Does the provision of postnatal parenting support in primary care improve cardiometabolic health in early childhood among at-risk-families?

在初级保健中提供产后育儿支持是否可以改善高危家庭儿童早期的心脏代谢健康？

• 批准号: 10402830
• 负责人: Maria E. Bleil
• 金额: $ 75.44万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-15 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10402830
• 关键词: Adjuvant; Adopted; Age; Area; Behavioral; Biological Markers; Blood; Blood Pressure; Cardiometabolic Disease; Child; Child Rearing; Clinical; Collection; Data Sources; Disadvantaged; Disease model; Distal; Early Intervention; Ethnic group; Exposure to; Family; Foundations; Funding; Goals; Health; Health behavior; Home; Home visitation; Individual; Infant; Inflammation; Informal Social Control; Intervention; Interviewer; Life; Life Cycle Stages; Literature; Low income; Maternal Health; Measures; Mediating; Mental Depression; Metabolic; Minority; Monitor; Mother-Child Relations; Mothers; National Institute of Child Health and Human Development; Outcome; Parents; Patient Self-Report; Polysomnography; Population; Primary Health Care; Questionnaires; Race; Recording of previous events; Risk; Risk Factors; Sampling; Shapes; Socioeconomic Status; Spottings; Testing; Time; Trauma; United States National Institutes of Health; Visit; Woman; Work; base; biological sex; cardiometabolic risk; cardiometabolism; cardiovascular health; design; disorder risk; early childhood; early life adversity; evidence base; health disparity; improved; infancy; intervention effect; maternal depression; physical conditioning; postnatal; prevent; programs; prospective; remediation; resilience; social health determinants; therapy design; trend

PROJECT SUMMARY: Worsening population-level trends in cardiometabolic health highlight the profound need to move away from traditional disease models focused on the remediation of downstream cardiometabolic risk factors to instead focus on relevant upstream exposures. Relevant upstream exposures include early life adversities (ELA), a unique subset of social determinants of health that occur early in life and are hypothesized to become biologically embedded, thereby shaping life course trajectories of health and disease risk over time. A robust literature shows ELA exposures confer prospective risk for cardiometabolic disease, yet few—albeit promising—studies have examined whether early intervention in ELA-exposed children may lessen this risk. Review of relevant literatures suggests generally that 1) earlier intervention is more effective; 2) intervention benefits are greatest in families most in need; 3) parenting is a mechanism through which early intervention benefits are transmitted; and 4) existing parenting interventions, deemed successful with respect to parent-child behavioral and relationship outcomes, are candidates for testing in relation to child physical health outcomes. Building on this foundation, the proposed study represents a unique and time-sensitive opportunity to extend the aims of an existing RCT in which a parenting intervention—Promoting First Relationships® (PFR) versus no intervention—was implemented as an adjuvant to depression treatment in a sample of low income, postnatal women. The purpose of the proposed study is to determine whether benefits of the PFR intervention, originally designed to impact parent- child behavioral and relationship outcomes in infancy may extend to the child’s cardiometabolic health in early childhood. It is hypothesized that the PFR intervention will augment an upstream resiliency factor—parenting quality—at an early period of vulnerability, potentially benefiting the child’s cardiometabolic health. Expected intervention effects on the more distal child cardiometabolic health outcomes are hypothesized to be partially attributable to changes in the more proximal intervention-related targets, including maternal sensitivity, parent understanding, mother-child relationship quality, and child self-regulation. The proposed study seeks NIH funding to support the return of 214 mother-child dyads (85% of 252 total families) who participated in the original RCT. The majority of families (80%) belong to a minority race/ethnic group, 32% are Spanish-speaking, and all are considered low income. Families will complete two home-based visits between child’s age 5-6 and 7-8 years. These visits will entail assessments that parallel measures in the original study regarding parent-child behavioral and relationship outcomes but will also include health-focused assessments in domains known to predict long- term risk for disease, including cardiovascular health, metabolic health, and inflammation. Health indicators will be derived from data sources including anthropometric and blood pressure assessments, a dried blood spot collection, activity and sleep monitoring, and interviewer-administered questionnaires. Results will extend broadly to vulnerable families at disproportionate risk for poor cardiometabolic health.

项目摘要： 心脏代谢健康的人口级趋势恶化了，突出了搬家的深刻需求 来自传统疾病模型的重点是修复下游心脏代谢风险因素 专注于相关的上游暴露。相关上游暴露包括早期生活逆境（ELA），一个 在生活早期发生的社会决定者的独特子集，并被认为是生物学上的 嵌入式，从而塑造了健康和疾病风险的生活轨迹。强大的文学表明 ELA暴露会议对心脏代谢疾病的预期风险，但很少（尽管承诺） 检查了对ELA暴露儿童的早期干预是否可以减轻这种风险。相关文献的评论 一般来说，1）早期干预更有效； 2）干预益处在家庭中最大 最需要的； 3）育儿是一种传递早期干预益处的机制；和4） 现有的育儿干预措施，被认为是在亲子行为和关系方面成功的 结果是与儿童身体健康结果有关的候选人。在这个基础上建立 拟议的研究代表了扩展现有RCT目标的独特且敏感的机会 育儿干预（促进第一关系®（PFR）而不是干预）是实施的 作为低收入后妇女样本中的抑郁症治疗。目的 拟议的研究是确定PFR干预措施的益处，最初是为了影响父母的 儿童行为和婴儿期的关系结果可能会延伸到儿童的心脏代谢健康 童年。假设PFR干预将增强上游的弹性因素 - 质量 - 在脆弱性的早期，有可能使孩子的心脏代谢健康受益。预期的 干预对更透明的儿童心脏代谢健康结果的影响是部分的 归因于更近端干预相关的目标的变化，包括母体灵敏度，父母 理解，母子关系质量和儿童自我调节。拟议的研究寻求NIH资金 为了支持参加原始RCT的214个母子二元组（252个家庭中的85％）。 大多数家庭（80％）属于少数族裔/族裔，有32％是说西班牙语的 被认为是低收入的。家庭将在5-6岁至7-8岁之间完成两次基于家庭的访问。 这些访问将需要进行评估，这些评估与原始研究中有关亲子行为的措施平行 和关系结果，但还将包括已知可以预测长期的领域中以健康为中心的评估 疾病的期限风险，包括心血管健康，代谢健康和炎症。健康指标将 源自包括人体测量和血压评估在内的数据源，干燥的血点 收集，活动和睡眠监控以及面试官管理问卷。结果将扩展 广泛地面向脆弱的家庭，其心脏代谢健康的风险不成比例。