The California Endowment's Healthy Eating, Active Communities Program: A Midpoint Review

摘要

Objectives. We conducted a midpoint review of The California Endowment's Healthy Eating, Active Communities (HEAC) program, which works in 6 low-income California communities to prevent childhood obesity by changing children's environments. The HEAC program conducts interventions in 5 key childhood environments: schools, after-school programs, neighborhoods, health care, and marketing and advertising. Methods. We measured changes in foods and beverages sold at schools and in neighborhoods in HEAC sites; changes in school and after-school physical activity programming and equipment; individual-level changes in children's attitudes and behaviors related to food and physical activity; and HEAC-related awareness and engagement on the part of community members, stakeholders, and policymakers. Results. Children's environments changed to promote healthier lifestyles across a wide range of domains in all 5 key childhood environments for all 6 HEAC communities. Children in HEAC communities are also engaging in more healthy behaviors than they were before the program's implementation. Conclusions. HEAC sites successfully changed children's food and physical activity environments, making a healthy lifestyle a more viable option for low-income children and their families. Childhood obesity is at epidemic levels in the United States. More than 1 in 7 children and adolescents aged 6 to 17 years are considered obese. 1 Additionally, disparities in obesity rates exist among ethnic groups. Black, Hispanic, and Native American children and adolescents have higher rates of diabetes and obesity than do White children and adolescents. 1 Poor diet and inadequate physical activity have been linked to obesity and preventable chronic illnesses. 2 , 3 Overweight and obese children may develop a number of risk factors for chronic disease and are increasingly diagnosed with diseases that have historically had their onset in adulthood, such as type 2 diabetes, hypertension, and high cholesterol. 4 Most strategies to prevent or reduce childhood obesity have focused on individual behavior modification and pharmacological treatment, with limited success. 5 Current research suggests that childhood dietary habits and physical activity levels are influenced by a variety of environmental factors, 6 such as increasing portion sizes, 7 – 10 increasing availability of fast food and soft drinks, 11 – 20 availability of soda and unhealthy food on school campuses, 21 – 29 curtailment or elimination of physical education and recess in schools, 30 insufficient or inadequate parks and recreational facilities, 31 public policy favoring personal transportation over mass transit, 32 – 39 limited access to healthy foods and ready availability of unhealthy foods, 37 , 40 – 44 and disproportionate advertising of low-nutrient-dense foods and sedentary activities to children and their families. 25 , 45 – 49 Many of these factors are exacerbated in low-income communities, where healthy and affordable food options and safe opportunities for physical activity are noticeably absent. 40 , 42 These factors are contributing to high levels of diseases related to nutrition and physical activity among Black and Latino populations. 34 , 40 , 42 , 50 A better understanding of the underlying factors that lead to obesity has led to the emergence of a new type of initiative that seeks to reduce childhood obesity by making environmental improvements that promote healthy eating and physical activity, rather than focusing on changing individual eating and activity patterns. Although this type of environmental intervention is relatively new, early results are encouraging. 51 – 53 It has been demonstrated that better access to healthy foods and opportunities for physical activity results in healthier diets and increased physical activity: people in the presence of supermarkets eat more fruits and vegetables, 40 , 42 , 54 and when a venue for physical activity is available, people are more likely to be physically active. 34 , 55 To help prevent obesity and type 2 diabetes among children and adolescents, the Healthy Eating, Active Communities (HEAC) program was established to promote public health environmental change in 6 California communities. We conducted a midpoint review of HEAC's progress to assess how well these communities were translating models for change into on-the-ground practices resulting in real improvements in the food and physical activity opportunities available to low-income children and families.