Physical Activity Measures in the Healthy Communities Study

Neighborhood environments underpin screen time intervention success in children: Evidence from a study of greenspace and community programming across 130 US communities

The goal of this study was to understand how neighborhood greenspace access may support or hinder the effectiveness of community programs and policies (CPPs) aimed at reducing racial and ethnic inequities in screen time among 4598 US children. We found higher CPP intensity was significantly associated with fewer screen time behaviors in high greenspace neighborhoods, but not neighborhoods with low or moderate greenspace. Moreover, there were significant differences in greenspace access by neighborhood-level race and ethnicity. Implementing CPPs without regard for racial and ethnic greenspace inequities may be an underlying cause in the perpetuation of inequities in childhood screen time.

Park Area and Physical Activity Among Children and Adolescents: Findings From the Healthy Communities Study

BACKGROUND

There is currently a nationwide effort to bring parks and green spaces within a 10-minute walk of the home. We examined the association between park area within 1 km of a child's residence and self-reported park-specific physical activity (PA) along with accelerometer-derived moderate to vigorous physical activity (MVPA).

METHODS

A subsample of K through eighth-grade youth (n = 493) from the Healthy Communities Study reported whether they engaged in park-specific PA during the last 24 hours and wore an accelerometer for up to 7 days. Park area was defined as the percentage of park land in a 1 km Euclidean buffer around the participant's residence, categorized into quintiles. Analysis consisted of logistic and linear regression modeling with interaction effects that controlled for clustering within communities.

RESULTS

Regression models estimated greater park-specific PA for participants in the fourth and fifth quintiles of park land. Age, sex, race ethnicity, and family income were unrelated to park-specific PA. Accelerometer analysis indicated that total MVPA was unrelated to park area. Older children (β = -8.73, P < .001) and girls (β = -13.44, P < .001) engaged in less MVPA. Seasonality significantly predicted both park-specific PA and total MVPA.

CONCLUSION

Increasing park area is likely to improve youth PA patterns, lending support for the 10-minute walk initiative.

Household food insecurity and children's physical activity and sedentary behaviour in the United States: the Healthy Communities Study

Objective:

To examine associations between household food insecurity and children’s physical activity and sedentary behaviours.

Design:

Secondary analysis was conducted on the Healthy Communities Study, an observational study from 2013 to 2015. Household food insecurity was assessed by two items from the US Department of Agriculture’s 18-item US Household Food Security Survey Module. Physical activity was measured using the 7-d Physical Activity Behaviour Recall instrument. Data were analysed using multilevel statistical modelling.

Setting:

A total of 130 communities in the USA.

Participants:

In sum, 5138 US children aged 4–15 years.

Results:

No associations were found for the relationship between household food insecurity and child physical activity. A significant interaction between household food insecurity and child sex for sedentary behaviours was observed (P = 0·03).

Conclusions:

Additional research capturing a more detailed assessment of children’s experiences of food insecurity in relation to physical activity is warranted. Future studies may consider adopting qualitative study designs or utilising food insecurity measures that specifically target child-level food insecurity. Subsequent research may also seek to further explore sub-group analyses by sex.

The role of parental support for youth physical activity transportation and community-level poverty in the healthy communities study

This study evaluates whether parental provision of transportation for physical activity is associated with child/adolescent moderate-to-vigorous physical activity, while also evaluating community-level poverty. Self- and parental-reported surveys were administered with parents/caregivers and children in the Healthy Communities Study (N = 5138). Associations between individual-level demographics, community-level poverty, parental provision of transportation for physical activity, and moderate-to-vigorous physical activity were examined in multi-level models. Even when accounting for community-level poverty, which was significantly associated with lower moderate-to-vigorous physical activity, parental provision of transportation for physical activity was positively associated with greater moderate-to-vigorous physical activity. This study provides evidence for the importance of considering multiple systems of influence (e.g., community and individual factors) and considering how gaps in physical activity transportation for youth can be addressed in future health policies.

Associations between three measures of physical activity and selected influences on physical activity in youth transitioning from elementary to middle school

Measurement of physical activity is challenging, and objective and subjective methods can be used. The purposes of this study were to apply structural equation modeling in: 1) examining the associations between three distinct measures of physical activity and three factors that are often found to be correlated to physical activity in children, and 2) examining the associations of the combination of three measures with the same correlates in a cohort of youth followed from 5th to 7th grade. A total of 409 children (45% boys) had complete physical activity data derived from accelerometers, self-report by youth, and proxy-report by parents. The potential correlates of physical activity included self-efficacy, physical activity support, and facilities for physical activity. Structural equation models were used to assess the relationship between physical activity and the correlates. The structural equation models examining associations between individual measures of physical activity and selected correlates showed that parent-reported and child self-reported physical activity were associated with parental support for physical activity and self-efficacy. Objectively measured physical activity was associated only with facilities for physical activity. A structural equation model showed that a composite expression of physical activity, based on the inclusion of all three individual measures, was associated with all three correlates of physical activity. In conclusion, combining measures of physical activity from different sources may improve the identification of correlates of physical activity. This information could be used to plan more effective physical activity interventions in children and youth.

Decoding the Street-Based Spatiality of Urban Gyms: Implications for Healthy City Planning

Many cities face health issues that result from ineffective urban planning strategies. The chances of doing exercises in sportive venues implicate public health and citizen quality of life. With the advent of the geo-big data era, it is crucial to explore the spatial pattern of sports facilities to reflect urban health issues. This study aims to decode the street-based spatiality of gyms (one prevailing type of sportive venues) from a comprehensive perspective by both geometric methods (i.e., segment streets) and topological analytics in the context of complexity science (i.e., complex network derived from the topology of natural streets). We found that: (1) gyms are spatially clustered and distributed unevenly; (2) community-to-gym walkability fits the power-law with a heavy-tailed distribution at the 10-min and 20-min temporal scales; (3) the model for the street connectivity and the multi-distance reachability of gyms is with high polynomial fitting goodness. This article is conducive to strategies-making of healthy city planning and the further optimization of urban spatial structure.

The Role of the Neighborhood Social Environment in Physical Activity among Hispanic Children: Moderation by Cultural Factors and Mediation by Neighborhood Norms

Little is known about how the neighborhood social environment (e.g., safety, crime, traffic) impacts child physical activity. We examine the mechanism by which the neighborhood social environment is associated with child physical activity, moderated by individual-level cultural factors (e.g., language at home, immigrant generation) and mediated by neighborhood physical activity-related social norms (e.g., seeing walkers in the neighborhood). Data included 2749 non-Hispanic White and Hispanic children from the Healthy Communities Study. Multilevel regression was performed. The neighborhood social environment was not associated with physical activity in the full sample. However, Hispanic children speaking both English and Spanish and first- or second-generation Hispanic children engaged in more physical activity when the quality of the neighborhood social environment was higher (b = 1.60, p < 0.001 for Hispanic children speaking English and Spanish; b = 2.03, p < 0.01 for first-generation Hispanic children; b = 1.29, p < 0.01 for second-generation Hispanic children). Neighborhood physical activity-related social norms mediated the association between the neighborhood social environment and physical activity among Hispanic children speaking English and Spanish (b = 0.33, p < 0.001) and second-generation Hispanic children (b = 0.40, p < 0.001). Findings suggest heterogeneity in how neighborhood social environments impact physical activity by cultural factors. Health promotion programs may need to enhance neighborhood social environments to increase Hispanic children’s physical activity.

Identification of Effective Programs to Improve Access to and Use of Trails among Youth from Under-Resourced Communities: A Review

The primary purpose of this paper is to identify and review studies evaluating the effectiveness of programs to increase access to trails and trails use (physical activity) among youth from under-resourced communities. Three additional goals include identifying: (1) Correlates of physical activity/trail use and features of transportation systems and/or built environment and land use destinations, that may inform and support the planning and implementation of programs to promote trail use among youth, (2) benefits associated with trail use, and (3) barriers to trail use. Under-resourced communities are defined as those lacking sufficient resources (i.e., under-funded).

METHODS

A review of the literature was conducted to identify, abstract, and evaluate studies related to programs to promote trail use among youth and youth from under-resourced communities. In anticipation of very few studies being published about this topic, studies were also reviewed to identify correlates of transportation systems and built environment and land use destinations related to increases in physical activity, and benefits of, and barriers to trail use. PUBMED, MEDLINE, PsycINFO, Sportdiscus, Annual Reviews, American Trails, and Google Scholar databases were searched using terms including trails, built environment, physical activity, exercise, walking, children, adolescents, and youth to identify studies that potentially related to the purposes for conducting this review. Review methods identified, 5278 studies based on our search terms. A review of study titles, abstracts, and select full article screens determined that 5049 studies did not meet the study inclusion criteria, leaving 221 studies included in this review.

RESULTS

No studies were located that evaluated programs designed to promote and increase trail use among youth, including youth from under-resourced communities. Eight studies used longitudinal or quasi-experimental designs to evaluate physical activity and neighborhood characteristics prospectively among adolescent girls (n = 1), the effects of the path or trail development on physical activity behaviors of children, youth, and adults (n = 4), marketing or media campaigns (n = 2), and wayfinding and incremental distance signage (n = 1) to promote increased trail use. Correlates of transportation systems (e.g., trail access, road traffic congestion related to safe active travel, lack of sidewalks, closer proximity to trails, access to transportation), destinations (e.g., park availability and access, park improvements, greenspaces), or both routes and destinations (e.g., perceptions of safety, lighting), were identified. These correlates may support the planning and implementation of programs to increase trail use among youth, or may facilitate the connection of trails or routes to destinations in communities. Barriers to trail use included costs, crime, lack of transportation, lack of role models using trails, and institutional discrimination.

CONCLUSIONS

Scientific evidence in support of addressing the underrepresentation of trail use by youth from under-resourced communities is lacking. However, there is a related body of evidence that may inform how to develop programs that support trail use by youth from under-resourced areas. Dedicated, deliberate, and systematic efforts will be required to address research and knowledge gaps, and to evaluate programs and practice related to trail use among youth from low income, often racially or ethnically diverse under-resourced neighborhoods or communities.

Living in High-SES Neighborhoods Is Protective against Obesity among Higher-Income Children but Not Low-Income Children: Results from the Healthy Communities Study

Numerous studies have focused on the role of neighborhood socioeconomic status in childhood obesity and physical activity, but few studies have examined the effect of neighborhood socioeconomic changes over time and the interaction between family and neighborhood SES on childhood obesity and physical activity. This study measured neighborhood socioeconomic histories between 2000 and 2010 and examined the associations between neighborhood socioeconomic histories and childhood obesity, as well as physical activity. The moderating role of family poverty status was also examined. Using the Healthy Communities Study (2013-2015), we measured obesity indicators (objectively measured body mass index z-score and waist circumference) and a physical activity indicator (self-reported moderate-to-vigorous physical activity) for a cohort of 4114 children. Multilevel linear regression models were used to examine the associations between neighborhood socioeconomic histories between 2000 and 2009-2013 and body-mass index z-score, waist circumference, and moderate-to-vigorous physical activity. Results showed that higher-income children in consistently high socioeconomic neighborhoods had lower measured BMIz and WC and engaged in more moderate-to-vigorous physical activity than higher-income children in consistently low socioeconomic neighborhoods. Additionally, low-income children in consistently moderate socioeconomic neighborhoods reported a lower level of moderate-to-vigorous physical activity than low-income children in consistently low socioeconomic neighborhoods. The findings indicate that considering both family and neighborhood socioeconomic status may help elucidate the underlying differences in childhood obesity and physical activity levels by socioeconomic status.

Community-level obesity prevention is not associated with dieting behaviours and weight dissatisfaction in children: The Healthy Communities Study

BACKGROUND

Within the context of high childhood obesity prevalence, there is a concern that community efforts intended to reduce childhood obesity may lead to unintended adverse outcomes.

OBJECTIVE

This analysis examined relationships between community programs, policies, and environmental changes (CPPs) for obesity prevention with unhealthy dieting behaviours and body weight satisfaction in children.

METHODS

Using the Healthy Communities Study 2013 to 2015 survey sample of 5138 US children aged 4 to 15 years old, multilevel models examined associations between standardized CPP intensity scores and child dieting behaviours and weight satisfaction, adjusting for community and child-level covariates and clustered study design.

RESULTS

In fully adjusted models, higher total, physical activity, and nutrition CPP intensity scores were associated with lower odds of dissatisfaction with weight (1 year total CPP odds ratio [OR]: 0.41, 95% confidence interval [CI], 0.22-0.73; 6 year total CPP OR: 0.48, 0.29-0.80). Higher physical activity CPP intensity over the past year was associated with greater odds of weight satisfaction (OR: 1.77, 95% CI, 1.10-2.84). No associations were observed with dieting behaviours.

CONCLUSIONS

Results suggest that community efforts focusing on nutrition and physical activity to prevent childhood obesity may be associated with weight satisfaction and not with unhealthy dieting behaviours.

Comparison of the NHANES dietary screener questionnaire to the Automated Self-Administered 24-Hour Recall for Children in the Healthy Communities Study

Background

A dietary screener questionnaire (DSQ) was used to assess dietary outcomes among children in the Healthy Communities Study (HCS), a study of the relationships between programs and policies to prevent child obesity and child diet, physical activity and weight outcomes.

Methods

To compare dietary intake estimates derived from the DSQ against those from the Automated Self-Administered 24-Hour Recalls for Children (ASA24-Kids) among children, a measurement error model, using structural equation modelling, was utilized to estimate slopes, deattenuated correlation coefficients, and attenuation factors by age and sex, ethnicity, and BMI status.

Participants/setting

A randomly selected sub-sample of HCS participants aged 4–15 years in 130 communities throughout the U.S. who completed the DSQ and up to two ASA24-Kids recalls (n = 656;13% of HCS participants).

Results

For most nutrient/foods examined, the DSQ yielded larger mean intake estimates than the ASA24-Kids, and agreement between the two measures varied by food/nutrient, age and sex, ethnicity, and BMI category. Deattenuated correlation coefficients of 0.4 or greater were observed for added sugars from SSBs (0.54), fruits and vegetables (0.40), and dairy foods (0.50). Lower deattenuated correlation coefficients were seen for total added sugars (0.37), whole grains (0.34), and fiber (0.34). Attenuation factors were most severe for total added sugars intake among overweight children, and for several other dietary outcomes among children aged 9–11 years.

Conclusions

The DSQ was found to be a tool with acceptable agreement with the ASA24-Kids for measuring multiple dietary outcomes of interest in the HCS, although there may be potential due to measurement error to underestimate results (bias towards the null). In future studies, measurement error modelling and regression calibration may be possible solutions to correct for bias due to measurement error in most food/nutrient intake estimates from the DSQ when used among children.

Electronic supplementary material

The online version of this article (10.1186/s12937-018-0415-1) contains supplementary material, which is available to authorized users.

Community characteristics modify the relationship between obesity prevention efforts and dietary intake in children: the Healthy Communities Study

BACKGROUND

The influence of community characteristics on the effectiveness of childhood obesity prevention efforts is not well understood.

OBJECTIVE

Examine the interaction of community characteristics with the relationship between community programmes and policies (CPPs) and dietary intake.

METHODS

An observational study of 5138 children in grades K-8 in 130 US communities was conducted in 2013-2015. Key informant interviews identified and characterized CPPs. CPP scores were generated for the number of target behaviours (CPP-Behav) and the number of behaviour change strategies (CPP-Strat) addressed by all CPPs and CPPs with nutrition goals over the prior 6 years in each community. Dietary intake was assessed by dietary screener and included intake of sugar from sugar-sweetened beverages; energy-dense foods; fruits and vegetables; whole grains; and fibre. Multivariate statistical models assessed the interactions between US region, urbanicity, community-level income, and community-level race/ethnicity and CPP scores in relation to dietary intake.

RESULTS

CPP-Strat was positively associated with healthier dietary intakes in the Northeast and West, and in high Hispanic communities; the reverse was true in the South, and in high African-American and low-income communities. The CPP-Behav was positively associated with healthier dietary intakes in the South and rural areas, and the reverse was true in the West.

CONCLUSION

The relationships between CPP index scores and dietary intake were most strongly influenced by region and urbanicity and to a lesser extent by community-level race/ethnicity and income. Findings suggest that different considerations may be needed for childhood obesity prevention efforts in communities with different characteristics.

Associations between community programmes and policies and children's physical activity: the Healthy Communities Study

BACKGROUND

Community initiatives to promote physical activity in children are common, but evidence supporting their effectiveness is limited.

OBJECTIVES

The objective of this study is to examine the relationships between community programmes and policies and children's physical activity in a large and diverse sample of US communities.

METHODS

Programmes and policies to promote children's physical activity were assessed in 130 communities by key informant interviews, and physical activity behaviours were measured by self-report and parental report in samples of children in each community (total n = 5138). Associations between composite indices of community programmes and policies and indicators of total and moderate-to-vigorous physical activity were examined without and with adjustment for demographic factors.

RESULTS

An index reflecting the 6-year history of the number of behaviour change strategies used in community programmes and policies was positively associated with children's moderate-to-vigorous physical activity. This association was attenuated with adjustment for demographic factors. Effect modification analyses found that the association was positive among non-Hispanic children but was negative for Hispanic children.

CONCLUSIONS

Community initiatives to promote physical activity in children were positively associated with children's physical activity in non-Hispanic children. Such initiatives were negatively associated with physical activity in Hispanic children, suggesting that future research should consider unique cultural factors when designing community initiatives to promote activity in this population sub-group.

Regional comparisons of walking or bicycling for fun or exercise and for active transport in a nationally distributed sample of community-based youth

BACKGROUND

Physical activity helps prevent excessive weight gain in youth. Few studies have examined regional variations in common activities, walking and bicycling.

OBJECTIVE

The primary aim was to examine participation in previous 7-day walking/bicycling for active transport and for fun/exercise by region, gender and age groups.

METHODS

Children (n = 2693) from 130 diverse, geographically distributed US communities reported participation in previous 7-day walking/bicycling. Mixed model ANOVAs were used to compare walking/bicycling by region, gender and age groups using Healthy Communities Study data.

RESULTS

Walking/bicycling for fun/exercise was higher in the Midwest, South and West compared with the Northeast, with the same regional patterns for boys, girls and 9-11-year olds. Walking/bicycling to non-school destinations was higher in the Midwest compared with the South and Northeast, with the same pattern for girls and 9-11-year olds. Walking/bicycling to school was higher Midwest, Northeast and West compared with the South, with similar patterns for girls and 12-15-year olds.

CONCLUSIONS

Walking/bicycling for fun/exercise and to non-school destinations had higher prevalence than active transport to school. The Northeast reported lower walking/bicycling for fun/exercise; the South and Northeast reported lower walking/bicycling to non-school destinations. Program/policy initiatives should consider contextual demographic influences, as well as purpose/destination of walking/bicycling.

Supplement overview: what the Healthy Communities Study is telling us about childhood obesity prevention in U.S. communities

The Healthy Communities Study (HCS), conducted between 2010 and 2016, tells a real-world story of how childhood obesity prevention efforts have unfolded in 130 U.S. communities. The study documented nearly 10,000 current and past community policies and programs (CPPs) and assessed dietary and physical activity behaviors, weight, height, and waist circumference of more than 5,000, 4- to 15-year-old children. The articles in this HCS supplement describe the variables created to characterize the CPPs, CPP relationships with children's behavioral and weight status, other analyses of interest, and recruitment challenges. Findings suggest that many of the strategies being implemented work as intended to improve children's behaviors and weight status. However, of concern, findings also indicate lesser reach to children in demographic groups at highest risk of obesity. Overall, the HCS insights can guide the next phase of efforts to strengthen existing CPPs and motivate other, novel approaches to combating childhood obesity.

Associations of community programs and policies with children's dietary intakes: the Healthy Communities Study

BACKGROUND

The impact of community-based obesity prevention efforts on child nutrition has not been adequately studied.

OBJECTIVE

Examine relationships between number, type and intensity of community programs and policies (CPPs) and child nutrition.

METHODS

An observational study of 5138 children (grades K-8) in 130 U.S. communities was conducted in 2013-2015. CPPs were identified by 10-14 key informant interviews per community. CPPs were characterized based on: count, intensity, number of different strategies used and number of different behaviours targeted. Scores for the prior 6 years were calculated separately for CPPs that addressed primarily nutrition, primarily physical activity (PA) or total combined. Child intakes were calculated from a dietary screener and dietary behaviours were based on survey responses. Multi-level statistical models assessed associations between CPP indices and nutrition measures, adjusting for child and community-level covariates.

RESULTS

Implementing more types of strategies across all CPPs was related to lower intakes of total added sugar (when CPPs addressed primarily PA), sugar-sweetened beverages (for nutrition and PA CPPs) and energy-dense foods of minimal nutritional value (for total CPPs). Addressing more behaviours was related to higher intakes of fruit and vegetables (for nutrition and total CPPs) and fibre (total CPPs). Higher count and intensity (PA and total CPPs) were related to more consumption of lower fat compared with higher fat milk. A higher count (PA CPPs) was related to fewer energy-dense foods and whole grains. No other relationships were significant at P < 0.05.

CONCLUSION

Multiple characteristics of CPPs to prevent obesity appear important to improve children's diets.

Relationship of objective street quality attributes with youth physical activity: findings from the Healthy Communities Study

BACKGROUND

Residential environments may significantly influence youth physical activity (PA). However, few studies have examined detailed street quality attributes via observational audits in relation to context-specific PA among youth.

OBJECTIVES

The objective of this study was to explore whether the overall quality of street environments, as well as specific attributes, was associated with neighbourhood-based and street-based PA within a national sample of youth in the Healthy Communities Study.

METHODS

Data were collected from 4616 youth from 130 communities across the USA. Youth PA in the neighbourhood and on the participant's street was captured using 7-d recall interviews. Windshield survey observational audits documented five street quality variables: burned, boarded up or abandoned residential units, litter, overall condition of residences, street type and presence of sidewalks in good condition.

RESULTS

Youth with no litter on their street reported significantly lower neighbourhood-based PA and youth living on a side street, cul-de-sac, dead-end or one-way street reported greater neighbourhood-based PA. No significant associations were detected for the overall street quality index or with street-based PA.

CONCLUSIONS

Specific street quality attributes may be associated with youth PA. Further research and collaboration between diverse disciplines and agencies should focus on understanding and improving street quality to promote youth PA and health.

Utility of the Youth Compendium of Physical Activities

PURPOSE

The purposes of this article are to: (a) describe the rationale and development of the Youth Compendium of Physical Activities (Youth Compendium); and (b) discuss the utility of the Youth Compendium for audiences in research, education, community, health care, public health, and the private sector.

METHODS

The Youth Compendium provides a list of 196 physical activities (PA) categorized by activity types, specific activities, and metabolic costs (youth metabolic equivalents of task [MET_y]) as measured by indirect calorimetry. The utility of the Youth Compendium was assessed by describing ways in which it can be used by a variety of audiences.

RESULTS

Researchers can use MET_y values to estimate PA levels and determine changes in PA in intervention studies. Educators can ask students to complete PA records to determine time spent in physical activities and to identify health-enhancing activities for classroom PA breaks. Community leaders, parents, and health care professionals can identify activity types that promote healthful behaviors. Public health agencies can use the MET_y values for surveillance and as a resource to inform progress toward meeting national physical activity guidelines. Applications for the private sector include the use of MET_y in PA trackers and other applications.

CONCLUSION

The National Collaborative on Childhood Obesity Research Web site presents the Youth Compendium and related materials to facilitate measurement of the energy cost of nearly 200 physical activities in children and youth. The Youth Compendium provides a way to standardize energy costs in children and youth and has application for a wide variety of audiences.

Project SWEAT (Summer Weight and Environmental Assessment Trial): study protocol of an observational study using a multistate, prospective design that examines the weight gain trajectory among a racially and ethnically diverse convenience sample of economically disadvantaged school-age children

INTRODUCTION

Racial/ethnic minority school-age children are at risk for unhealthy weight gain during the summer, and there is a dearth of information regarding the underlying behavioural and environmental factors. The study objective is to provide an in-depth examination of dietary and physical activity behaviours and food, physical activity, and social environments of African American and Hispanic school-age children during the summer.

METHODS AND ANALYSIS

An observational study will be conducted using a multistate (Ohio and Indiana, USA) prospective design examining the weight gain trajectory among a racially/ethnically diverse convenience sample of economically disadvantaged school-age children. In addition, a subset of these children will be evaluated to learn their daily health behaviours and food, physical activity, and social environments during the summer. Comparisons will be made between children who routinely attend programming and those who do not, both in the larger sample and subset. Determinants of programme participation and factors that may enhance the beneficial effects of programme participation will also be identified. Data collection at the Indiana site is planned for summer 2018.

ETHICS AND DISSEMINATION

This study is approved by The Ohio State University Behavioral and Social Sciences Institutional Review Board. Results from this study will be disseminated in publications for practitioners, scientists and stakeholders.

TRIAL REGISTRATION NUMBER

NCT03010644; Pre-results.

Statistical Design Features of the Healthy Communities Study

The Healthy Communities Study is designed to assess relationships between characteristics of community programs and policies targeting childhood obesity and children's BMI, diet, and physical activity. The study involved a complex data collection protocol implemented over a 2-year period (2013-2015) across a diverse sample of 130 communities, defined as public high school catchment areas. The protocol involved baseline assessment within each community that included in-person or telephone interviews regarding community programs and policies and in-home collection of BMI, nutritional, and physical activity outcomes from a sample of up to 81 children enrolled in kindergarten through eighth grade in public schools. The protocol also involved medical record reviews to establish a longitudinal trajectory of BMI for an estimated 70% of participating children. Staged sampling was used to collect less detailed measures of physical activity and nutrition across the entire sample of children, with a subset assessed using more costly, burdensome, and detailed measures. Data from the Healthy Community Study will be analyzed using both cross-sectional and longitudinal models that account for the complex design and correct for measurement error and bias using a likelihood-based Markov-chain Monte Carlo methodology. This methods paper provides insights into the complex design features of the Healthy Communities Study and may serve as an example for future large-scale studies that assess the relationship between community-based programs and policies and health outcomes of community residents.

Operational Implementation of the Healthy Communities Study: How Communities Shape Children's Health

The Healthy Communities Study (HCS) is examining how characteristics of community programs and policies targeting childhood obesity are related to childhood diet, physical activity, and obesity outcomes. The study involves selected districts and public schools in 130 communities; families recruited through schools; and data collected at the community, school, household, and child levels. Data collection took place in two waves-Wave 1 in Spring 2012 and Wave 2 from 2013 to 2015-with analysis to be completed by August 2016. This paper describes operational elements of the HCS, including recruitment activities, field operations, training of data collectors, human subjects protection, and quality assurance and quality control procedures. Experienced trainers oversaw and conducted all training, including training of (1) district and school recruitment staff; (2) telephone interviewers for household screening and recruitment; (3) field data collectors for conducting household data collection; and (4) community liaisons for conducting key informant interviews, document abstraction, and community observations. The study team developed quality assurance and quality control procedures that were implemented for all aspects of the study. Planning and operationalizing a study of this complexity and magnitude, with multiple functional teams, required frequent communication and strong collaboration among all study partners to ensure timely and effective decision making.

Weight Status Measures Collected in the Healthy Communities Study: Protocols and Analyses

The Healthy Communities Study is one of the largest studies to assess the relationship between characteristics of community programs and policies to prevent childhood obesity and obesity-related outcomes. The purpose of this paper is to describe the protocol that was developed for collecting the anthropometric data for the study and the procedures for analyzing the data. Data were collected from 2013 to 2015 and analyses will be completed by mid-2016. During in-home visits, Healthy Communities Study staff collected height, weight, and waist circumference measurements from child participants and height and weight measurements from adult participants. The protocol for obtaining these measurements was adapted from the protocol used by the National Health and Nutrition Examination Survey, with modifications to accommodate assessments conducted in homes rather than in a Mobile Examination Center. In addition to anthropometric data from in-home visits, the Healthy Communities Study collected retrospective height and weight measurements from the medical records of child participants. These data were used to calculate trajectories of BMI and BMI z-scores. The study implemented procedures for ensuring the accuracy of the in-home measurements and abstracted medical data. These procedures included automatically checking the ranges on entered data, reviewing data for end-digit patterns, and abstracting selected medical records using two independent abstractors to assess agreement. The collection of longitudinal height and weight measures will allow researchers to address several pressing questions related to how characteristics of community programs and policies are associated with obesity-related outcomes among children.

The Healthy Communities Study: Its Rationale, Aims, and Approach

Communities across the U.S. are implementing programs and policies designed to address the epidemic of childhood obesity. These programs vary widely in their approaches, including the intensity level, duration, funding, target population, and implementation techniques. However, no previous studies have examined these variations and determined how such aspects of community programs and policies are related to childhood obesity outcomes. The Healthy Communities Study is an observational study that is assessing the associations between characteristics of community programs and policies and BMI, nutrition, and physical activity in children. The Healthy Communities Study was funded in 2010, field data collection and medical record abstraction will be completed in 2015, and data cleaning and analyses will be completed by mid-year 2016. One-hundred and thirty communities (defined as a high school catchment area) and approximately 5,000 children in kindergarten through eighth grade and their parents have been recruited from public elementary and middle schools across the country. The study is examining quantitative and qualitative information obtained from community-based initiatives; measures of community characteristics (e.g., school environment); and child and parent measures, including children's physical activity levels and dietary practices and children's and parents' BMI. The Healthy Communities Study employs a complex study design that includes a diverse sample of communities across the country and combines current/cross-sectional and retrospective data (abstracted from children's medical records). This paper describes the rationale for the Healthy Communities Study, the study aims and logic model, and a brief overview of the study design.