Caregivers as the Agent of Change for Childhood Obesity and Chronic Disease Risk Among Latino Families

护理人员是拉丁裔家庭儿童肥胖和慢性病风险变革的推动者

• 批准号: 10437272
• 负责人: Kerri N Boutelle
• 金额: $ 75.7万
• 依托单位: CHILDREN'S HOSPITAL OF LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10437272
• 关键词: 10 year old; Acculturation; Address; Adherence; Adolescence; Adult; Affect; Aftercare; Age; Behavior; Biological Markers; Body mass index; California; Caregivers; Child; Child Rearing; Chronic; Chronic Disease; Control Groups; Data; Development; Diet; Dietary intake; Dyslipidemias; Eating Behavior; Education; Environmental Risk Factor; Family; Family member; Feeding behaviors; Food; Future; Gender; Goals; Health; Health education; Home; Household; Inflammation; Intervention; Latino; Life; Life Style; Mediator of activation protein; Metabolic syndrome; Mothers; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Overweight; Parents; Physical activity; Populations at Risk; Randomized; Randomized Clinical Trials; Recommendation; Risk; Self Efficacy; Strategic Planning; Target Populations; Time; Travel; Treatment Cost; Treatment Efficacy; United States National Institutes of Health; Visit; Weight; Weight maintenance regimen; base; behavior change; blood lipid; cardiometabolism; caregiver education; comparative efficacy; cost; cultural values; disorder risk; disparity reduction; efficacy testing; family burden; family structure; follow-up; food environment; health disparity; improved; liver function; member; non-alcoholic fatty liver disease; obesity in children; prevent; programs; psychosocial; recruit; response; social factors; telehealth; therapy development; treatment program

Latino children have higher rates of overweight and obesity (OW/OB) and related chronic diseases, such as type 2 diabetes, non-alcoholic fatty liver disease, and dyslipidemia. This disparity starts early in life, persists into adulthood, and is associated with a myriad of negative cardiometabolic and psychosocial health consequences. At present, the most effective program for weight management in children is family-based treatment (FBT), which is delivered to the target child and a parent (typically the mother). An emerging strategy is parent-based treatment (PBT), which provides intervention to the parent only, without the child. PBT has several benefits, including decreased treatment costs, developmental appropriateness for younger children and potential for broader dissemination. In ongoing trials, we have found that Latino families attend less visits and consequently treatment in children is less effective. Thus, a tailored program for Latino families is needed that can address cultural values and capitalize on the value of familismo. The goal of Project 2 is to test the efficacy of a durable, feasible, culturally relevant program to treat OW/OB and reduce chronic disease risk in Latino children and their parents. We propose a randomized clinical trial to compare a telehealth PBT for Latino families with a health education (HE) control group on changes in child and parent weight and chronic disease risk. We will recruit 160 Latino families consisting of at least one parent with OW/OB, at least one other willing caregiver, and a 5-10-year-old child with OW/OB and randomize them to 6-month PBT or control. We will assess outcomes before treatment (month 0), mid-treatment (month 3), post-treatment (month 6), and at 6- and 12-month follow- up. Specific Aim 1 will compare the efficacy of PBT versus control on child weight (BMIz) over 18 months. Specific Aim 2 will determine the efficacy of PBT on parent BMI, child and parent diet and physical activity, home food environment, parent feeding behaviors and parenting confidence and self-efficacy. Specific Aim 3 will determine the efficacy of PBT on child and parent biomarkers of risk of type 2 diabetes, liver function and dyslipidemia. In an exploratory aim we will evaluate the impact of potential moderators (e.g., parent and child gender and age, acculturation level, parent education) and mediators (e.g., change in home food environment, parent feeding behaviors, family functioning) on intervention efficacy. In a cross-center aim, data from this Project will be combined with Projects 1 and 3 to examine the multi-level determinants of chronic disease risk in Latino children, and how social and environmental factors affect the response to different types of interventions in Latino families for reducing chronic disease risk. The development of interventions for Latino children with OW/OB that address cultural values around food and the importance of family structure are needed to increase acceptance and adherence to lifestyle changes, and to improve chronic diseases risk, not just in children but also in parents. Further, delivering this intervention via telehealth will increase the reach of this intervention, decrease family burden, lower the cost and make it more broadly appealing for dissemination to a wider audience.

拉丁裔儿童超重和肥胖 (OW/OB) 以及相关慢性病的发生率较高，例如 如2型糖尿病、非酒精性脂肪肝和血脂异常。这种差异从生命早期就开始并持续存在 进入成年期，并与许多负面的心脏代谢和社会心理健康有关 结果。目前，最有效的儿童体重管理方案是以家庭为基础 治疗 (FBT)，交付给目标儿童和家长（通常是母亲）。新兴战略 是以父母为基础的治疗（PBT），仅向父母提供干预，而不向孩子提供干预。 PBT有 多项好处，包括降低治疗成本、适合年幼儿童的发育以及 更广泛传播的潜力。在正在进行的试验中，我们发现拉丁裔家庭的探访次数较少，而且 因此，儿童的治疗效果较差。因此，需要为拉丁裔家庭量身定制计划 可以解决文化价值观并利用家庭主义的价值。项目2的目标是测试功效 制定持久、可行、文化相关的计划来治疗拉丁裔 OW/OB 并降低慢性病风险 孩子们和他们的父母。我们提出一项随机临床试验来比较拉丁裔家庭的远程医疗 PBT 健康教育（HE）对照组关注儿童和父母体重的变化以及慢性病风险。我们 将招募 160 个拉丁裔家庭，其中至少包括一名 OW/OB 家长，以及至少一名其他愿意看护的人， 以及一名患有 OW/OB 的 5-10 岁儿童，并将他们随机分配到 6 个月的 PBT 或对照组。我们将评估结果 治疗前（第 0 个月）、治疗中期（第 3 个月）、治疗后（第 6 个月）以及 6 个月和 12 个月的随访时 向上。具体目标 1 将比较 PBT 与对照在 18 个月内对儿童体重 (BMIz) 的功效。具体的 目标 2 将确定 PBT 对父母 BMI、儿童和父母饮食和身体活动、家庭食品的功效 环境、父母喂养行为以及养育信心和自我效能。具体目标 3 将确定 PBT 对儿童和父母 2 型糖尿病、肝功能和血脂异常风险生物标志物的功效。在 作为一个探索性目标，我们将评估潜在调节因素的影响（例如，父母和孩子的性别和年龄， 文化适应水平、家长教育）和中介因素（例如家庭饮食环境的变化、家长喂养 行为、家庭功能）对干预效果的影响。在跨中心目标中，该项目的数据将 结合项目 1 和 3 检查拉丁裔儿童慢性病风险的多层次决定因素， 以及社会和环境因素如何影响拉丁裔家庭对不同类型干预措施的反应 降低慢性病风险。针对患有 OW/OB 的拉丁裔儿童制定干预措施，以解决 需要围绕食物的文化价值观和家庭结构的重要性来提高接受度和 坚持生活方式的改变，并降低慢性病的风险，不仅是儿童，也是父母。 此外，通过远程医疗提供这种干预措施将扩大这种干预措施的范围，减少家庭 减轻负担，降低成本，使其更广泛地吸引更广泛的受众传播。