Adolescent Physical Activity at Public Schools, Private Schools, and Homeschools, United States, 2014.

INTRODUCTION: Physical activity overall and during school-related opportunities among homeschool adolescents are poorly documented. METHODS: We used data from the National Cancer Institute's Family Life, Activity, Sun, Health, and Eating (FLASHE) study, a national sample of parent-child dyads. We examined reported frequency of physical activity in middle-school and high-school respondents (N = 1,333). We compared the overall physical activity by school type (ie, public school, private school, and homeschool), compared school-related contexts (eg, recess, physical education [PE] class), and tested for level of physical activity by school for those reporting PE. RESULTS: Middle-school homeschool adolescents reported less physical activity during school hours compared with public school, but not private school, adolescents. Physical activity was not different by school type for out of school or weekends. Physical activity of high-school homeschool adolescents was not different from that of high-school adolescents at traditional schools; homeschool adolescents in both middle and high school reported less physical activity in PE compared with public and private school adolescents. Other school-related contexts of physical activity were not different by school type. More homeschool students reported not having PE (middle school, 54.8%; high school, 57.5%) compared with public (middle school, 18.7%; high school, 38.0%) or private schools (middle school, 13.5%; high school, 41.5%). CONCLUSION: Homeschool adolescents in middle school reported less physical activity compared with middle-school adolescents in traditional schools during school hours, likely because of having fewer PE classes and less physical activity during PE.

Impact of Physical Education Litigation on Fifth Graders' Cardio-Respiratory Fitness, California, 2007-2018.

Objectives. To examine the impact of physical education (PE) litigation on changes in cardio-respiratory fitness among racially/ethnically and socioeconomically diverse students.Methods. We used annual school-level data for all California schools with measures of fifth graders' cardio-respiratory fitness spanning 2007-2008 through 2017-2018. A difference-in-difference design assessed changes before and after lawsuits in the proportion of students meeting fitness standards in schools in districts that were parties to PE lawsuits (n = 2715) versus in schools in districts not involved (n = 3152). We ran separate models with the proportion of students meeting fitness standards by sex, race/ethnicity, and low-income status as outcomes.Results. PE litigation led to a 1-percentage-point increase in the proportion of fifth-grade students meeting cardio-respiratory fitness standards (95% confidence interval [CI] = 0.03%, 2.0%). Effects were especially pronounced for female (1.3-percentage-point increase; 95% CI = 0.1%, 2.5%), African American (3.4-percentage-point increase; 95% CI = 0.5%, 6.2%), and low-income (2.8-percentage-point increase; 95% CI = 0.5%, 6.0%) students.Conclusions. Schools in districts subject to PE litigation showed greater improvements in student fitness, particularly among students typically at higher risk for inactivity and low fitness. Litigation may be an impactful tool for enforcing PE provision in accordance with the law.

Evaluation of Implementation of Massachusetts Sports Concussion Regulations: Results of Focus Groups With School Nurses and Athletic Trainers.

In 2015, the Massachusetts Department of Public Health conducted focus groups with school nurses (SNs) and athletic trainers (ATs) from Massachusetts middle and high schools to assess implementation of legislated regulations relative to the management of students' head injuries incurred during extracurricular sports. Four tape-recorded focus groups were conducted by experienced facilitators. Lists of themes were synthesized by investigators for each focus group. Participating SNs and ATs supported the sports concussion legislation, felt that implementation had gone well, indicated that the law empowered them in managing return-to-school/play for students with concussion, and experienced support from their school administrators. Some SNs reported that they had applied relevant procedures to all students with head injuries, regardless of how or where the injury occurred. Challenges identified included protocols for away games, inconsistent concussion care by physicians, and a need for teacher education. Further research is required to quantify these findings.

Patterns and predictors of state adult obesity prevention legislation enactment in US states: 2010-2013.

OBJECTIVE: This study examined bill- and state-level factors associated with enactment of adult obesity prevention legislation in US states. METHODS: A review of bills in the Rudd Center for Food Policy and Obesity's legislative database identified 487 adult obesity prevention bills, or proposed legislation, introduced between 2010 and 2013. Multilevel models were constructed to examine bill- and state-level characteristics associated with enactment. RESULTS: From 2010 to 2013, 81 (17%) of obesity prevention bills introduced were enacted across 35 states and the District of Columbia. Bills introduced in 2010 were more likely to be enacted than in 2013 (OR=9.49; 95% CI: 2.61-34.5). Bills focused on access to healthy food, physical activity, general and educational programs, as well as modifying rules and procedures (e.g., preemption) had greater odds of enactment relative to food and beverage taxes (OR=8.18; 95% CI: 2.85-23.4 healthy food; OR=17.3; 95% CI: 4.55-65.7 physical activity; OR=15.2; 95% CI: 4.80-47.9 general; OR=13.7; 95% CI: 3.07-61.5 rules). CONCLUSION: The year of bill introduction and overall bill enactment rate were related to adult obesity prevention legislation enactment in states. This study highlights the importance of a bill's topic area for enactment and provides insights for advocates and policymakers trying to address enactment barriers.

Beliefs of chinese physical educators on teaching students with disabilities in general physical education classes.

This study examined the behavioral beliefs of physical education (PE) teachers about teaching students with disabilities in their general PE (GPE) classes and to identify the factors that contribute to their beliefs. A total of 195 PE teachers from a region in eastern China were surveyed. Results of the Physical Educators' Attitudes Toward Teaching Individuals With Disabilities-III survey indicate that although some teachers felt that including students with disabilities in GPE classes provides benefit for them, they were concerned about the practical difficulties of teaching students with disabilities in GPE classes, the lack of support, and the possible rejection of students with disabilities by their peers. Moreover, the behavioral beliefs of teachers vary according to the disability conditions of the students. Results show that there is no significant effect of demographic factors on the beliefs of PE teachers. Quality of experience predicts positive beliefs. The study has important implication for teacher training, provision of equipment, and support from teacher assistants.

Hygienic and sanitary requirements of gyms in force in Italy: national issues and analysis of regional regulations.

In recent years, the awareness of the importance of physical activity for human health is growing, as people practicing it; the number of gyms has also substantially increased. Currently, in Italy there is not a consistent regulation regarding hygienic and sanitary requirements of gyms. Several Italian regions issued laws about this topic. The authors analyse the standards required by the Italian Olympic Committee (CONI) and the regional laws, highlighting the numerous issues, among which the possible location of gyms in semi-basements and basements. They eventually call for a national regulation that should clearly transpose the hygienic and sanitary requirements of gyms into a satisfactory rule of law.

Correlates of state enactment of elementary school physical education laws.

OBJECTIVE: To describe variation in U.S. state elementary school physical education (PE) policies and to assess associations between state PE policy enactment and education funding, academic achievement, sociodemographic disadvantage, and political characteristics. METHODS: U.S. state laws regarding school PE time, staffing, curriculum, fitness assessment, and moderate-to-vigorous physical activity (MVPA) in 2012 were classified as strong/specific, weak/nonspecific, or none based on codified law ratings within the Classification of Laws Associated with School Students (C.L.A.S.S.). Laws were merged with state-level data from multiple sources. Logistic regression was used to determine associations between state characteristics and PE laws (N=51). RESULTS: Laws with specific PE and MVPA time requirements and evidence-based curriculum standards were more likely in states with low academic performance and in states with sociodemographically disadvantaged populations. School day length was positively associated with enacting a PE curriculum that referenced evidence-based standards. School funding and political characteristics were not associated with PE laws. CONCLUSIONS: Limited time and high-stake testing requirements force schools to prioritize academic programs, posing barriers to state passage of specific PE laws. To facilitate PE policy enactment, it may be necessary to provide evidence on how PE policies can be implemented within existing time and staffing structures.

Association between state physical education (PE) requirements and PE participation, physical activity, and body mass index change.

OBJECTIVE: To determine if state physical education (PE) laws are associated with student physical education attendance and physical activity (PA), and whether physical education and competitive food laws, in conjunction, are associated with lower BMI change. METHOD: State laws regarding physical education time requirements and competitive foods in 2003 and 2006 were classified as strong, weak, or none, based on codified law ratings obtained from the Classification of Laws Associated with School Students. Laws were linked to student data on PE attendance and physical activity (8th grade, Spring 2007) and BMI change (5th-8th grade, 2004-2007), obtained from the Early Childhood Longitudinal Study (n=5510 students in 40 states). RESULTS: Girls reported 0.31 more days of activity (95% CI: 0.02, 0.61) and were more likely to attend physical education ≥ 3 days/week (74.1% versus 52.1%, difference=22.0, 95% CI: 2.1, 42.0) if they resided in states with strong physical education laws compared to no physical education laws. Weak physical education laws had modest associations with PE and activity, and there was no evidence that weak laws reduce BMI gain regardless of competitive food laws. CONCLUSION: Strong physical education laws with specific time requirements may increase physical education attendance and activity in girls. There is insufficient evidence that physical education laws reduce student weight gain.

Physical education in West Virginia schools: are we doing enough to generate peak bone mass and promote skeletal health?

Peak bone mass (PBM) is attained at 25-35 years of age, followed by a lifelong decline in bone strength. The most rapid increase in bone mass occurs between the ages of 12-17. Daily school physical education (PE) programs have been shown to produce measurable increases in PBM, but are not federally mandated. Increases in PBM can decrease the lifelong risk of osteoporosis and fractures; critical for West Virginia prevention programs. Nationally only 1 in 6 schools require PE three days per week, with 4% of elementary schools, 8% of middle schools and 2% of high schools providing daily PE. In 2005, West Virginia passed the Healthy Lifestyles Act that returned physical education to the K-12 curriculum. This law requires only one credit of PE from grades 9-12 and provides only 35% of the recommended PE for grades K-12. This article highlights the relationship of PE to PBM and discusses the potential impact on West Virginia skeletal health.

Geographic differences in physical education and adolescent BMI: have legal mandates made a difference?

The school environment is an ideal setting for healthy weight programming with adolescents. The federal government has reinforced the importance of school-based health promotion. The current study examined the preliminary influence of the 2006 school wellness policy requirement of the Child Nutrition and WIC Reauthorization Act (CNWICRA) on adolescent Body Mass Index (BMI) and physical education participation. Nationally representative data from the 2003 and 2007 Youth Risk Behavior Surveillance Survey (YRBSS) were used. The authors examined BMI percentile and physical education participation based on survey year and geographic region. Results suggest a slight decrease in BMI with no changes in physical education participation. A main effect for geographic region was found for both physical education participation and BMI percentile, while a geographic region-by-survey year interaction was discovered when analyzing BMI percentiles. Results suggest a need for continued investigation and may inform future healthy weight programming and geographically tailored wellness policies.

The association of state law to physical education time allocation in US public schools.

OBJECTIVES: We examined whether public schools in states with specific and stringent physical education (PE) laws, as assessed by the Physical Education-Related State Policy Classification System (PERSPCS), available on the Classification of Laws Associated with School Students (C.L.A.S.S.) Web site, reported more weekly PE time in the most recent School Health Policies and Programs Survey (SHPPS). METHODS: Schools (n=410) were grouped by their state's PERSPCS time requirement scores (none, nonspecific requirement, or specific requirement). Average weekly school-level PE was calculated using the SHPPS-reported PE minutes. Weighted analyses determined if PE minutes/week differed by PERSPCS group. RESULTS: Schools in states with specific requirement laws averaged over 27 and 60 more PE minutes/week at the elementary and middle school levels, respectively, compared with schools within states with nonspecific laws and over 40 and 60 more PE minutes per week, respectively, compared with elementary and middle schools in states with no laws. High school results were nonsignificant. CONCLUSIONS: Public health guidelines recommend at least 60 minutes of daily physical activity for children, and PE may further this goal. Strong codified law with specific time requirements for PE may be an important tool contributing toward adequate PE time and daily physical activity recommendations.

Patterns and predictors of enactment of state childhood obesity legislation in the United States: 2006-2009.

OBJECTIVES: We developed a content review for state policies related to childhood obesity, and we have quantitatively described the predictors of enactment. METHODS: We collected an inventory of 2006 through 2009 state legislation on 27 childhood obesity topics from legislative databases. We coded each bill for general information, topic content, and other appropriate components. We conducted a general descriptive analysis and 3 multilevel analyses using bill- and state-level characteristics to predict bill enactment. RESULTS: Common topics in the 27% of the bills that were enacted were community physical activity access, physical education, and school food policy. Committee and bipartisan sponsorship and having term limits significantly predicted enactment in at least 1 model. Bills with safe routes to school or health and nutrition content were twice as likely to be enacted. Bills containing product and menu labeling or soda and snack taxes were significantly less likely to be enacted. CONCLUSIONS: Bipartisan and committee support and term limits are important in bill enactment. Advocacy efforts can be tailored to increase awareness and sense of priority among policymakers.

State school policies and youth obesity.

The objective of this study was to examine relations between state-level school policies and childhood obesity for youth ages 10-17 years. Secondary analysis of the 2003-2006 School Nutrition Environment State Policy Classification System, 2003-2007 Physical Education Related State Policy Classification System, and 2003 and 2007 National Surveys of Children's Health was performed. Eleven nutrition and 5 physical education (PE) domains were examined for elementary (ES), middle (MS), and high school (HS) children. Logistic regression models examined the association of policies on obesity prevalence in 2007 as well as change scores for the policy assessments. Scores for 5 of 11 nutrition domains and 4 of 5 PE domains increased between 2003 and 2006-2007. Controlling for individual, family and neighborhood factors, nutrition policies were positively associated with the odds of 2007 obesity in 3 ES and 2 MS domains and negatively associated with 1 HS domain. Adjusted positive associations also were observed between 2 ES and 1 MS PE policy domains and 2007 obesity. Controlling for covariates, nutrition policy change scores showed positive associations between increases in 1 ES and 1MS domain, and negative associations with 1 ES and 1 HS domain and 2007 obesity. PE policy change scores showed positive adjusted associations between increases in 2 ES, 2 MS and 1 HS domains and 2007 obesity. The findings indicate that state-level school health policies are associated with childhood obesity after adjusting for related factors, suggesting that states with higher obesity levels have responded with greater institution of policies.

Comparative analysis of state-level concussion legislation and review of current practices in concussion.

OBJECT: Forty-two states and the District of Columbia have passed legislation based on the Lystedt law of Washington state, enacted in 2009 to protect young athletes who have sustained a concussion. The aim of this study was to note the several similarities and differences among the various laws. METHODS: Concussion legislation was compared for 50 states and the District of Columbia. Evaluation parameters of this study included stipulations of concussion education, criteria for removal from play, requirements for evaluation and return to play after concussion, and individuals required to assess young athletes. Other parameters that were not consistent across states were also noted. RESULTS: Forty-three states and the District of Columbia have passed concussion legislation, and an additional 4 states have pending legislation. All states with existing legislation support concussion education for coaches; however, only 48% require coaches to undergo formal education. Athletes must be educated on concussion in 86% of states and parents in 88.7%. Suspicion of concussion is a criterion for removal from play in 75% of states; signs and symptoms of concussion are criteria for removal from play in 16% of states. The individuals allowed to evaluate and clear an athlete for return to play differ greatly among states. CONCLUSIONS: Injury prevention legislation holds historical precedent, and given the increasing attention to long-term sequelae of repeated head trauma and concussion, concussion legislation has been rapidly passed in 43 states and the District of Columbia. Although the exact stipulations of these laws vary among states, the overall theme is to increase recognition of concussion in young athletes and ensure that they are appropriately cleared for return to play after concussion.

Public school parents' perspectives of the Mississippi Healthy Students Act of 2007: findings from 2009-2011.

Annual evaluations of the Mississippi Healthy Students Act of 2007 (MHSA) were conducted from 2009-2011 among four stakeholder groups: (1) parents of public school students; (2) adolescents; (3) school officials (e.g., superintendents); (4) state-level policymakers (e.g., legislators). We examine results from the first state-wide study among a randomized sample of parents (N>3,600 per year) on childhood obesity as it related to MHSA. Parents were surveyed to determine: (1) knowledge/attitudes towards MHSA; (2) knowledge/attitudes/behaviors (KAB) that influence children's health; and (3) perceived overweight/obesity of self and child versus BMI-determined overweight/obesity. Across all three years, parents were very supportive of MHSA across a number of variables, while parents greatly underestimated obesity among self and child when compared to their BMI data. Results highlight complexities of parents' KAB that potentially influence children's health, including the MHSA. Policy implications are discussed.

Let's get moving: the need for more effective state-level physical education policies.

This study reviews obesity trends and physical education policies of 13 states with the highest and lowest youth obesity rates. A review of state policies for physical education was compared and analyzed. Although a majority of the states had physical education policies, they were typically not mandated and varied in time and grade-level requirements. However, little distinction in policies between states with higher and lower prevalence of obese youth was found. Financial and infrastructure support for the implementation and evaluation of physical education policies are needed, as well as innovative strategies including socioecological models to better address the obesity epidemic.

State laws governing school physical education in relation to attendance and physical activity among students in the USA: A systematic review and meta-analysis.

BACKGROUND: This study systematically synthesized and quantified the relationship linking state laws governing school physical education (PE) to PE attendance and physical activity (PA) in class and throughout the day and week among students in the USA. METHODS: A keyword search was performed in PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Complete, and EconLit. Meta-analyses were performed to estimate the effects of state PE laws. RESULTS: A total of 17 studies were included in the review, and five contributed to the meta-analyses. A total of 8 studies used nationally representative school- or student-level data, three focused on multiple states, and the remaining six examined the PE laws of a single state. The presence and strength of state PE laws were positively associated with PE attendance and the frequency and duration of PA during PE classes and throughout the school day. Compared to those residing in states with weak or no PE laws, students in states with strong PE laws had an additional 0.2 days (95% confidence interval (95%CI): 0.1-0.4) of PE attendance per week and spent an additional 33.9 min (95%CI: 22.7-45.0) participating PE classes per week. State PE laws affected girls' PA more than boys'. Different aspects of state PE laws tended to affect students' PE attendance differently. Disparities in the implementation of state PE laws existed across schools. CONCLUSION: Future studies should adopt objective measures on PE and PA participation and examine the roles schools and districts play in mediating the effect of state PE laws on students' PE attendance and PA.

The evidence for the impact of policy on physical activity outcomes within the school setting: A systematic review.

BACKGROUND: Despite the well-established health benefits of physical activity (PA) for young people (aged 4-19 years), most do not meet PA guidelines. Policies that support PA in schools may be promising, but their impact on PA behavior is poorly understood. The aim of this systematic review was to ascertain the level and type of evidence reported in the international scientific literature for policies within the school setting that contribute directly or indirectly to increasing PA. METHODS: This systematic review is compliant with Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Six databases were searched using key concepts of policy, school, evaluation, and PA. Following title and abstract screening of 2323 studies, 25 progressed to data synthesis. Methodological quality was assessed using standardized tools, and the strength of the evidence of policy impact was described based on pre-determined codes: positive, negative, inconclusive, or untested statistically. RESULTS: Evidence emerged for 9 policy areas that had a direct or indirect effect on PA within the school setting. These were whole school PA policy, physical education, sport/extracurricular PA, classroom-based PA, active breaks/recess, physical environment, shared use agreements, active school transport, and surveillance. The bulk of the evidence was significantly positive (54%), 27% was inconclusive, 9% was significantly negative, and 11% was untested (due to rounding, some numbers add to 99% or 101%). Frequency of evidence was highest in the primary setting (41%), 34% in the secondary setting, and 24% in primary/secondary combined school settings. By policy area, frequency of evidence was highest for sport/extracurricular PA (35%), 17% for physical education, and 12% for whole school PA policy, with evidence for shared use agreements between schools and local communities rarely reported (2%). Comparing relative strength of evidence, the evidence for shared use agreements, though sparse, was 100% positive, while 60% of the evidence for whole school PA policy, 59% of the evidence for sport/extracurricular PA, 57% of the evidence for physical education, 50% of the evidence for PA in classroom, and 50% of the evidence for active breaks/recess were positive. CONCLUSION: The current evidence base supports the effectiveness of PA policy actions within the school setting but cautions against a "one-size-fits-all" approach and emphasizes the need to examine policy implementation to maximize translation into practice. Greater clarity regarding terminology, measurement, and methods for evaluation of policy interventions is needed.

Surveillance of obesity-related policies in multiple environments: the Missouri Obesity, Nutrition, and Activity Policy Database, 2007-2009.

INTRODUCTION: The objective of this study was to develop the Missouri Obesity, Nutrition, and Activity Policy Database, a geographically representative baseline of Missouri's existing obesity-related local policies on healthy eating and physical activity. The database is organized to reflect 7 local environments (government, community, health care, worksite, school, after school, and child care) and to describe the prevalence of obesity-related policies in these environments. METHODS: We employed a stratified nested cluster design using key informant interviews and review of public records to sample 2,356 sites across the 7 target environments for the presence or absence of obesity-related policies. RESULTS: The school environment had the most policies (88%), followed by after school (47%) and health care (32%). Community, government, and child care environments reported smaller proportions of obesity-related policies but higher rates of funding for these policies. Worksite environments had low numbers of obesity-related policies and low funding levels (17% and 6%, respectively). Sixteen of the sampled counties had high obesity-related policy occurrence; 65 had moderate and 8 had low occurrences. CONCLUSION: Except in Missouri schools, the presence of obesity-related policies is limited. More obesity-related policies are needed so that people have access to environments that support the model behaviors necessary to halt the obesity epidemic. The Missouri Obesity, Nutrition, and Activity Policy Database provides a benchmark for evaluating progress toward the development of obesity-related policies across multiple environments in Missouri.

The Association Between State Physical Education Laws and Student Physical Activity.

INTRODUCTION: This study examined the association between state physical education time requirements and physical activity and physical education outcomes among high school students. METHODS: State physical education time requirement laws for 2004-2016 from the Classification of Laws Associated with School Students database were linked with 2005-2017 national Youth Risk Behavior Survey data using state and year identifiers. Analyses were conducted between 2018 and 2019 to assess associations between physical education time requirement laws and physical activity or physical education outcomes using multinomial logistic regressions, while controlling for sociodemographic characteristics, year-fixed effects, and state confounders. RESULTS: State laws requiring ≥90 minutes of physical education per week were associated with 3.1 percentage points lower probability of no days of physical activity ≥60 minutes (95% CI= -5.0, -1.1), 3.7 percentage points lower probability of no days of moderate exercise ≥30 minutes (95% CI= -6.2, -1.3), 4.2 percentage points lower probability of no days of vigorous exercise ≥20 minutes (95% CI= -5.2, -3.3), and 19.3 percentage points lower probability of not attending physical education class (95% CI= -34.4, -4.2). The laws were associated with a 2.4 percentage point higher probability of daily moderate exercise ≥30 minutes in male students (95% CI=0.6, 4.2) and a 3.4 percentage point higher probability in female students (95% CI=1.9, 4.9), with larger associations for female students (p<0.01). CONCLUSIONS: Findings from this study help support the role that physical education state requirements can play in enhancing adolescents' ability to meet recommended amounts of daily physical activity and the related public health benefits.