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

描述（由申请人提供）：拟议的项目将进行一个控制评估的影响，在食品和体育活动（PA）环境的变化对儿童肥胖和相关行为在五个新泽西城市。这些城市已成为三项主要举措的干预目标，为进行自然实验提供了机会。该研究旨在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，并展示一种用于社区干预措施控制评估的创新方法。三个研究问题和隐含的假设将被测试：1）什么是儿童的暴露于社区食品环境，学校食品环境，社区PA环境，学校PA环境的变化，在饮食和PA行为的变化的相对影响？2)儿童暴露于社区食物环境、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)在这些关系中，对环境的看法和获取的障碍发挥了什么作用？ 研究设计依赖于一个前瞻性的，纵向的研究，随机选择的1200名儿童在这些城市。研究小组在2009-2010年收集了与肥胖相关的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接触的食物和体力活动环境的文件（地理编码用于分析）。将在四年内重复收集关于儿童的全面数据，并在同一时期监测环境的有关变化。变化可能包括健康饮食或体育活动的新机会的存在（例如，新的超市，游乐场）;显著增强现有的（例如，在便利店增加健康食品，在学校扩大体育教育），以及与非干预相关的变化（例如，关闭的零售店）。将通过环境变化与每个儿童住所的接近程度（使用地理空间方法）来衡量个人接触水平。该分析将评价暴露于这些变化对一系列综合结局的影响，包括与摄食量和PA以及体重状态相关的行为。研究设计有利于在隔离特定干预策略的影响的特殊程度的控制。该项目对政策的影响将通过研究人员与所研究城市的利益相关者的广泛关系，持续努力传播最近进行的横断面研究的结果，以及罗格斯州卫生政策中心在新泽西州和全国各地宣传州级政策的历史来放大。 公共卫生相关性：有证据表明，儿童肥胖受学校和社区的食物和体育活动环境的影响（例如，超市、游乐场、学校自动售货机中的健康产品）。然而，难以区分环境的特定要素的影响（例如，超市的存在）与其它的（例如，自动售货机提供的食品）破坏了预防儿童肥胖症的有效干预措施的规划。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来分离环境的各个方面对儿童的体重状况和行为的影响，在五个新泽西城市，大量的低收入和少数民族人口。

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.