Identifying an implementation strategy to maximize the public health nutrition impact of the Child and Adult Care Food Program

项目总结/摘要 近五分之一的2-5岁美国儿童患有肥胖症，预计今天超过一半的儿童将患有肥胖症。 成年后肥胖。因此，未能预防儿童肥胖使我们大多数儿童面临更大的风险 与饮食有关的慢性疾病，包括II型糖尿病。幼儿期对于儿童的成长至关重要。 饮食习惯，体育活动和其他有助于健康体重的行为，但饮食在早期 现在的童年是贫穷的。一个有前途的公共卫生方法，以建立健康的饮食习惯，在早期 儿童是通过加强儿童和成人护理食品计划（CACFP）的营养标准， 一项联邦食品援助计划，该计划覆盖了数百万在儿童保育机构工作的儿童。 我们CACFP的膳食标准最近得到了更新，但执行不完整， 这一政策变化的影响。确定一项改进执行工作的战略有助于确保 对CACFP的预期政策改进转化为儿童健康的改善。本研究建议， 首先收集新的数据，儿童保育提供者在采用更健康的饮食方面面临的实施挑战 标准然后，利用这一形成性研究，我们将制定一个实施干预，以帮助儿童 护理中心采用更严格的CACFP营养标准。干预措施的有效性将通过以下方式进行试点测试： 在儿童护理中心水平进行随机分组对照试验。最后，研究将收集 关于实施干预过程的定性数据和关于成本的定量数据。NIDDK K 01指导研究科学家发展奖将有助于填补1）传播和 实施科学和2）成本分析，并将建立在我在干预评估方面的高级培训 社会流行病学。我的长期职业目标是开发一个强大的研究计划， 科学告知有效的政策制定和政策执行，预防营养相关慢性病 在人口水平上。培训计划包括实施科学和成本方面的课程 分析，结合结构化的指导，会议，讲习班和研讨会，以建立新的技能， 这些地区所提出的研究计划将使我能够应用这些新技能，并建立在我现有的技能 集产学研相结合的培养计划，拥有强大的机构支持和优秀的知识分子队伍， 环境的哈佛T.H.陈公共卫生学院，将确保我过渡到一个独立的 研究人员能够成功地竞争R 01资金，并帮助我发展成为该领域的领导者。 公共卫生方法，以改善儿童营养和预防以后与饮食有关的慢性病。

PROJECT SUMMARY/ABSTRACT Nearly one in five 2-5 year old U.S. children has obesity, and over half of today’s children are expected to have obesity by adulthood. Failure to prevent childhood obesity thus puts a majority of our children at increased risk of diet-related chronic diseases including type II diabetes mellitus. Early childhood is critical for the formation of habits for eating, physical activity, and other behaviors that contribute to a healthy weight, yet diet in early childhood is currently poor. A promising public health approach to establishing healthy eating habits in early childhood is through strengthening the nutrition standards of the Child and Adult Care Food Program (CACFP), a federal food assistance program that reaches millions of young children attending child care settings in the US. CACFP standards for meals served were recently updated, but incomplete implementation has weakened the impact of this policy change. Identification of a strategy to improve implementation could help to ensure that the intended policy improvements to CACFP translate into improved child health. This study proposes to first collect novel data the implementation challenges that child care providers face in adopting healthier eating standards. Then, using this formative research, we will develop an implementation intervention to help child care centers adopt stronger CACFP nutrition standards. The efficacy of the intervention will be pilot-tested by conducting a cluster-randomized, controlled trial at the child care center level. Lastly, the study will collect qualitative data on the process of the implementation intervention and quantitative data on costs. The NIDDK K01 Mentored Research Scientist Development Award will help fill critical training gaps in 1) dissemination and implementation science and 2) cost analysis, and will build on my advanced training in intervention evaluation and social epidemiology. My long-term career goal is to develop a robust research program that uses strategic science to inform effective policy development and policy implementation, to prevent nutrition-related chronic diseases at a population level. The training plan involves coursework in implementation science and cost analysis, combined with structured mentoring, meetings, workshops, and seminars, to establish new skills in these areas. The research plan proposed will allow me to apply these new skills and build on my existing skill set. The combined training and research plan, with the strong institutional support and excellent intellectual environment of the Harvard T.H. Chan School of Public Health, will ensure my transition into an independent researcher able to compete successfully for R01 funding and help me develop into a leader in the field of public health approaches to improving child nutrition and preventing later diet-related chronic diseases.