In-home obesity prevention to reach low-income infants through maternal and social transmission

家庭肥胖预防通过孕产妇和社会传播惠及低收入婴儿

基本信息

批准号：
10163227
负责人：
Sarah-Jeanne Salvy
金额：
$ 50.22万
依托单位：
UNIVERSITY OF SOUTHERN CALIFORNIA
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-01 至 2023-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10163227
关键词：
Address African American Age Age-Months Alaskan American Indians Americas Behavior Birth Body Weight Breast Feeding Child Color Communities Community Networks Comparative Effectiveness Research Cost Savings Diet Dissemination and Implementation Eating Educational Curriculum Effectiveness Energy Intake Enrollment Ethnic Origin Failure Family Funding Goals Health Health Policy Health Services Accessibility Hispanics Home Home visitation Human Infant Infrastructure Institute of Medicine (U.S.)Intervention Language Latino Life Low income Mediating Metabolic Metabolic Marker Methods Modeling Mothers Nurses Obesity Outcome Overweight Physical activity Population Poverty Procedures Race Randomized Recommendation Research Research Infrastructure Research Personnel Resources Risk Sampling Services Social Characteristics Social Network Structure Testing Time Training United States United States Department of Agriculture Weight Work adult obesity arm base cost cost effective cultural competence density disparity reduction early childhood economic evaluation evidence base feeding food insecurity health inequalities healthy lifestyle housing instability infancy infant adiposity infant outcome innovation interest intergenerational maternal outcome mother nutrition nutrition obese mothers obesity in children obesity prevention obesity risk preference programs racial and ethnic racial diversity recruit service programs social social determinants success support network transmission process

项目摘要

IN-HOME OBESITY PREVENTION TO REACH LOW-INCOME INFANTS THROUGH MATERNAL AND SOCIAL TRANSMISSION ABSTRACT The proposed comparative effectiveness research capitalizes on the strengths and capabilities of Home Visitation Programs (HVPs), to deliver in-home obesity prevention to low-income infants and their families from diverse racial and ethnic backgrounds, and correct disparities in priority populations. Annually, over 500 publicly and privately funded HVPs provide services to 650,000 low-income, at-risk infants and their families in the United States, yet HVPs have not yet systematically targeted childhood obesity. Over the last four years, we have integrated evidence-based obesity prevention components into the services provided by our partner HVP, a collaborative initiative called COPE: Childhood Obesity Prevention @ homE /Contrarrestar Obesidad: Programa para niños En casa. Our pilot work successfully integrated COPE into the ongoing, weekly, in-home visits of our HVP partner for six months, alongside their standard curriculum. The proposed research builds upon our pilot work and partnerships to test the larger-scale effectiveness of delivering primary (infants) and secondary (mothers) obesity prevention as part of HVP services for the full 2-year duration of these services. Specifically, 400 low income mothers and their infants (70% Hispanic/Latino, 13% African American, 8% White, 5% American Indian/Alaskan, 4% mixed/other race) already receiving HVP services will be enrolled into the study, for an effective final sample of 300 mothers/infants. Home visitors delivering services will be randomly assigned to deliver the standard HVP curriculum only or HVP + COPE. Mothers and infants will be assessed at enrollment and after receiving the intervention for 12 and 24 months. Aim 1. Test the direct effects of COPE on infants and mothers’ weight, metabolic risks, diet/energy intake, and physical activity. This will be accomplished by comparing changes in body weight, metabolic markers, and eating and activity-related behaviors between infants/mothers across study arms (HVP only vs. HVP+COPE). These results will indicate whether the HVP is an effective infrastructure for primary and secondary obesity prevention. Aim 2. Test whether breastfeeding and maternal diet and activity, feeding practices, and food insecurity mediate the effect of COPE on infants’ outcomes. This aim will test mechanisms of maternal transmission on infants’ obesity risks. Aim 3 is two-pronged. Aim 3a tests the direct effect of HVP+COPE (vs. HVP only) on the characteristics of the social and community networks that surround mothers and infants (i.e., the density, composition, and quality of their “health support networks”). Aim 3b tests whether the characteristics of social networks mediate the effects of COPE on maternal and infant outcomes. These findings will indicate if HVP obesity prevention efforts can alter and/or activate social network mechanisms. A Secondary Aim of this project is to conduct a real-life economic analysis (costs, cost- savings and non-monetary benefits) of integrating COPE into existing HVPs. The project is poised to test an innovative, scalable, sustainable, and potentially cost-effective model for preventing obesity among children who are at the greatest risk for health inequities.

预防家庭肥胖，通过母亲和社交传播抽象的拟议的比较有效性研究利用了家庭的优势和能力探视计划（HVP），向低收入婴儿及其家人提供预防家庭肥胖各种种族和种族背景，并在优先人群中正确分布。每年公开500多个私人资助的HVP为联合的650,000个低收入，处于危险的婴儿及其家人提供服务州但HVP尚未系统地针对儿童对象。在过去的四年中，我们有综合循证肥胖预防组件纳入我们的合作伙伴HVP提供的服务中合作计划称为COPE：儿童肥胖预防@Home /Cortarrestar obesidad：Programa 我们的飞行员工作成功地整合了我们 HVP合作伙伴六个月，以及他们的标准课程。拟议的研究基于我们的飞行员工作和合作伙伴关系，以测试交付初级（婴儿）和次要的更大范围的有效性（母亲）预防肥胖症作为HVP服务的一部分，这些服务在整个服务期限为2年。具体来说， 400名低收入母亲及其婴儿（70％的西班牙裔/拉丁裔，13％的非裔美国人，8％白人，美国5％印度/阿拉斯加，4％的混合/其他种族）已经接受了HVP服务的研究有效的300名母亲/婴儿的最终样本。提供服务的家庭访客将随机分配给仅提供标准的HVP课程或HVP + COPE。母亲和婴儿将在入学时进行评估在接受干预12和24个月后。 AIM 1。测试COPE对婴儿的直接影响和母亲的体重，代谢风险，饮食/能量摄入和体育锻炼。这将通过比较体重的变化，代谢标记以及饮食和活动相关的行为跨研究臂的婴儿/母亲（HVP仅与HVP+COPE）。这些结果将指示HVP是否为预防初级和继发性肥胖症的有效基础设施。目标2。测试母乳喂养和是否孕产妇饮食和活动，喂养实践和粮食不安全介绍了应对对婴儿预后的影响。这个目标将测试婴儿肥胖风险的产妇传播机制。 AIM 3是两管齐的。目的 3A测试HVP+COPE（仅与HVP）对社会和社区特征的直接影响围绕母亲和婴儿的网络（即，健康支持的密度，成分和质量网络”）。目标3B测试社交网络的特征是否介导了应对对母性的影响和婴儿的结果。这些发现将表明HVP肥胖预防工作是否可以改变和/或激活社会网络机制。该项目的次要目的是进行现实生活中的经济分析（成本，成本 - 将COPE整合到现有HVP中的储蓄和非货币好处）。该项目被中毒以测试创新，可扩展，可持续性且潜在的具有成本效益的模型，以防止儿童的肥胖症面临健康不平等的最大风险。