Understanding Disparities in Obesity and its Comorbidities in the US

描述（由申请人提供）：了解美国肥胖及其合并症的差异肥胖/超重已经成为美国的公共卫生危机，目前影响着2/3的成年人和1/3的儿童。肥胖可以作为不健康生活方式的良好指标，如不健康的饮食和身体活动不足（PA），这是包括2型糖尿病（T2D）和高血压（HBP）在内的许多慢性疾病的两个关键可改变的危险因素。全国数据显示，在肥胖、糖尿病、高血压和医疗保健方面，种族/社会地位存在巨大差异。肥胖被认为是大量生物、行为、社会、环境和经济因素以及它们之间促进正能量平衡的复杂相互作用的结果。人们对这些差异的决定因素仍然知之甚少。根据越来越多的文献，人们对主要因素进行了许多推测，这些文献主要集中在个人因素上，如社会地位、身体形象和生活方式因素，以及最近一些关于选定社区特征的研究。我们对这些因素的相对贡献、它们之间的相互作用以及社会、经济和环境背景对个人行为的影响的理解是有限的。我们提出的为期3年的研究是一项基于全国性调查、大型队列研究和其他来源收集的数据的系统调查，旨在了解美国成人和儿童肥胖及其合并症（T2D和HBP）中种族/社会地位差异的原因，以及相关的医疗保健。我们将采用跨学科的方法，使用几种复杂的统计方法来研究个人、家庭和社区水平的决定因素：目的1：研究肥胖和主要合并症中种族/社会经济地位差异的可改变决定因素。我们将研究个人、家庭和社区层面的风险因素的贡献（绝对和相对而言），包括社会心理、行为、环境、经济和政策因素。目标1a：研究个人水平（如饮食、PA、SES、社会支持、心理社会因素）和家庭水平变量（如SES、参与食品援助计划、父母与子女在饮食、PA和体重状况方面的相似性）的贡献；目标1b：研究社会环境因素的贡献（例如，食品销售点，健身设施，食品价格，社区特征，学校体育和休息政策，学校餐饮服务）。目标1c：从多个层面同时考虑所有相关因素，研究其相对贡献。目的1d：采用类似的方法研究T2D和HBP。目标1e：进行生态/汇总分析，研究州和大都市统计区（MSA）水平差异的根本原因。目的2：研究初级卫生保健对肥胖差异的影响以及卫生保健（与肥胖相关）差异的原因。目标3：使用系统分析方法进行模拟分析，以检查有助于消除种族/社会地位差异的潜在干预措施和情景的影响。这项研究的结果将有助于实现NIH PAR中规定的几个目标，并有助于指导未来的干预措施，以消除健康差距。公共卫生相关性：这项拟议的为期3年的研究是一项基于国家调查和其他来源的数据的系统调查，旨在通过跨学科的方法了解美国肥胖及其合并症（包括2型糖尿病和高血压）中种族/社会地位差异的个人、家庭和社区层面的原因，以及相关的医疗保健。

DESCRIPTION (provided by applicant): Understanding Disparities in Obesity and Its Comorbidities in the U.S. Obesity/overweight has become a public health crisis in the U.S., and currently affects 2/3 of adults and 1/3 of children. Obesity can serve as a good indicator of unhealthy lifestyles such as unhealthy diet and inadequate physical activity (PA), two key modifiable risk factors for many chronic diseases including Type 2 diabetes (T2D) and hypertension (HBP). National data show large ethnic/SES disparities in obesity, T2D, HBP and healthcare. Obesity is believed as the result of a large number of biological, behavioral, social, environmental and economic factors and the complex interactions between them that promote a positive energy balance. The determinants of these disparities are still poorly understood. Many speculations have been made regarding the major contributors based on a growing body of literature, which has focused largely on individual factors such as SES, body image, and lifestyle factors and in some recent studies regarding selected community characteristics. Our understanding of the relative contribution of these factors, the interplay between them, and the social, economic and environmental context on individual-level behaviors is limited. Our proposed 3-year study is a systematic investigation based on data collected from national surveys, large cohort studies and other sources and aims to understand the causes of ethnic/SES disparities in obesity and its co-morbidities (T2D and HBP) as well as the related health care in the U.S., both adults and children. We will use an interdisciplinary approach to study the determinants at the individual-, family-, and community- level using several sophisticated statistical methods: Aim 1: To study the modifiable determinants of ethnicity/SES disparities in obesity and main co-morbidities. We will study the contributions (in absolute and relative terms) of risk factors at the individual-, family-, and community-level, including psychosocial, behavioral, environmental, economic, and policy factors. Aim 1a: Study the contribution of individual-level (e.g., diet, PA, SES, social support, psychosocial factors), and family-level variables (e.g., SES, participation in food assistance programs, resemblance between parents and their children in diet, PA, and weight status); Aim 1b: Study the contribution of social context factors (e.g., food outlets, fitness facilities, food prices, community characteristics, school PE and recess policies, school food service). Aim 1c: Consider all related factors at multi-levels simultaneously to study their relative contributions. Aim 1d: Using similar approaches study T2D and HBP. Aim 1e: Conduct ecological/ aggregated analysis to study the underlying causes of the disparities at the state and metropolitan statistical area (MSA) levels. Aim 2: To study the influence of primary healthcare on the disparities of obesity and the causes of health care (related to obesity) disparities. Aim 3: To conduct simulation analyses using systems analysis approaches to examine the effects of potential interventions and scenarios for helping eliminate the ethnicity/SES disparities. Findings of this study will help achieve several of the objectives specified in the NIH PAR, and help direct future interventions to eliminate health disparities. PUBLIC HEALTH RELEVANCE: The proposed 3-year study is a systematic investigation based on data from national surveys and other sources to understand the individual-, family-, and community-level causes of ethnic/SES disparities in obesity and its co-morbidities including type 2 diabetes and hypertension as well as the related health care in the U.S. using an interdisciplinary approach.