Obesity Prevention in Head Start: The Miranos! Program

摘要 美国2-5岁儿童的肥胖患病率仍然很高，而三分之一的儿童是 超重或肥胖。这项拟议中的研究旨在测试一种儿童早期肥胖症 预防计划，“肥胖预防在头开始：米拉诺斯！计划”，促进健康 主要是拉丁裔儿童的成长。米拉诺人！包括基于中心的（策略改变， 工作人员发展，大运动计划，营养教育）和家庭为基础（家长参与/ 教育和家访）干预措施，以解决预防青少年肥胖的关键因素和障碍。 孩子我们与启导计划合作，证明了 提出了干预措施，以影响能量平衡相关的行为有利的开端儿童。 采用三组分组随机化设计，将随机分配21个相同数量的Head Start中心 分配到三个条件之一：1）结合中心和家庭为基础的干预，2）中心为基础的 （3）控制;（4）控制。干预措施将在学年期间提供（为期8个月的 期间）。共有525名3岁儿童（52%为女性;基线时每个中心n=25）将入组 研究并在干预后一年进行前瞻性随访。数据收集将在基线时进行， 干预后即刻和1年随访，包括身高、体重、体力活动（PA）和 通过加速度计测量的久坐行为、父母报告的睡眠持续时间和看电视时间、粗大运动 发育、饮食摄入量以及食物和活动偏好。家庭背景、父母 体重、PA和营养相关的实践和行为、PA和营养政策以及中心环境 家庭、干预计划费用和治疗忠诚度也将被收集。该研究有三个具体的 目的：1）测试Míranos的功效！健康体重增长的干预（主要结局） 正常体重、超重和肥胖儿童，2）测试Míranos的影响！对儿童的干预 PA，久坐行为，睡眠和饮食行为（次要结果），以及3）评估成本- Míranos的有效性！干预 在当地一个大型的Head Start管理员和一个多学科研究团队的支持下， 米拉诺斯一项针对不同文化的肥胖预防计划，准备为一项政策提供证据， 低收入拉丁美洲人预防肥胖早发的环境方法及其成本效益 学龄前儿童通过针对不同影响水平和多种环境中的多种行为， 米拉诺斯有很大的希望发展长期的健康习惯，减少能源不平衡的差距， 针对多种能量平衡相关的行为。米拉诺人！可以传播到各种有组织的 儿童保育设置，因为它是建立在先声夺人计划及其基础设施-一个黄金标准， 儿童教育，以及目前的PA和学龄前儿童的营养建议。

Abstract The prevalence of obesity remains high in American children aged 2-5 while one in three Head Start children is overweight or obese. The proposed study is designed to test the efficacy of an early childhood obesity prevention program, “Obesity Prevention in Head Start: The Míranos! Program”, which promotes healthy growth in predominantly Latino children in Head Start. The Míranos! includes center-based (policy changes, staff development, gross motor program, and nutrition education) and home-based (parent engagement/ education and home visits) interventions to address key enablers and barriers in obesity prevention in young children. In partnership with Head Start, we have demonstrated the feasibility and acceptability of the proposed interventions to influence energy-balance-related behaviors favorably in Head Start children. Using a three-arm cluster randomized design, 21 Head Start centers in equal number will be randomly assigned to one of three conditions: 1) a combined center- and home-based intervention, 2) center-based intervention only, or 3) control. The interventions will be delivered during the academic year (an 8-month period). A total of 525 3-year-old children (52% females; n=25 per center at baseline) will be enrolled in the study and followed prospectively one year post intervention. Data collection will be conducted at baseline, immediate post-intervention, and 1-year follow-up and include height, weight, physical activity (PA) and sedentary behaviors by accelerometry, parent-reports of sleep duration and TV watching time, gross motor development, dietary intakes and food and activity preferences. Information on family background, parental weight, PA- and nutrition-related practices and behaviors, PA and nutrition policy and environment at center and home, intervention program costs, and treatment fidelity will also be collected. The study has three specific aims: 1) to test the efficacy of the Míranos! intervention on healthy weight growth (primary outcome) in normal weight, overweight and obese children, 2) to test the impact of the Míranos! intervention on children's PA, sedentary behavior, sleep, and dietary behaviors (secondary outcomes), and 3) to evaluate cost- effectiveness of the Míranos! intervention. With endorsement of a large local Head Start administrator and a multi-disciplinary research team, the Míranos!, a culturally tailored obesity prevention program, is poised to provide evidence of a policy and environmental approach to prevent early onset of obesity and its cost-effectiveness in low-income Latino preschool children. By targeting multiple behaviors at different levels of influence and in multiple settings, the Míranos! holds great promise of developing long-term health habits that reduce the energy imbalance gap by targeting multiple energy-balance-related behaviors. The Míranos! can be disseminated to various organized child care settings since it is built on Head Start program and its infrastructure—a gold standard in early childhood education, as well as current PA and nutrition recommendations for preschool children.