Using implementation mapping to maximize equity of school-based policies for obesity prevention

项目总结 这个K01奖项的总体目标是为Gabriella McLoughlin博士和硕士提供培训和 指导建立一个独立的研究方案，重点是改善政策的实施， 儿童肥胖和心血管疾病预防的环境(PSE)干预措施。 近年来，儿童肥胖差距加剧，以至于来自种族/民族的儿童 少数族裔和低收入背景面临的风险最大。多重因素，如粮食不安全加剧 导致低质量的饮食，加剧了这种威胁。儿童肥胖症一直持续到成年， 增加心血管疾病的风险，并需要对青年采取可持续的干预措施 健康的社会决定因素。由于儿童和青少年摄入的能量有一半以上是在 学校，通过环球校餐为低收入青年提供免费的营养丰富的早餐和午餐 (USM)是解决肥胖差距的关键PSE方法。采用USM与减少 低收入学生的肥胖风险，改善饮食质量，减少食物不安全，并提高学术水平 成就成果。不幸的是，采用USM的学校报告说，它面临着持续的挑战 实施，如学生参与率低，财政困难，坚持联邦营养 要求。旨在缓解肥胖健康差距的计划和政策不能最大限度地 如果他们没有接触到他们的目标人群，就会产生影响。因为联邦政府对学校的报销率是 与接受学校膳食的学生数量挂钩，保持参与度是制定USM的关键 在财务上可行。该K01奖项的目的是进行实施映射程序， 费城学区(SDP)，导致开发和测试以股权为重点的 USM的实施战略。这将通过三个目标来实现：1)调查决定因素 通过健康公平的视角实施USM；2)制定和定制USM实施战略 通过社区参与的方法；以及3)评估以下措施的实施和学生健康结果 实施策略。要实现这些目标，并为更大的实施效果做好准备 试行期间，申请人将接受严格的正式培训：1)评估执行决定因素是否扎根 在卫生公平方面，2)社区参与的实施规划，3)随机对照试验，4)成本 在Jennifer Fisher博士、Omar Martinez博士、Resa Jones博士、Ross博士指导下的执行情况分析 布朗森、亚历克斯·多普和熊谷志贵。天普大学是这部作品的理想背景，因为 与当地社区的长期关系，促进了McLoughlin博士与SDP和 通过社区参与的方式完成这项研究的目的。这一K01奖项具有重要的意义 对公共健康的潜在影响，并将使麦克洛夫林博士能够建立一个严格的研究计划，以 改进PSE实施，降低弱势人群中肥胖和心血管疾病的风险。

PROJECT SUMMARY The overall goal of this K01 award is to provide Gabriella McLoughlin, PhD, MS, with the training and mentorship to establish an independent program of research focused on improving implementation of Policy, Systems, and Environmental (PSE) interventions for childhood obesity and cardiovascular disease prevention. Childhood obesity disparities have been exacerbated in recent years, such that children from racial/ethnic minority and low-income backgrounds are most at risk. Multiple factors, such as increased food insecurity resulting in a low-quality diet, contribute to this increased threat. Childhood obesity tracks into adulthood, increasing the risk of cardiovascular disease, and warranting sustainable interventions for youth to address social determinants of health. Since children and adolescents consume over half of their energy intake at school, providing free nutrient-rich breakfast and lunch to low-income youth through Universal School Meals (USM) is a key PSE approach to addressing obesity disparities. Adoption of USM is linked with reductions in obesity risk for low-income students, improved diet quality, reduced food insecurity, and enhanced academic achievement outcomes. Unfortunately, schools adopting USM report consistent challenges to its implementation such as low student participation and financial difficulty in adhering to Federal nutrition requirements. Programs and policies designed to mitigate health disparities for obesity cannot make the most impact if they are not reaching their target population. Because the federal reimbursement rate for schools is tied to the number of students receiving school meals, maintaining participation is critical to making USM financially feasible. The purpose of this K01 award is to conduct an implementation mapping procedure with the School District of Philadelphia (SDP), resulting in the development and testing of an equity-focused implementation strategy for USM. This will be achieved through three aims: 1) Investigate determinants of USM implementation through a health equity lens; 2) Develop and tailor a USM implementation strategy through a community-engaged approach; and 3) Evaluate the implementation and student health outcomes of the implementation strategy. To accomplish these aims and prepare for a larger implementation effectiveness trial, the applicant will receive rigorous formal training in 1) assessing implementation determinants grounded in health equity 2) community-engaged implementation mapping, 3) randomized controlled trials, and 4) cost analysis of implementation under the mentorship of Drs. Jennifer Fisher, Omar Martinez, Resa Jones, Ross Brownson, Alex Dopp, and Shiriki Kumanyika. Temple University is the ideal setting for this work given a longstanding relationship with the local community, facilitating Dr. McLoughlin's collaboration with SDP and completion of the study aims through a community-engaged approach. This K01 award holds significant potential for public health impact and will enable Dr. McLoughlin to establish a rigorous program of research to improve PSE implementation and reduce obesity and cardiovascular disease risk in vulnerable populations.