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

项目总结 Futuros Fuertes 2.0：预防低收入拉丁裔儿童肥胖的初级保健干预 与非西班牙裔白人相比，拉美裔儿童患肥胖症和肥胖后遗症的风险更高 孩子们。贫困也会增加肥胖风险。拉美裔儿童肥胖的差异在早期出现 儿童时期，进食和久坐增加肥胖风险的行为在生命的头两年就开始了。 因此，制定和测试预防低收入拉丁裔肥胖的干预措施至关重要。 从婴儿期开始的儿童。初级保健为预防婴儿和儿童肥胖提供理想的环境 蹒跚学步的孩子在出生后的头两年经常被看望。融入文化和谐的家庭健康 教育工作者进入初级保健环境，为不同的低收入人群服务是一种战略性的方法 利用初级保健访问促进健康行为。此外，使用文本消息是一种 扩大以初级保健为基础的干预措施的范围和吸引家庭成员参与的有希望的战略 不参加面对面探访的人。我们的团队开发并成功试运行了Futuros Fuertes 1.0 (Strong Futures)，这是一种根据文化定制的、以初级保健为基础的干预措施，旨在预防拉丁裔婴儿和 蹒跚学步的孩子Futuros Fuertes 1.0的试点试验发现，它对儿童健康行为和BMI z得分以及 明智的修改和增强导致了Futuros Fuertes 2.0。 家长/照顾者通过以下方式接受Futuros Fuertes 2.0干预内容：健康教育和 来自非专业健康教育者的辅导课程，每周两条短信，以及环境提示。文本 信息还可以发送给多达两个额外的家庭成员。通过Futuros Fuertes 2.0，家长们 对孩子和孩子健康的喂养技巧、食物和饮料进行培训 避免，屏幕时间指南，以及提高睡眠持续时间的策略。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、基于初级保健的干预措施通过 婴幼儿时期的健康教育和辅导课程，并通过短信加强 在目标1中，我们将确定Futuros的影响 Fuertes 2.0关于儿童BMI以及关于进食、屏幕时间和睡眠的研究。低收入的拉丁裔婴儿- 父母/照顾者双亲(n=576)将在北方的两个健康中心从出生到1个月招募 加利福尼亚州随机分为：Futuros Fuertes 2.0或对照干预。在目标2中，我们将评估调解员 干预效果的调节因子。在目标3中，我们将使用定性方法(半结构化面试) 了解家长和提供者对Futuros Fuertes 2.0干预的体验。未来的富尔特斯 2.0模式可改善低收入拉丁裔儿童的进食、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.