The Voices for Healthy Kids Campaign and US State Legislation to Prevent Childhood Obesity

Prevention of Atherosclerotic Cardiovascular Disease in Childhood

PURPOSE OF REVIEW

Atherosclerotic-CVD processes begin early in life and are influenced over the life course by interaction of genetic and potential modifiable risk factors, behaviors, and environmental exposures. The purpose of this review is to highlight importance of primordial and primary prevention beginning early in the life course.

RECENT FINDINGS

Evidence-based guidelines and recommendations for primordial and primary prevention support importance of individual/clinical and population-based approaches to CVD prevention beginning early in life with goal of reducing the risk and burden of CVD. Substantial evidence supports the individual and societal benefits of prevention of CVD and promotion of optimal cardiovascular health beginning early in life and extending across the life course and the need for additional research to guide and inform practices and policies enabling optimal cardiovascular health for all.

US State-Level Preemption Legislation, 2017-2018: Implications for Public Health Policy and Practice

OBJECTIVES

We sought to systematically identify US state-level proposed legislation focused on preemption and introduced over a 2-year period. We analyzed each bill's objectives and intended impacts on local public health policy making and practice.

DESIGN/SETTING

Using standardized search terms, we used the LexisNexis State Capital database to identify state-level bills relating to preemption that were introduced between January 1, 2017, and December 31, 2018. Information was abstracted from relevant bills via an electronic data collection form. Abstracted information was analyzed using descriptive statistics to identify preemption-related patterns and trends.

RESULTS

One hundred thirty-four bills were included in our analysis. The bills were introduced in 35 states and 28 received sufficient votes to pass into law. The majority of the 134 bills (89%), and all of the bills that passed into law (100%), removed or restricted local authority to regulate. Of the bills that became law, the most common topic areas in which local regulatory authority was restricted were firearms (14%), business and professions (11%), and employment (11%).

CONCLUSIONS

Lawmakers at the state level are introducing and passing legislation that preempts local regulatory authority on a variety of public health topics. To preserve local control, local leaders should anticipate the introduction of state preemption legislation, engage with public health stakeholders, and work to counter bills that would restrict local authority.

The Voices for Healthy Kids and State Legislation to Prevent Childhood Obesity: An Update

INTRODUCTION

The purpose of this study is to examine general time trends in childhood obesity legislative activity in all 50 states (overall and by health equity focus) and whether the Voices for Healthy Kids Campaign (Voices) was associated with increased legislative activity.

METHODS

LexisNexis State Capital was used to identify bills related to childhood obesity from 2012 to 2016. Linear and linear probability models were used to assess general time trends and regression-based difference-in-difference models to assess whether time trends differed for states that received a Voices grant. The data were analyzed in 2017.

RESULTS

A total of 989 bills were introduced (Year 1=304, Year 2=364; Year 3=321), and a total of 93 bills were enacted (Year 1=34, Year 2=24, Year 3=35) after baseline. The mean number of bills introduced (baseline=4.3, Year 1=6.6, Year 2=7.3, Year 3=7.0, p=0.007), and the average state enactment rate (baseline=11%, Year 1=16%, Year 2=8%, Year 3=27%, p-trend=0.02) increased significantly. States with Voices grantees introduced 2.1 more bills than non-grantee states (p=0.04). The estimated difference over time in bill enactment and health equity focus did not differ by Voices grantee status.

CONCLUSIONS

Childhood obesity bill introduction and enactment increased between 2013 and 2016. The evidence-based advocacy supported by Voices appears to be significantly associated with greater increases in state-level bill introduction, but not enactment of legislation to address childhood obesity.

Trends in Attitudes and Practice Patterns of Physical Therapists in Addressing Childhood Obesity in Schools

PURPOSE

This study investigated trends in attitudes of school physical therapists about intervention for childhood obesity.

METHODS

A survey was developed to quantify attitudes. Two cases investigated the influence of attitudes on choices in treatment frequency. Factor analysis further delineated reasons for treatment frequency recommendations.

RESULTS

Attitudes did not change. Variability in responses decreased. Personal characteristics had evolving influence. In 2008, the perception of the PT's role in childhood obesity intervention had a greater influence on the choice to treat, but in 2015 the perception of the seriousness had a bigger effect on that decision.

DISCUSSION

Changing demographics of the therapists, increasing prevalence of obesity, and recent attention to the problem may have contributed to the trends.

CONCLUSION

There is no consensus as to the role of school physical therapy with intervention for obesity, but influential variables are emerging and practice patterns are evolving.

What Can Be Learned from Existing Investigations of Weight-Related Practices and Policies with the Potential to Impact Disparities in US Child-Care Settings? A Narrative Review and Call for Surveillance and Evaluation Efforts

Child-care settings and the combination of policies and regulations under which they operate may reduce or perpetuate disparities in weight-related health, depending on the environmental supports they provide for healthy eating and activity. The objectives of this review are to summarize research on state and local policies germane to weight-related health equity among young children in the United States and on how federal policies and regulations may provide supports for child-care providers serving families with the most limited resources. In addition, a third objective is to comprehensively review studies of whether there are differences in practices and policies within US child-care facilities according to the location or demographics of providers and children. The review found there is growing evidence addressing disparities in the social and physical child-care environments provided for young children, but scientific gaps are present in the current understanding of how resources should best be allocated and policies designed to promote health equity. Additional research is needed to address limitations of prior studies relating to the measurement of supports for weight-related health; complexities of categorizing socioeconomic position, ethnicity/race, and urban and rural areas; exclusion of legally nonlicensed care settings from most research; and the cross-sectional nature of most study designs. There is a particularly great need for the development of strong surveillance systems to allow for better monitoring and evaluation of state policies that may impact weight-related aspects of child-care environments, implementation at the program level, and needed implementation supports.

Evidence-based policies on school nutrition and physical education: Associations with state-level collaboration, obesity, and socio-economic indicators

Despite calls for more cross-sector collaboration on obesity prevention, little is known about the role of collaborative partnerships, or groups of organizations from different sectors working together toward a shared goal, in state policy activities. This study examined associations between competitive food/beverage and physical education policies and state-level collaboration and state characteristics (obesity, socioeconomic indicators, public health funding levels) for all 50 states and the District of Columbia, USA, in 2012. We examined cross-sectional associations between evidence-based competitive food/beverage and physical education policies from the Classification of Laws Associated with School Students and state characteristics from the School Health Policies and Practices Study and other national data sources using prevalence ratios and generalized linear models. Analyses were conducted in 2016. Cross-sector collaboration (i.e., state staff reports of working together on school nutrition or physical education activities) between state-level nutrition and physical education staff and ten types of organizations was not significantly associated with having state policies. Childhood obesity (RR=1.78, 95% CI[1.11,2.85]), high-school non-completion (RR=2.35, 95% CI[1.36,4.06]), poverty (RR=1.89, 95% CI[1.16,3.09]) and proportion non-white or Hispanic residents (RR=1.75, 95% CI[1.07, 2.85]) were positively associated with the presence of elementary school competitive food/beverage policies. Fewer indicators were associated with policies for middle and high schools. The large investment of time and resources required for cross-sector collaboration demands greater research evidence on how to structure and manage collaborative partnerships for the greatest impact.

Nutritional Status of Korean Children and Adolescents with Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) has been associated with an elevated risk for obesity but this seems to be paradoxical to the fact that many youths with ADHD have symptoms of hyperactivity. People diagnosed with ADHD tend to have a high risk of developing undesirable diet habits and consequently have health related problems. However, less attention has been paid to obesity in ADHD while many efforts have been devoted to the prevention of childhood obesity in mentally normal people. Hence the purpose of this study was to explore the nutritional status and life habits of children and adolescents with ADHD (n = 76) based on degree of obesity by utilizing the Korean National Health and Nutrition Examination Survey (KNHANES) data from 2005–2013. As results the levels of blood pressure, total triglycerides and the fat intake relative to total energy intake in overweight ADHD group were higher than those in normal weight group. Interestingly, overweight ADHD subjects consumed significantly less amount of iron compared to normal weight ADHD subjects and the level of serum ferritin was lower in the overweight ADHD group (59.0 ng/mL) than in the normal weight ADHD group (47.9 ng/mL). After adjusting total energy intake, total vegetable consumption was 14.3% lower in overweight group compared to the consumption in normal weight group. These results indicate a plausible relationship of iron status and obesity in ADHD subjects but this relationship may not be specific to ADHD. A future study with case-control design is necessary to investigate the association of obesity, nutrient intake, and cognitive/mental status of ADHD.