Increasing Low-income Children's Access to Healthy Structured Programming to Reduce Obesity

增加低收入儿童获得健康结构化规划的机会以减少肥胖

• 批准号: 10654378
• 负责人: Robert G Weaver
• 金额: $ 45.25万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-15 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10654378
• 关键词: Address; Administrator; Adult; Age; Behavior; Body fat; Body mass index; Calendar; Child; Communities; Diet; Disparity; Effectiveness; Environment; Family; Fatty acid glycerol esters; Fee-for-Service Plans; Food; Health; Hour; Household; Incentives; Income; Intervention; Interview; Learning; Literature; Low income; Obesity; Outcome; Overweight; Parents; Participant; Physical activity; Play; Policies; Prevalence; Public Health; Randomized; Recording of previous events; Reporting; Role; Schools; Services; Side; Sleep; Sleep disturbances; Structure; Testing; Time; United States; United States Department of Agriculture; Weight; Weight Gain; after-school program; cost; cost-effectiveness evaluation; design; disparity reduction; excessive weight gain; experience; food insecurity; fourth grade; good diet; implementation barriers; income disparities; innovation; learning community; lower income families; novel; nutrition; obesity in children; obesity treatment; obesogenic; prevent; primary outcome; program costs; programs; secondary outcome; sleep pattern; summer program; systematic review; treatment program; voucher

Disparities in overweight and obesity (OWOB) prevalence between children (ages 5-11) from low- and middle-to- high-income families persist. The structured days hypothesis posits that structure within a day, defined as a pre- planned, segmented, and adult-supervised compulsory environment (like a school day), plays a protective role for children against obesogenic behaviors and, ultimately, prevents the occurrence of negative health outcomes, such as excessive weight gain. Essentially, the structured days hypothesis draws upon concepts in the ‘filled-time perspective’ literature which posits that time filled with favorable activities cannot be filled with unfavorable activities. There are at least two “windows of vulnerability” for children outside of the school day. These critically important windows include the hours immediately following school (i.e., 3-6pm school days) and the 10 weeks of summer vacation. Programs that can provide a healthy structured environment and prevent unhealthy weight gains exist for both of these time periods (i.e., afterschool programs and summer day camps). Unfortunately, these programs are too expensive for children from low-income families to attend. Thus, based on demand-side financing, which has a long history addressing large scale public health problems in the United States through federal, state, and local programs like the Supplemental Nutrition Assistance Program and the 21st Century Learning Centers Program, we will rigorously test the impact of providing access to pre-existing, community- operated afterschool and summer programs on weight status (i.e., BMI z-score) and obesogenic behaviors (i.e., physical activity, screen use, diet, and sleep) of elementary children from low-income households. This approach will potentially be less costly than current obesity treatment programs which cost up to $4,600 per child. This study will employ a 2x2 full factorial design. The four groups will be a no-treatment control, afterschool program voucher only, summer day camp voucher only, and vouchers for afterschool and summer day camp combined. We will accomplish the following specific aims: AIM 1: Compare differences in primary and secondary outcomes among children provided no voucher, a voucher for after-school only, a voucher for summer camp only, and a voucher for both after-school and summer camp. AIM 2: Evaluate the cost-effectiveness of providing a voucher for after-school only, a voucher for summer camp only, and a voucher for both after-school and summer camp. Aim 3: Evaluate facilitators and barriers to the implementation, effectiveness, and sustainability of the voucher program by conducting qualitative interviews with key stakeholders (i.e., children, parents, staff, administrators). This study is significant because nearly one in five children are obese, and disparities in OWOB exist between children from low- and middle-to-high-income households persist despite past school-based interventions. This study is innovative because it represents one of the first attempts to provide access to healthy structured programming during two “windows of vulnerability” for children outside of the school day. Should the proposed intervention strategy prove effective, it has the potential to mitigate disparities in OWOB prevalence.

从低到中间到中间的儿童（5-11岁）超重和肥胖（OWOB）的差异（OWOB） 高收入家庭坚持不懈。结构化的假设假设在一天之内定义为结构。 计划，细分和成人监督的强制性环境（例如上学日），对 反对肥胖行为的儿童，并最终防止发生负面健康结果，这种情况 作为体重增加的过多。本质上，结构化假设借鉴了“填充时间”中的概念 观点的文学作品所处的文学作品充满了有利的活动，这不可能充满不利的活动。 上学之外的儿童至少有两个“脆弱窗户”。这些至关重要 窗户包括放学后立即的时间（即上午3-6点）和夏季的10周 假期。可以提供健康的结构化环境并防止不健康的体重增加的程序 对于这两个时期（即，课后课程和夏日营地）。不幸的是，这些 对于低收入家庭的儿童来说，计划太昂贵了。那是基于需求侧的 融资，历史悠久，通过 联邦，州和地方计划，例如补充营养援助计划和21世纪 学习中心计划，我们将严格测试提供访问已存在的，社区的影响 有关体重状况（即BMI Z得分）和肥胖行为（即，即， 来自低收入家庭的小学儿童的体育锻炼，筛查，饮食和睡眠。这种方法 与目前的肥胖治疗计划相比，每个孩子的成本高达4,600美元。这 研究将采用2x2完整的阶乘设计。这四个组将是一个不进行治疗的控制，课后计划 仅限凭证，仅限夏日营地代金券，以及夏季营地和夏日营地的凭证。我们 将完成以下特定目标：目标1：比较主要和次要结果的差异 在儿童中，没有提供任何凭证，仅提供课后的代金券，仅适用于夏令营的代金券，还有一个 用于课后和夏令营的代金券。目标2：评估提供代金券的成本效益 仅用于课后，仅适用于夏令营的优惠券，以及课后和夏令营的优惠券。 目标3：评估凭证的实施，有效性和可持续性的促进者和障碍 通过对主要利益相关者（即子女，父母，员工，管理人员）进行定性访谈来计划。 这项研究很重要，因为几乎五分之一的孩子是肥胖的，而OWOB的差异存在 来自低收入和最高收入家庭的儿童持续了以学校为基础的干预措施。这 研究具有创新性，因为它代表了提供健康结构化访问的首次尝试之一 在上学日以外的两个儿童的“脆弱窗口”中编程。应该提出的 干预策略证明有效，它有可能减轻OWOB患病率的分布。