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.

项目概要/摘要 在许多常见情况下，拉丁裔儿童的健康状况比非拉丁裔白人儿童更差，包括 呼吸道疾病和肥胖，为整个生命周期的健康差异奠定了基础。先前的研究 证明基于依恋的育儿干预措施，旨在培养敏感的育儿方式 行为和安全的婴儿父母依恋，提高母亲的敏感性，依恋安全性，儿童 社会情感发展，以及儿童心理生理调节的某些方面。迄今为止，还没有 一项大规模试验，测试基于依恋的干预措施对支持身体健康的功效 更广泛地说。这是一个巨大的差距，特别是在拉丁裔儿童健康促进方面，因为 (a) 基于依恋的干预措施的承诺，以及 (b) 造成负面影响的健康差异的早期根源 拉丁裔儿童是美国人口中规模最大且增长最快的群体。拟议的 RCT 将测试 基于依恋的干预措施对低收入拉丁裔新兴健康结果的影响 儿童（N = 260）。我们将重点关注低收入拉丁裔家庭，他们是健康风险极高的群体 问题。手动干预，依恋和生物行为追赶（ABC），包括 10 由经过培训的家长教练为主要照顾者及其家中的婴儿提供课程。我们将 招募有 9 个月大婴儿的家庭并纵向跟踪他们直到 2 岁。在目标 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效果 幼儿疾病（例如呼吸道疾病）、低度炎症、体重指数和睡眠。在目标 2 中，我们将 检验干预效果的中介变量。我们假设（a）对敏感群体的积极干预作用 养育行为和儿童压力调节，以及（b）这些因素将调节干预效果 关于儿童健康结果。在目标 3 中，我们将测试社会文化背景作为干预的调节因素 影响。我们假设对高风险二人组（即母亲的风险更高）的干预效果更强。 与低风险的二人组相比，他们已经适应了文化，得到的支持较少，或者受到更多的歧视。我们的 该提案的创新之处在于，RCT 设计提供了前所未有的机会来测试以下因素的因果影响： 对已知可追踪的一系列全面的早期健康结果进行基于依恋的干预 生命历程。该提案意义重大，因为它直接符合 NICHD 理解社会的优先事项 健康的决定因素和减少健康差异的发展知情策略。我们将（一） 检查基于依恋的干预如何支持健康基础并 (b) 确定亚组 未来努力优先考虑优化低收入拉丁裔儿童的健康。