Presenter Disclosures Julie Metos (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to.
Download ReportTranscript Presenter Disclosures Julie Metos (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to.
Presenter Disclosures Julie Metos (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose Are obesity prevention practices in high schools associated with school district wellness policies? Julie Metos James VanDerslice Elizabeth Joy Rebecca Utz Christine Porucznik Norman Waitzman American Public Health Association School 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 Policies Written Policy Implementation – 99% of school districts wrote a policy – Barriers: time, people, incentives, resources – Language is weak – Increased nutrition education – Variety of policy components – Fewer sugar sweetened beverages – Adolescents in school districts with mandated wellness policies may have lower BMI – No change in physical education or activity – No studies with BMI Adolescent obesity rates vary by community Social, economic, behavioral and cultural factors influence adolescent BMI – – – – – Income Education Race Ethnicity Marital Status of Parents Socioecologic Model (Institute of Medicine, 2005) Government Policy School Gaps in the school literature Wellness Policy Practices Wellness Policy Mandate Federal level Written Wellness Policy School district level Implementation Adolescent BMI Adolescent behaviors Individual level School level Individual level GAP IN LITERATURE GAP IN LITERATURE Methods – School Practices School 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 No in 2004 Yes in 2004 Yes in 2004 Yes in 2008 No in 2008 Yes in 2008 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 Characteristics of Utah High Schools, n=86 (79%). 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 1010.9 741.7 116.0 1950.0 Student Enrollment Students can purchase sugary drinks Students can purchase snacks Students can purchase chocolate Students can purchase candy Students can purchase chips Students can purchase fruit/veg PE teacher certification required PE is required Can be exempt from PE for school sport Can be exempt from PE for other sport 2004 2006 2008 Can be exempt from PE for a course Can be exempt from PE for school club Intramural sports available to students 0% 20% 40% 60% 80% 100% Figure 1. Proportion of high school principals reporting school environment practices, 2004, 2006 and 2008, n=66. 2004 2006 2008 Teach to increase nutrition knowledge Benefits of healthy eating Risk of unhealthy weight loss Increase whole grains, fruits, veg Moderate fat intake Aim for healthy weight Relationship-health and fitness Food guide pyramid Moderate sugar intake Accepting body size Food labels Healthy meals & snacks 0% 20% 40% 60% 80% 100% Figure 2. Proportion of lead health education teachers reporting they teach nutrition topics in Utah high schools 2004, 2006 and 2008, n=57. Individual PA plan 2004 2008 PA opportunities in community 2006 Overcoming PA barriers Phases of a workout How much PA is needed Decrease TV and sedentary time Benefits of PA Teach to increase PA knowledge 0% 20% 40% 60% 80% 100% Figure 3. Proportion of lead health education teachers reporting they teach physical activity topics in Utah high schools 2004, 2006 and 2008, n=57. Health teachers & food service collaborate 2004 Teachers received nutrition training in past year 2008 2006 School health advisory group at school Teachers received PE/PA training in past year Teachers want PE/PA training Teachers want nutrition training Health teachers & PE teachers collaborate Policy-fruit & vegetables at parties & events 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 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 Acknowledgements James VanDerslice, PhD Family and Preventive Medicine-Division of Public Health Elizabeth Joy, PhD, MD Family and Preventive Medicine-Division of Public Health Rebecca Utz, PhD Social and Behavioral Sciences-Department of Sociology Christine Porucznik, PhD Family and Preventive Medicine-Division of Public Health Norman Waitzman, PhD Social and Behavioral Sciences-Department of Economics