Food for LifecOURse equity In maternal Security and Health

孕产妇安全与健康中的食品促进生命全程公平

• 批准号: 10748848
• 负责人: Emily Jean Jones
• 金额: $ 49.7万
• 依托单位: UNIVERSITY OF OKLAHOMA HLTH SCIENCES CTR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-17 至 2030-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10748848
• 关键词: Acculturation; Address; Affect; Alaska Native; American Indians; Behavior; Behavioral; Biological; Biological Markers; Birth; Child; Childbirth; Chronic; Collaborations; Communities; Community Health; Community Healthcare; Data; Decision Making; Diabetes Mellitus; Diagnosis; Diet; Dietary intake; Discrimination; Disparity; Educational Curriculum; Ensure; Equation; Equity; Evaluation; Excision; Family; Feedback; Female of child bearing age; Focus Groups; Food; Gestational Diabetes; Glycosylated hemoglobin A; Group Interviews; Health; Health Food; Health Personnel; Healthcare; High Prevalence; High-Risk Pregnancy; Home; Homicide; Household; Hypertension; Immune; Indigenous; Inflammation; Influentials; Intervention; Interview; Involuntary Sterilization; Kansas; Lactation consultant; Life Cycle Stages; Link; Live Birth; Managed Care; Maternal Health; Maternal Health Services; Maternal health equity; Measures; Medicine; Midwife; Modeling; Morbidity - disease rate; Mothers; Native Americans; Needs Assessment; Nutrient; Nutrition Assessment; Nutritional; Obesity; Observational Study; Oklahoma; Outcome; Participant; Pathway interactions; Pattern; Perinatal; Personal Satisfaction; Physical activity; Population; Postpartum Depression; Postpartum Period; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Premature Birth; Prenatal care; Prevalence; Prevention; Provider; Randomized; Recording of previous events; Reporting; Research; Research Design; Risk; Risk Behaviors; Risk Factors; Security; Self Care; Self-Injurious Behavior; Series; Sleep; Social support; Source; Stress; Stressful Event; Suicide; Support System; Surveys; Testing; Texas; Trauma; Tribes; Victimization; Violence; Well in self; Woman; adverse childhood events; cardiometabolic risk; cardiometabolism; care giving burden; care providers; comorbidity; comparison group; cultural health; design; dietary; dietary manipulation; experience; follow-up; food insecurity; food security; gender-based violence; gestational weight gain; group intervention; health care availability; health care service utilization; health inequalities; high risk; indigenous community; intergenerational; intimate partner violence; maternal morbidity; maternal safety; maternal stress; maternal wellbeing; motherhood; nutrition; parous; perceived stress; pregnancy disorder; pregnant; prepregnancy; primary outcome; recruit; resilience; rural area; secondary outcome; severe maternal morbidity; social; social health determinants; stress management; stress reduction; structural determinants; substance use; theories; tribal community; tribal health; whole health

Project Summary / Abstract The Food for LifecOURse equity In maternal Security and Health (FLOURISH) Study uses a cross-cutting research design that is widely-applicable to the prevention and treatment of many chronic co-morbidities that disproportionately affect Indigenous women of childbearing age. Through intentional engagement with community stakeholders across all project years, diverse perspectives will be integrated into the research strategy and aims to ensure study findings are relevant, actionable, and yield the greatest potential for reducing health inequities. Broadly, FLOURISH will elucidate nutritional and non-nutritional behavioral risk pathways linking food insecurity to severe maternal morbidity (SMM) and related outcomes among Indigenous women during pregnancy and the immediate post-partum period. A primary focus will be the impact of trauma on food insecurity and health risk, as well as the rigorous evaluation and manipulation of dietary intake as an influential pathway, with a special focus on dietary quality, chronic inflammation and dysglycemia. The study will be conducted in Oklahoma, which is home to 39 of the federally-recognized Tribes that comprise the Southern Plains region, in collaborative partnership with the Southern Plains Tribal Health Board. It is comprised of three aims. First, the team will test and refine a conceptual integrated framework of food insecurity and SMM to identify significant structural, social, behavioral, and biological pathways as candidate intervention points. This aim will be accomplished through an observational study (n=350) of pregnant Indigenous women followed to 3-months postpartum. Structural equation modeling will be used to test the study’s overall conceptual multi-level framework of food insecurity and SMM. The final model will be refined through input with community stakeholders. Second, the community-academic research team will develop the FLOURISH intervention, to be adapted from perinatal food is medicine models used in non-Indigenous populations, with an emphasis on whole person health, including stress management and self-care. The FLOURISH intervention will strategically address key nutrition disparities and other health risk behaviors identified as significant path contributors to various drivers of SMM in this specific population. This adaptation will be informed by findings from the first aim, and further refined and finalized through a series of interviews groups with primiparous and multiparous Indigenous women with history of SMM and various community care providers for this population (n=36). A series of focus groups with intended users will solicit final feedback before the intervention is launched. Third, the research team will use a randomized parallel group design (n=150) involving an additional external control comparison group to test the FLOURISH and FLOURISH PLUS (including community healthcare workers) interventions to assess for feasibility, acceptability, and preliminary impact. Participants will be stratified by pre-pregnancy cardiometabolic risk (high versus low). Primary outcomes include excess gestational weight gain with multiple secondary outcomes (prenatal care, post-partum depression, stress, food security, dietary quality, inflammation, and hemoglobin A1c).

项目摘要/摘要 《以食物换取生命过程中的孕产妇安全与健康公平》(FORMISH)研究使用了一项交叉研究 广泛适用于预防和治疗许多慢性并存疾病的研究设计 对土著育龄妇女的影响不成比例。通过故意与 社区利益相关者在所有项目年，不同的视角将被整合到研究中 战略，旨在确保研究结果是相关的、可操作的，并产生最大的减少 健康不平等。从广义上讲，弗洛里什将阐明营养和非营养行为风险途径。 将粮食不安全与土著妇女的严重孕产妇发病率及相关后果联系起来 在怀孕期间和产后即刻。主要的焦点将是创伤对食物的影响 不安全和健康风险，以及对饮食摄入量的严格评估和操纵，作为一个有影响力的 途径，特别关注饮食质量、慢性炎症和血糖紊乱。这项研究将是 在俄克拉何马州进行，该州是39个联邦承认的部落的所在地，这些部落组成了南部 平原地区，与南方平原部落健康委员会合作。它由三个部分组成 目标。首先，该小组将测试和完善粮食不安全和SMM的概念性综合框架，以确定 重要的结构、社会、行为和生物途径作为候选干预点。这一目标将 通过对怀孕3个月的土著孕妇进行观察性研究(n=350)来完成 产后。将使用结构方程建模来检验研究的总体概念多层次框架 粮食不安全和SMM。最终的模型将通过与社区利益攸关方的投入进行改进。第二, 社区-学术研究团队将开发适合围产期的Flomish干预措施 食物是非土著人口使用的药物模式，强调整体健康， 包括压力管理和自我照顾。蓬勃发展的干预将从战略上解决关键营养问题 差异和其他健康风险行为被确定为SMM各种驱动因素的重要路径贡献者 这一特定人群。这一适应将以第一个目标的调查结果为依据，并进一步完善和 通过一系列访谈小组对初产和经产的有历史的土著妇女进行最后敲定 为这一人群提供SMM和各种社区护理服务(n=36)。一系列具有目标的焦点小组 在启动干预之前，用户将征求最终反馈。第三，研究小组将使用随机的 平行分组设计(n=150)，包括额外的外部对照对照组以测试繁荣性 以及加强(包括社区医护人员)干预，以评估可行性， 可接受性和初步影响。参与者将按孕前心脏代谢风险(高风险)分层 与低)。主要结局包括妊娠体重超标，并伴有多个次要结局 (产前护理、产后抑郁症、压力、食品安全、饮食质量、炎症和血红蛋白A1c)。