Disparities in Local Wellness Policies Implementation Across Maryland Schools

BACKGROUND

School-level implementation of district-level local wellness policies (LWPs) is needed to create school environments that promote nutrition and physical activity (PA). Disparities in classroom-specific LWPs implementation were examined.

METHODS

An administrator survey (N = 756 schools; 24/24 districts) included 6 classrooms LWP best-practice items (fully/not fully implemented: restricting food celebrations or rewards, incorporating PA breaks or integrating PA in curricula, restricting withholding or using PA as punishment). A sum score (alpha = .71; elementary and middle/high examined separately) was used to examine associations with student body income (free-and-reduced priced meals (FARMS): ≤40%, 41-75%, ≥75%), race/ethnicity, and school location (rural/urban/suburban), accounting for district-level clustering, with moderation examined.

RESULTS

Classroom implementation scores were: elementary = 3.1 ± 1.8 (range: 0-6/6 items) and middle/high = 2.3 ± 1.6 (range:0-5/5 items). Among elementary and middle/high schools, 65% and 55% had >40% FARMS, 39% and 46% had ≥50% white student body, and 24% and 23% were urban, respectively. Elementary schools with >40% of FARMS-eligible students and middle/high schools with <25% white students reported implementing fewer items. Location was not associated with classroom practices nor was moderation observed.

CONCLUSIONS

Disparities in classroom-specific LWP best practices implementation were observed by income and race/ethnicity. Tailored support may be needed to improve classroom LWP implementation in schools serving low-income students.

Associations Between Executive Functions and Physical Fitness in Preschool Children

Considering the current agreement on the significance of executive functions, there is growing interest in determining factors that contribute to the development of these skills, especially during the preschool period. Although multiple studies have been focusing on links between physical activity, physical fitness and executive functions, this topic was more investigated in schoolchildren and adults than in preschoolers. The aim of the current study was to identify different levels of physical fitness among pre-schoolers, followed by an analysis of differences in their executive functions. Participants were 261 5–6-years old children. Inhibitory control and working memory were positively linked with physical fitness. Cognitive flexibility was not associated with physical fitness. The research findings are considered from neuropsychological grounds, Jean Piaget’s theory of cognitive development, and the cultural-historical approach.

Effectiveness of the POWER Program in Improving Physical Activity and Executive Function in Fifth Grade Students

BACKGROUND

High volumes of school-based sedentary time may impact academic achievement and executive function negatively. This study evaluated a multimodal classroom program's (POWER) effect on fifth graders' physical activity (PA) and executive function.

METHODS

Six 5th grade classes (3 = intervention [POW]; 3 = waitlist control [CONT]) in 2 diverse New Jersey schools participated. Data were collected before, during, and post-intervention. PA was assessed via accelerometer, executive function by NIH Toolbox, and academic achievement via standardized math tests. The POW principal, teachers, and select students participated in follow-up interviews. Group comparisons were made by multivariate repeated-measures ANOVA and linear regression.

RESULTS

PA decreased in both groups over time, but POW's post-intervention class-time PA was significantly higher than CONT's. POW's NIH Toolbox score increased 3 percentiles more than CONT's. Intervention fidelity was associated with significantly higher scores for one NIH Toolbox test. Student math test scores increased significantly for both schools, but there was no significant main effect for group. POW's feedback was positive, with the principal reporting fewer disciplinary referrals and teachers and students conveying positive growth.

CONCLUSIONS

Overall, POW's positive changes and the favorable reception of POWER support POWER'S ability to improve children's socioemotional and physical health.

Use of School Wellness Policy Templates in One Texas Public Health Region: A Mixed-Methods Analysis

BACKGROUND

Federal law requires most school districts to develop school wellness policies (SWPs), which state agencies assist in by providing templates. Templates provide standard language, which districts may edit for numerous reasons. We aimed to identify the frequency/consistency of template usage and identify the types of edits districts make when using SWP templates.

METHODS

We identified SWPs (N = 117) and templates (N = 2) from districts in 1 Texas public health region. We developed template specific coding guides, which allowed us to examine the frequency SWPs used template text within multiple areas (eg, nutrition goals, reporting). We also collected/categorized SWP edits from the template text and conducted a thematic analysis of locally developed SWPs and SWP templates.

RESULTS

Of 117 SWPs, 81.2% used a 2020 template, 13.7% used a 2005 template, and 5.1% created their own SWP. Across template-based SWPs, 44 content edits (0.4 per policy) occurred in 9 categories. Thematic analysis revealed: (1) locally developed SWPs created an informed mission statement linked to their goals; (2) Locally developed SWPs provided details that the current template includes in wellness plans.

CONCLUSIONS

Most districts used exact template language when writing their SWP. Adding spaces where districts can specify details could improve SWP content.

Health Empowers You: Impact of a School-Based Physical Activity Program in Elementary School Students, Georgia, 2015-2016

BACKGROUND

Most youth in the United States do not meet the recommended 60 minutes of daily physical activity (PA). The school environment offers an opportunity to engage students in PA. The purpose of this study was to evaluate the impact of a comprehensive school-based physical activity program on student PA across student-level and school-level characteristics.

METHODS

PA levels from 3294 fourth grade students in 24 intervention schools and 7 control schools in metropolitan Atlanta, Georgia were measured during the 2015-2016 academic year. PA measures included daily steps in school, steps taken in physical education class (PE), and percent of PE class time spent in moderate-to-vigorous physical activity (MVPA). Intervention effectiveness was assessed using generalized estimating equations adjusting for sex and school-level socioeconomic status (SES).

RESULTS

After adjusting for sex and school-level SES, intervention students had significantly higher increases in average daily steps (p < .05), steps taken in PE (p < .01), and percent of PE class spent in MVPA (p < .01) than control students.

CONCLUSIONS

Our findings demonstrate the effectiveness of CSPAPs in increasing PA. Further research using randomized controlled trials of large-scale implementations, longer follow-up periods, and more diverse student sample is warranted.

Factors Associated With Leisure Time Physical Activity Among Schoolchildren in a Predominantly Latino Community

BACKGROUND

School initiatives aimed at increasing physical activity (PA) may improve the health of children in low-income communities.

METHODS

Assessors completed 5909 observations of students' PA during leisure periods using a validated instrument in 19 schools in low-income Latino communities. We examined relationships between school environment factors (eg, presence of playground equipment) and levels of moderate-to-vigorous physical activity (MVPA).

RESULTS

Overall, 16.4% of students were engaged in vigorous activity, lower than reported in prior analyses. Consistent with earlier reports, boys were more engaged in vigorous PA than girls (18.6% vs 13.2%). Playground equipment, such as balls and jump ropes, were present in 27.5% of activity areas. Supervision was present in 83.1% of observations; however, staff members were only observed leading organized activity in 1.7%. Playground equipment was associated with higher rates of MVPA, particularly among elementary boys (p < .0001). Staff supervision was not associated with MVPA, possibly because staff members rarely led organized activity.

CONCLUSIONS

We found low rates of leisure time PA among students in this low-income Latino community. The presence of playground equipment was favorably associated with activity levels. Increasing the availability of playground equipment might promote activity among children in similar populations.

Pattern of Sedentary Behavior in Different Periods of School Time of Brazilian Adolescents

BACKGROUND

Sedentary behavior (SB) is related to unhealthy outcomes and is performed in many contexts, including school. The aim of this study was to identify sociodemographic, biological, and psychosocial correlates of SB performed at school in a sample of adolescents.

METHODS

Adolescents provided information regarding sex, age, socioeconomic status, and psychosocial variables related to physical activity (self-efficacy, attitudes, perception of school environment, peer and parental support). Body fat was estimated using skinfolds, and maximum aerobic capacity with a 20 m shuttle run. Adolescents wore accelerometers and SB performed during class time, physical education (PE) classes, and recesses was estimated.

RESULTS

Adolescents (N = 567, 53% female, 12.9 ± 5.3 years old) spent 67% of class time, 41% of PE classes, and 41% of recesses in SB. Girls spent more time in SB, and age was negatively associated with SB. Body fat was positively associated with SB in class time and PE classes. Peer support for physical activity was negatively associated with SB in class time, whereas attitudes related to physical activity were negatively associated with SB during PE classes and recesses.

CONCLUSION

Adolescents spend long periods in SB at school, even during opportunities to be active like PE classes and recesses.

Unintentional Injuries in Primary and Secondary Schools in the United States, 2001-2013

BACKGROUND

Unintentional injuries are the leading cause of youth morbidity. However, limited nationally representative data are available to characterize the occurrence of unintentional injuries at US schools. Given this paucity, we characterized secular trends in unintentional injuries at schools that led to emergency department (ED) visits.

METHODS

A retrospective analysis of the National Electronic Injury Surveillance System-All Injury Program from 2001 to 2013 compared injuries occurring at schools to injuries occurring elsewhere in youth ages 5-18 years. Incidence rates were calculated using weighted frequency estimates as numerators and US population estimates as denominators.

RESULTS

School injuries accounted for 21% of unintentional injury-related ED visits, with an estimated annual incidence rate of 1385 injuries per 100,000 5- to 18-year-olds. Middle school-aged youth (10-13 years) had the highest annual incidence rate (1640 per 100,000 youth) compared with younger and older counterparts. School injuries were more likely to be due to sports/recreation than nonschool injuries (55% vs 41%, p < .0001). Importantly, no detectable change in incidence rates of school injuries between 2001 and 2013 was found (p = .11).

CONCLUSIONS

Stagnant annual incidence rates of unintentional injuries at schools and large numbers of school-based injuries demonstrate that school-based injuries are a notable opportunity for future prevention efforts.

Long-Term Trends of Participation in Physical Activity During Adolescence With Educational Ambition and Attainment

BACKGROUND

Insufficient physical activity is a significant concern because a growing body of research demonstrates that physical activity during adolescence has numerous benefits on physical health, mental health, and educational achievement. A less-studied area of physical activity research is how physical activity participation in adolescence relates to educational and career aspirations and attainment.

METHODS

Using the Add Health dataset consisting of over 15,000 participants, this study addressed several research questions relating to the long-term benefits of habitual physical activity in adolescence. Physical activity levels in adolescence and associations with activity participation in later adolescence and young adulthood were explored as were relationships with physical activity participation in adolescence and educational ambition and attainment in young adulthood. Moderator variables including adolescent sex, race, and age were also examined.

RESULTS

Results indicated several significant relationships between physical activity in adolescence and future physical activity and educational attainment outcomes.

CONCLUSIONS

Given short- and long-term benefits of physical activity, school personnel and parents should ensure children are meeting the required activity guidelines for children and find ways to keep children active as they approach adolescence.

"Even If They're Being Bad, Maybe They Need a Chance to Run Around": What Children Think About Recess

BACKGROUND

The withholding of recess for disciplinary purposes has been acknowledged but studied on a limited basis. The perspectives of children have not been heard at all on this subject.

METHODS

Our paper draws upon semistructured child interviews, which were one activity within a multifaceted study. A subset of students was interviewed about recess and about the experience of having teachers who withheld recess.

RESULTS

Interviewees favored recess and other parts of school that allowed physical activity and social interaction over more sedentary, isolating parts of school. Many understood teachers' rationale for withholding recess; some thought it was helpful, up to a point. Others did not think it was solving the problems it was designed to address. They were skeptical it was having a beneficial effect on the small number of peers who lost recess regularly.

CONCLUSION

Most respondents showed deference to their teachers and were inclined to regard them as wise and fair. The data from these interviews indicated that many children experienced anxiety, regret, and sometimes resentment with regard to the practice of withholding recess. Many wished teachers could identify other means of discipline to address issues that led to losing recess. This study provides a valuable perspective that has been missing from the policy discussions about recess.

Effects of a School-Based Pedometer Intervention in Adolescents: 1-Year Follow-Up of a Cluster-Randomized Controlled Trial

BACKGROUND

Physical activity (PA) is one of the most important health behaviors that may be modified by each individual. To foster PA in adolescents, a school-based intervention was evaluated.

METHODS

A cluster-randomized controlled trial with preassessment in 2014 and follow-up assessment in 2015 included 29 schools with 1020 students (47.6% girls, mean age = 13.69 years). Intervention students received pedometers and monitored their steps for 12 weeks. Classes with the most steps were awarded. Primary outcomes included moderate-to-vigorous PA, out-of-school sports activities, active transport assessed through questionnaires, as well as cardiorespiratory fitness measured using the 20-m shuttle-run test and anthropometric data (weight, height, body fat, and waist circumference) assessed by study staff.

RESULTS

Significant interaction terms between group and time were found for all 3 indicators of PA; intervention students showed a higher increase of PA than control students. The same pattern was shown for cardiorespiratory fitness, but the effect missed significance. A more favorable development for the intervention students was shown for body fat and waist-to-height ratio, while there was no effect on body mass index percentile.

CONCLUSIONS

An easy way to administer school-based PA program may enhance students' leisure-time PA even 1 year after the intervention has ended.

Longitudinal Evaluation of Aerobic Fitness and Academic Achievement Among Schoolchildren

BACKGROUND

Research is emerging suggesting that fitness not only improves health, but enhances academic achievement in children. Many studies have found the strongest correlation with academic achievement to be aerobic fitness. The purpose of this study is to examine the influence of aerobic fitness and academic ranking on the association between improvements in students' aerobic fitness and their academic achievement.

METHODS

Data were collected from 1152 second- through fifth-grade students enrolled in 10 Midwestern schools. School-fixed effects models were used to estimate the impact of improved aerobic fitness from the fall to the spring semester on students' spring percentile rankings in math and reading.

RESULTS

Students whose progressive aerobic cardiovascular endurance run improved from the fall to spring semester moved up the national spring math percentile rankings by 2.71 percentiles (p < .001) for all students, 4.77 (p < .001) for less-fit students, and 3.53 (p < .05) for lower performing math students. No statistically significant relationship was found between improved aerobic fitness and reading achievement.

CONCLUSIONS

Improving fitness could potentially have the greatest academic benefit for those elementary students who need it the most-the less fit and the lower academic performers.

Use of a Model Wellness Policy May Not Increase the Strength and Comprehensiveness of Written School Wellness Policies

BACKGROUND

Many state agencies have developed model wellness policies (MWPs) to serve as examples for schools when writing their own school wellness policy (SWP). The purpose of this study was to evaluate if a MWP aids schools in writing stronger, more comprehensive SWPs.

METHODS

For this cross-sectional study, 91 school districts submitted their current SWP and completed a survey that classified districts into either districts that utilized the state MWP (N = 56; 61.5%) or those that did not (NMWP, N =35; 38.5%). The Wellness School Assessment Tool (WellSAT) was used to assess the strength, comprehensiveness, total overall score, and subsection scores of each policy. Dependent variables were compared between groups using t tests. Statistical significance was set at p ≤ .05. Data are presented as mean ±SD.

RESULTS

No significant differences were found between groups in total overall (MWP 76.8 ± 37.9; NMWP 62.1 ± 34.3), strength (MWP 25.3 ± 17.6; NMWP 19.1 ± 12.8), or comprehensiveness scores (MWP 51.5 ± 21.2; NMWP 43.0 ± 22.1). The only subsection score difference identified between groups was the Nutrition Standards comprehension score (p = .02).

CONCLUSIONS

These data suggest MWPs may not improve the quality of written SWPs. Further research is needed to better understand the needs of school districts in SWP development.

Physical and Social Contexts of Physical Activity Behaviors of Fifth and Seventh Grade Youth

BACKGROUND

The purpose of this study was to characterize the temporal, social, and physical contexts for physical activities commonly reported in a diverse cohort of 753 boys and girls from fifth to seventh grade.

METHODS

Data were obtained from a multilevel longitudinal study, the Transitions and Activity Changes in Kids. The Physical Activity Choices instrument assessed previous 5-day participation in specific physical activities and their temporal, social, and physical contexts. Mixed model repeated measure analyses of variance and multinomial analyses examined sex differences and change over time.

RESULTS

Fifth grade boys and girls reported participation in similar activities at similar frequencies, which declined significantly by seventh grade. One temporal pattern, playing with younger children, changed over time from "both inside/outside" to "outside" school. Boys and females reported more activities performed in class/team groups over time. Most activities took place primarily at home for all participants in both grades.

CONCLUSIONS

Boys and girls reported declines in the variety and frequency of activities from fifth to seventh grade. There were sex-specific patterns in physical activities and groups; however, all participants reported home as the primary location and a shift to class/team groups over time. Schools are well-positioned to provide additional physical activity opportunities.

How Healthy Is Homeschool? An Analysis of Body Composition and Cardiovascular Disease Risk

BACKGROUND

Public school children regularly participate in school-based physical activity, physical education, and fitness testing. However, almost 2 million American children are homeschooled. The purpose of this research was to assess the body composition of elementary school-aged homeschool children and their corresponding cardiovascular disease (CVD) risk.

METHODS

This research explored the body composition and CVD risk of 145 homeschool children aged 5-11 years using body mass index (BMI), percent body fat, and waist circumference. Chi-square and Mann-Whitney U tests examined differences in CVD risk within the homeschool population.

RESULTS

Overall, homeschool children had average BMI z-scores (SD [range]) with a mean of -0.11 (0.97 [-3.47 to 2.53]). Unhealthy classifications were seen in 11.2% of the sample by BMI, 19.6% by percent body fat, and 49.7% by waist circumference. Statistical analysis revealed no difference in CVD risk between sexes (χ² (1) = 0.062, p = .804) or ethnicities (χ² (1) = 0.927, p = .336) but increased prevalence in children aged 5-9 years (U = 1427, z = -4.559, p < .001).

CONCLUSIONS

Almost half of elementary school-aged homeschool children showed increased risk for CVD and need regular assessment of central adiposity.

Developing the System for Observing Behavioral Ecology for Youth in Schools Instrument

BACKGROUND

Behavioral support may be effective in increasing physical activity (PA) in school settings. However, there are no data collection systems to concurrently record PA and behavioral support. This paper describes the development and validation of the System for Observing Behavioral Ecology for Youth in Schools (SOBEYS)-an instrument used with existing observation systems to record PA within a behavioral ecological context.

METHODS

In 2013, experts created a set of behavioral categories to record prompting and reinforcement of PA during a recreational school activity program. The school provided supervision and equipment for lunchtime PA, making it possible to assess both PA and behavioral support. The system was implemented in spring semester 2014 at 1 suburban junior high school (N = 1452; 48% girls, 74% Caucasian) in the western Unites States.

RESULTS

Following multiple field trials, the SOBEYS instrument recorded behavioral categories of visual and verbal prompting, verbal, and nonreinforcement by adults and peers, and token reinforcement. Construct validity and acceptable interobserver agreement (>90%; kappa between 0.22 and 0.94) resulted.

CONCLUSION

Trained SOBEYS users can accurately and reliably record the presence of behavioral support aimed at prompting and reinforcing PA in conjunction with established systematic observation instruments to record PA context and quantity.

Mixed-Methods Evaluation of a Healthy Exercise, Eating, and Lifestyle Program for Primary Schools

BACKGROUND

Reversing decline in physical fitness and increase in excess body weight in school children are considered major public health challenges. We evaluated a proposed model to integrate a screening and healthy exercise, eating, and lifestyle program (HEELP) into primary schools in Canberra, Australia. Objectives were: (1) to establish body status and physical competencies of 5- to 10-year-old children; (2) to evaluate the service's impact on body status and physical fitness; and (3) to gauge parent/guardian and school perspectives on the service.

METHODS

A mixed-methods approach was used over 4 school years, 2010-2013. Primary evaluation used direct quantitative measurement. Confirmatory qualitative methods were implemented in the last 2 years.

RESULTS

The service was delivered on 71 occasions involving 25 schools; 7750 children were screened and 709 completed all aspects of the HEELP evaluation. Over 60% of children screened had 2 or more measures that would benefit from remedial intervention.

CONCLUSIONS

All body status and physical fitness measures showed small beneficial changes on a population basis immediately after the HEELP. Further benefit did not accrue at 6 months after the program. Semistructured interviews with schools and parent/guardian surveys confirmed some beneficial effects observed by direct quantitative measurement.

A Review of Implementation Outcome Measures of School-Based Physical Activity Interventions

BACKGROUND

Measuring the implementation of school-based physical activity (PA) interventions is an important prerequisite in assessing their impact. Prior to conducting a study to assess the implementation of the daily physical activity (DPA) policy in Ontario, Canada, a literature review was conducted to identify existing survey instruments to measure 5 implementation outcomes: adoption, fidelity, implementation cost, reach, and sustainability.

METHODS

A search for survey instruments to assess these implementation outcomes at the teacher and school administrator levels was conducted in 7 bibliographic databases, as well as the gray literature. Each survey instrument was coded as assessing 1 of the 5 implementation outcomes if it included at least 1 item measuring the construct.

RESULTS

Twenty-three survey instruments were identified. None of the instruments were specifically developed to measure the implementation outcomes. Fidelity was the most common implementation outcome measured, followed by adoption. The least common implementation outcome measured was sustainability. Thirty-five percent of survey instruments assessed were previously tested for validity and 26% were previously tested for reliability.

CONCLUSIONS

Based on this review, a gap in available instruments to measure implementation outcomes of school-based PA programs was identified. An adapted theoretical framework, presented here, has potential application in future implementation studies.

The Role of Ethnicity in School-Based Obesity Intervention for School-Aged Children: A Pilot Evaluation

BACKGROUND

Rates of obesity have risen disproportionately for ethnic minority youth in the United States. School-based programs may be the most comprehensive and cost-effective way to implement primary prevention in children. In this study we evaluated the effect of a school-based obesity prevention on the outcome of body mass index percentile (BMI%), with baseline weight class and ethnicity examined as moderators.

METHODS

Participants (N = 125), ages 7-11 (56% female) from 4 urban, low-income, ethnic minority (58% black, 42% Latino) schools were recruited. Two schools received the Urban Initiatives Work to Play health intervention, and 2 demographically matched schools served as wait-list controls.

RESULTS

Hierarchical multiple regression was used to analyze the independent and interactive effects of key variables on BMI%. An interaction between intervention status and ethnicity revealed Latino youth in the intervention had lower BMI% than those in the control group. Participation did not cause BMI% outcomes to decrease for black participants.

CONCLUSIONS

The study demonstrates the intervention is effective, but that the effectiveness varies across ethnicity. Interventions can be made more efficient and cost-effective by targeting youth of a common ethnicity that has shown empirical responsiveness to certain program elements.

Implementation of Local Wellness Policies in Schools: Role of School Systems, School Health Councils, and Health Disparities

BACKGROUND

Written local wellness policies (LWPs) are mandated in school systems to enhance opportunities for healthy eating/activity. LWP effectiveness relies on school-level implementation. We examined factors associated with school-level LWP implementation. Hypothesized associations included system support for school-level implementation and having a school-level wellness team/school health council (SHC), with stronger associations among schools without disparity enrollment (majority African-American/Hispanic or low-income students).

METHODS

Online surveys were administered: 24 systems (support), 1349 schools (LWP implementation, perceived system support, SHC). The state provided school demographics. Analyses included multilevel multinomial logistic regression.

RESULTS

Response rates were 100% (systems)/55.2% (schools). Among schools, 44.0% had SHCs, 22.6% majority (≥75%) African-American/Hispanic students, and 25.5% majority (≥75%) low-income (receiving free/reduced-price meals). LWP implementation (17-items) categorized as none = 36.3%, low (1-5 items) = 36.3%, high (6+ items) = 27.4%. In adjusted models, greater likelihood of LWP implementation was observed among schools with perceived system support (high versus none relative risk ratio, RRR = 1.63, CI: 1.49, 1.78; low versus none RRR = 1.26, CI: 1.18, 1.36) and SHCs (high versus none RRR = 6.8, CI: 4.07, 11.37; low versus none RRR = 2.24, CI: 1.48, 3.39). Disparity enrollment did not moderate associations (p > .05).

CONCLUSIONS

Schools with perceived system support and SHCs had greater likelihood of LWP implementation, with no moderating effect of disparity enrollment. SHCs/support may overcome LWP implementation obstacles related to disparities.

Association Between Physical Fitness and Academic Achievement in a Cohort of Danish School Pupils

BACKGROUND

Time spent on physical activity in elementary school has been altered to improve core academics. However, little is known about the relationship between physical fitness and academic achievement. We examined the association between physical fitness and academic achievement and investigated the influence of parental socioeconomic status and ethnicity.

METHODS

Participants were 542 girls and 577 boys aged 13 to 15 residing in the Danish municipality of Aalborg. A watt-max cycle ergometer test was completed to evaluate physical fitness as represented by VO2 max (mL·kg(-1) ·min(-1) ). Academic achievement was measured 1 school year later through a series of mandatory exams within the humanities, sciences, and all obligatory defined exams. Parental income and education were drawn from nationwide registers. Linear regression models were used to investigate the association.

RESULTS

Adjusting for ethnicity and parental socioeconomic status, the effect size of the humanities was 0.08 grad/VO2 max (95% Cl: 0.05 to 0.11) for girls and 0.06 grad/VO2 max (95% Cl:0.03 to 0.08) for boys. The effect size of the sciences was 0.09 grad/VO2 max (95% Cl:0.05 to 0.13) for girls and 0.06 grad/VO2 max (95% Cl:0.03 to 0.09) for boys. The effect size of the defined exams was 0.09 grad/VO2 max (95% Cl:0.06 to 0.11) for girls and 0.06 grad/VO2 max (95% Cl:0.03 to 0.08) for boys.

CONCLUSION

We found a statistically significant positive association between physical fitness and academic achievement after adjusting for ethnicity and parental socioeconomic status.

Bigger ≠ Better: The Comprehensiveness and Strength of School Wellness Policies Varies by School District Size

BACKGROUND

District size has been shown to impact the anticipated barriers to wellness policy creation and implementation. Therefore, the purpose of the present study was to determine if strength and comprehensiveness of wellness policies differs among school districts of varying size.

METHODS

Wellness policies were collected from 10 large, 29 medium, and 31 small school districts in a rural Midwest state. District size was categorized by the average daily membership in grades 9-11. Polices were coded using the Wellness School Assessment Tool (WellSAT). Strength and comprehensiveness of the full policy and policy sections were compared among small, medium, and large districts using 1-way analyses of variance (ANOVAs). Data are presented as mean ± SD. Statistical significance was set at p ≤ .05.

RESULTS

There was a difference in the total combined (p = .041), total comprehensiveness (p = .043), and total strength scores (p = .031) based on school district size, such that small districts had stronger, more comprehensive wellness policies than large districts. Section comparisons revealed the section focused on Standards for United States Department of Agriculture School Meals was primarily responsible for these differences.

CONCLUSIONS

These data suggest smaller districts write policies that are more comprehensive to governmental standards and use more definitive language than larger districts.

Physical fitness in Spanish schoolchildren aged 6-12 years: reference values of the battery EUROFIT and associated cardiovascular risk

BACKGROUND

Physical fitness is considered an important indicator of health in children. The aims of this study were to (1) provide sex- and age-specific EUROFIT battery levels of fitness in Spanish children; (2) compare Spanish children's fitness levels with those of children from other countries; and (3) determine the percentage of Spanish children with cardiovascular risk associated with low cardiorespiratory fitness (CRF).

METHODS

Physical fitness was assessed using the EUROFIT tests in 1725 children, aged 6 to 12, from Castilla-La Mancha, Spain. We derived specific values for physical fitness using LMS method. FITNESSGRAM 2010 criteria were used to estimate the percentage of children with cardiovascular risk associated with low CRF.

RESULTS

Boys scored higher in all the physical fitness tests, except for the flexibility test. Physical fitness improved as age increased, except for flexibility, which worsened in boys, and VO2max, which decreased in both sexes. The prevalence of boys and girls with cardiovascular risk associated to low CRF was 13% and 26%, respectively.

CONCLUSIONS

Specific fitness test scores for children and adolescents can represent the fitness status of schoolchildren accurately. Schools need to make efforts to improve the fitness level of the schoolchildren to prevent cardiovascular risk.

The association of screen time, television in the bedroom, and obesity among school-aged youth: 2007 National Survey of Children's Health

BACKGROUND

Among school-aged youth, we sought to identify characteristics associated with (1) exceeding screen time recommendations (ie, television/videos/video games more than 2 hours/weekday), and (2) exceeding screen time recommendations, the presence of a television in the bedroom, and obesity.

METHODS

Using 2007 National Survey of Children's Health data, we used multivariable logistic regression to identify sociodemographic and behavioral characteristics associated with excessive screen time among 6 to 11- and 12 to 17-year-olds on a typical weekday. For 12 to 17-year-olds only, we used logistic regression to examine the odds of obesity using the same variables as above, with the addition of screen time.

RESULTS

Overall, 20.8% of 6 to 11-year-olds and 26.1% of 12 to 17-year-olds had excessive screen time. For both age groups, having a bedroom TV was significantly associated with excessive screen time. For the older age group, the dual scenario of excessive screen time with a bedroom TV had the strongest association with obesity (OR = 2.5, 95% CI 1.9, 3.2).

CONCLUSIONS

Given the similar risk factors for excess screen time and having a TV in the bedroom, a public health challenge exists to design interventions to reduce screen time among school-aged youth.

Relationship between socioeconomic status and physical fitness in junior high school students

BACKGROUND

Research on physical fitness often regards socioeconomic status (SES) as a confounding factor. However, few studies investigate the impact of SES on fitness. This study investigated the impact of SES on physical fitness in both males and females, with an economic-based construct of SES.

METHODS

The sample consisted of 954 6th, 7th, and 8th graders from a public, urban, Illinois middle school. The students participated in the FITNESSGRAM battery of fitness assessments as part of physical education. Descriptive statistics were calculated for height, weight, age, and sex. Students were grouped as high or low SES depending on whether they qualified for the federal free lunch program. A multivariate analysis of variance controlled for age and stratified by sex compared the raw scores from the fitness test for low and high SES students. Odds ratios stratified by sex were calculated for the likelihood of not achieving the FITNESSGRAM Healthy Fitness Zone standards among SES groups.

RESULTS

Girls of the low SES group had significantly lower scores on the FITNESSGRAM assessments and were significantly less likely to achieve Healthy Fitness Zone status than the girls from the high SES groups. For boys, SES was a significant main effect for body composition but not for the other fitness tests conducted.

CONCLUSION

SES is related to physical fitness in girls but not in boys. A potential explanation for this is that boys are more likely to engage in vigorous leisure time activity regardless of SES than girls.

An adaptive community-based participatory approach to formative assessment with high schools for obesity intervention*

BACKGROUND

In the emerging debate around obesity intervention in schools, recent calls have been made for researchers to include local community opinions in the design of interventions. Community-based participatory research (CBPR) is an effective approach for forming community partnerships and integrating local opinions. We used CBPR principles to conduct formative research in identifying acceptable and potentially sustainable obesity intervention strategies in 8 New Mexico school communities.

METHODS

We collected formative data from 8 high schools on areas of community interest for school health improvement through collaboration with local School Health Advisory Councils (SHACs) and interviews with students and parents. A survey based on formative results was created to assess acceptability of specific intervention strategies and was provided to SHACs. Quantitative data were analyzed using descriptive statistics while qualitative data were evaluated using an iterative analytic process for thematic identification.

RESULTS

Key themes identified through the formative process included lack of healthy food options, infrequent curricular/extracurricular physical activity opportunities, and inadequate exposure to health/nutritional information. Key strategies identified as most acceptable by SHAC members included healthier food options and preparation, a healthy foods marketing campaign, yearly taste tests, an after-school noncompetitive physical activity program, and community linkages to physical activity opportunities.

CONCLUSION

An adaptive CBPR approach for formative assessment can be used to identify obesity intervention strategies that address community school health concerns. Eight high school SHACs identified 6 school-based strategies to address parental and student concerns related to obesity.

Leisure-time physical activity in elementary schools: analysis of contextual conditions

BACKGROUND

Little is known about children's leisure-time physical activity (PA) at school and how it is associated with contextual variables. The purpose of this study was to objectively assess children's voluntary PA during 3 daily periods and examine modifiable contextual factors.

METHODS

We conducted SOPLAY (System for Observing Play and Leisure Activity in Youth) observations before school, during recess, and at lunchtime in 137 targeted activity areas in 13 elementary schools over 18 months. During observations, each child was coded as Sedentary, Walking, or Vigorous, and simultaneous entries were made for area characteristics (accessibility, usability, presence of supervision, loose equipment, and organized activities). Logistic regression analysis was used to test associations between PA and area characteristics.

RESULTS

Assessors made 2349 area visits and observed 36,995 children. Boys had more moderate-to-vigorous physical activity (MVPA; 66.2 vs 60.0%, p < .001) and more vigorous PA (29.8 vs 24.6%; p < .001) than girls. Areas were typically accessible and usable, but provided organized activities infrequently (16.5%). Odds of engaging in MVPA were greater during lunch and recess than before school and in areas with play equipment (p < .05).

CONCLUSIONS

Children accrued a substantial amount of voluntary PA during leisure time at school. Their PA would likely be increased if school playground equipment was more readily available and if supervisors were taught to provide active games and promote PA rather than suppress it.

Correlates of depressive symptoms in urban youth at risk for type 2 diabetes mellitus

BACKGROUND

Rates of overweight in youth have increased at an alarming rate, particularly in minority youth, and depressive symptoms may affect the ability of youth to engage in healthy lifestyle behaviors to manage weight and reduce their risk for health problems. The purpose of this study was to examine the relationships between depressive symptoms, clinical risk factors, and health behaviors and attitudes in a sample of urban youth at risk for type 2 diabetes mellitus (T2DM).

METHODS

We obtained self-report questionnaire data on depressive symptoms and health attitudes and behaviors related to diet and exercise and clinical data on risk markers (eg, fasting insulin) from 198 youth from an urban setting. Seventh-grade students were eligible if they were at risk for developing T2DM because they had a body mass index (BMI) in the 85th percentile or higher and a family history of diabetes.

RESULTS

Clinically significant levels of depressive symptoms were evident in approximately 21% of the sample, and Hispanic youth reported higher levels of depressive symptoms than black youth. Higher levels of depression were associated with several health behaviors and attitudes, in particular less perceived support for physical activity and poorer self-efficacy for diet. Depressive symptoms were also related to some clinical risk markers, such as higher BMI and fasting insulin levels.

CONCLUSIONS

Because depressive symptoms may affect ability to engage in healthy behavior changes, evaluation and treatment of depressive symptoms should be considered in preventive interventions for youth at risk for T2DM.