Community and Public Health Nutrition
Objectives. While many community interventions have shown promise in preventing childhood obesity, gaps remain in understanding which combinations of efforts to improve child nutrition and physical activity are most impactful. The aim of the California Healthy Kids Study was to identify community programs, policies and practices (CPPs) that predict a higher prevalence of healthy weight (BMI < 85th percentile averaged over three school years, 2013-2016) among 7th grade students.
Methods. Sixty public middle schools were recruited based on a combination of purposeful and random selection. Key informants were interviewed about CPPs implemented over the prior 10 years. Observational data were collected at schools and food and physical activity environments near schools were characterized using GIS data. Seventy independent variables characterizing CPPs were divided into seven domains based on data source and topic. Separate multivariable linear regression models were fit for each domain. Given the large number of potentially important and correlated measured factors, we also applied a novel data adaptive method combining dimension reduction and targeted effect estimation.
Results. Two of the multivariable linear regression analyses included variables associated with an increased percentage of healthy weight students: promotion of drinking water at school (p=0.01) and CPPs designed to increase access to healthier food and beverage options in the broader community (p=0.03). From the data adaptive method the following had the highest average linear combination contribution to increased healthy weight: use of scratch cooking for preparing school meals, not using physical activity for discipline at school, promoting drinking water at school, having less total crime within a half-mile of school, and having a school wellness committee or coordinator.
Conclusion. To our knowledge this is the first naturalistic study to identify a particular set of largely school-based program and policy interventions associated with healthy weight status of middle school children.