Extension Family Lifestyle Intervention Project (FLIP for Kids)

描述(申请人提供)：生活在农村地区的儿童超重的可能性比他们的城市同龄人高25%。很少有研究将重点放在解决这种差距的策略上。制定和评估对儿童长期体重状况和相关健康参数产生积极影响的具有成本效益的干预措施，对于促进改善农村地区青年的健康至关重要。儿童肥胖症的成功治疗可以带来显著的健康益处。以家庭为基础的行为干预，包括孩子和父母，已经证明在儿童减肥方面取得了成功。然而，这些干预措施的普遍性是有限的。在医疗服务不足的社区环境中进行的试验很少。提供有效干预措施所需的资源水平是传播到农村社区环境的重大障碍。越来越多的研究表明，专门针对父母治疗儿童肥胖症可能与以家庭为基础的计划一样有效。对于农村人口来说，仅由父母参与干预可能是一种特别有益且成本效益高的替代方案。我们通过农村社区合作推广服务(CES)办公室提供的试点生活方式干预(R34 DK071555)的数据表明，在这些农村环境中，仅由父母参与的干预可能是一种相对于以家庭为基础的计划的经济有效的替代干预。这一系列研究的下一个合乎逻辑的步骤是评估综合的“以家庭为基础”和“仅限父母”的行为干预对衡量儿童体重和健康状况的长期影响，以及成本效益。这项拟议的研究需要一项三臂随机对照试验，以测试旨在促进长期体重管理和改善农村医疗服务不足地区超重和肥胖儿童健康状况的干预措施的有效性。将240名8-12岁的儿童及其父母(S)随机分配到仅限家长(PO)、以家庭为基础(FB)或健康教育控制(HEC)的干预组。PO和FB干预都将采取行为生活方式来改变饮食和体力活动模式。在PO干预中，只有家长(S)会参加小组会议，而在FB干预中，孩子和家长(S)都会参加小组会议。孩子和家长(S)都将在港灯的情况下参加小组会议。所有干预措施将通过CES办公室提供，将包括为期4个月的12次会议，然后是接下来8个月的每月小组会议。将在基线、治疗后(12个月)和随访(24个月)评估体重状况、代谢参数、体力活动、营养摄入量和生活质量。我们还将评估这些干预措施的成本效益。研究假设：(A)在12个月和24个月时，保育中心和家庭护理中心的儿童在体重状况方面的改善程度会较港灯中心的儿童为大；及(B)在成本效益方面，保育服务中心的儿童较家庭护理中心和港灯中心的儿童更具成本效益。这一结果可能对在服务不足的农村地区治疗儿童肥胖症具有重要意义，因为它确定了一种成本效益高和有效的替代家庭干预措施。 公共卫生相关性：拟议的研究将填补在将研究从疗效试验翻译和传播到社区环境中的最佳实践方面的一个重要文献空白--这是美国国立卫生研究院路线图倡议的一个关键目标。这项研究将对在服务不足的农村环境中治疗儿童肥胖症具有重要的公共卫生影响。

DESCRIPTION (provided by applicant): Children living in rural areas are 25% more likely to be overweight than their metropolitan peers. Little research has focused on strategies to address this disparity. Developing and evaluating cost-effective interventions that positively impact children's long-term weight status and related health parameters are critical to promoting improved health of youth in rural settings. Successful treatment of childhood obesity can yield significant health benefits. Behavioral family-based interventions, including both the child and parent, have demonstrated success in producing weight loss in children. The generalizability of these interventions, however, is limited. Few trials have been conducted in medically underserved community settings. The level of resources needed to deliver effective interventions represents a significant barrier to dissemination into rural community settings. A growing body of research suggests that exclusively targeting parents in the treatment of childhood obesity may be as effective as family-based programs. A parent-only intervention may be a particularly beneficial and cost-effective alternative for rural populations. Data from our pilot lifestyle intervention (R34 DK071555) delivered through Cooperative Extension Service (CES) offices in rural communities suggests that a parent-only intervention may be a cost-effective alternative intervention to family-based programs in these rural settings. The next logical step in this line of research is to evaluate the long-term effects of comprehensive "Family-Based" and "Parent-Only" behavioral interventions on measures of child weight and health status, and cost-effectiveness. The proposed study entails a three arm RCT to test the effectiveness of interventions designed to promote long-term weight management and improved health status in overweight and obese children from medically underserved, rural areas. Children (n = 240), ages 8-12 years, and their parent(s) will be randomly assigned to a Parent-Only (PO), Family-Based (FB), or a Health Education Control (HEC) intervention. Both the PO and FB interventions will take a behavioral lifestyle approach to modify dietary and physical activity patterns. In the PO intervention, only the parent(s) will attend group meetings, while in the FB intervention both the child and parent(s) will attend group sessions. Both the child and parent(s) will attend group sessions in the HEC condition. All interventions will be delivered through CES offices and will include 12 sessions over the course of 4 months, followed by monthly group sessions for the next 8 months. Weight status, metabolic parameters, physical activity, nutritional intake and quality of life will be assessed at baseline, post-treatment (month 12), and follow-up (month 24). We will also evaluate the cost effectiveness of these interventions. It is hypothesized that: (a) children in the PO and FB will exhibit greater improvements in weight status than children in the HEC at months 12 and 24, and (b) the PO will demonstrate greater cost-effectiveness than the FB and HEC. Results may have significant implications for treatment of pediatric obesity in underserved rural areas by identifying a cost-efficient and effective alternative to family-based interventions. PUBLIC HEALTH RELEVANCE: The proposed study will fill a critical gap in the literature regarding translation and dissemination of research from efficacy trials to best practices in community settings - a key objective of the NIH Roadmap Initiative. The study will have important public health implications for the treatment of pediatric obesity in underserved rural settings.