Association between multi-component initiatives and physical activity-related behaviors: interim findings from the Healthy Schools Healthy Communities Initiative

Abstract

Background: Little is known about the intensity of multi-component initiatives (MCI) inclusive of any combination of programs, practices, policies, and environmental changes (P3E) on youth behaviors. Methods: The Healthy Schools Healthy Communities (HSHC) initiative worked to increase access to PA opportunities as part of 33 MCIs targeting school districts and respective communities. The purpose of this study was to assess whether MCIs with higher scoring PA-related strategies were associated with improved PA and sedentary behaviors among youth. PA-related interventions were assigned point values based on three characteristics: 1) purpose of initiative); 2) duration; and 3) reach. An overall composite score of all activities was calculated for each school district. Multivariate longitudinal regressions were applied, controlling for measurement period, Cohort, and district enrollment. Results: P3E scores ranged from 0.3 to 3.0 with 20% considered “higher-scoring” (score > 2.1) and 47% considered “lower-scoring” ( < 1.2 ). Average composite district P3E scores more than tripled over the evaluation period, rising from 14.8 in the first grant year to 32.1 in year 2, 41.1 in year 3, and 48.1 in year 4. For each additional point increase in average composite district P3E intensity score, the number of days per week that students reported being physically active for at least 60 minutes increased by 0.010 (p<0.01). For each additional point increase in district P3E intensity score, the number of hours per weekday that students reported engaging in screen time activities decreased by 0.006 hours (p<0.5). Conclusions: MCIs are difficult to evaluate given the variations within which they are implemented. Findings from this study suggest the value of a systematic scoring approach in assessing MCIs. In addition to tracking intensity over time, scoring can provide justification for, or against, an individual activity and ways to increase the likelihood of the MCI impacting population-health outcomes.