Increasing Low-income Children's Access to Healthy Structured Programming to Reduce Obesity

增加低收入儿童获得健康结构化规划的机会以减少肥胖

• 批准号: 10654378
• 负责人: Robert G Weaver
• 金额: $ 45.25万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-15 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10654378
• 关键词: Address; Administrator; Adult; Age; Behavior; Body fat; Body mass index; Calendar; Child; Communities; Diet; Disparity; Effectiveness; Environment; Family; Fatty acid glycerol esters; Fee-for-Service Plans; Food; Health; Hour; Household; Incentives; Income; Intervention; Interview; Learning; Literature; Low income; Obesity; Outcome; Overweight; Parents; Participant; Physical activity; Play; Policies; Prevalence; Public Health; Randomized; Recording of previous events; Reporting; Role; Schools; Services; Side; Sleep; Sleep disturbances; Structure; Testing; Time; United States; United States Department of Agriculture; Weight; Weight Gain; after-school program; cost; cost-effectiveness evaluation; design; disparity reduction; excessive weight gain; experience; food insecurity; fourth grade; good diet; implementation barriers; income disparities; innovation; learning community; lower income families; novel; nutrition; obesity in children; obesity treatment; obesogenic; prevent; primary outcome; program costs; programs; secondary outcome; sleep pattern; summer program; systematic review; treatment program; voucher

Disparities in overweight and obesity (OWOB) prevalence between children (ages 5-11) from low- and middle-to- high-income families persist. The structured days hypothesis posits that structure within a day, defined as a pre- planned, segmented, and adult-supervised compulsory environment (like a school day), plays a protective role for children against obesogenic behaviors and, ultimately, prevents the occurrence of negative health outcomes, such as excessive weight gain. Essentially, the structured days hypothesis draws upon concepts in the ‘filled-time perspective’ literature which posits that time filled with favorable activities cannot be filled with unfavorable activities. There are at least two “windows of vulnerability” for children outside of the school day. These critically important windows include the hours immediately following school (i.e., 3-6pm school days) and the 10 weeks of summer vacation. Programs that can provide a healthy structured environment and prevent unhealthy weight gains exist for both of these time periods (i.e., afterschool programs and summer day camps). Unfortunately, these programs are too expensive for children from low-income families to attend. Thus, based on demand-side financing, which has a long history addressing large scale public health problems in the United States through federal, state, and local programs like the Supplemental Nutrition Assistance Program and the 21st Century Learning Centers Program, we will rigorously test the impact of providing access to pre-existing, community- operated afterschool and summer programs on weight status (i.e., BMI z-score) and obesogenic behaviors (i.e., physical activity, screen use, diet, and sleep) of elementary children from low-income households. This approach will potentially be less costly than current obesity treatment programs which cost up to $4,600 per child. This study will employ a 2x2 full factorial design. The four groups will be a no-treatment control, afterschool program voucher only, summer day camp voucher only, and vouchers for afterschool and summer day camp combined. We will accomplish the following specific aims: AIM 1: Compare differences in primary and secondary outcomes among children provided no voucher, a voucher for after-school only, a voucher for summer camp only, and a voucher for both after-school and summer camp. AIM 2: Evaluate the cost-effectiveness of providing a voucher for after-school only, a voucher for summer camp only, and a voucher for both after-school and summer camp. Aim 3: Evaluate facilitators and barriers to the implementation, effectiveness, and sustainability of the voucher program by conducting qualitative interviews with key stakeholders (i.e., children, parents, staff, administrators). This study is significant because nearly one in five children are obese, and disparities in OWOB exist between children from low- and middle-to-high-income households persist despite past school-based interventions. This study is innovative because it represents one of the first attempts to provide access to healthy structured programming during two “windows of vulnerability” for children outside of the school day. Should the proposed intervention strategy prove effective, it has the potential to mitigate disparities in OWOB prevalence.

中低体重儿童（5-11 岁）超重和肥胖 (OWOB) 患病率的差异 高收入家庭依然存在。结构化日假说假定一天内的结构，定义为预 有计划、分段、有成人监督的强制环境（如上学日），对儿童起到保护作用 儿童反对肥胖行为，并最终防止负面健康结果的发生，例如 由于体重增加过多。从本质上讲，结构化日假说借鉴了“充实的时间”中的概念 观点的文献认为，充满有利活动的时间不能充满不利活动。 在校外，孩子们至少有两个“脆弱之窗”。这些至关重要 窗口包括放学后的时间（即上课日下午 3 点至 6 点）和夏季的 10 周 假期。现有的计划可以提供健康的结构化环境并防止不健康的体重增加 这两个时间段（即课后计划和夏令营）。不幸的是，这些 对于低收入家庭的孩子来说，参加这些项目的费用太高。因此，根据需求方 融资，在解决美国大规模公共卫生问题方面有着悠久的历史 联邦、州和地方计划，例如补充营养援助计划和 21 世纪计划 学习中心计划，我们将严格测试提供对现有社区的访问的影响 开展关于体重状况（即 BMI z 分数）和肥胖行为（即 低收入家庭小学生的体力活动、屏幕使用、饮食和睡眠）。这种做法 与目前每个儿童高达 4,600 美元的肥胖治疗计划相比，该计划的成本可能更低。这 研究将采用 2x2 全因子设计。这四组将是无治疗对照的课后计划 仅优惠券、​​仅夏令营优惠券、以及课后和夏令营组合优惠券。我们 将实现以下具体目标： 目标 1：比较主要和次要结果的差异 儿童中没有提供优惠券、仅提供课后优惠券、仅提供夏令营优惠券、以及 课后和夏令营的优惠券。目标 2：评估提供优惠券的成本效益 仅适用于放学后的优惠券、仅适用于夏令营的优惠券以及适用于课后和夏令营的优惠券。 目标 3：评估优惠券实施、有效性和可持续性的促进因素和障碍 通过与主要利益相关者（即儿童、家长、工作人员、管理人员）进行定性访谈来制定计划。 这项研究意义重大，因为近五分之一的儿童患有肥胖症，并且 OWOB 之间存在差异 尽管过去采取了以学校为基础的干预措施，但来自低收入和中高收入家庭的儿童仍然存在。这 研究具有创新性，因为它代表了提供健康结构化的途径的首次尝试之一 在校外儿童的两个“脆弱窗口”进行规划。如果建议 干预策略被证明是有效的，它有可能缩小 OWOB 患病率的差异。