1. Epidemiology of exercise and physical activity
MARY THOMAS M.B.& B.S., M.P.H. Communities Putting Prevention to Work City of San Antonio Metropolitan Health District

2. Mary Thomas, MPH (presenter) Katherine Velasquez, RN, PhD
Relationship between physical activity and mental health among Texas adolescents – the role of physical education (PE) class attendance
Alice Fang Yan MD PhD
Mary Thomas, MPH (presenter)
Katherine Velasquez, RN, PhD
Gentry Kuehn, MS
Sha Ge, MA, PhD

3. Presenter Disclosures
Mary Thomas
The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
“No relationships to disclose”

4. Youth Risk Behavior Survey TEXAS 2009
Focus on behaviors among youth causing important health problems
Assess how risk behaviors change over time
Unintentional injuries and violence
Tobacco use
Alcohol and other drug use
Sexual behaviors
Unhealthy dietary behaviors
Inadequate physical activity
Provide comparable data

5. PRESENTATION LEARNING OBJECTIVES
Learn how theory based analysis is applied
Understand the complex relationship between physical activity and mental health
Understand the positive contribution of attending PE classes on mental health of adolescents

6. Background: Physical Activity Improves Mental Health
Reduced depression
Reduced anxiety
Increased self-esteem

7. Objective
To assess association of physical activity (PA), particularly attending physical education (PE) classes, with four mental health outcomes : (1) feelings of sadness or hopeless, (2) considering suicide, (3) making suicide plan, and (4) attempting suicide) among Texas adolescents (9th – 12th graders).

8. Methods
A sample of 3,168 adolescents (grades 9 through 12) from the 2009 Texas Youth Risk Behavior Survey (YRBS) was examined.
Dependent variables: four mental health outcomes : (1) feelings of sadness or hopeless, (2) considering suicide, (3) making suicide plan, and (4) attempting suicide)
Independent variables of interests: (1) Active 60 min on 5+ past 7 days; (2) Attended PE class 1+ days average week; (3) Participated in 1+ sports team, and (4) Attended PE class daily
Covariates: grade, race, substance use/abuse, overweight or obese
Statistical analyses were conducted using SAS 9.2 (Cary, NC), which accounts for multistage sampling.

9. Methods: Analysis
Estimate the prevalence; Chi-square tests were used to examine the strength of association between each of the independent variables and the outcome variables.
Univariate logistic regression models (data not shown)
Multivariate logistic regression was used to identify the most significant variables in relation to the mental health outcome variables. The final model included all statistically significant independent variables (p<.05) from the univariate logistic regression models. Adjusted ORs and 95% CI were examined to assess the significance of their unique relationship to outcome variables.

10. Results: Prevalence of Mental Health Problems by Independent Variables (IV)
Demographics
Sad or hopeless (yes)
p value
Consider (yes)
Plan (yes)
Attempt (yes)
Grade
Row percent %
0.4878
0.5898
0.8047
0.883
9th
9.8372
7.4479
10th
14.294
7.7854
11th
6.83
12th
9.2596
6.551
Race
0.0732
0.8638
0.6226
0.0728
1=white
6.1766
2=Black
9.2181
5.9875
3=Hispanic
9.9735
8.5817
Gender
<.0001
0.0003
Girls
Boys
9.7404
7.3157
4.2418
Protective Factors
Active 60 min on 5+ past 7 days
0.001
Yes
7.803
4.1992 No
9.8778
Attended PE class 1+ days average week
0.0015
0.0017
0.003
7.9341
5.1804
31.183
9.2679
Played on 1+ sports team
0.0013
8.4129
5.4135
9.4299
Attended PE class daily
0.0328
0.025
0.0295
8.1941
5.0098
31.052
8.5281

11. Results
Multivariate analysis revealed that self-reported NOT participating in physical activity for at least 60 minutes per day on five or more days of the past week was associated with increased risk of all four depression or suicidal behaviors.

12. Results
NOT attending PE classes daily was associated with increased risk in
Contemplating suicide (OR=1.791, 95% CI = ~ 2.746)
Planning suicide (OR=2.295, 95% CI = ~ 4.002)
Attempting suicide (OR=3.038, 95% CI = ~ 5.276)

13. Results: Multivariate Logistic Regression
Demographics
 Sad or hopeless (yes)
 Consider (yes)
 Plan (yes)
 Attempt (yes)
Grade
9th
Reference
10th
0.857
0.878
0.885
0.758
11th
0.981
0.767
0.831
0.635
12th
0.818
0.512
0.531
0.414
Race
1=white
2=Black
1.109
0.954
0.838
0.85
3=Hispanic
1.119
0.94
0.833
1.248
Gender
Girls
Boys
0.51
0.53
0.526
0.382

14. Results: Multivariate Logistic Regression
Sad or hopeless (yes)
 Consider (yes)
 Plan (yes)
 Attempt (yes)
Protective Factors
 OR
95% CI OR
Active 60 min on 5+ past 7 days
Yes
Reference No
1.342
1.517
1.51
2.151
Attended PE class 1+ days average week
0.976
1.791
2.295
3.038
Played on 1+ sports team
1.274
1.189
1.08
0.908
Attended PE class daily
1.163
0.635
0.605
0.441

15. Conclusion

16. THANK YOU
QUESTIONS ???