RESUMEN
The prevalence and attributable risk of disease due to physical inactivity require it to be made a public health priority. Public health planning allows for prioritization and resource allocation, particularly at the state and local levels. The extent to which state planning efforts for physical activity exist in the United States is unknown. The purpose of this paper is to describe the scope in which physical activity is incorporated in state-level public health plans in the United States, with an emphasis on alignment with the national guidelines and the National Physical Activity Plan. A standardized internet search audit was developed and conducted for each of 50 US states and the District of Columbia between May 2017 and January 2018 to determine the prevalence and characteristics of health planning documents that include physical activity. Data abstracted for analysis used a standardized search protocol that included the components of the Physical Activity Guidelines for Americans and the US National Physical Activity Plan. Results found that most states had between 4 and 6 chronic disease prevention and control plans that mention physical activity; however, it was inconsistently aligned with recommendations from both the Guidelines and the National Plan. Only 2 states had stand-alone public health planning documents explicitly dedicated to physical activity promotion. No state planning documents addressed children and adolescents, adults, and older adults simultaneously. To be maximally effective, state public health planning for physical activity should be made a priority and these efforts should align as much as possible with current guidance from the Physical Activity Guidelines for Americans and the US National Physical Activity Plan.
Asunto(s)
Ejercicio Físico , Planificación en Salud , Adolescente , Niño , Humanos , Estados Unidos , Anciano , Planificación en Salud/métodos , Salud Pública , Factores de Riesgo , District of ColumbiaRESUMEN
Background: The purpose of this study was to explore the development and implementation of state level accountability policy and systems. Methods: The study was conducted using an explanatory multiple-case study design using the SWOT analysis (strengths, weaknesses, opportunities to improve, and threats). Ten leaders from three states participated in the study (State A n = 3; State B n = 4; State C n = 3 [female n = 1, 1, 2, respectively]). Semi-structured interviews and document analysis were used to collect data. The data was analyzed using the structural narrative analysis method. Results: All ten state leaders discussed that the high obesity rate within the state was one of the motives of adopting an accountability system. The commonly identified strengths of the system were having legislation and using existing resources to help facilitate the process. Some weaknesses included the lack of accessibility to individual data at the state level and the absence of a reflexive cycle for future improvement. For opportunities to improve, all state leaders mentioned having an assessment system enhanced the status of physical education in schools. Consistently discussed threats were turnover of associated personnel and teacher pushbacks. Conclusion: This study revealed that there are several factors to consider making an accountability policy and system meaningful and valuable. Physical educators are all policy actors. Everyone has a responsibility to act as stewards of the field to be critically reflective in what we do, and to understand the why behind our actions.
Asunto(s)
Educación y Entrenamiento Físico , Estudiantes , Humanos , Femenino , Masculino , Responsabilidad SocialRESUMEN
BACKGROUND: Rural environments present many barriers to regular physical activity (PA), and residents who live in these communities are at higher risk for a variety of health issues. OBJECTIVES: We used community-based participatory research (CBPR) to guide the development of project interventions and enhance partnerships within the communities. METHODS: University-community partnerships, including Extension professionals, were used to gather data from twenty key informants in two West Virginia counties. RESULTS: Respondents identified "places" as both barriers (lack of access or quality) and assets in their communities. "Community culture" was identified as a significant barrier. Solutions that emerged from the data include "new/enhanced places" or "events/programs". CONCLUSIONS: These data supported the notion that there are unique social, cultural, and environmental factors affecting rural PA behavior. These interviews also contributed to increased capacity for local engagement and reinforced the need for community member leadership in the larger project.
RESUMEN
Background. Schools are an important setting for health promotion because they afford children and adolescents numerous opportunities to accumulate the recommended physical activity (PA) minutes and make other health-related decisions, including healthy eating. Unfortunately, there is little evidence of coordinated school-based health interventions in rural Appalachia. The Greenbrier Children's Health Opportunities Involving Coordinated Efforts in Schools Project was a federally funded, 3-year, multicomponent school-based health intervention focused on PA, healthy eating, and weight management. Aims. The purpose of this study was to evaluate the impact of Greenbrier Children's Health Opportunities Involving Coordinated Efforts in Schools on adolescent PA, dietary behaviors, and weight status. Method. Measures of PA, dietary behaviors, and body mass index were collected across 14 data points throughout the intervention (including a baseline in Year 1). Results. Participants included 4,633 randomly selected middle school students (M = 2,289, F = 2,344) across the intervention. Baseline to Year 3 findings revealed a 12.8 percentage point increase in students achieving 60 minutes of daily PA. There were no significant differences in either dietary behavior or body mass index. Discussion. Findings provide evidence of the positive impact comprehensive school-based health interventions can have on middle school student health-related behaviors. Conclusion. Schools remain an ideal setting for health promotion. Initiatives targeting more than one level of influence on health-related behaviors are more likely to succeed.
Asunto(s)
Promoción de la Salud , Smilax , Adolescente , Región de los Apalaches , Niño , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Servicios de Salud Escolar , Instituciones AcadémicasRESUMEN
OBJECTIVES: The purpose of this study was to determine the perceived impact of I am Moving, I am Learning (IMIL) on physical activity (PA) levels, along with family and community involvement in a Head Start program in Illinois. METHODS: Employing qualitative methods, data were collected via a parent/caregiver survey and program staff focus groups in Rock Island, Illinois. RESULTS: IMIL was perceived to have made an impact in several areas including knowledge, health-related behaviors, and supportive school and home environments. A positive impact also was reported regarding 6 types of family involvement (parenting, communicating, decision making, volunteering, community collaboration, and learning at home). CONCLUSIONS: Participants in the study reported that IMIL contributed to increased levels of PA and family/community involvement. The participants perceived that the use of IMIL helped parents/caregivers and their children become healthier, by improving the whole family's activity levels. Faculty and staff also reported that there were few barriers related to the implementation and sustainability of IMIL use in childcare settings.
Asunto(s)
Participación de la Comunidad/métodos , Intervención Educativa Precoz , Ejercicio Físico/psicología , Familia/psicología , Conocimientos, Actitudes y Práctica en Salud , Adolescente , Adulto , Anciano , Docentes/psicología , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Investigación Cualitativa , Adulto JovenRESUMEN
BACKGROUND: The purpose of this study was to evaluate the relationship between adolescents' adherence to the 5-2-1-0 goals and the number of completed Progressive Cardiovascular Endurance Run (PACER) laps. METHODS: Participants included 1792 students aged 10 to 16 years who were randomly selected across 9 data collection periods between 2012 and 2014. The Survey of Physical Activity and Nutrition was used to measure time spent in physical activity and sedentary behavior, and dietary intake and the dependent variable was the number of PACER laps achieved. The Kruskal-Wallis test and pairwise post hoc comparisons were conducted. RESULTS: Only 0.95% (N = 17) participants met all 4 goals outlined within the 5-2-1-0 guidelines. Whereas 10.04% met 3 (N = 180), 41.63% met 2 (N = 746), 34.99% met 1 (N = 627), and 12.39% did not meet any goals (N = 222). Pairwise comparisons indicated there were significant differences: between groups not meeting any of the 5-2-1-0 goals and other groups (meeting one goal [p = .000], 2 goals [p = .000], 3 goals [p = .000], and all 4 [p = .008]). CONCLUSIONS: The positive relationship between PACER laps and adherence to the 5-2-1-0 goals suggests targeted and sequential behavioral changes may have positive implications on adolescents' cardiovascular fitness and body mass index.
Asunto(s)
Objetivos , Adhesión a Directriz/estadística & datos numéricos , Promoción de la Salud/métodos , Obesidad/prevención & control , Adolescente , Niño , Dieta , Ejercicio Físico , Prueba de Esfuerzo , Femenino , Guías como Asunto , Humanos , Masculino , Carrera , Servicios de Salud Escolar , Instituciones Académicas , Conducta Sedentaria , Encuestas y Cuestionarios , West VirginiaRESUMEN
Short stature is associated with increased LDL-cholesterol levels and coronary artery disease in adults. We investigated the relationship of stature to LDL levels in children in the West Virginia Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project to determine whether the genetically determined inverse relationship observed in adults would be evident in fifth graders. A cross-sectional survey of schoolchildren was assessed for cardiovascular risk factors. Data collected at school screenings over 18 years in WV schools were analyzed for 63,152 fifth-graders to determine relationship of LDL to stature with consideration of age, gender, and BMI. The first (shortest) quartile showed an LDL level of 93.6 mg/dl compared with an LDL level of 89.7 mg/dl for the fourth (tallest) quartile. Each incremental increase of 1 SD of height lowered LDL by 0.049 mg/dl (P < 0.0001). Multivariate analysis showed LDL to vary inversely as a function of the first (lowest) quartile of height after controlling for gender, median age, BMI percentile for age and gender, and year of screening. The odds ratio for LDL ≥ 130 mg/dl for shortest versus tallest quartile is 1.266 (95% CL 1.162-1.380). The odds ratio for LDL ≥ 160 mg/dl is 1.456 (95% CL 1.163-1.822). The relationship between short stature and LDL, noted in adults, is confirmed in childhood.
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Estatura , LDL-Colesterol/sangre , Instituciones Académicas , Niño , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: The Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project is a chronic disease risk factor surveillance, intervention, and research initiative aimed at combating the unacceptably high prevalence of heart disease, diabetes, and other chronic illnesses in West Virginia. OBJECTIVES AND METHODS: The school-based public health project identifies health risk factors in children, educates families, informs primary care physicians, and provides resources to schools to help improve population health, beginning with children. RESULTS AND CONCLUSION: Details regarding methodology, results, and conclusions derived from this unique public health initiative that has screened over 200,000 children are the subject of this 18- year review.
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Enfermedad de la Arteria Coronaria/epidemiología , Tamizaje Masivo/métodos , Región de los Apalaches/epidemiología , Niño , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/etiología , Vasos Coronarios , Femenino , Humanos , Masculino , Factores de Riesgo , Servicios de Salud Escolar/estadística & datos numéricos , West VirginiaRESUMEN
BACKGROUND: The US National Physical Activity Plan (NPAP) was released in 2009 as a national strategic plan to increase physical activity (PA). The NPAP emphasized implementing state and local PA programs. Dissemination of information about NPAP has been limited, however. COMMUNITY CONTEXT: West Virginia is a predominantly rural state with high rates of chronic diseases associated with physical inactivity. In 2015 an evaluability assessment (EA) of the West Virginia Physical Activity Plan (WVPAP) was conducted, and community stakeholders were invited to participate in updating the plan. METHODS: A good EA seeks stakeholder input, assists in identifying program areas that need improvement, and ensures that a full evaluation will produce useful information. Data for this EA were collected via national stakeholder interviews, document reviews, discussions among workgroups consisting of state and local stakeholders, and surveys to determine how well the WVPAP had been implemented. OUTCOME: The EA highlighted the need for WVPAP leaders to 1) establish a specific entity to implement local PA plans, 2) create sector-specific logic models to simplify the WVPAP for local stakeholders, 3) evaluate the PA plan's implementation frequently from the outset, 4) use quick and efficient engagement techniques with stakeholders when working with them to select strategies, tactics, and measurable outcomes, and 5) understand the elements necessary to implement, manage, and evaluate a good PA plan. INTERPRETATION: An EA process is recommended for other leaders of PA plans. Our project highlights the stakeholders' desire to simplify the WVPAP so that it can be set up as a locally driven process that engages communities in implementation.
Asunto(s)
Conducta Cooperativa , Ejercicio Físico , Implementación de Plan de Salud/métodos , Promoción de la Salud/métodos , Desarrollo de Programa , Enfermedad Crónica/epidemiología , Enfermedad Crónica/prevención & control , Humanos , Evaluación de Procesos, Atención de Salud , West VirginiaRESUMEN
BACKGROUND: McDowell CHOICES (Coordinated Health Opportunities Involving Communities, Environments, and Schools) Project is a county wide endeavor aimed at increasing opportunities for physical activity (PA) in McDowell County, West Virginia (WV). A comprehensive needs-assessment laid the foundation of the project. METHODS: During the 6 month needs assessment, multiple sources of data were collected in two Town Hall Meetings (n = 80); a student online PA interest survey (n = 465); a PA and nutrition survey among 5(th) (10-11 years) and 8(th) graders (13-14 years) with questions adapted from the CDC's Youth Risk Behavior Surveillance Survey (n = 442, response rate = 82.2%); six semi-structured school and community focus groups (n = 44); school site visits (n = 11); and BMI screening (n = 550, response rate = 69.7%). RESULTS: One third of children in McDowell County meet the national PA minimum of 60 minutes daily. At least 40% of 5(th) and 8(th) graders engage in electronic screen activity for 3 hours or more every day. The prevalence of obesity in 5(th) graders is higher in McDowell County than the rest of WV (~55% vs. 47% respectively). SWOT analyses of focus group data suggest an overall interest in PA but also highlight a need for increase in structured PA opportunities. Focus group data also suggested that a central communication (e.g. internet-based) platform would be beneficial to advertise and boost participation both in current and future programs. Schools were commonly mentioned as potential facilities for public PA participation throughout the county, both with regards to access and convenience. School site visits suggest that schools need more equipment and resources for before, during, and after school programs. CONCLUSIONS: An overwhelming majority of participants in the McDowell CHOICES needs assessment were interested to participate in more PA programs throughout the county as well as to improve opportunities for the provision of such programs. Public schools were widely recognized as the hub of the communities and provide the best venue for PA promotion for both students and adult citizens, and can potentially serve as a platform for change in rural communities such as McDowell County.
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Protección a la Infancia/estadística & datos numéricos , Promoción de la Salud/organización & administración , Actividad Motora , Evaluación de Necesidades/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Adolescente , Niño , Ejercicio Físico , Femenino , Humanos , Masculino , Instituciones Académicas/estadística & datos numéricos , Estudiantes/estadística & datos numéricos , West Virginia/epidemiologíaRESUMEN
OBJECTIVE: To characterize adults who participate in a free health screening based on their children's participation in the same program and to identify factors that potentially contribute to their participation. METHODS: Child (n = 81,156) and parent (n = 5,257) results from a statewide, school-based project from 1998-2010 were assessed. Parent and child health outcomes including fasting lipids, and body composition were assessed using standardized procedures. RESULTS: Many mothers enrolled fathers into the program. These mothers had significantly higher total cholesterol and low-density lipoprotein levels than mothers who participated alone (p < .01). A greater proportion of parents participated in the program if their child had received an abnormal screening than their healthier counterparts (p < .001). CONCLUSIONS: Adult participation in preventive health screening is limited. Identifying successful ways to recruit adults for preventive health screening is necessary given the increased potential for these programs to identify risks and intervene early. Incorporating parent screening into an existing program for children may be a successful recruitment method, particularly for those who may be aware of a family vulnerability to chronic cardiovascular disease.
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Enfermedades Cardiovasculares/diagnóstico , Hipercolesterolemia/diagnóstico , Hipertensión/diagnóstico , Tamizaje Masivo/estadística & datos numéricos , Padres , Aceptación de la Atención de Salud/estadística & datos numéricos , Medición de Riesgo/estadística & datos numéricos , Adulto , Niño , Escolaridad , Femenino , Humanos , Hipercolesterolemia/sangre , Masculino , Persona de Mediana Edad , Fumar/epidemiología , West Virginia/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Modeled after the National Physical Activity Plan (NPAP), ActiveWV 2015: The West Virginia Physical Activity Plan was developed to provide strategic direction for physical activity promotion within the state. The purpose of this manuscript is to describe the systematic approach taken in developing ActiveWV. METHOD: Plan development began with establishing capacity and leadership among key stakeholders representing all societal sectors. A multiphase, statewide decision-making process allowed for input across sectors and geographic regions. The process results identified five priority areas that served as the conceptual framework for ActiveWV. Sector teams, comprised of key organization stakeholders across the eight sectors, finalized the sector-specific strategies and tactics using the NPAP evidence-based recommendations, results from a formalized strategic process, and the teams' expertise and experience. RESULTS: ActiveWV was officially released on January 19, 2012 at the State Capitol in Charleston, West Virginia. Community events throughout the state surrounded the release and celebrated West Virginia Physical Activity Day. Ongoing implementation and dissemination efforts are underway at state and local levels. CONCLUSIONS: As the NPAP calls for states and communities to develop plans that meet the needs of their particular context, other states may find the lessons learned from West Virginia helpful in the development process.
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Promoción de la Salud/organización & administración , Actividad Motora , Desarrollo de Programa/métodos , Asociación entre el Sector Público-Privado , Planes Estatales de Salud/organización & administración , Conducta Cooperativa , Toma de Decisiones , Implementación de Plan de Salud/métodos , Implementación de Plan de Salud/organización & administración , Humanos , Formulación de Políticas , Práctica de Salud Pública , West VirginiaRESUMEN
The Coronary Artery Risk Detection In Appalachian Communities (CARDIAC) Project has screened more than 80,000 children (10-12 years) for cardiovascular and diabetes risk factors over the past 15 years. Simultaneous referral and intervention efforts have also contributed to the overall program impact. In this study, we examined evidence of programmatic impact in the past decade at the individual, family, community, and policy levels from child screening outcomes, referral rates, participation in subsequent services, and policies that embed the activities of the project as a significant element. Within this period of time, fifth-grade overweight and obesity rates were maintained at a time when rates elsewhere increased. 107 children were referred for additional screening and treatment for probable familial hypercholesterolemia (FH); 82 family members were subsequently screened in family-based screening efforts. 58 grants were distributed throughout the state for community-appropriate obesity intervention. A state wellness policy embedded CARDIAC as the method of assessment and national child cholesterol screening guidelines were impacted by CARDIAC findings. The sustainability and successful impact of this school-based program within a largely underserved, rural Appalachian state are also discussed.
Asunto(s)
Enfermedades Cardiovasculares/diagnóstico , Salud de la Familia , Política de Salud , Tamizaje Masivo , Área sin Atención Médica , Obesidad Infantil/diagnóstico , Servicios de Salud Rural , Servicios de Salud Escolar , Factores de Edad , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Niño , Comorbilidad , Salud de la Familia/legislación & jurisprudencia , Política de Salud/legislación & jurisprudencia , Estado de Salud , Humanos , Tamizaje Masivo/legislación & jurisprudencia , Tamizaje Masivo/métodos , Aceptación de la Atención de Salud , Obesidad Infantil/epidemiología , Obesidad Infantil/terapia , Valor Predictivo de las Pruebas , Prevalencia , Evaluación de Programas y Proyectos de Salud , Derivación y Consulta , Medición de Riesgo , Factores de Riesgo , Servicios de Salud Rural/legislación & jurisprudencia , Servicios de Salud Escolar/legislación & jurisprudencia , Factores de Tiempo , West Virginia/epidemiologíaRESUMEN
OBJECTIVES: The goal was to determine the sensitivity and specificity of family history in identifying children with severe or genetic hyperlipidemias in a rural, predominantly white population. METHODS: A total of 20,266 fifth-grade children in West Virginia, from the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project, who completed a family history and fasting lipid profile were used in analyses. The relationship between hyperlipidemia and family history was determined, and the use of family history to predict the need for pharmacologic treatment among children with dyslipidemia was evaluated. RESULTS: A total of 71.4% of children met the National Cholesterol Education Program (NCEP) guidelines for cholesterol screening on the basis of positive family history. Of those, 1204 (8.3%) were considered to have dyslipidemia (low-density lipoprotein > or =130 mg/dL), and 1.2% of these children with dyslipidemia warranted possible pharmacologic treatment (low-density lipoprotein > or =160 mg/dL). Of the 28.6% who did not have a positive family history (did not meet NCEP guidelines), 548 (9.5%) had dyslipidemia, 1.7% of whom warranted pharmacologic treatment. Sensitivity and specificity data demonstrated that family history does not provide a strong indication as to whether pharmacologic treatment may be warranted. CONCLUSIONS: Results indicate that the use of family history to determine the need for cholesterol screening in children would have (1) missed many with moderate dyslipidemia and (2) failed to detect a substantial number with likely genetic dyslipidemias that would require pharmacologic treatment. The use of universal cholesterol screening would identify all children with severe dyslipidemia, allowing for proper intervention and follow-up and leading to the prevention of future atherosclerotic disease.
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LDL-Colesterol/sangre , Dislipidemias/sangre , Dislipidemias/epidemiología , Adolescente , Región de los Apalaches/epidemiología , Índice de Masa Corporal , Dislipidemias/genética , Femenino , Humanos , Masculino , Tamizaje Masivo/métodos , Obesidad/epidemiología , Población Rural/estadística & datos numéricos , Encuestas y Cuestionarios , TriglicéridosRESUMEN
Questionnaire reports and universal screening procedures from 244 children (kindergarten, 5th grade, and 9th grade) were used to explore differences in parent health knowledge and attitudes of cardiovascular risks among children and parental involvement in promoting healthy lifestyles relative to whether their children were identified as being overweight or at risk of being overweight. The knowledge, attitudes, and behaviors of the parents of children who were identified as being at risk or overweight were further examined based on their perceptions of their children's level of risk. Parents' reports demonstrated significantly greater parent encouragement and knowledge of issues related to eating healthier foods and ways to cut calories among parents of children who were identified as being at risk or already overweight. A significant portion of parents underestimated their children's weight risks. Differences in parents' appraisals of their children's overweight risks were associated with differences in their knowledge, attitudes, and behaviors. These findings illustrate the need to address inaccuracies in parents' assessments of their children's overweight risks to improve parent investment and involvement in children's health modification programs.
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Enfermedades Cardiovasculares/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Sobrepeso , Padres , Adolescente , Índice de Masa Corporal , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Masculino , Tamizaje Masivo , Medición de Riesgo , Población Rural , West VirginiaRESUMEN
West Virginia's prevalence of obesity is among the highest in the nation, contributing to an excess mortality rate from heart disease. Individuals who are overweight and obese have a greater risk for coronary artery disease. To gain insight into the impact of obesity on other modifiable cardiovascular disease (CVD) risk factors among children, 5,887 students from 27 rural West Virginia counties participated in the school-based Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project during the 1999-2002 school years. Results confirmed a very high prevalence of overweight and obese children in this rural, pre-adolescent population. Almost 43 percent of the children screened were considered to be overweight (BMI > or = 85th percentile), and over one-fourth of them were obese (BMI > or = 95th percentile). This high rate of obesity among schoolchildren in West Virginia is associated with increased prevalence of other CVD risk factors such as hypertension, dyslipidemia, and insulin resistance. Interventions for prevention of excess weight and obesity should be implemented through schools and community-based programs.