Reducing Health Disparities in Childhood Obesity Using Financial Incentives in Low-income Households - Children (6-12yrs) from low-income households are at an elevated risk for obesity, type 2 diabetes, and other
associated comorbidities and cardiometabolic dysfunction. The vast majority of obesity prevention
interventions targeting these children are delivered during the 9-month school-year, either in school or during
afterschool programs. Substantial evidence developed over the past decade consistently indicates that all
improvements in weight and other health outcomes achieved during the school year from in-school or
afterschool programs are erased during summer vacation. Observational studies indicate that summer
vacation exerts a negative effect on the obesogenic behaviors (i.e., activity, screen time, diet, sleep) and
weight status of children, especially children from low-income households. Emerging evidence from
observational studies shows that when children attend summer programs, they engage in higher levels of
physical activity, consume more foods/beverages that meet federal guidelines for child nutrition/caloric density,
and maintain a more consistent sleep schedule. Thus, evidence indicates that summer programs exert a
beneficial influence on children’s obesogenic behaviors. Unfortunately, children from low-income households
have limited access to summer programs. The proposed study builds upon the scientific literature that
examines the effects of demand-side financing, such as financial incentives to improve adults’ health behaviors
and the use of vouchers/subsidies in low-income populations and developing countries, and applies this
intervention approach to childhood obesity in low-income households. We hypothesize that by addressing the
cost barrier to participating in summer programs, increased attendance at existing community-operated
summer programs will occur, and this will lead to marked improvements in children’s obesogenic behaviors. In
turn, we hypothesize improvements in obesogenic behaviors will result in a reduction in excessive, unhealthy
weight gain over summer. For this study, we will rigorously test the impact of providing access to existing
community-operated summer programs, through the use of a voucher program, on weight status (i.e., BMI z-
score) and obesogenic behaviors of 1st-3rd grade children from low-income households. Using a randomized
design, we will compare changes in weight status and obesogenic behaviors of 420 children from low-income
households randomized to one of two conditions: voucher program for summer programming or
comparison/control. We believe this study is significant because the research questions are of high policy
relevance to federal, state, and local policymakers, with the majority of parents supporting the use of public
funds to provide access to summer programs. We believe this study is innovative because it draws from the
demand-side financing literature, which is widely used to change adult health behaviors, and will test a novel
and innovative voucher program to eliminate cost barriers to attending existing community-operated summer
programs as an intervention to overcome the health disadvantages of growing up in poverty.
