Reducing Sugared Fruit Drinks in Alaska Native Children

减少阿拉斯加原住民儿童的含糖水果饮料

基本信息

批准号：
9507145
负责人：
Donald Leslie Chi
金额：
$ 65.79万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-01 至 2019-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9507145
关键词：
Address Adopted Age Alaska Alaska Native American Heart Association American Indians Behavior Behavioral Behavioral trial Beverages Biological Markers Caregivers Cessation of life Child Childhood Chronic Communication Communities Community Health Aides Consumption Country Data Dental Dental Care Dental caries Development Drops Eating Elements Energy Intake Enhancers Ensure Epidemic Etiology Evidence based program Exercise Face Family Focus Groups Food Fruit Goals Health Health Food Health Promotion Health education Healthy People 2020 Home environment Hospitalization Hour Human Resources Improve Access Industry Infant Intake Interdisciplinary Study Intervention Interview Knowledge Lead Learning Life Low Income Population Manuals Manuscripts Measures Milk Misinformation Modeling Morbidity - disease rate National Institute of Dental and Craniofacial Research Native Americans Oral Oral health Outcome Outcome Measure Output Persons Population Quality of life Recruitment Activity Reporting Research Resources Sampling Schools Self Efficacy Social support Structure Testing Time Tooth Extraction Toothache Training Translating Update Visit Water Water consumption Weight Work Yukon Kuskokwim Yukon-Kuskokwim Delta Yup&apos ik active method arm base behavior change caregiver education community planning drinking water early childhood education access effective intervention experience health inequalities healthy lifestyle improved indigenous community member middle childhood nutrition post intervention primary outcome program dissemination programs response rural Alaska secondary outcome social cognitive theory sugar sweet taste perception systematic review tool

项目摘要

PROJECT SUMMARY/ABSTRACT Yup’ik children in Alaska’s YK Delta consume 50 teaspoons of added sugar each day, 16 times the American Heart Association’s recommended maximum. Most of this added sugar is from sugared fruit drinks (mostly Tang and Kool-Aid) consumed at home. Consequently, Yup’ik children experience tooth decay rates that are 16 times the U.S. average and suffer from oral health inequalities compared to children from better off communities. We propose a 2-arm quasi-experimental behavioral trial in 3 rural Alaska Native communities to test the hypothesis that Community Health Worker-led health education and self-efficacy training for caregivers will decrease child added sugar intake. The Specific Aims are to: (1) Refine and finalize the health promotion intervention; (2) Implement the intervention and determine outcomes; and (3) Identify intervention improvement strategies and disseminate findings. Beverage substitution interventions involving health education and access to alternatives are effective, but improvements are not typically sustained long-term. The reason for this drop off is that the interventions lack specific efforts to boost self-efficacy, a critical omission according to Bandura’s Social Cognitive Theory. This application builds on previous research and will test these concepts in Alaska Native communities. In the proposed study, 3 communities will be assigned to 1 of 2 arms based on the order in which the community is ready. 101 families with children ages 0-10 years in 2 Yup’ik communities will be recruited to test the 6-month culturally-adapted, 5-session intervention consisting of interactive health education and self-efficacy training delivered in-person by an indigenous Community Health Worker. 41 families in a third Yup’ik community will be recruited to a comparison condition in which health education with the same culturally-adapted content will be delivered by mail. Health education will address tooth decay etiology and misinformation about sugared fruit drinks, and promote sugar-free water enhancers. Self-efficacy training will empower caregivers to initiate and sustain behavior change over time. Local stores in all 3 communities will stock sugar-free fruit drinks (Tang and Kool-Aid drops, also called water enhancers by industry) as a tool to help shift children from sugared fruit drinks. The primary outcomes at the child level are sugared fruit drink intake (caregiver-reported 24-hour recalls) and added sugar intake (through a validated, non-invasive biomarker) measured at baseline and at 1, 3, 6, and 12 months. Secondary outcomes include % total energy intake from added sugar and caregiver self-efficacy to provide alternatives. This work has the support of the Yukon Kuskokwim Health Corporation which will maintain and disseminate the program if it works and can address a critical problem facing over 15,000 Alaska Native children in the YK Delta and millions more if adopted throughout Alaska and American Indian country in the Lower 48. Moreover, it can be adapted to meet the needs of other populations with similar problems.

项目概要/摘要阿拉斯加 YK 三角洲的尤皮克儿童每天摄入 50 茶匙添加糖，是美国人的 16 倍心脏协会建议的最大糖分含量大部分来自含糖水果饮料。在家中饮用 Tang 和 Kool-Aid 后，尤皮克儿童的蛀牙率是这样的。是美国平均水平的 16 倍，与富裕家庭的儿童相比，口腔健康状况不平等我们建议在 3 个阿拉斯加原住民农村社区进行 2 臂准实验行为试验。检验以下假设：社区卫生工作者主导的健康教育和自我效能培训护理人员将减少儿童添加糖的摄入量，具体目标是： (1) 完善并最终确定健康状况。干预推广；(2) 实施干预并确定结果；以及 (3) 确定干预措施改进策略并传播涉及健康的饮料替代干预措施。教育和获得替代方案是有效的，但改善通常不会长期持续。这种下降的原因是干预措施缺乏提高自我效能感的具体努力，而自我效能感是提高自我效能感的一个关键因素。根据班杜拉的社会认知理论，该应用程序建立在先前的研究和基础上。将在阿拉斯加原住民社区测试这些概念。在拟议的研究中，将分配 3 个社区。根据社区准备好 101 个有 0-10 岁儿童的家庭的顺序，分配给 2 个分支中的 1 个。将招募 2 个尤皮克社区来测试为期 6 个月、为期 5 次的文化适应干预措施包括由土著人亲自提供的互动健康教育和自我效能培训第三个 Yup'ik 社区的 41 个家庭将被招募来进行比较。其中具有相同文化适应内容的健康教育将通过邮寄方式进行。将解决蛀牙病因和有关含糖果汁饮料的错误信息，并推广无糖水自我效能培训将使护理人员能够随着时间的推移发起并维持行为改变。所有 3 个社区的当地商店都将备有无糖果汁饮料（Tang 和 Kool-Aid 滴剂，也称为水）行业增强剂）作为帮助儿童摆脱含糖果汁饮料的工具。儿童水平包括含糖水果饮料摄入量（护理人员报告的 24 小时召回）和添加糖摄入量（通过一种经过验证的非侵入性生物标志物）在基线以及 1、3、6 和 12 个月时进行测量。结果包括添加糖的总能量摄入百分比和护理人员提供替代方案的自我效能。这项工作得到了育空 Kuskokwim 健康公司的支持，该公司将维护和传播该计划是否有效并且可以解决 YK 地区 15,000 多名阿拉斯加原住民儿童面临的关键问题如果在阿拉斯加和美洲印第安人乡村地区的 48 州地区采用，达美航空和更多的数百万人。此外，它可以适应其他有类似问题的人群的需求。