Reducing Health Disparities through an Adaptive Healthy Eating Program for Underserved Infants in a Home Visiting Program

项目摘要 不良的饮食习惯和肥胖风险在婴儿期就开始了。来自服务不足和少数族裔背景的婴儿 与肥胖相关的营养不良结果和随后的健康差距的比率各不相同。 每个婴儿和他们的家庭都经历了一系列独特的风险因素和健康饮食障碍。然而， 在文化上和背景上与服务不足的家庭相关的肥胖预防计划，并进行调整 根据个别家庭的需求是缺乏的。目前的研究将开发一种预防肥胖的方法 计划，为我的婴儿提供健康饮食(HEMI)，使用社区参与的方法，涉及社区 参与项目开发和交付的成员。HEMI的目标是通过六个月的健康婴儿喂养 与3-8个月大的婴儿进行对话。该计划将作为现有计划的补充提供 循证家访计划，每一个孩子都成功(ECS)，主要服务于低收入家庭 收入和少数民族/种族背景。治疗单元包括：1)两个标准化疗程 重点关注儿童营养建议、响应性喂养和儿童进餐行为，2)两个量身定做 根据个人家庭需求和偏好从模块列表中选择课程；3)两个课程 拥有宝贵的生活经验专业知识和个人第一手知识的同伴辅导员 关于他们社区的日常生活，这可能对家庭有益。通过小组级别的评估 (GLA)、社区利益相关者(例如ECS领导层、社区合作伙伴、家庭访客和家庭)将 确定有关ECS照顾者的需求、资源和障碍的主题，这些障碍与婴儿健康饮食和 喂养，包括创伤史的影响。这些主题将在行动规划会议上使用 社区成员为HEMI内容制定一个计划，这对家庭是相关的和有帮助的。而当 自适应模块的具体内容将根据GLA和行动规划阶段确定， 治疗单元可以处理诸如产妇心理健康和既往创伤的影响等主题。 关于进食行为、情绪化进食和非饥饿进食的历史，解决儿童营养问题 并在许多其他生活需求的背景下进食，准备时间和成本效益高的家庭膳食，以及 动员其他照顾者促进健康饮食。将完成HEMI的先导性随机对照试验 有15个治疗家庭和15个对照家庭参加了ECS计划。这项试验将检验 实施并收集家庭和同伴辅导员对治疗满意度和相关性的反馈。 降低体重指数第85百分位数和改善儿童饮食方案的效果 (通过面谈进行评估-实施24小时饮食召回)在治疗后也将进行检查。 制定适应和有效的肥胖预防计划，满足服务不足者的需求 婴儿对于解决婴儿进食和肥胖方面的健康差距至关重要。

Project Abstract Poor dietary habits and obesity-risk begin early in infancy. Infants from underserved and minority backgrounds experience disparate rates of poor nutritional outcomes and subsequent health disparities related to obesity. Each infant and their family experiences a unique set of risk factors and barriers to healthy eating. However, obesity prevention programs that are culturally and contextually relevant for underserved families and adapted based on the needs of individual families are lacking. The current study will develop an obesity prevention program, Healthy Eating for My Infant (HEMI), using a community-engaged approach involving community members in development and delivery of the program. HEMI targets healthy infant feeding through six monthly sessions with infants 3-8 months old. The program will be delivered as a supplement to an already existing evidence-based home visiting program, Every Child Succeeds (ECS), serving families with primarily low income and ethnic/racial minority backgrounds. Treatments modules include: 1) two standardized sessions focused on child nutrition recommendations, responsive feeding, and child mealtime behaviors, 2) two tailored sessions selected from a list of modules based on individual family need and preference, and 3) two sessions with a peer counselor who has valuable lived-experience expertise and personal firsthand knowledge regarding everyday life in their community that can be of benefit to families. Through a group level assessment (GLA), community stakeholders (e.g., ECS leadership, community partners, home visitors, and families) will identify themes regarding ECS caregivers’ needs, resources, and barriers related to healthy infant eating and feeding, including the influence of trauma history. These themes will be used in an action planning session with community members to develop a plan for HEMI content that is relevant and helpful for families. While the specific content of adaptive modules will be determined based on the GLA and action planning phase, treatment modules could address topics such as the influence of maternal mental health and past trauma history on feeding behaviors, emotional eating and eating in the absence of hunger, addressing child nutrition and feeding in the context of many other life demands, preparing time and cost-efficient home meals, and engaging other caregivers to promote healthy eating. A pilot randomized control trial of HEMI will be completed with 15 treatment and 15 control families enrolled in the ECS program. This trial will examine the feasibility of implementation and gather family and peer counselor feedback on treatment satisfaction and relevance. Effectiveness of the program for reducing rates of Body Mass Index > 85th percentile and improving child diet (assessed via interview-administered 24-hr dietary recalls) at post-treatment will also be examined. Development of an adaptive and effective obesity prevention program meeting the needs of underserved infants is critical for addressing health disparities in infant eating and obesity.