Effects of Attachment-Based Intervention on Low-Income Latino Children's Emerging Health Outcomes: A Randomized Controlled Trial

基于依恋的干预对低收入拉丁裔儿童新兴健康结果的影响：随机对照试验

• 批准号: 10707466
• 负责人: LISA J BERLIN
• 金额: $ 53.67万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-20 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10707466
• 关键词: Academy; Acculturation; Age; American; American Heart Association; Biological; Body mass index; COVID-19 pandemic; Child; Child Health; Child Rearing; Childhood; Community Networks; Development; Discrimination; Economics; Emotional; Enrollment; Environment; Face; Family; Fostering; Foundations; Future; Health; Health Promotion; Home; Household; Immigrant; Infant; Inflammation; Intervention; Investigation; Latina; Latino; Latino Population; Life; Life Cycle Stages; Longevity; Low income; Manuals; Mediating; Mediator; Modeling; Mothers; National Institute of Child Health and Human Development; Nature; Obesity; Observational Study; Outcome; Parents; Pediatrics; Population; Process; Psychophysiology; Randomized, Controlled Trials; Reduce health disparities; Regulation; Research; Risk; Sampling; Secure; Security; Skin; Sleep; Sleep Deprivation; Stress; Subgroup; Testing; Toddler; Training; United States National Institutes of Health; Work; biobehavior; caregiving; design; efficacy testing; ethnic health disparity; experience; health disparity; high risk; improved; innovation; intervention effect; minority children; physical conditioning; post intervention; prevent; preventive intervention; primary caregiver; racial health disparity; respiratory; social; social culture; social health determinants; social influence; social stressor; trial design

Project Summary/Abstract Latino children have worse health than non-Latino White children across many common conditions, including respiratory illnesses and obesity, laying a foundation for health disparities across the life course. Prior studies demonstrate that attachment-based parenting interventions, those designed to foster sensitive parenting behavior and secure infant-parent attachment, improve maternal sensitivity, attachment security, child socioemotional development, and some aspects of child psychophysiological regulation. To date, there has not been a large-scale trial testing the efficacy of an attachment-based intervention for supporting physical health more broadly. This is a significant gap, especially with regard to Latino child health promotion, given (a) the promise of attachment-based interventions, and (b) the early origins of health disparities that negatively impact Latino children, the largest and fastest-growing segment of the U.S. population. The proposed RCT will test the impacts of an attachment-based intervention on emerging health outcomes in low-income Latino children (N = 260). We will focus on low-income Latino families as a group at exceptionally high risk for health problems. The manualized intervention, Attachment and Biobehavioral Catch-up (ABC), consists of 10 sessions provided by a trained parent coach to primary caregivers and their infants in their homes. We will enroll families with 9-month-old infants and follow them longitudinally until age 2. In Aim 1, we will test the effects of ABC on child health outcomes. We hypothesize positive intervention effects on common infant and toddler illnesses (e.g., respiratory illnesses), low-grade inflammation, BMI, and sleep. In Aim 2, we will test mediators of intervention effects. We hypothesize (a) positive intervention effects on sensitive parenting behaviors and child stress regulation, and (b) that these factors will mediate intervention effects on child health outcomes. In Aim 3, we will test sociocultural context as a moderator of intervention effects. We hypothesize stronger intervention effects in higher-risk dyads (i.e., mothers who are more acculturated, who have fewer supports, or who experience more discrimination) than in lower-risk dyads. Our proposal is innovative in that the RCT design provides an unprecedented opportunity to test causal impacts of an attachment-based intervention on a comprehensive set of early health outcomes known to track across the life course. This proposal is significant in that it aligns directly with the NICHD priority of Understanding Social Determinants of Health and Developmentally Informed Strategies to Mitigate Health Disparities. We will (a) examine how attachment-based intervention supports a foundation for health and (b) identify subgroups to prioritize in future efforts to optimize health in low-income Latino children.

项目摘要/摘要 在许多常见情况下，拉丁裔儿童的健康 呼吸道疾病和肥胖，为整个生活过程中的健康差异奠定了基础。先前的研究 证明基于附件的育儿干预措施，旨在促进敏感育儿 行为和安全的婴儿父母的依恋，提高母性敏感性，依恋安全性，儿童 社会情感发展以及儿童心理生理学调节的某些方面。迄今为止，还没有 是一项大规模试验，测试基于依恋的干预措施支持身体健康的功效 更广泛。这是一个很大的差距，尤其是在拉丁裔儿童健康促进方面，给定（a） 承诺基于依恋的干预措施，以及（b）对健康差异的早期起源 拉丁裔儿童，是美国人口中最大，最快的人群。拟议的RCT将测试 基于依恋的干预对低收入拉丁裔的新兴健康结果的影响 儿童（n = 260）。我们将专注于低收入拉丁裔家庭，作为一个非常高的健康风险 问题。手动干预，依恋和生物行为追赶（ABC）由10个组成 训练有素的家长教练向主要护理人员及其婴儿提供的会议。我们将 注册有9个月大的婴儿的家庭，并纵向关注他们直到2岁。在AIM 1中，我们将测试 ABC对儿童健康结果的影响。我们假设对普通婴儿的积极干预影响 和蹒跚学步的疾病（例如呼吸道疾病），低度炎症，BMI和睡眠。在AIM 2中，我们将 干预效果的测试介质。我们假设（a）对敏感的阳性干预影响 育儿行为和儿童压力调节，（b）这些因素将介导干预效果 关于儿童健康结果。在AIM 3中，我们将测试社会文化背景作为干预者的主持人 效果。我们假设在高风险二元组中更强大的干预效果（即，更多的母亲 与低风险的二元组相比，受过训练的人的支持更少，或者经历更多的歧视）。我们的 提案具有创新性，因为RCT设计提供了一个前所未有的机会来测试因果关系的影响 基于依恋的干预措施，对一套已知的早期健康结果，可以追踪 生活课程。该提议很重要，因为它直接与理解社会的NICHD优先级保持一致 健康的决定因素和发展知情的策略，以减轻健康差异。我们将（a） 检查基于依恋的干预如何支持健康基础，（b）确定子组 优先考虑未来优化低收入拉丁裔儿童健康的努力。