Community Characteristics Modify The Relationship Between Obesity Prevention Efforts And Dietary Intake In Children: The Healthy Communities Study

BackgroundThe influence of community characteristics on the effectiveness of childhood obesity prevention efforts is not well understood.ObjectiveMethodsExamine the interaction of community characteristics with the relationship between community programmes and policies (CPPs) and dietary intake.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 6years 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.ResultsConclusionCPP-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.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.What this study adds: _ We found that region, urbanicity, community- level income, and community level race/ ethnicity modify the association between childhood obesity prevention efforts and dietary intake. _ We identified which aspects of obesity prevention efforts appear to influence the association between childhood obesity prevention efforts and dietary intake in communities with different characteristics. _ Our findings suggest that different approaches to childhood obesity prevention and promotion of healthy eating may be needed depending on region and urbanicity, and to a more limited extent, community income and race/ ethnicity.