Health Equity at the Intersection of Disability and Ethnic Group Status: Adaption of "Healthy Caregivers-Healthy
Children" for Children with Special Healthcare Needs (HC3)

Background: Obesity is 38% higher in CSHCN compared to their peers without special health care needs and the rate is twice as high among non-Hispanic black and Hispanic preschoolers compared to non-Hispanic whites. There is limited research on the causes consequences prevention and treatment of obesity among CSHCN and virtually no research has addressed the intersection of ethnic group disparities and CSHCN disparities in obesity prevention in the early childhood years (2-5 years old). Literature suggests that childhood-onset obesity significantly contributes to increased morbidity and mortality in adulthood particularly among ethnic minority groups. Our previous research has shown that providing an obesity prevention intervention in the child care setting is an effective strategy in promoting health and wellness and improving health equity with a preschool population. The goal of this project is to adapt test and evaluate our theoretically-based multifaceted obesity prevention intervention (called 'HC3' for this project) to CSHCN in community child care settings. In doing so this project will also inform the research and policy communities about the role of ethnicity disability and adult role modeling in obesity. This work focuses on strategies to eliminate health disparities (MCHB Strategic Research Issue #II) and to promote the healthy development of maternal and child health (MCH) populations (#IV). Method: Via a cluster randomized trial we will randomize ten preschools serving CSHCN between the ages of 2-5 to an HC3 intervention arm (n=5) or an attention-matched control arm (n=5). The intervention arm will receive a multi-tiered intervention (center teacher parent tiers) that incorporates environmental modifications and parent and teacher role modeling for healthy eating and physical activity. We will use the RE-AIM ('Reach Effectiveness Adoption Implementation and Maintenance) framework to evaluate the proposed project's outcomes. Outcomes: The primary outcome will be child BMI and secondary outcomes include quality dietary intake and amount of physical activity of the child. All outcome measurements will be collected at the baseline (beginning of school year Time 1) post intervention (end of each school year 1 Time2) 6 months (Time 3) 12 months (Time 4) and 18 months post-intervention (Time 5). Hierarchical linear (i.e. multilevel) growth modeling techniques will be used to measure outcomes. The cluster- randomized design of this study yields a 3-level model where repeated measures (level-1) are nested within children teachers and parents (individual) (level-2) and children teachers and parents are nested within preschools/childcare centers (level-3). This basic modeling framework will be used for all of the repeated measures outcomes (e.g. child BMI and parent and teacher measures). We will explore possible moderator variables such as ethnicity severity of disability and teacher role modeling that can impact outcomes

Natale RA, Cardenas EPV, Varanloo P, Ma R, Agosto Y, Palenzuela J, Hernandez J, Schladant M, Bloyer M, Messiah SE. Social Challenges as a Consequence of the COVID-19 Pandemic among South Florida Preschool Children with Disability and Obesity.�Children. 2023; 10(4):619. https://doi.org/10.3390/children10040619 DOI:https://doi.org/10.3390/children10040619 February 2023 Children