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识字技能，这与对健康信息的理解不足，健康行为不良和临床结果不良独立相关。我们的研究团队先前的工作表明，较低的健康素养或算术与母乳喂养率较低，混合婴儿配方奶粉的问题，难以理解食品标签和份量，难以理解生长图表，成人和儿童的身体质量指数（BMI）较高，以及药物剂量和其他安全问题的困难有关。然而，到目前为止，对父母识字在幼儿长期健康中不断演变的作用的研究有限，大多数研究只是横向的。 2009年，我们获得了为期5年的NIH R 01，进行了一项群集随机试验，以评估健康素养/健康沟通干预对四个学术初级保健诊所的儿童早期肥胖预防的影响（称为“绿光干预研究”）。两个诊所接受了预防肥胖的健康素养敏感干预，而两个积极控制点接受了 预防伤害。讲英语和西班牙语的父母和他们的婴儿参加了儿童2个月大的常规预防性护理访视，并随访至儿童2岁。在整个研究过程中，收集了儿童健康状况的多种指标，包括临床指标（例如，儿童体重和身长、免疫接种状况、保健利用情况）、行为指标（例如，饮食和身体活动，伤害预防行为），以及健康传播相关的评估（例如，父母的健康素养/算术能力，感知的提供者沟通）。2012年9月1日完成了对865个家庭的招募。到目前为止，保留率一直很有希望，超过90%的符合条件的家庭完成了2年的访问。对基线2个月健康儿童访视数据的横断面分析表明，低识字率与增加的“致肥”行为和更差的伤害预防行为之间存在显著关联。4个月和6个月的初步结果表明，干预改善了饮食和身体活动相关的婴儿护理行为。 通过这种竞争性的更新，我们建议继续跟踪这一独特的儿童队列，我们称之为“绿光队列研究”，每六个月通过电话调查和面对面访谈收集数据，直到儿童5岁。这将使我们能够评估最初干预的长期影响。此外，这个纵向队列将为我们提供机会，以检查父母识字和幼儿健康相关的结果，包括家庭健康行为，儿童肥胖，伤害和儿童发育之间的关系。这项研究还将提供新的信息，说明家长识字措施在儿童健康方面的长期有效性。这项拟议的研究将提供迄今为止对父母健康素养在儿童早期肥胖预防和其他儿童健康相关问题中的作用和重要性的最有力的理解，并制定未来的干预措施，以遏制肥胖和改善儿童健康。

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.