Early determinants of childhood obesity: Etiology, disparities, policy analysis

描述（由申请人提供）：到5岁时，超过10%的美国儿童肥胖，少数民族和更弱势环境的儿童受到不成比例的影响。虽然有证据表明怀孕和早期生活中的危险因素与儿童肥胖有关，但观察性研究和小样本、有限样本中可能存在混淆，这给推断因果关系带来了挑战。关于这些关系在多大程度上适用于所有种族/民族群体存在争议。为支持健康行为而制定的政策，如果只被来自某些种族/民族群体或更有利群体的母亲采纳，实际上可能会增加肥胖风险因素的差异。很少有研究解决了这一问题。K99/R00奖将为PI提供一个机会，通过正式课程和由知名学者组成的跨学科小组的指导，建立她在流行病学方面的背景，并获得因果推理、政策评估和将研究转化为政策的培训。这个K奖的总体目标是澄清儿童肥胖差异的围生期和产后风险因素，并检查政策对这些风险因素差异的影响。该研究项目将通过数据链接最大化公共数据的效用，整合经济学和流行病学的分析技术来推断因果关系，理解对种族/民族和社会经济差异的影响，以及确定行为改变的政策驱动因素，从而推动肥胖预防领域的发展。通过将马萨诸塞州的出生证明数据与健康儿童访问的电子数据库连接起来，PI将创建一个包含21.5万名儿童的数据集。在该奖项的指导阶段（K99）， PI将检查孕妇在怀孕期间吸烟、妊娠期体重过度增加和母乳喂养方面的差异，并检查这些风险因素与2岁和5岁时肥胖相关结果之间的关系。在奖励的独立阶段（R00）， PI将审查政策对这些风险因素的流行和种族/民族和社会经济差异的影响，重点是烟草控制政策的最新变化和妊娠期体重增加建议。马萨诸塞州和全国的早期儿童肥胖预防政策和项目将被评估，以确定怀孕和早期生活中哪些因素被包括在内。PI将把这个研究项目的结果提交给州政府的政策制定者，并帮助确定未来预防肥胖战略的领域。PI将在该奖项的第四年提交R01申请，继续推行这些方法和跨学科合作，以推动关于妇幼保健差异的研究议程。

DESCRIPTION (provided by applicant): By age 5, more than 10% of US children are obese and children from ethnic minority groups and more disadvantaged circumstances are disproportionately affected. While evidence exists that risk factors during pregnancy and early life are associated with childhood obesity, potential confounding in observational studies and small, restricted samples, present challenges to infer causation. There is debate about the extent to which these relationships apply to all racial/ethnic groups. Policies enacted to support healthy behaviors may actually increase disparities in the risk factors for obesity if they are adopted only by mothers from certain racial/ethnic groups or more advantaged groups. Few studies have addressed this concern. This K99/R00 award will provide an opportunity for the PI to build on her background in epidemiology and acquire training in causal inference, policy evaluation, and translating research into policy through formal courses and mentorship by an interdisciplinary group of renowned scholars. The overarching goals of this K award are to clarify peri- and post-natal risk factors for disparities in childhood obesity and to examine the effects of policies on disparities in these risk factors. This program of research will move forward the field of obesity prevention by maximizing the utility of public data through data linkage, integrating analytic techniques from economics and epidemiology to infer causality, understanding influences on racial/ethnic and socioeconomic disparities, and identifying policy drivers for behavior change. The PI will create a dataset of 215,000 children by linking Massachusetts birth certificate data to an electronic database of well-child visits. During the mentored phase of the award (K99), the PI will examine disparities in maternal smoking during pregnancy, excessive gestational weight gain, and breastfeeding as well as examine the associations between these risk factors and adiposity-related outcomes at ages 2 and 5 years. During the independent phase of the award (R00), the PI will examine the influence of policies on the prevalence and racial/ethnic and socioeconomic disparities in these risk factors, focusing on recent changes in tobacco control policies and gestational weight gain recommendations. Policies and programs for early childhood obesity prevention both in Massachusetts and nationally will be assessed to determine the extent to which factors during pregnancy and early life are included. The PI will present the findings from this program of research to policy makers in state government and help identify areas for future obesity prevention strategies. The PI will submit an R01 application during the fourth year of the award to continue to pursue these methods and interdisciplinary collaborations with the aim of pushing forward the research agenda on disparities in maternal and child health. PUBLIC HEALTH RELEVANCE: The aims of the program of research in this K99/R00 award are to address racial/ethnic and socioeconomic differences in perinatal and postnatal risk factors for childhood obesity and identify policy drivers for behavior change. The results will be presented to policy makers in state government to help identify areas for future obesity prevention strategies.