Healthy Start: An innovative, multi-level intervention with family child care providers and families to improve the dietary behaviors of preschool children

学龄前是形成食物偏好和饮食行为的关键时期 这反过来又会影响成年人的饮食行为和终身肥胖，糖尿病， 心血管疾病和其他慢性疾病。不幸的是，许多美国儿童， 特别是低收入和少数民族，有与肥胖相关的饮食模式， 增加发病率。因此，要提高儿童的饮食质量，制定有效的 在儿童（特别是高危儿童）生活的环境中采取有针对性的干预措施。 有一个国家呼吁饮食干预，跨越多个设置，包括 儿童保育和家庭环境。作为对PAS-20-160的回应，我们建立在我们有效的 健康开始干预与家庭儿童保育院（FCCH）提供者（FCCP）试点一种新的， 8-一个月的多层次定制干预，通过家庭保健中心接触家庭。这将是第一 将家庭干预内容纳入家庭保健服务的研究。FCCH是一个有前途的 干预设置为父母信任FCCP作为大家庭成员和FCCP感觉 与父母谈论孩子的饮食很舒服，但需要更多的培训来有效地做到这一点。 为期8个月的干预将包括健康开始干预的改编版本， 讲英语和西班牙语的FCCP以及FCCP培训， 家长使用现有的儿童保育应用程序，辅以FCCH环境提示， 为父母量身定制的印刷品和视频。具体目标是：SA.1。进行形成性研究 与FCCP和家长一起，为多层次干预的细化提供信息。SA.2.进行试点 40名FCCP和80名18-54个月大儿童的父母参加的试验，以评估可行性， 干预和研究方案的可接受性，以及营养的初步疗效 干预相比，注意力匹配的控制：a）。FCCH儿童膳食质量 和家，B）。社会/物理FCCH和家庭食物环境，c）。儿童真皮 类胡萝卜素水平和z-BMI评分。SA 3.对家长进行事后定性访谈， FCCP、教练、工作人员和合作伙伴评估干预措施的可接受性，并提出建议， 改进.总之，改善幼儿饮食的可行和有效的干预措施是 迫切需要。FCCH是一个新颖的和未开发的设置，以干预FCCP和 父母同时影响儿童的饮食在儿童保育和家庭环境， 有可能更全面地影响孩子的整体饮食和体重状况。这一试点 新的多层次干预的可行性研究将为未来的全面集群RCT提供信息， 这将填补重要的研究空白，推动营养研究的前沿。

The preschool years are a critical time for shaping food preferences and eating behaviors which, in turn, affect dietary behaviors in adults and life-long risks for obesity, diabetes, cardiovascular disease and other chronic conditions. Unfortunately, many US children, especially low-income and ethnic minorities, have dietary patterns associated with obesity and increased morbidity. Thus, to improve child diet quality, it is essential to develop effective targeted interventions in settings where children (especially higher risk children) spend time. There is a national call for dietary interventions that span multiple settings including the childcare and home environments. In response to PAS-20-160, we build upon our efficacious Healthy Start intervention with family childcare home (FCCH) providers (FCCP) to pilot a novel, 8-month multilevel tailored intervention to reach families through FCCH. This would be the first study to incorporate family-based intervention components into FCCH. FCCH are a promising intervention setting as parents trust FCCPs as extended family members and FCCP feel comfortable talking to parents about children’s diet, but want more training to do so effectively. The 8-month intervention will include an adapted version of the Healthy Start intervention for English and Spanish-speaking FCCP as well as FCCP training to deliver nutrition messages to parents using an existing childcare App, complemented with FCCH environmental cues and tailored print and videos for parents. Specific Aims are to: SA.1. Conduct formative research with FCCP and parents to inform refinement of the multi-level intervention. SA.2. Conduct a pilot trial with 40 FCCP and 80 parents with 18-54-month-old children to evaluate feasibility and acceptability of intervention and study protocols, and preliminary efficacy of the nutrition intervention compared to an attention-matched control on: a). children’s dietary quality at FCCH and home, b). social/physical FCCH and home food environments, c). children’s dermal carotenoid levels and z-BMI scores. SA3. Conduct post qualitative interviews with parents, FCCP, coaches, staff & partners to assess the intervention’s acceptability and suggestions for improvement. In sum, feasible and effective interventions to improve young children’s diets are urgently needed. The FCCH is a novel and untapped setting to intervene with both FCCP and parents simultaneously to affect children’s diets in both the childcare and home settings, which has the potential to more fully impact the child’s overall diet and weight status. This pilot feasibility research of a novel, multi-level intervention will inform a future full-scale cluster RCT, which will fill important research gaps and move the frontier of nutrition research forward.