During the past two decades the prevalence of childhood obesity has steadily increased in the United States. An ecological model of health behavior change has been recommended to address the rise in childhood obesity. The purpose of this study was to build a comprehensive, multi-disciplinary, ecological childhood obesity model by examining past theory and research in 25 journals covering five disciplines over a decade (1993-2002).

To identify environmental antecedents, this study collapsed 10 existing ecological models of obesity prevention and divided resultant antecedents (n=94) into five ecological categories (social norms/national policies, community factors, school factors, family/peer or interpersonal factors, and individual or intrapersonal factors). A proposed ecological framework was then devised, defined, and constructed. Codebook reliability tests were conducted resulting in intra-rater reliability of 91.4% and inter-rater reliability of 89.4%. Utilizing a grounded emergent process of content analysis, 874 studies were identified in twenty-five journals across five disciplines and coded for ecological antecedents. Five hundred forty five articles (62.4%) of the sample were identified as empirical articles and three hundred twenty nine theoretical articles (37.6%). Social norms/national policies had the largest contribution to the model with 345 antecedents (39.5% of the sample); followed by individual/intrapersonal antecedents (n = 314; 35.9%); family/interpersonal antecedents (n = 291; 33.3%); community (n =140; 16.0%) and school antecedents (n= 122; 14.0%). Ecological antecedents with the greatest contribution to the model were: (1) social norm/national policy "cultural inactivity/eating poorly" 148 (16.9%), followed by; (2) individual domain "low levels of physical activity -television viewing" 137 (15.7%); (3) individual domain "genetic predisposition towards obesity" 110 (12.6%); (4) family domain "family social economic status" 95 (10.9%); and (5) social norm domain "modern technology - labor saving devices" 80 (9.2%).

Study findings suggest key beliefs about critical environmental antecedents are being placed on environmental factors (external to child) providing increased opportunities for overeating and sedentary lifestyle. Results suggest: 1) there is a lack of research addressing childhood obesity in an ecological framework; 2) there is a lack of obesity research addressing community and school antecedents collectively; and 3) published articles on childhood obesity have steadily increased over the past decade, however it is still uncertain if stakeholders will support the proposed ecological initiatives that have been identified as critical to reverse obesity prevalence.



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