Enhancing Cardiovascular Health Equity in Mothers and Children Through Home Visiting

通过家访提高母亲和儿童的心血管健康公平性

• 批准号: 10618374
• 负责人: Victor G. Davila-Roman
• 金额: $ 79.69万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-05 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10618374
• 关键词: Age; American Heart Association; Behavior; Behavioral; Biological; Birth; Black race; Blood Pressure; Body mass index; Cardiovascular system; Characteristics; Child; Child Health; Childbirth; Cholesterol; Chronic Disease; Clinical Trials; Communities; Complex; Diet; Dose; Educational process of instructing; Effectiveness; Enrollment; Ensure; Equity; Evidence based practice; Family; Foundations; Funding; Generations; Gestational Diabetes; Glycosylated hemoglobin A; Healthy Eating; Home; Home visitation; Housing; Hybrids; Implementation readiness; Individual; Intervention; Latinx; Lead; Learning; Life; Life Style; Low income; Measures; Missouri; Modeling; Morbidity - disease rate; Mothers; Outcome; Parent-Child Relations; Parents; Patient Recruitments; Persons; Phase; Physical activity; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnant Women; Preschool Child; Protocols documentation; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Resources; Scientific Advances and Accomplishments; Site; Sleep; Smoking; Specific qualifier value; Testing; Time; Training; United States National Institutes of Health; Universities; Visit; Washington; Weight; Women' s Health; Work; active lifestyle; cardiovascular disorder risk; cardiovascular health; cardiovascular risk factor; child bearing; clinical research site; evidence base; experience; follow-up; food insecurity; health assessment; health disparity; health equity; healthy weight; housing instability; implementation science; improved; innovation; intergenerational; kindergarten; lifestyle intervention; mortality; parental influence; pragmatic randomized trial; prenatal; prevent; programs; recruit; screening; social health determinants; socioeconomic disadvantage; study population; teacher; treatment as usual; young mother

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.

项目总结/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，具有长期的生物和行为后果。生活方式 随着时间的推移，干预措施可以促进母亲及其子女的CVH。学术伙伴关系 与家访组织接触到经历健康差距的家庭， 代际CVH公平。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的研究团队与Parents合作， 教师（PAT），一个基于证据的家访计划，位于所有50个州。最近，我们 合作的工作证明了健康饮食和积极的生活在家里教的有效性 在这项研究中，我们成功地测试了一种生活方式干预，以促进理想体重和CVH 在孕妇和年轻母亲及其子女中。我们现在寻求与 通过严格测试此实施就绪的持续CVH影响， approach.在UG 3规划阶段（第1-2年），我们将与ENRICH合作， 确定由HEALTH告知的通用CVH协议。在UH 3实施阶段（第3-7年）， 我们将严格测试这种为母亲准备的实施方法对CVH的持续影响 和3岁以上分娩的幼儿，从产前开始，持续到产后30个月， 分娩混合1型群集随机化务实试验建立在这种伙伴关系的基础上（N=10个站点 在高负担圣路易斯，密苏里州，大都会地区; 750对母子;研究人群中有一个或 更多的以下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 根据美国心脏协会综合评分评估的母体CVH的健康状况 从入组（妊娠20周前）到出生时随访的3年内，生活简单7，6，18， 和分娩后30个月;以及通过BMIz轨迹和饮食，活动，睡眠， 以及从出生到6、18和30个月随访的父母影响。我们将运用专业知识， 实施科学，以确保干预措施在所有国家得到公平实施和影响 PAT和ENRICH协作。这项重要的研究将进一步推动科学 了解和循证实践如何破坏心血管风险的影响， 通过几代人来改善CVH公平性。本研究的创新之处在于， 确定健康对母亲向儿童转移生活方式行为的影响， 生育的连续性