Understanding Disparities in Obesity and its Comorbidities in the US

了解美国肥胖及其合并症的差异

基本信息

批准号：
7896522
负责人：
YOUFA WANG
金额：
$ 60.56万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-07-20 至 2013-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7896522
关键词：
Address Adult Affect Area Atherosclerosis Attitude Behavior Behavioral Biological Biological Models Body Image Censuses Cessation of life Characteristics Child Chronic Disease Cohort Studies Communities Comorbidity Complex Cost-Benefit Analysis Crime Data Data Sources Diet Dietary intake Disease Economic Factors Economic Policy Economics Education Environment Environmental Policy Epidemic Equation Ethnic Origin Expenditure Family Food Food Assistance Programs Food Services Future Goals Health Health Services Health Services Accessibility Healthcare Household Hypertension Income Individual Intervention Intervention Trial Investigation Knowledge Life Cycle Stages Life Style Literature Longitudinal Studies Longitudinal Surveys Marital Status Measures Mediating Medical Methods Minority Modeling National Health and Nutrition Examination Survey Neighborhoods Non obese Non-Insulin-Dependent Diabetes Mellitus Obesity Outcome Overweight Parents Patients Perception Physical activity Play Policies Prevalence Prevention Price Primary Health Care Psychosocial Factor Public Health Public Policy Relative (related person)Research Research Design Resources Restaurants Risk Risk Factors Role Safety Sampling Schools Science Scoring Method Social Environment Social support Socioeconomic Status Solutions Source Specific qualifier value Statistical Methods Surveys System Systems Analysis Testing Transportation United States United States National Institutes of Health Weight World Health Organization Youth base behavioral/social science cationic antimicrobial protein CAP 37 contextual factors density design disability disorder prevention early childhood energy balance ethnic difference fast food fitness health belief health care quality health care service utilization health disparity interdisciplinary approach lifestyle factors low socioeconomic status metropolitan modifiable risk multilevel analysis nutrition obesity risk parental influence programs psychosocial public health relevance simulation social social science research

项目摘要

DESCRIPTION (provided by applicant): Understanding Disparities in Obesity and Its Comorbidities in the U.S. Obesity/overweight has become a public health crisis in the U.S., and currently affects 2/3 of adults and 1/3 of children. Obesity can serve as a good indicator of unhealthy lifestyles such as unhealthy diet and inadequate physical activity (PA), two key modifiable risk factors for many chronic diseases including Type 2 diabetes (T2D) and hypertension (HBP). National data show large ethnic/SES disparities in obesity, T2D, HBP and healthcare. Obesity is believed as the result of a large number of biological, behavioral, social, environmental and economic factors and the complex interactions between them that promote a positive energy balance. The determinants of these disparities are still poorly understood. Many speculations have been made regarding the major contributors based on a growing body of literature, which has focused largely on individual factors such as SES, body image, and lifestyle factors and in some recent studies regarding selected community characteristics. Our understanding of the relative contribution of these factors, the interplay between them, and the social, economic and environmental context on individual-level behaviors is limited. Our proposed 3-year study is a systematic investigation based on data collected from national surveys, large cohort studies and other sources and aims to understand the causes of ethnic/SES disparities in obesity and its co-morbidities (T2D and HBP) as well as the related health care in the U.S., both adults and children. We will use an interdisciplinary approach to study the determinants at the individual-, family-, and community- level using several sophisticated statistical methods: Aim 1: To study the modifiable determinants of ethnicity/SES disparities in obesity and main co-morbidities. We will study the contributions (in absolute and relative terms) of risk factors at the individual-, family-, and community-level, including psychosocial, behavioral, environmental, economic, and policy factors. Aim 1a: Study the contribution of individual-level (e.g., diet, PA, SES, social support, psychosocial factors), and family-level variables (e.g., SES, participation in food assistance programs, resemblance between parents and their children in diet, PA, and weight status); Aim 1b: Study the contribution of social context factors (e.g., food outlets, fitness facilities, food prices, community characteristics, school PE and recess policies, school food service). Aim 1c: Consider all related factors at multi-levels simultaneously to study their relative contributions. Aim 1d: Using similar approaches study T2D and HBP. Aim 1e: Conduct ecological/ aggregated analysis to study the underlying causes of the disparities at the state and metropolitan statistical area (MSA) levels. Aim 2: To study the influence of primary healthcare on the disparities of obesity and the causes of health care (related to obesity) disparities. Aim 3: To conduct simulation analyses using systems analysis approaches to examine the effects of potential interventions and scenarios for helping eliminate the ethnicity/SES disparities. Findings of this study will help achieve several of the objectives specified in the NIH PAR, and help direct future interventions to eliminate health disparities. PUBLIC HEALTH RELEVANCE: The proposed 3-year study is a systematic investigation based on data from national surveys and other sources to understand the individual-, family-, and community-level causes of ethnic/SES disparities in obesity and its co-morbidities including type 2 diabetes and hypertension as well as the related health care in the U.S. using an interdisciplinary approach.

描述（由申请人提供）：了解美国肥胖及其合并症的差异肥胖/超重已成为美国的公共卫生危机，目前影响 2/3 的成年人和 1/3 的儿童。肥胖可以作为不健康生活方式的良好指标，例如不健康饮食和体力活动不足 (PA)，这是许多慢性疾病（包括 2 型糖尿病 (T2D) 和高血压 (HBP)）的两个关键的可改变危险因素。国家数据显示，在肥胖、T2D、HBP 和医疗保健方面，种族/社会经济地位存在巨大差异。肥胖被认为是大量生物、行为、社会、环境和经济因素以及它们之间促进正能量平衡的复杂相互作用的结果。这些差异的决定因素仍然知之甚少。基于越来越多的文献，人们对主要贡献者做出了许多猜测，这些文献主要关注社会经济地位、身体形象和生活方式因素等个人因素，以及最近一些关于选定社区特征的研究。我们对这些因素的相对贡献、它们之间的相互作用以及社会、经济和环境背景对个人行为的理解是有限的。我们提出的为期 3 年的研究是一项基于全国调查、大型队列研究和其他来源收集的数据的系统调查，旨在了解肥胖及其合并症（T2D 和 HBP）以及肥胖的种族/社会经济地位差异的原因。美国的相关医疗保健，包括成人和儿童。我们将采用跨学科方法，使用几种复杂的统计方法来研究个人、家庭和社区层面的决定因素：目标 1：研究肥胖和主要合并症中种族/社会经济地位差异的可改变决定因素。我们将研究个人、家庭和社区层面风险因素的贡献（绝对和相对），包括社会心理、行为、环境、经济和政策因素。目标 1a：研究个人层面（例如饮食、PA、社会经济地位、社会支持、社会心理因素）和家庭层面变量（例如社会经济地位、参与粮食援助计划、父母及其子女在饮食方面的相似性）的贡献、PA 和体重状况）；目标 1b：研究社会环境因素（例如食品店、健身设施、食品价格、社区特征、学校体育和课间政策、学校餐饮服务）的贡献。目标 1c：同时考虑多层次的所有相关因素以研究它们的相对贡献。目标 1d：使用类似的方法研究 T2D 和 HBP。目标 1e：进行生态/汇总分析，研究州和大都市统计区 (MSA) 层面差异的根本原因。目标 2：研究初级卫生保健对肥胖差异的影响以及医疗保健（与肥胖相关）差异的原因。目标 3：使用系统分析方法进行模拟分析，以检查潜在干预措施和情景的效果，以帮助消除种族/社会经济地位差异。这项研究的结果将有助于实现 NIH PAR 中指定的几个目标，并有助于指导未来的干预措施，以消除健康差距。公共卫生相关性：拟议的为期 3 年的研究是一项基于全国调查和其他来源的数据的系统调查，旨在了解肥胖及其合并症的种族/社会经济地位差异的个人、家庭和社区层面的原因，包括使用跨学科方法在美国研究 2 型糖尿病和高血压以及相关医疗保健。