Jacob Smith

Intervention assignment – HS 490

Intervention Assignment
HS 490 Health Promotion

Directions

The following pages guide you on each step of this assignment. You will look for
intervention resources on web sites, class readings, class notes and peer reviewed
journals (Research Notes 1-3). You will pull it all together and create an evidence-
based intervention plan based on your findings (Pulling it All Together) and include
references cited using APA format. You may type directly on these pages, but it is not
required. I put the assignment in boxes to make it easier to follow but it may be
easier for you to create a word document with all the assignment components.

Total Point Value- 100 points

 Website Review -10 points

 Intervention Research Readings- 10 points
 Research Articles-Peer Reviewed 45 points
 Pulling it All Together- 30 points
 Writing-spelling, grammar, APA – 5 pts.

Please submit on Canvas. Due April 17th 10 pm

Intervention Assignment
NAME: Jacob Smith #1 Intervention Website Review- 10 pts.

Briefly describe: Your health topic, the affected population, the geographic location, and the primary
location of the intervention efforts (e.g., health care setting, school, campus, work site, community, etc.)

Like many other counties in the United States, Kootenai County, Idaho, is facing an obesity epidemic. From
2011-2020, adult obesity in Idaho increased from 27% to 31.1% (CDC, 2022) and last year, 13.1% of youth
aged 10-17 had obesity (Idaho..., 2019). Sugar-sweetened beverages (SSB) are readily available in most
learning environments and adolescents have easy access to them. SSB are highly caloric dense beverages
that contain little nutritional value. SSB likely have a high impact in promoting weight gain because they
represent the primary source of added sugars in the American diet and displace more satiating foods which
leads to overconsumption and excess calorie intake (Wilson C., 2012). Intervention efforts may take place
within schools themselves, within foodservice companies supplying foods to schools, in restaurants near
schools, or within policy regulating the three.

Review a website with intervention strategies related to your topic. Only 1 is required, recommend you
look at more than one for greater learning. The site must contain intervention strategies. For example:
Associations, organizations, public health sites, etc. CDC and SAMSHA cites offer strategy examples.
Website Name and Link:

Prevention Strategies & Guidelines

[Link]

General Purpose of the Website

(e.g., what type of information presented, what populations are addressed?)

The CDC has a website with several nutrition, physical activity, and obesity prevention strategies. It
includes guidance for program managers, policy makers, and others for learning how to select strategies to
increase physical activity, combines built environment strategies and interventions to improve pedestrian
transport systems, guidance on increasing fruit and vegetable consumption, and even includes guidance for
breastfeeding interventions. It covers early care and education strategies, school health guidelines, and
gives community and clinical guidelines for reducing chronic disease risk (Prevention Strategies and
Guidelines, 2019).

What did you learn about effective interventions for your topic? Answer the questions below and add
additional comments.
What intervention tools and resources are available? What are the top recommended interventions? Is there
an evidence base for the recommended interventions? (Make sure the website is useful to your topic).
Several resources are provided on this CDC website. Not only does it provide guidance for encouraging
health-promoting activities among a variety of different age groups, it also provides what the current
guidelines are which allows the reader to more comprehensively apply these newly learned strategies
properly. All of the external resources provided on the site are well-researched and provide some examples
of the efficacy of their strategies.
The Guide to Strategies to Increase Physical Activity in the Community (2011) lists intervention examples,
such as Wheeling Walks, which encouraged physically inactive adults to get 30 minutes of physical activity
per day, and B.C. Walks, which was a similar program in Broome County, NY. These strategies seem to
focus on promoting small, attainable changes in physical activity levels for residents of a community. They
did not mention a specific theory-based approach.
The CDC Guide to Strategies to Increase the Consumption of Fruits and Vegetables (2011), another
resource provided on the website, gives historical intervention examples such as the Pennsylvania Fresh
Food Financing Initiative (FFFI), which was designed to improve food access to underserved areas and
provide economic stimulus for communities that needed it. Because of the program, public-private
partnerships leveraged an initial $30 million of funds into $120 million for improving food access. This
document also provides access to dozens of external resources giving examples of previous initiatives.

Critical thinking and relation to your health promotion topic

What did you learn from the website that you can apply to your project? Organize by answering # 1-3
below:
1) Intervention activities that are appropriate for your project:
The website provides access to the CDC’s Increasing Access to Drinking Water In Schools (2014).
Increasing access to drinking water is a previously explored tactic for reducing SSB consumption in
schools, which is at the heart of my project. I learned from this that the Institute of Medicine and the CDCP
recommend that drinking water be available throughout the day for free for students and that if other drinks
are sold, they should only include plain drinking water, fat-free or low-fat milk, and fruit juice. Despite this
recommendation, most schools still have vending machines full of SSBs. If this recommendation could
become actual policy, it would certainly reduce SSB consumption in schools.
Water testing requirements and recommendations differ at the federal, state, and local levels. This means
that there may be inequities when it comes to access to clean water. If students are unsure about the quality
of water provided by their schools, they may turn to purchasing beverages from vending areas. If a student
is going to be spending money for a drink either way, they will likely buy one that is more enjoyable and
flavorful to drink, such as a SSB. Policy to limit access to SSBs while also improving access to clean, fresh
water would be beneficial for the health of this population.
2) Useful tools and resources, including health education/promotion resources:
The website has a “Reports” page which gives several reports on children’s food environment, CDC vital
signs (cancer and obesity, progress on child obesity, and adult obesity), morbidity and mortality weekly
reports, maps, etc. There is also a “Facts Sheets” page which has neatly organized sheets giving
information on adult obesity, obesity health disparities, using fruits and vegetables to manage obesity (very
relevant for school-aged adolescents), and several other related topics.
Another good resource is the Whole School, Whole Community, Whole Child (WSCC) Model. Each
aspect of this model can be clicked on and leads to more information. On the left is the WSCC model, the
middle image is an infographic provided about sleep, and on the right is about physical activity in schools.
The rightmost two images are provided through the model. The foundation of this model is that schools are
in a unique position to promote healthy behaviors given that students spend 6-7 hours per day at school. It
highlights the importance of nutrition services, physical education, physical activity, education on sleep,
and social and emotional climates in schools.
3) Other resources- give web links for at least two other helpful resources the web page directed you to and
write 1-2 sentences about what you found helpful about each site.
[Link]
This resource, provided by Action for Healthy Kids, describes using non-food rewards in schools. This is
something I briefly touched on in my assessment assignment. I questioned why junk foods like pizza and
cookies are used to reward good behaviors among adolescents when other reinforcement techniques may be
equally or nearly as effective in promoting good behavior.
[Link]
[Link]
The Community Guide provides information on built environment intervention approaches and increasing
street connectivity, sidewalk and trail infrastructure, bicycle infrastructure, and access to public transport.
These are all very important for increasing physical activity, which is associated with lower risk for
overweight and obesity development.

#2 Intervention Research Readings- 10 pts.

General Intervention Considerations- Answer the following using lectures and readings. 1 paragraph
for each. Each answer worth 5 points. 1= mostly incomplete 2=1/2 complete, 3=3/4 complete, 4-
complete, 5-exceptional
1. Read the Spectrum of Prevention- from the Prevention Institute-what levels (at least 2) of
prevention are most important for your topic/population/ and location? The type/level of change
desired will direct you to types of interventions that will have the most impact.
I believe that levels 1 and 6 of the spectrum of prevention are most important for my topic. Because
individual skills (such as identifying healthy foods, identifying resources available, cooking skills, etc.) are
extremely important for promoting health, level 1, Strengthening Individual Knowledge and Skills is
something that needs to be focused on. Interventions that teach skills to individuals at risk are likely to
improve peoples’ self-efficacy and likelihood of change.
Level 6, Influencing Policy and Legislation is something I have touched on in this assignment and on my
needs assessment. Policies need to be put in place to limit access to sugar-sweetened beverages and
unhealthy foods in schools. Currently, there is no legislation limiting access to these things for vulnerable
populations such as school-aged adolescents.
2. Discuss what you learned about the predisposing, enabling, and reinforcing factors from your
project assessment are most related to the health behaviors most in need of change for your
project? Cite literature to support your answer. (It’s fine to use a citation from the assessment)
Some predisposing factors related to adolescent obesity include genetics and the relationship between
genetics and the environment (Walley, et al., 2009). An individual’s diet also has a strong effect on their
likelihood to develop obesity, specifically increasing their risk by consuming too much energy, saturated
fat, and added sugars (NHLBI, 2022). It is not possible to influence genetics, so we need to focus on food
consumption choices. These can be influenced in many ways. Namely by improving people’s knowledge
and also by changing the accessibility to food and improving the quality of food accessible. Enabling factors
include walkability of a town and proximity to fast-food establishments or exercise areas. For my location,
walkability and exercise access are reinforcing factors and are not huge problems (not considering cost of
memberships to gyms), but access to fast-food, an enabling factor, is (US Census Bureau QuickFacts,
2022). Policy to limit where fast-food joints are allowed to operate would likely improve health.

#3 RESEARCH ARTICLES– PEER REVEIWED- 1 of 3

3 peer reviewed research articles that describe interventions are required. Use original research, not
review articles or websites. Do not include assessment literature. 15 pt. each 45-pt. total

APA Citation of article

Humpel, N., Marshall, A. ., Iverson, D., Leslie, E., & Owen, N. (2004). Trial of print and telephone
delivered interventions to influence walking. Preventive Medicine, 39(3), 635–641.
doi:10.1016/[Link].2004.02.032 

Participants or population reached:

Australian adults over the age of 40.

Describe the intervention and its effectiveness.

  Briefly describe the intervention – what did they do? What was unique or most interesting to you?
Participants were split up into two groups (Print, and Print + Telephone). One group received print
material which included self-help information in the form of brochures and other materials. The aim of
the material was to promote walking. Group two also received the print material but in addition to that
got three weekly support calls.
I like this study because it compares simply providing information with actually speaking with someone
to help develop a skill or a behavior change. We know that simply providing information does not create
behavior change.

 What did you learn about the effectiveness of the intervention?

I learned that when it comes to influencing walking, there was not much of a difference between the
groups that just received print and those that received print and phone calls. It seems that promoting
exercise for a variety of reasons, more than just for health, seems to be better for helping people make
behavior change. The use of telephone intervention appears to be an effective and cheap way to reach
larger audiences.

 If a health behavior theory was identified, briefly discuss which one was used and how it shaped the
intervention?
A behavior theory was not mentioned by name but in the discussion they mention how people walking
for different reasons saw increases depending on the reason (i.e. walking for exercise; walking for
pleasure) which makes me believe they were using the Health Belief Model or the Theory of Reasoned
Action. Participants’ beliefs about the results of the walking seem to have had an effect on whether or
not they actually did it.

 What were the main conclusions about the interventions reached by the author(s) and what were the
limitations of the interventions? (Most peer reviewed papers will cite the limitations of the findings).
They found that almost half of the Print + Telephone group found the calls moderately to extremely
useful and reported that the calls had moderately to very much influenced their walking. They also
found, however, that there was no statistical significance between groups when it came to walking
measures. Both groups did increase the reported number of minutes walked per week significantly.
When surveyed after 10 weeks, 25.4% of participants reported walking a little bit more than before the
intervention and 8.3% reported walking a lot more. They concluded that additional telephone contact
after providing print information does not increase the likelihood of exercise behavior change and that
this seems to correspond with other studies performed before.
The main limitation listed was the cross-sectional design and the possible cognitive overlap in reporting
of time spent walking for different purposes (combining walking for pleasure or for exercise). Basically,
the amount of time could be skewed because people may have reported the same type of walking for
two different categories, doubling the amount reported.
Critical thinking and relation to your project

 What did you learn from this research/intervention that can be applied to your project?
I was hoping to learn that telephone interventions are very effective, but in this specific case it seems
that they really aren’t. Given the limitation of this study, their reported behavior change may even be
less significant than how it appears. They did report that mailed print material improved walking time
 for participants, so I think it may be realistic to use print material to improve awareness of adolescent
obesity. Telephone contact may just be a waste of resources.

 What would you need to do to adapt the intervention to fit your population and why?
To fit my population, a lot would have to change. High schoolers have phones but are not as fond of
answering phone calls in my experience. Also, most high schoolers live with their guardians and will
not be receiving mail directly which means that printed materials may not make it to them. This study
also focused on 40+ year old Australian adults, which is a lot different from teenage Americans.
Overall, I think this style of study could be performed by providing written/verbal information in high
school classrooms followed by face-to-face contact or informed telephone contact and it would be more
successful.

#3 RESEARCH ARTICLES– PEER REVEIWED- 2 of 3

APA Citation of Article

O’Hara, B. J., Phongsavan, P., Venugopal, K., Eakin, E. G., Eggins, D., Caterson, H., … Bauman, A. E.
(2012). Effectiveness of Australia’s Get Healthy Information and Coaching Service®: Translational
research with population wide impact. Preventive Medicine, 55(4), 292–298.
doi:10.1016/[Link].2012.07.022 

Participants or population reached.

1,440 adults that participated in an online coaching program.

Describe the intervention and its effectiveness.

 Briefly describe the intervention – what did they do? What was unique or most interesting to you?
This was another telephone-based intervention, but this study used an individualized intervention that
focused on coaching for behavior change rather than just providing information like the previous study.

 What did you learn about the effectiveness of the intervention?

I learned that by using an evidence-based program that has been shown to improve health behaviors and
implanting an over-the-phone service provider, you can still get significant positive results despite the
lack of face-to-face communication.

 If a health behavior theory was identified, briefly discuss which one was used and how it shaped the
intervention?
A health behavior theory was not identified.

 What were the main conclusions about the interventions reached by the author(s) and what were the
limitations of the interventions? (Most peer reviewed papers will cite the limitations of the findings).
Participants reported significant improvements in weight, waist circumference, BMI, number of walking
and moderate to vigorous physical activity sessions >30 minutes per week, servings of vegetables, fruit,
take-away meals, and sweetened drinks.
One large limitation of this study is that it relied on self-reported data from participants. There was also
no comparison group and was only an experimental group, which means the results should be treated
with caution (though the results are contradictory to global obesity trends, meaning there is likely some
 importance to them). There were also a large number of participants that dropped out of the program
before conclusion, which could bias results.

Critical thinking and relation to your project

 What did you learn from this research/intervention that can be applied to your project?
I learned that, when used properly, communication via the phone can help promote healthful behavior
for those who are willing and ready to try. Between this study and the last one, I learned quite a bit
about what works and what doesn’t work with phone contact. We already knew that just providing
information does not lead to behavior change, but that working with a professional may help bring about
change.

 What would you need to do to adapt the intervention to fit your population and why?
Many adolescents may not want to follow a coaching program over the phone. A hybrid approach may
be more appropriate for this population, where they meet in-person and online with a provider that helps
them through the process of behavior change. Group sessions within schools may also save resources
and reach a larger audience.

#3 RESEARCH ARTICLES– PEER REVEIWED 3 of 3

APA Citation
Lindstrom, J., Louheranta, A., Mannelin, M., Rastas, M., Salminen, V., Eriksson, J., … Tuomilehto, J.
(2003). The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and
physical activity. Diabetes Care, 26(12), 3230–3236. doi:10.2337/diacare.26.12.3230 

Participants or population reached.

522 middle-aged (40-64), overweight (BMI >24) subjects with impaired glucose tolerance.

Describe the intervention and its effectiveness.

 Briefly describe the intervention – what did they do? What was unique or most interesting to you?
Multiple centers in different parts of Finland employed a physician, study nurse, nutritionist, and
exercise instructor. High risk individuals (such as first-degree relatives of people with T2D) were
recruited.
Aerobic and resistance training were offered to participants because it has been shown previously to
reduce diabetes risk significantly. Participants consumed a moderate fat, low saturated fat diet, with the
majority of fat coming from monounsaturated fats. Nutrition counseling sessions were offered and
intervention goals were translated into practice. 7 sessions were given during the first year and one
every 3 months afterwards. Sessions focused on nutrition education (knowledge of macronutrients),
physical activity, and problem solving. Discussions were individualized. Participants were encouraged
to make small, practical goals for change. Exercise programs were individualized following the process
of progressive overload (slowly increasing volume or intensity over time).
This study was interesting to me because they managed to reduce the risk for diabetes development by
58% after 3 years! Most lifestyle interventions do not cause such a strong impact and especially not after
multiple years. As learned in my assessment project, most health behavior interventions fail within a
 year of implementation or cessation.

 What did you learn about the effectiveness of the intervention?

The intervention was so effective that the study had to be terminated early because the intervention
group’s incidence of obesity was so significantly lower than the control group’s.

 If a health behavior theory was identified, briefly discuss which one was used and how it shaped the
intervention?
A behavior theory was not mentioned, but it seems like they were using motivational interviewing as a
basis for counseling sessions. Goal setting was a large part of these sessions.

 What were the main conclusions about the interventions reached by the author(s) and what were the
limitations of the interventions? (Most peer reviewed papers will cite the limitations of the findings).
The lifestyle intervention caused positive long-term changes in diet, physical activity, clinical
biochemical parameters, and reduced risk of diabetes without the use of pharmacology. Interventions
need to be individualized and continued and performed by skilled professionals to be maximally
effective. The type of intervention used is a reasonable option for preventing type 2 diabetes and should
be implemented in primary health care.
They also speculated that small negative energy balances in those who are trying to lose weight are
probably more advantageous to glucose tolerance than large negative energy balances, meaning that the
longer the weight loss takes, the more sustainable and healthier it is.
The authors did not provide a list of strengths, weaknesses and limitations, but they did mention that
their results at the 3-year follow-up may be biased due to slight participant dropout at that time. They
also mentioned that they relied on self-reported 3-day food logs and that historically participants
underreport their energy intake using this measure, especially when they are overweight.
Critical thinking and relation to your project

 What did you learn from this research/intervention that can be applied to your project?
It is hard to apply this style of intervention to my population because it is individualized and requires a
lot of resources. One thing I can take away is that nonpharmacological measures to reduce risk of type 2
diabetes (and obesity) are effective when they include physical activity, nutrition education, and
increasing self-efficacy.

 What would you need to do to adapt the intervention to fit your population and why?
The way I would adapt this intervention is to focus on a way to include this type of counseling within
schools. Schools have nurses and counselors already, but they do not necessarily have trained nutrition
professionals readily available. If there were nutritionists working within schools that provided nutrition
education and motivational interviewing for students, they may be able to reduce their risk of some
chronic disease as they age.

Pulling it All Together- Intervention Plan - 30 pts

1. What level of prevention is the focus of your intervention: primary, secondary, or tertiary?
Are the intervention efforts focused on: individuals (one to one), groups, community, population (policy,
systems, environments, information campaigns, or street/direct action/advocacy?
For my topic of adolescent obesity, the focus will be on primary prevention. This will be done by removing
risk factors (such as access to sugar-sweetened beverages and high energy, low nutritional value foods).
Physical activity will also be promoted as it has been shown to reduce the risk of obesity. The focus will be
on individuals (students).

Discuss the types of interventions you feel are most important for your topic and the specific strategies and
activities under each intervention type. Limit to three types of interventions. For full points, cite
literature to support the strategies selected. Write out intervention strategies in essay style or bullets. Add
enough information so it is clear what the intervention strategies will accomplish and write them as you are
going to carry them out.

 Regulatory activities:
o Create and enforce policy to limit the types of food stores opening near schools because
proximity of corner stores to schools is associated with adolescent obesity risk (Rummo, et
al., 2020).
o Include more opportunities for physical activity within school curricula without academic
consequences (Story, et al., 2009).
o Ensure foods rich in animal protein (with non-animal substitutes) and micronutrients, with
considerable dietary diversity are available within schools to promote proper growth and
development of adolescents (Lobstein, et al. 2015).

 Technology-delivered activities:
o Include in-person and over-the-phone nutrition counseling services for students attending
schools to help them improve knowledge levels and develop skills that promote healthy eating
(O’Hara, et al., 2012).
o Promote the use of online gaming activities that include physical activity via heart rate and/or
motion tracking to increase energy expenditure at home (Vandoni, et al., 2021).

 Incentives and disincentive activities:

o Provide group incentives for health-promoting activities in schools (i.e. more free time, field
trips, etc.) (Paloyo, et al., 2015).
o Providing monetary incentives for individuals (because students in high school are mostly
minors and not allowed to be given money directly, this could be in the form of paying for
school supplies, admission tickets for games, or waiving fees) when they improve physical
activity will likely offset the financial burdens associated with inactivity, and has previously
been shown to be effective in promoting physical activity at even a low cost to the institution
providing the money (Adams, et al., 2017).

2. Potential for Success- 5 pts (critical thinking questions)

a. Discuss why your intended approaches would work (e.g., how do they impact predisposing,
enabling, or reinforcing factors?) Write no more than two paragraphs and cite for support.
 a. Because there is currently no legislature surrounding what types of food can be sold near
schools, any passing of policy would likely create an improvement in the food
environment for students. As stated in my assessment assignment, there are 0.51-0.75 fast
food restaurants per 1,000 people in Kootenai county (Number… [Link], 2015)
(which is actually better than the national average but is not great) and many of these are
near schools. These fast-food restaurants are enabling factors for adolescents to have high
energy consumption. As for increasing the opportunities for physical activity, it can be
assumed that more options will lead to more activity for students.
There have been a handful of studies investigating the use of technology for nutrition and
physical activity education. Covid has been a catalyst for this research because of the
recommendations to stay home. The amount of classwork that has been mandatorily
completed online has allowed students to become accustomed to that type of education
and has shown them how convenient it can be to log onto a computer and receive their
lectures. With research showing the effectiveness of online nutrition counseling, students
already having access to computers, and also having a knowledge base of how to use
programs for education (i.e., Zoom), implementing online counseling and education
interventions would be easy, convenient, and cost effective.

b. Discuss sustainability of the intervention plan- what will help this work continue? Think about
reinforcing factors in the community- organizations, leaders, schools, etc.
a. What is really needed for adolescent obesity prevention is experimentation and long-term
studies. We do not really know what effect many interventions within schools have on
obesity once students leave the school and become adults. Of course, for an intervention
to be implemented, the schools need to be on board. With the direction we are going and
with how health trends are moving, we will slowly approach the point where we have no
choice but to implement some sort of change to slow down the progression of obesity. It
would be better to start trying things out now. Though providing a nutrition counselor to
students would be a cost up front to schools, it would save money in the long run when it
comes to the cost of obesity and diabetes on the healthcare system. Financial incentives
for institutions seem to be pretty powerful when it comes to bringing about change.

References:

Adams, M. A., Hurley, J. C., Todd, M., Bhuiyan, N., Jarrett, C. L., Tucker, W. J., … Angadi, S. S. (2017).
Adaptive goal setting and financial incentives: a 2 × 2 factorial randomized controlled trial to
increase adults’ physical activity. BMC Public Health, 17(1). doi:10.1186/s12889-017-4197-8 

Centers for Disease Control and Prevention. (2011). Strategies to Prevent Obesity and Other Chronic
Diseases The CDC Guide to Strategies to Increase the Consumption of Fruits and Vegetables
National Center for Chronic Disease Prevention and Health Promotion Division of Nutrition,
Physical Activity, and Obesity. U.S. Department of Health and Human Services.
[Link]

Centers for Disease Control and Prevention. (2022, September 27). Adult obesity prevalence maps. Centers
for Disease Control and Prevention. [Link]
[Link]
“Idaho – State of Childhood Obesity.” (2019). State of Childhood Obesity,
[Link]/state-data/?state=id. Accessed 3 Mar. 2023.
Increasing Access to Drinking Water in Schools. (2014). In Centers for Disease Control and Prevention. US
Dept of Health and Human Services.
[Link]

Lobstein, T., Jackson-Leach, R., Moodie, M. L., Hall, K. D., Gortmaker, S. L., Swinburn, B. A., …
McPherson, K. (2015). Child and adolescent obesity: part of a bigger picture. The Lancet, 385(9986),
2510–2520. doi:10.1016/s0140-6736(14)61746-3 

NHLBI. (2022, March 24). Overweight and Obesity - Causes and Risk Factors | NHLBI, NIH.
[Link]. [Link]
Number of fast food restaurants per capita varies across the U.S. (2015). [Link].
[Link]
O’Hara, B. J., Phongsavan, P., Venugopal, K., Eakin, E. G., Eggins, D., Caterson, H., … Bauman, A. E.
(2012). Effectiveness of Australia’s Get Healthy Information and Coaching Service®: Translational research
with population wide impact. Preventive Medicine, 55(4), 292–298. doi:10.1016/[Link].2012.07.022 

Paloyo, A. R., Reichert, A. R., Reuss-Borst, M., & Tauchmann, H. (2015). Who responds to financial
incentives for weight loss? Evidence from a randomized controlled trial. Social Science & Medicine,
145, 44–52. doi:10.1016/[Link].2015.09.034 

Prevention Strategies & Guidelines. (2019). Centers for Disease Control and Prevention.
[Link]

Rummo, P. E., Wu, E., McDermott, Z. T., Wagner, R. F., Schwartz, A. E., & Elbel, B. (2020). Relationship
between retail food outlets near public schools and adolescent obesity in New York City. Health &
Place, 65, 102408. doi:10.1016/[Link].2020.102408 
STORY, M., NANNEY, M. S., & SCHWARTZ, M. B. (2009). Schools and Obesity Prevention: Creating
School Environments and Policies to Promote Healthy Eating and Physical Activity. The Milbank
Quarterly, 87(1), 71–100. [Link]

U.S. Census Bureau QuickFacts: Coeur d’Alene city, Idaho. (2022). [Link]. Retrieved February
28, 2023, from [Link]
AGE295221#AGE295221

Vandoni, M., Codella, R., Pippi, R., Carnevale Pellino, V., Lovecchio, N., Marin, L., Silvestri, D., Gatti, A.,
Magenes, V. C., Regalbuto, C., Fabiano, V., Zuccotti, G., & Calcaterra, V. (2021). Combatting
Sedentary Behaviors by Delivering Remote Physical Exercise in Children and Adolescents with
Obesity in the COVID-19 Era: A Narrative Review. Nutrients, 13(12), 4459–.
[Link]

Walley, A. J., Asher, J. E., & Froguel, P. (2009). The genetic contribution to non-syndromic human obesity.
Nature Reviews Genetics, 10(7), 431–442. doi:10.1038/nrg2594 

Wilson, C. (2012). Obesity: Sugar-sweetened beverages--fueling the epidemic of childhood

obesity? Nature Reviews. Endocrinology, 8(12), 696. [Link]