As part of Governor Gavin Newsom's newly budgeted California Comeback Plan and the California Initiative to Advance Precision Medicine (CIAPM), researchers at UC San Diego, led by the Altman Clinical and Translational Research Institute (ACTRI), will receive approximately $3 million to create a precision, community-based program to address specific health problems related to adverse childhood experiences or ACEs, a term that describes potentially traumatic events that affect children, such as family violence, abuse or neglect.
Specifically, the funding will be used to develop and deliver interventions designed to mitigate childhood trauma within the Latino community and improve a key clinically relevant endpoint: childhood obesity.
The effort will be conducted by a community-centered research team comprised of academic researchers from ACTRI and its Dissemination and Implementation Science Center, the Herbert Wertheim School of Public Health and Human Longevity Science, and San Diego County Childhood Obesity Initiative associated Latino community organizations. Family Health Centers of San Diego is the key clinical partner that will implement the approach in partnership with the San Diego Promotores Coalition, and powered via the digital health tool, Streetwyze. Collaborating community partners include American Academy of Pediatrics, County of San Diego, Olivewood Gardens and Learning Center, Poder Popular and Vista Community Clinic, among others.
The new study will systematically examine community, organizational, family, and individual predictors of childhood obesity, including ACEs-related behaviors (stress, anxiety, reactivity, over-eating), while also intervening on key behavioral targets for obesity (e.g., self-regulatory skills, resiliency, diet, physical activity). Recommendations and best practices to address ACEs and resilience will be developed and disseminated to local, regional, and state organizations at the study's conclusion.
"Working with the Latino community, we want to create a family-based approach to improve individual and community resilience to stress and address the obesity epidemic," said lead principal investigator Gary S. Firestein, MD, Distinguished Professor of Medicine and ACTRI director.
"We want to test whether this approach, which involves the use of extensive informatics and analytics, works better than what's normally been done. Is a precision, community-based approach superior to the existing standard of care and what's been tried in the past?"
Job Godino, PhD, scientific director of the Laura Rodriguez Research Institute at Family Health Centers of San Diego, agreed: "We are very excited by the potential of this work. Our mission is to ensure that health care innovations engage and benefit uninsured, low-income, and medically underserved persons, and this effort provides an opportunity to do so. We currently lack a systematic program that simultaneously addresses ACEs and obesity and is embedded in our community health setting. We sincerely hope that the community-centered precision medicine approach will advance health and resiliency in the families we serve."
Childhood and adolescent obesity have reached epidemic levels in the United States, with an estimated 17 percent presenting with obesity. Rates continue to rise, with older children more likely to experience obesity and at greater risk of becoming adults with obesity.
(In adults, obesity is roughly defined as a body mass index of 30.0 or higher. BMI measurement is different in children due to different rates of growth, and is based on percentiles.)
The prevalence of childhood obesity varies among ethnic groups, age, sex, education levels and socioeconomic status. In a 2019 published study, prevalence of obesity among non-Hispanic Black (22.0 percent) and Hispanic (25.8 percent) children and adolescents ages 2 to 19 years was higher than among both non-Hispanic white (14.1 percent) and non-Hispanic Asian (11.0 percent) children and adolescents.
While the prevalence for obesity among girls was similar to overall percentages, Hispanic boys had a 28 percent higher prevalence of obesity than non-Hispanic Black boys (19 percent).
Blanca Meléndrez, director of the Center for Community Health at UC San Diego and a co-principal investigator on the study with Eric Hekler, PhD, professor and interim associate dean for community partnerships in the Herbert Wertheim School of Public Health, said that beyond determining which methods best promote resiliency and reduce obesity among children, researchers and community collaborators will seek to create interventions that can be delivered to different families that match a family's unique circumstances and needs.
"Our approach is new in many ways," Meléndrez said. "First, the intervention will be much stronger because, as a community-based approach to ACEs and obesity, community members and researchers will come together and inform each other's work. Second, our approach is developed to continually learn and improve upon previous intervention iterations. We want to adapt and better account for different family needs so that each family gets the right support at the right time for them."
CIAPM was launched in 2015 to support collaborative, patient-focused research and foster a new approach to health and medicine. It relies on translating available large data sets and technical innovation into better health outcomes.
Governor Newsom's $100 billion economic post-pandemic recovery package, part of the state's $262.6 billion 2021-2022 budget, allocates $12.4 million in new CIAPM funding for three projects, among them the San Diego effort. They join four projects that the state had previously funded.