The impact of state policies for school-based BMI/fitness assessments on children's BMI outcomes in rural versus urban schools: Evidence from a natural experiment.
The impact of state policies for school-based BMI/fitness assessments on children's BMI outcomes in rural versus urban schools: Evidence from a natural experiment.
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DOI：
10.1016/j.ypmed.2020.106257
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发表时间：
2020-12
影响因子：
5.1
通讯作者：
Datar A
中科院分区：
文献类型：
--
作者：
Nicosia N;Datar A
儿童肥胖症仍然是一个公共卫生危机，因为其流行程度令人震惊，并可能造成代价高昂的长期健康后果，特别是在农村儿童中。学校被认为是制定防治肥胖政策的天然场所，因为儿童在学校度过了大部分活动时间，消耗了相当大一部分卡路里。最近的州政策努力涉及测量儿童的BMI和/或健康状况，以通知家长或为监测工作提供信息，但迄今为止的经验证据还远未确定。本研究利用合理的外生分配军人家庭作为一个自然的实验，以评估这种政策与儿童的BMI和肥胖行为的关联。由于肥胖患病率和支持健康生活方式所需的环境可能存在差异，因此样本按城市化程度分层。数据收集于2013-2014年，并于2018-9年进行分析。这些政策与农村学校儿童的超重几率（OR：0.422; CI：0.251-0.708）和超重风险（OR：0.360; CI：0.161-0.801）较低相关，但与城市学校无关。这些政策还与更高的活动水平和更少的不健康食品摄入有关，特别是在农村学校的儿童中。结果是强大的分层的基础上，城市化的安装与学校，遗漏的家庭协变量，和其他敏感性分析。对儿童身高、父母BMI结果、家庭食物环境和邻里环境的伪造检查表明，这些发现不是由选择驱动的。BMI评估政策与农村儿童的BMI结果和健康行为相关，但与城市学校无关。
Childhood obesity remains a public health crisis because of its alarming prevalence and potential for costly long-term health consequences, especially among rural children. Schools are considered natural loci for policies to combat obesity because children spend most of their active hours and consume a substantial share of their calories, at school. Recent state policy efforts have involved measuring children’s BMI and/or fitness to notify parents or inform surveillance efforts, but the empirical evidence to date is far from definitive. This study leverages plausibly exogenous assignment of military families as a natural experiment to assess the association of such polices with children’s BMI and obesogenic behaviors. The sample is stratified by urbanicity because of the likely differences in obesity prevalence and in environments necessary to support healthy lifestyles. Data were collected in 2013-2014 and analyzed in 2018-9. The policies were associated with lower odds of overweight (OR: 0.422; CI: 0.251-0.708) and at-risk of overweight (OR: 0.360; CI: 0.161-0.801) among children in rural, but not urban, schools. The policies were also associated with greater activity levels and less frequent intake of unhealthy foods, particularly among children attending rural schools. Results were robust to stratification based on urbanicity of the installation versus school, omission of family covariates, and other sensitivity analyses. Falsification checks on children’s height, parental BMI outcomes, home food environments and neighborhood environments indicate findings are not driven by selection. BMI assessment policies were associated with children’s BMI outcomes and health behaviors in rural, but not urban schools.
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DOI：
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发表时间：
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影响因子：
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作者：
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DOI：
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发表时间：
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影响因子：
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