Presenter Disclosures
(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
Julie Metos
No relationships to disclose
Are obesity prevention practices in high schools associated with school
district wellness policies?Julie Metos
James VanDersliceElizabeth JoyRebecca Utz
Christine PorucznikNorman Waitzman
American Public Health AssociationSchool Health Education and Services
October 30, 2012
Percentage of Adolescents Who Were Obese, Grades 9-12, Utah and U.S., 1999, 2001, 2003, 2005, 2007, 2009, and 2011
Consequences of Obesity in Adolescence
• Hypertension• Diabetes• Asthma• Joint problems• Sleep apnea• Liver abnormalities• Depression
• Negative stereotyping• Stigmatization• Poor peer interaction• Discrimination• Fewer academic and
employment opportunities
Research on School Wellness PoliciesWritten Policy
– 99% of school districts wrote a policy
– Language is weak
– Variety of policy components
– Adolescents in school districts with mandated wellness policies may have lower BMI
Implementation
– Barriers: time, people, incentives, resources
– Increased nutrition education
– Fewer sugar sweetened beverages
– No change in physical education or activity
– No studies with BMI
Social, economic, behavioral and cultural factors influence adolescent BMI
– Income– Education– Race– Ethnicity– Marital Status of Parents
Adolescent obesity rates vary by community
Socioecologic Model
Government Policy
Community
School
Family
Adolescent
(Institute of Medicine, 2005)
Gaps in the school literature
Wellness Policy Mandate
Federal level
Written Wellness Policy
School district level
Wellness Policy Practices Implementation
School level
GAP IN LITERATURE
Adolescent behaviors
Individual level
Adolescent BMI
Individual level
GAP IN LITERATURE
Methods
– School PracticesSchool Health Profiles- Centers for Disease Control and Prevention
– School Characteristics Common Core of Data- U.S. Department of Education
– School wellness policies Utah school districts
– Compared high school practices 2004 and 2008
Questions: Principals
Can students purchase snack foods or beverages from one or more vending machines, school stores or canteens?
Can students purchase chocolate candy, other candy, SSB..)?
Has this school adopted a policy that celebrations will have fruits and/or vegetables?
Can students be exempt from required PE (for school sport, community sport, other class, school activity…)?
Does this school offer intramurals or physical activity clubs?
Does school have a wellness committee?
Questions: Teachers
Did teachers…
teach ‘decrease sedentary activities like TV’? teach ‘overcoming barriers to physical activity’? teach ‘balance food intake with physical activity’? teach ‘opportunities for physical activity in the community’? teach ‘eat more fruits and vegetables’? teach ‘preparing healthy meals and snacks’? collaborate with food services staff? collaborate with physical education teachers? receive staff development on nutrition? receive staff development on physical activity?
Methods
– Characterized practices for each high school as:• No in 2004 Yes in 2008• No in 2004 No in 2008• Yes in 2004 Yes in 2008• Yes in 2004 No in 2008
– Analyzed implementation by:• school characteristics• district wellness policy content• nutrition, physical activity and collaboration/ training domains• comparing high schools in same district
Results
Mean or %
SD 10%ile 90%ile
Race/ Ethnicity
% Black 1.1 1.4 0.0 2.6 % Pacific Islander 1.0 1.0 2.0 1.3 % American Indian 5.3 1.7 0.2 7.7 % Asian 2.5 2.7 0.0 6.1 %Hispanic 10.6 1 1.4 1.7 2.6 %White 80.3 19.4 54.2 94.8
% Rural 36.9 NA 0.0 1.0
Free & Reduced Price Lunch (proportion eligible) 32.5 19.6 4.2 98.5
Student Enrollment 1010.9 741.7 116.0 1950.0
Characteristics of Utah High Schools, n=86 (79%).
Figure 1. Proportion of high school principals reporting school environment practices, 2004, 2006 and 2008, n=66.
Intramural sports available to students
Can be exempt from PE for school club
Can be exempt from PE for a course
Can be exempt from PE for other sport
Can be exempt from PE for school sport
PE is required
PE teacher certification required
Students can purchase fruit/veg
Students can purchase chips
Students can purchase candy
Students can purchase chocolate
Students can purchase snacks
Students can purchase sugary drinks
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
2004 2006 2008
Healthy meals & snacks
Food labels
Accepting body size
Moderate sugar intake
Food guide pyramid
Relationship-health and fitness
Aim for healthy weight
Moderate fat intake
Increase whole grains, fruits, veg
Risk of unhealthy weight loss
Benefits of healthy eating
Teach to increase nutrition knowledge
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
2004 2006 2008
Figure 2. Proportion of lead health education teachers reporting they teach nutrition topics in Utah high schools 2004, 2006 and 2008, n=57.
Teach to increase PA knowledge
Benefits of PA
Decrease TV and sedentary time
How much PA is needed
Phases of a workout
Overcoming PA barriers
PA opportunities in community
Individual PA plan
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
2004 20062008
Figure 3. Proportion of lead health education teachers reporting they teach physical activity topics in Utah high schools 2004, 2006 and 2008, n=57.
Policy-fruit & vegetables at parties & events
Teachers want nutrition training
Teachers received PE/PA training in past year
Teachers received nutrition training in past year
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
2004 2006
2008
Figure 4. Proportion of school staff reporting obesity related collaboration or training practices in 2004, 2006 and 2008, n=64 principals or 57 health teachers
School Characteristics and Wellness Practices
• The following were not associated with wellness practices:
– Race and ethnicity of school population– School enrollment– Rurality– Proportion of students receiving free and reduced
price meals– Mandated policy versus recommended policy– Practices in schools within the same district
Strengths and Limitations
Strengths• Adds to scarce literature• Profiles allowed
examination of practices pre and post CNRA without lag time
• Able to look at the same schools over multiple time periods
Limitations• Profiles survey inadequate
for examining wellness policies
• No information on school cafeterias
• Principals may not be best source of competitive foods and PE practices
• Limited to one state
Summary• Few changes in high school nutrition and physical activity practices
post CNRA
• No associations of practices by:– School characteristics– School district wellness policy content– Schools in the same district
• In Utah:– Junk foods are available in >90% of high schools– 67% of high schools allow exemption from PE for at least one reason– Nutrition and PA concepts are consistently taught in the health classroom
Discussion
Research• Assess practices pre- and post CNRA
2010 – develop better tools for wellness
policy implementation and evaluation
– evaluate middle school practices• Include built environment surrounding
schools in analyses• Strive to understand changes in health
behaviors and outcomes resulting from wellness policies
Public Health Application• Policy is different than practice
– In state policy– In federal policy
• Ensure quality nutrition and physical activity education in health classes
• Do a better job with obesity prevention in high schools– Competitive foods/ PE– Make guidelines specific– Work towards long-term
sustainability
Logic Model
District WellnessPolicy Content
High School Practices
Individual Characteristics
CommunityCharacteristics
Adolescent BMI
Family Characteristics
SchoolCharacteristics
Acknowledgements
James VanDerslice, PhDFamily and Preventive Medicine-Division of Public Health
Elizabeth Joy, PhD, MDFamily and Preventive Medicine-Division of Public Health
Rebecca Utz, PhDSocial and Behavioral Sciences-Department of Sociology
Christine Porucznik, PhDFamily and Preventive Medicine-Division of Public Health
Norman Waitzman, PhDSocial and Behavioral Sciences-Department of Economics
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