Reducing Health Disparities in Childhood Obesity Using Financial Incentives in Low-income Households

来自低收入家庭的儿童(6-12岁)患肥胖症、2型糖尿病和其他疾病的风险增加 相关的合并症和心脏代谢功能障碍。绝大多数预防肥胖的措施 针对这些儿童的干预措施是在9个月的学年期间提供的，无论是在学校还是在 课外活动。过去十年发展起来的大量证据一直表明，所有 在校或在校期间体重和其他健康成果的改善 课外活动在暑假期间被取消。观测研究表明，夏季 假期对肥胖行为(即活动、屏幕时间、饮食、睡眠)和 儿童，特别是来自低收入家庭的儿童的体重状况。新出现的证据来自 观察性研究表明，当孩子们参加暑期项目时，他们会参与更高水平的 体力活动，摄入更多符合联邦儿童营养/卡路里密度指南的食物/饮料， 并保持更一致的睡眠时间表。因此，有证据表明，暑期项目对 对儿童肥胖行为的有益影响。不幸的是，来自低收入家庭的孩子 参加暑期项目的机会有限。这项拟议的研究建立在科学文献的基础上， 考察需求侧融资的影响，例如改善成年人健康行为的财务激励 以及在低收入人口和发展中国家使用代金券/补贴，并适用这一点 低收入家庭儿童肥胖的干预方法。我们假设，通过解决 参加暑期项目的成本障碍，现有社区运营的上座率增加 暑期项目将会出现，这将导致儿童肥胖行为的显著改善。在……里面 反过来，我们假设肥胖行为的改善将导致过度的、不健康的减少 夏天体重增加。对于这项研究，我们将严格测试提供现有访问权限的影响 社区运营的夏季计划，通过使用代金券计划，关于体重状况(即BMI z- 低收入家庭1-3年级儿童的肥胖行为。使用随机化的 设计：我们将比较420名来自低收入家庭的儿童体重状况和肥胖行为的变化。 家庭随机分为两种情况之一：暑期节目代金券计划或 比较/对照。我们认为这项研究具有重要意义，因为研究问题具有很高的政策性。 与联邦、州和地方政策制定者相关，大多数家长支持使用公共 提供参加暑期项目的资金。我们相信这项研究是创新的，因为它借鉴了 需求侧融资文献，它被广泛用于改变成年人的健康行为，并将考验一部小说 和创新的代金券计划，以消除参加现有社区运营夏季活动的成本障碍 方案作为一种干预措施，以克服在贫困中长大对健康的不利影响。

Children (6-12yrs) from low-income households are at an elevated risk for obesity, type 2 diabetes, and other associated comorbidities and cardiometabolic dysfunction. The vast majority of obesity prevention interventions targeting these children are delivered during the 9-month school-year, either in school or during afterschool programs. Substantial evidence developed over the past decade consistently indicates that all improvements in weight and other health outcomes achieved during the school year from in-school or afterschool programs are erased during summer vacation. Observational studies indicate that summer vacation exerts a negative effect on the obesogenic behaviors (i.e., activity, screen time, diet, sleep) and weight status of children, especially children from low-income households. Emerging evidence from observational studies shows that when children attend summer programs, they engage in higher levels of physical activity, consume more foods/beverages that meet federal guidelines for child nutrition/caloric density, and maintain a more consistent sleep schedule. Thus, evidence indicates that summer programs exert a beneficial influence on children’s obesogenic behaviors. Unfortunately, children from low-income households have limited access to summer programs. The proposed study builds upon the scientific literature that examines the effects of demand-side financing, such as financial incentives to improve adults’ health behaviors and the use of vouchers/subsidies in low-income populations and developing countries, and applies this intervention approach to childhood obesity in low-income households. We hypothesize that by addressing the cost barrier to participating in summer programs, increased attendance at existing community-operated summer programs will occur, and this will lead to marked improvements in children’s obesogenic behaviors. In turn, we hypothesize improvements in obesogenic behaviors will result in a reduction in excessive, unhealthy weight gain over summer. For this study, we will rigorously test the impact of providing access to existing community-operated summer programs, through the use of a voucher program, on weight status (i.e., BMI z- score) and obesogenic behaviors of 1st-3rd grade children from low-income households. Using a randomized design, we will compare changes in weight status and obesogenic behaviors of 420 children from low-income households randomized to one of two conditions: voucher program for summer programming or comparison/control. We believe this study is significant because the research questions are of high policy relevance to federal, state, and local policymakers, with the majority of parents supporting the use of public funds to provide access to summer programs. We believe this study is innovative because it draws from the demand-side financing literature, which is widely used to change adult health behaviors, and will test a novel and innovative voucher program to eliminate cost barriers to attending existing community-operated summer programs as an intervention to overcome the health disadvantages of growing up in poverty.