title: Relationships between County Health Rankings and child overweight and obesity prevalence: a serial cross-sectional analysis.
abstract: The County Health Rankings (CHR) system provides health rankings for U.S. counties. These factors may have utility for evaluating and predicting health outcomes. This study examined the association between CHR factors and the prevalence of child overweight/obesity (OWOB) in the state of Pennsylvania over 3 years.
  
  
  
  The prevalence of childhood OWOB was obtained for all Pennsylvania school districts for the 2009-10 through 2011-12 school years. Correlational and inferential statistical analyses were used to examine the associations between the prevalence of OWOB in grades K-6 (OWOB1) and 7-12 (OWOB2) and z-score for the overall CHR Health Factors rank, as well as for individual predictive factors (Health Behaviors, Clinical Care, Social and Economic Factors and Physical Environment).
  
  
  
  Low to moderate correlations (0.29-0.43) were found between OWOB1 and CHR factors. Weaker and less consistent correlations were found for adolescents. There was a significantly higher prevalence of OWOB in counties with poorer CHR scores.
  
  
  
  County-level adult indicators of health are significantly associated with levels of child obesity. Future studies should examine the relationship between CHR and other health outcomes.
authors.affiliation: Iowa State University, 283 Forker Building, Ames, IA, 50011, USA. karissapeyer@gmail.com.
authors.forename: Karissa
authors.initials: K
authors.lastname: Peyer
authors.affiliation: Iowa State University, 283 Forker Building, Ames, IA, 50011, USA.
authors.forename: Greg J
authors.initials: GJ
authors.lastname: Welk
authors.affiliation: Geisinger Health System, 100 N. Academy Ave., MC 44-00, Danville, PA, 17822, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Bailey-Davis
authors.affiliation: Iowa State University, 283 Forker Building, Ames, IA, 50011, USA.
authors.forename: Senlin
authors.initials: S
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D050177:Overweight / Q000453:epidemiology*; D063766:Pediatric Obesity / Q000453:epidemiology*; D010414:Pennsylvania / Q000453:epidemiology; D015995:Prevalence; D014481:United States; D055815:Young Adult
keywords: Child obesity; County Health Rankings; Social determinants of health