Population-level interventions and community environment effects on child obesity disparities

背景和意义：肥胖率仍然居高不下，尽管全国范围内的肥胖率下降和停滞不前 肥胖在某些群体中的总体流行率。至关重要的是，黑人和拉丁裔儿童的肥胖率更高 比非西班牙裔白人更高的失业率(以下简称“差距”)。减少儿童肥胖的有效策略和 差异可大大促进人口健康的改善和种族/民族的减少 健康差距。营养政策-管理食品和饮料的营养含量的政策 学校，包括所谓的“竞争性”食品，因为它们与学校餐食分开出售-- 可在一级预防肥胖症和相关慢性病方面发挥关键作用。营养的作用 然而，政策可以通过学校附近的社区食物环境来加强或削弱(例如， 通过儿童获取、购买和消费不健康食品)。到目前为止还没有研究检查 多种营养政策和社区饮食环境对儿童肥胖的联合影响 差距。目的：这项准实验研究是对美国国立卫生研究院肥胖战略计划和 建议：(1)确定加州改善和限制获得营养政策对肥胖的影响 “竞争性”食品/饮料，以及最近的改善学校膳食营养的联邦政策 标准；以及(2)调查社区食物环境是否改变了营养政策对 肥胖和相关的差异。创新。这项研究：(A)改进了对以下因素影响的因果推断 使用严格的补充方法制定关于肥胖和差异的营养政策(中断的时间序列 设计、倾向评分和潜在类别分析，地理信息系统)；(B)同时调查肥胖影响 营养政策和周围的学校食物环境；以及(C)使用纵向的、稳健的(&gt；16 百万)以人口为基础的数据，其中包含不同儿童的客观个人水平BMI测量(51% 拉丁裔，6%黑人，33%白人，8%亚裔)与所有公立学校的社区食物环境联系在一起 2001年至2017年，加州的儿童参加了这项活动。

Background and significance: Obesity rates remain high, despite nationwide declines and plateaus in the overall prevalence of obesity among some groups. Crucially, Black and Latino children have higher obesity rates than non-Hispanic Whites (hereafter “disparities”). Effective strategies to reduce child obesity and disparities could significantly contribute to population health improvements and reductions in racial/ethnic health disparities. Nutrition policies—those that regulate the nutritional content of foods and beverages in schools, including the so-called “competitive” foods because they are sold separately from school meals— could play a key role in the primary prevention of obesity and related chronic diseases. The effect of nutrition policies however, can be strengthened or weakened by the community food environment near schools (e.g., through children’s access, purchases and consumption of unhealthy foods). No studies have yet examined the combined influences of multiple nutrition policies and community food environments on child obesity and disparities. Objectives: This quasi-experimental study is responsive to the NIH Obesity Strategic Plan and proposes to: (1) determine the obesity effects of the California nutrition policy improving and limiting access to “competitive” foods/beverages together with the recent federal policy to improve school meal nutrition standards; and (2) investigate whether community food environments modify the effect nutrition policies on obesity and related disparities. Innovation. The study: (a) improves causal inferences about the effects of nutrition policies on obesity and disparities using rigorous, complementary methods (interrupted time series design, propensity scores, and latent class analysis, GIS); (b) simultaneously investigates the obesity effects of the nutrition policies and the surrounding school food environment; and (c) uses a longitudinal, robust (>16 million) population-based data containing objective individual-level BMI measures of diverse children (51% Latino, 6% Black, 33% White, 8% Asian) linked with the community food environments of all the public schools to which children attended in California from 2001 to 2017.