A Promotora-mediated, Family-based Intervention to Prevent Obesity in Latino Pres

描述（由申请人提供）：与其他种族/民族的儿童相比，拉丁裔学龄前儿童超重和肥胖的比例更高。很少有以家庭为基础的肥胖干预措施关注拉丁裔学龄前儿童，并使用文化上适当的措施和方法。拉丁裔同伴健康教育者（促进者）可以有效地增加拉丁裔人口的知识和促进行为改变；然而，到目前为止，还没有针对拉丁裔学龄前儿童的促进剂介导的儿童肥胖干预措施。本研究的目的是发展和评估以家庭为基础、促进因子介导的儿童肥胖干预的可行性和有效性。拟议的研究将采用混合方法顺序研究设计，分为两个主要阶段：第一阶段：进行形成性研究（焦点小组和对学龄前儿童的拉丁裔父母的认知访谈），以告知文化适当干预和措施的发展；第二阶段：检验促进因子介导的家庭干预预防拉丁裔学龄前儿童肥胖的可行性和有效性；30名2-5岁儿童的拉丁裔父母（第一阶段）和50对亲子对（第二阶段）将由他们自己的社会网络（如邻里、教堂、学校、街角商店）中的推广人员从南卡罗来纳的纽伯里和萨鲁达县招募。促进者将接受20小时的培训，使用第一阶段开发的干预课程，然后在每周10次的家庭会议上向家庭提供干预。干预措施将教育和培训父母制定与家庭饮食、体育活动和久坐活动有关的可行目标，以创造支持性的家庭环境，促进子女的健康体重。干预前后将评估主要结局（即儿童身体质量指数（BMI） z-score和百分位数）和次要结局（即儿童腰围、饮食和身体活动、父母BMI和腰臀比、物理和社会家庭环境以及人口统计学）。过程评估将使用多种数据源和混合方法评估保真度、剂量、覆盖范围、招募和背景因素。在过程评估协议中，将使用基于从促进者和家长收集的数据的描述性分析来确定干预的可行性和实施水平。干预对控制相关变量的主要和次要结局的影响将在SAS中使用ANCOVA进行评估。这项拟议中的研究具有很高的公共卫生意义，因为它将影响已被证明会导致体重过度增加的父母和孩子的特定行为。这项研究是创新的，因为它将是第一个在拉丁美洲学龄前儿童肥胖干预中使用促进剂的研究。如果成功，这种方法将在一项大规模的干预研究中进行评估，并提供一个潜在的模型来帮助解决和预防有幼儿的拉丁裔家庭的肥胖问题。

DESCRIPTION (provided by applicant): Latino preschool children have higher rates of overweight and obesity compared with children in other racial/ethnic groups. Few family-based obesity interventions exist that focus on Latino preschool children and use culturally-appropriate measures and approaches. Latino peer health educators (promotoras) can be effective in increasing knowledge and promoting behavior change in Latino populations; however, to date, no promotora-mediated child obesity interventions targeting Latino preschool children exist. The purpose of the proposed research is to develop and evaluate the feasibility and effectiveness of a family-based, promotora-mediated child obesity intervention. The proposed study will employ a mixed methods sequential research design, organized into two major phases: Phase I: Conduct formative research (focus groups and cognitive interviews with Latino parents of preschool children) to inform the development of a culturally-appropriate intervention and measures; Phase II: Test the feasibility and effectiveness of a promotora-mediated, family-based intervention to prevent obesity in Latino preschool children; Thirty Latino parents of children aged 2-5 years (Phase I) and fifty parent-child dyads (Phase II) will be recruited from Newberry and Saluda counties, South Carolina by promotoras from within their own social networks (e.g., neighborhood, church, school, corner stores). Promotoras will receive 20 hours of training using the intervention curriculum developed in Phase I and then deliver the intervention to families over 10 weekly home sessions. The intervention will educate and train parents to set feasible goals related to family diet, physical activity, and sedentary activity to create supportive home environments to promote a healthy weight in their children. Primary outcomes (i.e., child body mass index (BMI) z-score and percentile) and secondary outcomes (i.e., child waist circumference, diet, and physical activity, parent BMI and waist-to-hip ratio, te physical and social home environment, and demographics) will be assessed pre- and post-intervention. Process evaluation will assess fidelity, dose, reach, recruitment, and contextual factors using multiple data sources and mixed methods. Descriptive analyses based on data collected from the promotoras and parents in the process evaluation protocol will be used to determine intervention feasibility and level of implementation. Intervention impact on primary and secondary outcomes controlling for relevant variables will be assessed with ANCOVA in SAS. The proposed research carries high public health significance because it will influence specific behaviors in parents and children that have been shown to contribute to excessive weight gain. The research is innovative because it will be the first to use promotoras in a child obesity intervention for Latino preschool- age children. If successful, this approach will be evaluated in a large-scale intervention study and provide a potential model to help to address and prevent obesity in Latino families with young children.