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).

项目总结/摘要 “粮食换生命-孕产妇安全和健康公平”研究采用了一种跨领域的方法， 广泛适用于预防和治疗许多慢性合并症的研究设计， 对土著育龄妇女的影响尤为严重。通过有意参与， 社区利益相关者在所有项目年，不同的观点将被纳入研究 战略和目标，以确保研究结果是相关的，可操作的，并产生最大的潜力，减少 卫生不平等。从广义上讲，FLOURISH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严重孕产妇发病率及相关结果联系起来 在怀孕期间和产后期间。一个主要的焦点将是创伤对食物的影响 不安全和健康风险，以及严格评估和控制饮食摄入量作为一个有影响的 途径，特别关注饮食质量，慢性炎症和失调。本研究将 在俄克拉荷马州进行，这是家庭对39个联邦承认的部落，构成南部 平原地区，与南部平原部落卫生委员会合作。它由三个 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， 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 通过对土著孕妇进行观察性研究（n=350），随访3个月， 产后结构方程模型将用于测试研究的整体概念多层次框架 粮食不安全和SMM。最终模型将通过社区利益攸关方的投入进行完善。第二、 社区学术研究小组将开发FLOURISH干预措施，以适应围产期 在非土著人口中使用的食物即药物模式，重点是整个人的健康， 包括压力管理和自我照顾。FLOURISH干预措施将从战略上解决关键的营养问题 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。这一调整将以第一个目标的结果为依据，并进一步加以完善， 通过一系列与有历史的经产和多产土著妇女的访谈小组， SMM和各种社区护理提供者为这一人群（n=36）。一系列焦点小组， 用户将在启动干预措施之前征求最后反馈意见。第三，研究小组将使用随机 平行组设计（n=150），包括额外的外部对照比较组，以测试FLOURISH 和FLOURISH PLUS（包括社区卫生保健工作者）干预措施，以评估可行性， 可接受性和初步影响。受试者将按孕前心脏代谢风险（高风险）分层 相对于低）。主要结局包括妊娠期体重过度增加，以及多个次要结局 （产前护理、产后抑郁、压力、食品安全、饮食质量、炎症和血红蛋白A1 c）。