More Outside Your Door (MOYD)

摘要 阿拉斯加农村社区行动计划(农村CAP)，管理农村的Head Start学校 阿拉斯加的一份报告称，3至5岁的阿拉斯加原住民儿童中有68%超重，43%肥胖。 饮食、体力活动和睡眠卫生是儿童肥胖的主要危险因素，也是儿童肥胖的危险因素 晚年心脏代谢性疾病。值得注意的是，亚临床心血管病理最早可以被检测到。 3岁。曾经靠陆地和海洋为生的阿拉斯加原住民遭受了数十年的殖民统治 和迁入，这干扰了传统的食物消费，标志着当地 食物系统。饮食和体力活动是早期干预的主要目标，就像口味偏好和锻炼一样 从小养成的习惯会锻造终生坚守。因此，我们在您的门外设计了更多 (Moyd)，这是一种多层次的干预，在个人层面上建立在我们先前促进传统 减少学龄前儿童肥胖风险的饮食和活动。在家庭层面，莫伊德提供反馈 向父母介绍他们孩子的健康筛查；在学校层面，它以传统食物、户外食品为特色 传统的体育活动和以文化为中心的课程。在社区层面，它提供资源 为安全的户外活动改善建筑环境，邀请所有社区成员参与。在……里面 合作伙伴、阿拉斯加原住民部落健康联盟、农村CAP和合作者将完善和测试 育空-库斯科维姆地区12所学前班的MOYD效果：(1)我们将使用质化 与Head Start工作人员、家长和社区长老一起为阿拉斯加西南部最佳定制Moyd的方法 社区；以及(2)我们将进行阶梯式楔形组随机试验，以测试其对儿童 饮食、体力活动(PA)、身体质量指数(BMI)和其他肥胖相关慢性病的危险因素 三年了。主要结果是饮食(课堂用餐、基于活动的体力活动和身体质量 指数。次要结果包括个别儿童水平的血红蛋白水平测量以及教育和 发育进展；父母对家庭饮食、活动和睡眠的报告；以及传统的 食品/加糖/加工食品，通过使用指甲剪下的碳和氮稳定同位素比率。 我们还将衡量学校层面(课堂用餐、户外时间)和社区层面的成果。 (游戏空间使用情况的客观数据)。(3)我们将使用RE-AIM框架进行流程评估。 我们的具体目标是：(1)领导幼儿园工作人员和家长/长辈工作组完善模式 对学龄前儿童肥胖预防的最佳效果的干预；(2)测试 Moyd对a)饮食、PA、户外活动时间和BMI的有效性；以及b)改善其他临床和行为风险 学龄前儿童肥胖相关慢性病的影响因素；及(3)实施RE-AIM框架，以 评估Moyd干预措施在Head Start方案中的传播和实施情况。

ABSTRACT The Rural Alaska Community Action Program (RurAL CAP), which administers Head Start schools in rural Alaska, reports that 68% of Alaska Native children ages 3 to 5 years are overweight and 43% are obese. Diet, physical activity, and sleep hygiene are primary risk factors for childhood obesity, a risk factor for cardiometabolic diseases later in life. Notably, subclinical cardiovascular pathology can be detected as early as 3 years of age. Once living off the land and sea, Alaska Native (AN) people have suffered decades of colonization and in-migration, which have interfered with traditional food consumption, signaling a striking change in local food systems. Diet and physical activity are prime targets for early intervention, as taste preferences and exercise habits established in childhood forge lifelong adherence. Thus, we have designed More Outside Your Door (MOYD), a multilevel intervention, which at the individual level builds on our prior efforts to promote traditional diet and activities to decrease risk for obesity in AN preschoolers. At the family level, MOYD provides feedback to parents about their child’s health screenings; at the school level, it features traditional foods, outdoor traditional physical activities, and a culturally centered curriculum. At the community level, it offers resources to improve the built environment for safe outdoor play that invites all community members to participate. In partnership, the Alaska Native Tribal Health Consortium, RurAL CAP, and collaborators will refine and test the effectiveness of MOYD at 12 Head Start preschools in the Yukon-Kuskokwim region: (1) we will use qualitative methods with Head Start staff, parents, and community Elders to optimally tailor MOYD for southwest Alaska communities; and (2) we will conduct a stepped-wedge group-randomized trial to test its effect on children’s diet, physical activity (PA), body mass index (BMI), and other risk factors for obesity-related chronic disease over three years. Primary outcomes are diet (classroom meals, actigraphy-based physical activity, and body mass index. Secondary outcomes include individual child level measures of hemoglobin levels and educational and developmental progress; parent report of diet, activity, and sleep at home; and measures of traditional foods/sugar-sweetened/processed foods by carbon and nitrogen stable isotope ratios using fingernail clippings. We will also measure outcomes at the school level (classroom meals, outdoor time) and community level (objective data on use of play space). (3) We will conduct a process evaluation using the RE-AIM framework. Our Specific Aims are to (1) conduct preschool staff and parent/elder workgroups to refine the MOYD intervention for optimal effectiveness for obesity prevention among AN preschool children; (2) test the effectiveness of MOYD on a) diet, PA, outdoor time, and BMI; and b) improving other clinical and behavioral risk factors for obesity-related chronic disease in preschool children; and (3) implement the RE-AIM framework to evaluate dissemination and implementation of the MOYD intervention in Head Start programs.