B
Glossary

Accountability The systematic inclusion of the elements of program planning, implementation, monitoring, and evaluation to achieve program goals and results.

Active Living A way of life that integrates physical activity into daily routines. The two types of activities that comprise active living are recreational or leisure such as jogging, skateboarding, or playing basketball, and utilitarian or occupational, such as walking or biking to school, shopping, or running errands.

Activities The actions implemented by a program and its staff to achieve desired outcomes in a target population or specific setting.

Assessment In this report, refers to the process of observing, describing, collecting, and measuring the quality and effectiveness of an initiative, program, or policy. Also see Evaluation.

Away-from-Home Foods Foods categorized according to where they are obtained, such as restaurants and other places with wait service; quick serve restaurants and self-service or take-out eateries; ready-to-eat foods from supermarkets; schools, including child-care centers, after-school programs, and summer camp; and other outlets, including vending machines, community feeding programs, and eating at someone else’s home.



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Progress in Preventing Childhood Obesity: How Do We Measure Up? B Glossary Accountability The systematic inclusion of the elements of program planning, implementation, monitoring, and evaluation to achieve program goals and results. Active Living A way of life that integrates physical activity into daily routines. The two types of activities that comprise active living are recreational or leisure such as jogging, skateboarding, or playing basketball, and utilitarian or occupational, such as walking or biking to school, shopping, or running errands. Activities The actions implemented by a program and its staff to achieve desired outcomes in a target population or specific setting. Assessment In this report, refers to the process of observing, describing, collecting, and measuring the quality and effectiveness of an initiative, program, or policy. Also see Evaluation. Away-from-Home Foods Foods categorized according to where they are obtained, such as restaurants and other places with wait service; quick serve restaurants and self-service or take-out eateries; ready-to-eat foods from supermarkets; schools, including child-care centers, after-school programs, and summer camp; and other outlets, including vending machines, community feeding programs, and eating at someone else’s home.

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Progress in Preventing Childhood Obesity: How Do We Measure Up? Balanced Diet The overall dietary pattern of foods consumed that provide all the essential nutrients in the appropriate amounts to support life processes, including growth and development in children without promoting excess body fat accumulation and excess weight gain. Behavioral Branding A strategy used by social marketing programs to create brands that individuals associate with a specific behavior or lifestyle. Examples include the VERB™ campaign, which encourages tweens (children ages 8 to 13 years) to associate VERB with physical activity, and the truth® brand, which represents an inspirational antismoking brand for teens that builds a positive image of youth as nonsmokers, cool and edgy, and rebellious against the tobacco industry. Behavioral Outcomes Behavioral changes made by individuals or populations that affect diet and physical activity levels and that enhance health. These may include increasing physical activity levels, increasing fruit and vegetable consumption, balancing caloric intakes and expenditures, reducing television viewing time, and increasing breastfeeding rates. Best Practice An intervention or effort that is likely to reduce childhood obesity and for which there is a sufficient amount of robust evidence that provides a level of certainty that the intervention is linked to reducing the incidence or prevalence of childhood obesity and related co-morbidities. Bill A proposed new law or amendment to an existing law that is presented to the legislature for consideration. A bill requires approval by both chambers of the legislature and action by a governor or the president to amend an existing law or to become a law. Body Mass Index Body mass index (BMI) is an indirect measure of body fat calculated as the ratio of a person’s body weight (in kilograms) to the square of a person’s height in meters: BMI (kg/m2 ) = weight (kilograms) ÷ height (meters)2 BMI (lb/in2 ) = weight (pounds) ÷ height (inches)2 × 703 In children and youth, assessment of BMI is based on growth charts for age and gender and is referred to as BMI for age. According to the Centers for Disease Control and Prevention (CDC), a child with a BMI for age that is equal to or greater than the 95th percentile is considered overweight. A child with a BMI for age that is equal to or between the 85th and 95th percentile is considered to be at risk of becoming overweight. In this report,

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Progress in Preventing Childhood Obesity: How Do We Measure Up? the definition of obesity is equivalent to the CDC definition of overweight, and at risk of becoming obese is equivalent to the CDC definition of at risk for becoming overweight. Calorie A kilocalorie is defined as the amount of heat required to change the temperature of 1 gram of water from 14.5° C to 15.5° C. In this report, calorie is used synonymously with kilocalorie as a unit of measure for energy obtained from foods and beverages. Capacity Building A multidimensional and dynamic process that improves the ability of individuals, groups, communities, organizations, and governments to meet their objectives or enhance performance to address population health. In public health, capacity building involves the ability to carry out essential functions, such as developing and sustaining partnerships, leveraging resources, surveillance and monitoring, providing training and technical assistance, and conducting evaluations. Caregiver An individual, such as a parent, foster parent, or head of a household, who attends to the needs of a child or an adolescent. Channel An organized system through which interventions can be delivered efficiently to reach large segments of the population, such as schools, communities, and families at home. Children’s Advertising Review Unit (CARU) The Children’s Advertising Review Unit (CARU) was founded in 1974 to promote responsible children’s advertising as a component of the strategic alliance with major advertising trade associations through the National Advertising Review Council. CARU is the children’s arm of the advertising industry’s self-regulation program and evaluates child-directed advertising and promotional material in all media to advance the accuracy, truthfulness, and consistency of advertisements. Coalition An organized group of people in a community working toward a common goal. A coalition can have individual, group, institutional, community, or public policy goals. Cognitive Outcomes Changes in an individual’s knowledge, awareness, beliefs, and attitudes about the importance of healthy diets and regular physical activity to reduce the risk of obesity and related chronic diseases. Collaboration A cooperative effort between and among groups of people (e.g., governmental entities and private partners) through which partners work together toward mutual advantage and to achieve common goals.

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Progress in Preventing Childhood Obesity: How Do We Measure Up? Collaboration can range from informal ad hoc activities to more planned, organized, and formalized ways of working together. Collective Efficacy The willingness of community members to look out for each other and intervene when problems arise. Community A social entity that can be either spatial, based on where people live in local neighborhoods, residential districts, or municipalities, or relational, based on common ethnic, cultural, or other characteristics or similar interests. Community Readiness In broad terms, the community’s awareness of, interest in, and ability to support policies, programs, and initiatives. Community Youth Mapping A tool that young people can use to explore their communities. In this process, youth and adults document, analyze, and disseminate information on community resources, issues, and gaps in available resources. Community youth mapping provides opportunities for meaningful involvement by youth and adults as well as the development of skills, including public speaking, data collection, entry, and analysis; oral and written communications; knowledge about community resources; and conflict resolution. Competitive Foods Foods and beverages other than meals and snacks offered at schools through the federally reimbursed National School Lunch Program, School Breakfast Program, and after-school snack programs. Competitive foods include food and beverage items sold through á la carte lines, snack bars, student stores, vending machines, and school fundraisers. Confounder A factor that may cause or prevent a desired outcome that is associated with a factor under investigation and that does not represent an intermediate variable. Context The set of factors or circumstances that surrounds a situation or event and that gives meaning to its interpretation; the broader environment in which a program operates. Coordination The process of seeking concurrence from one or more groups, organizations, or agencies regarding a proposal or an activity for which they share some responsibility and that may result in contributions from each of the entities.

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Progress in Preventing Childhood Obesity: How Do We Measure Up? Correlate To put or bring into causal, complementary, parallel, or reciprocal relation. Cost-Benefit Analysis An evaluation tool used to compare the various costs associated with an investment in a program or initiative with its proposed benefits. Cost-Effectiveness Analysis An evaluation tool used to assess the most efficient method for achieving a program or policy goal. The costs of alternatives are measured by their requisite estimated dollar expenditures. Effectiveness is defined by the degree of achieving a goal and may be measured in dollars. Cost-Utility Analysis An evaluation tool used to assess the relative economic value (e.g., cost-utility ratio) of alternative strategies that aim to achieve similar outcomes. This type of analysis converts effects into personal preferences and describes how much it costs for some additional quality gain (e.g., cost per additional quality-adjusted life-year). Cross-Sectional Survey The observation of a defined population at a single point in time or time interval. Cultural Competence The ability of individuals to consider ethnic, racial and cultural aspects in all dimensions of their work relative to obesity prevention and population health programs and interventions. Cultural competence is optimized when program staff involve clients or recipients in all phases of a program, from planning to implementation, monitoring, and evaluation. Culture The values, norms, beliefs, attitudes, traditions, and customs shared by a group of people who are unified by race, ethnicity, language, faith, nationality, or life experience. Dietary Guidelines for Americans A federal summary of the latest dietary guidance for the American public based on current scientific evidence and medical knowledge. The guidelines are issued jointly by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture and are revised every 5 years. Discourse The language used by members of a community to define and discuss a specific topic. It can also represent an institutionalized way of thinking. Discretionary Calories The amount of calories in an individual’s “energy allowance” after the person consumes sufficient amounts of foods and

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Progress in Preventing Childhood Obesity: How Do We Measure Up? beverages to meet one’s daily calorie and nutrient needs while promoting weight maintenance. Discretionary Fat The ability of a person to selectively add dietary fat (e.g., salad dressing, butter, and oil) according to personal preferences, which contributes to total calorie intake. This is distinct from the obligatory fat that has been added to foods prior to consumption and that cannot be removed prior to consumption. Energy Balance A state in which calorie intake is equivalent to energy expenditure, resulting in no net weight gain or weight loss. In this report, energy balance in children is used to indicate the equality between energy intake and energy expenditure that supports normal growth and development without promoting excess weight gain. Energy Density The amount of calories stored in a given food per unit volume or mass. Fat stores 9 kilocalories/gram (g), alcohol stores 7 kilocalories/g, carbohydrate and protein each store 4 kilocalories/g, fiber stores 1.5 to 2.5 kilocalories/g, and water has no calories. Foods that are almost entirely composed of fat with minimal water (e.g., butter) are more calorie dense than foods that consist largely of water, fiber, and carbohydrates (e.g., fruits and vegetables). Energy Expenditure Calories used to support the body’s basal metabolic needs plus those used for thermogenesis, growth, and physical activity. Energy Intake Calories ingested as foods and beverages. Environment The aggregate of the social and cultural conditions that influence the life of an individual or a community. Environmental Justice Efforts that address the disproportionate exposure to harmful environmental conditions by low-income and minority communities. Environmental Outcomes Changes that create a health-promoting environment, including access to healthful foods and beverages; opportunities for physical activity; changes in the commercial marketplace, including the media; and changes in the built environment, including schools, the transportation system, recreational facilities and opportunities, and food retail outlets. Evaluation A systematic assessment of the quality and effectiveness of an initiative, program, or policy and its effects to produce information

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Progress in Preventing Childhood Obesity: How Do We Measure Up? that can be used by those who have an interest in its improvement or effectiveness. Evaluative Research The use of scientific research methods to assess the effectiveness of an initiative, program, or policy. Fast Food Foods and meals designed for ready availability, use, or consumption and sold at eating establishments for quick availability or take-out. Fidelity The rigor with which an intervention adheres to a program’s purpose and intent. For obesity prevention programs, fidelity is the degree of fit between the planned intervention and its actual implementation in a given institutional or community setting. Focus Group A research method whereby a moderator convenes a group of participants who often have common characteristics (e.g., age, gender, or ethnicity) to discuss the attributes of a specific concept or product. Focus groups are often used in the marketing development phase to generate ideas and provide insights into consumer reactions and perceptions. Formative Evaluation A method of assessing the value of a program while the program activities are developing. Formative evaluation focuses on process issues such as understanding how a program works and its strengths and weaknesses. Generalizability The extent to which the results produced by a specific intervention or set of interventions under specific conditions may be expected to produce similar findings in future efforts in different settings or contexts with different populations. Geographic Information System A system of computer hardware, software, and spatial data used to capture, manage, analyze, and display geographically referenced information. Goal A clear and specific measurable outcome or change that can be reasonably expected at the end of a planned program or interventions. Health A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Health Disparities The population-specific differences in the presence of disease, health outcomes, or access to health care across racial, ethnic, and different socioeconomic groups.

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Progress in Preventing Childhood Obesity: How Do We Measure Up? Health Impact Assessment A combination of procedures, methods, and tools by which a policy, program, or project may be evaluated in terms of its potential effects on the health of a population and the distribution of those effects within the population. Health Outcomes Changes made by individuals or populations that either reduce or increase their risk of developing specific health conditions. This report identifies three health outcomes of interest: reduced mean population body mass index levels, reduced obesity prevalence, and reduced obesity-related morbidity in children and youth. Health Promotion The process of enabling people to increase control over and to improve their health through networks and initiatives that create healthy environments. To reach a state of complete physical, mental, and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living, and is a positive concept emphasizing social and personal resources, as well as physical capacities. Healthful Diet For children and adolescents, a healthful diet provides recommended amounts of nutrients and other food components within estimated energy requirements to promote normal growth and development, a healthy weight trajectory, and energy balance. A healthful diet is consistent with the Dietary Guidelines for Americans and reduces the long-term risk for obesity and related chronic diseases associated with aging, including type 2 diabetes and metabolic syndrome. Healthfulness The quality of promoting good health. Healthy Weight In children and youth, a level of body fat that supports normal growth and development and at which there are no observed co-morbidities. The current guidelines for healthy weight in children and youth of the Centers for Disease Control and Prevention are in the range of the 5th to the 85th percentiles of the age- and gender-specific body mass index charts. Horizontal Integration An approach that encourages partners at the same level of operation—neighborhood, city, country, region, or state—to work across organizational lines to deliver a consistent, comprehensive, multicomponent intervention to target groups. Human Capacity The collective knowledge, attitudes, motivation, and skill sets of program implementers.

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Progress in Preventing Childhood Obesity: How Do We Measure Up? Impact Evaluation A measure of whether or not an outcome, such as the effectiveness of a program, is the result of an intervention. To draw a cause-and-effect conclusion, an impact evaluation incorporates research methods that eliminate alternative explanations for an outcome and shows how much difference an intervention can make compared with the effect seen when no intervention is used. In public health programs, an impact evaluation often occurs over a long period of time. Incidence The frequency of new cases of a condition or disease within a defined time period. Incidence is commonly measured in new cases per 1,000 (or 100,000) population at risk per year. Indicators Aggregates of raw and processed data that are used to measure social, economic, and health outcomes such as unemployment rates, gross national product, obesity rates, morbidity, and life expectancy. Indices are aggregated measures of several indicators and are used to describe the performance of an institution or sector. Inputs The type and level of resources required—such as people, time, and money—to support, implement, and sustain program activities. Institutional Outcomes Changes in organizational cultures, norms, policies, and procedures related to dietary patterns and physical activity behaviors. An example of an institutional outcome is the development or expansion of a company’s employee wellness program to incorporate obesity prevention into its activities. Integrated Marketing A planning process designed to ensure that all promotional activities, including media advertising, direct mail, sales promotion, and public relations, produce a unified, customer-focused promotion message that is relevant to a customer and that is consistent over time. Intervention A policy, program, or action intended to bring about identifiable outcomes. Land Use The way in which land is used, including for residential, commercial, industrial, or mixed-use development or for the preservation of open spaces, including parks and agricultural land. Leisure Screen Time The total amount of time spent using electronic media during one’s free time. It includes exposure to television, DVDs, videos, videogames, movies, and computers.

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Progress in Preventing Childhood Obesity: How Do We Measure Up? Life Course Perspective How health status at any given age or for a given birth cohort reflects both contemporary conditions and prior living circumstances, from the time in utero throughout the life course. A life course perspective acknowledges that over time individuals have developmental trajectories (both biological and social) that are shaped by society’s social, economic, political, technological, and ecological contexts. Longitudinal Survey A survey that examines the specific characteristics of individuals, sub-groups, or populations over time. Marketing An organizational function and a set of processes for creating, communicating, and delivering value to customers and for managing customer relationships in ways that benefit an organization and its stakeholders. Marketing encompasses a wide range of activities, including market research; analyzing the competition; positioning a new product; pricing products and services; and promoting products and services through advertising, consumer promotion, trade promotions, public relations, and sales. Measured Media The categories tracked by media research companies, including television (e.g., network; spot; and cable, syndicated, and Spanish-language networks), radio (e.g., network, national spot, and local), magazines (e.g., local and Sunday magazines), business publications, newspapers (e.g., local and national newspapers), outdoor, direct mail, the yellow pages, and the Internet. Mediator The mechanism by which one variable affects another variable. Mixed-Method Design Uses methodologies drawn from a variety of disciplines and both qualitative and quantitative data gathering and analysis methods that combine extensive descriptions of context and the experiences of program participation with standardized assessments of changes in institutions or systems, the environment, and individual or population behaviors. Moderator A variable that changes the impact of one variable on another. Monitoring The collection and analysis of data as a program, intervention, or policy progresses to ensure the integrity of its planned implementation. Multifaceted Interventions Interventions that involve more than one component that are delivered concurrently to a target group in combination.

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Progress in Preventing Childhood Obesity: How Do We Measure Up? National School Lunch Program The National School Lunch Program (NSLP) is a federally funded meal program established in 1946 that operates in public and nonprofit private schools and residential child-care institutions. NSLP provides nutritionally balanced, reduced-cost, or free lunches to children every school day. Natural Experiment Naturally occurring circumstances in which different populations are exposed or not exposed to a potential causal factor or intervention such that the circumstances resemble a true experiment in which study participants are assigned to exposed and unexposed groups. Nutrient Density The amount of nutrients that a food contains per unit volume or mass. Nutrient density is independent of energy density, although, in practice, the nutrient density of a food is often described in relationship to the food’s energy density. Nutrition Facts Panel Standardized detailed information on the nutrient contents and serving sizes of nearly all packaged foods sold in the U.S. marketplace. The panel was designed to provide nutrition information to consumers and was mandated by the Nutrition Labeling and Education Act of 1990. Obesity An excess amount of subcutaneous body fat in proportion to lean body mass. In adults, a body mass index (BMI) of 30 or greater is considered obese. In this report, obesity in children and youth refers to the age-and gender-specific BMI that is equal to or greater than the 95th percentile of the BMI charts of the Centers for Disease Control and Prevention (CDC). At-risk for obesity in children and youth is defined as a BMI for age and gender that is between the 85th and 95th percentiles of the CDC BMI curves. In most children, these values are known to indicate elevated body fat and to reflect the possibility of comorbidities associated with excessive body fatness. Obesogenic Environmental factors that may promote obesity and encourage the expression of a genetic predisposition to gain weight. Outcome The changes that result from a program’s activities and outputs. Depending on the nature of an intervention and the theory of change guiding it, an outcome can be short term, intermediate term, or long term. Indicators or indices are used to assess whether progress has been made toward achieving specific outcomes as a result of an intervention.

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Progress in Preventing Childhood Obesity: How Do We Measure Up? Outcome Evaluation An approach to assessing whether or not anticipated changes or differences have occurred as a result of an intervention. This type of evaluation assesses the extent of change in targeted attitudes, values, behaviors, policies, programs, environments, or conditions between the baseline measurement and subsequent points of measurement over time. Output The direct products of activities; usually, a tangible deliverable produced as a result of an activity. Examples of outputs include the number of people reached, the number of sessions conducted, the number of volunteers engaged, or the amount of educational materials distributed. Physical Activity Body movement produced by the contraction of skeletal muscles that results in energy expenditure above the basal level. Physical activity consists of athletic, recreational, housework, transport, and occupational activities that require physical skills and that use strength, power, endurance, speed, flexibility, range of motion, or agility. Policy A written statement reflecting a plan or course of action taken by a government, businesses, communities, or institutions that is intended to influence and guide present and future decisions. For a government, a policy may represent a law, regulation, ordinance, executive order, or resolution. Policy Maker An individual elected or appointed to office at some level of government; may include federal, state, and local executive branch chiefs of staff and staff assistants who often play central roles in the policy process. Population Health The state of health of an entire community or population as opposed to that of an individual. It is concerned with the interrelated factors that affect the health of populations over the life course and the distribution of the patterns of health outcomes. Portion Size The amount of food that an individual is served at home or away from home and that an individual chooses to consume for a meal or snack. Portions can be larger or smaller than the serving sizes listed on the food label or the Food Guide Pyramid. Poverty Guidelines A simplified version of the federal poverty thresholds issued annually in the Federal Register by the U.S. Department of Health and Human Services. They are used for administrative purposes such as determining financial eligibility of individuals and households for federal programs, including the Medicaid, Food Stamps, the Special Supplemental

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Progress in Preventing Childhood Obesity: How Do We Measure Up? Nutrition Program for Women, Infants, and Children (WIC), and the school nutrition programs. Poverty Thresholds Used to calculate all official poverty population statistics, such as data on the number of Americans living in poverty each year. Poverty thresholds are updated each year by the U.S. Bureau of the Census. Precursor Something that precedes and indicates, suggests, or forecasts something to come; a factor in a stage or a process that precedes a later stage. Prevalence The number of instances of a condition or a disease in a population at a designated period of time; usually expressed as a percentage of the total population. Prevention With regard to obesity, primary prevention represents avoiding the occurrence of obesity in a population, secondary prevention represents the early detection of disease through screening with the purpose of limiting its occurrence, and tertiary prevention involves preventing the sequelae of obesity in childhood and adulthood. Process Evaluation The means of assessing strategies and actions to reveal insights into the extent to which implementation is being carried out in accordance with expected standards and the extent to which a given action or strategy is working as planned. Program An integrated set of planned strategies and activities that support clearly stated goals and objectives that lead to desirable changes and improvements in the well-being of people, institutions, or environments, or all of these. Promising Practice An intervention that is likely to reduce childhood obesity and that has been reasonably well evaluated but for which there is a lack of sufficient evidence to provide a level of certainty that the intervention may be linked to reducing the incidence or prevalence of childhood obesity and related comorbidities. Promotion The means by which a business or company communicates with its target audience or customers to inform, persuade, or influence customers’ purchase decisions. Proprietary Privately owned and operated; something that is held under patent, trademark, or copyright by a private person or company.

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Progress in Preventing Childhood Obesity: How Do We Measure Up? Proprietary Data Information obtained from private companies or firms that hold the exclusive rights to distribute the information or data which are often collected for specific commercial purposes intended for a targeted audience. The information or data may be available to customers who can purchase it, and is usually not widely available to the broad public due to the expense. Protective Factors Conditions that build resilience to buffer the negative effects of potential risks, such as those that exist in an obesogenic environment. Public Health Program A coordinated set of complementary activities designed to produce desirable health outcomes. Public Relations A company’s communications and relationships with various groups, including customers, employees, suppliers, stockholders, governments, general public, and society. Public Service Announcement An advertisement or commercial that is carried by an advertising vehicle at no cost as a public service to its readers, viewers, or listeners; a promotional message for a nonprofit organization or for a social cause printed or broadcast at no charge by the media. Quality of Life The degree to which intellectual, spiritual, economical, social, and health pursuits are achieved and maintained. A person’s overall sense of well-being and a supportive environment when applied to a community. Quasi-Experimental An experiment in which the investigator lacks full control over the allocation or timing of the intervention. Quick Serve Restaurant A category of restaurants characterized by food that is supplied quickly after ordering and with minimal service. Foods and beverages purchased may be consumed at the restaurant or served as take-out. Race A socially defined population based on visible and genetically transmitted physical characteristics. A socially defined population based on visible and genetically transmitted physical characteristics. Randomized Controlled Trial A study design in which a group of patients is randomized into an experimental group and a control group. The groups are monitored for the variables or outcomes of interest.

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Progress in Preventing Childhood Obesity: How Do We Measure Up? Reliability Assessment of the extent to which the same measurement technique, applied repeatedly, is likely to yield the same results. Resolution A formal expression of the will, opinion, or direction of one or both houses of the legislature on a matter of public interest. Joint and concurrent resolutions are voted on by both houses but require no action on the part of the governor. Resolutions tend to be temporary in nature and do not have the support of law. Risk Factor A condition that increases the possibility that an individual, group, community, or population may experience a problem, such as the incidence or prevalence of obesity. Safety The condition of being either protected from or unlikely to cause danger, risk, or injury that may be either perceived or objectively defined. Sales Promotion Marketing activities other than advertising, personal selling, and publicity that stimulate consumer purchases at the point-of-sale such as a display, product demonstration, trade show, contest, coupon, premium, prize, toy, or price discount. Also called consumer promotion. School Breakfast Program A federally administered program that provides cash assistance to states to operate breakfast programs in U.S. schools and residential child-care institutions. School Meal Initiative for Healthy Children A program launched by the U.S. Department of Agriculture in 1995 to improve the nutritional quality of school lunches and breakfasts. Screen Time The number of hours that a child or adolescent spends watching various types of electronic media (e.g., broadcast and cable television, video, digital video disc, movie, or computer) per day, week, month, or year. It may be for either leisure or educational purposes. Sector A distinct subset of a market, society, industry, or the economy in which the members share similar characteristics. Examples of the sectors described in this report include government or the public sector; communities, including nonprofit and philanthropic organizations; health care; business or the private sector; schools; and home. Sedentary A way of living or a lifestyle that requires minimal physical activity and that encourages inactivity through limited choices, disincentives, or structural or financial barriers.

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Progress in Preventing Childhood Obesity: How Do We Measure Up? Serving A standardized unit of measure used to describe the total amount of food from each of the food groups from MyPyramid recommended to be consumed daily or a specific amount of food that contains the quality of nutrients listed on the Nutrition Facts panel. This may differ from “portion size,” which represents the amount of food that an individual is served at home or away from home and chooses to consume for a meal or snack. Social Determinants In regard to health, both the specific features of and the pathways by which societal conditions affect health and can be potentially altered by actions. Social Marketing The application of commercial marketing principles to the analysis, planning, implementation, and evaluation of programs designed to influence voluntary behavioral changes in target audiences to improve their personal welfare and for the benefit of society. Social Norms A set of beliefs and behaviors characteristic of a group, community, or society. Social Outcomes Changes in social attitudes and norms that are related to dietary and physical activity behaviors that support healthy lifestyles. Stakeholder A person or organization that is invested in a policy or program or interested in the results of an evaluation. Strategy A set of actions taken to achieve a goal. Structural Outcomes Policies, laws, and resources that have been developed, implemented, or revised to bring about changes in the dietary patterns and physical activity levels of children, youth, and their families. Examples of structural outcomes include policies that mandate physical education in all public schools, policies that restrict the types of competitive foods that may be sold in schools, and laws that require nutrition labeling in full serve and quick serve restaurants. Surveillance The systematic collection, analysis, interpretation, and dissemination of data to assist in the planning, implementation, and evaluation of public health policies, programs, and interventions. Sustainability The likelihood that a program will continue over a period of time after grant funding has ended. In broader terms, society’s ability to shape its economic and social systems to maintain both natural resources

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Progress in Preventing Childhood Obesity: How Do We Measure Up? and human life. Sustainability improves quality of life in the present while ensuring continued prosperity in the future. Systemic Outcomes Eating and physical activity environments and health systems to which changes have been made in the way that they are organized and delivered. Examples of systemic outcomes include changes in the mission of a community health center to include obesity prevention responsibilities or changes in health insurance policies to include obesity prevention activity-related expenses. These also include changes in social norms regarding obesity-related behaviors. Systems Approach An approach that views a phenomenon and its components in its entirety and that emphasizes the interactions and connectedness of the components to understand the entire system. A systems approach acknowledges that individuals and families are embedded within broader social, political, and economic systems that shape behaviors and constrain access to resources necessary to maintain health. Target Population A group of individuals at risk to whom a policy, program, or intervention is designed to reach. Technical Assistance Services provided by program staff that are intended to provide guidance to individuals, institutions, or communities to conduct, strengthen, or enhance obesity prevention activities, such as implementing, monitoring, or evaluating programs and interventions. Technical Capacity The specific expertise or skills required for program planning, implementation, monitoring, and evaluation. Triangulation The application and combination of several research methodologies (e.g., focus groups, interviews, participant observation, and content analysis of documents) to study a phenomenon. By combining multiple observers, theories, methods of data collection, and empirical approaches, researchers can address intrinsic biases that emerge from a single method and a single-observer study. Triangulation is often used to establish the credibility of qualitative analyses, in contrast to the reliability and validity of quantitative analyses. Unhealthfulness The quality of promoting poor health. Unmeasured Media The difference between a company’s reported or estimated advertising costs and its measured media spending. Unmeasured

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Progress in Preventing Childhood Obesity: How Do We Measure Up? 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.