Brophy-Herb Holly E, Horodynski Mildred, Contreras Dawn, Kerver Jean, Kaciroti Niko, Stein Mara, Lee Hannah Jong, Motz Brittany, Hebert Sheilah, Prine Erika, Gardiner Candace, Van Egeren Laurie A, Lumeng Julie C
Department of Human Development and Family Studies, Michigan State University, 552 West Circle Drive, 48824, East Lansing, MI, USA.
College of Nursing, Michigan State University, 1355 Bogue Street, 48824, East Lansing, MI, USA.
BMC Public Health. 2017 Feb 10;17(1):184. doi: 10.1186/s12889-017-4074-5.
Despite slight decreases in obesity prevalence in children, nearly 25% of preschool-aged children are overweight or obese. Most interventions focused on promoting family meals as an obesity-prevention strategy target meal planning skills, knowledge and modeling of healthy eating without addressing the practical resources that enable implementation of family meals. There is a striking lack of evidence about what level of resources low-income parents need to implement family meals. This study will identify resources most effective in promoting family meals and, subsequently, test associations among the frequency of family meals, dietary quality and children's adiposity indices among children enrolled in Head Start.
The Multiphase Optimization Strategy, employed in this study, is a cutting-edge approach to maximizing resources in behavioral interventions by identifying the most effective intervention components. We are currently testing the main, additive and interactive effects of 6 intervention components, thought to support family meals, on family meal frequency and dietary quality (Primary Outcomes) as compared to Usual Head Start Exposure in a Screening Phase (N = 512 low-income families). Components yielding the most robust effects will be bundled and evaluated in a two-group randomized controlled trial (intervention and Usual Head Start Exposure) in the Confirming Phase (N = 250), testing the effects of the bundled intervention on children's adiposity indices (Primary Outcomes; body mass index and skinfolds). The current intervention components include: (1) home delivery of pre-made healthy family meals; (2) home delivery of healthy meal ingredients; (3) community kitchens in which parents make healthy meals to cook at home; (4) healthy eating classes; (5) cooking demonstrations; and (6) cookware/flatware delivery. Secondary outcomes include cooking self-efficacy and family mealtime barriers. Moderators of the intervention include family functioning and food security. Process evaluation data includes fidelity, attendance/use of supports, and satisfaction.
Results will advance fundamental science and translational research by generating new knowledge of effective intervention components more rapidly and efficiently than the standard randomized controlled trial approach evaluating a bundled intervention alone. Study results will have implications for funding decisions within public programs to implement and disseminate effective interventions to prevent obesity in children.
Clincaltrials.gov Identifier NCT02487251 ; Registered June 26, 2015.
尽管儿童肥胖率略有下降，但近25%的学龄前儿童超重或肥胖。大多数将促进家庭聚餐作为预防肥胖策略的干预措施，其目标是膳食计划技能、健康饮食知识以及树立健康饮食榜样，却未涉及能够实施家庭聚餐的实际资源。关于低收入父母实施家庭聚餐需要何种程度的资源，目前证据极为匮乏。本研究将确定促进家庭聚餐最有效的资源，并随后测试参与“启智计划”的儿童家庭聚餐频率、饮食质量与儿童肥胖指数之间的关联。
本研究采用的多阶段优化策略，是一种通过确定最有效的干预成分来最大化行为干预资源的前沿方法。在筛查阶段（N = 512个低收入家庭），我们正在测试6种被认为有助于家庭聚餐的干预成分对家庭聚餐频率和饮食质量（主要结果）的主要、累加和交互作用，同时与常规“启智计划”暴露情况进行比较。在确认阶段（N = 250），将对产生最显著效果的成分进行整合，并在两组随机对照试验（干预组和常规“启智计划”暴露组）中进行评估，测试整合后的干预措施对儿童肥胖指数（主要结果；体重指数和皮褶厚度）的影响。当前的干预成分包括：（1）配送预制的健康家庭餐食；（2）配送健康餐食食材；（3）社区厨房，家长可在此制作健康餐食以便在家中烹饪；（4）健康饮食课程；（5）烹饪示范；（6）配送炊具/餐具。次要结果包括烹饪自我效能感和家庭用餐障碍。干预的调节因素包括家庭功能和食品安全。过程评估数据包括依从性、对支持措施的参与/使用情况以及满意度。
与仅评估整合干预措施的标准随机对照试验方法相比，本研究结果将通过更快、更有效地产生有效干预成分的新知识，推动基础科学和转化研究。研究结果将对公共项目内的资金决策产生影响，以实施和推广预防儿童肥胖的有效干预措施。
ClinicalTrials.gov标识符NCT02487251；于2015年6月26日注册。
