Predictors of differences in adolescent adiposity trends and weight-related behaviors among states in the United States Public Deposited

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  • March 22, 2019
  • Taber, Daniel R.
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Background: Many states took legislative action to reduce youth obesity in recent years. A "plateau" in youth obesity from 1999 to 2006 was found in a nationally representative sample, leading to speculation that policies have been effective, but the impact of state policies has not been extensively studied. Legislative activity and youth obesity vary by state, suggesting that the national plateau in youth obesity may not be particularized to all states. Objectives: To estimate between-state variation in time trends of adolescent adiposity and weight-related behaviors, and the association between state policy changes and adolescent soda consumption and adiposity. Methods: Mixed models estimated between-state variation in time trends of body mass index (BMI) percentile and several diet and physical activity behaviors, using cross-sectional data from 272,044 students in 29 states in the 2001, 2003, 2005, and 2007 Youth Risk Behavior Survey. A state-level case-control analysis compared states with disparate trends with respect to behavioral, demographic, and contextual changes. Using data from the 2000 and 2006 School Health Policies and Programs Study, mixed models estimated the association between state policy changes targeting junk food in schools and 2007 soda consumption and BMI percentile, and tested for racial/ethnic differences in the association. Results: State BMI percentile trends were similar despite differences in state behavioral trends. Boys experienced a modest linear increase in BMI percentile ([Beta] = 0.18, 95% confidence interval (CI): 0.07, 0.30) and girls experienced a non-linear increase that suggested a decelerating trend ([Beta}linear = 1.10, [Beta]quad = -0.08). TV viewing was the only behavior associated with BMI percentile among students and BMI percentile time trends across states. Policy changes were associated with lower soda consumption among non-Hispanic Blacks ([less than or equal to]1.33 fewer servings/week), but not with BMI percentile among any racial/ethnic group. Conclusion: State policy changes may have affected student behaviors, but not sufficiently to affect adiposity. Adolescent adiposity increased across states in 2001-2007, particularly among girls. Students may compensate for isolated policy changes through behaviors outside of school and environmental factors beyond a school's jurisdiction (e.g., TV marketing). Future research should explore the effect of comprehensive policy change across sectors.
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  • In Copyright
  • "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Epidemiology."
  • Stevens, June Sheppa
Degree granting institution
  • University of North Carolina at Chapel Hill
Place of publication
  • Chapel Hill, NC
  • Open access

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