Addressing Health Literacy and Numeracy to Prevent Childhood Obesity

描述（由申请人提供）：2003年，卫生局局长理查德·卡莫纳（Richard Carmona）表示，低健康素养是“我们国家超重和肥胖流行的最大原因之一”。最近的研究支持了这一说法，这些研究发现，卫生知识或计算能力低与护理人员母乳喂养知识较差、婴儿配方奶粉混合不正确、难以理解食品标签和份量以及成人和儿童的身体质量指数（BMI）较高有关。特别值得关注的是肥胖对我们最小的孩子的影响。超过26%的学龄前儿童现在超重（BMI指数为85%）或肥胖（BMI指数为95%）（基于2007年HHS/CDC专家小组的定义）。学龄前儿童的肥胖率在过去十年中翻了一番，其中低收入和少数族裔儿童的增幅最大，而这些社区也是受卫生知识普及程度低影响最严重的社区。迄今为止，预防或治疗儿童肥胖的临床努力效果有限。需要尽早开始努力，因为两岁前超重的儿童成为超重青少年的可能性是其他儿童的五倍，随后患肥胖相关并发症的风险更高，包括早发性2型糖尿病和心血管疾病。没有发表的临床研究严格地解决了2岁之前的肥胖预防问题，特别关注低读写能力和计算能力。提高幼儿期照顾者的健康素养是一项创新战略，旨在促进这些家庭的健康营养和活动，并在儿童一生中预防不健康的体重增加，通过预防儿童和成人慢性疾病，这将具有重大的公共卫生意义。该研究是一项多地点随机对照试验，旨在评估以低识字/计算能力为导向的干预措施的效果，该干预措施旨在促进健康的家庭生活方式和预防儿童早期肥胖。干预措施将通过资源不足社区初级保健机构的儿科住院医师提供。四所学术医疗中心将被随机分配：范德比尔特大学、迈阿密大学、北卡罗来纳大学教堂山分校和纽约大学。两个中心将接受干预，而另外两个中心将接受主动控制。在每个地点，将招募250名说英语或西班牙语的看护人-儿童二人组，并从孩子4-6个月的健康儿童访问到24个月的健康儿童访问进行跟踪。干预措施将包括为儿科住院医师提供面向家庭的低识字率工具包，并为儿科住院医师提供明确的健康沟通培训。在控制点，儿科住院医师将提供生活方式方面的“常规护理”，但他们也将接受伤害预防教育计划，作为注意力控制。主要的假设是，干预将改善家庭饮食和体育活动行为，并将降低24个月大的儿童超重率（体重指数为85%）。公共卫生相关性：2003年，外科医生Richard Carmona表示，低健康素养是“我们国家超重和肥胖流行的最大原因之一”。超过26%的学龄前儿童现在超重或肥胖，24个月时超重的儿童成为超重青少年的可能性是非超重儿童的5倍。本研究的目的是评估以低识字/算术为导向的干预措施的效果，该干预措施旨在教育儿科住院医师在资源不足的社区中促进健康的家庭生活方式并预防幼儿（0-2岁）及其家庭超重。

DESCRIPTION (provided by applicant): In 2003, Surgeon General Richard Carmona stated that low health literacy was "one of the largest contributors to our nation's epidemic of overweight and obesity." This assertion is supported by recent studies which have found that low health literacy or numeracy is associated with poorer caregiver breastfeeding knowledge, incorrect mixing of infant formula, difficulty understanding food labels and portion sizes, and higher Body Mass Index (BMI) in adults and children. Of particular concern is the impact of the obesity epidemic on our youngest children. Over 26 percent of preschool children are now overweight (BMI>85 percent) or obese (BMI>95 percent) (based on 2007 HHS/CDC Expert Panel definitions). Rates of obesity in preschool children have doubled over the past decade, with the highest increases among low income and minority children-- the same communities most affected by low health literacy. To date, clinical efforts to prevent or treat childhood obesity have had limited efficacy. Efforts need to start early, because children who are overweight by age two are five times as likely to become overweight adolescents, and subsequently at higher risk for obesity-related complications including early-onset Type-2 Diabetes and cardiovascular disease. No published clinical studies have rigorously addressed obesity prevention prior to age 2 with a specific low-literacy and numeracy focus. Addressing caregiver health literacy in early childhood is an innovative strategy to promote healthy nutrition and activity among these families and prevent unhealthy weight gain across the child's life, which would have great public health significance by preventing both child and adult chronic illness. The proposed study is a multi-site randomized, controlled trial to assess the efficacy of a low- literacy/numeracy-oriented intervention designed to promote healthy family lifestyles and to prevent early childhood obesity. The intervention will be delivered through pediatric resident physicians in primary care settings in under-resourced communities. Four academic medical centers will be randomized: Vanderbilt University, the University of Miami, the University of North Carolina at Chapel Hill, and New York University. Two centers will receive the intervention, while the other two centers will receive an active control. At each site, a cohort of 250 English- or Spanish-speaking caregiver-child dyads will be enrolled and followed from the child's 4-6 month well-child visit through the 24-month well-child visit. The intervention will include a low- literacy-oriented toolkit for pediatric residents to use with families and clear health communication training for the pediatric residents. At control sites, pediatric residents will provide "usual care" with respect to lifestyle counseling, but they will also receive an injury-prevention education program to act as an attention control. The primary hypotheses are that the intervention will improve family dietary and physical activity behaviors and that it will reduce the rate of childhood overweight (BMI > 85 percent) at age 24 months. PUBLIC HEALTH RELEVANCE: In 2003, Surgeon General Richard Carmona suggested that low health literacy is "one of the largest contributors to our nation's epidemic of overweight and obesity." Over 26 percent of preschool children are now overweight or obese, and children who are overweight by age 24 months are five times as likely as non- overweight children to become overweight adolescents. The aim of the study is to assess the efficacy of a low- literacy/numeracy-oriented intervention aimed at teaching pediatric resident physicians to promote healthy family lifestyles and prevent overweight among young children (age 0-2) and their families in under-resourced communities.