Addressing Health Literacy and Numeracy to Prevent Childhood Obesity

提高健康素养和算术能力以预防儿童肥胖

• 批准号: 7847073
• 负责人: ELIANA M. PERRIN
• 金额: $ 1.23万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-06-01 至 2010-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7847073
• 关键词: 2 year old; Academic Medical Centers; Address; Adolescent; Adoption; Adult; Affect; Age; Age-Months; American; Attention; Beech; Behavior; Behavior Therapy; Body mass index; Breast Feeding; Cardiovascular Diseases; Caregivers; Caring; Child; Childhood; Chronic Disease; Clinical; Clinical Research; Communication; Communities; Control Groups; Counseling; Development; Disadvantaged; Education; Educational process of instructing; Enrollment; Epidemic; Family; Food Labeling; Future; Health; Health Communication; Health behavior; Hypertension; Infant formula; Intake; Intervention; Juice; Knowledge; Latino; Life; Life Cycle Stages; Life Style; Low income; Minority; Modeling; New York; Non obese; Non-Insulin-Dependent Diabetes Mellitus; North Carolina; Nursery Schools; Obesity; Outcome; Overweight; Parenting behavior; Parents; Perception; Physical activity; Physicians; Plant Roots; Preschool Child; Prevalence; Prevention education; Prevention strategy; Preventive; Primary Care Physician; Public Health; Publishing; Randomized; Randomized Controlled Trials; Reading; Reporting; Research; Role; School-Age Population; Self Efficacy; Site; Surgeon; Television; Time; Training; United States; Universities; Visit; Weight; Weight Gain; Weight Perception; Yin; active control; base; burden of illness; clinical care; cohort; cost; early childhood; early onset; ethnic minority population; experience; group intervention; health literacy; high risk; improved; injury prevention; innovation; intervention effect; literacy; nutrition; obesity in children; obesity prevention; pattern perception; pediatrician; prevent; primary care setting; programs; public health relevance; satisfaction; skills; socioeconomics; therapy design; tool; treatment as usual

DESCRIPTION (provided by applicant): In 2003, Surgeon General Richard Carmona stated that low health literacy was "one of the largest contributors to our nation's epidemic of overweight and obesity." This assertion is supported by recent studies which have found that low health literacy or numeracy is associated with poorer caregiver breastfeeding knowledge, incorrect mixing of infant formula, difficulty understanding food labels and portion sizes, and higher Body Mass Index (BMI) in adults and children. Of particular concern is the impact of the obesity epidemic on our youngest children. Over 26 percent of preschool children are now overweight (BMI>85 percent) or obese (BMI>95 percent) (based on 2007 HHS/CDC Expert Panel definitions). Rates of obesity in preschool children have doubled over the past decade, with the highest increases among low income and minority children-- the same communities most affected by low health literacy. To date, clinical efforts to prevent or treat childhood obesity have had limited efficacy. Efforts need to start early, because children who are overweight by age two are five times as likely to become overweight adolescents, and subsequently at higher risk for obesity-related complications including early-onset Type-2 Diabetes and cardiovascular disease. No published clinical studies have rigorously addressed obesity prevention prior to age 2 with a specific low-literacy and numeracy focus. Addressing caregiver health literacy in early childhood is an innovative strategy to promote healthy nutrition and activity among these families and prevent unhealthy weight gain across the child's life, which would have great public health significance by preventing both child and adult chronic illness. The proposed study is a multi-site randomized, controlled trial to assess the efficacy of a low- literacy/numeracy-oriented intervention designed to promote healthy family lifestyles and to prevent early childhood obesity. The intervention will be delivered through pediatric resident physicians in primary care settings in under-resourced communities. Four academic medical centers will be randomized: Vanderbilt University, the University of Miami, the University of North Carolina at Chapel Hill, and New York University. Two centers will receive the intervention, while the other two centers will receive an active control. At each site, a cohort of 250 English- or Spanish-speaking caregiver-child dyads will be enrolled and followed from the child's 4-6 month well-child visit through the 24-month well-child visit. The intervention will include a low- literacy-oriented toolkit for pediatric residents to use with families and clear health communication training for the pediatric residents. At control sites, pediatric residents will provide "usual care" with respect to lifestyle counseling, but they will also receive an injury-prevention education program to act as an attention control. The primary hypotheses are that the intervention will improve family dietary and physical activity behaviors and that it will reduce the rate of childhood overweight (BMI > 85 percent) at age 24 months. PUBLIC HEALTH RELEVANCE: In 2003, Surgeon General Richard Carmona suggested that low health literacy is "one of the largest contributors to our nation's epidemic of overweight and obesity." Over 26 percent of preschool children are now overweight or obese, and children who are overweight by age 24 months are five times as likely as non- overweight children to become overweight adolescents. The aim of the study is to assess the efficacy of a low- literacy/numeracy-oriented intervention aimed at teaching pediatric resident physicians to promote healthy family lifestyles and prevent overweight among young children (age 0-2) and their families in under-resourced communities.

描述（由申请人提供）：2003年，外科医生理查德·卡莫纳说，低健康素养是“我国超重和肥胖流行病的最大贡献者之一。“最近的研究支持了这一说法，这些研究发现，健康素养或算术能力低与护理人员母乳喂养知识较差，婴儿配方奶粉混合不正确，难以理解食品标签和份量以及成人和儿童的身体质量指数（BMI）较高有关。特别令人关切的是肥胖流行病对我国最年幼儿童的影响。超过26%的学龄前儿童现在超重（BMI> 85%）或肥胖（BMI> 95%）（基于2007年HHS/CDC专家小组定义）。学龄前儿童的肥胖率在过去十年中翻了一番，其中低收入和少数民族儿童的肥胖率增幅最大，而这些社区受健康知识水平低的影响最大。迄今为止，预防或治疗儿童肥胖症的临床努力效果有限。需要尽早开始努力，因为两岁时超重的儿童成为超重青少年的可能性是五倍，随后患肥胖相关并发症的风险更高，包括早发性2型糖尿病和心血管疾病。没有已发表的临床研究严格解决了2岁之前的肥胖预防与特定的低识字和算术重点。解决照顾者在幼儿期的健康知识普及问题是一项创新战略，可促进这些家庭的健康营养和活动，并防止儿童一生中不健康的体重增加，这将通过预防儿童和成人慢性病而具有重大的公共卫生意义。这项拟议的研究是一项多中心随机对照试验，旨在评估旨在促进健康家庭生活方式和预防儿童早期肥胖的低识字/算术导向干预措施的有效性。干预措施将通过儿科住院医生在资源不足的社区的初级保健环境中提供。四个学术医疗中心将被随机分配：范德比尔特大学、迈阿密大学、查佩尔山的北卡罗来纳州大学和纽约大学。两个中心将接受干预，而另外两个中心将接受主动控制。在每个研究中心，将入组250名讲英语或西班牙语的双胞胎儿童，并从儿童4-6个月健康儿童访视至24个月健康儿童访视进行随访。干预措施将包括一个面向低识字率的工具包，供儿科住院医师与家庭使用，并为儿科住院医师提供明确的健康沟通培训。在控制点，儿科住院医生将提供关于生活方式咨询的“常规护理”，但他们也将接受伤害预防教育计划，以控制注意力。主要假设是，干预措施将改善家庭饮食和体育活动行为，并降低24个月大时儿童超重（BMI > 85%）的比例。公共卫生相关性：2003年，卫生部长理查德·卡莫纳（Richard Carmona）提出，健康素养低下是“我国超重和肥胖流行病的最大贡献者之一”。“超过26%的学龄前儿童现在超重或肥胖，24个月前超重的儿童成为超重青少年的可能性是非超重儿童的五倍。该研究的目的是评估低识字率/算术为导向的干预措施的有效性，旨在教导儿科住院医生促进健康的家庭生活方式，防止资源不足社区的幼儿（0-2岁）及其家庭超重。