Strong Families Start at Home/Familias Fuertes Comienzan en Casa: A novel Video and Motivational Interviewing Intervention to improve diet quality of low-income, ethnically diverse children

美国儿童的饮食是次优的，有效的初级预防干预措施是 迫切需要在生命早期塑造饮食行为，特别是在拉丁裔家庭中，他们 肥胖和心血管疾病的患病率较高。社区能量 平衡框架建议需要在多个层面上进行干预，同时解决文化 和背景因素，以有效地影响疾病预防的饮食质量，包括：1)儿童 水平，包括食欲特征(饱腹感反应(对内在饱腹感信号的敏感性)， 食物反应性(对外部食物暗示的敏感性)和食物挑剔；2)亲本水平 包括他们用来喂养孩子的食物养育做法；3)家庭层面，包括 粮食的可获得性和可及性；4)更广泛的背景，包括社会决定因素、粮食 安全/获得健康食品。虽然已经有几次干预旨在 为了改善幼儿的饮食质量，很少有人把目标定在这些水平中的一个以上 而且几乎没有一种是为孩子的胃口特征量身定做的，文化上合适，而且方便 为忙碌、工作的拉丁裔家庭服务。此外，大多数人只关注父母不应该做的事情 做他们应该做的事情，而不是支持他们应该做的事情。这项提议将建立在我们的 最近完成了R34试点可行性试验(R34HL140229-01A1)，以测试一种新型 对257个拉丁裔学龄前儿童家庭进行家庭干预。建议的6个月 干预措施将包括：1)一名社区卫生工作者(CHW)接受过三次家访 简短的激励性访谈，包括上门烹饪示范做饭 让孩子参与进来；使用家庭用餐时间视频提供关于食物养育的反馈；2) 筛查健康的社会决定因素并将家庭与联邦/州/地方联系起来 资源；3)文本消息(2x/wk)；4)定制材料/消息；以及5)三个CHW 电话加强食品养育、食品资源管理和健康饮食。 具体目标是：提高2-5岁儿童膳食摄入量的质量(目标1)； 改进食品养育做法(目标2)；改善家庭健康食品供应情况 (目标3)。探索性目标将评估：结果衡量标准和 干预剂量；结果测量与潜在的介体和 主持人和干预对儿童BMI的影响。这项研究填补了一个重要的研究空白。 通过以积极的食物养育为目标的家庭食物环境，同时承认 孩子的食欲特征。它还满足了美国国立卫生研究院对减少健康所需研究的呼吁 在拉丁裔人群中存在差异，并有可能对公共卫生造成严重影响。

The diets of US children are suboptimal and effective primary prevention interventions are urgently needed to shape dietary behaviors early in life, especially among Latinx families, who experience higher prevalence of obesity and cardiovascular disease. The community energy balance framework suggests the need to intervene at multiple levels, while addressing cultural and contextual factors, to effectively impact diet quality for disease prevention including: 1) Child level, including appetitive traits (satiety responsiveness (sensitivity to internal satiety signals), food responsiveness (sensitivity to external food cues), and food fussiness; 2) Parent level including the food parenting practices they use to feed children; 3) Home level including the availability and accessibility of food, and; 4) Broader context including social determinants, food security/access to healthy foods. While there have been several interventions aimed at improving the diet quality of young children, few have targeted more than one of these levels and almost none are tailored to a child’s appetitive traits, culturally appropriate, and convenient for busy, working Latinx families. Further, most have only focused on what parents should not be doing, rather than supporting what they should be doing. This proposal will build on our recently completed R34 pilot feasibility trial (R34HL140229-01A1) to test the efficacy of a novel home-based intervention with 257 Latinx families of preschool children. The proposed 6-month intervention will include: 1) Three home visits by a community health worker (CHW) trained in brief motivational interviewing that include in-home cooking demonstrations to prepare a meal involving the child; using a family meal-time video to provide feedback on food parenting; 2) Screening for social-determinants of health and connecting families to federal/state/local resources; 3)Text-messages (2x/wk); 4) Tailored materials/messages; and 5) Three CHW phone calls to reinforce food parenting, food resource management and healthy eating. Specific Aims are to: Improve quality of the dietary intakes of 2–5-year-old children (Aim 1); Improve food parenting practices (Aim 2); and Improve the home availability of healthy foods (Aim 3). Exploratory aims will assess: the relationship between outcome measures and intervention dose; the relationship between outcome measures and potential mediators and moderators and the intervention’s effect on child BMI. This study fills an important research gap by targeting the home food environment with positive food parenting while acknowledging a child’s appetitive traits. It also meets the NIH call for needed research to reduce health disparities among Latinx populations and has the potential for high public health impact.