Enhancing Cardiovascular Health Equity in Mothers and Children Through Home Visiting

通过家访提高母亲和儿童的心血管健康公平性

基本信息

批准号：
10618374
负责人：
Victor G. Davila-Roman
金额：
$ 79.69万
依托单位：
WASHINGTON UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-05 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10618374
关键词：
Age American Heart Association Behavior Behavioral Biological Birth Black race Blood Pressure Body mass index Cardiovascular system Characteristics Child Child Health Childbirth Cholesterol Chronic Disease Clinical Trials Communities Complex Diet Dose Educational process of instructing Effectiveness Enrollment Ensure Equity Evidence based practice Family Foundations Funding Generations Gestational Diabetes Glycosylated hemoglobin A Healthy Eating Home Home visitation Housing Hybrids Implementation readiness Individual Intervention Latinx Lead Learning Life Life Style Low income Measures Missouri Modeling Morbidity - disease rate Mothers Outcome Parent-Child Relations Parents Patient Recruitments Persons Phase Physical activity Pre-Eclampsia Pregnancy Pregnancy Complications Pregnant Women Preschool Child Protocols documentation Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Research Resources Scientific Advances and Accomplishments Site Sleep Smoking Specific qualifier value Testing Time Training United States National Institutes of Health Universities Visit Washington Weight Women&apos s Health Work active lifestyle cardiovascular disorder risk cardiovascular health cardiovascular risk factor child bearing clinical research site evidence base experience follow-up food insecurity health assessment health disparity health equity healthy weight housing instability implementation science improved innovation intergenerational kindergarten lifestyle intervention mortality parental influence pragmatic randomized trial prenatal prevent programs recruit screening social health determinants socioeconomic disadvantage study population teacher treatment as usual young mother

项目摘要

Project Summary/Abstract The foundation for cardiovascular health (CVH) is laid in early life by intergenerational interactions, passed from parent to child, that have long-lasting biological and behavioral consequences. Lifestyle interventions can promote CVH among mothers and their children over time. Academic partnerships with home visiting organizations that reach families experiencing health disparities advance intergenerational CVH equity. This study builds on a decades-long academic-home visiting partnership between the research team at Washington University in St. Louis and Parents as Teachers (PAT), an evidence-based home visiting program located in all 50 states. Most recently, our partnered work demonstrated the effectiveness of Healthy Eating and Active Living Taught at Home (HEALTH), in which we successfully tested a lifestyle intervention to promote ideal weight and CVH among pregnant and young mothers and their children. We now seek to advance this work with the ENRICH Collaborative by rigorously testing the ongoing CVH impact of this implementation-ready approach. During the UG3 planning phase (years 1-2), we will work with the ENRICH Collaborative to identify a common CVH protocol informed by HEALTH. In the UH3 implementation phase (years 3-7), we will rigorously test the ongoing impact on CVH of this implementation-ready approach for mothers and young children, delivered over 3 years, beginning prenatally and continuing to 30 months post- childbirth. The Hybrid Type 1 cluster-randomized pragmatic trial builds on this partnership (N=10 sites in high burden St. Louis, Missouri, metro region; 750 mother-child dyads; study population with one or more of the following characteristics associated with increased risk of cardiovascular disease: Black or Latinx, body mass index ≥ 30, and/or socioeconomic disadvantage). We will determine the effect of HEALTH on maternal CVH as assessed by a composite score on the American Heart Association Life’s Simple 7 over 3 years from enrollment (before 20 weeks pregnancy) to follow-up at birth, 6, 18, and 30-months post childbirth; and on child CVH assessed by BMIz trajectory and diet, activity, sleep, and parental influence from birth to 6, 18, and 30-month follow-up. We will apply expertise in implementation science to ensure the intervention has equitable implementation and impact across PAT and the ENRICH Collaborative. This significant study will further advance scientific understanding and evidence-based practice on how to disrupt the impact of cardiovascular risk that passes across generations to improve CVH equity. The innovation of this study is that it will rigorously determine the impact of HEALTH on the transfer of lifestyle behaviors from mother to child, across the childbearing continuum.

项目概要/摘要心血管健康 (CVH) 的基础是在生命早期通过代际互动奠定的，从父母传给孩子，对生活方式产生持久的生物学和行为影响。随着时间的推移，干预措施可以促进母亲及其子女的 CVH。与接触健康差异家庭的家访组织一起推进这项研究建立在长达数十年的学术家访的基础上。圣路易斯华盛顿大学研究团队与家长之间的合作伙伴关系教师 (PAT) 是一项基于证据的家访计划，最近在全美 50 个州开展。合作工作证明了在家教授健康饮食和积极生活的有效性（健康），其中我们成功测试了生活方式干预措施，以促进理想体重和 CVH 我们现在寻求与怀孕和年轻母亲及其孩子一起推进这项工作。 ENRICH Collaborative 通过严格测试此实施就绪的持续 CVH 影响在 UG3 规划阶段（第 1-2 年），我们将与 ENRICH Collaborative 合作，确定由 HEALTH 通知的通用 CVH 协议在 UH3 实施阶段（第 3-7 年），我们将严格测试这种为母亲实施的准备方法对 CVH 的持续影响以及 3 岁以上出生的幼儿，从产前开始一直持续到产后 30 个月混合型 1 类整群随机实用试验建立在这种伙伴关系的基础上（N = 10 个站点）密苏里州圣路易斯市高负担都会地区的 750 名母子研究人群；以下更多特征与心血管疾病风险增加相关：黑人或拉丁裔、体重指数 ≥ 30 和/或社会经济劣势）。根据美国心脏协会的综合评分评估孕产妇 CVH 的健康状况生活简单 7 从入组（怀孕 20 周前）到出生随访 3 年多， 6, 18, 以及产后 30 个月的儿童 CVH，通过 BMIz 轨迹和饮食、活动、睡眠、从出生到 6、18 和 30 个月的随访，我们将应用专业知识。实施科学，以确保干预措施在各个领域得到公平实施和影响 PAT 和 ENRICH 合作研究将进一步推进科学发展。关于如何消除心血管风险影响的理解和循证实践这项研究的创新之处在于它将严格地代代相传以提高 CVH 公平性。确定健康对生活方式行为从母亲到孩子的转移的影响生育连续体。