Implementing Prevention Plus for childhood overweight and obesity in food secure and insecure families

 描述（由申请人提供）：在切罗基卫生系统（CHS），一个联邦合格的卫生中心，提供综合初级保健服务不足的东田纳西州，超重和肥胖的患病率在4至10岁的儿童约为42%，超过50%的家庭与儿童接受照顾CHS是粮食不安全。因此，这些儿童在以后的生活中面临健康不平等的高风险。建议在初级保健环境中实施“预防加”（PP）治疗儿童肥胖症。我们对PP进行了评估，以确定能量平衡行为的最佳组合，以及6个月内的接触频率和方式，以优化4至10岁儿童标准化体重指数（zBMI）的降低。我们的PP计划已经将zBMI降低到一定程度，可以改善幼儿的心脏代谢健康，这对于解决健康差距非常重要。然而，这个计划的能力，以改善体重状况时，提供初级保健提供者服务不足的儿童是未知的。由于家庭粮食不安全在社区卫生服务家庭中非常普遍，以家庭为基础的方法，其中向照顾者和儿童提供能量平衡行为目标，可能会降低整体家庭依从性和方案满意度，因为粮食不安全家庭中的女性照顾者在参与儿童干预时可能会感到不太舒服，或者当多个家庭成员有饮食目标时，可能关心购买被认为更昂贵的食物所需的变化程度。不解决这些问题可能会降低社区卫生服务方案的整体有效性。因此，本申请的目的是进行一项随机对照试验，检查我们的PP计划，该计划通过电子健康记录（EHR）实施，并由CHS初级保健提供者行为健康顾问提供，对在CHS接受初级保健的服务不足儿童以及超重和肥胖儿童的儿童zBMI进行评估。此外，我们将探索家庭粮食安全状况对我们在有和没有看守目标的情况下交付的PP计划的调节作用。来自CHS的60个食物安全和60个食物不安全的家庭，其中有一名女性看护人和一名年龄在4至10岁且BMI>第85百分位数的儿童，将被随机分配到3个6个月条件中的一个：1）时事通讯; 2）具有看护人能量平衡行为目标的PP（PP+）;和3）没有看护人能量平衡行为目标的PP（PP-）。主要目的是确定：1）在6个月时，PP+和PP-儿童的zBMI是否低于Newsletter;并探索：a）在粮食安全家庭中，PP+是否产生比PP-更低的儿童zBMI;以及B）在粮食不安全家庭中，PP-是否产生比PP+更低的儿童zBMI。从EHR中提取的数据将提供有关计划实施和交付的信息，并将对儿童和看护人的饮食和活动以及看护人计划满意度进行比较，以更好地了解家庭粮食安全状况可能缓和结果的潜在机制。

 DESCRIPTION (provided by applicant): At Cherokee Health Systems (CHS), a federally qualified health center which provides integrated primary care to the underserved in East Tennessee, the prevalence of overweight and obesity in children aged 4 to 10 years is approximately 42% and over 50% of households with children receiving care at CHS are food insecure. Thus, these children are at high risk for experiencing health disparities later in life. Implementing "Prevention Plus" (PP) is recommended for childhood obesity treatment within a primary care setting. We have evaluated PP to determine the best combination of energy balance behaviors, and frequency and mode of contact over 6 months, to optimize reductions in standardized body mass index (zBMI) in children aged 4 to 10 years. Our PP program has reduced zBMI to a degree that should improve cardiometabolic health in young children, which is important in addressing health disparities. However, the ability of this program to improve weight status when delivered by primary care providers to underserved children is unknown. As household food insecurity is so prevalent with CHS families, a family-based approach, in which energy balance behavior goals are provided to both caretaker and child, may reduce overall family adherence and program satisfaction, as female caretakers in food insecure households may feel less comfortable meeting their own dietary goals while participating in an intervention for their child, or may be concerned with the degree of change required in purchasing food perceived as more costly when multiple family members have dietary goals. Not addressing these concerns may reduce overall effectiveness of the program in CHS. Thus, the aim of this application is to conduct a randomized controlled trial examining our PP program implemented through the electronic health record (EHR) and delivered by CHS primary care providers, Behavioral Health Consultants, on child zBMI in underserved children who receive their primary care at CHS and who are overweight and obese. Furthermore, we will explore the moderating effect of household food security status on our PP program delivered with and without caretaker goals. Sixty food secure and 60 food insecure families from CHS, with a female caretaker and a child aged 4 to 10 years who is > 85th percentile BMI, will be randomized to 1 of 3, 6-month conditions: 1) Newsletter; 2) PP with caretaker energy balance behavior goals (PP+); and 3) PP without caretaker energy balance behavior goals (PP-). The primary aim is to determine if: 1) at 6 months, children in PP+ and PP- will have a lower zBMI than Newsletter; and explore if: a) in food secure households, if PP+ produces a lower child zBMI than PP-; and b) in food insecure households, if PP- produces a lower child zBMI than PP+. Data extraction from the EHR will provide information about program implementation and delivery and comparisons will be made on child and caretaker diet and activity and caretaker program satisfaction to better understand potential mechanisms by which household food security status may moderate outcomes.