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

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）的摄入量，每一种都与父母的饮食有关，父母 喂养方法、父母对婴儿气质/行为的看法以及是否接受母乳喂养。而 在过去十年中，针对这一年龄组的行为干预措施数量大幅增加， 仍然存在着若干重大差距。首先，五项已发表的试验中的每一项都集中在后期的饮食质量上， 婴儿期提供了多组分的预防包，模糊了我们对哪些干预策略的认识， 是有效的。第二，重要的社会变化没有被纳入研究设计，即 妇女更多地加入劳动力队伍，母亲的传统角色趋于一致， 缺乏针对多个照顾者的干预措施。第三，移动的技术 已被证明有效地改善了年龄较大的儿童和成人的各种健康行为，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）循证行为的系统构建 试验;（2）社会支持的复杂理论;（3）用于健康干预的移动的技术（mHealth）; 和（4）独立的，由财政部发起的R-赠款。我已经制定了一个强有力的培训计划和指导 团队，其中包括在每个这些领域的领先研究人员;研究表明NIH的资金 和丰富的指导经验。对于研究计划，我提出了“共同健康成长”，一个移动健康， 因子筛选实验，将积极干预多个照顾者，并将利用最新进展 在行为干预的系统设计中，这将允许干预组件的隔离 方面的影响.采用24析因设计，将对150个家庭进行随机分组， 接受标准营养教育的核心干预措施，加上多达4个干预组成部分：1）文本 消息传递强化和反馈，2）通过激励措施增强干预参与，3）增强 伙伴社会支持，和/或4）婴儿行为训练。共同健康成长的目标是 确定一组干预成分，以改善：1）12个月的婴儿饮食，2）改变照顾者 3-12个月之间的饮食和3）3-12个月之间的照顾者响应喂养方式的变化。 改善婴儿饮食、护理人员饮食或护理人员喂养方式的成分将包含在优化的 可以在随后的随机对照试验中进行测试的干预包。

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, fathers, and grandmothers; interventions that target multiple caregivers 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 multiple caregivers 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 up to 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 caregiver diet between 3-12 months and 3) change in caregiver responsive feeding style between 3-12 months. Components that improve infant diet, caregiver diet, or caregiver feeding style will be included in an optimized intervention package that can be tested in a subsequent randomized controlled trial.