Systems Approach to Obesity Prevention in Underserved Children in Texas

描述(由申请人提供)：项目摘要/摘要尽管国家在解决儿童肥胖问题上做出了密集的努力，但该流行病仍然存在。认识到这些挑战，国家卫生研究院(NIH)和医学研究所(IOM)呼吁采取一种以系统为导向的方法来解决儿童肥胖问题。我们假设，在2-12岁的低收入、种族多样化的超重和肥胖儿童中，系统地处理儿童肥胖问题，将二级预防计划嵌入到一级预防中，与单独进行一级预防相比，将降低身体质量指数(BMI)z得分。干预策略将根据研究调查人员开发的循证项目组合进行调整。将与奥斯汀和休斯顿贫困社区集水区的研究和社区合作伙伴一起进行基于资产的评估；数据将为干预战略的整合提供信息，并为项目的可持续性提供结构。我们的具体研究目标是：目标1：在奥斯汀和休斯顿的低收入、种族多元化的集水区实施和评估一级预防肥胖计划。将在2个示范区(n=1614)和2个对照集水区(n=1614)收集有关儿童超重流行率、风险因素以及保健服务和社区计划可获得性的基线和两年跟踪数据。家长、儿童和社区的数据将提供匹配的比较数据，以评估初级预防干预的效果。目的2：通过在社区一级预防计划中嵌入为期12个月的以家庭为基础的二级预防计划，实施和评估儿童肥胖系统方法在减少肥胖方面的效果。二级预防体重管理方案将在一级预防集水区的超重/肥胖儿童及其家庭中实施。超重/肥胖儿童家庭(总计n=576)，年龄2-12岁，将被随机分配到为期12个月的二级预防计划(实验)或单独预防计划(对照)，按年龄(2-5岁、6-8岁和9-12岁)分层。结果包括儿童BMI z评分、生活质量测量和项目使用指标。目的3：量化为期12个月的以家庭为基础的二级预防计划相对于儿童肥胖一级预防的增量成本效益。将使用基于活动的成本计算方法来量化与一级预防相关的二级预防方案的递增成本。

DESCRIPTION (provided by applicant): Project Summary/Abstract Despite intensive national efforts to address childhood obesity, the epidemic persists. Recognizing the challenges, the National Institutes of Health (NIH) and the Institute of Medicine (IOM) have called for a systems-oriented approach to address childhood obesity. We hypothesize that among low-income, ethnically diverse overweight and obese children, aged 2-12 years, a systems approach to child obesity incorporating secondary prevention programs embedded within primary prevention will reduce body mass index (BMI) z-scores compared to primary prevention alone. Intervention strategies will be adapted from the portfolio of evidence-based programs developed by study investigators. An assets-based assessment will be conducted with research and community partners in disadvantaged neighborhood catchment areas in Austin and Houston; data will inform integration of intervention strategies and provide a structure for program sustainability. Our specific study aims are: Aim 1: To implement and evaluate a primary prevention obesity program in low-income, ethnically diverse catchment areas in Austin and Houston. Baseline and 2-year follow-up data on the prevalence of child overweight, risk factors, and the availability of healthcare services and community programs will be collected in 2 demonstration (n=1614) and 2 control catchment areas (n=1614). Parent, child and community data will provide matched comparison data to assess the efficacy of the primary prevention intervention. Aim 2: To implement and evaluate the efficacy of a systems approach to child obesity on reducing obesity by embedding a 12-month family-based secondary prevention program within the community primary prevention program. The secondary prevention weight management program will be conducted with overweight/obese children and their families in the primary prevention catchment areas. Families of overweight/obese children (total n=576), aged 2-12 years, will be randomly assigned to either the 12-month secondary prevention program (experimental) or prevention program alone (control), stratified by age (2-5, 6-8, and 9-12 y). Outcomes include child BMI z-score, quality of life measures, and program use indicators. Aim 3: To quantify the incremental cost-effectiveness of the 12-month family-based secondary prevention program relative to primary prevention alone for child obesity. Activity Based Costing methods will be used to quantify the incremental cost of delivering the secondary prevention program relative to primary prevention.