Developing an index of exposure to obesity-related community interventions and policies

In Los Angeles County (LAC), considerable neighborhood variation in obesity rates exists among low-income preschool-aged children who participate in the Special Supplemental Nutrition Program for Women, Infants and Children. Differences in exposure to a myriad of community interventions and policies that have been implemented since 2003, in response to high obesity rates in LAC, may partially account for this variation. In 2013, we initiated a NICHD-funded study to evaluate the cumulative and combined impact of these interventions and policies on preschool-aged obesity risk, using systems science methods. One primary aim of this study was to develop and validate an index to quantify exposure to obesity-related programs and policies.  Adapting the method from the American Stop Smoking Intervention Study, we established a workgroup of content experts, to (i) identify and operationalize relevant constructs and domains for assessing the effects of program and policy-related activities on preschool-aged obesity risk (e.g. resources, capacity, intervention activities, built and social environmental changes), and (ii) develop criteria for rating the measure of each construct/domain. A heuristic approach produced a hierarchical index of evaluation items: “constructs” representing higher-level themes generally applicable to a broad range of health-related interventions; “domains” within the constructs representing key indicators specific to obesity interventions; and a series of “measures” for each domain to quantify intervention dose. In identifying the relevant constructs/domains/measures, criteria such as parsimony, scientific support and feasibility, were considered. This presentation will share the findings of this workgroup, with the purpose of informing childhood obesity prevention planning.