COACH: Competency Based Approaches for Community Health

项目摘要 尽管认识到肥胖的健康差异，但低收入和低收入人群的行为干预措施， 少数民族人口取得的成功一直有限。这部分是由社会原因造成的。 健康的决定因素。社区层面的障碍阻碍了健康行为的持续参与。 拟议的辅助研究将客观的社区一级数据和相应的分析纳入正在进行的 针对低收入拉丁裔家庭的肥胖行为干预，名为COACH（R 01 HD 100458，来自NICHD，PI Heerman）。通过使用考虑身体活动环境的综合测量方法， 食物环境，社会环境和历史/结构环境，我们的目标是表征 这些复杂的和累积的背景风险的儿童参加我们正在进行的COACH临床试验。 COACH（基于竞争力的社区健康方法）实施了一个个人定制的 方法，使家庭能够不顾动态障碍参与健康行为。教练是一个多层次的 干预目标：1）通过适合儿童发展的健康行为课程，2） 通过直接解决父母减肥问题，并让父母成为改变他们生活方式的推动者， 3）社区通过建设公园和娱乐中心的能力，为父母和孩子提供 编程.在为期两年的研究中，使用新的多组分评估， 干预识别个人，家庭和社区健康行为的障碍，并提供结构化的 7个领域的个性化干预内容：水果/蔬菜，零食，含糖饮料，体育活动， 睡眠、媒体使用和育儿。 这一辅助建议旨在通过增加关键的社区一级的背景资料， 变量，以衡量这些变量对干预措施有效性的调节作用。我们 建议收集与城市密度有关的数据;食物获取，可用性和质量; 体育活动环境;与社会不平等有关的变量。我们将结合联合收割机数据从1） 前瞻性地进行邻里和杂货店调查，2）地方和国家公开提供 数据集，以确定个人层面的社区风险评估，然后可以纳入 主要试验的分析计划。除了对每个项目进行单独的主持人分析外， 变量，我们将进行前瞻性队列分析，以评估其对儿童BMI的累积影响， 时间

PROJECT SUMMARY Despite the recognition of health disparities in obesity, behavioral interventions among low-income and minority populations have consistently met with limited success. This is partially explained by social determinants of health. Barriers at the community level impede consistent engagement in healthy behaviors. The proposed ancillary study adds objective community-level data and corresponding analyses to an ongoing behavioral obesity intervention for low-income Latino families, entitled COACH (R01HD100458 from NICHD, PI Heerman). By using a comprehensive measurement approach that considers the physical activity environment, the food environment, the social environment, and the historical/structural environment, we aim to characterize these complex and cumulative contextual risks for children enrolling in our ongoing COACH clinical trial. COACH (COmpetency-Based Approaches to Community Health) implements a personally tailored approach, equipping families to engage in health behaviors despite dynamic barriers. COACH is a multi-level intervention targeting 1) the individual child through developmentally appropriate health behavior curriculum, 2) the family by addressing parent weight loss directly and engaging parents as agents of change for their children, and 3) the community by building capacity of Parks and Rec centers to offer parent-child programming. Using novel multi-component assessments throughout the two years of the study, the intervention identifies individual, family, and community barriers to healthy behaviors and delivers structured yet personalized intervention content in 7 domains: fruits/vegetables, snacks, sugary drinks, physical activity, sleep, media use, and parenting. This ancillary proposal seeks to augment the data collection by adding key community-level contextual variables to measure the moderating impact of those variables on the effectiveness of the intervention. We propose collecting data related to urban density; food access, availability, and quality; multiple components of the physical activity environment; and variables related to social inequality. We will combine data from 1) prospectively conducting neighborhood and grocery store surveys and 2) local and national publicly available datasets to identify individual-level assessments of community-risk that can then be incorporated into the analysis plan for the main trial. In addition to conducting individual moderator analyses for each of the variables, we will conduct a prospective cohort analysis to evaluate their cumulative impact on child BMI over time.