Systems Approach to Obesity Prevention in Underserved Children in Texas

描述（由申请人提供）：项目摘要/摘要尽管国家为解决儿童肥胖问题做出了大量努力，但这一流行病仍然存在。认识到这些挑战，美国国立卫生研究院（NIH）和医学研究所（IOM）呼吁采取一种系统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、不同种族的超重和肥胖儿童中，与单独的一级预防相比，在一级预防中纳入二级预防计划的儿童肥胖系统方法将降低体重指数（BMI） z分数。干预策略将根据研究人员开发的基于证据的项目组合进行调整。将与研究人员和社区伙伴在奥斯汀和休斯顿的弱势社区集水区进行基于资产的评估；数据将为干预策略的整合提供信息，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、种族多样化的集水区实施和评估一项初级预防肥胖计划。将在2个示范区（n=1614）和2个对照集水区（n=1614）收集关于儿童超重患病率、危险因素、卫生保健服务和社区项目可获得性的基线和2年随访数据。家长、儿童和社区数据将提供匹配的比较数据，以评估初级预防干预的效果。目标2：通过在社区一级预防计划中嵌入一个为期12个月的家庭二级预防计划，实施和评估儿童肥胖系统方法在减少肥胖方面的效果。二级预防体重管理项目将在一级预防集水区对超重/肥胖儿童及其家庭进行。2-12岁超重/肥胖儿童的家庭（总n=576）将随机分配到12个月二级预防计划（实验）或单独预防计划（对照）中，按年龄（2-5岁、6-8岁和9-12岁）分层。结果包括儿童BMI z-score、生活质量测量和项目使用指标。目的3：量化针对儿童肥胖的12个月家庭二级预防项目相对于单纯一级预防的增量成本效益。基于活动的成本计算方法将被用于量化相对于初级预防的提供二级预防项目的增量成本。

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.