Schools are a recommended place for childhood obesity prevention. Local Wellness Policies (LWPs) establish guidelines for schools to provide opportunities for students to access nutritious foods and be physically active. Little is known about the impact of LWPs, when implemented, on students’ behavior and body mass index (BMI). The Wellness Champions for Change trial assesses the student-level impact of providing theory-based training and technical assistance to help schools implement LWPs. This 3-arm, cluster randomized controlled trial will take place in 30 low- or middle-income schools (15 elementary and 15 middle) in five Maryland school districts. Ten schools will receive both Wellness Champions for Change (WCC), which involves training teacher-led wellness teams, and Wellness Champions for Change-Student (WCC-S), which engages students as wellness team members. Ten schools will receive WCC only, and ten control schools will receive a delayed intervention. The RE-AIM framework will guide evaluation. Student Effectiveness measures will include BMI z-scores, self-reported diet patterns, and objectively-measured physical activity. The sample size (1080 students across 30 schools, followed for 2.5 years) will enable power (>0.8) to detect BMI z-score differences. A three-level linear mixed model that accounts for clustering will be used to assess Effectiveness. A mixed methods approach will assess school- and district-level Reach, Adoption, and Implementation. If effective, this approach will represent a sustainable, multi-level, school-based strategy to prevent childhood obesity. The evaluation framework will allow for the description of factors necessary to broadly disseminate this approach for obesity prevention on a large scale.
Background Few studies have evaluated teacher- and school-level characteristics associated with implementation of recommended physical activity (PA) promoting practices. The purpose of this study is to examine associations between teachers’ PA practices and: [1] teacher-level factors, including their own PA, and [2] school-level factors. Methods This cross-sectional study examined time spent daily in light PA (LPA) and moderate-vigorous PA (MVPA) in association with 7 teacher PA practices among 288 classroom/special area teachers and teaching assistants in 20 urban, suburban and rural schools (recruited through a school wellness trial) in 4 districts. LPA and MVPA was assessed using 24-h ankle accelerometry (up to seven consecutive days). A sum score for teacher PA practices was assessed via survey (7 items; sum score range: 7–35; Cronbach’s alpha = 0.73; higher scores indicate more PA promoting practices). Teacher-level factors included gender, race, self-reported height/weight, years teaching, and education. School-level factors included school type, free-and-reduced-price meal eligibility, student racial/ethnic composition, and urbanicity. Analyses included multilevel regression models, accounting for clustering within schools and adjusting for demographic covariates and school district. Results Teachers were 91% female, 63% elementary, 60% white, mean age 43.2 years (SD = 11.3), and 41% obese). Teachers wore accelerometers an average of 5.8 days, spent 399.6 min in LPA (SD = 85.0) per day, 24.1 min in MVPA (SD = 14.4) per day, and the mean teacher PA practices sum score was 22.4 (SD = 5.0). Every 15-min increase in MVPA was related to an increase in teacher PA practices sum score (coeff =1.07; SE = 0.28; p < 0.001). Female gender (versus males; coeff = − 1.95; SE = 0.92, p = 0.034), an obese weight status (versus non-obese; coeff = − 1.38; SE = 0.54, p = 0.010), and teaching in a middle school (versus elementary; coeff = − 3.86; SE = 0.54, p < 0.001) were associated with lower teacher PA practices scores. LPA was not associated with teacher PA promoting practices. Conclusions Teachers with higher MVPA, but not higher LPA, and those without obesity were more likely to implement PA promoting practices that could positively impact their students’ PA. Similar to prior studies, these practices were more commonly implemented in elementary schools and by male teachers. Future studies in schools should explore whether improvement of teacher health behaviors subsequently impacts student health behaviors. Trial registration Clinical Trials, NCT03432715; Registered on 02/2/2018.
This study examined pre-pandemic (2017-early March 2020) to early-pandemic (Spring 2020) changes in moderate-to-vigorous PA (MVPA), light PA (LPA), and sedentary behavior/sleep (SS), by weekday/weekend, and age (preschool, elementary, middle school). We re-enrolled children from two pre-pandemic obesity prevention trials and examined differences in accelerometer-measured PA from pre-pandemic to early-pandemic across age groups using linear mixed models. Children (n = 75) were 51% multiple race/ethnicities, 29% preschool, 28% elementary, 43% middle school, 65% suburban, 21% rural, and 13% urban. Pre-pandemic to early-pandemic changes in weekday MVPA (p = 0.006), LPA (p = 0.018), and SS (p = 0.003) differed by age. On weekdays, middle schoolers’ MVPA decreased 15.36 min/day (p = 0.002) and SS increased 94.36 min/day (p < 0.001) with non-significant changes among preschoolers and elementary schoolers. Compared to elementary schoolers, middle schoolers’ changes in weekday MVPA (b = −16.34, p = 0.036) and SS (b = 63.28, p = 0.039) significantly differed. Declines in weekday MVPA and increases in SS among middle schoolers suggest that, compared with younger children, middle schoolers are dependent on school and recreational facilities for PA, and in their absence engage in more sedentary activities and sleep.
IntroductionFew instruments assess key outcomes of school-based obesity interventions, including student perceptions of school environments and school-specific dietary intake patterns. This study describes development of PEA-PODS (Perceptions of the Environment and Patterns of Diet at School), a 2-part survey to measure these outcomes.MethodsPart 1 (PEA) assessed student perceptions of policies, physical environment, and practices related to healthy eating and physical activity at school. Part 2 (PODS) assessed usual intake (ie, frequency, location obtained, and foods consumed) of breakfast and lunch. Foods consumed were presented by MyPlate categories (eg, Fruits, Grains). Students in grades 3, 6, and 9 participated in 2 phases: cognitive pre-testing (n = 10) and reliability/validation testing (n = 58). Both surveys were administered 1 week apart to assess test-retest reliability and 5-day food records validated PODS. Analyses included percent agreement (70% = acceptable), Pearson correlations, and Cronbach α.ResultsCognitive pre-testing provided feedback on content, length, and age-appropriateness. Percent agreements were acceptable for test-retest reliability of PEA (71%–96%). The final version included 34 items with Likert-type responses in 4 subscales (α ≥0.78). For PODS, agreement for breakfast and lunch location was ≥75% for both reliability and validation. For foods consumed at breakfast, reliability agreement ranged from 74% to 93%, and validation agreement from 68% to 91%. For foods consumed at lunch, agreement ranges were 76% to 95% and 73% to 88%, respectively.ConclusionBoth parts of the instrument demonstrate acceptable reliability, and PODS demonstrates acceptable validity. This demonstrates appropriateness for assessing perceptions of the environment and usual dietary intake patterns for school-based obesity prevention initiatives.
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