Association of Multisetting Community Programs and Policies With Child Body Mass Index: The Healthy Communities Study

Abstract

Introduction Expert opinion suggests that efforts to address childhood obesityshould seek to transform the environments in which children operate. The objective of this study was to describe the extent to whichmultisetting programs and policies interact with community andchild predictors and are associated with child body mass index(BMI) in the 130 US communities participating in the Healthy Communities Study. Methods For 2 years beginning in fall 2013, we collected data through keyinformant interviews on community programs and policies relatedto healthy weight among children that occurred in the 10 years beforethe interview. We characterized community programs andpolicies by intensity of efforts and the number of settings in whicha program or policy was implemented. Child height and weightwere measured during household data collection. We used multilevelmodeling to examine associations of community programsand policies in multiple settings and child and community predictorswith BMI z scores of children. Results The mean number of settings in which community policies andprograms were implemented was 7.3 per community. Of 130 communities,31 (23.8%) implemented community programs andpolicies in multiple settings. Higher-intensity community programsand policies were associated with lower BMI in communitiesthat used multiple settings but not in communities that implementedprograms and policies in few settings. Conclusion Efforts to prevent childhood obesity may be more effective whencommunity programs and policies are both intensive and are implementedin multiple settings in which children live, learn, andplay.