Impact of Universal Free Meals on Childhood Obesity Risk and Obesity Disparities

普遍免费膳食对儿童肥胖风险和肥胖差异的影响

基本信息

批准号：
10471313
负责人：
Jessica C Jones-Smith
金额：
$ 44.32万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-19 至 2025-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10471313
关键词：
Address Adoption Affect Asian Behavior Black race Body Weight Body mass index California Calories Censuses Characteristics Charge Child Childhood Communities Consumption Data Data Aggregation Data Sources Eating Economic Factors Eligibility Determination Environmental Risk Factor Ethnic Origin Exposure to Family Food Food Policy Goals Health Health Food Health Promotion Heterogeneity Household Hunger Income Individual Intervention Latinx Lead Literature Longitudinal cohort Low income Measures Mediating Medical Records Methods Native Americans Natural experiment Obesity Outcome Pathway interactions Personal Satisfaction Physical activity Plant Roots Policies Population Poverty Prevalence Price Proxy Public Health Race Sampling Schools Sleep Source Stress Structural Racism Time Time trend Variant Weight Work base cohort cost experience fifth grade food insecurity food security health data health economics income disparities ninth grade obesity in children obesity prevention obesity risk prevent programs racial disparity safety net school district seventh grade social social determinants

项目摘要

ABSTRACT Childhood obesity is highly prevalent, difficult to treat and prevent, and of major health and economic consequence. Lower income children and children of Black, Latinx, and Native American race/ethnicity experience a disproportionate burden of obesity as compared to higher income and White or Asian children. Evidence suggests that economic and environmental factors, many driven by structural racism, underlie racial and income disparities in obesity. These structural factors are often acknowledged as potential root causes of obesity and obesity disparities; however, they are also recognized as difficult to intervene upon. Policy interventions are one option for affecting change upon these potential root causes. Using a natural experiment approach, we have an opportunity to leverage a recent policy change—the Community Eligibility Provision (CEP) of the Healthy Hunger-Free Kids Act of 2010—to assess the degree to which providing free meals to all children in high poverty schools affects obesity prevalence. The CEP was passed in 2010 and allows schools in high- poverty school districts to provide universal free meals (breakfast and lunch) to all children in the school without requiring individuals to sign up for the free and reduced lunch program. The goal is to increase participation in school meals and ultimately reduce both food insecurity and obesity. The program is targeted at lower- and lower-middle income children, many of whom were not receiving free- and reduced-price lunches despite being eligible. Because the CEP is targeted to high-poverty schools, focuses on a social determinant (income constraints) and is a non-agentic policy (i.e. children and their families do not need to do anything extra to receive the benefits), this policy has high theoretical potential to decrease obesity and possibly decrease obesity disparities. CEP could be expected to impact child body weight by prompting individuals to substitute healthier foods for unhealthier food and by providing two meals a day at no cost, thus affecting child BMI through indirect pathways of increased disposable household income. This increase in disposable income could lead to decreased food insecurity, decrease parental stress, and/or could potentially be used for health promoting behaviors, such physical activity or purchasing of healthier foods in the household, each of which has been associated with obesity. CEP represents a significant change in school policy and an expansion of social safety nets, but scant scientific literature exists on the health impacts of CEP. The proposed study aims to comprehensively assess the impacts of CEP on obesity outcomes through using robust data and methods for causal inference in order to assess: 1) the impact of CEP on obesity 2) impact of CEP on potential mediating mechanisms 3) heterogeneities in impacts on obesity by race/ethnicity and income 4) impacts on population- level obesity disparities.

抽象的儿童肥胖非常普遍，难以治疗和预防，并且对健康和经济造成重大影响低收入儿童以及黑人、拉丁裔和美洲原住民种族/族裔的儿童。与高收入的白人或亚洲儿童相比，他们经历了不成比例的肥胖负担。有证据表明，经济和环境因素（许多是由结构性种族主义驱动）是种族歧视的基础这些结构性因素通常被认为是肥胖的潜在根本原因。肥胖和肥胖差异；然而，它们也被认为是难以干预的政策。干预措施是利用自然实验影响这些潜在根本原因的改变的一种选择。方法，我们有机会利用最近的政策变化——社区资格规定 (CEP) 2010 年《健康无饥饿儿童法案》——评估向所有儿童提供免费膳食的程度 2010 年通过的 CEP 允许高中贫困学校的肥胖发生率。贫困学区向所有在校儿童提供普遍免费餐（早餐和午餐）要求个人报名参加免费和减价午餐计划，目的是增加参与度。学校供餐并最终减少粮食不安全和肥胖。该计划针对的是低收入和肥胖人群。中低收入儿童，其中许多人尽管在因为 CEP 针对的是高度贫困学校，所以重点关注社会决定因素（收入）。限制），并且是一项非代理政策（即儿童及其家庭不需要做任何额外的事情来接受的好处），这项政策在减少肥胖方面具有很高的理论潜力，并可能减少肥胖 CEP 可能会通过促使人们选择更健康的食物来影响儿童的体重。食品不健康，免费提供一日两餐，从而间接影响儿童体重指数可支配收入的增加可能会导致家庭可支配收入的增加。减少粮食不安全，减少父母压力，和/或可能用于促进健康行为，例如身体活动或在家里购买更健康的食物，每一项都已 CEP 代表了学校政策的重大变化和社会安全的扩大。网，但关于 CEP 对健康影响的科学文献很少。通过使用可靠的数据和方法来全面评估 CEP 对肥胖结果的影响因果推断以评估：1) CEP 对肥胖的影响 2) CEP 对潜在中介的影响机制 3) 种族/民族和收入对肥胖影响的异质性 4) 对人口的影响肥胖水平差异。