1
|
Lang IM, Fischer AL, Antonakos CL, Miller SS, Hasson RE, Pate RR, Collie-Akers VL, Colabianchi N. Neighborhood environments underpin screen time intervention success in children: Evidence from a study of greenspace and community programming across 130 US communities. Health Place 2024; 89:103341. [PMID: 39217807 DOI: 10.1016/j.healthplace.2024.103341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/15/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
The goal of this study was to understand how neighborhood greenspace access may support or hinder the effectiveness of community programs and policies (CPPs) aimed at reducing racial and ethnic inequities in screen time among 4598 US children. We found higher CPP intensity was significantly associated with fewer screen time behaviors in high greenspace neighborhoods, but not neighborhoods with low or moderate greenspace. Moreover, there were significant differences in greenspace access by neighborhood-level race and ethnicity. Implementing CPPs without regard for racial and ethnic greenspace inequities may be an underlying cause in the perpetuation of inequities in childhood screen time.
Collapse
Affiliation(s)
- Ian-Marshall Lang
- School of Kinesiology, University of Michigan, 803 N University Ave, Ann Arbor, MI, 48109, USA.
| | - Anna L Fischer
- School of Kinesiology, University of Michigan, 803 N University Ave, Ann Arbor, MI, 48109, USA.
| | - Cathy L Antonakos
- School of Kinesiology, University of Michigan, 803 N University Ave, Ann Arbor, MI, 48109, USA.
| | - Stephanie S Miller
- School of Kinesiology, University of Michigan, 803 N University Ave, Ann Arbor, MI, 48109, USA.
| | - Rebecca E Hasson
- School of Kinesiology, University of Michigan, 803 N University Ave, Ann Arbor, MI, 48109, USA; Department of Nutritional Sciences, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Russell R Pate
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly St., Columbia, SC, 29208, USA.
| | - Vicki L Collie-Akers
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 1008, Kansas City, KS, 66160, USA.
| | - Natalie Colabianchi
- School of Kinesiology, University of Michigan, 803 N University Ave, Ann Arbor, MI, 48109, USA; Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, USA.
| |
Collapse
|
2
|
Gance-Cleveland B, Frenn M, Browne N, Greenberg CS, Snethen JA, Hodges EA, Fial AV, Small L, Irving SY. A scoping review of the role of policy in mitigating childhood obesity in underserved populations using the RE-AIM framework. Worldviews Evid Based Nurs 2024; 21:445-453. [PMID: 38584314 DOI: 10.1111/wvn.12725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Childhood obesity is an escalating crisis in the United States. Health policy may impact this epidemic which disproportionally affects underserved populations. AIM The aim was to use the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to assess health policy impact on preventing or treating school-aged children (5 > 18 years) with obesity in underserved populations. METHODS A scoping review of 842 articles was conducted. Twenty-four articles met the inclusion criteria and underwent data extraction. RESULTS Twelve studies included subgroup analysis, with four suggesting an impact of policy on at-risk groups. None of the 24 studies fully applied the RE-AIM framework. Policies positively impacted childhood obesity in 12 studies across the sample. LINKING EVIDENCE TO ACTION Our review revealed inconsistent evidence for the effectiveness of policy on childhood obesity, perhaps due to the lack of focus on the social determinants of health. In addition, many studies did not evaluate the outcomes for underserved populations. Therefore, we propose more attention to social determinants in future legislation and evaluation of policy effectiveness on underserved populations. Findings identify an urgent need for the design, implementation, and evaluation of policies specifically directed to address the inequities of racism, social injustices, and social determinants of health that impact childhood obesity in the United States. Future work needs to identify who was reached by the policy, who benefitted from the policy, and how policies were implemented to address obesity-related health disparities. Nurses should advocate for the evaluation of childhood obesity policies, particularly in underserved populations, to determine effectiveness. Nurses, particularly those trained in population and community health and research, should advocate for policy research that considers inequities rather than controls for these variables. Multi-layered interventions can then be tailored to sub-populations and evaluated more effectively.
Collapse
Affiliation(s)
- Bonnie Gance-Cleveland
- University of Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marilyn Frenn
- Marquette University College of Nursing, Milwaukee, Wisconsin, USA
| | | | | | - Julia A Snethen
- University of Wisconsin-Milwaukee, School of Nursing, Milwaukee, Wisconsin, USA
| | - Eric A Hodges
- The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina, USA
| | - Alissa V Fial
- Marquette University, Raynor Memorial Libraries, Milwaukee, Wisconsin, USA
| | - Leigh Small
- Michigan State University College of Nursing, East Lansing, Michigan, USA
| | - Sharon Y Irving
- University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania, USA
| |
Collapse
|
3
|
Zhang L, Dai S, Chen Y, Jin T, Li W, Wang W, Pu J, Jia P, Zhao L, Sun X. Scoping review of obesity interventions: Research frontiers and publication status. iScience 2024; 27:109240. [PMID: 38495822 PMCID: PMC10940913 DOI: 10.1016/j.isci.2024.109240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Obesity and overweight are significant global health issues, and numerous obesity intervention studies have been conducted. Summarizing current knowledge of interventions aims to inform researchers and policymakers to keep up-to-date with the latest scientific advancements and trends. In this review, we comprehensively retrieved and screened 4,541 studies on obesity intervention published between 2018 and 2022 in the Web of Science Core Collection, and objectively presented research frontiers using bibliometric analysis. The research frontiers of intervention are mainly focused on dietary, exercise, pharmacological interventions, bariatric surgery, environmental, and cognitive interventions. Time-restricted eating is the hottest research topic, followed by probiotics and Roux-en-Y gastric bypass. Gut microbiota is located in the "Basic and transversal themes" quadrant with a high centrality and low density, which has great development potentiality. Obesity intervention is becoming increasingly common,and we advocate for researchers to undertake more focused research endeavors that consider the specific characteristics of diverse populations or patients.
Collapse
Affiliation(s)
- Longhao Zhang
- Department of Endocrinology & Metabolism, West China Hospital, Sichuan University, Chengdu, China
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Medical Discipline Construction, West China Hospital, Sichuan University, Chengdu, China
| | - Shuang Dai
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yufei Chen
- Core Facilities, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tingting Jin
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Wei Li
- Department of Medical Discipline Construction, West China Hospital, Sichuan University, Chengdu, China
| | - Wen Wang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Pu
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Li Zhao
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xin Sun
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
4
|
Heerman WJ, Kenney E, Block JP, Fiechtner L, McMahon E, Kruse L, Sharifi M, Edmondson EK, Virudachalam S. A Narrative Review of Public Health Interventions for Childhood Obesity. Curr Obes Rep 2024; 13:87-97. [PMID: 38172483 DOI: 10.1007/s13679-023-00550-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Public health interventions that intervene on macrolevel systems hold the promise of reducing childhood obesity at the population level through prevention. The purpose of this review is to highlight some of the recent and best scientific evidence related to public health interventions for the prevention of childhood obesity. We provide a narrative review of scientific evidence for six categories of public health interventions and their impact on childhood obesity: federal nutrition assistance programs, programs implemented in early care and education centers, interventions to support healthy nutrition and physical activity in schools, community-based programs and policies, labeling policies and marketing to children, and taxes on sugar sweetened beverages (SSB). RECENT FINDINGS Federal nutrition assistance programs have the strongest evidence to support reduction in childhood obesity and serve populations with the highest prevalence of childhood obesity. Other interventions including SSB taxes, community-wide interventions, and interventions at schools and early care and education centers also show significant improvements in child weight status. Overall public health interventions have strong evidence to support widespread implementation in service of reducing childhood obesity rates at the population level. To effectively address the recalcitrant childhood obesity epidemic, multi-pronged solutions are needed. The current evidence for public health obesity interventions is consistent with the paradigm that recognizes the importance of macrolevel systems influences on childhood obesity: interventions that are most effective intervene at macrolevels.
Collapse
Affiliation(s)
- William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA.
| | - Erica Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, USA
| | - Lauren Fiechtner
- Division of Pediatric Gastroenterology and Nutrition, Mass General for Children, The Greater Boston Food Bank, Boston, USA
| | - Ellen McMahon
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
| | - Lauren Kruse
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
| | - Mona Sharifi
- Department of Pediatrics, Yale School of Medicine, New Haven, USA
| | - Emma K Edmondson
- Department of Pediatrics and Leonard Davis Institute of Health Economics at University of Pennsylvania Perelman School of Medicine, Division of General Pediatrics, PolicyLab, and Clinical Futures at Children's Hospital of Philadelphia, Philadelphia, USA
| | - Senbagam Virudachalam
- Department of Pediatrics and Leonard Davis Institute of Health Economics at University of Pennsylvania Perelman School of Medicine, Division of General Pediatrics, PolicyLab, and Clinical Futures at Children's Hospital of Philadelphia, Philadelphia, USA
| |
Collapse
|
5
|
Kim H, Rajbhandari A, Krile R, Lang IM, Antonakos CL, Colabianchi N. Body Mass Index Trajectories among the Healthy Communities Study Children: Racial/Ethnic and Socioeconomic Disparities in Childhood Obesity. J Racial Ethn Health Disparities 2024; 11:203-215. [PMID: 36656440 PMCID: PMC9851105 DOI: 10.1007/s40615-023-01511-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/20/2022] [Accepted: 12/31/2022] [Indexed: 01/20/2023]
Abstract
The purpose of this study is to identify statistically distinguishable trajectories of childhood body mass index (BMI), an important indicator of developmental status of children, and to provide a summary description of demographic characteristics of children based on these distinctive trajectories. Using data from the Healthy Communities Study (HCS), a large longitudinal dataset with oversamples of Hispanic and Black children across 130 communities in the USA, a group-based trajectory analysis approach was used to estimate trajectories of children based on their BMI-z scores. The three most distinguishable BMI trajectory groups identified for the HCS children show no marked increase or decrease in standardized BMI over an age range of 2 to 11. Approximately 28.5% of children were in a trajectory group with consistently obese BMI-z scores for their sex and age. The patterns of BMI trajectory groups identified for boys and girls are similar, but BMI-z scores for boys tend to be slightly higher than those for girls. These BMI trajectories are characterized by racial/ethnic and socioeconomic status disparities. Hispanic and Black children were more likely to be in the obese trajectory group than White children. Children with parents having less education, or children from low family income level, were more likely to be in the obese trajectory group than counterpart children. The findings suggest that BMI disparities exist from the early years of childhood and persist across childhood, with higher BMI associated with Black and Hispanic children as well as those from low socioeconomic status backgrounds.
Collapse
Affiliation(s)
- Hyoshin Kim
- Battelle Memorial Institute, Health Analytics, 1100 Dexter Avenue North, Suite 275, Seattle, WA, 98109, USA.
| | | | - Robert Krile
- Battelle Memorial Institute, Health Analytics, Columbus, OH, USA
| | | | | | - Natalie Colabianchi
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
6
|
Ohri-Vachaspati P, Acciai F, Melnick EM, Lloyd K, Martinelli S, DeWeese RS, DiSantis KI, Tulloch D, DeLia D, Yedidia MJ. Food Environments Within and Outside of Schools Play a Critical Role in Curtailing the Rise in Obesity among School-Aged Children over Time. J Nutr 2023; 153:3565-3575. [PMID: 37844841 PMCID: PMC10739773 DOI: 10.1016/j.tjnut.2023.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/28/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Sound evidence for effective community-based strategies is needed to curtail upward trends in childhood obesity in the United States (US). OBJECTIVES The aim of the study was to assess the association between school and community food environments and the prevalence of obesity over time. METHODS Data were collected from K-12 schools in 4 low-income New Jersey cities in the US. School-level obesity prevalence, calculated from nurse-measured heights and weights at 4 time points, was used as the outcome variable. Data on the school food environment (SFE) measured the healthfulness of school lunch and competitive food offerings annually. The community food environment (CFE), i.e., the number of different types of food outlets within 400 m of schools, was also captured annually. The count and presence of food outlets likely to be frequented by students were calculated. Exposure to composite environment profiles both within schools and in communities around schools was assessed using latent class analysis. Data from 106 schools were analyzed using multilevel linear regression. RESULTS The prevalence of obesity increased from 25% to 29% over the course of the study. Obesity rates were higher in schools that had nearby access to a greater number of limited-service restaurants and lower in schools with access to small grocery stores and upgraded convenience stores participating in initiatives to improve healthful offerings. Interaction analysis showed that schools that offered unhealthier, competitive foods experienced a faster increase in obesity rates over time. Examining composite food environment exposures, schools with unhealthy SFEs and high-density CFEs experienced a steeper time trend (β = 0.018, P < 0.001) in obesity prevalence compared to schools exposed to healthy SFE and low-density CFEs. CONCLUSIONS Food environments within and outside of schools are associated with differential obesity trajectories over time and can play an important role in curtailing the rising trends in childhood obesity.
Collapse
Affiliation(s)
| | - Francesco Acciai
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Emily M Melnick
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Kristen Lloyd
- Center for State Health Policy, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, United States
| | - Sarah Martinelli
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Robin S DeWeese
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | | | - David Tulloch
- Department of Landscape Architecture, Rutgers University, New Brunswick, NJ, United States
| | - Derek DeLia
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, United States
| | - Michael J Yedidia
- Center for State Health Policy, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, United States
| |
Collapse
|
7
|
Ullevig SL, Parra-Medina D, Liang Y, Howard J, Sosa E, Estrada-Coats VM, Errisuriz V, Li S, Yin Z. Impact of ¡Míranos! on parent-reported home-based healthy energy balance-related behaviors in low-income Latino preschool children: a clustered randomized controlled trial. Int J Behav Nutr Phys Act 2023; 20:33. [PMID: 36944986 PMCID: PMC10029790 DOI: 10.1186/s12966-023-01427-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 02/19/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Widespread establishment of home-based healthy energy balance-related behaviors (EBRBs), like diet, physical activity, sedentary behavior, screen time, and sleep, among low-income preschool-aged children could curb the childhood obesity epidemic. We examined the effect of an 8-month multicomponent intervention on changes in EBRBs among preschool children enrolled in 12 Head Start centers. METHODS The Head Start (HS) centers were randomly assigned to one of three treatment arms: center-based intervention group (CBI), center-based plus home-based intervention group (CBI + HBI), or control. Before and following the intervention, parents of 3-year-olds enrolled in participating HS centers completed questionnaires about their child's at-home EBRBs. Adult-facilitated physical activity (PA) was measured by an index based on questions assessing the child's level of PA participation at home, with or facilitated by an adult. Fruit, vegetable, and added sugar intake were measured via a short food frequency questionnaire, and sleep time and screen time were measured using 7-day logs. A linear mixed effects model examined the intervention's effect on post-intervention changes in PA, intake of fruit, vegetable, and added sugar, sleep time, and screen time from baseline to post-intervention. RESULTS A total of 325 parents participated in the study (CBI n = 101; CBI + HBI n = 101; and control n = 123). Compared to control children, CBI and CBI + HBI parents reported decreases in children's intake of added sugar from sugar-sweetened beverages. Both CBI and CBI + HBI parents also reported smaller increases in children's average weekday screen time relative to controls. In addition, CBI + HBI parents reported CBI + HBI parents reported increases in children's adult-facilitated PA, fruit and vegetable intake, and daily sleep time during weekdays (excluding weekends) and the total week from baseline to post-intervention, while children in the CBI increased sleep time over the total week compared to the children in the control group. CONCLUSIONS Parent engagement strengthened the improvement in parent-reported EBRBs at home in young children participating in an evidence-based obesity prevention program in a childcare setting. Future studies should investigate equity-related contextual factors that influence the impact of obesity prevention in health-disparity populations. TRIAL REGISTRATION ClinicalTrials.gov, NCT03590834. Registered July 18, 2018, https://clinicaltrials.gov/ct2/show/NCT03590834.
Collapse
Affiliation(s)
- Sarah L Ullevig
- College for Health, Community and Policy, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, USA
| | - Deborah Parra-Medina
- Latino Research Institute, University of Texas at Austin, 210 W. 24th Street, GWB 1.102, Austin, TX, 78712, USA.
| | - Yuanyuan Liang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 660 W. Redwood Street, Baltimore, MD, USA
| | - Jeffrey Howard
- Department of Public Health, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, USA
| | - Erica Sosa
- Department of Public Health, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, USA
| | - Vanessa M Estrada-Coats
- Department of Public Health, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, USA
| | - Vanessa Errisuriz
- Latino Research Institute, University of Texas at Austin, 210 W. 24th Street, GWB 1.102, Austin, TX, 78712, USA
| | - Shiyu Li
- School of Nursing, UT Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, USA
| | - Zenong Yin
- Department of Public Health, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, USA
| |
Collapse
|
8
|
Mattaini MA, Roose KM, Fawcett SB. Behavioral Interventions Contributing to Reducing Poverty and Inequities. BEHAVIOR AND SOCIAL ISSUES 2022; 32:1-24. [PMID: 38625310 PMCID: PMC9718469 DOI: 10.1007/s42822-022-00114-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 12/04/2022]
Abstract
Behavioral science has a long history of engaging in efforts to understand and address socially important issues. Poverty and inequities in health and development are among the most important and complex social issues facing the world today. With its Sustainable Development Goals (SDGs), the United Nations (2015) has focused attention and guidance on addressing key global challenges, including to "end poverty" (SDG 1), "ensure good health and well-being for all" (SDG3), and "reduce inequality within and among countries" (SDG 10). In this paper, we provide a framework and illustrative examples of contributions of behavioral science to these issues. We feature illustrative behavioral interventions at the individual, relationship, community, and societal levels. We highlight the diversity of issues, intervention methods, and settings reflected in applications of behavioral science. By joining methods from behavioral science, public health, and other disciplines-and the experiential knowledge of those most affected by inequities-behavioral methods can make significant contributions to collaborative efforts to assure health and well-being for all.
Collapse
Affiliation(s)
- Mark A. Mattaini
- Jane Addams College of Social Work, University of Illinois Chicago, PO Box 1045, Paguate, NM 87040 USA
| | | | - Stephen B. Fawcett
- Department of Applied Behavioral Science, University of Kansas, Lawrence, KS USA
| |
Collapse
|
9
|
Abstract
Population-based solutions are needed to stabilize and then reverse the continued upward trends in obesity prevalence in the US population and worldwide. This review focuses on the related, urgent issue of disparities in obesity prevalence affecting US racial/ethnic minority and other socially marginalized populations. The review provides background on these disparities from a health equity perspective and highlights evidence of progress in equity-focused obesity efforts. Five recommendations for advancing equity efforts are offered as potential approaches to build on progress to date: (a) give equity issues higher priority, (b) adopt a health equity lens, (c) strengthen approaches by using health equity frameworks, (d) broaden the types of policies considered, and (e) emphasize implementation science concepts and tools. Potential challenges and opportunities are identified, including the prospect of longer-term, transformative solutions that integrate global and national initiatives to address obesity, undernutrition, and climate change.
Collapse
Affiliation(s)
- Shiriki K Kumanyika
- Dornsife School of Public Health, Drexel University, and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| |
Collapse
|
10
|
Fawcett SB. A Reflection on Community Research and Action as an Evolving Practice. BEHAVIOR AND SOCIAL ISSUES 2021; 30:535-544. [PMID: 38624970 PMCID: PMC8589455 DOI: 10.1007/s42822-021-00083-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/28/2022]
Abstract
Community research and action is an evolving field of practice with multiple influences. Its varied ways of knowing and doing reflect recombined elements from different disciplines, including behavioral science, community psychology, public health, and community development. This article offers a personal reflection based on my evolving practice over nearly 50 years. The focus is on three types of influence: (a) engaging with different communities, fields, and networks (e.g., discovering shared values, diverse methods); (b) building methods and capabilities for the work (e.g., methods for participatory research, tools for capacity building); and (c) partnering for collaborative research and action, locally and globally. This story highlights the nature of the field's evolution as an increasing variation in methods. Our evolving practice of community research and action-individually and collectively-emerges from the recombination of ideas and methods discovered through engagement in a wide variety of contexts.
Collapse
Affiliation(s)
- Stephen B. Fawcett
- Center for Community Health and Development, Life Span Institute, University of Kansas, 4082 Dole Center, 1000 Sunnyside Ave, Lawrence, KS 66045 USA
| |
Collapse
|
11
|
Collie-Akers V, Landry S, Ehule NJ, Pecha D, Beltran MM, Gilbert C, Abresch C. Enhancing the Capacity of Local Health Departments to Address Birth Equity: The Institute for Equity in Birth Outcomes. Matern Child Health J 2021; 25:1010-1018. [PMID: 33929652 PMCID: PMC8184551 DOI: 10.1007/s10995-021-03135-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Significant and persistent racial and ethnic disparities exist related to infant mortality and other birth outcomes. Few models exist that aim to prepare organizations to implement essential features, such as community engagement or intervening on social determinants of health. METHODS Between 2013 and 2015, teams from seven local health departments participated in the Institute for Equity in Birth Outcomes (EI) with the goals of building capacity and implementing changes to address equity in birth outcomes. Four of the teams enrolled in the first cohort (2013-2015), and three enrolled in cohort two (2014-2015). To examine the EI effort and its impact on capacity and implementation of changes, two types of assessments were completed. Capacities of the teams in specific key areas were assessed using "Best Change Process" instruments at the completion of participation in the EI. Teams also documented on an ongoing basis implementation of interventions. The data were analyzed using descriptive statistics and Pearson Correlation tests. RESULTS Best Change Process capacity scores were higher in the first cohort than in the second and were highly correlated with implementation of changes (Pearson's Correlation = 0.838, p = 0.037). Collectively, the teams implemented about 32 new programs, policies, practices, and systems changes aimed at addressing equity in birth outcomes. Most interventions were based on scientific recommendations and local epidemiologic data. DISCUSSION The results of the study suggest the EI is a promising approach that may result in strong capacity and ability to implement interventions aimed at addressing equity in birth outcomes.
Collapse
Affiliation(s)
- Vicki Collie-Akers
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 1008, Kansas City, KS 66160 USA
| | - Sarah Landry
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 1008, Kansas City, KS 66160 USA
| | - N. Jessica Ehule
- University of Nebraska Medical Center, 982170 Nebraska Medical Center, Omaha, NE 68198-2170 USA
| | - Denise Pecha
- University of Nebraska Medical Center, 982170 Nebraska Medical Center, Omaha, NE 68198-2170 USA
| | | | - Carol Gilbert
- University of Nebraska Medical Center, 982170 Nebraska Medical Center, Omaha, NE 68198-2170 USA
| | - Chad Abresch
- University of Nebraska Medical Center, 982170 Nebraska Medical Center, Omaha, NE 68198-2170 USA
| |
Collapse
|
12
|
Household food insecurity and children's physical activity and sedentary behaviour in the United States: the Healthy Communities Study. Public Health Nutr 2021; 25:381-388. [PMID: 34108064 PMCID: PMC8660938 DOI: 10.1017/s1368980021002536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective: To examine associations between household food insecurity and children’s physical activity and sedentary behaviours. Design: Secondary analysis was conducted on the Healthy Communities Study, an observational study from 2013 to 2015. Household food insecurity was assessed by two items from the US Department of Agriculture’s 18-item US Household Food Security Survey Module. Physical activity was measured using the 7-d Physical Activity Behaviour Recall instrument. Data were analysed using multilevel statistical modelling. Setting: A total of 130 communities in the USA. Participants: In sum, 5138 US children aged 4–15 years. Results: No associations were found for the relationship between household food insecurity and child physical activity. A significant interaction between household food insecurity and child sex for sedentary behaviours was observed (P = 0·03). Conclusions: Additional research capturing a more detailed assessment of children’s experiences of food insecurity in relation to physical activity is warranted. Future studies may consider adopting qualitative study designs or utilising food insecurity measures that specifically target child-level food insecurity. Subsequent research may also seek to further explore sub-group analyses by sex.
Collapse
|
13
|
Lee DL, Gurzo K, Nhan L, Homel Vitale E, Yoshida S, Ritchie LD. Nutrition Provided to Infants in Licensed Childcare Centers and Homes: A Descriptive Study. Matern Child Health J 2021; 24:932-942. [PMID: 32350730 DOI: 10.1007/s10995-020-02929-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Infant nutrition can influence development, eating behaviors and obesity risk. Nearly half of infants in the U.S. are in non-parental care where they consume much of their daily nutrition. Because little is known about the quality of infant nutrition in childcare, the study objective was to characterize the foods and beverages provided to infants in childcare in California. METHODS From a randomly selected sample of 2,400 licensed childcare in California, 736 responded to a 2016 survey; a subset of 297 cared for infants. Differences in 26 foods and 7 beverages provided between centers and homes, and by CACFP participation, were assessed using logistic regression models adjusted for CACFP participation and whether the site was a center or home, respectively. RESULTS Several differences between centers and homes were identified. One the day prior to the survey, more centers than homes ever provided cow's milk (25.1% vs 13.0%, p = 0.02) and whole grains (76.7% vs 62.9%, p = 0.03), and fewer centers than homes provided frozen treats (1.4% vs 10.3%, p = 0.003). When comparing difference by CACFP participation, fewer CACFP than non-CACFP sites usually provided breastmilk (32.6% vs 54.2%, p = 0.0004) and ever provided cow's milk (14.2% vs 37.1%, p < 0.0001). On the day prior to the survey, more CACFP than non-CACFP provided vegetables (91.0% vs 80.8%, p = 0.02), fruit (centers only) (97.2% vs 80.8%, p = 0.0003), and infant cereals (86.0% vs 61.2%, p < 0.0001). Fewer CACFP than non-CACFP provided sweetened yogurt (14.8% vs 36.7%, p < 0.0001). CONCLUSIONS FOR PRACTICE Childcare centers and CACFP participants tended to serve nutritious foods more than childcare homes and non-CACFP participants, respectively. Additional education and policies for childcare providers on appropriate foods and beverages for infants is recommended.
Collapse
Affiliation(s)
- Danielle L Lee
- Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, 2115 Milvia Street, 3rd Floor, Berkeley, CA, 94704, USA
| | - Klara Gurzo
- Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, 2115 Milvia Street, 3rd Floor, Berkeley, CA, 94704, USA.,Department of Public Health Sciences, Stockholm University, Sveavägen 160, 106 91, Sveaplan, Sweden
| | - Lilly Nhan
- Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, 2115 Milvia Street, 3rd Floor, Berkeley, CA, 94704, USA.,Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E. Young Drive South, 26-051B CHS, Box 951772, Los Angeles, CA, 90095, USA
| | - Elyse Homel Vitale
- California Food Policy Advocates, 1970 Broadway, Suite 760, Oakland, CA, 94612, USA.,Child Care Food Program Roundtable, Los Angeles, CA, USA
| | - Sallie Yoshida
- Sarah Samuels Center for Public Health Research & Evaluation, 1222 Preservation Park Way, Oakland, CA, 94612, USA.,Social Policy Research Associates, 1333 Broadway, Suite 301, Oakland, CA, 94612, USA
| | - Lorrene D Ritchie
- Division of Agriculture and Natural Resources, Nutrition Policy Institute, University of California, 2115 Milvia Street, 3rd Floor, Berkeley, CA, 94704, USA.
| |
Collapse
|
14
|
Anderson YC, Wynter LE, O'Sullivan NA, Wild CEK, Grant CC, Cave TL, Derraik JGB, Hofman PL. Two-year outcomes of Whānau Pakari, a multi-disciplinary assessment and intervention for children and adolescents with weight issues: A randomized clinical trial. Pediatr Obes 2021; 16:e12693. [PMID: 32959996 DOI: 10.1111/ijpo.12693] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether 12-month BMI SDS reductions persisted at 24 months in a multi-disciplinary assessment and intervention program for children and adolescents with obesity, and whether secondary outcomes improved. METHODS This was a community-based 12-month RCT in Aotearoa/New Zealand. Eligible participants were aged 5 to 16 years with BMI ≥98th centile or BMI >91st centile with weight-related comorbidities. The low-intensity control received comprehensive home-based baseline assessments and advice, and 6-monthly follow-up. The high-intensity intervention received the same assessments and advice, but also weekly multidisciplinary sessions. Primary outcome was BMI SDS at 12 months. Secondary outcomes included cardiovascular and metabolic markers. RESULTS 121 participants (60% of participants at baseline) were assessed at 24 months. BMI SDS reduction at 12 months was lost at 24 months in the modified intention-to-treat analysis [Control -0.03 (95%CI -0.14, 0.09) and Intervention -0.02 (-0.12, 0.08); P = .93]. However, sweet drink intake was reduced, water intake increased, and there were improvements in cardiovascular fitness in the high-intensity intervention. ≥70% attendance in the high-intensity intervention resulted in a persistent BMI SDS reduction of -0.22 after 24 months (95%CI -0.38, -0.06). CONCLUSIONS This trial was negative in terms of primary outcome at 24 months. However, high engagement led to sustained treatment effect, and there were multiple improvements in health measures.
Collapse
Affiliation(s)
- Yvonne C Anderson
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand.,Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Lisa E Wynter
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
| | - Niamh A O'Sullivan
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
| | | | - Cameron C Grant
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand.,Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Tami L Cave
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| |
Collapse
|
15
|
Lappan SN, Carolan M, Parra-Cardona JR, Weatherspoon L. Promoting Healthy Eating and Regular Physical Activity in Low-Income Families Through Family-Centered Programs: Implications for Practice. J Prim Prev 2020; 41:503-528. [PMID: 33125592 PMCID: PMC10732148 DOI: 10.1007/s10935-020-00612-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2020] [Indexed: 11/29/2022]
Abstract
Research concerning children who are overweight has historically focused on providing services to the affected individuals, and limited attention has been paid to their families. Further, childhood obesity prevention and clinical programs continue to be impacted by contextual factors that increase the likelihood of attrition when targeting underserved populations. This paper provides data with relevance for interventions aimed at promoting healthy eating and regular physical activity with low-income families. Participants in a childhood obesity exploratory study provided recommendations to improve programs by reflecting on specific family and contextual issues related to children who are overweight and obese. Following a thematic analysis approach, we conducted semi-structured interviews with 16 low-income, single, female parents. All participants had, at the time of the interview, at least one overweight or obese child between the ages of 3 and 8. We report the critical role of context in the etiology and challenges of childhood obesity among disadvantaged populations. Findings also highlight the need for interventions to be culturally relevant and sensitive and to create opportunities to address and discuss participant experiences of discrimination, cultural factors, and family of origin influences. Interventions that do not address these contextual factors run the risk of being unsuccessful. Our findings are important for mental and public health professionals who are interested in the direct provision of services using a combination of social determinants of systemic perspectives.
Collapse
Affiliation(s)
- Sara N Lappan
- Department of Human Studies, University of Alabama At Birmingham, 1720 2nd Ave. S, Birmingham, AL 35294, USA.
| | - Marsha Carolan
- Department of Human Development and Family Studies, Michigan State University, East Lansing, USA
| | | | - Lorraine Weatherspoon
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, USA
| |
Collapse
|
16
|
Slot-Heijs JJ, Collard DCM, Pettigrew S, Vinck J, Edell D, Barriguete A, Visscher TLS. The training and support needs of 22 programme directors of community-based childhood obesity interventions based on the EPODE approach: an online survey across programmes in 18 countries. BMC Health Serv Res 2020; 20:870. [PMID: 32933494 PMCID: PMC7491184 DOI: 10.1186/s12913-020-05709-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tackling childhood obesity is complex and requires a community-based approach implemented in multiple environments. It is known from literature that knowledgeable and skilled professionals are essential to implement such an approach successfully. The aim of the present study was to assess the need for training and support among a global network of programme directors implementing a Community-Based Childhood Obesity Intervention (CBCOI) based on the EPODE approach, in order to assist them in optimising the implementation process. METHODS An online survey was sent to 40 programme directors representing programmes implementing a CBCOI based on the EPODE approach. The survey consisted of statements on a 5-point Likert scale and multiple-choice questions about attitude towards and usefulness of training and support, and preferences for some predefined training types and training topics. In total, 22 programme directors responded to the survey (55% response rate). Data were analysed using descriptive statistics to describe the need for support in order to improve successful implementation. RESULTS Respondents strongly agreed that continually updating skills and learning how to make their programmes more effective and sustainable at the start and during the implementation was important. On-site training was preferred most at the commencement of a programme, while a 2-day training course was most valued during implementation. Monitoring, measuring and programme evaluation was identified as the most valuable training topic. CONCLUSIONS The results indicate a continuing and significant need for support and training among programme directors implementing a CBCOI. The findings give directions regarding topics and types of training and support in order to improve the implementation process.
Collapse
Affiliation(s)
| | - Dorine C M Collard
- Mulier Institute, Herculesplein 269, NL-3584, AA, Utrecht, The Netherlands
| | - Simone Pettigrew
- The George Institute for Global Health, Level 5/ 1 King Street, Newtown, NSW, 2042, Australia
| | - Jan Vinck
- Hasselt University, Martelarenlaan 42, BE-3500, Hasselt, Belgium
| | - Dennis Edell
- EPODE Canada, 20 Gothic Ave, Toronto, M6P 1T5, Canada
| | - Armando Barriguete
- National Institute of Medical Sciences and Nutrition, Vasco Quiroga, 14080, Tlalpan, Mexico
| | - Tommy L S Visscher
- Hanze University of Applied Sciences, Zernikeplein 7, 9747, AS, Groningen, The Netherlands
| |
Collapse
|
17
|
Romanelli R, Cecchi N, Carbone MG, Dinardo M, Gaudino G, Miraglia Del Giudice E, Umano GR. Pediatric obesity: prevention is better than care. Ital J Pediatr 2020; 46:103. [PMID: 32709246 PMCID: PMC7379757 DOI: 10.1186/s13052-020-00868-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
Pediatric obesity is one of the most relevant health issues of the last century. Obesity-related short and long-term consequences are responsible of a large amount of economic cost. In addition, the different therapeutic strategies, such as lifestyle correction, drug, and bariatric surgery have displayed low effectiveness. Considering this evidence, prevention appears to be more promising than treatment in contrasting obesity epidemic. In this review, we summarize obesity pathogenesis with the aim of highlight the main obesity risk factors that can be addressed as target of preventive interventions. Moreover, we report the evidence about effectiveness of different interventions targeting family, school, and community. A multiple-component intervention, addressing different targets and settings, might be desirable, however more studies are needed to confirm long-term efficacy and to direct policy interventions.
Collapse
Affiliation(s)
- Roberta Romanelli
- Clinical Nutrition Unit -Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Nicola Cecchi
- Clinical Nutrition Unit -Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Maria Grazia Carbone
- Clinical Nutrition Unit -Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Michele Dinardo
- Clinical Nutrition Unit -Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giuseppina Gaudino
- Department of the Woman, of the Child, of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. de Crecchio, 2, 80138, Naples, Italy
| | - Emanuele Miraglia Del Giudice
- Department of the Woman, of the Child, of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. de Crecchio, 2, 80138, Naples, Italy
| | - Giuseppina Rosaria Umano
- Department of the Woman, of the Child, of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. de Crecchio, 2, 80138, Naples, Italy.
| |
Collapse
|
18
|
Berthoud HR, Morrison CD, Münzberg H. The obesity epidemic in the face of homeostatic body weight regulation: What went wrong and how can it be fixed? Physiol Behav 2020; 222:112959. [PMID: 32422162 DOI: 10.1016/j.physbeh.2020.112959] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/23/2020] [Accepted: 05/04/2020] [Indexed: 12/14/2022]
Abstract
Ever since the pioneering discoveries in the mid nineteen hundreds, the hypothalamus was recognized as a crucial component of the neural system controlling appetite and energy balance. The new wave of neuron-specific research tools has confirmed this key role of the hypothalamus and has delineated many other brain areas to be part of an expanded neural system sub serving these crucial functions. However, despite significant progress in defining this complex neural circuitry, many questions remain. One of the key questions is why the sophisticated body weight regulatory system is unable to prevent the rampant obesity epidemic we are experiencing. Why are pathologically obese body weight levels defended, and what can we do about it? Here we try to find answers to these questions by 1) reminding the reader that the neural controls of ingestive behavior have evolved in a demanding, restrictive environment and encompass much of the brain's major functions, far beyond the hypothalamus and brainstem, 2) hypothesizing that the current obesogenic environment impinges mainly on a critical pathway linking hypothalamic areas with the motivational and reward systems to produce uncompensated hyperphagia, and 3) proposing adequate strategies for prevention and treatment.
Collapse
Affiliation(s)
- Hans-Rudolf Berthoud
- Neurobiology of Nutrition & Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA.
| | - Christopher D Morrison
- Neurobiology of Nutrition & Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Heike Münzberg
- Neurobiology of Nutrition & Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| |
Collapse
|
19
|
Collie-Akers VL, Fawcett SB, Schultz JA, Fleming KK, Swinburne Romine RE, Ritchie LD, Frongillo EA, Arteaga SS. Association of Multisetting Community Programs and Policies With Child Body Mass Index: The Healthy Communities Study. Prev Chronic Dis 2020; 17:E34. [PMID: 32379597 PMCID: PMC7207048 DOI: 10.5888/pcd17.190196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Expert opinion suggests that efforts to address childhood obesity should seek to transform the environments in which children operate. The objective of this study was to describe the extent to which multisetting programs and policies interact with community and child predictors and are associated with child body mass index (BMI) in the 130 US communities participating in the Healthy Communities Study. Methods For 2 years beginning in fall 2013, we collected data through key informant interviews on community programs and policies related to healthy weight among children that occurred in the 10 years before the interview. We characterized community programs and policies by intensity of efforts and the number of settings in which a program or policy was implemented. Child height and weight were measured during household data collection. We used multilevel modeling to examine associations of community programs and policies in multiple settings and child and community predictors with BMI z scores of children. Results The mean number of settings in which community policies and programs were implemented was 7.3 per community. Of 130 communities, 31 (23.8%) implemented community programs and policies in multiple settings. Higher-intensity community programs and policies were associated with lower BMI in communities that used multiple settings but not in communities that implemented programs and policies in few settings. Conclusion Efforts to prevent childhood obesity may be more effective when community programs and policies are both intensive and are implemented in multiple settings in which children live, learn, and play.
Collapse
Affiliation(s)
- Vicki L Collie-Akers
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas.,University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1008, Kansas City, Kansas 66160.
| | - Stephen B Fawcett
- Center for Community Health and Development, University of Kansas, Lawrence, Kansas
| | - Jerry A Schultz
- Center for Community Health and Development, University of Kansas, Lawrence, Kansas
| | | | | | - Lorrene D Ritchie
- Nutrition Policy Institute, Division of Agriculture and National Resources, University of California, Berkeley, California
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - S Sonia Arteaga
- Office of the Director, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
20
|
Plimier CC, Hewawitharana SC, Webb KL, Au LE, Neumark-Sztainer D, Ritchie LD. Community-level obesity prevention is not associated with dieting behaviours and weight dissatisfaction in children: The Healthy Communities Study. Pediatr Obes 2020; 15:e12594. [PMID: 31867897 PMCID: PMC7939126 DOI: 10.1111/ijpo.12594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 08/12/2019] [Accepted: 10/08/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Within the context of high childhood obesity prevalence, there is a concern that community efforts intended to reduce childhood obesity may lead to unintended adverse outcomes. OBJECTIVE This analysis examined relationships between community programs, policies, and environmental changes (CPPs) for obesity prevention with unhealthy dieting behaviours and body weight satisfaction in children. METHODS Using the Healthy Communities Study 2013 to 2015 survey sample of 5138 US children aged 4 to 15 years old, multilevel models examined associations between standardized CPP intensity scores and child dieting behaviours and weight satisfaction, adjusting for community and child-level covariates and clustered study design. RESULTS In fully adjusted models, higher total, physical activity, and nutrition CPP intensity scores were associated with lower odds of dissatisfaction with weight (1 year total CPP odds ratio [OR]: 0.41, 95% confidence interval [CI], 0.22-0.73; 6 year total CPP OR: 0.48, 0.29-0.80). Higher physical activity CPP intensity over the past year was associated with greater odds of weight satisfaction (OR: 1.77, 95% CI, 1.10-2.84). No associations were observed with dieting behaviours. CONCLUSIONS Results suggest that community efforts focusing on nutrition and physical activity to prevent childhood obesity may be associated with weight satisfaction and not with unhealthy dieting behaviours.
Collapse
Affiliation(s)
- Colleen C. Plimier
- School of Public Health; University of California, Berkeley, California; UC Berkeley School of Public Health, 50 University Ave Hall #7360, Berkeley, CA 94720, USA
| | - Sridharshi C. Hewawitharana
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 2115 Milvia Street, Suite 301, Berkeley, CA 94704, USA
| | - Karen L. Webb
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 2115 Milvia Street, Suite 301, Berkeley, CA 94704, USA
| | - Lauren E. Au
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 2115 Milvia Street, Suite 301, Berkeley, CA 94704, USA
| | - Dianne Neumark-Sztainer
- Division of Epidemiology, School of Public Health, University of Minnesota, 1300 Sound Second Street, Suite 300, Minneapolis, MN 55454, USA
| | - Lorrene D. Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 2115 Milvia Street, Suite 301, Berkeley, CA 94704, USA
| |
Collapse
|
21
|
Sallis JF, Conway TL, Cain KL, Geremia C, Bonilla E, Spoon C. Race/ethnic variations in school-year versus summer differences in adolescent physical activity. Prev Med 2019; 129:105795. [PMID: 31400375 DOI: 10.1016/j.ypmed.2019.105795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/29/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Abstract
Children and adolescents gain more weight in the summer than the school year, and there are race/ethnic differences in this pattern. Youth physical activity is lower in the summer, and the main aim of the present study was to examine race/ethnic and sex differences in adolescent physical activity, sedentary behavior, and related variables, comparing the school-year and summer. Adolescents aged 11-17 years were recruited from lower-income areas of five states in 2017-2018, and n = 207 completed surveys in both the school-year and summer: 56 African Americans, 30 American Indians, 21 Asian/Pacific Islanders, 49 Latinos, and 51 White, non-Hispanics. Of these, n = 150 also had accelerometer data. Objectively-measured physical activity was lower in the summer, especially among American Indian, Asian/Pacific Islander, and Latino subgroups. Reported screen time was substantially higher in the summer (p < .04), with the biggest increase among African Americans. Reported enjoyment of physical activity was generally lower in the summer (p < .02), which could help explain reduced physical activity. Which race/ethnic groups were at higher risk in the summer varied for physical activity and screen time, so interventions should be tailored for each group. Improved strategies to increase physical activity in the summer, especially among higher-risk groups, could contribute to youth obesity control.
Collapse
Affiliation(s)
- James F Sallis
- Department of Family Medicine and Public Health, University of California San Diego, United States of America.
| | - Terry L Conway
- Department of Family Medicine and Public Health, University of California San Diego, United States of America
| | - Kelli L Cain
- Department of Family Medicine and Public Health, University of California San Diego, United States of America
| | - Carrie Geremia
- Department of Family Medicine and Public Health, University of California San Diego, United States of America
| | - Edith Bonilla
- Department of Family Medicine and Public Health, University of California San Diego, United States of America
| | - Chad Spoon
- Department of Family Medicine and Public Health, University of California San Diego, United States of America
| |
Collapse
|
22
|
Building evidence to reduce inequities in youth physical activity and obesity: Introduction to the Physical Activity Research Center (PARC) Special Section. Prev Med 2019; 129:105767. [PMID: 31739908 DOI: 10.1016/j.ypmed.2019.105767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/06/2019] [Indexed: 11/22/2022]
Abstract
This guest editorial introduces the rationale and goals of the Physical Activity Research Center. It provides an overview of the five papers in this Special Section plus six commissioned studies intended to inform advocacy efforts.
Collapse
|
23
|
Deng X, Ma J, Yuan Y, Zhang Z, Niu W. Association between overweight or obesity and the risk for childhood asthma and wheeze: An updated meta-analysis on 18 articles and 73 252 children. Pediatr Obes 2019; 14:e12532. [PMID: 31033249 DOI: 10.1111/ijpo.12532] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/12/2019] [Accepted: 03/23/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Overweight or obesity is increasingly recognized as a possible risk factor for childhood asthma. OBJECTIVES We aimed to meta-analyse the association between overweight or obesity and the risk for childhood asthma and wheeze and meanwhile explore potential causes of between-study heterogeneity. METHODS Literature search, study selection, and data extraction were performed independently and in duplicate. Data were analysed by STATA software. RESULTS Eighteen articles and 73 252 children were analysed. In overall analyses, there was a significant association between overweight or obesity and the risk for childhood asthma (odds ratio [OR] = 1.30; 95% confidence interval [CI], 1.23-1.39; P < 0.001) and wheeze (OR = 1.90; 95% CI, 1.38-2.63; P < 0.001), with none/marginal publication bias as revealed by the Egger test (P = 0.938/0.038), respectively. Subgroup analyses showed that children with obesity (OR = 1.40; 95% CI, 1.29-1.52) were more likely to have asthma than children with overweight (OR = 1.22; 95% CI, 1.14-1.31), and in children with overweight or obesity, girls (OR = 1.34; 95% CI, 1.16-1.56) were more likely to have asthma than boys (OR = 1.27; 95% CI, 1.15-1.40). CONCLUSIONS Our findings indicate that overweight or obesity is a significant risk factor for childhood asthma and wheeze and in children with overweight or obesity, the risk is more evident in girls than in boys.
Collapse
Affiliation(s)
- Xiangling Deng
- Graduate School, Beijing University of Chinese Medicine, Beijing, China.,Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Jia Ma
- Graduate School, Beijing University of Chinese Medicine, Beijing, China.,Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Yuan Yuan
- Graduate School, Beijing University of Chinese Medicine, Beijing, China.,Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Zhixin Zhang
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Wenquan Niu
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| |
Collapse
|
24
|
Tomayko EJ, Prince RJ, Cronin KA, Kim K, Parker T, Adams AK. The Healthy Children, Strong Families 2 (HCSF2) Randomized Controlled Trial Improved Healthy Behaviors in American Indian Families with Young Children. Curr Dev Nutr 2019; 3:53-62. [PMID: 31453428 PMCID: PMC6700460 DOI: 10.1093/cdn/nzy087] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/13/2018] [Accepted: 11/09/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND American Indian (AI) families experience a disproportionate risk of obesity due to a number of complex reasons, including poverty, historic trauma, rural isolation or urban loss of community connections, lack of access to healthy foods and physical activity opportunities, and high stress. Home-based obesity prevention interventions are lacking for these families. OBJECTIVE Healthy Children, Strong Families 2 (HCSF2) was a randomized controlled trial of a healthy lifestyle promotion/obesity prevention intervention for AI families. METHODS Four hundred and fifty dyads consisting of an adult primary caregiver and a child ages 2 to 5 y from 5 AI communities were randomly assigned to a monthly mailed healthy lifestyle intervention toolkit (Wellness Journey) with social support or to a child safety control toolkit (Safety Journey) for 1 y. The Wellness Journey toolkit targeted increased fruit/vegetable (F/V) intake and physical activity, improved sleep, decreased added sugar intake and screen time, and improved stress management (adults only). Anthropometrics were collected, and health behaviors were assessed via survey at baseline and at the end of Year 1. Adults completed surveys for themselves and the participating child. Repeated measures analysis of variance was used to assess change over the intervention period. RESULTS Significant improvements to adult and child healthy diet patterns, adult F/V intake, adult moderate-to-vigorous physical activity, home nutrition environment, and adult self-efficacy for health behavior change were observed in Wellness Journey compared with Safety Journey families. No changes were observed in adult body mass index (BMI), child BMI z-score, adult stress measures, adult/child sleep and screen time, or child physical activity. Qualitative feedback suggests the intervention was extremely well-received by both the families and our community partners across the 5 participating sites. CONCLUSIONS This multi-site community-engaged intervention addressed key gaps regarding family home-based approaches for early obesity prevention in AI communities and showed several significant improvements in health behaviors. Multiple communities are working to sustain intervention efforts. This trial was registered at clinicaltrials.gov as NCT01776255.
Collapse
Affiliation(s)
- Emily J Tomayko
- Nutrition, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR
| | - Ronald J Prince
- Departments of Population Health, University of Wisconsin, Madison, WI
| | - Kate A Cronin
- Departments of Surgery, University of Wisconsin, Madison, WI
| | - KyungMann Kim
- Departments of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Tassy Parker
- Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM
| | - Alexandra K Adams
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, MT
| |
Collapse
|
25
|
Dietz WH. We Need a New Approach to Prevent Obesity in Low-Income Minority Populations. Pediatrics 2019; 143:peds.2019-0839. [PMID: 31126970 DOI: 10.1542/peds.2019-0839] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- William H Dietz
- Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| |
Collapse
|
26
|
Abstract
PURPOSE OF REVIEW To explore the relationship between the built environment and type 2 diabetes, considering both risk factors and policies to reduce risk. The built environment refers to the physical characteristics of the areas in which people live including buildings, streets, open spaces, and infrastructure. RECENT FINDINGS A review of current literature suggests an association between the built environment and type 2 diabetes, likely driven by two key pathways-physical activity and the food environment. Other hypothesized mechanisms linking the built environment and type 2 diabetes include housing policy, but evidence in these areas is underdeveloped. Policies designed to enhance the built environment for diabetes risk reduction are mechanistically plausible, but as of yet, little direct evidence supports their effectiveness in reducing in type 2 diabetes risk. Future work should rigorously evaluate policies meant to reduce type 2 diabetes via the built environment.
Collapse
Affiliation(s)
- Aisha T Amuda
- University of North Carolina School of Medicine, 1001 Bondurant Hall, CB 9535, Chapel Hill, NC, 27599, USA
| | - Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, Chapel Hill School of Medicine, University of North Carolina, 5034 Old Clinic Bldg. CB 7110, Chapel Hill, NC, 27599, USA.
- Cecil G. Sheps Center for Health Services Research, Chapel Hill, University of North Carolina, Chapel Hill, NC, USA.
| |
Collapse
|
27
|
Arteaga SS, Esposito L, Osganian SK, Pratt CA, Reedy J, Young-Hyman D. Childhood obesity research at the NIH: Efforts, gaps, and opportunities. Transl Behav Med 2018; 8:962-967. [PMID: 30329138 PMCID: PMC6454453 DOI: 10.1093/tbm/iby090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Childhood obesity is a major public health challenge. This article describes an overview of the National Institutes of Health (NIH) behavioral and social sciences childhood obesity research efforts. The overview will highlight five areas of childhood obesity research supported by the NIH: (a) basic behavioral and social sciences; (b) early childhood; (c) policies, programs, and environmental strategies; (d) health disparities; and (e) transagency and public-private collaboration. The article also describes potential gaps and opportunities in the areas of childhood obesity and severe obesity, measurement, and sleep.
Collapse
Affiliation(s)
- S Sonia Arteaga
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Layla Esposito
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Stavroula K Osganian
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Charlotte A Pratt
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jill Reedy
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Deborah Young-Hyman
- Office of Behavioral and Social Science Research, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
28
|
Sagatov RD, John LV, Gregoriou M, Arteaga SS, Weber S, Payn B, Strauss W, Weinstein N, Collie-Akers V. Recruitment outcomes, challenges and lessons learned: the Healthy Communities Study. Pediatr Obes 2018; 13 Suppl 1:27-35. [PMID: 30209890 PMCID: PMC6424514 DOI: 10.1111/ijpo.12455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 05/11/2018] [Accepted: 05/30/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Healthy Communities Study (HCS) was a national study of community programs and policies that aimed to address childhood obesity; it necessitated recruitment of a large sample of children from communities throughout the United States. OBJECTIVE The HCS aimed to complete visits with an average of 45 children and 12 key informants from at least 120 communities, diverse with respect to region of the country, urbanicity, socioeconomic status, race, ethnicity and intensity of community programs and policies that aim to address childhood obesity. METHODS Purchased address lists were utilized to select households for recruitment during Wave 1 of the study, and recruitment of families through schools was employed for Wave 2. RESULTS The HCS successfully obtained approval from 149 school districts and 478 schools in 130 communities, recruited 5138 families, and interviewed 1421 key informants to allow for characterization of overall intensity of obesity prevention/treatment efforts in each community. CONCLUSIONS Lessons learned are presented. Future studies should plan for inclusion of the following in development of recruitment strategies: literature review, formative research, pilot testing, and ongoing monitoring and adjustment.
Collapse
Affiliation(s)
| | | | | | - S. Sonia Arteaga
- National Institutes of Health, National Heart, Lung and Blood Institute, Bethesda, MD
| | | | - Betsy Payn
- University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, WA
| | - Warren Strauss
- W.J. Strauss, Health Analytics Hub, LLC – Lewis Center, OH, USA
| | | | - Vicki Collie-Akers
- Work Group for Health and Community Development, University of Kansas, Lawrence, KS
| | | |
Collapse
|
29
|
Collie-Akers VL, Schultz JA, Fawcett SB, Obermeier SM, Pate RR, John LV, Weber SA, Logan A, Arteaga SS, Loria CM, Webb K. The prevalence of community programmes and policies to prevent childhood obesity in a diverse sample of US communities: the Healthy Communities Study. Pediatr Obes 2018; 13 Suppl 1:64-71. [PMID: 30270519 DOI: 10.1111/ijpo.12475] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 06/02/2018] [Accepted: 08/15/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This manuscript describes the prevalence and attributes of community programmes and policies (CPPs) to address childhood obesity documented as occurring in 130 diverse US communities. METHODS Key informant interviews (N = 1420) and document abstraction were used to identify and characterize CPPs to promote physical activity and healthy nutrition occurring during a 10-year retrospective study period. Data were collected in 2013-2015 and analysed in 2016. RESULTS Across all 130 communities, 9681 distinct CPPs were reported as occurring by key informants. Of these, 5574 (58%) focused on increasing physical activity, 2596 (27%) on improving nutrition and 1511 (16%) on both behaviours. The mean number of CPPs per community was 74.0, with a range of 25 to 295 across all communities. Most CPPs occurred more than once (63%) and on average lasted 6.1 years. The greatest number of reported CPPs occurred in school settings (44%). CONCLUSIONS Communities showed a wide range of investment in the amount of CPPs occurring in settings that affect opportunities for children to engage in physical activity and healthy nutrition. The pattern of implementation of CPPs showed variation over time, with an increase in more recent years. This observational study provides new and valuable information about what US communities are doing to prevent childhood obesity.
Collapse
Affiliation(s)
- V L Collie-Akers
- Center for Community Health and Development, University of Kansas, Lawrence, KS, USA
| | - J A Schultz
- Center for Community Health and Development, University of Kansas, Lawrence, KS, USA
| | - S B Fawcett
- Center for Community Health and Development, University of Kansas, Lawrence, KS, USA
| | - S M Obermeier
- Center for Community Health and Development, University of Kansas, Lawrence, KS, USA
| | - R R Pate
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | - L V John
- Battelle Health and Analytics, St. Louis, MO, USA
| | - S A Weber
- Battelle Health and Analytics, Columbus, OH, USA
| | - A Logan
- Battelle Health and Analytics, Columbus, OH, USA
| | - S S Arteaga
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - C M Loria
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - K Webb
- Division of Agriculture and Natural Resources, University of California, Nutrition Policy Institute, Oakland, CA, USA
| | | |
Collapse
|
30
|
Kumanyika SK. Supplement overview: what the Healthy Communities Study is telling us about childhood obesity prevention in U.S. communities. Pediatr Obes 2018; 13 Suppl 1:3-6. [PMID: 30345706 DOI: 10.1111/ijpo.12478] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/01/2022]
Abstract
The Healthy Communities Study (HCS), conducted between 2010 and 2016, tells a real-world story of how childhood obesity prevention efforts have unfolded in 130 U.S. communities. The study documented nearly 10,000 current and past community policies and programs (CPPs) and assessed dietary and physical activity behaviors, weight, height, and waist circumference of more than 5,000, 4- to 15-year-old children. The articles in this HCS supplement describe the variables created to characterize the CPPs, CPP relationships with children's behavioral and weight status, other analyses of interest, and recruitment challenges. Findings suggest that many of the strategies being implemented work as intended to improve children's behaviors and weight status. However, of concern, findings also indicate lesser reach to children in demographic groups at highest risk of obesity. Overall, the HCS insights can guide the next phase of efforts to strengthen existing CPPs and motivate other, novel approaches to combating childhood obesity.
Collapse
Affiliation(s)
- S K Kumanyika
- Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| |
Collapse
|