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，这与对健康信息的缺乏理解、糟糕的健康行为和糟糕的临床结果独立相关。我们研究团队之前的工作表明，较低的健康素养或计算能力与较低的母乳喂养率、婴儿配方奶粉的混合问题、理解食品标签和分量大小的困难、理解生长图表的困难、成人和儿童较高的身体质量指数(BMI)以及用药困难和其他安全问题有关。然而，到目前为止，关于父母识字在幼儿长期健康中的演变作用的研究有限，而且大多数研究只是横向的。2009年，我们获得了一项为期5年的NIH R01随机整群试验，在四个学术初级保健诊所评估健康素养/健康沟通干预对儿童早期肥胖症预防的影响(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#年的教育。 预防伤害。说英语和西班牙语的父母和他们的婴儿参加了孩子2个月大的常规预防护理访问，并一直跟踪到孩子2岁。在整个研究过程中，收集了儿童健康状况的多种衡量标准，包括临床指标(例如，儿童体重和身长、免疫状况、保健利用情况)、行为指标(例如，饮食和体力活动、预防伤害行为)以及与健康沟通相关的评估(例如，父母健康素养/计算能力、感知的提供者沟通)。865个家庭的招募工作已于2012年9月1日完成。到目前为止，保留率一直很有希望，90%的符合条件的家庭完成了两年的访问。对基线2个月健康儿童访视数据的横断面分析表明，低识字率与更多的“肥胖”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，干预改善了与饮食和体力活动相关的婴儿护理行为。通过这次竞争性的更新，我们计划继续跟踪这一独特的儿童队列，我们将其称为“绿光队列研究”，每六个月通过电话调查和面对面采访收集数据，直到孩子们5岁。这将使我们能够评估最初干预的长期影响。此外，这一纵向队列将为我们提供机会来检验父母识字与儿童早期健康相关结果之间的关系，包括家庭健康行为、儿童肥胖、伤害和儿童发展。这项研究还将提供有关家长识字措施随时间推移在儿童健康方面有效性的新信息。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与儿童健康有关的问题上的作用和重要性的最强有力的理解，并形成未来遏制肥胖和改善儿童健康的干预措施。

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.