Strengthening Screening and Referral Systems to Address Early Childhood Obesity Risk - PROJECT SUMMARY/ABSTRACT Disparities in weight outcomes begin in infancy and persist across the lifespan, fueling obesity rates and its comorbid diseases. Most current prevention strategies are narrow in scope, coaching parents to invest substantial effort into managing their infant’s feeding and activity practices. These approaches face limitations in families with financial challenges, as they compete directly with efforts to manage co-existing food, housing, or utility needs. Social risks account for up to 27.4% of obesity outcomes, yet only 1.6% of strategies target them. The Medicaid Section 1115 Demonstration Waiver enables each US state to customize its Medicaid program to tailor disease prevention for its specific population. Researchers have shown that screening for social needs — adverse social conditions unevenly distributed across racial and ethnic communities — may be more effective than genetics screening in predicting health outcomes. Subsequently, New York state was awarded a temporary Waiver to reimburse health and community systems for social needs screening and resource connections, with targeted eligibility for early maternal-child health. This proposal represents a rare and scientifically significant opportunity to identify policy strategies that may prevent racial, ethnic, and socioeconomic disparities in obesity. We propose a strategic study design that capitalizes on the time-sensitive window to evaluate New York’s Medicaid 1115 Waiver, set to expire on March 31, 2027. This proposal’s overall goal is to evaluate impacts of New York’s Waiver Demonstration on early obesity risk in New York City Health + Hospitals, the largest US public hospital system. Our specific aims are: 1) Evaluate whether a greater degree of Waiver exposure is associated with healthier weight outcomes, as well as healthier infant feeding and activity practices; 2) Describe stakeholder attitudes and perspectives on facilitators and barriers to Waiver implementation. AIM 2’s qualitative exploration will identify contextual factors that influence real-world implementation, informing the predictive framework in AIM 3; 3) Assess trends in infant weight outcomes before and after Waiver implementation and evaluate how stakeholder-identified facilitators and barriers from AIM 2 may influence Waiver impact. This proposal draws upon world-class clinical, research, and teaching resources available at NYU Grossman School of Medicine, New York City Health + Hospitals, and Stanford University School of Medicine. The PI has assembled a scientific team comprised of leading experts in pediatrics, health services research, social determinants of health, advanced biostatistics, epidemiology, early childhood obesity disparities, and policy implementation. This urgent research will provide actionable insights for other states considering similar Waivers and support integration of social needs into obesity prevention.
