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May 2010 Promoting Children’s Physical Activity via a Socio-Ecological Framework  Andrew Springer, DrPH Assistant Professor, University of.

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Presentation on theme: "May 2010 Promoting Children’s Physical Activity via a Socio-Ecological Framework  Andrew Springer, DrPH Assistant Professor, University of."— Presentation transcript:

1 May 2010 Promoting Children’s Physical Activity via a Socio-Ecological Framework  Andrew Springer, DrPH Assistant Professor, University of Texas SPH-Austin Michael & Susan Dell Center for Advancement of Healthy Living Building Bridges Conference- TDSHS, June 16, 2010 Springer

2 Topics Ecological perspectives for PA
Steps CATCH Project Topics Ecological perspectives for PA School-based health promotion strategies for PA Examples of partnerships to promote PA in children Hoelscher

3 Trends in U.S. Child Obesity
May 2010 Trends in U.S. Child Obesity *Obesity is > 95th Percentile for BMI by Age/Sex HP 2010 Goal Sources: Ogden et al., 2006; Hoelscher et al, SPAN study; CATCH ‘07. Springer

4 Steps CATCH Project Physical Activity “If there were a single medication you could take – a pill that is free, with no side effects – that helped reduce your risk of developing or dying from many chronic diseases, would you take it? Daily physical activity is that magic pill.” -Jane Wargo & Russell Pate Hoelscher

5 Benefits of PA for children
Steps CATCH Project Benefits of PA for children Chronic disease prevention Hypertension, type 2 diabetes, obesity, CVD. Improves overall health and adult health status Cardiovascular system Musculoskeletal system Mental health, psychological and emotional well-being Reduces stress & symptoms of depression and anxiety Improves self-esteem IOM, 2005 Hoelscher

6 PA Guidelines for Children & Adolescents (ages 6-17)
Steps CATCH Project PA Guidelines for Children & Adolescents (ages 6-17) 1 hour or more of PA every day. Most of the 1 hour should be MPA or VPA Vigorous intensity activity on at least 3 days per week. Muscle-strengthening and bone-strengthening activity on at least 3 days/ week. (USDHHS 2008) Hoelscher

7 Healthy People 2010 Goals Travis County CATCH Study ‘06-’10
Steps CATCH Project Healthy People 2010 Goals Travis County CATCH Study ‘06-’10 Healthy People (HP) 2010: 50% MVPA in PE 39.1% MVPA in PE (3rd, 4th, 5th graders). HP 2010 Goal: 85% of children (adolescents) engage in VPA on 3 or more days/wk. 67% of girls & 74% of boys (n= th graders). American Academy of Pediatrics: 1-2 hrs/day 43% of girls & 65% of boys spent ≥3 hrs watching TV/playing video games (4th grade). Hoelscher, Springer et al, 2010 Hoelscher

8 How do we increase physical activity in children and adolescents?
Steps CATCH Project How do we increase physical activity in children and adolescents? Hoelscher

9 Health Promotion: An Historical Perspective
The LaLonde Report (1974): “The Genesis of Health Promotion” First report from industrialized nation: health is not determined only by biological factors. Recognition that biomedical interventions are not the main cause of well-being of a population. “Field of Health” influenced by 4 aspects: Human biology Environment Health services Lifestyles un informe Canadiense que presenta una estrategia comprehensiva para controlar las enfermedades crónicas El Informe Lalonde fue criticado por un sobre-enfasis en el estilo de vida de los individuos y sus efectos en la salud; este enfasis se podria ver mucho en la literatura de la promocion de salud durante los 80s y 90s, Mention ‘medical model”? Reagan enfasis? Este ha sido una diferencia importante en cuanto a como perceben la salud en america latina y los EEUU… medicina social? Sallis & Owen, 1997

10 Health Promotion: An Historical Perspective
The Ottawa Charter for Health Promotion (1986): 1st Int’l conf. on health promotion. Importance of socio-cultural and economic influences of health. 5 areas of action: Re-orienting health services toward prevention Building healthy public policy Creating supportive environments Strengthening community action Developing personal skills Hace la llamada para estrategias de promoción de la salud que enfatizan la creación de ambientes de apoyo además de la promoción de las habilidades personales y la reorientación de servicios de salud. Los modelos ecologicos se origen naturalmente de esta enfasis en la importancia del espacio fuera del individuo… Stokols argues that the health promotion interventions must address the environmental resroucrse that may either faicliate or hinder the tareted health behavior. In addition to havein indirect environmental effects on health through influencing health behavior, sociophysical environments can have more direct effects throught he kind of emotional health and social cohesion they encourage.

11 Steps CATCH Project Ecological Fallacy Ecological Fallacy: inferences about the nature of individuals are based solely upon aggregate statistics for the group to which those individuals belong. Example: Florida sells the most cat food and has the most senior citizens = senior citizens eat cat food. Yum! Hoelscher

12 Steps CATCH Project Reductionist Fallacy Reductionist Fallacy: incorrect conclusions about group-level processes are based on individual-level data. Example: Race causes violence because higher arrests for violent crime among African Americans. 40% of poor Blacks live in areas of extreme poverty vs. 7% of poor whites. (Wilson, 1987) Hoelscher

13 Steps CATCH Project Racial/Ethnic Disparity in PA & School Ethnic Composition (Richmond et al., 2006, Pediatrics) Racial/Ethnic disparities in physical activity. Cross-sectional analysis of 17,007 teens in the Nat’l Longitudinal Study of Adolescent Health. Findings: Participants attended segregated schools: 80% of Hispanic students attended schools with student populations that were majority white (66%) Nearly 40% of the white adolescents attended schools that were >94% white. Black/Hispanic students attended poorer schools Previous studies have found racial/ethnic disparities in adolescents’ physical activity Hoelscher

14 Racial/Ethnic Disparity in PA Findings (continued)
Steps CATCH Project Racial/Ethnic Disparity in PA Findings (continued) Black and Hispanic adolescent girls reported lower PA than white girls. Black and Hispanic adolescent girls were more likely to attend poorer schools with lower levels of physical activity No difference within schools between black, white, and Hispanic girls’ PA levels. Within the same schools, black and Hispanic boys had >PA when compared to white boys. Hoelscher

15 Steps CATCH Project Conclusion Lower physical activity levels in Hispanic and black girls largely attributable to the schools they attended. Black and Hispanic males had higher activity levels than white males when attending the same schools. Future research is needed to determine the mechanisms through which school environments contribute to racial/ethnic disparities in adolescent physical activity Hoelscher

16 Physical Activity by Parental Language Group & Ethnicity
Steps CATCH Project Physical Activity by Parental Language Group & Ethnicity Objective: To compare PA participation in children by parental language and ethnicity: (Spanish-Hispanic, English-Hispanic, and English Other). Methods: Cross-sectional analysis of SPAN data (n = 22,049 4th, 8th, 11th graders) Springer, Barroso , et al., J Immigrant Minority Health 2010 Hoelscher

17 PH 2998, Adolescent Health Edi
3/14/03 % of Texas Girls who Played on ≥1 Sports Team at School in last year (n=11,111; ‘04-05) (Springer, Barroso , et al., J Immigrant Minority Health 2010) % 4th Grade 58.4% % % 8th Grade 58.6% 65% 76.7% 11 Grade 51.9% 49.5% 59.6 % Span (ref) 1.00 Eng-Hisp 1.52 (1.23, 1.88) 1.67 (1.36, 2.04) 1.71 (1.40, 2.10) Eng-Other 1.46 (1.18, 1.80) 2.58(2.10, 3.17) 2.06 (1.68, 2.51) Hoelscher 17

18 Why lower PA in Hispanic children?
PH 2998, Adolescent Health Edi 3/14/03 Why lower PA in Hispanic children? Acculturation Hypothesis: Culture = Lifestyle Representative study of 5,406 ninth-grade students in public schools in Matamoros (Mexico) and Lower Rio Grande Valley (Texas, U.S.) found similar participation in sports (Perez et al., ‘06). Familismo: putting family needs before one’s own; Hispanic girls more likely to report child care (Grieser et al., 2006). Communication & Social Barrier: Is language a barrier for accessing organized PA? More English-speaking parents reported receiving communication from school (NHES, 2003) Discrimination & Exclusion: Is language a target for discrimination by dominant ethnic groups? Non-English adolescents at >risk of alienation (Yu et al., 2003) Lower volunteer opportunities for Sp-speaking parents (NHES, 2003) Language as Proxy for Economic Status(SES) Hoelscher 18

19 Ecological models for understanding engagement in physical activity
PH 2998, Adolescent Health Edi 3/14/03 Ecological models for understanding engagement in physical activity Definitions Ecology: the interrelationship between organisms and their environment. Environment: space external to individuals Ecological perspective: emphasizes the interaction between people and their physical and socio-cultural surroundings. (the key to ecological models). Hoelscher

20 Common Principles of Ecological Models of Behavior
Marathon Kids Logic Model, ISBNPA 2008 Common Principles of Ecological Models of Behavior Multiple dimensions & levels of influence Emphasis on place: behavior-specific models. Environments directly influence behaviors. Interactions of influence across dimensions. Multiple Dimensions & Levels of Influence: A key concept in ecological models is that interventions will be most effective when they operate on multiple levels and with multiple dimensions. Multiple dimensions may include intrapersonal factors, social and cultural environments, and physical environments. Environments directly influence behaviors: “Ecological models direct attention to environmental and policy factors that may be root causes of the epidemic of sedentary lifestyles. Thus, environments may influence behavior directly, not necessarily through psychological processes. Emphasis on place: Behavior-Specific: “Specific ecological models will be needed to guide research and intervention for each health behavior.” Environmental influences are much more behavior specific. Health behaviors are performed in many behavior settings, and each setting has numerous characteristics that may affect each behavior differently. Interactions of Influence: It is important to understand how the different dimensions of the ecological model interact. Thus, an intervention that succeeds on the intrapersonal level in motivating individuals to consume more fruits and vegetables may fail if those individuals do not have the environmental supports to allow for fruit and vegetable consumption. Sallis et al., 2006; Sallis & Owen, 1997 AE Springer

21 Ecological Model of Active Living (Sallis et al 2006)
Marathon Kids Logic Model, ISBNPA 2008 Ecological Model of Active Living (Sallis et al 2006) Policy Multiple Dimensions & Levels of Influence: A key concept in ecological models is that interventions will be most effective when they operate on multiple levels and with multiple dimensions. Multiple dimensions may include intrapersonal factors, social and cultural environments, and physical environments. Environments directly influence behaviors: “Ecological models direct attention to environmental and policy factors that may be root causes of the epidemic of sedentary lifestyles. Thus, environments may influence behavior directly, not necessarily through psychological processes. Emphasis on place: Behavior-Specific: “Specific ecological models will be needed to guide research and intervention for each health behavior.” Environmental influences are much more behavior specific. Health behaviors are performed in many behavior settings, and each setting has numerous characteristics that may affect each behavior differently. Interactions of Influence: It is important to understand how the different dimensions of the ecological model interact. Thus, an intervention that succeeds on the intrapersonal level in motivating individuals to consume more fruits and vegetables may fail if those individuals do not have the environmental supports to allow for fruit and vegetable consumption. Sallis et al., 2006 AE Springer

22 Multiple Dimensions & Levels
Marathon Kids Logic Model, ISBNPA 2008 Multiple Dimensions & Levels Policy Social Culture Policy Inform. Natural/Built Environment Multiple Dimensions & Levels of Influence: A key concept in ecological models is that interventions will be most effective when they operate on multiple levels and with multiple dimensions. Multiple dimensions may include intrapersonal factors, social and cultural environments, and physical environments. Environments directly influence behaviors: “Ecological models direct attention to environmental and policy factors that may be root causes of the epidemic of sedentary lifestyles. Thus, environments may influence behavior directly, not necessarily through psychological processes. Emphasis on place: Behavior-Specific: “Specific ecological models will be needed to guide research and intervention for each health behavior.” Environmental influences are much more behavior specific. Health behaviors are performed in many behavior settings, and each setting has numerous characteristics that may affect each behavior differently. Interactions of Influence: It is important to understand how the different dimensions of the ecological model interact. Thus, an intervention that succeeds on the intrapersonal level in motivating individuals to consume more fruits and vegetables may fail if those individuals do not have the environmental supports to allow for fruit and vegetable consumption. Sallis et al., 2006 AE Springer

23 Marathon Kids Logic Model, ISBNPA 2008
Behavioral Settings Policy Neighborhood Work place Behavior Settings Recreation Environment Perceptions School Multiple Dimensions & Levels of Influence: A key concept in ecological models is that interventions will be most effective when they operate on multiple levels and with multiple dimensions. Multiple dimensions may include intrapersonal factors, social and cultural environments, and physical environments. Environments directly influence behaviors: “Ecological models direct attention to environmental and policy factors that may be root causes of the epidemic of sedentary lifestyles. Thus, environments may influence behavior directly, not necessarily through psychological processes. Emphasis on place: Behavior-Specific: “Specific ecological models will be needed to guide research and intervention for each health behavior.” Environmental influences are much more behavior specific. Health behaviors are performed in many behavior settings, and each setting has numerous characteristics that may affect each behavior differently. Interactions of Influence: It is important to understand how the different dimensions of the ecological model interact. Thus, an intervention that succeeds on the intrapersonal level in motivating individuals to consume more fruits and vegetables may fail if those individuals do not have the environmental supports to allow for fruit and vegetable consumption. Home Sallis et al., 2006 Behavior-Specific Models & Settings AE Springer

24 Marathon Kids Logic Model, ISBNPA 2008
Active Living Domains Policy Multiple Dimensions & Levels of Influence: A key concept in ecological models is that interventions will be most effective when they operate on multiple levels and with multiple dimensions. Multiple dimensions may include intrapersonal factors, social and cultural environments, and physical environments. Environments directly influence behaviors: “Ecological models direct attention to environmental and policy factors that may be root causes of the epidemic of sedentary lifestyles. Thus, environments may influence behavior directly, not necessarily through psychological processes. Emphasis on place: Behavior-Specific: “Specific ecological models will be needed to guide research and intervention for each health behavior.” Environmental influences are much more behavior specific. Health behaviors are performed in many behavior settings, and each setting has numerous characteristics that may affect each behavior differently. Interactions of Influence: It is important to understand how the different dimensions of the ecological model interact. Thus, an intervention that succeeds on the intrapersonal level in motivating individuals to consume more fruits and vegetables may fail if those individuals do not have the environmental supports to allow for fruit and vegetable consumption. Sallis et al., 2006 AE Springer

25 Perceived Environment
Marathon Kids Logic Model, ISBNPA 2008 Perceived Environment Policy Multiple Dimensions & Levels of Influence: A key concept in ecological models is that interventions will be most effective when they operate on multiple levels and with multiple dimensions. Multiple dimensions may include intrapersonal factors, social and cultural environments, and physical environments. Environments directly influence behaviors: “Ecological models direct attention to environmental and policy factors that may be root causes of the epidemic of sedentary lifestyles. Thus, environments may influence behavior directly, not necessarily through psychological processes. Emphasis on place: Behavior-Specific: “Specific ecological models will be needed to guide research and intervention for each health behavior.” Environmental influences are much more behavior specific. Health behaviors are performed in many behavior settings, and each setting has numerous characteristics that may affect each behavior differently. Interactions of Influence: It is important to understand how the different dimensions of the ecological model interact. Thus, an intervention that succeeds on the intrapersonal level in motivating individuals to consume more fruits and vegetables may fail if those individuals do not have the environmental supports to allow for fruit and vegetable consumption. Sallis et al., 2006 AE Springer

26 Intrapersonal Environment
Marathon Kids Logic Model, ISBNPA 2008 Intrapersonal Environment Policy Multiple Dimensions & Levels of Influence: A key concept in ecological models is that interventions will be most effective when they operate on multiple levels and with multiple dimensions. Multiple dimensions may include intrapersonal factors, social and cultural environments, and physical environments. Environments directly influence behaviors: “Ecological models direct attention to environmental and policy factors that may be root causes of the epidemic of sedentary lifestyles. Thus, environments may influence behavior directly, not necessarily through psychological processes. Emphasis on place: Behavior-Specific: “Specific ecological models will be needed to guide research and intervention for each health behavior.” Environmental influences are much more behavior specific. Health behaviors are performed in many behavior settings, and each setting has numerous characteristics that may affect each behavior differently. Interactions of Influence: It is important to understand how the different dimensions of the ecological model interact. Thus, an intervention that succeeds on the intrapersonal level in motivating individuals to consume more fruits and vegetables may fail if those individuals do not have the environmental supports to allow for fruit and vegetable consumption. Sallis et al., 2006 AE Springer

27 Environments Directly Influence Behavior
Marathon Kids Logic Model, ISBNPA 2008 Environments Directly Influence Behavior Policy Multiple Dimensions & Levels of Influence: A key concept in ecological models is that interventions will be most effective when they operate on multiple levels and with multiple dimensions. Multiple dimensions may include intrapersonal factors, social and cultural environments, and physical environments. Environments directly influence behaviors: “Ecological models direct attention to environmental and policy factors that may be root causes of the epidemic of sedentary lifestyles. Thus, environments may influence behavior directly, not necessarily through psychological processes. Emphasis on place: Behavior-Specific: “Specific ecological models will be needed to guide research and intervention for each health behavior.” Environmental influences are much more behavior specific. Health behaviors are performed in many behavior settings, and each setting has numerous characteristics that may affect each behavior differently. Interactions of Influence: It is important to understand how the different dimensions of the ecological model interact. Thus, an intervention that succeeds on the intrapersonal level in motivating individuals to consume more fruits and vegetables may fail if those individuals do not have the environmental supports to allow for fruit and vegetable consumption. Sallis et al., 2006 AE Springer

28 Marathon Kids Logic Model, ISBNPA 2008
Interactions of Influence across Dimensions Policy Multiple Dimensions & Levels of Influence: A key concept in ecological models is that interventions will be most effective when they operate on multiple levels and with multiple dimensions. Multiple dimensions may include intrapersonal factors, social and cultural environments, and physical environments. Environments directly influence behaviors: “Ecological models direct attention to environmental and policy factors that may be root causes of the epidemic of sedentary lifestyles. Thus, environments may influence behavior directly, not necessarily through psychological processes. Emphasis on place: Behavior-Specific: “Specific ecological models will be needed to guide research and intervention for each health behavior.” Environmental influences are much more behavior specific. Health behaviors are performed in many behavior settings, and each setting has numerous characteristics that may affect each behavior differently. Interactions of Influence: It is important to understand how the different dimensions of the ecological model interact. Thus, an intervention that succeeds on the intrapersonal level in motivating individuals to consume more fruits and vegetables may fail if those individuals do not have the environmental supports to allow for fruit and vegetable consumption. Sallis et al., 2006 AE Springer

29 Steps CATCH Project Parental Influences on Children’s TV Watching Springer, Kelder, Barroso, Drenner, Shegog, Ranjit, Hoelscher, Under Review Study Objective: To assess the association of parental TV rules (policy environment) on children’s meeting AAP guidelines of ≤2 hours TV watching/day Examine potential modifying effect of TV in bedroom (built environ.), parent TV watching, Afterschool context (social environments) Sample: n = 734 primarily Hispanic 4th graders Methods: Self-administered questionnaire Hoelscher

30 Percentage of Children who met AAP by Parent TV Rules
Steps CATCH Project Percentage of Children who met AAP by Parent TV Rules AOR: 1.68 (1.22, 2.32) Adjusted for age, gender, ethnicity, parent language Hoelscher

31 Percentage of Children who met AAP by TV Rules: TV in Bedroom
Steps CATCH Project Percentage of Children who met AAP by TV Rules: TV in Bedroom AOR: 1.04 (.50, 2.19) (1.39, 2.97) Hoelscher

32 Percentage of Children who met AAP by TV Rules: Parental TV Watching
Steps CATCH Project Percentage of Children who met AAP by TV Rules: Parental TV Watching AOR: 1.80 (1.26, 2.56) (0.30, 1.69) Hoelscher

33 May 2010 Summary Policy Environment: Children with Parental TV Limits more likely to meet AAP recommendations Social Environment: Children with high TV watching parents less likely to meet AAP recommendations. Interactions of Influence across Dimensions: TV location modifies TV rule and AAP Nonsignificant association when parents watch TV frequently Springer

34 Schools… “… have more influence on the lives of young people than any other social institution except the family and provide a setting in which friendship networks develop, socialization occurs, and norms that govern behavior are developed and reinforced.” Healthy People 2010 The U.S. Department of Health and Human Services (HHS) noted that schools have more influence on the lives of young people than any other social institution except the family. HHS also noted the importance of schools in social development and highlighted the opportunity that schools offer for improving the health status of children and youth. ASTHO and SSDHPER

35 Elementary school PE does not harm academic achievement
Steps CATCH Project Elementary school PE does not harm academic achievement Students who participated in school PA did not experience negative effects on their standardized test scores, though less time was available for other academic subjects. Sallis et al, 1999 Shephard, 1996 Dwyer et al, 1983 Hoelscher

36 2001 Grade 5 SAT 9 and Physical Fitness
Stanford Achievement Test Gives to students in grades 5, 7 & 9 Used Fitnessgram to assess physical fitness CA Dept. of Education, 2002

37 Measurement of Physical Activity (Schools)
PH 2998, Adolescent Health Edi 3/14/03 Measurement of Physical Activity (Schools) Self-report: diary, questionnaires, activity checklists (SAPAC) Direct observation (SOFIT, SOPLAY) Pedometers, accelerometers, heart rate monitors. 1.) Just to point out the different levels of precision with measurement. The data I will be presenting tonight is based on self-report, and thus, there may be more issues with measurement error- both in terms of validity of instruments in measuring physical activity as well as the biases the go along with data based on self-report. Calorimetry: some type of chamber to measure heat; doubly labeled water: they put an isotope and then measure urine… Gait analysis is the technical part of gait assessment. The patient walks up and down the laboratory, while special television cameras observe the positions of reflectors fixed to their skin. A computer uses these observations to provide detailed information on the way the patient walks. Hoelscher

38 Strategies for PA promotion in the school setting
Steps CATCH Project Strategies for PA promotion in the school setting Intrapersonal Classroom PA Curriculum Policy/Social Environment Mandated PA time PE Organization/Training (CATCH) Activity Breaks Built Environment Community-School Partnership Hoelscher

39 Curriculum-Only Salmon et al. (2007): Review of PA studies.
May 2010 Curriculum-Only Salmon et al. (2007): Review of PA studies. 5 intervention curriculum-only studies : 1 effective but not effective in replication. TV curriculum (e.g., Planet Health) = effects on reducing TV/ weight gain. Springer

40 Strategies for PA promotion in the school setting
Steps CATCH Project Strategies for PA promotion in the school setting Policy/Social Environment Mandated PA Time PE Organization/Training (CATCH) Activity Breaks Built Environment Community-School Partnership Hoelscher

41 Percentage of U.S. high school students that attend daily PE class, 1991-2007
CDC YRBS

42 Steps CATCH Project Texas School PA Policy Texas Senate Bill 19 (2001): K – 5th grade The Texas Coalition for Coordinated School Health and Physical Education 30 minutes of daily structured physical activity or a total of 135 minutes/week Coordinated School Health Program (CSH) Classroom curriculum, physical activity, child nutrition services, and parental involvement. Creation of local district School Health Education Advisory Council. In 2001, the 77th legislature pass Senate Bill 19. Until SB19 was passed, current law only required PE for grades 9 – 12. (SB19 coauthored by Nelson and Wentworth?) The board of trustees of each school district shall establish a local school health [education] advisory council to assist the district in ensuring that local community values are reflected in the district's health education instruction. Every school district is required to have a school health advisory council. The law doesn’t stipulate how often they should meet or how long they should exist. However, since the duties of a council are so extensive and important, this should be a permanent body and they should meet a minimum of six times during the year. Hoelscher

43 Implementation of Texas Senate Bill 19 in Elementary Schools
Steps CATCH Project Implementation of Texas Senate Bill 19 in Elementary Schools Kelder SH, Springer AE, Barroso C, Smith C, Sanchez E, Hoelscher DM, Ranjit N. RESEARCH AIMS To assess awareness of and adherence to SB19 in a representative sample of Texas elementary schools. To assess the implementation of SB19 in Texas/Mexico border schools (2 regions): weekly minutes of PA; quality of child PA during PE. Hoelscher

44 Reported PE and Recess Min per Week
State of Obesity in Texas Reported PE and Recess Min per Week 135 min per week R10-R11 = 82 min/week (Kelder , Springer et al., J Public Health Policy, 2009) Hoelscher, SPAN

45 Steps CATCH Project Hoelscher

46 Selected Policies to Promote PA during School
Steps CATCH Project Selected Policies to Promote PA during School California Legislation: 50% of PE classes to be spent in MVPA by 2013. Increase supervision of recess (Sallis et al., 2001; Sallis et al., 2003; Farley et al., 2007) CATCH Middle School: Open Gym Provide PA as a reward, not discipline (PLAY-ON study, Leatherdale et al., 2010). WOW Time: 30 minutes of PA/day (Springer et al., in progress) Hoelscher

47 Strategies for PA promotion in the school setting
Steps CATCH Project Strategies for PA promotion in the school setting Policy/Social Organization Mandated PA Time PE Organization/Training (CATCH) Activity Breaks Built Environment Community-School Partnership Hoelscher

48 Students participate in MVPA for >=50% of class time.
Steps CATCH Project Healthy People 2010: PE Objective Students participate in MVPA for >=50% of class time. Hoelscher

49 CATCH PE Maintain children in high levels of activity.
Steps CATCH Project CATCH PE Maintain children in high levels of activity. All children participate. Non-competitive, fun activities. Hoelscher

50 Community Partnerships with CATCH
Steps to a Healthier Houston-Harris County Consortium (Steps Consortium) Formed in 2003; 25 area organizations The Houston Endowment Inc. awarded $2.4 million to implement CATCH in >450 schools Travis County CATCH Project UTSPH & 4 central Texas districts Funding from Michael & Susan Dell Foundation for implementation in ~100 elementary schools CATCH Consortium & support of CATCH teams

51 Steps CATCH Project May 2010 Percentage of PE Class Time 3rd, 4th, & 5th grade students engaged in MVPA. Harris County CATCH (n = 94 class observations/ 36 schools). * 46.3% 41.6% * 36.7% a partnership between Steps to a Healthier Houston/Harris County Consortium (SHHHCC), Harris County Public Health and Environmental Services (HCPHES), the University of Texas School of Public Health, and the Houston Endowment was established in 2005 to disseminate CATCH (Coordinated Approach to Child Health)—an integrated school health program that promotes physical activity and healthy eating with children and their families—in public elementary schools in Harris County. *p<.001 (Hoelscher, Springer et al., in process) Hoelscher

52 [a: p = .023; b: p = <.001; c: p = .001.]
Steps CATCH Project Percentage of PE class time 3rd, 4th, and 5th grade students engaged in MVPA Travis County CATCH Project (n = 103 class observations). HP 2010 Goal b, c 48.4 a, b 42.8 38.8 [a: p = .023; b: p = <.001; c: p = .001.] Hoelscher, Springer, et al., Obesity 2010 Hoelscher

53 Strategies for PA promotion in the school setting
Steps CATCH Project Strategies for PA promotion in the school setting Policy/Social Environment Mandated PA Time PE Organization/Training (CATCH) Activity Breaks Built Environment Community-School Partnership Hoelscher

54 Steps CATCH Project Activity Breaks “Promoting Lifetime Activity in Youth” (PLAY) (Pangrazi et al., 2003; Ernst et al., 1999) Teacher-led games. (Connolly & McKenzie, 1995) “Take 10!” (Stewart et al, 2004) Hoelscher

55 Pass & CATCH improves Stanford math scores
Steps CATCH Project Pass & CATCH improves Stanford math scores At Risk: adaptability, social skills, leadership, study skills, functional communication * * * Murray (UTSPH), unpublished Hoelscher

56 Active Play Project Investigators: Springer, Kelder, Ranjit; Funding: Michael & Susan Dell Foundation To assess the effect of low-cost strategies for promoting children’s MVPA during recess and WOW time. Strategies: Peer-led Games Approach Teacher-led Approach Playground Markings Design: RCT in 8 schools

57

58 Strategies for PA promotion in the school setting
Steps CATCH Project Strategies for PA promotion in the school setting Policy/Social Environment Mandated PA Time PE Organization/Training (CATCH) Activity Breaks Built Environment Community-School Partnerships Hoelscher

59 Steps CATCH Project Built Environment “We shape our buildings, and thereafter they shape us.” -Winston Churchill ( ) Hoelscher

60 “As drivers expand, car makers develop new designs.”
Boston Globe, 2005

61 “Supports your ‘sit bones’…!”
Steps CATCH Project “Supports your ‘sit bones’…!” = Hoelscher

62 Playground Markings Stratton (2000): Children 5-7 yrs
Steps CATCH Project Playground Markings Stratton (2000): Children 5-7 yrs (UK). MVPA increased by 18 mins/d. Stratton & Mullan (2005): 4-11 yrs: MVPA increased from 37% to 50%. Ridgers et al. (2007) Hoelscher

63 Playground Equipment & Enhancements
Steps CATCH Project Playground Equipment & Enhancements Games equipment & activity cards intervention increased MVPA in 5th/6th grade girls in Belgian. (Verstraete et al, 2006). Middle school students attending schools with improved playgrounds had higher observed MVPA (Sallis et al., 2001). Hoelscher

64 Strategies for PA promotion in the school setting
Steps CATCH Project Strategies for PA promotion in the school setting Policy/Social Environment Mandated PA Time PE Organization/Training (CATCH) Activity Breaks Built Environment Community-School Partnerships Hoelscher

65 Community-School Partnerships
Steps CATCH Project Community-School Partnerships Schools and communities have long been cited as important vehicles for promoting PA in young people (IOM, 2006; USDHHS, 1996) Partnerships among schools, community organizations and businesses: recommended to implement PA programs (CDC, 1997). PLAY-ON study (n = 30 schools; 2, graders): children more likely to be moderately active if attending a school with well-established community partnerships (Leatherdale et al., 2010) Hoelscher

66 Marathon Kids Established 1996 in Austin, Texas.
Steps CATCH Project Marathon Kids Established 1996 in Austin, Texas. Currently operating in 7 sites in the U.S. Objectives: To engage children (and families) in running/walking 26.2 miles over six month period. To promote children’s consumption of fruit & vegetables 5 times a day/26 days per month. Hoelscher

67 Goal Setting/ Monitoring
Steps CATCH Project Goal Setting/ Monitoring Fuel & Mileage Logs Hoelscher

68 Policy/ Organizational Environment
Marathon Kids Policy/ Organizational Environment School physical activity legislative mandates (Senate Bill 19/530) Structured School Time for PA Before, during & after school. In Texas and other states in the U.S., we have recently enacted physical activity mandates. The structuring of time within school for MK miles may be facilitated by those mandates. AE Springer

69 Information Environment
Steps CATCH Project Information Environment Bumper Stickers Marathon Kids T-Shirts Information Packets Presentations Media Coverage Hoelscher

70 Social Environment: Positive Social Influences
Steps CATCH Project Social Environment: Positive Social Influences Austin Mayor Will Wynn Teachers Parents Volunteers/Comm. Leaders; Businesses Hoelscher

71 Social Environment: Instrumental Support
Steps CATCH Project Social Environment: Instrumental Support Teachers/Schools: Enroll students in program. Track progress with miles. Facilitate transportation to celebratory events. Hoelscher

72 Social Environment: Positive Social Influences
Steps CATCH Project Social Environment: Positive Social Influences LA Mayor Antonio Villaraigosa Shawn Colvin Musician Eduardo Sanchez Texas Health Commis. Austin Mayor Will Wynn Austin Mayor Will Wynn (Keepin’ Austin Weird…) Hoelscher

73 Social Environment: Positive Reinforcement
Steps CATCH Project Social Environment: Positive Reinforcement Public Recognition = “Kick-Off” and “Final Mile Run Events” Final Mile Medal & Finisher T-Shirt Hoelscher

74 Selected Findings: MK Study
Springer, Kelder, Ranjit et al, under review

75 Steps CATCH Project Summary Beware the ecological fallacy… but also beware of a reductionist fallacy The sociological imagination: the capacity to discern the relationship between large-scale social forces and the actions of individuals. Ecological Models: a broad framework for exploring social-environmental influences on PA Too broad? Need to continue to elucidate dimensions of ecological models Schools as a key setting for PA Hoelscher

76 Building Bridges for Promoting Children’s PA
Steps CATCH Project Building Bridges for Promoting Children’s PA How do we enhance social environment/ social organization of schools to promote child PA? (e.g., Wellness committees) How do we harness school-community partnerships to increase effectiveness of school policies and quality of PA? How do we expand the focus from individuals to settings (‘active schools’, ‘active school districts’, and active communities)? Hoelscher

77 Steps CATCH Project THANK YOU Hoelscher


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