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策略，以预防和控制儿童肥胖的证据。这项研究由行为与社区卫生研究所与帝国县公共卫生部和联邦合格卫生中心，Clinicas de Salud del Pueblo，Inc.，将评估一项多部门、多层次的干预措施，以解决加州州因皮里尔县儿童肥胖率最高的问题（39%对全州28%）。与疾病控制和预防中心（CDC）、评估中心和其他受资助的研究中心协调，本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。方法将包括审计，焦点小组，深入访谈和档案研究。在此阶段，将与拟议的合作伙伴和其他受资助的研究中心、评估中心和CDC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。 1440名2至10岁的儿童。两个诊所将被分配到一个多部门，多层次的干预（MSML）和一个诊所将被分配到一个卫生保健系统（HCS）的干预。与资助者的要求一致，这项示范研究将使用基于证据的策略来针对一系列一致的行为，以促进四个不同部门的健康饮食，体育活动和减少久坐行为：联邦合格的社区卫生中心，托儿中心，小学和社区（餐馆和公园和娱乐部门）。作为一项补充创新，拟议的项目还将针对家庭系统和家庭环境，通过促进者方案将其与保健系统干预联系起来。所有干预活动都将针对多个层面， 影响力包括政策、制度和环境。第3阶段（第4年，第4-12个月）将涉及评估干预措施的有效性和成本效益，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。干预目标是建立一个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措施对1440名儿童在两年期间的体重指数（BMI）z评分的有效性。过程评价审查了几乎所有重要方面，以了解维持和向类似的农村和低收入社区传播干预组成部分的潜力。最后，成本效益分析将检查BMI z评分的变化，“BMI z评分变化的美元”是评估的主要比率。假设在基线后12个月随访时，MSML儿童（n=720）的BMI z评分降低幅度大于HCS儿童（n=720），并在24个月随访时维持这些变化。

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.