A Multi-Level Intervention to Promote Healthy Beverage Intake through Childcare

通过儿童保育促进健康饮料摄入的多层次干预

• 批准号: 10473741
• 负责人: Anisha Indravadan Patel
• 金额: $ 62.83万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-24 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10473741
• 关键词: 5 year old; Adult; Affect; Age; Beverages; Body mass index; California; Calories; Caregivers; Child; Cluster randomized trial; Consumption; Counseling; Development; Early Intervention; Education; Energy Intake; Environment; Family; Food; Future; Goals; Health; Height; Home; Hour; Intake; Intervention; Juice; Latino; Liquid substance; Low income; Magic; Measurement; Measures; Mediating; Mediator of activation protein; Metabolic; Modeling; Motivation; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Overweight; Parents; Persons; Pilot Projects; Policies; Prevention; Prevention strategy; Provider; Public Health; Randomized Controlled Trials; Research; Risk; Science; Self Administration; Self Efficacy; Source; Surveys; Treatment Efficacy; Water consumption; Weight; aged; base; behavior change; cardiometabolism; comorbidity; dietary; early childhood; efficacy outcomes; efficacy testing; expectation; food environment; improved; intervention effect; non-alcoholic fatty liver disease; nutrition; obesity in children; obesity prevention; post intervention; prevent; primary outcome; secondary outcome; social; social cognitive theory; sugar; sweetened beverage; wasting

PROJECT SUMMARY There is little debate that sugar-sweetened beverages (SSBs; drinks with added sugar) lack nutrition, are a major source of added sugar and calories, and promote obesity and poor cardiometabolic health, especially when consumed during early childhood. Nearly half of children aged 2-5 drink SSBs on a daily basis, with heavier consumption in low-income Latino children. After decades of research, it is clear that there is no single “magic bullet” for solving obesity. What we need are bundled interventions that combine incremental changes that transform food environments with targeted behavior changes that steer people towards those healthy options. Childcare centers, which serve 12.5 million children per year, provide an efficient way to intervene early by engaging childcare providers and parents to make resonant, mutually reinforcing changes in both the home and childcare environment. Interventions that promote water consumption in place of SSBs have shown promise for preventing childhood obesity in schoolchildren. Yet, no studies have examined whether interventions to promote intake of water instead of SSBs in childcare could prevent childhood obesity at an even earlier stage of development. The proposed cluster-randomized controlled trial will test the efficacy of an intervention called Healthy Drinks, Healthy Futures (Bebidas Saludables, Futuros Saludables) that is culturally adapted for Latino children and families. Following the Social-Ecological Model and Social Learning Theory, the intervention supports complementary changes in the childcare and home food environments that promote water consumption while reducing SSB availability. This is combined with education for childcare providers and children, and a one-on-one brief motivational counseling intervention with parents to reduce SSB intake and encourage water consumption in the home. Fourteen childcare centers serving low-income, predominately Latino children (n=420) will participate in this trial. The primary outcome is child BMI z-score (BMI standard deviation score). Key secondary outcomes are intake of water and beverage calories at centers and at home. Outcomes will be captured using anthropometrics (weight, height), plate waste measurements (water and caloric intake at centers), and Automated Self-Administered 24-hour dietary recalls (water and caloric intake at home) at baseline, 6, and 12 months post-intervention. Surveys of childcare providers and parents will allow us to explore possible mediators of the intervention effect. We hypothesize that the childcare-based healthy beverage intervention will increase intake of water and reduce beverage calories consumed at both childcare and at home. BMI z-score will also improve among children in intervention centers vs. control centers. If shown to be effective, the Healthy Drinks, Healthy Futures intervention will offer a strategy for intervening early to prevent obesity for millions of low-income children attending childcare centers. Findings from this study will contribute to the science of multilevel obesity prevention, and inform the implementation of state, federal, and local policies to promote healthy beverage intake in childcare centers.

项目摘要 加糖饮料（SSBs;添加糖的饮料）缺乏营养， 添加糖和热量的主要来源，并促进肥胖和心脏代谢健康不良，特别是 在儿童早期食用。近一半的2-5岁儿童每天饮用SSB， 低收入拉丁裔儿童的消费量更大。经过几十年的研究，很明显， 解决肥胖的“灵丹妙药”我们需要的是将联合收割机渐进式变革结合起来的捆绑式干预措施 通过有针对性的行为改变来改变食物环境， 选项.儿童保育中心每年为1250万儿童提供服务， 尽早让儿童保育提供者和父母参与，在儿童保育和儿童教育两个方面做出共鸣的、相互加强的改变， 家庭和儿童保育环境。促进水消费而不是SSBs的干预措施表明， 预防学龄儿童肥胖的承诺。然而，没有研究调查是否 在儿童保育中促进水的摄入而不是SSB的干预措施可以预防儿童肥胖， 甚至更早的发展阶段。拟议的随机分组对照试验将测试 健康饮料，健康的未来（Bebidas Saludables，Futuros Saludables） 适合拉丁裔儿童和家庭。遵循社会生态模型和社会学习理论， 干预措施支持儿童保育和家庭食品环境的互补性变化， 水消耗，同时减少SSB可用性。这与对儿童保育提供者的教育相结合， 儿童，并与父母进行一对一的简短动机咨询干预，以减少SSB的摄入量， 鼓励家庭用水。14个儿童保育中心为低收入者服务， 拉丁裔儿童（n=420）将参加本试验。主要结局是儿童BMI z评分（BMI标准 偏差分数）。关键的次要结果是在中心和家中摄入的水和饮料卡路里。 将使用人体测量学（体重、身高）、平板废物测量（水和 中心的卡路里摄入量）和自动自我管理24小时饮食回忆（ 在基线、干预后6个月和12个月时在家中）。对儿童保育提供者和父母的调查将使我们能够 探讨干预效应的可能介质。我们假设，以儿童保育为基础的健康 饮料干预将增加水的摄入量，并减少儿童保育和儿童营养的饮料卡路里消耗。 还有家里与对照中心相比，干预中心的儿童BMI z评分也会有所改善。如果示出 为了有效，健康饮料，健康未来干预将提供一个早期干预的战略， 防止数百万低收入家庭儿童在托儿中心肥胖。这项研究的结果将 有助于多层次肥胖预防的科学，并告知州，联邦， 促进儿童保育中心健康饮料摄入的地方政策。