Enhanced Primary Care Nutrition and Screen time Education to Prevent Obesity in Latino Infants

 描述(由申请人提供)：基于初级保健的喂养和预防拉丁裔婴儿肥胖的筛查时间教育拉美裔儿童的肥胖率高于非拉美裔白人儿童，这一差异在婴儿时期就出现了。在拉丁裔儿童中，父母说西班牙语的儿童患肥胖症的风险最高。研究表明，早期的最佳喂养策略和避免看电视的时间可能会降低儿童肥胖的风险，这反过来又会通过以下方式降低肥胖及其并发症的风险 成人期。然而，很少有干预措施试图在讲西班牙语的拉丁裔父母中促进最佳的婴儿喂养和屏幕时间做法。此外，文献中关于婴儿肥胖预防的大多数干预措施都是通过父母家访或专门前往干预地点进行的，由于成本和参与者的负担，这种方法在低资源环境下可能无法持续。鉴于预计婴儿在出生第一年将有7次健康儿童探视，初级保健是向父母提供有关婴儿喂养和筛查时间建议的理想环境。这项建议的总体目标是设计、试点测试和改进西班牙语、文化上适当的、基于初级保健的干预措施，以预防讲西班牙语的拉丁裔婴儿肥胖。 母亲们。我们的主要假设是，关于婴儿喂养和屏幕时间避免的重点教育将导致讲西班牙语的拉丁裔母亲使用最佳的婴儿喂养和屏幕时间做法，并导致出生第一年体重增加较少。为了准备提交R01申请来验证这一假设，我们建议在旧金山综合医院(SFGH)儿科门诊进行以下具体目标的研究：目标1：使用信息-动机-行为技能模型设计5个小组教育模块，在讲西班牙语的拉丁裔母亲中促进最佳婴儿喂养和筛选时间实践；目的2：使用先导性随机对照试验(RCT)测试为期一年的干预措施，其中5个模块(目标1)在2周、2、4、6和12个月的健康儿童探视后立即提供给讲西班牙语的拉丁裔母亲(主要结果将包括使用响应性喂养做法、婴儿饮食摄入量以及婴儿主动和被动观看电视的时间；次要结果将是婴儿人体测量学)；目标3：使用定性方法评估目标2干预措施的个别组成部分如何影响喂养和筛选时间做法。通过得出的结论 在这个奖项中，我们将对婴儿喂养和屏幕时间做法进行可扩展和潜在可重复的干预，这种干预在语言和文化上都适合讲西班牙语的拉丁裔父母，旨在减少出生第一年的体重增加，同时促进终身预防肥胖的习惯。艾米·贝克博士是这项指导职业发展奖的PI，是一名双语儿科医生，拥有丰富的临床经验，照顾低收入的拉丁裔儿童，并致力于改善健康结果 在这群人中。贝克医生是SFGH的儿科主治医生(这是一家附属于加州大学旧金山分校的公立医院，为大多数拉丁裔人口提供服务)，在那里她既提供普通儿科护理，也是儿科肥胖诊所的联席主任。关于她的研究背景，Beck博士拥有公共卫生硕士学位，并在加州大学旧金山分校(UCSF)完成了普通儿科研究奖学金。在担任研究员期间，贝克博士用定量和定性的方法调查了拉美裔儿童肥胖的风险因素。 她有5本第一作者的出版物，其中4本直接为这项提议提供信息。她目前正在进行两项针对拉丁裔儿童肥胖预防和治疗的试点干预研究。她的长期职业目标是成为肥胖预防领域的独立调查员，专注于改善对低收入拉丁裔儿童的预防服务。为了实现这一目标，贝克博士必须加强她在生物统计学和定性方法方面的技能，并在饮食分析和行为干预的随机对照试验方面掌握新技能。贝克博士已经形成了一种 具有普通儿科学、营养学、心理学、人类学、拉丁裔健康、儿童肥胖和健康政策方面专业知识的教师导师和顾问组成的跨学科团队。她的主要导师迈克尔·卡巴纳博士是一位享誉国际的卫生服务研究员，也是加州大学旧金山分校普通儿科的主任。卡巴纳博士在门诊环境下的随机对照试验的设计和实施方面拥有广泛的专业知识，并在指导方面有着良好的记录。除了指导她的研究计划和正在进行的教程之外 通过组建多元化的导师团队，Beck博士将充分利用加州大学旧金山分校众多的研究培训机会。她将参加通过临床研究培训计划提供的额外课程，这些课程涵盖了她职业发展计划的特定领域。她还将在加州大学伯克利分校公共卫生学院参加一门关于饮食评估的课程。最后，她将参加由普通儿科提供的研讨会，并参加由加州大学旧金山分校临床和翻译科学研究所提供的K学者计划。贝克博士得到了加州大学旧金山分校儿科部门和普通儿科部门的全力支持。到这个奖项结束时，贝克博士将成为一名 儿童肥胖预防研究领域的独立调查者。

 DESCRIPTION (provided by applicant): Primary Care Based Feeding and Screen Time Education to Prevent Obesity in Latino Infants Latino children experience higher rates of obesity than non-Hispanic white children, a disparity that emerges in infancy. Among Latino children, those with Spanish-speaking parents are at highest risk for obesity. Research has shown that optimal feeding strategies in early life and avoidance of screen time may lower the risk of childhood obesity, which in turn, reduces the risk of obesity and its comorbidities through adulthood. However, few interventions have sought to promote optimal infant feeding and screen time practices among Spanish-speaking Latino parents. In addition, most interventions in the literature that address infant obesity prevention have been conducted through home visits or special trips to the intervention site by parents, approaches that may not be sustainable in low-resource settings due to cost and the burden on participants. Given that infants are expected to have 7 well-child visits in the first year of life, primary care is an ideal setting in which to ofer parental education on infant feeding and screen time recommendations. The overall objective of this proposal is to design, pilot test, and refine a Spanish-language, culturally appropriate, primary care-based intervention to prevent obesity in Latino infants born to Spanish-speaking mothers. Our overarching hypothesis is that focused education on infant feeding and screen time avoidance will lead to use of optimal infant feeding and screen time practices among Spanish-speaking Latino mothers and result in less weight gain in the first year of life. In preparation for submitting an R01 application to test this hypothesis, we propose research with the following specific aims to be conducted at the San Francisco General Hospital (SFGH) outpatient pediatric clinic: Aim 1: Use the Information-Motivation-Behavioral Skills model to design 5 group educational modules that promote optimal infant feeding and screen time practices among Spanish-speaking Latino mothers; Aim 2: Use a pilot randomized-controlled trial (RCT) to test a yearlong intervention in which the 5 modules (Aim 1) are provided to Spanish-speaking Latino mothers just after well-child visits at ages 2 weeks, and 2, 4, 6, and 12 months (primary outcomes will include use of responsive feeding practices, infant dietary intake, and infant active and passive television viewing time; secondary outcomes will be infant anthropometrics); Aim 3: Use qualitative methods to assess how individual components of the intervention from Aim 2 affected feeding and screen time practices. By the conclusion of this award, we will have a scalable and potentially reproducible intervention for infant feeding and screen time practices, one that is linguistically and culturally appropriate for Spanish-speaking Latino parents and aims to reduce weight gain in the first year of life while promoting habits that protect against obesity across the lifespan. Dr. Amy Beck, PI for this mentored career development award, is a bilingual pediatrician with considerable clinical experience caring for low-income Latino children and a deep commitment to improving health outcomes in this population. Dr. Beck is a pediatric attending at SFGH (a public hospital affiliated with UCSF that serves a majority Latino population) where she provides both general pediatric care and also is the co-director of the pediatric obesity clinic. With respect to her research background, Dr. Beck holds a MPH and completed a General Pediatrics research fellowship at the University of California, San Francisco (UCSF). During her fellowship, Dr. Beck used both quantitative and qualitative methods to investigate risk factors for obesity among Latino children. She has 5 first-author publications, of which 4 directly inform this proposal. She is currently conducting two pilot intervention studies in obesity prevention and treatment for Latino children. Her long-term career goal is to be an independent investigator in the field of obesity prevention with a focus on improving preventive services for low-income Latino children. To accomplish this goal, Dr. Beck must strengthen her skills in biostatistics and qualitative methods and acquire new skills in dietary analysis and RCTs of behavioral interventions. Dr. Beck has formed an interdisciplinary team of faculty mentors and consultants with expertise in general pediatrics, nutrition, psychology, anthropology, Latino health, pediatric obesity, and health policy. Her primary mentor, Dr. Michael Cabana, is an internationally respected health services researcher and the Division Chief of General Pediatrics at UCSF. Dr. Cabana has extensive expertise in the design and conduct of RCTs in the ambulatory setting and a strong track record of mentorship. In addition to her mentored research plan and ongoing tutorials with her diverse mentorship team, Dr. Beck will take advantage of UCSF's numerous opportunities for research training. She will enroll in additional courses offered through the Training in Clinical Research Program that cover specific areas of her career development plan. She will also take a course at the UC Berkeley School of Public Health on dietary assessment. Finally, she will attend seminars offered by the Division of General Pediatrics and participate in the K scholars program offered by the Clinical and Translational Science Institute at UCSF. Dr. Beck has the full support of the UCSF Department of Pediatrics and the Division of General Pediatrics for this proposed award. By the conclusion of this award, Dr. Beck will be well positioned as an independent investigator in the field of childhood obesity prevention research.