摘要：US legislatures and program administrators have sought to control the sale of foods offered outside of federally funded meal programs in schools, but little is known about which policies, if any, will prevent obesity in children. We used a theoretical policy science typology to understand the types of policy instruments used by US state governments from 2001 to 2006. We coded 126 enacted bills and observed several types of instruments prescribed by state legislatures to influence the foods sold in schools and improve the school food environment. Our study helps to better understand the various instruments used by policymakers and sets the stage to examine the effectiveness of the policy instruments used to prevent obesity. IN THE UNITED STATES OVER the past 20 years, the prevalence of obesity has increased from 6.5% to 17.0% among children aged 6 to 11 years and from 5.0% to 17.6% among those aged 12 to 19 years. 1–3 Sugar-sweetened beverages and unhealthy snacks are associated with obesity among children and young people in these age groups. 4–6 Children obtain sugar-sweetened beverages and snacks predominantly at home and at restaurants, stores, and schools. Because children spend most of their waking hours in school and have multiple opportunities to eat while there, improving the school food environment is a target of policymakers seeking to improve dietary intake and reduce obesity. 7 Intervention research has demonstrated that changes in school meal programs and à la carte programs can alter children's dietary behaviors, 4,8 and recently legislatures and program administrators have sought to control the sale of competitive foods (i.e., foods offered outside of federally funded meal programs), which are generally high in fat and sugar and low in nutrients. 9,10 Policies intended to control the sale of competitive foods vary widely, and little is known about which, if any, of these policies reduce obesity in children. There are substantial gaps in knowledge about evidence-based policies in public health, but the science of policy analysis and understanding contextual factors associated with the selection of policy tools is gaining recognition in the field of public health policy. 11 In this regard, public health research can benefit from studies of policy processes, content, and outcomes that incorporate policy science frameworks and theory. 12–14 To help meet that need, we used a theoretical framework from the policy science literature to help understand the policy instruments used by state governments to address the high prevalence of childhood obesity in the United States. 15 Policy instruments are the tools prescribed by policymakers to bring about proposed changes in a policy (i.e., the “devices government has at its disposal for implementing policies” 15 (p87)). We studied legislation related to the sale or availability of competitive foods in schools to identify the types and range of policy instruments used in this sector. Specifically, we examined the policy instruments used during 2001 to 2006 by legislatures in the 50 US states seeking to improve the school food environment in the context of addressing child obesity. Although the legislative bills we analyzed cannot illuminate all of the rich social process and social environment contexts that are crucial to an understanding of the substance of policy development and ultimate implementation success or failure, our analysis provides a better understanding of the policy instruments used by state legislatures in their attempts to achieve their policy intents. Our main objective was to formulate a policy framework that classifies the types of policy instruments used by policymakers, so the reasons for their selection and their impact, or lack of it, might be better understood. Here we describe the salient features of the framework and illustrate its utility in understanding the choices governments have made and the opportunities they have missed in their efforts to control child obesity.
