Schools

Show on Home Page: 
Yes

Schools play a critical role in helping children lead active, healthy lives. Recess, PE classes, after-school programs, and walking or biking to and from school all have the potential to get kids moving. Research shows that kids who move more aren’t just healthier, they also tend to do better academically, behave better in class and miss fewer days of school.  Unfortunately, many schools do not offer enough opportunities for children to be active. Policy-makers, teachers and parents can use research on the benefits of school physical activity to advocate for programs and policies that help children be active before, during and after school.

Download our Schools-related Resources Sheet for the best evidence available about a variety of school-based strategies for promoting physical activity.

You can also view and download our The Role of Schools in Promoting Physical Activity infographic.

Show on Audience Block: 
Yes
Topic Image: 
Show on About Page: 
Yes

A Contextual Look at Safe Routes to School Program Implementation in Texas: Results of Qualitative Interviews

Date: 
02/25/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
The Texas Childhood Obesity Prevention Program Evaluation (T-COPPE), a five year project funded from July 2008 to August 2013 by the Robert Wood Johnson Foundation (RWJF), was designed to evaluate the statewide implementation of two national policies in Texas:  1) the Safe Routes to School (SRTS) program administered through the Texas Department of Transportation; and 2) the program rule revising the federal food allocation package administered through Texas Women, Infants and Children Nutrition Program, Texas Department of State Health Services.    Initial findings from the SRTS evaluation and discussions with school administrators and teachers during the final year of the data collection period suggested that schools were still in the process of implementing their SRTS grant, and clarification was needed on the status of the implementation of the SRTS grants.  In an effort to better understand the SRTS grant process for grant awardees and implementation of the SRTS program in Texas, RWJF provided additional funding in September 2013 to conduct interviews with community and state-level SRTS stakeholders.  The interviews focused on the planning and implementation of the SRTS grants, and the sustainability of the SRTS program and other school safety programs.

Objectives
The purpose of the community and state-level SRTS stakeholder interviews was to gain a more comprehensive understanding of the implementation of the SRTS program in Texas, including the grant planning process, implementation, and future plans for the SRTS program.

Methods
The TCOPPE study included a natural experiment, which compared schools funded for SRTS in 2007 with comparison schools with similar characteristics but no funding. Structured phone interviews were conducted from February to May 2014 with local and statewide SRTS stakeholders including: 1) city and community individuals listed on the 2007 SRTS applications; 2) individuals from the public works department in communities that received 2007 SRTS infrastructure and planning grants; and 3) members of the Texas Bicycle Coalition involved in the review of the 2007 and 2009 SRTS grants.  Eight communities from the original T-COPPE project were selected for the additional interviews, including 4 schools that received infrastructure project funding and 4 schools that received non-infrastructure project funding.  Members of the project’s study team and steering committee identified potential state-level stakeholders.   Interview questionnaires were developed by investigators with input from an external advisory committee.  Separate questionnaires were developed for the community and state-level interviews, and project staff conducted the interviews with stakeholders over the phone. Participants were asked a series of open-ended and multiple-choice questions with follow-up to clarify their responses.  Interviews were recorded and transcribed.  Transcribed responses were organized and grouped according to thematic elements using standard procedures (Krueger & Casey 2009).

Results
Phone interviews were conducted with 34 community members from eight communities that received 2007 SRTS grants for either infrastructure or non-infrastructure projects and three state-level stakeholders from February to May 2014.  Community members included school and district administrators, city officials, public works employees, engineers, city police, and volunteers from community groups.  The SRTS programs in the communities interviewed were complete or in the process of finishing the program.  The focus of the infrastructure projects was installing sidewalks and traffic signals, and the focus of the non-infrastructure projects was to create a plan for future infrastructure projects.   Applicants participated in the SRTS program because they saw a need to improve safety at their schools, especially in low-income neighborhoods, and to increase opportunities for physical activity by enhancing the built environment around the school.  As projects were completed, most communities perceived increased walking to and from school, increased neighborhood pride, and positive reactions from parents and teachers.   Challenges that communities experienced that led to delayed implementation of SRTS programs were lack of communication with the granting agency and in some cases, within the community and changes in construction design standards.

Conclusions
The interviews conducted by the T-COPPE project provided insight on the implementation of the SRTS program in Texas and context for the survey and audit results.  Communities in Texas want to provide their students with a safe environment to walk and bike to and from school, and the SRTS program was perceived as beneficial by providing funds for infrastructure and education projects.  While most community representatives reported they completed their project, many had significant challenges when planning, creating, and implementing their plans.  The biggest challenges were lack of communication and navigating approval processes and policies, which caused delays in the completion of the project.

Implications
The interview results show that the SRTS program is needed and valued by communities in Texas; however implementation without subsequent technical assistance and support is difficult and inefficient.  Communities that had dedicated grant writers or resources, viable partnerships with local decision-makers, and community support were more likely to report more favorable results.  Future grants should include at least partial funding up-front, rather than relying specifically on cost reimbursement policies, especially in smaller communities with less resources.

References
Krueger, RA and Casey MA.  (2009).  Focus groups:  a practical guide for applied research. Los Angeles: Sage Publications.

Support / Funding Source
Robert Wood Johnson Foundation

Authors: 
Heather Atteberry, MPH, University of Texas School of Public Health
Location by State: 
Study Type: 

A Multi-Site Study of Environmental Correlates of Active Commuting to School in Mexican Children

Date: 
02/28/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
Physical inactivity is endemic in Mexico, and a majority of Mexican children fail to meet physical activity recommendations.  Walking or bicycling to school, also known as active commuting to school (ACS), has been identified as an effective, low-cost strategy for increasing physical activity in the daily routines of children. Studies conducted in various settings in high- (HIC) and low- and middle-income countries (LMIC) have found that ACS can lead to increased energy expenditure, increased levels of physical activity, and increased likelihood of meeting physical activity guidelines. Correlates associated with promoting and inhibiting ACS include a wide range of individual and familial characteristics as well as home and school neighborhood characteristics. While demographic correlates of ACS have been widely explored, there is a lack of studies that investigate environmental and familial characteristics simultaneously. Therefore, the purpose of this work is to expand current knowledge on ACS behavior in a Latin American context, by examining family and environmental correlates of ACS in a sample of school-age children attending public schools in three Mexican cities.

Objectives
To evaluate the associations between ACS and environmental features surrounding public elementary schools in 3 Mexican cities.

Methods
In 2012, the Understanding Health Habits in Mexican Children project collected physical activity data on children in public elementary schools and environmental audit data in surrounding neighborhoods in Guadalajara (N=10), Mexico City (N=13), and Puerto Vallarta (N=3). A modified version of the 4th grade School Physical Activity and Nutrition (SPAN) survey was used to capture demographic and family structure information, as well as transportation mode to school. ACS was defined as walking or bicycling to school. A modified version of the Pedestrian Environment Data Scan (PEDS) was used to measure street scale elements within a 400-meter buffer surrounding each school. The PEDS measures the quality and nature of the pedestrian environment including land-use diversity, sidewalk, connectivity and quality, traffic control devices and crossing aids and speed limits of street segments. Environmental data were completed using geographic information systems. Information on neighborhood demographics, connectivity and residential density was collected. Multilevel logistic modelling was used to explore the environmental correlates of ACS.

Results
A total of 1237 children (Guadalajara N=627, Puerto Vallarta N=119, Mexico City N=491) from grades 3 through 5 were measured. 52.8% of children were female, mean age was of 9.63 years (±0.06), and 41% of families had more than two children. A total of 50.5% (N=625) of children overall engaged in ACS. Higher sidewalk availability was found in Guadalajara (80% of street segments) compared to Puerto Vallarta (65% of segments) and Mexico City (69% of segments). Mexico city had the highest proportion of segments with traffic control devices (42%) and crossing aids (32%), as well as residential density (3530 households/km squared), while the highest values of street connectivity and land-use mix were found in Puerto Vallarta (3- and 4-way intersections per km squared=1.25) and Guadalajara (3-category land use mix score=0.81), respectively.

Conclusions
Engagement in ACS was associated with multiple factors at multiple levels (i.e., family and environment). We identified number of children in the household, higher residential density and higher proportion of employed population in the neighborhood as important correlates of ACS. Identified correlates were different from what has been observed in HIC. Our findings suggest that land-use mix and residential density in the Mexican context may be negatively associated with ACS, consistent with the IPEN-Mexico adult study findings (Salvo et al, 2014). Likewise, no associations were found for sidewalk availability, traffic control devices, crossing aids or posted speed limits. This is probably due to the fact that ACS is necessity driven, underplaying the importance of street safety features.

Implications
While further examination is needed before formal policy recommendations for Mexico can be made, findings support the notion that evidence from HIC is inadequate to guide local programs and policies to promote PA through environmental changes. By examining multiple factors at multiple levels of environment, this study will provide context-specific evidence on family and environmental determinants of ACS that can be used to inform future research, policy, and health promotion strategies in Mexico and Latin America.

References
Salvo D, Reis RS, Rivera JA, Martorell R, Pratt M. Characteristics of the Built Environment in Relation to Objectively Measured Physical Activity Among Mexican Adults, 2011. Prev Chronic Dis. 2014;(in press; Accepted May 30, 2014).

Support / Funding Source
This work made possible by a Fulbright-García Robles Core Scholar Fellowship awarded to Dr. Lee., the Canadian Institutes for Health Research and the Public Health Agency of Canada.

Authors: 
Alejandra Jáuregui de la Mota, MSc, PhD(c), Instituto Nacional de Salud Pública
Location by State: 
Study Type: 

Environmental Correlates of Active Travel to School, by Distance Ranges

Date: 
02/25/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
Active Travel to School (ATS) (e.g., walking or bicycling to school) can help increase children’s physical activity levels [1]. A growing body of literature has identified environmental correlates of ATS leading to active discussions on relevant intervention strategies [2-4]. Home-to-school distance is one of the most influential factors determining the likelihood of choosing an active travel mode. However, the distance variable in previous studies has been used primarily as one of the independent or control variables predicting the rates/odds of ATS. Potential differences in the roles that the built and natural environmental variables may have on ATS by different home-to-school distance ranges have not been explored sufficiently.

Objectives
This study examines the built and natural environmental correlates of ATS separately at four distance ranges: 1.5 miles. One mile has been generally reported as an acceptable maximum distance for walking or bicycling to school [5], and therefore this study uses 1 mile and 1±0.5 miles as the thresholds to divide up the distance ranges.

Methods
This cross-sectional study utilized the secondary survey data derived from a research project (2008-11) funded by the Robert Wood Johnson Foundation’s Active Living Research Program. A total of 4,602 parents whose children were enrolled in 20 public elementary schools in the Austin Independent School District in Austin, Texas, participated in the surveys. The survey variables including child’s gender, grade, language spoken at home, parent’s car ownership, and parental education levels were used as confounders for this study. The main outcome variable, also derived from the survey, was a dummy variable indicating whether the child walked or biked to/from school on a normal day. The built and natural environmental variables were measured objectively utilizing Geographic Information Systems (GIS) techniques and remote sensing software, Environment for Visualizing Images, within 100 feet home-to-school route buffers. The shortest home-to-school routes were calculated in GIS based on the geocoded home and school addresses. The built environmental variables captured transportation infrastructure (sidewalks, bike lanes, highways, etc.), land uses, and crime and crash incidences, within the buffer. For the natural environments, park presence, land cover types, greenness measured by a Normalized Difference Vegetation Index (NDVI), temperature, and tree height variables were included. Mixed-effects logistic regression models were estimated separately for each of the four distance ranges.

Results
Results from the regression models demonstrated that the relationships between the environmental variables and ATS varied by home-to-school distance ranges. Among the personal factors, higher grades and using Spanish (vs. English) at home were positively associated with ATS at the two shortest ranges only; and more cars in the household and higher parental education levels were negatively associated with ATS in all but the longest range.   Regarding the environmental correlates of ATS, shorter home-to-school distances (continuous variable) were associated with increased odds of walking/bicycling to school at the two shorter distance ranges only. Other significant environmental correlates of ATS across the distance ranges included: (1) the percentage of sidewalks, positive at the 1-1.5 miles range only, (2) the presence of bike lanes, positive at 0.5-0.99 and 1-1.5 miles, (3) the presence of playgrounds, positive at 1.5 miles.

Conclusions
Except for a few studies conducted outside the US [3, 4], this study is one of the first US studies to examine the potentially different roles of the environmental factors in promoting or hindering ATS by different home-to-school distance ranges. This study found that children’s ATS in the shorter, walkable distance ranges were shown to have strong associations with both personal factors such as child’s grade, language, and car ownership, and the built environmental features such as playgrounds, parks, bike lanes, and crash-safety en route to school. However, from the longer distance ranges, no personal factors were found significant, and only a small number of environmental correlates were found significant, including two natural (steep slopes, and tree canopies) and one built (highways) environmental variables.

Implications
This study showed that ATS intervention strategies targeting the built environment may be more effective at shorter distance ranges. Provision of playgrounds and parks, and improvement of crash-related safety near schools can help encourage ATS. Providing shade trees and avoiding hilly terrains en route to school may help longer-distance commuters to consider active modes. However, a more realistic intervention recommendation for longer-distance commuters would be to promote the school bus use, instead of walking or bicycling, as a more feasible alternative to driving, and to revisit the current school bus eligibility policy (e.g. changing from 2+ miles to 1−1.5+ miles in case of Austin).

References

  1. Faulkner, G. E. J., Buliung, R., Flora, P., & Fusco, C. (2009). Active school transport, physical activity levels and body weight of children and youth: A systematic review. Preventive Medicine, 48(1), 3-8.
  2. Davison, K. K., Werder, J. L., & Lawson, C. T. (2008). Children’s active commuting to school: Current knowledge and future directions. Prev Chronic Dis, 5, A100.
  3. Panter, J. R., Jones, A. P.,  Van Sluijs, E. M., & Griffin S. J. (2010). Attitudes, social support and environmental perceptions as predictors of active commuting behaviour in school children. Journal of Epidemiology and Community Health, 64, 41-48.
  4. Panter, J. R., Jones, A. P., Van Sluijs, E. M. & Griffin, S. J. (2010). Neighborhood, route, and school environments and children's active commuting. American Journal of Preventive Medicine, 38, 268-278.
  5. McDonald, N. C., Brown, A. L., Marchetti, L. M. & Pedroso, M. S. (2011). U.S. school travel, 2009: An assessment of trends. American Journal of Preventive Medicine, 41, 146-151.

 

Support / Funding Source
This study was supported by a Robert Wood Johnson Foundation’s Active Living Research Grant (Grant ID: 65539).

Authors: 
Young-Jae Kim, PhD, Texas A&M University
Location by State: 
Study Type: 

Adaptive Partnerships: Collaborative Research as a Basis for Comprehensive Obesity Prevention Strategies for Latino Middle-School Children

Date: 
02/25/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
Over 20% of Latino youth in the US are considered obese. Culturally adapted interventions that address the physical, social, and environmental influences on physical activity and diet are needed to help reduce health disparities in Latino youth. However, there is often a lack of understanding among researchers about how to tailor interventions to positively reach these communities. Community-Engaged Research (CEnR) can bridge this gap. This poster highlights lessons learned from The Healthy Activities Partnership Program for Youth (HAPPY), an ongoing intervention to promote healthy nutrition, physical activity, and media literacy among Latino children.

Description
The HAPPY intervention is a partnership between the United Community Center and the University of Wisconsin School of Medicine and Public Health. Intervention design was guided by results from a previous pilot study, which analyzed individual, social, and environmental barriers to physical activity and healthy eating among Latino children (age 10-14) enrolled in UCC's Bruce-Guadalupe Community School (BGCS). Results indicated that there was a strong need for a multilevel intervention.    The percentage of overweight children (n=190) in the pilot study was 52%, significantly higher than the national average (39%). The study found that higher body-mass index (BMI) values were associated with higher sugar intake and among those living on streets with heavy traffic. Despite the availability of fresh-food alternatives, almost all food trips made by children in the study were to convenience stores. The children explained the importance of snack foods for socializing. Children in the study whose parents paid more attention to their children’s diet and physical activity had lower BMI values, indicating that family support is a crucial component of a successful intervention program.   The team worked together to develop a culturally appropriate intervention combining three components: enhanced physical activity curriculum, school and home-based nutrition education, and a media literacy/neighborhood environmental assessment class. The intervention was designed to improve (1) individual knowledge, skill and self-efficacy, (2) peer and family support, (3) media literacy, and (4) neighborhood support.

Lessons Learned
Establishing trust in CEnR takes time and hinges primarily on the involvement of all parties during all phases of research. Successful interventions are built on research results that are interpreted by both sides of the partnership. However, this does not guarantee success. The first year of the HAPPY intervention concluded in July 2014 and the team noted a number of challenges.    ·  Identified Organizational Barriers Barriers were identified from within UCC’s organizational system that interfered with delivery of the intervention. (1) Another childhood obesity prevention research study was also being conducted at BGCS, which competed for recruits. (2) BCGS’s strong after school program lowered recruitment levels and created attendance difficulties for children who enrolled in HAPPY. (3) Lack of indoor recreation space during winter months limited the physical activity opportunities.   ·  Qualitative Retention Barriers Students were generally pleased with the program and expressed appreciation for the class. One student stated, “I went to a fast food restaurant with my family and chose a salad instead of getting a hamburger and fries.” Another said, “I’m shocked by how many calories my favorite snacks have.” However, many experienced barriers to participation and translating what they learned in class to their everyday life. For example, students stated that they did not walk or ride their bikes, even though they had learned that these were healthy activities, because of real or perceived dangers in their neighborhoods, including high traffic volume, concerns about crime, and worries about sexual predators. We also learned from parents that there are many unpredictable barriers to participation including miscommunication between the child and the parent, unexpected lack of transportation, and the need to have a participating student stay at home to care for younger siblings.

Conclusions
CEnR has the potential to significantly increase the success of physical activity and healthy eating interventions for children. The HAPPY intervention will include students, parents and school administrators in planning changes to years two and three in order to address barriers to participation.

Next Steps
The HAPPY project will continue for two more years. Findings will be disseminated through presentations, publications, and to state and local education policy makers. Lessons learned will be incorporated into a curriculum guide that will support project duplication through other Latino serving community organizations.

Support / Funding Source
HAPPY 1: 2010 Wisconsin Partnership Program (WPP); Partnership Education and Research Committee; University of Wisconsin School of Medicine and Public Health (PI: Aaron Carrol, MD and David Allen, MD)    HAPPY 2: 2012 Wisconsin Partnership Program (WPP); Community-Academic Partnership Implementation Grant; University of Wisconsin School of Medicine and Public Health (PI: Samuel F Dennis Jr, PhD, Community Partner: Al Castro, MS, United Community Center).

Authors: 
Alexandra Wells, MS, UW-Madison Environmental Design Lab
Location by State: 

Measuring Policy Environment Characteristics: Responsiveness to Change of the Healthy Afterschool Activity and Nutrition Documentation Instrument

Date: 
02/24/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
Quality audit tools are the cornerstone for understanding and quantifying the impact of healthy eating and physical activity (HEPA) supportive policies.1 Audit tools  are frequently used as a method to evaluate policy intervention effectiveness (i.e. policy impact evaluation) and as a way to track changes in the environment over time.2  For audit tools to be useful in informing decision makers about an intervention’s effectiveness they must demonstrate the ability to detect changes in the policy environment characteristics.2,3 Yet in the majority of cases, such tools are rarely evaluated for how well they capture changes in policy environment characteristics. The Healthy Afterschool Activity and Nutrition Documentation (HAAND) instrument is a newly developed audit tool consisting of two sub-indices - the Healthy Afterschool Program Index for Physical Activity (HAPI-PA) and for Nutrition (HAPI-N). Each of the HAPI-PA and HAPI-N indices consist of 7 domains (i.e. polices, training, child involvement, evaluation, curriculum, screen time or access to vending machines, scheduling of activity or quality of snack served). The HAAND instrument is designed to quantify the physical activity and nutrition environment within afterschool programs. Although the validity and reliability of the HAAND instrument has been established.4 To date the responsiveness of the HAAND to changes in the policy environment and practice has not yet been established.

Objectives
The purpose of this study is to examine the responsiveness of the HAAND instrument to changes in the policy environment characteristics following implementation of strategies aimed at helping afterschool programs meet HEPA policies.

Methods
Twenty afterschool programs across South Carolina serving over 1700 children (5-12 years old) participated in a group randomized controlled trial with 10 intervention and 10 control sites.  The intervention, STEPs (Strategies To Enhance Practice), focused on intentional programming of healthy eating and physical activity in each afterschool programs’ daily schedule, and included a grocery store partnership to reduce price barriers to purchasing FV, professional development training to promote physical activity to develop core physical activity competencies, as well as ongoing technical support/assistance. Responsiveness to change of the HAAND instrument was assessed using HAAND baseline data (Spring 2013) and post intervention year 1 follow up data (Spring 2014). HAAND data was collected during a single day’s visit and consisted of an interview with the ASP site leader, review of existing documents, and observation of the scheduled physical activities. HAAND scores were computed and policy environment characteristics changes were calculated as difference between baseline and post intervention (year 1 - baseline). Wilcoxon sign-rank tests were used to examine the difference between intervention and control group.

Results
Over the entire intervention group the total HAAND median scores (sum of HAPI-PA & N scales) showed a significant increase of 16 points (p = 0.001,) whereas the control group total HAAND median score increased only 1.0 point (p = 0.623) from baseline to year 1 follow up. The intervention group median (SD) baseline for total HAPI-PA was 9.5 (3.5), and increased to 13.5 (1.6) by post-assessment (p = 0.002).  For the HAPI-N, the intervention group median (SD) baseline was 6.5 (3.9) and improved to 21.0 (3.1) by post-assessment (p = 0.001). In comparison, the HAAND scores showed non- significant changes between baseline and year 1 follow up in the control group. With total HAPI-PA median (SD) scores showing a slight decrease from 9.0 (2.4) to 8.5 (3.4) (p = 0.500) and the HAPI-N scores median (SD) also showed a slight decrease from 8.0 (4.2) to 7.5 (4.7) (p = 0.6367) from baseline to year 1 follow up.

Conclusions
The HAAND instrument can detect changes to the policy environment characteristics of afterschool programs. Additional studies should examine the responsiveness to change of the HAAND instrument in comparison to other tools designed to evaluate HEPA policy environment and practices in the afterschool program setting.

Implications
The ability to detect policy changes and identify effective policies in a timely and efficient manner is increasingly important for policy makers. The HAAND instrument is capable of detecting changes in afterschool programs’ policy and practice environment. This makes the HAAND instrument a valuable tool that serves as an outcome or process measure to evaluate policy and practice changes over time.

References

  1. Saelens BE, Glanz K. Work group I: Measures of the food and physical activity environment: instruments. Am J Prev Med 2009;36(4 Suppl):S166-70.
  2. Kelly CM, Hoehner CM, Baker EA, Brennan Ramirez LK, Brownson RC. Promoting physical activity in communities: Approaches for successful evaluation of programs and policies. Evaluation and Program Planning 2006;29(3):280-292.
  3. Story M, Giles-Corti B, Yaroch AL, Cummins S, Frank LD, Huang TT, et al. Work group IV: Future directions for measures of the food and physical activity environments. Am J Prev Med 2009;36(4 Suppl):S182-8.
  4. Ajja R, Beets MW, Huberty J, Kaczynski AT, Ward DS. The healthy afterschool activity and nutrition documentation instrument. Am J Prev Med 2012;43(3):263-71.
Authors: 
Rahma Ajja, MPT, MPH, University of South Carolina
Location by State: 
Study Type: 

Promoting Physical Activity in Early Care and Education

Date: 
02/24/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
As the rate of childhood obesity has more than tripled in the United States over the past 30 years, many obesity prevention efforts have focused on school-age children and the school environment. Child care settings play a fundamental role in establishing healthy eating and physical activity habits. Over half of all children between the ages of zero and five regularly spend significant time in non-parental child care.  There is untapped potential for government to take meaningful action to prevent childhood obesity through the implementation of nutrition, physical activity, screen time standards and other policies in child care settings. Every state regulates the child care setting in some manner. These state regulations differ between states, however, depending on the type of child care facility and provider.   Regulatory standards play a critical role in establishing norms in child care settings.  These standards also establish important baseline protections for the health and safety of children receiving non-parental care.  Recent studies have assessed the strength of state child care regulatory schemes, finding that state regulations generally do not provide adequate nutrition or physical activity standards.

Description
In the summer 2014, the Public Health Law Center conducted a 50‐state review using legal analytical methods to research and examine state laws relating to nutrition, physical activity, and screen time standards for child care.  This training outlines intervention and policy strategies to promote healthy eating and physical activity in the child care setting. The presenters will provide an analysis of the child care legal landscape, including statutes and regulations. The presenters will also provide a summary of the 50-state review, highlighting examples how state-specific efforts and researchers have utilized the dataset.

Lessons Learned
States regulate the early care and education settings very differently across the country.  Each state defines the setting differently, and uses different terms and standards relating to nutrition, physical activity and screen-time.  The American Academy of Pediatrics, American Public Health Association, and National Resource Center for Health and Safety in Child Care and Early Education have created National Health and Safety Performance Standards relating to nutrition, physical activity and screen time, yet few states incorporate those standards into the state regulatory landscape.

Conclusions
The variability of regulation in the early care and education setting makes research in this are difficult. It is critical for researchers and policymakers to understand the current state of the legal landscape prior to working on healthy eating and physical activity efforts.

Next Steps
The Public Health Law Center is using this information to develop several state-specific materials to assist stakeholders across the country.  The Public Health Law Center is also providing the information to the public on its website.

References
Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 3rd Edition (CFOC3) - http://nrckids.org/index.cfm/products/preventing-childhood-obesity-in-early-care-and-education/

Authors: 
Natasha Frost, JD, Public Health Law Center at William Mitchell College of Law
Location by State: 
Study Type: 

The Social Cost of Physical Inactivity in Switzerland in 2011

Date: 
02/23/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
Physical inactivity is a common behavior in affluent societies and increases the risk for several non-communicable diseases. These diseases have a heavy burden in terms of healthy life years lost by the patients affected and lead to important social costs in two dimensions: the direct medical costs due to treatment of the diseases and the productivity losses due to absenteeism, disability and premature death. Direct medical costs and productivity losses due to physical inactivity in Switzerland had been estimated for 2001. More recent data has not been available yet.

Objectives
To estimate direct medical costs and productivity losses due to physical inactivity in Switzerland in 2011.

Methods
In this study, a person is considered as physically inactive, if she does not meet the following recommendations for health enhancing physical activity: at least 2.5 hours of physical activity with moderate intensity per week or 1.25 hours of sports with high intensity per week. Prevalence of physical inactivity is estimated based on the Swiss Health Survey. Risk ratios of diseases are extracted from literature. Population attributable fractions (PAFs) are calculated based on the prevalence of physical inactivity and the risk ratios. PAFs are then applied to the disease costs in order to estimate the direct medical costs and productivity losses due to physical inactivity. The disease costs stem from a recent study on the costs of non-communicable diseases in Switzerland.

Results
Based on the Swiss Health Survey 27.5% of the population over the age of 15 is physically inactive. The direct medical costs due to physical inactivity are estimated at CHF 1.165 billion or at 1.8% of total health care expenditures. 29% of these direct medical costs are due to cardiovascular diseases (ischemic heart disease, stroke and hypertension), 28% due to low back pain, 26% due to depression and the remaining 16% due to osteoporosis, diabetes type 2, obesity, colon cancer and breast cancer. Productivity losses are estimated at CHF 1.368 billion and are mainly caused by back pain (47%), depression (28%) and cardiovascular diseases (14%).

Conclusions
These results show the heavy impact of physical inactivity on the Swiss health care system and the society as a whole. Low back pain and depression, two diseases often not included in cost studies related to physical inactivity, significantly contribute to direct medical costs and productivity losses.

Implications
Interventions to reduce physical inactivity are indicated. Future research should investigate the effectiveness and the cost-effectiveness of such interventions.

Authors: 
Renato Mattli, MSc, Zurich University of Applied Sciences, Switzerland
Location by State: 
Population: 
Study Type: 

Evaluation of Healthy Kids, Healthy Communities

Date: 
02/25/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
The evaluation of the Robert Wood Johnson Foundation’s (RWJF) Healthy Kids, Healthy Communities (HKHC) national program is an example of an effort to apply systems science and mixed-methods evaluation approaches to comprehensive policy, systems, and environmental interventions. The HKHC national program (www.healthykidshealthycommunities.org) supported community-based efforts to implement policy, system, and environmental changes aimed to make communities healthier, particularly for higher-risk children and families (ethnic/racial minorities, lower-income populations, or those living in southern states), by increasing both active living and healthy eating. RWJF funded one year of evaluation planning (mid-March 2009 to mid-March 2010) and four subsequent years to support a mixed-methods evaluation of HKHC (April 2010 to March 2014), including all 49 communities across the United States and Puerto Rico. Communities selected to participate in this multi-year demonstration varied in population and geographic sizes (municipal to eight counties), sociodemographic composition (median annual household income, race/ethnicity, urban/suburban/rural), scale (county-wide to specific organizations or settings), scope of their proposed strategies (e.g., new or modified parks versus nutrition assistance in farmers’ markets), lead organizations (nonprofit, education, philanthropy, government), and age of the community partnerships. The evaluation did not focus on changes in individual behaviors and health outcomes.

Description
Eight complementary evaluation methods addressed four primary aims seeking to: 1) coordinate data collection for the evaluation through the web-based project management system and provide training and technical assistance for use of this system; 2) guide data collection and analysis through use of the Assessment & Evaluation Toolkit; 3) conduct a quantitative cross-site impact evaluation among a subset of community partnership sites; and 4) conduct a qualitative cross-site process and impact evaluation among all 49 community partnership sites. The evaluation consisted of the following key components: HKHC Community Dashboard: This web-based project management system (www.hkhcdashboard.org) coordinated data collection for the evaluation. It was designed to encourage the formation of a collective learning network among community partnerships, Project Officers, and Evaluation Officers. This website included functions such as social networking, progress reporting, and access to the assessment and evaluation toolkit to maintain a steady flow of users over time and increase peer engagement across communities. Individual and Group Interviews: Evaluators collaborated with community partnerships to conduct individual and group interviews with staff, partners, and community representatives before, during, and after site visits. Interview protocols focused on organizational and community factors influencing processes and means used to develop, implement, and enforce policies. In addition, evaluators tracked costs and funding associated with the design, development, implementation, and enforcement of cross-site strategies. Group Model Building: The evaluation team and partners from the Social System Design Lab at Washington University in St. Louis co-designed a group model building process to develop behavior-over-time-graphs and graphical system dynamics models (causal loop diagrams) with community partnerships. These exercises provide deeper and shared insights among representatives from the community partnerships into the drivers of obesity dynamics, better understanding of local systems at play, more rigorous critique of assumptions underlying the systems, and greater “buy in” to high-leverage prevention policy recommendations. Enhanced Evaluation: The evaluation team created tools, protocols, and trainings for environmental audits and direct observations associated with cross-site strategies to be conducted by community partnerships. Participation in these methods was voluntary, yet 31 of 49 community partnerships engaged in these activities. Supplemental Methods: Evaluators also collected and analyzed data from an online partnership and community capacity survey, photos, community partnerships’ annual narrative and financial reports, and surveillance systems (e.g., U.S. census). A synopsis of cross-site findings with community examples will be presented.

Lessons Learned
Several themes emerged, including: the value of systems approaches, the need for capacity building for evaluation, the value of focusing on upstream and downstream outcomes, and the importance of practical approaches for dissemination. Constraints included: a lack of standards in the field for indicators and measures of many of these factors, difficulty in attributing effects or impacts to specific strategies, and challenges with analyzing, interpreting, and applying what is learned, particularly with respect to complex systems science methods.

Conclusions
Community-based initiatives such as HKHC provide promising approaches for addressing childhood obesity. This presentation illustrates how mixed-methods evaluation approaches can provide practice-relevant evidence that has the potential to improve population health. The mixed-methods evaluation of HKHC advances evaluation science related to community-based efforts for addressing childhood obesity in complex community settings.

Next Steps
This evaluation will inform research and practice related to the design, implementation, and evaluation of policy, system, and environmental interventions; key partners to engage in the process to change community environments; and possible causal relationships among social determinants as well as factors associated with partnership and community capacity that influence healthy eating and active living policies and environments, and health and health behaviors.

References
Evaluation of Healthy Kids, Healthy Communities Supplement  to be published in March/April 2015.

Support / Funding Source
Support for this evaluation was provided by a grant from the Robert Wood Johnson Foundation (#67099).

Authors: 
Laura Brennan, PhD, MPH, Transtria LLC
Location by State: 

Effectiveness of Using WellSAT in Improving School District Wellness Policies

Date: 
02/24/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
In 2012, Nemours received funding from the CDC to work in partnership with targeted school districts and community partners to develop and implement local policy, infrastructure and programmatic changes that will result in positive changes in weight, eating behaviors, physical activity and the social emotional wellness of the students in those districts. Key objectives include engaging school districts in improving their wellness policies by providing districts with technical assistance and a coding tool to self-score policies, and working collaboratively with districts to include recommended language to strengthen policies, increasing the number of schools with school-wide physical activity plans, implementing 10-minute classroom “energizers” of physical activity throughout the day for elementary and middle school students, and increasing the number of schools with written nutrition promotion plans. This effort contributes to a coordinated school health approach that enables schools to promote health using a sustainable model shared by multiple stakeholders.  Policy analysis provides an opportunity for schools to recognize when practice and policy do not match, to educate stakeholders and staff on model policy and practice, and to plan for policy changes.  This presentation will share how 6 school districts in the state of Delaware (urban, rural, and suburban; district free and reduced lunch rates of 59% to 70%) used the Wellness School Assessment Tool (WellSAT) from the Yale Rudd Center to self-evaluate their policies.   This validated, comprehensive coding system allows districts to evaluate their policies according to best practices and federal requirements.  The tool has been shown to be reliable and feasible for use by public health professionals to support schools in rating their policies (Brissette et al 2013).  However, it has not been previously studied in use by school professionals with little or no policy or public health background.     The process of self-evaluation streamlined policy change by highlighting areas where practice outperformed policy as well as areas where practice did not match policy.  Teachers, staff, and community members engaged in the process used this easy-to-use tool to gain practical, hands-on professional development in the area of school health and policy development.  This session will share the success of this process in strengthening wellness policies through engaging staff in the process and ensuring a positive political environment for policy adoption.

Description
The program built on qualitative research studies that had been conducted in Delaware school districts: Nemours conducted two previous studies in 2009 and 2011 using key informant interview methodology to collect data on the process of wellness policy revision, as well as policy implementation facilitators and barriers, and stakeholder need and recommendations.   Data from both studies was used to improve Nemours’ technical assistance to schools and districts, and was used in a grant application for a Center for Disease Control (CDC) Small Communities Grant (CTG).  Six school districts in the state of Delaware were recruited to participate in a Community Transformation Grant Small Communities project.  Districts were recruited due to high free and reduced lunch participation, educational attainment in surrounding communities, and health disparities.   Six comparison districts were matched for size, student demographics and geographic location.  Each district gathered a wellness committee to including physical education teachers, guidance counselors, school psychologists, school nurses, assistant superintendents, district nutrition supervisor, community mental health agencies, and community members.  Wellness committees were to meet monthly.  At the start of the grant period, each district’s wellness committee met to score the current wellness policy using the WellSAT.  They received no prior training on the use of the tool or model policy.  During the self-scoring process, a trained facilitator coached the committee to only look at what was written in the policy. Committees met monthly to create draft policies for recommendation to districts boards of education, using the knowledge gained during the self-scoring as a guide.  During the policy process school-level wellness committees completed the School Health Index, focusing primarily on the areas of nutrition, physical activity, and social and emotional wellness.   School action plans were developed and implementation began in school year 2013-2014.  This school-level work contributed to the policy environment.  District wellness committees shared the model policy with district leadership, who presented it to the boards of education.  All districts adopted new wellness policies by July 2014, with no changes from the model policy developed by wellness committees.   This presentation will focus on the lessons learned on using research-based self-assessment tools to change district policy and policy implementation.

Lessons Learned
Self-assessment is a quality technical assistance tool that can help districts make policy changes. The WellSAT tool can be used by non-public health professionals to make significant change in wellness policy strength and breadth.

Conclusions
Communicating research through self-assessment is an effective tool for policy and practice change at the school level.

Next Steps
Proposed new USDA wellness policy regulations present new challenges to schools as they work to increase policy strength while maintaining quality.

References
Brissette I, Wales K, O'Connell M. Evaluating the Wellness School Assessment Tool for use in public health practice to improve school nutrition and physical education policies in New York. J Sch Health. 2013 Nov;83(11):757-62. doi: 10.1111/josh.12091. PubMed PMID: 24138345.

Support / Funding Source
Funding for this project was provided by a Centers for Disease Control and Prevention Community Transformation Grant Small Communities Grant.

Location by State: 

SPARK Parks: Monitoring the Implementation and Impact of Schoolyards-turned-Community Parks

Date: 
02/24/2015
Description: 

Presentation at the 2015 Active Living Research Annual Conference.

Abstract: 

Background
The importance of physical activity to individual health is widely recognized, and empirical research shows that close-to-home access to parks and other recreational amenities can encourage higher levels of physical activity.[i] However, many Americans do not have parks close to home. Within the largest 60 U.S. cities, 31.7% of residents (over 16 million people) do not have access to a park within a 10-minute walk of their home[ii]; “high-need” neighborhoods (those with low-income, high-minority, and dense populations of children) tend to be particularly short of park space.[iii] Increasingly, schools and joint-use agreements (JUAs) are being used to provide essential recreational spaces and studied for their obesity prevention potential.[iv] The SPARK School Park Program, created in 1983 as a way to increase park space and access in Harris County, Texas, works to develop public schoolyards into community parks. Over 130 schoolyard-to-park conversions (“SPARK Parks”) currently exist within the county, and provide much needed park space to local residents. 340,000 people in Harris County live within a half-mile of a SPARK Park, and 129,917 people in Houston (6% of the total population) only have access to public park space within a 10-minute walk because a SPARK Park exists nearby. While access, design, and quality/condition of the built environment are understood to influence physical activity, there is a gap in the knowledge regarding what specific park features, characteristics, and policies most impact use and health.[v]

Description
Recently, The Trust for Public Land, a national non-profit land conservation and parks organization, partnered with the SPARK School Park Program to evaluate the use of SPARK Parks and to monitor the implementation of joint-use agreements. Direct observations using SOPARC: the System for Observing Play and Recreation in Communities are being conducted at all completed SPARK Parks and ten control parks.[vi] Evaluations measure use (number of people, age, and activity levels) and accessibility, and are taking place during time periods when the SPARK Parks are available for public use (during non-school hours and on weekends). An assessment tool, based upon the Community Park Audit Tool, CPAT, is also being used in all of these parks.[vii] In addition, a survey of park users is being conducted to gather additional information about the use of these parks, barriers to use, design preferences, and other perceived benefits or impacts of parks. This information about park access, features/characteristics, conditions, and use, will help evaluate the success of these joint-use agreements, and lessons learned will be developed in collaboration with SPARK and other stakeholders.

Lessons Learned
The data collected will be used to find strategies to maximize the impacts of current parks, and develop and provide recreation practitioners with evidence-based recommendations for creating active and engaging schoolyard parks. Data collection is currently underway, and will be completed in October 2014. This data will be used in the following, specific ways: (1) Evaluate the role (in terms of park access and park use) of SPARK School Parks and associated JUAs within the county's parks and open space system; (2) Assess how park features and characteristics contribute to park use and activity (with a focus on moderate and vigorous levels); and (3) Study SPARK service areas and explore the impact of potential new SPARK Parks.  Information about the current SPARK implementation process and use of these SPARK Parks, as well as new lessons learned and recommendations to improve the implementation of JUAs and schoolyard-to-park conversions, will be the focus of this presentation.

Conclusions
It is a unique opportunity to be able to monitor the implementation of joint-use policies and evaluate the impact of parks among such a large number of completed projects. Determining how existing schoolyard-to-park conversion programs successfully implement joint-use agreements and renovations is important for both maximizing the impact of existing programs, informing new programs, and providing information to researchers and practitioners alike. The data collected will also help inform park design and the creation of better-used, effective, and impact-maximizing park spaces.

Next Steps
The Trust for Public Land is currently documenting the need for new parks and identifying the most park-deficient neighborhoods in Harris County through our ParkScore methods. This on-the-ground measurement of park access and use could identify underserved areas and support the development of new SPARK Parks, help inform decisions regarding investments or reinvestment in park projects, and help to engage public agencies, elected officials, and nonprofit partners in decisions regarding the priorities and funding for improved park access and related policy implementation.

References

  1. Mowen A, Kaczynski AT, Cohen DA. The Potential of Parks and Recreation in Addressing Physical Activity and Fitness. President’s Council on Physical Fitness and Sports. Research Digest. 2008; 9(1). www.presidentschallenge.org/informed/digest/docs/march2008digest.pdf.
  2. Kaczynski AT, Henderson KA. Environmental correlates of physical activity: A review of evidence about Parks and Recreation. Leisure Sciences. 2007; 29(4):315-354.
  3. The Trust for Public Land. Data from ParkScore® index. The Trust for Public Land; 2014. http://parkscore.tpl.org/.
  4. Sherer PM. The Benefits of Parks: Why America Needs More City Parks and Open Space. San Francisco, CA: The Trust for Public Land; 2006. www.tpl.org/health-benefits-parks.
  5. Bocarro J, Kanters M, Edwards M, Suau L, Floyd M. Shared Use of School Facilities: A Systematic Observation of Facility Use and Physical Activity. [Presentation at the 2014 Active Living Research Conference].
  6. Kanters M, Bocarro J, Carlton T, Moore R, Floyd. After-school Shared Use of Public Facilities for Physical Activity in North Carolina. [Presentation at the 2014 Active Living Research Conference].
  7. Slater S, Chriqui J, Chaloupka F, Johnston L. The Pros and Cons of the Influence of Joint Use Agreements and Adolescent Physical Activity and Sedentary Behaviors. [Presentation at the 2014 Active Living Research Conference].
  8. Cohen D, Marsh T, Williamson S, et al. Parks and physical activity: why are some parks used more than others? Prev Med. 2010; 50(Suppl 1):S9–S12.
  9. Dunton GF, Kaplan J, Wolch J, et al. Physical environmental correlates of childhood obesity: a systematic review. Obes Rev. 2009; 10(4):393–402.
  10. Bedimo-Rung AL, Mowen AJ, Cohen DA. The Significance of Parks to Physical Activity and Public Health: A Conceptual Model. Am J Prev Med. 2005; 28(2 Suppl 2):159 –168.
  11. McKenzie TL, Cohen DA. 2006. SOPARC (System for Observing Play and Recreation in Communities) Description and Procedures Manual. http://activelivingresearch.org/sites/default/files/SOPARC_Protocols.pdf.
  12. Cohen DA, Setodji C, Evenson KR, Ward P, Lapham S, Hillier A, McKenzie TL. 2011. How much observation is enough? Refining the administration of SOPARC. J Phys Act Health; 8(8): 1117-23. http://www.ncbi.nlm.nih.gov/pubmed/22039130.
  13. Kaczynski AT, Wilhelm Stanis SA, GM Besenyi. 2012. Community Park Audit Tool (CPAT). http://activelivingresearch.org/sites/default/files/CPAT_AuditTool_v3.pdf.

 

Support / Funding Source
Funding for the SPARK School Park evaluation is provided by The Houston Endowment.

Authors: 
Bianca Shulaker, MPL, The Trust for Public Land & Kathleen Ownby, SPARK School Park Program
Location by State: 
Population: 

Pages

Subscribe to RSS - Schools