Food-Body-Mind Intervention: Promote whole child health

摘要 精神、情绪和行为（MEB）障碍开始于儿童早期，美国学龄前儿童中有六分之一 3-5岁，诊断为MEB疾病。低收入和经济边缘化儿童 （LIEM）背景的人被诊断患有MEB疾病的风险高于收入较高的人 家庭为了解决基于社会经济地位、族裔/种族、 和城市/农村居住，拟议的研究将针对头开始种族/民族多样化的学龄前儿童 来自城市和农村地区的LIEM背景。在行为者-伙伴相互依赖模型的指导下， 非稳态负荷模型，压力和应对的transmittance理论，建议16周的食物， 身心干预包括：1）一个以学校为基础的正念组件提供装备学龄前儿童 具有正念饮食和运动方面的知识和技能（例如，瑜伽，深呼吸练习）; 2）一个家- 基于正念的组成部分，以提高护理人员在练习正念饮食，运动和 在家庭中的养育行为，以促进更积极，更细心和更健康的家庭环境;以及3）学校 学习和家庭实践连接组件，以改善幼儿园-学龄前儿童的关系。的 这项为期5年的随机对照试验的目的是评估为期16周的学校教育的效果， 以家庭为基础，多成分，食物-身体-心理干预对改善学龄前儿童和照顾者的影响 MEB与身体健康长期目标是在幼儿期实现最佳的儿童整体健康， 在美国培养更健康的一代。50个学前日托中心将被随机分配到 干预（n=25：8个城市[16个教室]和17个农村[17个教室]日托中心）或常规护理 对照组（n=25：8个城市和17个农村日托中心）。将招募五个成年人-学龄前儿童的二对儿 （共330对：城市160对，农村170对）。分析将基于 根据意向治疗原则这三个目标是：1）确定干预措施对改善 学龄前儿童的主要结果包括精神（慢性压力），情感（悲伤，恐惧，愤怒，积极 影响）、行为（问题行为、社交技能）健康以及身体健康（BMI z评分、身体百分比 从基线（0个月）至4个月（干预后即刻）和至12个月 随访与对照组相比; 2）检查干预对改善照顾者身体状况的影响 (BMI 0至4个月的身体脂肪、血压）和精神（压力、焦虑、抑郁）健康， 12-与对照组相比，随访一个月; 3）探讨干预措施如何改变学龄前儿童的 照顾者的MEB和身体健康通过正念，情绪化饮食， 水果/蔬菜摄入量、体力活动、儿童-学龄前儿童关系和照顾者应对（0 - 4） 12个月和12个月随访。这项研究的结果将改善补充的证据基础 以及可以在地理位置不同的日托环境中提供的综合健康方法。

ABSTRACT Mental, emotional, and behavioral (MEB) disorders begin in early childhood, with one in six US preschoolers aged 3-5 years diagnosed with a MEB disorder. Children from low income and economically marginalized (LIEM) backgrounds have a higher risk of being diagnosed with MEB disorders than those from higher income families. To address the mental and physical health disparities based on socioeconomic status, ethnicity/race, and urban/rural residency, the proposed study will target Head Start racially/ethnically diverse preschoolers from LIEM backgrounds in both urban and rural areas. Guided by the Actor-Partner Interdependence Model, the Allostatic Load Model, and the Transactional Theory of Stress and Coping, the proposed 16-week Food- Body-Mind intervention includes: 1) a school-based mindfulness component delivered to equip preschoolers with knowledge and skills in mindful eating and movement (e.g., yoga, deep breathing exercises); 2) a home- based mindfulness component to increase caregivers’ skills in practicing mindful eating, movement, and parenting behaviors at home to foster a more positive, mindful, and healthy home environment; and 3) a school learning and home practice connection component to improve caregiver-preschooler relationships. The purpose of this 5-year cluster randomized controlled trial is to evaluate the effects of the 16-week school- and home-based, multi-component, Food-Body-Mind intervention on improving both preschoolers’ and caregivers’ MEB and physical health. The long-term goal is to achieve optimal whole child health in early childhood to foster a healthier generation in the US. Fifty Head Start daycare centers will be randomized into the intervention (n=25: 8 urban [16 classrooms] and 17 rural [17 classrooms] daycare centers) or usual care control group (n=25: 8 urban and 17 rural daycare centers). Five caregiver-preschooler dyads will be recruited from each daycare classroom (total 330 dyads: 160 urban dyads and 170 rural dyads). Analyses will be based on the intention-to-treat principle. The three aims are to: 1) determine effects of the intervention on improving preschoolers’ primary outcomes including mental (chronic stress), emotional (sadness, fear, anger, positive affect), and behavioral (problem behaviors, social skills) health as well as physical health (BMI z-score, % body fat; secondary outcomes) from baseline (0 month) to 4 months (immediate post-intervention) and to 12-month follow-up compared to control; 2) examine the effects of the intervention on improving caregivers’ physical (BMI, % body fat, blood pressure) and mental (stress, anxiety, depression) health from 0 to 4 months and to 12-month follow-up compared to control; and 3) explore how the intervention will modify both preschoolers’ and caregivers’ MEB and physical health via the mediating mechanisms of mindfulness, emotional eating, fruit/vegetable intake, physical activity, caregiver-preschooler relationship, and caregiver coping from 0 to 4 months and to 12-month follow-up. Results from this study will improve the evidence base of complementary and integrative health approaches that can be delivered in geographically diverse daycare settings.