communities' role in childhood obesity prevention: the
TRANSCRIPT
Communities' Role in Childhood Obesity Prevention: The Healthy Communities Study
Healthy Communities Study: First National Study of Child Obesity Programs and Policies
Robyn D.F. Sagatov, PhD, MHS, RDN – Battelle
Vicki Collie-Akers, Lorrene Ritchie, S. Sonia Arteaga
Biennial Childhood Obesity Conference • July 2019
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• I have no disclosures or conflict of interest
Presenter Disclosure
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• NIH – NHLBI, NIDDK, NICHD, NCI, OBSSR • Battelle – Prime Contractor• University of Kansas – Community measures• University of California, Ag & Natural Resources – Nutrition• University of South Carolina – Physical activity• Scientific partners – CDC and RWJF• Observational Study Monitoring Board
Special Thank you to the study participants and communities!Funded by NHLBI, NIDDK, NICHD, NCI, OBSSR Contract No. HHSN268201000041C.
Acknowledgments
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• Learning objective: Understand the Healthy Communities Study design and be able to describe the study sample.
• Logic Model and Context
• Rationale and purpose
• Study aims
• Methods: Study Design
• Results: Sample Description
• Conclusions
Overview
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Inputs/Resources Activities Short-Term Outcomes
Intermediate Outcomes
Longer Term Outcomes
Factors affecting the likelihood that Community Programs & Policies will be put in place:
•Level of funding/other resources available
•Leadership•Existing partnership
•Level of collaboration
•Level of planning
Community/ Environment:
•Support for and Access to nutrition/physical activity
Community Programs & Policies (CP)Intensity is related to: A. Amount of CP
B. Attributes of CP: i.e. duration, change strategy, reach
Other related attributes:
C. Goal addressedD. Behavioral
objective addressed
E. Population targeted (e.g., targeted/ overweight)
G. Type of environmental strategy used (CDC, MAPP)
School Environment:
•Support for and Access to nutrition/physical activity
Behaviors:•Nutrition behaviors (e.g., increase in fruits/vegetables)
•Physical activities behaviors (e.g., Increase in physical activity, decrease in sedentary behaviors)
Home/FamilyEnvironment:
•Support for and Access to nutrition/physical activity
BMI :•BMI in children in grades k-8th in HCS communities
Community-Level Contextual/Moderating Factors: Community income, education, employment, racial/ethnic composition (e.g., Latinos, African Americans), immigrant status, geographical differences (e.g., urban, rural), housing (e.g., owners/renters), transportation (e.g., walkability), crime/safety
HEALTHY COMMUNITIES STUDY: HOW COMMUNITIES SHAPE CHILDREN’S HEALTH (NIH)LOGIC MODEL
Arteaga, S. S., Loria, C. M., Crawford, P. B., Fawcett, S. B., Fishbein, H. A., Gregoriou, M., … Strauss, W. J. (2015). The Healthy Communities Study: Its Rationale, Aims, and Approach. American journal of preventive medicine, 49(4), 615–623. doi:10.1016/j.amepre.2015.06.029
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Rationale and Purpose
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• Childhood obesity prevalence: 18.5% of youth ages 2-19 years had obesity in 2015-2016.1
• Health Disparities: Prevalence is higher in non-Hispanic black (22.0%) and Hispanic (25.8%) youth (vs. 14.1% in non-Hispanic white and 11.0% in non-Hispanic Asian youth).1
• While many studies have examined the impact of individual programs and policies, it is important to understand the collective community impact of efforts at multiple levels on children’s health.
Rationale
1 Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS data brief, no 288. Hyattsville, MD: National Center for Health Statistics. 2017.
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To assess/identify:
• Associations between characteristics of community programs/policies (CPPs) and BMI, diet, and physical activity for children
• Community, family, and child factors that modify or mediate such associations
• Associations between characteristics of CPPs and BMI, diet, and physical activity in communities with a high proportion of African American, Latino, and/or low-income residents
Study Aims
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Methods: Study Design
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Design: Observational study 2010-2016
Community = public high school catchment area
Data collected at multiple levels:
- Children – up to 81 children and their families
- Schools – up to 2 elementary and 2 middle schools
- Communities – 10-14 key informants interviewed per community
Study Overview2
2Arteaga, S. S., Loria, C. M., Crawford, P. B., Fawcett, S. B., Fishbein, H. A., Gregoriou, M., … Strauss, W. J. (2015). The Healthy Communities Study: Its Rationale, Aims, and Approach. American journal of preventive medicine, 49(4), 615–623. doi:10.1016/j.amepre.2015.06.029
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Cross–sectional and Retrospective
• Cross-sectional – BMI, diet, physical activity, program/policy
• Retrospective – previous 10 years for data on
-Children (medical record abstraction) AND
-Communities (program/policy review)
Study Design Overview3
2Arteaga, S. S., Loria, C. M., Crawford, P. B., Fawcett, S. B., Fishbein, H. A., Gregoriou, M., … Strauss, W. J. (2015). The Healthy Communities Study: Its Rationale, Aims, and Approach. American journal of preventive medicine, 49(4), 615–623. doi:10.1016/j.amepre.2015.06.0293Strauss, W. J., Sroka, C. J., Frongillo, E. A., Arteaga, S. S., Loria, C. M., Leifer, E. S., … John, L. V. (2015). Statistical Design Features of the Healthy Communities Study. American journal of preventive medicine, 49(4), 624–630. doi:10.1016/j.amepre.2015.06.021
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HCS Household Data Collection
Standard Protocol• BMI/anthropometry
• Nutrition questions
• Physical activity questions
• Medical history
• Demographics
• Behaviors/attitudes
• Exposure to community programs/policies
• Request consent to obtain child’s medical record
• Modified Windshield Survey of the home
Enhanced Protocol
Standard Protocol plus
• 24-hour dietary recall at first home visit and repeated at second home visit 1 week later
• Physical activity recall questions
• Accelerometers used over the 1-week period between the first and second home visits
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HCS: Community and School Data collection
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Community Selection
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Total of 130 communities
• National Probability Based Sample(N=102) -communities selected using a stratified national probability sample
• Certainty Communities (N=28) - communities selected with certainty because of their promising programs and policies
Community Selection
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National Probability Based Sample (N=102)
1. Region: Northeast, Midwest, West, South
2. Urbanicity: Urban, Suburban, Rural
3. Race/Ethnicity: 30% African American, 30% Latino, 30% other
4. Income: Low Income or Non low-income
5. Pre-Selection Activity rating of Community-Based Programs/Policies (High, Moderate, and Low/None)
Community Selection3
3Strauss, W. J., Sroka, C. J., Frongillo, E. A., Arteaga, S. S., Loria, C. M., Leifer, E. S., … John, L. V. (2015). Statistical Design Features of the Healthy Communities Study. American journal of preventive medicine, 49(4), 624–630. doi:10.1016/j.amepre.2015.06.021
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Community Characteristic N
EthnicityAfrican American 34Latino 42Other 54
Income Low 50Other 80
UrbanicityUrban 50Suburban 50Rural 30
Region
Northeast 20South 55Midwest 26West 29
Community Selection
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Results: Sample Description
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• 130 communities
• 149 school districts
• 436 schools
• 1,421 key informants
• 5,138 children/households
• 3,396 (66%) children with medical records abstracted
Sample Description
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Communities: N=130
Low income,
39%Not low income,
62%
Income
Urban, 39%
Suburban, 39%
Rural, 23%
Urbanicity
South, 42%
West, 22%
Midwest, 20%
Northeast, 15%
Region
≥30% Hispanic,
32%
≥30% African American, 26%
Other, 42%
Race/Ethnicity
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Children: N=5,138
Low-income, 35%
Not low-income, 65%
Child's Family Income
African American,
22%
Not African American, 78%
Child Race
Hispanic, 43%
Non-Hispanic, 57%
Child Ethnicity
Male, 49%
Female, 51%
Child Sex
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Weight Status
16%,
25%59%
Child Weight Status
39%
41%
21%
Father's Weight Status
30%
43%
27%
Mother's Weight Status
LegendDid not have overweight or obesityHad overweightHad obesity
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• Large and diverse samples of communities and families; Oversampled Hispanic and African American Communities
• Extensive BMI repeated-measures information collected through pediatric medical record review
• First study to document and assess relationships between CPPs and BMI
• Breadth of information allows for exploration into a variety of influences on childhood obesity
Study Strengths
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Questions???
Contact Information
Robyn D.F. Sagatov
Thank you!