media spending includes activities such as sales promotions, coupons, direct mail, catalogs, and special events, and is not systematically tracked.

Upstream The determinants of health that are removed from the biological and behavioral bases for disease, including social relations, neighborhoods and communities, institutions, and social and economic policies.

Validity The extent to which an instrument directly and accurately measures what it is intended to measure.

Variable Anything that is not constant but that can and does change in different circumstances.

Vertical Integration The organization of production whereby one business entity controls or owns all stages of the production and distribution of goods or services. In public health, an approach in which partners work at different levels—the national, regional, state, county, and community levels—to deliver interventions planned at a higher level and delivered at a lower level in a coordinated and complementary way.

Well-Being A view of health that, in this report, takes into account a child’s physical, social, and emotional health.

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