Identifying an implementation strategy to maximize the public health nutrition impact of the Child and Adult Care Food Program

项目摘要/摘要 近五分之一的2-5岁的美国儿童患有肥胖症，今天超过一半的儿童预计会有肥胖症 成人期肥胖。因此，未能预防儿童肥胖使我们的大多数儿童面临更大的风险 与饮食有关的慢性疾病，包括II型糖尿病。幼儿时期对儿童精神分裂症的形成至关重要。 饮食习惯、体育活动和其他有助于健康体重的行为，但应尽早节食 童年目前是贫穷的。在早期建立健康饮食习惯的一种有前途的公共卫生方法 儿童是通过加强儿童和成人护理食品计划(CACFP)的营养标准来实现的， 一项联邦食品援助计划，惠及数百万参加托儿所的儿童 我们。CACFP提供的餐饮标准最近得到了更新，但执行不到位的情况有所减弱 这一政策变化的影响。确定改进执行情况的战略有助于确保 对CACFP的预期政策改进转化为儿童健康的改善。这项研究建议 首先收集新的数据，儿童保育提供者在采用更健康的饮食方面面临的实施挑战 标准。然后，利用这项形成性研究，我们将制定一项实施干预措施，以帮助儿童 护理中心采用更严格的CACFP营养标准。干预措施的效果将通过以下方式进行试点测试 在托儿中心层面进行一项整群随机对照试验。最后，这项研究将收集 关于实施干预过程的定性数据和关于费用的定量数据。NIDDK K01指导研究科学家发展奖将有助于填补1)传播和 实施科学和2)成本分析，并将以我在干预评估方面的高级培训为基础 和社会流行病学。我的长期职业目标是开发一个强大的研究项目，使用战略 科学为有效的政策制定和政策执行提供信息，以预防与营养相关的慢性病 在人口层面上的疾病。培训计划涉及实施科学和成本方面的课程 分析，结合有组织的指导、会议、研讨会和研讨会，以建立新的技能 这些区域。建议的研究计划将使我能够应用这些新技能，并在现有技能的基础上发展 准备好了。培养和研究相结合的计划，有强有力的制度支持和优秀的智力 哈佛大学公共卫生学院的环境，将确保我过渡到独立的 能够成功竞争R01基金的研究人员，并帮助我发展成为该领域的领导者 改善儿童营养和预防日后与饮食有关的慢性病的公共卫生方法。

PROJECT SUMMARY/ABSTRACT Nearly one in five 2-5 year old U.S. children has obesity, and over half of today’s children are expected to have obesity by adulthood. Failure to prevent childhood obesity thus puts a majority of our children at increased risk of diet-related chronic diseases including type II diabetes mellitus. Early childhood is critical for the formation of habits for eating, physical activity, and other behaviors that contribute to a healthy weight, yet diet in early childhood is currently poor. A promising public health approach to establishing healthy eating habits in early childhood is through strengthening the nutrition standards of the Child and Adult Care Food Program (CACFP), a federal food assistance program that reaches millions of young children attending child care settings in the US. CACFP standards for meals served were recently updated, but incomplete implementation has weakened the impact of this policy change. Identification of a strategy to improve implementation could help to ensure that the intended policy improvements to CACFP translate into improved child health. This study proposes to first collect novel data the implementation challenges that child care providers face in adopting healthier eating standards. Then, using this formative research, we will develop an implementation intervention to help child care centers adopt stronger CACFP nutrition standards. The efficacy of the intervention will be pilot-tested by conducting a cluster-randomized, controlled trial at the child care center level. Lastly, the study will collect qualitative data on the process of the implementation intervention and quantitative data on costs. The NIDDK K01 Mentored Research Scientist Development Award will help fill critical training gaps in 1) dissemination and implementation science and 2) cost analysis, and will build on my advanced training in intervention evaluation and social epidemiology. My long-term career goal is to develop a robust research program that uses strategic science to inform effective policy development and policy implementation, to prevent nutrition-related chronic diseases at a population level. The training plan involves coursework in implementation science and cost analysis, combined with structured mentoring, meetings, workshops, and seminars, to establish new skills in these areas. The research plan proposed will allow me to apply these new skills and build on my existing skill set. The combined training and research plan, with the strong institutional support and excellent intellectual environment of the Harvard T.H. Chan School of Public Health, will ensure my transition into an independent researcher able to compete successfully for R01 funding and help me develop into a leader in the field of public health approaches to improving child nutrition and preventing later diet-related chronic diseases.