A Positive Deviance Inquiry into the Protective Health Behaviors of Children during Summer

摘要 一项新的证据表明，在为期3个月的暑假期间，孩子们的体重增加幅度比 他们在整个9个月的学年里都是这样做的。夏季体重的加速增加是 低收入家庭的孩子比收入较高的同龄人要高得不成比例。 对对夏天做出积极反应的儿童的研究(例如，保持或减轻体重，增加活动/睡眠， 减少屏幕时间，改善饮食)可以让我们深入了解是什么让一些孩子克服障碍 与夏季体重加速增加有关，而其他人则不是。为了解决这个重要的问题，我将 使用正偏差框架并将其应用于儿童肥胖。正偏差(PD) 框架提出，在任何人群中，都有那些设法从事健康行为的人 尽管经历了与那些没有经历过类似障碍的人。PD框架被用来解决 营养不良、婴儿死亡率和传染病等复杂的公共卫生问题。正向偏离 定量地识别个人，并利用定量分析和定性访谈技术来 了解PD使用哪些创新策略来克服提高健康的障碍。的目标 这个F31多样性联谊会申请是为了确定邻居、家庭、父母和孩子层面的因素， 使用PD框架，这与儿童肥胖行为的健康变化有关- 中等强度的体力活动、久坐时间、睡眠和饮食--以及夏季体重的变化。 为了实现这些目标，本研究将利用来自大型观测队列的数据(R01- DK116665，PI甜菜)比较低收入和高收入人群体重和肥胖行为的变化 学校和暑假期间的小学儿童。拟议的研究将有目的地抽样， 从现有的673名儿童中，那些在夏季表现出良好结果的个人。这就做 将PD定义为从学校到暑假在BMI Z-Score(ZBMI)方面表现出良好变化的儿童。 定量分析将评估邻居、家庭、父母和孩子层面的因素之间的关联 随着zBMI和健康行为的变化。以PD框架为基础的定性方法将确定 帕金森病儿童的父母所使用的策略，但在表现出 体重和肥胖行为中最不健康的变化。此F31的结果将用于支持 新干预措施的开发将在完成博士学位后在F32奖项申请中进行测试 程序。

Abstract An emerging body of evidence suggests children gain more weight during the 3-month summer vacation than they do during the entire 9-month school year. This accelerated weight gain during summer is disproportionately higher among children from low-income families compared to their higher-income peers. Studies of children who respond positively to summer (i.e., maintain or lose weight, increase activity/sleep, reduce screen time, improve diet) can provide insight into what enables some children to overcome barriers linked to accelerated weight-gain during summer, while others do not. To address this important question, I will employ the Positive Deviance framework and apply it to childhood obesity.The Positive Deviance (PD) framework proposes that within any population, there are those who manage to engage in healthy behaviors despite experiencing similar obstacles as those who do not. The PD framework has been used to solve complex public health issues such as malnutrition, infant mortality, and infectious diseases. Positive deviance identifies individuals quantitatively and utilizes quantitative analyses and qualitative interviewing techniques to discover what innovative strategies PDs use to overcome barriers to improving their health. The objectives of this F31 Diversity Fellowship application are to identify neighborhood, home, parent, and child-level factors, using the PD framework, that are associated with healthful changes in children’s obesogenic behaviors – Moderate-Vigorous Physical Activity, Sedentary time, Sleep, and Diet - and changes in weight during summer. To accomplish these objectives, this study will leverage data from a large observational cohort (R01- DK116665, PI Beets) comparing changes in weight & obesogenic behaviors of low and high-income elementary-age children during school and summer vacation. The proposed study will purposively sample, from the existing cohort of 673 children, individuals who display favorable outcomes during summer. I will define PDs as children who exhibit favorable changes in BMI Z-score (zBMI) from school to summer. Quantitative analyses will assess associations between neighborhood, home, parent, and child-level factors with changes in zBMI and health behaviors. Qualitative methods, grounded in the PD Framework, will identify strategies utilized by the parents of PD children that are not present among parents of children who exhibit the least healthy changes in weight and obesogenic behaviors. The results of this F31 will be used to support the development of novel interventions to be tested in a F32 award application upon completion of the doctoral program.