Preventing Childhood Obesity Through Youth Empowerment: A Cluster RCT of the H2GO! Program

项目概要/摘要 美国超过三分之一的儿童超重或肥胖，面临短期和长期健康风险 后果，包括糖尿病、高血压、心脏病和某些类型的癌症。实质性 有证据表明，减少含糖饮料 (SSB) 的消费是以下人群的一个关键饮食目标： 儿童肥胖的预防。缺乏针对 SSB 的有效行为干预措施，特别是 在低收入和少数族裔早期和青春期前的青少年中，SSB 摄入量较高，并且 肥胖风险。青年赋权干预措施有可能促进儿童行为改变 肥胖干预背景可能对低收入和少数族裔青年特别有吸引力。 然而，很少有关于青年赋权健康干预措施的研究采用严格的研究设计或 审查了赋权作为变革的调解者/机制。为了弥补这一差距，我们与 Boys and Girls Clubs of America (BGCs)，一个覆盖 400 万青少年的全国性课后托管系统 每年，制定并试点测试基于社区的青年赋权干预措施，以减少 SSB 摄入量和预防儿童肥胖。以赋权理论为基础，干预针对 SSB 通过健康课程进行消费，通过培养年轻人的信心和技能来增强他们的能力； 通过培养批判性思维来增强青年能力的叙事会议，以及由青年主导的活动 通过在家庭中产生变革的机会赋予青年权力。由此产生的 H2GO!干预 旨在由 BGC 工作人员在 BGC 内交付。在 H2GO! 成功试点研究的基础上，我们 现在准备测试H2GO的功效！与马萨诸塞州 BGC 网络合作进行干预， 每年总共为超过 160,000 名儿童提供服务。采用整群随机设计，共 10 BGC站点将随机分配给H2GO！干预或等待名单、常规护理条件。总共有 将登记450对亲子（N=每个站点45对亲子）。数据将在基线时收集，2 个月、6 个月和 12 个月，包括儿童人体测量、SSB 和饮水量以及青少年 赋权。该提案的具体目标包括：1）测试H2GO的功效！儿童BMI干预 使用整群随机对照试验进行 z 评分； 2）测试H2GO的功效！对儿童SSB的干预 和饮水量； 3）考察青年赋权作为干预效果的中介因素。由此得出的结论 该提案将提供青年赋权的证据，作为减少 SSB 摄入量和肥胖风险的方法 并为建立预防儿童肥胖的干预模型的长期目标做出贡献 适合通过青年环境进行传播。

Project Summary/Abstract Over one-third of children in the U.S. are overweight or obese and at risk for short-term and long-term health consequences, including diabetes, hypertension, heart disease and certain types of cancer. Substantial evidence exists on reducing sugar-sweetened beverage (SSB) consumption as a critical dietary target for childhood obesity prevention. Efficacious behavioral interventions targeting SSBs are lacking, particularly among low-income and ethnic minority early and pre-adolescent youth who have higher SSB intake and obesity risk. Youth empowerment interventions hold potential for catalyzing behavior change in childhood obesity intervention contexts and may be particularly engaging for low-income and ethnic minority youth. However, few studies of youth empowerment health interventions have utilized rigorous study designs or examined empowerment as a mediator/mechanism of change. To this gap, we worked collaboratively with Boys and Girls Clubs of America (BGCs), a national system of afterschool care that reaches 4 million youth annually, to develop and pilot-test a community-based youth empowerment intervention on reducing SSB intake and preventing childhood obesity. Grounded in Empowerment Theory, the intervention targets SSB consumption through health sessions that empower youth through developing their confidence and skills; narrative sessions that empower youth through cultivating critical thinking, and youth-led activities that empower youth through opportunities to produce change within their families. The resulting H2GO! intervention is designed to be delivered within BGCs by BGC staff. Building on our successful pilot study of H2GO!, we are now positioned to test the efficacy of the H2GO! intervention in collaboration with the BGC network in MA, which collectively serves over 160,000 children each year. Using a cluster-randomized design, a total of 10 BGC sites will be randomly assigned to the H2GO! intervention or a wait-list, usual care condition. A total of 450 parent-child pairs (N=45 parent-child pairs per site) will be enrolled. Data will be collected at baseline, 2 months, 6 months, and 12 months and include child anthropometrics, SSB and water intake, and youth empowerment. Specific aims of the proposal include: 1) test the efficacy of the H2GO! intervention on child BMI z scores using a cluster randomized controlled trial; 2) test the efficacy of the H2GO! intervention on child SSB and water intake; 3) examine youth empowerment as a mediator of intervention effects. Findings from this proposal will provide evidence of youth empowerment as an approach to reduce SSB intake and obesity risk and contribute to a long-term goal of producing an intervention model for childhood obesity prevention that is well-positioned for dissemination through youth-based settings.