Evaluation of a Walking School Bus Program: A Cluster Randomized Controlled Trial

步行校车项目的评估：整群随机对照试验

• 批准号: 8331808
• 负责人: Jason A Mendoza
• 金额: $ 59.53万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-09 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8331808
• 关键词: Acculturation; Address; Adult; Advocacy; Affect; Age; Behavior; Body mass index; Child; Communities; Community Health Education; Commuting; Crime; Data; Data Analyses; Disadvantaged; Educational process of instructing; Effectiveness; Environment; Epidemic; Epidemiology; Evaluation; Future; Generations; Goals; Health; Health Promotion; Individual; Injury; Intervention; Intervention Trial; Link; Low income; Malignant Neoplasms; Mediating; Mediator of activation protein; Modeling; Neighborhoods; Obesity; Observational Study; Outcome; Parents; Pediatrics; Physical activity; Psychology; Public Health; Randomized Controlled Trials; Recruitment Activity; Reporting; Research; Research Personnel; Risk; Safety; Schools; Self Efficacy; Survey Methodology; Testing; Time; Travel; Walking; Weight; behavior change; cancer prevention; cost; design; effectiveness trial; efficacy trial; elementary school; ethnic minority population; expectation; experience; high risk; injury prevention; innovation; instrument; interdisciplinary approach; lifetime risk; obesity in children; obesity prevention; obesity risk; pedestrian injury; pedestrian safety; prevent; programs; racial and ethnic; skills; social; social cognitive theory; socioeconomics

DESCRIPTION (provided by applicant): Physical activity decreases the risk of multiple cancers and is important for obesity prevention, which in turn is important for cancer prevention. Children's active commuting to school (ACS), previously common (42 percent in 1969-1970) is now uncommon (13 percent in 2009). This decline coincided with the obesity epidemic, which disproportionately affects low-income and ethnic minority children. Programs to increase children's moderate- to-vigorous physical activity (MVPA) and lower obesity risk are necessary. The walking school bus (WSB) is an innovative program in which children walk to and from school led by adults, who teach pedestrian safety. The WSB provides additional time for MVPA, and this team's pilot WSB study reported increases to children's ACS and MVPA in the short-term. No randomized controlled trials (RCTs) have reported on long-term (i.e. over one school year) efficacy of WSB programs on children's ACS, MVPA, pedestrian safety, and adiposity. Few studies have included children from disadvantaged socioeconomic or racial/ethnic backgrounds. The Primary Goal is to conduct a cluster RCT to evaluate the long-term efficacy of a WSB program to increase low-income, ethnic minority children's ACS and MVPA. The investigators will take an interdisciplinary approach and use a social ecological model to consider multiple correlates of ACS and levels of analysis: (1) individual-level influences e.g. acculturation and constructs from social cognitive theory, (2) schools, and (3) macro-environmental influences e.g. neighborhood walkability and safety. To achieve the project goals among 3-5th grade children, the Specific Aims include: SA1) To recruit 770 child-parent dyads from 22 elementary schools over 4 years and conduct a cluster RCT to assess the efficacy of a WSB program on children's ACS, MVPA, and BMI z-score over a school-year SA2) To collect and analyze data on individual-, school-, and macro-level influences on changes to children's ACS resulting from the WSB program The Primary Hypotheses to be tested include: H1) The WSB program will increase children's ACS over a school-year. H1a) Parents' outcome expectations and self-efficacy will mediate the relationship between the WSB and changes to children's ACS. H1b) Walkability, safety, and acculturation will moderate changes to children's ACS. H2) The WSB program will increase children's MVPA and decrease BMI z-scores over a school-year. H3) The WSB program will increase school-level pedestrian safety behaviors over a school-year. The proposed research will allow for optimal assessment of changes to children's ACS, test moderators and mediators of children's ACS, evaluate long term changes to MVPA and BMI z-score, and provide crucial planning information for a future community effectiveness trial. PUBLIC HEALTH RELEVANCE: Childhood obesity is at record high levels in the US, and low-income and ethnic minority children are at highest risk. This project will test "the walking school bus" program, in which children walk to and from school with adults, and its impact on low-income, ethnic minority children's walking to school, physical activity, and risk for obesity. Ultimately, this line of research has the potential to provide a low-cost, easy to disseminate program to reduce risk of obesity and cancer for at-risk children.

描述（由申请人提供）：体育活动可以降低患多种癌症的风险，对预防肥胖很重要，而肥胖对预防癌症也很重要。儿童主动通勤上学（ACS）以前很常见（1969-1970年为42%），现在不常见（2009年为13%）。这种下降与肥胖的流行相吻合，肥胖对低收入和少数民族儿童的影响尤为严重。增加儿童适度到剧烈的体育活动（MVPA）和降低肥胖风险的计划是必要的。步行校车（WSB）是一项创新计划，孩子们在成年人的带领下步行上下学，成年人教导行人安全。WSB为MVPA提供了额外的时间，该团队的试点WSB研究报告了儿童ACS和MVPA在短期内的增加。没有随机对照试验（RCTs）报道WSB项目对儿童ACS、MVPA、行人安全和肥胖的长期（即超过一个学年）疗效。很少有研究包括来自弱势社会经济或种族/民族背景的儿童。本研究的主要目标是进行一项随机对照试验，以评估WSB项目对提高低收入、少数民族儿童的ACS和MVPA的长期效果。研究人员将采用跨学科的方法，并使用社会生态模型来考虑ACS的多个相关因素和分析水平：(1)个人层面的影响，如社会认知理论的文化适应和结构；(2)学校；(3)宏观环境影响，如社区可步行性和安全性。为了在3-5年级儿童中实现项目目标，具体目标包括：1)从22所小学招募770名子女-父母对，为期4年，并进行聚类随机对照试验，以评估WSB计划对儿童ACS， MVPA和BMI z-score在一学年期间的有效性；2)收集和分析个人，学校和宏观层面对WSB计划对儿童ACS变化的影响数据。WSB计划将在一个学年中增加儿童的ACS。H1a)父母的结果期望和自我效能感将中介WSB与儿童ACS变化之间的关系。H1b)可步行性、安全性和文化适应将缓和儿童ACS的变化。H2) WSB计划将在一学年内提高儿童的MVPA并降低BMI z分数。H3) WSB计划将在一学年期间提高学校层面的行人安全行为。该研究将允许对儿童ACS的变化进行最佳评估，测试儿童ACS的调节因子和中介因子，评估MVPA和BMI z-score的长期变化，并为未来的社区有效性试验提供重要的规划信息。