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

描述（由申请人提供）：儿童肥胖的流行仍然相对有增无减，并且在学龄前范围内，低收入儿童的肥胖患病率已经较高。众所周知，父母教养方式会影响肥胖风险，并且父母教养方式已被列入《儿童肥胖预防、评估和治疗专家建议》。尽管人们认识到母亲喂养方式对儿童肥胖风险的重要性，但对母亲喂养方式的描述仍然相对简单，而且随着时间的推移，尤其是与儿童体重状况有关的潜在变化，几乎完全没有得到探索。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随着儿童体重状况的变化而变化，以便为干预措施提供信息和量身定制。因此，拟议的项目旨在确定4至6岁儿童的低收入母亲的喂养方式。我们之所以关注这一人群，是因为这一群体中肥胖的患病率很高，而且之前在这一领域对低收入家庭的研究非常缺乏。我们还开展了大量初步工作，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的孩子中有一半以上肥胖。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发展与儿童体重状况的关系。项目团队有独特的定位来解决这个研究问题。首席研究员获得了美国国立卫生研究院的挑战拨款，研究压力、饮食行为、每日唾液皮质醇和低收入3至5岁儿童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。我们建议用300名参与者解决4个目标，从现有的队列中吸引大多数参与者。目标1：采用多种方法确定产妇喂养方式。目的2：确定基线时不同母亲喂养方式的体重指数z得分和儿童肥胖患病率的差异。目标3：研究两年内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得分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。我们确定喂养方式的多方法方法将包括一个完善的关于喂养的半结构化访谈，我们将使用一个完善的编码方案对母亲的信心、权威和投资进行编码；在实验室和家中对喂养期间的母婴互动进行录像，我们将使用可靠和经过验证的方案对其进行编码；以及一系列的调查问卷。该项目的结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。

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.