Obesity Prevention in Head Start: The Miranos! Program

摘要 美国2-5岁儿童的肥胖率仍然居高不下，而三分之一的学前班儿童 超重或肥胖。这项拟议的研究旨在测试儿童早期肥胖的疗效。 预防计划，“先行一步预防肥胖：米拉诺斯！计划“，该计划促进健康 Head Start中以拉丁裔为主的儿童的生长发育。米拉诺斯队！包括以中心为基础(政策变化、 员工发展、总体运动计划和营养教育)和以家庭为基础(家长参与/ 教育和家访)干预措施，以解决青少年肥胖预防中的关键促进因素和障碍 孩子们。通过与Head Start的合作，我们证明了 建议对学前班儿童的能量平衡相关行为产生有利影响的干预措施。 采用三臂整群随机设计，随机抽取相同数量的21个首发中心 分配给以下三种情况之一：1)基于中心和基于家庭的联合干预；2)基于中心的干预 只进行干预，或3)对照。这些干预措施将在学年(为期8个月)内进行 句号)。共有525名3岁儿童(52%为女性；基线每个中心n=25人)将参加 研究，并在干预后一年进行前瞻性跟踪。数据收集将在基线上进行， 干预后即刻，并进行为期一年的随访，包括身高、体重、体力活动(PA)和 通过加速计测量久坐行为、父母报告睡眠时间和看电视时间、粗大运动 发展、饮食摄入量以及食物和活动偏好。家庭背景、父母信息 与体重、PA和营养相关的做法和行为、PA和营养政策以及中心的环境 家庭、干预计划费用和治疗保真度也将被收取。这项研究有三个具体的 目标：1)测试米拉诺斯的疗效！对健康体重增长的干预(主要结果) 正常体重、超重和肥胖儿童，2)测试米拉诺斯的影响！对儿童的干预 PA、久坐行为、睡眠和饮食行为(次要结果)，以及3)评估成本- 米拉诺斯的有效性！干预。 在当地一位大型的Head Start管理人和一个多学科研究团队的支持下， 米拉诺斯！，一个为文化量身定做的肥胖预防计划，准备提供政策和 低收入拉丁裔预防早期肥胖的环境方法及其成本效益 学龄前儿童。通过在不同的影响级别和多种环境中针对多种行为， 米拉诺斯！养成长期的健康习惯，通过以下方式减少能源失衡差距 瞄准多种与能量平衡相关的行为。米拉诺斯队！可以传播到各种组织 儿童保育环境，因为它是建立在Head Start计划及其基础设施之上的--早期的黄金标准 儿童教育，以及目前对学龄前儿童的PA和营养建议。

Abstract The prevalence of obesity remains high in American children aged 2-5 while one in three Head Start children is overweight or obese. The proposed study is designed to test the efficacy of an early childhood obesity prevention program, “Obesity Prevention in Head Start: The Míranos! Program”, which promotes healthy growth in predominantly Latino children in Head Start. The Míranos! includes center-based (policy changes, staff development, gross motor program, and nutrition education) and home-based (parent engagement/ education and home visits) interventions to address key enablers and barriers in obesity prevention in young children. In partnership with Head Start, we have demonstrated the feasibility and acceptability of the proposed interventions to influence energy-balance-related behaviors favorably in Head Start children. Using a three-arm cluster randomized design, 21 Head Start centers in equal number will be randomly assigned to one of three conditions: 1) a combined center- and home-based intervention, 2) center-based intervention only, or 3) control. The interventions will be delivered during the academic year (an 8-month period). A total of 525 3-year-old children (52% females; n=25 per center at baseline) will be enrolled in the study and followed prospectively one year post intervention. Data collection will be conducted at baseline, immediate post-intervention, and 1-year follow-up and include height, weight, physical activity (PA) and sedentary behaviors by accelerometry, parent-reports of sleep duration and TV watching time, gross motor development, dietary intakes and food and activity preferences. Information on family background, parental weight, PA- and nutrition-related practices and behaviors, PA and nutrition policy and environment at center and home, intervention program costs, and treatment fidelity will also be collected. The study has three specific aims: 1) to test the efficacy of the Míranos! intervention on healthy weight growth (primary outcome) in normal weight, overweight and obese children, 2) to test the impact of the Míranos! intervention on children's PA, sedentary behavior, sleep, and dietary behaviors (secondary outcomes), and 3) to evaluate cost- effectiveness of the Míranos! intervention. With endorsement of a large local Head Start administrator and a multi-disciplinary research team, the Míranos!, a culturally tailored obesity prevention program, is poised to provide evidence of a policy and environmental approach to prevent early onset of obesity and its cost-effectiveness in low-income Latino preschool children. By targeting multiple behaviors at different levels of influence and in multiple settings, the Míranos! holds great promise of developing long-term health habits that reduce the energy imbalance gap by targeting multiple energy-balance-related behaviors. The Míranos! can be disseminated to various organized child care settings since it is built on Head Start program and its infrastructure—a gold standard in early childhood education, as well as current PA and nutrition recommendations for preschool children.