physical activity and nutrition policies and programs in the nation’s schools: are we making...
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Physical Activity and Nutrition Policies and Programs in the
Nation’s Schools: Are We Making Progress?
Physical Activity and Nutrition Policies and Programs in the
Nation’s Schools: Are We Making Progress?
Terry O’Toole, PhDHealth Scientist, Division of Adolescent and School Health,
CDC DNPAO TeleconferenceMay 8, 2008
Terry O’Toole, PhDHealth Scientist, Division of Adolescent and School Health,
CDC DNPAO TeleconferenceMay 8, 2008
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Key MessagesKey Messages
■ Health is academic
■ A coordinated, multi-component, evidence-based approach is the best way to make a difference
■ Change has happened…
■ Health is academic
■ A coordinated, multi-component, evidence-based approach is the best way to make a difference
■ Change has happened…
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Government Agencies
Family
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Why Schools?Why Schools?
■ Most young people are enrolled in school■ Health programs have long been part of the school
experience■ School health programs can improve students’
• Health knowledge, attitudes, and skills• Health behaviors and health outcomes• Social outcomes• Educational outcomes
■ Most young people are enrolled in school■ Health programs have long been part of the school
experience■ School health programs can improve students’
• Health knowledge, attitudes, and skills• Health behaviors and health outcomes• Social outcomes• Educational outcomes
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30.734.4
19.7
34.4
11.2 7.9
47.3 47.3
30.3
41.2
20.814.9
0
25
50
75
100
Watched TV ≥3hours/day
Insufficientphysical activityin past 7 days
Watched TV ≥3hours/day
Played videogames ≥3hours/day
Fasted to controlweight
Took diet pills tocontrol weight
% o
f stu
dent
s
Mostly A's or Mostly B's Mostly D's or F's
Percentage of U.S. High School Students Getting Mostly A’s or B’s and Mostly D’s or F’s*
Who Engage in Selected Health Risk Behaviors
Percentage of U.S. High School Students Getting Mostly A’s or B’s and Mostly D’s or F’s*
Who Engage in Selected Health Risk Behaviors
Unpublished analyses of CDC, National Youth Risk Behavior Survey, 2003*As reported by students
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Participation in the School Breakfast Program and Academic PerformanceParticipation in the School Breakfast Program and Academic Performance
■ Compared to peers who do not participate in the School Breakfast Program, low-income elementary school students who do participate have:• greater improvements in standardized test scores
and math grades• reduced rates of absenteeism, tardiness, and
psychosocial problems
■ Compared to peers who do not participate in the School Breakfast Program, low-income elementary school students who do participate have:• greater improvements in standardized test scores
and math grades• reduced rates of absenteeism, tardiness, and
psychosocial problems
Murphy et al. Arch Pediatr Adolesc Med 1998; Meyers et al. Am J Dis Child 1989
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Physical Activity and Academic PerformancePhysical Activity and
Academic Performance
■ Physical activity among adolescents: • is consistently related to higher levels of self-esteem and
lower levels of anxiety and stress.1
• can positively affect concentration, memory, and classroom behavior.2
■ Spending more time in physical education class did not have a negative effect on students’ standardized test scores, even though less time was available for other academic subjects.3
■ Physical activity among adolescents: • is consistently related to higher levels of self-esteem and
lower levels of anxiety and stress.1
• can positively affect concentration, memory, and classroom behavior.2
■ Spending more time in physical education class did not have a negative effect on students’ standardized test scores, even though less time was available for other academic subjects.3
1. Calfas and Taylor. Pediatr Exerc Sci 1994; 2. Strong et al. J Pediatr 2005; and 3. Sallis, et al. Res Q Exerc Sport 1999.
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Analysis of Associations Between Time Spent in Physical Education and Academic Achievement* Analysis of Associations Between Time Spent in Physical Education and Academic Achievement*
■ Nationally representative sample: 5,316 students starting kindergarten in 1998-99, followed through 5th grade
■ PE measure: Low (0-35 mins./week), Medium (36-69), High (70-300)
■ AA measure: Mathematics and reading tests designed by experts
■ Higher amounts of PE not associated with AA in boys■ A small but significant benefit on both the math and
reading tests were observed for girls in the high PE category compared with those in the low PE category
■ Nationally representative sample: 5,316 students starting kindergarten in 1998-99, followed through 5th grade
■ PE measure: Low (0-35 mins./week), Medium (36-69), High (70-300)
■ AA measure: Mathematics and reading tests designed by experts
■ Higher amounts of PE not associated with AA in boys■ A small but significant benefit on both the math and
reading tests were observed for girls in the high PE category compared with those in the low PE category
*Carlson SA et al. Am J Pub Health 2008 April
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www.cdc.gov/HealthyYouth/health_and_academicswww.cdc.gov/HealthyYouth/health_and_academics
Journal of School Health 2007;77:589-600
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“Health and success in school are interrelated. Schools cannot achieve their primary mission of education if students and staff are not healthy and fit physically, mentally, and socially.” - National Association of State Boards of Education
“NSBA recognizes the critical link of health and learning and the role of schools in promoting life-long health and preventing health risk behaviors.” - National School Board Association
“Health and success in school are interrelated. Schools cannot achieve their primary mission of education if students and staff are not healthy and fit physically, mentally, and socially.” - National Association of State Boards of Education
“NSBA recognizes the critical link of health and learning and the role of schools in promoting life-long health and preventing health risk behaviors.” - National School Board Association
National Perspectives on the Relationship Between Health and Education
National Perspectives on the Relationship Between Health and Education
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National Perspectives on the Relationship Between Health and Education
National Perspectives on the Relationship Between Health and Education
“No educational tool is more essential than good health…We believe that healthy kids make better students and that better students make healthy communities. We recognize that children who come to school hungry, are absent due to asthma, suffer from other chronic diseases such as Type 2 diabetes, are depressed or distracted by family problems, or stay away from school because of fear of violence cannot benefit fully from the sound educational programs we are putting into place to ensure that no child in our schools is left behind. Policies and practices that address the health and developmental needs of young people must be included in any comprehensive strategy for improving academic performance.”
- Council of Chief State School Officers
“No educational tool is more essential than good health…We believe that healthy kids make better students and that better students make healthy communities. We recognize that children who come to school hungry, are absent due to asthma, suffer from other chronic diseases such as Type 2 diabetes, are depressed or distracted by family problems, or stay away from school because of fear of violence cannot benefit fully from the sound educational programs we are putting into place to ensure that no child in our schools is left behind. Policies and practices that address the health and developmental needs of young people must be included in any comprehensive strategy for improving academic performance.”
- Council of Chief State School Officers
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www.wholechildeducation.orgwww.wholechildeducation.org
Association for Supervision and Curriculum Development
Association for Supervision and Curriculum Development
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Under the New Compact for the Whole Child, Schools Provide:
Under the New Compact for the Whole Child, Schools Provide:
■ Challenging and engaging curriculum.■ Adequate professional development with collaborative
planning time embedded within the school day.■ High-quality teachers and administrators.
■ Challenging and engaging curriculum.■ Adequate professional development with collaborative
planning time embedded within the school day.■ High-quality teachers and administrators.
The Whole Child, www.ascd.org
■ A safe, healthy, orderly, and trusting environment.■ A climate that supports strong relationships between
adults and students.■ Support for active coordinated school health council or
other collaborative structures.
■ A safe, healthy, orderly, and trusting environment.■ A climate that supports strong relationships between
adults and students.■ Support for active coordinated school health council or
other collaborative structures.
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Bienestar Health ProgramSan Antonio, Texas
Bienestar Health ProgramSan Antonio, Texas
AUDIENCE • Low income, Mexican American 4th graders
PROGRAM • Health & physical education class• After-school health club• Family Fun Fiesta• School food service
RESULTS
(1 year)
• Decline in fasting capillary glucose• Increases in dietary fiber intake and physical fitness
Trevino RP et al. Impact of the Bienestar school-based diabetes mellitus prevention program on fasting capillary glucose levels: a randomized controlled trial. Arch Pediatr Adolesc Med. 2004;158:911.
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Coordinated Approach to Child Health (CATCH)
El Paso, Texas
Coordinated Approach to Child Health (CATCH)
El Paso, TexasAUDIENCE • Low income 3rd graders
• 95-99% Hispanic population
PROGRAM • Physical education • Food service modifications• Classroom health education • Family communication
RESULTS (2 years)
• The rate of increase in obesity was smaller among students in the CATCH program
Source: Coleman KJ et al. Prevention of the epidemic increase in child risk of overweight in low-income schools: The El Paso coordinated approach to child health. Arch Pediatr Adolesc Med. 2005;159:217.
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Planet HealthBoston, Massachusetts
Planet HealthBoston, Massachusetts
AUDIENCE • Multiethnic 6th – 8th graders
PROGRAM • Interdisciplinary curriculum in which lessons related to physical activity, nutrition (< fat, > fruits and vegetables), and reduced TV watching were integrated into math, language arts, science, social studies, and PE.
RESULTS (2 years)
• Among girls: decrease in obesity, increase in fruit and vegetable intake• Among girls & boys: decrease in hours of TV watched
Source: Gortmaker SL et al. Reducing obesity via a school-based interdisciplinary intervention among youth. Arch Pediatr Adolesc Med.1999;153:409.
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Linking Education, Activity and Food (LEAF) program
Linking Education, Activity and Food (LEAF) program
■ Grants to 16 middle and high schools in 9 California school districts.
■ Implement policies to promote the consumption of California grown fresh produce
■ Implement an array of related policies to improve student nutrition and fitness.
■ Grants to 16 middle and high schools in 9 California school districts.
■ Implement policies to promote the consumption of California grown fresh produce
■ Implement an array of related policies to improve student nutrition and fitness.
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Coordinated School Health ProgramCoordinated School Health Program
Healthy and Safe School Environment
Healthy and Safe School Environment
HealthPromotion
for Staff
HealthPromotion
for Staff
Physical EducationPhysical EducationHealth EducationHealth Education
Health ServicesHealth Services
Counseling, Psychological, and
Social Services
Counseling, Psychological, and
Social Services
NutritionServicesNutritionServices
Family and Community Involvement
Family and Community Involvement
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What Can Schools Do?What Can Schools Do?
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Priority Strategies■ Strong wellness policies■ Coordinated School Health
Program ■ Self-assessment and planning for
improvement■ School health council and
coordinator■ High-quality health education ■ High quality physical education■ Increased physical activity
opportunities■ Quality school meal program■ Appealing, healthy food and
beverage choices outside of school meals
■ Health promotion for staff
Priority Strategies■ Strong wellness policies■ Coordinated School Health
Program ■ Self-assessment and planning for
improvement■ School health council and
coordinator■ High-quality health education ■ High quality physical education■ Increased physical activity
opportunities■ Quality school meal program■ Appealing, healthy food and
beverage choices outside of school meals
■ Health promotion for staff
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Healthy and Safe School Environment
Healthy and Safe School Environment
HealthPromotion
for Staff
HealthPromotion
for Staff
Physical EducationPhysical EducationHealth EducationHealth Education
Health ServicesHealth Services
Counseling, Psychological, and
Social Services
Counseling, Psychological, and
Social Services
NutritionServicesNutritionServices
Family and Community Involvement
Family and Community Involvement
■ States■ Districts■ Schools
• Elementary school• Middle school • High school
■ Classrooms
■ States■ Districts■ Schools
• Elementary school• Middle school • High school
■ Classrooms
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31
56
40
67
46
55
82
66
0
25
50
75
100
Used part-skim or low-fat cheese
Trimmed fat from meat Removed skin frompoultry
Steamed or bakedvegetables
Perc
ent
2000 2006
Percentage of Schools That Almost Always or Always Used Healthy Food Preparation Practices, 2000 and 2006
Percentage of Schools That Almost Always or Always Used Healthy Food Preparation Practices, 2000 and 2006
CDC, School Health Policies and Programs Study, 2000 and 2006
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Percentage of U.S. Schools That Offered Specific A La Carte Foods, 2000 and 2006Percentage of U.S. Schools That Offered Specific A La Carte Foods, 2000 and 2006
CDC, School Health Policies and Programs Study, 2000 and 2006
403638
53
19
50
73
53
0
25
50
75
100
Salads Low-fat salty snacks Low-fat or nonfatyogurt
Deep-fried potatoes
Perc
ent
2000 2006
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Percentage of U.S. Schools in Which Students Could Purchase Specific Items in Vending Machines or at
School Stores, Canteens, or Snack Bars, 2000 and 2006
Percentage of U.S. Schools in Which Students Could Purchase Specific Items in Vending Machines or at
School Stores, Canteens, or Snack Bars, 2000 and 2006
CDC, School Health Policies and Programs Study, 2000 and 2006
21
3838
2625
11
0
25
50
75
100
High-fat baked goods High-fat ice cream High-fat salty snacks
Perc
ent
2000 2006
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Percentage of Schools in Which Junk Foods and Soft Drinks Were Sold to Students in Vending
Machines, School Stores, Canteens, or Snack Bars During Lunch Periods*, 2000 and 2006
Percentage of Schools in Which Junk Foods and Soft Drinks Were Sold to Students in Vending
Machines, School Stores, Canteens, or Snack Bars During Lunch Periods*, 2000 and 2006
*Among the schools that sold these items in these locations.CDC, School Health Policies and Programs Study, 2000 and 2006
68
34
23
48
0
25
50
75
100
Junk Foods Soda pop, sports drinks, or fruit drinks not100% juice
Perc
ent
2000 2006
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Percentage of Schools That Sold Baked Goods Not Low in Fat for Fund-Raising for Any School Organization, 2000 and 2006
Percentage of Schools That Sold Baked Goods Not Low in Fat for Fund-Raising for Any School Organization, 2000 and 2006
67
54
0
25
50
75
100
2000 2006
Perc
ent
CDC, School Health Policies and Programs Study, 2000 and 2006
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Percentage of States ThatRequired Schools to Prohibit Junk Foods
in Specific Settings, 2000 and 2006
Percentage of States ThatRequired Schools to Prohibit Junk Foods
in Specific Settings, 2000 and 2006
20
8 62 2
42
32
8 6
32
0
25
50
75
100
A la carte In vendingmachines
In school stores,canteens, orsnack bars
At student parties At concessionstands
Perc
ent
2000 2006
CDC, School Health Policies and Programs Study, 2000 and 2006
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26
11
0
25
50
75
100
2000 2006
Perc
ent
Percentage of Districts that Prohibited Use of Food or Food Coupons as Reward,
2000 and 2006
Percentage of Districts that Prohibited Use of Food or Food Coupons as Reward,
2000 and 2006
CDC, School Health Policies and Programs Study, 2000 and 2006
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2536
0
25
50
75
100
Schools requiring students to repeat PE
Perc
ent
2000 2006
Percentage of Schools that Required Students Who Failed Required Physical Education to Repeat the Class/Course,* 2000 and 2006
Percentage of Schools that Required Students Who Failed Required Physical Education to Repeat the Class/Course,* 2000 and 2006
*Among schools that required physical educationCDC, School Health Policies and Programs Study, 2000 and 2006
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Percentage of Districts That Had Supportive Physical Education Policies, 2000 and 2006Percentage of Districts That Had Supportive Physical Education Policies, 2000 and 2006
8379
93 93
0
25
50
75
100
Required PE at elementary school level Required high school PE teachers to becertified
Perc
ent
2000 2006
CDC, School Health Policies and Programs Study, 2000 and 2006
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59
76
0
25
50
75
100
States
Perc
ent
20002006
Percentage of States That Required or Encouraged Districts or Schools to Follow Standards or
Guidelines Based on the National Standards for Physical Education
CDC, School Health Policies and Programs Study, 2000 and 2006
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66
81
0
25
50
75
100
Districts
Perc
ent
20002006
Percentage of Districts That Had Adopted a Policy Stating that Schools Will Follow National, State, or District Physical Education Standards
or Guidelines
CDC, School Health Policies and Programs Study, 2000 and 2006
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Percentage of States that Prohibited or Actively Discouraged Schools from Using Physical
Activity to Punish Students for Bad Behavior in Physical Education, 2000 and 2006
Percentage of States that Prohibited or Actively Discouraged Schools from Using Physical
Activity to Punish Students for Bad Behavior in Physical Education, 2000 and 2006
2
26
16
56
0
25
50
75
100
Prohibited Actively Discouraged
Perc
ent
2000 2006
CDC, School Health Policies and Programs Study, 2000 and 2006
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Percentage of States and Districts That Required Elementary Schools to Provide
Regularly Scheduled Recess, 2000 and 2006
Percentage of States and Districts That Required Elementary Schools to Provide
Regularly Scheduled Recess, 2000 and 2006
4
46
12
57
0
25
50
75
100
States Districts
Perc
ent
2000 2006
CDC, School Health Policies and Programs Study, 2000 and 2006
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Percentage of Districts That Provided Funding for or Offered Health Promotion Programs for
Faculty and Staff,* 2000 and 2006
Percentage of Districts That Provided Funding for or Offered Health Promotion Programs for
Faculty and Staff,* 2000 and 2006
13
24
11
2832
36
0
25
50
75
100
Weight management Physical activity programs Nutrition education
Per
cent
2000 2006
*During the 12 months preceding the study.CDC, School Health Policies and Programs Study, 2000 and 2006
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Despite These Dramatic Improvements…Despite These Dramatic Improvements…
■ 45% of middle schools and 77% of high schools allowed students to buy soft drinks from vending machines or a school store
■ 25% of middle schools and 48% of high schools allowed students to buy junk food from vending machines or a school store during lunch period
■ 19% of middle schools and 24% of high schools offered brand name fast foods
■ 24% of high schools sold deep fried foods at lunch every day
■ 45% of middle schools and 77% of high schools allowed students to buy soft drinks from vending machines or a school store
■ 25% of middle schools and 48% of high schools allowed students to buy junk food from vending machines or a school store during lunch period
■ 19% of middle schools and 24% of high schools offered brand name fast foods
■ 24% of high schools sold deep fried foods at lunch every day
CDC, School Health Policies and Programs Study, 2000 and 2006
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Despite These Dramatic Improvements…Despite These Dramatic Improvements…■ Only 4% of elementary schools, 8% of middle schools, and
2% of high schools provided daily physical education for all students for the entire school year
■ 31% of elementary schools did not require any physical education
■ 31% of high schools allowed students to be exempted from physical education for inappropriate reasons
■ 68% of the schools that required physical education taught dodgeball
■ 32% of elementary schools did not provide daily recess for all students
■ 52% of schools did not offer intramural activities or physical activity clubs for students
■ Only 4% of elementary schools, 8% of middle schools, and 2% of high schools provided daily physical education for all students for the entire school year
■ 31% of elementary schools did not require any physical education
■ 31% of high schools allowed students to be exempted from physical education for inappropriate reasons
■ 68% of the schools that required physical education taught dodgeball
■ 32% of elementary schools did not provide daily recess for all students
■ 52% of schools did not offer intramural activities or physical activity clubs for students
CDC, School Health Policies and Programs Study, 2000 and 2006
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CDC-Funded State Coordinated School Health Programs
CDC-Funded State Coordinated School Health Programs
Funded StatesFunded States
IDID
AZAZ
MNMN
OHOH
MSMS
NJNJ
CTCT
www.cdc.gov/healthyyouth/partners/funded/cshp.htmwww.cdc.gov/healthyyouth/partners/funded/cshp.htm
WAWA
CACACOCO
SDSD
NDND
MIMINYNY
MEME
KYKYWVWV
NCNC
WIWI
SCSC
MAMA
ARAR
Nez Perce TribeNez Perce Tribe
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www.cdc.gov/HealthyYouthwww.cdc.gov/HealthyYouth
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Physical Activity and Nutrition Policies and Programs in the
Nation’s Schools: Are We Making Progress?
Physical Activity and Nutrition Policies and Programs in the
Nation’s Schools: Are We Making Progress?
Terry O’Toole, PhDHealth Scientist, Division of Adolescent and School Health,
CDC DNPAO TeleconferenceMay 8, 2008
Terry O’Toole, PhDHealth Scientist, Division of Adolescent and School Health,
CDC DNPAO TeleconferenceMay 8, 2008