Risk and Protective Factors for Childhood Obesity in the Home Food Environment

儿童肥胖症在过去二十年中几乎增加了两倍，被认为是青少年面临的最严重的健康问题之一，少数民族和低收入儿童的风险不成比例地高。虽然以前的研究已经提供了一个很好的理解个人水平的风险因素（如食物的选择），有助于儿童肥胖，家庭食物环境和人际交往（如支持，沟通，冲突）之间的连接存在于家庭环境中的饮食行为和儿童肥胖已在很大程度上被忽视。本申请的主要目的是确定家庭食物环境和与饮食行为相关的家庭成员之间的人际互动如何产生儿童肥胖的风险或保护因素。拟议的两年横断面研究，按体重状态分层（如正常体重与超重/肥胖），使用创新的混合方法方法收集直接观察数据（视频记录的家庭膳食，家庭食物库存），定性数据（与照顾者的访谈）和定量数据（BMI，饮食摄入量），以提供一个在研究中的参考。 深入描述家庭食物环境，并检查与儿童体重状况和饮食摄入量的关联。将从初级保健诊所招募60名超重/肥胖儿童（年龄和性别的第85位BMI百分比）和60名正常体重儿童（年龄和性别的第55位BMI百分比<第85位），年龄6-12岁，与他们的家人一起参加家庭观察研究。为期一周的居家观察将包括：（a）通过笔记本电脑连续八天对家庭用餐进行录像，（B）对家庭食物环境进行观察评估，（c）对照顾者进行深入的定性访谈（至少一名照顾者，如有两名照顾者），（d）目标儿童的人体测量，两名照顾者（e）与主要照顾者一起对目标儿童进行三次24小时饮食召回。家庭观察将获得家庭层面、二元层面和个人层面的数据。通过对这些数据来源进行三角测量，可以全面深入地了解家庭食品环境，并能够评估复杂的家庭动态。本研究中确定的新风险和保护因素将用于开发一项R 01基于家庭的干预研究，研究对象为6-12岁的种族/种族多样化儿童，这些儿童超重和肥胖的风险最大。这项拟议研究的结果预计将确定关键的新干预目标，这些目标可以与初级保健诊所和其他家庭卫生保健机构合作实施，以预防儿童超重和肥胖。跨学科研究团队带来了家庭社会科学，儿童和青少年营养，肥胖预防，家庭医学，流行病学和生物统计学的专业知识。拟议研究的结果将推动该领域更全面地概念化家庭食物环境，以创建更有效预防儿童肥胖的研究知情干预措施。 公共卫生相关性：这项创新的研究使用家庭观察（视频记录的家庭膳食，家庭食物库存，访谈）家庭食物环境，以更全面地了解家庭环境中儿童肥胖的风险和保护因素。预计结果将直接为预防儿童肥胖的干预措施的制定提供信息。

DESCRIPTION (provided by applicant): Childhood obesity has almost tripled in the last two decades and is considered one of the most serious health problems facing youth, with minority and low-income children at disproportionately higher risk. Although previous research has provided a good understanding of individual level risk factors (e.g. food choices) that contribute to childhood obesity, the connection between the home food environment and interpersonal interactions (e.g. support, communication, conflict) that exist in the home environment related to eating behaviors and childhood obesity has been largely overlooked. The primary objective of this application is to identify how the home food environment and the interpersonal interactions among family members related to eating behaviors create risk or protective factors for childhood obesity. The proposed two year cross-sectional study, stratified by weight status (e.g. normal weight vs. overweight/obese), uses an innovative mixed methods approach to collect direct observational data (video-recorded family meals, home food inventory), qualitative data (interviews with caregivers), and quantitative data (BMI, dietary intake) in order to provide an in depth description of the home food environment and examine associations with child weight status and dietary intake. Sixty overweight/obese children (e85th BMI %tile for age and gender) and 60 normal weight children (>5th %tile BMI <85th for age and gender), ages 6-12, will be recruited from primary care clinics to participate in an in-home observation study with their families. The one week in-home observation will include: (a) video- recordings of family meals for eight consecutive days via a laptop computer, (b) an observational assessment of the home food environment, (c) an in-depth qualitative interview with caregivers (at least one caregiver, and two when available), (d) anthropometric measures of target child, two caregivers (when available) and closest aged sibling (when available), and (e) three 24-hour dietary recalls on the target child conducted with the primary caregiver. The in-home observations will acquire family level, dyadic level and individual level data. By triangulating these data sources, a comprehensive and in-depth look at the home food environment will be possible and complex family dynamics will be able to be assessed. The novel risk and protective factors identified in this study will be used to develop an R01 family-based intervention study with ethnically/racially diverse children ages 6-12, who are at greatest risk for overweight and obesity. The results from the proposed study are expected to identify critical new targets for interventions that can be implemented in partnership with primary care clinics and other health care settings with families to prevent childhood overweight and obesity. The interdisciplinary research team brings expertise from family social science, child and adolescent nutrition, obesity prevention, family medicine, epidemiology and biostatistics. Findings from the proposed study will move the field forward in conceptualizing the home food environment more comprehensively, in order to create research-informed interventions that are more effective in preventing childhood obesity. PUBLIC HEALTH RELEVANCE: This innovative study uses in-home observations (video-recorded family meals, home food inventory, interviews) of the home food environment to obtain a more comprehensive understanding of the risk and protective factors for childhood obesity in the home environment. The results are expected to directly inform the creation of interventions to prevent childhood obesity.