Understanding Community Obesity Initiatives and Informing Tailored Community Interventions to Reduce Childhood Obesity

美国儿童肥胖率在20世纪80年代至21世纪初急剧上升， 在所有人口分组中仍然很高。在非洲裔美国人和西班牙裔美国人中， 孩子为了应对这些趋势并遵循主要卫生当局的建议，许多 美国社区实施了旨在改善儿童饮食的计划和政策， 他们的身体活动水平，并减少儿童肥胖。然而，这些努力的影响一直是 有限，无论是研究还是专业实践都尚未确定社区计划的属性 以及在改善儿童饮食、增加他们的体育活动方面一贯成功的政策， 降低他们超重或肥胖的可能性。拟议的总体目标 研究的目的是产生结果，为公共卫生政策和实践提供信息，旨在减少 儿童肥胖症的患病率。具体目标将是确定社区方案的属性， 与儿童饮食、体育活动和体重状况有关的政策， 社区、学校和家庭按种族/民族和社会经济地位分层。这些目标将是 通过对现有数据集进行二次分析来解决，该数据集包括对 对5000多名儿童进行了不同的抽样调查，并对9500多个社区方案和政策进行了评估， 在美国130个社区减少儿童肥胖。此外，在这些社区内， 学校营养和体育活动政策、做法和资源可供274名小学生和 149所中学基于家庭的数据收集协议提供人体测量数据以及详细的 关于儿童饮食和体育活动行为的信息。两种分析方法，分类和 回归树（CART）和梯度提升机（GBM），将被用来检查 社区计划和政策的属性与儿童的饮食，体育活动和 体重状况这些分析程序将在社区、学校和 按种族/族裔和社会经济地位概况分层的家庭。拟议研究的结果将 使研究人员和从业人员能够根据 人口分组。这项研究将是重要的，因为它将为预防战略提供信息。 儿童肥胖症在社区和人口亚组，不成比例地受到影响， 肥胖的负面影响。这项研究将是创新的，因为它将采用最先进的分析方法， 方法使用的数据集是唯一的大和全面的。

Childhood obesity rates in the United States increased dramatically between the 1980’s and the 2000’s and remain high in all demographic sub-groups. The rates are particularly high in African American and Hispanic children. In response to these trends and following the recommendations of leading health authorities, many U.S. communities have implemented programs and policies aimed at improving children’s diets, increasing their physical activity levels, and reducing childhood obesity. However, the impact of these efforts has been limited, and neither research nor professional practice has yet identified the attributes of community programs and policies that are consistently successful in improving children’s diet, increasing their physical activity, and decreasing the probability that they will develop overweight or obesity. The overarching goal of the proposed research is to produce findings that inform public health policies and practices aimed at reducing disparities in the prevalence of childhood obesity. Specific aims will be to identify attributes of community programs and policies that are associated with children’s diet, physical activity and weight status within groups of communities, schools, and families stratified by race/ethnicity and socioeconomic status. These aims will be addressed by conducting secondary analyses in an existing dataset that includes in-depth observations of a diverse sample of over 5000 children and assessment of over 9500 community programs and policies to reduce childhood obesity in 130 U.S. communities. Further, within those communities, extensive data on school nutrition and physical activity policies, practices and resources are available for 274 elementary and 149 middle schools. A home-based data collection protocol provided anthropometric data as well as detailed information on children’s diet and physical activity behaviors. Two analytic methods, Classification and Regression Trees (CART) and Gradient Boosting Machines (GBM), will be employed in examining relationships between attributes of community programs and policies and children’s diet, physical activity and weight status. These analytic procedures will be conducted within sub-groups of communities, schools and families stratified by race/ethnicity and socioeconomic status profiles. The findings of the proposed study will enable researchers and practitioners to tailor community-based interventions to the characteristics of demographic sub-groups. This research will be significant because it will inform strategies for preventing childhood obesity in communities and population sub-groups that are disproportionately affected by the negative consequences of obesity. The study will be innovative because it will apply state-of-the-art analytical methods using a dataset that is uniquely large and comprehensive.