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

项目总结 几乎没有争论的是，加糖饮料(SSB；添加糖的饮料)缺乏营养，是一种 增加糖和卡路里的主要来源，并促进肥胖和心脏代谢健康不良，尤其是 在儿童早期食用时。近一半的2-5岁儿童每天喝SSB， 低收入拉丁裔儿童的消费增加。经过几十年的研究，很明显，没有单一的 解决肥胖问题的“灵丹妙药”。我们需要的是结合增量变化的捆绑干预 通过有针对性的行为改变来改变食物环境，引导人们转向那些健康的 选择。每年为1250万儿童提供服务的托儿中心提供了一种有效的干预方式 及早让儿童保育提供者和父母在这两个方面做出共鸣、相辅相成的改变 家庭和育儿环境。促进用水取代SSB的干预措施表明 承诺预防学龄儿童肥胖。然而，还没有研究检验是否 在儿童保育中促进水而不是SSB摄入量的干预措施可以预防儿童肥胖 甚至是发展的早期阶段。拟议的整群随机对照试验将测试一种 干预被称为健康饮料，健康未来(Bebias Saludables，Futuros Saludables)，这是文化上的 改编为拉丁裔儿童和家庭。遵循社会生态模型和社会学习理论， 该干预措施支持儿童保育和家庭食品环境的互补变化，从而促进 在降低SSB利用率的同时消耗水资源。这与对儿童保育提供者的教育和 以及与父母进行一对一简短的励志咨询干预，以减少SSB的摄入量和 鼓励家庭用水。14个托儿中心，主要为低收入者提供服务 拉丁裔儿童(n=420)将参加这项试验。主要结果是儿童BMI z评分(BMI标准 偏差分数)。关键的次要结果是在中心和家里摄入水和饮料卡路里。 结果将使用人体测量(体重、身高)、餐盘废物测量(水和 中心的卡路里摄入量)，以及自动24小时自助饮食召回(水和卡路里摄入量在 在基线、干预后6个月和12个月时)。对儿童保育提供者和父母的调查将使我们能够 探讨影响干预效果的可能中介因素。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，并减少在两个托儿所消耗的饮料卡路里 在家里也是。在干预中心与控制中心的儿童中，BMI z-Score也会有所改善。如果显示 为了有效，健康饮料，健康期货干预将提供一种早期干预的策略 防止数百万低收入儿童在托儿中心肥胖。这项研究的发现将 为多层次肥胖预防的科学做出贡献，并为州、联邦和 促进托儿中心健康饮料摄取的地方政策。

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.