Reducing Sugared Fruit Drinks in Alaska Native Children

工程摘要 在阿拉斯加州的Yk三角洲，Yup'ik儿童平均每天消耗50茶匙糖，是美国儿童的16倍。 美国心脏协会推荐的最大值。这些糖大部分来自水果饮料， Kool-Aid在家中使用。因此，Yup'ik儿童的蛀牙率是美国的16倍。 与来自富裕社区的儿童相比，平均水平和口腔健康不平等。 蛀牙是一种多因素疾病，但我们的试点工作表明，含糖水果饮料是关键的风险因素。YK 三角洲社区表示希望针对继续伤害他们孩子的含糖水果饮料。 这项研究是在YK三角洲社区内进行了5年多的研究的结果， 文化上适当的，可行的，可持续的计划，以解决持续存在的公共卫生问题造成的 加糖的水果饮料我们提出了一个2臂准实验行为试验在3个小的，孤立的阿拉斯加 土著社区，以检验假设，社区卫生工作者领导的健康教育和自我- 对照顾者进行效能训练将减少儿童添加糖的摄入量。我们将向家庭介绍无糖食品 将通过当地商店提供的水增强剂。具体目标是：（1）完成前期工作; （2）实施干预措施并评估结果;以及 (3)确定改进干预措施的机会并传播调查结果。此应用程序基于 研究小组先前的R56研究，并将首次寻求改变含糖果汁饮料的摄入量， 阿拉斯加土著社区3个社区将根据社区顺序分配到2个武器中的1个 被招募到研究中。在社区A和B，将招募136名0至10岁的Yup'ik儿童， 测试为期6个月的文化适应性干预，包括互动式健康教育和自我 由土著社区卫生工作者亲自提供的功效培训。在C社区，56名儿童 将被招募到一个比较条件，其中健康教育具有相同的文化适应内容 通过邮寄方式送达。健康教育将解决有关含糖果汁饮料的错误信息， 无糖水增强剂。自我效能训练将使照顾者能够维持行为改变， 时间所有3个社区的当地商店将储存无糖水增强剂（Tang，Kool-Aid和其他）。 流行口味）作为一种工具，以帮助转移儿童从含糖水果饮料。儿童的主要结局 水平是含糖水果饮料摄入量（24小时食物召回）和添加糖摄入量（经验证，非侵入性 生物标志物），并将在基线和1、3、6和12个月时测量。育空地区Kuskokwim卫生部 公司将维护和传播该计划，如果它的工作，以解决面临的关键问题15，000 + 阿拉斯加原住民的孩子们在YK三角洲。此外，它还可以适应其他人口的需要 包括下48州数百万土著儿童。

Project Abstract Yup’ik children in Alaska’s YK Delta consume an average of 50 teaspoons of sugar each day, 16 times the American Heart Association’s recommended maximum. Most of this sugar is from fruit drinks like Tang and Kool-Aid consumed at home. Consequently, Yup’ik children experience tooth decay rates that are 16x the U.S. average and suffer from oral health inequalities compared to children from communities that are better off. Tooth decay is a multifactorial disease, but our pilot work shows sugared fruit drinks are the key risk factor. YK Delta communities have expressed a desire to target sugared fruit drinks that continue to harm their children. This study is a culmination of over 5 years of engaged research within YK Delta communities to co-develop a culturally-appropriate, feasible, and sustainable program to address persisting public health problems caused by sugared fruit drinks. We propose a 2-arm quasi-experimental behavioral trial in 3 small, isolated 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. We will introduce families to sugar-free water enhancers that will be made available through local stores. The Specific Aims are to: (1) Complete pre- intervention activities and finalize the intervention; (2) Implement the intervention and assess outcomes; and (3) Identify intervention improvement opportunities and disseminate findings. This application builds on previous R56 research by the study team and will for the first time seek to change sugared fruit drink intake in Alaska Native communities. 3 communities will be assigned to 1 of 2 arms based on the order communities were recruited into the study. In Communities A and B, 136 Yup’ik children ages 0-10 years 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. In Community C, 56 children will be recruited to a comparison condition in which health education with the same culturally-adapted content is delivered by mail. Health education will address misinformation about sugared fruit drinks and promote sugar-free water enhancers. Self-efficacy training will empower caregivers to sustain behavior change over time. Local stores in all 3 communities will stock sugar-free water enhancers (Tang, Kool-Aid, and other popular flavors) as a tool to help shift children from sugared fruit drinks. The primary outcomes at the child level are sugared fruit drink intake (24-hour food recalls) and added sugar intake (validated, non-invasive biomarker) and will be measured at baseline and at 1, 3, 6, and 12 months. The Yukon Kuskokwim Health Corporation will maintain and disseminate the program if it works to address a critical problem facing 15,000+ Alaska Native children in the YK Delta. Moreover, it can be adapted to meet the needs of other populations with similar problems, including the millions of indigenous children in the Lower 48.