Rapid Response Pilot Core
Recipients of Time-Sensitive Pilot Project Grants
The Rapid Response Pilot Project Core provides a mechanism to support the study of time-sensitive, innovative, rapid response pilot projects that use a systems-oriented approach to the study of impending policy and environmental changes ("natural experiments") relevant to understanding and combating childhood obesity. There have been nine awardees so far in the program, covering topics ranging from walking paths to school meals. We are particularly interested in new policies and environmental changes where baseline data can be captured as "natural experiments."
Each year, the RRPC will issue at least two RFAs in January and July. Applicants can request up to $30,000 in total costs (including institutional overhead). One or two awards will be made in each RFA round, depending on the funds available and the quality of the proposals received. Investigators worldwide are eligible and the RRPC encourages both junior and senior investigators to apply. Research proposals are evaluated by scientific peers based from within and outside of the JHGCCO. The Center will fund the most competitive proposals each year and provide support via the services and resources of the other Center units. In the last two years, we received applications from more than 12 countries in Asia, Africa, North America and South America.
Round 5: Rapid Response Pilot Project
RFA Announced January 7, 2014
See Round 5 Announcement
Round 4: Rapid Response Pilot Project Recipients
RFA Announced: July 8, 2013
Recipients notified on October 8.
Using Systems Thing Concepts and Processes to Guide Obesity Prevention Practice and Policy Development.
Principal Investigator: Christine Siokou, Ph.D., Strategic Research Advisor, The Centre of Excellence in Intervention and Prevention Science, and Research and Evaluation Officer, Preventive Health Partnership, City of Whittlesea, Australia.
Funding dates: 1/1/14-12/31/14
The State Government of Victoria (Australia), in partnership with the Australian Federal Government, has made an unprecedented investment in the use of systems science and systems thinking for obesity prevention. This investment is administered through local and state government initially in 14 geographical sites around the state, prior to a phased roll out across the whole state if the initiative proves successful.
A new preventive health workforce of 150 people is charged with implementing a systems approach to prevention practice and policy development at the local level. The intervention works across schools, workplaces and communities to reduce the incidence and burden of obesity. The workforce, now one year into implementation, is grappling with the groundbreaking task of applying systems theory to obesity prevention practice. The question this research grant begins to address is: Can the introduction of system dynamic concepts through group model building processes build practitioner capacity to take a systems approach to obesity prevention? The long-term aim, not addressed directly here, is to assess whether this ultimately improves policy and practice.
In partnership with Dr. Peter Hovmand (Founding Director, Social System Design Lab, George Warren Brown School of Social Work, Washington University), we propose to pilot an innovative approach to building capacity in systems thinking in two geographical sites, with two sites as comparisons, with the aim eventually of extending this to all 14 sites in the first wave of the Victorian initiative. The pilot will include a one-day workshop that utilizes scripts, presentations and group model building methods to introduce system dynamic concepts. This provides practitioners with a range of tools and concepts and the language of systems science, to ‘map’ their local system, and to identify leverage points to ascertain what policies and environmental changes are worth pursuing to address childhood obesity. The workshop approach will be evaluated using quantitative methods to determine progression in understanding systems concepts and qualitative evaluation to assess the practicality of model building in assisting practice, and its potential in guiding policy and practice.
The research team has multiple existing collaborations and track record in developing approaches to systems science. Notably they are co-investigators on a US NIH bid on systems thinking in obesity prevention among under 5s, and an Australian National Health and Medical Research Council Centre for Research Excellence in Policy Research for Obesity Prevention in Food Systems. The work proposed here complements these initiatives by investigating how one might develop systems expertise among the prevention workforce, and how this in turn influences practice.
Introduction of Physical Activity Classes in Girls' Private Schools in Saudi Arabia: Evaluation of the New Policy.
Principal Investigator: Hazzaa M. Al-Hazzaa, PhD, FACSM, Professor & Director, Pediatric Exercise Physiology Research Laboratory, College of Education, King Saud University, Riyadh, Saudi Arabia.
Funding dates: 11/1/13-10/31/14
Physical activity level and sedentary behaviors are known to have a major influence on the risk of obesity, yet few studies have examined this effect prospectively, and even fewer in the Middle East, a region undergoing massive lifestyle transition with rapid increases in the prevalence of childhood obesity and its co-morbidities. This proposal takes advantage of a ‘natural experiment’ about to unfold, wherein girls in private schools in Saudi Arabia will soon be allowed for the first time to engage in physical activity/fitness classes. We propose to study this emerging change, using an integrated, systems science framework. We anticipate that this study will shed light on both the multiple complex factors that influence the childhood obesity associated behavioral risks, and the potential value of focused changes in school or public policy that may be of benefit in battling the epidemic of childhood obesity in the Middle East and other regions. Therefore, this research aims to evaluate, in a natural setting, the influence of this new policy on lifestyle behaviors of Saudi high school girls. The expected outcomes of this project will be to obtain baseline and end of school-year data on anthropometric, PA, sedentary behaviors and related environmental determinants from the private girls’ schools policy adopters and non-adopters. Students’ knowledge, attitude and practice will also be evaluated. In addition, data will be collected from parents as well as school teachers and principals. The minimal target sample will be 350 pupils from each group; the policy adopters and the non-adopters. The analysis will be conducted at multiple levels comprising the microsystem, exosystem and macrosystem. Both qualitative and quantitative evaluation methods will be employed.
Round 3 Abstracts: Rapid Response Pilot Project Recipients
RFA Announced: January 18, 2013
1. Using Point of Sale (POS) Systems to Measure Changes in Purchases Before and After Environmental Interventions in Corner Stores
Principal Investigator: Allison Karpyn, PhD – Director of Research and Evaluation, The Food Trust, Philadelphia, PA USA
Funding Dates: 06/1/13-05/31/15
The Food Trust, through partnership with the Philadelphia Department of Public Health’s ―Get Healthy Philly‖ program, has been at the forefront of a growing national movement to increase healthy food access in corner stores in low-income urban areas as an environmental strategy to reduce obesity. In 2012, The Food Trust implemented Point of Sales (POS) systems in 5 corner stores in Philadelphia to: (1) objectively measure product sales in corner stores, particularly at peak times for youth purchases before and after school, and (2) evaluate the efficacy of interventions designed to increase sales of healthier products. POS systems offer an unprecedented opportunity to analyze stores’ real-time sales. Real-time sales data are considered the gold standard for tracking and analyzing grocery purchases in supermarkets, but are rare in corner stores, which typically use non-computerized cash registers. The Food Trust has worked with owners at 5 corner store locations to install POS systems, and provides ongoing, intensive, in-store training on use and maintenance of scanners, touch screens and computerized cash registers to process product sales. The overall goal for this pilot study is to evaluate the efficacy of environmental interventions on corner stores purchases, using the POS system.
The timing for this research project is critical: This spring, The Food Trust will partner with the Philadelphia Department of Public Health to implement a new Healthy Corner Store Certification policy, along with physical renovations to the store environment that will employ marketing and pricing strategies to increase healthier food and beverage sales. The Food Trust will utilize POS data from corner stores to examine customers’ purchases, before and after implementation of policy and environmental interventions. These analyses will add to understanding of the impact of corner stores on shopping patterns, dietary intake, and on overweight and obesity, leading to more informed decisions for implementing policies for childhood obesity prevention in underserved areas.
2. Examining the outcomes of collaborative networks to improve school nutrition environments
Principal Investigator: Donna B. Johnson, PhD, RD, Associate Professor, Nutrition Sciences, Interim Director, Center for Public Health Nutrition, University of Washington, Seattle WA, USA
Funding Dates: 06/1/13-05/31/15
Rigorous and comprehensive school wellness policies are part of systematic recommendations to make it easier for children to choose healthy foods and be physically active. Across the United States, many wellness policies are weak and ineffective, but school districts are mandated to improve those policies. As part of a Community Transformation Grant (CTG) that is serving diverse low-income communities in King County Washington, the county health department is funding a School Learning Network (SLN). The SLN will support district nutrition directors as they do the challenging work of bringing together diverse stakeholders to develop new policies that must be approved by local school boards. This project will apply social network analysis to determine: the extent to which the SLN fosters the development of ties between directors and the characteristics of those ties; the extent to which the position of the directors in the network and the strength of their ties is related to the quality of district wellness policy revisions; and how best practices are diffused through the network. The sample for this project will be an intervention group of 19 nutrition directors from King County and a control group of 27 directors from adjacent counties. Baseline data for this project must be collected as soon as possible as the SLN is beginning in the spring of 2013. Data will be collected in the spring/summer of 2013 and one year later in 2014. This project is a partnership between the University of Washington (WA), the CTG principal investigators and evaluators, and the WA Nutrition Obesity Policy and Evaluation Network. This assures that findings from the study will be disseminated and applied to other collaborative networks that are underway in the state and nationally and that the research methodologies will be applied to future studies of the policy development process.
Round 2 Abstracts: Rapid Response Pilot Project Recipients
RFA Announced: July 1, 2012
1. Dynamics between the Community Eligibility Option and Elementary Students’ School Breakfast/Lunch Program Participation
Principal Investigators: Maryann Mason, PhD, Consortium to Lower Obesity in Chicago Children (CLOCC), Ann & Robert H. Lurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL; Soyang Kwon, PhD, Consortium to Lower Obesity in Chicago Children (CLOCC), Ann & Robert H. Lurie Children’s Hospital of Chicago, IL, USA
Funding Dates: 11/1/12-10/31/13
The primary aim of this project is to evaluate dynamics of the Community Eligibility Option (CEO) and elementary students’ participation in school breakfast and lunch programs among six CEO participating schools. The CEO is a new extension of free breakfast and lunch to all students at low-income schools. We will collect data on school enrollment, monthly school breakfast and lunch counts, estimated meal reimbursement, menus, school food environment, and other elements in a hypothesized dynamics model from six predominantly minority, low-income, public schools located in Chicago suburbs during school year (SY) 2012-2013. We will retrospectively collect SY 2011-2012 school breakfast and lunch counts to compare students’ participation in school meal programs before CEO implementation. The exploratory aim is to qualitatively identify the determinants of schools’ CEO participation among six CEO participating schools and three non-participating schools. The secondary aim is to estimate the potential impact size of changes in nutrition standards for school lunch (e.g. offering fruit daily, vegetables subgroups weekly, and only fat-free and low-fat milk) on intake of students’ fruits, vegetables, reduced-fat milk. The new federal nutrition standards for school meals will be implemented beginning SY 2011-2012. Students’ behaviors of whether taking and consuming fruit, vegetables, and reduced-fat milk will be observed in six CEO school lunch rooms at the beginning of implementation (beginning of SY) and at the end of SY. We explore whether the consumption changes over time within a SY. The CEO will be available to all states beginning SY 2014-2015. The proposed study will inform the full roll out of the CEO policy. Further, our evaluation of the CEO policy coupled with the new nutrition standards for school meals will help to estimate the combined contribution of these two policy efforts aimed at improved student access to healthy foods and childhood obesity prevention.
2. Systems-Oriented Analysis of Two Multilevel, Multisector Childhood Obesity Prevention and Control Projects
Principal Investigator:�Emmeline Chuang, Ph.D, San Diego State University; San Diego State University Research Foundation, San Diego CA, USA
Funding Dates: 11/1/12-04/30/14
To more effectively prevent and control childhood obesity, the NIH and CDC have begun to promote multi-sector (e.g., family, school, healthcare, community) systems-oriented approaches. Successfully implementing and sustaining such approaches requires significant buy-in and coordination of activities from diverse stakeholders, each of whom may vary in their readiness and willingness to implement the environmental, policy, and systems changes involved. The scale of proposed changes and diversity of actors involved may also result in policy resistance, i.e. unintended side effects which can negatively affect intervention outcomes and sustainability. However, currently little is known about potential sources of and strategies for overcoming such resistance and effectively coordinating prevention and control efforts within communities. The proposed project seeks to address this knowledge gap by examining the dynamic, emergent effects of policy, environment, and systems changes introduced in October 2012 via Mass in Motion Kids and Our Choice-Nuestra Opcion, two multilevel, multi-sector childhood obesity prevention and control projects being implemented in two different regions of the country (MA and CA). Both projects involve multiple settings (e.g. clinics, schools, childcare) as well as community-level intervention components such as coalition building and social marketing. Time-sensitive, mixed-methods data will be collected from participating stakeholders at two points of uptake: shortly after initial implementation (phase 1) and 12 months later (phase 2). Quantitative surveys will document implemented changes as well as respondent perceptions of factors known to affect intervention success. Qualitative interviews with key stakeholders, document analysis of project materials, and in-vivo observation of coalition meetings will contextualize implementation processes, identify facilitators and barriers to change, and examine different mechanisms through which activities are coordinated within and across sectors. Findings from this study will be shared with participating stakeholders, refined based on their feedback, and used to inform future project activities and subsequent systems research in this area.
Round 1 Abstracts: Rapid Response Pilot Project Recipients
RFA Announced: February 15, 2012
1. Does an Activity-Friendly Community Improve Children's Physical Activity?: Where, When, and How?
Principal Investigator:�Xuemei Zhu, Ph.D., Department of Architecture and Center for Health Systems & Design, Texas A&M University, TX USA
Funding Dates: 07/01/12-06/30/14
Obesity is a growing public health problem influenced by a complex system of multilevel factors. Built environment acts as a risk regulator for obesity-related behavior—diet and physical activity (PA). However, the understanding of causal relationships between environmental interventions and PA changes is limited due to the difficulty in completely changing people's actual living environment. This project examines the impact of a rare "natural experiment"— moving into a new, activity friendly community (Mueller, Austin, TX)—on increasing children’s PA. Mueller is the largest pilot project certified by LEED-ND, US’s first certification system for sustainable and healthy communities. It is planned for 13,000 residents and 13,000 employees, and made possible by innovative land development policy interventions. The specific aims are to examine if and how moving to Mueller: (a) increases children's PA, (b) improves relevant personal attitude and social environments, and (c) reduces PA disparities among its mixed-income residents. Mueller's current development status allows for the timely collection of pre- and post-move data, and the development of a future longitudinal study. This project is facilitated by the rich data and recruitment resources from researchers' previous projects. Pre-post and case-control comparisons will be used. The “case” subjects are 3- to 18- year olds moving to 781 Mueller homes in 2012 and 2013. For each case subject, a “control” subject will be recruited from the same/similar pre-move neighborhood with matching socio demographic characteristics. Data will be collected through survey, GIS, GPS and accelerometer measurement. Pre-post and case-control differences in PA will be examined using t test. ANOVA will be used to examine the PA differences between affordable and market-rate housing residents. Structural equation models will examine if and how this environmental intervention influences children’s PA directly and indirectly (by affecting personal attitude and social factors). A longer-term, longitudinal project will be developed based on this pilot study. It will examine: (a) if PA improvement is sustained, (b) how the feedback loops among environmental interventions and personal and social factors help sustain increased PA, and (c) what policy barriers were encountered and what solutions were used during this community's development.
2. St. Vincent Greenway Evaluation: The role of local bike policies and greenways in preventing childhood obesity
Principal Investigator:�Elizabeth A. Dodson, PhD, MPH, Research Assistant Professor, Brown School and Prevention Research Center, Washington University in St. Louis, MO USA
Funding Dates: 07/01/12 - 08/31/13
The St. Louis, Missouri region recently completed and approved a comprehensive Gateway Bike Plan to support over 1,000 miles of on-road and greenway bicycle paths. An early example of this work is the extension of the St. Vincent Greenway, which will connect the University of Missouri-St. Louis, and north St. Louis County and City communities with Forest Park (a 1371 acre urban park) and additional opportunities for recreation, transportation, and civic engagement. Great Rivers Greenway, a non-profit agency overseeing the greenway extension, estimates that construction will be completed in July 2012. The proposed study is a natural experiment, in which we seek to evaluate the effects of the environmental change (greenway extension) on childhood and family health behaviors before and after the greenway is completed. The greenway project is publicly-funded, through a small sales tax passed by the City of St. Louis and two surrounding counties, and is designed to connect residential areas, commercial areas, and major city/county parks to enhance quality of life of nearby residents and offer safe places for recreation and active transportation. The greenway portion to be evaluated has been identified as a 2012 priority by a collaborative of state and local governing bodies and will be built in an underserved neighborhood of St. Louis where access to safe places for active transportation and recreation is limited and chronic disease and poverty rates are above state and national averages. Increasing access to recreation and active transportation is an evidence-based means of promoting childhood and family wellbeing. The creation of the greenway has potential to increase healthy behaviors of all residents.
3. Evaluation of the Policy Effectiveness of "Three-Class, One Exercise and Two Opening Activities" on Control of Childhood Obesity in Shanghai, China
Principal Investigator:�Weidong Qu, M.D., Ph.D., Center for Global Health, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, China
Funding Dates: 07/01/12-06/30/13
Obesity in China has become a crucial health issue for children. Economic development and lifestyle changes have led to a significant increase of childhood obesity, especially in developed regions such as Shanghai and Beijing. A recent survey conducted by Shanghai CDC and Fudan University found that 13.3% of primary school children (PSC) aged 7-12 years in urban areas are overweight, and 6.5% are obese, much higher than the national average. The number of obese children has increased by 24.4% in the past decade. It has now reached a level comparable to developed countries. To effectively reduce the prevalence and impacts of childhood obesity, Shanghai’s municipal government in 2009 launched “3-1-2 Activities*,” to be carried out in the primary schools. The core idea is to promote physical exercise in school-age children. In order to evaluate this new policy’s effectiveness in reducing childhood obesity, we will investigate 30 of the total 615 primary schools in urban and suburban Shanghai. Of these, 10 schools have implemented this policy for 2 years now, 10 have for half a year and 10 have not yet implemented. The effects of policy implementation on reducing childhood overweight and obesity will be evaluated by comparing the changes in these schools. At the same time, we will use the comprehensive annual physical examination data covering all PSC children to analyze changes in childhood overweight and obesity before and after policy implementation. We will also anayze the effectiveness and issues in policy implementation to understand how to better promote practical and optimal policies for controlling childhood obesity.
[*Note: “3-1-2 Activity” is an abbreviation of the “Three-Class, One Exercise, and Two Opening Activities” policy for controlling childhood obesity in Shanghai. 3 or Three-Class means students have 3 exercise lessons per week, of 45 minutes each. 1 or One Exercise means everyday, students keep doing exercise for 15 minutes. Two Opening Activities refers to sports activity classes (45 minutes) two times a week. Concisely, “3-1-2 Activities” means every day, students will have one hour of physical
exercise in the school.]