Parent Preferences for Physical Activity in Before and After School Programs in Rural and Suburban Communities: A Discrete Choice Experiment.

BACKGROUND: The purpose of this study was to examine and compare parent preferences of before and after school physical activity program components in rural and suburban elementary schools. METHODS: A discrete choice experiment was conducted to measure parent preferences for components of before/after school programs. A total of 183 parents (age = 37.2 [8.2] y, 155 females) sampled from 15 elementary schools (K-6 grades) in the Western United States took part in the study, half of which were from a rural community (n = 93, 50.8%). Results from the discrete choice experiment were analyzed using hierarchic Bayesian methodology, which estimated utility scores and was used to calculate important scores for program components. RESULTS: The specific goal of the before/after school program was the strongest determinant of parents' stated choice overall, followed by leaders, time of day, length, and main focus. Learning sports as the physical activity goal was the top-rated attribute. Subgroup analyses revealed discrepancies between suburban and rural parents and parents of boys and girls. CONCLUSION: This study extends the application of discrete choice experiments to school-based programming, providing a unique way to design empirically based, stakeholder informed school programs, specifically within before and after school settings.

Parent and Child Perceptions of Barriers to Active School Commuting.

BACKGROUND: Active commuting (AC) to and from school can contribute to physical activity, although it has recently seen a global decline. The purpose of this study was to examine the agreement between parent and child perceptions of barriers to school AC. METHODS: Participants were parents (N = 152, Mage  = 40.6 ± 6.3 years) and elementary school children (N = 98, Mage  = 10.0 ± 1.2 years). School commute type/frequency and barriers to AC were collected via surveys. Intraclass correlation coefficients (ICCs) were used to assess relative agreement between parent and child perceptions (N = 98 dyads). Paired t tests and equivalence testing were employed to assess group-level agreement. Bland-Altman analysis was used to assess individual-level agreement. Partial correlations of AC with perceptions were also assessed. RESULTS: All parent and child perceptions of barriers to AC to school had low agreement. Bland-Altman Plots indicated negative bias for all but 3 barrier perceptions. Paired t tests indicated significant differences between parent and child perceptions for 8 out of 15 barriers while equivalence testing deemed no parent-child perception equivalent. Partial correlations with AC frequency were significant for 7 parent perceptions and 2 child perceptions. CONCLUSIONS: Parent and child perceptions have low agreement. Programs aimed at promoting AC to and from school should account for these discrepancies.

A Pilot Study of a Comprehensive School Physical Activity Program in Elementary Schools: Be a Champion!

OBJECTIVE: In the present study, we sought to determine if a comprehensive school physical activity program (CSPAP) delivered using the Be a Champion! (BAC) framework was effective in increasing moderate-to-vigorous physical activity (MVPA) and decreasing sedentary time in elementary school youth. METHODS: We implemented a CSPAP in 3 elementary schools to determine its effectiveness to youth behaviors compared to 2 control schools. Youth physical activity was assessed via accelerometry in spring 2015 and spring 2016 during school hours on school days. Implementation of the BAC components and youth behavior was assessed through direct observation from fall 2015 through winter 2016. RESULTS: In a multilevel, mixed model examining the effects of intervention, we found no statistically significant effect of the intervention on overall MVPA. However, a significant increase in MVPA was observed among girls (but not boys) in the intervention schools relative to controls. No differences in sedentary behaviors were observed by group. CONCLUSION: CSPAP implementation may be effective in reducing sedentary time and increasing MVPA in girls, but not boys. Research is necessary to increase implementation dose and fidelity to best practices in physical activity promotion.

Physical Activity Surveillance in the United States for Work and Commuting: Understanding the Impact on Population Health and Well-being.

OBJECTIVE: To summarize and describe the current US surveillance systems that assess physical activity (PA) for work and commuting. METHODS: An expert group conducted an environmental scan, generating a list (n = 18) which was ultimately reduced to 12, based on the inclusion of PA and/or sedentary behavior data. RESULTS: The 12 surveys or surveillance systems summarized provide nationally representative data on occupational-level PA or individual-level PA at work, data on active commuting, some are scorecards that summarize workplace health best practices and allow benchmarking, and one is a comprehensive nationally representative survey of employers assessing programs and practices in different worksites. CONCLUSIONS: The various surveillance systems and surveys/scorecards are disparate and need to be better analyzed and summarized to understand the impact of occupational-level PA and commuting on population health and well-being, life expectancy, and workforce productivity.

School-based physical activity interventions in rural and urban/suburban communities: A systematic review and meta-analysis.

Disparities in physical activity and health outcomes exist between urban and rural youth. School settings can be utilized to promote physical activity in youth regardless of urban-rural status. This systematic review and meta-analysis aimed to assess and compare the effect of rural and urban/suburban school-based physical activity programs on total physical activity in youth. A search of five databases was conducted. A total of 33 studies remained after the exclusion process, 28 of which took place in urban/suburban schools and five of which took place in rural schools. The DerSimonian and Laird random effects model was employed with the estimates of heterogeneity taken from the inverse-variance fixed-effect model. For rural studies, the Hartung-Knapp-Sidak-Jonkman method was used to obtain error estimates. Results from the total sample indicated a significant but small pooled increase in daily physical activity (Hedge's g = 0.12, 95% confidence interval [CI]: 0.06-0.18), which held for interventions conducted in urban/suburban schools (Hedge's g = 0.12, 95% CI: 0.06-0.19). For rural school-based interventions, there was no significant pooled effect (Hedge's g = 0.06, 95% CI: -0.50 to 0.61). This meta-analysis provides evidence that school-based interventions can be marginally effective for increasing daily physical activity in children and adolescents; however, no effect was observed for interventions implemented in rural settings.

A Systematic Review of Multi-Component Comprehensive School Physical Activity Program (CSPAP) Interventions.

OBJECTIVE: To identify, review, and describe multicomponent physical activity (PA) interventions in terms of: (a) number and combination of Comprehensive School Physical Activity Program (CSPAP) components, (b) study characteristics, and (c) primary outcomes. DATA SOURCE: Five electronic databases (i.e., PubMed, PsychInfo, Physical Education Index, Sport Discus, and ERIC). STUDY INCLUSION AND EXCLUSION CRITERIA: Included articles were peer-reviewed, written in English language, published since 1987, and included multicomponent school-based interventions. DATA EXTRACTION: Data items extracted were: school level, setting, CSPAP component description, health outcomes, academic outcomes, main conclusion, and reference. DATA SYNTHESIS: Included articles were synthesized by: (1) CSPAP components utilized, and (2) research outcome measured (i.e., health or academic). RESULTS: Across 32 studies, 11 included physical education plus 1 additional CSPAP component (PE + 1); 10 included PE + 2 additional CSPAP components; 8 included PE + 3 additional CSPAP components; and 1 included all 5 CSPAP components. Two other studies included 2 or 3 CSPAP components without PE. Most interventions targeted health outcomes (94%) rather than academic outcomes (6%). CONCLUSIONS: Multicomponent approaches aligned with CSPAPs are effective in promoting PA and other positive outcomes for youth in schools. Future research should seek to understand effects of CSPAP components on a variety of outcomes and settings.

Parents' Perceptions and Engagement Regarding School-Based Physical Activity Promotion.

PURPOSE: This study examined parents' perceived importance of, and engagement in, school-based physical activity (PA) promotion. DESIGN: A cross-sectional, quantitative survey design was employed. SETTING: The survey was conducted in the United States. SUBJECTS: Using a probability-based panel (AmeriSpeak®), a national sample of 3599 parents was randomly recruited to participate in the survey and 1015 participants (28.2%) completed it. Parents or legal guardians of children enrolled in K-12 during the 2017-2018 school year were eligible to participate. MEASURES: The survey was developed and distributed by a national collaborative for active schools with the support of a national research center. ANALYSIS: Data were analyzed using structural equation modeling and path analysis. RESULTS: The data supported a 6-factor solution encompassing perceived importance of PA before, during, and after school, communication with administrators, and volunteering and participating in school-based PA (CFI = .974, RMSEA = .034, SRMR = .056). Path coefficients from perceived importance of PA before/after school to current (ß = .43; 95%CI[.25, .61]) and future communication with administrators (ß = .40; 95%CI[.23, .55]) were statistically significant, as were coefficients from perceived importance of PA before/after school to past (ß = .60; 95%CI[.35, .83]) and current volunteering/participating in school-based PA (ß = .63; 95%CI[.42, .85]). CONCLUSION: Parents' perceived importance of school-based PA opportunities before and after school warrants emphasis in future research and advocacy.

Comprehensive School Physical Activity Program Policies and Practices Questionnaire (CSPAP-Q).

Purpose: The Comprehensive School Physical Activity Program (CSPAP) model has recently been adopted as a national framework for physical activity (PA) promotion in schools. As a result, there is a need to develop an instrument to help leaders of PA measure policies and practices across the five component areas of a CSPAP. To address this gap, our team systematically developed and assessed the psychometric properties of the CSPAP-Q, an instrument designed to assess school policies and practices related to the five components of CSPAP. Methods: The instrument development process began by reviewing existing school health and PA surveys. The Delphi method was then used to evaluate face and content validity through expert feedback. Thirty-eight physical education teachers completed the CSPAP-Q twice over a 14-day period to further establish validity and to assess test-retest reliability. Results: In total, 117 items were identified for the initial review. Upon completion of expert feedback, 22 items were eliminated and 66 items were revised. After reliability testing, three additional items were eliminated due to low test-retest agreement levels (Kappa <.40; non-significant χ2). Ninety-two items were retained in the final version of the CSPAP-Q and kappa values indicated moderate to substantial agreement among items. Conclusions: After validity and reliability testing, results suggest that the CSPAP-Q is a valid and reliable tool for assessing policies and practices related to CSPAP.

A Systematic Review of Community Engagement Outcomes Research in School-Based Health Interventions.

BACKGROUND: Involving communities in school health has been purported as a practice integral to supporting a Whole School, Whole Community, Whole Child (WSCC) approach. Although community collaboration is often included in school-based health initiatives, there is little research considering methods for increasing community engagement. The purpose of this study was to identify effective school-based health interventions documenting changes in community engagement. METHODS: Academic experts and school stakeholders guided procedures for a systematic review of studies published from 1987-2017 and gray literature (ie, best practice documents; policy documents, etc.) on comprehensive school health interventions including community engagement as a targeted outcome. RESULTS: The search identified 9 studies addressing community as an outcome of school-based health interventions; types of partnership mechanisms and partners' roles were classified. CONCLUSIONS: Although involving communities is a WSCC component and commonly recommended as a strategy fundamental to school health, there is little empirical research examining effective strategies for engaging communities and engagement is often not measured as part of intervention studies. Further measurement and research in engaging communities in school health is warranted.

Implementation evaluation of a professional development program for comprehensive school physical activity leaders.

The purpose of this study was to conduct an implementation monitoring evaluation of a yearlong comprehensive school physical activity program (CSPAP) professional development program across eight multi-state physical education (PE) teacher cohorts. Mixed-method data were collected during a three-year implementation period via workshop attendance sheets and evaluations, post-workshop implementation plans and artifacts, and follow-up phone interviews to enumerate and evaluate the program's process of recruitment, reach, dose delivered, dose received, fidelity, and context. Recruitment strategies reached a total of 234 PE teacher attendees across eight workshops, with 77 PE teachers (primarily female, elementary, public school teachers) completing all program requirements. Facilitators among full program completers were participation incentives and network opportunities, while common inhibitors were difficulty with online technology and perceptions of added workload. Completers submitted implementation plans with at least three action steps, ranging from 4 to 7 months to accomplish, that predominately commenced with securing administration approval as the first step (81%), focused on implementing student physical activity initiatives beyond PE (76%), and evidenced with mostly picture artifacts (78%). Implementation was facilitated by the presence of multilevel support at school and an elevated image of PE and PE teachers at school, and was inhibited by scheduling constraints, unrealistic planning, and conflicting perceptions of physical activity and PE. Overall, this evaluation reveals unique perspectives of PE teachers regarding schoolwide PA promotion and informs future efforts to target and effectively support CSPAP leaders.

Effects of Sharing Data With Teachers on Student Physical Activity and Sedentary Behavior in the Classroom.

BACKGROUND: Data-driven decision making is an accepted best practice in education, but teachers seldom reflect on data to drive their physical activity (PA) integration efforts. The purpose of this study was to explore the impact of a data-sharing intervention with classroom teachers on teacher-directed movement integration and students' PA and sedentary behavior. METHODS: Teacher-directed movement behaviors from 8 classroom teachers in 1 primary school were systematically observed during four 1-hour class periods before (pre) and after (post) an intervention in which teachers individually discussed student movement data with a trained interviewer. Teachers' K-2 students (N = 132) wore accelerometers for 10 school days both preintervention and postintervention. RESULTS: Multilevel mixed effects regression indicated a nonsignificant increase in teacher-directed movement from preintervention to postintervention (+7.42%, P = .48). Students' classroom time spent in moderate to vigorous PA increased (males: +2.41 min, P < .001; females: +0.84 min, P = .04) and sedentary time decreased (males: -9.90 min, P < .001; females: -7.98 min, P < .001) postintervention. Interview data inductively analyzed revealed teachers' perspectives, including their surprise at low student PA during the school day. CONCLUSIONS: Findings suggest that sharing data with classroom teachers can improve student PA and decrease sedentary behavior at school.

Evaluation of a comprehensive school physical activity program: Be a Champion!

BACKGROUND: Comprehensive School Physical Activity Programs (CSPAPs) are widely supported to increase physical activity (PA) in schools, but little has been reported to inform a comprehensive evaluation effort. The purpose of this report is to describe a comprehensive evaluation and monitoring strategy for CSPAP implementation. METHODS: The System for Observing Staff Promotion of Activity and Nutrition (SOSPAN), System for Observing Student Movement in Academic Routines and Transitions (SOSMART), and System for Observing Play and Leisure Activity (SOPLAY) were employed to record student and staff behaviors (2642 total scans). To assess policies, practices, and environments, a CSPAP Policies and Practices questionnaire was used, which included components of the School Health Index, the School PA Policy Assessment, the School Environment and Policies Survey, and the School Health Policies and Practices Study. Youth PA (minutes/day) was assessed using accelerometers. RESULTS: Working with school sites to ascertain the number of opportunities that are provided for PA and the amount of PA students engage in is challenging but feasible. The use of systematic observation, accelerometers, and questionnaires can provide a comprehensive representation of policies, practices, and behaviors to aid in establishing targeted PA action items. CONCLUSIONS: Developing an evaluation framework that was rigorous enough to assess the physical, social, and policy environment of a school in order to answer the overarching research questions of the study but flexible enough to be feasibly streamlined for utilization by a school implementation team proved to be challenging but possible.

The Application of an Implementation Science Framework to Comprehensive School Physical Activity Programs: Be a Champion!

Comprehensive school physical activity programs (CSPAPs) have been endorsed as a promising strategy to increase youth physical activity (PA) in school settings. A CSPAP is a five-component approach, which includes opportunities before, during, and after school for PA. Extensive resources are available to public health practitioners and school officials regarding what should be implemented, but little guidance and few resources are available regarding how to effectively implement a CSPAP. Implementation science provides a number of conceptual frameworks that can guide implementation of a CSPAP, but few published studies have employed an implementation science framework to a CSPAP. Therefore, we developed Be a Champion! (BAC), which represents a synthesis of implementation science strategies, modified for application to CSPAPs implementation in schools while allowing for local tailoring of the approach. This article describes BAC while providing examples from the implementation of a CSPAP in three rural elementary schools.

Health Promotion Efforts as Predictors of Physical Activity in Schools: An Application of the Diffusion of Innovations Model.

BACKGROUND: Implementing a comprehensive school physical activity program (CSPAP) effectively addresses public health issues by providing opportunities for physical activity (PA). Grounded in the Diffusion of Innovations model, the purpose of this study was to identify how health promotion efforts facilitate opportunities for PA. METHODS: Physical and health education teachers (N = 256) nationwide were surveyed using a CSPAP Index to identify teacher's efforts for providing opportunities for PA within a school setting. RESULTS: A hierarchical regression analysis revealed total number of PA opportunities was significantly predicted by teachers' health promotion efforts, p < .001. Sex and years of experience were not significant covariates, p = .35, in the final step of the model. Accounting for teaching environments, the model was significant, p < .001. The strongest predictors were the promotional efforts of PA for family and community, p < .001, PA for staff members, p < .01, PA during the school day, p < .05, and PA before school, p < .05. CONCLUSIONS: To increase PA opportunities for children in schools, emphasis should be placed on health promotion. This study confirms the importance of teachers involving family, community, and staff members as co-health promoters when trying to increase PA engagement surrounding schools.

Impact of trained champions of comprehensive school physical activity programs on school physical activity offerings, youth physical activity and sedentary behaviors.

OBJECTIVE: A quasi-experimental cluster-controlled design was used to test the impact of comprehensive school physical activity program (CSPAP) professional development on changes in school physical activity (PA) offerings, moderate-to-vigorous physical activity (MVPA) and sedentary behaviors of 9-14 year-old children during school. METHODS: Two groups of Louisiana elementary and middle school physical education teachers (N=129) attended a CSPAP summer workshop (95 in 2012=intervention, 34 in 2013=control) and were assessed on school PA offerings (teacher-reported; pre, mid, and post). During the 2012-2013 school year, intervention teachers received CSPAP support while implementing new school PA programs. MVPA and sedentary behaviors were assessed (accelerometry; baseline and post) on a sample of 231 intervention, 120 control students from 16 different schools. RESULTS: Multivariate analysis of covariance indicated that intervention teachers reported significantly more PA offerings during school (3.35 vs. 2.37) and that involve staff (1.43 vs. 0.90). Three-level, mixed model regressions (stratified by sex) indicated that students overall spent less time in MVPA and more time being sedentary during school, but the effects were significantly blunted among intervention students, especially boys. CONCLUSIONS: This study provides preliminary evidence for CSPAP professional development programs to influence school-level PA offerings and offset student-level declines in MVPA and increases in sedentary behavior.

Physical literacy and Comprehensive School Physical Activity Programs.

OBJECTIVE: The purpose of this paper is to make a case for Comprehensive School Physical Activity Program (CSPAP) to be the organizational framework for providing physical activity opportunities for children that is most likely to result in physical literacy. METHOD: Beginning in 2010, the authors used multiple search engines to ascertain the existent literature surrounding physical literacy and physical activity interventions to identify common approaches to providing physically activity in and around school. Grounded in the Health Belief Model and the idea that physical literacy is a desired outcome of physical education, publications focused on each of the components of the CSPAP were synthesized to describe evidence-based practice. RESULTS: There is adequate evidence to suggest that quality physical education, before/after school, during school, staff involvement, and family and community engagement can serve as logical points of intervention to provide increased opportunities for physical activity participation leading to physical literacy among children. CONCLUSIONS: Since only 6% of all children participate in daily physical education classes and only six states offer K-12 physical education, the implementation of CSPAP may be the most logical avenue for providing greater opportunities for physical activity engagement that fosters physical literacy as a health-oriented educational goal.

School-based physical activity promotion: a conceptual framework for research and practice.

Despite public health concerns and the many recognized benefits of physical activity (PA), levels of participation among youth remain below national recommendations. To this end, a variety of strategies for promoting physical activity for youth have been advocated, including multi-faceted, school-based approaches. One that continues to be identified as having great potential is a comprehensive school physical activity program (CSPAP). The aim of this article is to introduce a conceptual framework for school-based PA promotion that serves to stimulate, guide, and organize related research and practice. The CSPAP conceptual framework is a proposed framework, informed by existing science, recommendations, and a social ecological perspective with individual PA behavior as the epicenter. Discussed in turn are the four proposed interactive levels of influence (i.e., components, facilitators, leaders, and culture) and several integral elements proposed to operate at each level. The article concludes with a presentation of the utility of the framework for research and practice.

Emotional exhaustion, absenteeism, and turnover intentions in childcare teachers: examining the impact of physical activity behaviors.

Drawing on Salmon's (2001) unifying theory of the beneficial effects of physical exercise, we examined physical activity behaviors as an important, but understudied, buffer against experiences of emotional exhaustion, absenteeism, and turnover intentions in 189 childcare teachers. Structural equation modeling revealed that workplace and leisure-time physical activity were negatively related to emotional exhaustion, which in turn, was positively related to teacher migration and attrition intentions. Post-hoc analyses revealed indirect (mediated) effects between physical activity behaviors and teacher turnover intentions via emotional exhaustion. This theoretically driven model fit the data better than an alternative model whereby emotional exhaustion predicts physical activity behaviors.