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Andrew Springer, DrPH Assistant Professor, University of Texas SPH-Austin Michael & Susan Dell Center for Advancement of Healthy Living Building Bridges.

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Presentation on theme: "Andrew Springer, DrPH Assistant Professor, University of Texas SPH-Austin Michael & Susan Dell Center for Advancement of Healthy Living Building Bridges."— Presentation transcript:

1 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

2 Ecological perspectives for PA School-based health promotion strategies for PA Examples of partnerships to promote PA in children

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

4 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

5 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

6 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)

7 Healthy People (HP) 2010: 50% MVPA in PE 39.1% MVPA in PE (3 rd, 4 th, 5 th 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 (4 th grade). Hoelscher, Springer et al, 2010

8 How do we increase physical activity in children and adolescents?

9 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 Sallis & Owen, 1997

10 The Ottawa Charter for Health Promotion (1986): 1st Intl 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

11 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!

12 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)

13 Racial/Ethnic disparities in physical activity. Cross-sectional analysis of 17,007 teens in the Natl 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

14 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.

15 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

16 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 4 th, 8 th, 11 th graders) Springer, Barroso, et al., J Immigrant Minority Health 2010

17 % 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) 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-Other1.46 (1.18, 1.80) 2.58 (2.10, 3.17) 2.06 (1.68, 2.51) %

18 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 ones 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)

19 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).

20 Sallis et al., 2006; Sallis & Owen, 1997 Multiple dimensions & levels of influence Emphasis on place: behavior-specific models. Environments directly influence behaviors. Interactions of influence across dimensions.

21 Policy Sallis et al., 2006

22 Policy Natural/Built Environment Inform. Social Culture Sallis et al., 2006

23 Policy Sallis et al., 2006 Behavior Settings Perceptions Neighborhood Home Work place Recreation Environment School Behavior-Specific Models & Settings

24 Policy Sallis et al., 2006

25 Policy Sallis et al., 2006

26 Policy Sallis et al., 2006

27 Policy Sallis et al., 2006

28 Policy Sallis et al., 2006 Interactions of Influence across Dimensions

29 Study Objective: To assess the association of parental TV rules (policy environment) on childrens 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 4 th graders Methods: Self-administered questionnaire

30 AOR: 1.68 (1.22, 2.32) Adjusted for age, gender, ethnicity, parent language

31 AOR: 1.04 (.50, 2.19) 2.03 (1.39, 2.97)

32 AOR: 1.80 (1.26, 2.56) 0.71 (0.30, 1.69)

33 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

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

35 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

36 CA Dept. of Education, 2002

37 Self-report: diary, questionnaires, activity checklists (SAPAC) Direct observation (SOFIT, SOPLAY) Pedometers, accelerometers, heart rate monitors.

38 Intrapersonal Classroom PA Curriculum Policy/Social Environment Mandated PA time PE Organization/Training (CATCH) Activity Breaks Built Environment Community-School Partnership

39 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.

40 Policy/Social Environment Mandated PA Time PE Organization/Training (CATCH) Activity Breaks Built Environment Community-School Partnership


42 Texas Senate Bill 19 (2001): K – 5 th 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.

43 Kelder SH, Springer AE, Barroso C, Smith C, Sanchez E, Hoelscher DM, Ranjit N. RESEARCH AIMS 1) To assess awareness of and adherence to SB19 in a representative sample of Texas elementary schools. 2) To assess the implementation of SB19 in Texas/Mexico border schools (2 regions): weekly minutes of PA; quality of child PA during PE.

44 135 min per week R10-R11 = 82 min/week (Kelder, Springer et al., J Public Health Policy, 2009)


46 California Legislation: 50% of PE classes to be spent in MVPA by 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)

47 Policy/Social Organization Mandated PA Time PE Organization/Training (CATCH) Activity Breaks Built Environment Community-School Partnership

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

49 Maintain children in high levels of activity. All children participate. Non-competitive, fun activities.

50 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 Percentage of PE Class Time 3 rd, 4 th, & 5 th grade students engaged in MVPA. Harris County CATCH (n = 94 class observations/ 36 schools). *p< % 41.6% 46.3% * * ( Hoelscher, Springer et al., in process)

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

53 Policy/Social Environment Mandated PA Time PE Organization/Training (CATCH) Activity Breaks Built Environment Community-School Partnership

54 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)

55 * * * Murray (UTSPH), unpublished At Risk: adaptability, social skills, leadership, study skills, functional communication

56 To assess the effect of low-cost strategies for promoting childrens MVPA during recess and WOW time. Strategies: Peer-led Games Approach Teacher-led Approach Playground Markings Design: RCT in 8 schools


58 Policy/Social Environment Mandated PA Time PE Organization/Training (CATCH) Activity Breaks Built Environment Community-School Partnerships

59 We shape our buildings, and thereafter they shape us. -Winston Churchill ( )

60 . Boston Globe, 2005

61 =

62 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)

63 Games equipment & activity cards intervention increased MVPA in 5 th/ 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).

64 Policy/Social Environment Mandated PA Time PE Organization/Training (CATCH) Activity Breaks Built Environment Community-School Partnerships

65 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)

66 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 childrens consumption of fruit & vegetables 5 times a day/26 days per month.

67 Fuel & Mileage Logs

68 School physical activity legislative mandates (Senate Bill 19/530) Structured School Time for PA Before, during & after school.

69 Bumper Stickers Marathon Kids T-Shirts Information Packets Presentations Media Coverage

70 Teachers Parents Volunteers/Comm. Leaders; Businesses

71 Teachers/Schools: Enroll students in program. Track progress with miles. Facilitate transportation to celebratory events.

72 Austin Mayor Will Wynn (Keepin Austin Weird…) LA Mayor Antonio Villaraigosa Shawn Colvin Musician Eduardo Sanchez Texas Health Commis.

73 Public Recognition = Kick-Off and Final Mile Run Events Final Mile Medal & Finisher T-Shirt

74 Springer, Kelder, Ranjit et al, under review

75 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

76 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)?


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