Effectiveness of population level interventions in schools and academic performance

项目摘要 非裔美国人和拉丁美洲人的成年健康状况比他们的白色同龄人更差（以下称为“健康 差异”）。这些健康差距往往开始在童年，并一直存在，部分原因是，继续 健康的社会决定因素方面的不平等。更少的研究确定了人口层面的干预措施 这就为各人口亚群健康的社会决定因素创造了公平的竞争环境。极少 关于有效的人口干预措施的证据是缩小健康差距的一个重大障碍。严格 先前的研究表明，大规模的营养政策，以减少种族/民族差距的可行性， 儿童的学业成绩-成人教育程度的一个强有力的预测因素，这是最重要的因素之一。 健康的基本决定因素。这些研究阐明了在这一过程中的中介机制， 学校营养政策、学校附近社区的（垃圾）食品供应和儿童营养之间的途径 学习成绩没有纵向研究彻底调查人口水平的影响 关于营养政策的学术表现以及附近学校可改变的特点 邻里关系这项纵向研究利用了加州的一系列自然实验， 改善向学校儿童出售的食品和饮料的营养标准的政策， 2010年《健康无饥饿儿童法》规定的学校膳食营养标准。这项研究将 确定（a）人口一级学校营养政策干预措施在改善儿童营养方面的有效性; 学习成绩和减少非洲裔美国人和拉丁美洲人与白色同龄人之间的相关差距;（B） 学校附近社区中与食物有关的可变因素对 学习成绩差异;以及（c）学校营养政策的有效性是否因社区而异 因素为了对这些政策在学术上的人口水平的有效性产生有效的推断， 性能，本研究使用最强的方法来评估非随机暴露： 差异中的差异分析，包括儿童内暴露的变化。差异差异 分析还将审查儿童一级变化对附近社区可改变特征的影响， 他们的学校和学习成绩的变化（和差距）。这项研究无与伦比，因为我们 使用关于1180万儿童的不同人口的学习成绩的有力纵向数据。 学校内部和周围的政策和社区干预措施有可能减少差异， 以社区为重点，现有的基础设施和网络，以促进其大规模实施 和广泛的影响。鉴于其稳健的设计，该研究将对循证营养产生重大影响 政策和人口一级的干预措施，以减少种族/民族健康差距;确定机会， 教育程度;以及扩大干预措施的范围，以改善健康的基本决定因素。

PROJECT SUMMARY African American and Latino populations have worse adult health than their White peers (hereafter “health disparities”). These health gaps often begin in childhood, and have persisted, in part, because of continuing inequalities in the social determinants of health. Far less research has identified population-level interventions that level the playing field on the social determinants of health across population subgroups. The scant evidence on effective population-level interventions is a significant barrier to reducing health gaps. Rigorous prior studies have revealed the plausibility for large-scale nutrition policies to reduce racial/ethnic gaps in children’s academic performance—a strong predictor of adult educational attainment, which is one of the most fundamental determinants of health. These studies have illuminated the intermediary mechanisms in the pathway between school nutrition policies, (junk) food availability in communities near schools and children’s academic performance. No longitudinal studies have thoroughly investigated the population-level influences on academic performance of nutrition policies together with modifiable characteristics of nearby-school neighborhoods. This longitudinal study capitalizes on a series of natural experiments generated by California’s policies to improve nutrition standards for foods and drinks sold to children in schools, and the changes in nutrition standards for school meals put in place by the Healthy, Hunger Free Kids Act of 2010. The study will determine (a) the effectiveness of population-level school nutrition policy interventions in improving children’s academic performance and reducing related gaps among African American and Latino vs. White peers; (b) the extent to which modifiable, food-related factors in communities near schools influence longitudinal changes in academic performance disparities; and (c) if school nutrition policy effectiveness varies by those community factors. To generate valid inferences about the population-level effectiveness of these policies on academic performance, this study uses the strongest possible approach to evaluate non-randomized exposures: a difference-in-differences analysis that includes within-child change in exposures. Difference in difference analyses will also examine the effects of child-level changes in modifiable characteristics of communities near their schools and changes in academic performance (and disparities). This study is unparalleled because we use powerful longitudinal data on academic performance among a diverse population of 11.8 million children. Policy and community interventions in and around schools hold potential to reduce disparities given their community-oriented focus, existing infrastructures and networks that facilitate their large-scale implementation and broad reach. Given its robust design, the study will have a significant impact on evidence-based nutrition policy and population-level interventions to mitigate racial/ethnic health gaps; identify opportunities to enhance educational attainment; and broaden the scope of interventions to improve fundamental determinants of health.