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

学龄前阶段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，以及肥胖、糖尿病、 心血管疾病和其他慢性病。不幸的是，许多美国儿童， 尤其是低收入和少数民族，他们的饮食模式与肥胖和 发病率增加。因此，要提高儿童的饮食质量，就必须开发出有效的 在儿童(特别是高危儿童)花费时间的环境中进行有针对性的干预。 有一种全国性的呼吁，要求跨多个环境的饮食干预，包括 儿童保育和家庭环境。作为对PAS-20-160的回应，我们建立在我们的有效 与家庭托儿所(FCCH)提供者(FCCP)一起进行健康开始干预试验一项新的、 通过FCCH为家庭提供为期8个月的多层次量身定制干预。这将是第一次 将家庭干预内容纳入妇幼保健院的研究。催化裂化是一种很有前途的 父母信任FCCP作为大家庭成员和FCCP感觉到的干预设置 与父母谈论孩子的饮食很舒服，但需要更多的培训才能有效地做到这一点。 为期8个月的干预措施将包括健康启动干预措施的改编版本 英语和西班牙语FCCP以及FCCP培训，以向 父母使用现有的育儿应用程序，辅之以FCCH环境线索和 为家长量身定做的印刷品和视频。具体目标是：SA.1。开展形成性研究 配合FCCP和家长通知细化多层次干预。SA.2.进行一次试点 对40名FCCP和80名有18-54个月大孩子的父母进行试验，以评估可行性和 干预和研究方案的可接受性，以及营养的初步效果 A)将干预与注意力匹配的对照进行比较。FCCH儿童膳食质量调查 和家，b)。社会/物质FCCH和家庭食品环境，c)。儿童真皮 类胡萝卜素水平和z-BMI评分。SA3.对家长进行事后定性访谈， FCCP、教练、员工和合作伙伴评估干预的可接受性和建议 进步。总而言之，改善幼儿饮食的可行和有效的干预措施是 急需之物。FCCH是一种新的、未开发的设置，可同时干预FCCP和 父母同时在育儿和家庭环境中影响儿童的饮食，这 有可能更全面地影响孩子的整体饮食和体重状况。这位飞行员 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，并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.