StEP OUT

项目摘要/摘要 这项以患者为导向的指导研究职业发展奖(K23)提案将解决一个紧迫的问题 需要在低收入、少数族裔社区推进儿童肥胖预防的科学，这是 国家心肺血液研究所。同时，它将为申请人，医学博士米歇尔·卡佐做准备， MS，成为一名独立调查员，专门从事从怀孕开始的预防干预措施 使用创新和可扩展的交付平台来解决儿童肥胖问题。终生心脏代谢异常的危险因素 与肥胖相关的发病率和死亡率可在怀孕和早期婴儿中确定，其中最高的 在低收入的拉丁裔社区中普遍存在。很少有干预措施改善与儿童肥胖相关的 在这一高危人群中的结果。启动早期计划(STEP)就是为了填补这一空白。该计划 在初级保健环境中提供营养和育儿支持课程，并具有显著的积极意义 对儿童肥胖相关结果的影响。这些影响是剂量依赖的，所以参加的家庭 参加更多会议的家庭比参加更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度的主要障碍。尽管最初的节目是在 人，2020年接受该计划的第二批人经历了快速转变为远程， 由于全球大流行，视频会议的交付。尽管大流行带来了许多挑战， 正在进行的队列中参与者的出席率高于原始队列的参与者， 面对面的队列。除了提高出勤率，远程交付还创造了更多机会 在初级保健之外的情况下比通常情况下更频繁的会话，否则非常适合 肥胖预防计划，如妇女、婴儿和儿童特别补充营养计划 儿童(WIC)。WIC覆盖了全国一半以上的婴儿，儿童密度很高 有肥胖的风险。然而，还没有研究检查基于视频会议的纵向干预措施 WIC的儿童肥胖预防。这款K23建议及早开始开发和测试，以预防肥胖 TeleHealth(Step Out)，STEP的改编版本，针对通过WIC的远程虚拟交付进行了优化。目标1 将确定可能影响STEP的参与度和结果的关键利益相关者的知识和态度 目标2将在连续的小群体中迭代地适应和测试步骤；目标3将进行试点 采用随机对照试验(RCT)评价退出的可接受性和可行性。在这个过程中， 应聘者将在四个领域获得基本的职业发展技能：1)定性方法；2)CBPR；3) 迭代干预适应；以及4)在脆弱人群中进行临床试验。的资源 Northwell Health和一个由跨学科导师和顾问组成的专家团队将提供杰出的 启动卡佐博士职业生涯的背景。该项目将为Katzow博士未来的R01提供必要的数据 提交一次大规模随机对照试验，检验步出效果。

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.