Does the provision of postnatal parenting support in primary care improve cardiometabolic health in early childhood among at-risk-families?

在初级保健中提供产后育儿支持是否可以改善高危家庭儿童早期的心脏代谢健康？

• 批准号: 10630869
• 负责人: Maria E. Bleil
• 金额: $ 75.13万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-15 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10630869
• 关键词: Adjuvant; Adopted; Age; Area; Behavioral; Biological Markers; Blood; Blood Pressure; Cardiometabolic Disease; Child; Child Rearing; Clinical; Collection; Data Sources; Disadvantaged; Disease model; Distal; Dryness; Early Intervention; Ethnic Population; Exposure to; Family; Foundations; Funding; Goals; Health; Health behavior; Home; Home visitation; Individual; Infant; Inflammation; Informal Social Control; Intervention; Interviewer; Life; Life Cycle Stages; Literature; Low income; Maternal Health; Measures; Mediating; Mental Depression; Metabolic; Monitor; Mother-Child Relations; Mothers; National Institute of Child Health and Human Development; Outcome; Parents; Patient Self-Report; Polysomnography; Population; Primary Care; Questionnaires; Recording of previous events; Risk; Risk Factors; Sampling; Shapes; Socioeconomic Status; Spottings; Testing; Time; Trauma; United States National Institutes of Health; Visit; Woman; Work; biological sex; cardiometabolic risk; cardiometabolism; cardiovascular health; design; disorder risk; early childhood; early life adversity; evidence base; health disparity; improved; infancy; intervention effect; maternal depression; physical conditioning; postnatal; prevent; programs; prospective; racial minority population; remediation; resilience factor; social health determinants; therapy design; transmission process; trend

PROJECT SUMMARY: Worsening population-level trends in cardiometabolic health highlight the profound need to move away from traditional disease models focused on the remediation of downstream cardiometabolic risk factors to instead focus on relevant upstream exposures. Relevant upstream exposures include early life adversities (ELA), a unique subset of social determinants of health that occur early in life and are hypothesized to become biologically embedded, thereby shaping life course trajectories of health and disease risk over time. A robust literature shows ELA exposures confer prospective risk for cardiometabolic disease, yet few—albeit promising—studies have examined whether early intervention in ELA-exposed children may lessen this risk. Review of relevant literatures suggests generally that 1) earlier intervention is more effective; 2) intervention benefits are greatest in families most in need; 3) parenting is a mechanism through which early intervention benefits are transmitted; and 4) existing parenting interventions, deemed successful with respect to parent-child behavioral and relationship outcomes, are candidates for testing in relation to child physical health outcomes. Building on this foundation, the proposed study represents a unique and time-sensitive opportunity to extend the aims of an existing RCT in which a parenting intervention—Promoting First Relationships® (PFR) versus no intervention—was implemented as an adjuvant to depression treatment in a sample of low income, postnatal women. The purpose of the proposed study is to determine whether benefits of the PFR intervention, originally designed to impact parent- child behavioral and relationship outcomes in infancy may extend to the child’s cardiometabolic health in early childhood. It is hypothesized that the PFR intervention will augment an upstream resiliency factor—parenting quality—at an early period of vulnerability, potentially benefiting the child’s cardiometabolic health. Expected intervention effects on the more distal child cardiometabolic health outcomes are hypothesized to be partially attributable to changes in the more proximal intervention-related targets, including maternal sensitivity, parent understanding, mother-child relationship quality, and child self-regulation. The proposed study seeks NIH funding to support the return of 214 mother-child dyads (85% of 252 total families) who participated in the original RCT. The majority of families (80%) belong to a minority race/ethnic group, 32% are Spanish-speaking, and all are considered low income. Families will complete two home-based visits between child’s age 5-6 and 7-8 years. These visits will entail assessments that parallel measures in the original study regarding parent-child behavioral and relationship outcomes but will also include health-focused assessments in domains known to predict long- term risk for disease, including cardiovascular health, metabolic health, and inflammation. Health indicators will be derived from data sources including anthropometric and blood pressure assessments, a dried blood spot collection, activity and sleep monitoring, and interviewer-administered questionnaires. Results will extend broadly to vulnerable families at disproportionate risk for poor cardiometabolic health.

项目概要： 人口心脏代谢健康状况恶化的趋势凸显了远离人群的迫切需要 从专注于下游心脏代谢危险因素修复的传统疾病模型转变为 重点关注相关上游风险敞口。相关的上游风险包括早期生活逆境（ELA）、 健康的社会决定因素的独特子集，发生在生命早期，并被假设在生物学上成为 嵌入，从而随着时间的推移塑造健康和疾病风险的生命历程轨迹。可靠的文献表明 ELA 暴露会带来心脏代谢疾病的潜在风险，尽管有希望，但很少有研究表明 研究了对 ELA 暴露儿童的早期干预是否可以降低这种风险。相关文献综述 一般认为 1) 早期干预更有效； 2）干预对家庭的好处最大 最需要帮助的； 3）养育是早期干预效益传递的机制；和 4) 现有的育儿干预措施在亲子行为和关系方面被认为是成功的 结果是与儿童身体健康结果相关的测试候选者。在此基础上， 拟议的研究代表了一个独特且时间敏感的机会，可以扩展现有随机对照试验的目标 实施了一项育儿干预措施——促进第一关系® (PFR) 与不采取干预措施 作为低收入产后妇女样本抑郁症治疗的辅助剂。目的 拟议的研究旨在确定 PFR 干预措施是否有益处，最初旨在影响家长 婴儿期儿童的行为和关系结果可能会影响儿童早期的心脏代谢健康 童年。据推测，PFR 干预将增强上游的弹性因素——养育 质量——在脆弱的早期阶段，可能有利于孩子的心脏代谢健康。预期的 假设干预对更远端儿童心脏代谢健康结果的影响部分是 可归因于更近端的干预相关目标的变化，包括产妇敏感性、父母 理解力、母子关系质量和孩子的自我调节能力。拟议的研究寻求 NIH 资助 支持参与最初 RCT 的 214 名母子夫妻（占 252 个家庭的 85%）返回。 大多数家庭 (80%) 属于少数种族/族裔群体，32% 讲西班牙语，而且全部都是 被认为是低收入。家庭将在孩子 5-6 岁和 7-8 岁之间完成两次家访。 这些访问将需要进行与原始研究中有关亲子行为的平行测量的评估 和关系结果，但还将包括已知可预测长期关系的领域中以健康为重点的评估 疾病的术语风险，包括心血管健康、代谢健康和炎症。健康指标将 来自数据源，包括人体测量和血压评估、干血点 收集、活动和睡眠监测以及访谈员管理的问卷。结果将延长 广泛针对心脏代谢健康状况不佳的弱势家庭。