Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-30 (of 32 Records) |
Query Trace: Lee SM[original query] |
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Dietary and physical activity behaviors among high school students - Youth Risk Behavior Survey, United States, 2019
Merlo CL , Jones SE , Michael SL , Chen TJ , Sliwa SA , Lee SH , Brener ND , Lee SM , Park S . MMWR Suppl 2020 69 (1) 64-76 Establishing healthy dietary and physical activity patterns among youths is an important public health strategy for improving health and preventing chronic diseases; however, few adolescents meet U.S. government recommendations for dietary or physical activity behaviors, and disparities by sex and race/ethnicity exist. CDC analyzed data from the 2019 Youth Risk Behavior Survey to update estimates of dietary and physical activity behaviors among U.S. high school students overall and by sex and race/ethnicity. In addition, 2-year comparisons (2017 and 2019) and trends in prevalence of these behaviors during 2009-2019 were examined. In 2019, overall, during the 7 days before the survey, 41.8% of students had eaten fruit or drunk 100% fruit juices <1 time/day; 40.7% had eaten vegetables <1 time/day; and 16.7% had not eaten breakfast on all 7 days. Moreover, although 57.4% of students had played on ≥1 sports team during the 12 months before the survey, less than half of students had been physically active for ≥60 minutes/day on all 7 days (23.2%), had exercised to strengthen or tone their muscles on ≥3 days/week (49.5%), had met both aerobic and muscle-strengthening physical activity guidelines (16.5%), or had attended physical education classes on all 5 days in an average school week (25.9%). Trend data indicate limited progress in shifting dietary and physical activity behaviors. That is, with the exception of decreases in the percentage of students who had consumed soda ≥1 time/day (2009: 29.2%; 2019: 15.1%), sports drinks ≥1 time/day (2015: 13.8%; 2019: 10.6%), and <3 glasses/day of plain water (2015: 50.5%; 2019: 44.6%), high school students' dietary and physical activity behaviors have not improved and, in certain cases, have worsened. These findings support the need for multicomponent approaches, including policy and environmental changes, and opportunities for adolescents to learn about and practice making healthy choices. |
Dietary and physical activity behaviors in 2021 and changes from 2019 to 2021 among high school students - Youth Risk Behavior Survey, United States, 2021
Michael SL , Jones SE , Merlo CL , Sliwa SA , Lee SM , Cornett K , Brener ND , Chen TJ , Ashley CL , Park S . MMWR Suppl 2023 72 (1) 75-83 The fall of 2021 was the first school semester to begin with widespread in-person learning since the COVID-19 pandemic began. Understanding dietary and physical activity behaviors of adolescents during this time can provide insight into potential health equity gaps and programmatic needs in schools and communities. This report uses data from the 2021 national Youth Risk Behavior Survey conducted among a nationally representative sample of U.S. public and private school students in grades 9-12 to update estimates of dietary and physical activity behaviors among U.S. high school students overall and by sex and race and ethnicity. In addition, 2-year comparisons (2019 versus 2021) of these behaviors were examined. In 2021, daily consumption of fruits, vegetables, and breakfast during the past 7 days remained low and decreased overall with specific disparities by sex and race and ethnicity from 2019 to 2021. The overall prevalence of students attending physical education classes daily, exercising to strengthen muscles on ≥3 days/week (i.e., met the guideline for muscle-strengthening activity), and playing on at least one sports team decreased from 2019 to 2021; whereas being physically active for ≥60 minutes/day on all 7 days (i.e., met the guideline for aerobic activity) and meeting both aerobic and muscle-strengthening guidelines remained low but did not change. These findings underscore the need for strategies to increase healthy dietary and physical activity behaviors both in the recovery phase of COVID-19 and longer term. |
Transforming evidence into action: A commentary on school-based physical activity and nutrition intervention research
Lee SM , Harwell OR , Sliwa SA , Hawkins GT , Michael S , Merlo C , Pitt Barnes S , Chung CS , Cornett K , Hunt H . J Sch Health 2023 93 (9) 864-870 The Whole School, Whole Community, Whole Child (WSCC) framework advances an intentional and integrated vision of policies, practices, and programs that support students' health and academic success across 10 components within school settings. WSCC promotes family and community engagement with schools and recognizes schools as key locations for equitable access to services for addressing health disparities and increasing healthy options for all students.1-3 This approach has some formal recognition in the United States; 18 states and the District of Columbia have statutes or regulations addressing WSCC or a coordinated school health approach, and another 17 include these concepts in noncodified policy language, such as nonbinding guidance, agreements, or procedures from state agencies.4 | | This special issue presents a decade of school-based physical activity (PA) and nutrition intervention research conducted across multiple WSCC components. Individually and collectively, these articles identified evidence-based strategies that can be implemented within schools and highlighted opportunities for future research focused on school-based PA and nutrition interventions. Here, we use the terms interventions and strategies interchangeably to describe changes to school policies, practices, or infrastructure. |
Using health education to address student physical activity and nutrition: Evidence and implications to advance practice
Lee SM , Szucs LE , Young E , Fahrenbruch M . J Sch Health 2023 93 (9) 788-798 BACKGROUND: School-based health education can provide students with learning experiences that improve knowledge, attitudes, and perceptions (KAP) and behaviors regarding physical activity and nutrition. METHODS: We conducted a 2-phase systematic review. Phase 1 was a review of reviews (ie, systematic reviews or meta-analyses) that were published 2010-2018. Phase 2 was a search for individual articles published 2010-2020 addressing topics relevant to our review; we searched for articles that had not been part of a sufficiently relevant or recent review or that had been part of a review that concluded that too few articles were available to assert sufficient evidence. RESULTS: Forty-three studies were assessed: 20 randomized controlled trials and 23 quasi-experimental designs. Collectively, interventions had a favorable impact on students' PA and nutrition KAP, but behavioral and secondary outcome results (eg, body mass index) were mixed. CONCLUSIONS: Using the evidence-based health education strategies identified in this review can help contribute to improvements in students' KAP and behaviors. |
A Whole School, Whole Community, Whole Child approach to support student physical activity and nutrition: Introduction/methods
Sliwa SA , Hawkins GT , Lee SM , Hunt H . J Sch Health 2023 93 (9) 750-761 BACKGROUND: We introduce the Whole School, Whole Community, Whole Child approach to supporting student and school staff physical activity and nutrition and describe the methods used to generate the evidence synthesized across the special issue articles. METHODS: A 2-phase literature review search included a search of systematic reviews (2010-2018) for individual qualifying articles (Phase 1) and a search for individual articles on topics not addressed by a review (2010-2020) or that needed an update because they were in a review that was older (2010-2016) or showed insufficient evidence (Phase 2). Research librarians developed search strategies. In each phase, pairs of subject matter experts applied criteria to review abstracts and full-text articles and extracted data using standardized forms. We included 314 articles, describing 293 studies. FINDINGS: Most of the included studies looked at elementary or secondary school level interventions; 51% were rated poor quality, and few took place in a rural setting. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Most of the identified studies engaged majority minority or racially/ethnically diverse schools, suggesting that these interventions are feasible in a variety of settings. CONCLUSIONS: This collection of 10 articles identifies evidence-based interventions, gaps in research, and implications for health equity. |
Out of School Time Providers Innovate to Support School-Aged Children During the COVID-19 Pandemic.
Sliwa SA , Lee SM , Gover LE , Morris DD . Prev Chronic Dis 2022 19 E12 The article “Addressing Racial and Ethnic Disparities in COVID-19 Among School-Aged Children: Are We Doing Enough?” described how a shift to virtual schooling strained learning and disproportionately affected school-aged children from racial and ethnic minority groups (1). The authors identified partnerships between school and community organizations, including out of school time (OST) providers (eg, before school, after school, and summer programming), among strategies to curb inequities in health and education that the COVID-19 pandemic exacerbated (1). In this essay, we reflect on how OST organizations exemplified this approach through their responsiveness to challenges that remote learning presented during school year 2020–2021 and how programs continue to support students’ learning and well-being. © 2022, Preventing Chronic Disease. All Rights Reserved. |
Individual and Collective Positive Health Behaviors and Academic Achievement Among U.S. High School Students, Youth Risk Behavior Survey 2017
Hawkins GT , Lee SH , Michael SL , Merlo CL , Lee SM , King BA , Rasberry CN , Underwood JM . Am J Health Promot 2021 36 (4) 8901171211064496 PURPOSE: We examined associations between academic grades and positive health behaviors, individually and collectively, among U.S. high school students. DESIGN: Cross-sectional study design. SETTING: Data were from the 2017 national Youth Risk Behavior Survey. Response rates were 75% for schools, 81% for students, and 60% overall (n = 14,765 students). SUBJECTS: Youth in grades 9th-12th. MEASURES: We focused on youth behaviors that can prevent or delay the onset of chronic health conditions. Seven dietary, 3 physical activity, 2 sedentary screen time, and 4 tobacco product use behaviors were assessed. Variables were dichotomized (0/1) to indicate that a score was given to the positive health behavior response (e.g.,, did not smoke cigarettes = 1). A composite score was created by summing each positive health behavior response among 16 total health behaviors. ANALYSIS: Multivariable logistic regression analyses for each individual health behavior, and a multivariable negative binomial regression for the composite score, were conducted with self-reported academic grades, controlling for sex, grade in school, race/ethnicity, and body mass index (BMI) categories. RESULTS: Controlling for covariates, students who reported mostly A's had 2.0 (P < .001) more positive health behaviors; students who reported mostly B's had 1.3 (P < .001) more positive health behaviors; and students who reported mostly C's had .78 (P < .001) more positive health behaviors, compared to students who reported mostly D's/F's. CONCLUSIONS: Higher academic grades are associated with more positive individual and cumulative health behaviors among high school students. Understanding these relationships can help inform efforts to create a healthy and supportive school environment and strive for health equity. |
Surveillance of Meeting the Youth Physical Activity Guideline: Impact of Including Vigorous-Intensity and Bone-Strengthening Activities
Hyde ET , Watson KB , Omura JD , Janz KF , Lee SM , Fulton JE , Carlson SA . Res Q Exerc Sport 2021 93 (4) 1-6 PURPOSE: The US youth physical activity guideline recommends participation in four types of physical activity: moderate-to-vigorous intensity aerobic (MVPA), vigorous-intensity aerobic (VPA), muscle-strengthening, and bone-strengthening physical activity. Current national prevalence estimates of meeting the youth physical activity guideline are typically based on measures of the MVPA and muscle-strengthening components. This study sought to examine differences in prevalence estimates using this current approach and then including measures of all four components. METHODS: Data from US high school student respondents to the 2010 National Youth Physical Activity and Nutrition Survey were analyzed (n = 10,596). Prevalence of students meeting the youth physical activity guideline were assessed and compared using 1) measures of MVPA and muscle-strengthening components only and 2) also including measures of the VPA and bone-strengthening components. RESULTS: Overall, 15.2% students met the MVPA, 50.7% met the muscle-strengthening, 70.6% met the VPA, and 80.7% met the bone-strengthening components. In total, 12.1% (95% confidence interval: 10.9, 13.3) of students met both the MVPA and muscle-strengthening components, and 11.2% (95% confidence interval: 10.0, 12.4) met all four components. CONCLUSIONS: Incorporating additional measures of VPA and bone-strengthening activity into current surveillance systems may not meaningfully impact national estimates of meeting the youth physical activity guideline. |
Disparities in youth sports participation in the U.S., 2017-2018
Hyde ET , Omura JD , Fulton JE , Lee SM , Piercy KL , Carlson SA . Am J Prev Med 2020 59 (5) e207-e210 INTRODUCTION: In 2019, the National Youth Sports Strategy was released and called for regular analysis, interpretation, and dissemination of U.S. youth sports surveillance data. The purpose of this study is to provide the recent national estimates of U.S. youth aged 6-17 years who participate in sports and examine the differences in participation by demographic characteristics, overall and across age groups. METHODS: Nationally representative data on parent-reported youth sports participation from the 2017-2018 National Survey of Children's Health (n=36,779) were analyzed in 2019. The prevalence and 95% CIs of youth sports participation were estimated by demographic characteristics, overall and by age group. Investigators assessed the significant (p<0.05) differences and trends in participation using pairwise t-tests and orthogonal polynomial contrasts and effect modification by age group using logistic regression models. RESULTS: Overall, 57.7% (95% CI=56.6, 58.9) of U.S. youth participated in sports. Participation was highest among youth who were aged 10-13 years, male, and white, non-Hispanic and increased with increasing parent/caregiver education and household income (all p<0.05). Differences in participation by demographic characteristics were more pronounced among younger youth. For example, prevalence by household income level ranged from 32.7% to 79.9% among children aged 6-9 years and from 41.6% to 67.2% among youth aged 14-17 years. CONCLUSIONS: Although nearly 6 in 10 U.S. youth participate in sports, substantial disparities exist, especially among younger children. Identifying and overcoming the barriers may help increase youth sports participation in the U.S. |
Concussion and academic impairment among U.S. high school students
Lowry R , Haarbauer-Krupa JK , Breiding MJ , Thigpen S , Rasberry CN , Lee SM . Am J Prev Med 2019 57 (6) 733-740 Introduction: Sports and physical activities are a frequent cause of traumatic brain injury, primarily concussions, among adolescents. These concussions may adversely affect students’ ability to learn and impair academic achievement in educational settings. Methods: The 2017 Youth Risk Behavior Survey, conducted among a nationally representative sample of 14,765 U.S. high school students, was analyzed in 2018 to examine associations between self-reported sports- and physical activity-related concussions and symptoms of cognitive impairment (difficulty concentrating, remembering, or making decisions) and self-reported academic grades (mostly A's=4.0, mostly B's=3.0, mostly C's=2.0, mostly D's=1.0, mostly F's=0.0). Adjusted prevalence ratio and the difference in self-reported estimated grade point average were adjusted for sex, race/ethnicity, grade, and athlete status (participation on sports teams) and considered statistically significant if p<0.05. Results: Male students were more likely than female students (17.1% vs 13.0%), and athletes were more likely than nonathletes (21.4% vs 7.6%) to have a self-reported sports- and physical activity-related concussion in the 12 months preceding the survey. Students with a reported sports- and physical activity-related concussion were more likely than students without one to report symptoms of cognitive impairment regardless of whether they were male (adjusted prevalence ratio=1.49), female (adjusted prevalence ratio=1.37), athletes (adjusted prevalence ratio=1.45), or nonathletes (adjusted prevalence ratio=1.42). Self-reported grade point averagedecreased significantly from 3.14 among students who reported no concussions (referent), to 3.04 among students who reported a single concussion, and 2.81 among students who reported >/= 2 concussions. Conclusions: School-based programs are needed to monitor students’ academic performance and provide educational support and resources to promote academic success following a concussion. |
Characteristics associated with school health services for the management of chronic health conditions
Tiu GF , Leroy ZC , Lee SM , Maughan ED , Brener ND . J Sch Nurs 2019 37 (5) 1059840519884626 It is unknown how health services staff (school nurse or school physician) or school characteristics are associated with the number of services provided for chronic health conditions in schools. Using data from the 2014 School Health Policies and Practices Study, four services (identification or school-based management, tracking, case management, and referrals) were analyzed using a multivariable ordered logistic regression. Approximately 57.2% of schools provided all four, 17.5% provided three, 10.1% provided two, 5.8% provided one, and 9.4% did not provide any such services. Schools with a school nurse were 51.5% (p < .001) more likely to provide all four, and schools with access to consult with a school physician were 15.4% (p < .05) more likely, compared to schools without one. Schools comprised of mostly racial/ethnic minority students (less than or equal to 50% non-Hispanic White) were 14.7% (p < .05) less likely to provide all four, compared to schools with greater than 50% White students. |
Strategies to improve physical activity surveillance among youth in the United States
Dunton GF , Berrigan D , Young DR , Pfeiffer KA , Lee SM , Slater SJ , Pate RR . J Pediatr 2019 210 226-231 Physical activity has well documented benefits for youth, including improved academic achievement, musculoskeletal health, cardiovascular health, adiposity, blood pressure, and mental health.1–4 However, adherence to physical activity guidelines is low. Only a small portion of American children achieve the recommended 1 hour or more of moderate-to-vigorous physical activity daily.5 National, state, and local programs and policies to promote physical activity in children rely on regular and comprehensive surveillance of physical activity behaviors in youth to assess critical areas of need and evaluate impact of programming. |
Physical education policies in US schools: Differences by school characteristics
Michael SL , Brener N , Lee SM , Clennin M , Pate RR . J Sch Health 2019 89 (6) 494-502 BACKGROUND: We assessed the extent to which schools in the United States implement physical education policies identified in SHAPE America's Essential Components of Physical Education document and how implementation of these policies varies by school characteristics. METHODS: School policy data were collected as part of the 2014 School Health Policies and Practices Study via computer-assisted personal interviews in a nationally representative sample of K-12 schools and were linked to extant data on school characteristics. Bivariate analyses and Poisson regression model were used to examine how physical education policies differed by school characteristics. RESULTS: Five physical education policies varied by region and 3 varied by school level. Requiring certified, licensed, or endorsed physical education teachers varied by all school characteristics except school level and percentage of students eligible for free or reduced-price lunch. The average number of physical education policies implemented by schools was 3.0. The number of policies varied by metropolitan status and school level. CONCLUSIONS: The findings suggest many schools are only implementing a few of the physical education policies that can strengthen their physical education programs. These findings can be used to target professional development and technical assistance for physical education practitioners on policy and implementation. |
Practices that support and sustain health in schools: An analysis of SHPPS data
Lee SM , Miller GF , Brener N , Michael S , Jones SE , Leroy Z , Merlo C , Robin L , Barrios L . J Sch Health 2019 89 (4) 279-299 BACKGROUND: The Whole School, Whole Community, Whole Child (WSCC) model provides an organizing framework for schools to develop and implement school health policies, practices, and programs. The purpose of this study was to examine the presence of practices that support school health for each component of the WSCC model in US schools. METHODS: Data from the School Health Policies and Practices Study 2014 were analyzed to determine the percentage of schools with practices in place that support school health for WSCC components. RESULTS: Less than 27% of schools had a school health council that addressed any specific WSCC component, but more than 50% had a coordinator for all but one component. The use of other practices that support school health varied widely across the WSCC components. For example, more than 80% of schools reported family engagement for health education and nutrition environment and services, but less than 50% reported family engagement for other components. CONCLUSIONS: These results indicate that many US schools are using practices that support school health and align with WSCC components, but improvement is needed. These results also highlight discrepancies in the types of practices being used. |
Do schools that screen for body mass index have recommended safeguards in place
Sliwa SA , Brener ND , Lundeen EA , Lee SM . J Sch Nurs 2018 35 (4) 1059840518758376 The Centers for Disease Control and Prevention recommends that schools adopt 10 safeguards before launching a body mass index (BMI) screening program; however, little is known about schools' safeguard adoption. Authors identified questions from the 2014 School Health Policies and Practices Study that aligned with 4 of the 10 safeguards to estimate safeguard prevalence among schools that screened students for BMI (40.7%, N = 223). Among these schools, 3.1% had all four safeguards and 56.5% had none or one. The most prevalent safeguard was having reliable and accurate equipment (54.1%, 95% confidence interval [CI] = [46.1, 62.1]). Providing staff with appropriate expertise and training was the least prevalent; respondents in 26.4% (95% CI [17.1, 35.6]) of schools received recent training on weight status assessment, weight management, and eating disorder identification. School-based BMI screening is common, but adopting multiple recommended safeguards is not. Absent these safeguards, BMI screening programs may fall short of intended outcomes and potentially incur unintended consequences. |
Health-related behaviors and academic achievement among high school students - United States, 2015
Rasberry CN , Tiu GF , Kann L , McManus T , Michael SL , Merlo CL , Lee SM , Bohm MK , Annor F , Ethier KA . MMWR Morb Mortal Wkly Rep 2017 66 (35) 921-927 Studies have shown links between educational outcomes such as letter grades, test scores, or other measures of academic achievement, and health-related behaviors. However, as reported in a 2013 systematic review, many of these studies have used samples that are not nationally representative, and quite a few studies are now at least 2 decades old (1). To update the relevant data, CDC analyzed results from the 2015 national Youth Risk Behavior Survey (YRBS), a biennial, cross-sectional, school-based survey measuring health-related behaviors among U.S. students in grades 9-12. Analyses assessed relationships between academic achievement (i.e., self-reported letter grades in school) and 30 health-related behaviors (categorized as dietary behaviors, physical activity, sedentary behaviors, substance use, sexual risk behaviors, violence-related behaviors, and suicide-related behaviors) that contribute to leading causes of morbidity and mortality among adolescents in the United States (5). Logistic regression models controlling for sex, race/ethnicity, and grade in school found that students who earned mostly A's, mostly B's, or mostly C's had statistically significantly higher prevalence estimates for most protective health-related behaviors and significantly lower prevalence estimates for most health-related risk behaviors than did students with mostly D's/F's. These findings highlight the link between health-related behaviors and education outcomes, suggesting that education and public health professionals can find their respective education and health improvement goals to be mutually beneficial. Education and public health professionals might benefit from collaborating to achieve both improved education and health outcomes for youths. |
Strategic priorities for physical activity surveillance in the United States
Fulton JE , Carlson SA , Ainsworth BE , Berrigan D , Carlson C , Dorn JM , Heath GW , Kohl HW 3rd , Lee IM , Lee SM , Masse LC , Morrow JR Jr , Gabriel KP , Pivarnik JM , Pronk NP , Rodgers AB , Saelens BE , Sallis JF , Troiano RP , Tudor-Locke C , Wendel A . Med Sci Sports Exerc 2016 48 (10) 2057-69 PURPOSE: Develop strategic priorities to guide future physical activity surveillance in the United States. METHODS: The Centers for Disease Control and Prevention and the American College of Sports Medicine convened a Scientific Roundtable of physical activity and measurement experts. Participants summarized the current state of aerobic physical activity surveillance for adults, focusing on practice and research needs in three areas: 1) behavior, 2) human movement, and 3) community supports. Needs and challenges for each area were identified. At the conclusion of the meeting, experts identified one overarching strategy and five strategic priorities to guide future surveillance. RESULTS: The identified overarching strategy was to develop a national plan for physical activity surveillance similar to the U.S. National Physical Activity Plan for promotion. The purpose of the plan would be to enhance coordination and collaboration within and between sectors, such as transportation and public health, and to address specific strategic priorities identified at the Roundtable. These strategic priorities were: 1) identify and prioritize physical activity constructs, 2) assess the psychometric properties of instruments for physical activity surveillance, 3) provide training and technical assistance for those collecting, analyzing, or interpreting surveillance data, 4) explore accessing data from alternative sources, and 5) improve communication, translation, and dissemination about estimates of physical activity from surveillance systems. CONCLUSION: This Roundtable provided strategic priorities for physical activity surveillance in the United States. A first step is to develop a national plan for physical activity surveillance that would provide an operating framework from which to execute these priorities. |
Physical activities of U.S. high school students - 2010 National Youth Physical Activity and Nutrition Survey
Song M , Carroll DD , Lee SM , Fulton JE . J Phys Act Health 2015 12 Suppl 1 S11-7 BACKGROUND: The 2008 Physical Activity Guidelines recommend youth participate in a variety of physical activities; however, few nationally representative studies describe the types and variety of youth activity. This study assessed the most frequently reported types and variety of activities among U.S. high school students, and examined the association between variety and meeting the 2008 Guidelines for aerobic activity (aerobic guideline). METHODS: We analyzed data on 8628 U.S. high school students in grades 9-12 from the 2010 National Youth Physical Activity and Nutrition Survey. Types of physical activity were assessed by identifying which activities each student reported in the past 7 days. Variety was assessed by the total number of different activities each student reported. Percentage (95% CI) of students who reported engaging in each activity was assessed. Logistic regression was used to examine the association between variety and meeting the aerobic guideline. RESULTS: Walking was the most frequently reported activity among U.S. high school students. On average, students reported participating in 6 different activities. Variety was positively associated with meeting the aerobic guideline. CONCLUSIONS: These findings support encouraging youth to participate in many physical activities and may be useful for developing interventions that focus on the most prevalent activities. |
Active Gaming Among High School Students - United States, 2010
Song M , Carroll DD , Lee SM , Fulton JE . Games Health J 2015 4 (4) 325-31 OBJECTIVES: Our study is the first to describe the prevalence and correlates (demographics, body mass index [BMI], sedentary behaviors, and physical activity) of high school youth who report active videogame playing (active gaming) in a U.S. representative sample. MATERIALS AND METHODS: The National Youth Physical Activity and Nutrition Study of 2010 provided data for this study. Active gaming was assessed as the number of days in the 7 days prior to the survey that students in grades 9-12 (14-18 years of age) reported participating in active videogames (e.g., "Wii Fit" [Nintendo, Kyoto, Japan], "Dance Dance Revolution" [Konami, Osaka, Japan]). Students reporting ≥1 days were classified as active gamers. Logistic regression was used to examine the association among active gaming and demographic characteristics, BMI, sedentary behaviors, and physical activity. RESULTS: Among 9125 U.S. high school students in grades 9-12 surveyed, 39.9 percent (95 percent confidence interval=37.9 percent, 42.0 percent) reported active gaming. Adjusting for covariates, the following characteristics were positively associated (P<0.05) with active gaming: being in 9th and 10th grades compared with being in 12th grade; being of black, non-Hispanic race/ethnicity; being overweight or obese; watching DVDs >0 hours/day; watching TV >0 hours/day; and meeting guidelines for aerobic and muscle-strengthening physical activity. CONCLUSIONS: Four out of 10 U.S. high school students report participating in active gaming. Active gamers tend to spend more time watching DVDs or TV, meet guidelines for physical activity, and/or be overweight or obese compared with nonactive gamers. These findings may serve to provide a baseline to track active gaming in U.S. youth and inform interventions that target sedentary behaviors and/or physical activity. |
Variety, enjoyment, and physical activity participation among high school students
Michael SL , Coffield E , Lee SM , Fulton JE . J Phys Act Health 2015 13 (2) 223-30 BACKGROUND: Federal guidelines state that youth should participate in a variety of physical activity (PA) they find enjoyable. Little is known, however, about how variety and enjoyment are associated with PA participation among adolescents. METHODS: Data came from the 2010 National Youth Physical Activity and Nutrition Survey, a nationally representative survey of adolescents. Path analysis was used to examine the association of a variety of self-reported PA, defined as the number of activities and activity types (i.e., team sports/weightlifting, individual activities, and other competitive/recreational sports), on self-reported PA enjoyment and participation. The analysis also examined whether enjoyment mediates the association between a variety of PA and participation. Separate models were estimated for boys and girls. RESULTS: Number of activities was associated with increased PA enjoyment and participation. For boys and girls, team sports/weightlifting was associated with increased participation, and individual activities were indirectly associated with increased participation through enjoyment. For boys, team sports/weightlifting was indirectly related with participation. CONCLUSIONS: These findings suggest that participation in a variety of PA is associated with increased PA enjoyment and participation. Providing opportunities for adolescents to engage in a variety of activities might help them identify PA they enjoy and facilitate lifelong PA habits. |
Opportunities for public health to increase physical activity among youths
Piercy KL , Dorn JM , Fulton JE , Janz KF , Lee SM , McKinnon RA , Pate RR , Pfeiffer KA , Young DR , Troiano RP , Lavizzo-Mourey R . Am J Public Health 2015 105 (3) e1-e6 Despite the well-known benefits of youths engaging in 60 or more minutes of daily physical activity, physical inactivity remains a significant public health concern. The 2008 Physical Activity Guidelines for Americans (PAG) provides recommendations on the amount of physical activity needed for overall health; the PAG Midcourse Report (2013) describes effective strategies to help youths meet these recommendations. Public health professionals can be dynamic change agents where youths live, learn, and play by changing environments and policies to empower youths to develop regular physical activity habits to maintain throughout life. We have summarized key findings from the PAG Midcourse Report and outlined actions that public health professionals can take to ensure that all youths regularly engage in health-enhancing physical activity. |
Behaviors related to physical activity and nutrition among U.S. high school students
Brener ND , Eaton DK , Kann LK , McManus TS , Lee SM , Scanlon KS , Fulton JE , O'Toole TP . J Adolesc Health 2013 53 (4) 539-46 PURPOSE: National data related to physical activity (PA) and nutrition among adolescents are needed to help develop effective obesity prevention programs. The 2010 National Youth Physical Activity and Nutrition Study (NYPANS) was conducted to provide nationally representative data on behaviors and behavioral correlates related to healthy eating and PA. METHODS: NYPANS used a three-stage cluster sample design to obtain data representative of public- and private-school students in grades 9 through 12 in the United States (n=11,429). Students completed an anonymous, self-administered questionnaire in their classrooms during a regular class period. Trained data collectors directly measured the students' height and weight at school using a standard protocol. RESULTS: Analyses revealed that 19.0% of students were obese and 17.8% were overweight. Students participated in a range of physical activities during the 12 months before the survey; prevalence ranged from 5.0% for ice hockey to 83.9% for walking. In addition, 52.5% of students enjoyed the physical education classes they took at school. During the 7 days before the survey, 74.8% of students ate at least one meal or snack from a fast food restaurant, with black students more likely than white and Hispanic students to have done so. Forty-one percent of students always or most of the time have a TV on while eating dinner at home. CONCLUSIONS: These and other NYPANS results can be used to develop obesity prevention programs that address specific behaviors and behavioral correlates, and target subgroups in which behaviors and behavioral correlates related to obesity are most prevalent. |
Obesity and other correlates of physical activity and sedentary behaviors among US high school students
Lowry R , Lee SM , Fulton JE , Demissie Z , Kann L . J Obes 2013 2013 276318 Understanding correlates of physical activity (PA) can help inform and improve programs that promote PA among youth. We analyzed data from the 2010 National Youth Physical Activity and Nutrition Study, a representative sample of US students in grades 9-12. Logistic regression was used to examine associations between PA correlates (obesity, physical education classes, sports team participation, attitude toward PA, adult support for PA, and environmental support for PA) and participation in daily PA (DPA), vigorous PA (VPA), muscle-strengthening activity (MSA), viewing television (TV), and using computers or video games (C/VG). A positive attitude toward PA and adult support for PA were both associated with increased PA and decreased sedentary behavior. However, among students who lived in neighborhoods that were not safe for PA, a positive attitude toward PA was not associated with increased DPA or decreased sedentary behavior and was less strongly associated with VPA and MSA. Efforts to increase PA among youth should promote a positive attitude toward PA among youth and encourage adult family members to support their efforts to be active. Policies that promote safe neighborhoods may work synergistically with a positive attitude toward PA to increase participation in PA and decrease sedentary behaviors. |
School health guidelines to promote healthy eating and physical activity
Centers for Disease Control and Prevention , Lee SM . MMWR Recomm Rep 2011 60 1-76 During the last 3 decades, the prevalence of obesity has tripled among persons aged 6--19 years. Multiple chronic disease risk factors, such as high blood pressure, high cholesterol levels, and high blood glucose levels are related to obesity. Schools have a responsibility to help prevent obesity and promote physical activity and healthy eating through policies, practices, and supportive environments. This report describes school health guidelines for promoting healthy eating and physical activity, including coordination of school policies and practices; supportive environments; school nutrition services; physical education and physical activity programs; health education; health, mental health, and social services; family and community involvement; school employee wellness; and professional development for school staff members. These guidelines, developed in collaboration with specialists from universities and from national, federal, state, local, and voluntary agencies and organizations, are based on an in-depth review of research, theory, and best practices in healthy eating and physical activity promotion in school health, public health, and education. Because every guideline might not be appropriate or feasible for every school to implement, individual schools should determine which guidelines have the highest priority based on the needs of the school and available resources. |
Trends by age in youth physical activity: Youth Media Campaign Longitudinal Survey
Wall MI , Carlson SA , Stein AD , Lee SM , Fulton JE . Med Sci Sports Exerc 2011 43 (11) 2140-7 PURPOSE: To characterize longitudinal age trajectories across 5 years in prevalence of free-time and organized physical activity participation among U.S. youth, by sex, race, and parental education. METHODS: Study participants were a nationally representative sample of youth, 9-13 years old in 2002, who participated in the Centers for Disease Control and Prevention's Youth Media Campaign Longitudinal Survey. Baseline data were collected in 2002. Attrition over the next four years resulted in an overall response rate of 23% by 2006 (n=1,623). The survey collected information concerning respondents' frequency of participation in free-time and organized physical activities outside of school. Organized activities were defined as activities involving a coach, instructor, or other leader. Orthogonal polynomial contrasts were used to test for linear and quadratic trends in respondents' participation free-time and organized physical activity sessions during the previous 7 days over ages 9-17. Pairwise t-tests were used to determine whether age-specific estimates of participation rates differed significantly by sex, race, and parental education level. RESULTS: Free-time physical activity participation prevalence declined linearly from ages 9 to 17 in both sexes but also demonstrated a quadratic trajectory in boys, peaking at age 13. Organized physical activity demonstrated a quadratic trajectory and declined most notably after age 14 in both sexes. Free-time physical activity participation was lower in girls compared to boys between ages 12-16 (difference range: 12-17 percentage points). Both non-white youth and those with less educated parents had lower organized physical activity participation at most ages (difference range: 15-29 percentage points). CONCLUSION: Free-time and organized physical activity exhibit different trajectories between ages 9-17 and are subject to dissimilar demographic level variation. |
The association between school-based physical activity, including physical education, and academic performance: a systematic review of the literature
Rasberry CN , Lee SM , Robin L , Laris BA , Russell LA , Coyle KK , Nihiser AJ . Prev Med 2011 52 Suppl 1 S10-20 OBJECTIVE: The purpose of this review is to synthesize the scientific literature that has examined the association between school-based physical activity (including physical education) and academic performance (including indicators of cognitive skills and attitudes, academic behaviors, and academic achievement). METHOD: Relevant research was identified through a search of nine electronic databases using both physical activity and academic-related search terms. Forty-three articles (reporting a total of 50 unique studies) met the inclusion criteria and were read, abstracted, and coded for this synthesis. Findings of the 50 studies were then summarized. RESULTS: Across all the studies, there were a total of 251 associations between physical activity and academic performance, representing measures of academic achievement, academic behavior, and cognitive skills and attitudes. Slightly more than half (50.5%) of all associations examined were positive, 48% were not significant, and 1.5% were negative. Examination of the findings by each physical activity context provides insights regarding specific relationships. CONCLUSION: Results suggest physical activity is either positively related to academic performance or that there is not a demonstrated relationship between physical activity and academic performance. Results have important implications for both policy and schools. |
Correlates of children and parents being physically active together
Lee SM , Nihiser A , Strouse D , Das B , Michael S , Huhman M . J Phys Act Health 2010 7 (6) 776-83 BACKGROUND: Co-physical activity (between parents and children), as an outcome variable, and its correlates have not been examined previously. The purpose of this study was to investigate correlates of co-physical activity among a nationally representative sample of 9- to 13-year-old children and their parents. METHODS: Data were from the 2004 Youth Media Campaign Longitudinal Survey, a national survey of 5177 child-parent dyads. Parents of 9- to 13-year-old children were asked to report co-physical activity. Parents and children responded to a series of sociodemographic, behavioral, and psychosocial measures. Co-physical activity was treated as a dichotomous variable (ie, some or none). Logistic regression was used to assess associations of correlates directly and possible interactions between correlates. RESULTS: More than three-quarters of parents reported co-physical activity at least 1 day in the prior week. Age, race/ethnicity, sports team participation, eating meals together, parental confidence to influence the child's organized activity, and the child's perception of parental support were significantly associated with co-physical activity. CONCLUSION: The majority of respondents reported participating in co-physical activity, and multiple sociodemographic, behavioral, and psychosocial correlates were significantly associated with co-physical activity. This study provides insight for physical activity interventions that might involve parents. |
Influence of limit-setting and participation in physical activity on youth screen time
Carlson SA , Fulton JE , Lee SM , Foley JT , Heitzler C , Huhman M . Pediatrics 2010 126 (1) e89-96 OBJECTIVES:To examine the associations of demographics, rules associated with television-viewing, and physical activity with daily screen time (including television, non-school-related computer use, and video games) in children and adolescents. METHODS: We analyzed data from a telephone survey of 7415 youth aged 9 to 15 years from the Youth Media Campaign Longitudinal Survey. We used logistic regression models to calculate odds of exceeding recommended screen-time limits (>120 minutes/day) according to demographics, rules, and physical activity. RESULTS: Odds that children would exceed recommended screen-time limits were positively associated with age and black race/ethnicity and negatively associated with income level. Children and adolescents who reported that they really agreed that their parents had rules about time spent watching television and playing video games were less likely to exceed recommended limits than those who strongly disagreed that their parents had rules. Similarly, when parents reported always or very often having limits on television watching (versus rarely or never) and when parents correctly identified the recommended limits, children were less likely to exceed recommended limits. Children whose parents reported consistent limits and who themselves reported consistent rules about time spent watching television had the lowest prevalence of exceeding recommended limits. Odds that children would exceed recommended limits decreased as physical activity in the previous week increased. CONCLUSIONS: Parental rules regarding screen time and participation in physical activity play a role in the amount of screen time among children and adolescents. Programs that encourage limit-setting by parents and promote physical activity may reduce screen time among youth. |
Healthy people 2010 objectives for physical activity, physical education, and television viewing among adolescents: national trends from the Youth Risk Behavior Surveillance System, 1999-2007
Lowry R , Lee SM , Fulton JE , Kann L . J Phys Act Health 2009 6 S36-45 BACKGROUND: To help inform policies and programs, a need exists to understand the extent to which Healthy People 2010 objectives for physical activity, physical education (PE), and television (TV) viewing among adolescents are being achieved. METHODS: As part of the Youth Risk Behavior Surveillance System, 5 national school-based surveys were conducted biennially from 1999 through 2007. Each survey used a 3-stage cross-sectional sample of students in grades 9 to 12 and provided self-reported data from approximately 14,000 students. Logistic regression models that controlled for sex, race/ethnicity, and grade were used to analyze secular trends. RESULTS: During 1999 to 2007, prevalence estimates for regular participation in moderate and vigorous physical activity, participation in daily PE classes, and being physically active in PE classes did not change significantly among female, male, white, black, or Hispanic students. In contrast, the prevalence of TV viewing for 2 or fewer hours on a school day increased significantly among female, male, white, black, and Hispanic students and among students in every grade except 12th grade. CONCLUSIONS: Among US adolescents, no significant progress has been made toward increasing participation in physical activity or school PE classes; however, improvements have been made in reducing TV viewing time. |
The role of lay health advisors in cardiovascular risk reduction: a review
Fleury J , Keller C , Perez A , Lee SM . Am J Community Psychol 2009 44 28-42 Interventions are needed to reduce the negative impact of cardiovascular disease. The combination of health risks for disease, disability, and mortality, particularly among underserved populations, might be best addressed with programs designed to enhance awareness and development of resources within a context of community support. The objectives of this review were to: (1) provide a comprehensive review and evaluation of the roles, evaluation, and effectiveness of LHA in community-based programs with an emphasis on cardiovascular risk reduction; and (2) provide recommendations for future research involving LHA in such programs. Computer and manual searches were conducted of articles in the English-language literature from 1980 to 2007. Twenty articles were evaluated, which emphasized the role of the LHA in cardiovascular risk reduction. A review of research literature provides a starting point for determining salient approaches for intervention and evaluation, issues related to program implementation and sustainability, and strengths and limitations of existing approaches. |
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