Value and mechanisms of home visitation in obesity interventions for low-income children

家访在低收入儿童肥胖干预中的价值及机制

• 批准号: 9204202
• 负责人: Bradley M. Appelhans
• 金额: $ 71.05万
• 依托单位: RUSH UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-02-01 至 2022-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9204202
• 关键词: Academic Medical Centers; Accountability; Accounting; Address; Adult; Affect; Age; Behavior Therapy; Beverages; Body Weight decreased; Body mass index; Calories; Caregivers; Caring; Characteristics; Child; Childhood; Chronic Disease; Communities; Control Groups; Costs and Benefits; Data; Eating; Eating Behavior; Environment; Equipment; Family; Food; Future; Goals; Health Services Accessibility; Health education; Healthcare; Home environment; Home visitation; Household; Income; Insurance Carriers; Intervention; Learning; Location; Longevity; Low Income Population; Low income; Mediating; Medical; Medical center; Modality; Monitor; Obesity; Outcome; Overweight; Persons; Physical activity; Positioning Attribute; Price; Provider; Public Health; Randomized; Randomized Controlled Trials; Recommendation; Research; Resources; Risk; Risk Factors; Schedule; Schools; Sleep; Sports; Testing; Third-Party Payer; Transportation; Treatment outcome; Universities; Waiting Lists; arm; base; cost; cost effectiveness; design; dosage; improved; individualized medicine; lower income families; next generation; obesity in children; obesity risk; obesity treatment; programs; randomized trial; sex; skills; staff intervention; treatment effect; tv watching; virtual

PROJECT SUMMARY/ABSTRACT Children from low-income families are more than twice as likely to become obese than those from higher- income households, which places them at increased risk for obesity-related chronic diseases throughout their adult lives. Family-based pediatric obesity interventions, particularly those designed for low-income populations, are increasingly delivered in children’s homes. Home visitation has a number of potential advantages that could enhance weight loss outcomes relative to delivering treatment in traditional medical and academic settings. By eliminating the need for transportation and childcare, home visitation may make treatment more accessible for low-income families, resulting in a higher dosage of intervention received. Home visitation allows intervention staff to directly observe and address risk factors in the home environment, potentially enabling them to provide more tailored and potent treatment recommendations. Caregivers may also be more likely to apply healthy changes in their household when they learn and rehearse new skills in the environment where they are to be implemented. Research to date has consistently found that home-based interventions are more effective than low-intensity comparison conditions such as wait-list controls, health education, and usual medical care. Yet, as the home visitation treatment modality has been confounded with intervention dosage, intensity, and content in prior studies, there is a lack of empirical evidence to support its use. The goal of this project is to systematically evaluate the incremental weight loss benefit and cost- effectiveness of delivering standard family-based treatment for pediatric overweight/obesity in the home setting vs. traditional medical settings. In a randomized controlled trial involving low-income households, 266 children ages 6-11 years will be allocated to 12 months of family-based treatment delivered either in their home or at an urban academic medical center. Both arms will receive the same intervention content and dosage, and differ only in the location of in-person treatment sessions. Aim 1 is to test the hypothesis that home-based treatment produces a greater reduction in child adiposity, reflected in 12-month change in BMI z-score. Aim 2 is to compare the cost-effectiveness of home-based treatment to medical center-based treatment, and calculate the added cost of the incremental weight loss benefit associated with home visitation. These data will inform efforts to disseminate home-based interventions for low-income populations by public health agencies and third-party payers. Aim 3 is to explore specific mechanisms through which home visitation may improve weight loss outcomes. The results of this trial will have a strong impact on the design of future pediatric overweight/obesity interventions, as virtually any program could be adapted for delivery in the home setting.

项目摘要/摘要 来自低收入家庭的儿童肥胖的可能性是来自更高的孩子的两倍以上 收入家庭，这使他们在整个过程中都有与肥胖有关的慢性疾病的风险 成人生活。基于家庭的小儿肥胖干预措施，尤其是专为低收入设计 人口越来越多地在儿童家中分配。家庭访问有许多潜力 相对于在传统医学中提供治疗的相对于提供减肥结果的优势， 学术环境。通过消除运输和育儿的需求，家庭探视可能会导致 低收入家庭更容易获得治疗，从而导致收到的干预剂量更高。家 探视使干预人员可以直接观察和解决家庭环境中的风险因素， 潜在的使他们能够提供更量身定制和潜在的治疗建议。照顾者可以 当他们学习和排练新技能时，更有可能在家庭中应用健康的变化 将要实施的环境。迄今为止的研究一直发现家庭基于家庭 干预措施比低强度比较条件（例如等待名单控制，健康状况）更有效 教育和通常的医疗服务。但是，由于家庭访问的治疗方式与 干预剂量，强度和内容在先前的研究中，缺乏经验证据来支持其 使用。该项目的目的是系统地评估增量减肥益处和成本 - 在家庭环境中为小儿超重/肥胖提供标准家庭治疗的有效性 与传统医疗环境。在涉及低收入家庭的随机对照试验中，有266名儿童 6-11岁的年龄将分配给在家中或在家中进行12个月的基于家庭的治疗 城市学术医学中心。两臂都将获得相同的干预内容和剂量，并且不同 仅在面对面治疗会议的位置。目标1是检验基于家庭治疗的假设 在BMI Z分数的12个月变化中，儿童肥胖量的降低较大。目标2是 将基于家庭治疗的成本效益与基于医学中心的治疗进行比较，并计算 与家庭访问相关的增量减肥益处的增加成本。这些数据将为努力提供信息 传播公共卫生机构和第三方低收入人群的家庭干预措施 付款人。目标3是探索家庭探视可以改善体重减轻的特定机制 结果。该试验的结果将对未来的儿科超重/肥胖的设计产生强烈的影响 干预措施，因为几乎任何程序都可以在家庭环境中进行交付。