Mothers and Others: Family-based Obesity Prevention for Infants and Toddlers

母亲和其他人：以家庭为基础的婴幼儿肥胖预防

• 批准号: 8342726
• 负责人: MARGARET E BENTLEY
• 金额: $ 61.94万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8342726
• 关键词: Achievement; Age-Months; Attention; Attitude; Behavior; Behavioral; Breast Feeding; Caregivers; Caring; Child; Child Care; Childhood; Code; Color; Community Health; Control Groups; Counseling; Cues; Dietary Fiber; Dietary intake; Electronics; Energy Intake; Epidemic; Exclusive Breastfeeding; Exposure to; Family; Fathers; Food; Fruit; Future; Growth; Health; Health Promotion; Health behavior; Health behavior outcomes; Home environment; Home visitation; House Call; Individual; Infant; Infant Care; Influentials; Intake; Intervention; Intervention Studies; Juice; Lactation; Length; Licensing; Life; Literature; Measures; Mediating; Mediation; Mediator of activation protein; Minority; Mothers; Newsletter; Not Hispanic or Latino; Obesity; Outcome; Overweight; Parenting behavior; Pattern; Perception; Population; Pregnancy; Pregnant Women; Prevalence; Prevention strategy; Publishing; Randomized Controlled Trials; Recruitment Activity; Reporting; Research; Research Personnel; Risk Factors; Safety; Self Efficacy; Sleep; Social support; Technology; Television; Testing; Text; Toddler; Vegetables; Visit; Weight; Weight Gain; Weight Perception; Woman; age group; arm; base; cohort; design; efficacy testing; efficacy trial; experience; feeding; fruits and vegetables; good diet; high risk; improved; infancy; innovation; meetings; modifiable risk; multi-component intervention; new technology; novel; obesity prevention; prevent; programs; public health relevance; rapid growth; secondary outcome; sedentary; uptake

DESCRIPTION (provided by applicant): Despite increases in obesity among infants and toddlers, few published interventions promoting healthy diet and decreased sedentary behaviors among this age group exist. To fill this gap, we propose a randomized controlled trial among 468 Non-Hispanic black women, their families, and their child caregivers to test the efficacy of a multi-component, tailored intervention versus an attention control (child safety) in promoting healthy weight gain patterns during infancy. The proposed intervention, Mothers and Others: Family-based Obesity Prevention for Infants and Toddlers will be one of the first to meet the unique needs of individual families by delivering anticipatory guidance on infant care, feeding and growth through multiple channels and to multiple caregivers. Primary modes of delivery for the intervention arm will include face-to-face counseling through 9 home visits (1 by a certified Lactation Consultant), 6 tailored health newsletters for mothers and 6 targeted health newsletters for "other" caregivers deemed influential by mothers, as well as ~160 cue-based text messages for mothers and "other" caregivers. The control group will receive messages on child safety delivered through general newsletters and text messages. Our main outcome is infant/toddler growth, captured by mean weight-for-length z-scores (WLZ) at 18 months, mean change in WLZ between 0-18 months, and likelihood of overweight (WLZ e 95th percentile) at 18 months. Differences between groups are expected to be achieved through uptake of targeted health behaviors, including a greater likelihood of breastfeeding initiation, exclusivity and duration; after 6 months, higher dietary intakes of whole fruits and vegetables and lower intakes of energy-dense snack foods; longer durations of infant and toddler sleep and fewer night awakenings; and, lower levels of television and electronic media exposure. We further hypothesize that these targeted health behaviors will be achieved through modifiable risk factors underpinning the intervention, namely more positive breastfeeding attitudes; higher levels of parenting and breastfeeding self-efficacy; higher levels of perceived social support; higher responsive feeding style scores; improved accuracy in perceiving infant/toddler weight status; and, diminished parental perceptions of infant fussiness. We believe Mothers and Others is highly significant and innovative, as it targets a minority population at high risk of early life obesity, it begins during pregnancy, a "teachable moment" for establishing healthy behaviors, it actively engages multiple child caregivers, and it utilizes novel intervention platforms, including tailoring and text messaging. We have assembled a strong, interdisciplinary team of researchers, each with an outstanding record for implementing and publishing research relevant to this intervention. Collectively, we have experience conducting similar interventions in this population; designing, implementing and evaluating the proposed tailoring and novel technology components; recruiting and retaining a similar cohort; and measuring and analyzing relationships between the proposed modifiable risk factors, targeted health behaviors and outcomes of early life growth. PUBLIC HEALTH RELEVANCE: Family-based Obesity Prevention for Infants and Toddlers is an efficacy trial of a multi-component, tailored intervention focused on infants of Non-Hispanic Black mothers and families, a minority population at high risk for pediatric obesity. Mothers and Others contains several innovations, including beginning during a 'teachable' moment, pregnancy; use of color-coded growth charts to enhance caregiver recognition of child growth and size; active engagement of multiple caregivers ('mothers and others'); and the use of tailoring and novel media technologies. If successful in promoting healthy infant growth and enhancing caregiver health behaviors, Mothers and Others will have high public health relevance for future obesity-prevention efforts aimed at children less than two years, including intervention research studies and federal, state and community health programs.

描述（由申请人提供）：尽管婴儿和幼儿的肥胖率增加，但很少有已发表的促进该年龄组健康饮食和减少久坐行为的干预措施。为了填补这一空白，我们提出了一个随机对照试验468非西班牙裔黑人妇女，他们的家庭，和他们的孩子照顾者，以测试的有效性的多组件，量身定制的干预与注意力控制（儿童安全），在促进健康的体重增长模式在婴儿期。拟议的干预措施“母亲和其他人：以家庭为基础的婴幼儿肥胖预防”将通过多种渠道向多个照顾者提供有关婴儿护理、喂养和成长的预期指导，成为满足个别家庭独特需求的首批干预措施之一。干预组的主要交付模式将包括通过9次家访（1次由认证的哺乳顾问进行）进行的面对面咨询，6份针对母亲的定制健康通讯，6份针对母亲认为有影响力的“其他”护理人员的有针对性的健康通讯，以及约160条针对母亲和“其他”护理人员的基于提示的短信。对照组将通过一般通讯和短信收到有关儿童安全的信息。我们的主要结果是婴儿/幼儿的生长，通过18个月时的平均身长体重z评分（WLZ），0-18个月之间WLZ的平均变化和18个月时超重的可能性（WLZ e第95百分位数）来捕获。通过采取有针对性的健康行为，包括更大的可能性母乳喂养的开始，排他性和持续时间; 6个月后，整个水果和蔬菜的饮食摄入量较高，能量密集的零食摄入量较低;婴儿和幼儿睡眠时间较长，夜间醒来较少;以及，电视和电子媒体曝光水平较低。我们进一步假设，这些有针对性的健康行为将通过支持干预的可改变的风险因素来实现，即更积极的母乳喂养态度;更高水平的育儿和母乳喂养自我效能感;更高水平的感知社会支持;更高的反应性喂养方式评分;提高感知婴儿/幼儿体重状况的准确性;并且，减少父母对婴儿大惊小怪的看法。我们认为，“母亲和其他人”项目具有高度的意义和创新性，因为它针对的是早期肥胖风险高的少数群体，它始于怀孕期间，这是建立健康行为的“可教时刻”，它积极吸引多名儿童照顾者，并利用新颖的干预平台，包括 裁缝和短信我们已经组建了一支强大的跨学科研究团队，每个人都在实施和发表与这种干预相关的研究方面有着出色的记录。总的来说，我们有经验在这个人群中进行类似的干预;设计，实施和评估拟议的定制和新技术组件;招募和保留类似的队列;测量和分析拟议的可修改的风险因素之间的关系，有针对性的健康行为和早期生命成长的结果。 公共卫生相关性：以家庭为基础的婴儿和幼儿肥胖预防是一项多组分、量身定制的干预措施的有效性试验，重点关注非西班牙裔黑人母亲和家庭的婴儿，这是一种儿童肥胖高风险的少数群体。《母亲和其他人》包含了几项创新，包括从“可教”的时刻-怀孕开始;使用彩色编码的生长图表，以提高照顾者对儿童生长和体型的认识;多个照顾者（“母亲和其他人”）的积极参与;以及使用剪裁和新的媒体技术。如果成功地促进健康的婴儿成长和提高照顾者的健康行为，母亲和其他人将有高度的公共卫生相关性，为未来的肥胖预防工作，针对儿童不到两年，包括干预研究和联邦，州和社区的健康计划。