daily physical activity and energy expenditure, and on changes in weight over time. Programs promoting safe routes to school, as well as other efforts to increase students’ walking and bicycling, should include funding for evaluation, and the organizations that implement these programs should work with researchers to develop rigorous evaluation designs. Because so much remains to be learned about the various approaches to increasing walking and bicycling to school, thorough evaluations of such initiatives are critical.

Community Food Environment

All members in a community need access3 to affordable and healthful food on a regular basis. Food security is commonly defined as “access by all people at all times to enough food for an active, healthy life and includes at a minimum: a) the ready availability of nutritionally adequate and safe foods, and b) the assured ability to acquire acceptable foods in socially acceptable ways (p. 1560)” (LSRO, 1990). Food security is one of the necessary conditions to ensure the health of a population.

In 2002, 11.1 percent of U.S. households, representing more than 35 million people, experienced food insecurity—that is, their access to nutritious food on a regular basis was limited or uncertain (Nord et al., 2003). In general, households with children report food insecurity at more than twice the rate of households without children (16.5 percent versus 8.1 percent, respectively) (Nord et al., 2003). Children living in food-insecure households are more likely to have compromised well-being than children living in food-secure households (Alaimo et al., 2001); evidence has linked food insecurity to declines in children’s health, mental and psychological functioning, and academic achievement (ADA, 2004). As discussed in Chapter 3, however, evidence linking childhood food insecurity to obesity is inconclusive.

In 2002, a food-secure household in the United States spent 35 percent more on food than the typical food-insecure household of the same size and composition (Nord et al., 2003), though food accounted for a greater proportion of the latter’s budget (Lang and Caraher, 1998). Thus, it stands to reason that food cost is a significant predictor of dietary choices and health outcomes, particularly in low-income ethnic minority urban communities (Perry, 2001; Morland et al., 2002a; Pothukuchi et al., 2002; Sloane et al., 2003) and rural communities (Holben et al., 2004). At the same time, while


Food access is defined broadly in this context to represent improved availability of adequate amounts of healthful foods that households and communities have the financial resources to afford on a regular basis.

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