Physical Activity and Nutrition Policies and Programs in the Nation’s Schools: Are We Making Progress? Terry O’Toole, PhD Health Scientist, Division of

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



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…

Government Agencies

Family

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

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Unpublished analyses of CDC, National Youth Risk Behavior Survey, 2003*As reported by students

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

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.

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

www.cdc.gov/HealthyYouth/health_and_academicswww.cdc.gov/HealthyYouth/health_and_academics

Journal of School Health 2007;77:589-600

“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




“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

www.wholechildeducation.orgwww.wholechildeducation.org

Association for Supervision and Curriculum Development

Association for Supervision and Curriculum Development

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.

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.

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.

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.

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.

Coordinated School Health ProgramCoordinated School Health Program

Healthy and Safe School Environment


HealthPromotion

for Staff

HealthPromotion

for Staff

Physical EducationPhysical EducationHealth EducationHealth Education

Health ServicesHealth Services

Counseling, Psychological, and

Social Services


Social Services

NutritionServicesNutritionServices

Family and Community Involvement


What Can Schools Do?What Can Schools Do?

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



HealthPromotion

for Staff

HealthPromotion

for Staff

Physical EducationPhysical EducationHealth EducationHealth Education

Health ServicesHealth Services


Social Services


Social Services

NutritionServicesNutritionServices



■ States■ Districts■ Schools

• Elementary school• Middle school • High school

■ Classrooms

■ States■ Districts■ Schools

• Elementary school• Middle school • High school

■ Classrooms

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

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


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

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


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

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

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


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


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


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

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


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


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


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


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


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

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


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-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

www.cdc.gov/HealthyYouthwww.cdc.gov/HealthyYouth









Documents

Physical Activity and Nutrition Policies and Programs in the Nation’s Schools: Are We Making Progress? Terry O’Toole, PhD Health Scientist, Division of