Community-based interventions may reduce and prevent childhood obesity by transforming the environments in which children live, learn, and play through a series of interventions implemented throughout the community that encourage healthy behaviors. While empirical support is building for the effectiveness of such interventions, little is known about the economic costs and benefits of community-wide childhood obesity interventions. This study examined whether the benefits of a community-wide, child-focused, obesity prevention intervention, Shape Up Somerville: Eat Smart Play Hard (SUS), exceeded its costs by estimating its return on investment. The SUS intervention study occurred in Somerville, Massachusetts (and in two additional geographic areas, which were the study's control group) during the 2003/04 and 2004/05 school years. We estimated SUS's costs using SUS data over the two-year intervention. We estimated benefits (i.e., healthcare costs and productivity losses averted for children and their parents) over a ten-year time horizon using SUS effectiveness results and other sources. SUS generated an estimated $1.51 in savings for every $1.00 invested in the program (return on investment of $0.51). Over ten years, the estimated costs averted were over $500,000 with net benefits of $197,120 (2014 dollars). SUS was estimated to be a cost-saving intervention when examined over a ten-year time horizon. The excess benefits generated by SUS likely arose from the community-wide nature of the intervention which extended exposure (and estimated benefits) beyond children to parents as well. These results illustrate that allocating resources to community-wide, child-focused obesity prevention interventions may be a beneficial investment.

INTRODUCTION: Foods and beverages marketed in schools are typically of poor nutritional value. School districts may adopt policies and practices to restrict marketing of unhealthful foods and to promote healthful choices. Students' exposure to marketing practices differ by school demographics, but these differences have not yet been examined by district characteristics. METHODS: We analyzed data from the 2012 School Health Policies and Practices Study to examine how food and beverage marketing and promotion policies and practices varied by district characteristics such as metropolitan status, size, and percentage of non-Hispanic white students. RESULTS: Most practices varied significantly by district size: a higher percentage of large districts than small or medium-sized districts restricted marketing of unhealthful foods and promoted healthful options. Compared with districts whose student populations were majority (>50%) non-Hispanic white, a higher percentage of districts whose student populations were minority non-Hispanic white (≤50% non-Hispanic white) prohibited advertising of soft drinks in school buildings and on school grounds, made school meal menus available to students, and provided families with information on school nutrition programs. Compared with suburban and rural districts, a higher percentage of urban districts prohibited the sale of soft drinks on school grounds and used several practices to promote healthful options. CONCLUSION: Preliminary findings showing significant associations between district demographics and marketing policies and practices can be used to help states direct resources, training, and technical assistance to address food and beverage marketing and promotion to districts most in need of improvement.

The objective is to examine the prevalence and health-care costs associated with asthma, epilepsy, hypertension, food allergies, and diabetes in children aged 0-18 years. Prevalence was calculated using 2005-2012 Medical Expenditure Panel Survey (MEPS) data, a population-based, nationally representative sample. Using MEPS, two-part models estimated the cost of each condition for all children while controlling for sociodemographic categories. Prevalence rates varied by race and ethnicity across conditions. Females had higher prevalence of all chronic conditions, except epilepsy. An additional US$1,377.60-US$9,059.49 annually were spent on medical expenses for children aged 0-18 years, with asthma, diabetes, or epilepsy compared to children without these conditions. This is the first study to examine the costs and prevalence of chronic health conditions in children and adolescents using a single data set. Understanding the odds of having a condition by sociodemographic categories highlights disparities that can potentially inform school nurses on the best allocation of resources to serve students.

BACKGROUND: Federal guidelines state that youth should participate in a variety of physical activity (PA) they find enjoyable. Little is known, however, about how variety and enjoyment are associated with PA participation among adolescents. METHODS: Data came from the 2010 National Youth Physical Activity and Nutrition Survey, a nationally representative survey of adolescents. Path analysis was used to examine the association of a variety of self-reported PA, defined as the number of activities and activity types (i.e., team sports/weightlifting, individual activities, and other competitive/recreational sports), on self-reported PA enjoyment and participation. The analysis also examined whether enjoyment mediates the association between a variety of PA and participation. Separate models were estimated for boys and girls. RESULTS: Number of activities was associated with increased PA enjoyment and participation. For boys and girls, team sports/weightlifting was associated with increased participation, and individual activities were indirectly associated with increased participation through enjoyment. For boys, team sports/weightlifting was indirectly related with participation. CONCLUSIONS: These findings suggest that participation in a variety of PA is associated with increased PA enjoyment and participation. Providing opportunities for adolescents to engage in a variety of activities might help them identify PA they enjoy and facilitate lifelong PA habits.

OBJECTIVES: We investigated the body mass index (BMI; weight in pounds/[height in inches]2 x 703) of parents whose children participated in Shape Up Somerville (SUS), a community-based participatory research study that altered household, school, and community environments to prevent and reduce childhood obesity. METHODS: SUS was a nonrandomized controlled trial with 30 participating elementary schools in 3 Massachusetts communities that occurred from 2002 to 2005. It included first-, second-, and third-grade children. We used an inverse probability weighting estimator adjusted for clustering effects to isolate the influence of SUS on parent (n = 478) BMI. The model's dependent variable was the change in pre- and postintervention parent BMI. RESULTS: SUS was significantly associated with decreases in parent BMIs. SUS decreased treatment parents' BMIs by 0.411 points (95% confidence interval = -0.725, -0.097) relative to control parents. CONCLUSIONS: The benefits of a community-based environmental change childhood obesity intervention can spill over to parents, resulting in decreased parental BMI. Further research is warranted to examine the effects of this type of intervention on parental health behaviors and health outcomes.