Testing a Multilevel, Multicomponent, Multigenerational Dietary Intervention to Improve Southeast Asian Children's Diets

背景饮食质量差是东南亚（SEA）儿童的一个重要和关键问题， 家庭作为难民来到美国[例如，苗族、柬埔寨、老挝、越南]。孩子们在 肥胖率较高和其他与饮食有关的慢性病风险增加， 比如2型糖尿病相对于其他亚洲亚群，白人和“其他”种族。虽然饮食干预 已被证明可以预防/延迟与饮食有关的慢性疾病的发作，据我们所知， 专门为SEA儿童制定的饮食干预措施。因此，迫切需要饮食 利用最先进的方法来解决影响SEA的现有健康差异的干预措施 儿童和促进科学认识的差距在干预研究。提案概述。这 该提案反映了我们与SEA中心八年（正在进行）的学术社区研究伙伴关系 在罗得岛，与SEA家庭的形成工作，以及我们在成功饮食管理方面的丰富经验， 对服务不足的健康差距群体采取干预措施。目前的研究是一项试点可行性研究， 创新多层次、多成分、多代饮食干预，改善SEA人群的饮食质量 孩子概念模型。社区能量平衡和以家庭为中心的行动模式 干预布局和实施框架提供了干预的基本原理和结构。这些 框架提出，对于像SEA这样的差异少数民族群体，多层次，多成分， 代际干预是改变和维持 个人层面的行为改变。社会认知理论和大众教育哲学为我们提供了 干预内容。研究计划概述。75个有6至11岁儿童的SEA家庭将被 从罗得岛的普罗维登斯县招募来的成人-儿童配对将被随机分配到：（1）经济激励 唯一一个每周可获得15美元的财政奖励券，以补贴在 当地SEA杂货店;或（2）经济奖励加上每月两次的以家庭为基础的团体营养教育， 由SEA社区卫生工作者领导的SEA中心;由训练有素的 社区卫生工作者;成人饮食规范信息（通过每周短信）和儿童饮食规范信息（通过 营养教育会议上的信息图表）;以及每周15美元的财政奖励券， 在SEA杂货店购买健康食品;或（3）学术参与注意力控制臂， 将遵循财政激励加上营养教育、MI和短信的结构， 主要结果是研究的可行性和儿童的临床有意义的改善。 饮食质量（以健康饮食指数衡量）。次要结局是临床上有意义的变化， 儿童的体重（体重减轻约2 kg或体重未增加）、HbA 1c（0.5%）和父母的饮食质量、HbA 1c和 家庭食品环境。这些研究结果将用于为未来更大规模的临床试验提供信息。

Background. Poor diet quality is a significant and critical problem for Southeast Asian (SEA) children whose families came to the US as refugees [e.g., Hmong, Cambodian, Laotian, Vietnamese]. SEA children are disproportionately burdened by higher rates of obesity and increased risk of other diet-related chronic diseases like type 2 diabetes relative to other Asian subgroups, Whites and “Other” races. Although dietary interventions have been shown to prevent/delay onset of diet-related chronic diseases, to our knowledge, there are no dietary interventions developed specifically for SEA children. Thus, there is an urgent need for dietary interventions that leverage state-of-the-art methods to address existing health disparities affecting SEA children and to advance scientific understanding of gaps in intervention research. Overview of Proposal. This proposal reflects our eight year (ongoing) academic-community research partnership with the Center for SEA in Rhode Island, formative work with SEA families, and our extensive experience conducting successful dietary interventions with underserved health disparity groups. The current study is a pilot feasibility study that tests an innovative multilevel, multicomponent, multigenerational dietary intervention to improve diet quality among SEA children. Conceptual Model. The Community Energy Balance and Family-Centered Action Model of Intervention Layout and Implementation frameworks provide the intervention rationale and structure. These frameworks propose that for disparity ethnic minority groups like SEA, multilevel, multicomponent, intergenerational interventions are the most effective intervention approach for changing and sustaining individual-level behavior change. Social cognitive theory and popular education philosophy inform the intervention content. Overview of Research Plan. 75 SEA families with children ages 6 to 11 years will be recruited from Providence County, Rhode Island. Adult-child pairs will be randomized to: (1) financial incentive only arm that will receive weekly $15 financial incentive coupons to subsidize purchase of healthy foods at a local SEA grocery store; or (2) financial incentive plus twice-monthly, family-based group nutrition education at the Center for SEA led by SEA community health workers; three motivational interviewing (MI) calls by trained community health workers; dietary norms messaging for adults (via weekly text messages) and for children (via Infographics at nutrition education sessions); and weekly $15 financial incentive coupons to subsidize purchase of healthy foods at SEA grocery stores; or (3) an Academic Engagement attention control arm that will follow the structure of the financial incentive plus nutrition education, MI and text messages and infographics arm. The primary outcomes are study feasibility and clinically meaningful improvement in child’s diet quality (measured by healthy eating index). Secondary outcomes are clinically meaningful changes in children’s body mass (~ 2kg weight loss or no weight gain), HbA1c (0.5%) and parent’s diet quality, HbA1c and the home food environment. These study findings will be used to inform a future, larger clinical trial.