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超重的可能性比城市同龄人高25%。很少有研究集中在解决这一差距的战略。制定和评价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。儿童肥胖症的成功治疗可以产生显着的健康益处。以家庭为基础的行为干预措施，包括儿童和父母，已证明在儿童减肥方面取得了成功。然而，这些干预措施的普遍性有限。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向农村社区传播的一个重大障碍。越来越多的研究表明，专门针对父母治疗儿童肥胖症可能与以家庭为基础的计划一样有效。对农村人口来说，仅由父母进行干预可能是一种特别有益和具有成本效益的替代办法。我们通过农村社区合作推广服务（CES）办公室提供的生活方式干预试点（R34 DK 071555）的数据表明，在这些农村环境中，仅针对父母的干预可能是一种具有成本效益的替代干预措施，可以替代以家庭为基础的方案。这一系列研究的下一个合乎逻辑的步骤是评估综合的“以家庭为基础”和“仅限父母”的行为干预措施对儿童体重和健康状况以及成本效益的长期影响。这项拟议的研究需要一个三臂随机对照试验来测试干预措施的有效性，这些干预措施旨在促进医疗服务不足的农村地区超重和肥胖儿童的长期体重管理和改善健康状况。8-12岁的儿童（n = 240）及其父母将被随机分配至仅父母（PO）、基于家庭（FB）或健康教育对照（HEC）干预组。PO和FB干预措施都将采取行为生活方式方法来改变饮食和体力活动模式。在PO干预中，只有父母将参加小组会议，而在FB干预中，孩子和父母都将参加小组会议。孩子和家长都将在HEC条件下参加小组会议。所有干预措施都将通过欧洲统计员会议办公室提供，包括在4个月内举行12次会议，然后在接下来的8个月内每月举行小组会议。将在基线、治疗后（第12个月）和随访（第24个月）时评估体重状态、代谢参数、体力活动、营养摄入和生活质量。我们还将评估这些干预措施的成本效益。假设：（a）在12个月和24个月时，PO和FB中的儿童将比HEC中的儿童表现出更大的体重状况改善，并且（B）PO将比FB和HEC显示出更大的成本效益。结果可能有显着的影响，通过确定一个具有成本效益和有效的替代以家庭为基础的干预措施，在服务不足的农村地区的儿童肥胖症的治疗。 公共卫生相关性：这项拟议的研究将填补文献中关于从疗效试验到社区环境中最佳实践的研究翻译和传播的关键空白-这是NIH路线图倡议的关键目标。这项研究将对服务不足的农村地区儿童肥胖症的治疗具有重要的公共卫生意义。

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.