Identifying an implementation strategy to maximize the public health nutrition impact of the Child and Adult Care Food Program

近五分之一的2-5岁的美国儿童患有肥胖症，目前超过一半的儿童到成年时预计会患有肥胖症。因此，如果不能预防儿童肥胖，大多数儿童患与饮食有关的慢性疾病（包括II型糖尿病）的风险就会增加。幼儿期对于形成饮食习惯、体育活动和其他有助于健康体重的行为至关重要，但幼儿期的饮食目前很差。加强儿童和成人保健食品计划（CACFP）的营养标准是一种很有前途的公共卫生方法，可以在幼儿时期建立健康的饮食习惯。CACFP是一项联邦食品援助计划，覆盖了美国数百万在儿童保育机构就读的幼儿。CACFP提供的膳食标准最近更新了，但执行不完整削弱了这一政策变化的影响。确定一项改进执行的战略，有助于确保对《儿童健康与家庭计划》的预期政策改进转化为对儿童健康的改善。本研究建议收集关于儿童保育提供者在采用健康饮食标准时面临的实施挑战的新数据，包括管理挑战和成本的数据。然后，利用这一形成性研究，我们将制定一项实施干预措施，以帮助托儿中心采用更严格的CACFP营养标准。

Nearly one in five 2-5 year old U.S. children has obesity, and over half of today’s children are expected to have obesity by adulthood. Failure to prevent childhood obesity thus puts a majority of our children at increased risk of diet-related chronic diseases including type II diabetes mellitus. Early childhood is critical for the formation of habits for eating, physical activity, and other behaviors that contribute to a healthy weight, yet diet in early childhood is currently poor. A promising public health approach to establishing healthy eating habits in early childhood is through strengthening the nutrition standards of the Child and Adult Care Food Program (CACFP), a federal food assistance program that reaches millions of young children attending child care settings in the US. CACFP standards for meals served were recently updated, but incomplete implementation has weakened the impact of this policy change. Identification of a strategy to improve implementation could help to ensure that the intended policy improvements to CACFP translate into improved child health. This study proposes to collect novel data on the implementation challenges that child care providers face in adopting healthier eating standards, including data on administrative challenges and costs. Then, using this formative research, we will develop an implementation intervention to help child care centers adopt stronger CACFP nutrition standards. The NIDDK K01 Mentored Research Scientist Development Award will help fill critical training gaps in 1) dissemination and implementation science and 2) cost analysis, and will build on my advanced training in intervention evaluation and social epidemiology. My long-term career goal is to develop a robust research program that uses strategic science to inform effective policy development and policy implementation, to prevent nutrition-related chronic diseases at a population level. The training plan involves coursework in implementation science and cost analysis, combined with structured mentoring, meetings, workshops, and seminars, to establish new skills in these areas. The research plan proposed will allow me to apply these new skills and build on my existing skill set. The combined training and research plan, with the strong institutional support and excellent intellectual environment of the Harvard T.H. Chan School of Public Health, will ensure my transition into an independent researcher able to compete successfully for R01 funding and help me develop into a leader in the field of public health approaches to improving child nutrition and preventing later diet-related chronic diseases.