Clinical/Behavioral Approach to Overweight Latino Youth

超重拉丁裔青少年的临床/行为方法

• 批准号: 8446474
• 负责人: JOHN P. ELDER
• 金额: $ 52.07万
• 依托单位: SAN DIEGO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-05-01 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8446474
• 关键词: 9 year old; Acculturation; Americas; Attitude; Behavior; Behavioral; Body Weight decreased; Body mass index; Caring; Child; Child Behavior; Child health care; Childhood; Clinic; Clinic Visits; Clinical; Coercion; Communities; Consumption; Controlled Study; County; Data; Devices; Diet; Eating; Educational process of instructing; Electronics; Elements; Enrollment; Equation; Evaluation; Evidence based intervention; Family; Fasting; Feeding behaviors; Genetic Predisposition to Disease; Goals; Health; Health Educators; Health Promotion; Health behavior; Health education; High Density Lipoprotein Cholesterol; Home environment; Hypertension; Income; Instruction; Insulin; Intention; Intervention; Latino; Measurement; Measures; Mediator of activation protein; Mexican Americans; Mexico; Modeling; Newsletter; Obesity; Outcome; Outcome Study; Overweight; Parenting behavior; Parents; Participant; Patients; Philosophy; Physical activity; Poverty; Prevention; Primary Health Care; Procedures; Process; Provider; Randomized; Randomized Controlled Trials; Research Personnel; Resources; Rest; Risk Reduction; Sampling; Serum; Services; Statistical Models; Structure; Subgroup; Teaching Materials; Telephone; Time; Triglycerides; Validity and Reliability; Visit; Weight; Weight Gain; Weight maintenance regimen; Youth; arm; base; behavior change; cardiovascular disorder risk; cohort; design; efficacy testing; energy balance; experience; fasting glucose; follow-up; group intervention; improved; intervention effect; nutrition; obesity in children; parental involvement; post intervention; primary outcome; public health relevance; response; sedentary; skills; social; treatment as usual; waist circumference

DESCRIPTION (provided by applicant): Overweight and obesity is a serious problem for Mexican-American children, due in part to poverty, acculturation, genetic predisposition or other factors. Clinic-based weight control studies have shown promise, but often include convenience samples with few or no Latino children. This randomized controlled trial will test the efficacy of a culturally and linguistically appropriate, evidence-based intervention to lower Body Mass Index (BMI) or slow weight gain among 390 overweight 6-9 year old Mexican-American children randomly sampled from a large (36,192 pediatric patients) community clinic providing services to low and medium income families in a US-Mexico border community (San Ysidro, CA). Intervention and measurement design and selection are based on a "Socioecological Model for Latino Health Promotion". 69 Children and their parents will be randomly assigned to either a Special Intervention (SI) or Usual Care (UC) group. The SI group will participate in the following behavior change activities based on Prevention Plus and Structured Weight Management approaches 1 : (1) classes providing culturally-sensitive health education regarding healthy eating, increasing physical activity, decreasing sedentary behaviors, and effective parenting behaviors to model and reinforce children's health behaviors, instruction on how to modify both social and structural aspects of the home environment, and skills-building to navigate community resources; (2) group clinical visits (GCV) with a Health Educator and Mid-Level Provider (MLP); (3) family visits with primary care providers (PCP); (4) newsletters to refer families to community resources; and (5) phone calls to reinforce goal setting. The UC group will receive standard health education for childhood obesity already provided by the community clinic. The primary outcome for the study is child BMI, which along with other changes in physical outcomes, child health behaviors and parenting behaviors will be evaluated at four time-points (baseline, 6-, 12-, and 18-months). The primary hypothesis is that the SI group will demonstrate lower mean BMI than the UC group at the end of a 6 month intervention with a maximum difference occurring at 12 months, and will sustain this difference for an additional six months (18 months after baseline). Secondary aims include examining intervention effects on children's energy balance, physical activity levels, sedentary behavior and parenting strategies related to their children's health behaviors. This proposal is revised following a previous positive review. Changes in response to the review and other improvements include the addition of validity/reliability information for measures of electronic home devices, a complete dissemination plan, outcome data for preliminary studies, description of cohort retention strategies, clarification of intention to treat statistical modeling, inclusion of Structural Equation Modeling, increased effort level of co-investigators, consistent delineation of primary outcome (child BMI), sample teaching materials and description of teaching philosophy, estimates of clinic visit revenues, and procedures to reduce potential participant coercion to enroll in the study.

描述（由申请人提供）：超重和肥胖是墨西哥裔美国儿童的一个严重问题，部分原因是贫困、文化适应、遗传易感性或其他因素。以临床为基础的体重控制研究显示出了希望，但通常包括很少或没有拉丁裔儿童的方便样本。这项随机对照试验将测试一种文化和语言上合适的、以证据为基础的干预措施对降低体重指数（BMI）或减缓体重增加的效果，这些干预措施是在390名超重的6-9岁墨西哥裔美国儿童中随机抽取的，这些儿童来自为美墨边境社区（San Ysidro， CA）的中低收入家庭提供服务的大型社区诊所（36,192名儿科患者）。干预和测量的设计和选择基于“促进拉丁裔健康的社会生态模型”。69名儿童及其父母将被随机分配到特殊干预组（SI）或常规护理组（UC）。SI组将参与以下基于预防+和结构化体重管理方法1的行为改变活动：(1)提供有关健康饮食、增加体育活动、减少久坐行为和有效父母行为的文化敏感健康教育课程，以示范和加强儿童的健康行为，指导如何改变家庭环境的社会和结构方面，并培养利用社区资源的技能；(2)与一名健康教育工作者和中层医务人员（MLP）进行集体临床访视（GCV）；(3)与初级保健提供者（PCP）进行家庭访问；(4)向家庭介绍社区资源的通讯；(5)打电话来强化目标设定。UC组将接受社区诊所已经提供的标准儿童肥胖健康教育。该研究的主要结果是儿童BMI，以及其他身体结果的变化，儿童健康行为和父母行为将在四个时间点（基线，6个月，12个月和18个月）进行评估。主要假设是，SI组在6个月的干预结束时表现出比UC组更低的平均BMI，最大差异出现在12个月，并将维持这种差异6个月（基线后18个月）。次要目的包括检查干预对儿童能量平衡、身体活动水平、久坐行为和与儿童健康行为相关的养育策略的影响。这项建议是在先前的积极审查之后修订的。对综述的响应变化和其他改进包括：增加了家用电子设备测量的效度/信度信息、完整的传播计划、初步研究的结果数据、对队列保留策略的描述、对处理统计模型的意图的澄清、结构方程模型的纳入、共同研究者的努力水平的提高、对主要结果（儿童BMI）的一致描述、样本教学材料和教学理念的描述，诊所访问收入的估计，以及减少潜在参与者强制参加研究的程序。