Developing tailored home environment interventions to address childhood obesity

描述(由调查人员提供)：在美国，肥胖是一个严重的健康问题，会增加患某些癌症、心脏病和糖尿病的风险。儿童肥胖症在低收入、黑人和拉丁裔儿童中尤为普遍。预防和治疗青少年超重取决于帮助家庭发展新的生活方式和创造有利的环境，在这种环境中可以促进健康的饮食和体育活动(PA)。迫切需要为低收入和少数族裔家庭开发和测试儿童肥胖症预防和治疗方法，这些方法既有效，又在文化上可接受和可持续。目前拟议的R21项目的目的是：1)。开展形成性研究，为2-5岁儿童的低收入、不同族裔的父母制定适合文化的评估工具和针对家庭的干预措施提供信息；和2)。开展试点可行性研究，为设计和实施未来的区域现金转移项目提供信息。在二零零一年，我们会进行形成性研究，包括：a)与WIC营养师进行焦点小组讨论，探讨他们对教育幼儿低收入父母关于饮食、PA和儿童肥胖预防的见解；b)与目标受众家长组成焦点小组，以确定目标行为、表现目标、个人和外部决定因素、改变目标和干预方法/策略。C)健康饮食、PA和体重控制；与目标受众家长一起进行认知评估测试，测试现有的测量儿童饮食和PA行为的工具、社会和物质家庭环境以及相关的心理社会问题，以修订这些工具，使其在文化和语言上都是合适的。这些信息将用于制定干预和评估工具。在二零零二年，我们会进行一项试验可行性研究，为日后的研究小组提供资料。试点研究将：a)。确定受试者招募和保留方法、干预措施、过程和结果评价方法和措施的可行性；b)实施过程评价，以确定执行的忠诚度，包括剂量及其与主要和次要结果衡量的关系；c)在试点研究中，50对亲子将接受量身定做的干预，将提供给父母：一段家庭锻炼视频，一台电视监视器，4套文化和语言上合适的单独定制的低识字率书面材料，其间穿插着电话咨询电话，将在20周内向父母/家庭发送三次。干预措施将集中于帮助父母发展新的生活方式，并创造支持性环境，以促进/促进他们孩子的健康饮食和PA。在2002年年底，我们将收集所有定性和定量的形成性、过程性和结果评估数据，并使用干预地图方法应用这些数据来规划未来的RCT，以测试以家庭为基础的量身定制干预措施对BMI测量、儿童的饮食和PA行为以及社会和物理家庭环境的有效性。与公共健康相关：在美国，儿童肥胖症是一个严重的健康问题，因为儿童肥胖率很高，而且还在上升，特别是在低收入以及非裔美国人和西班牙裔儿童中。拟议的项目将进行形成性研究和可行性研究，为未来的随机对照试验提供信息，该试验将测试可持续干预措施的有效性，以预防/治疗低收入、种族多元化家庭的儿童肥胖症。

DESCRIPTION (provided by investigator): Obesity is a serious health problem in the US that increases risk of certain cancers, heart disease and diabetes. Childhood obesity is particularly prevalent in low income, Black and Latino children. The prevention and treatment of overweight in youth hinges on helping families develop new lifestyles and create supportive environments in which healthful eating and physical activity (PA) can be promoted. There is a pressing need to develop and test childhood obesity prevention and treatment approaches for low income and minority families that are effective, but also culturally acceptable and sustainable. The purposes of the current proposed R21 project are to: 1). conduct formative research to inform the development of culturally appropriate evaluation tools and family-tailored interventions for low income ethnically diverse parents of children aged 2-5; and 2). conduct a pilot feasibility study to inform the design and implementation of a future RCT. In Year 01, we will conduct formative research including: a). Focus groups with WIC nutritionists to explore their insights into educating low income parents of young children about diet, PA and childhood obesity prevention; b). Focus groups with target audience parents to determine target behaviors, performance objectives, personal and external determinants, change objectives and intervention methods/strategies re. healthy eating, PA and weight control; c). Cognitive assessment testing with target audience parents on existing instruments for measuring children's dietary and PA behaviors, the social and physical home environment and relevant psychosocial issues to revise these tools so they are culturally and linguistically appropriate. This information will be used to develop intervention and evaluation tools. In Year 02, we will conduct a pilot feasibility study to inform the future RCT. The pilot study will: a). determine the feasibility of subject recruitment and retention methods, interventions, process and outcome evaluation methods and measures; b) implement process evaluation to determine implementation fidelity including dose and its' relationship with primary and secondary outcome measures; c). Explore relationships between primary and secondary outcome measures and potential mediating variables In the pilot study, 50 parent-child pairs will receive the tailored intervention, which will be delivered to parents will include: a family exercise video, a TV monitor, 4 sets of culturally and linguistically appropriate individually tailored low literacy written materials interspersed with telephone counseling calls that will be delivered three times over a 20 week period to the parent/family. The intervention will focus on helping parents to develop new lifestyles and create supportive environments to promote/facilitate healthful eating and PA in their children. At the end of Year 02, we will compile all qualitative and quantitative formative, process and outcome evaluation data and apply it using an intervention mapping approach to plan a future RCT that will test the efficacy of tailored home-based interventions on BMI measures, dietary and PA behaviors of children, and the social and physical home environment. PUBLIC HEALTH RELEVANCE: Childhood obesity is a serious health problem in the US as the prevalence is high and increasing, especially in low income as well as African American and Hispanic children. The proposed project will conduct formative research and a feasibility study to inform a future randomized controlled trial that will test the effectiveness of sustainable interventions to prevent/treat childhood obesity in low income, ethnically diverse families.