Fit 5 Kids Screen Time Reduction Curriculum for Latino Preschoolers: A RCT

Fit 5 Kids 针对拉丁裔学龄前儿童的屏幕时间减少课程：随机对照试验

• 批准号: 10112898
• 负责人: Jason A Mendoza
• 金额: $ 61.12万
• 依托单位: SEATTLE CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-02-01 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10112898
• 关键词: 5 year old; Academy; Acculturation; Adolescence; Adult; Affect; Age; American; Behavior; Body mass index; Books; Cardiovascular Diseases; Child; Child Rearing; Childhood; Chronic Disease; Communities; Dietary intake; Disease; Educational Curriculum; Effectiveness; Energy Intake; Environment; Family; Future; Goals; Guidelines; Head Start Program; Healthy Eating; Hour; Individual; Intervention; Intervention Studies; Latino; Libraries; Link; Malignant Neoplasms; Measures; Mediating; Mediation; Mediator of activation protein; Metabolic; Minority; Modeling; Neighborhoods; Newsletter; Non-Insulin-Dependent Diabetes Mellitus; Nursery Schools; Obesity; Outcome; Parents; Pediatrics; Physical activity; Pilot Projects; Population; Public Health; Randomized Controlled Trials; Reading; Reporting; Research; Research Personnel; Resources; Risk; Risk Factors; Rural; Sample Size; Sampling; Schools; Self Efficacy; Site; Social support; Stress; Television; Testing; Text Messaging; Time; Washington; Work; adult obesity; awake; base; behavioral outcome; cardiometabolic risk; depressive symptoms; design; dietary; dietary excess; effectiveness trial; efficacy trial; excessive weight gain; exercise intervention; expectation; experience; health goals; health inequalities; high risk; lifetime risk; neighborhood safety; obesity in children; obesity prevention; obesity risk; peer; physical inactivity; pilot trial; prevent; preventive intervention; primary outcome; programs; social; social cognitive theory; systematic review; teacher; tv watching

ABSTRACT Screen time is a major risk factor for childhood obesity and inadequate physical activity, both of which are determinants of type 2 diabetes (T2D), cardiovascular disease, and multiple cancers. Latinos are the largest and fastest growing minority in the US. Because US Latino children have more screen time and higher rates of obesity than their non-Latino White peers, interventions to reduce screen time adapted for Latino preschoolers are necessary to reduce health inequities related to obesity and T2D in the US. However, a systematic review reported no successful screen time reduction interventions among Latino preschoolers. Our team's pilot study tested the culturally adapted Fit 5 Kids screen time reduction curriculum among Latino preschoolers in Head Start. This short term cluster randomized controlled trial (RCT) is the only successful screen time reduction program for Latino preschoolers, having significantly reduced screen time by over 25 minutes/day. Our culturally adapted, multi-level intervention consists of lessons taught by study staff directly to preschoolers during Head Start, a weekly parent newsletter, child-tailored goal setting with parents, a lending library (books, games, arts/crafts, etc.) and parenting tips via text messages several times/week. We will use a social ecological model and consider multiple levels of influences for analyses: (1) individual-level influences, e.g., acculturation and social cognitive theory, (2) families, e.g., screen time parenting practices, (3) schools, and (4) macro-environmental influences, e.g., neighborhood disorder. Building on this pilot work, we propose a long term, efficacy, cluster RCT of the culturally adapted Fit 5 Kids among Latino preschoolers in Head Start from three US settings: Seattle, Houston, and the rural Central Valley of Washington State. Among 280 Latino 3-5 year olds at 20 Head Start centers, our Specific Aims (SA) and Hypotheses (H) include: SA1) To conduct a cluster RCT of the culturally adapted Fit 5 Kids curriculum to evaluate its efficacy in reducing screen time and excessive weight gain over a school year (8-months) H1) Fit 5 Kids will decrease children's screen time (primary outcome), BMI z-scores and dietary energy intake, and increase MVPA compared to controls SA2) To examine mediators and moderators associated with reducing Latino preschoolers' screen time H2) Parents' outcome expectations, self-efficacy, and screen time parenting practices will mediate the relationship between Fit 5 Kids and changes to preschoolers' screen time H3) Parents' depressive symptoms, stress, and social support will moderate changes to child screen time The proposed Fit 5 Kids cluster RCT will confirm the pilot's promising results, and the larger sample will allow for mediation analyses to better understand mechanisms. This research will provide justification for a future community effectiveness trial with implementation by Head Start teachers, and the eventual widespread dissemination of Fit 5 Kids in Head Start centers nationally.

摘要 屏幕时间是儿童肥胖和身体活动不足的主要风险因素， 是2型糖尿病（T2 D）、心血管疾病和多种癌症的决定因素。拉丁裔是 美国最大和增长最快的少数民族。因为美国拉丁裔儿童有更多的屏幕时间和更高的 肥胖率高于非拉丁裔白色同龄人，减少拉丁裔屏幕时间的干预措施 学龄前儿童是必要的，以减少与肥胖和T2 D在美国的健康不公平。但 系统回顾报告没有成功的屏幕时间减少干预拉丁美洲学龄前儿童。 我们团队的试点研究测试了适应文化的Fit 5 Kids屏幕时间减少课程， 拉丁裔学龄前儿童在头开始。这项短期随机对照试验（RCT）是唯一一项 成功的屏幕时间减少计划，为拉丁美洲学龄前儿童，有显着减少屏幕时间， 超过25分钟/天。我们的文化适应，多层次的干预包括由研究人员讲授的课程 直接向学龄前儿童在头开始，每周家长通讯，儿童量身定制的目标设定与家长， 借阅图书馆（书籍、游戏、工艺品等）和育儿技巧通过短信几次/周。我们 本文将采用社会生态学模型，考虑多个层次的影响进行分析：（1）个体层次 影响，例如，文化适应和社会认知理论，（2）家庭，例如，屏幕时间育儿实践，（3） 学校，和（4）宏观环境的影响，例如，邻里混乱在试点工作的基础上，我们 提出了一个长期的，有效的，集群随机对照试验的文化适应适合5个孩子在拉丁美洲学龄前儿童， 从三个美国设置开始：西雅图，休斯顿和华盛顿州的乡村中央谷。之间 280名拉丁裔3-5岁的奥尔兹在20个开端中心，我们的具体目标（SA）和假设（H）包括： SA 1）对适应文化的Fit 5 Kids课程进行一项集群RCT，以评估其在以下方面的有效性： 减少屏幕时间和过度体重增加超过一个学年（8个月） H1）Fit 5 Kids将减少儿童的屏幕时间（主要结果），BMI z评分和饮食能量 与对照组相比，MVPA增加 SA 2）检查与减少拉丁美洲学龄前儿童屏幕时间相关的调解人和主持人 H2）父母的结果期望，自我效能和屏幕时间的父母行为将介导 Fit 5 Kids与学龄前儿童屏幕时间变化之间的关系 H3）父母的抑郁症状，压力和社会支持将缓和儿童屏幕时间的变化 拟议的Fit 5 Kids集群RCT将证实试点的有希望的结果，更大的样本将 允许进行调解分析，以更好地了解机制。这项研究将为一项 未来的社区有效性试验与实施的开端教师，并最终广泛 在全国的“先声夺人”中心宣传“适合5个孩子”。