Reducing Sugared Fruit Drinks in Alaska Native Children

项目概要/摘要 在阿拉斯加的Yk三角洲，Yup'ik儿童每天消耗50茶匙的添加糖，是美国的16倍。 心脏协会建议的最大值。大多数添加的糖来自含糖的水果饮料（大多数 Tang和Kool-Aid）在家中消费。因此，Yup'ik儿童的蛀牙率 是美国平均水平的16倍，与富裕家庭的儿童相比， 社区.我们提出了一个2臂准实验行为试验在3个农村阿拉斯加原住民社区， 检验社区卫生工作者主导的健康教育和自我效能训练对 照顾者将减少儿童添加糖的摄入量。具体目标是：（1）完善和确定健康 促进干预;（2）实施干预并确定结果;（3）确定干预 改进战略和传播调查结果。涉及健康的饮料替代干预措施 教育和获得替代办法是有效的，但改善通常不能长期持续。 这种下降的原因是干预措施缺乏提高自我效能的具体努力，这是一个关键因素。 根据班杜拉的社会认知理论，省略。该应用程序建立在以前的研究基础上， 将在阿拉斯加土著社区测试这些概念。在拟议的研究中，将分配3个社区 根据社区准备就绪的顺序，选择2个武器中的1个。101个有0-10岁儿童的家庭 将招募2个Yup'ik社区，以测试为期6个月的文化适应，5次干预 包括互动式健康教育和自我效能培训，由一名土著人亲自提供， 社区卫生工作者。第三个Yup'ik社区的41个家庭将被招募到一个比较条件 其中将通过邮寄方式提供具有相同文化适应内容的健康教育。健康教育 将解决蛀牙的病因和有关含糖水果饮料的错误信息，并推广无糖水 增强剂。自我效能训练将使照顾者能够随着时间的推移开始和维持行为改变。 所有3个社区的当地商店都将供应无糖水果饮料（Tang和Kool-Aid滴剂，也称为水 增强剂）作为一种工具，以帮助改变儿童从含糖水果饮料。主要成果 儿童水平是含糖水果饮料摄入量（24小时召回报告）和添加糖摄入量（通过 在基线和1、3、6和12个月时测量的经验证的非侵入性生物标志物）。二次 结果包括来自添加糖的总能量摄入百分比和提供替代品的照顾者自我效能。 这项工作得到了育空地区Kuskokwim保健公司的支持，该公司将维持和传播 如果该计划有效，并能解决约克郡15,000多名阿拉斯加土著儿童面临的一个关键问题， 三角洲和数百万以上，如果通过整个阿拉斯加和美洲印第安人的国家在下48。 此外，它还可以进行调整，以满足其他有类似问题的人群的需要。

PROJECT SUMMARY/ABSTRACT Yup’ik children in Alaska’s YK Delta consume 50 teaspoons of added sugar each day, 16 times the American Heart Association’s recommended maximum. Most of this added sugar is from sugared fruit drinks (mostly Tang and Kool-Aid) consumed at home. Consequently, Yup’ik children experience tooth decay rates that are 16 times the U.S. average and suffer from oral health inequalities compared to children from better off communities. We propose a 2-arm quasi-experimental behavioral trial in 3 rural Alaska Native communities to test the hypothesis that Community Health Worker-led health education and self-efficacy training for caregivers will decrease child added sugar intake. The Specific Aims are to: (1) Refine and finalize the health promotion intervention; (2) Implement the intervention and determine outcomes; and (3) Identify intervention improvement strategies and disseminate findings. Beverage substitution interventions involving health education and access to alternatives are effective, but improvements are not typically sustained long-term. The reason for this drop off is that the interventions lack specific efforts to boost self-efficacy, a critical omission according to Bandura’s Social Cognitive Theory. This application builds on previous research and will test these concepts in Alaska Native communities. In the proposed study, 3 communities will be assigned to 1 of 2 arms based on the order in which the community is ready. 101 families with children ages 0-10 years in 2 Yup’ik communities will be recruited to test the 6-month culturally-adapted, 5-session intervention consisting of interactive health education and self-efficacy training delivered in-person by an indigenous Community Health Worker. 41 families in a third Yup’ik community will be recruited to a comparison condition in which health education with the same culturally-adapted content will be delivered by mail. Health education will address tooth decay etiology and misinformation about sugared fruit drinks, and promote sugar-free water enhancers. Self-efficacy training will empower caregivers to initiate and sustain behavior change over time. Local stores in all 3 communities will stock sugar-free fruit drinks (Tang and Kool-Aid drops, also called water enhancers by industry) as a tool to help shift children from sugared fruit drinks. The primary outcomes at the child level are sugared fruit drink intake (caregiver-reported 24-hour recalls) and added sugar intake (through a validated, non-invasive biomarker) measured at baseline and at 1, 3, 6, and 12 months. Secondary outcomes include % total energy intake from added sugar and caregiver self-efficacy to provide alternatives. This work has the support of the Yukon Kuskokwim Health Corporation which will maintain and disseminate the program if it works and can address a critical problem facing over 15,000 Alaska Native children in the YK Delta and millions more if adopted throughout Alaska and American Indian country in the Lower 48. Moreover, it can be adapted to meet the needs of other populations with similar problems.