Presenter Disclosures

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