Impact of Local Wellness Policies on District Level Physical Activities

Local wellness policies (LWPs) are state required documents that outline school districts’ goals for improving the physical activity of their students. In Texas, most districts use a template for developing their LWP, which has seven prespecified goals that districts may include or further expand upon to include additional goals. PURPOSE: Determine if physical activity components of districts’ LWPs were related to practices within the district. METHODS: LWPs published by public school districts in Texas were collected from district websites, analyzed for content related to physical activity, and assessed to determine if the district text matched the template. Then, responses were compared to the respective districts’ responses to the Texas\u27 Student Health Policies and Practices Surveys (SHPPS) for the years 2018-2021. The SHPPS data was requested through the Texas Education Agency, and district IDs were used to match the responses to their LWP. On the SHPPS, districts self-report: whether the Student Health Advisory Committee (SHAC) presented policy recommendations (yes/no), whether the district implemented changes recommended by the SHAC (yes/no), the content of changes (e.g., having off-campus physical activity programs), whether the wellness policy addressed specific factors influencing physical activity (e.g., increased opportunities for students to be physically active), and if the district notified parents about their child\u27s physical fitness assessment results (yes/no). Bivariate analysis using logistic [Odds Ratio (OR) and 95% Confidence Intervals (95% CI)] and linear regression [Unstandardized Beta (B) and 95% CI] models were used to determine relationships between goals included in LWPs and self-reported practices. RESULTS: Overall, 431 districts had LWPs that could be matched with their SHPPS. LWPs which had additional guidelines (reported as Other_PA_Goals) were marginally more likely to receive feedback from the district’s SHAC (2019-2020 [OR: 1.183, 95% CI: (0.988, 1.416), p= .067], 2020-2021 [OR: 1.19, CI: (0.992, 1.427), p=.061]) and implement more changes recommended by their SHAC during the years of 2018-2019 [OR: 1.19, 95% CI: (0.992, 1.427), p=.061]. Districts with LWPs that included the specific goal to “make physical activity enjoyable for students and staff” were also marginally more likely to notify parents that they could request their children’s physical assessment results in all three years 2018-2019 [OR: 1.447, 95% CI: (0.939, 2.229), p=.094], 2019-2020 [OR: 1.458, 95% CI: (0.967, 2.198), p= .072], 2020-2021 [OR: 1.498, 95% CI (0.976, 2.299), p= .064]). CONCLUSION: Districts with LWPs that further expanded on the template presented by the state or had used alternate text compared to the template, were more likely to report positive physical activity practices in their district, including having the SHAC make policy recommendations and the districts implementing changes recommended by the SHAC. These findings may suggest that SHACs play an important role in the development and implementation of a districts’ LWP

Understanding Implementation Strategies to Support Classroom-Based Physical activity approaches in Elementary Schools: a Qualitative Study

BACKGROUND: Classroom-based physical activity approaches can improve children\u27s physical activity levels during school. However, the implementation of these approaches remains a challenge. The purpose of this study was to examine implementation strategies to support the delivery of classroom-based physical activity approaches from the perspectives of elementary school staff. METHODS: We conducted individual interviews with elementary school staff from a mid-sized school district in Texas. Interviews lasted approximately 60 min and were audio recorded and transcribed for analyses. We used directed content analysis and an iterative categorization approach to identify emerging themes related to implementation strategies. RESULTS: We interviewed 15 participants (4 classroom teachers, 4 physical education teachers, 3 assistant principals, and 4 principals) about implementation strategies supporting classroom-based physical activity approaches. Four prominent themes related to implementation strategies emerged: 1) the role of program champions, 2) the use and function of staff training, 3) the importance of strategic planning, and 4) the use of positive reinforcements to support implementation. CONCLUSIONS: Results highlight the need for multiple implementation strategies to support the delivery of classroom-based physical activity approaches. Results also highlight potential mechanisms through which the implementation strategies operate. This information is valuable to future planning efforts for classroom-based physical activity approaches

Evidence-Based intervention (Ebi) Mapping: a Systematic approach to Understanding the Components and Logic of Ebis

BACKGROUND: Despite the development of numerous evidence-based interventions (EBIs), many go unused in practice. Hesitations to use existing EBIs may be due to a lack of understanding about EBI components and what it would take to adapt it or implement it as designed. to improve the use of EBIs, program planners need to understand their goals, core components, and mechanisms of action. This paper presents EBI Mapping, a systematic approach based on Intervention Mapping, that can be used to understand and clearly describe EBIs, and help planners put them into practice. METHODS: We describe EBI Mapping tasks and provide an example of the process. EBI Mapping uses principles from Intervention Mapping, a systematic framework for planning multilevel health promotion interventions. EBI Mapping applies the Intervention Mapping steps retrospectively to help planners understand an existing EBI (rather than plan a new one). We explain each EBI Mapping task and demonstrate the process using the VERB Summer Scorecard (VSS), a multi-level community-based intervention to improve youth physical activity. RESULTS: EBI Mapping tasks are: 1) document EBI materials and activities, and their audiences, 2) identify the EBI goals, content, and mechanisms of action, 3) identify the theoretical change methods and practical applications of those methods, 4) describe design features and delivery channels, and 5) describe the implementers and their tasks, implementation strategies, and needed resources. By applying the EBI Mapping tasks, we created a logic model for the VSS intervention. The VSS logic model specifies the links between behavior change methods, practical applications, and determinants for both the at-risk population and environmental change agents. The logic model also links the respective determinants to the desired outcomes including the health behavior and environmental conditions to improve the health outcome in the at-risk population. CONCLUSIONS: EBI Mapping helps program planners understand the components and logic of an EBI. This information is important for selecting, adapting, and scaling-up EBIs. Accelerating and improving the use of existing EBIs can reduce the research-to-practice gap and improve population health

Urban-Rural Differences in School Districts\u27 Local Wellness Policies and Policy Implementation Environments

Higher rates of obesity in rural compared to urban districts suggest environmental differences that affect student health. This study examined urban-rural differences in districts\u27 local wellness policies (LWPs) and LWP implementation environments. Cross-sectional data from two assessments in Texas were analyzed. In assessment one, each district\u27s LWP was reviewed to see if 16 goals were included. In assessment two, an audit was conducted to identify the presence of a wellness plan (a document with recommendations for implementing LWPs), triennial LWP assessment, and school health advisory councils (SHACs) on the district website. Rural districts\u27 LWPs had a smaller number of total goals (B = -2.281

Design and methodology of a cluster-randomized trial in early care and education centers to meet physical activity guidelines: Sustainability via Active Garden Education (SAGE)

Strategies are needed to help early care and education centers (ECEC) comply with policies to meet daily physical activity and fruit and vegetable guidelines for young children. This manuscript describes the design and methodology of Sustainability via Active Garden Education (SAGE), a 12-session cluster-randomized controlled crossover design trial using community-based participatory research (CBPR) to test a garden-based ECEC physical activity and fruit and vegetables promotion intervention for young children aged 3–5 years in 20 sites. The SAGE curriculum uses the plant lifecycle as a metaphor for human development. Children learn how to plant, water, weed, harvest, and do simple food preparation involving washing, cleaning, and sampling fruit and vegetables along with active learning songs, games, science experiments, mindful eating exercises, and interactive discussions to reinforce various healthy lifestyle topics. Parents will receive newsletters and text messages linked to the curriculum, describing local resources and events, and to remind them about activities and assessments. Children will be measured on physical activity, height, and weight and observed during meal and snack times to document dietary habits. Parents will complete measures about dietary habits outside of the ECEC, parenting practices, home physical activity resources, and home fruit and vegetable availability. SAGE fills an important void in the policy literature by employing a participatory strategy to produce a carefully crafted and engaging curriculum with the goal of meeting health policy guidelines and educational accreditation standards. If successful, SAGE may inform and inspire widespread dissemination and implementation to reduce health disparities and improve health equity

Healthy School Recognized Campus’ Impact on Middle School Children’s Physical Activity Levels and Cardiovascular Fitness

Most current research is focused on the effectiveness of a single physical activity intervention. Healthy School Recognized Campus (HSRC) is a Texas A&M AgriLife Extension initiative that promotes the delivery of multiple physical activity and nutrition programs on a school campus, such as Walk Across Texas. PURPOSE: This study aims to determine whether HSRC will improve cardiovascular fitness and increase physical activity among middle school students. METHODS: Students completed the Youth Activity Profile (YAP) survey to assess the amount of time that students spent engaging in physical activity (during school, outside of school, on weekends) and sedentary behaviors, the FitnessGram PACER test to determine their cardiovascular fitness, and they wore a FitBit for one week during school hours to monitor daily steps and heart rate. Assessments were completed at baseline (the start of the school year) and follow-up (the end of the school year) after implementing HSRC. Descriptive and comparative statistics were used to determine pre- to post-intervention changes in physical activity and cardiovascular fitness among the 8 schools. RESULTS: Among the 106 students (51.9% female; 12.53 ± 0.90 years old), there were no statistically significant changes in the at-school YAP measurements, including percentage of time spent engaging in moderate to vigorous physical activity (MVPA), minutes engaging in MVPA, and YAP score. There were statistically significant decreases for the out-of-school percent of time spent engaging in MVPA (14.82 ± 1.27 to 14.55 ± 1.26; p=.026), minutes engaging in MVPA (68.73 ± 7.27 to 67.15 ± 7.57; p=.039), and YAP score (3.64 ± 0.99 to 3.27 ± 0.90; p2 max (measure of oxygen consumption). Students’ maximum heart rate recorded on the Fitbit increased post-intervention (155.28 bpm ± 22.37 to 161.67 ± 15.87 bpm; p=.028). Although it did not reach statistical significance, there was also an increase in the average number of steps students took per day (4837.23 ± 1647.40 to 5162.30 ± 1579.15; p=0.06). Data by gender, ethnicity, and grade level will also be presented. CONCLUSION: Although participation in multiple physical activity programs can have a positive health impact for students, HSRC produced few changes to students’ normal physical activity patterns outside of an increase in max heart rate and minor improvements to students’ daily steps at school

Coordinated Health in Texas Elementary Schools’ Campus Improvement Plans: Analysis of Regional Differences and Trends between 2016 and 2020

Schools signal health priorities through policies. Using a repeated cross-sectional study design, we compare the presence and strength of policies related to four topics—physical activity, nutrition, mental health, and bullying—described in elementary school Campus Improvement Plans (CIPs; also called school improvement plans) within Texas, across four Texas Public Health Regions (PHRs), and between 2016 and 2020. CIPs were collected using a multi-stage probability-based survey approach, scored using an adapted WellSAT tool, and analyzed to determine associations between PHR or year and health topic. Across 170 CIPs, bullying was the most frequently addressed topic, followed by mental health, physical activity, and nutrition. On average, schools addressed 2.7 ± 1.3 topics within their CIP; 38.2% of schools addressed all four, 26.5% addressed three, 12.4% addressed two, 15.3% addressed one, and 7.6% addressed none. CIPs in the same district had high levels of clustering (ICCs = 0.28–0.55). The mostly rural Panhandle PHR included the fewest topics in their CIPs and used the weakest policy language. Between 2016 and 2020, there was a decrease in the proportion of CIPs that addressed nutrition; the strength of language for mental health and bullying also decreased. Regional and time trends reveal opportunities for more robust school health policy interventions

Physical Activity and Healthy Eating Programming in Schools to Support Student’s Health-Related Fitness: An Observational Study

Centers for Disease Control (CDC) guidelines recommend schools use a coordinated health approach to support healthy eating and physical activity. This study examines whether the number of healthy eating and physical activity programs and activities used by schools and their perceived success relate to students’ health-related fitness. This observational study used data from the Healthy Zone Schools Program. Data (collected in 2017–2019) were integrated from three sources: (1) school surveys, (2) FitnessGram®, and (3) the Texas Education Agency. Independent variables were the number of health promotion programs and activities and their perceived success; dependent variables were meeting Healthy Fitness Zone Standards (HFZ) for aerobic capacity and body mass index (BMI). We used mixed-effects logistic regression models. Fifty-six schools were in the analytic sample (n = 15,096 students with aerobic capacity data and n = 19,969 with BMI data). Results indicated the perceived success of physical activity programs/activities was significantly associated with students meeting HFZ standards for aerobic capacity (OR = 1.32, CI = 1.06–1.63). There was a significant direct association between the number of physical activity and healthy eating activities implemented (OR = 1.04, CI = 1.01–1.06) and students meeting HFZ for BMI. Schools using multiple health programs and activities need to balance the number provided with their capacity to maintain success

Design and methodology of a cluster-randomized trial in early care and education centers to meet physical activity guidelines: Sustainability via Active Garden Education (SAGE)

Strategies are needed to help early care and education centers (ECEC) comply with policies to meet daily physical activity and fruit and vegetable guidelines for young children. This manuscript describes the design and methodology of Sustainability via Active Garden Education (SAGE), a 12-session cluster-randomized controlled crossover design trial using community-based participatory research (CBPR) to test a garden-based ECEC physical activity and fruit and vegetables promotion intervention for young children aged 3–5 years in 20 sites. The SAGE curriculum uses the plant lifecycle as a metaphor for human development. Children learn how to plant, water, weed, harvest, and do simple food preparation involving washing, cleaning, and sampling fruit and vegetables along with active learning songs, games, science experiments, mindful eating exercises, and interactive discussions to reinforce various healthy lifestyle topics. Parents will receive newsletters and text messages linked to the curriculum, describing local resources and events, and to remind them about activities and assessments. Children will be measured on physical activity, height, and weight and observed during meal and snack times to document dietary habits. Parents will complete measures about dietary habits outside of the ECEC, parenting practices, home physical activity resources, and home fruit and vegetable availability. SAGE fills an important void in the policy literature by employing a participatory strategy to produce a carefully crafted and engaging curriculum with the goal of meeting health policy guidelines and educational accreditation standards. If successful, SAGE may inform and inspire widespread dissemination and implementation to reduce health disparities and improve health equity

A qualitative exploration of the health needs and goals of urban women to inform the tailoring and adaptation of Strong Hearts Healthy Communities: a community-based cardiovascular disease prevention intervention

Abstract Background In the United States, cardiovascular diseases (CVD) are the leading cause of death and disability in women. CVD-modifiable risk factors, including poor diet quality and inadequate physical activity, can be addressed through evidence-based interventions (EBIs). Strong Hearts Healthy Communities (SHHC) is an EBI that has demonstrated effectiveness in reducing CVD risk and improving health outcomes among rural white women. The aims of this study were to understand the general health, diet, and physical activity-related needs and goals of women living in an urban community, to inform the tailoring and adaptation of the SHHC EBI to an urban setting and more diverse population. Methods Focus groups (FGs) were conducted with African American/Black and Hispanic/Latinx women in the Dallas metropolitan area who had a BMI ≥ 25 kg/m2 and engaged in ≤ 150 min per week of moderate physical activity. The data were coded using a team-based, deductive, and thematic analysis approach, that included multiple coders and in-depth discussions. Results Four FGs with a total of 18 participants (79% Black and 21% Latinx) were conducted, and three themes were developed: (1) participants had adequate knowledge and positive attitudes towards healthy living but faced many barriers to practicing healthy behaviors; (2) culturally-based beliefs and community practices exerted a strong influence on behaviors related to food and stress, revealing barriers to healthy eating and generational differences in stress and stress management; (3) participants desired a more individualized approach to nutrition and physical activity interventions that included familiar and enjoyable activities and social support centered around shared health goals. Conclusions The SHHC intervention and similar health programs for Black/African American and Hispanic/Latinx women in urban settings should emphasize individualized nutrition and practical skills for healthy eating with accessible, familiar, and enjoyable exercises. Additionally, stress management strategies should be culturally and generationally sensitive and social support, whether through family, friends, or other program participants, should be based on shared health goals