Document text
Principal Investigator: Victor G. Davila-Roman
Organization: WASHINGTON UNIVERSITY
Fiscal Year: 2024
Award: $955,765
Funding agency: National Heart Lung and Blood Institute
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.
Terms: <0-11 years old><1-5 years old><Active Follow-up><Age><American Heart Association><BMI><BMI percentile><BMI z-score><Behavior><Behavioral><Biological><Birth><Black><Black race><Blood Pressure><Body mass index><Cardiovascular><Cardiovascular Body System><Cardiovascular Organ System><Cardiovascular system><Characteristics><Child><Child Health><Child Youth><Childbirth><Children (0-21)><Cholesterol><Chronic Disease><Chronic Illness><Clinical Trials><Communities><Complex><Diet><Dose><EPH Gestosis><Educational process of instructing><Effectiveness><Enrollment><Ensure><Equity><Evidence based practice><Family><Female Health><Foundations><Funding><Generations><Gestation><Gestational Diabetes><Gestational Diabetes Mellitus><Glycohemoglobin A><Glycosylated hemoglobin A><Hb A1><Hb A1a+b><Hb A1c><HbA1><HbA1c><Healthy Eating><Heart Vascular><Hemoglobin A(1)><Home><Home visitation><House Call><Housing><Hybrids><Implementation readiness><Individual><Intervention><Intervention Strategies><Latine><Latinx><Lead><Learning><Life><Life Style><Lifestyle><Low income><Measures><Missouri><Modeling><Morbidity><Morbidity - disease rate><Mothers><NIH><National Institutes of Health><Outcome><Parent-Child Relations><Parent-Child Relationship><Parents><Parturition><Patient Recruitments><Pb element><Persons><Phase><Physical activity><Pre-Eclampsia><Preeclampsia><Pregnancy><Pregnancy Complications><Pregnancy Toxemias><Pregnancy-Induced Diabetes><Pregnant Women><Preschool Child><Proteinuria-Edema-Hypertension Gestosis><Protocol><Protocols documentation><Quetelet index><RE-AIM><Randomized><Reach, Effectiveness, Adoption, Implementation, and Maintenance><Research><Research Resources><Resources><Scientific Advances and Accomplishments><Site><Sleep><Smoking><Socioeconomically disadvantaged><Specific qualifier value><Specified><Teaching><Testing><Time><United States National Institutes of Health><Universities><Visit><Washington><Weight><Women's Health><Work><active followup><active life style><active lifestyle><active living><ages><bear children><bearing children><biologic><cardiovascular disease risk><cardiovascular disorder risk><cardiovascular health><cardiovascular risk><cardiovascular risk factor><care as usual><child bearing><child birth><childbearing><chronic disorder><circulatory system><clinical research site><clinical site><complications during pregnancy><diets><disparity in health><enroll><evidence base><expectant mother><expecting mother><experience><follow up><follow-up><followed up><followup><food insecurity><health assessment><health disparity><health equity><healthy weight><heavy metal Pb><heavy metal lead><hemoglobin A1c><home visit><homes><housing instability><implementation science><improved><innovate><innovation><innovative><instably housed><intergenerational><interventional strategy><kids><kindergarten><life style intervention><lifestyle intervention><mortality><parent><parent child interaction><parent influence><parent offspring interaction><parental influence><parenting education intervention><parenting education programs><parenting intervention><parenting program><parenting skill training><parenting training><participant recruitment><pragmatic randomized trial><pre-eclamptic><pregnancy diabetes><pregnancy toxemia/hypertension><pregnancy-related complications><pregnant mothers><prenatal><preschool child (1-5)><prevent><preventing><programs><randomisation><randomization><randomly assigned><reach, efficacy, adoption, implementation, and maintenance><recruit><scientific accomplishments><scientific advances><screening><screenings><social health determinants><socio-economic disadvantage><socio-economically disadvantaged><socio-economically underprivileged><socioeconomic disadvantage><socioeconomically underprivileged><study population><teacher><treatment as usual><unborn><unstable housing><unstably housed><usual care><weights><young mother><youngster>