Implementation of a school-based state policy to increase physical activity*

Associations Between State Laws Governing Recess Policy with Children's Physical Activity and Health

BACKGROUND

State-level laws governing recess policies vary widely across the United States. We characterize the presence of such laws and assess their associations with child-level outcomes.

METHODS

The presence of a state recess law was determined using the Classification of Laws Associated with School Students (CLASS) database. Parents of 6- to 11-year-old children reported physical activity, overall health, school absences, school-related problems, and ability to make/keep friends as part of the National Survey of Children's Health (NSCH). Logistic regression was used to compare outcomes in states with and without recess laws cross-sectionally in 2018 and between 2003 and 2011/2012 using a difference-in-differences analysis.

RESULTS

In 2018, 20 states had a law recommending or requiring recess. Cross-sectionally, the odds of being physically active every day (odds ratio, 95% confidence interval: 2.8, 1.2-6.5) and having no difficulty making or keeping friends (2.9, 1.2-7.2) were significantly higher for children residing in states with versus without a recess law. There were no significant associations in the difference-in-differences model.

CONCLUSIONS

Significant cross-sectional associations in 2018 were not confirmed by a difference-in-differences analysis of two waves of the NSCH. Short follow-up time and the apparent weakness of existing state laws warrant further assessment of state-level recess law.

A systematic review of school health policy measurement tools: implementation determinants and outcomes

BACKGROUND

Governments in some countries or states/provinces mandate school-based policies intended to improve the health and well-being of primary and secondary students and in some cases the health of school staff. Examples include mandating a minimum time spent per week in programmed physical activity, mandating provision of healthy foods and limiting fat content of school meals, and banning tobacco products or use on school campuses. Although school health researchers have studied whether schools, districts, or states/provinces are meeting requirements, it is unclear to what extent implementation processes and determinants are assessed. The purposes of the present systematic review of quantitative measures of school policy implementation were to (1) identify quantitative school health policy measurement tools developed to measure implementation at the school, district, or state/provincial levels; (2) describe the policy implementation outcomes and determinants assessed and identify the trends in measurement; and (3) assess pragmatic and psychometric properties of identified implementation measures to understand their quality and suitability for broader application.

METHODS

Peer-reviewed journal articles published 1995-2020 were included if they (1) had multiple-item quantitative measures of school policy implementation and (2) addressed overall wellness, tobacco, physical activity, nutrition, obesity prevention, or mental health/bullying/social-emotional learning. The final sample comprised 86 measurement tools from 67 peer-review articles. We extracted study characteristics, such as psychometric and pragmatic measure properties, from included articles based on three frameworks: (1) Implementation Outcomes Framework, (2) Consolidated Framework for Implementation Research, and (3) Policy Implementation Determinants Framework.

RESULTS

Most implementation tools were developed to measure overall wellness policies which combined multiple policy topics (n = 35, 40%) and were in survey form (n = 75, 87%). Fidelity was the most frequently prevalent implementation outcome (n = 70, 81%), followed by adoption (n = 32, 81%). The implementation determinants most assessed were readiness for implementation, including resources (n = 43, 50%), leadership (n = 42, 49%), and policy communication (n = 41, 48%). Overall, measures were low-cost and had easy readability. However, lengthy tools and lack of reported validity/reliability data indicate low transferability.

CONCLUSIONS

Implementation science can contribute to more complete and rigorous assessment of school health policy implementation processes, which can improve implementation strategies and ultimately the intended health benefits. Several high-quality measures of implementation determinants and implementation outcomes can be applied to school health policy implementation assessment. Dissemination and implementation science researchers can also benefit from measurement experiences of school health researchers.

Essential Components of Physical Education: Policy and Environment

Purpose: Physical education policies provide guidance and accountability to develop quality programs that increase physical literacy. The purpose of this study was to conduct a systematic review of physical education policy research to explore its effects on the school environment and programming as an essential component of physical education. Methods: Using the PRISMA guidelines of identify, screen, determine eligibility, and include, studies were extracted from four different databases, using search terms related to the essential physical education component of policy and environment. Of the 225 publications identified, 42 studies met the inclusion criteria for this investigation. Each paper was coded, and emergent themes were identified. Results: The policy research was predominantly descriptive and focused on: (a) minutes in physical education (83%), (b) moderate to vigorous physical activity (MVPA; 31%), (c) certified/qualified teachers (24%), (d) exemptions (17%), and (e) student-teacher ratio (12%). Emergent themes of adherence, policy strength, and implementation accountability were identified as influential physical education policy aspects. Conclusions: Policy research over the last 20 years was focused on the regulatory mandate of time. Policy research did not directly address disciplinary process variables of learning activities or outcomes of physical education. The effects of policy exemptions and class size were underrepresented. Themes may explain the lack of reporting student performance as the primary outcome. Further research is needed to examine the downstream effects of physical education policy and determine whether well-written policies increase the number of physically literate individuals.

State laws governing school physical education in relation to attendance and physical activity among students in the USA: A systematic review and meta-analysis

BACKGROUND

This study systematically synthesized and quantified the relationship linking state laws governing school physical education (PE) to PE attendance and physical activity (PA) in class and throughout the day and week among students in the USA.

METHODS

A keyword search was performed in PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Complete, and EconLit. Meta-analyses were performed to estimate the effects of state PE laws.

RESULTS

A total of 17 studies were included in the review, and five contributed to the meta-analyses. A total of 8 studies used nationally representative school- or student-level data, three focused on multiple states, and the remaining six examined the PE laws of a single state. The presence and strength of state PE laws were positively associated with PE attendance and the frequency and duration of PA during PE classes and throughout the school day. Compared to those residing in states with weak or no PE laws, students in states with strong PE laws had an additional 0.2 days (95% confidence interval (95%CI): 0.1-0.4) of PE attendance per week and spent an additional 33.9 min (95%CI: 22.7-45.0) participating PE classes per week. State PE laws affected girls' PA more than boys'. Different aspects of state PE laws tended to affect students' PE attendance differently. Disparities in the implementation of state PE laws existed across schools.

CONCLUSION

Future studies should adopt objective measures on PE and PA participation and examine the roles schools and districts play in mediating the effect of state PE laws on students' PE attendance and PA.

Implementation of Physical Activity in US Elementary Schools: The Role of Administrative Support, Financial Resources, and Champions

The intentional integration of physical activity in elementary school classrooms-including brief instructional breaks for activity, or integration into lessons-can benefit children's physical activity and education outcomes. Teachers are key implementation agents, but despite physical activity in the classroom being an evidence-informed practice, many teachers do not regularly implement it. The aim of this study was to obtain updated nationally representative prevalence estimates in United States public elementary schools, regarding four key outcomes: (1) school adoption of physically active lessons (PA lessons); (2) school adoption of physical-activity breaks (PA breaks); (3) penetration in the classroom, defined as ≥50% of teachers using PA breaks; and (4) dose, defined as an average of at least 50 min per week of PA breaks. We examined variations in outcomes by school demographic characteristics, and by three factors hypothesized to be implementation facilitators (administrative support, financial resources, and presence of a wellness champion at the school). In the 2019-20 school year, surveys were distributed to a nationally representative sample of 1010 public elementary schools in the US; responses were obtained from 559 (55.3%). The weighted prevalence of schools reporting adoption of PA lessons was 77.9% (95% CI = 73.9% to 81.9%), and adoption of PA breaks was nearly universal at 91.2% (95% CI = 88.4% to 94.1%). Few demographic differences emerged, although adoption of PA lessons was less prevalent at higher-poverty schools (73.9%) and medium-poverty schools (77.0%) as compared to schools with lower poverty levels (87.1%; p < 0.01). Across all four outcomes, associations emerged with facilitators in multivariable logistic regression models. The prevalence of adoption of PA lessons, adoption of PA breaks, and dose of PA breaks were all significantly higher at schools where administrative encouragement occurred more frequently. Financial support was associated with implementation outcomes, including adoption of PA lessons, and penetration and dose of PA breaks. Presence of a champion was associated with higher prevalence of reporting adoption of PA lessons. School leaders can play a crucial role in supporting teachers' implementation of PA breaks and lessons in the classroom, through providing financial resources, encouragement, and supporting champions. Effective school-leadership practices have the potential to positively impact students at a large-scale population level by supporting implementation of PA lessons and breaks.

Evaluating the implementation of the SWITCH® school wellness intervention and capacity-building process through multiple methods

Background

School wellness programming is important for promoting healthy lifestyles and academic achievement in youth; however, research is needed on methods that can help schools implement and sustain such programs on their own. The purpose of this study was to investigate factors within and outside the school environment that influenced school capacity for implementation and potential sustainability of wellness programming.

Methods

As part of the School Wellness Integration Targeting Child Health (SWITCH®) intervention, elementary school wellness teams (N = 30) were guided through a capacity-building process focused on promoting the adoption of healthy lifestyle behaviors in students. Data on implementation were collected through three standardized surveys and interviews (pre-mid-post) and a post-implementation interview. Indicators of organizational capacity were assessed using the School Wellness Readiness Assessment (SWRA). Paired t-tests were run to assess changes in implementation (classroom, physical education, and lunchroom settings), capacity, and stakeholder engagement over time. One-way analysis of variance (ANOVA) tests were run to examine how implementation of best practices (low, moderate, high) explained differences in capacity gains. Qualitative data were analyzed through inductive and deductive analysis, following the Consolidated Framework for Implementation Research (CFIR).

Results

Paired t-tests showed non-significant increases in school and setting-specific capacity and implementation of SWITCH best practices over time, in addition to a consistent level of engagement from key stakeholders. ANOVA results revealed non-significant associations between implementation group and gains in school capacity (F [2, 24] = 1.63; p = .21), class capacity (F [2, 24]=0.20 p = .82), lunchroom capacity (F [2, 24]=0.29; p = .78), and physical education (F [2, 24]=1.45; p = .25). Qualitative data demonstrated that factors within the outer setting (i.e., engaging community partners) facilitated programming. Inner-setting factors (i.e., relationships with administration and staff) influenced implementation. Implementation process themes (e.g., planning, adaptation of resources to meet school capacity/needs, and engaging students as leaders) were cited as key facilitators. Schools discussed factors affecting sustainability, such as school culture and knowledge of school wellness policy.

Conclusions

The results from this implementation study document the importance of allowing schools to adapt programming to meet their local needs, and highlight the strengths of measuring multiple implementation outcomes. Increased support is needed for schools regarding the formation and improvement of wellness policies as a means to enhance sustainability over time.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-020-01070-y.

Elementary Classroom Teachers' Self-Reported Use of Movement Integration Products and Perceived Facilitators and Barriers Related to Product Use

Movement integration (MI) products are designed to provide children with physical activity during general education classroom time. The purpose of this study was to examine elementary classroom teachers' self-reported use of MI products and subsequent perceptions of the facilitators of and barriers to MI product use. This study utilized a mixed-methods design. Elementary classroom teachers (n = 40) at four schools each tested four of six common MI products in their classroom for one week. Teachers completed a daily diary, documenting duration and frequency of product use. Following each product test, focus groups were conducted with teachers to assess facilitators and barriers. MI product use lasted for 11.2 (Standard Deviation (SD) = 7.5) min/occasion and MI products were used 4.1 (SD = 3.5) times/week on average. Activity Bursts in the Classroom for Fitness, GoNoodle, and Physical Activity Across the Curriculum were most frequently used. Facilitators of and barriers to MI product use were identified within three central areas-logistics, alignment with teaching goals, and student needs and interests. Teachers were receptive to MI products and used them frequently throughout the week. When considering the adoption of MI products, teachers, administrators, and policy makers should consider products that are readily usable, align with teaching goals, and are consistent with student needs and interests.

Adolescent Physical Activity at Public Schools, Private Schools, and Homeschools, United States, 2014

INTRODUCTION

Physical activity overall and during school-related opportunities among homeschool adolescents are poorly documented.

METHODS

We used data from the National Cancer Institute's Family Life, Activity, Sun, Health, and Eating (FLASHE) study, a national sample of parent-child dyads. We examined reported frequency of physical activity in middle-school and high-school respondents (N = 1,333). We compared the overall physical activity by school type (ie, public school, private school, and homeschool), compared school-related contexts (eg, recess, physical education [PE] class), and tested for level of physical activity by school for those reporting PE.

RESULTS

Middle-school homeschool adolescents reported less physical activity during school hours compared with public school, but not private school, adolescents. Physical activity was not different by school type for out of school or weekends. Physical activity of high-school homeschool adolescents was not different from that of high-school adolescents at traditional schools; homeschool adolescents in both middle and high school reported less physical activity in PE compared with public and private school adolescents. Other school-related contexts of physical activity were not different by school type. More homeschool students reported not having PE (middle school, 54.8%; high school, 57.5%) compared with public (middle school, 18.7%; high school, 38.0%) or private schools (middle school, 13.5%; high school, 41.5%).

CONCLUSION

Homeschool adolescents in middle school reported less physical activity compared with middle-school adolescents in traditional schools during school hours, likely because of having fewer PE classes and less physical activity during PE.

Predictor Selection Using Lasso to Examine the Association of Motor Proficiency, Postural Control, Visual Efficiency, and Behavior With the Academic Skills of Elementary School-Aged Children

The associations between motor proficiency, postural control, and visual efficiency with teacher and parent ratings of children’s behavior and academic skills were examined among a sample of elementary school-aged children (N = 50). Teacher and parent ratings of students’ academic skills were analyzed separately to examine the predictive nature of measures of motor proficiency. Spearman rank order correlations reported low to moderate relationships between motor proficiency, postural control, and children’s behavior (e.g., ADHD inattention) and academic skills. The least absolute shrinkage and selection operator (lasso) procedure is demonstrated as an approach for variable selection of measures of children’s motor proficiency, postural control, and visual efficiency to predict academic skills. For teacher and parent ratings of academic skills, ADHD symptom of inattention was the strongest model predictor, whereas directional control (postural control) was also a predictor for parent ratings. Study findings shed light on practical and methodological factors associated with motor skills in educational contexts.

Comprehensive Policies to Support Comprehensive Practices: Physical Activity in Elementary Schools

BACKGROUND

Schools are a setting in which students learn about the importance of lifelong physical activity (PA). Best practice guidelines indicate that schools should provide students with adequate physical education (PE) minutes and opportunities to engage in PA throughout the school day.

METHODS

Data from the nationally representative School Nutrition and Meal Cost Study in 2014-2015 were utilized to assess PA practices (including PE) at 412 public elementary schools. These data were linked to state- and district-level policy data from the National Wellness Policy Study to examine the relationships between state law and school district policies and school practices.

RESULTS

Just over half of the schools were in a state with a policy regarding PE minutes. The comprehensiveness and strength of PA policies were higher at the district level than the state level, but were still low overall. Comprehensiveness of PA policies at the state level, but not at the district level, was related to schools within those states that provide more PA practices.

CONCLUSIONS

Existence of PE and PA policies at the state level appears to be an important predictor of school PA practices. Having more comprehensive policies at the state level may be an important facilitator of school implementation of comprehensive PA practices.

High School Physical Activity and Nutrition Policy: Summarizing Changes Over Time Using Latent Class Analysis

INTRODUCTION

High school physical activity and nutrition policies can substantially affect student behavior and outcomes. Although public health officials and legislators have advocated for policy improvements, the extent to which policies have changed at local levels is not well understood. This study identifies latent classes of physical activity and nutrition policy environments and explores changes in prevalence of these classes from 2000 to 2016.

METHODS

Data from the School Health Policies and Practices Study, a repeated cross-sectional survey from the Centers for Disease Control and Prevention administered at the school district level in 2000, 2006, 2012, and 2016, were analyzed in 2018. Using latent class analysis, policy environment subgroups were identified, described, and then dichotomized based on satisfaction in meeting recommendations. Associations of latent classes with year and urbanicity were evaluated using logistic regression.

RESULTS

Five latent classes were identified each for physical activity and nutrition policy environments, all with distinct characteristics. Physical activity policies improved from 2000 to 2006 (p<0.001) and then plateaued until 2016, whereas nutrition policies improved consistently from 2000 to 2016 (p<0.001, p=0.011, p<0.001). Though significant disparities between urban and rural school districts were found, these disparities narrowed during the studied years, particularly for physical activity policies.

CONCLUSIONS

The estimated proportion of school districts with satisfactory physical activity and nutrition policy environments increased from 2000 to 2016, possibly because of legislative and policy advocacy efforts. However, many areas for improvement remain. Unsatisfactory latent classes that remained prevalent though 2016 may highlight policy domains that should be targeted by future interventions or subject to further research.

Physical activity and screen time in out of school hours care: an observational study

BACKGROUND

This study aimed to describe, and identify predictors of, physical activity and screen time in children attending out of school hours care (OSHC).

METHOD

Twenty-three randomly selected OSHC centres (n = 1068 children) participated in this observational, cross-sectional study. Service directors completed interviews regarding policy, training, scheduling and equipment related to physical activity and screen time. Children's activity behaviours (moderate to vigorous physical activity (MVPA), light physical activity, sedentary time and screen time) were measured using standardised direct observation.

RESULTS

Directors' interviews revealed a lack of formal policy guiding physical activity and screen time. Time spent in activity behaviours varied widely among OSHC services; for example, average time spent in MVPA ranged from 4 to 49% of the session, time spent sedentary ranged from 31 to 79%, and screen time accounted for 0 to 41%. MVPA was inversely associated with total sedentary time (p < 0.001). Higher screen time was associated with OSHC services being larger in size (p = 0.04), offering screen activities on a daily basis (as opposed to less than daily; p = 0.001), offering screen activities prior to 5 pm (as opposed to offering screen activity 5 pm or later; p = 0.02), and having a larger number of screen devices available (p = 0.08).

CONCLUSION

Physical activity and screen time practices in OSHC services are currently ad hoc and variable. In future, development of guidelines, policy and intervention programs may help improve physical activity and screen time in the OSHC setting.

Impact of State Laws Governing Physical Education on Attendance Among US High School Students, 2003 to 2017

PURPOSE

This study assessed the influence of state laws governing physical education (PE) on weekly PE class attendance among US high school students.

DESIGN

Cross-sectional.

SETTING

2003 to 2017 US national Youth Risk Behavior Survey (YRBS).

PARTICIPANTS

A total of 533 468 high school students.

MEASURES

Data on state laws governing PE came from National Cancer Institute's Classification of Laws Associated with School Students (CLASS). Eight distinct state PE policies were scored, with higher scores denoting stronger laws.

ANALYSIS

Individual-level YRBS data were merged with CLASS data based on students' residential state and survey year. State fixed-effect negative binomial regressions were performed, adjusting for individual-level characteristics and YRBS survey design.

RESULTS

A 1-score increase in state laws governing PE class time, staffing for PE, joint use agreement for physical activity, assessment of health-related fitness, and PE curriculum was associated with an increase in weekly PE attendance by 0.30, 0.28, 0.22, 0.20, and 0.13 days (P < .001), respectively. In contrast, a 1-score increase in state laws governing moderate-to-vigorous-intensity physical activity time in PE, PE proficiency, and recess time was associated with a reduction in weekly PE attendance by 0.25, 0.15, and 0.09 days (P < .001), respectively. The effects of most state PE policies on PE class attendance were larger among girls than boys.

CONCLUSION

State PE policies differentially impacted US high school students' PE class attendance, with larger effects on female students.

The Association between Perceived Adequacy and Capacity for School Food Policy Implementation with Food Availability and Policy Adherence in Nova Scotia, Canada

Supporting the implementation of school food and nutrition policies is an international priority to encourage healthier eating among children and youth. Schools are an important intervention setting to promote childhood nutrition, and many jurisdictions have adopted policies, guidelines, and programs to modify the school nutrition environment and promote healthier eating. The purpose of this study was to explore the association between perceived adequacy of facilities or equipment and capacity of staff to support policy implementation with food availability and policy adherence in the province of Nova Scotia (NS), Canada, one of the first regions in Canada to launch a comprehensive school food and nutrition policy (SFNP). A cross-sectional online survey was conducted in 2014-2015 to provide a current-state assessment of policy implementation and adherence. Adequacy and capacity for food policy implementation was used to assess policy adherence through the availability of prohibited 'minimum' nutrition foods. An exploratory factor analysis was conducted on a selection of available foods, and 'slow'- and 'quick'-service food composition measures were dichotomized for food availability. Schools with above-average perceived adequacy and capacity for policy implementation had greater odds (OR = 3.62, CI = 1.56, 8.40) of adhering to a lunch policy, while schools that adhered to a snack and lunch policy had lower odds (OR = 0.48, CI = 0.23, 1.01 and OR = 0.18, CI = 0.08, 0.41) of serving quick-service foods. This study identified the need for appropriate adequacy of facilities or equipment and capacity of staff for policy implementation to ensure policy adherence and improve the school food environment. These findings highlight the relationship between school food and nutrition policies, suggesting that better supporting their implementation could increase the likelihood of their success.

Facilitators and Barriers to Movement Integration in Elementary Classrooms: A Systematic Review

PURPOSE

A systematic review was conducted to identify facilitators and barriers to movement integration (MI) in elementary school classrooms.

METHOD

Online databases (Educational Resources Information Center, Google Scholar, PsycINFO, and PubMed) served as data sources for the study. Following the PRISMA guidelines, relevant published research on MI was identified and screened for inclusion in a qualitative synthesis. Content analysis of the included articles (N = 28) was used to identify themes of MI facilitators and barriers. Facilitators and barriers were then categorized using a social-ecological framework.

RESULTS

A total of 12 themes of MI facilitators and barriers were identified and categorized into two social-ecological levels: institutional factors (e.g., administrative support, resources) and intrapersonal factors (e.g., teacher confidence, ease of implementation).

CONCLUSION

This review can inform research and practice aimed at supporting the implementation of MI in elementary classrooms.

Influence of school environments on childhood obesity in California

OBJECTIVE

To conduct a state-wide examination of public schools and the school neighborhood as potential targets for environmental public health tracking to address childhood obesity.

METHODS

We examined the relationship of social and physical environmental attributes of the school environment (within school and neighborhood) and childhood obesity in California with machine learning (Random Forest) and multilevel methods. We used data compiled from the California Department of Education, the U.S. Geological Survey, ESRI's Business Analyst, the U.S. Census, and other public sources for ecologic level variables for various years and assessed their relative importance to obesity as determined from the statewide Physical Fitness Test 2003 through 2007 for grades 5, 7, and 9 (n = 5,265,265).

RESULTS

In addition to individual-level race and gender, the following within and school neighborhood variables ranked as the most important model contributors based on the Random Forest analysis and were included in multilevel regressions clustered on the county. Violent crime, English learners, socioeconomic disadvantage, fewer physical education (PE) and fully credentialed teachers, and diversity index were positively associated with obesity while academic performance index, PE participation, mean educational attainment and per capita income were negatively associated with obesity. The most highly ranked built or physical environment variables were distance to the nearest highway and greenness, which were 10th and 11th most important, respectively.

CONCLUSIONS

Many states in the U.S. do not have school-based surveillance programs that collect body mass index data. System-level determinants of obesity can be important for tracking and intervention. The results of these analyses suggest that the school social environment factors may be especially important. Disadvantaged and low academic performing schools have a higher risk for obesity. Supporting such schools in a targeted way may be an efficient way to intervene and could impact both health and academic outcomes. Some of the more important variables, such as having credentialed teachers and participating in PE, are modifiable risk factors.

Motor Competence Levels and Prevalence of Developmental Coordination Disorder in Spanish Children: The MOVI-KIDS Study

BACKGROUND

Motor competence (MC) affects numerous aspects of children's daily life. The aims of this study were to: evaluate MC, provide population-based percentile values for MC; and determine the prevalence of developmental coordination disorder (DCD) in Spanish schoolchildren.

METHODS

This cross-sectional study included 1562 children aged 4 to 6 years from Castilla-La Mancha, Spain. MC was assessed using the Movement Assessment Battery for Children-Second Edition. Values were analyzed according to age, sex, socioeconomic status (SES), environment (rural/urban), and type of school.

RESULTS

Boys scored higher than girls in aiming and catching, whereas girls aged 6 scored higher than boys in balance. Children living in rural areas and those attending to public schools obtained better scores in aiming and catching than those from urban areas and private schools. The prevalence of DCD was 9.9%, and 7.5% of children were at risk of having movement problems.

CONCLUSION

Motor test scores can represent a valuable reference to evaluate and compare the MC in schoolchildren. Schools should identify motor problems at early ages and design initiatives which prevent or mitigate them.

Rural Active Living: A Call to Action

Rural residents are less physically active than their urban counterparts and disproportionately affected by chronic diseases and conditions associated with insufficient activity. While the ecological model has been successful in promoting and translating active living research in urban settings, relatively little research has been conducted in rural settings. The resulting research gap prohibits a comprehensive understanding and application of solutions for active living in rural America. Therefore, the purpose of this article was to assess the evidence base for an ecological model of active living for rural populations and outline key scientific gaps that inhibit the development and application of solutions. Specifically, we reexamined the 4 domains conceptualized by the model and suggest that there is a dearth of research specific to rural communities across all areas of the framework. Considering the limited rural-specific efforts, we propose areas that need addressing to mobilize rural active living researchers and practitioners into action.

Barriers and facilitators to the implementation of physical activity policies in schools: A systematic review

Research consistently indicates that schools fail to implement mandatory physical activity policies. This review aimed to describe factors (barriers and facilitators) that may influence the implementation of school physical activity policies which specify the time or intensity that physical activity should be implemented and to map these factors to a theoretical framework. A systematic search was undertaken in six databases for quantitative or qualitative studies published between 1995-March 2016 that examined teachers', principals' or school administrators' reported barriers and/or facilitators to implementing mandated school physical activity policies. Two independent reviewers screened texts, extracted and coded data from identified articles using the Theoretical Domains Framework (TDF). Of the 10,346 articles identified, 17 studies met the inclusion criteria (8 quantitative, 9 qualitative). Barriers and facilitators identified in qualitative studies covered 9 and 10 TDF domains respectively. Barriers and facilitators reported in quantitative studies covered 8 TDF domains each. The most common domains identified were: 'environmental context and resources' (e.g., availability of equipment, time or staff), 'goals' (e.g., the perceived priority of the policy in the school), 'social influences' (e.g., support from school boards), and 'skills' (e.g., teachers' ability to implement the policy). Implementation support strategies that target these factors may represent promising means to improve implementation of physical activity policies and increase physical activity among school-aged children. Future studies assessing factors that influence school implementation of physical activity policies would benefit from using a comprehensive framework to help identify if any domains have been overlooked in the current literature.

REGISTRATION

This review was prospectively registered with PROSPERO (CRD42016051649) on the 8th December 2016.

Culture matters: a case of school health promotion in Canada

Rising concerns of poor health behaviours of children and youth have stimulated international support for a comprehensive approach to promoting the development of healthy behaviours in the early years. Health promoting schools (HPS) is increasingly adopted as an approach to guide supportive practices, but there is limited research that has reported how to effectively implement HPS at a population level. The purpose of this research was to qualitatively explore the factors preventing and facilitating implementation of HPS practices in the Canadian province of Nova Scotia. Interviews (n = 23) were conducted with school stakeholders (principals, teachers and parents) from a diverse sample of schools (n = 9) and data were analysed to develop an understanding of how school circumstances and experiences influenced HPS implementation. At a broad level, the reported barriers were structural and systemic, whereas the facilitating factors were related to organizational capacity and political leadership. It was evident that implementing and sustaining HPS required a shift in values and integration of supportive school health practices into school priorities. The results suggest that, without addressing the competing culture, which is persistently reinforced by strict academic mandates and unhealthy community norms, HPS will be vulnerable to circumstances that prevent implementation. Considering the emerging importance of mental wellbeing, it will also be important to provide schools with adequate and appropriate staff capacity and support to address this issue. Sustaining the positive effects of HPS will require continuous engagement and collaboration with multiple stakeholders to embed health promotion into school community norms.

Barriers and facilitators to the implementation of a school-based physical activity policy in Canada: application of the theoretical domains framework

Background

In British Columbia Canada, a Daily Physical Activity (DPA) policy was mandated that requires elementary school teachers to provide students with opportunities to achieve 30 min of physical activity during the school day. However, the implementation of school-based physical activity policies is influenced by many factors. A theoretical examination of the factors that impede and enhance teachers’ implementation of physical activity policies is necessary in order to develop strategies to improve policy practice and achieve desired outcomes. This study used the Theoretical Domains Framework (TDF) to understand teachers’ barriers and facilitators to the implementation of the DPA policy in one school district. Additionally, barriers and facilitators were examined and compared according to how the teacher implemented the DPA policy during the instructional school day.

Methods

Interviews were conducted with thirteen teachers and transcribed verbatim. One researcher performed barrier and facilitator extraction, with double extraction occurring across a third of the interview transcripts by a second researcher. A deductive and inductive analytical approach in a two-stage process was employed whereby barriers and facilitators were deductively coded using TDF domains (content analysis) and analyzed for sub-themes within each domain. Two researchers performed coding.

Results

A total of 832 items were extracted from the interview transcripts. Some items were coded into multiple TDF domains, resulting in a total of 1422 observations. The most commonly coded TDF domains accounting for 75% of the total were Environmental context and resources (ECR; n = 250), Beliefs about consequences (n = 225), Social influences (n = 193), Knowledge (n = 100), and Intentions (n = 88). Teachers who implemented DPA during instructional time differed from those who relied on non-instructional time in relation to Goals, Behavioural regulation, Social/professional role and identity, Beliefs about Consequences. Forty-one qualitative sub-themes were identified across the fourteen domains and exemplary quotes were highlighted.

Conclusions

Teachers identified barriers and facilitators relating to all TDF domains, with ECR, Beliefs about consequences, Social influences, Knowledge and Intentions being the most often discussed influencers of DPA policy implementation. Use of the TDF to understand the implementation factors can assist with the systematic development of future interventions to improve implementation.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4846-y) contains supplementary material, which is available to authorized users.

A theoretical analysis of the barriers and facilitators to the implementation of school-based physical activity policies in Canada: a mixed methods scoping review

BACKGROUND

Given the potential impact school-based daily physical activity (DPA) policies can have on the health outcomes of Canadian children, it is surprising that such little research has examined the implementation and student-level effectiveness of these policies, and that even less have used theory to understand the barriers and facilitators affecting uptake of this policy by teachers. This review descriptively summarizes the implementation status, approaches used to implement DPA, and the effectiveness of DPA at increasing the physical activity of children at school. In addition, the Theoretical Domains Framework (TDF) was used to explore the barriers and facilitators to DPA implementation.

METHODS

A scoping review of English articles using ERIC, CINAHL, and Google Scholar (2005 to 2016) was conducted. Only studies that evaluated the implementation and/or student-level effectiveness of DPA policies in Canadian elementary schools were included. Only articles that examined DPA implementation barriers and facilitators by teachers, principals, and/or administration were eligible for the TDF analysis. Data on study characteristics and major findings regarding implementation status, implementation approach used, and impact on student's physical activity were extracted and were summarized descriptively, including study quality indicators. Two coders extracted and categorized implementation barriers and facilitators into TDF domains.

RESULTS

The search resulted in 66 articles being retrieved and 38 being excluded for not meeting the eligibility criteria, leaving 15 eligible for review (10 of which examined barriers and facilitators to implementation from DPA deliverers' perspective). Eleven of 15 studies examined the Ontario DPA policy, and 2 studies were from both Alberta and British Columbia. Thirteen studies examined implementation, and only two examined effectiveness. DPA implementation status, approaches to delivery, and effectiveness on student's PA levels are inconsistent across the three provinces. A total of 203 barriers/facilitators were extracted across the ten implementation studies, most of which related to the environmental context and resources (ECR; n = 86; 37.4%), beliefs about consequences (n = 41; 17.8%), and social influences (n = 36; 15.7%) TDF domains.

CONCLUSIONS

With the limited research examining the DPA policy in Canada, the current status and approaches used to implement DPA and the student-level effectiveness is not well understood; however, this review revealed that DPA deliverers often report many barriers to DPA implementation. Most importantly, in conducting a TDF-based analysis of the barriers/facilitators affecting implementation, this review provides a theoretical basis by which researchers and policy-makers can design interventions to better target these problems in the future.

REGISTRATION

A protocol for this review was not registered.

Not Enough Time in the Day: A Qualitative Assessment of In-School Physical Activity Policy as Viewed by Administrators, Teachers, and Students

BACKGROUND

In recent decades, the alignment of health and education has been at the forefront of school reform. Whereas the establishment of national in-school physical activity (ISPA) recommendations and state-level mandates demonstrates success, there has been less achievement in areas that address health disparities. The purpose of this investigation was to explore barriers and facilitators to implementing state-mandated ISPA policies in the Mississippi Delta.

METHODS

Focus groups or interviews were conducted with district administrators, school principals, teachers, and students. A total of 2 semistructured moderator guides were developed to focus on (1) student ISPA practices and preferences and (2) facilitators and barriers to implementing ISPA policies and practices.

RESULTS

A total of 6 themes were developed. In that, 2 themes addressed participant-described barriers (primary challenges and interferences and excuses). Three themes highlighted participant-described facilitators (compromises, things that work, and being active at school). Finally, 1 theme encompassed the participant-described need to address educating the whole child.

CONCLUSIONS

There is a critical need for meaningful and relevant solutions to circumvent challenges to implementing ISPA policies and practices in the Mississippi Delta. The Whole School, Whole Community, Whole Child model offers a broad means of visualizing rural, low-income, racially concentrated schools to circumvent challenges and foster ISPA policies and practices.

Development of the System for Observing Student Movement in Academic Routines and Transitions (SOSMART)

National attention on whole-of-school approaches to decrease children's sedentary behavior and increase physical activity includes movement integration (MI) in classrooms. The purpose of this study was to describe instrument development, reliability, and validity of the System for Observing Student Movement in Academic Routines and Transitions (SOSMART), designed to assess MI in elementary classrooms. An a priori conceptual framework was developed based on existing literature. The framework was expanded/refined using videos from elementary classrooms and a Delphi survey. The survey, sent to 85 experts, yielded a 38% response rate. The final system includes 11 MI variables (three categories of teacher variables, two categories of student variables) and uses a 20-second continuous interval recording format. Reliability and validity data were collected in 12 classrooms across four elementary schools. Instrument reliability was tested using interval-by-interval percentage agreement for each category. Construct validity was tested by estimating multilevel random effects logistic regression models comparing student accelerometer derived activity with the presence/absence of each MI variable. Intraobserver reliability resulted in 97.5% agreement and exceeded 80% on all variables. Construct validity was supported for 8 out of 11 MI variables. SOSMART can provide valid, reliable, and objective data about MI in elementary schools.

A multiple case history and systematic review of adoption, diffusion, implementation and impact of provincial daily physical activity policies in Canadian schools

BACKGROUND

Few children meet physical activity (PA) recommendations, and are therefore at increased risk for overweight/obesity and adverse health outcomes. To increase children's opportunities for PA, several Canadian provinces have adopted school-based daily PA (DPA) policies. It is not clear why some jurisdictions have adopted DPA policies, and others have not, nor whether these policies have been implemented and have achieved their intended outcomes. The purpose of this study was to understand the processes underlying adoption and diffusion of Canadian DPA policies, and to review evidence regarding their implementation and impact.

METHODS

We adopted a multiple case history methodology in which we traced the chronological trajectory of DPA policies among Canadian provinces by compiling timelines detailing key historical events that preceded policy adoption. Publicly available documents posted on the internet were reviewed to characterize adopter innovativeness, describe the content of their DPA policies, and explore the context surrounding policy adoption. Diffusion of Innovations theory provided a conceptual framework for the analyses. A systematic literature search identified studies that had investigated adoption, diffusion, implementation or impact of Canadian DPA policies.

RESULTS

Five of Canada's 13 provinces and territories (38.5%) have DPA policies. Although the underlying objectives of the policies are similar, there are clear differences among them and in their various policy trajectories. Adoption and diffusion of DPA policies were structured by the characteristics and capacities of adopters, the nature of their policies, and contextual factors. Limited data suggests implementation of DPA policies was moderate but inconsistent and that Canadian DPA policies have had little to no impact on school-aged children's PA levels or BMI.

CONCLUSIONS

This study detailed the history and current status of Canadian DPA policies, highlighting the conditional nature of policy adoption and diffusion, and describing policy and adopter characteristics and political contexts that shaped policy trajectories. An understanding of the conditions associated with successful policy adoption and diffusion can help identify receptive contexts in which to pioneer novel legislative initiatives to increase PA among children. By reviewing evidence regarding policy implementation and impact, this study can also inform amendments to existing, and development of future PA policies.

Joint use policies: are they related to adolescent behavior?

OBJECTIVE

Joint use policies (JUP) encourage shared facility use, usually between schools and a city or private organization, for both physical activity-related and non-physical activity-related programs. Little is known about JUP's impact on physical activity (PA). This study examined whether more specific JUPs were associated with increased PA and decreased sedentary behavior (SB) in adolescents.

METHODS

Data on PA, sports participation, and SB were taken from annual cross-sectional nationally representative samples of 51,269 8th, 10th and 12th grade public school students nested in 461 school districts in the US from 2009-2011. JUP measures were constructed using information obtained from corresponding school district JU policies. Multivariable analyses were conducted, controlling for individual demographic and socioeconomic characteristics and clustering at the district level.

RESULTS

Results showed small associations between more specific JUPs and increased PA (IRR 1.01, 95% CI: 1.00, 1.02). Closer examination of specific JUP provisions indicates that specifying what times facilities are available for use was associated with vigorous exercise and prioritizing school or affiliated organizations' use and which spaces were available for use were associated with vigorous exercise and more frequent PA participation, which includes participation in sports or athletics. No associations were found between more specific JUPs and SB.

CONCLUSIONS

JUPS may have small influences on adolescent physical activity behavior. Future longitudinal studies should be conducted to examine the impact of JUPs in conjunction with other physical activity-related policies and environmental changes to determine what impact they have on overall adolescent physical activity and sedentary behavior.

Physical activity practices in elementary schools and associations with physical education staffing and training

PURPOSE

Authorities recommend that schools provide a variety of opportunities for students to obtain physical activity (PA) before, during, and after school. This study assessed the prevalence of several school PA practices-including measures of quantity and quality of physical education (PE)-in elementary schools and examined the associations of PA practices with school resources (PE staffing, training, and facilities).

METHOD

Surveys were obtained from respondents in nationally representative samples of elementary schools from 2009-2010 to 2011-2012 (1,831 schools).

RESULTS

Few schools (20.8%) provided students with PE class every day, but most (76.3%) had an appropriate PE student-to-teacher ratio ( ≤ 25:1). Many schools (74.0%) offered 20 min of recess daily, but fewer than half offered organized opportunities for PA before or after school (e.g., sports). After controlling for demographics and school size, having a full-time PE teacher and requiring PE teachers to obtain PE-related continuing education (CE) were associated with PE practices such as offering ≥ 150 min of PE per week (for 3rd-grade students) and testing PE knowledge, skills, and fitness. Required CE was also associated with a higher likelihood of offering PA during the school day (i.e., activity breaks and PA outside of PE class) and before or after the school day (i.e., afterschool PA programs).

CONCLUSION

Few schools offer a broad array of PA programming. However, PE staffing and CE are positively associated with many PA practices including those outside of PE, possibly indicating that PE staff serve a crucial role in promoting a whole-school PA-supportive environment.

The "ins" and "outs" of physical activity policy implementation: inadequate capacity, inappropriate outcome measures, and insufficient funds

BACKGROUND

Despite broad public support and legislative activity, policies intended to promote physical activity in schools have not produced positive outcomes in levels of physical activity or student health. What explains the broad failure of Physical Activity Policies (PAPs)? Thus far, PAP research has used limited quantitative methods to assess PAP outcomes. New paradigms of qualitative policy implementation research can make important contributions to explaining the causes of policy failure and to the future design of more efficacious PAP legislation.

METHODS

This analysis is a case study of South Carolina's 2005 Student Health and Fitness Act (SHFA). Written documents, investigators' observation and experience, and an interview with a key stakeholder were analyzed to for themes based on theoretical frameworks from education implementation research including (1) bottom-up and top-down perspectives, (2) conceptualizing policy as practice, and (3) the implementer as learner.

RESULTS

"Weak policy signals" in SHFA undermined the implementation of PAP in 3 problematic areas: inadequate capacity development for implementers, inappropriate measures of implementation, and insufficient funding.

CONCLUSIONS

These findings illustrate the contributions of qualitative research and establish the need for further qualitative research into PAP implementation processes. To ensure successful future physical activity policies, policymakers, and stakeholders need to consider implementation, evaluation, and funding from the beginning phases of policy development.

Dejavniki gibalne aktivnosti in z zdravjem povezane kakovosti življenja

Uvod: Gibalna aktivnost koristi telesnemu in duševnemu zdravju. Namen članka je ugotoviti dejavnike, ki vplivajo nanjo, in možne ukrepe za povečanje te dejavnosti. Cilj članka je spodbuditi strokovnjake s področij zdravja in športne dejavnosti k sodelovanju pri oblikovanju in izvajanju učinkovitih ukrepov za povečanje gibanja med prebivalstvom. Metode: Opravljen je bil pregled literature o dejavnikih, ki vplivajo na gibalno aktivnost in z zdravjem povezano kakovost življenja, ter o ukrepih, povezanih z njimi. V pregled so vključene raziskave, ki so objavljene v angleškem jeziku v obdobju 2000–2010 in evidentirane v Web of Science (SCI-EXPANDED ali SSCI). Članek povzema izsledke 46 objav, za potrebe teoretičnih izhodišč pa še dodatnih 43 objav. Rezultati: Na odločitev za gibanje vplivajo lastnosti posameznika in širšega družbenoekonomskega okolja. Bistveni so starost, spol in zdravstveni status posameznika. Pri posameznih skupinah populacije prepoznamo specifične dejavnike, ki vplivajo na odločitev za gibalno aktivnost. Učinkoviti ukrepi spodbujanja gibanja so zato usmerjeni na te skupine in izhajajo iz identificiranih dejavnikov. Diskusija in zaključek: Raznolikost omenjenih skupin in dejavnikov je osnova za načrtovanje preventivnih oziroma interventnih ukrepov. Smiselno je, da se pri organiziranju in izvajanju programov povežejo organizacije s področij zdravstva, športa in druge interesne skupine. Pri tem naj izkoristijo obstoječe zakonske okvire.

Self-efficacy, physical activity, and aerobic fitness in middle school children: examination of a pedometer intervention program

Physical activity in children has been associated with a number of health benefits. Unfortunately, physical inactivity continues to increase. The purpose of this study was to examine the relationships among self-efficacy levels, physical activity, aerobic fitness, and body composition (relative body mass index [RBMI]) and to determine whether a school-based pedometer intervention program would improve those variables. The sample consisted of 116 rural 11- to 13-year-old students. Weakly positive correlations between self-efficacy, physical activity, and aerobic fitness and weakly correlated inverse relationships between self-efficacy, physical activity, aerobic fitness and RBMI were found. There was no statistical significance between the intervention and control group when analyzing outcome variables. These findings suggest that those with optimal RBMI levels have higher self-efficacy, physical activity and aerobic fitness levels. Although not statistically significant, the intervention group had greater improvements in mean self-efficacy scores, aerobic fitness levels, and RBMI.

School-based physical activity promotion: a conceptual framework for research and practice

Despite public health concerns and the many recognized benefits of physical activity (PA), levels of participation among youth remain below national recommendations. To this end, a variety of strategies for promoting physical activity for youth have been advocated, including multi-faceted, school-based approaches. One that continues to be identified as having great potential is a comprehensive school physical activity program (CSPAP). The aim of this article is to introduce a conceptual framework for school-based PA promotion that serves to stimulate, guide, and organize related research and practice. The CSPAP conceptual framework is a proposed framework, informed by existing science, recommendations, and a social ecological perspective with individual PA behavior as the epicenter. Discussed in turn are the four proposed interactive levels of influence (i.e., components, facilitators, leaders, and culture) and several integral elements proposed to operate at each level. The article concludes with a presentation of the utility of the framework for research and practice.

School Reform: The Role of Physical Education Policy in Physical Activity of Elementary School Children in Alabama's Black Belt Region

Purpose.

To investigate the implementation of state- and school-mandated physical education (PE) and physical activity policies on students' school-day physical activity behaviors.

Design.

Observational, cross-sectional study.

Setting.

Five elementary schools in rural Alabama.

Subjects.

Six hundred and eighty-three school-age children.

Measures.

School-day physical activity behaviors were assessed with pedometer step count, the System for Observing Fitness Instruction Time (SOFIT), and the System for Observing Play and Leisure Activity in Youth (SOPLAY).

Analysis.

Descriptive statistics (means and standard deviations) were used to describe the current health and in-school physical activity behaviors of students.

Results.

Students accumulated a daily average of 4079.57 (± 1678.1) and 3473.44 (± 1073.37) steps for boys and girls, respectively, throughout the school day. SOFIT findings indicate that students spent an average of 23.80 ± 5.33 min/d in PE and that 14.33 ± 6.10 min/d were spent in moderate to vigorous physical activity (MVPA). This equates to 59.38% of PE time spent in MVPA. SOPLAY findings showed that recess and before/after school activity was not provided.

Conclusions.

It appears that schools were in compliance with the state-mandated PE policies on paper but not in actuality. Students did not attend PE for 30 min/d. The implementation of PE as the sole physical activity opportunity provides inadequate amounts of physical activity during the school day.

Effects of a 2-year school-based intervention of enhanced physical education in the primary school

BACKGROUND

This study aimed to assess whether a school-based physical education intervention was effective in improving physical abilities and influencing daily physical activity habits in primary school children. The possible effect on body mass index (BMI) was also considered.

METHODS

Twenty-six 3rd-grade classes were randomly selected stratifying by geographic location (city, plain, hills) and were assigned either to an intervention (127 boys; 120 girls) or to a traditional (129 boys; 121 girls) physical education program. At baseline (age: 8-9 years) and after a 2-year follow-up (age: 10-11 years), information was collected about sport participation and daily activity habits using a self-administered questionnaire. Height, weight, and BMI were measured and physical performance was assessed by means of standardized tests.

RESULTS

The enhanced program of physical education was effective in improving physical abilities of children and determining a decrease (boys: 10%; girls: 12%) in daily sedentary activities (preintervention versus postintervention, p < .05; intervention versus control group, p < .01). The percentages of overweight and obese children did not vary significantly, but the experimental group showed a significantly lower rise in BMI compared to the control group (p < .001).

CONCLUSION

The school proved to be an ideal setting for promoting physical activity and achieving the required daily activity levels.

Treatment of dyssomnias and parasomnias in childhood

OPINION STATEMENT

Dyssomnias are sleep disorders associated with complaints of insomnia or hypersomnia. The daytime sleepiness of narcolepsy is treated by a combination of planned daytime naps, regular exercise medications such as modafinil, or salts of methylphenidate, or amphetamine. Cataplexy that accompanies narcolepsy is treated with anticholinergic agents, selective serotonin reuptake inhibitors, or sodium oxybate. Children with neurodevelopmental disabilities such as autism have sleep initiation and maintenance difficulties on a multifactorial basis, with favorable response to melatonin in some patients. Childhood onset restless legs syndrome is often familial, associated with systemic iron deficiency, and responsive to iron supplementation and gabapentin. Parasomnias are episodic phenomena events which occur at the sleep -- wake transition or by intrusion on to sleep. Arousal parasomnias such as confusional arousals and sleep walking can sometimes be confused with seizures. A scheme for differentiating arousal parasomnias from nocturnal seizures is provided. Since arousal parasomnias are often triggered by sleep apnea, restless legs syndrome, or acid reflux, treatment measures directed specifically at these disorders often helps in resolution. Clonazepam provided in a low dose at bedtime can also alleviate sleep walking and confusional arousals. Obstructive sleep apnea affects about 2 percent of children. Adeno-tonsillar hypertrophy, cranio-facial anomalies, and obesity are common predisposing factors. Mild obstructive sleep apnea can be treated using a combination of nasal corticosteroids and a leukotriene antagonist. Moderate to severe obstructive sleep apnea are treated with adeno-tonsillectomy, positive airway pressure breathing devices, or weight reduction as indicated. This paper provides an overview of the topic, with an emphasis on management steps. Where possible, the level of evidence for treatment recommendations is indicated.

Physical activity policies and legislation in schools: a systematic review

CONTEXT

Current physical activity levels of youth are alarmingly low. One way to promote higher levels of physical activity to youth is through school-based government policies. The current review examines evaluation of school-based physical activity policies for youth over the past 10 years.

EVIDENCE ACQUISITION

Articles included met the following criteria: was an original research study published in an academic journal in English; examined or was related to physical activity behavior; applied to a youth population in a school setting; highlighted a law, bill, or policy reflective of physical activity based on government initiatives; and involved an evaluation. After searching five databases in January 2011, a total of 13 articles were selected for inclusion.

EVIDENCE SYNTHESIS

All policies came from the U.S.; seven studies highlighted the federal Child Nutrition and Women, Infants, and Children Reauthorization Act of 2004 whereas the other six studies highlighted state-level policies dealing with safe routes to schools, physical activity-only initiatives, or physical activity as well as other initiatives. Eight articles evaluated policy implementation, three examined policy implementation and impact, and two articles considered only policy impact.

CONCLUSIONS

This evaluation of the impact of policies on school-based physical activity indicates that such policies can affect health outcomes, specifically by increasing levels of physical activity. This study highlights the value of policy reform and calls attention to the need for independent evaluation of such policies.

The association of state law to physical education time allocation in US public schools

OBJECTIVES

We examined whether public schools in states with specific and stringent physical education (PE) laws, as assessed by the Physical Education-Related State Policy Classification System (PERSPCS), available on the Classification of Laws Associated with School Students (C.L.A.S.S.) Web site, reported more weekly PE time in the most recent School Health Policies and Programs Survey (SHPPS).

METHODS

Schools (n=410) were grouped by their state's PERSPCS time requirement scores (none, nonspecific requirement, or specific requirement). Average weekly school-level PE was calculated using the SHPPS-reported PE minutes. Weighted analyses determined if PE minutes/week differed by PERSPCS group.

RESULTS

Schools in states with specific requirement laws averaged over 27 and 60 more PE minutes/week at the elementary and middle school levels, respectively, compared with schools within states with nonspecific laws and over 40 and 60 more PE minutes per week, respectively, compared with elementary and middle schools in states with no laws. High school results were nonsignificant.

CONCLUSIONS

Public health guidelines recommend at least 60 minutes of daily physical activity for children, and PE may further this goal. Strong codified law with specific time requirements for PE may be an important tool contributing toward adequate PE time and daily physical activity recommendations.

The impact of state laws and district policies on physical education and recess practices in a nationally representative sample of US public elementary schools

OBJECTIVE

To examine the impact of state- and school district-level policies on the prevalence of physical education (PE) and recess in a nationally representative sample of US public elementary schools.

DESIGN

Analyses from annual, nationally representative, cross-sectional surveys of school administrators in the United States.

SETTING

Data were collected through surveys conducted between February and June during the 2006-2007 through 2008-2009 school years. State laws and district policies were compiled annually by researchers at the University of Illinois at Chicago using established legal research techniques.

PARTICIPANTS

The sample size was 47 states, 690 districts, and 1761 schools.

MAIN EXPOSURES

State- and school district-level PE and recess-related laws.

MAIN OUTCOME MEASURES

Twenty minutes of daily recess and 150 min/wk of PE.

RESULTS

The odds of schools having 150 min/wk of PE increased if they were located in states (odds ratio [OR], 2.8; 95% CI, 1.3-5.7) or school districts (OR, 2.4; 95% CI, 1.3-4.3) having a law or policy requiring 150 min/wk of PE. Schools located in states with laws encouraging daily recess were significantly more likely to have 20 minutes of recess daily (OR, 1.8; 95% CI, 1.2-2.8). District policies were not significantly associated with school-level recess practices. Adequate PE time was inversely associated with recess and vice versa, suggesting that schools are substituting one form of physical activity for another rather than providing the recommended amount of both recess and PE.

CONCLUSION

By mandating PE or recess, policy makers can effectively increase school-based physical activity opportunities for youth.

Impact of short bouts of physical activity on attention-to-task in elementary school children

OBJECTIVE

The study's objective was to describe the measurement of on-task behavior and review the research on the effects of short physical activity breaks on attention-to-task in elementary school students, with a particular focus on a promising approach to improving on-task behavior with short bouts of physical activity in the classroom setting.

METHODS

Procedures to directly observe attention-to-task were detailed. Published studies that measured attention-to-task in elementary school students following physical activity breaks were reviewed.

RESULTS

Direct measurement of attention-to-task is intensive and demanding on observers. Previous research on attention-to-task following physical activity breaks is sparse. The limited evidence suggests a small to moderate improvement on attention-to-task following physical activity breaks (Effect Sizes typically ranged from 0.13 to 0.60). Teachers can be trained in a relatively short time to effectively lead classroom-based physical activities. Students who participated in classroom-based physical activities that incorporate academic concepts demonstrated significantly better improvements (+8.3%) in attention-to-task than control group participants (-3.1%).

CONCLUSIONS

Attention-to-task is a variable that directly relates to concerns of classroom teachers. The limited available research has demonstrated moderate to good evidence that physical activity during the school day improves attention-to-task in elementary school students. Because of the positive effects of physical activity on attention-to-task, it is recommended that elementary school teachers consider implementing physical activity sessions throughout the school day in the form of recess and classroom-based physical activities.

School playgrounds and physical activity policies as predictors of school and home time activity

BACKGROUND

Previous work has suggested that the number of permanent play facilities in school playgrounds and school-based policies on physical activity can influence physical activity in children. However, few comparable studies have used objective measures of physical activity or have had little adjustment for multiple confounders.

METHODS

Physical activity was measured by accelerometry over 5 recess periods and 3 full school days in 441 children from 16 primary schools in Dunedin, New Zealand. The number of permanent play facilities (swing, fort, slide, obstacle course, climbing wall etc) in each school playground was counted on three occasions by three researchers following a standardized protocol. Information on school policies pertaining to physical activity and participation in organized sport was collected by questionnaire.

RESULTS

Measurement of school playgrounds proved to be reliable (ICC 0.89) and consistent over time. Boys were significantly more active than girls (P < 0.001), but little time overall was spent in moderate-vigorous physical activity (MVPA). Boys engaged in MVPA for 32 (SD 17) minutes each day of which 17 (10) took place at school compared with 23 (14) and 11 (7) minutes respectively in girls. Each additional 10-unit increase in play facilities was associated with 3.2% (95% CI 0.0-6.4%) more total activity and 8.3% (0.8-16.3%) more MVPA during recess. By contrast, school policy score was not associated with physical activity in children.

CONCLUSION

The number of permanent play facilities in school playgrounds is associated with higher physical activity in children, whereas no relationship was observed for school policies relating to physical activity. Increasing the number of permanent play facilities may offer a cost-effective long-term approach to increasing activity levels in children.

An Exploratory Look at Teacher Perceptions of School Food Environment and Wellness Policies

Many factors affect wellness efforts in schools, including food services, health policies, and a lack of systematic support. The purpose of this study was to explore teacher perceptions of the school nutrition environment and assess whether teacher characteristics predicted these perceptions. For this cross-sectional, descriptive research, a 24-item Food and Wellness Questionnaire was designed using items adapted from the Minnesota-based TEENS study and newly developed items with expert panel review and pilot testing. Teachers (n = 345) from all grade levels of a large, suburban school district in the Midwest voluntarily participated. Descriptive statistics and multiple regression analyses were carried out. Participants were well distributed among grade levels (elementary = 34.5%, middle school = 30%, high school = 35.5%), with a 37% response rate. Teachers largely agreed with the importance of school food and nutrition guidelines (subscale mean rating = 3.82 of 5), although teaching techniques to implement nutrition education appeared lacking (subscale mean rating = 2.50 of 5). Those with a college-level nutrition course felt more prepared than those without. Useful resources included local policies, public materials, and access to nutrition experts (eg, registered dietitians). Optimizing school food services, resources for teaching about nutrition, and consistent health messages, especially related to grade level, appear to be needed.

Childhood obesity and schools: evidence from the national survey of children's health

BACKGROUND

The international prevalence of childhood obesity and obesity-related diseases has received increasing attention. Applying data from the Centers for Disease Control and Prevention, we explore relationships between childhood obesity and school type, National School Lunch Program (NSLP) and School Breakfast Program (SBP) eligibility, membership in sports clubs and other sociodemographic, and household factors.

METHODS

Nonlinear regression models with interaction terms were developed to investigate the effects of school type, physical activity, and NSLP/SBP, etc, on children's body mass index (BMI). Probit models then examine the probability of a child being overweight.

RESULTS

Though clinically small, statistically significant effects on BMI were found for children from households eligible for the NSLP/SBP, attending public schools. They have a mean BMI value 0.401 higher than counterparts attending private schools (p < .05). If the child both attends public school and is eligible for the NSLP/SBP, then his or her BMI is 0.725 higher (p < .001). Children taking part in the NSLP or SBP have a 4.5% higher probability of being overweight (p < .001).

CONCLUSIONS

Regardless of household socioeconomic status, children attending public schools have higher BMI than those attending private schools. Eligibility for free or reduced-cost lunch or breakfast programs at public schools is positively correlated with children's BMI. Children attending public schools are more likely to be overweight. In lower socioeconomic status households, school type does not have a significant effect on the probability of being overweight. Policy recommendations for factors to address childhood obesity are discussed.