Pathways to Integrate Maternal-Child Health and Nutrition Interventions to Transform Equity and Human Potential

管理副刊 批准号：8 U01 HD115256-02，(上期：U01OD033239) 摘要摘要 加强妇幼保健和营养是实现2030年健康人目标的关键。 投资于从先入为主到童年的综合护理干预定义了一个人的 在整个生命过程中积累并促进社会正义的利益的发展轨迹(即， 通过为子孙后代修复制度，使公平更进一步)。新冠肺炎大流行已经 中断基本的护理服务，如产前、围产期和儿科服务。因此，结束 预计将发生一百万可预防的儿童和产妇死亡，原因是极端贫困和家庭 粮食不安全(HFI；由于有限的原因，无法持续获得足够的健康食品，以实现积极、健康的生活 财政资源)。在新冠肺炎平台上，美国有孩子的家庭高频指数增加了两倍(约19.5%)， 给边缘化的低收入和有色人种家庭带来不成比例的负担。肾综合征出血热与 种族/族裔不平等和不利的母婴健康和营养结果。整合有效的食物 作为新冠肺炎应对和恢复努力的养育护理服务中的安全干预是一种 促进公平的可实现战略。西拉斯维加斯承诺社区(WLVPN)是一个 针对健康的社会决定因素的干预措施，以减少历史上种族/族裔中的结构性种族主义 内华达州拉斯维加斯的边缘社区。WLVPN由50多个多部门合作伙伴实施 在内华达州协调的关键生活领域(健康、教育、就业、住房和社会正义) 合作伙伴公司，我们与他们有着坚实的合作关系。虽然WLVPN社会干预是一种独特的 为解决母婴死亡率和粮食不安全水平方面普遍存在的不平等现象提供机会和平台， 缺乏对母婴健康和营养的关注。因此，我们与内华达伙伴公司的合作伙伴关系是 在WLVPN内促进母婴组成部分并推动实施和 股权研究。这一实施科学项目正在利用以社区为基础的参与式方法 以及一个种族公平框架，与社区共同创建早期响应性养育关怀 粮食安全干预措施，将母婴健康和营养结合起来。Eain-FS是一种 系统级干预，由一系列以股权为重点的实施战略组成，以适应和 整合有效的粮食安全干预措施--(1)普遍筛查肾综合征出血热，(2)转诊以获得现有的 WLVPN社区内的健康-营养和其他养育护理资源，以及(3)护理协调，以 实现粮食安全的途径。该项目旨在告知如何最好地采取多部门干预 (母婴健康和粮食不安全干预措施)可以结合起来，以促进 历史上被边缘化社区的母婴保健和营养。一种三阶段混合方法 将采用一种方法来实现该项目的主要目标： 第一阶段将包括对以下方面的详细分析：(1)整合有效食物的背景障碍和促进者 母婴养育服务的安全干预措施和(2)母婴基线评估 社会经济、人口和健康需求。 第二阶段将包括与社区共同创建一系列以股权为重点的实施 调整和将收入-家庭服务干预措施纳入母婴养育服务的战略 第三阶段将包括评估实施可行性(第三阶段A和第三阶段B)和第三类混合项目 开展执行研究，以评价注重公平的执行和成效成果，即 母子二人组的粮食不安全程度(阶段3C)。

Admin Supplement Grant Number: 8 U01 HD115256-02, (previous FAIN: U01OD033239) Abstract Summary Strengthening maternal and child health and nutrition is critical to achieving the Healthy People 2030 Goals. Investing in integrated nurturing care interventions from preconception through childhood defines one’s developmental trajectory with benefits that accumulate across the life course and promote social justice (i.e., taking equity one step further by fixing the systems for generations to come). The COVID-19 pandemic has disrupted essential nurturing care services such as prenatal, perinatal, and pediatric services. As a result, over a million preventable child and maternal deaths are projected to occur due to extreme poverty and household food insecurity (HFI; lack of consistent access to enough healthful food for an active, healthy life due to limited financial resources). Amid COVID-19, HFI in the US tripled among households with children (~19.5%), disproportionately burdening marginalized low-income and families of color. HFI is strongly linked with racial/ethnic inequities and adverse maternal-child health and nutrition outcomes. Integrating effective food security interventions within nurturing care services as a COVID-19 response & recovery effort is an achievable strategy to promote equity. The West Las Vegas Promise Neighborhood (WLVPN) is an intervention addressing social determinants of health to reduce structural racism in historically racial/ethnic marginalized communities in Las Vegas, Nevada. The WLVPN is implemented by over 50 multi-sector partners in key life domains (health, education, employment, housing, and social justice) coordinated by Nevada Partners, Inc., with whom we have a solid collaboration. While WLVPN social intervention is a unique opportunity and platform to address endemic inequities in maternal-child mortality and food insecurity levels, it lacks focus on maternal-child health and nutrition. Therefore, our partnership with Nevada Partners, Inc. is well-placed for promoting the maternal-child component within WLVPN and advancing implementation and equity research. This implementation science project is utilizing a community-based participatory approach along with a racial equity framework to co-create WITH the community the Early Responsive Nurturing Care for Food Security (EARN-FS) intervention to integrate maternal-child health and nutrition. The EARN-FS is a system-level intervention consisting of a bundle of equity-focused implementation strategies to adapt and integrate effective food security interventions – (i) universal screening for HFI, (ii) referrals to access existing health-nutrition & other nurturing care resources within WLVPN communities, and (iii) care coordination to achieve pathways for food security. This project is designed to inform how best multi-sectoral interventions (maternal-child health and food insecurity interventions) can be integrated to promote transformation in the maternal-child health and nutrition of historically marginalized communities. A three-phase mixed-methods approach will be used to achieve the major goals of this project: Phase 1 will consist of a detailed analysis of (i) contextual barriers and facilitators to integrating effective food security interventions into maternal-child nurturing care services and (ii) baseline assessment of maternal-child socioeconomic, demographic, and health needs. Phase 2 will consist of the co-creation WITH the community of a bundle of equity-focused implementation strategies to adapt and integrate the EARN-FS intervention within maternal-child nurturing care services Phase 3 will consist of assessing implementation feasibility (phases 3A & 3B) and a hybrid type III implementation study to evaluate equity-focused implementation and effectiveness outcomes, i.e., changes in levels of food insecurity of maternal-child dyads (phase 3C).