文章基本信息

标题：Implementing Childhood Obesity Policy in a New Educational Environment: The Cases of Mississippi and Tennessee
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作者：John M. Amis ; Paul M. Wright ; Ben Dyson 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2012
卷号：102
期号：7
页码：1406-1413
DOI：10.2105/AJPH.2011.300414
语种：English
出版社：American Public Health Association
摘要：Objectives. Our purpose was to investigate the processes involved in, and outcomes of, implementing 3 new state-level, school-oriented childhood obesity policies enacted between 2004 and 2007. Methods. We followed policy implementation in 8 high schools in Mississippi and Tennessee. We collected data between 2006 and 2009 from interviews with policymakers, administrators, teachers, and students; observations of school-based activities; and documents. Results. Significant barriers to the effective implementation of obesity-related policies emerged. These most notably include a value system that prioritizes performances in standardized tests over physical education (PE) and a varsity sport system that negatively influences opportunities for PE. These and other factors, such as resource constraints and the overloading of school administrators with new policies, mitigate against the implementation of policies designed to promote improvements in student health through PE. Conclusions. Policies designed to address health and social problems in high-school settings face significant barriers to effective implementation. To have a broad impact, obesity-related policies must be tied to mainstream educational initiatives that both incentivize, and hold accountable, the school-level actors responsible for their implementation. With recent estimates suggesting that 31.7% of children aged 2 to 19 years and 34.2% of adolescents are overweight or obese, 1 the childhood obesity problem has become one of the defining health and social issues of our time. In addition to the physical, psychological, and social problems that overweight children frequently experience, 1 obesity has become a leading cause of preventable deaths in the United States, with only tobacco use posing an equally large, potentially reversible, long-term health threat. 2–4 It is clear that increasing levels of physical activity and altering nutritional intake constitute the most effective strategies toward reversing childhood obesity rates. 5 To this end, hundreds of policies have been developed at state and federal levels in recent years in attempts to increase levels of activity and improve the nutritional value of food that children consume. 6 Predictably, the majority of such legislation has been directed at schools. However, there is strong evidence that, “concerns about childhood obesity and overweight have not led to widespread adoption of state- and district-level policies” particularly at the middle- and high-school levels. 7 ^(p5) One area that policymakers have focused upon is the provision of physical education (PE) in schools, seen as a natural setting in which to enhance all children’s activity levels, irrespective of access to facilities or athletic ability. Indeed, influential actors, such as US Surgeon General Regina Benjamin, 8 Robert Wood Johnson Foundation President Risa Lavizzo-Mourey, 9 President Barack Obama’s Childhood Obesity Taskforce, 10 and First Lady Michelle Obama’s Let’s Move! Campaign, 11 have identified improvements to the quantity and quality of PE as being key components of strategies intended to reverse the upward trend in childhood obesity. These sentiments have been accompanied by a substantial increase in legislation over recent years with 90% of states now requiring high school PE. 12 However, despite its prevalence, there is compelling evidence that such legislation is having little effect on levels of PE participation, 13, 14 particularly among older students. 7, 15 Therefore, the purpose of our research was to investigate the ways in which stakeholders within schools responded to new legislation designed to increase levels of physical activity and improve the quality of PE in high schools in Mississippi and Tennessee, states with among the highest levels of childhood obesity and obesity-related illnesses in the country. We focused on high-school students because, although they are more able to understand the importance of a healthy lifestyle, 16 they also have higher levels of overweight and obesity than do younger children. 1 Furthermore, most research on children’s health has focused upon elementary- and, to a lesser degree, middle-school children; little research has examined the impact of obesity-related policy on high-school children. We offer theoretical and practical insights into why these policies have proven largely ineffective, and provide recommendations for bringing about the organizational and institutional changes required for more effective future policy formulation and implementation.