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

描述（由申请人提供）：儿童肥胖仍然是一个重要的公共卫生问题，最近估计4岁儿童的肥胖患病率为18%。儿童期肥胖一旦形成，很可能一直延续到成年期，预防肥胖要比治疗肥胖有效得多。因此，需要在儿童早期实施有效的肥胖预防计划，但迄今为止还没有确定的有效干预措施具有强大而持久的效果。儿童肥胖在低收入和少数民族儿童中也更为常见，因此特别需要对这一群体进行有效的干预。启智计划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。它每年为美国近100万名儿童提供服务，覆盖了所有符合条件的儿童的一半以上。为了获得联邦资金，学前教育项目必须遵守具体的绩效标准，这些标准规范了与健康、营养和体育活动有关的大量项目。尽管有广泛的影响范围和良好的肥胖相关规划，但迄今为止还没有评估学前教育与低收入儿童肥胖患病率的有益影响之间的潜在联系。虽然每个学前教育项目都要求保存这些数据，但目前还没有一个全国性的数据库包含参加学前教育项目的儿童的人体测量数据。拟议中的项目将利用过去5年里在密歇根州参加启智计划的儿童的现有人体测量数据，来评估儿童在学年（参加启智计划时）与夏季（未参加启智计划时）生长模式的变化。该项目的三个目的是：目的1：测试在两个学年中接受学前教育对低收入家庭儿童的身体质量指数（BMI）有有益影响的假设。我们预计这些影响将在夏季期间减弱，并且随着“学前教育”接触/剂量的减少。目的2：验证“先发计划”对低收入儿童BMI的有益影响与“先发计划”肥胖预防计划和菜单营养质量有关的假设。目的3：验证学前教育对儿童BMI的有益影响受到环境/地点特征的调节，包括社区社会无序性、与公园和绿地的接近/距离、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“先头计划”是否是低收入儿童儿童肥胖的有效预防或治疗方法。此外，通过向密歇根州的项目提供反馈，它将产生立竿见影的影响，这些反馈可能会通知项目的变化，以最大限度地提高单个项目的效果。

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.