Health Outcomes in Preschool: INnovations for Obesity Prevention (HOP-IN)

项目摘要/摘要 儿童肥胖是一个严重的公共健康威胁，也是加速心脏代谢健康的主要风险因素。 儿童期和成年期的状况。此外，儿童时期的肥胖对学业有负面影响 成就，它预测一生的健康结果，并具有戏剧性的经济影响。托儿所设置 已被确定为儿童早期肥胖干预的高影响目标。平均而言，75%的 美国学龄前儿童每周花在日托上的时间为35个小时，托儿机构 能够为儿童提供健康的膳食，增加体育活动的机会，并促进 睡眠--所有这些都有助于预防肥胖。尽管学龄前环境提供了定期的身体锻炼机会 在这方面，大多数托儿所的儿童都不符合现行的指导方针。2014年，只有12%的日托中心 华盛顿州达到了体育锻炼的目标，只有22%的人在户外活动。因为孩子们花在 更多的时间在户外更多的身体活动比那些花更多的时间在室内的人，学前班和 以户外和游戏为基础的课程可能有助于增加体力活动。唯一发表的关于这一主题的研究 研究发现，在户外幼儿园的瑞典儿童超重的可能性较小，睡眠时间也比他们的孩子长 室内幼儿园里的同龄人。但是，这项研究是横断面的，招募的样本很少，没有进行检验 学术成就或成本影响，并在一个医疗保健和成本不同的国家进行 比美国的教育系统更好。对于这一K01应用，我们提出了一种前瞻性观测 一项利用自然实验评估户外学龄前儿童模型对健康影响的研究 成绩和学业成就。我们将与华盛顿州西雅图的一家幼儿园微小树合作，与 这是一个完全户外的、以游戏为基础的课程。我们将招募100名3-5岁的儿童参加小树，还有100名 来自小树的孩子们正在等待，他们目前正在上一所传统的室内幼儿园。我们会收集 体力活动、睡眠、体重指数和学习成绩的客观和主观测量 为期3年的学习过程。我们还将进行成本效益分析，以评估这些微小的树木 户外学前教育模式，以实现更长期的可持续性。我们的具体目标是：1)面对面的比较 微小树参与者(干预)和等待名单儿童之间健康和学习结果的变化 (对照)，2)估计小树户外幼儿园模式的短期和长期成本效益，3) 完成严格的有指导的职业发展计划，该计划将定位首席调查员进行 在预防儿童肥胖的干预措施方面的开创性研究，建立对 为政策提供信息的干预措施，并开始作为独立调查员的成功职业生涯。这项建议 通过优先考虑新的流行病学研究，与国家心肺血液研究所的议程保持一致 为了预防儿童肥胖，这是心血管疾病的关键风险因素，并将产生亟需的成本- 效益数据，以检验户外学龄前儿童模型的肥胖预防能力和可持续性。

PROJECT SUMMARY/ABSTRACT Childhood obesity is a critical public health threat, and a major risk factor for accelerating cardiometabolic health conditions in childhood and adulthood. In addition, obesity in childhood negatively impacts academic achievement, which predicts lifetime health outcomes and has dramatic economic implications. Daycare settings have been identified as a high impact target for early childhood obesity intervention. On average, 75% of preschool-aged children in the United States spend 35 hours per week in daycare, and childcare settings have the ability to offer children healthy meals, increase opportunities for physical activity, and promote adequate sleep – all of which help to prevent obesity. Although preschool settings offer regular opportunities for physical activity, most children in daycare do not meet current guidelines. In 2014, only 12% of daycare centers in Washington State met goals for physical activity, and only 22% for outdoor time. Because children who spend more time outdoors are more physically active than those who spend more time indoors, preschools with outdoor- and play-based curricula may help to increase physical activity. The only published study on this topic found that Swedish children in outdoor preschools were less likely to be overweight and slept longer than their peers in indoor preschools. However, the study was cross-sectional, recruited a small sample, did not examine academic achievement or cost implications, and was conducted in a country with different healthcare and educational systems than the United States. For this K01 application, we propose a prospective observational study that leverages a natural experiment to evaluate the impact of an outdoor preschool model on health outcomes and academic achievement. We will partner with Tiny Trees, a preschool in Seattle, Washington, with an entirely outdoor, play-based curriculum. We will recruit 100 children ages 3-5 who attend Tiny Trees, and 100 children from the Tiny Trees waitlist who are currently attending a traditional indoor preschool. We will collect objective and subjective measures of physical activity, sleep, body mass index, and academic performance over the course of the 3-year study period. We will also perform a cost-benefit analysis to evaluate the Tiny Trees outdoor preschool model for longer-term sustainability. Our Specific Aims are to: 1) compare within-person change in health and academic outcomes between Tiny Trees enrollees (intervention) and waitlisted children (control), 2) estimate the short- and long-term cost-benefit of the Tiny Trees outdoor preschool model, and 3) complete a rigorous mentored career development plan that will position the Principal Investigator to conduct groundbreaking research in interventions to prevent childhood obesity, establish cost-benefit estimates of interventions to inform policy, and launch a successful career as an independent investigator. This proposal aligns with the National Heart, Lung, and Blood Institute agenda by prioritizing novel epidemiological research to prevent childhood obesity, a critical risk factor for cardiovascular disease, and will yield much-needed cost- benefit data to examine the capacity for obesity prevention and sustainability of an outdoor preschool model.