Food Allergies (FA) are a growing health crisis affecting approximately 2.0 million young children (i.e., < 8 years of age) in the United States. Strict avoidance (e.g., elimination of allergenic foods from one?s diet) is the only intervention capable of preventing potentially devasting health-related sequelae including anaphylaxis and death. Adhering to recommendations for strict avoidance (i.e., not ingesting, touching, or playing with potentially allergenic food) is challenging for young children. Youths from disadvantaged backgrounds (i.e., low socioeconomic status) are particularly impacted by FAs (i.e., greater financial burden, increased risk of complications); thus, it is critical that adherence-promoting interventions take into account SES-related disparities. Behavioral Skills Training (BST) is a brief (i.e., <5 sessions, 15-20 min/session), portable, skills- based, and engaging intervention designed to educate, reinforce through modeling, provide praise/corrective feedback, and practice (i.e., rehearsal) the skills necessary for children to remain adherent to safety-related behaviors. Prior research has shown BST superior to education alone. The primary aim of this R21 proposal is to test the efficacy of a 5-session intervention designed to increase adherence to FA safety guidelines among low-income, young children (6-8 years of age) with FAs. This intervention, the Food Allergy Superheroes Training (FAST) Program, will be developed and refined across Phases 1a and 1b to target skills beneficial to promote adherence to FA guidelines (i.e., food avoidance). During Phase 1a, we will recruit a parent-child advisory board to aide in integrating principles of BST within the FAST Program manual. We will then examine the initial acceptability and feasibility of the FAST Program in an open trial with 10 low-income, young children with FAs to further refine the intervention?s content. During Phase 1b, we will randomize 50 young children with a FA who are from a low-income background to receive either the FAST Program or FA knowledge. We will employ developmentally relevant FA assessments (i.e., child-report, role-play, in situ) before, after, and one- month post-intervention as our primary outcomes.
Aim 1 : Determine feasibility and acceptability of the FAST intervention. We will evaluate the feasibility and acceptability of this intervention with 60 participants (n=10 in pilot trial [Phase 1a] and n=50 in a preliminary randomized trial [Phase 1b]).
Aim 2 : Estimate the effect size of the FAST intervention relative to FA knowledge alone. Adherence will be measured via a multi-modal, FA assessment including child-report, role-play, and in situ assessment. This form of naturalistic, FA assessment will be designed to measure the child?s behavior (i.e., ingest food, touch or play with food, etc.) in a safe yet realistic manner. This study will contribute to the field?s knowledge of efficacious interventions for promoting adherence among young children with FAs.
Among children with a food allergy, strict avoidance (e,g, elimination of allergenic foods from one?s diet) is the only intervention capable of preventing potentially devasting health-related sequelae including anaphylaxis and death. Youths from low-income backgrounds are particularly impacted by food allergies and may be the population most apt to benefit from a brief, portable, and engaging skills-based intervention designed to teach young children the skills needed to remain adherent to food allergy safety guidelines. Data collected as part of the proposed project will lay the groundwork for a line of federally-funded intervention research broadly examining how to promote adherence to food allergy safety guidelines among young children from low-income backgrounds through implementation of a robust, efficient, and portable intervention.
