Project 2: Leveraging Ongoing Home Visitation Programs to Address Obesity Disparities among Underserved, Low-Income Mothers and Children

这项拟议的研究解决了社会经济弱势群体中与肥胖和健康相关的差异 母亲和她们的孩子参加了联邦资助的家访计划。这很重要 因为低收入和种族/少数民族的母亲及其年幼的孩子特别容易受到 肥胖缺乏获得循证肥胖努力的机会进一步加剧了这些差距。的 一项拟议的随机对照试验测试了（1）一种简单、循证和生态学的 相关肥胖干预（习惯）作为持续家访服务的一部分，与（2） 现有的家访课程没有关于母亲和儿童肥胖风险的肥胖相关内容。 HABITS侧重于习惯的形成和对食物/活动家庭环境的改变，以促进 目标体重相关行为的变化。参与者将是298名母亲（>50%非裔美国人; 100%符合联邦贫困水平）和他们的孩子（基线时3- 5岁）参加了我们的家访合作伙伴 在亚拉巴马中部。家访者将被随机分配到提供家访课程， 作为每周家访的一部分，为期12个月。对母亲的评估（体重、腰围 周长、喂养习惯和目标行为的习惯强度）、儿童（体重增加率），以及 家庭环境（有助于目标食物、活动和 监测行为）将在入组、12和24个月（治疗后1年随访）时进行。要求1 （主要成果）。比较12岁时治疗对儿童和母亲体重结果的影响 24个月。假设1a：接受HABITS的母亲体重和腰围低于接受HABITS的母亲。 接受标准服务的母亲。假设1b：接受HABITS的儿童体重增长速度较慢 比接受标准服务的儿童获得的收益更大。目标2（次要结果）。为了比较 对母亲喂养习惯、目标行为的习惯强度和家庭特征的治疗 与12和24个月时的目标行为相关的环境。假设2：与标准服务相比， 习惯将导致更健康的产妇喂养习惯（少油炸食品和SSB;更多的蔬菜/水果）， 目标行为的习惯强度更大，以及线索的家庭可用性/可达性/可见性更大， 支持目标行为。目标3（儿童肥胖风险的母亲/环境传播）。到 测试母亲和家庭环境变量是否介导了习惯对儿童死亡率的影响。 12和24个月时体重增加。假设3：母体体重、喂养方式、针对性的习惯强度 行为和家庭环境将介导HABITS与儿童 体重增加.我们将进一步探讨非洲人的主要（目标1）和次要（目标2）结局是否不同。 美国和白色母亲和孩子，以及种族是否会调节母亲和孩子之间的关系。 家庭环境变量和儿童体重增加率（目标3）。

The proposed study addresses obesity and health-related disparities among socioeconomically disadvantaged mothers and their young children enrolled in federally-funded home visitation programs. This is important because low-income and racial/ethnic minority mothers and their young children are especially at-risk of obesity. The lack of access to evidence-based obesity efforts further contributes to these disparities. The proposed randomized controlled trial tests the effectiveness of (1) a simple, evidence-based and ecologically relevant obesity intervention (HABITS) delivered as part of ongoing home visitation services, compared to (2) the existing home visitation curriculum without obesity-related content on mothers’ and children’s obesity risks. HABITS focuses on habit formation and modifications to the food/activity home environment to promote changes in the targeted weight-related behaviors. Participants will be 298 mothers (>50% African American; 100% meet federal poverty level) and their children (3-5yo at baseline) enrolled in our home visitation partner in central Alabama. Home visitors will be randomly assigned to deliver the home visitation curriculum with or without HABITS as part of their weekly home visits for 12 months. Assessments of mothers (weight, waist circumference, feeding practices and habit strength of targeted behaviors), children (rate of weight gain), and household environment (availability/accessibility/visibility of cues conducive to targeted food, activity and monitoring behaviors) will be conducted at enrollment, 12, and 24mo (1y post-treatment follow-up). Aim 1 (primary outcomes). To compare the effects of treatment on children and mothers’ weight outcomes at 12 and 24mo. Hypothesis 1a: Mothers receiving HABITS will have a lower weight and waist circumference than mothers receiving standard services. Hypothesis 1b: Children receiving HABITS will have slower rate of weight gain than children receiving standard services. Aim 2 (secondary outcomes). To compare the effects of treatment on maternal feeding practices, habit strength of targeted behaviors, and features of the household environment relevant to targeted behaviors at 12 and 24 mo. Hypothesis 2: Compared to standard services, HABITS will result in heathier maternal feeding practices (less fried foods and SSB; more vegetables/fruits), greater habit strength of targeted behaviors, and greater home availability/accessibility/visibility of cues that support targeted behaviors. Aim 3 (maternal/environmental transmission of children’s obesity risk). To test whether maternal and household environment variables mediate the effect of HABITS on children’s rate of weight gain at 12 and 24mo. Hypothesis 3: Maternal weight, feeding practices, habit strength of targeted behaviors, and household environment will mediate the relationship between HABITS and children’s rate of weight gain. We will further explore whether primary (Aim 1) and secondary (Aim 2) outcomes differ for African American and White mothers and children, and whether race moderates the relationships between maternal and household environment variables and children’s rate of weight gain (Aim 3).