Part 1: Needs Assessment

Needs Assessment

Physical activity in childhood and adolescents has several well-documented benefits on health. Physical activity helps build healthy bones and muscles, helps reduce and control weight, reduces anxiety and stress, increases self-esteem, and may improve blood pressure and cholesterol levels. Physical activity also helps in reducing the risk of developing obesity and chronic diseases such as diabetes, and cardiovascular disease (Center for Disease Control and Prevention, 2015). The Guidelines recommend that children and adolescents do 60 minutes or more of physical activity each day. The activities should include aerobic exercises for at least 3 days of the week for 60 minutes or more, muscle strengthening and bone strengthening as part of the 60 minutes for at least 3 days of the week (Office of Disease Prevention and Health Promotion, 2016).

Overweight and obesity among adolescents is a significant public health problem. In 2011-2012 obesity in 6-11-year olds and 12-19- year olds was 17.7% and 20.5% respectively. There are also disparities among certain racial and ethnic groups. The prevalence of overweight and obesity is higher among Hispanics and non-Hispanics blacks compared to their White counterpart (Center for Disease Control and Prevention, 2015b). In Georgia 17.1% of adolescents were overweight and 12.7% were obese (Center for Disease Control and Prevention, 2015a). Male high school students are more likely to be obese than females while African Americans students are more likely to be overweight and obese than any other race (The Georgia Department of Public Health, 2012). Physical inactivity and poor diet has been determine to influence overweight and obesity. In 2013, 75.3% of adolescents in Georgia were not physically active at least 60 minutes per day on all 7 days. 66.4% of adolescents did not attend daily physical education classes on all 5 days during an average week when they go to school and 32.2% of adolescents watched television 3 or more hours per day on an average school day (Center for Disease Control and Prevention, 2015a). Health interventions are needed to encourage adolescents to increase physical activity and reduce screen time.

Classroom-based health education focused on providing information is one of the approaches used in overweight and obese prevention among high school students. This approach aims at increasing physical activity by providing information that might motivate and enable people to change their behaviors and maintain change over time. The content of the class education is usually non-specific with the teachers educating students about physical activity/inactivity, nutrition, smoking, and alcohol and drug abuse. Behavioral skills components such as role-playing, and goal setting should be included. This type of education class usually does not include spending additional time engaging in physical activity. Other objectives of informational approaches is to increase awareness of opportunities for increasing physical activity, explain methods for overcoming barriers and negative attitudes about physical activity and increase physical activity behaviors among high school students (Task Force on Community Preventive Services, 2002).

Adolescents in DeKalb County, Georgia, have lower rates of physical activity compared to national averages. In 2015, The Youth Risk Behavior Surveillance Survey had 76.3% high school students in DeKalb County not physically active at least 60 minutes per day on all 7 days. This is slightly higher than the average in Georgia, 75.3%. Approximately 73.9% high school students in DeKalb County did not attend physical education classes on all 5 days and 30.9% watched 3 or more hours per day of television (Center for Disease Control and Prevention, 2015c). As part of overweight and obesity prevention efforts, a health intervention focused on providing information will be offered to initially the 10th graders of Chamblee Charter High School. The program will be part of their health education class curriculum.

There are several stakeholders that will be involved with the health intervention. They include physical education instructors, school board, parents, and the local public health department. The following table shows the stakeholders involvement within the program.

StakeholderRole in InterventionQuestions from StakeholderEffect on Stakeholder of a Successful ProgramEffect on Stakeholder of an Unsuccessful Program
Physical education InstructorsTeaching, provision of educational materialIs there a special training of the class? Will I be working or collaborating with other people?Acknowledgment and certification as a physical health education instructor. Involvement in further progress of the class to other gradesEvaluation of individual work and efforts in delivering of the class
School BoardApproval of the integration of the Health Intervention to the Physical Education curriculumWhat resources are needed for the program? Can the school budget afford to implement the intervention? How will this benefit the school in the end?Acknowledgment of the success of the program. Possible future funding of the intervention to include other gradesWasted funding, resources, and effort, effect on the reputation of the school

 

ParentsApproval of the child’s participation to the program, Agreement to participate in the program as per the parent section guidelinesHow will this benefit my child? How much will it cost? How much time and effort will I have to invest as participation?Children become equipped to lead healthier lives. Parent-child relationship may improve and be helpful with the healthy lifestyle changeWasted time and effort,

Effect it has on the children

Local Public Health DepartmentCollaboration with the instructors, guest lectures, supply educational materialHow will the students receive the program? How successful will the instructors deliver the class? Are equipped enough to deal with any setbacks during the delivery of the programAcknowledgment of a successful program. Involvement in future progress of the program i.e. offered to other grades, Publication of the findings and proposal of future considerationsWasted resources,

Evidence against the informational approach for the population.

StudentsParticipating in the program through their health education classWhat does the program entail?

How are the lesson plans organized? What kinds of activities are included in the program? How long is the program?

Increase in physical activity behaviors.

Decrease in barriers and negative attitudes about physical activity.

No change in physical activity behaviors.

Decrease in physical activity behaviors.

Increase in barriers and negative attitudes about physical activity.

Intervention Identification

The strategy used in this intervention is known as classroom-based health education focused on information provision. This strategy is part of the campaigns and informational approaches aimed at increasing physical activity. These programs consist of health education classes that provide information and skills, with the syllabus generally addressing physical activity, nutrition, smoking and cardiovascular disease. The class content is usually non-specific, with teachers educating students about physical inactivity, nutrition, smoking, and alcohol and drug misuse. In some cases, the class content may include behavioral skills component such as role-playing and goal setting. Nonetheless, the classes do not include additional time spent in participating in physical activity.

Classroom-based health education classes are taught in elementary, middle, or high schools. The classes are designed to effect behavior change through personal and behavioral factors that provide students with the skills they need to adopt healthy behaviors and make rational decisions. This strategy has previously been implemented in elementary schools but would also work in a high school setting. Both elementary and high school students are at a developmental stage where it is key for them to adopt healthy behaviors as they are growing up into adolescents and young adults. The students spend most of their time at school where a social environment, personality and behavioral attributes are likely to influence changes in eating and physical activity patterns.

Based on the Task Force findings, ten studies qualified for the review. The studies showed variable effects of these interventions on the time spent in physical activity outside the school setting. Two studies showed increases in activity while two other studies showed decreases in self-reported activity. One study found positive changes in self-reported behavior and two more studies found no change or negative changes in self-reported behavior. The studies did not measure for aerobic capacity. The results were therefore inconsistent across the body of evidence. The review yielded insufficient evidence to make a conclusion about whether the programs were effective or not. On the other hand, one study showed an increase in general health knowledge, exercise-related knowledge and self-efficacy about exercise. This showed that the classes therefore, might end up providing other benefits such as increased knowledge, more supportive attitudes for physical activity initiatives, or changes in other health-related behaviors.

This strategy has been successful in two studies included in the Task Force Findings. Both studies were carried out among fifth graders and predominantly minority populations. One of the studies was implemented in a school district that predominantly served the Hispanic community while the second study was implemented in schools serving American Indian reservations. Similarly Chamblee Charter High School has a predominantly minority enrollment. African American and Hispanic students make up approximately 76 percent of the student body. However, unlike the two successful studies, the intervention will be implemented among 10th graders at Chamblee Charter High School.

 

Intervention example 1: Impact of a school-based interdisciplinary intervention on diet and physical activity among urban primary school children. Eat Well and Keep Moving

The Eat Well and Keep Moving classroom-based intervention was implemented in 6 public elementary schools in Baltimore. Students included in the intervention were in grades 4 and 5 during the two-year period that the intervention was carried out. The Eat Well and Keep Moving Program was integrated into existing school structures and curricula through an interdisciplinary approach using classroom teachers. The material used was developed to fit into the regular math, science, language arts, and social studies classes. They also provided links to the school food service and physical education activities. The intervention focused on four behavioral changes: decreasing consumption of foods high in total and saturated fat, increasing consumption of fruits and vegetables to 5 a day or more, reducing television viewing to less than 2 hours per day, and increasing moderate and vigorous physical activity. The classroom-based material was grounded in social cognitive theory. The material help enhance cognitive and behavioral skills by enabling students to make changes in their own behavior, develop skills that strengthen perceived competence in employing new behaviors, and provide support for these behaviors.

The units implemented during the 2-year period consisted f 13 lessons each for the grades 4 and 5. There were also five physical education lessons that focused on nutrition issues, using a ‘Safe Workout’ format. Three of the classroom lessons had a physical education theme involving students in movement. Each lesson was designed for use by a classroom teacher during a 50- minute period. Additionally, Eat Well cards were developed to link classroom and food services, and teachers used the cards to introduce students to wide variety of different foods, particularly fruits and vegetables. The cards were designed to be used on days that school lunch selections included the foods.

Al though the intervention was classroom-based, it included activities at home that involved family members and the community. This was meant to increase opportunities for students to try the recommended behaviors even when not in school. The intervention activities and information were listed in existing school newspapers that were sent to parents. A coalition was developed to link parents at schools with representatives of organizations that provided free to low-cost nutrition and physical activity programs to parents.

The primary outcome was behavioral change, while the secondary outcome included increasing knowledge of healthy diet and activity choices. Using the 24-Hour Recalls, students were interviewed focusing on food, snack and beverages intake during the 24-hour period. Information was keyed directly into a laptop computer using the Food Intake Analysis System, which contains standardized prompts and appropriate probes and visuals for food recognition and quantification. The interviews were scheduled throughout the school week, providing a chance to recall for Sunday through Thursday. The 24-hour recalls were conducted at approximately 2-week intervals. The intervention also used a physical activity 24-hour recall. This was administered immediately following the dietary interviews. Each reported activity was classified as sleep, stand, sit and watch TV, sit and watch videos or play games, walk or other activity. Time spent in each activity was recorded to the nearest minute.

Analysis of the repeated 24-hour recall data revealed that the percentage of total energy from fat was reduced in the students in the intervention. Additionally, the percentage of total energy from fat was reduced. There was an increase in consumption of fruits and vegetables of 0.73 serving per day. The data analyzed suggested that hours per day of television and video viewing were reduced but the difference was not statistically significant. The intervention did not provide any evidence for a difference in vigorous physical activity (Gortmaker et al., 1999).

Intervention 2: Linking implementation process to intervention outcomes in a middle school obesity prevention curriculum, “Choice, Control an Change’

 

This intervention was carried out in the 2006-2007 school year within 10 middle schools in underserved, low-income neighborhoods in New York City. The intervention included five schools in the experimental group and five schools in the control group. The mean age of the students was 12 years and a little more than half of students were male. The intervention was a science and nutrition education curriculum designed to impact middle school students energy balance related behaviors such as eating more fruits and vegetables, drinking more water, increasing physical activity and decreasing intakes of sweetened beverages and packed snacks, eating at food restaurants and leisure screen time. The intervention was based on the social cognitive theory and self-determination theory. The curriculum addressed theory constructs including self-efficacy, autonomy and competence.

The curriculum of the intervention consisted of 24 lessons, taught by science teachers in science classes. The lessons were offered over an 8-10 weeks period, between the months of September and December 2006. The control schools received regular science curriculum at that time, with the delayed intervention given to them during the spring 2007. A 30-item food and activity frequency questionnaire measured the students’ behavioral outcomes. The questionnaire ‘EatWalkSurvey’ used was a modified version of the validated Block food frequency instrument for children. An instrument “Tell Me About You’ measured theory constructs of outcome expectations, intention to change, perceived barriers, self-efficacy and autonomous motivation.

The intervention resulted in significant changes in the targeted energy balance related behaviors in that students who participated in the curriculum reported fewer sweetened beverages and processed packaged snacks, smaller sizes at fast food restaurants, decreased leisure screen time and increased physical activity compared to the students the control schools. Students also showed significantly positive results in outcome expectations, self-efficacy, goal intentions, competence and autonomy.

Teacher implementation, student reception and student satisfactions were the factors more influential on the students outcomes from the intervention. Teacher implementation consisted of faithfulness to the curriculum and lesion completion. Student reception was a combined score of student engagement and classroom management. Students with high ‘teacher implementation’ classes significantly consumed fewer sweetened beverages at meal and with snacks, fewer packaged snacks, and fast food meals than the students in the control group. There were no significant differences in any eating behavior outcomes between medium ‘teacher implementation’ and the control students. There was also a significant improvement in physical and screen time behavior outcomes compared with the control group. Both high and medium ‘teacher implementation’ groups showed significant improvement in self-efficacy on drinking fewer sweetened beverages.

‘Student reception’ was divided into high, medium and control. The results showed that high ‘student reception’ group showed significant improvements on sweetened beverage frequency at meals and with snacks, packaged snack frequency, smaller sizes of sweetened beverages and fast food compared with the control group. Both medium and high ‘student reception’ groups significantly improved in frequencies of purposely walking, stair climbing, and reducing screen time compared to control groups. High ‘student reception’ showed an improved self-efficacy, autonomy and competence in intention to change fast food, packaged snacks and water intake behaviors.

‘Student Satisfaction’ was also a significant predictor of student outcomes. Higher ‘student satisfaction’ was associated with desirable outcomes including improving outcome expectation and self-efficacy for eating more fruit and vegetables, outcome expectation for drinking more water, self-efficacy for reducing sweetened beverages intake, improving autonomous motivation on healthy eating, and increasing physical activity and improving intention to walk more. There was no significant association with ‘student satisfaction’ and packaged snack behavior (Gray, Contento, & Koch, 2015).

Intervention 3: Effectiveness of a universal parental support programme to promote health behaviors and prevent overweight and obesity in 6-year-old children in disadvantage areas, the Healthy School Start Study II

 

The intervention A healthy School Start was offered to 13 schools and 31 pre-school classes in Sweden. The intervention lasted for 6 months with 90-95% of all six-year-old children attending. The intervention was grounded in social cognitive theory, focusing on the self-efficacy construct. Parental self-efficacy was the primary target, which referred to the parents’ belief in his or her own ability to perform specific action such as serving vegetables to each meal eaten at home. Parental self-efficacy, knowledge, attitude, preference, care and control, role modeling and willingness to change were identified as possible mediators of change when it comes to children’s dietary and physical activity habits and weight development. There were three intervention components and materials developed relevant to this study which include, a brochure with health information targeting parental knowledge, motivational interviewing targeting parental self-efficacy, willingness to change and care and control, and classroom activities targeting children’s knowledge, attitudes, and preferences and indirectly parental role modeling.

The brochure aimed at increasing parental knowledge on how to promote children’s healthy dietary and physical activity habits. It contained facts and advice for parents within seven areas 1) parental feeding practices; 2) healthy food and family meal time; 3) physical activity; 4) sweets, snacks, ice-cream and soft drinks; 5) fruits and vegetables; 6) physical inactivity, screen time and commercials; 7) sleep. The brochure was written in basic, easy-to-read Swedish with many illustrations. The children were sent home with the brochures for the parents and group meetings were offered at each school as an opportunity for parents to discuss the content of the brochure. Motivational interviewing was offered to the parents in two individual sessions without the presence of the child. The session lasted about 45 minutes and the parents met the same interviewer at both times. During those sessions, parents set goals related to the target behavior to work on at home and later followed up with support from the motivational interviewer. Classroom activities came from a teacher’s manual and workbook developed to facilitate the class. The activities were also related to the different areas in the brochure sent home to parents. The children received 30- minute, teacher-led sessions, after which the children were given homework to discuss and complete together with their parents. Data from the intervention was collected at three times, baseline, directly after the intervention and follow-up five months after the intervention.

The results revealed that the intervention group has a significantly lower intake of unhealthy foods directly after the intervention. This effect was sustained at the follow-up five months later but only in boys. Intake of unhealthy drinks was also significantly lower in the intervention group directly after the intervention. This effect was however not sustained five months later. No significant changes were observed on measurements of physical activity directly after the intervention. At the five months follow-up, the intervention group spent 9.2 minutes less engaging in sedentary behaviors during the week and 11.3 minutes less during the weekend. The effect were not sustained either (Nyberg, Norman, Sundblom, Zeebari, & Elinder, 2016).

 

Objectives.

Process

  1. Enroll 200 students going to 10th grade and have at least 90% complete the program in full duration.
  2. Organize the class to ensure no more than 50 students attend each class.
  3. 100% of participants will be administered a pre-test before the start of the first class and a post-test following the last session of the program.
  4. 70% of the students will maintain wearing their pedometers every day of the week during the program.
  5. 70% of students report including family at home as part of the class exercises in the program.

Outcome

  1. At least 50% of the participating students will report an increase in positive attitude and aspirations to improve physical activity by the end of the program.
  2. 75% of the participating students will indicate an increase in knowledge about the importance of physical activity by 25% from pre to post test.
  3. 70% of participants will participate in 150 minutes of physical activity every week following program completion.
  4. By the end of the program, 75% of the participating students will report an increase in self-efficacy to improve or continue physical activity behaviors.
  5. At the duration of the program, at least 80% of participants will be able to provide at least 5 barriers to being physically active and strategies to address each one.
  6. By the end of the program, 75% of the students will report getting social support from family (emotional, instrumental, informational, appraisal).

Logic Model

Inputs/Resources Activities OutputsShort-term OutcomesIntermediate OutcomesLong-term Outcomes
·   Funding

·   Trained Teachers

·   Evidence-based and evidence-informed curriculum.

·   Exercise trainers

·   Volunteers

·   Local Public Health Department.

·   Local YMCA

·   Materials (worksheets, pamphlets, posters) showing different physical activities.

·   Exercise plans, videos, and blogs.

·   Information on current places offering physical activity opportunities in the community.

·   Pedometers.

 

·   Pre-test and post-test to measure knowledge on importance of physical activity.

·   Group discussions on different physical activities including low, moderate and high impact.

·   In-class exercises.

·   Implement simulation activities for students to learn how to overcome barriers in performing physical activity.

·   Set-up goals to increase physical activity.

·   Create take home materials to share with family to help create a positive and supportive environment for physical activity.

·   Make referrals to free physical activity opportunities in the community.

·   Weekly physical activity log.

·   Poster campaign for promoting physical activity.

·   Assigned peer mentoring.

·   Low, moderate and high impact workout exercise examples (printed).

·   Free workout opportunities at the YMCA.

 

·   Increase in knowledge of the importance of physical activity.

·   Increase in knowledge on ways to be more physically active

·   Increase positive attitudes and aspirations to improve physical activity behaviors.

·   Gain self-efficacy to utilize strategies to get physically active.

·   Identify barriers to being physically active

·   Identify ways of including home environment

·   Increase in time spent engaging in physical activity

·   Reduction in sedentary behaviors

·   Increase in social support/social networks to be more physically active

·   Increase in use of the local YMCA to engage in physical activity.

·   Increase in self-efficacy to utilize strategies to get physically active.

·   Identify strategies to address barriers to being physical active.

·   Reports of social support from home environment

 

·   Increase in students engaging in 150 minutes of physical activity per week

·   Increase physical stamina and endurance.

·   Use of suggested strategies to prevent being physically inactive.

·   Improved access to resources in the community to engage in physical activity (YMCA).

·   Reduce proportion of children and adolescents who are overweight or obese.

·   Increase in social support from home environment

 

The classroom-based health education class focused on providing information to improve physical activity is grounded in Social Cognitive Theory (SCT). Prior school-based interventions based on the theory have shown modest effectiveness (Davis, Lambert, Gomez, & Skipper, 1995; Gortmaker et al., 1999). It is also widely recommended that programme design should be based on theory where a theoretical framework supports the identification of the causal chain and possible mediators (Nyberg et al., 2016). Social cognitive theory explains behavior as a reciprocal interaction between person, behavior, and environmental factors. In this program, the student represents the person and behavior represents physical activity. The environment can be categorized as social and physical environment. Social environment includes friends, family members and colleagues. The physical environment represents school, home or community facilities where physical activity will take place. The program enables participants to access information on physical activity while interacting with the other participants belonging to the same social circle. The students are able to share information on ways of how to get physically active. This creates social support in the school and home environments. Social support from peers or family is more likely to initiate changing behaviors to become more physically active. A central construct in SCT is self-efficacy, an individual’s belief in his or her ability to successfully perform a certain action (Bandura, 1986). The students in the program are encouraged to wear pedometers. Pedometers will enable the students to keep track of their physical activity endeavors. This in turn may lead to increase in self-regulation and self-efficacy where the students feel confident about their ability to stay on track about physical activity. Additionally, collective efficacy among the students as a group may influence them to engage in physical activity. Other associated SCT constructs focused in the program include outcome expectations, enjoyment, and observational learning. The program promotes outcome expectations by providing personal testimonials on the benefits of being physical active and showing videos of different people performing physical activity. This is meant to demonstrate to the students the positive outcomes of physical activity as a way to influence them to engage in the desired behavior. Exercise videos will be provided for observational learning and to provide credible role models who the target population can identify and relate to. Exercise plans, videos and blogs will be provided to reinforce behavioral capability. They are used as tools and resources to provide knowledge-based training and skills to being physically active.

There are limitations to the strategy used for the intervention. First, the program does not include time for the students to participate in physical activity. The program assumes that the information provided in the class is enough to encourage and eventually change behaviors of the students to get them to be more physically active. Proper monitoring of the students workout sheet plans would provide insight as to whether or not the students are engaging in physical activity. Secondly, the program has little control over the family influence on the students. Students who come from a more physically active conscious family will more likely benefit more from the program than the students who don’t have the same kind of support. Peer mentors are guided on how to provide social support for the students lacking family support. Lastly, free physical activity opportunities in the community are external factors that influence the outcome of the program. The facilities need to be available and accessible as agreed throughout the implementation of the intervention. The program maintains regular contact with the facility to ensure no issues are encountered.

Chamblee Charter High School has approximately 150 tenth graders. Regular health education classes are held three times a week, Mondays, Wednesday and Friday, with a capacity of 50 students per class. Each student is expected to enroll in one of the classes based on their schedule. The program will be implemented during the fall semester of the upcoming year, 2017-2018. The programme will be delivered during the classes held on the first and third week of every month in the fall semester. A total of 8 classes will be held where different components of the program will be delivered.

Process evaluation of the program will enable the school to measure whether the program is being implemented as intended. Data through process evaluation will also provide accountability to community partners and funders. The information needed to answer process evaluation would cover dose delivered, dose received (exposure and satisfaction), reach, and fidelity. Dose delivered measures the number of intended classes of the program delivered by the teachers. Dose received (exposure), measures the extent to which participants actively engage with, interact with, are receptive to, and use materials in the program. On the other hand, dose received (satisfaction), measures participation satisfaction with the program as well as interactions with the teachers. Reach measures the proportion of intended audience that will participate in the program. Fidelity measures the extent to which the program was implemented as planned.

For dose delivered, data will be collected using self-reported checklist filled out by the teachers and in-class observation checklist filled out two volunteers from the local public health department. The checklists covers units/components contained in the program, specific materials supposed to be used during the class, time spent on the units, and specific methods, strategies, and/or activities used in each class. To measure dose-received exposure, the two volunteers who perform in-class observations will collect data in the form of structured observations notes. The notes will describe how well the students participated in the program during the class, and the use of materials provided by the program. Data to measure dose-received satisfaction will be collected in form of a student satisfaction survey administered at the end of each class. Additionally, four focus groups will be held during the semester with the students to discuss progress and problems in the implementation of the program. Data to measure reach will be collected through attendance records. Using class rosters provided by the teacher, students will sign in at the end of each class. This will enable to monitor numbers and ensure sufficient numbers of the target population is being reached. Fidelity during the program will be measured through teacher’s weekly report that include self-reported checklist to describe whether key program activities are being completed. The teachers are trained prior to implementation of the program as well as during training booster sessions to refresh their skills. Additionally the teachers are provided with an instruction manual containing the units to be covered. The manuals are updated accordingly. Progress meetings are set up to go over lesson plans and make sure consistency is maintained with regards to what each class is receiving from the program implementation. Additionally, during these meetings any issues or problems identified through the student focus groups will be discussed. The teachers have access to a troubleshooting manual to help in dealing with any implementation issues or problems.

Reflection.

The second strategy that would be suitable for the 10th graders at Chamblee High School is the enhanced school-base physical education. This strategy involves curricular or practice-based changes that increase the amount of time that K-12 students engage in moderate-or-vigorous-intensity physical activity during physical education classes. Enhanced school-based physical education includes instructional strategies and lessons that increase physical activity such as substituting less active games with more active games. Additionally, the strategy includes physical education lessons plans that incorporate fitness and circuit training activities. This program requires a well-designed physical education curriculum to be developed and implemented, as well as providing teachers with appropriate training. This strategy also provides an opportunity to combine with other school and community based interventions such as activities that foster family involvement, and community partnerships to increase opportunities for physical activity.

This strategy would work for my target population because the curriculum sets time for actual physical activity participation. These activities are usually of moderate-or-vigorous intensity such as aerobic fitness, running, jump rope, and obstacle courses. The teachers are trained to safely demonstrate these activities. The activities are usually done in the last 10-20 minutes of the classes. Additionally, this strategy offers the opportunity to combine programs with other schools or community organizations. Teachers can set up lessons where they combine students from neighboring schools to participate in physical activity games. Students can also get an opportunity to involve family in physical activity by participating in community events centered on physical activity. The strategy focuses on getting the students to normalize physical activity within their social circles at school and at home.

Setting time to participate in physical activity teaches the students the necessary skills to perform the behavior. Teaching students the skills helps in building their self-efficacy to participate in physical activity. Consequently, changing the environment in schools and at home to encourage physical activity is very important. Students need the equipment and spaces to perform activities, which this strategy requires in order to be properly implemented. Lastly, programs that use this strategy can be as long as 130 weeks. This means that the program is able to run for a little more than a year. This provides adequate time for students to develop physical activity behaviors and continue engaging in those behaviors in attempt to make it a norm for them. These factors make enhanced school-based physical education a great option for the 10th graders at Chamblee High School.

In the future I can use the community guide to help me review evidence-based findings on a different public health topic. The community guide can help me gather information on interventions that have been recommended for prevention of obesity in adults. The community guide also includes strategies that can be used in other settings such as healthcare system, public laws, and workplace. The information would be specific to a setting and population to better help me narrow down my strategy of choice. I like the fact that the community guide applies the scientific process to reduce bias in how the conclusions are reached, improve the power and precision of results, analyze generalizability findings, and identify knowledge gaps and need for additional research. This makes me confident in the information I will find under the community guide topics. On the other hand, I did not like the fact that I could not easily find the original studies included in the systematic reviews. I was only able to find one or two at most. I think it would very helpful to have a link that connects the findings to the original studies for people who want to look at them. Being able to see the original studies can help with finding out how the individual programs were implemented in the different populations.

The Nutrition Education Library conducts systematic reviews to answer important diet-related questions. I love the fact that the reviews project the answers in a clearly formulated question. I can go to the exact review that would be able to answer my questions. I however did not like how the reviews are not categorized into other age groups other than infants. It would be helpful to have reviews grouped into different age groups such as adolescents, adults or older adults so that one can know which systematic reviews to look at.

 

Reference:

Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory: Prentice-Hall, Inc.

Center for Disease Control and Prevention. (2015). Physical Activity Facts.   Retrieved from http://www.cdc.gov/healthyschools/physicalactivity/facts.htm

Center for Disease Control and Prevention. (2015a). Georgia state nutrition, physical activity, and obesity profile.

Center for Disease Control and Prevention. (2015b). Childhood obesity facts.

Center for Disease Control and Prevention. (2015c). DeKalb County, GA 2015 and United States 2015 results.   Retrieved from https://nccd.cdc.gov/youthonline/App/Results.aspx?TT=G&OUT=0&SID=HS&QID=QQ&LID=DKC&YID=2015&LID2=XX&YID2=2015&COL=T&ROW1=N&ROW2=N&HT=QQ&LCT=LL&FS=S1&FR=R1&FG=G1&FSL=S1&FRL=R1&FGL=G1&PV=&TST=True&C1=DKC2015&C2=XX2015&QP=G&DP=1&VA=CI&CS=N&SYID=&EYID=&SC=DEFAULT&SO=ASC&PF=1

Davis, S. M., Lambert, L. C., Gomez, Y., & Skipper, B. (1995). Southwest Cardiovascular Curriculum Project: Study Findings for American Indian Elementary Students. Journal of Health Education, 26(sup2), S72-S81. doi:10.1080/10556699.1995.10603152

Gortmaker, S. L., Cheung, L. W., Peterson, K. E., Chomitz, G., Cradle, J. H., Dart, H., . . . Laird, N. (1999). Impact of a school-based interdisciplinary intervention on diet and physical activity among urban primary school children: eat well and keep moving. Archives of Pediatrics & Adolescent Medicine, 153(9), 975-983.

Gray, H. L., Contento, I. R., & Koch, P. A. (2015). Linking implementation process to intervention outcomes in a middle school obesity prevention curriculum, ‘Choice, Control and Change’. Health Education Research, 30(2), 248-261. doi:10.1093/her/cyv005

Nyberg, G., Norman, Å., Sundblom, E., Zeebari, Z., & Elinder, L. S. (2016). Effectiveness of a universal parental support programme to promote health behaviours and prevent overweight and obesity in 6-year-old children in disadvantaged areas, the Healthy School Start Study II, a cluster-randomised controlled trial. The International Journal Of Behavioral Nutrition And Physical Activity, 13, 4-4. doi:10.1186/s12966-016-0327-4

Office of Disease Prevention and Health Promotion. (2016). Physical activity guidelines: Children and adolescents.   Retrieved from https://health.gov/paguidelines/guidelines/children.aspx

Task Force on Community Preventive Services. (2002). Recommendations to increase physical activites in communities. . Americal Journal of Prevention Medicine.

The Georgia Department of Public Health. (2012). Obesity in high school students.   Retrieved from https://dph.georgia.gov/sites/dph.georgia.gov/files/related_files/site_page/2011 High School Obesity Data Summary.pdf