Maternal and Child Health Journal

, Volume 16, Supplement 1, pp 111–118

State School Policies and Youth Obesity

  • Jenna Riis
  • Holly Grason
  • Donna Strobino
  • Saifuddin Ahmed
  • Cynthia Minkovitz


The objective of this study was to examine relations between state-level school policies and childhood obesity for youth ages 10–17 years. Secondary analysis of the 2003–2006 School Nutrition Environment State Policy Classification System, 2003–2007 Physical Education Related State Policy Classification System, and 2003 and 2007 National Surveys of Children’s Health was performed. Eleven nutrition and 5 physical education (PE) domains were examined for elementary (ES), middle (MS), and high school (HS) children. Logistic regression models examined the association of policies on obesity prevalence in 2007 as well as change scores for the policy assessments. Scores for 5 of 11 nutrition domains and 4 of 5 PE domains increased between 2003 and 2006–2007. Controlling for individual, family and neighborhood factors, nutrition policies were positively associated with the odds of 2007 obesity in 3 ES and 2 MS domains and negatively associated with 1 HS domain. Adjusted positive associations also were observed between 2 ES and 1 MS PE policy domains and 2007 obesity. Controlling for covariates, nutrition policy change scores showed positive associations between increases in 1 ES and 1MS domain, and negative associations with 1 ES and 1 HS domain and 2007 obesity. PE policy change scores showed positive adjusted associations between increases in 2 ES, 2 MS and 1 HS domains and 2007 obesity. The findings indicate that state-level school health policies are associated with childhood obesity after adjusting for related factors, suggesting that states with higher obesity levels have responded with greater institution of policies.


Childhood obesity State policy School policy Nutrition Physical education 


  1. 1.
    Ogden, C. L., Carroll, M. D., Curtin, L. R., McDowell, M. A., Tabak, C. J., & Flegal, K. M. (2006). Prevalence of overweight and obesity in the United States, 1999–2004. JAMA, 295, 1549–1555.PubMedCrossRefGoogle Scholar
  2. 2.
    Institute of Medicine, Committee on Prevention of Obesity in Children and Youth, Food and Nutrition Board, Board on Health Promotion and Disease Prevention. (2005). Preventing childhood obesity: Health in the balance. In: J. P. Koplan, C. T. Liverman, V. I. Kraak (Eds.), Washington, DC: The National Academies Press.Google Scholar
  3. 3.
    Robert Wood Johnson Foundation. (2005). A nation at risk: Obesity in the United States: A statistical sourcebook. Dallas, TX: American Heart Association.Google Scholar
  4. 4.
    Wang, G., & Dietz, W. H. (2002). Economic burden of obesity in youths aged 5 to 17 years: 1979–1999. Pediatrics, 109, E81–E86.PubMedCrossRefGoogle Scholar
  5. 5.
    Finkelstein, E. A., Trogdon, J. G., Cohen, J. W., & Dietz, W. (2009). Annual medical spending attributable to obesity: Payer- and service-specific estimates. Health Affairs, 28(5), 822–831.CrossRefGoogle Scholar
  6. 6.
    Thomas, H. (2006). Obesity prevention programs for children and youth: Why are their results so modest? Health Education Research, 21, 783–795.PubMedCrossRefGoogle Scholar
  7. 7.
    Snethen, J. A., Broome, M. E., & Cashin, S. E. (2006). Effective weight loss for overweight children: A meta-analysis of intervention studies. Journal of Pediatric Nursing, 21, 45–56.PubMedCrossRefGoogle Scholar
  8. 8.
    Summerbell, C. D., Ashton, V., Campbell, K. J., Edmunds, L., Kelly, S., & Waters, E. (2003). Interventions for treating obesity in children. Cochrane Database Systematic Review, 3, CD001872.Google Scholar
  9. 9.
    Summerbell, C. D., Waters, E., Edmunds, L. D., Kelly, S., Brown, T., & Campbell, K. J. (2005). Interventions for preventing obesity in children. Cochrane Database Systematic Review, 3, CD001871.Google Scholar
  10. 10.
    Bell, J., Rogers, V. W., Dietz, W. H., Ogden, C. L., Schuler, C., & Popovic, T. (2011). CDC grand rounds: Childhood obesity in the United States. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, 60(2), 42–46.Google Scholar
  11. 11.
    Swinburn, B., Gill, T., & Kumanyika, S. (2005). Obesity prevention: A proposed framework for translating evidence into action. Obesity Reviews, 6, 23–33.PubMedCrossRefGoogle Scholar
  12. 12.
    Nanney, M. S., Toben, N., Wall, M., Haddad, T., Kubik, M., Laska, M. N., et al. (2010). State school nutrition and physical activity policy environments and youth obesity. American Journal of Preventive Medicine, 38(1), 9–16.PubMedCrossRefGoogle Scholar
  13. 13.
    Institute of Medicine. (2007). Nutrition standards for foods in schools: Leading the way toward healthier youth. Washington, DC: The National Academies Press.Google Scholar
  14. 14.
    Masse, L. C., Frosh, M. M., Chriqui, J. F., Yaroch, A. L., Agurs-Collins, T., Blanck, H. M., et al. (2007). Development of a school nutrition-environment state policy classification system (SNESPCS). American Journal of Preventive Medicine, 33(4S), S277–S291.PubMedCrossRefGoogle Scholar
  15. 15.
    Masse, L. C., Chriqui, J. F., Igoe, J. F., Atienza, A. A., Kruger, J., Kohl, H. W., et al. (2007). Development of a physical education-related state policy classification system (PERSPCS). American Journal of Preventive Medicine, 33(4S), S264–S276.PubMedCrossRefGoogle Scholar
  16. 16.
    Kuczmarski, R. J., Ogden, C. L., Guo, S. S., Grummer-Strawn, L. M., Flegal, K. M., Mei, Z., et al. (2002). 2000 CDC growth charts for the United States: methods and development. Vital Health Statistics, 11(246), 1–190.Google Scholar
  17. 17.
    StataCorp. (2009). Stata statistical software: Release 11. College Station, TX: StataCorp LP.Google Scholar
  18. 18.
    Singh, G. K., Kogan, M. D., & van Dyck, P. C. (2010). Changes in state-specific prevalence in the United States from 2003 to 2007. Archives of Pediatrics and Adolescent Medicine, 164(7), 598–607.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Jenna Riis
    • 1
  • Holly Grason
    • 1
  • Donna Strobino
    • 1
  • Saifuddin Ahmed
    • 1
  • Cynthia Minkovitz
    • 1
  1. 1.Department of Population, Family and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA

Personalised recommendations