Systems Thinking and Simulation Modeling to Inform Childhood Obesity Policy and Practice.

OBJECTIVES: In 2007, 31.7% of Georgia adolescents in grades 9-12 were overweight or obese. Understanding the impact of policies and interventions on obesity prevalence among young people can help determine statewide public health and policy strategies. This article describes a systems model, originally launched in 2008 and updated in 2014, that simulates the impact of policy interventions on the prevalence of childhood obesity in Georgia through 2034. METHODS: In 2008, using information from peer-reviewed reports and quantitative estimates by experts in childhood obesity, physical activity, nutrition, and health economics and policy, a group of legislators, legislative staff members, and experts trained in systems thinking and system dynamics modeling constructed a model simulating the impact of policy interventions on the prevalence of childhood obesity in Georgia through 2034. Use of the 2008 model contributed to passage of a bill requiring annual fitness testing of schoolchildren and stricter enforcement of physical education requirements. We updated the model in 2014. RESULTS: With no policy change, the updated model projects that the prevalence of obesity among children and adolescents aged ≤18 in Georgia would hold at 18% from 2014 through 2034. Mandating daily school physical education (which would reduce prevalence to 12%) and integrating moderate to vigorous physical activity into elementary classrooms (which would reduce prevalence to 10%) would have the largest projected impact. Enacting all policies simultaneously would lower the prevalence of childhood obesity from 18% to 3%. CONCLUSIONS: Systems thinking, especially with simulation models, facilitates understanding of complex health policy problems. Using a simulation model to educate legislators, educators, and health experts about the policies that have the greatest short- and long-term impact should encourage strategic investment in low-cost, high-return policies.

Georgia's Utilization Minigrant Program: promoting Medicaid/CHIP outreach.

Funded community-based organizations improved utilization of children's health services by developing innovative staffing patterns, creating new data systems for scheduling appointments and maintaining records, and forging new collaborative relationships to leverage financial support. These strategies were rooted in collaboration with community-based organizations, health care providers, and the state Medicaid agency.

Contribution of the school environment to physical fitness in children and youth.

BACKGROUND: This study analyzed the effect of school practices regarding the provision of physical education (PE) on the physical fitness of children and youth. METHODS: Using an untapped sample of approximately 5000 5th and 7th graders from 93 schools in Georgia in 2006, individual-level and merged school-level data on physical education were analyzed. Multivariate regression analyses were conducted to estimate the potential influence of the school environment on measured health outcomes. Controls were included for grade, gender, race/ethnicity, urbanicity, and county of residence. RESULTS: Variables measuring 8 school-level practices pertaining to physical education were found to have significant effects on cardiovascular fitness as measured by the FitnessGram, with signs in the expected direction. These variables, combined with demographic variables, explained 29.73% of the variation in the Progressive Aerobic Cardiovascular Endurance Run but only 4.53% of the variation in the body mass index. CONCLUSIONS: School-level variables pertaining to PE practices were collectively strong predictors of physical fitness, particularly cardiovascular fitness. Schools that adopt these policies will likely encourage favorable physical activity habits that may last into adulthood. Future research should examine the causal relationships among physical education practices, physical activity, and health outcomes.

Low physical fitness among fifth- and seventh-grade students, Georgia, 2006.

BACKGROUND: The nationwide epidemic of obesity may be due, in part, to declining levels of physical activity, raising the possibility that other components of health-related physical fitness may also be in decline. Few data are available to describe and monitor the physical fitness of children and youth. The Georgia Youth Fitness Assessment was conducted to assess health-related fitness in Georgia's fifth- and seventh-grade students, provide a baseline against which future progress could be measured, and guide public and private leaders and decision makers. METHODS: A statewide probability sample of fifth- and seventh-grade students designed to enable grade-specific comparisons by gender, race/ethnicity, and urban/rural status was drawn. Measurements included aerobic capacity; body composition; and muscular strength, endurance, and flexibility. Physical activity during the most recent 3 days was assessed. The survey was conducted in 2006; the data were analyzed in 2007-2008. RESULTS: Ninety-three schools (86% response rate) and 5248 students (77% response rate) participated. Fifty-two percent of students did not meet the standard for healthy aerobic fitness; 23% did not meet the standard for muscular strength, endurance, and flexibility; 30% were outside the recommended range for BMI. Twenty-two percent did not achieve the recommended 60 minutes of daily moderate-to-vigorous physical activity. All subgroups (e.g., boys/girls, urban/rural) scored poorly. CONCLUSIONS: Substantial numbers of Georgia's fifth- and seventh-grade students exhibit unhealthy levels of physical fitness. These data are consistent with the suggestion that physical inactivity has led to deficient levels of health-related fitness in more areas than just body composition. Monitoring all components of health-related fitness would provide helpful information about the health of children and youth.