Implementing Prevention Plus for childhood overweight and obesity in food secure and insecure families

 描述(申请人提供)：切诺基健康系统(CHS)是一家联邦合格的健康中心，为东田纳西州服务不足的人提供综合初级保健，4至10岁儿童超重和肥胖的流行率约为42%，有超过50%的儿童在CHS接受护理的家庭粮食不安全。因此，这些儿童在以后的生活中经历健康差距的风险很高。建议将“预防加”(PP)用于初级保健环境中的儿童肥胖症治疗。我们评估了PP，以确定能量平衡行为以及6个月内接触频率和方式的最佳组合，以优化4至10岁儿童的标准化体重指数(ZBMI)的减少。我们的PP计划已经将zBMI降低到了一定程度，应该可以改善幼儿的心脏代谢健康，这对解决健康差距非常重要。然而，这项计划在初级保健提供者提供给未得到充分服务的儿童时改善体重状况的能力尚不清楚。由于家庭食品不安全在CHS家庭中非常普遍，以家庭为基础的方法，即向照顾者和儿童提供能量平衡行为目标，可能会降低总体家庭依从性和计划满意度，因为在食物不安全的家庭中，女性照顾者在参与对孩子的干预时可能会对实现自己的饮食目标感到不舒服，或者可能担心当多个家庭成员有饮食目标时，购买被认为更昂贵的食品所需的变化程度。如果不解决这些问题，可能会降低社区卫生服务计划的整体有效性。因此，本应用程序的目的是进行一项随机对照试验，检查我们通过电子健康记录(EHR)实施的PP计划，该计划由CHS初级保健提供者行为健康咨询公司提供，对在CHS接受初级保健的儿童和超重和肥胖的儿童进行zBMI。此外，我们将探索家庭食品安全状况对我们的PP计划的调节作用，该计划在有和没有看护目标的情况下提供。来自CHS的60个食物安全和60个食物不安全的家庭，有一名女性照顾者和一个4至10岁的孩子，体重指数为85%，将被随机分为以下三种情况中的一种：1)时事通讯；2)有看护能量平衡行为目标(PP+)的PP；以及3)没有看护能量平衡行为目标(PP-)的PP。主要目的是确定：1)在6个月时，PP+和PP-的儿童的zBMI是否会低于时事通讯；并探索：a)在粮食安全家庭中，PP+产生的儿童zBMI是否低于PP-；以及b)在粮食不安全的家庭中，PP-产生的儿童zBMI是否低于PP+。从EHR中提取的数据将提供有关计划实施和交付的信息，并将对儿童和照顾者的饮食和活动以及照顾者计划满意度进行比较，以更好地了解家庭食品安全状况可能影响结果的潜在机制。

 DESCRIPTION (provided by applicant): At Cherokee Health Systems (CHS), a federally qualified health center which provides integrated primary care to the underserved in East Tennessee, the prevalence of overweight and obesity in children aged 4 to 10 years is approximately 42% and over 50% of households with children receiving care at CHS are food insecure. Thus, these children are at high risk for experiencing health disparities later in life. Implementing "Prevention Plus" (PP) is recommended for childhood obesity treatment within a primary care setting. We have evaluated PP to determine the best combination of energy balance behaviors, and frequency and mode of contact over 6 months, to optimize reductions in standardized body mass index (zBMI) in children aged 4 to 10 years. Our PP program has reduced zBMI to a degree that should improve cardiometabolic health in young children, which is important in addressing health disparities. However, the ability of this program to improve weight status when delivered by primary care providers to underserved children is unknown. As household food insecurity is so prevalent with CHS families, a family-based approach, in which energy balance behavior goals are provided to both caretaker and child, may reduce overall family adherence and program satisfaction, as female caretakers in food insecure households may feel less comfortable meeting their own dietary goals while participating in an intervention for their child, or may be concerned with the degree of change required in purchasing food perceived as more costly when multiple family members have dietary goals. Not addressing these concerns may reduce overall effectiveness of the program in CHS. Thus, the aim of this application is to conduct a randomized controlled trial examining our PP program implemented through the electronic health record (EHR) and delivered by CHS primary care providers, Behavioral Health Consultants, on child zBMI in underserved children who receive their primary care at CHS and who are overweight and obese. Furthermore, we will explore the moderating effect of household food security status on our PP program delivered with and without caretaker goals. Sixty food secure and 60 food insecure families from CHS, with a female caretaker and a child aged 4 to 10 years who is > 85th percentile BMI, will be randomized to 1 of 3, 6-month conditions: 1) Newsletter; 2) PP with caretaker energy balance behavior goals (PP+); and 3) PP without caretaker energy balance behavior goals (PP-). The primary aim is to determine if: 1) at 6 months, children in PP+ and PP- will have a lower zBMI than Newsletter; and explore if: a) in food secure households, if PP+ produces a lower child zBMI than PP-; and b) in food insecure households, if PP- produces a lower child zBMI than PP+. Data extraction from the EHR will provide information about program implementation and delivery and comparisons will be made on child and caretaker diet and activity and caretaker program satisfaction to better understand potential mechanisms by which household food security status may moderate outcomes.