Role of Parent Health Literacy in Early Child Obesity and Other Health Outcomes

描述（由申请人提供）：超过9000万美国人具有基本或低于基本的读写能力，这与对健康信息的理解不足、健康行为不佳和临床结果不佳独立相关。我们研究小组先前的工作表明，较低的健康素养或计算能力与较低的母乳喂养率、婴儿配方奶粉混合问题、难以理解食品标签和份量、难以理解生长图表、成人和儿童较高的身体质量指数（BMI）以及药物剂量和其他安全问题有关。然而，迄今为止，关于父母读写能力在幼儿长期健康中不断演变的作用的研究有限，而且大多数研究只是横断面的。2009年，我们获得了一项为期5年的NIH R01，在四家学术初级保健诊所进行了一项随机分组试验，以评估健康素养/健康沟通干预对早期儿童肥胖预防的影响（称为“绿光干预研究”）。两家诊所接受了健康素养敏感干预，以预防肥胖，而两家积极控制网站接受了教育

DESCRIPTION (provided by applicant): Over 90 million Americans have basic or below basic literacy skills, which are independently associated with poor understanding of health information, poor health behaviors and poor clinical outcomes. Prior work from our study team has demonstrated that lower health literacy or numeracy is associated with lower rates of breastfeeding, problems mixing infant formula, difficulty understanding food labels and portion sizes, difficulty understanding growth charts, higher Body Mass Index (BMI) in adults and children, and difficulties with medication dosing and other safety issues. However, to date, there has been limited study of the evolving role of parent literacy in the long-term health of young children, and most studies have only been cross-sectional. In 2009, we were awarded a 5-year NIH R01 to perform a cluster randomized trial to evaluate the impact of a health literacy/health communication intervention on early childhood obesity prevention (known as the "Greenlight Intervention Study") in four academic primary care clinics. Two clinics received a health literacy sensitive intervention for obesity prevention, while two active control sites received education in injury prevention. English- and Spanish-speaking parents and their infants were enrolled at the child's routine 2 month-old preventive care visit and are followed until the child is 2 years old. Throughout the study, multiple measures of child health status are collected, including clinical indicators (e.g., child weight and length, immunization status, health-care utilization), behaviora indicators (e.g., dietary and physical activity, injury prevention behaviors), and health communication-related assessments (e.g., parent health literacy/numeracy, perceived provider communication). Recruitment of 865 families was completed September 1, 2012. Retention rates have been promising to date, with >90 percent of eligible families completing their 2 year visits. Cross-sectional analyses of data from the baseline 2 month well-child visit demonstrated significant associations between low literacy and increased "obesogenic" behaviors and worse injury prevention behaviors. Preliminary results at 4 and 6 months suggest that the intervention improved dietary and physical activity-related infant care behaviors. Through this competing renewal, we propose to continue to follow this unique child cohort, which we call the "Greenlight Cohort Study," with data collection through phone surveys and in-person interviews every six months until children are 5 years old. This will allow us to assess the long-term effects of the original intervention. In addition, this longitudinal cohort will provide us the opportunity to examine the relationship between parent literacy and early childhood health-related outcomes, including family health behaviors, child obesity, injury, and child development. This study will also contribute new information on the validity of parent literacy measures over time in the context of child health. The proposed study will provide the most robust understanding to date of the role and importance of parent health literacy in early childhood obesity prevention and other child health-related issues and shape future interventions to curb obesity and improve child health.