Many of these efforts are primarily focused on changing the school environment. However, there are some proposals relevant to childhood obesity prevention through its influence on communities (e.g., establishing farmers’ markets, creating walking or bike paths, supporting smart growth, preserving green spaces, and addressing urban sprawl issues and industry (e.g., restaurant menu and product labeling, proposing taxes on soda or snack foods) (Boehmer et al., 2006; TFAH, 2005).

State legislation specific to schools has largely been focused on establishing nutritional standards for school foods, with growing attention being paid to mandating physical activity standards (Chapter 7). For example, legislation and regulations in Texas have mandated a minimum number of minutes of physical education for students in elementary, middle, and junior high schools; created local school health advisory councils; and established nutritional requirements for foods, beverages, and meals served in schools (TAHPERD, 2006; Texas Department of Agriculture, 2003). Arkansas Act 1220 was enacted in 2003 and included several school-related mandates, such as eliminating access to vending machines in public elementary schools, disclosing contracts for competitive foods and beverages, conducting annual BMI assessments for all students, and establishing nutrition and physical activity advisory committees to develop local policies (Ryan et al., 2006). The committee encourages the states to develop accountability mechanisms that provide the general public with information on the extent to which schools are meeting obesity prevention standards and evaluation results of innovative obesity prevention programs. Additionally, the committee supports increased legislative and other state and local government actions that will facilitate childhood obesity prevention efforts at the community, regional, and state levels.

Program Resources and Evaluation

Many state and local agencies have essential roles to play in designing, funding, implementing, and evaluating effective programs to support childhood obesity prevention goals. The obesity prevention efforts of local governments are complementary to those of the state and federal governments. In particular, local public health departments are involved in providing leadership for the horizontal integration of interventions, communications, and funding requirements, as well as developing an adequate infrastructure in which policies and programs can be implemented and evaluated at the local level.

Horizontal integration is a useful public health approach that encourages partners at the same level of operation—the neighborhood, city, county, regional, or state level—to work across organizational lines to deliver consistent, comprehensive, and multicomponent interventions. Examples of hori-



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