Using implementation mapping to maximize equity of school-based policies for obesity prevention

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PROJECT SUMMARY The overall goal of this K01 award is to provide Gabriella McLoughlin, PhD, MS, with the training and mentorship to establish an independent program of research focused on improving implementation of Policy, Systems, and Environmental (PSE) interventions for childhood obesity and cardiovascular disease prevention. Childhood obesity disparities have been exacerbated in recent years, such that children from racial/ethnic minority and low-income backgrounds are most at risk. Multiple factors, such as increased food insecurity resulting in a low-quality diet, contribute to this increased threat. Childhood obesity tracks into adulthood, increasing the risk of cardiovascular disease, and warranting sustainable interventions for youth to address social determinants of health. Since children and adolescents consume over half of their energy intake at school, providing free nutrient-rich breakfast and lunch to low-income youth through Universal School Meals (USM) is a key PSE approach to addressing obesity disparities. Adoption of USM is linked with reductions in obesity risk for low-income students, improved diet quality, reduced food insecurity, and enhanced academic achievement outcomes. Unfortunately, schools adopting USM report consistent challenges to its implementation such as low student participation and financial difficulty in adhering to Federal nutrition requirements. Programs and policies designed to mitigate health disparities for obesity cannot make the most impact if they are not reaching their target population. Because the federal reimbursement rate for schools is tied to the number of students receiving school meals, maintaining participation is critical to making USM financially feasible. The purpose of this K01 award is to conduct an implementation mapping procedure with the School District of Philadelphia (SDP), resulting in the development and testing of an equity-focused implementation strategy for USM. This will be achieved through three aims: 1) Investigate determinants of USM implementation through a health equity lens; 2) Develop and tailor a USM implementation strategy through a community-engaged approach; and 3) Evaluate the implementation and student health outcomes of the implementation strategy. To accomplish these aims and prepare for a larger implementation effectiveness trial, the applicant will receive rigorous formal training in 1) assessing implementation determinants grounded in health equity 2) community-engaged implementation mapping, 3) randomized controlled trials, and 4) cost analysis of implementation under the mentorship of Drs. Jennifer Fisher, Omar Martinez, Resa Jones, Ross Brownson, Alex Dopp, and Shiriki Kumanyika. Temple University is the ideal setting for this work given a longstanding relationship with the local community, facilitating Dr. McLoughlin's collaboration with SDP and completion of the study aims through a community-engaged approach. This K01 award holds significant potential for public health impact and will enable Dr. McLoughlin to establish a rigorous program of research to improve PSE implementation and reduce obesity and cardiovascular disease risk in vulnerable populations.