PALS-CATCH Intervention for Obesity Prevention Among At-Risk Toddlers

 描述(申请人提供)：在德克萨斯州，即使是最小的儿童也会受到肥胖症的影响，32%的2-5岁儿童在入学前超重或肥胖。孩子生命早期的家庭环境和育儿技巧和做法对于建立健康饮食、体育活动和充足的睡眠时间等肥胖预防行为至关重要。然而，父母缺乏这些技能，针对孩子熟悉的环境--他们的家--的干预措施很少。这项研究的总体目标是试行一项以低收入、非裔美国人和西班牙裔父母为主的综合性、对文化敏感的家庭计划，以提高2至3岁幼儿的肥胖预防和控制的育儿技能。该项目名为PALS-CATCH，将整合两个经过研究验证的项目--游戏和学习策略(PALS)和儿童健康协调方法(CATCH)的战略。这项实验研究将以家中幼儿的父母为目标，教他们如何对幼儿的暗示做出反应和敏感，提供机会并确保幼儿用餐、活动和睡眠的时间表保持一致，从而促进儿童自我调节能力的发展和其他发展成果，以促进健康的饮食、活动和睡眠模式。我们的具体目标是：目标1.评估在以低收入、非裔美国人和西班牙裔超重或肥胖为主的2-3岁幼儿及其父母中开展PALS-CATCH的可行性和可接受性。目的2.探讨PALS-CATCH对儿童能量平衡相关行为的影响。我们将使用随机对照试验(RCT)设计，在60个孩子超重或肥胖的低收入、非裔美国人和西班牙裔亲子二人中测试PALS-CATCH(年龄和性别BMI&>第85个百分位数)。我们假设，干预后，与对照组相比，接受PALS-CATCH的父母的孩子将减少：a)BMI z-Score，b)每天摄入的含糖饮料，并增加：e)每天食用的水果和蔬菜的数量，f)平均每天的体育活动分钟数，包括中等到剧烈的体育活动。作为我们次要目标的一部分，我们将评估PARS-CAP对父母和孩子的心理社会和行为结果的影响，包括育儿技能、反应能力和与饮食、体育活动、屏幕时间和睡眠相关的儿童自我调节行为。我们还将检查这些因素在多大程度上中介了儿童BMI、饮食和体力活动行为的改善。干预前和干预后的测量将使用儿童人体测量、家长报告的儿童膳食摄入量的24小时饮食回忆、儿童体力活动加速计、视频 测量父母反应行为的观察，测量家庭环境和心理社会因素的父母调查。试点的结果将被用来获得效果大小来为RO1提供动力，以确定幼儿PALS-CATCH的效果。

 DESCRIPTION (provided by applicant): In Texas, even the youngest children are affected by the obesity epidemic with 32% of 2 to 5 year old children overweight or obese before they enter school. The home environment and parenting skills and practices during the very early years of a child's life are critically important to establish obesity prevention behaviors such as healthy eating, physical activity, and adequate duration of sleep. However, parents lack these skills and interventions targeting the child's familiar environment, their home, are sparse. The overall aim of this study is to pilot test an integrated, culturally sensitive home-based program targeting predominantly low- income, African American and Hispanic parents to improve parenting skills for obesity prevention and control among toddlers ages 2 to 3 years. The program, PALS-CATCH, will integrate strategies from two research proven programs - Play and Learn Strategies (PALS) and the Coordinated Approach to Child Health (CATCH). This experimental study will target parents of toddlers in their home setting, teaching them how to be responsive and sensitive to their young child's cues, provide opportunities and assure consistency in young children's schedules for mealtime, activity, and sleep, thus facilitating child's development of self-regulation and other developmental outcomes to facilitate healthy eating, activity, and sleep patterns. Our specific aims are: Aim 1. To evaluate the feasibility and acceptability of PALS-CATCH among predominantly low-income, African American and Hispanic overweight or obese toddlers ages 2 to 3 years and their parents. Aim 2. To determine the effect of PALS-CATCH on child energy balance-related behaviors. We will use a randomized controlled trial (RCT) design to pilot test PALS-CATCH among 60 low-income, African American and Hispanic parent-child dyads where the child is overweight or obese (BMI >85th percentile for age and gender). We hypothesize that post-intervention, as compared to those in the control group, children of parents receiving PALS-CATCH will decrease: a) BMI z-score, and b) ounces of sugar-sweetened beverages consumed per day, and increase: e) number of servings of fruits and vegetables consumed per day and, f) mean minutes of physical activity including moderate-to-vigorous physical activity per day. As part of our secondary aims, we will evaluate the effects of PALS-CATCH on parent and child psychosocial and behavioral outcomes including parenting skills, responsiveness, and child self-regulation behaviors related to diet, physical activity, screen time and sleep. We will also examine the extent to which these factors mediate the improvements in child BMI, dietary and physical activity behaviors. Pre and post-intervention measurements will be conducted using child anthropometric measurements, parent-reported 24-hour dietary recalls for child dietary intake, accelerometers for child physical activity, video observations measuring parent responsiveness behaviors and, parent surveys measuring home environmental, and psychosocial factors. Results from the pilot will be used obtain effect sizes to power a RO1 to determine the efficacy of PALS-CATCH for toddlers.