Lunch in the Bag: Packing More Fruit, Vegetables, Grain in Preschool Sack Lunches

描述（由申请人提供）：大多数美国人食用的水果、蔬菜和全谷物少于推荐量。这包括学龄前儿童，这是一个主要问题，因为儿童早期形成的食物偏好和饮食习惯会影响到儿童后期和成年早期。此外，富含水果、蔬菜和全谷物的饮食可以预防某些癌症，有助于保持健康的体重，降低患糖尿病和其他慢性疾病的风险。因此，迫切需要在学龄前儿童的饮食中增加水果、蔬菜和全谷物的消费。73%的3-5岁的美国儿童在非父母的定期照顾下，儿童保育是一个非常重要的环境，可以鼓励父母增加幼儿食用和享受水果、蔬菜和全谷物的机会；尽管有这样的机会，但在儿童保育环境中进行的研究很少。本提案的主要目的是评估“袋装午餐”，这是一项基于行为的多层次干预措施，旨在增加托儿中心袋装午餐中水果、蔬菜和全谷物的可用性。干预包括每周5次家长讲义，以及以中心为基础的家长和儿童活动，以加强讲义中的概念，随后在最初干预后三个月进行加强活动。结果测量包括以下方面的变化：(1)袋装午餐中水果、蔬菜、全谷物、薯条和糖果的数量；（二）儿童食用这些食物的量；(3)父母的知识、规范和意图；(4)教师的支持和意识；(5)中心环境支持健康饮食。次要目标是确定干预的中介因素。其他目标包括评价影响执行和适应的因素。要求家长从家里送盒饭的托儿中心（n=40）将随机分为干预组和对照组。家庭（n=800）将被登记为亲子二人组，由主要的午餐打包者和每个家庭一名3至5岁的孩子组成。结果测量将在(1)基线，(2)五周干预后立即（6周），(3)3个月后“加强”活动前立即（23周）和(4)加强后5周（28周）进行评估。调解分析将以计划行为理论（TPB）和社会认知理论（SCT）为指导，特别关注儿童的饮食行为和父母的食物包装行为以及对儿童食物偏好的感知的相互影响。定性和过程数据收集将贯穿整个干预过程。这项研究的数据将使我们能够确定通过托儿中心实施的以家长为基础的干预措施的有效性和可行性，以增加学龄前儿童饮食中水果、蔬菜和全谷物的可用性。这项工作的最终目标是制定新的战略，通过托儿中心促进儿童的健康饮食习惯，这将降低他们在以后的生活中患癌症和其他慢性病的风险。

DESCRIPTION (provided by applicant): The majority of Americans eat less than the recommended amounts of fruits, vegetables, and whole grains. This includes preschool age children, which is a major concern since food preferences and eating habits developed in early childhood track into later childhood and early adulthood. In addition, diets rich in fruits, vegetables and whole grains protect against certain cancers, help maintain healthy weight, and reduce risks for diabetes and other chronic diseases. Thus, there is an urgent need for increasing consumption of fruits, vegetables, and whole grains in the diets of preschool children. With 73% of US children ages 3-5 in regular non-parental care, childcare is a very important setting for encouraging parents to increase young children's opportunities to eat and enjoy fruits, vegetables and whole grains; despite this opportunity, few studies have been conducted in childcare settings. The primary aim of this proposal is to evaluate Lunch is in the Bag, a behaviorally-based, multilevel intervention to increase the availability of fruits, vegetables, and whole grains in sack lunches in childcare centers. The intervention includes 5 weekly parent handouts, along with center- based parent and child activities to reinforce concepts in the handouts, followed by a booster activity three months after the initial intervention. Outcome measures include changes in (1) the amounts of fruits, vegetables, whole grains, chips, and sweets packed in the sack lunches; (2) the amounts of these foods consumed by the children; (3) parent knowledge, norms and intention; (4) teacher support and awareness; and (5) center environment to support a healthy diet. Secondary aims are to determine the mediating factors for the intervention. Additional aims include the evaluation of factors affecting implementation and adaption. Childcare centers (n=40) that require parents to send sack lunches from home will be randomized to intervention and control groups. Families (n=800) will be enrolled as parent-child dyads comprised of the primary lunch packer and one 3 to 5 year old child per family. Outcome measures will be assessed at (1) baseline, (2) immediately after the five-week intervention (6 weeks), (3) 3 months later immediately before a "booster" activity (23 weeks), and (4) 5 weeks after the booster (28 weeks). Mediation analyses will be guided by the Theory of Planned Behavior (TPB) and Social Cognitive Theory (SCT), with particular attention to the reciprocal influences of the child's eating behavior and the parent's food packing behavior and perceptions of child food preferences. Qualitative and process data collection will be conducted throughout the intervention. Data from this study will enable us to determine the efficacy and feasibility of a parent-based intervention implemented through childcare centers to increase the availability of fruits, vegetables, and whole grains in diets of preschool children. The ultimate goal for this work is the development of new strategies for the promotion of healthy eating practices in children through childcare centers, which will decrease their risk of cancer and other chronic diseases later in life.