Project 2: Leveraging Ongoing Home Visitation Programs to Address Obesity Disparities among Underserved, Low-Income Mothers and Children

项目 2：利用持续的家访计划解决服务不足、低收入母亲和儿童之间的肥胖差异

• 批准号: 10161624
• 负责人: Sarah-Jeanne Salvy
• 金额: $ 26.06万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-22 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10161624
• 关键词: Address; African American; Aftercare; Alabama; Behavior; Behavior monitoring; Caregivers; Child; Consumption; Cues; Educational Curriculum; Enrollment; Environment; Family; Food; Funding; Habits; Health; Health Benefit; Home; Home environment; Home visitation; Household; Intake; Low income; Mediating; Mission; Modality; Modification; Monitor; Mothers; Obesity; Outcome; Outpatients; Participant; Preventive service; Procedures; Race; Randomized; Randomized Controlled Trials; Research; Risk; Services; Specialized Center; Testing; Training; Transportation; Vegetables; Weight; Weight Gain; Weight maintenance regimen; base; effectiveness testing; ethnic minority population; evidence base; federal poverty level; feeding; follow-up; fruits and vegetables; health disparity; healthy weight; maternal weight; minority health; obesity in children; obesity prevention; obesity risk; obesity treatment; primary outcome; programs; psychosocial; racial and ethnic; response; secondary outcome; service programs; socioeconomic disadvantage; sugar; sweetened beverage; transmission process; treatment effect; waist circumference

The proposed study addresses obesity and health-related disparities among socioeconomically disadvantaged mothers and their young children enrolled in federally-funded home visitation programs. This is important because low-income and racial/ethnic minority mothers and their young children are especially at-risk of obesity. The lack of access to evidence-based obesity efforts further contributes to these disparities. The proposed randomized controlled trial tests the effectiveness of (1) a simple, evidence-based and ecologically relevant obesity intervention (HABITS) delivered as part of ongoing home visitation services, compared to (2) the existing home visitation curriculum without obesity-related content on mothers’ and children’s obesity risks. HABITS focuses on habit formation and modifications to the food/activity home environment to promote changes in the targeted weight-related behaviors. Participants will be 298 mothers (>50% African American; 100% meet federal poverty level) and their children (3-5yo at baseline) enrolled in our home visitation partner in central Alabama. Home visitors will be randomly assigned to deliver the home visitation curriculum with or without HABITS as part of their weekly home visits for 12 months. Assessments of mothers (weight, waist circumference, feeding practices and habit strength of targeted behaviors), children (rate of weight gain), and household environment (availability/accessibility/visibility of cues conducive to targeted food, activity and monitoring behaviors) will be conducted at enrollment, 12, and 24mo (1y post-treatment follow-up). Aim 1 (primary outcomes). To compare the effects of treatment on children and mothers’ weight outcomes at 12 and 24mo. Hypothesis 1a: Mothers receiving HABITS will have a lower weight and waist circumference than mothers receiving standard services. Hypothesis 1b: Children receiving HABITS will have slower rate of weight gain than children receiving standard services. Aim 2 (secondary outcomes). To compare the effects of treatment on maternal feeding practices, habit strength of targeted behaviors, and features of the household environment relevant to targeted behaviors at 12 and 24 mo. Hypothesis 2: Compared to standard services, HABITS will result in heathier maternal feeding practices (less fried foods and SSB; more vegetables/fruits), greater habit strength of targeted behaviors, and greater home availability/accessibility/visibility of cues that support targeted behaviors. Aim 3 (maternal/environmental transmission of children’s obesity risk). To test whether maternal and household environment variables mediate the effect of HABITS on children’s rate of weight gain at 12 and 24mo. Hypothesis 3: Maternal weight, feeding practices, habit strength of targeted behaviors, and household environment will mediate the relationship between HABITS and children’s rate of weight gain. We will further explore whether primary (Aim 1) and secondary (Aim 2) outcomes differ for African American and White mothers and children, and whether race moderates the relationships between maternal and household environment variables and children’s rate of weight gain (Aim 3).

拟议的研究解决了社会经济处境不利的肥胖和与健康有关的差异 母亲及其小孩参加了联邦资助的家庭探视计划。这很重要 因为低收入和种族/种族/族裔少数族裔母亲及其幼儿特别处于危险之中 肥胖。缺乏获得循证肥胖工作的机会进一步导致了这些差异。 提出的随机对照试验测试（1）简单，基于证据和生态的有效性 作为正在进行的家庭访问服务的一部分，相关的肥胖干预（习惯）与（2）相比 现有的家庭探视课程没有与肥胖有关的母亲和儿童肥胖风险的内容。 习惯专注于习惯形成和对食品/活动家庭环境的修改以促进 目标重量相关行为的变化。参与者将是298位母亲（非裔美国人> 50％； 100％符合联邦贫困水平）及其子女（基线为3-5yo）参加了我们的家庭访问伙伴 在阿拉巴马州中部。家庭访客将被随机分配，以提供家庭探视课程 不用习惯作为他们每周访问的一部分，持续了12个月。评估母亲（体重，腰部 周长，喂养实践和目标行为的习惯强度），儿童（体重增加率）和 家庭环境（可用性/可访问性/提示导电到目标食品，活动和 监测行为）将在入学率，12和24MO（治疗后随访）中进行。目标1 （主要结果）。比较治疗对儿童和母亲体重成果的影响12时的影响 和24mo。假设1a：接受习惯的母亲的体重和腰围比 母亲接受标准服务。假设1B：接受习惯的孩子的体重率较慢 收益比获得标准服务的孩子。目标2（次要结果）。比较 对母亲喂养实践，靶向行为的习惯强度以及家庭特征的治疗 与目标行为相关的环境12和24 mo。假设2：与标准服务相比 习惯将导致希西尔材料喂养实践（少炒食物和SSB；更多的蔬菜/水果）， 有针对性行为的更大习惯强度，以及更大的房屋可用性/可访问性/可见性/可见性 支持目标行为。目标3（母亲/环境传播儿童肥胖风险）。到 测试母亲和家庭环境变量是否介导习惯对儿童率的影响 体重增加12和24mo。假设3：产妇体重，喂养实践，目标的习惯强度 行为和家庭环境将调解习惯与儿童的关系 我们将进一步探索非洲的初级（AIM 1）和次级（目标2）结果是否不同 美国和白人母亲和儿童，以及种族是否适应产妇之间的关系 以及家庭环境变量和儿童体重增加率（AIM 3）。