Head Start Exposure and Changes in Children's Body Mass Index

描述(申请人提供)：儿童肥胖症仍然是一个重大的公共卫生问题，最近估计4岁儿童肥胖率为18%。儿童肥胖症一旦确诊，很可能会延续到成年，一旦确诊，预防肥胖症比治疗肥胖症有效得多。因此，需要在儿童早期实施有效的肥胖预防计划，但到目前为止还没有确定具有强大和持久影响的有效干预措施。儿童肥胖在低收入和少数族裔儿童中也更为普遍，因此特别需要对这一群体采取有效的干预措施。Head Start是一个由美国联邦政府资助的学前教育项目，对生活在联邦贫困线以下的3至5岁儿童免费。它每年为全美近100万儿童提供服务，覆盖了所有符合条件的儿童的一半以上。为了获得联邦资助，Head Start计划必须遵守特定的绩效标准，这些标准规范着与健康、营养和体力活动有关的大量规划。尽管有广泛的覆盖面和良好的肥胖相关规划，但到目前为止，还没有对Head Start暴露与低收入儿童肥胖流行的有益影响之间的潜在联系进行评估。没有国家数据库包含参加Head Start的儿童的人体测量数据，尽管每个Head Start项目都需要维护这些数据。这项拟议的项目将利用密歇根州过去5年参加Head Start项目的儿童现有的Head Start人体测量数据，评估与夏季(未注册时)相比，儿童在学年(参加Head Start项目时)的生长模式的变化。该项目的三个目标是：目标1：检验头部接触会在两个学年内对低收入儿童的身体质量指数(BMI)产生有益影响的假设。我们预计，这些影响将在其间的夏季减弱，并在较少的头部暴露/剂量。目的：验证以下假设：Head Start对低收入儿童BMI的有益影响将与Head Start肥胖预防的特定计划和菜单的营养质量有关。目的3：检验头部暴露对儿童BMI的有益影响受到环境/地点特征的影响，这些特征包括社区社会组织混乱、离公园和绿地近/远、杂货店的位置和类型。该项目将具有广泛的公共卫生影响，因为它将确定参加Head Start是否是有效预防或治疗低收入儿童中儿童肥胖症的方法。此外，它将通过向密歇根州各地的项目提供反馈，从而产生立竿见影的影响，这些反馈可能会为项目的变化提供信息，以最大限度地发挥个别项目的效果。 公共卫生相关性：拟议的项目具有重大的公共卫生意义，因为它将确定头部暴露是否对低收入儿童的肥胖率产生有利影响，低收入儿童是肥胖风险较高的人群。此外，这些发现将通过确定哪些类型的规划与肥胖率的变化最密切相关，来为Head Start肥胖相关规划提供信息。

DESCRIPTION (provided by applicant): Childhood obesity continues to be a significant public health concern, with the prevalence of obesity among 4- year-old children most recently estimated at 18%. Childhood obesity, once established, is very likely to track into adulthood and prevention of obesity is much more effective than treating obesity once it is established. Effective obesity prevention programs in early childhood are therefore needed, but there have been no effective interventions identified to date that have robust and lasting effects. Childhood obesity is also more common among low-income and minority children, and effective interventions are therefore particularly needed for this group. Head Start is a United States federally-funded preschool program that is free to 3- to 5-year-old children living below the federal poverty line. It serves nearly one million children across the United States each year, and reaches more than half of all eligible children. In order to receive federal funding, Head Start programs are required to adhere to specific performance standards that regulate a substantial amount of programming related to health, nutrition, and physical activity. Despite the broad reach and well-regulated obesity-relevant programming, there has been no evaluation to date of the potential link between Head Start exposure and beneficial effects on obesity prevalence among low-income children. There is no national database that contains anthropometric data of the children enrolled in Head Start, even though every Head Start program is required to maintain these data. The proposed project will utilize existing Head Start anthropometric data from children enrolled in Head Start programs in the state of Michigan over the past 5 years to evaluate changes in children's growth patterns during the academic year (while enrolled in Head Start), compared to the summertime (when not enrolled). The 3 aims of this project are: Aim 1: To test the hypothesis that Head Start exposure will have beneficial effects on the body mass index (BMI) of low-income children during two academic years. We expect that these effects will weaken during the intervening summer, and with less Head Start exposure/dosage. Aim 2: To test the hypothesis that the beneficial effects of Head Start on the BMI of low-income children will be associated with Head Start obesity prevention-specific programming and the nutrition quality of menus. Aim 3: To test the hypothesis that the beneficial effects of Head Start exposure on children's BMI are moderated by environmental/place-based characteristics including neighborhood social disorganization, proximity/distance to parks and green spaces, and grocery store location and type. This project will have broad public health implications in that it will determine if Head Start enrollment is an effective preventive or treatment approach to childhood obesity among low-income children. In addition, it will have an immediate impact by providing feedback to programs around the state of Michigan which may inform programming changes to maximize the effects of individual programs. PUBLIC HEALTH RELEVANCE: The proposed project has great public health significance in that it will determine if Head Start exposure has beneficial effects on obesity prevalence for low-income children, a population group at high risk of obesity. In addition, the findings will inform Head Start obesity-relevant programming by determining which types of programming have the most robust associations with changes in obesity prevalence.