title: School environment and policies, child eating behavior and overweight/obesity in urban China: the childhood obesity study in China megacities.
abstract: Childhood obesity is rising rapidly in China, especially in urban areas. Knowledge about how school environment and policies (SEPs) may have contributed to the epidemic remains limited. We examined SEP and their associations with students' eating behaviors and overweight/obesity in urban China.
  
  
  
  Data were collected from 1648 students (plus their parents and schools) in 16 primary and middle schools (4 schools per city) in four megacities across China: Beijing, Shanghai, Nanjing and Xi'an. We examined nutrition-related SEP such as unhealthy food restriction, healthy food promotion, price control and nutrition guideline in school cafeterias (SCs), campus food stores (CFS), school vicinity food stalls (SVFS); SEP on physical activity, physical education (PE) and physical examination. Cluster robust regression models were fit to assess associations of SEP with child eating behaviors and overweight/obesity (defined based on body mass index, from measured weight and height).
  
  
  
  All 16 schools had regular PE classes and annual physical examination. Most schools (n=12; 75%) had food policies in SC; few had policies on CFS (n=1; 6.25%) or SVFS (n=4; 25%). Local governments had a major role in regulating food prices, setting nutrition guidelines and regulating SVFS. Policies on CFS and SVFS were associated with less frequent intake of sugary beverage (odds ratio (OR)=0.54 (0.47-0.61); OR=0.70 (0.61-0.80)), snack (OR=0.84 (0.74-0.95); OR=0.78 (0.67-0.92)) and fast food (OR=0.58 (0.42-0.81); OR=0.56 (0.39-0.80)). The associations were stronger for boys. Policies on SC, CFS and SVFS were associated with lower likelihood for overweight/obesity (OR=0.60 (0.46-0.79); OR=0.74 (0.62-0.90); OR=0.51 (0.35-0.73)) and central obesity (OR=0.79 (0.70-0.89); OR=0.67 (0.48-0.92); OR=0.63 (0.48-0.84)) in boys. Policies on SC were associated with lower overweight/obesity odds (OR=0.48 (0.28-0.82)) for girls.
  
  
  
  SEP are heterogeneous in the four Chinese megacities, high-income areas. They affect child unhealthy eating and overweight/obesity, and are critical for fighting childhood obesity in China.
authors.affiliation: Systems-Oriented Global Childhood Obesity Intervention Program, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, USA.|Department of Earth Observation Science, Faculty of Geo-Information Science and Earth Observation, University of Twente - ITC, Enschede 7500, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Jia
authors.affiliation: Systems-Oriented Global Childhood Obesity Intervention Program, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, USA.
authors.forename: M
authors.initials: M
authors.lastname: Li
authors.affiliation: Fisher Institute of Health and Well-being, College of Health, Ball State University, HP 302E, Muncie, IN 47306, USA.
authors.forename: H
authors.initials: H
authors.lastname: Xue
authors.affiliation: Beijing Xicheng District Center for Disease Control and Prevention, Beijing, China.
authors.forename: L
authors.initials: L
authors.lastname: Lu
authors.affiliation: Nanjing City Center for Disease Control and Prevention, Nanjing, China.
authors.forename: F
authors.initials: F
authors.lastname: Xu
authors.affiliation: Fisher Institute of Health and Well-being, College of Health, Ball State University, HP 302E, Muncie, IN 47306, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D017195:Adolescent Nutritional Physiological Phenomena; D015992:Body Mass Index; D002648:Child; D002652:Child Behavior / Q000523:psychology*; D002664:Child Nutritional Physiological Phenomena; D002681:China / Q000453:epidemiology; D002947:Cities; D015444:Exercise; D005247:Feeding Behavior / Q000523:psychology*; D005260:Female; D006293:Health Promotion; D006801:Humans; D008297:Male; D018673:Nutrition Policy; D009752:Nutritional Status; D063766:Pediatric Obesity / Q000453:epidemiology* / Q000517:prevention & control; D012574:Schools; D012931:Social Environment; D012959:Socioeconomic Factors; D013334:Students / Q000706:statistics & numerical data*; D014504:Urban Health