Addressing Obesity in Early Care and Education Settings

在早期护理和教育环境中解决肥胖问题

• 批准号: 9752319
• 负责人: Roshan Bastani
• 金额: $ 57.34万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9752319
• 关键词: Address; Adolescence; Adopted; Adoption; Adult; Age; Area; Behavior; Body mass index; Caring; Child; Child Care; Child Nutrition; Childhood; Cluster randomized trial; Collaborations; Communities; County; Eating; Education; Educational Curriculum; Effectiveness; Effectiveness of Interventions; Ensure; Environment; Epidemic; Evaluation; Frequencies; Future; Health; Healthy Eating; Height; Home environment; Individual; Intervention; Knowledge; Left; Los Angeles; Low income; Maintenance; Mediator of activation protein; Modeling; Nonprofit Organizations; Nursery Schools; Obesity; Obesity Epidemic; Outcome; Overweight; Parents; Patient Self-Report; Pattern; Physical activity; Policies; Population; Preschool Child; Preventive Intervention; Process; Public Health; Randomized; Reporting; Research; Resources; Sampling; Schools; Site; System; Targeted Research; Waiting Lists; Weight; Work; Workplace; base; early childhood; effective intervention; ethnic minority population; evidence base; experience; follow-up; health disparity; implementation research; intervention effect; minority communities; multi-component intervention; nutrition; obesity in children; obesity prevention; primary outcome; public health relevance; secondary outcome; societal costs; success; teacher; tool; uptake

PROJECT SUMMARY Childhood obesity is a national epidemic that disproportionately burdens low income and ethnic minority communities. By preschool, nearly one-third of low income children are already overweight or obese, setting the stage for a myriad of adverse health conditions in adolescence and adulthood. Experts agree that effective, scalable, and sustainable obesity prevention efforts are urgently needed and must shift their focus to early childhood. Preschools offer a very promising environment for implementation and wide dissemination of interventions targeting large numbers of young children. However, limited rigorous implementation research targeting low income and ethnic minority preschool age children has left a major evidence gap, severely constraining the tools available to educators and policymakers to address the obesity epidemic. Individually- focused and single-component interventions have generally failed to produce long-term changes in obesity- related outcomes. Evidence increasingly supports creating entire environments (e.g., preschools) where the healthy choice is the default option. Therefore, we propose to conduct a pragmatic cluster randomized trial, based on our Healthy-By- Default framework, to evaluate the effectiveness and implementation of a multi-level, multi-component intervention that integrates healthy eating and physical activity into preschool routines. Our intervention will involve 1) establishment of organization-level policies to support healthy nutrition and physical activity, 2) integration of nutrition and physical activity into the preschool curriculum, 3) modeling of healthy behaviors by preschool teachers and staff, and 4) engagement of parents as partners in this effort. The study is a collaboration between UCLA and the Child Care Resource Center (CCRC), a large non-profit organization dedicated to ensuring that all children receive high quality, comprehensive preschool/child care experiences, particularly in low resource, diverse communities. We will randomly assign 60 preschools served by CCRC, in underserved areas of Los Angeles County, to the intervention or a usual practice, wait-list control condition. Our aims are to: 1) implement a multilevel obesity prevention intervention for preschool settings that builds on existing evidence-based approaches, stakeholder input, and our pilot research; 2) evaluate the effectiveness of the intervention on child BMI z-scores (primary outcome), and parent-reported child nutrition and physical activity (secondary outcomes); and 3) systematically assess intervention reach, adoption, implementation, adaptation and maintenance, guided by the RE-AIM Framework, which we have tailored for our specific study focus and setting. By simultaneously evaluating both effectiveness and implementation of our intervention, we will efficiently generate new knowledge vital to informing widespread dissemination. Given the staggering long-term societal costs of childhood obesity, rigorous studies to identify effective and scalable obesity prevention interventions are needed now.

项目摘要 儿童肥胖是一种全国流行病，负担低收入和少数民族 社区。通过学龄前儿童，近三分之一的低收入儿童已经超重或肥胖 在青春期和成年期间，无数不良健康状况的阶段。专家认为这有效， 迫切需要进行可扩展和可持续的肥胖预防工作，必须将重点转移到早期 童年。学龄前儿童为实施和广泛传播提供了一个非常有希望的环境 针对大量幼儿的干预措施。但是，严格的实施研究有限 针对低收入和少数民族学龄前儿童的儿童留下了主要的证据差距 限制教育者和政策制定者可用的工具以解决肥胖症流行。单独 - 集中和单一组成的干预措施通常未能导致肥胖症的长期变化 - 相关结果。证据越来越支持创建整个环境（例如，学前班） 健康选择是默认选项。 因此，我们建议根据我们的健康逐个进行务实的簇随机试验 默认框架，以评估多级，多组件的有效性和实现 将健康的饮食和体育锻炼纳入学前教育的干预措施。我们的干预会 涉及1）制定组织水平的政策以支持健康的营养和体育锻炼，2） 将营养和体育活动整合到学龄前课程中，3）通过 学龄前的老师和员工，以及4）父母作为合作伙伴参与这项努力。该研究是 大型非营利组织之间的UCLA与儿童保育资源中心（CCRC）之间的合作 致力于确保所有儿童获得高质量，全面的学龄前/儿童保育经历， 特别是在低资源中，不同的社区。我们将随机分配CCRC服务的60个学龄前儿童 洛杉矶县服务不足的地区，干预或通常的练习，等待名单控制条件。 我们的目的是：1）针对学龄前环境实施多层次的肥胖预防干预措施 建立在现有的基于证据的方法，利益相关者的意见和我们的试点研究的基础上； 2）评估 干预对儿童BMI Z分数（主要结果）和父母报告的儿童营养的有效性 和体育锻炼（次要结果）； 3）系统评估干预措施，采用， 在Re-Aim框架的指导下，我们为此定制的实施，适应和维护 我们的特定研究重点和设置。通过同时评估有效性和实施 我们的干预措施，我们将有效地产生新的知识，对于通知广泛传播至关重要。给出 儿童肥胖的长期社会成本惊人的社会成本，严格的研究以识别有效且可扩展 现在需要预防肥胖干预措施。