Healthy Home Offerings via the Mealtime Environment (HOME) Plus

描述(申请人提供)：儿童肥胖是一个严重的公共卫生问题，到目前为止有效的预防策略有限。尽管以前的营养和体力活动环境预防肥胖的方法显示出一些希望，但大多数研究并没有显示超重增加的减少。此外，很少有预防研究显著地让父母参与，并将重点放在家庭环境上。为了预防儿童肥胖，必须促进家庭环境中的健康行为，因为父母是健康饮食和久坐行为的有影响力的主要榜样，是食物和饮料供应以及家庭内不活动程度的守门人。此外，家庭环境是儿童消耗大部分卡路里和高能量食物的地方，也是儿童进行大部分久坐行为的地方，特别是在屏幕上(例如，电视、电脑、游戏系统)。这项拟议的研究将通过餐时环境(HOME)+计划测试健康之家服务的有效性，该计划是一项为期一年的家庭健康促进干预措施，旨在防止8-12岁儿童超重。该方案以社会认知理论和社会生态框架为基础，提倡家庭成员一起进餐的常规和营养健康的零食和餐点(即家庭餐点)，并鼓励减少久坐行为，特别是在家庭环境中儿童在屏幕前的时间。干预的效果将在一项随机对照试验中进行测试，160个家庭被随机分成两种情况(干预或仅注意对照)。从课前和课后项目以及社区中心招募的两组家庭将被跟踪调查两年半。基本假设是，在为期12个月的干预结束时，干预家庭中的目标儿童在根据基线BMI值进行调整后，相对于对照家庭的儿童，身体质量指数(BMI；主要结果)将显著降低。次要结果包括每周家庭聚餐的频率和在家庭聚餐和零食中提供的健康食品和饮料的数量(如父母所报告的)，目标儿童每天健康食品和饮料的摄入量，以及目标儿童每周久坐的时间，特别是在屏幕前的时间。儿童和父母的测量将在他们的家中进行，由训练有素的研究人员在基线、干预后(随机化后12个月)和随访(干预后9个月)进行。建议的研究以我们的家庭试点研究(2006-2008；NIH R21-DK0072997)的成功方法为基础，具有创新性，因为它积极地让整个家庭参与体验活动，并利用家庭环境。这项研究将提供有关环境和行为策略的重要信息，家庭可以在家里使用这些策略来防止体重超标。该干预计划具有很高的翻译潜力，很可能立即对学龄儿童家庭有用，因为它将在现实世界的社区环境中进行测试，并由明尼苏达大学的推广服务在明尼苏达州各地进行支持。

DESCRIPTION (provided by applicant): Childhood obesity is a serious public health problem with limited effective prevention strategies to date. Although previous nutrition and physical activity environmental approaches for obesity prevention show some promise, most studies have not shown reductions in excess weight gain. Moreover, few prevention studies significantly engage parents and focus on the home environment. To prevent childhood obesity it is essential to promote healthy behaviors in the home environment because parents are influential primary role models for healthy eating and sedentary behavior, and are gatekeepers for food and beverage availability and degree of inactivity within the home. Moreover, the home setting is where most of children's calories and energy dense foods are consumed and where children engage in much of their sedentary behavior, particularly screen time (e.g., television, computer, game system). The proposed study will test the efficacy of the Healthy Home Offerings via the Mealtime Environment (HOME) Plus program, a year-long, family-based health promotion intervention to prevent excess weight gain among 8-12 year old children. The program is based on Social Cognitive Theory and a socio-ecological framework and promotes both regular and nutritionally-sound snacks and meals in which family members eat together (i.e., family meals) and encourages reductions in sedentary behavior, particularly screen time among children in the home setting. The efficacy of the intervention will be tested in a randomized controlled trial with 160 families randomized to two conditions (intervention or attention- only control). Two cohorts of families, recruited from before- and after-school programs and community centers, will be followed for 2.5 years. The primary hypothesis is that, by the end of the 12-month intervention, target children in the intervention families, relative to children in the control families, will have significantly lower body mass index (BMI; primary outcome) after adjustment for baseline BMI values. Secondary outcomes include frequency of weekly family meals and number of healthful foods and beverages available in the home and served at family meals and snacks (as reported by parent), target children's daily intakes of healthful foods and beverages, and target children's minutes of sedentary behavior per week, particularly screen time. Child and parent measurement will occur in their homes at baseline, post-intervention (12-months post- randomization), and follow-up (9-months post-intervention) by trained research staff. The proposed study builds upon successful methods from our HOME pilot study (2006-2008; NIH R21-DK0072997) and is innovative as it actively engages entire families in experiential activities and capitalizes on the home setting. The study will provide important information on environmental and behavioral strategies that families can use at home to prevent excess weight gain. The intervention program has high translation potential and is likely to be immediately useful to families of school-age children because it will be tested in real-world community settings and sustained across the state of Minnesota by the University of Minnesota's Extension Service.