Adaptive Implementation & Costs of Obesity Prevention in Early Care and Education

项目摘要 在美国，很少有2至5岁的儿童符合饮食指南。1 -3此外，10个儿童中有4个 5.4食用健康的饮食（例如，纤维、富含抗氧化剂的食物）7-9和维持 健康的体重9 -11提供了对死亡和疾病发展的显著保护。鉴于 早期生活模式跟踪到成年，12，13需要早期干预，以减少发展的风险 肥胖因此，早期护理和教育（ECE）是预防肥胖的一个有希望的环境。然而，在这方面， 在欧洲经委会实施干预措施仍然是一项挑战。 优化ECE中的肥胖预防存在两个关键差距：1）缺乏适应性实施 2）有关成本的文献有限， 欧洲经委会预防肥胖和促进营养工作的有效性。这个项目的首要目标是 应用程序的目的是收集涉众对自适应实现规范的看法 早期教育中肥胖预防的策略和可接受的成本效益阈值。 为此，我们将专注于循证营养计划“一起，我们共同打造智能饮食” （WISE）.与幼儿教育的通常做法相比，WISE表明， 在家里为儿童消费，23类胡萝卜素摄入量的改善，24和减少快餐和糖 23，25我们之前的工作表明，一个8个离散的利益相关者的包- 所选择的实现策略优于基本实现方法（即，培训和 ”（《明史》）。考虑到现实世界中的可行性和潜在的高昂成本， 将来向所有站点提供所有实施策略;此外，可能不需要所有策略， 实现预期的结果。此外，还没有审查WISE的费用数据。未来的研究将 需要基线比较数据，以了解WISE的成本和成本效益，而不实施 战略支持，以了解适应性方针等执行战略的相对效益。 具体目标1。确定WISE自适应实施策略的关键要素， 利益攸关方的投入。利益相关者对关键决策点、定制变量和决策规则的投入将 确定可根据现场需要定制的自适应实施策略的规范。 具体目标2。估算WISE干预措施的增量成本效益， 日常营养教育。我们假设WISE与常规营养相比具有成本效益 当比较每种方法预防儿童BMI增加的能力时，使用二次 数据，我们将确定目标儿童结果的每单位改善成本（即，体重指数， 水果/蔬菜，类胡萝卜素水平，垃圾食品摄入量）。

PROJECT SUMMARY Few children between 2 and 5 years old in the US meet dietary guidelines.1–3 Further, 4 out of 10 children are overweight or obese by age 5.4 Consuming a healthy diet (e.g., fiber, antioxidant-rich foods)7–9 and maintaining a healthy weight9–11 provide significant protection against mortality and development of disease. Given that early life patterns track into adulthood,12,13 early interventions are needed to decrease the risk of developing obesity. Thus, early care and education (ECE) is a promising setting for obesity prevention. However, implementation of interventions in ECE remains a challenge. There are two crucial gaps to optimizing obesity prevention in ECE: 1) the lack of adaptive implementation strategies that tailor the intensity of implementation support delivery and 2) limited literature surrounding cost- effectiveness of obesity prevention and nutrition promotion efforts in ECE. The overarching goal of this application is to gather stakeholder perspectives on specification of an adaptive implementation strategy and acceptable cost-effectiveness thresholds for obesity prevention in ECE. To this end, we will focus on the evidence-based nutrition program Together, We Inspire Smart Eating (WISE). Compared to usual practices in ECE, WISE has demonstrated an increase in fruit and vegetable consumption at home for children,23 improvements in carotenoid intake,24 and reductions in fast food and sugar sweetened beverage consumption.23,25 Our prior work demonstrated that a package of 8 discrete, stakeholder- selected implementation strategies outperformed a basic implementation approach (i.e., training and reminders) for WISE. Given feasibility and potential prohibitive costs in the real-world, it is likely not possible to provide all implementation strategies to all sites in the future; in addition, all strategies may not be necessary to achieve the desired outcomes. Further, data on costs of WISE have not been examined. Future studies will need baseline comparator data to understand the costs and cost effectiveness of WISE without implementation strategy support to understand the relative benefit of implementation strategies such as adaptive approaches. Specific Aim 1. Determine key elements of an adaptive implementation strategy for WISE using stakeholder input. Stakeholder input on critical decision points, tailoring variables and decision rules will determine specification of an adaptive implementation strategy that can be tailored to site needs. Specific Aim 2. Estimate the incremental cost effectiveness of the WISE intervention compared to usual nutrition education. We hypothesize that WISE will be cost-effective compared to usual nutrition education when comparing each approaches’ ability to prevent BMI increases in children. Using secondary data, we will determine the cost per unit improvement in target child outcomes (i.e., BMI, servings of fruit/vegetables, carotenoid levels, junk food intake).