Head Start Exposure and Changes in Children's Body Mass Index

描述（由申请人提供）：儿童肥胖症仍然是一个重大的公共卫生问题，最近估计4岁儿童肥胖症的患病率为18%。儿童肥胖症一旦确立，很可能会跟踪到成年期，预防肥胖症比一旦确立就治疗肥胖症有效得多。因此，需要在幼儿期实施有效的肥胖预防计划，但迄今为止还没有确定有效的干预措施，这些干预措施具有强大和持久的效果。儿童肥胖症在低收入和少数民族儿童中也更为常见，因此，特别需要对这一群体采取有效的干预措施。“先声夺人”是美国联邦政府资助的一项学前教育计划，免费向生活在联邦贫困线以下的3至5岁儿童提供。它每年为美国近100万儿童提供服务，并覆盖所有合格儿童的一半以上。为了获得联邦资助，“先声夺人”方案必须遵守具体的绩效标准，这些标准规范了大量与健康、营养和体育活动有关的方案。尽管有广泛的覆盖面和规范的肥胖相关规划，但迄今为止，尚未评估Head Start暴露与低收入儿童肥胖患病率的有益影响之间的潜在联系。没有任何国家数据库包含参加“开端教育”的儿童的人体测量数据，尽管每个“开端教育”方案都要求保存这些数据。拟议的项目将利用现有的头开始人体测量数据，从儿童入学的头开始计划在密歇根州在过去5年来评估儿童的生长模式的变化在学年（而入学的头开始），相比夏季（当没有注册）。该项目的3个目标是：目标1：在两个学年内，测试“领先”暴露对低收入儿童的身体质量指数（BMI）有有益影响的假设。我们预计，这些影响将在夏季期间减弱，并且使用较少的Head Start暴露/剂量。目标二：为了验证这一假设，即Head Start对低收入儿童BMI的有益影响将与Head Start肥胖预防特定程序和菜单的营养质量相关。目标3：为了检验这一假设，即开端暴露对儿童BMI的有益影响受到环境/基于场所的特征的调节，包括邻里社会组织混乱、与公园和绿色空间的接近度/距离以及杂货店的位置和类型。该项目将具有广泛的公共卫生影响，因为它将确定是否是一个有效的预防或治疗低收入儿童肥胖的方法。此外，它将通过向密歇根州周围的方案提供反馈产生直接影响，这些方案可能会告知方案的变化，以最大限度地发挥个别方案的效果。

DESCRIPTION (provided by applicant): Childhood obesity continues to be a significant public health concern, with the prevalence of obesity among 4- year-old children most recently estimated at 18%. Childhood obesity, once established, is very likely to track into adulthood and prevention of obesity is much more effective than treating obesity once it is established. Effective obesity prevention programs in early childhood are therefore needed, but there have been no effective interventions identified to date that have robust and lasting effects. Childhood obesity is also more common among low-income and minority children, and effective interventions are therefore particularly needed for this group. Head Start is a United States federally-funded preschool program that is free to 3- to 5-year-old children living below the federal poverty line. It serves nearly one million children across the United States each year, and reaches more than half of all eligible children. In order to receive federal funding, Head Start programs are required to adhere to specific performance standards that regulate a substantial amount of programming related to health, nutrition, and physical activity. Despite the broad reach and well-regulated obesity-relevant programming, there has been no evaluation to date of the potential link between Head Start exposure and beneficial effects on obesity prevalence among low-income children. There is no national database that contains anthropometric data of the children enrolled in Head Start, even though every Head Start program is required to maintain these data. The proposed project will utilize existing Head Start anthropometric data from children enrolled in Head Start programs in the state of Michigan over the past 5 years to evaluate changes in children's growth patterns during the academic year (while enrolled in Head Start), compared to the summertime (when not enrolled). The 3 aims of this project are: Aim 1: To test the hypothesis that Head Start exposure will have beneficial effects on the body mass index (BMI) of low-income children during two academic years. We expect that these effects will weaken during the intervening summer, and with less Head Start exposure/dosage. Aim 2: To test the hypothesis that the beneficial effects of Head Start on the BMI of low-income children will be associated with Head Start obesity prevention-specific programming and the nutrition quality of menus. Aim 3: To test the hypothesis that the beneficial effects of Head Start exposure on children's BMI are moderated by environmental/place-based characteristics including neighborhood social disorganization, proximity/distance to parks and green spaces, and grocery store location and type. This project will have broad public health implications in that it will determine if Head Start enrollment is an effective preventive or treatment approach to childhood obesity among low-income children. In addition, it will have an immediate impact by providing feedback to programs around the state of Michigan which may inform programming changes to maximize the effects of individual programs.