Population-level interventions and community environment effects on obesity among diverse Asian American ethnic subgroups

PROJECT SUMMARY Childhood obesity prevalence keeps rising, especially among school-age children, and varies by race/ethnicity. Children of origins in Asia and the Pacific Islands (Asian/PI), as a whole, have lower obesity prevalence; but, at lower BMI levels, they have higher risk of obesity-related diseases relative to White peers. Asian/PI children

have remained largely invisible in obesity prevention efforts, though obesity prevalence varies widely among Asian/PI subgroups, the fastest growing demographic group. Data scarcity is a significant barrier to the design of strategies to prevent obesity and reduce disparities among Asian/PI. Nutrition policies—those that regulate

the nutritional content of foods and beverages in schools, including the so-called “competitive” foods sold separately from school meals—could play a key role in the primary prevention of obesity and related chronic diseases among Asian/PI subgroups. The community food environment near schools can also influence

obesity (e.g., through children’s access, purchases and consumption of unhealthy foods). No studies have examined the combined influences of multiple nutrition policies and community food environments on child obesity and disparities among Asian/PI children. Using unprecedented, longitudinal BMI data on >1 million

Asian/PI children disaggregated by ethnicities (Indian, Cambodian, Chinese, Filipino, Guamanian, Japanese, Korean, Laotian, Native Hawaiian, Samoan and Vietnamese), this quasi-experimental study responds to the NIH Obesity Strategic Plan by evaluating policy and environmental effects on obesity disparities. The first of its kind, this longitudinal study will: (1) determine the effects of federal and state

nutrition policies designed to improve food and beverages in schools on obesity disparities among a wide range of Asian/PI ethnic groups; and (2) investigate how community food environments modify the effect nutrition policies on obesity disparities. To obtain robust inferences, the study uses the best available

methods to evaluate non-randomized exposures: interrupted time series design and difference-in- difference analysis to improve causal inferences. The study’s powerful design links longitudinal BMI measures of diverse Asian/PI children with time-varying measures of the community food environments of all the

public schools to which children attended. Expected results: This study will: (i) strengthen the evidence base by elucidating the causal effects large scale nutrition interventions on obesity disparities among Asian/PI ethnic subgroups; (ii) identify nutrition environments near schools where nutrition policies are most effective; and (iii)

illuminate environments (inside and/or near schools) where additional interventions are needed. The study results have potential to inform strategies focused on two major public health goals—prevent child obesity and reduce disparities among severely understudied, yet fastest growing Asian/PI populations.