Pilot Studies Core
Recipients of Systems-Oriented Pilot Project Grants
The Pilot Studies Core (PSC, formerly known as the Rapid Response Pilot Project Core)
supports time-sensitive, innovative pilot projects that use a systems-oriented approach to study
impending policy and environmental changes (known as natural experiments) relevant to
childhood obesity. So far there have been 10 awardees, 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 PSC issues at least two Requests for Applications (RFAs) in January and July.
Applicants can request up to $30,000 in total costs (including institutional overhead). One to
three awards are made in each round, depending on the funds available and the quality of the
proposals received. Investigators worldwide are eligible and the PSC encourages both junior and
senior investigators to apply. Research proposals are evaluated by scientific peers based from
within and outside of the Global Obesity Prevention Center. The Center funds the most
competitive proposals each year and provides research support via the services and resources of
its various units. In the last two years, we received applications from more than 12 countries in
Asia, Africa, North America and South America.
ROUND 5: RFA Announced January 7, 2014
Evaluating Changes in Food Access as a Result of the Minneapolis Staple
Food Ordinance.
Principle Investigator: Melissa N. Laska, PhD, RD, Associate Professor of Epidemiology and
Community Health, University of Minnesota, Minneapolis, Minn.
Funding Dates: 5/1/14 – 4/30/16
The Institute of Medicine, Centers for Disease Control and Prevention and others have identified
food access as an important issue for local governments to address when trying to prevent
obesity, including by increasing healthy food availability and decreasing high-calorie, nutrientpoor products in small food stores.
Although much of the current work in this area involves working one-on-one with stores through
“healthy corner store” initiatives, these efforts can be time- and resource-intensive. New policy
initiatives may help create mechanisms to broaden programmatic reach and enhance
sustainability.
A novel area for policy action involves the implementation of health criteria, such as minimum
stocking requirements for healthy foods, as a condition of store licensing. Minneapolis City
Council passed a Staple Food Ordinance in 2008 requiring stores with grocery licenses to carry
specific staple foods, including fresh fruits and vegetables.
To the best of the researchers’ knowledge, this is the only policy of its kind in the United States.
However, it was originally passed as a crime prevention policy (targeting “food stores” that
offered little food and served as venues for criminal activity) and contained numerous loopholes.
No minimum stocking quantities were specified in the ordinance, the number of varieties
mandated for each food type was limited, and the specified foods were not necessarily healthy
(i.e., meat, white bread and full-fat dairy).
The City Council is now revising the ordinance, and its approval is expected later this year.
Revisions include changes to align the policy with federal health guidelines and stocking
requirements for WIC vendors. As a result, stocking requirements for all eligible stores would
increase to include an array of nutrient-rich foods that are low in energy density, including fruits,
vegetables, 100 percent juices, whole grains and low-fat dairy. To take advantage of this timesensitive opportunity and evaluate the policy’s impact, this study aims to assess changes in
healthy and unhealthy food availability in 120 urban food stores at baseline and 6 months postpolicy implementation, and examine changes in store environments that are not directly
addressed by the policy, such as promotions and advertising, quality, price and placement of
healthy and unhealthy foods. The study uses a quasi-experimental, A-B study design with a
control community (St. Paul) for comparison.
ROUND 4: RFA ANNOUNCED: JULY 8, 2013
Using Systems Thinking Concepts and Processes to Guide Obesity Prevention
Practice and Policy Development.
Principal Investigator: Christine Siokou, PhD, 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, before 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. Now one year into implementation, the workforce 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 systems thinking capacity in two geographical sites, with two
sites as comparisons, with the aim of eventually extending this to all 14 sites in the first wave of
the Victorian initiative. The pilot will include a one-day workshop that uses 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 a track record in developing systems
science approaches. Notably, they are co-investigators on a U.S. 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 and 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 to engage
in physical activity and fitness classes for the first time. 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 childhood obesity associated behavioral
risks, and the potential value of focused changes in school or public policy that may 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 nonadopters. 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: RFA ANNOUNCED JANUARY 18, 2013
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, Penn.
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 five
corner stores in Philadelphia to:
1. Objectively measure product sales in corner stores, particularly at peak times for youth
purchases before and after school
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 five 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: In Spring 2014, The Food Trust partnered 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 use 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.
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, Wash.
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, Wash., 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
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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
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 and summer of 2013 and one year later in 2014.
This project is a partnership between the University of Washington, 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: RFA ANNOUNCED JULY 1, 2012
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,
Ill.
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 20112012 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 and reduced-fat milk.
The new federal nutrition standards for school meals will be implemented beginning SY 20112012. 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 the year. We explore whether the consumption changes over
time within a school year. 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.
Systems-Oriented Analysis of Two Multilevel, Multisector Childhood Obesity
Prevention and Control Projects.
Principal Investigator: Emmeline Chuang, PhD, San Diego State University; San Diego State
University Research Foundation, San Diego Calif.
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 factors 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
(Massachusetts and California).
Both projects involve multiple settings (e.g. clinics, schools, childcare) as well as communitylevel 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: RFA ANNOUNCED FEBRUARY 15, 2012
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, Texas.
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, the United States’ 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:
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Increases children's PA
Improves relevant personal attitude and social environments
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 or 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. 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:
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If PA improvement is sustained
How the feedback loops among environmental interventions and personal and social
factors help sustain increased PA
What policy barriers were encountered and what solutions were used during this
community's development.
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.
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.
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 percent of
primary school children (PSC) aged 7 to 12 years in urban areas are overweight, and 6.5 percent
are obese, much higher than the national average. The number of obese children has increased by
24.4 percent 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 two 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 analyze 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 every
day, 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.]