Increasing Sleep Health Literacy in Head Start: A Social-Ecological Approach

 描述(由申请人提供)：儿童早期睡眠不足和/或质量不佳会损害社会情绪和认知功能(通过对发育中的大脑的影响)，并显著增加肥胖风险(通过激素和内分泌影响)。学龄前儿童(3-5岁)睡眠时间短、行为睡眠问题和睡眠呼吸障碍的发生率最高，为20%-50%。健康的睡眠习惯可以延长睡眠时间，防止行为睡眠问题。意识到睡眠障碍呼吸症状会导致及时治疗。尽管有大量关于睡眠问题的数据，“但在促进睡眠作为一种健康行为的有效策略上所做的工作要少得多”(CDC 2013)。这项研究的首要目标是让学龄前儿童的家庭掌握健康睡眠所需的知识和技能，并认识到睡眠问题。它建立在我们在Head Start的工作基础上，Head Start是一项针对弱势学龄前儿童及其家庭的幼儿教育计划：我们的早期儿童睡眠教育计划(ECSEP(Tm))以他们能够处理和理解的方式教育Head Start教师、儿童和家长关于健康睡眠的知识。在一项随机对照试验中，ECSEP组的儿童每晚多睡30分钟。此外，我们加州大学洛杉矶分校健康护理研究所在Head Start中采用了结构化的低识字率健康培训方法(以减少急诊室就诊、肥胖等)。已经覆盖了10万个家庭。拟议的研究将实施多层次干预措施的社会-生态网络，以加强ECSEP，并在整个欧洲经委会促进健康睡眠。在Head Start中，我们将创建新的交付平台(印刷和视频、探亲)，以“放大”ECSEP。除了Head Start之外，我们还将教育社区，并与利益攸关方合作制定战略，将“睡眠健康扫盲”纳入欧洲经委会政策。该项目将：1)将睡眠教育材料改编成额外的 媒体格式；以及应用保健研究所模式，培训Head Start工作人员进行干预和收集数据。2)从纽约7家Head Start机构招募540名亲子二人参加阶梯式楔形随机对照试验。我们将分析试验对主要结果的影响：a)儿童睡眠时间，b)父母的知识、态度、自我效能和行为，以及c)儿童睡眠困难。3)评估对睡眠问题(与睡眠健康)进行筛查和指导的可行性，以用于未来的疗效研究。次要结果是：课堂行为、政策变化和流程数据。发育早期睡眠不佳会对未来几年产生影响，可能会持续到成年。Head Start服务于低收入家庭，主要是少数族裔家庭，这些家庭的睡眠健康差距最大，但可以修改。这项研究结合了Head Start中提供健康素养(Health Care Institute)和睡眠健康(ECSEP)计划的成熟方法。在社会-生态模型的每个层面上进行干预，最大限度地扩大了研究的范围和可持续性。在全国范围内将睡眠健康知识纳入幼儿教育，最终可使400多万儿童受益。对人类健康的潜在影响是深远的。

 DESCRIPTION (provided by applicant): Inadequate and/or poor quality sleep in early childhood impairs social-emotional and cognitive function (via effects on the developing brain), and markedly increases obesity risk (via hormonal and endocrine effects). Short sleep duration, behavioral sleep problems and sleep-disordered breathing peak at 20%-50%, during the preschool years (ages 3-5). Healthy sleep habits increase sleep duration and prevent behavioral sleep problems. Awareness of sleep-disordered breathing symptoms leads to timely treatment for it. Despite ample data on sleep problems "...much less work has been done on effective strategies to promote sleep as a healthy behavior (CDC 2013)". This study's overarching goal is to empower families of preschool children with the knowledge and skills needed for healthy sleep, and to recognize a sleep problem. It builds on our work in Head Start, an early childhood education (ECE) program for disadvantaged preschool children and their families: Our Early Childhood Sleep Education Program (ECSEP(tm)) educates Head Start teachers, children, and parents about healthy sleep in a way they can process and understand. In a randomized controlled trial, the children in the ECSEP group slept 30 minutes longer/night. As well, our UCLA Health Care Institute's structured approach to low literacy health training in Head Start (to reduce ER visits, obesity, etc.) has reached >100,000 families. The proposed study will implement a Social-Ecological web of multi-level interventions to reinforce the ECSEP, and to promote healthy sleep throughout ECE. Within Head Start, we will create new delivery platforms (print & video, family visits) that 'amplify' the ECSEP. Beyond Head Start, we will educate communities, and partner with stakeholders on strategies designed to embed `sleep health literacy' in ECE policy. This project will: 1) Adapt sleep education material into additional multi media formats, and; apply the Health Care Institute model to train Head Start staff to mount interventions and collect data. 2) Enroll 540 parent-child dyads from 7 Head Start agencies in New York in a stepped wedge randomized controlled trial. We will analyze trial effects on primary outcomes: a) child sleep duration, b) parent knowledge, attitudes, self-efficacy and behavior, and c) child sleep difficulties. 3) Assess the feasibility of screening and guidance for sleep problems (vs. sleep health) for a future efficacy study. Secondary outcomes are: classroom behaviors, policy change, and process data. Poor sleep in early development has ramifications for years to come, perhaps through adulthood. Head Start serves low-income, mainly racial-ethnic minority families, in whom sleep health disparities are greatest-- but are modifiable. This study joins together proven methods of delivering health literacy (Health Care Institute) and sleep health (ECSEP) programs in Head Start. Intervening at every level of the Social-Ecological model maximizes the study's reach and sustainability. Integrating sleep health literacy into ECE nationwide could ultimately benefit upwards of 4 million children. The potential impact upon human health is far-reaching.