INTRODUCTIONObesity is rapidly becoming one of the most critical health threats facing the United States. Rates of obesity among adults and children have increased at an alarming rate over the past four decades. Currently, 63% of US adults (1) and more than 33% of children and adolescents (2) may be classified as overweight or obese. The short-and long-term health implications of this epidemic are being considered with alarm by health professionals and policy experts. Among adults, obesity is linked to cardiovascular disease, hypertension, type 2 diabetes, osteoporosis, and some cancers. Even more alarming, children are being diagnosed with health problems previously considered to be "adult" conditions. Obese children are at greater risk than their normal-weight peers for type 2 diabetes, hypertension, high cholesterol, and orthopedic problems (3-5). The complications associated with these conditions, if unchecked, will follow this cohort of children, their health-care providers, and their health-care funders, with many more years of increased rates of morbidity and preventable mortality than preceding generations of children.Numerous experts, including the Institute of Medicine, have suggested that schools provide a unique venue within which to address childhood obesity (6-8). Schools provide access to large numbers of children each year, and children spend a significant portion of their time each weekday, each week, and over their lives in school (8). Further, schools provide daily meals for students; estimates are that more than a third of children's total energy intake occurs at school (9,10). In addition, schools provide health, nutrition, and physical education, all opportunities to teach and model healthy eating and physical activity practices that can help children establish healthy lifestyle practices (8,11,12). The importance of school-based obesity prevention programs grows as children and youth spend more time in school buildings, participating in preschool, before-school, and after-school programs at unprecedented rates (11,12).Schools are responding to concerns over childhood obesity by changing policies related to vending machine availability and contents, measuring and reporting BMI to parents, cafeteria selections and food preparation methods, and physical education requirements (6). Many of these changes are the result of local initiatives; others are being implemented because of statewide legislation, and the quantity and diversity are sufficiently great that the various initiatives are difficult,

In response to a nationwide rise in obesity, several states have passed legislation to improve school health environments. Among these was Arkansas's Act 1220 of 2003, the most comprehensive school-based childhood obesity legislation at that time. We used the Multiple Streams Framework to analyze factors that brought childhood obesity to the forefront of the Arkansas legislative agenda and resulted in the passage of Act 1220. When 3 streams (problem, policy, and political) are combined, a policy window is opened and policy entrepreneurs may advance their goals. We documented factors that produced a policy window and allowed entrepreneurs to enact comprehensive legislation. This historical analysis and the Multiple Streams Framework may serve as a roadmap for leaders seeking to influence health policy.

HIV prevalence has increased faster in the southern USA than in other areas, and persons living with HIV (PLWHIV) in the south are often rural, impoverished, or otherwise under-resourced. Studies of urban PLWHIV and those receiving medical care suggest that use of social services can enhance quality of life and some medical outcomes, but little is known about patterns of social service utilization and need among rural southern PLWHIV. The AIDS Alabama needs assessment survey, conducted in 2007, sampled a diverse community cohort of 476 adult PLWHIV representative of the HIV-positive population in Alabama (66% male, 76% Black, and 26% less than high school education). We developed service utilization/need (SUN) scores for each of 14 social services, and used regression models to determine demographic predictors of those most likely to need each service. We then conducted an exploratory factor analysis to determine whether certain services clustered together for the sample. Case management, assistance obtaining medical care, and financial assistance were most commonly used or needed by respondents. Black respondents were more likely to have higher SUN scores for alcohol treatment and for assistance with employment, housing, food, financial, and pharmacy needs; respondents without spousal or partner relationships had higher SUN scores for substance use treatment. Female respondents were more likely to have higher SUN scores for childcare assistance. Black respondents and unemployed respondents were more likely to have SUN scores in the highest quartile of the overall score distribution. Factor analysis yielded three main factors: basic needs, substance use treatment, and legal/medical needs. These data provide important information about rural southern PLWHIV and their needs for ancillary services. They also suggest clusters of service needs that often occur among PLWHIV, which may help case managers and other service providers work proactively to identify important gaps in care.