Testing a Multilevel, Multicomponent, Multigenerational Dietary Intervention to Improve Southeast Asian Children's Diets

背景资料。对于东南亚(海)儿童来说，糟糕的饮食质量是一个重大而关键的问题 家庭作为难民来到美国[例如苗族、柬埔寨人、老挝人、越南人]。海里的孩子 肥胖率高，患其他与饮食有关的慢性病的风险增加，这是不成比例的负担 与其他亚洲亚群、白人和其他种族相比，2型糖尿病患者的比例更高。虽然饮食干预 已被证明可以预防/延缓与饮食有关的慢性病的发病，据我们所知，没有 专门为海中儿童制定的饮食干预措施。因此，迫切需要饮食 利用最先进的方法解决影响SEA的现有健康差距的干预措施 并促进对干预研究中差距的科学理解。建议书概述。这 该提案反映了我们与SEA中心八年(持续)的学术-社区研究伙伴关系 在罗德岛，与海洋家庭一起进行的形成性工作，以及我们管理成功饮食的丰富经验 对服务不足的健康差距群体进行干预。目前的研究是一项试验性可行性研究，旨在测试 创新多层次、多成分、多世代饮食干预，改善海洋饮食质量 孩子们。概念模型。社区能量平衡与以家庭为中心的行动模式 干预布局和实施框架提供了干预的理论基础和结构。这些 框架提出，针对SEA等差距较大的少数民族群体，多层次、多成分、 代际干预是改变和维持的最有效的干预方法 个人层面的行为改变。社会认知理论和大众化教育哲学揭示了 干预内容。研究计划概述。75个有6到11岁孩子的海洋家庭将被 从罗德岛州普罗维登斯县招募。成人-儿童配对将随机分为：(1)经济奖励 唯一每周将获得15美元经济奖励优惠券的ARM，用于补贴购买健康食品 当地海杂货店；或(2)经济奖励加上每月两次的家庭团体营养教育，地址为 由SEA社区卫生工作者领导的SEA中心；训练有素的三次动机访谈(MI)电话 社区卫生工作者；成人(通过每周短信)和儿童(通过)的饮食规范信息 营养教育课程的信息图表)；每周15美元的经济奖励优惠券 在海上杂货店购买健康食品；或(3)学术敬业注意力控制部门， 将遵循财政激励加营养教育、MI和短信的结构和 信息图ARM。主要结果是研究的可行性和对儿童的临床有意义的改善 饮食质量(以健康饮食指数衡量)。次要结果是在临床上有意义的改变 儿童体重(~2 kg体重下降或无体重增加)、糖化血红蛋白(0.5%)和父母饮食质量、糖化血红蛋白和 家里的食物环境。这些研究结果将被用来为未来更大规模的临床试验提供信息。

Background. Poor diet quality is a significant and critical problem for Southeast Asian (SEA) children whose families came to the US as refugees [e.g., Hmong, Cambodian, Laotian, Vietnamese]. SEA children are disproportionately burdened by higher rates of obesity and increased risk of other diet-related chronic diseases like type 2 diabetes relative to other Asian subgroups, Whites and “Other” races. Although dietary interventions have been shown to prevent/delay onset of diet-related chronic diseases, to our knowledge, there are no dietary interventions developed specifically for SEA children. Thus, there is an urgent need for dietary interventions that leverage state-of-the-art methods to address existing health disparities affecting SEA children and to advance scientific understanding of gaps in intervention research. Overview of Proposal. This proposal reflects our eight year (ongoing) academic-community research partnership with the Center for SEA in Rhode Island, formative work with SEA families, and our extensive experience conducting successful dietary interventions with underserved health disparity groups. The current study is a pilot feasibility study that tests an innovative multilevel, multicomponent, multigenerational dietary intervention to improve diet quality among SEA children. Conceptual Model. The Community Energy Balance and Family-Centered Action Model of Intervention Layout and Implementation frameworks provide the intervention rationale and structure. These frameworks propose that for disparity ethnic minority groups like SEA, multilevel, multicomponent, intergenerational interventions are the most effective intervention approach for changing and sustaining individual-level behavior change. Social cognitive theory and popular education philosophy inform the intervention content. Overview of Research Plan. 75 SEA families with children ages 6 to 11 years will be recruited from Providence County, Rhode Island. Adult-child pairs will be randomized to: (1) financial incentive only arm that will receive weekly $15 financial incentive coupons to subsidize purchase of healthy foods at a local SEA grocery store; or (2) financial incentive plus twice-monthly, family-based group nutrition education at the Center for SEA led by SEA community health workers; three motivational interviewing (MI) calls by trained community health workers; dietary norms messaging for adults (via weekly text messages) and for children (via Infographics at nutrition education sessions); and weekly $15 financial incentive coupons to subsidize purchase of healthy foods at SEA grocery stores; or (3) an Academic Engagement attention control arm that will follow the structure of the financial incentive plus nutrition education, MI and text messages and infographics arm. The primary outcomes are study feasibility and clinically meaningful improvement in child’s diet quality (measured by healthy eating index). Secondary outcomes are clinically meaningful changes in children’s body mass (~ 2kg weight loss or no weight gain), HbA1c (0.5%) and parent’s diet quality, HbA1c and the home food environment. These study findings will be used to inform a future, larger clinical trial.