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: 10656516
• 负责人: Kerri N Boutelle
• 金额: $ 74.15万
• 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/10656516
• 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; Disparity; Dyslipidemias; Eating Behavior; Environmental Risk Factor; Family; Family member; Feeding behaviors; Food; Future; Gender; Goals; Health; Health education; Home; Household; Inflammation; Intervention; Latino; Latino Population; Life; Life Style; Mediator; Metabolic syndrome; Mothers; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Outcome Assessment; Overweight; Parenting Education; Parents; Physical activity; Populations at Risk; Randomized; 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; behavior change; blood lipid; cardiometabolism; comparative efficacy; cost; cultural values; disorder risk; disparity reduction; efficacy evaluation; efficacy testing; family burden; family structure; follow-up; food environment; food restriction; health disparity; improved; liver function; member; non-alcoholic fatty liver disease; obesity in children; prevent; programs; psychosocial; randomized, clinical trials; 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.

拉丁裔儿童的超重和肥胖（OW/ob）和相关慢性疾病的发生率更高， 作为2型糖尿病，非酒精性脂肪肝病和血脂异常。这种差异从生命的早期开始，仍然存在 成年，与无数的负面心脏代谢和社会心理健康有关 结果。目前，儿童体重管理最有效的计划是基于家庭的 治疗（FBT），该治疗已交付给目标孩子和父母（通常是母亲）。一种新兴策略 是基于父母的治疗（PBT），仅在没有孩子的情况下向父母提供干预。 PBT有 几种好处，包括降低治疗成本，年幼儿童的发育适用性和 潜力更广泛的传播。在正在进行的试验中，我们发现拉丁裔家庭参加较少的访问和 因此，儿童的治疗效率较小。因此，需要针对拉丁裔家庭量身定制的计划 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 耐用，可行，具有文化相关的计划，以治疗OW/OB并降低拉丁裔的慢性疾病风险 孩子和他们的父母。我们提出了一项随机临床试验，以比较拉丁裔家庭的远程医疗PBT 健康教育（HE）对照组的儿童体重和慢性疾病风险的变化。我们 将招募160个拉丁裔家庭，由至少一个由OW/ob的父母组成，至少一个愿意的照顾者， 还有一个5-10岁的OW/ob的孩子，并将其随机分配到6个月的PBT或对照中。我们将评估结果 在治疗之前（第0个月），中期治疗（第3个月），治疗后（第6个月）以及6个月和12个月的后续时间 向上。特定的目标1将在18个月内比较PBT与控制儿童体重（BMIZ）的功效。具体的 AIM 2将确定PBT对父母BMI，子女饮食以及体育锻炼的功效 环境，父母喂养行为以及育儿信心和自我效能感。具体目标3将决定 PBT对2型糖尿病，肝功能和血脂异常的儿童和父母生物标志物的功效。在 一个探索目的，我们将评估潜在主持人的影响（例如，父母，性别和年龄， 适应水平，父母教育）和调解员（例如，家庭食品环境的变化，父母喂养 行为，家庭功能）在干预功效上。在跨中心的目标中，该项目的数据将是 结合项目1和3，以检查拉丁裔儿童慢性疾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中对不同类型的干预措施的反应 降低慢性疾病风险。开发有关Latina儿童的干预措施，该地址 需要围绕食物的文化价值以及家庭结构的重要性，以增加接受和 遵守生活方式的改变，并改善慢性疾病的风险，不仅在儿童中，而且在父母中。 此外，通过远程医疗提供此干预将增加这种干预的影响，减少家庭 负担，降低成本，使其更广泛地吸引人们向更广泛的受众传播。