Date of Award
Doctor of Philosophy (PhD)
Health Services Research
George C. Maihafer
Holly D. Gaff
The purpose of this study is to examine the effect of school food and physical activity environments on energy balance-related behaviors and Body Mass Index (BMI) and to simulate the effect of school-based nutrition and physical activity policies on childhood obesity prevention. Four models based on the Social Ecological Framework of childhood obesity were developed. Parameters of these models were calibrated and validated with empirical data derived from the Early Childhood Longitudinal Study – Kindergarten Class of 1998-99 and the 2003-2004 National Health and Nutrition Examination Study. The correlation between observed and simulated BMI was 0.85 for 5th grade children and 0.87 for 8th grade children, indicating the validity of the models. The results demonstrated (1) one occasion of sweet snack consumption in school each week may lead to a 0.027 unit increase in BMI among 5th grade children in 2 years and among 8th grade children in 3 years; (2) one occasion of salty snack consumption in school each week may lead to a 0.025 unit increase in BMI among 5th grade children in 2 years and among 8th grade children in 3 years; (3) one occasion of sugar-sweetened beverage consumption in school each week may lead to a 0.05 unit increase in BMI among 5th grade children in 2 years and a 0.06 unit increase in BMI among 8th grade children in 3 years; (4) one minute of physical activity in school each week may lead to a 0.0008 unit decrease in BMI among 5th grade children in 2 years and one physical education class each week may lead to a 0.05 unit decrease in BMI among 8th grade children in 3 years. Comparison of simulated and observed data revealed that school-based policies targeting competitive food availability and physical activity opportunity in school had the potential to prevent childhood obesity. Moreover, prevention and interventions should be taken as early as the first few years of children’s school life. A simulation modeling approach was useful in exploring the effect of environmental factors on childhood obesity and energy balance-related behaviors.
"School Policy, Food and Physical Activity Environment, and Childhood Obesity"
(2016). Doctor of Philosophy (PhD), Dissertation, Health Services Research, Old Dominion University, DOI: 10.25777/hj7h-4123