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，今天超过一半的儿童预计在成年后会有肥胖症。因此，未能预防儿童肥胖使我们的大多数儿童患上与饮食有关的慢性疾病的风险增加，包括II型糖尿病。儿童早期对于形成饮食习惯、身体活动和其他有助于健康体重的行为至关重要，然而儿童早期的饮食目前很差。在儿童早期建立健康饮食习惯的一个有前途的公共卫生方法是通过加强儿童和成人护理食品计划(CACFP)的营养标准，该计划是一个联邦食品援助计划，覆盖了美国数百万儿童托儿所。最近更新了CACFP的餐饮标准，但不完全的执行削弱了这一政策变化的影响。确定改进执行情况的战略可有助于确保对CACFP的预期政策改进转化为改善儿童健康。这项研究建议收集关于儿童保育提供者在采用更健康的饮食标准方面面临的执行挑战的新数据，包括关于行政挑战和成本的数据。然后，利用这项形成性研究，我们将开发一种实施干预措施，帮助托儿中心采用更严格的CACFP营养标准。 NIDDK K01指导研究科学家发展奖将帮助填补1)传播和实施科学以及2)成本分析方面的关键培训空白，并将以我在干预评估和社会流行病学方面的高级培训为基础。我的长期职业目标是制定一个强有力的研究计划，利用战略科学为有效的政策制定和政策执行提供信息，在人口层面上预防与营养相关的慢性疾病。培训计划涉及实施科学和成本分析方面的课程，并结合有组织的指导、会议、讲习班和研讨会，以建立这些领域的新技能。建议的研究计划将使我能够应用这些新技能，并在现有技能的基础上发展。结合的培训和研究计划，加上哈佛大学公共卫生学院强有力的机构支持和良好的知识环境，将确保我转变为一名能够成功竞争R01资金的独立研究员，并帮助我发展成为公共卫生方法领域的领导者，以改善儿童营养和预防以后与饮食相关的慢性病。

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.