home (particularly at fast food restaurants) (Guthrie et al., 2002; Nielsen et al., 2003; Bowman et al., 2004), increases in portion size (Young and Nestle, 2002; Nielsen and Popkin, 2003), and increases in soft drink consumption (AAP, 2004).

The School Environment

Schools are an important setting to encourage health-promoting behaviors, including the prevention of obesity (Dietz and Gortmaker, 2001). CDC has issued guidelines for schools to prevent nicotine addiction that include smoke-free policies, tobacco prevention policies, and smoking cessation assistance for teachers, staff, and students (CDC, 1994). Similar guidelines exist for nutrition and physical activity programs in schools (CDC, 1996). There is good scientific evidence that manipulation of the school cafeteria and physical activity environment can improve the cardiovascular health of elementary school children, including body mass index (Wechsler et al., 2000). However, the presence of vending machines, concerns about cafeteria menus, and the declining requirement for physical education in schools suggest that the school environment may need improvement.

The American Public Health Association (2003) has called for the development of school policies for the promotion of healthful eating environments and the prohibition of soft drinks and other low-nutrition foods during the school day. The American Academy of Pediatrics (2004) calls for school policies that restrict the sale of soft drinks. There has been some progress in removing soft drinks and snack foods in vending machines from elementary and middle schools particularly in California. This has been achieved by state legislation or local school board policy (e.g., Los Angeles Unified School District), with the major concerns being loss of school district revenue and commitment to long-term contracts with soft drink manufacturers. There is a clear need for additional research on the relative importance of the school environment in contributing to the problem of overweight and obesity among children, as well as the role schools may play in ameliorating this problem. Recently, the National Institutes of Health announced a new funding program to support research in this area (NIH, 2004).

Economic Factors

In addition to altering the informational environment, Gostin (2003) also notes that the government’s power to tax and spend is one of the major ways in which governments can “assure the conditions for people to be healthy.” He goes on to note that the power to levy taxes can provide



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