Effects of Attachment-Based Intervention on Low-Income Latino Children's Emerging Health Outcomes: A Randomized Controlled Trial

项目总结/摘要 在许多常见的情况下，拉丁裔儿童的健康状况比非拉丁裔白色儿童差，包括 呼吸道疾病和肥胖，为整个生命过程中的健康差距奠定了基础。先前研究 证明基于依恋的育儿干预，那些旨在促进敏感的育儿干预， 行为和安全的婴儿-父母的依恋，提高母亲的敏感性，依恋安全，儿童 社会情感发展，以及儿童心理生理调节的某些方面。迄今为止， 是一项大规模的试验，测试基于依恋的干预措施对支持身体健康的有效性 更广泛地说。这是一个巨大的差距，特别是在促进拉丁美洲儿童健康方面， 承诺的依恋为基础的干预措施，和（B）健康差距的早期起源，产生负面影响 拉丁裔儿童，美国人口中最大和增长最快的部分。拟议的RCT将测试 基于依恋的干预对低收入拉丁美洲人新兴健康结果的影响 儿童（N = 260）。我们将把重点放在低收入拉丁裔家庭作为一个群体，在特别高的健康风险 问题人工干预，依恋和生物行为追赶（ABC），包括10 由受过培训的家长教练在家中为主要照顾者及其婴儿提供培训。我们将 招募有9个月大婴儿的家庭，并对其进行纵向跟踪，直到他们2岁。在目标1中，我们将测试 ABC对儿童健康的影响。我们假设积极的干预效果， 和幼儿疾病（例如，呼吸道疾病）、低度炎症、BMI和睡眠。在目标2中，我们将 测试干预效果的介质。我们假设（a）积极的干预效应对敏感的 父母教养行为和儿童压力调节，以及（B）这些因素将介导干预效果 儿童健康成果。在目标3中，我们将测试社会文化背景作为干预的调节因素 方面的影响.我们假设在高风险的二联体中干预效果更强（即，更多的母亲 与低风险的二人组相比，文化适应性差的人得到的支持更少，或者受到的歧视更多。我们 这项建议是创新的，因为随机对照试验的设计提供了一个前所未有的机会来测试因果影响， 一项基于依恋的干预措施，针对一套全面的早期健康结果， 生命历程这一建议的重要性在于，它直接符合NICHD的优先事项，即了解社会 健康的决定因素和减少健康差距的发展知情战略。我们将（a） 检查基于依恋的干预如何支持健康的基础，以及（B）确定亚组， 在未来的努力中，优先考虑优化低收入拉丁裔儿童的健康。

Project Summary/Abstract Latino children have worse health than non-Latino White children across many common conditions, including respiratory illnesses and obesity, laying a foundation for health disparities across the life course. Prior studies demonstrate that attachment-based parenting interventions, those designed to foster sensitive parenting behavior and secure infant-parent attachment, improve maternal sensitivity, attachment security, child socioemotional development, and some aspects of child psychophysiological regulation. To date, there has not been a large-scale trial testing the efficacy of an attachment-based intervention for supporting physical health more broadly. This is a significant gap, especially with regard to Latino child health promotion, given (a) the promise of attachment-based interventions, and (b) the early origins of health disparities that negatively impact Latino children, the largest and fastest-growing segment of the U.S. population. The proposed RCT will test the impacts of an attachment-based intervention on emerging health outcomes in low-income Latino children (N = 260). We will focus on low-income Latino families as a group at exceptionally high risk for health problems. The manualized intervention, Attachment and Biobehavioral Catch-up (ABC), consists of 10 sessions provided by a trained parent coach to primary caregivers and their infants in their homes. We will enroll families with 9-month-old infants and follow them longitudinally until age 2. In Aim 1, we will test the effects of ABC on child health outcomes. We hypothesize positive intervention effects on common infant and toddler illnesses (e.g., respiratory illnesses), low-grade inflammation, BMI, and sleep. In Aim 2, we will test mediators of intervention effects. We hypothesize (a) positive intervention effects on sensitive parenting behaviors and child stress regulation, and (b) that these factors will mediate intervention effects on child health outcomes. In Aim 3, we will test sociocultural context as a moderator of intervention effects. We hypothesize stronger intervention effects in higher-risk dyads (i.e., mothers who are more acculturated, who have fewer supports, or who experience more discrimination) than in lower-risk dyads. Our proposal is innovative in that the RCT design provides an unprecedented opportunity to test causal impacts of an attachment-based intervention on a comprehensive set of early health outcomes known to track across the life course. This proposal is significant in that it aligns directly with the NICHD priority of Understanding Social Determinants of Health and Developmentally Informed Strategies to Mitigate Health Disparities. We will (a) examine how attachment-based intervention supports a foundation for health and (b) identify subgroups to prioritize in future efforts to optimize health in low-income Latino children.