More Outside Your Door (MOYD)

更多户外活动 (MOYD)

• 批准号: 10621538
• 负责人: Timothy K Thomas
• 金额: $ 51.53万
• 依托单位: ALASKA NATIVE TRIBAL HEALTH CONSORTIUM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-11 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10621538
• 关键词: 3 year old; 5 year old; Adherence; Adolescent; Adoption; Adult; Age; Alaska; Alaska Native; Alaskan; Back; Behavioral; Body mass index; COVID-19 pandemic; Carbon; Cardiometabolic Disease; Cardiovascular Diseases; Cardiovascular Pathology; Child; Child Care; Child Health; Childhood; Chronic Disease; Clinical; Clip; Communities; Community Actions; Community Participation; Consumption; Control Groups; Data; Data Collection; Development; Diet; Diet Habits; Discrimination; Disparity; Dissemination and Implementation; Early Intervention; Education; Educational Curriculum; Effectiveness; Elderly; Enrollment; Ensure; Evidence based intervention; Exercise; Family; Feedback; Food; Funding; Growth; Guidelines; Habits; Head Start Program; Health; Healthy Eating; Hemoglobin concentration result; Home; Hour; Hypertension; Individual; Intervention; Intervention Trial; Isotopes; Learning; Life; Life Style; Longevity; Masks; Measures; Methods; Morbid Obesity; Native-Born; Nitrogen; Non-Insulin-Dependent Diabetes Mellitus; Nursery Schools; Nutrient; Obesity; Obesity associated disease; Outcome Measure; Overweight; Parents; Physical activity; Play; Preschool Child; Prevalence; Process; Program Effectiveness; Program Evaluation; Qualitative Methods; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Reporting; Research Personnel; Resources; Risk Factors; Rural; Schedule; School-Age Population; Schools; Sea; Seasons; Signal Transduction; Site; Sleep; Structure of nail of finger; System; Taste Perception; Taste preferences; Testing; Time; Travel; Tribes; Unhealthy Diet; Yukon Kuskokwim; Yup' ik; actigraphy; built environment; cardiometabolism; cardiovascular risk factor; community based participatory research; coronavirus disease; design; disparity reduction; effectiveness testing; empowerment; ethnic minority population; experience; falls; food consumption; forging; good diet; group intervention; improved; intervention program; lifestyle intervention; member; migration; obesity in children; obesity prevention; obesity risk; poor sleep; prevent; primary outcome; process evaluation; programs; racial minority population; randomized trial; risk minimization; rural Alaska; rural area; school closure; screening; secondary outcome; sleep health; sleep quantity; stable isotope; statistics; success; sugar; teacher; trial design; tribal health; uptake

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.

摘要 阿拉斯加农村社区行动计划（RurAL CAP），负责管理农村地区的学前教育。 阿拉斯加，报告说，68%的阿拉斯加土著儿童年龄在3至5岁超重，43%是肥胖。 饮食、体力活动和睡眠卫生是儿童肥胖的主要危险因素， 心脏代谢疾病。值得注意的是，亚临床心血管病理学可以早在 三岁。阿拉斯加原住民曾经依靠陆地和海洋生活，但他们遭受了数十年的殖民统治 和移民，这干扰了传统的食物消费，标志着当地的一个显着变化， 食品系统。饮食和体力活动是早期干预的主要目标， 童年养成的习惯可以终身坚持。因此，我们设计了更多的门外， （MOYD），一个多层次的干预，在个人层面上建立在我们以前的努力，以促进传统的 饮食和活动，以降低AN学龄前儿童肥胖的风险。在家庭一级，青年和青年发展部提供反馈， 向父母介绍他们孩子的健康检查;在学校一级，它以传统食品、户外活动、 传统的体育活动和文化中心课程。在社区一级，它提供资源， 改善户外安全游戏的建筑环境，邀请所有社区成员参与。在 阿拉斯加土著部落健康联盟，RurAL CAP和合作者将完善和测试 MOYD在育空-Kuskokwim地区12所学前教育机构的有效性：（1）我们将使用定性 方法与开端工作人员，家长和社区长老，以最佳定制MOYD阿拉斯加西南部 社区;（2）我们将进行一项阶梯楔形组随机试验，以测试其对儿童 饮食、身体活动（PA）、体重指数（BMI）和其他与肥胖相关的慢性疾病的危险因素超过 三年主要结果是饮食（教室用餐，基于活动记录的身体活动和体重 指数.次要结果包括血红蛋白水平的个体儿童水平测量和教育和 发育进展;父母报告的饮食，活动和睡眠在家里;和措施的传统 通过碳和氮稳定同位素比率，使用指甲剪，对食品/加糖/加工食品进行分析。 我们还将衡量学校一级（教室用餐，户外时间）和社区一级的成果 （关于游戏空间使用的客观数据）。(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）组织学前工作人员和家长/长者工作小组，完善MOYD 对学龄前AN儿童预防肥胖的最佳效果进行干预;（2）测试 MOYD对a）饮食、PA、户外时间和BMI有效性;和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因素;（3）实施RE-AIM框架， 评估青年发展部在“先声夺人”方案中干预措施的传播和实施情况。