Primary Care Obesity Prevention: One or Multiple Targets

初级保健肥胖预防：一个或多个目标

基本信息

批准号：
7418908
负责人：
NICOLAS STETTLER-DAVIS
金额：
$ 72.44万
依托单位：
CHILDREN'S HOSP OF PHILADELPHIA
依托单位国家：
美国
项目类别：
财政年份：
2005
资助国家：
美国
起止时间：
2005-09-23 至 2011-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7418908
关键词：
Accident Prevention Address Age Arts Behavior Behavior Therapy Behavioral Beverages Blood Pressure Body mass index Caring Child Childhood Clinical Trials Design Communities Consumption Control Groups Cost Analysis Data Development Diffuse Dyslipidemias Economics Effectiveness Family Fasting Health Knowledge, Attitudes, Practice Health Status High Density Lipoprotein Cholesterol Incidence Insulin Insulin Resistance Intermediate Variables Intervention Life Style Mediator of activation protein Methods Motivation Obesity Oral health Outcome Overweight Patients Pediatric Hospitals Perception Philadelphia Physical activity Practice based research Prevention Prevention intervention Prevention strategy Primary Health Care Private Practice Process Provider Randomized Research Risk Schools Score Skinfold Thickness Testing Time Training Triglycerides Upper arm Visit Weight Weight Gain Work base cardiovascular risk factor computerized data processing cost effectiveness energy balance inner city interest nutrition obesity prevention obesity treatment prevent response satisfaction scale up sedentary sex skills training subcutaneous theories waist circumference

项目摘要

DESCRIPTION (provided by applicant): Primary care is a promising setting for childhood obesity prevention, in addition to other settings, such as the family, schools, and the community. Unfortunately, most pediatric primary care providers are not trained to deliver behavior modification interventions and, according to our preliminary data, are less likely to address obesity prevention when they perceive insufficient time during well-care visits. In response to this RFA, we propose a controlled trial of obesity prevention, with group randomization at the practice level, of two standardized 12-month intervention strategies, based on the Behavioral Economics theory, and delivered by primary care providers after training in behavior modification. The first strategy will target change in multiple behaviors, while the other will target one behavior (beverage consumption). These two interventions will be compared to an active control intervention unrelated to weight (accident prevention). Eight primary care practices will be randomized to each arm with 21 subjects per practice, for a total of 24 practices and 504 subjects. The primary aim is to demonstrate that either obesity prevention intervention will result in less BMI increase (adjusted using z-score) in children age 8 to 12 years at risk for overweight (BMI 85th-95th percentile), compared to a control intervention, at the end of the intervention. We also hypothesize that, in this context, the multiple-behavior intervention, the single-behavior intervention, or both will result in less adjusted BMI increase than the control intervention at 24 months post-randomization, with no a priori assumption in differences between the two obesity prevention strategies. Blood pressure, insulin resistance, dyslipidemia, and oral health status will be secondary outcomes. Intermediate behavioral outcomes and process data will be collected. For this project, we combined the strengths of respected pediatric obesity and behavioral experts with the Practice-Based Research Network at The Children's Hospital of Philadelphia, which includes both inner city primary care practices and suburban private practices.

描述（由申请人提供）：除其他环境（例如家庭，学校和社区）外，初级保健是预防儿童肥胖症的有前途的环境。不幸的是，大多数小儿初级保健提供者没有接受进行行为修改干预措施的培训，并且根据我们的初步数据，当他们认为在良好的访问期间没有足够的时间时，他们就不太可能解决肥胖症。为了响应这种RFA，我们提出了一项对肥胖预防的对照试验，并根据行为经济学理论进行了两个标准化的12个月干预策略的群体随机化，并在培训行为修改后由初级保健提供者提供。第一个策略将针对多种行为的变化，而另一种策略将针对一种行为（饮料消耗）。将这两种干预措施与与体重无关的主动控制干预措施（事故预防）进行比较。总共24个练习和504名受试者，将有8种初级保健惯例随机分配给每个手臂，每练习21名受试者。主要目的是证明，与对照干预措施相比，在8至12岁的儿童中，预防肥胖症预防干预措施将导致8至12岁儿童的BMI增加（使用Z分数进行调整）（BMI 85th-95th百分位数）。我们还假设，在这种情况下，比随机后24个月的对照干预措施的多行为干预，单行为干预或两者都会导致调整的BMI增加，而两种肥胖预防策略之间的差异没有先验假设。血压，胰岛素抵抗，血脂异常和口腔健康状况将是次要结果。将收集中间行为结果和过程数据。对于这个项目，我们将受人尊敬的小儿肥胖症和行为专家的优势与费城儿童医院的基于实践的研究网络相结合，其中包括内城基础医疗实践和郊区的私人实践。