Evaluating Economic Subsidies To Improve Dietary Intake Among Low Income Families

描述（由申请人提供）：本申请涉及广泛的挑战领域（05）比较有效性研究和特定的挑战主题，05-MD-101：健康的社会决定因素。为了改善膳食摄入量并解决低收入儿童肥胖症高发的问题，美国农业部食品和营养服务局（USDA-FNS）在《联邦公报》上发布了一项临时规则，修订了妇女、婴儿和儿童特别补充营养计划（WIC）中的食品包装。妇女、儿童和社区为800多万低收入儿童和妇女提供补充食品。为了回应医学研究所的建议，美国农业部食品和营养服务局提议将WIC食品包装与美国人膳食指南相一致。在这些修订中，有脂肪含量的变化（例如，低脂牛奶）和纤维含量（例如，全麦面包）的食品批准购买WIC券，并增加了每月水果和蔬菜券。这些拟议的修改将于2009年8月生效。我们建议研究修订后的WIC计划对低收入儿童水果，蔬菜，纤维和低脂食品消费的影响，与当前WIC计划下的消费水平相比，我们将研究影响饮食摄入的个人，人际和社区机制。这项拟议的研究之所以重要，有几个原因。1)它提供了一个难得的机会来评估国家政策转变对粮食援助的影响，以支持低收入家庭的健康饮食。这一国家政策转变有可能改善健康饮食，在解决低收入人群中与饮食有关的健康差距，特别是肥胖方面可能特别重要。2)决策者越来越多地表示有兴趣利用经济补贴来改善饮食摄入和健康结果。从比较有效性的角度来看，我们将能够评估改善健康食品的获得是否会改变食物摄入量，并最终改变体重状况。3)拟议的研究将建立在一个试点项目（芝加哥WIC食品环境调查）的基础上，我们目前正在与伊利诺伊州人类服务部（IDHS）合作进行，该部门负责该州的WIC管理，以及芝加哥大主教管区的天主教慈善机构，负责芝加哥的WIC分配。该试点计划于2009年5月至7月进行，将为在2009年8月实施新政策之前评估WIC方案提供必要的基线数据（0个月）。4)与这两个机构合作，我们有能力将纵向代金券领取和代金券兑换数据与报告的饮食摄入量，重要的社会背景变量以及政策前18个月的儿童体重增加轨迹联系起来（知情同意）。拟议的研究还将使我们能够创造五个新的职位，并保留两名因项目完成而失去的现有员工。该项目包括七个全职员工，福利包括伊利诺伊大学的全额学费减免和所有符合福利条件的员工的健康保险福利。这对寻求进一步教育机会和稳定健康福利的个人特别有吸引力。该项目的面试者将获得研究技能，这将增加他们未来的市场竞争力。这项研究的总体目的是研究食品援助计划中提供的经济激励措施影响儿童膳食摄入的机制。我们目前正在收集政策实施前的基线数据（0个月），拟议研究的目的是纵向跟踪这300对母子，在政策实施后的6个月，12个月和18个月。主要目标1。比较政策实施前和实施后6个月、12个月和18个月儿童的水果和蔬菜摄入量。2.比较政策实施前和实施后6个月、12个月和18个月儿童的脂肪和纤维摄入量。3.研究个人，人际关系和社区机制影响饮食摄入量之前，并在6，12和18个月后的政策实施。次要目标1。比较政策实施前和实施后6个月、12个月和18个月母亲的FV摄入量。2.比较政策实施前和实施后6个月、12个月和18个月母亲的脂肪和纤维摄入量。探索目标1.比较政策实施前和政策实施后6个月、12个月和18个月的代金券领取和兑换情况。2.研究300名学龄前儿童在政策实施前到政策实施后18个月的体重增加轨迹。为了改善饮食摄入量，解决低收入儿童肥胖症高发的问题，妇女、婴儿和儿童特别补充营养方案计划修改其食品包装。这项拟议研究的总体目的是研究大型食品援助计划中提供的经济激励措施影响儿童膳食摄入的机制。如果计划的经济激励措施改善了这些高危儿童的饮食摄入量，改变了体重增加的轨迹，这可能对这一人群的健康差异产生深远的影响。

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (05) Comparative Effectiveness Research and specific Challenge Topic, 05-MD-101: Social Determinants of Health. In an effort to improve dietary intake and address the high prevalence of obesity among low-income children, the US Department of Agriculture Food and Nutrition Service (USDA-FNS) published an interim rule in the Federal Register revising the food packages in the Special Supplemental Nutrition Program for Women Infants and Children (WIC). WIC provides supplemental food to more than 8 million low-income children women. In response to recommendations from the Institutes of Medicine, the USDA Food and Nutrition Service proposed to align WIC food packages with the Dietary Guidelines for Americans. Among the revisions are changes in the fat content (e.g., reduced fat milk) and the fiber content (e.g., whole grain bread) of foods approved for purchase with WIC vouchers and the addition of a monthly fruit and vegetable voucher. These proposed changes will go into effect in August 2009. We propose to examine the effect of the revised WIC program on consumption of fruits, vegetables, fiber, and reduced-fat foods by low-income children compared to consumption levels under the current WIC program, and we will examine the individual, interpersonal, and community mechanisms that affect dietary intake over the course of the study. The proposed study is important for several reasons. 1) It provides a rare opportunity to evaluate the impact of a national policy shift in food assistance to support healthy eating in low- income families. This national policy shift has the potential to improve healthful eating and may be particularly important in addressing diet-related health disparities, particularly obesity, among low-income individuals. 2) Policymakers are increasingly expressing interest in the use of economic subsidies to improve dietary intake and health outcomes. From a comparative effectiveness perspective, we will be able to assess whether improving access to healthy food changes food intake and ultimately, weight status. 3) The proposed study will build on a pilot project (Chicago WIC Food Environment Survey) we are currently conducting in collaboration with the Illinois Department of Human Services (IDHS), which is responsible for WIC administration in the state, and the Catholic Charities of the Archdiocese of Chicago, the group responsible for WIC distribution in Chicago. The pilot, scheduled for May-July 2009, will provide essential baseline data (0 months) for evaluating the WIC program prior to implementation of the new policy in August 2009. 4) In conjunction with these two agencies, we have the ability to link longitudinal voucher pick-up and voucher redemption data with reported dietary intake, important social contextual variables, and child weight gain trajectory over the first 18 months of the policy (with informed consent). The proposed study will also allow us to create five new positions and retain two current employees that would have been lost due to project completions. The project includes seven FTEs with benefits including a full tuition waiver from the University of Illinois and health insurance benefits for all benefit-eligible employees. This will be particularly appealing to individuals who are seeking further educational opportunities and stable health benefits. Interviewers from the project will gain research skills that will increase their future marketability. The overall purpose of the proposed study is to examine the mechanisms by which economic incentives offered in food assistance program impact dietary intake of children. We are currently collecting pre-policy implementation baseline data (0 months), and the aims of the proposed study are to follow these 300 mother/child dyads, longitudinally, at 6, 12, and 18 months post-policy implementation. Primary Aims 1. To compare fruit and vegetable (FV) intake of children before and at 6, 12, and 18 months following policy implementation. 2. To compare fat and fiber intake of children before and at 6, 12, and 18 months following policy implementation. 3. To examine the individual, interpersonal, and community mechanisms influencing dietary intake before and at 6, 12, and 18 months following policy implementation. Secondary Aims 1. To compare FV intake of mothers before and at 6, 12, and 18 months following policy implementation. 2. To compare fat and fiber intake of mothers before and at 6, 12, and 18 months following policy implementation. Exploratory Aims 1. To compare pick-up and redemption of vouchers before and at 6, 12, and 18 months following policy implementation. 2. To examine weight gain trajectory of 300 preschool children prior to policy implementation through 18 months post policy implementation. In an effort to improve dietary intake and address the high prevalence of obesity among low-income children, the Special Supplemental Nutrition Program for Women Infants and Children (WIC) plans to revise their food packages. The overall purpose of the proposed study is to examine the mechanisms by which economic incentives offered in a large food assistance program impacts dietary intake of children. If the planned economic incentives produce improved dietary intake and altered weight gain trajectory among these high-risk children, this could have profound implications for heath disparities in this population.