Preventing Childhood Obesity
Researching a collaborative, policy-driven approach to preventing obesity
ccording to the Centers for Disease Control and Prevention, over one third of adults and 17% of children and adolescents in the U.S. are obese, and current trends suggest that total obesity-related health care expenses could reach $550 billion by 2030. The pressure is on to create nationwide policy changes and practices that will lower the obesity rate, reduce the related fiscal stress on the U.S. healthcare system, and—most importantly—boost the general wellbeing of the American population.
At the University of Minnesota School of Public Health’s Division of Epidemiology & Community Health, doctoral student Jennifer Pelletier is researching how multiple organizations are working together to combat obesity in the U.S. by studying the adoption process of policies that aim to curb the epidemic.
Understanding why some organizations can work together – and why others can’t
Pelletier wants to understand what types of organizations are collaborating to fight obesity, how they’ve changed over time, and whether these partnerships are associated with stronger state laws on school nutrition and physical education. Her dissertation examines partnerships and collaborations among organizations in all 50 states and Washington D.C.
“Previous research tells us that a collaborative approach to policymaking can be beneficial because you can combine the skills and expertise of people from many different sectors—public health, education, transportation, and agriculture, from the public, private, and non-profit sectors—but we don’t know if there is a particular recipe for collaboration that is most likely to be successful,” says Pelletier.
Pelletier’s research focuses on state agency staff who oversee school nutrition and physical education – those who help school districts implement state and federal policies. By combining data from several national sources, her analyses will describe whether state-level staff in some states (such as those with higher childhood obesity rates or more public health funding) collaborate more than others.
“I would expect to see more widespread collaboration in states with higher childhood obesity prevalence because a higher burden of obesity can be an incentive for organizations to work together to address the problem,” says Pelletier.
Pelletier also expects that collaboration may help states pass laws that set stricter requirements for school nutrition and physical education. If state agencies, the non-profit community, and health experts all work together to demonstrate support for and feasibility of higher standards, state legislatures may be more likely to pass new laws. However, Pelletier cautioned that new state laws can place pressure on schools that are already strapped for resources or divert funds away from businesses that sell unhealthy products to schools.
“Some organizations may have an interest in maintaining the status quo, so it’s possible that collaboration with these organizations could hinder efforts to strengthen state policies,” says Pelletier.
Examining collaboration in action: The “Safe Routes to School” program
In the second part of her dissertation, Pelletier hopes to learn how different organizations actually work together successfully by studying Minnesota’s Safe Routes to School program. Safe Routes to School is a program that encourages daily physical activity in school-aged children by establishing safe paths for students to walk or bike to school instead of getting a car ride or taking the bus. The program is a good fit with Pelletier’s research because it involves collaboration among several different types of health-oriented and traditionally non-health oriented entities.
“Safe Routes to School is inherently cross-sectoral,” Pelletier explains, “because it requires expertise from public health, transportation planning, education, and public safety to develop multi-component interventions to make it safe, convenient, and fun for kids to bike or walk to school.”
Minnesota, in particular, provides a noteworthy example of how cross-sector engagement enhances the effectiveness of the program: the Land of 10,000 Lakes is one of few states to build upon this federally-funded program by allocating state funding to its successful integration into communities.
“This state-funded program was the result of a coordinated advocacy effort that built on successful relationships between non-profit organizations, state and local government agencies, and schools and communities,” Pelletier explains. Minnesota’s partnerships in Safe Routes to School could serve as a model for other states looking to replicate Minnesota’s success. Pelletier’s analysis will describe the role and contribution of each sector, the leadership and management of the collaborative effort, and the importance of community capacity and engagement.
“The more we learn about how these partnerships work in practice, the better we can structure future partnerships to be effective,” says Pelletier.
Encouraging innovation for better research and bigger impact
Pelletier’s scope of inquiry has grown, in part, due to encouragement from epidemiology faculty to conduct research beyond her department. One of the highlights of Pelletier’s graduate experience has been learning the limits of current study—and instead of accepting them, pursuing opportunities to explore uncharted research avenues.
“In the first year of our program, we take a class on modern epidemiology theory, where we learn that a lot of the questions we would really like to answer are in fact unanswerable with the usual data and methods we have available. That was a particularly frustrating, but also motivating, moment, to be standing at the edge of what epidemiology can do, just months after deciding to get a Ph.D. in epidemiology!” says Pelletier.
Knowing these limitations has enticed Pelletier and her doctoral colleagues to pursue cutting-edge techniques in their research. For example, Pelletier is using mixed methods, or combining quantitative and qualitative data, to study Safe Routes to School. “I am analyzing data from key informant interviews with respect to participants’ positions in the collaborative network, which I measured based on their responses to a survey. This allows me to see if the leaders of the network have different perspectives from those who are participating in a more peripheral way. It enables a more nuanced analysis that can answer questions we couldn’t answer otherwise.”
“I feel like the professors in our division challenge us as Ph.D. students to push the field in new directions. None of my classmates is doing a traditional epidemiology dissertation. We are all using innovative methods and drawing on other disciplines such as political science, social work, decision science, and biologic sciences to ask and answer big questions,” Pelletier says.
The University of Minnesota epidemiology program has proved to be a fertile environment for graduate students to expand the field of epidemiological study while they are still in the process of “learning the ropes” of advanced research. Pelletier will finish up her dissertation this spring and hopes that her analysis of obesity policy adoption and implementation will have a real impact on the community.
Pelletier’s advisor, Dr. Melissa Laska, is confident about the direction of about her work: “Jennifer is leading innovative, cutting edge research in the area of childhood obesity prevention policies, as well as the importance of cross-sector collaborations in generating and supporting policy change. Her work is going to be valuable in moving the field forward.”