI: 1.04-5.34）。同样，虽然某些不良的SDoHs减少了StEP对体重的影响（如房屋失修），但其他（如高心理社会压力）则增强了StEP对体重的影响。结论：不良SDoH对干预结果的影响取决于特定的不良SDoH。在基线时，高社会心理压力患者的参与度和获益最高，这表明StEP成分可能减轻社会心理压力源的某些方面。研究结果还支持将不良SDoH评估纳入战略，以加强对物质困难家庭的肥胖预防影响。试验注册：本研究在clinicaltrials.gov: Starting Early Obesity Prevention Program （NCT01541761）上注册；https://clinicaltrials.gov/ct2/show/NCT01541761
Background:Adverse social determinants of health (SDoHs), specifically psychosocial stressors and material hardships, are associated with early childhood obesity. Less is known about whether adverse SDoHs modify the efficacy of early childhood obesity prevention programs.Methods:We conducted a secondary analysis of publicly insured birthing parent–child dyads with Latino backgrounds participating in a randomized controlled trial of the Starting Early Program (StEP), a child obesity prevention program beginning in pregnancy. We measured baseline adverse SDoHs categorized as psychosocial stressors (low social support, single marital status, and maternal depressive symptoms) and material hardships (food insecurity, housing disrepair, and financial difficulties) individually and cumulatively in the third trimester. Logistic regression models tested effects of adverse SDoHs on StEP attendance. We then tested whether adverse SDoHs moderated intervention impacts on weight at age 2 years.Results:We observed heterogeneous effects of adverse SDoHs on outcomes in 358 parent–child dyads. While housing disrepair decreased odds of higher attendance [adjusted odds ratio (aOR) 0.52, 95% confidence interval (CI): 0.29–0.94], high levels of psychosocial stressors doubled odds of higher attendance (aOR 2.36, 95% CI: 1.04–5.34). Similarly, while certain adverse SDoHs diminished StEP impact on weight (e.g.,housing disrepair), others (e.g.,high psychosocial stress) enhanced StEP impact on weight.Conclusions:Effects of adverse SDoHs on intervention outcomes depend on the specific adverse SDoH. Highest engagement and benefit occurred in those with high psychosocial stress at baseline, suggesting that StEP components may mitigate aspects of psychosocial stressors. Findings also support integration of adverse SDoH assessment into strategies to enhance obesity prevention impacts on families with material hardships.Trial Registration:This study is registered on clinicaltrials.gov: Starting Early Obesity Prevention Program (NCT01541761); https://clinicaltrials.gov/ct2/show/NCT01541761