An Ecological Approach to Addressing Childhood Obesity Issues in Imperial County

描述(由申请人提供)：拟议的示范研究将有助于建立潜在的可持续和可传播的干预战略的证据，以预防和控制儿童肥胖。这项研究由行为与社区健康研究所与帝国郡公共卫生部门和联邦合格健康中心，Clinicas de Salud del Pueblo，Inc.共同进行，将评估针对帝国郡儿童肥胖症的多部门、多层次干预措施，帝国郡是加利福尼亚州儿童肥胖率最高的县(39%对全州28%)。在疾病控制和预防中心(CDC)、评估中心和其他资助网站的协调下，这项研究将分三个阶段进行。第一阶段(第一年)将包括形成性研究，以完善干预和评估方案。方法包括审计、焦点小组、深度访谈和档案研究。评估中心和疾病预防控制中心将在这一阶段与拟议的合作伙伴和其他受资助的网站定期举行会议，以确定各级影响力的衡量标准。第二阶段(第二年至第四年，第三个月)将评估多部门、多层次干预对健康的影响 在1440名2至10岁的儿童中。两家诊所将被分配到多部门、多层次干预(MSML)，一家诊所将被分配到医疗保健系统(HCS)干预。根据资助者的要求，这项实证研究将使用基于证据的策略，在四个不同的部门：联邦合格的社区卫生中心、托儿中心、小学和社区(餐馆、公园和娱乐部门)，针对一系列一致的行为来促进健康的饮食、体育活动和较少的久坐行为。作为一项额外的创新，拟议的项目还将针对家庭系统和家庭环境，这将通过一个促进方案与卫生保健系统干预相联系。所有干预活动将针对多个级别的 影响包括政策、制度和环境。第三阶段(第4年，第4-12个月)将包括评估干预措施的效果和成本效益，为可持续性和传播做准备，并准备手稿、报告和可用性手册等产品。干预目标是开发一种认识到社区资产和需求的儿童肥胖症慢性护理模式。评估目标是评估干预对1440名儿童在两年期间的身体质量指数(BMI)z得分的效果。该进程评价审查了几乎所有重要的方面，这些方面对于向类似的农村和低收入社区提供维持和传播干预内容的潜力提供了信息。最后，成本效益分析将考察BMI z得分的变化，并将“BMI z得分每变化一美元”作为主要评估比率。据推测，MSML儿童(n=720)在基线后12个月的随访中，他们的BMI z得分将比HCS儿童(n=720)经历更大的下降，并在24个月的随访中保持这些变化。

DESCRIPTION (provided by applicant): The proposed demonstration study will help build the evidence of potentially sustainable and disseminable intervention strategies to prevent and control childhood obesity. This study, conducted by the Institute for Behavioral & Community Health in conjunction with the Imperial County Public Health Department and the Federally Qualified Health Center, Clinicas de Salud del Pueblo, Inc., will evaluate a multi-sector, multi-level intervention to address childhood obesity in Imperial County, the county in the State of California with the highest rates of childhood obesity (39% vs. 28% statewide). In coordination with the Centers for Disease Control and Prevention (CDC), the Evaluation Center, and the other funded sites, this study will occur in three phases. Phase 1 (Year 1) will consist of formative research to refine the intervention and evaluation protocols. Methods will include audits, focus groups, in-depth interviews, and archival research. Regular meetings with proposed partners and with the other funded sites, the Evaluation Center and CDC will occur during this phase to determine measurement at all levels of influence. Phase 2 (Year 2 through Year 4, Month 3) will assess the impact of the multi-sector, multi-level intervention on the health of 1440 children between 2 and 10 years old. Two clinics will be assigned to a multi-sector, multi-level intervention (MSML) and one clinic will be assigned to a health care system (HCS) intervention. Consistent with funder requirements, this demonstration study will use evidenced-based strategies to target a consistent set of behaviors to promote a healthy diet, physical activity, and fewer sedentary behaviors in four different sectors: federally qualified community health centers, childcare centers, elementary schools, and the community (restaurants and parks & recreation departments). As an added innovation, the proposed project will also target the family system and the home environment, which will be linked with the health care system intervention through a promotor program. All intervention activities will target multiple levels of influence including policy, systems, and the environment. Phase 3 (Yr 4, Months 4-12) will involve evaluating the efficacy and cost-effectiveness of the intervention, preparing for sustainability and dissemination, and preparing products such as manuscripts, reports, and usability manuals. The intervention goal is to develop a childhood obesity chronic care model that recognizes the communities' assets and needs. The evaluation goal is to assess the efficacy of the intervention on the body mass index (BMI) z-score of 1440 children over a two-year period. The process evaluation examines nearly all dimensions important for informing the potential to sustain and disseminate intervention components to similar rural and low-income communities. Finally, cost-effectiveness analyses will examine change in BMI z-score, with "dollars per change in BMI z-score" being the primary ratio evaluated. It is hypothesized that MSML children (n=720) will experience greater reductions in their BMI z-score than HCS children (n=720) at the 12- month post-baseline follow-up and sustain these changes at the 24-month follow-up.