Leveraging behavior change, social support and mHealth to advance early life obesity prevention

摘要 人们越来越认识到，生命的头两年是预防肥胖和 已经确定了有希望的行为目标，包括增加水果和蔬菜的摄入量以及 减少含糖饮料(SSB)的摄入量，每种SSB都与父母的饮食有关， 父母的喂养习惯、父母对婴儿性情/行为的看法以及是否已经母乳喂养。 虽然针对这一年龄段的行为干预措施的数量在过去十年中大幅增加 几年来，仍然存在几个关键差距。首先，五项已发表的试验中的每一项都集中在饮食质量上 在婴儿期后期，提供了多组分的预防方案，使我们对哪种干预措施的了解变得模糊 策略是有效的。第二，重要的社会变化没有被纳入研究设计， 即妇女更多地参与劳动力大军和妇女传统角色的汇聚 父母；缺乏针对父母的干预措施。第三，移动技术已经 在改善年龄较大的儿童和成年人的各种健康行为方面被证明是有效的，但已经 在现有的早期肥胖预防试验中未得到充分利用。我试图填补这些空白，成为一名领军人物 早期肥胖预防领域的研究人员，但需要额外的培训。NIDDK 导师研究科学家发展奖将为我提供寻求这种培训的保护时间 并培养实施拟议研究所需的技能。我的短期培训目标是 在以下方面培养科技技能：(1)循证系统建设 行为试验；(2)社会支持的复杂理论；(3)移动健康技术 干预措施(MHealth)；以及(4)独立的、由研究人员发起的R-赠款。我已经养成了一种强大的 培训计划和指导团队，其中包括上述每个领域的领先研究人员； 展示了NIH资助和丰富的指导经验。在研究计划方面，我建议“成长”。 一项mHealth因素筛查实验，将积极干预母亲和 并将利用行为干预的系统设计方面的最新进展，这将允许 干预成分效应的隔离。使用24乘因设计，150个家庭，在基线上分层 母乳喂养的母亲将随机接受标准营养教育加≥的核心干预 4个干预组件中的1个：1)短信强化和反馈，2)增强干预 通过激励来参与，3)加强伴侣的社会支持，和/或4)关于婴儿行为的培训。目标 共同健康成长的关键是确定一套改善婴儿饮食的干预成分：1) 12个月，2)3-12个月之间父母饮食的变化和3)父母反应性喂养方式的变化 在3-12个月之间。将包括改善婴儿饮食、父母饮食或父母喂养方式的成分 在优化的干预方案中，可以在随后的随机对照试验中进行测试。

ABSTRACT There is growing recognition that the first two years of life are a critical period for the prevention of obesity and promising behavioral targets have been identified, including increased intake of fruits and vegetables and decreased intake of sugar-sweetened beverages (SSBs), each of which is associated with parental diet, parental feeding practices, parental perception of infant temperament/behavior and having been breastfed. While the number of behavioral interventions targeting this age group has substantially increased in the last ten years, several critical gaps remain. First, each of the five published trials that focused on the quality of the diet in late infancy delivered multicomponent prevention packages, clouding our knowledge of which intervention strategies were effective. Second, important social changes have not been incorporated into study designs, namely the increased participation of women in the labor force and the convergence of the traditional roles of mothers and fathers; interventions that target mothers and fathers are lacking. Third, mobile technologies have been shown effective at improving a variety of health behaviors among older children and adults, but have been underutilized in existing early life obesity prevention trials. I seek to fill these gaps and become a lead researcher in the field of early life obesity prevention, but require additional training. The NIDDK Mentored Research Scientist Development Award will provide me protected time to seek this training and develop the skills necessary to implement the proposed research. My short-term training goals are to develop scientific and technical skills in: (1) the systematic construction of evidence-based behavioral trials; (2) complex theories of social support; (3) mobile technologies for health interventions (mHealth); and (4) independent, investigator-initiated R-grants. I have developed a strong training plan and mentoring team, which includes leading researchers in each of these areas; researches with demonstrated NIH-funding and extensive mentoring experience. For the research plan, I propose “Growing Healthy Together,” a mHealth factorial screening experiment that will actively intervene with mothers and fathers and will utilize recent advances in the systematic design of behavioral interventions, which will allow for the isolation of intervention component effects. Using a 24 factorial design, 150 families, stratified on baseline maternal breastfeeding, will be randomized to receive a core intervention of standard nutrition education plus ≥ 1 of 4 intervention components: 1) text messaging reinforcement and feedback, 2) enhanced intervention engagement via incentives, 3) enhanced partner social support, and/or 4) training in infant behavior. The aims of Growing Healthy Together are to determine the set of intervention components that improve: 1) infant diet at 12 months, 2) change in parent diet between 3-12 months and 3) change in parent responsive feeding style between 3-12 months. Components that improve infant diet, parent diet, or parent feeding style will be included in an optimized intervention package that can be tested in a subsequent randomized controlled trial.