Futuros Fuertes 2.0: A primary care-based intervention to prevent obesity in low-income Latino children

项目摘要 Futuros Fuertes 2.0：预防低收入拉丁裔儿童肥胖的基于初级护理的干预措施 相对于非西班牙裔白色儿童，拉丁裔儿童肥胖和肥胖后遗症的风险更高 孩子贫困也会增加肥胖风险。拉丁裔儿童肥胖的差异出现在早期 儿童时期;而增加肥胖风险的进食和久坐行为开始于生命的头两年。 因此，开发和测试干预措施以预防低收入拉丁美洲人的肥胖至关重要。 从婴儿期开始的儿童。初级保健为预防婴儿肥胖提供了理想的环境， 幼儿在出生后的头两年里经常被看望。促进文化和谐的非专业健康 教育工作者进入初级保健机构，为不同的低收入人群服务，是一种战略方法， 利用初级保健访问来促进健康行为。此外，使用短信是一个 扩大初级保健干预措施覆盖面和让家庭成员参与的有希望的战略 不亲自来探视的人。我们的团队开发了Futuros Fuertes 1.0并成功进行了试点测试 （强大的未来），一个文化定制的，以初级保健为基础的干预，以防止拉丁美洲婴儿肥胖， 幼儿Futuros Fuertes 1.0的试点试验发现对儿童健康行为和BMI z评分的影响， 为Futuros Fuertes 2.0做了大量的修改和改进。 父母/照顾者通过以下方式获得Futuros Fuertes 2.0干预内容：健康教育和 来自外行健康教育者的指导课程，每周两次短信，以及环境提示。文本 消息也被发送到多达2个额外的家庭成员。通过Futuros Fuertes 2.0，父母 指导他们的孩子和那些对他们的孩子健康的食物和饮料的反应喂养技术， 避免，屏幕时间指南和策略，以提高睡眠时间。我们的中心假设是， 针对低收入拉丁裔父母/照顾者的文化定制的、基于初级保健的干预措施， 在婴幼儿时期开展健康教育和辅导课程，并通过短信予以加强 多个家庭照顾者将导致2岁时BMI较低。在目标1中，我们将确定未来的影响 Fuertes 2.0对儿童的BMI和喂养，屏幕时间和睡眠。低收入拉丁裔婴儿- 将在北方的两个健康中心招募从出生到1个月的父母/照顾者二元组（n=576） 加州，随机分配至：Futuros Fuertes 2.0或对照干预。在目标2中，我们将评估调解人 干预效果的调节因子。在目标3中，我们将使用定性方法（半结构化访谈） 了解家长和提供者对Futuros Fuertes 2.0干预的体验。富埃尔特斯的未来 2.0该模型可以改善低收入拉丁裔儿童的喂养，屏幕时间和睡眠行为， 因此，有可能降低他们一生中患肥胖症和代谢并发症的风险。

PROJECT SUMMARY Futuros Fuertes 2.0: A primary care-based intervention to prevent obesity in low-income Latino children Latino children are at higher risk of obesity and obesity sequelae relative to non-Hispanic white children. Poverty also increases obesity risk. Disparities in obesity for Latino children emerge in early childhood; and feeding and sedentary behaviors that increase obesity risk begin in the first two years of life. Consequently, it is critical to develop and test interventions to prevent obesity among low-income Latino children beginning in infancy. Primary care provides an ideal setting for obesity prevention among infants and toddlers given frequent visits in the first two years of life. Incorporating culturally concordant lay health educators into primary care settings serving diverse, low-income populations is a strategic approach for leveraging primary care visits to promote healthy behaviors. Furthermore, the use of text messages is a promising strategy for extending the reach of primary care-based interventions and engaging family members who do not attend in-person visits. Our team developed and successfully pilot tested Futuros Fuertes 1.0 (Strong Futures), a culturally tailored, primary care-based intervention to prevent obesity in Latino infants and toddlers. A pilot trial of Futuros Fuertes 1.0 found impact on child health behaviors and BMI z-score and informed modifications and enhancements leading to Futuros Fuertes 2.0. Parents/caregivers receive Futuros Fuertes 2.0 intervention content through: health education and coaching sessions from a lay health educator, two text messages per week, and environmental prompts. Text messages are also sent to up to 2 additional family members. Through Futuros Fuertes 2.0, parents are coached on responsive feeding techniques, foods and beverages that are healthy for their child and those to avoid, screen time guidelines, and strategies to enhance sleep duration. Our central hypothesis is that a culturally tailored, primary care-based intervention for low-income Latino parents/caregivers delivered via health education and coaching sessions in the infant and toddler period and reinforced through text messages to multiple family caregivers will result in lower BMI at age 2. In Aim 1, we will determine the impact of Futuros Fuertes 2.0 on children’s BMI and on feeding, screen time and sleep. Low-income Latino infant- parent/caregiver dyads (n=576) will be recruited from birth to 1 month at two health centers in Northern California and randomized to: Futuros Fuertes 2.0 or a control intervention. In Aim 2, we will assess mediators and moderators of intervention effect. In Aim 3, we will use a qualitative approach (semi-structured interviews) to understand parent and provider experiences with the Futuros Fuertes 2.0 intervention. The Futuros Fuertes 2.0 model may improve feeding, screen time and sleep behaviors among low-income Latino children and therefore has the potential for lowering their lifetime risk of obesity and metabolic complications.