Research Project #1

德克萨斯州休斯敦的英亩家园地区是一个以非裔美国人和西班牙裔为主的社区，是一个持续贫困的地区，69%的居民生活在食物沙漠地区，据报道，超过40%的成年居民患有肥胖症。我们的是一项整群随机试验，旨在评估Bright ter Bites(BB)的影响，这是一种基于学校的干预措施，旨在改善获得新鲜农产品和营养教育的机会，对12所服务于Acres Homees社区的小学及其父母注册的儿童的肥胖和代谢结果的影响。在短期和长期内，BB被证明在低收入小学生中有效地吸引父母，改善健康的饮食行为，减少食物不安全。然而，该计划对儿童或父母的肥胖和代谢指标的影响尚不清楚。使用交织的方法，BB将被整合到Be Well Acres Home，这是一项以地方为基础的癌症预防倡议。小学将随机进入BB干预或等待名单控制条件(12所学校，720名亲子二人组)。在BB学校，家庭将获得16份20-25磅的分配。(~50份)新鲜农产品带回家，食谱品尝，在学校进行亲身实践的营养教育，对于家长来说，在一个学年期间访问BB移动应用程序，并可以选择在随后的两个学年继续参加BB计划。儿童和父母将在基线、干预后(~9个月)和21个月的随访中接受以下结果的评估：身高、体重、手指签糖化血红蛋白(HbA1c)、血压(BP)、通过筛选器的饮食摄入量、儿童皮肤类胡萝卜素水平、与饮食相关的行为、家庭可获得性/获得FV的机会以及通过问卷调查的食物不安全状况。目的1：我们的主要目的是比较干预后BB干预和等待名单控制对初级儿童结局(BMI z评分、HbA1c和蔬菜摄入量)的影响。目标2：检查干预后9个月BB干预和等待名单控制对次级结果(家庭食品安全状况、父母BMI、HbA1c、BP、父母和儿童饮食行为以及家庭可获得性/FV的可得性)的影响。目的3：研究干预后9个月食品安全状况、父母结局和家庭环境措施的变化对儿童结局变化的中介影响。目的：使用受试者内分析，检验和比较BB干预策略对儿童在21个月的随访中饮食、肥胖和代谢结果的长期和剂量反应效果。目的5：探讨社会(财务困境、歧视经历、健康素养和社会联系)和环境变量(接近食物来源、食物环境和社区社会脆弱性)对计划有效性的调节作用。这个项目将为BB的翻译和扩展工作提供信息，BB是一个非常成功的自然实验。它还通过研究和改进实施情况来促进传播和实施科学，以增加方案的覆盖范围和对诸如英亩家园等持续贫困地区的影响。

The Acres Homes region in Houston, TX, is a predominantly African American and Hispanic community, a persistent poverty area with 69% of the residents living in food desert areas, and over 40% of the adult residents reportedly being obese. Ours is a cluster-randomized trial to assess the impact of Brighter Bites (BB), a school-based intervention improving access to fresh produce and nutrition education, on obesity and metabolic outcomes among children enrolled across 12 elementary schools serving the Acres Homes community and their parents. BB is proven to be effective at engaging parents, improving healthy dietary behaviors, reducing food insecurity, in low-income elementary school children in the short and long term. However, the impact of the program on obesity and metabolic measures in children or parents is unknown. Using an interweaving approach, BB will be integrated into Be Well Acres Homes, a place-based cancer prevention initiative. Elementary schools will be randomized to the BB intervention or waitlisted control condition (12 schools, 720 parent-child dyads). At BB schools, families will receive 16 distributions of 20-25 lbs. (~50 servings) of fresh produce to take home, recipe tastings, and hands-on, robust nutrition education in school, and for parents, access to the BB mobile app during one school year, with the option to continue participation in the BB program for two subsequent school years. Children and parents will be assessed at baseline, post-intervention (~9 months) and 21-months follow-up for the following outcomes: height, weight, glycosylated hemoglobin (HbA1c) via finger stick, blood pressure (BP), dietary intake via screener, child skin carotenoid levels, diet-related behaviors, home availability/access to FV and food insecurity status via questionnaires. Aim 1: Our primary aim is to examine the effects of the BB intervention compared to wait-list control at post-intervention on changes in primary child outcomes (BMI z-score, HbA1c, and vegetable intake) Aim 2: To examine the effects of the BB intervention compared to wait-list control at 9-month post intervention on changes in secondary outcomes (household food security status, parent BMI, HbA1c, BP, parent and child dietary behaviors, and home access/availability of FV). Aim 3: To examine the mediational influence of changes in food security status, parent outcomes, and home environment measures on changes in child outcomes at 9-month post-intervention. Aim 4: Using within-subject analyses, examine and compare the long-term and dose-response effects of the BB intervention strategies on diet, adiposity, and metabolic outcomes at 21-mos follow-up in the children. Aim 5: Explore the moderating effects of social (financial distress, experiences of discrimination, health literacy, and social connectedness), and environmental variables (proximity to food access sources, food environment, and neighborhood social vulnerability) on program effectiveness. This project will inform the translation and scaling efforts of BB, a highly successful natural experiment. It also advances dissemination and implementation science by studying and improving upon implementation to increase program reach and impact in persistent poverty areas such as Acres Homes.