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Measuring Determinants of Health for a School-based Obesity Intervention

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Objective: In this study, we developed 2 scales to assess social determinants at 47 schools participating in an obesity intervention in North Carolina. We studied the relationship of the scales to participant baseline BMI z-score (zBMI), cardiovascular fitness, and intervention effects. Methods: After variable selection guided by literature review and expert input, each was scored from 1 to 5 (higher indicating healthier environment); the limited scale (range 10-50) included 10 county-level variables and the expanded scale (range 20-100) added 10 school-level variables. We determined scores for each school and used them in linear mixed models to assess the relationship as predictors of baseline zBMI and fitness (PACER), and post-program change in these measures. Results: Results from 4887 participants in 2017-18 show the scale comprised of county-level variables demonstrated statistically significant relationships with baseline cardiovascular fitness (p = .01) but not BMI; adding school-level variables for an expanded scale diminished the relationship, and program effect was not associated with either scale. Conclusions: Using the developed scales to assess determinants of health was informative in comparing school environments as settings for a wellness intervention and including school-level variables led to different conclusions. Intervention effectiveness was retained in more at-risk settings. These scales could help inform school-based health policy efforts.
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Document Type: Research Article

Publication date: May 1, 2020

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  • Health Behavior and Policy Review is a rigorously peer-reviewed scholarly bi-monthly publication that seeks manuscripts on health behavior or policy topics that represent original research, including papers that examine the development, advocacy, implementation, or evaluation of policies around specific health issues. The Review especially welcomes papers that tie together health behavior and policy recommendations. Articles are available through subscription or can be ordered individually from the Health Behavior and Policy Review site.
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