Value and mechanisms of home visitation in obesity interventions for low-income children

家访在低收入儿童肥胖干预中的价值及机制

• 批准号: 9204202
• 负责人: Bradley M. Appelhans
• 金额: $ 71.05万
• 依托单位: RUSH UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-02-01 至 2022-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9204202
• 关键词: Academic Medical Centers; Accountability; Accounting; Address; Adult; Affect; Age; Behavior Therapy; Beverages; Body Weight decreased; Body mass index; Calories; Caregivers; Caring; Characteristics; Child; Childhood; Chronic Disease; Communities; Control Groups; Costs and Benefits; Data; Eating; Eating Behavior; Environment; Equipment; Family; Food; Future; Goals; Health Services Accessibility; Health education; Healthcare; Home environment; Home visitation; Household; Income; Insurance Carriers; Intervention; Learning; Location; Longevity; Low Income Population; Low income; Mediating; Medical; Medical center; Modality; Monitor; Obesity; Outcome; Overweight; Persons; Physical activity; Positioning Attribute; Price; Provider; Public Health; Randomized; Randomized Controlled Trials; Recommendation; Research; Resources; Risk; Risk Factors; Schedule; Schools; Sleep; Sports; Testing; Third-Party Payer; Transportation; Treatment outcome; Universities; Waiting Lists; arm; base; cost; cost effectiveness; design; dosage; improved; individualized medicine; lower income families; next generation; obesity in children; obesity risk; obesity treatment; programs; randomized trial; sex; skills; staff intervention; treatment effect; tv watching; virtual

PROJECT SUMMARY/ABSTRACT Children from low-income families are more than twice as likely to become obese than those from higher- income households, which places them at increased risk for obesity-related chronic diseases throughout their adult lives. Family-based pediatric obesity interventions, particularly those designed for low-income populations, are increasingly delivered in children’s homes. Home visitation has a number of potential advantages that could enhance weight loss outcomes relative to delivering treatment in traditional medical and academic settings. By eliminating the need for transportation and childcare, home visitation may make treatment more accessible for low-income families, resulting in a higher dosage of intervention received. Home visitation allows intervention staff to directly observe and address risk factors in the home environment, potentially enabling them to provide more tailored and potent treatment recommendations. Caregivers may also be more likely to apply healthy changes in their household when they learn and rehearse new skills in the environment where they are to be implemented. Research to date has consistently found that home-based interventions are more effective than low-intensity comparison conditions such as wait-list controls, health education, and usual medical care. Yet, as the home visitation treatment modality has been confounded with intervention dosage, intensity, and content in prior studies, there is a lack of empirical evidence to support its use. The goal of this project is to systematically evaluate the incremental weight loss benefit and cost- effectiveness of delivering standard family-based treatment for pediatric overweight/obesity in the home setting vs. traditional medical settings. In a randomized controlled trial involving low-income households, 266 children ages 6-11 years will be allocated to 12 months of family-based treatment delivered either in their home or at an urban academic medical center. Both arms will receive the same intervention content and dosage, and differ only in the location of in-person treatment sessions. Aim 1 is to test the hypothesis that home-based treatment produces a greater reduction in child adiposity, reflected in 12-month change in BMI z-score. Aim 2 is to compare the cost-effectiveness of home-based treatment to medical center-based treatment, and calculate the added cost of the incremental weight loss benefit associated with home visitation. These data will inform efforts to disseminate home-based interventions for low-income populations by public health agencies and third-party payers. Aim 3 is to explore specific mechanisms through which home visitation may improve weight loss outcomes. The results of this trial will have a strong impact on the design of future pediatric overweight/obesity interventions, as virtually any program could be adapted for delivery in the home setting.

项目概要/摘要 低收入家庭的儿童肥胖的可能性是高收入家庭的儿童的两倍多 收入家庭，这使他们在一生中患肥胖相关慢性病的风险增加 成人生活。以家庭为基础的儿童肥胖干预措施，特别是针对低收入人群的干预措施 越来越多的人在儿童之家分娩。家访有很多潜力 相对于传统医学治疗而言，可以增强减肥效果的优势 学术设置。通过消除交通和儿童保育的需要，家访可以使 低收入家庭更容易获得治疗，从而获得更高剂量的干预措施。家 探视使干预人员能够直接观察和解决家庭环境中的风险因素， 可能使他们能够提供更有针对性和更有效的治疗建议。照顾者可能会 当他们学习和练习新技能时，他们也更有可能在家庭中进行健康的改变。 实施这些措施的环境。迄今为止的研究一致发现，以家庭为基础的 干预措施比低强度比较条件（例如等候名单控制、健康状况）更有效 教育和常规医疗保健。然而，由于家访治疗方式与 既往研究中干预剂量、强度和内容缺乏经验证据支持其 使用。该项目的目标是系统地评估增量减肥效益和成本 在家庭环境中为儿童超重/肥胖提供标准家庭治疗的有效性 与传统医疗环境相比。在一项涉及低收入家庭的随机对照试验中，266 名儿童 6-11 岁的儿童将被分配到 12 个月的家庭治疗，在家中或在诊所进行 城市学术医疗中心。双臂将接受相同的干预内容和剂量，并且不同 仅在现场治疗地点进行。目标 1 是检验家庭治疗的假设 可以更大程度地减少儿童肥胖，这反映在 BMI z 分数的 12 个月变化中。目标 2 是 比较家庭治疗与医疗中心治疗的成本效益，并计算 与家访相关的增量减肥效益的额外成本。这些数据将为努力提供信息 传播公共卫生机构和第三方针对低收入人群的家庭干预措施 付款人。目标 3 是探索家访可以改善减肥的具体机制 结果。该试验的结果将对未来儿科超重/肥胖的设计产生重大影响 干预措施，因为几乎任何计划都可以调整为在家庭环境中实施。