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The behavioral risk factor that I selected from the Healthy People 2020 objectives is overweight and obesity among children and adolescents (ages 6 through 19), which has increased significantly over the last three decades (Knickman & Kovner, 2015). Currently, only 36% of Floridians are at healthy weight, and if we stay on our current trend, by 2030, almost 60% will be obese (Florida Health, 2017). Additionally, six out of ten children born today will be obese by the time they graduate from high school (Florida Health, 2017). Five areas in which reform is critically needed in order to prevent obesity are creating safe environments for physical activity, healthy food and beverage choices, message environments, and health care, work and school environments (Knickman & Kovner, 2015). The population-based intervention model describes downstream, midstream and upstream interventions for preventing overweight and obesity among children and adolescents (Knickman & Kovner, 2015).

A downstream health prevention program focuses on changing behaviors at an individual level, rather than preventing risk behaviors (Knickman & Kovner, 2015). Given parents’ influence and control over their children’s diet, physical activity, media use, and sleep, family interventions are a key strategy in the effort to eliminate childhood obesity (Ash, Agaronov, Young, Aftosmes-Tobio & Davison, 2017). An example of a downstream intervention that would be effective is to provide a hand-out for parents and children through the school with helpful tips on reducing screen time, suggestions for healthy food swaps (having an apple instead of chips after school) and suggestions for easy ways to incorporate exercise into your day, such as go for a walk as a family for 20-30 minutes after school each day.

A midstream health prevention program focuses on changing behaviors at a community level, with health promotion programs that are targeted at populations to change or prevent risk factors (Knickman & Kovner, 2015). An example of a midstream intervention that would be effective is to provide school-based sports and physical activity to children each day. Two main individual behavior determinants of health are diet and physical activity (ODPHP, 2018). The school would provide coaches and equipment for children to participate in sports who may not have the ability to otherwise in their home environment.

An upstream health prevention program focuses on developing policies at state and national levels in order to reduce the promotion of unhealthy products and behaviors (Knickman & Kovner, 2015). An example of an effective upstream intervention is the great efforts made in the public-school system to improve the quality of food provided in school lunches, and to eliminate the availability of junk-food to kids. In April 2014, the US Department of Agriculture (USDA) issued new regulations, which took effect in July 2014, banning the sale of all junk-food in schools (Ballaro & Griswold, 2018). The regulations stated that only fruits, vegetables, dairy products, lean-protein foods, and whole-grain items could be sold in cafeterias or vending machines, limiting the maximum calorie count of 200 for snacks and 350 for entrées (Ballaro & Griswold, 2018). Foods containing trans-fats could not be sold, and drinks could contain no more than 35% sugar or fat, and must be limited to water, low- or no-fat milk, and 100% fruit or vegetable juice (Ballaro & Griswold, 2018).


Ash, T., Agaronov, A., Young, T., Aftosmes-Tobio, A., & Davison, K. (2017). Family-based childhood obesity prevention interventions: a systematic review and quantitative content analysis. International Journal of Behavioral Nutrition & Physical Activity, 14(1), 1-12. doi:10.1186/s12966-017-0571-2

Ballaro, B., & Griswold, A. (2018). Junk food in schools. Salem Press Encyclopedia. Retrieved from

Florida Health. (2017). Healthy weight. Retrieved from

Knickman, J. R., & Kovner, A. R. (Eds.). (2015). Health care delivery in the united states (11th ed.). New York, NY: Springer Publishing.

Office of Disease Prevention and Health Promotion. (2018). Determinants of health. Retrieved from

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