Enhancing Cardiovascular Health Equity in Mothers and Children Through Home Visiting

项目摘要/摘要 心血管健康(CVH)的基础是在生命早期通过代际互动奠定的， 从父母传给孩子，会产生长期的生物和行为后果。生活方式 随着时间的推移，干预措施可以在母亲和她们的孩子中促进CVH。学术伙伴关系 通过家访组织帮助经历健康差距的家庭取得进展 代际CVH股权。这项研究建立在长达数十年的学术家访的基础上 圣路易斯华盛顿大学的研究团队与家长AS 教师(PAT)，一个基于证据的家访计划，在所有50个州都有。最近，我们的 合作工作证明了在家里教授健康饮食和积极生活的有效性 (健康)，在其中我们成功地测试了一种生活方式干预措施，以促进理想体重和CVH 在怀孕和年轻的母亲及其子女中。我们现在寻求与 通过严格测试此实施就绪型产品的持续CVH影响来丰富协作 接近。在UG3规划阶段(第1-2年)，我们将与丰富合作伙伴合作 确定由运行状况通知的常见CVH协议。在UH3实施阶段(第3至第7年)， 我们将严格测试这一为母亲准备实施的方法对CVH的持续影响 和年幼的孩子，出生超过3年，从产前开始，一直持续到产后30个月- 分娩。混合类型1集群-随机实用试验建立在这种伙伴关系(N=10个站点)的基础上 在密苏里州圣路易斯的高负担地区；750名母子二人；研究人群中有一人或两人 以下特征中有更多与心血管疾病风险增加有关：黑色 或Latinx、身体质量指数≥30和/或社会经济劣势)。我们将确定 美国心脏协会综合评分评估母体CVH的健康状况 从注册(怀孕前20周)到出生时的随访，3年多的简单生活，6，18， 出生后30个月；对儿童CVH进行BMIz轨迹和饮食、活动、睡眠、 以及从出生到6个月、18个月和30个月随访的父母影响。我们将把专业知识应用于 实施科学，以确保干预措施具有公平的实施和影响 帕特和丰富合作伙伴。这项意义重大的研究将进一步推动科学 理解和循证实践如何干扰心血管风险的影响 代代相传，以提高CVH的股权。本研究的创新之处在于，它将严格地 确定健康对生活方式行为从母亲向儿童转移的影响 生育连续体。

Project Summary/Abstract The foundation for cardiovascular health (CVH) is laid in early life by intergenerational interactions, passed from parent to child, that have long-lasting biological and behavioral consequences. Lifestyle interventions can promote CVH among mothers and their children over time. Academic partnerships with home visiting organizations that reach families experiencing health disparities advance intergenerational CVH equity. This study builds on a decades-long academic-home visiting partnership between the research team at Washington University in St. Louis and Parents as Teachers (PAT), an evidence-based home visiting program located in all 50 states. Most recently, our partnered work demonstrated the effectiveness of Healthy Eating and Active Living Taught at Home (HEALTH), in which we successfully tested a lifestyle intervention to promote ideal weight and CVH among pregnant and young mothers and their children. We now seek to advance this work with the ENRICH Collaborative by rigorously testing the ongoing CVH impact of this implementation-ready approach. During the UG3 planning phase (years 1-2), we will work with the ENRICH Collaborative to identify a common CVH protocol informed by HEALTH. In the UH3 implementation phase (years 3-7), we will rigorously test the ongoing impact on CVH of this implementation-ready approach for mothers and young children, delivered over 3 years, beginning prenatally and continuing to 30 months post- childbirth. The Hybrid Type 1 cluster-randomized pragmatic trial builds on this partnership (N=10 sites in high burden St. Louis, Missouri, metro region; 750 mother-child dyads; study population with one or more of the following characteristics associated with increased risk of cardiovascular disease: Black or Latinx, body mass index ≥ 30, and/or socioeconomic disadvantage). We will determine the effect of HEALTH on maternal CVH as assessed by a composite score on the American Heart Association Life’s Simple 7 over 3 years from enrollment (before 20 weeks pregnancy) to follow-up at birth, 6, 18, and 30-months post childbirth; and on child CVH assessed by BMIz trajectory and diet, activity, sleep, and parental influence from birth to 6, 18, and 30-month follow-up. We will apply expertise in implementation science to ensure the intervention has equitable implementation and impact across PAT and the ENRICH Collaborative. This significant study will further advance scientific understanding and evidence-based practice on how to disrupt the impact of cardiovascular risk that passes across generations to improve CVH equity. The innovation of this study is that it will rigorously determine the impact of HEALTH on the transfer of lifestyle behaviors from mother to child, across the childbearing continuum.