Using Health Education to Address Student Physical Activity and Nutrition: Evidence and Implications to Advance Practice.

BACKGROUND: School-based health education can provide students with learning experiences that improve knowledge, attitudes, and perceptions (KAP) and behaviors regarding physical activity and nutrition. METHODS: We conducted a 2-phase systematic review. Phase 1 was a review of reviews (ie, systematic reviews or meta-analyses) that were published 2010-2018. Phase 2 was a search for individual articles published 2010-2020 addressing topics relevant to our review; we searched for articles that had not been part of a sufficiently relevant or recent review or that had been part of a review that concluded that too few articles were available to assert sufficient evidence. RESULTS: Forty-three studies were assessed: 20 randomized controlled trials and 23 quasi-experimental designs. Collectively, interventions had a favorable impact on students' PA and nutrition KAP, but behavioral and secondary outcome results (eg, body mass index) were mixed. CONCLUSIONS: Using the evidence-based health education strategies identified in this review can help contribute to improvements in students' KAP and behaviors.

A Whole School, Whole Community, Whole Child Approach to Support Student Physical Activity and Nutrition: Introduction/Methods.

BACKGROUND: We introduce the Whole School, Whole Community, Whole Child approach to supporting student and school staff physical activity and nutrition and describe the methods used to generate the evidence synthesized across the special issue articles. METHODS: A 2-phase literature review search included a search of systematic reviews (2010-2018) for individual qualifying articles (Phase 1) and a search for individual articles on topics not addressed by a review (2010-2020) or that needed an update because they were in a review that was older (2010-2016) or showed insufficient evidence (Phase 2). Research librarians developed search strategies. In each phase, pairs of subject matter experts applied criteria to review abstracts and full-text articles and extracted data using standardized forms. We included 314 articles, describing 293 studies. FINDINGS: Most of the included studies looked at elementary or secondary school level interventions; 51% were rated poor quality, and few took place in a rural setting. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Most of the identified studies engaged majority minority or racially/ethnically diverse schools, suggesting that these interventions are feasible in a variety of settings. CONCLUSIONS: This collection of 10 articles identifies evidence-based interventions, gaps in research, and implications for health equity.

Individual and Collective Positive Health Behaviors and Academic Achievement Among U.S. High School Students, Youth Risk Behavior Survey 2017.

PURPOSE: We examined associations between academic grades and positive health behaviors, individually and collectively, among U.S. high school students. DESIGN: Cross-sectional study design. SETTING: Data were from the 2017 national Youth Risk Behavior Survey. Response rates were 75% for schools, 81% for students, and 60% overall (n = 14,765 students). SUBJECTS: Youth in grades 9th-12th. MEASURES: We focused on youth behaviors that can prevent or delay the onset of chronic health conditions. Seven dietary, 3 physical activity, 2 sedentary screen time, and 4 tobacco product use behaviors were assessed. Variables were dichotomized (0/1) to indicate that a score was given to the positive health behavior response (e.g.,, did not smoke cigarettes = 1). A composite score was created by summing each positive health behavior response among 16 total health behaviors. ANALYSIS: Multivariable logistic regression analyses for each individual health behavior, and a multivariable negative binomial regression for the composite score, were conducted with self-reported academic grades, controlling for sex, grade in school, race/ethnicity, and body mass index (BMI) categories. RESULTS: Controlling for covariates, students who reported mostly A's had 2.0 (P < .001) more positive health behaviors; students who reported mostly B's had 1.3 (P < .001) more positive health behaviors; and students who reported mostly C's had .78 (P < .001) more positive health behaviors, compared to students who reported mostly D's/F's. CONCLUSIONS: Higher academic grades are associated with more positive individual and cumulative health behaviors among high school students. Understanding these relationships can help inform efforts to create a healthy and supportive school environment and strive for health equity.

Surveillance of Meeting the Youth Physical Activity Guideline: Impact of Including Vigorous-Intensity and Bone-Strengthening Activities.

Purpose: The US youth physical activity guideline recommends participation in four types of physical activity: moderate-to-vigorous intensity aerobic (MVPA), vigorous-intensity aerobic (VPA), muscle-strengthening, and bone-strengthening physical activity. Current national prevalence estimates of meeting the youth physical activity guideline are typically based on measures of the MVPA and muscle-strengthening components. This study sought to examine differences in prevalence estimates using this current approach and then including measures of all four components. Methods: Data from US high school student respondents to the 2010 National Youth Physical Activity and Nutrition Survey were analyzed (n = 10,596). Prevalence of students meeting the youth physical activity guideline were assessed and compared using 1) measures of MVPA and muscle-strengthening components only and 2) also including measures of the VPA and bone-strengthening components. Results: Overall, 15.2% students met the MVPA, 50.7% met the muscle-strengthening, 70.6% met the VPA, and 80.7% met the bone-strengthening components. In total, 12.1% (95% confidence interval: 10.9, 13.3) of students met both the MVPA and muscle-strengthening components, and 11.2% (95% confidence interval: 10.0, 12.4) met all four components. Conclusions: Incorporating additional measures of VPA and bone-strengthening activity into current surveillance systems may not meaningfully impact national estimates of meeting the youth physical activity guideline.

Dietary and Physical Activity Behaviors Among High School Students - Youth Risk Behavior Survey, United States, 2019.

Establishing healthy dietary and physical activity patterns among youths is an important public health strategy for improving health and preventing chronic diseases; however, few adolescents meet U.S. government recommendations for dietary or physical activity behaviors, and disparities by sex and race/ethnicity exist. CDC analyzed data from the 2019 Youth Risk Behavior Survey to update estimates of dietary and physical activity behaviors among U.S. high school students overall and by sex and race/ethnicity. In addition, 2-year comparisons (2017 and 2019) and trends in prevalence of these behaviors during 2009-2019 were examined. In 2019, overall, during the 7 days before the survey, 41.8% of students had eaten fruit or drunk 100% fruit juices <1 time/day; 40.7% had eaten vegetables <1 time/day; and 16.7% had not eaten breakfast on all 7 days. Moreover, although 57.4% of students had played on ≥1 sports team during the 12 months before the survey, less than half of students had been physically active for ≥60 minutes/day on all 7 days (23.2%), had exercised to strengthen or tone their muscles on ≥3 days/week (49.5%), had met both aerobic and muscle-strengthening physical activity guidelines (16.5%), or had attended physical education classes on all 5 days in an average school week (25.9%). Trend data indicate limited progress in shifting dietary and physical activity behaviors. That is, with the exception of decreases in the percentage of students who had consumed soda ≥1 time/day (2009: 29.2%; 2019: 15.1%), sports drinks ≥1 time/day (2015: 13.8%; 2019: 10.6%), and <3 glasses/day of plain water (2015: 50.5%; 2019: 44.6%), high school students' dietary and physical activity behaviors have not improved and, in certain cases, have worsened. These findings support the need for multicomponent approaches, including policy and environmental changes, and opportunities for adolescents to learn about and practice making healthy choices.

Do Schools That Screen for Body Mass Index Have Recommended Safeguards in Place?

The Centers for Disease Control and Prevention recommends that schools adopt 10 safeguards before launching a body mass index (BMI) screening program; however, little is known about schools' safeguard adoption. Authors identified questions from the 2014 School Health Policies and Practices Study that aligned with 4 of the 10 safeguards to estimate safeguard prevalence among schools that screened students for BMI (40.7%, N = 223). Among these schools, 3.1% had all four safeguards and 56.5% had none or one. The most prevalent safeguard was having reliable and accurate equipment (54.1%, 95% confidence interval [CI] = [46.1, 62.1]). Providing staff with appropriate expertise and training was the least prevalent; respondents in 26.4% (95% CI [17.1, 35.6]) of schools received recent training on weight status assessment, weight management, and eating disorder identification. School-based BMI screening is common, but adopting multiple recommended safeguards is not. Absent these safeguards, BMI screening programs may fall short of intended outcomes and potentially incur unintended consequences.

Implementation of an integrated pharmacy supply management strategy.

PURPOSE: Implementation of an integrated pharmacy supply management strategy is described. SUMMARY: In 2011, the formulary approval process and supply management for oncology medications were independent of each other at an oncology infusion center. Numerous nonformulary medications were kept on hand and reordered based on inventory levels that were established with inadequate usage information, while some formulary agents did not have on-hand inventory levels and had to be reordered on a patient-specific basis, which required paperwork and then a review by drug information staff per institutional policy. Because there was no true distinction in the ordering of formulary versus nonformulary oncology agents, the medical staff prescribed both in the same manner, leaving the pharmacy staff responsible for ensuring that enough quantities were on hand for many drugs, regardless of formulary status. Using supply chain management principles, a formal analysis of the on-hand inventory was performed. In addition, the formulary process for oncology drugs was restructured to align with how oncology drugs are managed for on-hand inventory levels. The alignment of these processes allowed the operation to have 1 supply strategy for the ambulatory oncology infusion center. As a result, inventory exhaustion rates were reduced by 70% and inventory turn rates improved by 78%. There was also significant time savings in the operational process streamlining, eliminating the rework and inefficiencies caused by an unclear process that was not fully captured in this assessment. CONCLUSION: Alignment of the formulary review process with inventory analyses that support supply management principles reduced inventory exhaustion while improving inventory turn rates.

Variety, Enjoyment, and Physical Activity Participation Among High School Students.

BACKGROUND: Federal guidelines state that youth should participate in a variety of physical activity (PA) they find enjoyable. Little is known, however, about how variety and enjoyment are associated with PA participation among adolescents. METHODS: Data came from the 2010 National Youth Physical Activity and Nutrition Survey, a nationally representative survey of adolescents. Path analysis was used to examine the association of a variety of self-reported PA, defined as the number of activities and activity types (ie, team sports/weightlifting, individual activities, and other competitive/recreational sports), on self-reported PA enjoyment and participation. The analysis also examined whether enjoyment mediates the association between a variety of PA and participation. Separate models were estimated for boys and girls. RESULTS: Number of activities was associated with increased PA enjoyment and participation. For boys and girls, team sports/weightlifting was associated with increased participation, and individual activities were indirectly associated with increased participation through enjoyment. For boys, team sports/weightlifting was indirectly related with participation. CONCLUSIONS: These findings suggest that participation in a variety of PA is associated with increased PA enjoyment and participation. Providing opportunities for adolescents to engage in a variety of activities might help them identify PA they enjoy and facilitate lifelong PA habits.

Active Gaming Among High School Students--United States, 2010.

OBJECTIVES: Our study is the first to describe the prevalence and correlates (demographics, body mass index [BMI], sedentary behaviors, and physical activity) of high school youth who report active videogame playing (active gaming) in a U.S. representative sample. MATERIALS AND METHODS: The National Youth Physical Activity and Nutrition Study of 2010 provided data for this study. Active gaming was assessed as the number of days in the 7 days prior to the survey that students in grades 9-12 (14-18 years of age) reported participating in active videogames (e.g., "Wii™ Fit" [Nintendo, Kyoto, Japan], "Dance Dance Revolution" [Konami, Osaka, Japan]). Students reporting ≥1 days were classified as active gamers. Logistic regression was used to examine the association among active gaming and demographic characteristics, BMI, sedentary behaviors, and physical activity. RESULTS: Among 9125 U.S. high school students in grades 9-12 surveyed, 39.9 percent (95 percent confidence interval=37.9 percent, 42.0 percent) reported active gaming. Adjusting for covariates, the following characteristics were positively associated (P<0.05) with active gaming: being in 9th and 10th grades compared with being in 12th grade; being of black, non-Hispanic race/ethnicity; being overweight or obese; watching DVDs >0 hours/day; watching TV >0 hours/day; and meeting guidelines for aerobic and muscle-strengthening physical activity. CONCLUSIONS: Four out of 10 U.S. high school students report participating in active gaming. Active gamers tend to spend more time watching DVDs or TV, meet guidelines for physical activity, and/or be overweight or obese compared with nonactive gamers. These findings may serve to provide a baseline to track active gaming in U.S. youth and inform interventions that target sedentary behaviors and/or physical activity.

Physical Activities of U.S. High School Students--2010 National Youth Physical Activity and Nutrition Survey.

BACKGROUND: The 2008 Physical Activity Guidelines recommend youth participate in a variety of physical activities; however, few nationally representative studies describe the types and variety of youth activity. This study assessed the most frequently reported types and variety of activities among U.S. high school students, and examined the association between variety and meeting the 2008 Guidelines for aerobic activity (aerobic guideline). METHODS: We analyzed data on 8628 U.S. high school students in grades 9-12 from the 2010 National Youth Physical Activity and Nutrition Survey. Types of physical activity were assessed by identifying which activities each student reported in the past 7 days. Variety was assessed by the total number of different activities each student reported. Percentage (95% CI) of students who reported engaging in each activity was assessed. Logistic regression was used to examine the association between variety and meeting the aerobic guideline. RESULTS: Walking was the most frequently reported activity among U.S. high school students. On average, students reported participating in 6 different activities. Variety was positively associated with meeting the aerobic guideline. CONCLUSIONS: These findings support encouraging youth to participate in many physical activities and may be useful for developing interventions that focus on the most prevalent activities.

Behaviors related to physical activity and nutrition among U.S. high school students.

PURPOSE: National data related to physical activity (PA) and nutrition among adolescents are needed to help develop effective obesity prevention programs. The 2010 National Youth Physical Activity and Nutrition Study (NYPANS) was conducted to provide nationally representative data on behaviors and behavioral correlates related to healthy eating and PA. METHODS: NYPANS used a three-stage cluster sample design to obtain data representative of public- and private-school students in grades 9 through 12 in the United States (n = 11,429). Students completed an anonymous, self-administered questionnaire in their classrooms during a regular class period. Trained data collectors directly measured the students' height and weight at school using a standard protocol. RESULTS: Analyses revealed that 19.0% of students were obese and 17.8% were overweight. Students participated in a range of physical activities during the 12 months before the survey; prevalence ranged from 5.0% for ice hockey to 83.9% for walking. In addition, 52.5% of students enjoyed the physical education classes they took at school. During the 7 days before the survey, 74.8% of students ate at least one meal or snack from a fast food restaurant, with black students more likely than white and Hispanic students to have done so. Forty-one percent of students always or most of the time have a TV on while eating dinner at home. CONCLUSIONS: These and other NYPANS results can be used to develop obesity prevention programs that address specific behaviors and behavioral correlates, and target subgroups in which behaviors and behavioral correlates related to obesity are most prevalent.

Obesity and other correlates of physical activity and sedentary behaviors among US high school students.

Understanding correlates of physical activity (PA) can help inform and improve programs that promote PA among youth. We analyzed data from the 2010 National Youth Physical Activity and Nutrition Study, a representative sample of US students in grades 9-12. Logistic regression was used to examine associations between PA correlates (obesity, physical education classes, sports team participation, attitude toward PA, adult support for PA, and environmental support for PA) and participation in daily PA (DPA), vigorous PA (VPA), muscle-strengthening activity (MSA), viewing television (TV), and using computers or video games (C/VG). A positive attitude toward PA and adult support for PA were both associated with increased PA and decreased sedentary behavior. However, among students who lived in neighborhoods that were not safe for PA, a positive attitude toward PA was not associated with increased DPA or decreased sedentary behavior and was less strongly associated with VPA and MSA. Efforts to increase PA among youth should promote a positive attitude toward PA among youth and encourage adult family members to support their efforts to be active. Policies that promote safe neighborhoods may work synergistically with a positive attitude toward PA to increase participation in PA and decrease sedentary behaviors.

Body mass index measurement in schools.

BACKGROUND: School-based body mass index (BMI) measurement has attracted much attention across the nation from researchers, school officials, legislators, and the media as a potential approach to address obesity among youth. METHODS: An expert panel, convened by the Centers for Disease Control and Prevention (CDC) in 2005, reviewed and provided expertise on an earlier version of this article. The panel comprised experts in public health, education, school counseling, school medical care, and a parent organization. This article describes the purposes of BMI measurement programs, examines current practices, reviews existing research, summarizes the recommendations of experts, identifies concerns, and provides guidance including a list of safeguards and ideas for future research. RESULTS: The implementation of school-based BMI measurement for surveillance purposes, that is, to identify the percentage of students in a population who are at risk for weight-related problems, is widely accepted; however, considerable controversy exists over BMI measurement for screening purposes, that is, to assess the weight status of individual students and provide this information to parents with guidance for action. Although some promising results have been reported, more evaluation is needed to determine whether BMI screening programs are a promising practice for addressing obesity. CONCLUSIONS: Based on the available information, BMI screening meets some but not all of the criteria established by the American Academy of Pediatrics for determining whether screening for specific health conditions should be implemented in schools. Schools that initiate BMI measurement programs should evaluate the effects of the program on BMI results and on weight-related knowledge, attitudes, and behaviors of youth and their families; they also should adhere to safeguards to reduce the risk of harming students, have in place a safe and supportive environment for students of all body sizes, and implement science-based strategies to promote physical activity and healthy eating.