Leveraging behavior change, social support and mHealth to advance early life obesity prevention

摘要 人们越来越认识到，生命的头两年是预防肥胖的关键时期， 已经确定了有希望的行为目标，包括增加水果和蔬菜的摄入量， 减少含糖饮料（SSB）的摄入，每种饮料都与父母饮食有关， 父母的喂养习惯、父母对婴儿气质/行为的看法以及是否接受母乳喂养。 虽然针对这一年龄组的行为干预数量在过去十年中大幅增加， 多年来，仍然存在一些关键差距。首先，五个已发表的试验中的每一个都集中在饮食质量上， 在婴儿期后期，我们提供了多方面的预防方案，模糊了我们对哪些干预措施的认识。 战略是有效的。其次，重要的社会变化没有被纳入研究设计， 也就是说，妇女在劳动力中的参与增加， 缺乏针对母亲和父亲的干预措施。第三，移动的技术 在改善年龄较大的儿童和成人的各种健康行为方面表现出有效性，但 在现有的早期肥胖预防试验中未得到充分利用。我试图填补这些空白，并成为一个领导 研究人员在该领域的早期生活肥胖预防，但需要额外的培训。NIDDK 指导研究科学家发展奖将为我提供受保护的时间来寻求这种培训 并发展必要的技能，以实施拟议的研究。我的短期培训目标是 发展科学和技术技能：（1）系统建设以证据为基础的 行为试验;（2）社会支持的复杂理论;（3）健康的移动的技术 干预措施（mHealth）;（4）独立的，由赞助商发起的R-赠款。我培养了一种强大的 培训计划和指导团队，其中包括每个领域的主要研究人员; 证明了NIH的资金和广泛的指导经验。在研究计划中，我提出了“成长 健康在一起，”一个mHealth因子筛选实验，将积极干预母亲和 父亲，并将利用最新进展的系统设计的行为干预，这将允许 隔离干预组件的影响。使用24因子设计，150个家庭，在基线上分层 母乳喂养的母亲，将随机接受标准营养教育+ ≥ 4个干预组成部分中的1个：1）短信强化和反馈，2）强化干预 通过激励的参与，3）增强的伴侣社会支持，和/或4）婴儿行为的训练。目标 《共同健康成长》的目的是确定一系列可以改善以下情况的干预成分：1）婴儿饮食 12个月，2）3-12个月之间父母饮食的变化和3）父母反应性喂养方式的变化 3-12个月之间。将包括改善婴儿饮食、父母饮食或父母喂养方式的成分 在一个优化的干预方案中，可以在随后的随机对照试验中进行测试。

ABSTRACT There is growing recognition that the first two years of life are a critical period for the prevention of obesity and promising behavioral targets have been identified, including increased intake of fruits and vegetables and decreased intake of sugar-sweetened beverages (SSBs), each of which is associated with parental diet, parental feeding practices, parental perception of infant temperament/behavior and having been breastfed. While the number of behavioral interventions targeting this age group has substantially increased in the last ten years, several critical gaps remain. First, each of the five published trials that focused on the quality of the diet in late infancy delivered multicomponent prevention packages, clouding our knowledge of which intervention strategies were effective. Second, important social changes have not been incorporated into study designs, namely the increased participation of women in the labor force and the convergence of the traditional roles of mothers and fathers; interventions that target mothers and fathers are lacking. Third, mobile technologies have been shown effective at improving a variety of health behaviors among older children and adults, but have been underutilized in existing early life obesity prevention trials. I seek to fill these gaps and become a lead researcher in the field of early life obesity prevention, but require additional training. The NIDDK Mentored Research Scientist Development Award will provide me protected time to seek this training and develop the skills necessary to implement the proposed research. My short-term training goals are to develop scientific and technical skills in: (1) the systematic construction of evidence-based behavioral trials; (2) complex theories of social support; (3) mobile technologies for health interventions (mHealth); and (4) independent, investigator-initiated R-grants. I have developed a strong training plan and mentoring team, which includes leading researchers in each of these areas; researches with demonstrated NIH-funding and extensive mentoring experience. For the research plan, I propose “Growing Healthy Together,” a mHealth factorial screening experiment that will actively intervene with mothers and fathers and will utilize recent advances in the systematic design of behavioral interventions, which will allow for the isolation of intervention component effects. Using a 24 factorial design, 150 families, stratified on baseline maternal breastfeeding, will be randomized to receive a core intervention of standard nutrition education plus ≥ 1 of 4 intervention components: 1) text messaging reinforcement and feedback, 2) enhanced intervention engagement via incentives, 3) enhanced partner social support, and/or 4) training in infant behavior. The aims of Growing Healthy Together are to determine the set of intervention components that improve: 1) infant diet at 12 months, 2) change in parent diet between 3-12 months and 3) change in parent responsive feeding style between 3-12 months. Components that improve infant diet, parent diet, or parent feeding style will be included in an optimized intervention package that can be tested in a subsequent randomized controlled trial.