Targeting Self-Regulation to Promote Adherence and Health Behaviors in Children

 描述（由申请人提供）：自我调节不良（即，无法利用认知、情感或动机资源来实现目标）会导致整个生命过程中的一些不健康行为，包括暴饮暴食、缺乏体育活动、吸烟、酗酒和滥用药物1 -12，这些都与长期健康状况不佳有关。产生对这些物质的渴望或使其难以养成健康习惯的自我调节过程在理论上是在生命的早期开始的。针对早期的自我调节特征，即参与不健康行为的风险信号，将允许更有效的干预。因此，识别生物行为自我调节过程是至关重要的，这些过程1）在生命早期就很明显; 2）与导致不良健康结果的行为相关; 3）可以改变。为了响应RFA-RM-14-020，行为变化科学：自我调节目标的测定开发和验证，我们建议评估青春期前的自我调节，这是一个关键的过渡时期，当儿童获得管理其健康选择的责任时，自我调节变得越来越与健康结果相关。肥胖是一个复杂的健康问题，具有与自我调节相关的早期出现的生物和行为前体;它是了解需要积极自我管理的广泛健康状况的良好模型。儿童肥胖症也是一个持续的公共卫生危机，近25%的儿童在4岁时超重（学龄儿童超重率为35%）。13本提案的目标是衡量已知与肥胖风险和药物治疗依从性差相关的儿童自我调节目标，并评估干预这些机制是否可以改善自我调节。我们建议在一组肥胖率高的儿童中这样做，这些儿童从幼儿期开始就被广泛地分型为生物行为自我调节和肥胖风险因素。对于UH 2阶段，目标是在现有ABC队列的250多名低收入学龄儿童中：目标1。现场测试措施，以评估执行功能（冷EF，热EF，和食物特定的热EF），情绪调节，和动机作为自我调节目标相关的健康行为。目标二。针对已知与肥胖和不良健康结果相关的近端构建体（例如，肥胖饮食行为，皮质醇模式变钝）。目标3。制定和现场测试旨在解决自我调节目标的干预措施，使用多阶段优化策略（MOST）设计来检测干预措施的有效性和儿童或家庭因素（例如，母亲的教育，家庭压力），可能缓和干预效果。 对于UH 3阶段，目标是在从儿科专科诊所抽取的94名儿童中：目标4。检验目标3中的干预措施是否能增强自我调节目标。目标5。探索增强自我调节目标是否预测一般和疾病特异性的医疗方案依从性（即，遵循体重管理建议;服用药物）。

 DESCRIPTION (provided by applicant): Poor self-regulation (i.e., inability to harness cognitive, emotional or motivational resources to achieve goals) contributes to a number of unhealthy behaviors across the life course, including overeating, a lack of physical activity, smoking, alcoholism and substance abuse1-12 that are linked to poor long-term health. The self- regulation processes that generate the desire for such substances or that make it difficult t engage in healthy habits are theorized to begin very early in the lifespan. Targeting early self-regulation profiles that signal risk for engaging in unhealthy behaviors would allow more effective intervention. It is thus vital to identify bio- behavioral self-regulation processes thatare 1) evident early in life; 2) associated with behaviors that lead to poor health outcomes; and 3) modifiable. In response to RFA-RM-14-020, Science of Behavior Change: Assay Development and Validation for Self-Regulation Targets, we propose to assess self-regulation during pre-adolescence, a critical transition when children gain responsibility for managing their health choices and self-regulation becomes increasingly associated with health outcomes. Obesity is a complex health issue with early-emerging biological and behavioral precursors that are related to self-regulation; it is a good model for understanding a broad range of health conditions that require active self-management. Childhood obesity is also an ongoing public health crisis, with almost 25% of children overweight by age 4 years (35% by school- age).13 The goal of this proposal is to measure childhood self-regulation targets known to be associated with obesity risk and poor adherence to medical regimens and to assess whether intervening on these mechanisms can improve self-regulation. We propose to do so in a cohort of children with a high rate of obesity who have been extensively phenotyped for bio-behavioral self-regulation and obesity risk factors from early childhood. For the UH2 phase, the Aims are to, in over 250 low-income school-age children from extant ABC cohorts: Aim 1. Field-test measures to assess executive function (cool EF, hot EF, and food-specific hot EF), emotion regulation, and motivation as self-regulation targets relevant for health behavior. Aim 2. Validate measures of the above self-regulation targets against proximal constructs known to be associated with obesity and poor health outcomes (e.g., obesogenic eating behavior, blunted cortisol pattern). Aim 3. Develop and field-test interventions designed to address self-regulation targets using a Multiphase Optimization Strategy (MOST) design to detect intervention effectiveness and child or family factors (e.g., maternal education, family stress) that may moderate intervention effects. For the UH3 phase, the Aims are to, in 94 children drawn from pediatric subspecialty clinics: Aim 4. Test the hypothesis that the interventions developed in Aim 3 enhance self-regulation targets. Aim 5. Explore whether enhancing self-regulation targets predicts general and disease-specific medical regimen adherence (i.e., following weight management recommendations; taking medications).