Healthy Child Weight Through Improved Parent Practices and Environmental Change

描述(由研究人员提供)：3-7岁之间的早期被描述为肥胖发展的关键时期。专家们一直强调家庭对幼儿饮食和身体活动行为发展的重要性，但到目前为止，还没有制定出以家庭为重点并强调改善育儿实践的肥胖预防干预措施。这里提出的工作将通过测试以家长为中心的12个月干预的有效性来解决这一差距，该干预旨在改变儿童家庭环境的多个方面(包括社会和身体)，这反过来将降低儿童的体脂百分比(%BF)。受试者将是280对通过托儿机构招募的父母和孩子，这些托儿机构为低收入家庭提供服务。在基线措施之后，配对将被随机分为干预或对照。干预将首先侧重于教授更有效的育儿技能(时间管理、沟通等)；然后展示具体的育儿实践如何影响孩子的身体和社会环境，并鼓励更健康的行为。干预将通过小组会议和家庭电话(小组聊天和量身定做的电话)提供，由认证的家长教育人员提供便利。小组会议将使用多种教学策略，如“Parentela Novilas”(类似肥皂剧的视频，提供技能练习的模型)。课程还将提供单独的儿童活动，这些活动建立在强迫假设的基础上，并为儿童接受新的育儿实践做好准备。小组电话聊天将在父母中建立同龄人的支持，定制的咨询电话将使用励志访谈技术来帮助父母克服实施新行为的障碍。该干预是由Darling和Steinberg的一体化育儿模式(1993)指导的，该模式强调了育儿价值观、育儿风格和育儿实践在儿童社会化中的重要性。此外，自我决定理论(Ryan，2000)被用来创建一个项目，该项目旨在培养父母采用新的育儿方式和做法的自主动机。其结果是一种干预措施，将帮助父母学习技能，以减少与育儿相关的压力，并创造一个支持健康体重行为发展的家庭环境。主要结果，儿童的BF%，将使用人体测量和有效的预测方程进行评估(Denzenberg，1999)。分析将包括结果的基线测量作为协变量。次要措施包括儿童和母亲的饮食和体力活动、育儿方式和做法、育儿压力和家庭环境。干预效果的维持将在12个月的不干预期间后进行评估。这种干预将产生必要的高强度暴露，从而改变父母和孩子的生活行为，从而减少体内脂肪。计划是基于广泛的形成工作，研究将由一组非常有经验的调查人员领导。 与公共健康相关：需要努力确保幼儿养成健康的饮食和身体活动行为，以实现健康的体重发育。父母的行为同时影响社会和物质的家庭环境，创造了这些行为发展的背景。几乎没有预防肥胖症的计划，使用以家庭为中心的方法的人仍然很少。这款应用描述了一种创新的、理论驱动的干预措施，旨在帮助父母实施更有效的育儿行为，减少与育儿相关的压力，同时还创造一个支持学龄前儿童健康体重实践发展的家庭环境。

DESCRIPTION (provided by investigator): The early years between ages 3 -7 have been described as a critical period in the development of obesity. The importance of the family on the development of eating and physical activity behaviors in young children has been emphasized by experts, yet to date no obesity prevention interventions incorporating a strong family focus with emphasis on improved parenting practices have been developed. The work proposed here will address this gap by testing the efficacy of a 12-mo parent-focused intervention designed to change multiple aspects of children's home environments (both social and physical), which in turn will reduced percent body fat (%BF) in children. Subjects will be 280 parent-child pairs recruited through child care settings that cater to lower income families. Following baseline measures, pairs will be randomized into intervention or control. The intervention will first focus on teaching more effective parenting skills (time management, communication, etc.); then showing how specific parenting practices can influence a child's physical and social environment and encourage healthier behaviors. The intervention will be delivered through group sessions and home-based telephone calls (group chats and tailored calls) facilitated by a certified parent educator. Group sessions will use multiple teaching strategies such as "Parentela Novellas" (soap opera-like videos which provides models for skills practice). Sessions will also provide separate child activities that build off the coercion hypothesis and prepare children to receive new parenting practices. Group phone chats will build peer support among parents and tailored counseling calls will use motivational interviewing techniques to help parents overcome barriers to implementing new behaviors. The intervention is guided by Darling and Steinberg's Integrative Model of parenting (1993) which highlights the importance of parenting values, style and practices in child socialization. In addition, Self-Determination Theory (Ryan, 2000) is used to create a program that fosters parents' autonomous motivation to adopt new parenting style and practices. The result is a intervention that will help parents learn skills to reduce their parenting-related stress and create a home environment that supports the development of healthy-weight behaviors. The primary outcome, %BF in children, will be assessed using anthropometry and a validated prediction equation (Denzenberg, 1999). Analyses will include baseline measurements of the outcome as a covariate. Secondary measures include child and mother diet and physical activity, parenting style and practices, parenting stress, and home environment. Maintenance of intervention effect will be assessed following a 12-mo no-intervention period. This intervention will create the intensive exposure necessary to make life-altering changes in parent and child behavior that will result in reduced body fat. Plans are based on extensive formative work, and the research will be lead by a group of very experienced investigators. PUBLIC HEALTH RELEVANCE: Efforts are needed to assure that young children develop healthy eating and physical activity behaviors for healthy weight development. Parent behavior affects both the social and physical home environment, creating the context within which these behaviors develop. Few programs exist to prevent obesity and fewer still have used a family-focused approach. This application describes an innovative, theory-driven intervention designed to help parents implement more effective parenting behaviors and reduce their parenting-related stress, while also creating a home environment that supports the development of healthy weight practices in their preschool children.