Adaptation of an Evidence-based Family Program for Obesity Prevention in Health Care Context: Testing Outcomes and Mechanisms with First-time Military Parents and their Infants

项目总结 这项拟议的研究将测试以家庭为重点的预防性干预在改善 军人家庭首次为人父母的健康生活方式与降低其肥胖风险 婴儿。干预的最终目标是减少婴儿体重的快速增加，这是 未来的肥胖风险，以及新妈妈产后体重保留，是代际肥胖的一个因素 肥胖传播。在三个试验中，家庭基金会(FF)计划--由一系列 在出生前和出生后的医疗保健环境中提供的课程-展示了强大的、可复制的、 对家庭关系(共同育儿、育儿、家庭暴力)和对父母和 儿童在出生后至少7年内会出现内化和外化问题。理论上的“活跃” 通过对项目影响的中介分析，验证了FF的要素是支持开发 凝聚力强、支持性强的合作关系。在拟议的研究中，我们将测试改编版本的 基金会(称为“基金会+”)，拓宽了合作的途径，以帮助父母的合作和支持 其他在建立和维持健康的家庭生活方式和具体的健康促进方面 育儿策略。我们建议在军人家庭中测试FF+，这些家庭在 与他们的文职对应人员相似的水平。招聘和干预将在年内进行 三家军队卫生系统医院的产科诊所。招聘、干预交付、数据 军事背景将为收集和后续行动提供便利。 目的1.在一项随机试验中评估改良的FF+方案的疗效。250个家庭将成为 随机设置为FF+或对照状态。数据将在测试前的家访中收集 怀孕、产后6个月的测试和产后12个月的随访，以及其他数据 从电子健康记录中获取。目的2.测试中介途径。目标3.评估是否 家长基准特征、计划交付保真度或参与者参与度适中计划 对结果的影响。

PROJECT SUMMARY The proposed study will test the efficacy of a family-focused preventive intervention in improving healthy lifestyles among first-time parents in military families and reducing obesity risk among their infants. The ultimate goals of the intervention are to reduce rapid infant weight gain, an early indicator of future obesity risk, and new mothers’ postpartum weight retention, a contributor to intergenerational obesity transmission. In three trials, the Family Foundations (FF) program—consisting of a series of classes delivered in a health care context before and after birth—has demonstrated robust, replicated, long-term impact on family relationships (coparenting, parenting, family violence) and on parent and child internalizing and externalizing problems through at least 7 years after birth. The theoretical “active ingredient” of FF, validated by mediation analysis of program impact, is support for the development of a cohesive, supportive coparenting relationship. In the proposed study, we will test an adapted version of FF (termed “FF+”) that broadens the coparenting approach to help parents’ cooperate and support each other in establishing and maintaining healthy family lifestyle behaviors and specific health-promoting parenting strategies. We propose to test FF+ in military families, who experience overweight/obesity at levels similar to their civilian counterparts. Recruitment and intervention will be conducted within obstetric clinics in three Military Health System hospitals. Recruitment, intervention delivery, data collection, and follow-up will be facilitated by the military context. Aim 1. To assess the efficacy of the adapted FF+ program in a randomized trial. 250 families will be randomized to FF+ or control conditions. Data will be collected in home visits at pre-test during pregnancy, post-test at 6 months postpartum, and follow-up at 12 months postpartum, with additional data obtained from electronic health records. Aim 2. To test mediation pathways. Aim 3. To assess whether baseline parent characteristics, program delivery fidelity, or participant engagement moderate program effects on outcomes.