National Childhood Obesity Efforts: Lessons Learned from the - PowerPoint PPT Presentation

National Childhood Obesity Efforts: Lessons Learned from the Healthy Com m unities Study Vicki Collie-Akers, Stephen Faw cett, & Jerry Schultz Center for Com m unity Health & Developm ent, University of Kansas http:/ / com m unityhealth.ku.edu/ Childhood Obesity Sum m it, June 2 8 , 2 0 1 8 ; Kansas City, MO

2 Healthy Com m unities Study Aim s To assess/ identify : • Click to edit Master text styles • Associations betw een characteristics of com m unity program s/ policies ( CPPs) and BMI , – Second level diet, and physical activity for children • Third level • Community, family, and child factors that modify or – Fourth level mediate such associations » Fifth level • 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 [ Source: Arteaga et al., Healthy Communities Study, Am J Prev Med 2015; 49(4): 615–623.]

3 Overview of Healthy Com m unities Study Observational study of children and com m unities: 2010-2016; 10-year retrospective • Click to edit Master text styles 1 3 0 Com m unities: high school catchment area – Second level 3 ,2 2 9 Children : with BMIs • Third level – Fourth level Design: » Fifth level • Cross-sectional – BMI, diet, physical activity, community program/ policy • Retrospective – previous 10 years for data on -Children (medical record abstraction) AND -Communities (community programs/ policies)

4 Big Study/ Lots of Partners • Battelle – Lead • Click to edit Master text styles • University of Kansas- Community measures – Second level • University of California, Agriculture & Natural Resources – Nutrition • Third level – Fourth level • University of South Carolina – Physical activity » Fifth level • NIH – NHLBI, NIDDK, NICHD, NCI, OBSSR • Scientific partners – CDC and RWJF • Observational Study Monitoring Board [ Funded by NHLBI, NIDDK, NICHD, NCI, OBSSR]

5 HCS Household Data Collection Standard Protocol Enhanced Protocol BMI/anthropometry Standard Protocol plus • Nutrition questions 24-hour dietary recall at • • first home visit and Physical activity questions • repeated at second Medical history • home visit 1 week later Demographics • Physical activity recall • Behaviors/attitudes • questions Exposure to community • Accelerometers used • programs/policies over the 1-week period Request consent to obtain • between the first and child’s medical record/BMI second home visits Modified Windshield Survey • of the home

W hy look at com m unity 6 program s/ policies in the HCS? • Communities throughout U.S. engaged in creating • Click to edit Master text styles environments to support healthy weight – Second level • To varying degrees • Third level • In different ways – Fourth level » Fifth level • Knowledge Gap--Little known about: • “Dose”—scope and intensity—of such efforts • Whether community programs/ policies—of different amounts and types—are associated with children’s diet, physical activity, and healthy weight

Focus & protocol for com m unity 7 m easurem ent Focus—Number and type/ intensity of community: • Click to edit Master text styles • Programs (e.g., nutrition program) • Policies (e.g., new PA requirement in school) – Second level • Environmental changes (e.g. bike path) • Third level – Fourth level Protocol: » Fifth level • Capture of Community Programs/ Policies (CPPs) • Code instances of CPPs • Characterize CPPs for key attributes • Calculate intensity scores Source: Fawcett, S.B., Collie-Akers, V., Schultz, J., Kelley, M. (2015). Measuring community programs and policies in the Healthy Communities Study. American Journal of Preventive Medicine . 49 (4), 636- 641.

Characterizing com m unity 8 program s/ policies by key attributes Attributes related to intensity: • Click to edit Master text styles • Duration (e.g., Higher—Ongoing; Lower—one time) – Second level • Reach (e.g., Higher—21% or more of children in area; Lower—1-5% ) • Third level • Behavioral intervention strategy used (e.g., Higher— – Fourth level Modifying access or policy change; Lower—Providing information) » Fifth level Other attributes, including: • Primary goal • Behavioral objective addressed • Sector in which implemented

9 Calculating intensity scores for CPPs • Click to edit Master text styles Each CPP characterized (High, Med, Low) for each attribute – Second level • Third level – Fourth level Formula: Individual CPP Intensity Score= (Duration + Reach » Fifth level + Strategy)/ 3

10 10 Calculating intensity scores for CPPs Each CPP characterized (High, Med, Low) for each attribute Formula: Individual CPP Intensity Score= (Duration + Reach + Strategy)/ 3 • Click to edit Master text styles – Second level I llustrative Com m unity/ Program Attributes used in I ntensity Scoring Policy ( Goal Addressed) Duration Reach Behavioral INTENSITY • Third level I ntervention SCORE Strategy Used – Fourth level Created w alking path/ greenw ay Ongoing High (1.0) Modifying access, 1.0 to connect neighborhoods and (1.0) barriers, and » Fifth level schools ( Physical activity) opportunities (1.0) Provided an educational sem inar One-time Low (0.1) Providing information 0.10 to parents attending elem entary event (0.1) and enhancing skills (0.1) school Parent Teacher Association m eeting about how to prom ote healthy eating am ong children. ( Healthy eating)

Distribution of com m unity program s and policies ( N= 9 ,6 8 1 ) for the 1 3 0 com m unities over 1 0 -year 11 11 study period. • Click to edit Master text styles – Second level • Third level – Fourth level » Fifth level (Collie-Akers, Schultz, Fawcett, et al., in press, Pediatric Obesity ).

Distribution of total intensity scores for the 1 3 0 12 12 com m unities over 1 0 -year study period • Click to edit Master text styles – Second level • Third level – Fourth level » Fifth level (Collie-Akers, Schultz, Fawcett, et al., in press, Pediatric Obesity ).

Take aw ay m essages for com m unity 13 13 efforts to prom ote healthier w eight • Some communities invest more—others relatively • Click to edit Master text styles little—in promoting healthier weight among children – Second level • Communities showed a wide range in number and intensity of CPPs, with increasing trend over time • Third level • Potential explanations of increasing trend: – Fourth level • Recommendations and calls to action by agenda- » Fifth level setting organizations, including reports from the National Academies of Science and the U.S. Centers for Disease Control and Prevention • Subsequent increases in initiatives and investments by national and local grant-makers

Distribution of CPPs by behavioral 14 14 objective—nutrition, all com m unities • Click to edit Master text styles – Second level • Third level – Fourth level » Fifth level (Collie-Akers, Schultz, Fawcett, et al., in press, Pediatric Obesity ).

Take aw ay m essages for nutrition 15 15 efforts to prom ote healthier w eight • Longer (multiple years) of exposure is better than shorter (1 year) • Click to edit Master text styles • Several features of community efforts are important; – Second level there is no “single” or “simple” solution • Third level • More effort needed to change some behaviors: eating from a fast food restaurant, eating dinner with family, – Fourth level and eating while watching TV » Fifth level • Physical activity efforts may also be associated with improved nutrition • Considerable room remains for changing environments to improve child diets [ Source: Ritchie et al, in press, Pediatric Obesity; Webb et al., in press, Pediatric Obesity ]

Distribution of CPPs by behavioral objective— 16 16 physical activity, all com m unities • Click to edit Master text styles – Second level • Third level – Fourth level » Fifth level (Collie-Akers, Schultz, Fawcett, et al., in press, Pediatric Obesity ).

Take aw ay m essages for physical activity 17 17 efforts to prom ote healthier w eight • Longer (6 year history of) exposure to behavior • Click to edit Master text styles change strategies used in community programs/ policies was positively associated with – Second level children’s moderate-to-vigorous physical activity • Third level • Community initiatives to promote physical activity in – Fourth level children may be more successful if they are sustained for several years and employ multiple behavior change » Fifth level strategies [ Source: Russ Pate and HCS Physical Activity Team]

Scatter plots of m ean BMI vs. CPP nutrition target 18 18 behavior score & CPP physical activity target behavior score Nutrition Physical Activity 22.5 • Click to edit Master text styles 22 – Second level 21.5 Mean of Child BMI • Third level – Fourth level 21 » Fifth level 20.5 20 19.5 5 10 15 5 10 15 CPP target behavior score Graphs by Type (Frongillo, et al., 2017, American Journal of Preventive Medicine).