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.

项目总结: