Addressing Obesity in Early Care and Education Settings

项目摘要 儿童肥胖症是一种全国性流行病，给低收入和少数民族造成了不成比例的负担。 社区.到学龄前，近三分之一的低收入儿童已经超重或肥胖， 青春期和成年期的各种不良健康状况的阶段。专家们一致认为， 迫切需要可扩展和可持续的肥胖预防工作，必须将重点转移到早期 童年.幼儿园为执行和广泛传播儿童权利提供了一个非常有希望的环境， 针对大量幼儿的干预措施。然而，严格的实施研究有限， 针对低收入和少数民族学龄前儿童留下了重大的证据缺口， 限制了教育工作者和政策制定者解决肥胖流行病的工具。单独地- 集中和单一成分的干预措施通常未能产生长期的肥胖变化- 相关成果。越来越多的证据支持创建整个环境（例如，幼儿园）， 健康的选择是默认选项。 因此，我们建议进行一项务实的集群随机试验，根据我们的健康， 默认框架，以多层次、多组件的方式评价实施效果 将健康饮食和体育活动纳入学前常规的干预措施。我们的干预将 包括：1）制定组织一级政策，支持健康营养和体育活动; 2） 将营养和体育活动纳入学前课程，3）通过以下方式建立健康行为模式： 幼儿园教师和工作人员，以及4）家长作为合作伙伴参与这一努力。本研究是一项 加州大学洛杉矶分校和儿童保育资源中心（CCRC），一个大型的非营利组织之间的合作 致力于确保所有儿童获得高质量，全面的学前/儿童保育体验， 特别是在资源贫乏、多样化的社区。我们将随机分配60所由CCRC服务的幼儿园， 服务不足的地区的洛杉矶县，干预或通常的做法，等待名单控制条件。 我们的目标是：1）在学龄前环境中实施多层次的肥胖预防干预， 建立在现有的循证方法，利益相关者的投入，和我们的试点研究; 2）评估 干预对儿童BMI z评分（主要结局）和父母报告的儿童营养的有效性 和身体活动（次要结果）;和3）系统地评估干预措施的覆盖范围，采用， 在RE-AIM框架的指导下，我们为客户量身定制了 我们的具体研究重点和设置。通过同时评估有效性和执行情况， 通过我们的干预，我们将有效地产生对广泛传播至关重要的新知识。给定 儿童肥胖的惊人的长期社会成本，严格的研究，以确定有效的和可扩展的 现在需要采取预防肥胖的干预措施。

PROJECT SUMMARY Childhood obesity is a national epidemic that disproportionately burdens low income and ethnic minority communities. By preschool, nearly one-third of low income children are already overweight or obese, setting the stage for a myriad of adverse health conditions in adolescence and adulthood. Experts agree that effective, scalable, and sustainable obesity prevention efforts are urgently needed and must shift their focus to early childhood. Preschools offer a very promising environment for implementation and wide dissemination of interventions targeting large numbers of young children. However, limited rigorous implementation research targeting low income and ethnic minority preschool age children has left a major evidence gap, severely constraining the tools available to educators and policymakers to address the obesity epidemic. Individually- focused and single-component interventions have generally failed to produce long-term changes in obesity- related outcomes. Evidence increasingly supports creating entire environments (e.g., preschools) where the healthy choice is the default option. Therefore, we propose to conduct a pragmatic cluster randomized trial, based on our Healthy-By- Default framework, to evaluate the effectiveness and implementation of a multi-level, multi-component intervention that integrates healthy eating and physical activity into preschool routines. Our intervention will involve 1) establishment of organization-level policies to support healthy nutrition and physical activity, 2) integration of nutrition and physical activity into the preschool curriculum, 3) modeling of healthy behaviors by preschool teachers and staff, and 4) engagement of parents as partners in this effort. The study is a collaboration between UCLA and the Child Care Resource Center (CCRC), a large non-profit organization dedicated to ensuring that all children receive high quality, comprehensive preschool/child care experiences, particularly in low resource, diverse communities. We will randomly assign 60 preschools served by CCRC, in underserved areas of Los Angeles County, to the intervention or a usual practice, wait-list control condition. Our aims are to: 1) implement a multilevel obesity prevention intervention for preschool settings that builds on existing evidence-based approaches, stakeholder input, and our pilot research; 2) evaluate the effectiveness of the intervention on child BMI z-scores (primary outcome), and parent-reported child nutrition and physical activity (secondary outcomes); and 3) systematically assess intervention reach, adoption, implementation, adaptation and maintenance, guided by the RE-AIM Framework, which we have tailored for our specific study focus and setting. By simultaneously evaluating both effectiveness and implementation of our intervention, we will efficiently generate new knowledge vital to informing widespread dissemination. Given the staggering long-term societal costs of childhood obesity, rigorous studies to identify effective and scalable obesity prevention interventions are needed now.