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Factors that relate to overweight and obesity in preschool children: An Investigation of Preschool Children in San Luis Obispo County Kyla Tom In the United States the trend towards overweight and obesity has been a major health concern as it has been linked to a variety of health problems. A nation-wide initiative, “Let’s Move” created by Michelle Obama was launched in February 2010 with the goal that, in one generation; every child born will be at a healthy weight at the start of adulthood. Healthy People 2020 are national health objectives for the United States to obtain by 2020. In 2009, San Luis Obispo (SLO) County preschool children overweight and obesity rates mirrored national rates of 1 in 5 four-year-old children were obese (Tom, Rivera, Ravalin, and Jankovitz, 2009). The goal of this study was to assess the 2010 prevalence of overweight or ≥ 85 th percentile (OW) and obesity or ≥ 95 th percentile (OB) among preschool children in SLO County, compare the results to 2006 and to identify if there were associations to demographic, lifestyle and parental factors. A total of 474 preschool children (4.54  0.65 years) from 24 preschools participated in the physical assessments. A questionnaire was given to parents or guardians whose child completed the physical assessment to determine demographic, lifestyle and parental factors related to OW/OB (Head Start preschools did not participate in the questionnaire portion). There was a 50% response rate for the questionnaires. FACTORS THAT RELATE TO OVERWEIGHT AND OBESITY v The results concluded that almost 1/3 of the preschool children were OW/OB, and about half of these children were OB. The Hispanic/Latino preschool children were twice as likely to be OW/OB as NW when compared to White children. Children attending a State preschool were 2.11 times more likely to be OW/OB versus NW than children attending a private preschool. Child health insurance plan, child birth weight, milk intake and parental BMI were found to be significant in effecting weight classification. When comparing 2006 to 2009/10, year, type of preschool and year (2006 or 2009/10) by ethnicity interaction were significant in determining weight class. There was greater than a 30% increase in the prevalence of OW/OB in preschool children from 2006 to 2009/2010, suggesting that current programs and funding are not sufficient in reducing the OW/OB prevalence of preschool children in SLO County. Repeating this study every three years will provide information that could be helpful to the community, public health services, and the medical field in SLO County in the prevention of overweight, obesity and health complications that are related. FACTORS THAT RELATE TO OVERWEIGHT AND OBESITY vi Acknowledgements First, I would like to express my appreciation to my committee chair, Dr. Kris Jankovitz, for all the time, energy and effort put into this thesis. Thank you for guiding me through. Second, I would like to thank my committee members, Dr. Ann McDermott and Dr. Suzanne Phelan. Their help and advice during my thesis were invaluable. Thank you for always leaving your door open. Third, I would like to thank Dayna Ravalin at the Public Health Department of San Luis Obispo County. I appreciate the help in contacting the preschools and giving me advice throughout this thesis. Fourth, I am grateful for the wonderful statistics department, especially Dr. Karen McGaughey and Scott Goodell. Thank you for making time in your busy schedules to run the analyses and help me with statistical questions. Fifth, I cannot thank my family enough for their support through my thesis. They kept me motivated to finish and have always believed in me. Mom, Dad, Cheryl, Darryl, Yeh-Yeh, Yin-Yin, and Bachan, thank you. I would especially like to thank my Dad for helping me with the formatting of this paper. It was long and tedious, but it looks great now. And thank you to my friends, Kasey Wong, Katie Stoddard, Danielle Dudley, Kristina Wong, Christie O’Hare, Jamie Benett, and the A-Team who gave up their time to help me when I needed it the most. I appreciate it more than I can express. FACTORS THAT RELATE TO OVERWEIGHT AND OBESITY vii Table of

Factors that Relate to Overweight and Obesity in Preschool Children: An Investigation of Preschool Children in San Luis Obispo County