Child Health Initiative for Lifelong Eating and Exercise (CHILE)

描述(申请人提供)：肥胖已在美国儿童中流行，并在一生中造成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。这项拟议研究的目的是设计、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岁的农村拉美裔和美国印第安人儿童的肥胖风险(以BMI百分位数衡量)。主要的干预地点将是Head Start中心，注册的低收入学龄前儿童大部分时间都在那里度过。这项名为儿童健康终身饮食和锻炼倡议(智利)的干预措施将包括政策变化，以解决健康饮食和体力活动的环境决定因素，以及个人和人际层面的战略，以促进增加中等到剧烈的体力活动；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；以及减少看电视/屏幕时间。干预措施包括六个部分：针对Head Start教室的课堂课程；针对Head Start教师和助手的在职培训计划；针对Head Start食品服务人员的培训；针对家庭的以家庭和Head Start为基础的计划；使用当地医疗保健提供者作为社区变革推动者、顾问和榜样；以及社区杂货店计划，以增加健康食品的供应和推广。这项研究将采用嵌套队列设计，将16个先行中心随机分配到干预或控制条件下。每个学前教育中心的两组3岁儿童将在随机化后进行为期两年的跟踪调查。参与者将在四个时间点使用测量和面试方案进行评估。数据将使用多水平建模进行分析，以将差异划分为个体和先行或干预水平的成分，并探索个体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.