摘要：Objectives. We developed a content review for state policies related to childhood obesity, and we have quantitatively described the predictors of enactment. Methods. We collected an inventory of 2006 through 2009 state legislation on 27 childhood obesity topics from legislative databases. We coded each bill for general information, topic content, and other appropriate components. We conducted a general descriptive analysis and 3 multilevel analyses using bill- and state-level characteristics to predict bill enactment. Results. Common topics in the 27% of the bills that were enacted were community physical activity access, physical education, and school food policy. Committee and bipartisan sponsorship and having term limits significantly predicted enactment in at least 1 model. Bills with safe routes to school or health and nutrition content were twice as likely to be enacted. Bills containing product and menu labeling or soda and snack taxes were significantly less likely to be enacted. Conclusions. Bipartisan and committee support and term limits are important in bill enactment. Advocacy efforts can be tailored to increase awareness and sense of priority among policymakers. The increase in the prevalence of childhood obesity in the United States is well documented. 1–3 Surveillance estimates that 12.5 million children and adolescents are obese. 4 Predictions of long-term outcomes of the obesity epidemic include a decline in population health because of disease and disability along with substantial societal and economic costs. 5 In response to this increasing prevalence, there is a focus on identifying effective interventions to reverse trends by 2015. 6 These intervention strategies include policy and environmental changes that are designed to provide opportunities, support, and cues to help people develop healthier behaviors. 7 Policy changes, particularly at the state level, can influence access, social norms, and opportunities for better nutrition and increased physical activity among children and the general population. 8 In recent years, states have introduced and adopted legislation that focuses either directly or indirectly on the prevention of childhood obesity. 9 Childhood obesity policies include nutrition and physical activity topics 10 and are applicable to school environments and the general community. 9 Examples of state policies that influence physical activity include the mandate of quality physical education programs in schools as well as transportation policies that facilitate walking or reduce automobile–bicycling conflicts and result in increased bicycling. 11 Examples of state-level nutrition policies include school food and vending policies, farmers’ market guidelines, and soda taxes. 9,10 Although research interest in childhood obesity prevention legislation is increasing and we are gaining greater understanding of what constitutes evidence-based policy, 12,13 there remains much to be learned about the patterns of policy introduction and enactment over time and across states. Some recent studies have focused on the methods for evaluating state policies, 14,15 whereas others looked more specifically at factors influencing bill enactment. In a study of state legislation from 2003 to 2005, Boehmer et al. found that certain obesity prevention bill topics such as safe routes to school and statewide obesity taskforces or initiatives were more likely to be enacted than were others and that certain state characteristics such as a 2-year legislative session or Democratic control of both chambers can predict enactment. 9,10 We have described the quantitative portion of a larger multimethod project on childhood obesity prevention legislation, the State Childhood Obesity Policy Evaluation, the overall aim of which is to examine patterns and predictors of childhood obesity legislation at the state level through both qualitative investigation and quantitative bill content analysis. The State Childhood Obesity Policy Evaluation builds on previous methods and frameworks from the studies of Boehmer at al. 9,10 and expands the topic areas and years studied. We sought to develop a descriptive content review for state policies relating to childhood obesity and to quantitatively describe the predictors of enactment of legislation on childhood obesity prevention.
