Physical education and physical activity: results from the School Health Policies and Programs Study 2006

BACKGROUND: Comprehensive school-based physical activity programs consist of physical education and other physical activity opportunities including recess and other physical activity breaks, intramurals, interscholastic sports, and walk and bike to school initiatives. This article describes the characteristics of school physical education and physical activity policies and programs in the United States at the state, district, school, and classroom levels. METHODS: The Centers for Disease Control and Prevention conducts the School Health Policies and Programs Study every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in all 50 states plus the District of Columbia and among a nationally representative sample of districts (n=453). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=988) and with a nationally representative sample of teachers of required physical education classes and courses (n=1194). RESULTS: Most states and districts had adopted a policy stating that schools will teach physical education; however, few schools provided daily physical education. Additionally, many states, districts, and schools allowed students to be exempt from participating in physical education. Most schools provided some opportunities for students to be physically active outside physical education. Staff development for physical education was offered by states and districts, but physical education teachers generally did not receive staff development on a variety of important topics. CONCLUSIONS: To enhance physical education and physical activity in schools, a comprehensive approach at the state, district, school, and classroom levels is necessary. Policies, practices, and comprehensive staff development at the state and district levels might enable schools to improve opportunities for students to become physically active adults.     

Availability of high school extracurricular sports programs and high-risk behaviors

BACKGROUND: The Surgeon General has called for an expansion of school-based extracurricular sports programs to address the obesity epidemic. However, little is known about the availability of and participation in high school extracurricular sports and how participation in these sports is related to high-risk behaviors. METHODS: We surveyed Los Angeles County public high schools in 2002 to determine the number of extracurricular sports programs offered and the percentage of students participating in those programs. We used community data on rates of arrests, births, and sexually transmitted diseases (STDs) among youth to examine associations between risk behaviors and participation in sports programs. RESULTS: The average school offered 14 sports programs, and the average participation rate was 39% for boys and 30% for girls. Smaller schools and schools with higher percentages of disadvantaged students offered fewer programs. The average school offering 13 or fewer programs had 14% of its students participating, while the average school offering 16 or more programs had 31% of its students participating in sports. Controlling for area-level demographics, juvenile arrest rates and teen birth rates, but not STD rates, were lower in areas where schools offered more extracurricular sports. CONCLUSIONS: Opportunities for participation in high school extracurricular sports are limited. Future studies should test whether increased opportunities will increase physical activity and impact the increasing overweight problem in youths.     

Applying the School Health Index to a nationally representative sample of schools: update for 2006

BACKGROUND: The School Health Index (SHI) is a tool designed to help schools assess the extent to which they are implementing practices included in the research‐based guidelines and strategies for school health and safety programs developed by the Centers for Disease Control and Prevention (CDC). CDC previously analyzed data from the 2000 School Health Policies and Programs Study (SHPPS) to determine the percentage of US schools meeting the recommendations in the SHI. A new edition of the SHI (2005) and the availability of 2006 SHPPS data made it necessary to update and repeat the analysis. METHODS: SHPPS 2006 data were collected through computer‐assisted personal interviews with faculty and staff in a nationally representative sample of schools. The data were then matched to SHI items to calculate the percentage of schools meeting the recommendations in 4 areas: school health and safety policies and environment, health education, physical education and other physical activity programs, and nutrition services. RESULTS: In accordance with the earlier findings, the present analysis indicated that schools nationwide were focusing their efforts on a few policies and programs rather than addressing the entire set of recommendations in the SHI. The percentage of items related to nutrition that schools met remained high, and an increase occurred in the percentage of items that schools met related to school health and safety policies and environment. CONCLUSIONS: More work needs to be done to assist schools in implementing school health policies and practices; this analysis helps identify specific areas where improvement is needed.     

Early effects of the federally mandated Local Wellness Policy on school nutrition environments appear modest in Colorado's rural, low-income elementary schools

To increase opportunities for healthy eating and physical activity, US school districts participating in the National School Lunch Program were required to create a Local Wellness Policy (LWP) by June 2006. The What's Working project described the initial influence of this mandate on nutrition environments and policies. In 2005 and 2007 (before and after the mandate went into effect), a survey about school features related to nutrition and physical activity was sent to a random sample of 45 low-income, rural elementary foodservice managers and principals. Schools averaged 204 students, 27% Hispanic. Districts' LWPs were coded for strength and comprehensiveness. In addition, key informant interviews were conducted with foodservice managers almost 2 years after the LWP went into effect. Three improvements were observed: increases in the percent of schools with policies stipulating predominantly healthy items be offered in classroom parties (21.4% in 2005 vs 48.7% in 2007), daily fresh fruit offerings in the lunchroom (0.80 choices in 2005 vs 1.15 choices in 2007), and the percent of schools using skinless poultry (27% in 2005 vs 59% in 2007). LWPs were weakly worded and rarely addressed energy content. Nutrition guideline elements most commonly addressed included vending machines, school stores, and à la carte food offerings. Seveny-three percent of foodservice managers were familiar with their district's LWP but did not perceive it changed lunchroom practices. Although LWPs offer a framework to support opportunities for healthy eating, few evidence-based practices were implemented as a direct result of the mandate. Schools need more information about evidence-based practices, as well as technical and financial assistance for implementation.     

The relationship between school health councils and school health policies and programs in US schools

ABSTRACT: This study analyzed data from the School Health Policies and Programs Study (SHPPS) 2000 to examine the relationship between school health councils and selected school health policies and programs. SHPPS 2000 collected data from faculty and staff in a nationally representative sample of schools. About two-thirds (65.7%) of US schools have school health councils. Schools with councils were significantly more likely than schools without councils to report policies and programs related to health services. mental health and social services; faculty and staff health promotion, and family and community involvement. Schools with councils were as likely as schools without councils to report policies and programs related to health education, physical education, and food service. Although school health councils are associated with the presence of some key school health policies and programs, a council does not guarantee a school will have all important school health policies and programs in place.     

Long-term effects of a physical activity intervention in high school girls

BACKGROUND: Physical activity (PA) decreases during childhood and adolescence, and PA levels are significantly lower in females than males, particularly during adolescence. Schools are attractive settings in which to implement interventions designed to promote PA in girls and young women, but few studies have tested the sustained effects of such interventions. DESIGN: Cross-sectional. Data were collected in 2002-2003 and analyzed in 2006-2007. SETTING/PARTICIPANTS: 1594 adolescent girls in 22 high schools. INTERVENTION: The intervention, Lifestyle Education for Activity Program (LEAP), was designed to increase physical activity in 9th-grade girls through two channels: changes in instructional practices and changes in the school environment. This study (LEAP 2) examined the extent to which effects of the intervention were maintained when the girls were in the 12th grade. MAIN OUTCOME MEASURES: Number of 30-minute blocks per day of vigorous physical activity. RESULTS: Girls in the intervention schools that most fully implemented and maintained the intervention were more likely than girls in the other schools to participate in an average of one or more blocks of vigorous physical activity per day (p=0.04, odds ratio=1.49, 95% confidence interval=1.01-2.20). CONCLUSIONS: A comprehensive physical activity intervention that is fully implemented and maintained can increase participation in vigorous physical activity by high school girls.     

Promoting physical activity in girls: a case study of one school's success

This case study profiles one of 24 high schools that participated in a school-based, NIH-funded study to increase physical activity among high school girls. The case study school was one of 12 randomly assigned to the intervention group. The study intervention was based on the premise that a successful intervention is developed and tailored by teachers and staff to fit the context of their school. Intervention guidelines (Essential Elements) and the Coordinated School Health Program (CSHP) model were used to direct intervention activities for physical education, health education, school environment, school health services,faculty/staff health promotion, andfamily/community involvement. All girls at the case study school received the intervention. A team of school employees provided leadership to develop and implement the intervention in collaboration with a university project staff. Data collected over a two-year period were used to describe changes that occurred in each CSHP area. Key changes were made in the school environment, curricula, policies, and practices. Qualitative measures showed girls more involved in physical activity. Quantitative measures taken in eighth grade, and repeated with the same set of girls in ninth grade, showed increases in both moderate-to-vigorous physical activity (p = < .01) and vigorous physical activity (p = .04). Other schools can use this case to modify components of the CSHP model to increase physical activity among high school girls.     

Geographic variations in elementary school-based physical activity practices

BACKGROUND: Physical activity (PA) is associated with health and academic benefits among children, but many schools do not meet national recommendations. This study examined school‐based PA practices in nationally representative samples of public elementary schools, and geographic variations in those practices. METHODS: Mail‐back surveys were used to gather data from 578 public elementary schools during the 2006‐2007 school year and 680 public elementary schools during the 2009‐2010 school year. RESULTS: Nationwide, only 1 in 5 schools met the national recommendation of at least 150 minutes of physical education (PE) per week, although PE was more prevalent in the South. Nearly three‐fourths of schools nationwide met recommendations for 20 or more minutes of recess daily, and this was more prevalent in the Midwest but less so in the South. Approximately 40% of schools offered sports and approximately 40% offered other opportunities for PA during the school day. The only practice that increased over time was formal classroom instruction on PA. CONCLUSIONS: There has been little change in elementary school‐based PA practices nationwide in recent years. With the upcoming renewal of the Elementary and Secondary Education Act, policymakers have an important opportunity to promote increased PA in schools.     

Children’s School-Related Food and Physical Activity Behaviors Are Associated with Body Mass Index

Childhood obesity is a critical public health issue, with prevalence rates reaching nearly one in five children. Schools may be a promising public policy intervention point. The foods schools sell and the physical activity environments they foster can influence dietary behaviors and overall physical activity. Using secondary data from a nationally representative sample of children from the kindergarten class of 1998-1999 and nonexperimental methods, this study examines the associations between the food and physical activity environments in school and body mass index (BMI) for low-income boys and girls in the 8th grade during 2007. Results reveal that participating in school sports is associated with a 0.55 lower BMI score for boys. For low-income girls, eating the school breakfast is associated with a 0.70 higher BMI score and eating the school lunch is associated with a 0.65 higher BMI score. Each hour spent on homework is associated with a 0.02 higher BMI score for low-income girls. These findings suggest that schools may influence adolescent BMI and that there is room for improvement in school food and physical activity environments to promote healthier weights for low-income boys and girls.     

Prevalence and correlates of physical activity behaviors among elementary schoolchildren in multiethnic, low income, inner-city neighborhoods in Montreal, Canada.

PURPOSE: To describe the prevalence and correlates of physical inactivity and of participation in organized sports at and outside school among elementary schoolchildren in multiethnic, low income, urban neighborhoods in Montreal, Canada. METHODS: As part of the evaluation of a school-based heart health promotion program, baseline data on physical activity behaviors and potential correlates of these behaviors, were collected from 2285 students aged 9-13 in all 130 grade 4 to 6 classes in 24 inner-city elementary schools from May to June 1993. RESULTS: One-fifth of boys (20.5%) and 24.4% of girls were inactive; 40.0% and 33.3% of boys and girls respectively, participated in school sports teams; 82.5% and 74.7% participated in organized sports outside school. Declines in activity levels with age were apparent in both genders. Children who participated in organized sports programs at and outside school, those with higher perceived self-efficacy for physical activity, and those with more parental support for engaging in physical activity were more active. Children of Asian family origin were less active. Socioeconomic status was related to participation in organized sports outside school. CONCLUSIONS: To reach children in socio-economically disadvantaged areas and to prevent age-related declines in activity levels, interventions promoting physical activity should focus on increasing availability and access to community-based organized sports programs at and outside school. Also they should include components to increase parental support and to improve perceived self-efficacy for physical activity.     

School health guidelines to promote healthy eating and physical activity

During the last 3 decades, the prevalence of obesity has tripled among persons aged 6--19 years. Multiple chronic disease risk factors, such as high blood pressure, high cholesterol levels, and high blood glucose levels are related to obesity. Schools have a responsibility to help prevent obesity and promote physical activity and healthy eating through policies, practices, and supportive environments. This report describes school health guidelines for promoting healthy eating and physical activity, including coordination of school policies and practices; supportive environments; school nutrition services; physical education and physical activity programs; health education; health, mental health, and social services; family and community involvement; school employee wellness; and professional development for school staff members. These guidelines, developed in collaboration with specialists from universities and from national, federal, state, local, and voluntary agencies and organizations, are based on an in-depth review of research, theory, and best practices in healthy eating and physical activity promotion in school health, public health, and education. Because every guideline might not be appropriate or feasible for every school to implement, individual schools should determine which guidelines have the highest priority based on the needs of the school and available resources.     

School-based health education programs can be maintained over time: results from the CATCH Institutionalization study

BACKGROUND: Developing and evaluating interventions to influence students' opportunities for healthful choices has been a focus of school-based health promotion research; however, few studies have examined the sustainability of these programs and viability of continued organizational implementation. METHODS: The purpose of this study was to determine the maintenance of Child and Adolescent Trial for Cardiovascular Health (CATCH) school-level changes in former intervention (n = 56) and former comparison (n = 20) schools 5 years post-intervention. Twelve schools unexposed to CATCH were measured as controls. Macronutrient content of 5 days of school lunch menus, amount and type of physical education (PE) classes, and health instruction practices in the classroom were assessed. An institutionalization score for schools was developed, using program maintenance variables: % kcal from fat and saturated fat in school lunches, % PE class spent in vigorous and moderate-to-vigorous physical activity, and class time devoted to CATCH topics. RESULTS: Menus from 50% of former intervention cafeterias met the Eat Smart guidelines for fat, compared to 10% of former control cafeterias and 17% of unexposed school cafeterias (P < 0.005). There were no significant differences in implementation of CATCH PE goals between conditions. Although the total time spent teaching CATCH was low in former CATCH schools, the former intervention schools spent significantly more time teaching CATCH and taught more lessons as compared to former comparison schools. Former intervention schools had a higher mean institutionalization score than former comparison schools (P < 0.001). Training had the greatest impact on maintenance of CATCH. CONCLUSIONS: Results from this study suggest that changes in the school environment to support healthful behaviors can be maintained over time. Staff training is an important factor in achieving institutionalization of these programs.     

Health education: results from the School Health Policies and Programs Study 2006

BACKGROUND: School health education can effectively help reduce the prevalence of health-risk behaviors among students and have a positive influence on students' academic performance. This article describes the characteristics of school health education policies and programs in the United States at the state, district, school, and classroom levels. METHODS: The Centers for Disease Control and Prevention conducts the School Health Policies and Programs Study every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in all 50 states plus the District of Columbia and among a nationally representative sample of districts (n=459). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=920) and with a nationally representative sample of teachers of classes covering required health instruction in elementary schools and required health education courses in middle and high schools (n=912). RESULTS: Most states and districts had adopted a policy stating that schools will teach at least 1 of the 14 health topics, and nearly all schools required students to receive instruction on at least 1 of these topics. However, only 6.4% of elementary schools, 20.6% of middle schools, and 35.8% of high schools required instruction on all 14 topics. In support of schools, most states and districts offered staff development for those who teach health education, although the percentage of teachers of required health instruction receiving staff development was low. CONCLUSIONS: Health education has the potential to help students maintain and improve their health, prevent disease, and reduce health-related risk behaviors. However, despite signs of progress, this potential is not being fully realized, particularly at the school level.     

Promoting physical activity in middle school girls: Trial of Activity for Adolescent Girls

BACKGROUND: Physical activity is important for weight control and good health; however, activity levels decline in the adolescent years, particularly in girls. DESIGN: Group randomized controlled trial. SETTING/PARTICIPANTS: Middle school girls with English-speaking skills and no conditions to prevent participation in physical activity in 36 schools in six geographically diverse areas of the United States. Random, cross-sectional samples were drawn within schools: 6th graders in 2003 (n=1721) and 8th graders in 2005 (n=3504) and 2006 (n=3502). INTERVENTION: A 2-year study-directed intervention (fall 2003 to spring 2005) targeted schools, community agencies, and girls to increase opportunities, support, and incentives for increased physical activity. Components included programs linking schools and community agencies, physical education, health education, and social marketing. A third-year intervention used school and community personnel to direct intervention activities. MAIN OUTCOME MEASURES: The primary outcome, daily MET-weighted minutes of moderate-to-vigorous physical activity (MET-weighted MVPA), was assessed using accelerometry. Percent body fat was assessed using anthropometry. RESULTS: After the staff-directed intervention (pre-stated primary outcome), there were no differences (mean= -0.4, 95% CI= -8.2 to 7.4) in adjusted MET-weighted MVPA between 8th-grade girls in schools assigned to intervention or control. Following the Program Champion-directed intervention, girls in intervention schools were more physically active than girls in control schools (mean difference 10.9 MET-weighted minutes of MVPA, 95% CI=0.52-21.2). This difference is about 1.6 minutes of daily MVPA or 80 kcal per week. There were no differences in fitness or percent body fat at either 8th-grade timepoint. CONCLUSION: A school-based, community-linked intervention modestly improved physical activity in girls.     

Applying the School Health Index to a nationally representative sample of schools

The School Health Index (SHI) is a self-assessment and planning tool that helps individual schools identify the strengths and weaknesses of their health policies and programs. To determine the percentage of US schools meeting the recommendations in the SHI, the present study analyzed data from the School Health Policies and Programs Study (SHPPS) 2000. The SHPPS 2000 data were collected through computer-assisted personal interviews with faculty and staff in a nationally representative sample of schools. The SHPPS 2000 questions were then matched to SHI items to calculate the percentage of schools meeting the recommendations in 4 areas: school health and safety policies and environment, health education, physical education and other physical activity programs, and nutrition services. Although schools nationwide are meeting a few SHI items in each of these areas, few schools are addressing the entire breadth of items. A more coordinated approach to school health would help schools reinforce health messages.     

Parents' perceptions of curricular issues affecting children's weight in elementary schools

The purpose of this study was to examine Ohio parents' perceptions of the role of elementary schools in preventing childhood overweight. In the United States, overweight is the most widespread health threat facing children and adolescents. Schools may be a useful point of intervention in addressing the escalating prevalence of childhood overweight because children spend over half their day at school. A questionnaire was developed based primarily on the School Health Index, a tool developed by the Centers for Disease Control and Prevention to help schools assess and improve their physical activity, healthy eating, tobacco use prevention, and safety policies and programs. Seven hundred surveys were sent to a random sample of Ohio parents of elementary school-aged children. This study (53% response rate) found that the majority (51-73%) of parents identified 14 items as very important in preventing childhood overweight, which is indicative of their support for these curricular topics within the elementary school. All items from the physical education component had less than 50% of the parents identifying these items as very important. The item that was least supported (16%) by the parents was measuring a child's body mass index. The majority (51%) of parents indicated their preference for elementary students' access to vending machines only if they contained nutritious foods and beverages, while 42% of parents preferred that elementary students should not be allowed access to vending machines at all. The findings from this study suggest that Ohio parents would be supportive of school-based interventions focusing on healthy eating, physical activity, and the school environment to help reduce the prevalence of overweight in elementary children.     

The strength of school wellness policies: one state's experience

BACKGROUND: This study examines the results of federal legislation on the content and quality of policies written in 2005-2006 by Utah school districts (n = 30). METHODS: Policies were gathered by phone call requests to school districts or obtained on district Web pages. Content was compared to requirements outlined in the Child Nutrition Reauthorization Act (CNRA) of 2004 and recommendations made by a state coalition of health and education agencies. The strength of the language was assessed (mandate vs recommendation), and characteristics of school districts that adopted strong policies were identified. RESULTS: The majority of Utah school districts (78%) complied with the federal guidelines, and a variety of state recommended nutrition and physical activity policy statements were included. The strength of the language used in the policies revealed that districts were more likely to mandate items already required by other entities or well established in the district. School districts with high participation in free- and reduced-price programs had significantly more mandatory policies (mean = 9.2) versus low (mean = 7.1) and medium enrollment (mean = 4.7). Urban school districts were more likely to indicate mandatory competitive food policies than rural and suburban (mean = 2.3 vs 0.93, 0.83). There were no differences in policy language between school districts based on race or size. CONCLUSIONS: Compliance with the CNRA may be a positive step toward improving the school nutrition and physical activity environment, but it does not ensure a comprehensive or powerful policy. Schools and community partners must continue to work together to strengthen wellness policies and programs.     

Faculty and staff health promotion: results from the School Health Policies and Programs Study 2006

BACKGROUND: US schools employ an estimated 6.7 million workers and are thus an ideal setting for employee wellness programs. This article describes the characteristics of school employee wellness programs in the United States, including state-, district-, and school-level policies and programs. METHODS: The Centers for Disease Control and Prevention conducts the School Health Policies and Programs Study every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in 49 states plus the District of Columbia and among a nationally representative sample of school districts (n=445). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=873). RESULTS: During the 2 years preceding the study, 67.3% of states provided assistance to districts or schools on how to develop or implement faculty and staff health promotion activities or services. Although nearly all schools offered at least 1 health promotion service or activity, few schools offered coordinated activities and services within a comprehensive employee wellness program. During the 12 months preceding the study, none of the health screenings were offered by more than one third of schools; only a few of the health promotion activities and services were offered by more than one third of schools; about one third of schools offered physical activity programs, employee assistance programs, and subsidies or discounts for off-site health promotion activities; and only 1 in 10 schools provided health-risk appraisals for faculty and staff. CONCLUSIONS: More schools should implement comprehensive employee wellness programs to improve faculty and staff health behaviors and health status.     

Nutrition services and foods and beverages available at school: results from the School Health Policies and Programs Study 2006

BACKGROUND: Schools are in a unique position to promote healthy dietary behaviors and help ensure appropriate nutrient intake. This article describes the characteristics of both school nutrition services and the foods and beverages sold outside of the school meals program in the United States, including state- and district-level policies and school practices. METHODS: The Centers for Disease Control and Prevention conducts the School Health Policies and Programs Study every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in all 50 states plus the District of Columbia and among a nationally representative sample of school districts (n=445). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=944). RESULTS: Few states required schools to restrict the availability of deep-fried foods, to prohibit the sale of foods that have low nutrient density in certain venues, or to make healthful beverages available when beverages were offered. While many schools sold healthful foods and beverages outside of the school nutrition services program, many also sold items high in fat, sodium, and added sugars. CONCLUSIONS: Nutrition services program practices in many schools continue to need improvement. Districts and schools should implement more food preparation practices that reduce the total fat, saturated fat, sodium, and added sugar content of school meals. In addition, opportunities to eat and drink at school should be used to encourage greater daily consumption of fruits, vegetables, whole grains, and nonfat or low-fat dairy products.