College-based Physical Education and Health Education

Part 1: Needs Assessment

• Describe in detail the population and setting with which you will work. Identify the public health problem. Use surveillance data to support the needs of the community. As appropriate, discuss the health disparities of your target community. (20 points)
• What stakeholders may be needed along the way? Describe the role of each stakeholder, and the questions they may want answered about the intervention. Also briefly describe how a successful intervention would impact that stakeholder, and how an unsuccessful program might impact that stakeholder. Stakeholders may be individuals, groups, or organizations. (20 points)

The program will be working with college students at University of Georgia. At a school this size, there is both a large amount of students to work with, and a wide course offering variety. Throughout high school, only 27% of students report getting moderate intensity physical activity. This number drops to 25% as adults, with 29% reporting to do no leisure time physical activity at all (CDC, 2001). Currently, there are no studies showing recommended studies showing the efficacy of college-based physical education and health education. Our goal is to turn current insufficient evidence in to recommended evidence for the target population of college students. This is one such disparity that needs to be fixed in order for us to be able to provide beneficial services to the college population.

As of 2008, 35% of adults over the age of 20 were overweight, with 10% of men and 14% of women classified as obese. Both obesity values were about doubled what they were from 1980, which shows a rapid increase in such a short time. Additionally, 2.8 million people annually have deaths caused from being overweight or obese. Furthermore, the prevalence of obesity increases based on higher socioeconomic status, as the upper middle income status has three times the obesity status of lower income status (WHO 2008). The upper middle income socioeconomic class is a great target group because they now make up about 30% of the population (Zumbrun, 2016), and based on income will very likely be attending college. College is a great time to target physical education because young adults are forming their lifelong habits. Based on the current obesity and physical activity statistics, many college students need physical activity incorporated into their lifestyles.

Previously, project GRAD taught behavioral change skills in lectures, but those showed no significant effects in men although they showed the desired effect in women (Sallis, 1999). At follow up with project GRAD, the only significant effects remaining were experiential and behavioral processes for women. Although data was initially collected on 321 out of the 338 students, the lack of long term effects from this intervention show a need for different studies (Calfas, 2000). With 35,197 students, the University of Georgia provides a great population to attempt an initiative on college based physical education and health education (Forbes, 2016).

Stakeholder	Role in Intervention	Questions from Stakeholder	Effect on Stakeholder of a Successful Program	Effect on Stakeholder of an Unsuccessful Program
College Student	Participating in PE courses, and improving health.	Why should I participate? How does this benefit me? How long is the study, and is there any follow up?	Healthier lifestyle. Increased physical activity, and want for physical activity. Decreased risk for health problems and risk factors. Enjoyment of physical activity. Improved mood. Better participation in classes.	No increase in physical activity. No increase or even potential decrease in health. Wasted time.
Student’s Parents	Encouraging their kids to want to participate in both mandatory and optional PE courses. Being role models who partake in regular physical activity to show benefits of it to their kids.	What behavioral changes are expected? What is the cost? Is there any downside to this program?	Improved wellness for their children. Better lifestyle for children and parents. Improved relationships with children.	Disappointment that children see no benefits. Potential decrease in healthy activities for parents.
School Faculty/Staff	Running classes for PE and health education. Main source of organization and implementation of intervention.	Why should we focus on this? Will this take away from our main/current foci? How will we be implementing this program?	Joy seeing students of theirs succeeding. Wanting and going out of the way to find more programs that work, and implementing them. Better classroom results. Better focus in class.	Wasted time. No benefit for faculty/staff. Loss of time to be used on important work. Resentment to help with future initiatives.
School Board	Lead decision makers on if there can/will be an intervention program in their school. Major source of funding and potential funding for an intervention.	Why do we want this in our school? Is there any value gained for our school through running this (is it worth the time and money)? Will this take away from our other programs? Is there enough benefit for this to become a long term program if it goes well initially? How will we be involved in seeing this through? Is this feasible?	Increased health at the campus. Increased student enrollment and satisfaction at school. Increased funding/donations coming from graduates/future graduates.	Wasted time. Provides less credibility for future intervention ideas. Unwillingness to attempt future programs.

Part 2: Intervention Identification

• State and define the intervention strategy – what does it mean? What populations has this strategy been used with? What settings has it been used in? How are your community characteristics similar or different to those of the communities in which the strategy has been effective? (20 points)
• Is the strategy recommended by the Task Force? Why or why not? (10 points)
• Provide at least 3 examples from existing articles (peer-reviewed preferably, but could come from other places). These should be different than the research-tested intervention programs(RTIP) listed already. You can include or link to this information, but you should provide different examples. (45 points total)
  1. Describe the intervention – what did the authors do? What was the procedure? How long was the intervention? Please describe individual components as well as the broader intervention plan.
  2. What were the outcomes measured?
  3. What amount of change did they find?

My intervention strategy is for College-Based Physical Education and Health Education. The aim for this intervention is providing college students the necessary skills and strategy to develop into healthy adults with good activity based habits. Although any age level can have a school based Physical and Health Education, this intervention is specific to college. The main goal of this intervention is physical and health education and awareness, and the ability to use the knowledge gained to effectively combat obesity. Unfortunately, this strategy has not been used much or effectively. I have chosen the University of Georgia as my campus for my strategy. I believe a big school like UGA is ideal for finding a good sized population to learn about Physical and Health Education in college students.

Project GRAD is the original college based PE program from right before the turn of the century. This is the main study looked at by the task force to date. Between Project GRAD, and it’s follow up study, the task force found insufficient evidence to prove the efficacy of a college based intervention.  The reasons for insufficient evidence were that the follow up showed a return to baseline level activity, and that there were not enough studies that were done in the same way to find an effective intervention pattern for this demographic.

While Project GRAD is the only study shown from the Community Guide, there are a few other studies that we can look at as well.

• Preventing Weight Gain in First Year College Students: An Online Intervention to Prevent the “Freshman Fifteen”

This intervention used four different groups to divide 170 freshmen between. The groups were control, 6 week online-intervention, 6 week weight and caloric feedback via email, and 6 week feedback and intervention combination. The main goal of the program was to see no BMI change or a drop in it rather than the typical gain from entering college. Another goal was improved eating and weight related opinions and actions. Like UGA is, this was done at a “large southeast university.” This intervention was initially intended to last 3 months when including time for follow up.

This program used online based programming as its main mode of intervening. Between both knowledge learned from being online, and emails for feedback, this program was run entirely online to help students adapt to college. The feedback only group weighed in once per week, and would email their feedback supervisor with their weight after each weigh in. The intervention group used online group activities, self-assessments, and experiential activities to help them build awareness to their eating habits and surroundings. Lastly, the feedback and intervention group used what both of those groups did.

Many measures used for accountability were used including:

• International Physical Activity Questionnaire
• Binge Eating Scale
• Block Food Screener
• Body Rating Scale
• Three Factor Eating Scale
• Eating Behaviors Questionnaire
• Eating Disorder Inventory
• Eating Disorder Screening Questions
• Smoking Items
• Demographic Questionnaire
• Anthropometric Measures

As shown, these were used to help measure health in many ways for the participants. The control and dual intervention and feedback group were the two groups with the highest retention rates. The only group with a significant lowering of BMI compared to control was the combined feedback and information group. The overall three month follow up was unsuccessful as not enough people completed that after finishing the original intervention.

• Prevention of weight gain in young adults through a seminar-based intervention program

This was a randomized control trial that lasted for two years. It studied 115 non-obese (BMI 18-30) first and second year students at college. Using anthropometric measurements (BMI, Body Fat %), physical activity level, fitness level (VO2), food intake, and lipid levels the study measured their outcomes. The group was split between intervention and control groups. The intervention group attended seminars every other week for the first two months of school, and every month after that for the remaining time of the two year duration. This came out to 23 almost hour long seminars attended. The initial three seminars provided health based knowledge promotion while the final 20 aimed to produce a behavior change.

While the control group gained weight over the two year period, the intervention group lost weight. This progressed more so during the follow up period as well. However significance here was minimal as the BMI had a 0.01 p score, and overall weight 0.06 p score. Overall, the study showed very similar results for both groups throughout its testing. Cholesterol change was not significant with a 0.06 p score. There was a correlation between weight gain and VO2 max, and lower activity level correlated with weight gain.

As a whole, this study showed that a social cognitive theory based intervention using small groups can effectively work to stop new college students from gaining weight. Although this looked at students in a healthcare based field, those in the control group gained weight similar to any incoming college student.

• Monitoring weight daily blocks the freshman weight gain: a model for combating the epidemic of obesity

This study used Tissue Monitoring System involving daily weigh-ins to monitor weight status over the first 12 weeks of college life. This study recruited 34 females 18-21 years old in their second week of school. The participants were randomly placed in control or intervention groups. Participants were told to eat three meals daily without snacks.

Those in the intervention group received a scale to weigh in daily, and then email them to the study staff. Six participants did not finish the study. The control group gained about 3.1 kg while the intervention group had about 0 kg change in weight. The difference provided a 0.001 p score that indicated high significance levels.

Another study for this measured 41 freshman females. 9 of the participants did not finish the study. The intervention group received daily instruction on caloric intake whereas the control group was not contacted until the end of the study. The control group gained 2 kg, and the intervention group lost 0.82 kg. The p score for difference in weight change was 0.01 indicating significance in this study.

While I believe daily weighing is excessive, and can lead to self-efficacy problems, it was shown to promote weight loss in these studies.

Part 3: Intervention Fit

• Provide a logic model and SMART Objectives for your intervention. You should have a SMART objective for each behavior you anticipate changing. (35 points; 10 points for SMART objectives, 25 points for the logic model)

Inputs/Resources	Activities	Outputs	Short-term Outcomes	Intermediate Outcomes	Long-term Outcomes
UGA Media UGA Faculty College Newsletters Fliers Course Curriculum	Formal classroom education with both lectures and lab like activities Radio and TV commercials Friend support and education Train faculty in providing formal education	Biweekly hour long class for fall and spring semester Monthly newsletter Bimonthly educational flier Rotation of 10 radio and 10 TV commercials to play throughout both semesters	Increased knowledge of health activities Better awareness of how to eat well Better understanding of quality body weight (BMI and Body Fat %) Better understanding of effects of alcohol	Increased physical activity and decreased sedentary time Decreased consumption of alcohol and unhealthy foods Increased consumption of nutrient dense foods (vegetables) and quality foods	Improved BMI, and Body Fat % Improved aerobic and anaerobic fitness levels High quality of eating Having friend or family time revolve around healthy activities

SMART Objectives:

Have half of the class students see a drop in BMI and/or Body Fat % that brings them down a level (obese to overweight for example) if they need to lose weight by the end of the class.

Increase consumption of vegetables to at least 3/4 of the daily recommendation by the end of the class.

Throughout follow-up, see at least 50% of students maintain benefits (BMI, Body Fat %, food consumption for example) that they improved during the intervention.

Have 65% of students at at least 40 or higher VO2, 50% at 45 or higher, 35% at 50 or higher, and 20% at 55 or higher by the end of the class.

Have all of the class meeting the ACSM activity guidelines (150 minutes moderate-vigorous physical activity) at the end of the intervention.

• Explain the logic of why this intervention may work. For example, why would teaching children about healthy eating change their actual eating behaviors? Or why would adding sidewalks increase physical activity for transportation or recreation? (15 points)
  1. Think about the “Field of Dreams” problem – if you offer the intervention, will it actually change behavior?
• Discuss limitations of the selected strategy, and things to look out for/be mindful of along the way. Examples may be limitations of resources, community capacity, or anticipated effect of the intervention. (15 points)
• What data would you collect to know if you are implementing the strategy the way it was intended (process evaluation/implementation monitoring)? Refer back to your logic model and the Logic Model module as needed. Be sure to cover dose, reach, fidelity, and implementation. (40 points)

I believe this intervention can work because it is offered at a time when kids determine what they want their future to be. While college kids are not the most easily moldable people, they are at a time where they have to decide what their adult life will be like. Because of this, a college course revolving on making good health decisions would be an ideal offering at a college level. I believe that having a college credited class is a way to offer extra incentive for students to participate. Additionally having media, and other outreaches like fliers are easy ways to provide knowledge to those not in the class. It is also a way to give a small extra reminder to those in the class in case they like the novelty of non class based items. Being hands on and focusing on both lectures and activities in the class setting is the best way to teach a student to become self-sufficient as he or she grows into adult life. I do think this intervention has a strong chance for success.

Limitations:

I think the main limitation is feasibility. When done at the university this can work; however, when students are gone and doing this on their own it may not work. Because resources are provided at school, and there is more free time there than in the real world, drop-off could occur once the class ends. Furthermore, if this can be done as a course, it would have to be a one credit class, and would probably require a tuition waiver, as an intervention should not require cost. Additionally, tuition waivers may make teachers and assistants not want to teach this class, which would be detrimental to all success. With a smaller class, this may only impact the few who take it, and that could cause this program to be questioned for the future.

Data:

The first piece of data to collect would be attendance. Simply knowing whether or not those who signed up, show up is the first step. If people are not showing up then we have a big problem to address. Lessons will be tracked based on knowledge provided, as time and dates are predetermined based on class schedule. At the end of all courses, an exam will be taken to see what was learned. The goal for both attendance, and exam scoring is 80%. While 80% is high for attendance, the hope is that a course that can go toward credit would help encourage extra participation compared to most interventions. Because it is an intervention, prior to participation waiver would be signed. With this, we can measure BMI and Body Fat % at implementation, end of class, and follow-up. Additionally, questionnaires will be used to measure leisure time, and physical activity. Seeing the difference in these at implementation all the way through to follow-up will be key in understanding just how well this intervention worked. Even if BMI and Body Fat % do not change too much for some people, just seeing their activity and attitude shift is still a win. As this class would be offered to students of all grades in college, follow-up would be once yearly to see their progress while still in school, and after school for a five year period. Barring students going through a Masters, and/or Doctoral program, this should show how effective the intervention is both during and after school. Hopefully, a smaller class has the ability to reach it students in a high impact manner, and they can bring this to their friends and family. Extra marketing like fliers and commercials would hopefully help promote the class, and reach those who are not in it.

Extra Data: (Revisions)

To measure if lessons are going according to plan, surveys will go out to students in order to see what was covered. These will both ask in an open-ended manner what was taught, and in a compare-contrast manner compared to what the original plan was. There will also be a survey sent to teachers to see how well they believe they taught the class compared to how the plan was originally given to them.

At the end of the course, there will also be a survey to see how much impact was created. In doing so, we will know for sure what students were involved in the intervention by finding out their activity levels before, during, and after the intervention. This tells if they were active, or needed the intervention, and if the intervention worked both during and after its completion.

Based on overall data collected, we will then have a 1-10 scale with explanation to assess how well the implementation went. The higher the score, the better the intervention. No matter what, there will be a way to improve it, but a score below 3 says that a different intervention should be planned instead.

Part 4: Reflection

• Oftentimes when working with communities, the initial plan is not what ultimately happens. What would your second choice strategy be for your identified behavior and community? Why would you choose this strategy? In other words, in what ways would this strategy also address the needs of the community based on your assessment for Part 1? (25 points)
• Reflect on how you may use the Community Guide, Nutrition Education Library, and other resources in the future. What did you like about these resources? What didn’t you like? Provide suggestions on how you would make the sites easier for practitioners to use. (20 points)

My backup strategy would be to make a club instead of a class oriented program. This provides a more informal manner that might appeal to college students better than a true formal setting. This will also allow for peer programming throughout and feel like it is coming straight from people who are of the same profile. College students tend to prefer to collaborate with each other, so this might lead to the ideal solution for an intervention. Additionally, this allows new students to familiarize with school, and opportunities that they would have otherwise been unfamiliar with if not for joining a physical activity club. The title of this intervention would be Physical Activity Club.

For me, the Community Guide will be a resource I check periodically to see if there are interventions occurring that work in the classroom for both high school and college. I find it to be a very simple page to navigate, and find what you are looking for, so I do not have suggestions to improve this site. Personally, the physical activity and active living sites pertain most to my future plans. These places show where physical activity has been effective in terms of intervention strategies, and will help me make plans when working in schools. I am a big fan of having easy access to this, which is provided on both sites. My main dislike is that there is not enough information out there yet on all physical activity interventions for high school and college aged students.

As a practitioner, I feel like these websites are well equipped to handle professionals in the field, and those who just want to learn for the sake of learning. I do wish there were more studies, but those are sure to come with time.