Developing tailored home environment interventions to address childhood obesity

描述（由研究者提供）：肥胖在美国是一种严重的健康问题，会增加某些癌症、心脏病和糖尿病的风险。儿童肥胖症在低收入、黑人和拉丁裔儿童中尤为普遍。预防和治疗青少年超重的关键在于帮助家庭发展新的生活方式，创造有利于促进健康饮食和体育活动的环境。迫切需要为低收入和少数民族家庭开发和测试儿童肥胖症预防和治疗方法，这些方法既有效，又在文化上可接受和可持续。目前拟议的R21项目的目的是：1）。开展形成性研究，为2-5岁儿童的低收入多族裔父母制定文化上适当的评估工具和适合家庭的干预措施提供信息; 2）。开展试点可行性研究，为未来随机对照试验的设计和实施提供信息。在01年，我们将进行形成性研究，包括：a）。与WIC营养学家组成焦点小组，探讨他们对教育幼儿低收入父母有关饮食、PA和儿童肥胖预防的见解; B）。与目标受众家长的焦点小组，以确定目标行为，绩效目标，个人和外部决定因素，改变目标和干预方法/策略。健康饮食、PA和体重控制; c）.与目标受众父母一起对现有的测量儿童饮食和PA行为的工具进行认知评估测试，社会和物理家庭环境以及相关的心理社会问题，以修改这些工具，使其在文化和语言上适当。这些信息将用于制定干预和评价工具。在2002年，我们将进行一项试验性可行性研究，为未来的RCT提供信息。试点研究将：（a）。确定受试者招募和保留方法、干预措施、过程和结局评价方法和措施的可行性; B）实施过程评价，以确定实施保真度，包括剂量及其与主要和次要结局指标的关系; c）.探索主要和次要结果指标与潜在中介变量之间的关系在试点研究中，50对父母和孩子将接受量身定制的干预，这些干预将提供给父母，包括：一个家庭锻炼录像，一个电视监视器，4套文化和语言上适当的低识字率个人定制的书面材料，穿插电话咨询电话，将在一年内提供三次20天的时间给父母/家人。干预措施将侧重于帮助父母发展新的生活方式，并创造支持性环境，以促进/促进儿童的健康饮食和PA。在2002年年底，我们将汇编所有定性和定量的形成、过程和结果评估数据，并使用干预映射方法将其应用于规划未来的RCT，该RCT将测试针对BMI测量、儿童的饮食和PA行为以及社会和物理家庭环境的定制家庭干预的有效性。公共卫生相关性：儿童肥胖症在美国是一个严重的健康问题，因为患病率很高并且不断增加，特别是在低收入以及非洲裔美国人和西班牙裔儿童中。拟议的项目将进行形成性研究和可行性研究，为未来的随机对照试验提供信息，该试验将测试可持续干预措施在低收入，种族多样化家庭中预防/治疗儿童肥胖的有效性。

DESCRIPTION (provided by investigator): Obesity is a serious health problem in the US that increases risk of certain cancers, heart disease and diabetes. Childhood obesity is particularly prevalent in low income, Black and Latino children. The prevention and treatment of overweight in youth hinges on helping families develop new lifestyles and create supportive environments in which healthful eating and physical activity (PA) can be promoted. There is a pressing need to develop and test childhood obesity prevention and treatment approaches for low income and minority families that are effective, but also culturally acceptable and sustainable. The purposes of the current proposed R21 project are to: 1). conduct formative research to inform the development of culturally appropriate evaluation tools and family-tailored interventions for low income ethnically diverse parents of children aged 2-5; and 2). conduct a pilot feasibility study to inform the design and implementation of a future RCT. In Year 01, we will conduct formative research including: a). Focus groups with WIC nutritionists to explore their insights into educating low income parents of young children about diet, PA and childhood obesity prevention; b). Focus groups with target audience parents to determine target behaviors, performance objectives, personal and external determinants, change objectives and intervention methods/strategies re. healthy eating, PA and weight control; c). Cognitive assessment testing with target audience parents on existing instruments for measuring children's dietary and PA behaviors, the social and physical home environment and relevant psychosocial issues to revise these tools so they are culturally and linguistically appropriate. This information will be used to develop intervention and evaluation tools. In Year 02, we will conduct a pilot feasibility study to inform the future RCT. The pilot study will: a). determine the feasibility of subject recruitment and retention methods, interventions, process and outcome evaluation methods and measures; b) implement process evaluation to determine implementation fidelity including dose and its' relationship with primary and secondary outcome measures; c). Explore relationships between primary and secondary outcome measures and potential mediating variables In the pilot study, 50 parent-child pairs will receive the tailored intervention, which will be delivered to parents will include: a family exercise video, a TV monitor, 4 sets of culturally and linguistically appropriate individually tailored low literacy written materials interspersed with telephone counseling calls that will be delivered three times over a 20 week period to the parent/family. The intervention will focus on helping parents to develop new lifestyles and create supportive environments to promote/facilitate healthful eating and PA in their children. At the end of Year 02, we will compile all qualitative and quantitative formative, process and outcome evaluation data and apply it using an intervention mapping approach to plan a future RCT that will test the efficacy of tailored home-based interventions on BMI measures, dietary and PA behaviors of children, and the social and physical home environment. PUBLIC HEALTH RELEVANCE: Childhood obesity is a serious health problem in the US as the prevalence is high and increasing, especially in low income as well as African American and Hispanic children. The proposed project will conduct formative research and a feasibility study to inform a future randomized controlled trial that will test the effectiveness of sustainable interventions to prevent/treat childhood obesity in low income, ethnically diverse families.