1. Walking School Bus and Its Impact on BMI Janette Quarles, DrPH, CPH, MPH, MA, CCC/SLP University of Oklahoma Health Sciences Center

2. Mandatory Disclosure Statement Dr. Janette Quarles and research team had no personal financial relationships with commercial interests relevant to this presentation during the past 12 months.during the past 12 months. 2

3. Introduction Since 1970, obesity in ages 6-11 more than quadrupled As child obesity increased, simultaneous decrease in children walking and biking to school 3

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5. Background Many families cannot – or will not – sacrifice time or money to purposely pursue exercise Normal daily routines can be useful to increase physical activity For children, a normal daily routine is the trip to and from school 5

6. Background Even in walkable areas, perceived safety a significant barrier to children actively commuting to school (Anderson, et al)(Baslington)(Carver, et al)(Eyler, et al)(Hayne, et al)(Hume, et al)(Lorenc, et al)(Merom, et al)(Ridgewell, et al)(Sallis, et al, 2009)(Zhu, et al) 6

7. Introduction Many parents’ work schedules – or other life situations – prevent them from walking the child to school Research indicated parents allow children to walk to school when chaperoned (Hayne, et al)(Johnston)(Kingham, et al)(National Center for Bicycling and Walking) 7

8. Walking School Bus Adult-chaperoned walk-to-school program Follows same route each day Has a specific starting point… …safe place for children to gather 8

9. Methods Quasi-experimental in design Evaluated: 1.Community walkability 2. Physical activity levels 3. Pre- & post- body mass index (BMI) in active commuters and controls 9

10. Parent Questionnaire 1.Contributors or barriers to active commute –Neighborhood walkability –Safety –Other factors influencing transportation choice 10

11. Parent Questionnaire 2.Dose response –Distance and frequency of active commute 3.Confounders –Measures of recreational physical activity 4.Differing beliefs for the active commute vs. other outdoor activities 11

12. Methods and Results Concurrent control group Exposed to similar opportunities 1102 total participants ages 5-12 –406 active commuters –696 controls – students driven to the same schools 12

13. Results In areas with lower walkability, Walking School Bus increased active commuting to school to 39.8%... …as compared to the national average of 5-14%, p <.0005 (one-tailed)(SPSS Nonparametric Binomial)… 13

14. Results …and reduced BMI, z = -10.125, p < 0.0005 (two-tailed) (SPSS Nonparametric Wilcoxon Signed- Rank Test). 14

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17. Dose Response Both distance and frequency of active commute demonstrated statistically significant association and correlation with BMI… Distance demonstrated a stronger correlation than frequency 17

18. Results - Distance Walking School Bus allowed children to walk farther…overcoming distance, a significant barrier to the active commute. Participants in the Walking School Bus walked an average of 65% farther than students that walked without an adult chaperone. 18

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20. Physical Activity Measures of recreational physical activity also demonstrated a statistically significant association with BMI… After controlling for confounders, active commute continued to demonstrate statistically significant association with BMI. 20

21. Results – Physical Activity No statistically significant association between the active commute and measures of recreational physical activity Measures were independent of one another 21

22. Results – Physical Activity In other words… Participation in the Walking School Bus was not limited to more physically active students. Walking School Bus increased opportunities for inactive students to actively commute to school. 22

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25. Practical Applications By measuring existing programs… …real world application should contribute to generalization and replication of the results with the knowledge gained regarding the simplicity, feasibility, sustainability and effectiveness of an adult-chaperoned walk-to-school program 25

26. Practical Applications Walking School Bus potential “big bang” for virtually no “bucks”! Uses existing school personnel or volunteers Simple strategy Does not interfere with instruction time 26

27. Summary 1.Walking School Bus sufficient to overcome many barriers to active commute to school –Age, Disability, Gender, –Physically inactive lifestyle, –Distance, Other environmental factors, –Parental safety concerns 27

28. Summary 2.…therefore significantly increasing percentage of children actively commuting to school and significantly decreasing BMI 28

29. Summary 3.Schools should recruit adult chaperones for routes… … in areas with high populations of students (apartment complexes) …overcoming environmental barriers 29

30. Questions? www.safekidsreflectors.com 30

31. http://library.ouhsc.edu/epub/dissertations /quarles-janette.pdf http://gradworks.umi.com/34/67/3467259. html 31

32. References Action for Healthy Kids. (2004). The learning connection: The value of improving nutrition and physical activity in our schools. Retrieved October 26, 2010 from www.actionforhealthykids.org/resources/files/learning-connection.pdf Anderson, P., Butcher, K. (2006). Childhood obesity: Trends and potential causes. The Future of Children, 16(1), 19-45. Bain, M. Walk Score. Retrieved August 17, 2009 from www.walkscore.com Baslington, H. (2008). School travel plans: Overcoming barriers to implementation. Transport Reviews, 28(2), 239-258. Carver, A., Timperio, A., Crawford, D. (2008). Playing it safe: The influence of neighborhood safety on children’s physical safety – a review. Health & Place, 14(2), 217-227. Eyler, A., Brownson, R., Doescher, M., Evenson, K., Fesperman, C., Litt, J., et al. (2008). Policies related to active transport to and from school: A multisite case study. Health Education Research, 23(6), 963-975. Google Maps. Obtained March 10, 2010 from www.google.com Hayne, C., Moran, P., Ford, M. (2004). Regulating environments to reduce obesity. Journal of Public Health Policy, 25(3/4), 391-407. Hume, C., Timperio, A., Salmon, J., Carver, A., Giles-Corti, B., Crawford, D. (2009). Walking and cycling to school: Predictors of increases among children and adolescents. Am J Prev Med, 36(3), 195-200. Johnston, B. (2008). Planning for child pedestrians: Issues of health, safety and social justice. Journal of Urban Design, 13(1), 141-145. 32

33. References Kingham, S., Ussher, S. (2007). An assessment of the benefits of the walking school bus in Christchurch, New Zealand. Transportation Research, 4(6), 502-510. Lorenc, T., Brunton, G., Oliver, S., Oliver, K., Oakley, A. (2008). Attitudes to walking and cycling among children, young people and parents: A systematic review. Journal of Epidemiology and Community Health, 62(10), 852-857. Merom, D., Tudor-Locke, C., Bauman, A., Rissel, C. (2006). Active commuting to school among NSW primary school children: Implications for public health. Health & Place, 12(4), 678-687. National Center for Bicycling and Walking. (2002). Increasing physical activity through community design: A guide for public health practitioners. Retrieved June 11, 2009 from www.bikewalk.org Ridgewell, C., Sipe, N., Buchanan, N. (2009). School travel modes: Factors influencing parental choice in four Brisbane schools. Urban Policy & Research, 27(1), 43-57. Robert Wood Johnson Foundation (RWJF), Trust for America’s Health. (2009). F as in fat: How obesity threatens America’s future. Retrieved July 2, 2010 from www.rwjf.org/childhoodobesity Sallis, J., Story, M., Lou, D. (2009). Study designs and analytic strategies for environmental and policy research on obesity, physical activity and diet. Am J Prev Med, 36(S), S72-S77. U.S. Department of Health and Human Services (USHHS), Centers for Disease Control and Prevention (CDC). (2010). The association between school-based physical activity, including physical education, and academic performance. Atlanta, Georgia: U.S. Department of Health and Human Services. White House Task Force on Childhood Obesity. (2010). Solving the problem of childhood obesity within a generation. Retrieved October 26, 2010 from www.letsmove.gov Zhu, X., Arch, B., Lee, C. (2008). Personal, social, and environmental correlates of walking to school behaviors: Case study in Austin, Texas. The Scientific World Journal, 8, 859-872. 33