Understanding Disparities in Obesity and its Comorbidities in the US

描述(申请人提供)：了解美国肥胖及其合并症的差异。肥胖/超重已成为美国的公共健康危机，目前影响到三分之二的成年人和三分之一的儿童。肥胖可以作为不健康生活方式的一个很好的指标，例如不健康的饮食和缺乏体力活动(PA)，这是许多慢性病的两个关键的可改变的风险因素，包括2型糖尿病(T2D)和高血压(HBP)。国家数据显示，在肥胖、T2D、HBP和医疗保健方面，种族/SES存在很大差异。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。对这些差异的决定因素仍然知之甚少。基于越来越多的文献，人们对主要贡献者进行了许多猜测，这些文献主要集中在个人因素上，如社会经济地位、身体形象和生活方式因素，以及最近关于选定的社区特征的一些研究。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层面行为的理解是有限的。我们建议的为期3年的研究是一项基于从全国调查、大型队列研究和其他来源收集的数据的系统调查，旨在了解美国成年人和儿童肥胖及其共病(T2D和HBP)的种族/SES差异的原因以及相关的医疗保健。我们将使用跨学科的方法，使用几种复杂的统计方法，在个人、家庭和社区层面上研究决定因素：目标1：研究肥胖和主要共病的种族/SES差异的可改变的决定因素。我们将研究风险因素在个人、家庭和社区层面的贡献(绝对和相对)，包括心理社会、行为、环境、经济和政策因素。目标1a：研究个人层面(例如，饮食、PA、SES、社会支持、心理社会因素)和家庭层面变量(例如，SES、食物援助计划的参与度、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：研究社会背景因素(例如，食物供应渠道、健身设施、食品价格、社区特征、学校体育和休息政策、学校食品服务)的贡献。目标1c：从多个层面同时考虑所有相关因素，以研究它们的相对贡献。目的1D：用相似的方法研究T2D和HBP。目标1e：进行生态/综合分析，以研究州和大都市统计区域(MSA)层面差异的根本原因。目的2：研究初级卫生保健对肥胖差异的影响及(与肥胖相关的)卫生保健差异的原因。目标3：使用系统分析方法进行模拟分析，以检查潜在干预措施和情景的影响，以帮助消除种族/社会经济差异。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全国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，了解美国肥胖的种族/SES差异及其共病(包括2型糖尿病和高血压)以及相关医疗保健的个人、家庭和社区层面的原因。

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.