Project 2: Leveraging Ongoing Home Visitation Programs to Address Obesity Disparities among Underserved, Low-Income Mothers and Children

这项拟议的研究针对的是社会经济弱势群体中的肥胖和与健康相关的差异。 母亲和她们年幼的孩子参加了联邦资助的家访计划。这事很重要 因为低收入和种族/少数民族的母亲和她们年幼的孩子特别容易患上 肥胖。缺乏以证据为基础的肥胖努力的机会进一步加剧了这些差异。这个 建议的随机对照试验测试(1)简单、循证和生态的有效性 相关肥胖干预(习惯)作为持续家访服务的一部分提供，相比之下(2) 现有的家访课程没有关于母亲和儿童肥胖风险的肥胖相关内容。 习惯侧重于习惯的养成和对食物/活动家庭环境的修改以促进 目标体重相关行为的变化。参与者将是298名母亲(&gt；50%非裔美国人； 100%达到联邦贫困水平)和他们的孩子(基线为3-5岁)在我们的家访伙伴中登记 在阿拉巴马州中部。家庭访客将被随机分配到提供家访课程，或 没有习惯作为他们每周家访的一部分，持续12个月。对母亲的评估(体重、腰围 目标行为的周长、进食习惯和习惯强度)、儿童(增重率)和 家庭环境(可获得性/可获得性/线索的可见性有利于有针对性的食物、活动和 监测行为)将在入选后12个月和24个月(一年后随访)进行。目标1 (主要结果)。比较治疗对12岁儿童和母亲体重结果的影响 和24mo。假设1a：接受习惯的母亲的体重和腰围会比 接受标准服务的母亲。假设1b：养成习惯的孩子体重会变慢 比儿童接受标准服务更有好处。目标2(次要结果)。比较……的效果 母亲喂养行为、目标行为习惯强度和家庭特征的处理 在12个月和24个月时与目标行为相关的环境。假设2：与标准服务相比， 习惯将导致更健康的母亲喂养习惯(较少油炸食品和SSB；更多蔬菜/水果)， 目标行为的习惯强度更高，提示的居家可用性/可访问性/可见性更高 支持有针对性的行为。目标3(儿童肥胖风险的母体/环境传播)。至 检验母亲和家庭环境变量是否在习惯对儿童死亡率的影响中起中介作用 体重在12个月和24个月时增加。假设3：母亲体重、喂养习惯、目标母亲的习惯强度 行为、家庭环境会在习惯与儿童退化率之间起中介作用 体重增加。我们将进一步探讨非洲的主要结果(目标1)和次要结果(目标2)是否不同 美国和白人母亲和孩子，以及种族是否缓和了母亲和孩子之间的关系 以及家庭环境变量和儿童体重增重率(目标3)。

The proposed study addresses obesity and health-related disparities among socioeconomically disadvantaged mothers and their young children enrolled in federally-funded home visitation programs. This is important because low-income and racial/ethnic minority mothers and their young children are especially at-risk of obesity. The lack of access to evidence-based obesity efforts further contributes to these disparities. The proposed randomized controlled trial tests the effectiveness of (1) a simple, evidence-based and ecologically relevant obesity intervention (HABITS) delivered as part of ongoing home visitation services, compared to (2) the existing home visitation curriculum without obesity-related content on mothers’ and children’s obesity risks. HABITS focuses on habit formation and modifications to the food/activity home environment to promote changes in the targeted weight-related behaviors. Participants will be 298 mothers (>50% African American; 100% meet federal poverty level) and their children (3-5yo at baseline) enrolled in our home visitation partner in central Alabama. Home visitors will be randomly assigned to deliver the home visitation curriculum with or without HABITS as part of their weekly home visits for 12 months. Assessments of mothers (weight, waist circumference, feeding practices and habit strength of targeted behaviors), children (rate of weight gain), and household environment (availability/accessibility/visibility of cues conducive to targeted food, activity and monitoring behaviors) will be conducted at enrollment, 12, and 24mo (1y post-treatment follow-up). Aim 1 (primary outcomes). To compare the effects of treatment on children and mothers’ weight outcomes at 12 and 24mo. Hypothesis 1a: Mothers receiving HABITS will have a lower weight and waist circumference than mothers receiving standard services. Hypothesis 1b: Children receiving HABITS will have slower rate of weight gain than children receiving standard services. Aim 2 (secondary outcomes). To compare the effects of treatment on maternal feeding practices, habit strength of targeted behaviors, and features of the household environment relevant to targeted behaviors at 12 and 24 mo. Hypothesis 2: Compared to standard services, HABITS will result in heathier maternal feeding practices (less fried foods and SSB; more vegetables/fruits), greater habit strength of targeted behaviors, and greater home availability/accessibility/visibility of cues that support targeted behaviors. Aim 3 (maternal/environmental transmission of children’s obesity risk). To test whether maternal and household environment variables mediate the effect of HABITS on children’s rate of weight gain at 12 and 24mo. Hypothesis 3: Maternal weight, feeding practices, habit strength of targeted behaviors, and household environment will mediate the relationship between HABITS and children’s rate of weight gain. We will further explore whether primary (Aim 1) and secondary (Aim 2) outcomes differ for African American and White mothers and children, and whether race moderates the relationships between maternal and household environment variables and children’s rate of weight gain (Aim 3).