Investigating the impact of food vouchers on diet composition and the prevention of childhood obesity

在英国，儿童肥胖率正在上升，来自弱势家庭的儿童更有可能患有肥胖症。儿童期肥胖与成年期肥胖和健康状况不佳有关。因此，我们必须努力预防和减少儿童肥胖方面的不平等现象。我们知道，来自弱势家庭的孩子更有可能饮食不良，而饮食不良的孩子更有可能肥胖。因此，改善年轻家庭的饮食质量可能有助于预防儿童肥胖的发生。“健康的开始”是英国的一项计划，旨在通过向贫困家庭提供购买牛奶、水果和蔬菜的代金券来提高饮食质量。然而，尽管食品价格不断上涨，代金券的价值并不高，而且十年来一直没有变化。该计划需要评估，以考虑它如何能最好地支持家庭，因为符合条件的家庭的使用率非常低，全国只有54%。保健视察员为年轻家庭提供支助，并为需求增加的家庭，包括贫困群体的家庭提供额外支助。这提供了一个独特的机会来支持有儿童肥胖风险并符合“健康起步”资格的年轻家庭。本研究的目的是了解代金券计划是否能对弱势家庭的饮食质量产生积极影响。这项研究将包含几个要素，包括审查文献以证明代金券计划的有效性，与家庭和健康访问者交谈，从家庭收集饮食和购物信息，以及为修改后的“健康起步”计划建立最佳方法模型。在第一阶段，将完成一项系统综述，从科学文献中收集证据，证明基于代金券的方案对儿童饮食质量和儿童肥胖的影响。第二阶段包括收集饮食信息，向接受健康访问服务的父母和健康访问人员介绍食品购买决定、健康饮食和健康开始。在第三阶段，来自第一阶段和第二阶段的信息将告知一个统计模型，该模型可用于预测如果代金券以某种方式改变，接收代金券的人会做什么。这将使用基于代理的建模（ABM），这是一种涉及编程“代理”（虚拟人）遵循某些规则并相互交互的方法，使研究人员能够预测改变“健康开始”的影响。例如，如果健康启动券增加到5英镑（从目前的3.10英镑）给有儿童肥胖风险的家庭，这会对人们购买的食物产生什么影响？从第一阶段和第二阶段收集的数据将用于准确地构建模型，从而确保模型尽可能地反映现实生活。患者和公众参与（PPI）工作已经塑造了这个应用程序，并将继续支持正在进行的项目，通过旨在增加贡献者多样性的外展工作，以及PPI贡献者参与指导小组。本研究的结果将通过摘要表传达给参与者，并支持PPI贡献者向当地社区传播信息。这些发现将被写下来发表，并提交给会议和同行评审期刊，以便与学术观众分享。这项研究将为政策、实践和进一步的研究提供证据，说明如何最好地修改“健康起步”，以改善饮食质量，并为面临儿童肥胖风险的弱势家庭提供支持。下一步将是在当地人群中试验最成功的“健康起步”模式变化。如果成功，这有可能改善饮食质量，降低弱势家庭儿童肥胖的风险。这反过来可能导致政策变化，有助于减少整个英格兰儿童的健康不平等。

Childhood obesity is increasing in the UK, and children from disadvantaged backgrounds are more likely to live with obesity. Obesity in childhood is linked to obesity in adulthood and poor health outcomes. It is therefore vital that we work to prevent and reduce inequalities in childhood obesity. We know that children from disadvantaged backgrounds are more likely to have poor diets, and children who have poor diets are more likely to be obese. Therefore, improving diet quality of young families may contribute to preventing the development of childhood obesity. Healthy Start is a scheme in England that aims to improve diet quality by providing vouchers to spend on milk, fruit and vegetables to disadvantaged families. However, the voucher value is modest and has not changed for a decade, despite increasing food prices. The scheme needs assessing to consider how it can best support families, as uptake among eligible families is very low, at 54% nationally. Health visitors support young families, and give extra support to those with increased needs, including those from deprived groups. This provides a unique opportunity to support young families who are at risk of childhood obesity and eligible for Healthy Start. The aim of this research is to understand if voucher schemes can have a positive effect on diet quality of disadvantaged families.This research will contain several elements, including reviewing the literature for evidence on the effectiveness of voucher schemes, speaking to families and health visitors, collecting diet and shopping information from families, and modelling the best approach to a modified Healthy Start scheme.In phase one, a systematic review will be completed to collect evidence from the scientific literature on the effect of voucher-based schemes on diet quality and childhood obesity in children.Phase two includes collection of dietary information and speaking to parents receiving health visiting services and health visitors about food buying decisions, healthy diets and Healthy Start. In phase three, information from phases one and two will inform a statistical model that can be used to predict what people receiving the voucher would do if the vouchers were changed in some way. This will use Agent Based Modelling (ABM), a method that involves programming 'agents' (virtual people) to follow certain rules and interact with each other, allowing researchers to predict the impact of a change to Healthy Start. For example, if Healthy Start vouchers were increased to £5 (from the current value of £3.10) for families at risk of childhood obesity, what affect would this have on the food that people buy? The data gathered from phases one and two will be used to build the model accurately, thus ensuring that the model reflects real life as closely as possible.Patient and public involvement (PPI) work has already shaped this application and will continue to support the ongoing project, through outreach work aiming to increase diversity of contributors, and PPI contributors' involvement in a steering group. The results from this study will be communicated to participants using a summary sheet, and PPI contributors will be supported to disseminate the information to local communities. The findings will be written up for publication and submitted to conferences and peer reviewed journals in order to share with academic audiences. This study will inform policy, practice and further research by providing evidence on how best to modify Healthy Start to improve diet quality and provide support to disadvantaged families at risk of childhood obesity. The next step would be to trial the most successful modelled changes to Healthy Start in local populations. If successful, this has the potential to improve diet quality and reduce risk of childhood obesity in vulnerable families. This in turn may lead policy change contributing to reduced health inequality for children across England.