Examination of trends and evidence-based elements in state physical education legislation: a content analysis

Longitudinal policy surveillance of state obesity legislation in California, 1999-2020

BACKGROUND

Obesity rates among children and adults continue to accelerate in the U.S., particularly among marginalized and low-income populations. Obesity prevention and reduction policies can significantly impact population health by improving environmental conditions and increasing access to health-promoting resources. Limited research has been conducted to examine state obesity policy change over time. The primary aim of this study is to examine legislative approaches used to prevent and reduce obesity in the state of California (U.S.).

METHODS

We used quantitative policy surveillance methods to develop a state database of obesity-related legislation (bills, resolutions) introduced in California's legislature between 1999 and 2020. Descriptive statistics were used to examine trends of introduced and enacted policy by legislative and policy characteristics. Chi-square tests were used to determine differences in characteristics between enacted and non-enacted legislation. Legislative session and policy characteristics found to be associated with enactment were used to predict adoption in a logistic regression.

RESULTS

A total of 284 obesity-related bills and resolutions were introduced in California's legislature between 1999 and 2020 with a peak of 43 in 2005-2006. On average, 25.8 bills and resolutions were introduced each 2-year legislative cycle. Findings indicate that (a) children and schools were the most frequently specified population and setting; (b) the most common policy topics were nutrition (45%) and physical activity (33%); and (c) only 15% of legislation mentioned race/ethnicity. Overall, 24.9% of bills were enacted compared to 82.1% of resolutions adopted. Legislation to raise awareness about obesity had 5.4 times the odds of being passed compared to other topics. Yet this difference was not statistically significant in a sensitivity analysis when we excluded resolutions.

CONCLUSIONS

This database can be leveraged to advance our knowledge of effective and equitable policy instruments to prevent and reduce obesity. Results reveal important policy elements that may impact legislative success, including policy topic, and contribute to a nascent evidence base for public health law research, legal epidemiology, and practice. Future work should investigate the role of policy effectiveness research and evidence on legislative policymaking.

Guiding officers to deflect citizens to treatment: an examination of police department policies in Illinois

BACKGROUND

The U.S. overdose crisis has motivated police departments to enact policies allowing officers to directly deflect individuals to substance use disorder treatment and other services shown to reduce recidivism and subsequent overdose risk, as well as refer people who voluntarily present at police facilities with a desire for treatment. As a new way of operating, and one that relies on an officer's use of discretion for successful implementation, the practice benefits from guidance through written directives, training, and supervisory support. However, there is little information on the establishment, content, and execution of police department deflection policies, which hampers the implementation and dissemination of this promising practice. We analyzed 16 policies of Illinois police department deflection programs. Using content analysis methodology, we coded the policies for language and terminology, as well as program components and procedures. We aimed to examine how the policies were written, as well as the content intending to guide officers in their work.

RESULTS

We found the policies and programs had notable differences in length, detail, terminology, and reading level. Only one policy mentioned the use of any type of addiction treatment medication, many used stigmatizing language (e.g., "abuse" and "addict"), and few mentioned "harm reduction" or training in the practice of deflection. Many policies restricted participation in deflection (i.e., no minors, outstanding warrants, current withdrawal symptoms), and critically, a majority of policies allowed police officers to exclude people from participation based on their own judgment.

CONCLUSIONS

We recommend police departments consider the readability of their policies and reduce barriers to deflection program participation to engage a larger pool of citizens in need of substance use disorder treatment. Since there is limited research on police policies generally, and the field of deflection is relatively new, this study offers insight into the content of different department policies and more specifically, how officers are directed to operate deflection programs.

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.

Internal and External Load Variations in Young Students: Comparisons between Small-Sided Games and Small-Sided Games Combined with Strength Training during Physical Education Classes

The purpose of this study was to compare the effects of internal and external load in soccer small-sided games (SSGs) and a strength program based on CrossFit combined with SSGs for 7 weeks. Fifty-five students participated in this research (age: 9.04 ± 0.19 years) and were randomly assigned to SSGs (n = 27) or strength combined with SSGs (n = 29) group. Two sessions/week were implemented. The results revealed that internal load on SSGs promoted higher levels (p ≤ 0.001; d = 0.35) of light physical activity (PA) (12.24 cpm) compared with strength combined with SSGs (11.46) and % heart rate (%HR) max (p = 0.002; d = 0.48) between SSGs (96.21) regarding strength combined with SSGs (92.09). On external load, significant differences appear in total distance (p ≤ 0.001; d = 0.80) on SSGs (1326 m) compared with strength combined with SSGs (1004 m) and mean velocity (p ≤ 0.001; d = 0.63) in both groups; 2.71 km/h on SSGs and 2.26 km/h on strength combined with SSGs. The SSGs seem to be more appropriate at the beginning of sessions, but as the weeks advance, strength combined with SSGs results in improved internal load compared with SSGs.

Policy content analysis: Qualitative method for analyzing sub-national insect pollinator legislation

This project examines sub-national legislative policy to identify trends and describe policy innovations for addressing insect pollinator declines. Content analysis is used to describe these policies quantitatively (number of policies and frequency per year) and qualitatively (topic, comparison of policy instruments used). The policies selected constitute a census-not a sample-of policies passed then approved by all US state legislatures and signed by state Governors into law from 2000 to 2017. We used QSR International's NVivo 10 text-based analytic software to organize and document our close-reading (line-by-line coding) of 109 laws to address insect pollinator population declines. Our analysis blended both conventional (inductive) and directed (deductive) content analysis approaches to reveal the spectrum of new legislative innovations and to describe lawmakers' evolving view of pollinating insects. Applying proven methods from the health sciences and communication studies can aid large-scale analysis of legal texts. •Qualitative content analysis of all US state-level laws passed from 2000 to 2017 addressing insect pollinators (N = 109).•The close-reading analysis mixed both conventional (inductive) and directed (deductive) content analysis approaches to reveal the spectrum of new legislative innovations and to describe evolving views of pollinating insects.•Compared inductively gathered findings from US policies to global experts' policy recommendations to evaluate status of conservation policy.

An assessment of Australian school physical activity and nutrition policies

OBJECTIVE

This study's objective was to identify and assess existing physical activity and nutrition policies for Australian schools.

METHODS

Policies were identified through a search of the websites of national and state/territory education departments and school associations, and were subsequently assessed against specific criteria.

RESULTS

Policies were identified for government schools, but only for one non-government school association. Physical activity policies were identified at the national level and for six of eight state/territories. The national policy was mandated, and most state/territory physical activity policies were mandated and consistent with the national policy. Several physical activity policies did not meet expert recommendations for time and instructor qualifications. Nutrition policies were identified at the national level and all eight states/territories. The national policy was not mandated, but all state/territory nutrition policies were mandated and consistent with the national policy and relevant guidelines. Most physical activity and nutrition policies lacked information about implementation monitoring.

CONCLUSIONS

To improve school practices, policies are needed that are mandated and consistent with expert recommendations, use clear language, and specify monitoring and accountability mechanisms. Implications for public health: Improvements in school policies can promote physical activity and healthy eating behaviours to positively influence student outcomes across Australia.

From Delivery to Adoption of Physical Activity Guidelines: Realist Synthesis

BACKGROUND

Evidence-based guidelines published by health authorities for the promotion of health-enhancing physical activity (PA), continue to be implemented unsuccessfully and demonstrate a gap between evidence and policies. This review synthesizes evidence on factors influencing delivery, adoption and implementation of PA promotion guidelines within different policy sectors (e.g., health, transport, urban planning, sport, education).

METHODS

Published literature was initially searched using PubMed, EBSCO, Google Scholar and continued through an iterative snowball technique. The literature review spanned the period 2002-2017. The realist synthesis approach was adopted to review the content of 39 included studies. An initial programme theory with a four-step chain from evidence emersion to implementation of guidelines was tested.

RESULTS

The synthesis furthers our understanding of the link between PA guidelines delivery and the actions of professionals responsible for implementation within health services, school departments and municipalities. The main mechanisms identified for guidance implementation were scientific legitimation, enforcement, feasibility, familiarity with concepts and PA habits. Threats emerged to the successful implementation of PA guidelines at national/local jurisdictional levels.

CONCLUSIONS

The way PA guidelines are developed may influence their adoption by policy-makers and professionals. Useful lessons emerged that may inform synergies between policymaking and professional practices, promoting win-win multisectoral strategies.

State Legislation Related to Increasing Physical Activity: 2006-2012

BACKGROUND

Strategies to improve physical activity prevalence often include policy and environmental changes. State-level policies can be influential in supporting access and opportunities for physical activity in schools and communities. The purpose of this study was to explore the prevalence of state legislation related to physical activity and identify the correlates of enactment of this legislation.

METHODS

An online legislative database was used to collect bills from 50 states in the U.S. from 2006 to 2012 for 1010 topics related to physical activity. Bills were coded for content and compiled into a database with state-level variables (eg, obesity prevalence). With enactment status as the outcome, bivariate and multivariate analyses were conducted.

RESULTS

Of the 1,542 bills related to physical activity introduced, 30% (N = 460) were enacted. Bills on public transportation and trails were more likely to be enacted than those without these topics. Primary sponsorship by the Republican Party, bipartisan sponsorship, and mention of specific funding amounts were also correlates of enactment.

CONCLUSION

Policy surveillance of bills and correlates of enactment are important for understanding patterns in legislative support for physical activity. This information can be used to prioritize advocacy efforts and identify ways for research to better inform policy.

The Voices for Healthy Kids Campaign and US State Legislation to Prevent Childhood Obesity

We documented childhood obesity legislative activity in all 50 US states that occurred in parallel to the first year of Voices for Healthy Kids (Voices), a campaign to mobilize evidence-based legislation addressing childhood obesity. We identified 217 bills in the year before Voices (November 2012 to October 2013) and 304 bills at follow-up (November 2013 to October 2014). In states with active Voices grantees, the bill enactment rate was 50% higher (increasing from 10% at baseline to 15% at follow-up).

Cost Effectiveness of an Elementary School Active Physical Education Policy

INTRODUCTION

Many American children do not meet recommendations for moderate to vigorous physical activity (MVPA). Although school-based physical education (PE) provides children with opportunities for MVPA, less than half of PE minutes are typically active. The purpose of this study is to estimate the cost effectiveness of a state "active PE" policy implemented nationally requiring that at least 50% of elementary school PE time is spent in MVPA.

METHODS

A cohort model was used to simulate the impact of an active PE policy on physical activity, BMI, and healthcare costs over 10 years for a simulated cohort of the 2015 U.S. population aged 6-11 years. Data were analyzed in 2014.

RESULTS

An elementary school active PE policy would increase MVPA per 30-minute PE class by 1.87 minutes (95% uncertainty interval [UI]=1.23, 2.51) and cost $70.7 million (95% UI=$51.1, $95.9 million) in the first year to implement nationally. Physical activity gains would cost $0.34 per MET-hour/day (95% UI=$0.15, $2.15), and BMI could be reduced after 2 years at a cost of $401 per BMI unit (95% UI=$148, $3,100). From 2015 to 2025, the policy would cost $235 million (95% UI=$170 million, $319 million) and reduce healthcare costs by $60.5 million (95% UI=$7.93 million, $153 million).

CONCLUSIONS

Implementing an active PE policy at the elementary school level could have a small impact on physical activity levels in the population and potentially lead to reductions in BMI and obesity-related healthcare expenditures over 10 years.

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.

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.

Correlates of state enactment of elementary school physical education laws

OBJECTIVE

To describe variation in U.S. state elementary school physical education (PE) policies and to assess associations between state PE policy enactment and education funding, academic achievement, sociodemographic disadvantage, and political characteristics.

METHODS

U.S. state laws regarding school PE time, staffing, curriculum, fitness assessment, and moderate-to-vigorous physical activity (MVPA) in 2012 were classified as strong/specific, weak/nonspecific, or none based on codified law ratings within the Classification of Laws Associated with School Students (C.L.A.S.S.). Laws were merged with state-level data from multiple sources. Logistic regression was used to determine associations between state characteristics and PE laws (N=51).

RESULTS

Laws with specific PE and MVPA time requirements and evidence-based curriculum standards were more likely in states with low academic performance and in states with sociodemographically disadvantaged populations. School day length was positively associated with enacting a PE curriculum that referenced evidence-based standards. School funding and political characteristics were not associated with PE laws.

CONCLUSIONS

Limited time and high-stake testing requirements force schools to prioritize academic programs, posing barriers to state passage of specific PE laws. To facilitate PE policy enactment, it may be necessary to provide evidence on how PE policies can be implemented within existing time and staffing structures.

Association between state physical education (PE) requirements and PE participation, physical activity, and body mass index change

OBJECTIVE

To determine if state physical education (PE) laws are associated with student physical education attendance and physical activity (PA), and whether physical education and competitive food laws, in conjunction, are associated with lower BMI change.

METHOD

State laws regarding physical education time requirements and competitive foods in 2003 and 2006 were classified as strong, weak, or none, based on codified law ratings obtained from the Classification of Laws Associated with School Students. Laws were linked to student data on PE attendance and physical activity (8th grade, Spring 2007) and BMI change (5th-8th grade, 2004-2007), obtained from the Early Childhood Longitudinal Study (n=5510 students in 40 states).

RESULTS

Girls reported 0.31 more days of activity (95% CI: 0.02, 0.61) and were more likely to attend physical education ≥ 3 days/week (74.1% versus 52.1%, difference=22.0, 95% CI: 2.1, 42.0) if they resided in states with strong physical education laws compared to no physical education laws. Weak physical education laws had modest associations with PE and activity, and there was no evidence that weak laws reduce BMI gain regardless of competitive food laws.

CONCLUSION

Strong physical education laws with specific time requirements may increase physical education attendance and activity in girls. There is insufficient evidence that physical education laws reduce student weight gain.

State policies about physical activity minutes in physical education or during school

BACKGROUND

School policies can change practices on a relatively permanent basis. This study investigated adoption and implementation of state-level policies specifying minutes (or percent) of physical activity in physical education (PE) or during school.

METHODS

Policies were identified from existing databases and rated as having weak, moderate, or strong wording. Interviews with state-level PE coordinators were conducted to investigate the level of implementation, monitoring, and enforcement of the identified policies.

RESULTS

Sixteen states had a policy that met inclusion criteria (19 policies total); 11 states had a policy addressing minutes of physical activity during school, 2 had a policy addressing percent of PE time to be spent in physical activity, and 3 had policies addressing both. None of the 19 policies were rated as having strong wording and 5 were rated as having moderate wording. The range in minutes of physical activity per week addressed in the policies was 60 to 300. Four of the 5 (elementary) and 5 of 5 (middle) policies addressing percent of PE spent physically active specified 50%. The only monitoring efforts reported consisted of schools self-reporting progress to the state.

CONCLUSIONS

More states need to adopt school physical activity policies and policy language needs to be more specific to prevent potential loopholes. Monitoring and evaluation strategies, beyond school self-report, are likely needed for these policies to lead to increases in physical activity.

Patterns and predictors of enactment of state childhood obesity legislation in the United States: 2006-2009

OBJECTIVES

We developed a content review for state policies related to childhood obesity, and we have quantitatively described the predictors of enactment.

METHODS

We collected an inventory of 2006 through 2009 state legislation on 27 childhood obesity topics from legislative databases. We coded each bill for general information, topic content, and other appropriate components. We conducted a general descriptive analysis and 3 multilevel analyses using bill- and state-level characteristics to predict bill enactment.

RESULTS

Common topics in the 27% of the bills that were enacted were community physical activity access, physical education, and school food policy. Committee and bipartisan sponsorship and having term limits significantly predicted enactment in at least 1 model. Bills with safe routes to school or health and nutrition content were twice as likely to be enacted. Bills containing product and menu labeling or soda and snack taxes were significantly less likely to be enacted.

CONCLUSIONS

Bipartisan and committee support and term limits are important in bill enactment. Advocacy efforts can be tailored to increase awareness and sense of priority among policymakers.

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.

Factors influencing the implementation of school wellness policies in the United States, 2009

Introduction

The quality of school wellness policy implementation varies among schools in the United States. The objective of this study was to characterize the school wellness policy environment nationally and identify factors influencing the quality and effectiveness of policy implementation.

Methods

We invited school administrators from 300 high schools to complete a questionnaire; 112 administrators responded. We performed a 2-step cluster analysis to help identify factors influencing the implementation of school wellness policies.

Results

Eighty-two percent of schools reported making staff aware of policy requirements; 77% established a wellness committee or task force, 73% developed administrative procedures, and 56% trained staff for policy implementation. Most commonly reported challenges to implementation were lack of time or coordination of policy team (37% of respondents) and lack of monetary resources (33%). The core domains least likely to be implemented were communication and promotion (63% of respondents) and evaluation (54%). Cluster 1, represented mostly by schools that have taken action toward implementing policies, had higher implementation and effectiveness ratings than Cluster 2, which was defined by taking fewer actions toward policy implementation. In Cluster 1, accountability was also associated with high ratings of implementation quality and effectiveness.

Conclusion

The development of organizational capacity may be critical to ensuring an environment that promotes high-quality policy implementation. Assessing, preventing, and addressing challenges; establishing clear definitions and goals; and requiring accountability for enacting policy across all core domains are critical to ensuring high-quality implementation.

It's all in the lens: differences in views on obesity prevention between advocates and policy makers

BACKGROUND

Intervention strategies to reduce obesity include policy and environmental changes that are designed to provide opportunities, support, and cues to help people develop healthier behaviors. Policy changes at the state level are one way to influence access, social norms, and opportunities for better nutrition and increased physical activity among the population.

METHODS

Ten states were selected for a broad variance in obesity rates and number of enacted obesity prevention policies during the years of 2006-2009. Within the selected states, a purely qualitative study of attitudes of childhood obesity policy using semistructured telephone interviews was conducted. Interviews were conducted with state policy makers who serve on public health committees. A set of six states that had more than eight childhood obesity policies enacted were selected for subsequent qualitative interviews with a convenience sample of well-established advocates.

RESULTS

Policy makers in states where there was more childhood obesity policy action believed in the evidence behind obesity policy proposals. Policy makers also varied in the perception of obesity as a constituent priority. The major differences between advocates and policy makers included a disconnect in information dissemination, opposition, and effectiveness of these policies.

CONCLUSIONS

The findings from this study show differences in perceptions among policy makers in states with a greater number of obesity prevention bills enacted. There are differences among policy makers and advocates regarding the role and effectiveness of state policy on obesity prevention. This presents an opportunity for researchers and practitioners to improve communication and translation of evidence to policy makers, particularly in states with low legislation.

Are physical education-related state policies and schools' physical education requirement related to children's physical activity and obesity?

BACKGROUND

This study examines whether the extent of states' physical education (PE) requirement policies and the prevalence of schools requiring PE are associated with children's physical activity (PA) and obesity.

METHODS

Two cycles (2002-2003 and 2006-2007) of cross-sectional data with individual- and state-level information were analyzed. Information on states' PE requirement was from the 2003 and 2006 Physical Education-Related State Policy Classification System, and the prevalence of schools requiring PE was from the 2002 and 2006 School Health Profiles. The individual-level sample includes 11- to 17-year-old children from the 2003 (N = 25,251) and 2007 (N = 23,728) National Survey of Children's Health. The associations of states' PE requirement and schools' PE requirement with children's PA and obesity were examined, controlling for individual, family, and state covariates. Variation in the associations by individual and family characteristics was also tested.

RESULTS

States' PE requirement was not associated with any outcome. In cycle 1, overall, a 10% increase in the percentage of schools requiring PE was associated with a 28% increase in the number of days having vigorous PA per week. In cycle 2, the association was not significant. However, significant variation in the association by gender in cycle 2 suggests an influence of schools' PE requirement on girls' PA only. No association was found between schools' PE requirement and obesity.

CONCLUSIONS

Gaps exist between state PE-related policies and implementation in schools. However, schools' PE requirement seems to improve children's PA with some gender variation. The association between schools' PE requirement and children's weight is less clear.

Physical education's role in public health: steps forward and backward over 20 years and HOPE for the future

The 1991 paper, "Physical education's role in public health" described the importance of physical education in addressing public health problems. On its 20th anniversary, this article reviews accomplishments in improving the health impact of physical education and identifies areas lacking progress. Major accomplishments include development of evidence-based programs, documentation of health and academic benefits of physical education, and acceptance of physical education as a public health resource. Additional work is needed to evaluate the uptake of evidence-based programs, improve national surveillance of physical education quantity and quality, establish stronger policies supporting active physical education, and achieve wide acceptance of public health goals within the physical education field. These opportunities constitute an agenda for actualizing the promise of health-optimizing physical education before the next 20 year anniversary.

An analysis of community use policies in Missouri school districts

BACKGROUND

Joint use or community use policies are state-, district-, or school-level policies that allow for shared use of space or facilities between a school and a city or private organization. For this study, we (1) created an inventory of community use policies within Missouri school districts; (2) analyzed the policies for content, and (3) identified district characteristics that predict the presence of a community use policy.

METHODS

A coding tool was developed to assess the content of collected policies. Descriptors of 515 districts was gathered from the Missouri Department of Elementary and Secondary Education website. The policies were collected via district website or phone/e-mail contact and coded. Frequency of variables and a logistic regression to predict district presence of policy were computed.

RESULTS

Of the 515 districts in Missouri, 375 had a community use policy. Most (216) came from a policy template from the Missouri School Boards' Association or Missouri Consultants for Education (115). Only 42 districts had unique community use policies. Large or medium-sized districts were more likely to have a policy than small districts. Districts with higher percentage of students qualifying for free/reduced lunch were less likely to have a policy.

CONCLUSION

Making changes to the 2 main resource templates have the potential to improve many district community use policies. Future efforts should focus on increasing policies and implementation in low resource and small districts. More research is needed on implementation and evaluation of community use policies.

Behavioral medicine and the health of our nation: accelerating our impact

PURPOSE

A key goal of this paper is to illustrate the impact of behavioral medicine on the factors that influence population health. A second goal is to consider the delicate balance between relevance and excellence as we bring our science to bear on important social and public health problems. If we are to increase the translation of our evidence and accelerate our impact, we must increase our relevance while maintaining excellence in our scientific methods.

METHODS

What are the pressing questions facing those that we would like to use our work, and how we can increase our relevance to theirs? We must work on the marriage of relevance and excellence-use rigorous methodologies, but be flexible in our approach, using study designs and methods that will get rapid yet rigorous answers to the questions that are facing practice and policy settings.

CONCLUSION

We have the tools and the knowledge to impact the health of our nation.

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

BACKGROUND

In 2005, the North Carolina State Board of Education updated the Healthy Active Children Policy to include a requirement that all kindergarten through eighth-grade children receive at least 30 minutes of moderate-to-vigorous physical activity each school day through physical education, recess, and other creative approaches. This study describes how districts are meeting the physical activity-related portion of this policy and explores the policy implementation successes and challenges.

METHODS

An online survey was conducted in summer 2007 in all school districts in the state (response rate 106/111; 95.5%). Respondents were asked to describe the implementation successes and challenges associated with including 30 minutes of physical activity in the school day. Answers were double coded, checked, and grouped into themes.

RESULTS

The physical activity requirement was most often met through recess, physical education, classroom Energizers, and intramural sports. School districts reported numerous positive effects of the policy in elementary and middle schools. Benefits included increased student focus on studies, physical activity participation, awareness of healthy habits, alertness and enjoyment, and higher staff involvement. Implementation challenges to the policy included lack of time in the school day, teacher participation, and concerns about academics.

CONCLUSIONS

School districts reported that implementation of the policy produced many positive results for students and staff. Addressing several implementation challenges common across school districts would strengthen the ongoing success of the policy.