Research programs are conducted under two primary areas: Children in Balance and StrongWomen. Additional areas of research and university engagement include the President's Marathon Challenge and the Child Obesity180.
The Children in Balance initiative was launched in March 2005 with a $5 million gift from the New Balance Foundation. Its mission is to establish a balance between scientific rigor and public health action by creating and supporting healthy communities in America. Its objective is to secure the health and well-being of families and future generations of children by transforming thinking, providing a new vision of child health and wellness, and engaging the resources of the private sector, government and academia to further improve the health of America's children.
Through Children in Balance, we conduct rigorous scientific research to improve children's health and disseminate evidence-based interventions, and "best practices" to help create social change geared toward childhood obesity prevention. Over the past decade, we have committed ourselves to various clinical, school, community, and population-based studies. Listed below are highlights of the research falling under this initiative.
(2002 – 2005)
Shape Up Somerville: Eat Smart. Play Hard, funded by the Centers for Disease Control and Prevention, was a three-year, environmental change intervention designed to prevent obesity in culturally diverse, high-risk, early-elementary school children. Shape Up Somerville developed and implemented strategies designed to create energy balance for 1st-3rd graders in Somerville, Massachusetts. In before-, during-, and after-school environments, interventions were focused on increasing the number of physical activity options available to children throughout the day and on improving dietary choices.
The first publication reported that on average, Shape Up Somerville reduced approximately one pound of weight gain over eight months for an eight-year-old child. This may seem small for an individual, but on a population level this reduction in excess weight gain, observed through a decrease in BMI z-score, would translate into large numbers of children moving out of the overweight category. The second publication with the complete study results is forthcoming.
Shape Up Somerville was multi-faceted program that included: enhancements in the quality and quantity of healthy foods available for students in the Somerville schools; a new, classroom-based health curriculum and after-school cooking and nutrition education program; engagement of parents and community members; a community walking program with the creation of Safe Routes to School, a walking "school bus" and traffic calming campaign; education of policy makers about the link between city planning and public health issues such as obesity; and the creation of a comprehensive Wellness Policy. This successful model is currently being replicated in other studies including "CHANGE" and "Balance," described below.
The CHANGE Study, a partnership between Tufts University and Save the Children, is a randomized controlled trial to test the effectiveness of a community-based participatory childhood obesity prevention intervention in eight communities in four rural regions of the U.S.: California, Kentucky, Mississippi and South Carolina.
The elements of the intervention are based on the Shape Up Somerville model, focusing on changes to a child's home, school, and community environment. These changes aim to influence the dietary, physical activity and sedentary behaviors of elementary school-aged children by enhancing the availability of and access to daily physical activity; improving and increasing healthy food, beverage, and meal options; and reducing leisure screen time. We utilized community-based participatory strategies in the development, implementation, and evaluation of the CHANGE Study intervention to engage communities and to build capacity for sustainable change.
In addition to a rigorous outcome evaluation, we are investigating and understanding unique opportunities and barriers to childhood obesity prevention in rural communities through formative research and continuous process evaluation.
The Balance Project is replicating Shape Up Somerville in six under-served, urban communities across the country in a two-year, randomized controlled trial targeting 1st-3rd graders and their families. The Balance Project uses a multi-level, multi-disciplinary approach, which is grounded in the socio-ecological model of health behaviors. This model recognizes that various spheres of influence in a child's life need to be affected to achieve optimal health outcomes.
The Balance Project investigators seek to understand 1) whether the Shape Up Somerville model can be effectively replicated in diverse communities; and 2) the extent to which a community's readiness to engage in obesity prevention efforts changes with or without an investment of resources and inputs.
Throughout the study period, intervention communities receive technical assistance, training and materials from Tufts University, based on the lessons learned from Shape Up Somerville. Balance Project communities include six urban cities from Massachusetts, Illinois, Pennsylvania, Tennessee, North Carolina and Florida.
New immigrants to the U.S. are at high risk of weight gain and obesity as they adapt to their new "obesogenic" environment. This four-year, randomized, controlled research trial funded by the National Institutes of Health (NIH) includes a two-year preventive intervention designed to moderate or reduce weight gain in mother/child dyads of new immigrants in Somerville, Massachusetts. The 435 mother/child dyads recruited to participate will be randomized to either receive the intervention or to serve as controls. Once the main trial is completed, controls will receive a delayed intervention. Developed with active input from our community partners, this intervention aims to improve the long-term health of participants by promoting physical activity and proper nutrition as a means by which to prevent chronic disease.
The principals of community-based participatory research informed the design and implementation of the project. The steering committee, charged with the task of making decisions regarding all aspects of project implementation, consists of active input from five grass roots immigrant-led, community-based organizations in partnership with Tufts investigators, doctoral students, and project staff. The Brazilian Women Group, the Community Action Agency of Somerville, the Haitian Coalition, the Immigrant Service Provider Group, and the Welcome Project are our community partners.
(1999 – 2004)
The BONES Project aimed to promote bone health in early elementary school children participating in after-school programs. The behaviorally-based intervention included weight-loading physical activity, nutrition education, and calcium-rich snacks for 6-9 year old children. Lessons learned from this community based intervention in early elementary school aged children were used to develop the Shape Up Somerville research project.
The HEAT Club curriculum is designed to improve the eating habits and increase physical activity levels of children ages 5-10 participating in after school programs. Created in connection with the Shape Up Somerville research intervention, the HEAT Club has met with success in hundreds of programs around the country. We have developed and tested, through a randomized, controlled trial an online training mechanism for the HEAT Club after school curriculum.
The HEAT Club
The HEAT Club curriculum is available in print and online format. The HEAT Club Online has met with success in over 140 programs in 12 states.
My HEAT (Middle School Youth Healthy Eating, Active Time)
My HEAT offers some of the same research-based lessons featured in the HEAT Club at a level appropriate for middle school-age children.
This project is funded by the Robert Wood Johnson Foundation's Active Living Research Program. The purpose of this study is to conduct a mixed-methods assessment of physical activity opportunities and habits of rural American elementary school children between the ages of 6-11 years living in under-resourced areas within the Central Valley (California), Mississippi Delta (Mississippi, Arkansas), Appalachia (Kentucky), and Southeast (Georgia, South Carolina) regions of the U.S. This project was launched in January 2007.
Measuring Rural Environments for Physical Activity
This project was funded by a transition supplement award from the Robert Wood Johnson Foundation. The purpose of this research was to design and test rural-specific observational and self-report environmental measures. Disseminating results from this study will help to inform future research and allow for the evaluation of evidence-based interventions that can focus on changing policy, environment, and social norms to improve physical activity levels among rural populations.
The FIT Study
This study is examining the relative impact of body mass index and physical fitness on blood lipids and inflammation in 4th-8th grade children in Somerville, Massachusetts. During the late winter/early spring of 2009 and 2010, children volunteer to have a free cholesterol screening. Results are linked to their school-based fitness testing and body mass index measurements. To date, 280 children have participated. A second aim of this study is to examine whether normal-weight physically fit children who become physically unfit over time are at increased risk for becoming overweight. Data collected in Cambridge, Massachusetts and Somerville will be used to examine the change in fitness and weight status over three years in over 2,000 physically fit and normal-weight children. If indeed loss of fitness precedes the incidence of overweight and fitness overrides some of the negative lipid and inflammatory effects of overweight, these findings would further emphasize the importance of maintaining or enhancing physical fitness levels in school-age children to protect against future chronic disease.
TLHS was an ongoing investigation of the behavioral and physiologic profiles of college students to understand the individual and environmental factors that underlie health behaviors. The ultimate goal of the study was to provide the foundation and framework to build new health initiatives designed to change and enhance the existing culture and environment at Tufts. Results of this work include: analysis of freshman year weight gain in relationship to stress; impact of freshman weight gain on overall weight gain over a student's four-year tenure; relative impact of physical fitness versus body fat on blood lipids, glucose, and inflammatory factors; prevalence of eating disorders and their relationship to sports participation and athletic identity; and the association between sports participation, anthropometry, and bone density.
This research project investigates the possibility that the consumption of vitamin D-fortified orange juice will also improve 25(OH)D vitamin status in children ages 6-10. In addition orange jounce fortified with vitamins E and A were also examined. The randomized controlled trial was carried out at the Friedman School in collaboration with the pediatrics departments at Tufts Medical Center and Boston University Medical Center.
The Healthy Snacking and Soccer Study
This project was funded by the California Raisin Marketing Board. The study examined the effects of three different types of pre-exercise snacks on sustained energy, subjective assessments of physical and mental fatigue, and biochemical markers of stress in young children after playing soccer. Prior to a soccer game, 115 children were randomly assigned to consume 1 of 3 isocaloric snacks: 1) nutrient dense/high flavonoid raisin/nut bar; 2) low flavonoid peanut butter graham bar; or 3) low flavonoid/high sugar rice cereal bar. Children spent approximately 33% of the game in moderate to vigorous activity and 49% of the game in sedentary activity. The pre-exercise snacks formulated for this study did not affect blood sugar or salivary biomarkers of stress following a soccer game. The nutrient content of the single snack did not differentially influence these biomarkers or the exercise intensity; however subjective feelings of fatigue may be associated with low flavonoid/high sugar snacks.
The StrongWomen Program is a national evidence-based community exercise and nutrition program targeted to midlife and older women that we developed based on our early research at Tufts University. We have developed and evaluated two curricula: the first is based on strength training to help women maintain muscle mass, strength, and function as they age; while the second is a Healthy Hearts curriculum that focuses on aerobic activity and nutrition. Over the past five years, we have trained over 1,600 allied health professionals to conduct the StrongWomen Program, which is currently active in 40 states.
View more about this program at its official website: http://www.strongwomen.com
The original StrongWomen Program is an evidence-based strength-training program developed by Center faculty. The primary objective of the Program is to help communities nationwide to implement safe and effective strength training programs for midlife and older women. At the core of the model is the StrongWomen Toolkit, which contains the primary functional materials to be used by community leaders when starting programs within their town or county. In addition to containing all of the information and resources a community would need to begin and maintain the StrongWomen program, the Toolkit also provides information on fostering leadership and developing community projects such as working with local agencies to make neighborhoods more conducive to physical activity initiatives, such as an older adult walking program.
The StrongWomen-Healthy Hearts Program was designed to build on the successful strength-training program and expand it to focus on heart health for mid-life and older women. Participants meet twice-weekly for 12 weeks. The hour-long class consists of thirty minutes of aerobic exercise, via aerobic dancing to a DVD created for the project or walking outside if location and weather permit. The other 30 minutes includes leader-directed discussion and hands-on activities to modify dietary intake patterns, as well as weight control strategies. The Program emphasizes an eating pattern that is rich in fruits, vegetables, low-fat or nonfat dairy, fish, whole grains, and legumes; it encourages leaner meats and poultry, and fewer refined carbohydrates and saturated and trans fats. The theoretical basis for the intervention is Social Cognitive Theory. Behavioral strategies include self-monitoring of food intake and physical activity; goal-setting; and skill-building around food preparation, supermarket shopping, and restaurant eating. The objective of the Pilot Project was to test the effectiveness of the Program by conducting a randomized, controlled trial in eight counties in Arkansas and Kansas. Results indicate that the Program was effective at increasing physical activity, improving diet quality, and decreasing body weight.
Strong Women Move Mountains
The Strong Women Move Mountains study is designed to gather information about the leadership characteristics and styles of women who have been successful in promoting health in their communities and beyond. While there have been several rigorous studies of leadership in the business sector and a plethora of popular literature on the topic, very little is known about the leadership qualities that best determine success in the public sector, particularly in the area of health. We will learn about leaders' career paths, motivation, definitions of success, and perceptions about leadership. The goal is to develop a model that will ultimately lead to improved training of future leaders.
StrongWomen Across America - Change Yourself, Change the World
The goal of StrongWomen Across America - Change Yourself, Change the World, is to drive needed change by developing a social network of women across the U.S. while giving them the tools and inspiration to not only change themselves, but also change the communities in which they live. The hope is that the actions of these women will have a ripple effect, spreading beyond their communities to the country at large, creating the major change we so desperately need.
Beginning in September 2011, Miriam Nelson, PhD, and Eleanor Heidkamp-Young, BA, will launch a ten-week cross-country tour starting in Kenai, Alaska, home of one of the longest running StrongWomen Programs. The team will then drive to one community in each of seven additional states: Montana, Colorado, Kansas, Arkansas, Missouri, Wisconsin, and Pennsylvania. The team will stay three days in each community. Working closely with existing StrongWomen ambassadors through cooperative extension programs, the tour will initiate Change Clubs—groups of approximately 20 women who come together to target action steps, large and small, to change the food and physical activity environment in their own communities.
Growing Stronger is an evidence-based exercise program involving strengthening exercises. These exercises have been shown to increase the strength of muscles, maintain the integrity of bones, and improve balance, coordination, and mobility. In addition, strength training can help reduce the signs and symptoms of many chronic diseases, including arthritis. This project was developed in collaboration with experts at the Centers for Disease Control and Prevention and Tufts University. The program is supported with an interactive website (http://growingstronger.nutrition.tufts.edu/) and booklet called Growing Stronger: Strength Training for Older Adults.
The Strong Living Program is a group exercise program for older adults.
Each year, 200 runners make the journey from Hopkinton to Boston to support nutrition, medical, and fitness programs at Tufts University. Tufts Marathon Challenge is the largest known collegiate marathon program in the United States, attracting runners from around the country. Started in 2005 by Tufts University President Lawrence Bacow, the President's Marathon Challenge has raised over $1,890,000 from individual runners, with approximately $1,000,000 of this support directed to the Friedman School of Nutrition Science and Policy. We have had over 930 runners depart Hopkinton since 2005. Tufts' Marathon Challenge helped to create the dramatic story of the 2007 PBS NOVA Marathon Challenge that was viewed by six million people the first week it aired. The team is made up of approximately 100 undergraduate and graduate students from Tufts University who are required to raise a minimum of $1,000, while the remaining 100 runners represent a mix of Tufts staff, parents, alumni, and friends who are required to raise a minimum of $2,500. Donald Megerle is the head coach. Dr. Nelson is a Co-Captain of the President's Marathon Challenge with Eric Johnson, Executive Director of Development for Tufts University. Tufts' Marathon Challenge has engaged thousands within the Tufts community to provide support for important nutrition initiatives at the Friedman School of Nutrition Science and Policy. In 2008 the Center conducted a pilot study geared towards understanding how marathon training impacts body weight in recreational marathon runners. People training for a 2009 spring marathon were recruited to participate. Each runner's height and weight was measured pre- and post-training. Additionally, they were asked to complete a survey answering questions about training habits, nutritional behaviors, and motivations for running. The information gathered through this pilot study will inform a future doctoral student dissertation on marathon runners and body weight.
ChildObesity180 (CO180) seeks to provide an integrated national strategy and become a major catalyst to prioritize and drive the necessary systemic changes to reverse childhood obesity within one generation’s time. CO180 provides a politically neutral point of engagement; creates connections among leaders and organizations; and powers up key initiatives to deliver accelerated, amplified impact. Monitoring and evaluation are, as with all John Hancock Research Center projects, key components of this work.
The goal of ChildObesity180 is to bring together national leaders from government, public health, academia, media, industry, the food industry, community organizations, philanthropy, and advocacy to develop a national plan to reverse the trend of childhood obesity in one generation’s time. Peter Dolan, the former CEO of Bristol Myers Squibb, serves as the chair; Dr. Christina Economos as the project director; and Dr. Miriam Nelson as the co-director.
What makes CO180 truly distinctive is its people and their outstanding backgrounds, dedication, and realm of influence. For the first time, a team of prominent experts and leaders from all sectors – public, academic, nonprofit, and private – has gathered with singleness of purpose to address this crisis. While many individuals and organizations are working on this issue, CO180 will attempt to use its cross-sector composition, deep connections, and expertise to generate urgency, traction, and impact – to drive change on a national scale.
The GREEN Project Lunch Box Study
The GREEN Project Lunch Box Study is a school-based nutrition intervention designed to improve the nutritional quality of foods children bring from home to school. The three-year project, funded by the National Institutes of Health, involves the design, implementation, and evaluation of an innovative communications campaign for third and fourth grade students and their families. The pilot phase of the project was completed in June 2011, and the main intervention will take place in schools throughout Eastern Massachusetts during the 2011-2012 school year.
The Daily D Study: Impact of Vitamin D Supplementation on Cardiometabolic Risk in Schoolchildren
Vitamin D deficiency has been linked to the development of cardiovascular disease and it is estimated that six million children are currently vitamin D deficient. Vitamin D deficiency is even more common in northern latitudes, amongst some minority groups with darker skin pigmentation, and in those who are overweight or obese. In these groups, higher supplemental doses may be needed to maintain optimal serum levels and to prevent cardiovascular risk. As it is difficult for many children to consume the new recommended intake of 600 IU/d set forth by the Institute of Medicine, many have suggested that vitamin D supplementation is necessary. The overall objective of the proposed work is to determine the appropriate vitamin D supplementation requirements for children with various risk factors, living at northern latitudes (above 42°). We will also investigate for the first time in a randomized controlled trial what happens to serum 25(OH)D and cardiometabolic risk factors after supplementation is discontinued.
Fourth-eighth grade children from socioeconomically disadvantaged and racially diverse communities with high obesity rates in the northeastern U.S. will be randomized to 600 IU, 1000 IU, or 2000 IU/d for six months starting in the early winter. Adiposity, physical activity, dietary intake of vitamin D, and sun exposure will also be assessed. Results of this work will inform the development of evidence-based recommendations and guidelines regarding vitamin D supplementation to maintain optimal 25(OH)D levels and to reduce cardiometabolic risk. The Principal Investigator is Dr. Jennifer Sacheck of the John Hancock Research Center at Tufts University Friedman School of Nutrition Science and Policy. This study is funded by a grant from the National Institute of Health.
One current USDA Fellow will be studying Vitamin D serum levels and supplementation in relation to adiposity and skin pigmentation in overweight and obese children. This Fellow’s research will help us to better understand a number of interactions between childhood obesity and Vitamin D.
The VIVE Study
VIVE means Vitality, Independence, and Vigor in Elders. This study is funded by Nestlé Nutrition. The purpose of this study is to see how a targeted exercise program can improve mobility, independence, and well-being in older adults. We would also like to see how a supplemental beverage high in protein, vitamin D, and calcium can aid in this improvement. Lastly, we hope to be able to apply the lessons and information we learn in this study to other assisted living facilities and senior centers throughout the world in order to help all older adults maintain their independence.
For this study, we will be working with a number of housing sites and senior centers. These sites have been randomly assigned (like flipping a coin) to either one of two programs: a successful aging program or a physical activity-supplement program. Each program will run for six months whereby the researchers will measure outcomes predictive of functional mobility, behavior change, and other factors correlating with well being.