Empowerment as a mechanism for change in childhood obesity prevention

 描述(申请人提供)：在美国，近四分之一的学龄前儿童超重或肥胖。这个问题很重要，因为幼儿肥胖与糖尿病、高血压、心脏病和某些类型的癌症等直接和长期的健康后果有关。更重要的是，肥胖对健康的影响在低收入和少数民族儿童中经历的比例更大。鉴于儿童正在出现的饮食、体育活动、屏幕行为和睡眠行为深深植根于家庭，有效地让父母和家庭照顾者参与儿童肥胖预防是该项目成功的关键。然而，事实证明，家庭参与具有挑战性，针对幼儿的有效家庭干预仍然难以捉摸。作为回应，我们开发并测试了一种预防家庭肥胖的新方法。我们的方法以社区参与性研究(CBPR)为基础，承认父母是家庭专家，让他们成为共同研究人员，并将由此产生的以赋权为重点的干预措施--社区健康生活(CHL)--嵌入Head Start，这是一个覆盖100多万低收入家庭的全国性护理系统。在我们成功的CHL试点评估的基础上，并与我们的Head Start合作伙伴(包括每年为2000多名儿童提供服务的18个中心)合作，我们将扩大我们的CBPR方法，以吸引3至5岁儿童的父母和Head Start工作人员完善CHL，使其适应新的环境。为了确保这项工作的及时翻译，我们将使用实际行为试验(PBT)来测试CHL的有效性，并针对以下具体目标：(1)利用CBPR来适应和提炼CHL，以便在新的环境下实施；(2)使用小组随机对照试验测试CHL的有效性；以及(3)考察CHL与环境因素(包括社会经济、食物和体育活动环境)对CHL有效性的相互作用。将使用Head Start的现有数据系统评估参与中心登记的所有儿童的结果，包括身体质量指数和四种目标健康行为(饮食、体力活动、屏幕时间和睡眠)。这项研究的主要创新包括让家长和工作人员参与参与进程，一种偏离传统的营养和育儿教育模式并处理更广泛的家庭现实的干预措施，以及利用现有的Head Start数据系统来评估CHL，所有这些都支持未来的传播和可持续性。

 DESCRIPTION (provided by applicant): Nearly one in four preschool-aged children in the US is overweight or obese. This problem is significant because obesity in young children is linked with immediate and long-term health consequences including diabetes, hypertension, heart disease and certain types of cancer. What is more, the health effects of obesity are disproportionately experienced among low-income and ethnic minority children. Given that children's emerging dietary, physical activity, screen-based and sleep behaviors are deeply rooted in the family, effectively engaging parents and family caregivers in childhood obesity prevention is crucial to its success. Yet family engagement has proven challenging and effective family interventions targeting young children remain elusive. In response, we have developed and tested a new approach to obesity prevention in families. Grounded in community-based participatory research (CBPR), our approach recognizes parents as family experts, engages them as co-researchers and embeds the resulting empowerment-focused intervention - Communities for Healthy Living (CHL) - into Head Start, a national system of care reaching over one million low-income families. Building on our successful pilot assessment of CHL, and in collaboration with our Head Start partners including 18 centers serving over 2000 children each year, we will expand our CBPR approach to engage parents of 3- to-5-year old children and Head Start staff to refine adapt CHL to a new setting. To ensure the timely translation of this work, we will test CHL effectiveness using a practical behavioral trial (PBT) and addressing the following specific aims: (1) utilize CBPR to adapt and refine CHL for implementation in a new setting; (2) test the efficacy of CHL using a group randomized controlled trial; and (3) examine the interplay between CHL and environmental factors, including the socioeconomic, food and physical activity environments, on CHL efficacy. Child outcomes, including Body Mass Index and four target health behaviors (diet, physical activity, screen time, and sleep), will be assessed for all children enrolled in the participating centers using Head Start's existing data system. Primary innovations of this study include the engagement of parents and staff in the participatory process, an intervention that deviates from the traditional model of nutrition and parenting education and addresses broader family realities, and the utilization of existing Head Start data systems to evaluate CHL, all of which support future dissemination and sustainability.