iAmHealthy Parents First

项目摘要/摘要 农村地区的儿童和成年人的肥胖率都高于城市儿童和成年人。更少的访问 根据循证减肥干预措施，肥胖是导致发病率上升的主要风险因素。 以及美国农村地区心血管疾病、糖尿病和癌症的死亡率。肥胖症在家庭中流行 由于多种因素，包括遗传因素、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，以农村家庭单位为目标有可能加强 成人和儿童同时减肥。我们团队之前的研究表明，mHealth是 随着这类干预措施的减少，向农村家庭提供肥胖干预措施是可行和可接受的 儿童身体质量指数z评分(BMIz)，帮助儿童和家庭显著改变他们的健康 行为。目前的应用程序将这项工作扩展到一个新的和创新的方向，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。在随机化的 试验中，我们建议比较4个月的纯父母干预和6个月的基于家庭的行为干预 团体干预(iAmHealthy-父母优先)到父母等待名单对照，其次是基于家庭的 行为团体干预(IAmHealthy)。父母/子女二人组将从两个农村小学招募 8个乡镇的学校和乡村卫生室。每个镇将由一个地点组成，将招募30名家长/孩子 其中15人将被随机分配给iAmHealthy-父母优先，15人被随机分配给iAmHealthy，总共 240名父母和240名儿童。每个农村城镇将有20,000人和/或农村城市通勤 区号为4或更大，为了研究的目的，将包括农村卫生诊所的一名护士合作 和一名乡村小学的护士一起做一个单独的工地。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到第10个月的变化(干预后)，因为 以及通过改变饮食、改变体力活动以及改变父母和孩子体重相关的素质 生活的一部分。在目标2中，我们建议评估我们认为对以下方面特别重要的调解人和主持人 治疗模式和对农村人口的影响。在目标3中，我们建议探索覆盖范围和代表性 为了探索我们在成人和儿科试验中找到的关键概念--护士 订婚。我们的经验表明，护士敬业度在招聘、留住和 家庭的敬业度，在这里我们建议评估护士的敬业度，并通过 乡村护士敬业协作制的开发。这一探索性目标将提供关键的务实 为今后旨在测试当地执行和传播战略的研究提供参考的数据。IAmHealthy 父母优先干预是一种易于扩展、可广泛传播的肥胖干预选项，它可以 显著改善我们治疗农村家庭肥胖的方式。

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.