Pathways to Integrate Maternal-Child Health and Nutrition Interventions to Transform Equity and Human Potential

整合母婴健康和营养干预措施以转变公平和人类潜力的途径

• 批准号: 10912278
• 负责人: Gabriela Buccini
• 金额: $ 15.86万
• 依托单位: UNIVERSITY OF NEVADA LAS VEGAS
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-23 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10912278
• 关键词: Address; COVID-19; COVID-19 pandemic; Caring; Child; Child Mortality; Child Nutrition; Childhood; Collaborations; Color; Communities; Conceptions; Development; Dietary Intervention; Education; Employment; Equity; Ethnic Origin; Family; Food; Generations; Goals; Grant; Health; Household; Housing; Human; Hybrids; Inequity; Intervention; Investments; Life; Life Cycle Stages; Link; Low income; Maternal Mortality; Maternal and Child Health; Methods; Neighborhoods; Nevada; Outcome; Pathway interactions; Perinatal; Persons; Phase; Poverty; Race; Racial Equity; Recovery; Research; Resources; Social Justice; Solid; Structural Racism; System; care coordination; care systems; child services; design; effectiveness outcome; ethnic disparity; food insecurity; food security; implementation evaluation; implementation outcomes; implementation science; implementation strategy; implementation study; marginalization; marginalized community; nutrition; prenatal; response; screening; social health determinants; social interventions; socioeconomics

Admin Supplement Grant Number: 8 U01 HD115256-02, (previous FAIN: U01OD033239) Abstract Summary Strengthening maternal and child health and nutrition is critical to achieving the Healthy People 2030 Goals. Investing in integrated nurturing care interventions from preconception through childhood defines one’s developmental trajectory with benefits that accumulate across the life course and promote social justice (i.e., taking equity one step further by fixing the systems for generations to come). The COVID-19 pandemic has disrupted essential nurturing care services such as prenatal, perinatal, and pediatric services. As a result, over a million preventable child and maternal deaths are projected to occur due to extreme poverty and household food insecurity (HFI; lack of consistent access to enough healthful food for an active, healthy life due to limited financial resources). Amid COVID-19, HFI in the US tripled among households with children (~19.5%), disproportionately burdening marginalized low-income and families of color. HFI is strongly linked with racial/ethnic inequities and adverse maternal-child health and nutrition outcomes. Integrating effective food security interventions within nurturing care services as a COVID-19 response & recovery effort is an achievable strategy to promote equity. The West Las Vegas Promise Neighborhood (WLVPN) is an intervention addressing social determinants of health to reduce structural racism in historically racial/ethnic marginalized communities in Las Vegas, Nevada. The WLVPN is implemented by over 50 multi-sector partners in key life domains (health, education, employment, housing, and social justice) coordinated by Nevada Partners, Inc., with whom we have a solid collaboration. While WLVPN social intervention is a unique opportunity and platform to address endemic inequities in maternal-child mortality and food insecurity levels, it lacks focus on maternal-child health and nutrition. Therefore, our partnership with Nevada Partners, Inc. is well-placed for promoting the maternal-child component within WLVPN and advancing implementation and equity research. This implementation science project is utilizing a community-based participatory approach along with a racial equity framework to co-create WITH the community the Early Responsive Nurturing Care for Food Security (EARN-FS) intervention to integrate maternal-child health and nutrition. The EARN-FS is a system-level intervention consisting of a bundle of equity-focused implementation strategies to adapt and integrate effective food security interventions – (i) universal screening for HFI, (ii) referrals to access existing health-nutrition & other nurturing care resources within WLVPN communities, and (iii) care coordination to achieve pathways for food security. This project is designed to inform how best multi-sectoral interventions (maternal-child health and food insecurity interventions) can be integrated to promote transformation in the maternal-child health and nutrition of historically marginalized communities. A three-phase mixed-methods approach will be used to achieve the major goals of this project: Phase 1 will consist of a detailed analysis of (i) contextual barriers and facilitators to integrating effective food security interventions into maternal-child nurturing care services and (ii) baseline assessment of maternal-child socioeconomic, demographic, and health needs. Phase 2 will consist of the co-creation WITH the community of a bundle of equity-focused implementation strategies to adapt and integrate the EARN-FS intervention within maternal-child nurturing care services Phase 3 will consist of assessing implementation feasibility (phases 3A & 3B) and a hybrid type III implementation study to evaluate equity-focused implementation and effectiveness outcomes, i.e., changes in levels of food insecurity of maternal-child dyads (phase 3C).

行政补充 授权号：8 U01 HD115256-02，（之前的 FAIN：U01OD033239） 摘要摘要 加强妇幼健康和营养对于实现“2030 年健康人民”目标至关重要。 投资于从孕前到童年的综合养育护理干预措施决定了一个人的 发展轨迹，其效益在整个生命过程中积累并促进社会正义（即 通过修复子孙后代的系统，使公平更进一步）。 COVID-19 大流行已 产前、围产期和儿科服务等基本培育护理服务中断。结果，过了 由于极端贫困和家庭问题，预计将有 100 万可预防的儿童和孕产妇死亡 粮食不安全（HFI；由于有限的资源，无法持续获得足够的健康食品来维持积极、健康的生活） 财力）。在 COVID-19 期间，美国有孩子的家庭的 HFI 增加了两倍（约 19.5%）， 边缘化的低收入家庭和有色人种家庭负担过重。 HFI 与 种族/族裔不平等以及不良的母婴健康和营养结果。整合有效食物 作为 COVID-19 应对和恢复工作的一项重要内容，培育护理服务中的安全干预措施 促进公平的可实现战略。西拉斯维加斯承诺社区 (WLVPN) 是一个 针对健康问题社会决定因素的干预措施，以减少历史上种族/族裔中的结构性种族主义 内华达州拉斯维加斯的边缘化社区。 WLVPN 由 50 多个多行业合作伙伴实施 由内华达州协调的关键生活领域（健康、教育、就业、住房和社会正义） Partners, Inc.，我们与他们有着密切的合作。虽然 WLVPN 社交干预是一种独特的 解决孕产妇死亡率和粮食不安全水平方面普遍存在的不平等问题的机会和平台， 缺乏对母婴健康和营养的关注。因此，我们与 Nevada Partners, Inc. 的合作关系是 非常适合促进 WLVPN 中的母婴部分并推进实施和 股权研究。该实施科学项目采用基于社区的参与方法 以及种族平等框架，与社区共同创建早期响应养育护理 粮食安全 (EARN-FS) 干预措施将母婴健康和营养结合起来。 EARN-FS 是一个 系统级干预包括一系列以公平为中心的实施战略，以适应和 整合有效的粮食安全干预措施 – (i) 对 HFI 进行普遍筛查，(ii) 转介以获取现有的 WLVPN 社区内的健康营养和其他培育护理资源，以及 (iii) 护理协调 实现粮食安全的途径。该项目旨在告知如何最好地采取多部门干预措施 （妇幼健康和粮食不安全干预措施）可以整合起来，以促进转型 历史上边缘化社区的母婴健康和营养。三相混合法 方法将用于实现该项目的主要目标： 第一阶段将包括对 (i) 整合有效食品的背景障碍和促进因素的详细分析 母婴抚养服务的安全干预和（ii）母婴基线评估 社会经济、人口和健康需求。 第二阶段将包括与社区共同创建一系列以股权为中心的实施方案 将 EARN-FS 干预措施调整和整合到母婴养育护理服务中的策略 第三阶段将包括评估实施可行性（阶段 3A 和 3B）和混合类型 III 实施研究，以评估注重公平的实施和有效性结果，即 母婴二人组的粮食不安全程度（第 3C 阶段）。