Expanding the impact of cancer prevention policies through collaborative implementation research: a qualitative secondary analysis of federal child nutrition assistance policies during COVID-19

通过协作实施研究扩大癌症预防政策的影响：对 COVID-19 期间联邦儿童营养援助政策的定性二次分析

• 批准号: 10554412
• 负责人: Hannah G Lane
• 金额: $ 22.1万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-24 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10554412
• 关键词: Acceleration; Address; Adoption; Advocate; Affect; Area; Asthma; Black race; COVID-19; COVID-19 pandemic; Case Study; Child; Child Nutrition; Childhood; Chronic Disease; Complex; Country; County; Data; Data Analyses; Data Collection; Demographic Factors; Diet; Dietary intake; Drops; Ecosystem; Effectiveness; Eligibility Determination; Enrollment; Ensure; Equity; Evidence based program; Family; Food; Food Services; Foundations; Funding; Health Policy; Hispanic; Home; Household; Hybrids; Inequity; Intervention; Latino; Low income; Malignant Neoplasms; Marketing; Methodology; Methods; Natural experiment; Nutritional; Obesity; Persons; Policies; Policy Maker; Population; Prevalence; Price; Process; Provider; Public Health; Recording of previous events; Regulation; Research; Research Personnel; Research Priority; Resources; Risk; Risk Factors; Risk Reduction; Route; Rural; Sampling; Schools; Site; Students; System; Testing; Transportation; Unhealthy Diet; United States Department of Agriculture; Variant; Virus; Weight Gain; Work; cancer prevention; cancer risk; children of color; cost; design; ethnic minority; experience; falls; federal policy; feeding; flexibility; food insecurity; future implementation; health equity promotion; health inequalities; implementation context; implementation research; implementation strategy; implementation trial; improved; innovation; lens; member; minority children; novel; novel strategies; nutrition; operation; post-COVID-19; practice setting; programs; racial minority; response; rural area; rurality; school closure; secondary analysis; social health determinants; sustainability framework; theories; urban area; working group

ABSTRACT Evidence-informed public health policies have tremendous potential to reduce cancer health inequities by addressing cancer risk factors among priority populations. This impact is only achievable if policies are well- implemented among populations at greatest risk. Understanding how policy implementation varies across contexts is critical to developing tailored, equity-focused implementation strategies, but opportunities to evaluate these variations are sparse. This study evaluates variations in implementation of federal policies aimed at reducing child food insecurity and improving dietary intake during the COVID-19 crisis, in order to inform future implementation and sustainment strategies. Child nutrition programs (CNPs) are federally-funded, evidence-based programs to mitigate child food insecurity, a social determinant of health that is associated with many cancer risk factors (e.g., poor diet, asthma, obesity, chronic disease), and is disproportionately prevalent among Black and Hispanic/Latino children and those in low-income households. CNPs are offered year-round and reduce food insecurity and improve diet quality among enrolled children, yet reach and implementation of CNPs varies, especially in summer. CNP mandates are quite rigid, which limits adoption and in some districts (e.g., highly urban/rural or under-resourced), and stifles efforts to improve implementation and expand student reach. In the extraordinary circumstance of the COVID-19 crisis, however, the US Department of Agriculture allowed more flexibility so that CNPs could use novel implementation strategies to keep serving meals while reducing virus spread (e.g., home delivery via bus routes, waived adoption requirements). Understanding adoption and implementation of these strategies—especially variations across under-resourced districts—is critical to advocate for more equitable policies, and inform tailored implementation support (e.g., technical assistance from state entities) for CNPs following the crisis. This study leverages a national research collaborative to conduct a secondary analysis of implementation data from six studies during the initial COVID- 19 response (~Spring-Summer 2020) among CNP implementers (e.g., food service directors), combined with data verification with CNP implementers and families post-initial response (~Fall 2022). Driven by the Dynamic Sustainability Framework and CDC’s Policy Analytical Framework, we aim to: (1) describe system- and setting- level variations in CNP policy implementation during COVID-19, including challenges and facilitators, key partners, capacity, and adaptations; and (2) describe potential for sustainment of policy flexibilities, implementation support needs, and critical policy levers to continue novel implementation strategies beyond the COVID-19 crisis period. Findings can inform more equitable policies and tailored practice guidance, and generate data for a hybrid implementation trial to compare the reach, effectiveness, and sustainment potential of novel CNP implementation strategies to reduce food insecurity and promote health equity.

抽象的 证据意见的公共卫生政策具有巨大的潜力，可以减少癌症健康不平等 解决优先人群中的癌症危险因素。只有在政策是良好的情况下，这种影响才能实现 在人口中实施的风险很大。了解政策实施方式如何变化 环境对于制定量身定制的，以股权为中心的实施策略至关重要，但有机会 评估这些变化很少。这项研究评估了实施联邦政策的差异 旨在减少儿童粮食不安全和改善19日危机期间的饮食摄入量，以便为了 告知未来的实施和维持策略。儿童营养计划（CNP）是联邦政府资助的， 基于证据的计划来减轻儿童粮食不安全，这是一个与健康的社会有关的社会，与之相关 有许多癌症危险因素（例如，饮食不良，哮喘，肥胖，慢性病），并且不成比例 黑人和西班牙裔/拉丁美洲裔儿童以及低收入家庭中普遍存在。提供CNP 全年，减少粮食不安全，并提高注册儿童的饮食质量，但可以及 CNP的实施各种，尤其是在夏季。 CNP授权非常严格，限制了采用和 在某些地区（例如，高度城市/农村或资源不足），以及紧缩的努力来改善实施和 扩大学生的范围。然而，在19009年危机的特殊情况下，美国部门 农业允许更大的灵活性，因此CNP可以使用新颖的实施策略继续服务 在减少病毒传播的同时（例如，通过公交路线送货上门，放弃采用要求）。 了解这些策略的采用和实施，尤其是资源不足的变化 地区 - 对于倡导更公平的政策和为量身定制的实施支持而言至关重要（例如 危机后CNP的国家实体的技术援助。这项研究利用了国家研究 在最初的covid期间对六项研究的实施数据进行辅助分析 CNP实施者（例如食品服务总监）中的19个回应（〜春季夏季2020年），结合 对CNP实施者和家庭的数据验证后响应后响应（〜2022秋季）。由动态驱动 可持续性框架和CDC的政策分析框架，我们的目标是：（1）描述系统和设置 - COVID-19期间CNP政策实施的水平变化，包括挑战和促进者，关键 合作伙伴，能力和适应； （2）描述了维持政策灵活性的潜力， 实施支持需求以及关键的政策杠杆，以继续新的实施策略以外 共同-19危机时期。调查结果可以为更公平的政策和量身定制的实践指导提供信息，以及 为混合实施试验生成数据，以比较覆盖范围，有效性和维持潜力 CNP实施策略的新型策略，以减少粮食不安全并促进健康公平。