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Felipe Montes,
Olga L Sarmiento,
Roberto Zarama,
Michael Pratt,
Guijing Wang,
Enrique Jacoby, Thomas L Schmid,
Mauricio Ramos,
Oscar Ruiz,
Olga Vargas,
Gabriel Michel,
Susan G Zieff,
Juan Alejandro Valdivia,
Nick Cavill,
Sonja Kahlmeier
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ABSTRACT: One promising public health intervention for promoting physical activity is the Ciclovía program. The Ciclovía is a regular multisectorial community-based program in which streets are temporarily closed for motorized transport, allowing exclusive access to individuals for recreational activities and physical activity. The objective of this study was to conduct an analysis of the cost-benefit ratios of physical activity of the Ciclovía programs of Bogotá and Medellín in Colombia, Guadalajara in México, and San Francisco in the U.S.A. The data of the four programs were obtained from program directors and local surveys. The annual cost per capita of the programs was: U.S. $6.0 for Bogotá, U.S. $23.4 for Medellín, U.S. $6.5 for Guadalajara, and U.S. $70.5 for San Francisco. The cost-benefit ratio for health benefit from physical activity was 3.23-4.26 for Bogotá, 1.83 for Medellín, 1.02-1.23 for Guadalajara, and 2.32 for San Francisco. For the program of Bogotá, the cost-benefit ratio was more sensitive to the prevalence of physically active bicyclists; for Guadalajara, the cost-benefit ratio was more sensitive to user costs; and for the programs of Medellín and San Francisco, the cost-benefit ratios were more sensitive to operational costs. From a public health perspective for promoting physical activity, these Ciclovía programs are cost beneficial.
Journal of Urban Health 12/2011; 89(1):153-70. · 2.13 Impact Factor
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ABSTRACT: Street-scale urban design policies are recommended to increase physical activity in communities. Our purpose was to examine U.S. public support for local street-scale urban design features and policies.
Analysis is based on a cross-sectional national sample of adults (n = 4682) participating in the 2006 HealthStyles mail survey.
About 57% of adults rated local street-scale urban design as highly important in determining the amount of physical activity they obtain. Adjusted odds of rating neighborhood features as having high importance were higher in people aged ≥65 years versus those <65 and minority racial/ethnic groups versus non-Hispanic whites. Two-thirds of adults were willing to take civic action to support local street-scale urban design policy. Adjusted odds of being willing to take any action versus none was higher in non-Hispanic blacks and Hispanics versus non-Hispanic whites, was higher in those with household incomes ≥$60,000 versus ≤$15,000 per year, and increased as education and perceived importance of neighborhood features increased.
There are high levels of public support for local street-scale urban design policies; however, demographic differences exist in the level of support. These differences are important considerations for policymakers and for those designing community programs targeting street-scale urban design features and policies.
Journal of physical activity & health 01/2011; 8 Suppl 1:S125-34. · 1.95 Impact Factor
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Amy A Eyler,
Ross C Brownson,
Semra A Aytur,
Angie L Cradock,
Mark Doescher,
Kelly R Evenson,
Jacqueline Kerr,
Jay Maddock,
Delores L Pluto,
Lesley Steinman,
Nancy O'Hara Tompkins,
Philip Troped, Thomas L Schmid
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ABSTRACT: To develop a comprehensive inventory of state physical education (PE) legislation, examine trends in bill introduction, and compare bill factors.
State PE legislation from January 2001 to July 2007 was identified using a legislative database. Analysis included components of evidence-based school PE from the Community Guide and other authoritative sources: minutes in PE, PE activity, teacher certification, and an environmental element, including facilities and equipment. Researchers abstracted information from each bill and a composite list was developed.
In total, 781 bills were analyzed with 162 enacted. Of the 272 bills that contained at least 1 evidence-based element, 43 were enacted. Only 4 bills included all 4 evidence-based elements. Of these 4, 1 was enacted. Funding was mentioned in 175 of the bills introduced (37 enacted) and an evaluation component was present in 172 of the bills (49 enacted).
Based on this analysis, we showed that PE is frequently introduced, yet the proportion of bills with evidence-based elements is low. Future research is needed to provide the types of evidence required for development of quality PE legislation.
Journal of School Health 07/2010; 80(7):326-32. · 1.34 Impact Factor
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ABSTRACT: The Guide for Useful Interventions for Activity in Brazil and Latin America (GUIA), a systematic review of community-based physical activity (PA) interventions in Latin American literature, selected the CuritibAtiva program for a comprehensive evaluation. We describe the process of developing logic models (LM) of PA community interventions from Curitiba, Brazil, and discuss influential factors.
The year-long process included engaging stakeholders involved in the promotion of PA in Curitiba, working with stakeholders to describe the programs and their goals, and developing LMs for the 2 main secretaries promoting PA in the city.
As a result of stakeholder interviews and discussion and the development of the LMs, local officials are coordinating programming efforts and considering ways the programs can be more complementary. The process has prompted program managers to identify overlapping programs, refine program goals, and identify gaps in programming. It also helped to frame evaluation questions, identify data sources, describe realistic outcomes, and reinforce the importance of intersectoral alliances for public health impact. Developing LMs proved to be feasible in the Latin American context, therefore adaptable and useful for other PA promotion programs in the region.
Journal of physical activity & health 07/2010; 7 Suppl 2:S155-62. · 1.95 Impact Factor
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ABSTRACT: The Ciclovía-Recreativa is a free, community-based program in which streets are closed temporarily to motorized transport, allowing access to walkers, runners, rollerbladers, and cyclists only. We assessed existing information about the Ciclovía as a public health strategy and proposed next steps for research and public health practice.
We conducted a systematic search of peer-reviewed and other literature, which was complemented by expert interviews and consultation.
We reviewed 38 Ciclovías from 11 countries. Most programs (84.2%) take place in urban settings. The programs range from 18-64 events per year (54 + or - 24.6; 52 [mean + or - standard deviation; median]) with events lasting from 2-12 hours (6 + or - 2.4; 6). The length of the streets ranges from 1-121 km (14.6 + or - 22.1; 7), and the estimated number of participants per event ranges from 60-1,000,000 persons (61,203 + or - 186,668; 3810). Seventy-one percent of the programs include physical activity classes and in 89% of the Ciclovías, the streets are connected with parks.
Ciclovías have potential for positive public health outcomes, but evidence on their effectiveness is limited. The different stages of new and established programs offer a unique opportunity for transnational studies aimed at assessing their public health impact.
Journal of physical activity & health 07/2010; 7 Suppl 2:S163-80. · 1.95 Impact Factor
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ABSTRACT: Studies assessing the association between health-related quality of life (HR-QOL) with physical activity (PA) and built environment (BE) characteristics are limited.
A cross-sectional study was conducted among 1,334 adults from Bogotá, to assess the associations between HR-QOL with PA and BE characteristics. HR-QOL was measured using the World Health Organization and the Centers for Disease Control and Prevention instruments. PA was measured using the International PA Questionnaire. BE characteristics included the dimensions of density, diversity, design, and access to mass-transit. Analysis included multilevel modeling.
Adults who reported meeting PA recommendations and participating in the Ciclovía were more likely to have a high mean score of HR-QOL and were more likely to perceive their health status as good/excellent. Adults who reported biking for transportation were more likely to have a high mean score of HR-QOL. Regarding BE characteristics, land-use heterogeneity was associated with HR-QOL, perceived good health status and being positive about the future. Park density was associated with HR-QOL, perceived health status good/excellent and being positive about the future. Mass-transit stations availability was negatively associated with HR-QOL.
This study provides preliminary evidence that HR-QOL is associated with PA and BE characteristics among adults in an urban setting of the developing world.
Journal of physical activity & health 07/2010; 7 Suppl 2:S181-95. · 1.95 Impact Factor
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Luis F Gomez,
Olga L Sarmiento,
Diana C Parra, Thomas L Schmid,
Michael Pratt,
Enrique Jacoby,
Andrea Neiman,
Robert Cervero,
Janeth Mosquera,
Candance Rutt,
Mauricio Ardila,
Jose D Pinzón
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ABSTRACT: Even though there is increasing evidence that the built environment (BE) has an influence on leisure-time physical activity (LTPA), little is known about this relationship in developing countries. The objective of this study was to assess the associations between objective built environment characteristics and LTPA.
A cross-sectional multilevel study was conducted in 27 neighborhoods in which 1315 adults aged 18-65 years were surveyed. An adapted version of the IPAQ (long version) was used to assess LTPA. Objective BE characteristics were obtained using Geographic Information Systems. Associations were assessed using multilevel polytomous logistic regression.
Compared with inactive people, those who resided in neighborhoods with the highest tertile dedicated to parks (7.4% to 25.2%) were more likely to be regularly active (POR = 2.05, 95% CI = 1.13-3.72; P = 0.021). Those who resided in neighborhoods with presence of TransMilenio stations (mass public transportation system) were more likely to be irregularly active (POR = 1.27, 95% CI = 1.07-1.50, P = 0.009) as compared with inactive people.
These findings showed that park density and availability of TransMilenio stations at neighborhood level are positively associated with LTPA. Public health efforts to address physical inactivity should consider the potential influences of urban planning and mass public transportation systems on health.
Journal of physical activity & health 07/2010; 7 Suppl 2:S196-203. · 1.95 Impact Factor
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James F Sallis,
Leslie S Linton,
M Katherine Kraft,
Carmen L Cutter,
Jacqueline Kerr,
Julie Weitzel,
Amanda Wilson,
Chad Spoon,
Irvin D Harrison,
Robert Cervero,
Kevin Patrick, Thomas L Schmid,
Michael Pratt
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ABSTRACT: Changes in policies and built environments are advocated as part of efforts to increase physical activity, but in 2001 the knowledge base to inform these changes was limited. The Robert Wood Johnson Foundation addressed this deficit by initiating Active Living Research (ALR). The mission of ALR was to stimulate and support research that could guide the improvement of environments, policies, and practices to promote active living. The program's goals were to (1) build the evidence base about environmental and policy factors related to physical activity, (2) build the capacity of researchers in multiple fields to collaborate, and (3) inform and facilitate policy change. To build the evidence base, 121 grants were supported with $12.5 million. Efforts were made to support new investigators, fund investigators from numerous disciplines, and increase the demographic diversity of researchers. Activities to build capacity to conduct collaborative research included annual conferences, journal supplements, seminars for multiple disciplines, and the posting of environmental measures. Coordination with Active Living Leadership was a primary means of communicating research to policymakers. Other activities to facilitate the application of research included research summaries written for nonresearchers, collaborations with Active Living by Design, several components of the website (www.activelivingresearch.org), and using policy relevance as a funding criterion. Two independent evaluations were accomplished, and they concluded that ALR made progress on all three goals. ALR has been renewed through 2012. The new mission is to use a $15.4 million research budget to contribute to reversing the childhood obesity epidemic, especially among youth in the highest-risk groups.
American journal of preventive medicine 03/2009; 36(2 Suppl):S10-21. · 4.24 Impact Factor
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Amy A Eyler,
Ross C Brownson,
Kelly R Evenson,
David Levinger,
Jay E Maddock,
Delores Pluto,
Philip J Troped, Thomas L Schmid,
Cheryl Carnoske,
Katherine L Richards,
Lesley E Steinman
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ABSTRACT: This study explores processes and policies that facilitate the development of community trails. With funding from Active Living Research and the research framework of the Physical Activity Policy Research Network (PAPRN), we conducted a multiple-site case study. A total of six trails in Hawaii, Massachusetts, Missouri, North Carolina, South Carolina, and Washington were chosen for study. The goals of this case study were to identify the policy influences on trail development, explore the roles of key players in trail development, and compare and contrast findings from the different trails. Trail development can be a long process. Some of the trails took over a decade to complete because of funding, opposition, and roadblocks in the form of design standard policies. Work in trail development requires a team of many players, and it is necessary to balance their varied motives to accomplish a shared overall goal. Foresight through the master planning process is also a vital component of successful trail development. Finally, community involvement is key. Communities contemplating trail development should explore the effects of policy on the trail projects reported here to proactively identify potential influence.
Journal of Health Politics Policy and Law 07/2008; 33(3):407-27. · 0.87 Impact Factor
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Ross C Brownson,
Cheryl M Kelly,
Amy A Eyler,
Cheryl Carnoske,
Lisa Grost,
Susan L Handy,
Jay E Maddock,
Delores Pluto,
Brian A Ritacco,
James F Sallis, Thomas L Schmid
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ABSTRACT: Environmental and policy approaches are promising strategies to raise population-wide rates of physical activity; yet, little attention has been paid to the development and prioritization of a research agenda on these topics that will have relevance for both researchers and practitioners.
Using input from hundreds of researchers and practitioners, a research agenda was developed for promoting physical activity through environmental and policy interventions. Concept mapping was used to develop the agenda.
Among those who brainstormed ideas, 42% were researchers and 33% were practitioners. The data formed a concept map with 9 distinct clusters. Based on ratings by both researchers and practitioners, the policy research cluster on city planning and design emerged as the most important, with economic evaluation second.
Our research agenda sets the stage for new inquiries to better understand the environmental and policy influences on physical activity.
Journal of physical activity & health 07/2008; 5(4):488-503. · 1.95 Impact Factor
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Amy A Eyler,
Ross C Brownson,
Mark P Doescher,
Kelly R Evenson,
Carrie E Fesperman,
Jill S Litt,
Delores Pluto,
Lesley E Steinman,
Jennifer L Terpstra,
Philip J Troped, Thomas L Schmid
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ABSTRACT: Active transportation to and from school (ATS) is a viable strategy to help increase physical activity among youth. ATS can be challenging because initiatives require transdisciplinary collaboration, are influenced by the built environment and are affected by numerous policies. The purpose of this study is to identify policies and factors that influence ATS initiatives. Nine elementary schools in seven states participated in this case study. Sixty-nine stakeholders were interviewed. The interviews were transcribed, coded and analyzed using a master thematic codebook. This study identified two distinct aspects of policies: 'influential factors' which are factors that might impact policies related to ATS and 'policy actions' which are policies reported by people involved in ATS initiatives that directly affected their success. Influential factors included sidewalks, crosswalks/crossing guards, funding, personal safety concerns, advocacy group involvement and others. Policy actions included policies on school speed zone, drop-off, no-transport zones, school siting, school start/dismissal time and school choice. Despite the diversity of the schools studied, similarities included influence of built environment, safety concerns, funding and transdisciplinary collaboration. Stakeholders need to work together to stimulate action and ensure successful initiatives. Influential factors appear to be important to this process.
Health Education Research 11/2007; 23(6):963-75. · 1.66 Impact Factor
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ABSTRACT: People living in activity-friendly communities (AFCs) are more active but the self-selection influence is unknown. From 4856 respondents we explored mediating variables with expressed desire to live in AFCs. Association with desire to live in AFCs included ages 18-24 years (odds ratio [OR]=1.9), African American (OR=1.9) or Hispanic (OR=1.5), and believing AFCs would support activity-based transportation (OR=2.4). Regular physical activity (PA) was marginally associated with desire to live in AFCs (OR=1.3). These findings suggest that PA may be a significant factor in communities of this style. Strategies for social marketing along with changes to the built environment to increase PA levels are discussed.
Health & Place 10/2007; 13(3):767-73. · 2.67 Impact Factor
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ABSTRACT: The Task Force on Community Preventive Services strongly recommends environmental interventions that include enhanced access to opportunities for physical activity, such as walking and cycling trails. Although accumulating evidence indicates that trails can be effective in increasing physical activity, little is known about trail users.
Cross-sectional analysis of a national sample of 3717 adults from the HealthStyles and ConsumerStyles surveys using logistic regression to determine physical activity patterns and sociodemographic correlates related to trail use, and to identify support regarding trail development policies.
Almost 13% (12.7%) of the sample reported using trails at least once a month and 24.3% at least once a week. People who reported using trails at least once a week were twice as likely than people who reported rarely or never using trails to meet physical activity recommendations (odds ratio=2.3, 95% confidence interval=1.9-2.8). Nearly half (43.6%) of the non-trail users supported expanded public spaces for people to exercise, and 36.4% of the non-trail users reported that they would be willing to pay more taxes to build more parks and trails in their community.
Community trails facilitate physical activity, and almost half of frequent trail users report that access to trails and other green space is important in choosing a place to live. These results support the need for prospective research on whether newly built trails promote physical activity in previously inactive people.
American Journal of Preventive Medicine 12/2006; 31(5):399-405. · 4.04 Impact Factor
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ABSTRACT: In 1998 the mayor's office and the District Institute for Sports and Recreation created Muévete Bogotá, a physical activity and health promotion programme for the capital city of Colombia. Muévete means to move or to be active, and this campaign to promote physical activity was designed to improve the health and quality of life of the citizens of Bogotá through regular physical activity. The programme is based on the 1995 recommendations on physical activity of the U.S. Centers for Disease Control and Prevention and the American College of Sports Medicine (Pate el al, 1995), and was developed in close consultation with the Agita São Paulo programme in Brazil (Matsudo el al., 2003). Muévete Bogotá couples a mass media campaign with programmes targeted to change physical activity behaviour. The interventions, which are conducted at work sites, schools, health care centers and in community settings rely on partnerships created among professionals in areas of education and health, business officials and personnel, and community members, to deliver the programmes in each of these settings and populations. Like many developing countries, Colombia suffers from a growing epidemic of chronic diseases. In 1993 35.7% of total mortality in the city of Bogotá was due to chronic diseases (Espinosa, 1993). In 2002 cardiovascular diseases accounted for 40.3% of mortality among the population aged 60 years or older and 26.8% for persons 45 to 59 years of age. (Cardona, 2002) Bogotá has implemented extensive physical and social environmental changes over the last decade, which has increased opportunities for physical activity, but sedentary lifestyle continues to be a significant public health problem in the city. Programmes such as Muévete Bogotá that educate and motivate the population to become more physically active appear to be needed to complement the underlying environmental and policy changes. Muévete Bogotá provides an example of successful implementation of a comprehensive multi-sectoral approach to physical activity promotion in a large metropolitan area. This model may be used as an exemplary effort elsewhere in Latin America and in urban areas in developing countries around the world.
Promotion & Education 02/2006; 13(2):138-43, 164-9.
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ABSTRACT: A growing interest in promoting physical activity through multi-sectoral community-based programmes has highlighted the need for effective programme evaluation. Meeting in Rio de Janeiro, an international workgroup of behavioural, medical, public health and other scientists and practitioners endorsed the principle of careful evaluation of all programmes and in a consensus process developed the Rio de Janeiro Recommendations for Evaluation of Physical Activity Interventions". Among these recommendations and principles were that when possible, evaluation should 'built into' the programme from the beginning. The workgroup also called for adequate funding for evaluation, setting a goal of about 10% of programme resources for evaluation. The group also determined that evaluations should be developed in conjunction with and the results shared with all appropriate stakeholders in the programme; evaluations should be guided by ethical standards such as those proposed by the American Evaluation Association and should assess programme processes as well as outcomes; evaluation outcomes should be used to revise and refine ongoing programmes and guide decisions about programme continuation or expansion. It was also recognised that additional training in programme evaluation is needed and the Centers for Disease Control and Prevention's Physical Activity Evaluation Handbook could be easily adapted for use in culturally diverse communities, especially in Latin America. This paper describes a 6-step evaluation process and provides the full set of recommendations from the Rio de Janeiro Workgroup. The handbook has been translated and additional case studies from Colombia and Brazil have been added. Spanish and Portuguese language editions of the Evaluation Handbook are available from the Centers for Disease Control and Prevention, Physical Activity and Health Branch.
Promotion & Education 02/2006; 13(2):112-8.
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ABSTRACT: To date, nearly all research on physical activity and the built environment is based on self-reported physical activity and perceived assessment of the built environment.
To assess how objectively measured levels of physical activity are related with objectively measured aspects of the physical environment around each participant's home while controlling for sociodemographic covariates.
Objective measures of the built environment unique to each household's physical location were developed within a geographic information system to assess land-use mix, residential density, and street connectivity. These measures were then combined into a walkability index. Accelerometers were deployed over a 2-day period to capture objective levels of physical activity in 357 adults.
Measures of land-use mix, residential density, and intersection density were positively related with number of minutes of moderate physical activity per day. A combined walkability index of these urban form factors was significant (p =0.002) and explained additional variation in the number of minutes of moderate activity per day over sociodemographic covariates. Thirty-seven percent of individuals in the highest walkability index quartile met the > or =30 minutes of physical activity recommended, compared to only 18% of individuals in the lowest walkability quartile. Individuals in the highest walkability quartile were 2.4 times more likely (confidence interval=1.18-4.88) than individuals in the lowest walkability quartile to meet the recommended > or =30 minutes of moderate physical activity per day.
This research supports the hypothesis that community design is significantly associated with moderate levels of physical activity. These results support the rationale for the development of policy that promotes increased levels of land-use mix, street connectivity, and residential density as interventions that can have lasting public health benefits.
American Journal of Preventive Medicine 02/2005; 28(2 Suppl 2):117-25. · 4.04 Impact Factor
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ABSTRACT: Obesity is a major health problem in the United States and around the world. To date, relationships between obesity and aspects of the built environment have not been evaluated empirically at the individual level.
To evaluate the relationship between the built environment around each participant's place of residence and self-reported travel patterns (walking and time in a car), body mass index (BMI), and obesity for specific gender and ethnicity classifications.
Body Mass Index, minutes spent in a car, kilometers walked, age, income, educational attainment, and gender were derived through a travel survey of 10,878 participants in the Atlanta, Georgia region. Objective measures of land use mix, net residential density, and street connectivity were developed within a 1-kilometer network distance of each participant's place of residence. A cross-sectional design was used to associate urban form measures with obesity, BMI, and transportation-related activity when adjusting for sociodemographic covariates. Discrete analyses were conducted across gender and ethnicity. The data were collected between 2000 and 2002 and analysis was conducted in 2004.
Land-use mix had the strongest association with obesity (BMI >/= 30 kg/m(2)), with each quartile increase being associated with a 12.2% reduction in the likelihood of obesity across gender and ethnicity. Each additional hour spent in a car per day was associated with a 6% increase in the likelihood of obesity. Conversely, each additional kilometer walked per day was associated with a 4.8% reduction in the likelihood of obesity. As a continuous measure, BMI was significantly associated with urban form for white cohorts. Relationships among urban form, walk distance, and time in a car were stronger among white than black cohorts.
Measures of the built environment and travel patterns are important predictors of obesity across gender and ethnicity, yet relationships among the built environment, travel patterns, and weight may vary across gender and ethnicity. Strategies to increase land-use mix and distance walked while reducing time in a car can be effective as health interventions.
American Journal of Preventive Medicine 09/2004; 27(2):87-96. · 4.04 Impact Factor
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Ross C Brownson,
Elizabeth A Baker,
Rutha L Boyd,
Nicole M Caito,
Katie Duggan,
Robyn A Housemann,
Matthew W Kreuter,
Tonya Mitchell,
Freda Motton,
Cynthia Pulley, Thomas L Schmid,
Dorothy Walton
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ABSTRACT: Ecologic models are often recommended to promote physical activity, yet sparse data exist on their effectiveness.
A quasi-experimental design examined changes in walking behavior in six rural intervention communities in the Missouri "bootheel" region and in six comparison communities in Arkansas and Tennessee. SETTING/ PARTICIPANTS: The communities ranged in population from 2399 to 17,642; interventions focused on adults aged >/=18 years.
Interventions were developed with community input and included individually tailored newsletters, interpersonal activities that stressed social support, and community-wide events such as walk-a-thons.
Primary outcomes were rates of walking-trail use, total number of minutes walked in the past week, and total minutes walked for exercise.
Among persons who used trails at baseline (16.9% of the total population), 32.1% reported increases in physical activity since they began using the trail. From community-wide samples, two subgroups indicated a positive net change in rates of 7-day total walking: people with high school degrees or less and people living in households with annual incomes of <==$20,000. However, no studied group showed a statistically significant net intervention effect.
Although there was an increase in the rate of walking-trail use, a community-wide change in walking rates in rural communities was not documented. Results of this study should provide guidance for future projects.
American Journal of Preventive Medicine 08/2004; 27(1):28-34. · 4.04 Impact Factor
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ABSTRACT: In this Utah-based study, we sought to identify the types of municipal employees responsible for physical activity policies, identify municipal ordinances that may influence physical activity, and determine local governments' intentions to implement policies. In 2001, we mailed a survey to all of the state's municipalities with the goal of measuring 6 physical activity domains: sidewalks, bicycle lanes, shared-use paths, work sites, greenways, and recreational facilities. Data from 74 municipalities revealed that planners made up a small proportion of municipal staff. Relative to cities experiencing slow or medium growth, high growth cities reported more ordinances encouraging physical activity. Physical activity policies can be monitored across municipalities. Moreover, evidence-based public health practice provides direction for limited staff and funding resources.
American Journal of Public Health 10/2003; 93(9):1399-403. · 3.93 Impact Factor
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ABSTRACT: The rapid increases in childhood and adolescent overweight between 1980 and 1999 can only be explained by environmental factors. Historically, the most effective strategies to address nutritional problems that have caused such widespread disease have been policy-driven environmental changes. To develop effective public policy responses to the obesity epidemic, we must expand the science base linking environmental conditions and policies to health behaviors and conditions; establish effective intersectoral coalitions of stakeholders; and create effective policy at the national and state levels. Although the childhood obesity epidemic is still evolving, this article provides several examples of potentially effective strategic approaches to address it.
The Journal of Law Medicine & Ethics 02/2002; 30(3 Suppl):83-7. · 1.22 Impact Factor
