StEP OUT

项目概要/摘要 这个指导以病人为导向的研究职业发展奖（K23）的建议将解决一个紧迫的问题， 需要在低收入，少数民族社区推进儿童肥胖预防科学，这是一个优先事项。 国家心肺血液研究所。同时，它将准备申请人，米歇尔Katzow，医学博士， MS，成为一名独立的调查员，专门从事干预措施，开始在怀孕，以防止 儿童肥胖症使用创新和可扩展的交付平台。终身心脏代谢的危险因素 与肥胖有关的发病率和死亡率在怀孕和婴儿早期是可以确定的， 在低收入的拉丁裔社区中普遍存在。很少有干预措施改善了儿童肥胖相关的 在这个高风险群体中。早期启动计划（StEP）旨在填补这一空白。程序 在初级保健环境中提供营养和育儿支持课程， 对儿童肥胖相关结果的影响。这些影响是剂量依赖性的， 参加更多会议的家庭比参加较少会议的家庭的结果要好得多。许多家庭引用 地理距离是项目参与的主要障碍。虽然最初的计划是在 2020年，第二批接受该计划的人经历了快速转换到远程， 由于全球大流行病，视频会议交付。尽管这一流行病带来了许多挑战， 这一正在进行的队列中的参与者的出席率高于最初的参与者， 面对面的队列。除了提高出勤率，远程交付还为更多人创造了机会。 频繁的会话比在初级保健以外的环境中典型的会话更适合于 肥胖预防计划，如妇女、婴儿和青少年特别补充营养计划， 儿童（WIC）。WIC覆盖了全国一半以上的婴儿，并且儿童集中度很高 有肥胖的风险。然而，没有研究检查基于视频会议的纵向干预， WIC儿童肥胖预防。这K23建议开发和测试早期开始，以防止肥胖使用 远程保健（StEP OUT），这是StEP的一个改编版本，经过优化，可通过WIC进行远程虚拟交付。要求1 将确定可能影响“解决电子废物问题”的参与和成果的主要利益攸关方的知识和态度 目标2将在连续的小队列中反复调整和测试StEP OUT;目标3将进行试点 随机对照试验（RCT）评价StEP OUT的可接受性和可行性。在此过程中 候选人将获得四个领域的基本职业发展技能：1）定性方法; 2）CBPR; 3） 迭代干预适应;和4）在弱势群体中进行临床试验。的资源 Northwell Health和跨学科导师和顾问的专家团队将提供出色的 开启卡佐医生事业的背景该项目将为Katzow博士未来的R 01提供必要的数据 提交了一项大规模RCT，测试StEP OUT的疗效。

PROJECT SUMMARY/ABSTRACT This Mentored Patient-Oriented Research Career Development Award (K23) proposal will address an urgent need to advance the science of child obesity prevention in low-income, minority communities, a priority of the National Heart, Lung, and Blood Institute. Simultaneously, it will prepare the applicant, Michelle Katzow, MD, MS, to become an independent investigator specializing in interventions that begin in pregnancy to prevent child obesity using innovative and scalable delivery platforms. Risk factors for lifelong cardiometabolic morbidity and mortality related to obesity are identifiable in pregnancy and early infancy, with the highest prevalence in low-income, Latinx communities. Few interventions have improved child obesity related outcomes in this high-risk group. The Starting Early Program (StEP) was designed to fill this gap. The program delivers nutrition and parenting support sessions in the primary care setting and has significant positive impacts on child obesity-related outcomes. These impacts are dose dependent, such that families who attend more sessions have significantly better outcomes than families who attend fewer sessions. Many families cite geographic distance as a major barrier to program engagement. Though the original program was delivered in person, a second cohort receiving the program in 2020 experienced a rapid conversion to remote, videoconference delivery due to the global pandemic. Despite many challenges posed by the pandemic, attendance among participants in this ongoing cohort has been higher than among participants in the original, in-person cohort. In addition to improving attendance, remote delivery has created opportunities for more frequent sessions than would be typical in contexts outside of primary care that are otherwise well-suited for obesity prevention programs, such as the Special Supplemental Nutrition Program for Women, Infants, & Children (WIC). WIC reaches more than half of all infants in the nation and has a high concentration of children at risk of obesity. However, no studies have examined videoconference-based, longitudinal interventions for child obesity prevention in WIC. This K23 proposes to develop and test Starting Early to Prevent Obesity Using Telehealth (StEP OUT), an adapted version of StEP optimized for remote, virtual delivery through WIC. Aim 1 will identify knowledge and attitudes of key stakeholders likely to impact engagement and outcomes of StEP OUT; Aim 2 will iteratively adapt and test StEP OUT in sequential small cohorts; and Aim 3 will conduct a pilot randomized controlled trial (RCT) to evaluate acceptability and feasibility of StEP OUT. In the process, the candidate will obtain essential career development skills in four domains: 1) qualitative methods; 2) CBPR; 3) iterative intervention adaptation; and 4) conduct of clinical trials in vulnerable populations. The resources of Northwell Health and an expert team of interdisciplinary mentors and advisors will provide an outstanding context to launch Dr. Katzow’s career. This project will provide the necessary data for Dr. Katzow’s future R01 submission of a large-scale RCT testing the efficacy of StEP OUT.