Early childhood is a vulnerable time in the lifespan and a key opportunity for primary prevention. Significant health disparities exist, beginning in early childhood, in the Latino community, who are underrepresented in research. Most children attend early care and education centers (ECECs), making this an important setting for intervention for promoting healthy habits. Few studies have systematically investigated using community based participatory research (CBPR) strategies to develop practical, yet theoretically grounded, intervention strategies that comply with national health behavior guidelines and ECEC accreditation standards. Science & Community: Ending Obesity Improving Health (S&C; PI: Lee, U13HD063190) created an academic- community partnership that identified early childhood, healthy eating, physical activity opportunities as target health issues and community gardens as an intervention tool, resulting in the development of the pilot CBPR project, Sustainability via Active Garden Education (SAGE; PI: Lee, R21HD073685-01). The current project will expand and adapt SAGE for delivery over a four month period using a cluster randomized controlled trial adapted crossover design, along with testing a sustainability action plan (SAP) at the organizational level. In this study, we will determine the efficacy of the SAGE intervention on health in 3-4 year old children. This study will pair match and randomize 20 ECECs from neighborhoods with high proportions of Hispanic or Latino residents. ECEC receive either the SAGE intervention or the safety attention comparison. Then, ECEC will cross over and receive the treatment that they did not receive to ensure that all ECEC receive both curricula. We will determine improvement in accelerometry measured PA and sedentary behaviors, fruit and vegetable consumption and explore eating in the absence of hunger compared to those in a child safety attention comparison. We will explore secondary impacts on parenting practices that promote PA and fruit and vegetable consumption, home fruit and vegetable availability and improved household food security. This study will explore the process of delivery of the SAGE intervention on dimensions of reach, adoption, and implementation. This study will also develop, implement, and evaluate a SAP in the SAGE arm to determine replicability and institutionalization (sustainability) of the SAGE intervention and explore the relationship between of sustainability to child outcomes at follow up. The development and success of the community Partnership and SAGE Community Advisory Board will also be evaluated using indicators of participation, representativeness, and collaboration. This study will rely on CBPR strategies and an established theoretical model to implement an engaging and translational multilevel intervention linking policy and practice. This work will test strategies fr implementing IOM guidelines at the ECE level and will guide future efforts aimed at scaling up efficacious interventions for broad dissemination in vulnerable populations to reduce health disparities.

Public Health Relevance

Lack of physical activity (PA) and poor health habits have contributed to increased rates of overweight and obesity among preschool children, disproportionately affecting Hispanic or Latino children. The trajectory toward obesity is likely established as early as the age of five, making early childhood a vulnerable time in the lifespan and key opportunity for primary prevention. This study will incorporate community based participatory research strategies into a multidisciplinary, ecologic approach to evaluate the reach, delivery, adoption, and sustainability of an engaging, transcultural physical activity and nutrition garden-based curriculum to improve PA, sedentary behaviors, fruit and vegetable consumption, and eating in the absence of hunger in preschool aged children. This study will investigate factors needed to initiate and maintain PA and healthy dietary habits in the preschool setting while determining the potential for sustainability for broad scale implementation and informing policy enactment and enforcement.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZMD1)
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Dagher, Rada Kamil
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Arizona State University-Tempe Campus
Schools of Nursing
United States
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