Addressing Obesity in Early Care and Education Settings

项目总结 儿童肥胖是一种全国性的流行病，给低收入和少数民族带来了不成比例的负担 社区。到学龄前，近三分之一的低收入儿童已经超重或肥胖， 这是青春期和成年期出现无数不良健康状况的阶段。专家们一致认为，有效、 迫切需要可扩展和可持续的肥胖预防努力，必须将重点转移到早期 童年。幼儿园为实施和广泛传播《儿童权利公约》提供了一个非常有希望的环境 针对大量幼儿的干预措施。然而，严格的实施研究有限 针对低收入和少数民族学龄前儿童留下了一个重大的证据差距，严重 限制了教育工作者和政策制定者可用来解决肥胖流行病的工具。个别的- 集中和单一成分的干预措施通常无法产生肥胖症的长期变化-- 相关结果。越来越多的证据支持创造完整的环境(例如，幼儿园)，在那里 健康选择是默认选项。 因此，我们建议进行一项务实的整群随机试验，基于我们的Healthby-by- 默认框架，用于评估多层次、多组件的有效性和实施情况 将健康饮食和体力活动纳入学龄前常规的干预措施。我们的干预将 涉及1)制定组织一级的政策，以支持健康营养和体育活动；2) 将营养和体育活动整合到学龄前课程中，3)通过 幼儿园教师和工作人员，以及4)家长作为合作伙伴参与这一努力。该研究是一项 加州大学洛杉矶分校与大型非营利组织儿童保育资源中心(CCRC)的合作 致力于确保所有儿童获得高质量、全面的学前/托儿体验， 特别是在资源匮乏、多样化的社区。我们将随机分配60所由CCRC服务的幼儿园，在 洛杉矶县服务不足的地区，以干预或惯常做法，等待名单控制的情况。 我们的目标是：1)对学龄前环境实施多级肥胖预防干预， 建立在现有的基于证据的方法、利益相关者的意见和我们的试点研究的基础上；2)评估 干预对儿童BMI z评分(主要结果)和父母报告的儿童营养的有效性 和体力活动(次要结果)；以及3)系统地评估干预范围、采用、 实施、适应和维护，以我们为之量身定制的RE-AIM框架为指导 我们的具体研究重点和背景。通过同时评估以下各项的有效性和实施 通过我们的干预，我们将有效地产生对广泛传播至关重要的新知识。vt.给出 儿童肥胖令人震惊的长期社会成本，严格的研究确定有效和可扩展的 现在需要采取预防肥胖的干预措施。

PROJECT SUMMARY Childhood obesity is a national epidemic that disproportionately burdens low income and ethnic minority communities. By preschool, nearly one-third of low income children are already overweight or obese, setting the stage for a myriad of adverse health conditions in adolescence and adulthood. Experts agree that effective, scalable, and sustainable obesity prevention efforts are urgently needed and must shift their focus to early childhood. Preschools offer a very promising environment for implementation and wide dissemination of interventions targeting large numbers of young children. However, limited rigorous implementation research targeting low income and ethnic minority preschool age children has left a major evidence gap, severely constraining the tools available to educators and policymakers to address the obesity epidemic. Individually- focused and single-component interventions have generally failed to produce long-term changes in obesity- related outcomes. Evidence increasingly supports creating entire environments (e.g., preschools) where the healthy choice is the default option. Therefore, we propose to conduct a pragmatic cluster randomized trial, based on our Healthy-By- Default framework, to evaluate the effectiveness and implementation of a multi-level, multi-component intervention that integrates healthy eating and physical activity into preschool routines. Our intervention will involve 1) establishment of organization-level policies to support healthy nutrition and physical activity, 2) integration of nutrition and physical activity into the preschool curriculum, 3) modeling of healthy behaviors by preschool teachers and staff, and 4) engagement of parents as partners in this effort. The study is a collaboration between UCLA and the Child Care Resource Center (CCRC), a large non-profit organization dedicated to ensuring that all children receive high quality, comprehensive preschool/child care experiences, particularly in low resource, diverse communities. We will randomly assign 60 preschools served by CCRC, in underserved areas of Los Angeles County, to the intervention or a usual practice, wait-list control condition. Our aims are to: 1) implement a multilevel obesity prevention intervention for preschool settings that builds on existing evidence-based approaches, stakeholder input, and our pilot research; 2) evaluate the effectiveness of the intervention on child BMI z-scores (primary outcome), and parent-reported child nutrition and physical activity (secondary outcomes); and 3) systematically assess intervention reach, adoption, implementation, adaptation and maintenance, guided by the RE-AIM Framework, which we have tailored for our specific study focus and setting. By simultaneously evaluating both effectiveness and implementation of our intervention, we will efficiently generate new knowledge vital to informing widespread dissemination. Given the staggering long-term societal costs of childhood obesity, rigorous studies to identify effective and scalable obesity prevention interventions are needed now.