Ten-Year Study Reveals That What Communities Do Impacts Child Health
What is the issue?
When a journal dedicates an entire supplement to one study, you know it’s important. When a study is featured in two journal supplements, it’s an even bigger deal. That’s the case with the Healthy Communities Study, a 10-year NIH-funded nationwide investigation probing the impacts of community-based nutrition and physical activity programs on childhood obesity. Eleven articles revealing the first comprehensive set of findings were published recently in a special supplement to the journal Pediatric Obesity.
Typically, studies involve researchers implementing interventions and then measuring the impacts, but the Healthy Communities Study, or HCS, is “naturalistic and observational.” That means there were no a priori interventions; researchers studied what had already happened in 130 selected U.S. communities, and then related community efforts to changes in children’s body weight over the prior 10 years as well as to children’s current nutrition and physical activity behaviors.
The Nutrition Policy Institute was part of the large HCS team that includes researchers from Battelle, the University of Kansas, the University of South Carolina, the National Institutes of Health, and several other federal agencies.
Why is this important?
Child obesity is at an all-time high and most U.S. children fail to meet diet or physical activity recommendations. With poor nutrition now the leading cause of chronic disease, and health care for treatment costing nearly one-fifth of our nation’s GDP, helping children be healthy and stay that way has never been more urgent. Previous interventions have shown modest success, yet little is known about what communities are doing and which efforts are most promising for obesity prevention and health promotion.
The goal of the HCS, the largest national study of its kind, was to fill that gap in order to inform future efforts to improve child diet and physical activity. From 2013 to 2015 researchers interviewed over 1,400 key community members, visited the households of over 5,000 children in grades K-8, and abstracted over 30,000 weights and heights from medical records. Over 9,000 community programs and policies were scored on their “intensity” with higher ratings for ones that provided “more” — more time, greater reach or more compulsory participation. Efforts over the prior one-, three-, six-, and 10-year periods were then tallied and related to changes in body mass index (BMI) and to children’s diet and physical activity. |
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What can communities do?
The HCS revealed that the greater the intensity of a community’s efforts, the bigger the change in child BMI. In other words, putting more effort on children’s health is working. However, not all communities are seeing the same effect. Looking at just communities with at least one-third African American or Latino population, the trend was the same — the more intense the efforts, the lower the BMI — but not to a degree that was statistically significant. This suggests that programs and policies in those communities need to be tailored to make them more impactful.
Other lessons learned included that:
- Different features of community programs and policies were related to better child nutrition and physical activity suggesting that there is likely no ‘single’ or ‘simple’ solution to address all the behaviors that contribute to excess weight gain.
- Improving healthy options for children where they go to school and in their communities and homes is needed to improve diets. Giving information and enhancing skills in making dietary choices should accompany environmental changes.
- In addition, helping children make healthier choices involves limiting less healthy options, such as sugary drinks, sweets and fast food, as well as promoting more fruits and vegetables and whole grains.
- Similarly targeting multiple physical activity behaviors — such as increasing physical activity in Physical Education at school and reducing screen time at home — appears important for improving child physical activity.
- Finally, it appears to take several years for communities to reap benefits, so sustained efforts over time are warranted.
This landmark research provides evidence to community decision-makers that investments in child nutrition and physical activity have value, and, when done over time and through coupling different approaches across multiple settings, are making kids healthier. These findings validate that what communities do can make a difference in improving the health of the next generation.
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Pediatric Obesity
Volume 13, Issue S1, Pages 1-112, October 2018
Supplement: The Healthy Communities Study: Examining Community Programs, Policies and Other Characteristics in Relation to Child Weight, Diet, and Physical Activity. Guest Editor: Shiriki K. Kumanyika
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- Collie-Akers VL, Schultz JA, Fawcett SB, Landry S, Obermeier S, Frongillo EA, Forthofer M, Weinstein N, Weber SA, Logan A, Arteaga SS, Nebeling L, Au LE; Healthy Communities Study Team. Measuring the intensity of community programs and policies for preventing childhood obesity in a diverse sample of US communities: the Healthy Communities Study. Pediatr Obes. 2018 Oct;13 Suppl 1:56-63.
- Collie-Akers VL, Schultz JA, Fawcett SB, Obermeier SM, Pate RR, John LV, Weber SA, Logan A, Arteaga SS, Loria CM, Webb K; Healthy Communities Study Team. The prevalence of community programmes and policies to prevent childhood obesity in a diverse sample of US communities: the Healthy Communities Study. Pediatr Obes. 2018 Oct;13 Suppl 1:64-71.
- Kaczynski AT, Besenyi GM, Child S, Morgan Hughey S, Colabianchi N, McIver KL, Dowda M, Pate RR; Healthy Communities Study Team. Relationship of objective street quality attributes with youth physical activity: findings from the Healthy Communities Study. Pediatr Obes. 2018 Oct;13 Suppl 1:7-13.
- Kumanyika SK. Supplement overview: what the Healthy Communities Study is telling us about childhood obesity prevention in U.S. communities. Pediatr Obes. 2018 Oct;13 Suppl 1:3-6.
- Pate RR, Frongillo EA, McIver KL, Colabianchi N, Wilson DK, Collie-Akers VL, Schultz JA, Reis J, Madsen K, Woodward-Lopez G, Berrigan D, Landgraf A, Nagaraja J, Strauss WJ; Healthy Communities Study Team. Associations between community programmes and policies and children's physical activity: the Healthy Communities Study. Pediatr Obes. 2018 Oct;13 Suppl 1:72-81.
- Ritchie LD, Woodward-Lopez G, Au LE, Loria CM, Collie-Akers V, Wilson DK, Frongillo EA, Strauss WJ, Landgraf AJ, Nagaraja J, Sagatov RDF, Nicastro HL, Nebeling LC, Webb KL; Healthy Communities Study Team. Associations of community programs and policies with children's dietary intakes: the Healthy Communities Study. Pediatr Obes. 2018 Oct;13 Suppl 1:14-26.
- Sagatov RDF, John LV, Gregoriou M, Arteaga SS, Weber S, Payn B, Strauss W, Weinstein N, Collie-Akers V; Healthy Communities Study Team. Recruitment outcomes, challenges and lessons learned: the Healthy Communities Study. Pediatr Obes. 2018 Oct;13 Suppl 1:27-35.
- Saunders RP, Dowda M, McIver K, Pate RR; Healthy Communities Study Team.Regional comparisons of walking or bicycling for fun or exercise and for active transport in a nationally distributed sample of community-based youth. Pediatr Obes. 2018 Oct;13 Suppl 1:36-45.
- Schultz JA, Collie-Akers VL, Fawcett SB, Strauss WJ, Nagaraja J, Landgraf AJ, McIver KL, Weber SA, Arteaga SS, Nebeling LC, Rauzon SM; Healthy Communities Study Team. Association between community characteristics and implementation of community programmes and policies addressing childhood obesity: the Healthy Communities Study. Pediatr Obes. 2018 Oct;13 Suppl 1:93-102.
- Strauss WJ, Nagaraja J, Landgraf AJ, Arteaga SS, Fawcett SB, Ritchie LD, John LV, Gregoriou M, Frongillo EA, Loria CM, Weber SA, Collie-Akers VL, McIver KL, Schultz J, Sagatov RDF, Leifer ES, Webb K, Pate RR; Healthy Communities Study Team. The longitudinal relationship between community programmes and policies to prevent childhood obesity and BMI in children: the Healthy Communities Study. Pediatr Obes. 2018 Oct;13 Suppl 1:82-92.
- Webb KL, Hewawitharana SC, Au LE, Collie-Akers V, Strauss WJ, Landgraf AJ, Nagaraja J, Wilson DK, Sagatov R, Kao J, Loria CM, Fawcett SB, Ritchie LD; Healthy Communities Study Team. Objectives of community policies and programs associated with more healthful dietary intakes among children: findings from the Healthy Communities Study. Pediatr Obes. 2018 Oct;13 Suppl 1:103-112.
- Woodward-Lopez G, Gosliner W, Au LE, Kao J, Webb KL, Sagatov RD, Strauss WJ, Landgraf AJ, Nagaraja J, Wilson DK, Nicastro HL, Nebeling LC, Schultz JA, Ritchie LD; Healthy Communities Study Team. Community characteristics modify the relationship between obesity prevention efforts and dietary intake in children: the Healthy Communities Study. Pediatr Obes. 2018 Oct;13 Suppl 1:46-55.
Other publications on the Healthy Communities Study:
- Arteaga SS, Loria CM, Crawford PB, Fawcett SB, Fishbein HA, Gregoriou M, John LV, Kelley M, Pate RR, Ritchie LD, Strauss WJ. The Healthy Communities Study: Its Rationale, Aims, and Approach. Am J Prev Med. 2015 Oct;49(4):615-23.
- Au LE, Crawford PB, Woodward-Lopez G, Gurzo K, Kao J, Webb KL, Ritchie LD. School Wellness Committees Are Associated With Lower Body Mass Index Z-Scores and Improved Dietary Intakes in US Children: The Healthy Communities Study. J Sch Health. 2018 Sep;88(9):627-635.
- Au LE, Gurzo K, Gosliner W, Webb KL, Crawford PB, Ritchie LD. Eating School Meals Daily Is Associated with Healthier Dietary Intakes: The Healthy Communities Study. J Acad Nutr Diet. 2018 Aug;118(8):1474-1481.e1.
- Fawcett SB, Collie-Akers VL, Schultz JA, Kelley M. Measuring Community Programs and Policies in the Healthy Communities Study. Am J Prev Med. 2015 Oct;49(4):636-41.
- Frongillo EA, Fawcett SB, Ritchie LD, Sonia Arteaga S, Loria CM, Pate RR, John LV, Strauss WJ, Gregoriou M, Collie-Akers VL, Schultz JA, Landgraf AJ, Nagaraja J. Community Policies and Programs to Prevent Obesity and Child Adiposity. Am J Prev Med. 2017 Nov;53(5):576-583.
- Hewawitharana SC, Thompson FE, Loria CM, Strauss W, Nagaraja J, Ritchie L, Webb KL. Comparison of the NHANES dietary screener questionnaire to the Automated Self-Administered 24-Hour Recall for Children in the Healthy Communities Study. Nutr J. 2018 Nov 27;17(1):111.
- John LV, Gregoriou M, Pate RR, Fawcett SB, Crawford PB, Strauss WJ, Frongillo EA, Ritchie LD, Loria CM, Kelley M, Fishbein HA, Arteaga SS. Operational Implementation of the Healthy Communities Study: How Communities Shape Children's Health. Am J Prev Med. 2015 Oct;49(4):631-5.
- Pate RR, McIver KL, Colabianchi N, Troiano RP, Reis JP, Carroll DD, Fulton JE. Physical Activity Measures in the Healthy Communities Study. Am J Prev Med. 2015 Oct;49(4):653-9.
- Pate RR. Overview of the Protocol Manuscripts for the Healthy Communities Study. Am J Prev Med. 2015 Oct;49(4):614.
- Ritchie LD, Wakimoto P, Woodward-Lopez G, Thompson FE, Loria CM, Wilson DK, Kao J, Crawford PB, Webb KL. The Healthy Communities Study Nutrition Assessments: Child Diet and the School Nutrition Environment. Am J Prev Med. 2015 Oct;49(4):647-52.
- Sroka CJ, McIver KL, Sagatov RD, Arteaga SS, Frongillo EA. Weight Status Measures Collected in the Healthy Communities Study: Protocols and Analyses. Am J Prev Med. 2015 Oct;49(4):642-6.
- Strauss WJ, Sroka CJ, Frongillo EA, Arteaga SS, Loria CM, Leifer ES, Wu CO, Patrick H, Fishbein HA, John LV. Statistical Design Features of the Healthy Communities Study. Am J Prev Med. 2015 Oct;49(4):624-30.
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ANNOUNCEMENTS
Read the latest news from the National Drinking Water Alliance to access helpful resources on drinking water, including fact sheets, toolkits, webinars, workshops and much more. Be sure to read our latest research, in collaboration with the Prevention Research Center at the Harvard T.H. Chan School of Public Health, on state policies and state approaches to testing school drinking water for lead in the United States.
The Nutrition Policy Institute is part of the UC Global Food Initiative Healthy Vending Work Group, which aims to improve access to healthy food and beverage options sold in vending machines for students and employees throughout the entire UC system. Through research of existing healthy vending policies and extensive outreach with stakeholder groups throughout UC, the work group has developed the UC Healthy Vending Guidelines and a Best Practices Implementation Toolkit. See the UC Healthy Vending Policy section of our Resources page for more information.
FOOD FOR THOUGHT
U.S. Senators Patty Murray (D-WA), Elizabeth Warren (D-MA), Debbie Stabenow (D-MI) and Ed Markey (D-MA), released a new report from the U.S. Government Accountability Office (GAO) showing that college students around the country are struggling to afford food and basic nutrition. The report reviewed 31 studies on college student food insecurity, including groundbreaking studies conducted by the Nutrition Policy Institute. The report is the first time a federal government agency confirms that food insecurity among college students is a widespread issue.
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RECENT NPI PUBLICATIONS
Au LE, Paolicelli C, Gurzo K, Ritchie LD, Weinfield NS, Plank KR, Whaley SE. Contribution of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)-Eligible Foods to the Overall Diet of 13- and 24-Month-Old Toddlers in the WIC Infant and Toddler Feeding Practices Study-2. Journal of the Academy of Nutrition and Dietetics. Jan 9, 2019, e-pub ahead of print. DOI: https://doi.org/10.1016/j.jand.2018.11.001.
[Abstract] [FullText]
Cradock AL, Hecht CA, Poole MK, Vollmer LY, Flax CN, Barrett JL. State approaches to testing school drinking water for lead in the United States. Boston, MA: Prevention Research Center on Nutrition and Physical Activity at the Harvard T.H. Chan School of Public Health; January 2019.
[Abstract] [Full Text]
Cradock AL, Poole MK, Vollmer LY, Barrett JL, Flax CN, Hecht CA. State Policies on Testing Drinking Water for Lead in U.S. Schools. Research Brief. Durham, NC: Healthy Eating Research; January 2019.
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University of California Healthy Vending Policy: Implementation and Best Practices Toolkit. University of California Global Food Initiative Healthy Vending Working Group. University of California Global Food Initiative, 2018.
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United States Government Accountability Office. Better Information Could Help Eligible College Students Access Federal Food Assistance Benefits. December 2018.
[Abstract] [Full Text] [Accessible Version] [Website]
Hewawitharana SC, Thompson FE, Loria CM, Strauss W, Nagaraja J, Ritchie LD, Webb KL. Comparison of the NHANES dietary screener questionnaire to the Automated Self-Administered 24-Hour Recall for Children in the Healthy Communities Study. Nutrition Journal, Nov 27, 2018. DOI: doi.org/10.1186/s12937-018-0415-1
[Full Text]
Calancie L, Cooksey-Stowers K, Palmer A, Frost N, Calhoun H, Piner A, Webb K. Toward a Community Impact Assessment for Food Policy Councils: Identifying Potential Impact Domains. Journal of Agriculture, Food Systems, and Community Development. Published online September 24, 2018. DOI: https://doi.org/10.5304/jafscd.2018.083.001.
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