title: State school nutrition and physical activity policy environments and youth obesity.
abstract: BACKGROUND
  With the epidemic of childhood obesity, there is national interest in state-level school policies related to nutrition and physical activity, policies adopted by states, and relationships to youth obesity.
  
  
  OBJECTIVE
  This study develops a comprehensive state-level approach to characterize the overall obesity prevention policy environment for schools and links the policy environments to youth obesity for each state.
  
  
  METHODS
  Using 2006 School Health Policies and Programs Study (SHPPS) state data, qualitative and quantitative methods were used (2008-2009) to construct domains of state-level school obesity prevention policies and practices, establish the validity and reliability of the domain scales, and examine their associations with state-level obesity prevalence among youth aged 10-17 years from the 2003 National Survey of Children's Health.
  
  
  RESULTS
  Nearly 250 state-level obesity prevention-policy questions were identified from the SHPPS. Three broad policy topic areas containing 100 food service and nutrition (FSN) questionnaire items; 146 physical activity and education (PAE) items; and two weight assessment (WA) items were selected. Principal components analysis and content validity assessment were used to further categorize the items into six FSN, ten PAE, and one WA domain. Using a proportional scaled score to summarize the number of policies adopted by states, it was found that on average states adopted about half of the FSN (49%), 38% of the PAE, and 17% of the WA policies examined. After adjusting for state-level measures of ethnicity and income, the average proportion of FSN policies adopted by states was correlated with the prevalence of youth obesity at r =0.35 (p=0.01). However, no correlation was found between either PAE or WA policies and youth obesity (PAE policies at r =0.02 [p=0.53] and WA policies at r =0.16 [p=0.40]).
  
  
  CONCLUSIONS
  States appear to be doing a better job adopting FSN policies than PA or WA policies, and adoption of policies is correlated with youth obesity. Continued monitoring of these policies seems to be warranted.
authors.affiliation: Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, 55414, USA. msnanney@umn.edu
authors.forename: Marilyn S
authors.initials: MS
authors.lastname: Nanney
authors.forename: Toben
authors.initials: T
authors.lastname: Nelson
authors.forename: Melanie
authors.initials: M
authors.lastname: Wall
authors.forename: Tarek
authors.initials: T
authors.lastname: Haddad
authors.forename: Martha
authors.initials: M
authors.lastname: Kubik
authors.forename: Melissa Nelson
authors.initials: MN
authors.lastname: Laska
authors.forename: Mary
authors.initials: M
authors.lastname: Story
mesh_terms: D000293:Adolescent; D002648:Child; D003625:Data Collection; D015444:Exercise; D005522:Food Services; D006801:Humans; D018673:Nutrition Policy; D009765:Obesity / Q000517:prevention & control*; D011050:Policy Making; D012574:Schools; D013219:State Government; D014481:United States