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力活动(PA)干预的主要场所，因为超过70%的6岁以下美国儿童参加了平均每周35小时的户外托儿所，并在那里消耗了他们每日卡路里的50%-75%。学龄前几年是建立饮食和PA行为的关键时期。不健康的食物和PA行为导致儿童肥胖症和相关慢性病的高患病率，对低收入、种族和少数民族儿童造成不成比例的影响。改善托儿环境是改善儿童饮食和预防肥胖的建议战略；托儿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，而且耗时耗力。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)进行的，家庭托儿所为25%的美国和28%的罗伊岛学龄前儿童提供护理。与中心相比，FCCH受到的监管较少，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。国际扶轮尤其需要SuH的干预，因为最近其营养和PA法规的C+全国儿童保育成绩单评级，最近一项针对国际扶轮FCCP的全州调查也支持了儿童肥胖预防的必要性和兴趣。通过拟议的研究，我们的团队将调整以前循证干预措施的组成部分，以创建一种新的英语和西班牙语创新干预措施，以改善FCCH的食物和PA环境。干预将包括：a)具有儿童保育经验的同伴辅导员的支持，他们将担任FCCP小组的小组组长；b)量身定做的印刷和视频材料；以及c)一套便携式活动 玩具。一项包含132个FCCH的整群随机试验将在指导委员会和社区咨询委员会的指导下评估干预的有效性。研究的具体目的是：1)开展形成性研究，为FCCH干预的发展和适应提供信息。2)对66名FCCP和66名人口统计匹配的FCCP的干预效果进行整群随机试验，以评估其对以下方面的影响：a)FCCH儿童的整体饮食质量；b)FCCH儿童的PA和久坐行为；c)FCCH的物理和社会食物和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；探索结果测量与干预剂量以及中介/调节变量之间的关系，并探索干预对儿童BMI的影响。如果证明有效，这种干预措施有可能在国际扶轮和美国复制和广泛传播，在那里，改善儿童保育环境是高度优先的。