Addressing Health Literacy and Numeracy to Prevent Childhood Obesity

提高健康素养和算术能力以预防儿童肥胖

基本信息

批准号：
7559948
负责人：
ELIANA M. PERRIN
金额：
$ 62.13万
依托单位：
VANDERBILT UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-01-05 至 2013-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7559948
关键词：
2 year old Academic Medical Centers Address Adolescent Adoption Adult Affect Age Age-Months American Attention Beech Behavior Behavior Therapy Body mass index Breast Feeding Cardiovascular Diseases Caregivers Caring Child Childhood Chronic Disease Clinical Clinical Research Communication Communities Control Groups Counseling Development Disadvantaged Education Educational process of instructing Enrollment Epidemic Family Food Labeling Future Health Health Communication Health behavior Hypertension Infant formula Intake Intervention Juice Knowledge Latino Life Life Cycle Stages Life Style Low income Minority Modeling New York Non obese Non-Insulin-Dependent Diabetes Mellitus North Carolina Nursery Schools Obesity Outcome Overweight Parenting behavior Parents Perception Physical activity Physicians Plant Roots Preschool Child Prevalence Prevention education Prevention strategy Preventive Primary Care Physician Public Health Publishing Randomized Randomized Controlled Trials Reading Reporting Research Role School-Age Population Self Efficacy Site Surgeon Television Time Training United States Universities Visit Weight Weight Gain Weight Perception Yin active control base burden of illness clinical care cohort cost early childhood early onset ethnic minority population experience group intervention health literacy high risk improved injury prevention innovation intervention effect literacy nutrition obesity in children obesity prevention pattern perception pediatrician prevent primary care setting programs public health relevance satisfaction skills socioeconomics therapy design tool treatment as usual

项目摘要

DESCRIPTION (provided by applicant): In 2003, Surgeon General Richard Carmona stated that low health literacy was "one of the largest contributors to our nation's epidemic of overweight and obesity." This assertion is supported by recent studies which have found that low health literacy or numeracy is associated with poorer caregiver breastfeeding knowledge, incorrect mixing of infant formula, difficulty understanding food labels and portion sizes, and higher Body Mass Index (BMI) in adults and children. Of particular concern is the impact of the obesity epidemic on our youngest children. Over 26 percent of preschool children are now overweight (BMI>85 percent) or obese (BMI>95 percent) (based on 2007 HHS/CDC Expert Panel definitions). Rates of obesity in preschool children have doubled over the past decade, with the highest increases among low income and minority children-- the same communities most affected by low health literacy. To date, clinical efforts to prevent or treat childhood obesity have had limited efficacy. Efforts need to start early, because children who are overweight by age two are five times as likely to become overweight adolescents, and subsequently at higher risk for obesity-related complications including early-onset Type-2 Diabetes and cardiovascular disease. No published clinical studies have rigorously addressed obesity prevention prior to age 2 with a specific low-literacy and numeracy focus. Addressing caregiver health literacy in early childhood is an innovative strategy to promote healthy nutrition and activity among these families and prevent unhealthy weight gain across the child's life, which would have great public health significance by preventing both child and adult chronic illness. The proposed study is a multi-site randomized, controlled trial to assess the efficacy of a low- literacy/numeracy-oriented intervention designed to promote healthy family lifestyles and to prevent early childhood obesity. The intervention will be delivered through pediatric resident physicians in primary care settings in under-resourced communities. Four academic medical centers will be randomized: Vanderbilt University, the University of Miami, the University of North Carolina at Chapel Hill, and New York University. Two centers will receive the intervention, while the other two centers will receive an active control. At each site, a cohort of 250 English- or Spanish-speaking caregiver-child dyads will be enrolled and followed from the child's 4-6 month well-child visit through the 24-month well-child visit. The intervention will include a low- literacy-oriented toolkit for pediatric residents to use with families and clear health communication training for the pediatric residents. At control sites, pediatric residents will provide "usual care" with respect to lifestyle counseling, but they will also receive an injury-prevention education program to act as an attention control. The primary hypotheses are that the intervention will improve family dietary and physical activity behaviors and that it will reduce the rate of childhood overweight (BMI > 85 percent) at age 24 months. PUBLIC HEALTH RELEVANCE: In 2003, Surgeon General Richard Carmona suggested that low health literacy is "one of the largest contributors to our nation's epidemic of overweight and obesity." Over 26 percent of preschool children are now overweight or obese, and children who are overweight by age 24 months are five times as likely as non- overweight children to become overweight adolescents. The aim of the study is to assess the efficacy of a low- literacy/numeracy-oriented intervention aimed at teaching pediatric resident physicians to promote healthy family lifestyles and prevent overweight among young children (age 0-2) and their families in under-resourced communities.

描述（由申请人提供）：2003 年，卫生局局长理查德·卡莫纳 (Richard Carmona) 表示，健康素养低下是“导致我国超重和肥胖流行的最大因素之一”。这一说法得到了最近研究的支持，这些研究发现，健康素养或算术能力较低与护理人员母乳喂养知识较差、婴儿配方奶粉混合不正确、难以理解食品标签和份量以及成人和儿童较高的体重指数 (BMI) 有关。。特别值得关注的是肥胖流行对我们最小的孩子的影响。目前，超过 26% 的学龄前儿童超重（BMI>85%）或肥胖（BMI>95%）（根据 2007 年 HHS/CDC 专家小组的定义）。过去十年，学龄前儿童的肥胖率翻了一番，其中低收入儿童和少数族裔儿童的增幅最高，而这些社区受健康素养低下的影响最严重。迄今为止，预防或治疗儿童肥胖的临床努力效果有限。需要尽早开始努力，因为两岁时超重的儿童成为超重青少年的可能性是其五倍，并且随后出现肥胖相关并发症（包括早发性 2 型糖尿病和心血管疾病）的风险更高。目前尚无已发表的临床研究严格针对 2 岁之前的肥胖预防问题，特别关注读写能力和算术能力较低的儿童。在幼儿期提高看护者的健康素养是一项创新战略，可以促进这些家庭的健康营养和活动，并防止儿童一生中不健康的体重增加，这对于预防儿童和成人慢性病具有重大的公共卫生意义。拟议的研究是一项多中心随机对照试验，旨在评估以低识字/算数为导向的干预措施的有效性，该干预措施旨在促进健康的家庭生活方式和预防儿童早期肥胖。该干预措施将通过资源贫乏社区初级保健机构的儿科住院医生进行。四个学术医疗中心将被随机分配：范德比尔特大学、迈阿密大学、北卡罗来纳大学教堂山分校和纽约大学。两个中心将接受干预，而另外两个中心将接受主动控制。在每个站点，将登记 250 名讲英语或西班牙语的看护者与儿童二人组，并对其进行从 4-6 个月的儿童健康访视到 24 个月的儿童健康访视的跟踪。干预措施将包括一个供儿科住院医师与家人一起使用的面向低识字率的工具包，以及为儿科住院医师提供明确的健康沟通培训。在控制点，儿科住院医生将提供生活方式咨询方面的“常规护理”，但他们还将接受伤害预防教育计划，以作为注意力控制。主要假设是，干预措施将改善家庭饮食和身体活动行为，并将降低 24 个月大儿童超重率（BMI > 85%）。公共健康相关性：2003 年，卫生局局长理查德·卡莫纳 (Richard Carmona) 表示，健康素养低下是“导致我国超重和肥胖流行的最大因素之一”。目前，超过 26% 的学龄前儿童超重或肥胖，24 个月大时超重的儿童成为超重青少年的可能性是非超重儿童的五倍。该研究的目的是评估以低识字/算术为导向的干预措施的效果，该干预措施旨在教导儿科住院医生促进健康的家庭生活方式并预防资源贫乏地区幼儿（0-2岁）及其家庭的超重。社区。