Fit 5 Kids Screen Time Reduction Curriculum for Latino Preschoolers

Screen time is a major risk factor for childhood obesity and inadequate physical activity,
both of which are determinants of type 2 diabetes (T2D), cardiovascular disease, and multiple
cancers. Latinos are the largest and fastest growing minority in the US. Because US Latino
children have more screen time and higher rates of obesity than their non-Latino White peers,
interventions to reduce screen time adapted for Latino preschoolers are necessary to reduce
health inequities related to obesity and T2D in the US. However, a systematic review reported
no successful screen time reduction interventions among Latino preschoolers.

The investigative team's pilot study tested the culturally adapted Fit 5 Kids screen time
reduction curriculum among Latino preschoolers in Head Start. This short term cluster
randomized controlled trial (RCT) is the only successful screen time reduction program for
Latino preschoolers, having significantly reduced screen time by over 25 minutes/day. The
investigative team's culturally adapted, multi-level intervention consists of lessons taught
by study staff directly to preschoolers during Head Start, a weekly parent newsletter, and
parenting tips via text messages several times/week. The investigative team will use a social
ecological model and consider multiple levels of influences for analyses: (1)
individual-level influences, e.g., acculturation and social cognitive theory, (2) families,
e.g., screen time parenting practices, (3) schools, and (4) macro-environmental influences,
e.g., neighborhood disorder. Building on this pilot work, the investigative team proposes a
long term, efficacy, cluster RCT of the culturally adapted Fit 5 Kids among Latino
preschoolers in Head Start from three US settings: Seattle, Houston, and the Central Valley
of Washington State. Among 280 Latino 3-5 year olds at 20 Head Start centers, the
investigative team's Specific Aims (SA) and Hypotheses (H) include:

SA1) To conduct a cluster RCT of the culturally adapted Fit 5 Kids curriculum to evaluate its
efficacy in reducing screen time and excessive weight gain over a school year (8-months) H1)
Fit 5 Kids will decrease children's screen time, BMI z-scores and dietary energy intake, and
increase fruit/vegetable intake, skin carotenoids, and moderate/vigorous physical activity
(MVPA) compared to controls

SA2) To examine mediators and moderators associated with reducing Latino preschoolers' screen
time H2) Parents' outcome expectations, self-efficacy, and TV parenting practices will
mediate the relationship between Fit 5 Kids and changes to preschoolers' screen time H3)
Depressive symptoms, stress, and social support will moderate changes to preschoolers' screen
time

The proposed Fit 5 Kids RCT will confirm the pilot's promising results, and the larger sample
will allow for mediation analyses to better understand mechanisms. This research will provide
justification for a future community effectiveness trial with implementation by Head Start
teachers, and the eventual widespread implementation of Fit 5 Kids in Head Start centers
nationally.

Inclusion Criteria:

- Latino children, 3-5 years old, enrolled from 1 of the 20 Head Start Centers.

- Preschoolers do not require a minimum amount of screen time or devices in their
household to enroll in the study, because it is preventive and population-based.

- Parents must be able to complete forms in English or Spanish.

Exclusion Criteria:

- Any preschooler that is underweight or under medical supervision to gain weight.

- Only one preschooler per family may be enrolled, to avoid clustering of variables by
family.

- Preschoolers may only enroll once in the study.

- Children <3 years and >5 years of age.

- Children whose parents do not identify them as Latino or Hispanic.