Child Health Initiative for Lifelong Eating and Exercise (CHILE)

描述（由申请人提供）：肥胖已成为美国儿童的流行病，并在整个生命周期中导致严重的负面健康后果。因此，确定预防儿童肥胖的有效干预措施至关重要。这项研究的目的是设计、实施和评估一种文化上适当的、多层次的跨社区预防干预措施，以降低3至5岁农村西班牙裔和美洲印第安儿童的肥胖风险（以BMI百分位数衡量）。主要的干预地点将是学前教育中心，在那里登记的低收入学龄前儿童度过了他们的大部分时间。干预措施，儿童健康倡议终身饮食和锻炼，将包括政策变化，以解决健康饮食和体育活动的环境决定因素，以及个人和人际一级的战略，以促进增加中度到剧烈的体育活动;增加水果，蔬菜和全谷物的消费;减少含糖饮料和高脂肪食品的消费;以及减少电视观看/屏幕时间。干预措施包括六个组成部分：一个教室课程的开端教室;一个在职培训计划的开端教师和助手;培训开端食品服务人员;一个家庭和开端为基础的计划为家庭;使用当地的医疗保健提供者作为社区变革的代理人，顾问和榜样;和一个社区杂货店计划，以增加健康食品的选择和推广。本研究将采用嵌套队列设计，其中16家先行启动中心将被随机分配至干预或对照条件。将在随机化后对每个Head Start中心的两个3岁儿童队列进行为期两年的随访。参与者将在四个时间点使用测量和访谈协议进行评估。将使用多层次模型分析数据，将方差划分为个人和领先或干预水平的组成部分，并探索个人随时间的变化和潜在的中介效应。

DESCRIPTION (provided by applicant): Obesity has become epidemic among U.S. children and results in serious negative health consequences over the lifespan. Thus, identifying effective interventions for prevention of obesity in children is paramount. The purpose of the proposed study is to design, implement, and evaluate a culturally appropriate, multi-level trans-community prevention intervention for decreasing obesity risk (measured by BMI percentile) in 3 to 5- year-old rural Hispanic and American Indian children. The primary intervention site will be Head Start centers, where enrolled low-income preschool children spend the majority of their days. The intervention, Child Health Initiative for Lifelong Eating and Exercise (CHILE), will include policy changes to address environmental determinants of healthful eating and physical activity, as well as individual and interpersonal level strategies to promote increased moderate to vigorous physical activity; increased consumption of fruits, vegetables, and whole grains; decreased consumption of sweetened beverages and high-fat foods; and decreased television viewing/screen time. The intervention includes six components: a classroom curriculum for Head Start classrooms; an in-service training program for Head Start teachers and aides; training for Head Start food service staff; a home- and Head Start-based program for families; use of local health care providers as community change agents, advisors, and role models; and a community grocery store program to increase availability and promotion of healthy food options. The study will employ a nested cohort design in which 16 Head Start centers will be randomly assigned to intervention or control conditions. Two cohorts of 3-year-old children within each Head Start center will be followed for two years post-randomization. Participants will be assessed using a measurement and interview protocol across four time points. Data will be analyzed using multi-level modeling to partition variance into individual- and Head Start- or intervention- level components, and to explore individuals' change over time and potential mediating effects.