Measuring Determinants of Health for a School-based Obesity Intervention
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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