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

项目总结： 不断恶化的人口水平的心脏代谢性健康趋势突显了远离 从传统的疾病模型侧重于下游心脏代谢危险因素的补救改为 关注相关的上游风险敞口。相关的上游暴露包括早期生活逆境(ELA)， 健康的独特社会决定因素的子集，发生在生命早期，并被假设成为生物学上的 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。一部强有力的文献表明 ELA暴露会增加心脏代谢性疾病的潜在风险，然而几乎没有研究--尽管很有希望-- 研究了对暴露于ELA的儿童进行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)越早干预越有效；2)干预对家庭的益处最大 最有需要的人；3)养育子女是一种机制，通过这种机制可以传递早期干预的好处；以及4) 在亲子行为和关系方面被认为是成功的现有育儿干预措施 结果，是与儿童身体健康结果相关的测试候选对象。在此基础上， 拟议的研究是一个独特和对时间敏感的机会，可以扩大现有区域工作队在#年的目标 实施了哪一项育儿干预-促进第一关系®(PFR)与不干预 作为低收入产后妇女抑郁症治疗的辅助剂。该计划的目的是 拟议的研究是为了确定PFR干预的好处，最初旨在影响父母- 儿童在婴儿期的行为和关系结果可能会在早期延伸到儿童的心脏代谢健康 童年。假设PFR干预将增强上游的弹性因素--育儿 质量--在脆弱的早期，可能有益于儿童的心脏代谢健康。预期 对更远端儿童心脏代谢健康结局的干预效果被假设为部分 可归因于较近干预相关目标的变化，包括母亲敏感性、父母 理解、母子关系质量、儿童自我调节。拟议的研究寻求美国国立卫生研究院的资助 支持214个母子二人组(占252个家庭总数的85%)返回参加最初的随机抽样。 大多数家庭(80%)属于少数族裔，32%的家庭说西班牙语，所有家庭都是 被认为是低收入。家庭将在孩子5-6岁和7-8岁之间完成两次基于家庭的访问。 这些访问将需要评估最初研究中关于亲子行为的平行措施 和关系结果，但也将包括以健康为重点的评估，在已知的领域预测长期- 疾病的长期风险，包括心血管健康、代谢健康和炎症。健康指标将 来自数据来源，包括人体测量和血压评估，干燥的血迹 收集、活动和睡眠监测，以及面试者管理的问卷。结果将会扩大 广泛适用于心脏代谢健康状况不佳的风险极大的脆弱家庭。

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.