The Food Allergy Superheroes Training (FAST) Program: Increasing Adherence to Food Allergy Safety Guidelines

Food Allergies (FA) are a growing health crisis affecting approximately 2.0 million young children (i.e., < 8years of age) in the United States. Strict avoidance (e.g., elimination of allergenic foods from one?s diet) is theonly intervention capable of preventing potentially devasting health-related sequelae including anaphylaxis anddeath. Adhering to recommendations for strict avoidance (i.e., not ingesting, touching, or playing withpotentially allergenic food) is challenging for young children. Youths from disadvantaged backgrounds (i.e., lowsocioeconomic status) are particularly impacted by FAs (i.e., greater financial burden, increased risk ofcomplications); thus, it is critical that adherence-promoting interventions take into account SES-relateddisparities. 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/correctivefeedback, and practice (i.e., rehearsal) the skills necessary for children to remain adherent to safety-relatedbehaviors. Prior research has shown BST superior to education alone. The primary aim of this R21 proposal isto test the efficacy of a 5-session intervention designed to increase adherence to FA safety guidelines amonglow-income, young children (6-8 years of age) with FAs. This intervention, the Food Allergy SuperheroesTraining (FAST) Program, will be developed and refined across Phases 1a and 1b to target skills beneficial topromote adherence to FA guidelines (i.e., food avoidance). During Phase 1a, we will recruit a parent-childadvisory board to aide in integrating principles of BST within the FAST Program manual. We will then examinethe initial acceptability and feasibility of the FAST Program in an open trial with 10 low-income, young childrenwith FAs to further refine the intervention?s content. During Phase 1b, we will randomize 50 young children witha FA who are from a low-income background to receive either the FAST Program or FA knowledge. We willemploy 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 FASTintervention. We will evaluate the feasibility and acceptability of this intervention with 60 participants (n=10 inpilot trial [Phase 1a] and n=50 in a preliminary randomized trial [Phase 1b]). Aim 2: Estimate the effect size ofthe FAST intervention relative to FA knowledge alone. Adherence will be measured via a multi-modal, FAassessment including child-report, role-play, and in situ assessment. This form of naturalistic, FA assessmentwill be designed to measure the child?s behavior (i.e., ingest food, touch or play with food, etc.) in a safe yetrealistic manner. This study will contribute to the field?s knowledge of efficacious interventions for promotingadherence among young children with FAs.