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

项目摘要 这项拟议的研究将测试以家庭为中心的预防性干预措施在改善儿童健康方面的有效性。 健康的生活方式在军人家庭的第一次父母和减少肥胖的风险， 婴儿。干预的最终目标是减少婴儿体重的快速增加，这是婴儿肥胖的早期指标。 未来的肥胖风险，以及新妈妈产后体重的保持，这是代际差异的一个因素。 肥胖症传播。在三个试验中，家庭基金会（FF）计划-由一系列 在出生前后的卫生保健环境中提供的课程已经证明是强大的，可复制的， 对家庭关系（共同养育子女、养育子女、家庭暴力）以及对父母和 儿童内在和外在的问题，通过至少7年后出生。理论上的“积极 通过对项目影响的中介分析，验证了FF的“成分”是开发 有凝聚力的相互支持的共同养育关系在拟议的研究中，我们将测试一个改编版本的 FF（称为“FF+”），扩大了共同育儿的方法，以帮助父母的合作和支持， 其他在建立和保持健康的家庭生活方式行为和具体的健康促进 育儿策略我们建议在军人家庭中测试FF+，这些家庭在2008年经历超重/肥胖， 水平与民用类似。招募和干预将在 三家军事卫生系统医院的产科诊所。招募、提供干预措施、数据 收集和后续行动将由军事背景提供便利。 目标1.在一项随机试验中评估适应性FF+程序的有效性。250个家庭 随机分配至FF+或对照条件。将在试验前的家庭访视中收集数据， 妊娠、产后6个月后检测和产后12个月随访，以及其他数据 从电子健康记录中获取。目标2.测试调解途径。目标3。评估是否 基线家长特征、项目交付忠诚度或参与者参与度 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.