Addressing Health Literacy and Numeracy to Prevent Childhood Obesity

项目摘要 2003年，卫生局局长理查德·卡莫纳表示，健康素养低是最大的 这一论断得到了最近的研究的支持。 他们发现，低健康素养或低计算能力与较差的照顾者母乳喂养有关 知识，婴儿配方奶粉的不正确混合，难以理解食品标签和分量大小，以及更高 成人和儿童的体重指数(BMI)。特别令人关注的是肥胖流行病对 我们最小的孩子。超过26%的学龄前儿童现在超重(BMI 85%)或肥胖(BMI 95%) (根据2007年HHS/CDC专家小组定义)。学龄前儿童的肥胖率翻了一番 在过去十年中，低收入和少数族裔儿童的增长率最高--相同的社区 受健康素养较低的影响最大。 到目前为止，预防或治疗儿童肥胖症的临床努力效果有限。需要努力 早点开始，因为两岁时超重的儿童超重的可能性是五倍 青少年，并随后有更高的肥胖相关并发症风险，包括早发性2型 糖尿病和心血管疾病。没有已发表的临床研究严格解决肥胖问题。 2岁以前的预防，特别注重低识字率和算术能力。解决照顾者的健康素养问题 是一项创新战略，旨在促进这些家庭的健康营养和活动，并 防止儿童一生中不健康的体重增加，这将通过以下方式对公共卫生产生重大意义 预防儿童和成人慢性病。 这项拟议的研究是一项多点随机对照试验，旨在评估低密度脂蛋白的疗效。 以识字/算术为导向的干预措施，旨在促进健康的家庭生活方式，防止过早 儿童肥胖症。干预将通过初级保健中的儿科住院医生进行 在资源不足的社区中的环境。四个学术医学中心将被随机分配：范德比尔特 迈阿密大学、北卡罗来纳大学教堂山分校和纽约大学。 两个中心将接受干预，另外两个中心将接受主动控制。在每个地点， 将有250名讲英语或西班牙语的照顾者-儿童二人组参加，并将从 儿童4-6个月的健康儿童访问通过24个月的健康儿童访问。干预措施将包括一个低点- 面向儿科住院医生的识字工具包，用于家庭和明确的健康沟通培训 儿科住院医生。在控制点，儿科住院医师将提供有关生活方式的“常规护理”。 咨询，但他们也会接受一项预防伤害的教育计划，作为注意力控制。这个 基本假设是，干预将改善家庭的饮食和体力活动行为， 它将降低24个月大的儿童超重率(BMI为85%)。

Project Summary In 2003, Surgeon General Richard Carmona stated that low health literacy was "one of the largest contributors to our nation's epidemic of overweight and obesity." This assertion is supported by recent studies which have found that low health literacy or numeracy is associated with poorer caregiver breastfeeding knowledge, incorrect mixing of infant formula, difficulty understanding food labels and portion sizes, and higher Body Mass Index (BMI) in adults and children. Of particular concern is the impact of the obesity epidemic on our youngest children. Over 26% of preschool children are now overweight (BMIe85%) or obese (BMIe95%) (based on 2007 HHS/CDC Expert Panel definitions). Rates of obesity in preschool children have doubled over the past decade, with the highest increases among low income and minority children-- the same communities most affected by low health literacy. To date, clinical efforts to prevent or treat childhood obesity have had limited efficacy. Efforts need to start early, because children who are overweight by age two are five times as likely to become overweight adolescents, and subsequently at higher risk for obesity-related complications including early-onset Type-2 Diabetes and cardiovascular disease. No published clinical studies have rigorously addressed obesity prevention prior to age 2 with a specific low-literacy and numeracy focus. Addressing caregiver health literacy in early childhood is an innovative strategy to promote healthy nutrition and activity among these families and prevent unhealthy weight gain across the child's life, which would have great public health significance by preventing both child and adult chronic illness. The proposed study is a multi-site randomized, controlled trial to assess the efficacy of a low- literacy/numeracy-oriented intervention designed to promote healthy family lifestyles and to prevent early childhood obesity. The intervention will be delivered through pediatric resident physicians in primary care settings in under-resourced communities. Four academic medical centers will be randomized: Vanderbilt University, the University of Miami, the University of North Carolina at Chapel Hill, and New York University. Two centers will receive the intervention, while the other two centers will receive an active control. At each site, a cohort of 250 English- or Spanish-speaking caregiver-child dyads will be enrolled and followed from the child's 4-6 month well-child visit through the 24-month well-child visit. The intervention will include a low- literacy-oriented toolkit for pediatric residents to use with families and clear health communication training for the pediatric residents. At control sites, pediatric residents will provide "usual care" with respect to lifestyle counseling, but they will also receive an injury-prevention education program to act as an attention control. The primary hypotheses are that the intervention will improve family dietary and physical activity behaviors and that it will reduce the rate of childhood overweight (BMIe85%) at age 24 months.