摘要：Objectives. We investigated the body mass index (BMI; weight in pounds/[height in inches]2 × 703) of parents whose children participated in Shape Up Somerville (SUS), a community-based participatory research study that altered household, school, and community environments to prevent and reduce childhood obesity. Methods. SUS was a nonrandomized controlled trial with 30 participating elementary schools in 3 Massachusetts communities that occurred from 2002 to 2005. It included first-, second-, and third-grade children. We used an inverse probability weighting estimator adjusted for clustering effects to isolate the influence of SUS on parent (n = 478) BMI. The model’s dependent variable was the change in pre- and postintervention parent BMI. Results. SUS was significantly associated with decreases in parent BMIs. SUS decreased treatment parents’ BMIs by 0.411 points (95% confidence interval = −0.725, −0.097) relative to control parents. Conclusions. The benefits of a community-based environmental change childhood obesity intervention can spill over to parents, resulting in decreased parental BMI. Further research is warranted to examine the effects of this type of intervention on parental health behaviors and health outcomes. Acknowledging that childhood overweight and obesity are influenced by a multitude of factors, including a child’s environment, the Institute of Medicine recommends implementing multicomponent childhood obesity prevention efforts that involve the whole community. 1 One approach is a school-centered, community-based environmental change (SCCB) intervention. 2–5 This type of approach aims to alter the environments in which children live, learn, and play to help support and sustain physically active lifestyles and healthy dietary habits. Shape Up Somerville (SUS) was a community-based participatory research study in Somerville, Massachusetts, 2 that altered children’s household, school, and community environments to prevent and reduce childhood obesity. Over the 2–school year study, the body mass index (BMI; weight in pounds/[height in inches] 2 × 703) z scores of children exposed to SUS decreased by −0.06 (95% confidence interval [CI] = −0.08, −0.04) relative to children residing in control communities. 3 Although previous investigators speculated that the effects of SCCB or obesity interventions similar to SUS may spill over to other communities through regional networking 6 and that after-school program benefits may spill over to nonexposed children, 7 whether SCCB interventions influence the parents of exposed children has not been examined and merits investigation. It is known that parental involvement may enhance the impact of obesity prevention efforts on child outcomes 8,9 and that child obesity interventions targeting parents as the change agent reduce childhood obesity 10 ; however, the question is whether SCCB interventions, such as SUS, may result in a reverse pathway, in which the child-focused intervention influences parent health outcomes. If SCCB interventions positively influence parent health outcomes, the public health benefits and return on investment of SCCB interventions are underestimated; society receives additional, adult-based benefits from resources expended to change children’s health behaviors. We investigated whether SUS influenced the BMI of parents whose children attended the schools involved in the SUS intervention. The plausibility of SUS influencing parents’ BMIs arises from the community-based environmental change nature of the SUS intervention. 2,3 By changing children’s environments, SUS altered adults’ environments as well. Adults residing in Somerville may have been exposed, intentionally or inadvertently, to many SUS components that could have affected their health behaviors and potentially their BMIs. For instance, opportunities to engage in physical activity that materialized from new city walkability and bikeability ordinances were accessible to all community members, not just children. Likewise, all Somerville residents could select healthier menu options at Somerville restaurants that materialized from the SUS restaurant component. SUS also included numerous education-based components that community members could have been exposed to, such as a regular column in the Somerville Journal and resource guides. Although many SUS components were available to all community members, parents and guardians of school-aged children were more likely to be exposed to SUS school-based components than were adults without school-aged children. Parents of school-aged children were able to participate in school-based SUS events, whereas adults without school-aged children may not have been aware of or had access to these activities. For example, family newsletters with coupons and recipes, developed from formative work, were available only to parents of children attending SUS schools. Parents’ health behaviors may also have been indirectly influenced because of their child’s participation in SUS school-based components. Heim et al. found that school-based food taste testing events influence household fruit and vegetable availability. 11 Despite the plausibility of SCCB interventions influencing adult health behaviors, to our knowledge, this study is the first to examine whether a SCCB intervention influenced adults’ BMIs. Specifically, we estimated SUS’s effect on parents’ BMIs with an ordinary least squares regression–inverse probability weighting (OLS-IPW) estimator. 12–14 The OLS-IPW estimator adjusted for the selection bias that arose from SUS’s research design structure.
