Community-Based Healthy-lifestyle Intervention for Rural Preschoolers(CHIRP Study

描述(申请人提供)：近25%的学龄前儿童超重或肥胖。由父母创造的幼儿家庭环境对于建立与能量平衡和健康体重相一致的行为和做法至关重要。不幸的是，在年龄较小的儿童中，不太理想的饮食和体力活动模式正变得越来越普遍。在儿童早期解决这些饮食和活动模式对于减少 一生中疾病的风险因素。以家庭为基础的行为干预(BFI)在促进肥胖小学生体重状况改善方面取得了成功。这些干预措施使父母能够成为变革的推动者，并向父母传授差异化注意、应急管理、建模和刺激控制等育儿技能，以改善家庭环境，帮助激励和支持他们的孩子养成更健康的饮食和体育活动习惯。然而，很少有发表的研究考察这些干预措施对超重和肥胖学龄前儿童的影响。此外，大多数体重管理试验都是由训练有素的临床研究人员和多学科团队在大学医学中心进行的疗效研究。很少有研究检验BFI在现实世界社区环境中解决儿童肥胖问题的有效性，更不用说服务不足的人群了。儿童肥胖问题在农村地区尤为突出，那里的儿童肥胖症患病率比非农村地区高25%。不幸的是，农村地区的儿童和成年人是该国最大的医疗服务不足人口之一。这一系列研究的下一个合乎逻辑的步骤是评估 为医疗服务不足的农村地区的学龄前儿童及其父母量身定做的基于社区的行为家庭干预对儿童体重状况的影响。我们建议对农村学龄前儿童进行基于社区的健康生活方式干预(CHIRP研究)，这是一项为期两年的多地点随机对照试验，旨在评估BFI的有效性，旨在促进农村地区一个重要且服务不足的人群、学龄前儿童及其父母的健康生活方式习惯和体重管理。目前的研究将提供试点数据，以开发和支持更大规模的TRIL。96个孩子和父母将被随机分配到4个月长的BFI或等待名单控制(WLC)。被分配到BFI的儿童(3至6岁)和他们的父母将参加为期四个月的12次面对面小组治疗。BFI将在农村社区的合作推广服务办公室提供，并将为儿童及其父母提供同时但不同的治疗小组(S)。将在基线、治疗后(4个月)和随访(10个月)评估儿童BMI z评分、体力活动、营养摄入量、父母BMI和家庭环境变量。分配给WLC的DUAD将在10个月评估后收到BFI。如果成功，这一干预措施为广泛传播提供了极好的潜力，以解决紧迫的健康差距和公共卫生问题。

DESCRIPTION (provided by applicant): Almost 25% of preschool age children are overweight or obese. The early childhood home environment created by parents is crucial in establishing the behaviors and practices consistent with energy balance and healthy weight. Unfortunately, less than optimal eating and physical activity patterns are becoming more common in younger children. Addressing these eating and activity patterns during early childhood is vital to reducing risk factors for disease over the life span. Behavioral family-based interventions (BFI) have demonstrated success in facilitating improved weight status in obese elementary school children. These interventions empower parents to be agents of change and teach parenting skills such as differential attention, contingency management, modeling and stimulus control to modify the family environment and help motivate and support their children to adopt healthier eating and physical activity habits. However, little published research has examined the impact of these interventions for overweight and obese preschoolers. Moreover, most weight management trials have consisted of efficacy studies conducted in university medical centers by highly-trained clinical researchers and multidisciplinary teams. Little research has examined the effectiveness of BFI to address childhood obesity in real-world community settings, let alone underserved populations. The problem of childhood obesity is notably pronounced in rural areas, where the prevalence of pediatric obesity is 25% higher relative to non-rural areas. Unfortunately, children and adults of rural areas represent one of the largest medically underserved populations in the country. A next logical step in this line of research is to evaluate the impact on child weight status of a community-based behavioral family intervention tailored for preschool age children and their parents in medically underserved rural settings. We propose to conduct a Community-based Healthy-lifestyle Intervention for Rural Preschoolers (The CHIRP Study), a two-year multi- site randomized controlled trial that evaluates the effectiveness of a BFI designed to promote healthy lifestyle habits and weight management in an important and underserved population, preschool age children and their parents in rural settings. The current study will provide pilot data to develop and support a larger, full-scale tril. Ninety-six child and parent dyads will be randomly assigned to either a 4-month long BFI or a Wait List Control (WLC). Children (ages 3 to 6 years) and their parents assigned to the BFI will participate in 12 in-person group treatment sessions across four months. The BFI will be delivered in rural communities at Cooperative Extension Service offices and will involve simultaneous, but separate treatment groups for both the child and their parent(s). Child BMI z-score, physical activity, nutritional intake, parent BMI, and home environment variables will be assessed at baseline, post-treatment (month 4), and follow-up (month 10). Dyads assigned to the WLC will receive the BFI after the Month 10 assessment. If successful this intervention offers excellent potential for wide spread dissemination to address a pressing health disparity and public health problem.