title: Developing a coordinated school health approach to child obesity prevention in rural Appalachia: results of focus groups with teachers, parents, and students.
abstract: BACKGROUND
  High prevalence rates of obesity, particularly among those residing in US rural areas, and associated physical and psychosocial health consequences, direct attention to the need for effective prevention programs. The current study describes an initial step in developing a school-based obesity prevention program in rural Appalachia, USA. The program, modeled on the Centers for Disease Control and Prevention Coordinated School Health (CSH) Program, includes a community-based participatory research approach to addressing the health needs specific to this region.
  
  
  METHODS
  Focus groups with teachers, parents, and 4th grade students were used to understand perceptions and school policy related to nutrition, physical activity, and the role of the school in obesity prevention.
  
  
  RESULTS
  Results revealed that these community stakeholders were concerned about the problem of child obesity and supported the idea of their school doing more to improve the diet and physical activity of its students. Specifically, all groups thought that foods and drinks consumed by students at school should be healthier and that they should have more opportunities for physical activity. However, they cited limitations of the school environment, academic pressures, and lack of parental support as potential barriers to making such changes. Parents were most concerned that their children were not getting enough to eat and they and the teachers were not in favor of BMI screening at the school. Parents were in favor of increasing physical activity during school and thought that parent volunteers should help students select foods in the cafeteria. Students cited examples of how diet and physical activity affect their health and school performance, and thought that they should have more physical education time and recess.
  
  
  CONCLUSIONS
  The data collected in the current study contributed to the limited knowledge base regarding rural populations as well as identified strengths and potential barriers to assist with the development of a pilot program based on the CSH model, Winning with Wellness.
authors.affiliation: Department of Pediatrics, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA. schetzin@etsu.edu
authors.forename: Karen E
authors.initials: KE
authors.lastname: Schetzina
authors.forename: William T
authors.initials: WT
authors.lastname: Dalton
authors.forename: Elizabeth F
authors.initials: EF
authors.lastname: Lowe
authors.forename: Nora
authors.initials: N
authors.lastname: Azzazy
authors.forename: Katrina M
authors.initials: KM
authors.lastname: Vonwerssowetz
authors.forename: Connie
authors.initials: C
authors.lastname: Givens
authors.forename: Harold P
authors.initials: HP
authors.lastname: Stern
mesh_terms: D001061:Appalachian Region; D015992:Body Mass Index; D002648:Child; D004032:Diet; D015444:Exercise; D005178:Faculty; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D009765:Obesity / Q000517:prevention & control*; D010290:Parents; D012424:Rural Population; D012572:School Health Services / Q000458:organization & administration*; D013334:Students