Improving nutrition and physical activity environments in home-based child care

描述（由申请人提供）：儿童保育设施是健康饮食和体育活动（PA）干预学龄前儿童的主要设置，因为超过70%的美国。S. 6岁以下的儿童平均每周接受35个小时的家庭外托儿服务，每天在那里消耗50-75%的热量。学龄前是饮食和PA行为建立的关键时期。不健康的食物和PA行为导致儿童肥胖和相关慢性疾病的高患病率，这些疾病不成比例地影响低收入和种族和少数民族儿童。改善儿童保育环境是改善儿童饮食、PA和预防肥胖的一项建议战略;儿童保育干预研究已证明是有效的。然而，这些研究主要使用昂贵的专家来提供干预，并且是时间和劳动密集型的。此外，几乎所有这些研究都是在儿童保育中心进行的，而不是在家庭儿童保育院（FCCH），后者为25%的美国人和28%的RI提供护理。学龄前儿童FCCH比中心监管较少，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“最佳做法”培训或技术援助的机会也很有限。由于RI最近的营养和PA法规在国家儿童保育报告卡上获得了C+评级，因此特别需要此类干预措施，而且最近对RI FCCP进行的全州范围内的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的循证干预措施的组成部分，以英语和西班牙语创建一个新的创新干预措施，以改善FCCH的食品和PA环境。干预措施将包括：a）由具有幼儿照顾经验的朋辈辅导员提供支持，他们将担任儿童保育中心小组的组长; B）量身定制的印刷和录像材料;以及c）一套便携式活动 玩具一项有132个FCCH的随机分组试验将评估干预的有效性，指导委员会和社区咨询委员会将指导各个方面。本研究的具体目的是：1）进行形成性研究，为FCCH干预的发展和适应提供信息。2)对66名FCCP和66名人口统计学匹配的FCCP进行干预有效性的随机分组试验，以评估其对以下方面的影响：a）FCCH儿童的总体饮食质量; B）FCCH儿童的PA和久坐行为;以及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;探索结果测量和干预剂量以及与中介/调节变量之间的关系，并探索对儿童BMI的干预效果。如果证明有效，这种干预措施有潜力在整个国际扶轮和美国推广和广泛传播，改善儿童保育环境是高度优先事项。

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.