Healthy Child Weight Through Improved Parent Practices and Environmental Change

描述（由研究者提供）：3 - 7岁之间的早期被描述为肥胖发展的关键时期。专家们强调了家庭对幼儿饮食和体育活动行为发展的重要性，但迄今为止，还没有制定出将强烈的家庭关注重点放在改善育儿实践上的肥胖预防干预措施。本文提出的工作将通过测试12个月以父母为中心的干预措施的有效性来解决这一差距，该干预措施旨在改变儿童家庭环境的多个方面（包括社会和物理），从而降低儿童的体脂百分比（%BF）。受试者将是280对父母和孩子，他们是通过照顾低收入家庭的儿童保育机构招募的。基线测量后，将配对随机分为干预组或对照组。干预措施将首先侧重于教授更有效的育儿技巧（时间管理、沟通等）;然后展示特定的育儿实践如何影响孩子的身体和社会环境，并鼓励更健康的行为。干预措施将通过小组会议和家庭电话（群聊和定制电话）提供，由一名认证的家长教育工作者提供便利。小组会议将使用多种教学策略，如“Parentela Novellas”（肥皂剧般的视频，提供技能实践的模型）。课程还将提供单独的儿童活动，以胁迫假设为基础，并为儿童接受新的育儿实践做好准备。小组电话聊天将在父母之间建立同伴支持，量身定制的咨询电话将使用动机访谈技术来帮助父母克服实施新行为的障碍。干预措施以Darling和Steinberg的父母养育综合模式（1993年）为指导，该模式强调了父母养育价值观、风格和做法在儿童社会化中的重要性。此外，自我决定理论（瑞安，2000年）被用来创建一个程序，培养父母的自主动机，采用新的育儿方式和做法。其结果是一种干预措施，将帮助父母学习技能，以减少与父母有关的压力，并创造一个家庭环境，支持健康体重行为的发展。将使用人体测量学和经验证的预测方程（Denzenberg，1999）评估主要结局（儿童的%BF）。分析将包括结局的基线测量值作为协变量。次要措施包括儿童和母亲的饮食和体育活动，父母的方式和做法，父母的压力，和家庭环境。将在12个月无干预期后评估干预效果的维持。这种干预将创造必要的密集接触，使父母和孩子的行为发生改变生活的变化，从而减少体脂。计划是基于广泛的形成性工作，研究将由一组非常有经验的调查人员领导。 公共卫生相关性：需要努力确保幼儿发展健康的饮食和体育活动行为，以促进健康的体重发展。父母的行为影响社会和物理家庭环境，创造了这些行为发展的背景。几乎没有预防肥胖的项目，更少的项目采用了以家庭为中心的方法。该应用程序描述了一种创新的，理论驱动的干预措施，旨在帮助父母实施更有效的育儿行为，减少他们与父母相关的压力，同时也创造了一个家庭环境，支持他们的学龄前儿童健康体重实践的发展。

DESCRIPTION (provided by investigator): The early years between ages 3 -7 have been described as a critical period in the development of obesity. The importance of the family on the development of eating and physical activity behaviors in young children has been emphasized by experts, yet to date no obesity prevention interventions incorporating a strong family focus with emphasis on improved parenting practices have been developed. The work proposed here will address this gap by testing the efficacy of a 12-mo parent-focused intervention designed to change multiple aspects of children's home environments (both social and physical), which in turn will reduced percent body fat (%BF) in children. Subjects will be 280 parent-child pairs recruited through child care settings that cater to lower income families. Following baseline measures, pairs will be randomized into intervention or control. The intervention will first focus on teaching more effective parenting skills (time management, communication, etc.); then showing how specific parenting practices can influence a child's physical and social environment and encourage healthier behaviors. The intervention will be delivered through group sessions and home-based telephone calls (group chats and tailored calls) facilitated by a certified parent educator. Group sessions will use multiple teaching strategies such as "Parentela Novellas" (soap opera-like videos which provides models for skills practice). Sessions will also provide separate child activities that build off the coercion hypothesis and prepare children to receive new parenting practices. Group phone chats will build peer support among parents and tailored counseling calls will use motivational interviewing techniques to help parents overcome barriers to implementing new behaviors. The intervention is guided by Darling and Steinberg's Integrative Model of parenting (1993) which highlights the importance of parenting values, style and practices in child socialization. In addition, Self-Determination Theory (Ryan, 2000) is used to create a program that fosters parents' autonomous motivation to adopt new parenting style and practices. The result is a intervention that will help parents learn skills to reduce their parenting-related stress and create a home environment that supports the development of healthy-weight behaviors. The primary outcome, %BF in children, will be assessed using anthropometry and a validated prediction equation (Denzenberg, 1999). Analyses will include baseline measurements of the outcome as a covariate. Secondary measures include child and mother diet and physical activity, parenting style and practices, parenting stress, and home environment. Maintenance of intervention effect will be assessed following a 12-mo no-intervention period. This intervention will create the intensive exposure necessary to make life-altering changes in parent and child behavior that will result in reduced body fat. Plans are based on extensive formative work, and the research will be lead by a group of very experienced investigators. PUBLIC HEALTH RELEVANCE: Efforts are needed to assure that young children develop healthy eating and physical activity behaviors for healthy weight development. Parent behavior affects both the social and physical home environment, creating the context within which these behaviors develop. Few programs exist to prevent obesity and fewer still have used a family-focused approach. This application describes an innovative, theory-driven intervention designed to help parents implement more effective parenting behaviors and reduce their parenting-related stress, while also creating a home environment that supports the development of healthy weight practices in their preschool children.