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Naomi Kulp Mirowitz MPH Project Spring, 2006

Examining educators’ behaviors and attitudes toward school childhood obesity-related policies and practices. Naomi Kulp Mirowitz MPH Project Spring, 2006. Introduction.

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Naomi Kulp Mirowitz MPH Project Spring, 2006

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  1. Examining educators’ behaviors and attitudes toward school childhood obesity-related policies and practices Naomi Kulp Mirowitz MPH Project Spring, 2006

  2. Introduction • 17.1% of children and adolescents were overweight and 33.6% of children and adolescents were at risk of overweight or overweight in 2003-2004 • Trend tests showed that children and adolescents who were overweight or at risk of overweight increased from 28.2% in 1999-2000 to 33.6% in 2003-2004(Ogden et al., 2006)

  3. School system • 54.6 million children were enrolled in public and private schools in the U.S. in 2002 (U.S. Department of Education, 2005) • Some children interact with teachers just as much as they do with parents

  4. Purpose of the MPH Project To explore the possibility of conducting a nationally representative survey on middle school educators’ and administrators’ personal behaviors and attitudes towards health promotion policies and practices related to childhood obesity, specifically nutrition and physical activity

  5. Background informationNutrition • Two factors adding to the increase of childhood obesity are improper food intake and a lack of physical activity(Koplan et al. 2005) • As of 1994-96, 1998 children were not consuming the proper amount of food, beverages, and nutrients • Amounts of discretionary fat and sugar and beverages other than milk increased • Recommended amounts of dairy, meat and meat alternatives, fruits, and vegetables were not met (Enns, Mickle, & Goldman, 2002)

  6. Background informationPhysical activity • “Any bodily movement produced by skeletal muscles that results in energy expenditure” (Caspersen et al., 1985 as cited in Koplan et al., 2005, p. 98) • 61.5% of children were not participating in any organized physical activity during nonschool hours • 22.6% of children did not engage in free-time physical activity • 38.5% of children participated in an organized sport

  7. Healthy People 2010Objective 7-2 • 7-2: Increase the proportion of middle, junior high, and senior high schools that provide school health education to prevent health problems in the following areas: unintentional injury; violence; suicide; tobacco use and addiction; alcohol and other drug use; unintended pregnancy, HIV/AIDS, and STD infection; unhealthy dietary patterns; inadequate physical activity; and environmental health

  8. Healthy People 2010Objective 19-15 • 19-15: (Developmental) Increase the proportion of children and adolescents aged 6 to 19 years whose intake of meals and snacks at school contributes to good overall dietary quality

  9. Healthy People 2010Objectives 22-8, 22-9, & 22-10 • 22-8: Increase the proportion of the Nation's public and private schools that require daily physical education for all students • 22-9: Increase the proportion of adolescents who participate in daily school physical education • 22-10: Increase the proportion of adolescents who spend at least 50 percent of school physical education class time being physically active (US Department of Health and Human Services, 2000)

  10. Nutrition provided in school • Public Law 103-448, the Healthy Meals for Healthy Americans Act • National School Lunch Program (NSLP) and School Breakfast Program (SBP) must meet the Dietary Guidelines for Americans and other criteria(Wechsler et al., 2001; USDA SBP, 2005; & USDA NSLP, 2005) • 88%-NSLP & 64%-SBP (Cullen & Zakeri, 2004; SHPPS, 2000) • 60% children ate NSLP meals & 37% of children ate SBP meals (Story et al., 2006)

  11. Nutrition provided in school (cont’d) • Competitive foods • Foods of minimal nutritional value • When prohibited? • All other foods (USDA, 2001 & Story et al., 2006) • Vending machine or school store (using SHPPS 2000 data) • 74% of middle/junior high schools provided access • 84% sold soft drinks, sports drinks, and fruit drinks (SHPPS, 2000)

  12. Nutrition education in school • “School based nutrition-education can improve the eating behaviors of young persons” (CDC, 1996, p. 8) • Average of 5 hours per year was dedicated to teaching nutrition and dietary behavior in the classroom • 75% of nutrition and dietary behavior taught in health education courses and 50.8% taught in infused courses(Kann et al., 2001)

  13. Physical education in school • 85.7% of states, 84.6% of districts, and 32.2% of schools required physical education in middle/junior high school • Of the schools that required physical education, 6.4% provided it daily in middle/junior high schools • Students spent an average of 15.3 minutes partaking in games, sports, and dance(Burgeson et al., 2001)

  14. Components of the MPH Project • Literature review • In-depth interviews with school health experts

  15. Literature review • Focused on research that had been conducted on examining middle school educators’ personal behaviors and attitudes toward school policies and programs related to childhood obesity • Also examined research done in other health promotion areas, specifically reproductive health and tobacco smoke

  16. Literature review tasks and lessons learned Task #1: Scan literature for relevant articles -Library databases scanned: -University of Maryland and the National Institutes of Health -Reference lists of relevant articles scanned -Sample key term entry: Food OR beverage AND school AND food service -EndNote 9 used as reference manager -Lessons learned: most useful way to search for articles was through ERIC, PsychInfo, and other articles’ reference lists

  17. Literature review tasks and lessons learned cont’d Task #2: Review literature -Articles highlighted and notes taken -Outline finalized -Lessons learned: 1. Select few researchers that were cited in the majority of the articles read on each different topic; 2. Collect articles in advance; and 3. Abstracts were useful.

  18. Literature review tasks and lessons learned cont’d Task #3: Write the literature review -Summarize literature found -Lesson learned was that the task was best accomplished by writing one section at a time Task #4: Seek advisement and feedback -MPH Project Committee members asked to review literature review and provide feedback -Lesson learned was that it was beneficial to allot extra time for editing and making recommended changes

  19. In-depth interviewswith school health experts The purpose of conducting the study was to gather the perceptions of school health promotion experts regarding teachers’ and administrators’ personal behaviors and attitudes towards school health promotion policies and practices related to childhood obesity, specifically nutrition and physical activity

  20. In-depth Interviewstasks and lessons learned Task #1: Develop interview guide -11 open-ended questions -Developed by Naomi Kulp Mirowitz, Dr. Nancy L. Atkinson, and Dr. Robert S. Gold -Telephone or in-person interview, 30 min -Two lessons learned was that there are many different ways to ask a question and that bias needs to be minimized

  21. In-depth Interviewstasks and lessons learned cont’d Task #2: Submit application to the University of Maryland IRB -Application submitted March 1, 2006 and approved March 24, 2006 -Waiver of consent -Audio-tape -Interviewees’ names -A lesson learned surrounded informed consent and process of asking for consent to be waived

  22. In-depth Interviewstasks and lessons learned cont’d Task #3: Recruit and conduct interviewsThe participants met at least one of the following criteria:1. Currently hold or previously held a key position at a prominent professional association such as the American Public Health Association, Society for Public Health Education, or American School Health Association 2. Have received 1 or more awards on initiatives on school childhood obesity-related policies or practices 3. Served as an advisory member for the Journal of School Health or related professional journals

  23. In-depth InterviewsTask #3 cont’d 4. Conducted significant research in the field of school policies or practices related to childhood obesity 5. Received major funding from an institution such as the National Institutes of Health or the Centers for Disease Control and Prevention for research in the area of school childhood obesity-related policies or practices -Twelve experts invited to participate via an email invitational letter.

  24. Glen G. Gilbert, PhDDean,East Carolina UniversityThe College of Health & Human Performance Larry Olsen, MPH, DrPH, CHESProfessor and Associate Dean, New Mexico State UniversityDepartment of Health Science Margarita S. Treuth, PhDAssociate Professor,Johns Hopkins UniversityBloomberg School of Public Health Karen Weber Cullen, DrPH, RD, LDAssociate Professor of Pediatrics,Baylor College of MedicineChildren's Nutrition Research Center Susan Wooley, PhD, CHES, FAAHE, FASHAExecutive Director, American School Health Association In-depth InterviewsTask #3 cont’d

  25. In-depth InterviewsTask #3 cont’d • Format of the interviews was conversational • Couple of questions that needed clarification • Lessons learned: Audio-taping and question wording

  26. In-depth Interviewstasks and lessons learned Task #4: Analyze data collected -Theme and code -Explore qualitative analysis resources -An Expanded Sourcebook: Qualitative Data Analysis (Miles and Huberman, 1994)

  27. In-depth Interviewstasks and lessons learned Task #5: Summary Included: -Interviews in aggregate to protect interviewee identity -Strengths and weaknesses found -Limitations of the in-depth interviews -Background section omitted -First time conducted a qualitative analysis

  28. In-depth Interviewstasks and lessons learned Task #6: Seek advisement and feedback -MPH Project Committee members asked to review in-depth interview and provide feedback

  29. ConclusionsMiddle school level • Adolescent development changes • Biological • Psychological • Social-emotional (Roeser, Eccles, & Sameroff, 2000) • More food choice options • Physical activity levels decrease, especially for girls(Koplan et al., 2005)

  30. ConclusionsNeed for research • Gap in the research • Majority concentration on health education and physical education teachers • Wealth of literature on modeling, personal behaviors and attitudes • Not as much on general education teachers and administrators • Additional health promotion topics (reproductive health and tobacco smoke) • Positive response to justifiability for needed research from interviewees

  31. ConclusionsSuggestions for modification • In-depth interviews: • Increased time • Pilot test survey • More interviewees • Interview target audience, per suggestion of interviewees • Literature review: • Examine if there are any current or past programs professional associations and teacher’s unions sponsor to promote healthy living • Examples: American Association for Health Education or American Federation of Teachers

  32. Thank youDr. Atkinson and Dr. Gold!

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