Healthy Home Offerings via the Mealtime Environment (HOME) Plus

描述（由申请人提供）：儿童肥胖是一个严重的公共卫生问题，迄今为止有效的预防策略有限。虽然以前的营养和体育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出体重增加的减少。此外，很少有预防研究显著地让父母参与并关注家庭环境。为了预防儿童肥胖，必须在家庭环境中促进健康的行为，因为父母是健康饮食和久坐行为的有影响力的主要榜样，是家庭中食物和饮料供应和不活动程度的守门人。此外，家庭环境是孩子们消耗大部分卡路里和能量密集食物的地方，也是孩子们久坐不动的地方，尤其是在屏幕前（如电视、电脑、游戏系统）。拟议的研究将测试健康家庭产品的功效，通过用餐时间环境（Home） Plus计划，一个为期一年的，以家庭为基础的健康促进干预，以防止8-12岁儿童体重增加过多。该项目以社会认知理论和社会生态框架为基础，提倡定期食用营养合理的零食和家庭成员一起用餐（即家庭聚餐），并鼓励减少久坐不动的行为，特别是儿童在家里看屏幕的时间。干预的有效性将在一项随机对照试验中进行测试，160个家庭随机分为两种情况（干预或仅注意控制）。从课前、课后项目和社区中心招募的两组家庭将被跟踪研究2.5年。主要假设是，在12个月的干预结束时，干预家庭中的目标儿童在调整基线BMI值后，相对于对照家庭的儿童，其体重指数（BMI；主要结局）将显著降低。次要结果包括每周家庭聚餐的频率，家中提供的健康食品和饮料的数量，以及家庭聚餐和零食的数量（由家长报告），目标是儿童每天健康食品和饮料的摄入量，目标是儿童每周久坐的时间，特别是屏幕时间。在基线、干预后（随机化后12个月）和随访（干预后9个月）时，由训练有素的研究人员在家中对儿童和家长进行测量。拟议的研究建立在我们的HOME试点研究（2006-2008;NIH R21-DK0072997）的成功方法的基础上，并且具有创新性，因为它积极地让整个家庭参与体验活动并利用家庭环境。这项研究将为家庭提供重要的环境和行为策略信息，以防止体重过重。该干预项目具有很高的翻译潜力，可能会立即对学龄儿童的家庭有用，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整个明尼苏达州进行维护。

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.