Evaluation of a Comprehensive School Nutrition Enrichment Intervention (CSNEI) in Rural School Districts

农村学区综合学校营养丰富干预措施 (CSNEI) 的评估

• 批准号: 10657714
• 负责人: Christopher Long
• 金额: $ 56.7万
• 依托单位: UNIV OF ARKANSAS FOR MED SCIS
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10657714
• 关键词: Acceleration; Accounting; Address; Age; Agreement; Arkansas; Body mass index; Cardiovascular Diseases; Carotenoids; Child; Chronic Disease; Cluster randomized trial; Communities; Consolidated Framework for Implementation Research; Consumption; Data; Data Collection; Databases; Diabetes Mellitus; Diet Habits; Dietary Intervention; Disparity; Economics; Eligibility Determination; Ensure; Environment; Equity; Ethnic Origin; Evaluation; Exhibits; Face; Food; Food Services; Funding; Guidelines; Health; Health Food; Healthy Eating; Heterogeneity; High School Student; Household; Human Rights; Improve Access; Incidence; Individual; Intake; Intervention; K-12 student; Long-Term Effects; Low income; Malignant Neoplasms; Measures; Menu Planning; Methodology; Modeling; Modification; National Institute on Minority Health and Health Disparities; Nutrition Policy; Nutritional; Obesity; Outcome; Persons; Policies; Population; Prevalence; Price; Process; Race; Recipe; Research; Research Project Grants; Resources; Risk; Rural; Rural Community; Rural Population; Schools; Science; Skin; Social Justice; Students; Testing; Time; Translating; Translations; United States; United States Department of Agriculture; behavioral economics; cluster randomized design; disease disparity; effective intervention; effectiveness evaluation; evidence base; experience; follow-up; food consumption; food quality; fruits and vegetables; health disparity; implementation intervention; implementation study; improved; indexing; innovation; mortality; multidisciplinary; nutrition; obesity prevention; obesity risk; obesity treatment; overweight adults; population based; programs; rural area; rural counties; rural residence; school district; sex; social; social structure; synergism; theories; therapy design; treatment effect; wasting

SUMMARY – PROJECT 1 Nationally, 73.6% of adults are overweight or obese. Rural populations and persons living in low-income households have high rates of obesity. The greatest disparities in obesity prevalence between urban and rural counties are in the southern United States. Arkansas has the sixth highest proportion of rural population (~41%) and the third highest obesity prevalence (37.4%). The CDC estimates 18.5% of children age 2-19 in the US are obese. Arkansas has the third highest rate of obesity for high school students (22.1%) and the fifth highest rate for children in ages 10-17 (20.2%). Obesity contributes to increased diabetes incidence, cancer incidence and mortality, and cardiovascular disease incidence and mortality among rural communities. This application seeks funding to evaluate a Comprehensive School Nutrition Enrichment Intervention (CSNEI) for the first time in rural schools. The primary research question is: “Compared with demographically similar school districts that did not implement the CSNEI, does the CSNEI policy intervention yield improved obesity prevention outcomes among rural K-12 students?” We will conduct a matched-pairs cluster randomized trial with pre-test and repeated post- tests in 6 school districts, 3 implementing CSNEI and 3 matched comparison school districts. The evaluation will include ~11,500 students in 6 school districts: ~5,750 from CSNEP school districts and ~5,750 from matched comparison school districts. The study will explore heterogeneity of treatment effects for race/ethnicity, sex, age, and economic status to understand effects on populations most at risk for obesity. Our specific aims are: Aim 1.A Evaluate the effects of a CSNEI on students' relative (accounting for age and sex) BMI change over time. Aim 1.B Evaluate the short-term and long-term effects of a CSNEI on the nutritional quality of food served in school meals. Aim 1.C Evaluate the short-term and long-term effects of a CSNEI on students' consumption of food served in school meals. Aim 1.D Evaluate the short-term and long-term effects of a CSNEI on students' skin carotenoid levels, as an indicator of fruit and vegetable intake. Aim 2 Conduct an implementation study to document barriers and facilitators of CSNEI implementation in rural schools. We will complete the first implementation study of a CSNEI in rural schools, which will provide critical information to ensure successful implementation of similar interventions in school districts and will be an innovative step to accelerate translation of evidence into broad practice. Existing paradigms for the study of comprehensive school nutrition interventions do not appropriately address needs and potential barriers of rural children, particularly those living in low-income households. This study will fill critical gaps in evidence by rigorously evaluating a CSNEI in rural schools with high proportions of students eligible for free and reduced price meals (>50%); employing a matched-pairs cluster randomized design to compare changes in BMI z-scores over time; and incorporating economic status, age (in months), sex, and race/ethnicity in the analyses.

摘要 – 项目 1 全国范围内，73.6%的成年人超重或肥胖。农村人口和低收入人群 家庭肥胖率很高。城乡肥胖患病率差异最大 县位于美国南部。阿肯色州的农村人口比例排名第六（~41%） 肥胖患病率排名第三（37.4%）。 CDC 估计美国 2-19 岁儿童中有 18.5% 肥胖。阿肯色州高中生肥胖率排名第三（22.1%），排名第五 10-17岁儿童（20.2%）。肥胖导致糖尿病发病率、癌症发病率和 农村社区的死亡率、心血管疾病发病率和死亡率。此应用程序寻求 资助首次在农村评估综合学校营养强化干预措施（CSNEI） 学校。主要研究问题是：“与人口统计相似的学区相比，没有 实施CSNEI，CSNEI政策干预是否能改善肥胖预防结果 农村 K-12 学生？”我们将进行配对整群随机试验，进行预测试和事后重复试验。 在6个学区进行测试，其中3个实施CSNEI学区和3个匹配的比较学区。评估将 包括 6 个学区的约 11,500 名学生：约 5,750 名学生来自 CSNEP 学区，约 5,750 名学生来自匹配的学区 比较学区。该研究将探讨种族/民族、性别、年龄、 和经济状况，以了解对肥胖风险最高的人群的影响。我们的具体目标是： 目标 1.A 评估 CSNEI 对学生相对（考虑年龄和性别）BMI随时间变化的影响。 目标 1.B 评估 CSNEI 对食品营养质量的短期和长期影响 学校伙食。目标 1.C 评估 CSNEI 对学生消费的短期和长期影响 学校膳食中提供的食物。目标 1.D 评估 CSNEI 对学生的短期和长期影响 皮肤类胡萝卜素水平，作为水果和蔬菜摄入量的指标。目标 2 进行实施研究 记录农村学校实施 CSNEI 的障碍和促进因素。我们将完成第一个 农村学校CSNEI实施研究，这将为确保成功提供关键信息 在学区实施类似的干预措施，这将是加速翻译的创新步骤 将证据纳入广泛的实践。学校综合营养干预研究的现有范式 没有适当解决农村儿童，特别是低收入家庭儿童的需求和潜在障碍 家庭。这项研究将通过严格评估农村学校的 CSNEI 来填补证据的关键空白。 有资格获得免费和减价餐的学生比例（>50%）；采用配对集群 随机设计来比较 BMI z 分数随时间的变化；并纳入经济状况、年龄（在 月）、性别和种族/民族。