Impact of Built, Social, and Housing Environments on Obesity in Low-Income Children

摘要 儿童肥胖症是一个首要的公共卫生问题，其患病率在弱势群体中持续增加。 人口。有证据表明，肥胖与邻里建筑和社会环境有关 特色这些包括步行性、锻炼机会、绿色空间、食品店和社会凝聚力。 但尚不清楚这些特征本身是否会导致肥胖。确定因果关系对于 为公共卫生工作提供信息，以减少健康差距。我们建议通过研究一种自然的 在一个低收入的城市社区进行实验。洛杉矶市正在重新开发约旦唐斯（JD）， 700个单位的过时公屋计划。在5年内，重建将建立-（1）700个新单位， 现有居民，（2）700个新的混合收入住房居民单位，将改变社会环境， (3)一个新的社区中心与健身房，（4）零售空间，将提供健康饮食的机会，（5） 绿色空间，将增加身体活动的机会，以及（6）额外的建筑环境 促进身体活动和健康饮食的改进措施（例如步行和自行车道，街道 照明）。2017年12月，我们将开始研究这些改善措施对成年居民的影响。 BMI与肥胖将这项工作扩展到儿童是很重要的，因为儿童肥胖与 终生健康状况不佳。我们的目标是研究JD重建对儿童BMI的影响， 使用与成人研究类似的研究设计，对超重和肥胖进行研究。在目标1中，我们比较 JD儿童和对照组（来自2个类似公共住房的儿童）的这些结果的变化 项目）5年。在目标2中，我们将理清重建的三个主要组成部分的影响： 建筑环境、社会环境和新住房。我们将利用这一事实， 重建计划将分阶段进行。在目标3中，我们将评估为什么或为什么没有重建 影响儿童的BMI结果。为了做到这一点，我们将跟踪饮食，活动和潜在的介质（利用 新空间、父母建模、感知安全、家庭环境）。最后，在目标4中，我们将探讨 儿童性别、种族-民族和年龄的调节作用。我们从儿童收集的数据将包括亲自 调查、身体测量、饮食回忆和加速度测量。此外，关于父母的大量数据 将从成人研究中获得。由于第一期重建计划将于 将于2018年秋季完成。因此，必须完成招募儿童和收集儿童基线数据的工作， 沿着成人在2018年10月之前。

ABSTRACT Childhood obesity is a top public health concern and its prevalence continues to increase in disadvantaged populations. Evidence suggests that obesity is associated with neighborhood built and social environment characteristics. These include walkability, exercise opportunities, green space, food outlets and social cohesion. But it is not clear whether these characteristics themselves cause obesity. Establishing causality is important to inform public health efforts to reduce health disparities. We propose to address this gap by studying a natural experiment in a low-income urban community. The city of Los Angeles is redeveloping Jordan Downs (JD), an obsolete 700-unit public housing project. Over 5 years, the redevelopment will build–(1) 700 new units for existing residents, (2) 700 units for new mixed-income housing residents that will alter the social environment, (3) a new community center with a gymnasium, (4) retail space that will offer healthy eating opportunities, (5) green space that will increase opportunities for physical activity, and (6) additional built environment enhancements that will promote physical activity and healthy eating (e.g. walking and bike lanes, street lighting). In Dec 2017, we will begin a study to examine the effects of these improvements on adult residents' BMI and obesity. It is important to extend this work to children because childhood obesity is associated with poor life-long health outcomes. Our goal is to study the effect of the JD redevelopment on children's BMI, overweight and obesity using a similar research design as for the Adult Study. In Aim 1, we will compare changes in these outcomes for JD children and a control group (children from 2 similar public housing projects) for 5 years. In Aim 2, we will disentangle the effects of three major components of the redevelopment: built environment, social environment and new housing. We will do this by taking advantage of the fact that the redevelopment will occur in several phases. In Aim 3, we will assess why, or why didn't, the redevelopment affect children's BMI outcomes. To do this, we will track diet, activity, and potential mediators (utilization of new spaces, parent modeling, perceived safety, home environment). Finally, in Aim 4 we will explore the moderating effects of child sex, race-ethnicity and age. Our data collection from children will include in-person surveys, body measurements, dietary recalls, and accelerometry. In addition, a wealth of data about the parent will be available from the Adult Study. Our study is time-sensitive because the first phase of redevelopment will be completed by fall of 2018. Thus, recruitment and baseline data collection from children must be completed along with the Adults before Oct 2018.