SLIDE 1
Improving Physical Activity Opportunities in Elementary School Settings: Results of Power Up for 30, A Statewide Elementary School Physical Activity Initiative in Georgia
Chair: Emily Anne Vall, PhD, Georgia Department of Public Health Panelists: Christi Kay, MEd HealthMPowers, Inc. Patricia Cheung, MPH Emory University Erica Hamilton, Emory University
SLIDE 2 Few children meet physical activity recommendations
25% met
guidelines2
60 minutes of
MVPA per day1
19% no activity2
1http://www.who.int/dietphysicalactivity/factsheet_young_people/en/ 2Centers for Disease Control and Prevention. State Indicator Report on Physical Activity, 2014. Atlanta, GA: U.S. Department of
Health and Human Services, 2014
3Belcher BR, Berrigan D, Dodd KW, Emken BA, Chou C-P, Spruijt-Metz D. Physical activity in US youth: effect of race/ethnicity, age,
gender, and weight status. Med Sci Sports Exerc. 2010;42(12):2211-2221. doi:10.1249/MSS.0b013e3181e1fba9.
Disparities
gender, age, race/ethnicity,
SLIDE 3 Schools are an ideal place to intervene and increase physical activity
55 million
students enrolled1
>50% of the recommended 60
MVPA minutes in school2 Opportunity for
equity
1https://nces.ed.gov/fastfacts/display.asp?id=65 2Institute of Medicine, Press TNA. Educating the Student Body: Taking Physical Activity and Physical Education to School.
Washington, DC; 2013.
Half of waking
hours in school2
SLIDE 4 What is Georgia Shape
Addressing Childhood Obesity
Government Philanthropy Academia Business
A statewide, multi-agency, multi-dimensional initiative of Governor Nathan Deal
SLIDE 5 Initial Policy
Aerobic Capacity Flexibility Muscular Strength Muscular Endurance
BMI
(Body Mass Index)
Health Related Fitness Components
S.H.A.P.E Act : State-wide annual fitness assessment for students in grades 1- 12 taught by certified physical education teachers Launched 2011-2012 school year
SLIDE 6
Initial Results/Findings
43% of Georgia children are overweight or obese 20% of Georgia children were not in the Healthy Fitness Zone for ANY of the Fitnessgram assessments 16% of Georgia children were in the HealthyFitness Zone for all Fitnessgram assessments
SLIDE 7 Call to Action – Power Up for 30
Funded in part by The Coca-Cola Foundation
30 minutes Every Day Every School Every Child
SLIDE 8
Power Up for 30 Collaboration and Implementation Strategies
Panelist: Christi Kay, MEd President HealthMPowers, Inc. Christi.Kay@healthmpowers.org
SLIDE 9 HealthMPowers
Founding Sponsors Centers for Disease Control and Prevention Children’s Healthcare of Atlanta Rollins School of Public Health, Emory University Mission: To empower healthy habits and transform environments where children live, learn and play What We Do: Multi year comprehensive nutrition and physical activity programming Who We Serve: Child care centers, elementary, middle and high schools, out
- f school time providers and communities
SLIDE 10
60 Minute s
Staff Engagement Physical Activity During School Physical Education Before/After School Physical Activity Family and Community Engagement
Comprehensive School Physical Activity Program (CSPAP)
SLIDE 11 Pilot - 2013
- 39 Schools (5 districts)
- Key Partners
– Departments of Public Health and Education – Blue Cross Blue Shield of Georgia Foundation (funder) – HealthMPowers, Inc. (non-profit - training) – Georgia State University (evaluator)
- Three Trainings
- Data Collection
SLIDE 12 Program Components Program Outcomes Student Outcomes
Establish School Health Team Obtain Baseline Data Implement Trainings Provide Resources Increased MVPA in PE Improved Aerobic Capacity Improved Weight Status (BMI Percentile) Increased PA in Classroom Increased PA Before School Improved School Environment for PA
Pilot Intervention Model
SLIDE 13 Power Up for 30 Process
Assess Progress Implement Plan Create a Plan Attend Training Complete Assessment Establish Team Sign up
Admin, PE, Classroom Power up for 30 Survey Data Mining Best Practices PA Resources 30 Minutes! Follow Up Survey Sign Pledge
SLIDE 14 Training
- Facilitators and Barriers to PA in School
- Research
- Data Mining – Self Assessment Results
- Best Practices, Strategies and Resources
– Classroom PA – Recess – Before and After School
- Integration – Time
- Commitment Planning
SLIDE 15
Data Mining – Activity
Power Up for 30 Survey Results
SLIDE 16 Data Mining Processing and Planning
15 15 10 5 15 10 20 30 15 15 10 5 10 5 30 30
Use your school’s Power Up for 30 Data Mining to explore the areas of before, during, and/or after school. Let’s see where physical activity can be added to your school day.
BOKS HMP Mind in Motion JAMin’ Minute Example: 30 minutes, every day, every child
SLIDE 17
Power Up for 30 Plan Before/After School Program
SLIDE 18 Resources
- Online Trainings
- Physical Activity Resource Guide
- Handouts
- School PA self-assessment
- Power Up for 30 Plan templates
- Making the Pitch Slides and Notes
- Success Stories
- Incentives
SLIDE 19
Power Up for 30 School Engagement 881 Schools Reached 1898 Staff Trained 467,626 Students Impacted
SLIDE 20
Power Up for 30: a Quasi-experimental Study Evaluating the Impact of an Elementary School-Based Intervention on Physical Activity Opportunities in Georgia
Patricia Cheung, MPH Rollins School of Public Health, Emory University Email: pccheun@emory.edu
SLIDE 21 Impact of school-based physical activity interventions on physical activity
1Dobbins M, Husson H, DeCorby K, LaRocca RL. School-based physical activity programs for promoting physical activity and fitness in
children and adolescents aged 6 to 18. Cochrane database Syst Rev. 2013;2:CD007651. doi:10.1002/14651858.CD007651.pub2.
2Russ LB, Webster CA, Beets MW, Phillips and DS. Systematic Review and Meta-Analysis of Multi-component Interventions Through
Schools to Increase Physical Activity. J Phys Act Health. 2015.
3Kriemler S, Meyer U, Martin E, van Sluijs EMF, Andersen LB, Martin BW. Effect of school-based interventions on physical activity and
fitness in children and adolescents: a review of reviews and systematic update. Br J Sports Med. 2011;45(11):923-930. doi:10.1136/bjsports-2011-090186.
Generally thought to be
effective 1, 2, 3
Interventions have
small impact2 Multi-component
interventions increase effect sizes2, 3 Effective components:2
During school Before and after school Staff wellness
SLIDE 22 Types of multi-component physical activity interventions
1Brusseau TA, Hannon J, Burns R. Effect of a Comprehensive School Physical Activity Program on Physical Activity and Health-Related
Fitness in Children from Low-Income Families. J Phys Act Health. 2016;(May):888-894. doi:10.1123/jpah.2016-0028.
2Carson RL, Castelli DM, Pulling Kuhn AC, et al. Impact of trained champions of comprehensive school physical activity programs on
school physical activity offerings, youth physical activity and sedentary behaviors. Prev Med (Baltim). 2014;69:S12-S19. doi:10.1016/j.ypmed.2014.08.025.
Specified Intervention1
- Hired physical activity leader
- Monthly in-service
- pportunities for teachers
- PE curriculum changes
- Structured/semi-structured
recess
Adaptable Intervention2
teachers
- Action plan development
- Resources
- Support
SLIDE 23 Goal and Hypothesis
Power Up for 30 aims to increase physical activity (PA)
- pportunities (e.g. during physical education (PE), during recess,
in class, before school, and after school) offered to elementary school students By one year after PU30 training, PU30-trained schools will have more PA opportunity time than untrained schools, even after adjusting for demographics, school characteristics, and baseline physical activity
SLIDE 24 419 elementary schools with no training from 2/2014-9/2014
Study Design
All 1,333 Georgia elementary schools received PA School Survey in 2013-2014 (baseline) 719 elementary schools with response from admin, PE teacher, and at least 3 grade level chairs PU30 Arm: 79 randomly selected 0 declined to participate 79 included in study and received follow-up survey Comparison Arm: 80 randomly selected 0 declined to participate 80 included in study and received follow-up survey 614 elementary schools excluded 300 elementary schools with training from 2/2014-9/2014
SLIDE 25 Study Measures and Data Sources
Measures Data Sources School- level Outcomes Frequency (occurrences/week) and duration (minutes/occurrence) of: PE Recess Classroom PA breaks Before-school PA After-school PA Statewide School Physical Activity Survey Measures Data Sources School- level Outcomes Frequency (occurrences/week) and duration (minutes/occurrence) of: PE Recess Classroom PA breaks Before-school PA After-school PA Physical Activity School Setting Survey School- level Covariates Student Demographics Race/ethnicity Free/reduced lunch rate School Characteristics School size Geographical setting Department of Education
SLIDE 26 Baseline demographics and school characteristics differed by training status
Characteristic Untrained (n=62) Trained (n=71) Standardized Difference N or Mean % or SD N or Mean % or SD Socioeconomic Status Low (>75% FRL) 22 35.5 36 50.7 0.31 Mid-low (50%<FRL≤75%) 18 29.0 11 15.5
Mid-high (25%<FRL≤50%) 13 21.0 12 16.9
High (≤25% FRL) 9 14.5 12 16.9 0.07 Mean (SD) percent White 50.8 27.8 39.0 27.0
Mean (SD) percent Hispanic 11.2 11.7 19.8 18.4 0.56 School Size Large (>735 students) 17 27.4 28 39.4 0.24 Medium (550-735 students) 22 35.5 22 31.4
Small (<550 students) 23 37.1 21 30.0
School Geographical Location City 9 14.5 9 12.7
Suburban 21 33.9 46 64.8 0.65 Town 8 12.9 7 9.9
Rural 24 38.7 9 12.7
SLIDE 27 Baseline physical activity opportunities differed by training status
Baseline Follow-Up Untrained (n=62) Trained (n=71) Untrained (n=62) Trained (n=71) Mean SD Mean SD Mean SD Mean SD PE 100.9 6.1 104.3 5.0 105.5 5.5 104.9 4.3 Recess 100.4 3.9 89.8 4.2 96.2 3.7 98.8 3.6 In-class PA 30.4 2.3 40.5 2.6 36.1 2.6 52.0 2.5 Before-school PA Not Assessed at Baseline 3.6 1.3 14.1 3.2 After-school PA Not Assessed at Baseline 22.6 5.9 31.4 5.2 SD= standard deviation; PE= physical education; PA=physical activity
SLIDE 28 Trained schools provided moderately more physical activity opportunity time than untrained schools
Model 1 Mean Diff 99% UI Total PA time 41.8 37.8 45.8 PE time
2.0 At lower baseline PE time
- At higher baseline PE time
- Recess time
2.6 0.4 5.0 In class PA time 15.8 15.3 16.3 Before school PA time 10.5 10.0 11.0 After school PA time 8.8 8.3 9.3 UI= Uncertainty Interval PA=physical activity PE=physical education Model 1 Model 2 Mean Diff 99% UI Mean Diff 99% UI Total PA time 41.8 37.8 45.8 36.4 31.7 41.0 PE time
2.0
- At lower baseline PE time
- 1.8
- 4.5
1.0 At higher baseline PE time
Recess time 2.6 0.4 5.0 6.7 4.0 9.7 In class PA time 15.8 15.3 16.3 12.0 11.4 12.6 Before school PA time 10.5 10.0 11.0 9.4 8.9 9.8 After school PA time 8.8 8.3 9.3 3.1 2.6 3.6 UI= Uncertainty Interval PA=physical activity PE=physical education Model 1 Model 2 Model 3 Mean Diff 99% UI Mean Diff 99% UI Mean Diff 99% UI Total PA time 41.8 37.8 45.8 36.4 31.7 41.0 34.7 29.7 39.3 PE time
2.0
- At lower baseline PE time
- 1.8
- 4.5
1.0
At higher baseline PE time
- 4.8
- 8.4
- 1.4
- 8.7 -12.2 -5.5
Recess time 2.6 0.4 5.0 6.7 4.0 9.7 8.4 5.1 11.4 In class PA time 15.8 15.3 16.3 12.0 11.4 12.6 11.9 11.2 12.5 Before school PA time 10.5 10.0 11.0 9.4 8.9 9.8 7.5 7.2 7.9 After school PA time 8.8 8.3 9.3 3.1 2.6 3.6 1.0 0.5 1.5 UI= Uncertainty Interval PA=physical activity PE=physical education
SLIDE 29 Strengths and Limitations
Limitations Observational design, potential residual confounding Self-reported survey data Approximately one-year follow-up Limitations Strengths Observational design, potential residual confounding Adjusted for demographic and
- ther school characteristics
Self-reported survey data Informed implementation strategy Approximately one-year follow-up Identified school level-changes resulting from CSPAP-based intervention
SLIDE 30 Conclusions and Next Steps
- PU30 training modestly increased physical activity
- pportunities, particularly during recess, in class, and
before school
- Effects of PU30 on physical activity opportunities were
attenuated by school-level demographics, other characteristics and baseline PA
- Individual level data needed to assess the impact of
physical activity opportunity changes on student physical activity levels
SLIDE 31 THANK YOU!
CONTACT: PCCHEUN@EMORY.EDU
QUESTIONS?
SLIDE 32 The Exploration of the Barriers & Facilitators of Power Up for 30: A Qualitative Evaluation
Erica Hamilton, MPH Candidate Emory University Department of Behavioral Sciences & Health Education Email: erica.hamilton@emory.edu
SLIDE 33 Goal and Objectives
▪ Goal: ▪ To assess the barriers and facilitators of uptake and implementation of the Power Up for 30 initiative in the Georgia elementary school system by conducting individual, in-depth qualitative interviews with elementary school administrators, PE teachers and grade level chairs. ▪ Objectives:
- 1. To understand the decisional processing of participation in the
Power Up for 30 initiative.
- 2. To assess barriers to uptake and implementation of the Power Up for
30 initiative.
- 3. To assess the facilitators to uptake and implementation of the Power
Up for 30 initiative.
SLIDE 34 Barriers to implementation in school-setting
▪ Time ▪ Competing academic priorities ▪ Classroom management ▪ Poor student behavior ▪ Lack of buy-in from teachers & students ▪ Teacher frustration ▪ Limited school personnel ▪ Limited Space & Money ▪ Cost of the program ▪ Limited space in classroom ▪ Lack of equipment
Pommier, Guevel, & Jourdan, 2010; Stewart-Brown, 2006; World Health Organization, 2000; Skar, Kirstein and Kapur , 2007; Hall et al., 2014
SLIDE 35 Facilitators to implementation in school-setting
▪ Teacher & student engagement & buy-in ▪ Administrative support ▪ Adequate equipment & space ▪ Students physically engaging in health program ▪ Setting time slots for healthy activities ▪ Clean physical environment ▪ Communication with key stakeholders
Hall et al., 2014; Skar, Kirstein, & Kapur, 2007, 2015; Mwanga, Jensen, Magnussen & Aagaard-Hansen, 2007; Pommier, Guevel, & Jourdan, 2010; Rootman, Goodstadt, Potvin & Springett, 2001; WHO, 1998
SLIDE 36
Data Collection
▪ 19 interviews at 7 elementary schools ▪ 5 PU30 trained schools, 2 untrained schools ▪ 7 administrators, 6 PE teachers, 6 grade level chairs ▪ 3 counties in metro-Atlanta
SLIDE 37 Elementary School District Demographics
District 1 District 2 District 3 Total students 50,360 43,173 8,961 Gender 51% Males 49% Females 51% Males 49% Females 52% Males 48% Females Race 40% White 30% Black 21% Hispanic 5% Asian 4% American Indian
42% Black 30% White 16% Hispanic 10% Asian 2% American Indian
49% Black 38% White 8% Hispanic 4% Multiracial 1% Asian or American Indian Interviews conducted 10 (4 schools) 3 (1 school) 6 (2 schools)
SLIDE 38
Interview Guides
▪ 2 semi-structured interview guides: ▪ 1 for trained and 1 for untrained schools
▪ ~20 questions on trained guide ▪ ~10 questions on untrained guide
SLIDE 39 Example Interview Questions
▪ Interview Topics & Questions: ▪ Broad physical activity questions
▪ “Can you tell me about the physical activity that your students get at school?” ▪ “Have you noticed any changes to recess time and quality?”
▪ Barriers to each component of PA at school
▪ “Can you tell me about any barriers that you notice to recess?”
▪ Facilitators to each component of PA at school
▪ ”Can you tell me about any facilitators that you notice to recess?”
SLIDE 40 Example Interview Questions
▪ General knowledge and opinions on the PU30 initiative, training and resources
- Trained schools:
- “Can you tell me what you know about the Power Up for 30 initiative?”
- “Can you tell me about the Power Up for 30 resources that you use?"
- “What was the most effective part of the training?”
- Untrained schools:
▪ “Have you heard of the Power Up for 30 initiative?” ▪ “Can you tell me about other physical activity initiatives that your school participates in?”
▪ Follow up support and other needs/desires
- “What else can be done to be done or provided to make increasing physical activity at
your school easier?”
- “If your school were to take on a physical activity initiative, what would be the most
useful/helpful components?”
SLIDE 41
Key Findings ▪Barriers
▪ Time ▪ Lack of communication between those who attend training and those who do not ▪ Disconnect between different positions at school (PE teacher, classroom teacher, administrators) ▪ Competing initiatives ▪ Confusion about the initiative
SLIDE 42 Quotes about Barriers
Time Lack of communication Confusion about the initiative
“I guess there’s a lot of confusion leading up to it like, “What is this? What are we doing?” I know that day some people were like, “Well, I don’t know why we get to wear workout clothes but I’m wearing workout clothes ‘cuz—” so I think there was a lack of knowledge leading up to it. The day of, I would say some of our teachers really bought into it and some of them did absolutely nothing with it. ”(Administrator) “They (the teachers who attended the training) didn’t do a great job of
- redelivering. Maybe that’s our fault. We never let them, like at a staff
meeting or something, talk about what they learned. ” (Administrator) “It’s just the issue of making sure you have the time in your day to do it (brain breaks). That really is the biggest difficulty. It’s not a challenge to do it. The kids enjoy it and that helps.” (Grade Level Chair)
SLIDE 43
Key Findings
▪ Facilitators
▪ Administrative support ▪ Buy-In from teachers ▪ PU30 resources/sharing resources ▪ PE teacher as facilitator ▪ Importance of students’ health & wellbeing
SLIDE 44 Quotes about Facilitators
Administrative support, teacher buy-in & shared resources PE teacher facilitating brain breaks PU30 resources (GoNoodle)
“It’s the online program website that our teachers use that have different activities that they can click on. It’s anything from dance to even yoga stretching and they just click on an activity. Actually, our kids oftentimes pick their favorites cuz they’ve so used it. The screen facilitates the movement or the activity in front of them on the big screen. ” (Administrator) “The PE teacher frequently sends us (classroom teachers) different ideas for brain breaks. One year, she did a presentation and gave us a deck of cards and then gave us a whole exercise that you could do with cards. We have popsicle sticks with different sets of five activities on ‘em. She sends emails with ideas, at least monthly. ” (Grade level chair) “I think when you’ve got a staff that supports the initiative, it’s an infectious thing. I think the combination of the administrator and teachers who work very actively doing it has helped. It created shared resources like, we found this really cool link. Once you started creating a catalogue of variety of different things that made it a lot easier than having such a limited number of options for brain breaks. ” (Grade Level Chair)
SLIDE 45
Other Important Findings
▪ Desire for more follow-up support ▪ Desire for booster sessions ▪ Desire for school-wide trainings
SLIDE 46
Limitations
▪ Difficulty with recruitment ▪ Smaller sample size ▪ Fewer untrained schools
SLIDE 47
Conclusions
▪ Increased participation in training Increased participation in initiative ▪ Post-training presentation/meeting at school Increased participation in initiative ▪ Lack of knowledge Lack of participation ▪ Communication is KEY! ▪ Support from key stakeholders is essential
SLIDE 48
Next Steps
▪ Dig deeper into the data!
▪ Comparative analysis across positions at school & trained versus untrained schools
▪ Finish up Thesis & Final Report to send to participating schools, HealthMPowers & Department of Public Health
SLIDE 49 THANK YOU!
ERICA HAMILTON ERICA.HAMILTON@EMORY.EDU
SLIDE 50
Other Results
Pre-service Certification DOE Superintendent’s 2020 Vision
“Every elementary and middle school student will have access to at least 30 minutes of physical activity per day.”
Richard Woods State Superintendent
SLIDE 51 Sustainability Efforts
– Middle School Expansion – Out of School Time Expansion
– Booster Sessions – Continued Communication
- Monthly Newsletters
- Updated On line Resources
SLIDE 52
Thank You and Questions
Chair: Emily Anne Vall, PhD, Georgia Department of Public Health Panelists: Christi Kay, MEd HealthMPowers, Inc. Patricia Cheung, MPH Emory University Erica Hamilton, Emory University
