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What would be the effect of competitive food and beverage (CF&B) policies on student weight outcomes in comparison to the students who have not followed the CF&B policies and those who have followed some other policy according to which some of the competitive foods are available to students?
How the clinical question indicates the type of study that will be done (quasi-experimental vs. experimental)?
This clinical question is showing the comparison of two groups. One comparison is that of the students following CF&B policies with the students who have not followed these policies. Second comparison is that of the students following CF&B policies with the students who have following some other researcher-created policies according to which some of the competitive or junk foods are available to students and they are allowed to consume them without hindrance. Considering these comparisons, it can be found that the study is experimental in nature.
Type of study
Experimental research is commonly used in the fields of medicine, psychology, and sociology. According to experimental research, research designs are used in which controlled testing as well as manipulation is done to know the causal processes. In the experimental study, the researcher causes manipulation of one variable or more than one variables, and controls and checks any variation in other variables. Usually, experimental research is done to know the causal relationship, i.e. cause preceding effect. Moreover, it can be guessed that a particular cause would always result in the same effect. As a result of experimental research, people of a society can find some important outcomes and improve everyday lives.
In order to perform an experimental research, several aspects have to be considered. One of those aspects is the sampling of groups; especially, when there is more than one condition in the experiment. Among the groups, one group is considered as a control group, whereas the other groups are considered as experimental groups.
Transtheoretical model of health behavior change is a theoretical framework that illustrates the processes of change of behavior of people in order to prevent diseases such as obesity and to improve personal health. This model shows that changing the behavior of a person and gaining a healthy lifestyle occurs in six stages including precontemplation, contemplation, preparation, action, maintenance, and termination (Prochaska & Velicer, 1997). This model is utilized to facilitate in improving eating habits and lifestyles. Therefore, this model could help in guiding practice related to childhood obesity because it enables the family members and children to identify the current stage of behavior change and allowing the policy makers to develop policies.
A case-control design will be used with 2 related comparisons corresponding to our basic aim of the efficacy of CF&B policies. Up to 100 students from one school will be selected to know the efficacy of CF&B policies on student weight outcomes and those students will be compared with 100 students from another school without CF&B policies, and 100 students from still another school who will be asked to follow researcher-created policies according to which some of the competitive or junk foods will be available to students and they will be allowed to consume them without hindrance.
For these comparisons, groups of students will be individually matched within 1 year of the application of the intervention. Matching for current age could help in reducing the chances of age-related recall bias. Matching for parental social class could help in removing the potential confounding variables. Students in the controls group and their families will be questioned about their experience and adherence to the policies. The analyses will be done after considering the current age as well as parental social class. Unless otherwise shown, data will be provided as mean ± Standard Deviation.
Setting / Sample
Participants of the study will be students of 3rd to 7th grade having the age ranging from 7 years to 13 years. Students in the three different groups will be selected from three different schools. Participants will be considered only when they show no current and/or past eating disorders as found by interviews.
An informed consent will be sent to the participants of the study. This consent could help in assuring privacy of the information. However, informed consent is not the only research ethic, but protecting confidentiality as well as anonymity is also important for research ethics. In fact, information in the research will remain confidential with the help of anonymous data collection. This data will not be connected to any information that can help in recognizing the individual participants. Moreover, the detailed information obtained from the participants will be discarded once the research will be completed. The participants of the study will also be asked and trained to not to discuss any information regarding students or their family members.
Procedures / Intervention
CF&B policies will be considered as the intervention to control childhood obesity. CF&B policies are related to CF&B policies items. These policies are commonly sought to decrease sugar and fat consumption in CF&B items (Sanchez-Vaznaugh, Sánchez, Crawford, & Egerter, 2015). They not only decrease the consumption but also relate to the limited availability of those items to the students. On the other hand, the researcher-developed policies will be related to slight changes in those policies, so that some of the competitive or junk foods will be available to students and they will be allowed to consume them without hindrance.
Instruments / scales and measurement of outcomes
After confirming the participants of the study, their heights and weights will be determined. As shown earlier, data will also be collected utilizing interviews and questionnaires, and students and their family members will be asked to give as much information as asked by the researchers. After completion of the study, further information will be taken by physical assessments, and more interviews and questionnaires. Anthropometric, lifestyle, and family characteristics will be obtained before and after the research.
Data regarding research will be collected only in the start of the research, and then at the end of research. This form of testing frequency would be helpful not only for researchers but also for the participants of the study as it would not take much time of the participants and it would also help in giving reliable results.
In this research, our clinical question is “What would be the effect of CF&B policies on student weight outcomes in comparison to the students who have not followed the CF&B policies and those who have followed some other policy according to which some of the competitive foods are available to students?” In this question, childhood obesity is considered as a problem and the intervention that has been utilized to deal with this problem include CF&B policies.
After the implementation of CF&B policies, their effect on the obesity in childhood will be determined. Moreover, it will also be helpful in working on the changes in eating habits of children and variations in their lifestyles. Analysis of the changes in eating habits and obesity of the children will be determined through weight and height determination, body mass index (BMI) measurement, and questionnaires that will be presented to the children (participants) and their family members. Those questionnaires would further help in knowing thoughts and attitudes of the participants towards CF&B policies.
Statistical analysis will be done to confirm the statistical significance of the study. In order to perform statistical analysis, descriptive values will be obtained as mean ± Standard Deviation (as noted earlier). Moreover, differences between the groups will be assessed utilizing Student’s t test for means obtained through physical assessments and questionnaires provided to the participants of the study. Conditional logistic regression analysis will also be done for data analysis as it is an appropriate statistical procedure for case-control design. Logistic regression is helpful in describing the data and in explaining the connection between one dependent variable and one or more independent variables that could be ordinal or nominal. It will also help in estimating the strength of the association of several variables that could be considered as risk factors for obesity.
Demographic data will also be considered in the study. This data will include ethnicity, education of parents or guardians, income of parents or guardians, and employment status of parents or guardians.
The outcomes of the implementation of the CF&B policies would be decrease in the childhood obesity and increase in the better lifestyles. It will also help in knowing whether the availability of junk food items is related to an effect on BMI; thereby, further confirming or negating the findings of Datar & Nicosia, (2009).
Stakeholders in the present study will be parents, caregivers, guardians, and family members. They are directly related to the participants of the study and would help in strictly following the interventions in the study. Among the other stakeholders are teachers, principal, director, school nurse, and school board. Those stakeholders are related to the schools and they can help in appropriate implementation of policies and interventions in the schools.
Potential barriers and strategies to prevent or overcome them
Some of the barriers that could be faced in the study and the implementation of the intervention may include long times in studying the problem without acting on them, resistance to change as a result of the implementation of policies, and ineffective teams. It is important to work on these barriers and prepare the research team and ask them to educate others.
Potential barriers to project implementation that stakeholders may present and strategies to deal with them
General barriers that could be faced by researchers in this study include parents’ perception about the health of their children. They may think that their children are not overweight or obese. In this case, it is important to give education to the parents about the obesity and the ways to deal with this problem. They will be asked to fulfill their roles appropriately. Another barrier that could be faced by researches is the lack of support from school staff and administration. Again in this regard, it is important to work on coordination of efforts as well as to work on the guidelines to support the development and implementation of policies.
Datar, A., & Nicosia, N. (2009). Junk Food in Schools and Childhood Obesity: Much Ado About Nothing? Santa Monica: RAND Corporation.
Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American journal of health promotion, 12(1), 38-48.
Sanchez-Vaznaugh, E. V., Sánchez, B. N., Crawford, P. B., & Egerter, S. (2015). Association between competitive food and beverage policies in elementary schools and childhood overweight/obesity trends: differences by neighborhood socioeconomic resources. JAMA pediatrics, 169(5), e150781-e150781.