Value and mechanisms of home visitation in obesity interventions for low-income children

项目摘要/摘要 来自低收入家庭的孩子变得肥胖的可能性是来自高收入家庭的孩子的两倍多。 收入家庭，这使他们在整个一生中患肥胖症相关慢性病的风险增加 成年人的生活。以家庭为基础的儿童肥胖干预，特别是为低收入人群设计的干预措施 越来越多的儿童在儿童之家分娩。家访具有多方面的潜力 与提供传统医疗和治疗相比，可以提高减肥效果的优势 学术环境。通过消除交通和照看孩子的需要，家访可能会使 低收入家庭更容易获得治疗，从而获得更高的干预剂量。家 探视使干预人员能够直接观察和解决家庭环境中的风险因素， 潜在地使他们能够提供更有针对性和更有力的治疗建议。照顾者可以 当他们学习和排练新技能时，也更有可能在他们的家庭中应用健康的变化 它们将在何处实施的环境。到目前为止的研究一直发现，以家庭为基础 干预措施比低强度的比较条件更有效，如等待名单控制、健康 教育和常规医疗服务。然而，由于家访治疗方式与 在先前的研究中，干预的剂量、强度和内容缺乏经验证据来支持其 使用。该项目的目标是系统地评估增量减肥的效益和成本- 在家庭环境中为儿童超重/肥胖提供标准的家庭治疗的效果 与传统医疗环境的对比。在一项涉及低收入家庭的随机对照试验中，266名儿童 6-11岁的儿童将被分配到为期12个月的家庭治疗中，无论是在他们的家里还是在 城市学术医疗中心。两个武器将接受相同的干预内容和剂量，但不同 仅限于面对面治疗的地点。目标1是检验这样一种假设，即家庭治疗 在儿童肥胖方面产生更大的减少，反映在12个月的BMI z得分变化中。目标2是 比较家庭治疗和医疗中心治疗的成本-效果，并计算 增加了与家访相关的递增减肥收益的成本。这些数据将为我们的努力提供信息 由公共卫生机构和第三方为低收入人群提供居家干预 付款人。目标3是探索家访可以改善体重减轻的具体机制。 结果。这项试验的结果将对未来儿童超重/肥胖的设计产生重大影响 干预措施，因为几乎任何方案都可以改编成在家庭环境中实施。

PROJECT SUMMARY/ABSTRACT Children from low-income families are more than twice as likely to become obese than those from higher- income households, which places them at increased risk for obesity-related chronic diseases throughout their adult lives. Family-based pediatric obesity interventions, particularly those designed for low-income populations, are increasingly delivered in children’s homes. Home visitation has a number of potential advantages that could enhance weight loss outcomes relative to delivering treatment in traditional medical and academic settings. By eliminating the need for transportation and childcare, home visitation may make treatment more accessible for low-income families, resulting in a higher dosage of intervention received. Home visitation allows intervention staff to directly observe and address risk factors in the home environment, potentially enabling them to provide more tailored and potent treatment recommendations. Caregivers may also be more likely to apply healthy changes in their household when they learn and rehearse new skills in the environment where they are to be implemented. Research to date has consistently found that home-based interventions are more effective than low-intensity comparison conditions such as wait-list controls, health education, and usual medical care. Yet, as the home visitation treatment modality has been confounded with intervention dosage, intensity, and content in prior studies, there is a lack of empirical evidence to support its use. The goal of this project is to systematically evaluate the incremental weight loss benefit and cost- effectiveness of delivering standard family-based treatment for pediatric overweight/obesity in the home setting vs. traditional medical settings. In a randomized controlled trial involving low-income households, 266 children ages 6-11 years will be allocated to 12 months of family-based treatment delivered either in their home or at an urban academic medical center. Both arms will receive the same intervention content and dosage, and differ only in the location of in-person treatment sessions. Aim 1 is to test the hypothesis that home-based treatment produces a greater reduction in child adiposity, reflected in 12-month change in BMI z-score. Aim 2 is to compare the cost-effectiveness of home-based treatment to medical center-based treatment, and calculate the added cost of the incremental weight loss benefit associated with home visitation. These data will inform efforts to disseminate home-based interventions for low-income populations by public health agencies and third-party payers. Aim 3 is to explore specific mechanisms through which home visitation may improve weight loss outcomes. The results of this trial will have a strong impact on the design of future pediatric overweight/obesity interventions, as virtually any program could be adapted for delivery in the home setting.