Reducing Health Disparities in Childhood Obesity Using Financial Incentives in Low-income Households

来自低收入家庭的儿童（6- 12岁）患肥胖症、2型糖尿病和其他疾病的风险较高。 相关的合并症和心脏代谢功能障碍。绝大多数的肥胖预防 针对这些儿童的干预措施在为期9个月的学年中实施，无论是在学校还是在学校期间， 课外活动过去十年来的大量证据一致表明， 在学年期间，从在校或 课外活动在暑假期间取消。观察性研究表明， 度假对致肥胖行为产生负面影响（即，活动，屏幕时间，饮食，睡眠）和 儿童的体重状况，特别是低收入家庭的儿童。新出现的证据表明， 观察性研究表明，当孩子们参加暑期课程时，他们参与了更高水平的 体力活动，消费更多符合联邦儿童营养/热量密度指南的食物/饮料， 保持更稳定的睡眠时间因此，有证据表明，暑期课程发挥了 对儿童的肥胖行为产生有益的影响。不幸的是，低收入家庭的孩子 参加暑期项目的机会有限。拟议的研究建立在科学文献的基础上， 研究需求方融资的影响，如改善成年人健康行为的财政激励措施 以及在低收入人口和发展中国家使用代金券/补贴，并将其 低收入家庭儿童肥胖症的干预方法。我们假设，通过解决 参加暑期项目的成本障碍，增加了现有社区运营的 暑期项目将会出现，这将导致儿童肥胖行为的显著改善。在 反过来，我们假设肥胖行为的改善将导致过度的，不健康的 夏季体重增加。在这项研究中，我们将严格测试提供现有 社区经营的暑期项目，通过使用代金券计划，对体重状况（即，BMI z- 得分）和低收入家庭的1 - 3年级儿童的肥胖行为。采用随机 研究设计，我们将比较420名来自低收入家庭的儿童的体重状况和致肥胖行为的变化 家庭被随机分配到两个条件之一：夏季节目的代金券计划， 比较/控制。由于研究问题的政策性很强，因此本研究具有重要意义 与联邦、州和地方政策制定者的相关性，大多数家长支持使用公共教育。 提供资金，以获得夏季方案。我们认为这项研究是创新的，因为它借鉴了 需求方融资文献，这是广泛用于改变成人的健康行为，并将测试一个新的 和创新的代金券计划，以消除参加现有社区经营的夏季 计划作为一种干预措施，以克服在贫困中成长的健康不利因素。

Children (6-12yrs) from low-income households are at an elevated risk for obesity, type 2 diabetes, and other associated comorbidities and cardiometabolic dysfunction. The vast majority of obesity prevention interventions targeting these children are delivered during the 9-month school-year, either in school or during afterschool programs. Substantial evidence developed over the past decade consistently indicates that all improvements in weight and other health outcomes achieved during the school year from in-school or afterschool programs are erased during summer vacation. Observational studies indicate that summer vacation exerts a negative effect on the obesogenic behaviors (i.e., activity, screen time, diet, sleep) and weight status of children, especially children from low-income households. Emerging evidence from observational studies shows that when children attend summer programs, they engage in higher levels of physical activity, consume more foods/beverages that meet federal guidelines for child nutrition/caloric density, and maintain a more consistent sleep schedule. Thus, evidence indicates that summer programs exert a beneficial influence on children’s obesogenic behaviors. Unfortunately, children from low-income households have limited access to summer programs. The proposed study builds upon the scientific literature that examines the effects of demand-side financing, such as financial incentives to improve adults’ health behaviors and the use of vouchers/subsidies in low-income populations and developing countries, and applies this intervention approach to childhood obesity in low-income households. We hypothesize that by addressing the cost barrier to participating in summer programs, increased attendance at existing community-operated summer programs will occur, and this will lead to marked improvements in children’s obesogenic behaviors. In turn, we hypothesize improvements in obesogenic behaviors will result in a reduction in excessive, unhealthy weight gain over summer. For this study, we will rigorously test the impact of providing access to existing community-operated summer programs, through the use of a voucher program, on weight status (i.e., BMI z- score) and obesogenic behaviors of 1st-3rd grade children from low-income households. Using a randomized design, we will compare changes in weight status and obesogenic behaviors of 420 children from low-income households randomized to one of two conditions: voucher program for summer programming or comparison/control. We believe this study is significant because the research questions are of high policy relevance to federal, state, and local policymakers, with the majority of parents supporting the use of public funds to provide access to summer programs. We believe this study is innovative because it draws from the demand-side financing literature, which is widely used to change adult health behaviors, and will test a novel and innovative voucher program to eliminate cost barriers to attending existing community-operated summer programs as an intervention to overcome the health disadvantages of growing up in poverty.