Does the provision of postnatal parenting support in primary care improve cardiometabolic health in early childhood among at-risk-families?

项目概要： 心脏代谢健康的人口水平趋势恶化突出了人们对远离疾病的深刻需求。 从传统的疾病模型集中在下游心脏代谢危险因素的补救， 关注相关的上游风险。相关的上游风险包括早期生活逆境（ELA）， 健康的社会决定因素的独特子集，发生在生命早期，并假设成为生物学 嵌入式，从而随着时间的推移塑造健康和疾病风险的生命历程轨迹。大量文献表明， 暴露于ELA会带来心脏代谢疾病的潜在风险，但很少有研究（尽管有希望） 研究是否早期干预暴露于ELA的儿童可以减少这种风险。相关文献综述 一般认为：1）早期干预更有效; 2）家庭中的干预效益最大 3）养育子女是一种机制，通过这种机制，早期干预的好处得以传播; 4） 现有的育儿干预措施，在亲子行为和关系方面被认为是成功的 结果，是与儿童身体健康结果有关的测试的候选人。在此基础上， 拟议的研究是一个独特的和时间敏感的机会，以扩大现有的随机对照试验的目标， 实施了一项育儿干预-促进第一关系®（PFR）与不干预 作为低收入产后妇女抑郁症治疗的辅助药物。的目的 拟议的研究是为了确定PFR干预的好处，最初旨在影响父母- 婴儿期的儿童行为和关系结果可能会延伸到儿童早期的心脏代谢健康， 童年.据推测，PFR干预将增加上游的弹性因素-养育 质量-在脆弱的早期阶段，可能有益于儿童的心脏代谢健康。预计 干预对更远的儿童心脏代谢健康结果的影响被假设为部分 可归因于更近端干预相关目标的变化，包括母体敏感性、母体 理解、母子关系质量和儿童自我调节。这项拟议中的研究寻求NIH的资助 支持214名参加原始RCT的母子二人组（占252个家庭总数的85%）返回。 大多数家庭（80%）属于少数种族/民族，32%讲西班牙语，所有家庭都是 认为低收入。家庭将在孩子5 - 6岁和7 - 8岁之间完成两次家访。 这些访问将需要进行评估，这些评估与原始研究中关于父母-子女行为的评估平行。 和关系结果，但也将包括以健康为重点的评估领域，已知预测长期- 长期疾病风险，包括心血管健康、代谢健康和炎症。健康指标将 数据来源包括人体测量和血压评估，干血斑 收集，活动和睡眠监测，以及面试官管理的问卷调查。结果将扩大 广泛地提供给心脏代谢健康状况不佳风险不成比例的弱势家庭。

PROJECT SUMMARY: Worsening population-level trends in cardiometabolic health highlight the profound need to move away from traditional disease models focused on the remediation of downstream cardiometabolic risk factors to instead focus on relevant upstream exposures. Relevant upstream exposures include early life adversities (ELA), a unique subset of social determinants of health that occur early in life and are hypothesized to become biologically embedded, thereby shaping life course trajectories of health and disease risk over time. A robust literature shows ELA exposures confer prospective risk for cardiometabolic disease, yet few—albeit promising—studies have examined whether early intervention in ELA-exposed children may lessen this risk. Review of relevant literatures suggests generally that 1) earlier intervention is more effective; 2) intervention benefits are greatest in families most in need; 3) parenting is a mechanism through which early intervention benefits are transmitted; and 4) existing parenting interventions, deemed successful with respect to parent-child behavioral and relationship outcomes, are candidates for testing in relation to child physical health outcomes. Building on this foundation, the proposed study represents a unique and time-sensitive opportunity to extend the aims of an existing RCT in which a parenting intervention—Promoting First Relationships® (PFR) versus no intervention—was implemented as an adjuvant to depression treatment in a sample of low income, postnatal women. The purpose of the proposed study is to determine whether benefits of the PFR intervention, originally designed to impact parent- child behavioral and relationship outcomes in infancy may extend to the child’s cardiometabolic health in early childhood. It is hypothesized that the PFR intervention will augment an upstream resiliency factor—parenting quality—at an early period of vulnerability, potentially benefiting the child’s cardiometabolic health. Expected intervention effects on the more distal child cardiometabolic health outcomes are hypothesized to be partially attributable to changes in the more proximal intervention-related targets, including maternal sensitivity, parent understanding, mother-child relationship quality, and child self-regulation. The proposed study seeks NIH funding to support the return of 214 mother-child dyads (85% of 252 total families) who participated in the original RCT. The majority of families (80%) belong to a minority race/ethnic group, 32% are Spanish-speaking, and all are considered low income. Families will complete two home-based visits between child’s age 5-6 and 7-8 years. These visits will entail assessments that parallel measures in the original study regarding parent-child behavioral and relationship outcomes but will also include health-focused assessments in domains known to predict long- term risk for disease, including cardiovascular health, metabolic health, and inflammation. Health indicators will be derived from data sources including anthropometric and blood pressure assessments, a dried blood spot collection, activity and sleep monitoring, and interviewer-administered questionnaires. Results will extend broadly to vulnerable families at disproportionate risk for poor cardiometabolic health.