MULTILEVEL SYSTEMS-ORIENTED CHILDHOOD OBESITY STUDY IN CHINA

项目摘要：为解决高危人群中的肥胖症流行问题，迫切需要创新的和符合文化的多层次政策和环境干预措施。然而，绝大多数干预战略侧重于选定的目标和方法，例如，教育消费者有关健康食品选择的知识，而在许多情况下，减少获得健康食品选择的机会大大限制了影响。 MOPS将测试一种创新的多层次干预，直接解决与儿童饮食行为和肥胖症相关的复杂系统。我们的总体目标是开发和评估一个以社区为基础的肥胖预防计划，该计划在城市食品系统的多个层面(政策、批发商、街角商店、外卖、家庭、个人；在马里兰州巴尔的摩)运作，并将改善健康食品供应链，以提高低收入人群对健康食品的负担能力、可获得性、购买和消费 少数族裔社区。我们建议的研究将包括不同层面的利益相关者/合作伙伴，例如政策、批发商、零售商、成人照顾者和儿童个体层面，然后制定、实施和评估一项针对少数族裔和低收入儿童(主要是AA)的为期两年的基于多层次系统的儿童肥胖预防策略。将确定30个以AA为主的低收入地理区域(“健康饮食区域”)。这些区域中的一半将被随机分配到干预区，而另一半将被控制。在每个干预区内，我们将与至少5家小型食品店和预制食品来源合作 通过批发商折扣增加获得健康食品的机会，展示购物点宣传材料，并针对青年和照顾者提供营养和食品准备教育。我们将与当地政策制定者合作，使这些变化制度化并持续下去。该项目将评估该计划对以下方面的影响：a)健康食品的定价和可获得性，b)低收入非裔美国人成人食品的购买和准备，以及c)低收入非裔美国青年饮食，以及相关的心理社会因素。拟议的干预试验直接针对RFA，利用基于系统的方法在多个层面测试和评估结构性干预措施。

Project Summary: Innovative and culturally appropriate multilevel policy and environmental interventions are greatly needed to address the obesity epidemic in high-risk populations. However, the vast majority of intervention strategies have focused on selected targets and approaches, e.g., educating consumers about healthy food choices, while in many settings reduced access to healthy food choices greatly limits impact. MOPS will test an innovative multi-level intervention, which directly addresses the complex systems associated with childhood eating behaviors and adiposity. Our overarching goal is to develop and evaluate a community based obesity prevention program, which operates at multiple levels of an urban food system (policy, wholesaler, corner stores, carryout, household, individual; in Baltimore, MD), and will improve the healthy food supply chain to increase affordability, availability, purchasing and consumption of healthy foods within low income minority neighborhoods. Our proposed research will include stakeholders/ partners at different levels, e.g., the policy, wholesaler, retailer, adult caregiver, and individual child levels, and then develop, implement, and assess a two year multi-level systems-based child obesity prevention strategy targeting minority and low income children (predominantly AA). Thirty low-income, predominantly AA geographic zones will be identified ("healthy eating zones"). Half of these zones will be randomized to intervention, while the other half will be control. Within each intervention zone we will work with at least 5 small food stores and prepared food sources to increase access to healthy foods through wholesaler discounts, display point of purchase promotional materials, and provide nutrition and food preparation education targeting youth and caregivers. We will work with local policymakers to institutionalize and sustain these changes. The project will evaluate the impact of the program on: a) healthy food pricing and availability, b) low income African American adult food purchasing and preparation, and c) low-income African American youth diet, and associated psychosocial factors. The proposed intervention trial directly addresses the RFA by utilizing a systems-based approach to test and evaluate structural interventions at multiple levels.