communities' role in childhood obesity prevention: the

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:


Behaviors:•Nutrition behaviors (e.g., increase in fruits/vegetables)

•Physical activities behaviors (e.g., Increase in physical activity, decrease in sedentary behaviors)

Home/FamilyEnvironment:


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

[email protected]

Thank you!

mailto:[email protected]

communities' role in childhood obesity prevention: the

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