Preventing childhood obesity through state policy. Predictors of bill enactment.
BACKGROUND
To address the epidemic of childhood obesity, health professionals are examining policies that address obesogenic environments; however, there has been little systematic examination of state legislative efforts in childhood obesity prevention. Using a policy research framework, this study sought to identify factors that predict successful enactment of childhood obesity prevention in all 50 states.


METHODS
A legislative scan of bills introduced during 2003-2005 in all 50 states identified 717 bills related to childhood obesity prevention. Multilevel logistic regression modeling was performed in 2006 to identify bill-level (procedure, composition, and content) and state-level (sociodemographic, political, economic, and industrial) factors associated with bill enactment.


RESULTS
Seventeen percent of bills were enacted. Bill-level factors associated with increased likelihood of enactment included having more than one sponsor; bipartisan sponsorship; introduction in the state senate; budget proposals; and content areas related to safe routes to school, walking/biking trails, model school policies, statewide initiatives, and task forces and studies. State-level political factors, including 2-year legislative session and Democratic control of both chambers, increased enactment. An indicator of state socioeconomic status was inversely associated with bill enactment; economic and industrial variables were not significantly related to bill enactment.


CONCLUSIONS
In general, bill-level factors were more influential in their effect on policy enactment than state-level factors. This study provides policymakers, practitioners, and advocacy groups with strategies to develop more politically feasible childhood obesity prevention policies, including the identification of several modifiable bill characteristics that might improve bill enactment.
Boehmer
Tegan K
TK
Saint Louis University School of Public Health, St. Louis, Missouri 63104, USA.
Luke
Douglas A
DA
Haire-Joshu
Debra L
DL
Bates
Hannalori S
HS
Brownson
Ross C
RC
D000293:Adolescent; D001642:Bicycling; D002648:Child; D004779:Environment Design / Q000331:legislation & jurisprudence*; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D016015:Logistic Models; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control*; D012574:Schools; D013221:State Health Plans; D014481:United States / Q000453:epidemiology; D016138:Walking