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Study Aims

The Healthy Communities Study (HCS) is designed to investigate the associations between community-based childhood prevention programs/policies and body mass index (BMI), diet, and physical activity in children. The study design is tailored to meet the following primary aims:

  1. To determine the associations between community programs/policies and BMI, diet, and physical activity for children.
  2. To identify the community, family, and child factors that modify or mediate the associations between community programs/policies and BMI, diet, and physical activity in children.
  3. To assess the associations between programs/policies and BMI, diet, and physical activity in children in communities that have a high proportion of African American, Latino, and/or low-income residents.

Research Questions

The HCS is designed to address a variety of research questions that are both cross-sectional and longitudinal in nature. The main outcome variables of interest are BMI, diet, and physical activity behaviors in children. The study investigators expect to answer questions about how these variables are related to aspects of community programs and policies, which can be grouped into four broad areas: (a) intensity, (b) specific attributes, such as duration, funding, and target population, (c) combinations of programs and policies, and (d) factors that modify or mediate associations with the outcome variables of interest.

These research questions can be answered with both cross-sectional and longitudinal data. Cross-sectional analyses can examine the association of community programs and policies with BMI, diet, and physical activity at a single point in time on a large, nationally representative sample of children using measured height and weight to calculate BMI. In longitudinal analyses, BMI trajectories can be modeled as a function of the intensity of community programs and policies within each community over the same period. Analyses can explore which attributes or combinations of programs and policies are most strongly associated with BMI, diet, and physical activity among children, and if these associations are modified or mediated by community, family, or child factors. Examples of the primary HCS research questions are provided below.

A. Research Questions Related To Community Programs/Policies

  1. What intensity of community programs/policies is associated with BMI, diet, and physical activity behaviors among children? (Cross-sectional)
  2. Are changes in intensity of community programs/policies associated with changes in BMI among children? (Longitudinal)

Answers to these questions can lead to a better understanding of how the intensity of community programs and policies targeting childhood obesity is associated with lower BMI, as well as protective diet and physical activity behaviors among children.

B. Research Questions Related To Specific Attributes Of Community Programs/Policies

  1. What attributes of community programs/policies are most associated with BMI, diet, and physical activity among children? (Cross-sectional)
    1. For example, which of the following community program/policy attributes has the strongest association with childhood BMI: community program/policy duration, funding, or target population (e.g., targeting at-risk youth versus the general population)?
  2. What attributes of community programs/policies are most associated with changes in BMI? (Longitudinal)

Answers to these questions can help provide insights into which specific attributes of community programs/policies are most essential in lowering childhood obesity.

C. Research Questions Related To Specific Combinations Of Community Programs/Policies

  1. What combinations of community programs/policies are associated with BMI, diet, and physical activity among children? (Cross-sectional)
  2. What combinations of community programs/policies are associated with changes in BMI among children? (Longitudinal)

Answers to these questions will help address whether combinations of programs/policies – such as enhanced school programs in conjunction with expanded parks and recreational opportunities – have a stronger association with BMI, diet, and physical activity than one particular program.

D. Research Questions Related To Factors That Modify Or Mediate Associations

  1. What factors modify or mediate associations between community programs/policies and BMI, diet, and physical activity among children? (Cross-sectional)
    1. For example, do community and family socio-demographic characteristics modify the associations between community programs/policies and BMI, diet, and physical activity?
    2. Are community programs/policies that are associated with a lower BMI and protective diet and physical activity behaviors in children mediated through parent support for healthy eating and physical activity?
  2. What factors modify or mediate associations between community programs/policies and changes in BMI among children? (Longitudinal)

Answers to these questions will help address whether factors such as greater availability of healthy foods and less availability of unhealthy foods at schools or the presence of parks and walking paths in a community modify the association between community programs/policies and BMI, diet, and physical activity among children.

Design And Methods

120 communities and about 5,000 children and their parents/caregivers will be part of the HCS. A HCS community is defined as a high school catchment area and children in Kindergarten through 8th grade will be recruited into the study. A HCS community is defined as a high school catchment area and children in Kindergarten through 8th grade will be recruited into the study. The study examines quantitative and qualitative information obtained from community-based initiatives, community characteristics (e.g., school environment), and from child and parent assessments and measurements of children’s physical activity levels, children’s dietary practices, and children’s and parent’s BMI. This study is not designed to evaluate any one specific program, policy or community, but will instead systematically assess if components or characteristics of representative programs/policies in communities across the country are related to BMI, diet, and physical activity habits in children.

The HCS employs a complex study design that includes a nationally representative sample of communities as well as communities that are selected with certainty because of their known promising programs and policies targeting children’s diet and physical activities. The HCS study design combines cross-sectional and retrospective quantitative and qualitative data. Cross-sectional data include in-person assessment of BMI, diet, and physical activity. The retrospective data are comprised of the history of childhood obesity programs and policies and how they unfolded over the previous 10 years in each community. BMI trajectories over that same time period are also included by combining BMI measured cross-sectionally with BMI calculated from height and weight data abstracted from participant medical records.

Program/policy and environmental data are collected through interviews with key community members, participant perceptions of the school and home environments, document review, and GIS data.

Questions

If you have questions about the study, please visit the Researcher Contacts page.




Last Updated April 2014




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