Enhancing Cardiovascular Health Equity in Mothers and Children Through Home Visiting

项目概要/摘要 心血管健康 (CVH) 的基础是在生命早期通过代际互动奠定的， 从父母传给孩子，会产生长期的生物学和行为后果。生活方式 随着时间的推移，干预措施可以促进母亲及其孩子的 CVH。学术伙伴关系 与接触健康差异家庭的家访组织一起推进 代际 CVH 公平性。这项研究建立在长达数十年的学术家访的基础上 圣路易斯华盛顿大学研究团队与家长之间的合作伙伴关系 教师 (PAT)，一项遍布全美 50 个州的循证家访计划。最近，我们的 合作工作证明了在家教授健康饮食和积极生活的有效性 （健康），其中我们成功测试了生活方式干预措施，以促进理想体重和 CVH 怀孕和年轻的母亲及其孩子。我们现在寻求与 ENRICH Collaborative 通过严格测试此实施就绪的持续 CVH 影响 方法。在 UG3 规划阶段（第 1-2 年），我们将与 ENRICH Collaborative 合作， 确定由 HEALTH 通知的通用 CVH 协议。在 UH3 实施阶段（第 3-7 年）， 我们将严格测试这种可供母亲实施的方法对 CVH 的持续影响 以及 3 岁以上出生的幼儿，从产前开始一直持续到产后 30 个月 分娩。混合型 1 类整群随机实用试验建立在这种伙伴关系的基础上（N=10 个站点） 密苏里州高负担圣路易斯都会区； 750对母子；研究人群具有一种或 以下更多特征与心血管疾病风险增加相关：黑人 或拉丁裔、体重指数 ≥ 30 和/或社会经济劣势）。我们将确定效果 根据美国心脏协会的综合评分评估孕产妇 CVH 的健康状况 Life’s Simple 7 从入组（怀孕 20 周前）到出生随访 3 年多， 6, 18, 以及产后 30 个月；以及通过 BMIz 轨迹和饮食、活动、睡眠评估的儿童 CVH， 以及从出生到 6、18 和 30 个月随访期间父母的影响。我们将应用专业知识 实施科学，以确保干预措施在各个领域得到公平实施和影响 PAT 和 ENRICH 合作。这项重要的研究将进一步推动科学发展 关于如何消除心血管风险影响的理解和循证实践 代代相传，以提高 CVH 公平性。本研究的创新之处在于它严格 确定健康对生活方式行为从母亲到孩子的转移的影响 生育连续体。

Project Summary/Abstract The foundation for cardiovascular health (CVH) is laid in early life by intergenerational interactions, passed from parent to child, that have long-lasting biological and behavioral consequences. Lifestyle interventions can promote CVH among mothers and their children over time. Academic partnerships with home visiting organizations that reach families experiencing health disparities advance intergenerational CVH equity. This study builds on a decades-long academic-home visiting partnership between the research team at Washington University in St. Louis and Parents as Teachers (PAT), an evidence-based home visiting program located in all 50 states. Most recently, our partnered work demonstrated the effectiveness of Healthy Eating and Active Living Taught at Home (HEALTH), in which we successfully tested a lifestyle intervention to promote ideal weight and CVH among pregnant and young mothers and their children. We now seek to advance this work with the ENRICH Collaborative by rigorously testing the ongoing CVH impact of this implementation-ready approach. During the UG3 planning phase (years 1-2), we will work with the ENRICH Collaborative to identify a common CVH protocol informed by HEALTH. In the UH3 implementation phase (years 3-7), we will rigorously test the ongoing impact on CVH of this implementation-ready approach for mothers and young children, delivered over 3 years, beginning prenatally and continuing to 30 months post- childbirth. The Hybrid Type 1 cluster-randomized pragmatic trial builds on this partnership (N=10 sites in high burden St. Louis, Missouri, metro region; 750 mother-child dyads; study population with one or more of the following characteristics associated with increased risk of cardiovascular disease: Black or Latinx, body mass index ≥ 30, and/or socioeconomic disadvantage). We will determine the effect of HEALTH on maternal CVH as assessed by a composite score on the American Heart Association Life’s Simple 7 over 3 years from enrollment (before 20 weeks pregnancy) to follow-up at birth, 6, 18, and 30-months post childbirth; and on child CVH assessed by BMIz trajectory and diet, activity, sleep, and parental influence from birth to 6, 18, and 30-month follow-up. We will apply expertise in implementation science to ensure the intervention has equitable implementation and impact across PAT and the ENRICH Collaborative. This significant study will further advance scientific understanding and evidence-based practice on how to disrupt the impact of cardiovascular risk that passes across generations to improve CVH equity. The innovation of this study is that it will rigorously determine the impact of HEALTH on the transfer of lifestyle behaviors from mother to child, across the childbearing continuum.