Reducing Sugared Fruit Drinks in Alaska Native Children

项目摘要/摘要 是的，阿拉斯加YK三角洲的儿童每天摄入50茶匙的添加糖，是美国的16倍 心脏协会推荐的最大剂量。这些添加的糖大部分来自含糖水果饮料(主要是 唐和酷爱)在家里消费。因此，Yup‘ik儿童的龋齿发生率是 是美国平均水平的16倍，与富裕家庭的儿童相比，口腔健康不平等 社区。我们建议在阿拉斯加3个乡村原住民社区进行双臂准实验性行为试验，以 检验社区卫生工作者主导的健康教育和自我效能培训的假设 照顾者将减少儿童添加糖的摄入量。具体目标是：(1)提炼和敲定健康 促进干预；(2)实施干预并确定结果；(3)确定干预措施 改进策略和传播研究结果。涉及健康的饮料替代干预措施 教育和获得替代品是有效的，但改善通常不会长期持续。 这种下降的原因是干预措施缺乏提高自我效能的具体努力，而自我效能是一种关键的 根据班杜拉的社会认知理论，省略。这个应用程序建立在以前的研究和 将在阿拉斯加原住民社区测试这些概念。在拟议的研究中，将分配3个社区 根据社区准备好的顺序，2个武器中的1个。101个有0-10岁孩子的家庭 在2个Yupik社区将被招募来测试为期6个月的文化适应、5次会议的干预 包括互动健康教育和自我效能感培训，由一名土著 社区卫生工作者。第三个Yupik社区的41个家庭将被招募到比较条件下 其中将通过邮寄方式提供具有相同文化适应内容的健康教育。健康教育 将解决龋齿的病因和关于含糖水果饮料的错误信息，并推广无糖水 增强剂。自我效能培训将使照顾者能够随着时间的推移发起并维持行为改变。 所有三个社区的当地商店都将储备无糖水果饮料(唐和酷爱饮料，也称为水 增强剂)，作为帮助儿童远离含糖水果饮料的工具。会议的主要成果是 儿童水平是含糖水果饮料摄入量(照顾者报告的24小时召回)和添加糖摄入量(通过 一种有效的非侵入性生物标志物)，在基线、1、3、6和12个月时测量。次要的 结果包括来自添加糖的总能量摄入量的百分比和照顾者提供替代品的自我效能。 这项工作得到了育空库什科维姆健康公司的支持，该公司将维护和传播 如果该计划奏效，并能解决纽约州15,000多名阿拉斯加原住民儿童面临的关键问题 达美航空公司和更多的数百万人，如果在阿拉斯加和美国印第安人国家在较低的48。 此外，它还可以进行调整，以满足其他有类似问题的人群的需求。

PROJECT SUMMARY/ABSTRACT Yup’ik children in Alaska’s YK Delta consume 50 teaspoons of added sugar each day, 16 times the American Heart Association’s recommended maximum. Most of this added sugar is from sugared fruit drinks (mostly Tang and Kool-Aid) consumed at home. Consequently, Yup’ik children experience tooth decay rates that are 16 times the U.S. average and suffer from oral health inequalities compared to children from better off communities. We propose a 2-arm quasi-experimental behavioral trial in 3 rural Alaska Native communities to test the hypothesis that Community Health Worker-led health education and self-efficacy training for caregivers will decrease child added sugar intake. The Specific Aims are to: (1) Refine and finalize the health promotion intervention; (2) Implement the intervention and determine outcomes; and (3) Identify intervention improvement strategies and disseminate findings. Beverage substitution interventions involving health education and access to alternatives are effective, but improvements are not typically sustained long-term. The reason for this drop off is that the interventions lack specific efforts to boost self-efficacy, a critical omission according to Bandura’s Social Cognitive Theory. This application builds on previous research and will test these concepts in Alaska Native communities. In the proposed study, 3 communities will be assigned to 1 of 2 arms based on the order in which the community is ready. 101 families with children ages 0-10 years in 2 Yup’ik communities will be recruited to test the 6-month culturally-adapted, 5-session intervention consisting of interactive health education and self-efficacy training delivered in-person by an indigenous Community Health Worker. 41 families in a third Yup’ik community will be recruited to a comparison condition in which health education with the same culturally-adapted content will be delivered by mail. Health education will address tooth decay etiology and misinformation about sugared fruit drinks, and promote sugar-free water enhancers. Self-efficacy training will empower caregivers to initiate and sustain behavior change over time. Local stores in all 3 communities will stock sugar-free fruit drinks (Tang and Kool-Aid drops, also called water enhancers by industry) as a tool to help shift children from sugared fruit drinks. The primary outcomes at the child level are sugared fruit drink intake (caregiver-reported 24-hour recalls) and added sugar intake (through a validated, non-invasive biomarker) measured at baseline and at 1, 3, 6, and 12 months. Secondary outcomes include % total energy intake from added sugar and caregiver self-efficacy to provide alternatives. This work has the support of the Yukon Kuskokwim Health Corporation which will maintain and disseminate the program if it works and can address a critical problem facing over 15,000 Alaska Native children in the YK Delta and millions more if adopted throughout Alaska and American Indian country in the Lower 48. Moreover, it can be adapted to meet the needs of other populations with similar problems.