Examining the role of school characteristics in childhood body mass index, physical activity, and health promotion Open Access

Quader, Zerleen (Spring 2022)

Permanent URL: https://etd.library.emory.edu/concern/etds/5h73px32n?locale=en
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Abstract

School settings are important for childhood health, obesity prevention, and physical activity promotion. It is valuable to understand how school resources and characteristics can be leveraged to influence childhood health and behavior, and support school-based interventions and programs. Therefore, the overarching goal of this dissertation was to assess the role of school characteristics in childhood body mass index (BMI) change, physical activity, and the effectiveness of a school-level physical activity intervention.

 

In aim 1, we estimated the association between school characteristics and trajectories of BMI using data from the Early Childhood Longitudinal Study – Kindergarten Class 2010-11, a nationally representative sample of kindergarteners followed through fifth grade. Problems around the schools’ neighborhoods, such as vacant buildings, were modestly associated with an increased rate of BMI change among children who had obesity at baseline, and among children whose parents had less education. Overall, no other school characteristics were associated with BMI change.

 

In aim 2, using data from cluster randomized trial in 40 elementary schools in Georgia, we determined if, relative to individual and community level factors, school-level characteristics partially explain heterogeneity in BMI and physical activity among children attending elementary schools in Georgia. Although school-level factors explained some variability in moderate to vigorous physical activity (MVPA) and BMI, most of the variation was due to individual differences. Specific school characteristics were not associated with MVPA or BMI.

 

In aim 3, we used data from cluster randomized trial in 40 elementary schools in Georgia to determine if school characteristics modified the effectiveness of an evidence-based physical activity intervention. The intervention appeared to be more effective in schools with high concentrations of poverty.

 

In this dissertation, we found that the school characteristics explored were not independently associated with student MVPA or BMI. However, variability in MVPA and BMI across schools and effect modification by school-level factors reaffirms the importance of the school setting for the promotion of physical activity. This suggests that Comprehensive School Physical Activity Programs may be effective at reducing disparities in physical activity.

Table of Contents

Table of Contents

Chapter 1: Background and Significance 1

Childhood obesity burden 1

Childhood obesity prevention 2

Importance of school-based health promotion 2

Importance of school-based physical activity 3

Challenges to school-based physical activity 5

Effectiveness and equity in school-based health promotion 5

Disparities in school quality and historical context 8

School characteristics 10

Conceptual Framework 13

Research Goal and Aims 15

Chapter 2: Estimating the association between school characteristics and BMI trajectories in U.S. elementary school-aged children, the Early Childhood Longitudinal Study, Kindergarten Class of 2010-11 16

Abstract 16

Introduction 17

Methods 19

Results 23

Discussion 25

Tables 30

Appendix 38

Chapter 3: Contribution of school-level characteristics to the variability of physical activity and body mass index among children attending elementary schools in Georgia. 44

Abstract 44

Introduction 45

Methods 47

Results 51

Discussion 53

Tables 59

Appendix 64

Chapter 4: The role of school-level characteristics in the effectiveness of an evidence-based physical activity intervention implemented in elementary schools in Georgia. 68

Abstract 68

Introduction 69

Methods 71

Results 75

Discussion 76

Tables and figures 81

Appendix 91

Chapter 5: Conclusions 93

Summary of Findings 93

Strengths and Limitations 95

Future Directions and Public Health Implications 96

References 99

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