Low Income Mothers' Feeding Beliefs and Practices as Child Obesity Risk Factors

描述(申请人提供)：儿童肥胖症的流行仍相对有增无减，低收入儿童的肥胖率在学龄前阶段已经较高。众所周知，父母养育方式影响肥胖风险，父母养育方式被包括在儿童肥胖的预防、评估和治疗专家建议中。尽管人们认为母亲的喂养方式对儿童肥胖风险很重要，但对母亲喂养方式的描述仍然相对简单化，其随时间的潜在变化，特别是与儿童体重状况有关的变化，几乎完全没有被探索过。需要更好地了解母亲的喂养方式以及它们如何随着时间的推移而变化，以应对儿童体重状况的变化，以便为干预措施提供信息并进行量身定做。因此，拟议的项目力求确定4至6岁儿童的低收入母亲的喂养方式。考虑到肥胖在这一群体中的高流行率，以及在这一领域对低收入家庭的先前工作的显著缺乏，我们将重点放在这一群体上。我们还开展了大量的初步工作，确定了初步的产妇喂养方式。其中一种喂养方式我们称之为“冲突控制者”，这种喂养方式的母亲一半以上的孩子都是肥胖症患者。因此，该项目还将寻求更好地了解这种特定的喂养方式及其与儿童体重状况的发展关系。项目团队在解决这一研究问题方面具有得天独厚的优势。首席调查员被授予NIH挑战补助金，以检查低收入3至5岁儿童中压力、饮食行为、白天唾液皮质醇和肥胖风险之间的关系。数据收集工作正在提前进行，我们预计到2011年8月将招收350名儿童。我们建议解决4个目标，300名参与者，吸引了现有队列中的大多数参与者。目标1：采用多种方法确定母亲的喂养方式。目的2：确定基线时不同母亲喂养方式在体重指数z得分和儿童肥胖率方面的差异。目标3：检查两年期间从一种喂养方式到另一种喂养方式的转变。目的4：确定儿童体重指数z分数的变化是否预示着从一种喂养方式向另一种喂养方式的转变。我们采用多种方法确定喂养方式，包括精心设计的关于喂养的半结构化访谈，通过访谈，我们将使用成熟的编码方案对母亲的信心、权威和投资进行编码；在实验室和家里对喂养过程中的母子互动进行录像，我们将使用可靠和有效的方案进行编码；以及一系列调查问卷。该项目的成果将有助于为肥胖预防和治疗提供更有针对性和更有效的干预措施。 公共卫生相关性：儿童肥胖是一个日益严重的公共卫生问题，低收入人群是肥胖流行的最大负担。在儿童时期发展起来的肥胖很可能延续到成年，并与大量不良的健康、行为和社会后果有关。更好地了解母亲的喂养方式，特别是在低收入人群中，将有助于制定更有效的干预和预防计划。

DESCRIPTION (provided by applicant): The childhood obesity epidemic continues relatively unabated, and a higher prevalence of obesity among low- income children is already present in the preschool age range. It is well-recognized that parenting style impacts obesity risk, and parenting style was included in the Expert Recommendations for the Prevention, Assessment, and Treatment of Childhood Obesity. Despite the perceived importance of maternal feeding styles to childhood obesity risk, the characterization of maternal feeding styles remains relatively simplistic and their potential change over time, particularly in relation to the child's weight status, is nearly entirely unexplored. An improved understanding of maternal feeding styles as well as how they change over time in response to changes to a child's weight status is needed to inform and tailor interventions. The proposed project therefore seeks to identify maternal feeding styles among low-income mothers of 4- to 6-year-old children. We focus on this population given the high prevalence of obesity within this group, and the remarkable lack of prior work in this area with low-income families. We have also conducted substantial preliminary work that has identified preliminary maternal feeding styles. One of these feeding styles we call "Conflicted Controllers," and more than half of the children of mothers with this feeding style are obese. This project therefore also will seek to better understand this specific feeding style and its development in relation to child weight status. The project team is uniquely positioned to address this research question. The Principal Investigator was awarded an NIH Challenge Grant to examine relationships between stress, eating behavior, diurnal salivary cortisol, and obesity risk among low-income 3- to 5-year-old children. Data collection is proceeding ahead of schedule, and we anticipate enrolling 350 children by August 2011. We propose to address 4 aims with 300 participants, drawing most participants from this existing cohort. The aims are: Aim 1: To identify maternal feeding styles using a multi-method approach. Aim 2: To identify differences in body mass index z-score and the prevalence of child obesity across maternal feeding styles at baseline. Aim 3: To examine transitions from one feeding style to another over a two year period. Aim 4: To determine if changes in child body mass index z-score predict transition from one feeding style to another. Our multi-method approach to identifying feeding styles will include a well-developed semi-structured interview about feeding from which we will code maternal confidence, authority, and investment using a well-established coding scheme; videotaped maternal-child interactions during feeding both in the laboratory and at home which we will code using a reliable and validated scheme; and a series of questionnaires. The results of this project will contribute to more tailored and effective interventions for obesity prevention and treatment. PUBLIC HEALTH RELEVANCE: Childhood obesity is a growing public health problem, and low-income populations carry the greatest burden of the obesity epidemic. Obesity that develops in childhood is very likely to track into adulthood, and is associated with a large number of adverse health, behavioral, and social outcomes. An improved understanding of maternal feeding styles, particularly within low-income populations, would inform the development of more effective intervention and prevention programs.