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

家庭肥胖预防，通过孕产妇和家庭保健服务覆盖低收入婴儿 社会传播 摘要 拟议的比较有效性研究充分利用了Home的优势和能力 探访计划(HVP)，为低收入婴儿及其家人提供居家肥胖预防 不同的种族和族裔背景，纠正优先人口中的差距。每年，超过500名公众 私人资助的HPVP为美国650,000名低收入、高危婴儿及其家人提供服务 然而，艾滋病毒/艾滋病方案尚未系统地针对儿童肥胖。在过去的四年里，我们有 将基于证据的肥胖预防组件集成到我们的合作伙伴HVP提供的服务中，a 名为COPE：儿童肥胖预防@HOME/Contrarrestar Obsidad：Programa的合作倡议 卡萨尼奥斯群岛。我们的试点工作成功地将COPE整合到我们的持续、每周、上门访问中 HVP合作伙伴六个月，以及他们的标准课程。拟议的研究是以我们的试点项目为基础的 工作和伙伴关系，以测试初级(婴儿)和次级分娩的更大规模的有效性 (母亲)将预防肥胖症作为HVP服务的一部分，在这些服务的整个两年期间。具体来说， 400名低收入母亲及其婴儿(70%西班牙裔/拉丁裔，13%非裔美国人，8%白人，5%美国人 印度人/阿拉斯加人，4%的混血/其他种族)已经接受HVP服务的人将参加这项研究， 300名母亲/婴儿的有效最终样本。提供服务的家庭访客将被随机分配到 仅提供标准HVP课程或HVP+COPE。母亲和婴儿将在注册时接受评估 在接受干预12个月和24个月后。目的1.测试COPE对婴儿和婴儿的直接影响 母亲的体重、代谢风险、饮食/能量摄入量和体力活动。这将通过以下方式实现 比较两组患者体重、代谢标志物、饮食和活动相关行为的变化 婴儿/母亲跨研究臂(仅限HVP与HVP+COPE)。这些结果将指示HVP是否 为预防一级和二级肥胖提供有效的基础设施。目标2.测试母乳喂养和 母亲的饮食和活动、喂养习惯和食物不安全是COPE对婴儿结局的影响的中介因素。 这一目标将测试母体传播对婴儿肥胖风险的机制。目标3是双管齐下的。目标 3A测试HVP+COPE(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“)。目标3b检验社会网络的特征是否在应对方式对母亲的影响中起中介作用 以及婴儿的结局。这些发现将表明，HVP肥胖预防努力是否可以改变和/或激活社会 网络机制。该项目的次要目标是进行真实的经济分析(成本、成本- 节约和非货币利益)将COPE整合到现有的HEP中。该项目准备测试一种 用于预防儿童肥胖的创新、可扩展、可持续且可能具有成本效益的模式 是健康不平等的最大风险。

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.