childhood obesity prevention interventions that has conducted a cost-benefit and cost-effectiveness evaluation. The results of this evaluation found that the Planet Health program is likely to be cost-effective as it is currently implemented (Wang et al., 2003).

The end outcomes relate to promoting health—increasing the number of children and adolescents who are at a healthy weight, reducing the BMI levels in the population, reducing the number and prevalence of children and youth who are obese or at risk for obesity, and reducing the risks for obesity-related comorbidities such as type 2 diabetes and cardiovascular diseases (Chapter 3). These are the ultimate outcomes, but their achievement may require years of effort with sustained resources and societal change.

Crosscutting Factors

Certain programs, policies, strategies, or actions may be effective for some groups but not others. A variety of crosscutting factors influence program experiences and thus the evaluation process and will need to be considered at every stage of the evaluation framework for both individuals and populations. These include age, sex, socioeconomic status, race/ethnicity, culture, immigration status, acculturation, biobehavioral and gene-environment interactions, and psychosocial status, as well as social, political, and historical contexts. Context refers to the set of factors or circumstances that surround a situation or event and give meaning to its interpretation. All of these factors should be taken into account when obesity prevention initiatives are designed, monitored, and evaluated, as depicted in Figure 2-2 (Hopson, 2003) (Chapter 3).

A useful example of the important roles that are played by some of these crosscutting factors (e.g., age, sex, and race/ethnicity) can be drawn from the VERB™ social marketing campaign. The goal of the VERB campaign was to encourage more than 21 million multiethnic American tweens (i.e., ages 9 to 13 years) to become more physically active. (See Chapter 4 for a detailed description of the VERB campaign.) Before CDC launched the 5-year, VERB—It’s what you do. campaign in 2002, it conducted a formative evaluation that used marketing research techniques to gain insights into a variety of relevant factors to assist in understanding how physical activity levels can be increased and maintained in the targeted age group. The formative research showed that tweens would respond positively to messages that promoted moderate physical activity in a socially inclusive environment and that emphasized self-efficacy, self-esteem, and belonging to their peer group (Potter et al., 2004).

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