Improving Nutrition and Physical Activity Environments In Home-Based Child Care

描述（由申请人提供）：托幼机构是学龄前儿童健康饮食和身体活动（PA）干预的主要场所，因为超过70%的美国6岁以下儿童参加户外托幼服务，平均每周35小时，每天消耗50-75%的卡路里。学龄前是饮食和PA行为建立的关键时期。不健康的食物和PA行为导致儿童肥胖和相关慢性疾病的高患病率，对低收入和种族和少数民族儿童的影响尤为严重。改善儿童保育环境是改善儿童饮食、PA和预防肥胖的建议策略；儿童保育干预研究已被证明是有效的。然而，这些研究主要是使用昂贵的专家来进行干预，并且是时间和劳动密集型的。此外，几乎所有这些研究都是在托儿中心进行的，而不是在家庭托儿所（FCCHs）进行的，后者为25%的美国学龄前儿童和28%的罗德岛学龄前儿童提供照顾。与中心相比，儿童保健中心受到的监管较少，大多数儿童保健中心不符合国家营养或PA饮食或PA建议以及家庭儿童保健提供者（FCCPs）的要求。他们获得“最佳做法”培训或技术援助的机会也很有限。由于最近在营养和PA法规方面的国家儿童保育报告卡评级为C+， RI特别需要这种干预措施，并且最近对RI FCCPs的全州调查也支持对儿童肥胖预防的需求和兴趣。通过拟议的研究，我们的团队将调整以前基于证据的干预措施的组成部分，以创建一个新的创新干预措施，用英语和西班牙语来改善FCCH的食物和PA环境。干预措施将包括：a)由具有儿童保育经验的同伴咨询师提供支持，他们将作为fcpc小组的组长；B)定制的印刷和视频材料；c)一套便携式活动

DESCRIPTION (provided by applicant): Child care facilities are prime settings for healthy eating and physical activity (PA) interventions with preschoolers because over 70% of U. S. children under the age of six attend out-of-home child care averaging 35 hours per week and consuming 50-75% of their daily calories there. Preschool years are critical times when dietary and PA behaviors are established. Unhealthy food and PA behaviors contribute to the high prevalence rates of childhood obesity and associated chronic diseases that disproportionately affect low-income and racial and ethnic minority children. Improving child care environments is a recommended strategy for improving children's diets, PA and for preventing obesity; and childcare intervention studies have been shown to be effective. However these studies have predominantly used expensive experts to deliver the intervention and were time and labor-intensive. Moreover, almost all of these studies were conducted in childcare centers and not in family child care homes (FCCHs), which provide care for 25% of U.S. and 28% of R.I. preschoolers. FCCHs are less regulated than centers and most do not meet national nutrition or PA diet or PA recommendations and, family child care providers (FCCPs). They also have limited access to 'best practices' training or technical assistance. RI is in particular need of suh interventions due to its recent C+ national childcare report card rating for its nutrition and PA regulations, and a recent state-wide survey of RI FCCPs also supports the need for, and interest in, childhood obesity prevention. Through the proposed research, our team will adapt components of previous evidence-based interventions to create a new innovative intervention in both English and Spanish to improve food and PA environments of FCCH. The intervention will integrate: a) support from peer counselors with child care experience who will serve as team leaders for groups of FCCPs; b) tailored print and video materials; and c) a set of portable active toys. A cluster-randomized trial with 132 FCCHs will evaluate the effectiveness of the intervention with a Steering Committee and Community Advisory Board guiding all aspects. The Specific Aims of the study are to: 1) Conduct formative research to inform the development and adaptation of the FCCH intervention. 2) Conduct a cluster-randomized trial of the intervention's efficacy with 66 FCCPs and a control intervention with 66 demographically-matched FCCPs to evaluate its impact on: a) Children's overall dietary quality at FCCHs; b) Children's PA and sedentary behaviors at FCCHs; and c) the physical and social food and PA environments of FCCHs. We will also conduct extensive mixed-methods process evaluation to determine fidelity, dose, acceptability, context, and unintended consequences; explore the relationship between outcome measures and intervention dose as well as with mediating/moderating variables, and explore the intervention effect on child BMI. If proven effective, this intervention has the potental to be replicated and widely disseminated throughout RI and the US, where improvements in the childcare environment are a high priority.