title: Prevalence of physical activity, screen time, and obesity among US children by the service type of special health care needs.
abstract: BACKGROUND
  Children with special health care needs (SHCN) may be at greater risk of obesity than children without SHCN. A new classification system categorizes SHCN among children by service type using the following categories: No-SHCN, medication use only, services use only, medication + service use, and functional limitations. Research is needed to examine obesity and obesity-related behaviors among children using the new classification system.
  
  
  OBJECTIVE
  To determine the prevalence of inadequate vigorous physical activity (VPA), high screen time and obesity by SHCN category using the new classification system.
  
  
  METHODS
  Multivariate regression models were fitted for inadequate VPA, high screen time, and obesity to determine if there were differences in these outcomes by SHCN category, adjusting for multistage-sampling and survey-design effects using a nationally representative sample of children in the National Survey of Children's Health 2007.
  
  
  RESULTS
  22.9% of the sample was classified as having SHCN: 9% medication use only, 5% medication + service use, 4% service use only, and 5% functional limitations. Children in the medication use only and medication + service use groups were not at increased risk for inadequate VPA, high screen time, or obesity. Children in the service use only and functional limitation groups had increased odds of high screen time and obesity, which disappeared after controlling for confounders. However, the higher odds of inadequate VPA remained significant in the service use only [OR (95% CI) = 2.00 (1.34-3.00)] and the functional limitations groups with 2.21 (1.55-3.15).
  
  
  CONCLUSIONS
  Physical activity promotion programs are needed for children with SHCN, especially children with functional limitations and those who require service use only and do not use prescribed medication.
authors.affiliation: Department of Public Health, Center for Health Disparities, East Carolina University, 1800 W. 5th Street, Medical Pavilion Suite 9, MS-643, Greenville, NC 27834, USA. Electronic address: kimju@ecu.edu.
authors.forename: Juhee
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Kinesiology, University of Rhode Island, Kingston, RI, USA.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Greaney
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D002648:Child; D006233:Persons with Disabilities; D015444:Exercise; D005260:Female; D066086:Health Services for Persons with Disabilities / Q000145:classification*; D006306:Health Surveys; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D020380:Needs Assessment; D009765:Obesity / Q000209:etiology*; D015995:Prevalence; D012307:Risk Factors; D057185:Sedentary Behavior; D014481:United States
keywords: Health promotion; Obesity; Physical activity; Screen time; Special health care needs service