Influences of the home, school, and community contexts on childhood obesity: A multilevel study

Background: The prevalence of childhood obesity is increasing in the United States. The purpose of this study was to examine the ecological influences on childhood obesity within the contexts of the home, school, and community environments of children from kindergarten through fifth grade. Bronfenbrenner's ecological perspective of human development provided the conceptual framework for this study.

Methods: A sample of 19,634 children was derived from the Early Childhood Longitudinal Study, Kindergarten cohort (ECLS-K) restricted-use database. The ECLS-K was a national study of children's experiences with school from kindergarten through fifth grade. The data structure was nested—child within classroom within school. Data were collected from the child, family, teachers, and school administrators. The conceptual framework and ECLS-K data structure supported the use of a two-level hierarchical linear model for data analysis. The relationship between school context and children's body mass index (BMI) was examined while controlling for known biological and sociocultural moderators and behavioral mediators in the home, school, and community environments.

Results: The intraclass correlation coefficients showed an increasing trend in the relationship between the children's BMI scores and the influence of school context from kindergarten through fifth grade in the unconditional model (without explanatory variables; 3% to 6%): Conditional models (with home, school, and community explanatory variables) showed a consistent contextual effect (2% to 3%).

Conclusions: The impact of the school context on childhood obesity increases as children spend more time in school. The implications of these findings are important for public health and school health services, research, and policy. Public health and school nurses must transcend traditional public health borders in the prevention of childhood obesity.