Improving nutrition and physical activity environments in home-based child care

改善家庭托儿所的营养和身体活动环境

• 批准号: 9462272
• 负责人: Kim M. Gans
• 金额: $ 8.2万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9462272
• 关键词: 5 year old; Affect; Age; Behavior; Calories; Caring; Child; Child Care; Child Support; Chronic Disease; Cluster randomized trial; Communities; Computers; Control Groups; Controlled Environment; Counseling; Cues; Development; Diet; Dose; Effectiveness; Effectiveness of Interventions; Enrollment; Environment; Evaluation; Evidence based intervention; Evidence based practice; Family; Food; Health Professional; Healthy Eating; High Prevalence; Hispanics; Home environment; Hour; Intervention; Intervention Studies; Intervention Trial; Latino; Low income; Measures; Mediating; Mediator of activation protein; Methods; Mothers; Nursery Schools; Obesity; Outcome Measure; Parents; Physical activity; Policies; Practice Guidelines; Prevalence; Preventive Intervention; Process; Professional counselor; Provider; Recommendation; Regulation; Reporting; Research; Rhode Island; Risk; Surveys; Time; Toy; Training; Treatment Efficacy; base; collaborative environment; early childhood; effective intervention; efficacy trial; empowered; ethnic minority population; experience; group intervention; high risk; improved; indexing; innovation; interest; intervention effect; minority children; multi-component intervention; nutrition; obesity in children; obesity prevention; patient home care; peer; peer support; portability; prevent; primary outcome; public health relevance; racial and ethnic; racial minority; secondary outcome; sedentary; sedentary lifestyle; social; training opportunity; tv watching

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.

描述（由申请人提供）：托儿所是对学龄前儿童进行健康饮食和体育活动 (PA) 干预的主要场所，因为超过 70% 的 6 岁以下美国儿童平均每周 35 小时参加户外托儿所，并在那里消耗了每日卡路里的 50-75%。学龄前阶段是饮食和 PA 行为形成的关键时期。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，这些疾病尤其影响低收入和种族和民族儿童。改善儿童保育环境是改善儿童饮食、体质和预防肥胖的推荐策略；儿童保育干预研究已被证明是有效的。然而，这些研究主要使用昂贵的专家来提供干预，并且是时间和劳动力密集型的。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 (FCCH) 中进行的，后者为 25% 的美国学龄前儿童和 28% 的罗德岛州学龄前儿童提供照料。 FCCH 的监管比中心少，而且大多数不符合国家营养或 PA 饮食或 PA 建议以及家庭儿童保育提供者 (FCCP)。他们获得“最佳实践”培训或技术援助的机会也很有限。由于最近 RI 的营养和 PA 法规被评为 C+ 国家儿童保育成绩单，RI 特别需要 SUH 干预措施，并且最近对 RI FCCP 进行的全州范围调查也支持了预防儿童肥胖的必要性和兴趣。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，以英语和西班牙语创建新的创新干预措施，以改善 FCCH 的食品和 PA 环境。干预措施将整合： a) 具有儿童保育经验的同伴辅导员的支持，他们将担任 FCCP 小组的领导者； b) 定制印刷和视频材料； c) 一套便携式主动 玩具。一项针对 132 个 FCCH 的整群随机试验将评估干预措施的有效性，指导委员会和社区咨询委员会将指导各个方面。该研究的具体目标是： 1) 进行形成性研究，为 FCCH 干预措施的制定和调整提供信息。 2) 对 66 个 FCCP 的干预效果进行整群随机试验，并对 66 个人口统计匹配的 FCCP 进行对照干预，以评估其对以下方面的影响： a) FCCH 儿童的整体膳食质量； b) 儿童在 FCCH 的 PA 和久坐行为； c) FCCH 的物质和社会食物及 PA 环境。我们还将进行广泛的混合方法过程评估，以确定保真度、剂量、可接受性、背景和意外后果；探讨结果指标与干预剂量以及中介/调节变量之间的关系，并探讨干预对儿童BMI的影响。如果证明有效，这种干预措施有可能在罗德岛州和美国复制并广泛传播，改善儿童保育环境是这些国家的首要任务。