In-home obesity prevention to reach low-income infants through maternal and social transmission

通过母亲和母亲对低收入婴儿进行家庭肥胖预防 社会传播 摘要 拟议的比较有效性研究利用了本国的优势和能力 访问计划（HVP），为低收入婴儿及其家庭提供家庭肥胖预防， 不同种族和族裔背景，并纠正优先人群中的差异。每年，超过500名公众 私人资助的HVP为美国650，000名低收入的高危婴儿及其家庭提供服务 然而，HVP尚未系统地针对儿童肥胖问题。在过去的四年里，我们 将基于证据的肥胖预防成分整合到我们的合作伙伴HVP提供的服务中， 名为科普的合作倡议：儿童肥胖预防@ homE 给孩子们在家里。我们的试点工作成功地将科普整合到我们的家庭中， HVP合作伙伴六个月，除了他们的标准课程。拟议的研究建立在我们的试点基础上 * 开展工作和建立伙伴关系，以测试提供小学（婴儿）和中学 （母亲）肥胖预防作为保健方案服务的一部分，为期2年。具体地说， 400名低收入母亲及其婴儿（70%为西班牙裔/拉丁裔，13%为非洲裔美国人，8%为白色，5%为美国人 印度人/阿拉斯加人，4%混血/其他种族）将入组本研究， 最终有效样本为300名母婴。提供服务的家庭访客将被随机分配到 只提供标准的HVP课程或HVP +科普。母亲和婴儿将在入组时进行评估 干预12个月和24个月后。目标1.测试科普对婴儿的直接影响， 母亲的体重、代谢风险、饮食/能量摄入和身体活动。这将通过 比较两组在体重、代谢指标、饮食和活动相关行为方面的变化， 研究组间的婴儿/母亲（仅HVP vs. HVP+科普）。这些结果将表明HVP是否 一级和二级肥胖预防的有效基础设施。目标二。测试母乳喂养和 母亲的饮食和活动、喂养习惯和粮食不安全是科普对婴儿结局影响的中介因素。 这一目标将测试母亲传播婴儿肥胖风险的机制。目标3是双管齐下。目的 3a测试了HVP+科普（与仅HVP相比）对社会和社区特征的直接影响 围绕母亲和婴儿的网络（即，他们的“健康支持”的密度、组成和质量 网络”）。目的3b检验社交网络的特征是否介导了科普对孕产妇的影响。 婴儿的结果。这些研究结果将表明，如果HVP肥胖预防工作可以改变和/或激活社会 网络机制。该项目的第二个目的是进行现实生活中的经济分析（成本，成本- 节约和非货币收益）。该项目准备测试一个 创新、可扩展、可持续且具有潜在成本效益的预防儿童肥胖模型， 面临着最大的健康不平等风险。

IN-HOME OBESITY PREVENTION TO REACH LOW-INCOME INFANTS THROUGH MATERNAL AND SOCIAL TRANSMISSION ABSTRACT The proposed comparative effectiveness research capitalizes on the strengths and capabilities of Home Visitation Programs (HVPs), to deliver in-home obesity prevention to low-income infants and their families from diverse racial and ethnic backgrounds, and correct disparities in priority populations. Annually, over 500 publicly and privately funded HVPs provide services to 650,000 low-income, at-risk infants and their families in the United States, yet HVPs have not yet systematically targeted childhood obesity. Over the last four years, we have integrated evidence-based obesity prevention components into the services provided by our partner HVP, a collaborative initiative called COPE: Childhood Obesity Prevention @ homE /Contrarrestar Obesidad: Programa para niños En casa. Our pilot work successfully integrated COPE into the ongoing, weekly, in-home visits of our HVP partner for six months, alongside their standard curriculum. The proposed research builds upon our pilot work and partnerships to test the larger-scale effectiveness of delivering primary (infants) and secondary (mothers) obesity prevention as part of HVP services for the full 2-year duration of these services. Specifically, 400 low income mothers and their infants (70% Hispanic/Latino, 13% African American, 8% White, 5% American Indian/Alaskan, 4% mixed/other race) already receiving HVP services will be enrolled into the study, for an effective final sample of 300 mothers/infants. Home visitors delivering services will be randomly assigned to deliver the standard HVP curriculum only or HVP + COPE. Mothers and infants will be assessed at enrollment and after receiving the intervention for 12 and 24 months. Aim 1. Test the direct effects of COPE on infants and mothers’ weight, metabolic risks, diet/energy intake, and physical activity. This will be accomplished by comparing changes in body weight, metabolic markers, and eating and activity-related behaviors between infants/mothers across study arms (HVP only vs. HVP+COPE). These results will indicate whether the HVP is an effective infrastructure for primary and secondary obesity prevention. Aim 2. Test whether breastfeeding and maternal diet and activity, feeding practices, and food insecurity mediate the effect of COPE on infants’ outcomes. This aim will test mechanisms of maternal transmission on infants’ obesity risks. Aim 3 is two-pronged. Aim 3a tests the direct effect of HVP+COPE (vs. HVP only) on the characteristics of the social and community networks that surround mothers and infants (i.e., the density, composition, and quality of their “health support networks”). Aim 3b tests whether the characteristics of social networks mediate the effects of COPE on maternal and infant outcomes. These findings will indicate if HVP obesity prevention efforts can alter and/or activate social network mechanisms. A Secondary Aim of this project is to conduct a real-life economic analysis (costs, cost- savings and non-monetary benefits) of integrating COPE into existing HVPs. The project is poised to test an innovative, scalable, sustainable, and potentially cost-effective model for preventing obesity among children who are at the greatest risk for health inequities.