A culturally-tailored narrative intervention to target disparities in obesity

描述（由申请人提供）：美国三分之一的儿童超重或肥胖，在服务不足的人群中比例更高，包括低社会经济地位（SES）和/或种族/少数民族家庭。高糖饮料（SSB）的摄入是导致儿童肥胖的能量失衡的主要原因，低社会经济地位和少数种族/民族背景的儿童比高社会经济地位和白人更有可能成为高糖饮料的重度消费者。由于儿童食用的大多数SSB都是在家中进行的，因此父母的合作对于减少儿童的SSB摄入量至关重要。以叙述为基础的方法，即在儿童的故事背景下创建和呈现关键的健康信息，可用于开发适合文化的、特定于家庭的信息，这些信息可吸引父母的情感，因此与传统的说教和教育方法相比，更有可能促进行为改变。为了解决SSB摄入和儿童肥胖方面的健康差异，我们提出了一种针对服务不足的儿童和父母SSB摄入的文化量身定制的干预措施，其中青少年积极参与并被授权成为家庭中关键的行为改变推动者。青少年将通过印刷品、音频和电影项目设计创造性的、以叙事为基础的材料，突出ssb的关键行为信息，并与父母分享。由于儿童在很大程度上影响了父母的购买决定，我们提出这些信息会减少父母购买SSB，从而降低家庭环境中SSB的可用性。干预将通过美国男孩女孩俱乐部（Boys and Girls Clubs of America）提供，这是一个以青年为基础的社区环境，服务于种族多样化和主要是低社会经济地位人群。干预前测试和改进将基于焦点小组的意见；干预的可行性、可接受性和对儿童及家长SSB摄入量和儿童体重指数（BMI）的初步效果将通过地点匹配的随机对照试验进行评估，每个地点有54对父母对（N=108）。以王博士之前的试验为基础

DESCRIPTION (provided by applicant): One-third of children in the U.S. are overweight or obese, with disproportionately higher rates among underserved populations, including low socio-economic status (SES) and/or racial/ethnic minority households. High sugar-sweetened beverage (SSB) intake is a major contributor to the energy imbalance leading to childhood obesity, with children from low SES and minority racial/ethnic backgrounds more likely to be heavy consumers of SSBs than higher SES and White populations. As the majority of SSBs consumed by children take place at home, parental collaboration is critical to reduce children's SSB intake. Narrative-based approaches, in which key health messages are created and presented within the context of a story by children, can be used to develop culturally-tailored, family-specific messages that appeal to parents' emotions and thus facilitate greater likelihood of behavior change compared to traditional didactic, educational approaches. To address health disparities in SSB intake as well as childhood obesity, we propose a culturally-tailored intervention targeting underserved children and parents' SSB intake in which youth are actively engaged and empowered to be key behavior change agents within their families. Youth will design creative, narrative-based materials through print, audio, and film projects, highlighting key behavioral messages on SSBs that will be shared with their parents. As children heavily influence parental purchasing decisions, we proposed that these messages will reduce parental purchase of SSBs and subsequently decrease SSB availability in the home environment. The intervention will be delivered through the Boys and Girls Clubs of America, a youth-based community setting that serves an ethnically diverse and predominantly low SES population. Intervention pre- testing and refinement will be based on focus group input; intervention feasibility, acceptability, and preliminary efficacy on children and parents' SSB intake and children's body mass index (BMI) will be assessed through a site-matched, randomized controlled trial with 54 parent-child pairs (N=108) per site. Building upon Dr. Wang's prior pilot work on reducing SSB intake among inner-city youth, this award will provide her with training in developing behavioral interventions and conducting randomized controlled trials in community settings. The proposal will contribute to Dr. Wang's long-term goal of designing and evaluating family-based obesity prevention programs that can be sustained and disseminated in community settings. In addition to the highly supportive research environment at the University of Massachusetts Medical School and the local Boys and Girls Clubs, Dr. Wang's multidisciplinary team of mentors is highly experienced and committed to provide her with the support needed to achieve the proposed training and research goals.