Background and Purpose
In 2007, the Mississippi (MS) legislature acted to improve health and reduce childhood obesity through the MS Healthy Students Act (SB 2369) (1), which mandates school-age students engage in specific amounts of in-school physical activity (ISPA).  However, schools in predominantly rural, low-income, racially concentrated communities are not meeting the provisions of the law (2) and there are increasing disparity gaps in childhood obesity between black (27.8%) and white (19.5%) students.(3)   As facilitators linked to successful ISPA policy implementation are identified, the dissemination of best practices is pertinent and likewise, as barriers are revealed there is a need to develop and disseminate effective ISPA strategies.(4) Furthermore, it is important that these outcomes are identified as relevant by legislators and inform future decisions related to childhood ISPA, obesity and health disparities. Thus, the purpose of this investigation was to disseminate evidence-based findings to state policy-makers, and to identify and disseminate ISPA best practices at the district- and school-levels in the MS Delta.

Objectives
1) Translate and disseminate research findings to inform key lawmakers in the MS legislature; 2) Identify ISPA best practices at the school- and district-levels in the MS Delta; and 3) Foster collaboration among researchers, state agencies, and organizations that focus on reducing childhood obesity and child health disparities.

Methods
A collective case study (5) approach was used to investigate ISPA policy implementation in the MS Delta. Qualitative data collection procedures included: 1) two focus groups with school principals (n=11) and two interviews with district-level administrators to understand an administrator’s role in developing and implementing ISPA policy, to identify barriers to implementation, and to reveal best practices; 2) two focus groups  with PE teachers (n=21) to identify barriers to implementing PE curricula and to reveal best practices; and 3) two focus groups with elementary school students (n=16) to identify ISPA that students typically engage in and want to engage in, and to identify how frequently students are engaged in and want to engage in ISPA. Audio recordings were transcribed, verified, and consensus rendered by two co-investigators. Transcendent themes that emerged from the transcripts were identified within and across groups to provide a detailed description of factors that influence ISPA policy.(5)

Results
Students recognized the importance of ISPA for academic achievement, enjoyed having physical activity integrated into classroom learning, and valued PE and recess. Students were most interested in dance activities, organized competitions (i.e., obstacle courses, races), and sports (males). Some students believed they had ample time for ISPA while others did not.

PE teachers identified four primary barriers to implementing PE curricula: 1) schedules do not provide ample time for students to learn, practice, and master skills, 2) limited monetary resources for staff support, space, and equipment, and 3) lack of state, district, and school administrative support for PE, which 4) fosters a school-wide devaluing of the PE teacher and PE program. However, PE teachers that demonstrated successful ISPA practices had strong support from their principals and reported having strong community partnerships/collaborations.

The principals agreed that academic achievement is their primary concern but also recognized the importance of ISPA in achieving academic success and acknowledged funding as a barrier. Principals with successful ISPA programs reported having strong community partnerships/collaborations and those with less successful programs reported rurality and location as challenges to creating community partnerships/collaborations. Other successful practices included policies that incorporated “brain breaks” and physical activity into classroom instruction.

The district curriculum coordinator was aware of the state ISPA requirements and took responsibility to ensure the requirements were met by communicating with principals and conducting PE evaluations. The superintendant was familiar with the requirements but believed it was the responsibility of the principals to develop and implement ISPA policy.

Conclusions
Most district- and school-level personnel in the MS Delta recognize the importance of ISPA for students’ academic success but acknowledge there are formidable challenges. Despite these challenges, there are schools in the MS Delta with successful ISPA programs. A key concept is having a school principal that serves as an “ISPA champion” and plays an integral role in creating a school culture that values ISPA. The principals’ excitement for ISPA inspires teachers and students to support ISPA.

Implications for Practice and Policy
The most rural schools need assistance in developing and implementing ISPA policy to provide the most disadvantaged, at-risk students with sufficient ISPA opportunity. Policy-makers need to be informed of successes and challenges of the MS Healthy Students Act.  There is urgent need for specific policy to address rural and racial child health disparities. Advising policy-makers of the evidence-based outcomes will help them make informed decisions regarding ISPA and childhood obesity polices. Thus, we have a meeting to discuss the results of this project with MS legislators and other stakeholders in October 2013. In addition to the results of this project, we will be able to share the outcomes of this meeting at the ALR annual meeting.

References

1. Mississippi Healthy Students Act, SB 2369 Available at http://billstatus.ls.state.ms.us/documents/2007/pdf/SB/2300-2399/SB2369SG.pdf. Accessed September 3, 2013.
2. Gamble A. The role of policy on children’s in-school physical activity in the Mississippi Delta. Unpublished doctoral dissertation, The University of Mississippi, University.
3. Kolbo JR, Zhang L, Fontenot Molaison E et al. Prevalence and trends in overweight and obesity among Mississippi public school students, 2005-2011. J MSMA. 2012; 53: 140-146.
4. Gamble A, Waddell D, Ford MA, Bentley JP, et al. Obesity and health risk of children in the Mississippi Delta. J Sch Health. 2012; 82: 478-483.
5. Creswell JW. (2013). Qualitative inquiry and research design: Choosing among five approaches (3rd ed.). Thousand Oaks: Sage Publications, Inc.

Support / Funding Source
This investigation is funded by Active Living Research Translation Awards (RWJF #67132).