Kynna Wright

Impact of a nurse-directed, coordinated school health program to enhance physical activity behaviors and reduce body mass index among minority children: A parallel-group, randomized control trial

BACKGROUND Underserved children, particularly girls and those in urban communities, do not meet the recommended physical activity guidelines (>60min of daily physical activity), and this behavior can lead to obesity. The school years are known to be a critical period in the life course for shaping attitudes and behaviors. Children look to schools for much of their access to physical activity. Thus, through the provision of appropriate physical activity programs, schools have the power to influence apt physical activity choices, especially for underserved children where disparities in obesity-related outcomes exist. OBJECTIVES To evaluate the impact of a nurse directed, coordinated, culturally sensitive, school-based, family-centered lifestyle program on activity behaviors and body mass index. DESIGN, SETTINGS AND PARTICIPANTS This was a parallel group, randomized controlled trial utilizing a community-based participatory research approach, through a partnership with a University and 5 community schools. Participants included 251 children ages 8-12 from elementary schools in urban, low-income neighborhoods in Los Angeles, USA. METHODS The intervention included Kids N Fitness(©), a 6-week program which met weekly to provide 45min of structured physical activity and a 45min nutrition education class for parents and children. Intervention sites also participated in school-wide wellness activities, including health and counseling services, staff professional development in health promotion, parental education newsletters, and wellness policies for the provision of healthy foods at the school. The Child and Adolescent Trial for Cardiovascular Health School Physical Activity and Nutrition Student Questionnaire measured physical activity behavior, including: daily physical activity, participation in team sports, attending physical education class, and TV viewing/computer game playing. Anthropometric measures included height, weight, body mass index, resting blood pressure, and waist circumference. Measures were collected at baseline, completion of the intervention phase (4 months), and 12 months post-intervention. RESULTS Significant results for students in the intervention, included for boys decreases in TV viewing; and girls increases in daily physical activity, physical education class attendance, and decreases in body mass index z-scores from baseline to the 12 month follow-up. CONCLUSIONS Our study shows the value of utilizing nurses to implement a culturally sensitive, coordinated, intervention to decrease disparities in activity and TV viewing among underserved girls and boys.

Improving healthy dietary behaviors, nutrition knowledge, and self-efficacy among underserved school children with parent and community involvement.

BACKGROUND University–community partnerships through coordinated school health programs (CSHP) can play a key role in decreasing child obesity. The main objective of this study was to measure over a 1-year period whether a CSHP with parental, school, and home-based components to promote optimal nutrition will reduce BMI percentiles and z-scores and improve dietary behaviors in a sample of low-income, school-aged children. METHODS The intervention included, Kids Nutrition and Fitness, a 6-week nutrition, physical activity educational after-school program, and school activities, including creation of an Advisory Committee that made wellness policies. A randomized controlled pilot study evaluated the effectiveness of the intervention that contrasts 251 (n = 251) predominantly Mexican-American 8 to 12 year olds from low-income Los Angeles–based schools. A mixed model of repeated measures analysis assessed changes in BMI percentiles and z-scores, dietary behaviors, food preferences, knowledge, and self-efficacy measured by a reliable/valid questionnaire. These data were collected at baseline and at 4 and 12 months postintervention. Process measures, collected via focus groups with parents, evaluated parent/community involvement. RESULTS At the 12-month follow-up, children in the intervention group decreased their BMI on average by 2.80 (p = 0.04) and BMI z-scores on average by 0.48 (p = 0.03) and they increased their daily dietary intake of vegetables on average by 1.51 (p = 0.03), fruit on average by 2.00 (P = 0.001), and 100% fruit juice by 1.12 (p = 0.05). An increase of 1.02 (p = 0.03) was seen in self-efficacy of healthy food choices (p = 0.03). Parent (P = 0.04) and community (p = 0.001) involvement significantly increased to 100% participation by the 12-month follow-up. CONCLUSIONS A CSHP using parent and community involvement was effective in reducing the risk of obesity in school-aged Mexican- American children attending low-income schools. The findings need to be examined in a larger, more diverse sample of children.

Influence of body mass index, gender, and Hispanic ethnicity on physical activity in urban children

PURPOSE This community-based participatory research study examined the association between overweight status and activity among Hispanic urban, school-age children. DESIGN AND METHODS In a sample of 140 children, activities were assessed using the Youth Risk Behavior Surveys questions about physical activity (PA) and team sports. RESULTS Thirty-nine percent were overweight (body mass index [BMI] >85%). Normal-weight children had higher levels of PA and team sports. Females had lower levels of PA and team sports. Significant associations included BMI and sports team participation, and BMI and Hispanic ethnicity. PRACTICE IMPLICATIONS Nurses should be aware that Hispanic urban children are at risk for lower activity.

Using Community–Academic Partnerships and a Comprehensive School-Based Program to Decrease Health Disparities in Activity in School-Aged Children

Many underserved school-age children do not meet the recommended guidelines for physical activity. While children ultimately depend on parents, they also look to schools for their access to developmentally appropriate physical activity. The present randomized controlled trial study utilized a community–academic partnered participatory research approach to evaluate the impact of a culturally sensitive, comprehensive, school-based, program, Kids N Fitness©, on body mass index (BMI), and child physical activity behavior, including: daily physical activity, team sports participation, attending PE class, and TV viewing/computer game playing, among underserved children ages 8–12 (N = 251) in Los Angeles County. All measures were collected at baseline, 4 and 12 months post-intervention. Students who participated in the KNF program had significant decreases in BMI Z-score, TV viewing, and an increase in PE class attendance from baseline to the 12 month follow-up. Our study shows the value of utilizing community–academic partnerships and a culturally sensitive, multi-component, collaborative intervention.

Influence of BMI, Gender, and Hispanic Ethnicity on Physical Activity in Urban Children

PURPOSE This community-based participatory research study examined the association between overweight status and activity among Hispanic urban, school-age children. DESIGN AND METHODS In a sample of 140 children, activities were assessed using the Youth Risk Behavior Surveys questions about physical activity (PA) and team sports. RESULTS Thirty-nine percent were overweight (body mass index [BMI] >85%). Normal-weight children had higher levels of PA and team sports. Females had lower levels of PA and team sports. Significant associations included BMI and sports team participation, and BMI and Hispanic ethnicity. PRACTICE IMPLICATIONS Nurses should be aware that Hispanic urban children are at risk for lower activity.

A Comprehensive School Health Program to Reduce Disparities and Riskfor Type 2 Diabetes in Overweight At-Risk Youth

Background: South Asian Immigrants (SAIs) are the second fastest growing Asian immigrant population in the US, and at a higher risk of type 2 diabetes (diabetes) than the general US population. Coronary Artery Disease (CAD) is the principal cause of mortality globally, particularly in diabetic subjects. In this study, we sought to determine the; 1) distribution of risk factors for CAD in diabetic and non-diabetic SAIs; and 2) presence of sub-clinical CAD in diabetic and non diabetic SAIs in the US. Methods: 213 first generation SAIs subjects were recruited and broadly divided into two subgroups; 35 diabetics and 178 non diabetics. Their risk factors for CAD were compared. For sub-clinical CAD assessment, Common Carotid Artery Intima-Media Thickness (CCA-IMT) was used as a surrogate marker for atherosclerosis. For CAD diagnosis, Exercise Tolerance stress Test (ETT) was performed. Results: Both diabetics and non diabetics SAIs in general, share a very heavy burden of CAD risk factors. Hypertension (p=0.003), high cholesterol (p<0.0001) and family history of diabetes (p<0.0001) was significantly associated with diabetes. Presence of sub-clinical CAD was also higher in diabetics as compared to non diabetics (63% Vs 52%). 45% of diabetics (who were not previously diagnosed with CAD) were found to be ETT positive for CAD (p<0.0001). Conclusion: CAD risk factors and sub-clinical CAD are more prevalent amongst diabetic SAIs. Early screening and aggressive treatment for risk factor reduction in SAIs is the key to combating the increasing incidence of CAD. Larger prospective trials are required to confirm these study findings.

Influence of body mass index, gender, and Hispanic ethnicity on physical activity in urban children: Influence of Body Mass Index, Gender, and Hispanic Ethnicity on Physical Activity in Urban Children

PURPOSE This community-based participatory research study examined the association between overweight status and activity among Hispanic urban, school-age children. DESIGN AND METHODS In a sample of 140 children, activities were assessed using the Youth Risk Behavior Surveys questions about physical activity (PA) and team sports. RESULTS Thirty-nine percent were overweight (body mass index [BMI] >85%). Normal-weight children had higher levels of PA and team sports. Females had lower levels of PA and team sports. Significant associations included BMI and sports team participation, and BMI and Hispanic ethnicity. PRACTICE IMPLICATIONS Nurses should be aware that Hispanic urban children are at risk for lower activity.