Noel Kulik

Access to primary care child weight management programs: Urban parent barriers and facilitators to participation:

The prevalence and comorbidities of childhood obesity among low-income urban children are a significant health issue in the United States. Programs designed to assist families are underutilized. The aim of this study is to describe barriers and facilitators relevant to intervention program participation from the perspective of parents who have children who are overweight or obese. Systematic thematic analysis of focus groups and semi-structured interviews with parents from multiple urban pediatrics and family medicine practices were used to gather data. A framework analysis approach was used and a codebook of themes was developed. Transcripts were coded independently by the research team and consensus among researchers was reached. Forty-eight parents participated in the study. Perceived barriers to participation included (1) varied referral process (lack of follow-up or varying referral experience), (2) costs (time and program fee), (3) logistics (location and program schedule), and (4) child motivation. Perceived facilitators to participation included (1) systematic referral process (in-office referral and timely follow-up), (2) program content and organization, and (3) no cost. Multiple barriers and facilitators affect weight management program participation among families, which should be specifically targeted in future obesity interventions in order to effectively reach urban, minority parents and children.

Why inner-city high-school students attend after-school physical activity clubs

Objective: The population of young people most vulnerable to low levels of physical activity (e.g. urban/minority/low socio-economic status/female/non-athletes) often has the least access to physical activity opportunities and resources. It has been suggested that a comprehensive, school-based approach, including prudent use of time before, during and after the school day may be an effective way to increase overall physical activity, but little is known about why urban students voluntarily participate in these extracurricular programmes. Using social cognitive theory as a framework, this study examines urban high-school students’ rationale for attending after-school physical activity clubs designed to provide fun, safe, supportive places to do physical activities with friends. Design and setting: Qualitative study in an urban school district. Method: Over a 2-year period, adult leaders within 14 inner-city schools in a large urban district in the Midwest USA held 938 physical activity club sessions targeting traditionally inactive youth to promote non-competitive physical activity. Interviews with student participants (n = 278) and researcher field observations (n = 115) were used as primary data sources. Results: Three primary themes emerged to explain the voluntary participation of high-school students in after-school physical activity clubs: (a) social affiliation, especially group identification and establishing relationships with adult leaders and likeminded peers; (b) health and performance, including improving physical health and performance in other athletic endeavours; and (c) the ‘right’ types of activities and focus, including those that were student-centred, non-competitive and culturally relevant. Conclusion: Creation and sustainability of successful inner-city physical activity clubs will largely hinge upon the capitalisation on an understanding of the motivations of an urban student population.

Understanding Stress and Aggression Behaviors among Urban Youth

Background/Objective: Youth violence, including school bullying and fighting, has become a global public health problem. Stress has been identified as a factor related to aggression (i.e., bullying behaviors, fighting, and anger), of which inner-city youth are particularly vulnerable given their often disproportionately high stress living environments. Stress and aggression are of particular concern in urban physical education (PE) given the proliferation of competitive, sport-based curricula, “culture of basketball”, and the often-limited supervision that takes place. Using the Social Ecological Model, the purpose of this study was to examine the relationships between stress and aggression in inner-city elementary PE students. Methods: After parental consent, participants completed a questionnaire with validated scales measuring stress, aggression, and demographics. Participants included 138, 3rd-5th grade students (Mage = 9.77) from six inner-city schools in the Midwestern United States. Analysis/Results: After correlations were conducted to determine relationships, a series of multiple regression analyses were used to determine the predictors of aggression; controlling for gender, race, and age. Regression results revealed that fighting was significantly predicted by the independent variables with stress, anger, and bullying uniquely contributing (F (6,115) = 21.54, p < 0.01, adj. R2 = 0.51). Additionally, bullying was uniquely predicted by fighting and anger (F (6,115) = 35.01, p < 0.01, adj. R2 = 0.63). Conclusions: This study established a significant relationship between stress, anger, fighting and bullying behaviors in urban PE, possibly indicating a need for renewed focus on anti-aggressive approaches and positive stress response techniques. Specifically, mindfulness-based physical activities, such as Yoga, could enable educators to create more peaceful and less stressful climates, which might then lead to less bullying, fighting, and aggression, hence a more productive learning environment

Relationship between academic achievement and healthy school transformations in urban elementary schools in the United States

ABSTRACT Purpose: Given the recent push to increase children’s physical activity levels through whole-of-school approaches, the relationship between physical activity and academic achievement has received much attention. Therefore, this study sought to understand the relationship between academic achievement and healthy school transformations in urban elementary school children (4th grade; ∼10 years old). Method: A total of 378 urban elementary students participated in an 8-month healthy school transformation that included both physical activity and nutrition programming. The Building Healthy Communities (BHC) program is a nutrition and physical activity program that has six main components: (1) principal engagement, (2) classroom physical activity and nutrition education, (3) active recess, (4) physical education, (5) healthy kids club, and (6) student leadership team. A path analysis was conducted to determine the relationship between the BHC healthy school transformation and student academic achievement. Results: The final model in the path analysis had a good model fit ( = 28.43, p = .10; CFI = .991; TLI = .965; RMSEA = .03, 90% CI [.00–.06]; SRMR = .03). In the final model, program fidelity was a significant predictor of students’ reading comprehension rates of improvement, while students’ aerobic fitness level and time two physical activity levels were all significant contributors to rates of improvement in math. Conclusions: Given recent suggestions to increase physical activity throughout the school day, understanding the relationship that comprehensive programming has on the academic achievement of children is needed. This study demonstrated a clear link between academic achievement and healthy school transformations and sets the stage for more research in this area, as well as implications for pedagogy around health and wellness in the school setting.

Academic and Psychosocial Outcomes of a Physical Activity Program with Fourth Graders: Variations Among Schools in Six Urban School Districts

The purpose was to examine academic achievement, school attachment, and peer acceptance before and after a comprehensive school-based physical activity program (CSPAP) with 378 children in 12 fourth-grade classrooms across six schools in primarily low-socioeconomic status (SES) districts of a large Midwestern metropolitan area. Both personal and normative rate of academic achievement improvement metrics were used. Overall, all students showed personal math and reading growth. However, effects varied by types of achievement indicator and comparison group, revealing noteworthy school-level demographic and implementation characteristics that are inextricably intertwined with program effectiveness and student growth. Implications, especially for minimizing generalizations, are significant.

Sexual Health Knowledge, Self-Efficacy and Behavioral Intentions Following a Health Fair for Adolescents

ABSTRACT High rates of human immunodeficiency virus (HIV) exist among urban African American youth. There is a need to provide HIV information to youth prior to the onset of sexual activity. The Stomping Out HIV intervention combines a health fair and step show to increase awareness and healthy behaviors among this population. Questionnaires were administered to youth and parents before and after Stomping Out, and focused on health knowledge, satisfaction with Stomping Out, intended behavior changes and self-efficacy to make healthier choices related to HIV and STI prevention. Youth and adults reported increased knowledge and self-efficacy after Stomping Out. These findings suggest that health initiatives focusing on sociocultural issues can greatly impact adults and youth.