Assessing the influence of high school practices and community characteristics on adolescent obesity

This study examined the influence of federal obesity prevention policy on school practices and adolescent obesity. The study also examined the influence of community characteristics on adolescent obesity. A sample of all high schools participating in both the 2004 and 2008 School Health Profiles survey years was used to analyze practices over time. Adolescent and family attributes were obtained from the Utah Population Database. School characteristics were accessed via the Common Core of Data. Community characteristics were generated from the Behavioral Risk Factor Surveillance system data collected by the Utah Department of Health for 61 small statistical areas in Utah. Bivariate and multinomial analyses were performed to model the relationship of school practices and community level characteristics with adolescent overweight and obesity. Schools in districts with mandated wellness policy tenets were no more likely to report school environment or health education practices than schools with weaker or no policy tenets. Of the 42 school practices examined, only exempting students from PE was associated with the risk of obesity (RR a=0.76,95% CI: 1.16--1.74, p<0.02). Maternal obesity tripled the risk adolescent overweight (RRa=3.08, 95% CI: 2.54--3.76, p<0.001) and resulted in a six-fold risk of obesity (RRa=6.06, 95% CI: 4.988--7.52, p<0.001). The proportion of obese adults in a community was associated with adolescent overweight (RRa = 1.45, 95% CI: 1.04--1.24, p<0.008) and obesity (RRa =1.19,95% CI: 1.05--1.36, p<0.006). Community education level was protective for adolescent obesity (RRa=0.81, 95% CI: 0.69--0.97, p<0.024). Future research is needed to develop tools that assess the ability of policy initiatives to produce meaningful and sustainable changes in school practices. Adolescent obesity prevention policies and programs should address community disparities in adult obesity, income and education.