Expanding the impact of cancer prevention policies through collaborative implementation research: a qualitative secondary analysis of federal child nutrition assistance policies during COVID-19

通过协作实施研究扩大癌症预防政策的影响：对 COVID-19 期间联邦儿童营养援助政策的定性二次分析

• 批准号: 10372314
• 负责人: Hannah G Lane
• 金额: $ 20.09万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-24 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10372314
• 关键词: Address; Adoption; Advocate; Affect; Area; Asthma; Black race; COVID-19; COVID-19 pandemic; Case Study; Centers for Disease Control and Prevention (U.S.); Child; Child Nutrition; Childhood; Chronic Disease; Complex; Country; County; Data; Data Analyses; Data Collection; Demographic Factors; Diet; Dietary intake; Drops; Ecosystem; Effectiveness; Eligibility Determination; Enrollment; Ensure; Evidence based program; Family; Food; Food Services; Foundations; Funding; Health Policy; Hispanic; Home; Household; Hybrids; Intervention; Latino; Low income; Malignant Neoplasms; Marketing; Methodology; Methods; Natural experiment; Nutritional; Obesity; Persons; Plant Roots; Policies; Policy Maker; Population; Prevalence; Price; Process; Provider; Public Health; Recording of previous events; Regulation; Research; Research Personnel; Research Priority; Resources; Risk; Risk Factors; Route; Rural; Sampling; Schools; Site; Students; System; Testing; Transportation; Unhealthy Diet; United States Department of Agriculture; Variant; Virus; Weight Gain; Work; base; cancer prevention; cancer risk; children of color; cost; design; experience; falls; federal policy; feeding; flexibility; food insecurity; future implementation; health equity promotion; health inequalities; implementation context; implementation research; implementation strategy; implementation trial; improved; innovation; lens; member; minority children; novel; novel strategies; nutrition; operation; post-COVID-19; practice setting; programs; racial and ethnic; response; rural area; rurality; secondary analysis; social health determinants; sustainability framework; theories; urban area; working group

ABSTRACT Evidence-informed public health policies have tremendous potential to reduce cancer health inequities by addressing cancer risk factors among priority populations. This impact is only achievable if policies are well- implemented among populations at greatest risk. Understanding how policy implementation varies across contexts is critical to developing tailored, equity-focused implementation strategies, but opportunities to evaluate these variations are sparse. This study evaluates variations in implementation of federal policies aimed at reducing child food insecurity and improving dietary intake during the COVID-19 crisis, in order to inform future implementation and sustainment strategies. Child nutrition programs (CNPs) are federally-funded, evidence-based programs to mitigate child food insecurity, a social determinant of health that is associated with many cancer risk factors (e.g., poor diet, asthma, obesity, chronic disease), and is disproportionately prevalent among Black and Hispanic/Latino children and those in low-income households. CNPs are offered year-round and reduce food insecurity and improve diet quality among enrolled children, yet reach and implementation of CNPs varies, especially in summer. CNP mandates are quite rigid, which limits adoption and in some districts (e.g., highly urban/rural or under-resourced), and stifles efforts to improve implementation and expand student reach. In the extraordinary circumstance of the COVID-19 crisis, however, the US Department of Agriculture allowed more flexibility so that CNPs could use novel implementation strategies to keep serving meals while reducing virus spread (e.g., home delivery via bus routes, waived adoption requirements). Understanding adoption and implementation of these strategies—especially variations across under-resourced districts—is critical to advocate for more equitable policies, and inform tailored implementation support (e.g., technical assistance from state entities) for CNPs following the crisis. This study leverages a national research collaborative to conduct a secondary analysis of implementation data from six studies during the initial COVID- 19 response (~Spring-Summer 2020) among CNP implementers (e.g., food service directors), combined with data verification with CNP implementers and families post-initial response (~Fall 2022). Driven by the Dynamic Sustainability Framework and CDC’s Policy Analytical Framework, we aim to: (1) describe system- and setting- level variations in CNP policy implementation during COVID-19, including challenges and facilitators, key partners, capacity, and adaptations; and (2) describe potential for sustainment of policy flexibilities, implementation support needs, and critical policy levers to continue novel implementation strategies beyond the COVID-19 crisis period. Findings can inform more equitable policies and tailored practice guidance, and generate data for a hybrid implementation trial to compare the reach, effectiveness, and sustainment potential of novel CNP implementation strategies to reduce food insecurity and promote health equity.

抽象的 循证公共卫生政策具有巨大的潜力，可以通过以下方式减少癌症健康不平等： 解决优先人群中的癌症风险因素只有在政策完善的情况下才能实现。 了解不同地区政策实施的差异。 背景对于制定以公平为中心的实施战略至关重要，但机会 评估这些差异是稀疏的。本研究评估了联邦政策实施的差异。 旨在减少儿童粮食不安全并改善 COVID-19 危机期间的膳食摄入量，以便 为未来的实施和维持战略提供信息。儿童营养计划 (CNP) 由联邦政府资助， 缓解儿童粮食不安全的循证计划，这是相关的健康社会决定因素 具有许多癌症危险因素（例如不良饮食、哮喘、肥胖、慢性病），并且不成比例 在黑人和西班牙裔/拉丁裔儿童以及低收入家庭的儿童中普遍存在。 全年减少粮食不安全并提高入学儿童的饮食质量，但仍达到和 CNP 的实施情况各不相同，特别是在夏季，CNP 的要求相当严格，这限制了采用和实施。 在一些地区（例如高度城乡或资源贫乏地区），并加大力度改进实施和 然而，在 COVID-19 危机的特殊情况下，美国教育部扩大了学生覆盖范围。 农业部允许更大的灵活性，以便 CNP 可以使用新颖的实施策略来继续提供服务 膳食，同时减少病毒传播（例如，通过公交车路线送货上门，免除收养要求）。 了解这些战略的采用和实施——尤其是资源贫乏地区的差异 地区——对于倡导更公平的政策并提供量身定制的实施支持至关重要（例如， 危机后国家实体提供的技术援助）这项研究利用了一项国家研究。 合作对新冠肺炎疫情初期六项研究的实施数据进行二次分析 19 CNP 实施者（例如食品服务主管）的回应（~2020 年春夏），以及 初步响应后与 CNP 实施者和家庭进行数据验证（~2022 年秋季）。 可持续发展框架和CDC的政策分析框架，我们的目标是：（1）描述系统和环境 COVID-19 期间 CNP 政策实施的水平变化，包括挑战和促进因素、关键因素 合作伙伴、能力和适应措施；(2) 描述维持政策灵活性的潜力， 实施支持需求和关键政策杠杆，以继续实施新的实施战略 COVID-19 危机时期的调查结果可以为制定更公平的政策和量身定制的实践指南提供依据。 生成混合试验实施的数据，以比较范围、有效性和维持潜力 旨在减少粮食不安全和促进健康公平的新型 CNP 实施战略。