Addressing Poverty-Related Barriers to Prevent Obesity Beginning in Infancy

描述(由申请人提供)：母婴喂养方式，定义为母亲调节婴儿喂养的方法，是将贫困和儿童肥胖联系起来的一个关键的、可能会改变的中介因素。有证据表明，与贫穷有关的风险直接影响喂养方式，并对干预活动造成障碍。这表明，需要同时解决风险和障碍，以提高干预效果。儿科平台是解决这些风险和障碍的机会，因为它们有能力从婴儿期早期就开始接触有贫困风险的低收入家庭。候选人提出了为期五年的指导支持期，以获得制定战略以改善从婴儿期开始的贫困背景下预防肥胖症的专门知识。候选人是儿科学助理教授，长期目标是成为一名独立的临床研究调查员。将通过培训来自发展行为儿科学、应用发展心理学、营养科学和生物统计学、正规课程和其他职业发展活动领域的专家多学科导师来实现这一目标。她将在以下方面获得高级技能：1)将发展心理学的理论框架应用于以患者为导向的研究，解决与贫困有关的风险；2)评估母婴喂养互动的最新方法；3)通过重复测量进行复杂的纵向定量数据分析；4)定性研究方法，以确定与低收入家庭接触干预的障碍和促进者；5)干预措施的制定和评估；以及6)赠款的编写。这些目标的实际应用将通过三个研究目标来实现。在目标1中，格罗斯博士将对一项正在进行的关于早期肥胖预防干预的大型研究的纵向数据进行二次分析，以系统地描述贫困相关风险与母婴喂养方式之间的关系，以及这些喂养方式对卡路里摄入量和婴儿体重轨迹的影响程度。在目标2中，格罗斯博士将使用定性方法为解决与贫困有关的风险和障碍的战略的概念化和制定提供信息，这些战略可以纳入行为改变干预措施，并纳入以人口为基础的可扩展初级保健平台。在目标3中，格罗斯博士将对这些策略进行试点测试，以确定实施的可行性，并获得效果大小的初步估计。这项提议的成功执行将导致R01应用程序，以测试肥胖预防干预措施的有效性，该干预措施使用基于人口可扩展的初级保健平台来解决与贫困相关的风险和障碍，以增加响应性的母婴喂养方式，减少儿童早期肥胖。

DESCRIPTION (provided by applicant): Maternal-infant feeding style, defined as a mother's approach to regulating infant feeding, is a critical, potentially modifiable mediator linking povery and child obesity. Evidence has documented that poverty-related risks directly impact feeding styles and create barriers to intervention engagement. This suggests the need to address both risks and barriers to improve intervention impact. Pediatric platforms represent an opportunity to address these risks and barriers due to their ability to access low-income families with poverty-related risks beginning in early infancy. The candidate proposes a mentored support period of five years to acquire expertise in developing strategies to improve obesity prevention in the context of poverty beginning during infancy. The candidate is an Assistant Professor of Pediatrics with the long-term goal of becoming an independent clinical research investigator. This goal will be achieved through training from expert multidisciplinary mentors from the fields of developmental-behavioral pediatrics, applied developmental psychology, nutrition science and biostatistics, formal coursework and other career development activities. She will gain advanced skills in: 1) applying theoretical frameworks from developmental psychology to patient-oriented research addressing poverty-related risks; 2) state-of-the-art methodologies for assessing maternal-infant feeding interactions; 3) complex quantitative longitudinal data analysis with repeated measures; 4) qualitative research methodologies to identify barriers and facilitators of intervention engagement with low-income families; 5) intervention development and evaluation; and 6) grant writing. The practical application of these goals will be accomplished through three study aims. In Aim 1, Dr. Gross will conduct a secondary analysis of longitudinal data from a large ongoing study of an early obesity prevention intervention to systematically describe the relationships between poverty-related risks and maternal-infant feeding styles and the degree to which these styles impact caloric intake and infant weight trajectories. In Aim 2, Dr. Gross will use qualitative methodologies to inform the conceptualization and development of strategies to address poverty-related risks and barriers that can be incorporated into a behavior change intervention and integrated into a population-scalable primary care-based platform. In Aim 3, Dr. Gross will pilot test these strategies for feasibility of implementation and obtaining preliminary estimates of effect size. The successful execution of this proposal will lead to an R01 application to test the efficacy of an obesity prevention intervention that addresses poverty-related risks and barriers using a population-scalable primary care-based platform to increase responsive maternal-infant feeding styles and reduce early child obesity.