ONE PATH: Optimizing Nutrition Education for Parents And Teachers for Healthy Growth

项目摘要/摘要 在美国，儿童肥胖是一个严重且代价高昂的健康问题，对 生活在农村、低收入地区的经济困难儿童。尽管如此，几乎没有有效的 预防战略以儿童保育环境为目标，许多儿童在那里吃75%的饭。反应灵敏 喂养(RF)实践，提供结构和限制，同时允许儿童行使一些自主性， 促进食物摄入量自我调节的发展。射频已被证明是一个有希望的目标 但这些试验主要集中在家庭环境上。改善食品品质的策略 需要在多个环境中促进射频和儿童食欲调节。 One Path研究将严格测试将RF和食欲调节组件添加到 现有的、以证据为基础的计划，干预儿童保育环境。创新的 将使用多阶段优化策略(MOST)方法框架来确定 干预成分改善农村低收入儿童的RF和儿童食欲调节 注册了Head Start。使用析因设计，Head Start教室(n=48)将随机接收或 没有收到三个组成部分：a)针对幼儿教育提供者的射频培训，通过以下方式提供 在线模块；b)家长射频培训，由推广教育者在家提供；c)儿童自我 监管课程，在Head Start教室授课。干预将在以下过程中进行 一个学年(约9个月)，跨越三个年龄组。干预组件的有效性将通过以下方式确定 评估照料者喂养做法和儿童食欲调节(主要结果)以及 儿童保育和家庭环境，以及儿童BMI z得分(次要结果)。这项研究将产生一个 优化的干预由有效和高效的组件组成，这些组件将在 未来的随机对照试验。拟议的研究将改善所需的证据基础，以便将在 从实验室到儿童就餐的社区环境，优化学龄前儿童的护理。 为了成功完成这项研究，我们组建了一个跨学科的团队，包括研究人员， 教育工作者和推广专业人士。顾问委员会成员将代表美国科学院 儿科(AAP)、宾夕法尼亚州立大学合作扩展-更好的儿童护理和宾夕法尼亚州Head Start。我们的 多学科团队有合作的历史，非常适合设计和测试这个多学科的网站， 多组分干预。我们有在家庭和教室实施干预的经验 环境，与宾夕法尼亚州7个农村县的Head Start儿童接触。这个应用程序有几个 独特的特点/优势包括：公共卫生/临床意义，针对欧洲经委会提供者的射频，有吸引力 幼儿保育中的家长，并使用创新的方法来优化我们的干预。这项研究值得称赞 NIH的超常目标是改善妇幼保健，这与NIDDK的使命是一致的。

PROJECT SUMMARY/ABSTRACT Childhood obesity is a serious and costly health problem in the United States that disproportionately affects economically disadvantaged children living in rural, low-income areas. Despite this, virtually no effective preventive strategies target the childcare setting, where many children eat 75% of their meals. Responsive feeding (RF) practices, which provide structure and limits while allowing the child to exercise some autonomy, foster the development of self-regulation of food intake. RF has been shown to be a promising target of interventions, but these trials have focused primarily on the home environment. Strategies to improve the food environment and promote RF and child appetite regulation in multiple settings are needed. The ONE PATH study will rigorously test the effect of adding RF and appetite regulation components to an existing, evidence-based program that intervenes on the childcare setting environment. An innovative methodological framework, Multiphase Optimization Strategy (MOST), will be used to identify which intervention components improve RF and children’s appetite regulation among rural, low-income children enrolled in Head Start. Using a factorial design, Head Start classrooms (n=48) will be randomized to receive or not receive three components: a) RF training for early childhood education (ECE) providers, delivered via online module; b) RF training for parents, delivered at home by Extension educators; and c) child self- regulation curriculum, delivered in Head Start classrooms. The interventions will take place over the course of one school year (~9 months), spanning three cohorts. Intervention component efficacy will be determined by evaluating caregiver feeding practices and child appetite regulation (primary outcomes) and changes in childcare and home environments, and child BMI z-score (secondary outcomes). This study will yield an optimized intervention comprised of effective and efficient components that will be “packaged” and tested in a future RCT. The proposed research will improve the evidence base needed to translate lessons learned in the laboratory to community settings where children eat, optimizing the care of preschool-aged children. To successfully complete this study, we have assembled a transdisciplinary team, including researchers, educators, and Extension professionals. Advisory board members will represent the American Academy of Pediatrics (AAP), Penn State Cooperative Extension - Better Kid Care, and Pennsylvania Head Start. Our multi-disciplinary team has a history of working together and are well suited to design and test this multi-site, multi-component intervention. We have experiences implementing interventions in the home and classroom settings, with access to Head Start children in 7 rural counties in Pennsylvania. This application has several unique features/strengths including: public health/clinical significance, targeting RF of ECE providers, engaging parents in ECE care, and using innovative methods to optimize our intervention. This research compliments the over-reaching goal of NIH to improve maternal/child health and it is consistent with the NIDDK mission.