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

描述（由申请人提供）：尽管婴儿和学步儿童的肥胖有所增加，但在这一年龄组中促进健康饮食和减少久坐行为的干预措施很少。为了填补这一空白，我们建议在468名非西班牙裔黑人妇女、她们的家庭和她们的儿童照顾者中进行一项随机对照试验，以测试多成分、量身定制的干预与注意控制（儿童安全）在促进婴儿期健康体重增加模式方面的效果。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”将是首批满足个别家庭独特需求的干预措施之一，它通过多种渠道向多个照顾者提供有关婴儿护理、喂养和生长的预期指导。干预部门的主要分娩方式将包括通过9次家访（1次由经认证的哺乳顾问进行）进行面对面咨询，为母亲提供6份量身定制的健康通讯，为母亲认为有影响力的“其他”照顾者提供6份有针对性的健康通讯，以及为母亲和“其他”照顾者提供约160条基于线索的短信。控制组将通过普通通讯和短信接收有关儿童安全的信息。我们的主要结局是婴儿/幼儿的生长，通过18个月时的平均体重长度z分数（WLZ）、0-18个月间的平均体重z分数变化和18个月时超重的可能性（WLZ为第95百分位）来捕获。群体之间的差异预计将通过采取有针对性的保健行为来实现，包括更有可能开始母乳喂养、专一性和持续时间；6个月后，增加全水果和蔬菜的摄入量，减少能量密集的零食的摄入量；婴幼儿睡眠时间延长，夜间醒来次数减少；此外，电视和电子媒体曝光率也较低。我们进一步假设，这些目标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；较高的感知社会支持水平；更高的反应性喂养方式得分；提高婴儿/幼儿体重状况感知的准确性；并且，减少了父母对婴儿大惊小怪的看法。我们认为，“母亲和他人”是非常重要和创新的，因为它针对的是早期肥胖高风险的少数人群，它从怀孕期间开始，是建立健康行为的“教育时刻”，它积极吸引多个儿童照顾者，它利用了新的干预平台，包括

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.