iAmHealthy Parents First

项目概要/摘要 农村地区的儿童和成人的肥胖率都高于城市地区。更少的访问 以证据为基础的减肥干预措施，肥胖构成了一个主要的危险因素，导致发病率上升 以及心血管疾病、糖尿病和癌症的死亡率。肥胖症在家族中遗传 由于多种因素，包括遗传成分，家庭环境和周围的行为模式， 饮食摄入量、体力活动和屏幕时间。因此，以农村家庭为目标有可能加强 成人和儿童同时减肥。我们团队之前的研究表明， 向农村家庭提供肥胖干预措施是可行和可接受的，因为这种干预措施降低了 儿童身体质量指数z评分（BMIz），并帮助儿童和家庭显着改变他们的健康 行为。目前的应用程序将这项工作扩展到一个新的创新方向，首先针对父母 通过经验支持的肥胖干预，然后继续治疗家庭单位。以随机 试验，我们建议比较4个月的父母单独干预，随后6个月的家庭为基础的行为 小组干预（iAmHealthy-Parents First），以父母等待名单控制，然后以家庭为基础 行为团体干预（iAmHealthy）。父母/孩子的二人组将从农村小学和 在8个镇设立了学校和农村诊所。每个镇将包括一个单一的网站，并将招募30名家长/儿童 其中15人将被随机分配到iAmHealthy-Parents First，15人将被随机分配到iAmHealthy，总共 240名家长和240名儿童。每个农村城镇的人口将小于20，000人，并且/或者农村城市通勤 区号为4或更大，出于研究目的，将包括农村卫生诊所的护士， 和一个乡村小学的护士一起做一个单独的网站。在目标1中，我们建议研究有效性 通过儿童BMIz和父母体重减轻百分比从基线至第10个月（干预后）的变化， 以及通过改变饮食、改变体力活动和改变父母和儿童体重相关的质量 生命在目标2中，我们建议评估我们认为特别重要的调解人和主持人， 治疗模式和农村人口。在目标3中，我们建议探讨 的干预，并探讨一个概念，我们发现在我们的成人和儿科试验的关键-护士 订婚我们的经验表明，护士的参与在招聘，保留， 家庭的参与，在这里，我们建议评估护士的参与，以及通过促进它， 发展农村护士参与协作。这一探索性的目标将提供关键的务实 为今后旨在测试地方执行和传播战略的研究提供资料。关于iAmHealthy 父母优先干预是一种易于扩展、广泛传播的肥胖干预选择， 显著改善我们治疗农村家庭肥胖症的方式。

Project Summary/Abstract Both children and adults in rural areas have higher obesity rates than their urban counterparts. With less access to evidence-based weight loss interventions, obesity poses a major risk factor contributing to elevated morbidity and mortality from cardiovascular disease, diabetes, and cancer among rural Americans. Obesity runs in families due to multiple factors including hereditary components, home environment, and behavioral modeling around dietary intake, physical activity, and screen time. Thus, targeting the rural family unit has the potential to enhance weight loss for adults and children simultaneously. Previous research from our team indicates that mHealth is feasible and acceptable for the delivery of obesity interventions to rural families as this type of intervention lowers child Body Mass Index z score (BMIz) and helps children and families to significantly change their health behaviors. The current application extends this work in a new and innovative direction, targeting parents first with an empirically supported obesity intervention, and then moving on to treat the family unit. In a randomized trial, we propose to compare a 4-month parent-only intervention followed by a 6-month family based behavioral group intervention (iAmHealthy-Parents First) to a parent wait-list control followed by the family based behavioral group intervention (iAmHealthy). Parent/child dyads will be recruited from both rural elementary schools and rural medical clinics in 8 towns. Each town will consist of a single site and will recruit 30 parent/child dyads, 15 of whom will be randomly assigned to iAmHealthy-Parents First and 15 to iAmHealthy, for a total of 240 parents and 240 children. Each rural town will have a population < 20,000 and/or the Rural Urban Commuting Area Codes of 4 or greater, and for the purposes of the study will include a nurse at a rural health clinic partnering with a nurse at a rural elementary school to make a single site. In Aim 1 we propose to study effectiveness through change in child BMIz and parent percent weight loss from baseline to month 10 (post-intervention), as well as through change in diet, change in physical activity and change in parent and child weight related quality of life. In Aim 2, we propose to assess mediators and moderators that we believe are specifically important to the treatment model and to the rural population. In Aim 3 we propose to explore the reach and representativeness of the intervention, and to explore a concept we have found key in both our adult and pediatric trials – nurse engagement. Our experience suggests that nurse engagement plays a key role in recruitment, retention, and engagement of the families, and here we propose to assess nurse engagement as well as foster it through the development of a Rural Nurse Engagement Collaborative. This exploratory aim will provide critical pragmatic data to inform future studies aimed at testing local implementation and dissemination strategies. The iAmHealthy Parents First intervention is an easily scalable, widely disseminable obesity intervention option which could significantly improve the way we treat obesity among rural families.