Healthy Caregivers-Healthy Children (HC2) Phase II
Condition: Pediatric Obesity; Obesity
MeSH terms: Obesity; Pediatric Obesity
Study type: Interventional

Summary: 
      One in four U.S. children under the age of 5 years old are either overweight or obese with
      ethnic-minority children being disproportionately affected. Low-income preschool children,
      many from ethnic minority backgrounds, receive childcare in federal/state subsidized centers
      where daily meals are provided. Nationally, the Quality Rating and Improvement Systems (QRIS)
      organization is responsible for rating the quality of childcare centers. However, nutrition
      and physical activity policy standards have not been incorporated into QRIS childcare center
      policies. Therefore, the goal of this project is to address the 2014 AFRI program area
      priority of Childhood Obesity Prevention by building on the phase I "Healthy Caregivers,
      Healthy Children (HC2)" NRI/AFRI funded project (2010-2013), in partnership with the Miami
      Dade County Cooperative Extension team, to evaluate the program via randomized-controlled
      trial outcomes, and deliver an evidence-based effective childcare center-based
      program/toolkit. This project (phase II) will expand HC2 Phase I findings by transferring the
      evidence-based HC2 program/toolkit to QRIS childcare centers via a train-the-trainers (TTT)
      model. The following specific aims are proposed; (1) to evaluate the TTT model of delivery
      for the evidence-based HC2 toolkit's effectiveness versus an attention control on parent and
      teacher adoption of healthy lifestyle role modeling behaviors, and policy integration; (2) to
      evaluate the impact of a TTT delivery model versus an attention control on child body
      composition and short- and long-term behavioral health outcomes, and (3) to disseminate the
      HC2 early childhood obesity prevention toolkit TTT model within the QRIS early childhood
      network at the Miami Dade County-level.
    

Detailed description: 
      While all states are responsible for childcare licensing standards, 26 states serving over 1
      million preschool-age children currently implement QRIS. In MDC, QRIS-affiliated childcare
      facilities (collectively called Quality Counts or QC centers from this point forward) provide
      care to 1/3 of MDC's preschool-age children (80% are ethnic minorities) in 417 centers. At
      this time there are no nutrition policies included in the QRIS standards for childcare
      centers. Therefore, in light of the current childhood obesity epidemic, this project will
      address a major gap in knowledge and the disparities in access to healthy food consumption in
      the childcare center setting through HC2 implementation.

      This study builds on previously funded work and will maximize the initial 3-year (2010-2013)
      investment the USDA made in phase I of the project to test effective obesity prevention
      strategies in the early childhood setting utilizing both educators and parents as nutritional
      gatekeeper, healthy lifestyle role models for 2-to-5 year-old children. The goal of this
      proposed project (phase II) is to expand the phase I evidence-based HC2 findings by giving
      ownership of the program/toolkit to the childcare centers via a train-the-trainers model and
      by implementing nutrition and physical activity standards into the Quality Rating Improvement
      System.

      The proposed integrated project is responsive to the USDA's National Institute of Food and
      Agriculture (formerly CSREES) functions by addressing all three areas of the agricultural
      knowledge system, including (1) a scientifically-based and rigorous Research design that
      assesses obesity prevention efforts with young children in a novel setting of childcare
      facilities; (2) the development of an Educational tool kit to improve training and capacity
      of teachers and parents/families. Extension and capacity building will be enhanced through
      HC2 toolkits delivered to the centers and train-the-trainer program manuals for use
      throughout the QRIS network and in cooperation with Florida FNP. Finally, by incorporating
      HC2 practices into permanent QRIS policy, centers can sustain the project's benefits for
      future children, teachers, and families. Additionally, the investigators will collaborate
      with two community nutritionists to provide services to a large number of childcare centers
      in the county therefore, extending project materials. Lastly, the toolkit will sustain
      education and extension functions beyond the life of the project by giving ownership of HC2
      to the childcare centers.
    

Intervention name(s): Healthy Caregivers- Healthy Children Toolkit; Safety Curriculum
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The treatment arm will receive the train-the-trainer model (utilizing Quality Counts coaches) to deliver the evidence- based HC2 toolkit.; Centers randomized to the control arm will receive an attention control consisting of three visits from 'Safety Sam,' a character and safety curriculum that was fully developed and implemented in phase I of HC2. The same delivery model (train-the-trainers utilizing Quality Counts coaches) will be implemented.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: childhood obesity; obesity; prevention; nutrition; health; preschool; childcare; role model; pediatric obesity; weight; overweight; early childhood; train the trainer