Fit 5 Kids Screen Time Reduction Curriculum for Latino Preschoolers: A RCT

Fit 5 Kids 针对拉丁裔学龄前儿童的屏幕时间减少课程：随机对照试验

• 批准号: 10343737
• 负责人: Jason A Mendoza
• 金额: $ 62万
• 依托单位: SEATTLE CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-02-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10343737
• 关键词: 5 year old; Academy; Acculturation; Adolescence; Adult; Affect; Age; American; Behavior; Body mass index; Books; Cardiovascular Diseases; Child; Child Rearing; Childhood; Chronic Disease; Communities; Dietary intake; Disease; Educational Curriculum; Effectiveness; Energy Intake; Environment; Family; Future; Goals; Guidelines; Head Start Program; Healthy Eating; Hour; Individual; Intervention; Intervention Studies; Latino; Latino Population; Libraries; Link; Malignant Neoplasms; Measures; Mediating; Mediation; Mediator of activation protein; Metabolic; Minority; Modeling; Neighborhoods; Newsletter; Non-Insulin-Dependent Diabetes Mellitus; Nursery Schools; Obesity; Outcome; Parents; Pediatrics; Physical activity; Pilot Projects; Population; Public Health; Randomized Controlled Trials; Reading; Reporting; Research; Research Personnel; Resources; Risk; Risk Factors; Rural; Sample Size; Sampling; Schools; Self Efficacy; Site; Social support; Stress; Television; Testing; Text Messaging; Time; Washington; Work; adult obesity; awake; base; behavioral outcome; cardiometabolic risk; depressive symptoms; design; dietary; dietary excess; effectiveness trial; efficacy trial; excessive weight gain; exercise intervention; expectation; experience; health goals; health inequalities; high risk; intervention delivery; lifetime risk; neighborhood safety; obesity in children; obesity prevention; obesity risk; peer; physical inactivity; pilot trial; prevent; preventive intervention; primary outcome; programs; social; social cognitive theory; systematic review; teacher; tv watching

ABSTRACT Screen time is a major risk factor for childhood obesity and inadequate physical activity, both of which are determinants of type 2 diabetes (T2D), cardiovascular disease, and multiple cancers. Latinos are the largest and fastest growing minority in the US. Because US Latino children have more screen time and higher rates of obesity than their non-Latino White peers, interventions to reduce screen time adapted for Latino preschoolers are necessary to reduce health inequities related to obesity and T2D in the US. However, a systematic review reported no successful screen time reduction interventions among Latino preschoolers. Our team's pilot study tested the culturally adapted Fit 5 Kids screen time reduction curriculum among Latino preschoolers in Head Start. This short term cluster randomized controlled trial (RCT) is the only successful screen time reduction program for Latino preschoolers, having significantly reduced screen time by over 25 minutes/day. Our culturally adapted, multi-level intervention consists of lessons taught by study staff directly to preschoolers during Head Start, a weekly parent newsletter, child-tailored goal setting with parents, a lending library (books, games, arts/crafts, etc.) and parenting tips via text messages several times/week. We will use a social ecological model and consider multiple levels of influences for analyses: (1) individual-level influences, e.g., acculturation and social cognitive theory, (2) families, e.g., screen time parenting practices, (3) schools, and (4) macro-environmental influences, e.g., neighborhood disorder. Building on this pilot work, we propose a long term, efficacy, cluster RCT of the culturally adapted Fit 5 Kids among Latino preschoolers in Head Start from three US settings: Seattle, Houston, and the rural Central Valley of Washington State. Among 280 Latino 3-5 year olds at 20 Head Start centers, our Specific Aims (SA) and Hypotheses (H) include: SA1) To conduct a cluster RCT of the culturally adapted Fit 5 Kids curriculum to evaluate its efficacy in reducing screen time and excessive weight gain over a school year (8-months) H1) Fit 5 Kids will decrease children's screen time (primary outcome), BMI z-scores and dietary energy intake, and increase MVPA compared to controls SA2) To examine mediators and moderators associated with reducing Latino preschoolers' screen time H2) Parents' outcome expectations, self-efficacy, and screen time parenting practices will mediate the relationship between Fit 5 Kids and changes to preschoolers' screen time H3) Parents' depressive symptoms, stress, and social support will moderate changes to child screen time The proposed Fit 5 Kids cluster RCT will confirm the pilot's promising results, and the larger sample will allow for mediation analyses to better understand mechanisms. This research will provide justification for a future community effectiveness trial with implementation by Head Start teachers, and the eventual widespread dissemination of Fit 5 Kids in Head Start centers nationally.

摘要 看电视时间是儿童肥胖和体力活动不足的主要风险因素，这两者都是 是2型糖尿病(T2D)、心血管疾病和多种癌症的决定因素。拉丁裔是 美国规模最大、增长最快的少数民族。因为美国拉丁裔儿童有更多的屏幕时间和更高 肥胖率高于非拉丁裔白人同龄人，干预措施减少适合拉丁裔的屏幕时间 在美国，学龄前儿童是必要的，以减少与肥胖和T2D相关的健康不平等。然而，a 系统审查报告称，在拉美裔学龄前儿童中，没有成功的减少屏幕时间的干预措施。 我们团队的试点研究测试了文化适应的Fit 5 Kids屏幕时间减少课程 拉美裔学龄前儿童领先一步。这项短期整群随机对照试验(RCT)是唯一 为拉美裔学龄前儿童成功地减少了屏幕时间，显著减少了 每天超过25分钟。我们的文化适应，多层次的干预包括由研究人员教授的课程 在Head Start期间直接发送给学龄前儿童，每周一次的家长时事通讯，与父母一起为孩子量身定做的目标， 借阅图书馆(书籍、游戏、工艺品等)每周几次通过短信传递育儿技巧。我们 将使用社会生态模型并考虑多个层面的影响进行分析：(1)个人层面 影响，例如，文化适应和社会认知理论，(2)家庭，例如屏幕时间的育儿实践，(3) 学校；(4)宏观环境影响，如邻里秩序混乱。在这项试点工作的基础上，我们 建议在拉美裔学龄前儿童中对文化适应的Fit 5儿童进行长期、有效的整群随机对照试验 先从三个美国背景开始：西雅图、休斯顿和华盛顿州农村的中央山谷。其中 20个启蒙中心的280名3-5岁的拉丁裔儿童，我们的具体目标(SA)和假设(H)包括： Sa1)对适应文化的Fit 5 Kids课程进行分组RCT，以评估其在#年的效果 减少一个学年的屏幕时间和体重过度增加(8个月) H1)适合5个孩子将减少孩子的屏幕时间(主要结果)、BMI z分数和饮食能量 摄入量，并与对照组相比增加MVPA Sa2)检查与减少拉丁裔学龄前儿童屏幕时间相关的调解人和主持人 H2)父母的结果期望、自我效能感和屏幕时间育儿实践将在 Fit 5儿童与学龄前儿童屏幕时间变化的关系 父母的抑郁症状、压力和社会支持会缓和孩子在屏幕前的时间变化 建议的Fit 5 Kids集群RCT将证实飞行员的有希望的结果，更大的样本将 允许进行调解分析，以更好地了解机制。这项研究将为 未来由Head Start教师实施的社区有效性试验，并最终得到广泛应用 在全国的Head Start中心推广Fit 5 Kids。