title: Obesity disparities among elementary-aged children: data from school-based BMI surveillance.
abstract: OBJECTIVE
  To examine 3-year trends and spatial clustering in the prevalence of obesity among elementary-aged children in Pennsylvania.
  
  
  METHODS
  Height and weight were measured for ~980 000 children between ages 5 and 12 years, corresponding to kindergarten through grade 6 in 3 consecutive school years (2006-2007, 2007-2008, 2008-2009). These data were obtained at the school district level and reported to the Pennsylvania Department of Health in response to a state mandate requiring public schools to conduct annual surveillance of student growth. Analyses at the school district level (n = 501) regarding obesity prevalence (BMI ≥ 95th percentile) according to age and gender were conducted to examine associations over time and in relation to population density, geographic boundaries, and a calculated family distress index.
  
  
  RESULTS
  The mean prevalence of obesity remained stable over 3 years at ~17.6% of elementary-aged children. However, within the state, significant differences in the prevalence of obesity were identified. Schools in the most rural areas had adjusted obesity prevalence over 2 percentage points higher than urban schools. Consistent with secular findings for the nation in general, students with families living in socioeconomic distress exhibited upward trends in obesity risk.
  
  
  CONCLUSIONS
  School-based surveillance elucidates the disparate risk of obesity for younger students living in the most rural areas, a key finding for primarily rural states. Preventive interventions are needed to reach the most rural children with an emphasis on families where parents are single, are unemployed, have a lower income, and lower educational attainment.
authors.affiliation: Department of Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, PA, USA. ldbaileydavis@geisinger.edu
authors.forename: Lisa
authors.initials: L
authors.lastname: Bailey-Davis
authors.forename: Michael
authors.initials: M
authors.lastname: Horst
authors.forename: Marianne M
authors.initials: MM
authors.lastname: Hillemeier
authors.forename: Alison
authors.initials: A
authors.lastname: Lauter
mesh_terms: D015992:Body Mass Index; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D009765:Obesity / Q000453:epidemiology*; D010414:Pennsylvania; D011159:Population Surveillance; D011203:Poverty / Q000706:statistics & numerical data; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D013223:Statistics as Topic; D014505:Urban Population / Q000706:statistics & numerical data