Impact of Environmental Changes on Children's BMI and Behaviors: A Panel Study

描述(由申请者提供)：拟议的项目将对新泽西州五个城市食物和体育活动(PA)环境的变化对儿童肥胖症及相关行为的影响进行受控评估。这些城市已成为三大举措的干预目标，为进行自然实验提供了机会。这项研究的目的是促进我们对环境因素与儿童肥胖及相关行为之间关系的理解，评估特定环境干预措施的影响，并展示一种社区干预措施受控评估的创新方法。将检验三个研究问题和内隐假设：1)儿童接触社区食物环境、学校食物环境、社区PA环境和学校PA环境的变化对饮食和PA行为的变化有何相对影响？2)儿童接触社区食物环境、学校食物环境、社区PA环境和学校PA环境的变化对儿童体重状况变化的相对影响是什么？3)对环境的感知和获得障碍在这些关系中扮演了什么角色？研究设计依赖于对这些城市中随机选择的1200名儿童进行的前瞻性纵向研究。研究小组收集了2009-2010年间肥胖相关行为和体重指数的全面基线数据。这些数据还包括这些儿童所处的食物和体育活动环境的记录(地理编码以供分析)。将在四年内重复全面收集有关儿童的数据，并在同一时期监测环境的相关变化。变化可能包括健康饮食或体育活动的新机会(例如，新的超市、游乐场)；现有机会的显著加强(例如，在便利店增加健康食品，扩大学校的体育课)，以及与非干预相关的变化(例如，零售店关闭)。个人水平的接触将通过环境变化与每个儿童住所的接近程度来衡量(使用地理空间方法)。该分析将评估暴露在这些变化中对一系列综合结果的影响，包括与食物消费和PA相关的行为以及体重状况。研究设计有助于在隔离特定干预策略的影响方面进行特殊程度的控制。该项目对政策的影响将被放大，因为研究人员与研究城市的利益相关者建立了广泛的关系，正在努力传播最近进行的横断面研究的结果，以及罗格斯州立卫生政策中心为新泽西州和全国各地的州一级政策提供信息的历史。 与公共健康相关：有证据表明，儿童肥胖受到学校和社区食物和体育活动环境的影响(例如，超市、操场的存在，学校自动售货机上的健康产品)。然而，难以区分环境的特定因素(例如，超市的存在)和其他因素(例如，自动售货机中的产品)的影响，破坏了预防儿童肥胖的有效干预措施的规划。为了为设计更成功的策略提供证据，该项目将使用一种创新的方法，在新泽西州五个拥有大量低收入和少数族裔人口的城市中，分离环境的不同方面对儿童体重状况和行为的影响。

DESCRIPTION (provided by applicant): The proposed project will conduct a controlled evaluation of the impact of changes in the food and physical activity (PA) environments on childhood obesity and related behaviors in five New Jersey cities. These cities have been targeted for interventions by three major initiatives, affording the opportunity to conduct a natural experiment. The study aims are to advance our understanding of the relationship between elements of the environment and childhood obesity and related behaviors, assess the impact of specific environmental interventions, and demonstrate an innovative methodology for controlled evaluation of community interventions. Three research questions and implicit hypotheses will be tested: 1) What is the relative impact of children's exposure to changes in the community food environment, the school food environment, the community PA environment, and the school PA environment on changes in eating and PA behaviors? 2) What is the relative impact of children's exposure to changes in the community food environment, the school food environment, the community PA environment, and the school PA environment on changes in children's weight status? 3) What roles do perceptions of the environment and barriers to access play in these relationships? The research design relies upon a prospective, longitudinal study of a randomly selected panel of 1200 children in these cities. The research team collected comprehensive baseline data on obesity-related behaviors and body mass index in 2009-2010. The data also include documentation of the food and physical activity environments to which these children were exposed (geo-coded for analysis). Comprehensive data collection on children will be repeated in four years and relevant changes in the environment will be monitored over the same period. Changes may include presence of new opportunities for healthy eating or physical activity (e.g., new supermarkets, playgrounds); significant enhancement of existing ones (e.g., addition of healthy foods to convenience stores, expanded physical education in schools), as well as non-intervention related change (e.g., retail outlets that close). Individual-level exposure will be measured by proximity of the environmental change to each child's residence (using geo-spatial methods). The analysis will evaluate the impact of exposure to these changes on a comprehensive set of outcomes including behaviors relevant to food consumption and PA as well as weight status. The research design facilitates an exceptional degree of control in isolating the effects of particular intervention strategies. The project's impact on policy will be amplified by the researchers' extensive relationships with stakeholders in the studied cities, ongoing efforts to disseminate findings from the recently conducted cross-sectional study, and the Rutgers Center for State Health Policy's history of informing state-level policy in NJ and around the nation. PUBLIC HEALTH RELEVANCE: There is evidence that childhood obesity is affected by aspects of the food and physical activity environment in schools and communities (e.g., presence of supermarkets, playgrounds, healthy offerings in school vending machines). However, difficulties in separating the impact of particular elements of the environment (e.g., presence of supermarkets) from that of others (e.g., offerings in vending machines) has undermined planning of effective interventions to prevent childhood obesity. To provide evidence for designing more successful strategies, this project will use an innovative methodology to separate the impact of various aspects of the environment on children's weight status and behaviors in five New Jersey cities with large low-income and minority populations.