Reducing Sugared Fruit Drinks in Alaska Native Children

减少阿拉斯加原住民儿童的含糖水果饮料

• 批准号: 10115247
• 负责人: Donald Leslie Chi
• 金额: $ 1.44万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10115247
• 关键词: Address; Age; Alaska; Alaska Native; American Heart Association; American Indians; Behavior; Behavioral trial; Belief; Beverages; Biological Markers; Caregivers; Child; Chronic; Communication; Communities; Community Health Aides; Consumption; Data; Dental; Dental Care; Dental caries; Development; Diet; Disease; Elements; Enhancers; Ensure; Evidence based program; Exercise; Family; Focus Groups; Food; Fruit; Goals; Group Interviews; Hair; Health; Health Promotion; Health education; Healthy People 2020; Home environment; Hour; Indigenous; Infant; Intake; Interdisciplinary Study; Intervention; Lead; Learning; Life; Maintenance; Manuals; Manuscripts; Measures; Milk; Misinformation; Modeling; Morbidity - disease rate; Mouth Diseases; National Institute of Dental and Craniofacial Research; Native Americans; Oral health; Outcome; Output; Paper; Participant; Persons; Population; Price; Program Sustainability; Public Health; Quality of life; Research; Resources; Risk Factors; Rural; Sampling; Schools; Selection Bias; Self Efficacy; Services; Social support; Structure; Systemic disease; Taste Perception; Testing; Time; Training; Update; Vulnerable Populations; Water; Weight; Work; Yukon Kuskokwim; Yukon-Kuskokwim Delta; Yup' ik; active method; arm; base; behavior change; caregiver education; community planning; early childhood; experience; health inequalities; healthy lifestyle; improved; indigenous community; member; middle childhood; nutrition; primary outcome; program dissemination; programs; recruit; research study; response; social cognitive theory; sugar; systematic review; tool; treatment arm

Project Abstract Yup’ik children in Alaska’s YK Delta consume an average of 50 teaspoons of sugar each day, 16 times the American Heart Association’s recommended maximum. Most of this sugar is from fruit drinks like Tang and Kool-Aid consumed at home. Consequently, Yup’ik children experience tooth decay rates that are 16x the U.S. average and suffer from oral health inequalities compared to children from communities that are better off. Tooth decay is a multifactorial disease, but our pilot work shows sugared fruit drinks are the key risk factor. YK Delta communities have expressed a desire to target sugared fruit drinks that continue to harm their children. This study is a culmination of over 5 years of engaged research within YK Delta communities to co-develop a culturally-appropriate, feasible, and sustainable program to address persisting public health problems caused by sugared fruit drinks. We propose a 2-arm quasi-experimental behavioral trial in 3 small, isolated Alaska Native communities to test the hypothesis that Community Health Worker-led health education and self- efficacy training for caregivers will decrease child added sugar intake. We will introduce families to sugar-free water enhancers that will be made available through local stores. The Specific Aims are to: (1) Complete pre- intervention activities and finalize the intervention; (2) Implement the intervention and assess outcomes; and (3) Identify intervention improvement opportunities and disseminate findings. This application builds on previous R56 research by the study team and will for the first time seek to change sugared fruit drink intake in Alaska Native communities. 3 communities will be assigned to 1 of 2 arms based on the order communities were recruited into the study. In Communities A and B, 136 Yup’ik children ages 0-10 years will be recruited to test the 6-month culturally-adapted, 5-session intervention consisting of interactive health education and self- efficacy training delivered in-person by an indigenous Community Health Worker. In Community C, 56 children will be recruited to a comparison condition in which health education with the same culturally-adapted content is delivered by mail. Health education will address misinformation about sugared fruit drinks and promote sugar-free water enhancers. Self-efficacy training will empower caregivers to sustain behavior change over time. Local stores in all 3 communities will stock sugar-free water enhancers (Tang, Kool-Aid, and other popular flavors) as a tool to help shift children from sugared fruit drinks. The primary outcomes at the child level are sugared fruit drink intake (24-hour food recalls) and added sugar intake (validated, non-invasive biomarker) and will be measured at baseline and at 1, 3, 6, and 12 months. The Yukon Kuskokwim Health Corporation will maintain and disseminate the program if it works to address a critical problem facing 15,000+ Alaska Native children in the YK Delta. Moreover, it can be adapted to meet the needs of other populations with similar problems, including the millions of indigenous children in the Lower 48.

项目摘要 阿拉斯加 YK 三角洲的尤皮克儿童平均每天消耗 50 茶匙糖，是美国儿童的 16 倍。 美国心脏协会建议的最大值。这些糖大部分来自果汁饮料，如唐和 在家喝酷爱饮料。因此，尤皮克儿童的蛀牙率是美国儿童的 16 倍。 与来自富裕社区的儿童相比，他们的口腔健康状况处于平均水平，并且遭受着口腔健康不平等的困扰。 蛀牙是一种多因素疾病，但我们的试点工作表明，含糖果汁饮料是关键的风险因素。阳康 三角洲社区表示希望针对继续伤害儿童的含糖果汁饮料。 这项研究是 YK Delta 社区 5 年多来共同开发的研究成果 文化上适当、可行且可持续的计划，以解决造成的持续公共卫生问题 加糖果汁饮料。我们提议在阿拉斯加的 3 个小型偏远地区进行 2 臂准实验行为试验 原住民社区检验社区卫生工作者主导的健康教育和自我保健的假设 对看护者进行效能培训将减少儿童添加糖的摄入量。我们将向家庭介绍无糖 水强化剂将通过当地商店出售。具体目标是： (1) 完成预 干预活动并完成干预； (2) 实施干预并评估结果；和 (3) 确定干预改进机会并传播研究结果。该应用程序构建于 研究小组之前进行的 R56 研究，将首次寻求改变含糖果汁饮料的摄入量 阿拉斯加原住民社区。 3 个社区将根据社区顺序分配到 2 个分支中的 1 个 被招募到该研究中。在 A 社区和 B 社区，将招募 136 名 0-10 岁的尤皮克儿童 测试为期 6 个月、为期 5 次的文化适应干预措施，其中包括互动健康教育和自我干预 由土著社区卫生工作者亲自提供的功效培训。 C社区，56名儿童 将被招募到比较条件，其中健康教育具有相同的文化适应内容 通过邮件递送。健康教育将解决有关含糖果汁饮料的错误信息并促进 无糖水强化剂。自我效能培训将使护理人员能够维持行为改变 时间。所有 3 个社区的当地商店都将备有无糖水强化剂（Tang、Kool-Aid 和其他 流行口味）作为帮助儿童摆脱含糖果汁饮料的工具。孩子的主要结果 水平是含糖果汁饮料摄入量（24小时食品召回）和添加糖摄入量（经过验证的、非侵入性的） 生物标志物）并将在基线以及 1、3、6 和 12 个月时进行测量。育空地区 Kuskokwim 健康中心 如果该计划能够解决超过 15,000 人面临的关键问题，公司将维护并传播该计划 YK 三角洲的阿拉斯加原住民儿童。此外，它可以适应其他人群的需求 也有类似的问题，其中包括 48 区数百万土著儿童。