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.

通过产妇和家庭预防肥胖，惠及低收入婴儿社会传播抽象的拟议的比较有效性研究利用了主页的优势和能力探访计划 (HVP)，为低收入婴儿及其家人提供家庭肥胖预防服务不同种族和民族背景，并纠正优先人群中的差异每年超过 500 名公众。和私人资助的 HVP 为美国 650,000 名低收入高危婴儿及其家人提供服务但 HVP 尚未系统地针对儿童肥胖问题。在过去四年中，我们已经做到了这一点。将基于证据的肥胖预防成分纳入我们的合作伙伴 HVP 提供的服务中，HVP 是一家名为 COPE 的合作倡议：儿童肥胖预防 @ homE /Contrarrestar Obesidad：Programa para niños En casa 我们的试点工作成功地将 COPE 融入到我们每周进行的家访中。 HVP 合作伙伴为期六个月，以及他们的标准课程。拟议的研究以我们的试点为基础。开展工作和建立伙伴关系，以测试提供小学（婴儿）和中学的更大规模的有效性（母亲）肥胖预防作为 HVP 服务的一部分，持续整个 2 年服务期限。 400 名低收入母亲及其婴儿（70% 西班牙裔/拉丁裔、13% 非裔美国人、8% 白人、5% 美国人已接受 HVP 服务的印第安人/阿拉斯加人（4% 混血/其他种族）将被纳入该研究，以获得 300 名提供服务的母亲/婴儿的有效最终样本将被随机分配给。仅提供标准 HVP 课程或 HVP + COPE 将在入学时进行评估。接受干预 12 个月和 24 个月后目标 1. 测试 COPE 对婴儿和婴儿的直接影响。母亲的体重、代谢风险、饮食/能量摄入和身体活动将通过以下方式实现。比较体重、代谢标志物以及饮食和活动相关行为的变化跨研究组的婴儿/母亲（仅 HVP 与 HVP+COPE）这些结果将表明 HVP 是否是。目标 2. 测试母乳喂养和继发性肥胖预防的有效基础设施。母亲的饮食和活动、喂养方式以及粮食不安全会影响 COPE 对婴儿结局的影响。该目标将测试母体传播对婴儿肥胖风险的机制。目标 3 有两个方面。 3a 测试 HVP+COPE（相对于仅 HVP）对社会和社区特征的直接影响围绕母亲和婴儿的网络（即其“健康支持”的密度、组成和质量）目标 3b 测试社交网络的特征是否介导 COPE 对母亲的影响这些发现将表明预防 HVP 肥胖的努力是否可以改变和/或激活社交。该项目的第二个目标是进行现实经济分析（成本、成本- 将 COPE 集成到现有 HVP 中的节省和非金钱收益）该项目准备测试一个。预防儿童肥胖的创新、可扩展、可持续且具有潜在成本效益的模式面临健康不平等的最大风险。