MULTILEVEL SYSTEMS-ORIENTED CHILDHOOD OBESITY STUDY IN CHINA

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Project Summary: Innovative and culturally appropriate multilevel policy and environmental interventions are greatly needed to address the obesity epidemic in high-risk populations. However, the vast majority of intervention strategies have focused on selected targets and approaches, e.g., educating consumers about healthy food choices, while in many settings reduced access to healthy food choices greatly limits impact. MOPS will test an innovative multi-level intervention, which directly addresses the complex systems associated with childhood eating behaviors and adiposity. Our overarching goal is to develop and evaluate a community based obesity prevention program, which operates at multiple levels of an urban food system (policy, wholesaler, corner stores, carryout, household, individual; in Baltimore, MD), and will improve the healthy food supply chain to increase affordability, availability, purchasing and consumption of healthy foods within low income minority neighborhoods. Our proposed research will include stakeholders/ partners at different levels, e.g., the policy, wholesaler, retailer, adult caregiver, and individual child levels, and then develop, implement, and assess a two year multi-level systems-based child obesity prevention strategy targeting minority and low income children (predominantly AA). Thirty low-income, predominantly AA geographic zones will be identified ("healthy eating zones"). Half of these zones will be randomized to intervention, while the other half will be control. Within each intervention zone we will work with at least 5 small food stores and prepared food sources to increase access to healthy foods through wholesaler discounts, display point of purchase promotional materials, and provide nutrition and food preparation education targeting youth and caregivers. We will work with local policymakers to institutionalize and sustain these changes. The project will evaluate the impact of the program on: a) healthy food pricing and availability, b) low income African American adult food purchasing and preparation, and c) low-income African American youth diet, and associated psychosocial factors. The proposed intervention trial directly addresses the RFA by utilizing a systems-based approach to test and evaluate structural interventions at multiple levels.