Community characteristics modify the relationship between obesity prevention efforts and dietary intake in children: The Healthy Communities Study

BACKGROUND: The influence of community characteristics on the effectiveness of childhood obesity prevention efforts is not well understood. OBJECTIVE: Examine the interaction of community characteristics with the relationship between community programs and policies (CPPs) and dietary intake. METHODS: An observational study of 5138 children in grades K-8 in 130 U.S. communities was conducted in 2013–2015. Key informant interviews identified and characterized CPPs. CPP scores were generated for the number of target behaviors (CPP-Behav) and the number of behavior change strategies (CPP-Strat) addressed by all CPPs and CPPs with nutrition goals over the prior 6 years 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 fiber. Multivariate statistical models assessed the interactions between U.S. region, urbanicity, community-level income, and community-level race/ethnicity and CPP scores in relation to dietary intake. RESULTS: CPP-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. CONCLUSION: 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.