Extension Family Lifestyle Intervention Project (FLIP for Kids)

描述（由申请人提供）：生活在农村地区的儿童比他们的城市同龄人超重的可能性高25%。很少有研究关注解决这种差异的策略。制定和评估对儿童长期体重状况和相关健康参数产生积极影响的具有成本效益的干预措施，对于促进改善农村青年的健康至关重要。成功治疗儿童肥胖可产生显著的健康益处。以家庭为基础的行为干预，包括儿童和父母，已经证明在使儿童减肥方面取得了成功。然而，这些干预措施的普遍性是有限的。在医疗服务不足的社区环境中进行的试验很少。提供有效干预措施所需的资源水平是传播到农村社区环境的一个重大障碍。越来越多的研究表明，在治疗儿童肥胖方面，专门针对父母的项目可能与以家庭为基础的项目一样有效。对农村人口来说，仅由父母干预可能是一种特别有益和具有成本效益的替代办法。我们在农村社区通过合作推广服务（CES）办事处提供的试点生活方式干预（R34 DK071555）数据表明，在这些农村环境中，仅父母干预可能是一种具有成本效益的替代方案，可以替代以家庭为基础的项目。这方面研究的下一个合乎逻辑的步骤是评估“以家庭为基础”和“仅限父母”的综合行为干预措施对儿童体重和健康状况的长期影响，以及成本效益。拟议的研究包括一项三组随机对照试验，以测试旨在促进长期体重管理和改善医疗服务不足的农村地区超重和肥胖儿童健康状况的干预措施的有效性。8-12岁的儿童（n = 240）及其父母将被随机分配到仅限父母（PO）、基于家庭（FB）或健康教育控制（HEC）干预组。PO和FB干预都将采取行为生活方式方法来改变饮食和身体活动模式。在PO干预中，只有家长参加小组会议，而在FB干预中，孩子和家长都参加小组会议。在HEC条件下，孩子和家长都将参加小组会议。所有干预措施都将通过CES办事处提供，包括在4个月内的12次会议，然后在接下来的8个月内每月举行一次小组会议。体重状况、代谢参数、体力活动、营养摄入和生活质量将在基线、治疗后（第12个月）和随访（第24个月）进行评估。我们还将评估这些干预措施的成本效益。假设：(a)在第12个月和第24个月时，PO和FB组的儿童比HEC组的儿童在体重状况方面表现出更大的改善；(b) PO组将比FB和HEC组表现出更大的成本效益。通过确定一种成本效益高且有效的替代家庭干预措施，研究结果可能对服务不足的农村地区儿童肥胖的治疗具有重要意义。

DESCRIPTION (provided by applicant): Children living in rural areas are 25% more likely to be overweight than their metropolitan peers. Little research has focused on strategies to address this disparity. Developing and evaluating cost-effective interventions that positively impact children's long-term weight status and related health parameters are critical to promoting improved health of youth in rural settings. Successful treatment of childhood obesity can yield significant health benefits. Behavioral family-based interventions, including both the child and parent, have demonstrated success in producing weight loss in children. The generalizability of these interventions, however, is limited. Few trials have been conducted in medically underserved community settings. The level of resources needed to deliver effective interventions represents a significant barrier to dissemination into rural community settings. A growing body of research suggests that exclusively targeting parents in the treatment of childhood obesity may be as effective as family-based programs. A parent-only intervention may be a particularly beneficial and cost-effective alternative for rural populations. Data from our pilot lifestyle intervention (R34 DK071555) delivered through Cooperative Extension Service (CES) offices in rural communities suggests that a parent-only intervention may be a cost-effective alternative intervention to family-based programs in these rural settings. The next logical step in this line of research is to evaluate the long-term effects of comprehensive "Family-Based" and "Parent-Only" behavioral interventions on measures of child weight and health status, and cost-effectiveness. The proposed study entails a three arm RCT to test the effectiveness of interventions designed to promote long-term weight management and improved health status in overweight and obese children from medically underserved, rural areas. Children (n = 240), ages 8-12 years, and their parent(s) will be randomly assigned to a Parent-Only (PO), Family-Based (FB), or a Health Education Control (HEC) intervention. Both the PO and FB interventions will take a behavioral lifestyle approach to modify dietary and physical activity patterns. In the PO intervention, only the parent(s) will attend group meetings, while in the FB intervention both the child and parent(s) will attend group sessions. Both the child and parent(s) will attend group sessions in the HEC condition. All interventions will be delivered through CES offices and will include 12 sessions over the course of 4 months, followed by monthly group sessions for the next 8 months. Weight status, metabolic parameters, physical activity, nutritional intake and quality of life will be assessed at baseline, post-treatment (month 12), and follow-up (month 24). We will also evaluate the cost effectiveness of these interventions. It is hypothesized that: (a) children in the PO and FB will exhibit greater improvements in weight status than children in the HEC at months 12 and 24, and (b) the PO will demonstrate greater cost-effectiveness than the FB and HEC. Results may have significant implications for treatment of pediatric obesity in underserved rural areas by identifying a cost-efficient and effective alternative to family-based interventions. PUBLIC HEALTH RELEVANCE: The proposed study will fill a critical gap in the literature regarding translation and dissemination of research from efficacy trials to best practices in community settings - a key objective of the NIH Roadmap Initiative. The study will have important public health implications for the treatment of pediatric obesity in underserved rural settings.