Research Project #1

研究项目

• 批准号: 10661204
• 负责人: Shreela V Sharma
• 金额: $ 32.73万
• 依托单位: UNIVERSITY OF TX MD ANDERSON CAN CTR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-15 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10661204
• 关键词: Adult; African American; Area; Behavior; Behavior Therapy; Bite; Blood Pressure; Body mass index; COVID-19 pandemic; Carotenoids; Characteristics; Child; Cluster randomized trial; Communities; Diet; Dietary Intervention; Dietary intake; Dose; Education; Effectiveness; Enrollment; Environment; Family; Financial Hardship; Fingers; Food; Food Access; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Goals; Height; Hispanic Americans; Home; Home environment; Household; Improve Access; Intake; Intervention; Low income; Measures; Mediating; Metabolic; Natural experiment; Neighborhoods; Nutritive Value; Obesity; Obesity associated cancer; Outcome; Parents; Participant; Poverty; Poverty Areas; Program Effectiveness; Public Health; Questionnaires; Randomized; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recipe; Reporting; Research; Research Project Grants; Schools; Skin; Source; Taste Perception; Testing; Texas; Translations; Vegetables; Waiting Lists; Weight; cancer prevention; comparison control; comparison intervention; dietary; dissemination science; elementary school; evidence base; follow-up; food desert; food environment; food insecurity; food security; fruits and vegetables; health literacy; hispanic community; implementation science; implementation strategy; improved; innovation; mobile application; nutrition; nutrition education; obesity prevention; perceived discrimination; post intervention; programs; response; school health; secondary outcome; social; social health determinants; social vulnerability; volunteer

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.

德克萨斯州休斯敦的英亩房屋地区是一个主要是非裔美国人和西班牙裔社区，是一个持续存在的贫困地区，居住在食品沙漠地区的居民中有69％，据报道超过40％的成年居民肥胖。我们的是一项集群的试验，旨在评估更明亮的叮咬的影响（BB），这是一种基于学校的干预措施，可改善获得新鲜农产品和营养教育的机会，对在12个小学的儿童中肥胖和代谢成果，为英亩住宅社区及其父母提供服务。事实证明，在短期和长期的低收入小学儿童中，BB可以有效地与父母联系，改善健康的饮食行为，减少粮食不安全。但是，该计划对儿童或父母的肥胖和代谢措施的影响尚不清楚。使用交织方法，BB将集成到Acres Homes，这是一项基于地方的癌症预防计划。小学将被随机分配到BB干预或候补控制条件（12所学校，720个亲子二元）。在BB学校，家庭将获得16磅20-25磅的分配。 （〜50份新鲜农产品）可以带回家，食谱品尝，动手，在学校中进行健壮的营养教育，并在一个学年中使用BB移动应用程序，可以选择继续参加BB计划，以持续两个随后的学年。儿童和父母将在基线，干预后（〜9个月）和21个月的随访，以进行以下结果：身高，体重，糖基化血红蛋白（HBA1C）通过手指棒，血压（BP），饮食摄入，通过筛选器，筛选器，儿童皮肤素水平，饮食中的饮食习惯，饮食中的饮食量和互联网依据，饮食中的饮食习惯和食物依次依赖FV。 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行为，FV的家庭访问/可用性）。目标3：检查粮食安全状况的变化，父母结果和家庭环境对儿童结局变化的调解在干预后9个月的变化的措施。 AIM 4：使用受试者内分析，检查和比较BB干预策略对儿童的21-MOS随访中BB干预策略对饮食，肥胖和代谢结果的长期和剂量反应影响。 AIM 5：探索社会困扰，歧视，健康素养和社会联系的经验以及环境变量（靠近食品获取来源，食品环境和社区社会脆弱性）对计划有效性的调节作用。该项目将为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来提高传播和实施科学，以增加计划的影响力并影响持续的贫困地区，例如英亩房屋。