centre for physical activity and cardiometabolic health in youth manitoba increasing physical...
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Centre for Physical Activity and Cardiometabolic Health in Youth
Manitoba Increasing Physical Activity among Secondary Students: MIPASS
An natural experiment evaluating the Manitoba Grade 11 and 12 PE Policy
Jonathan McGavock, PhDDepartment of Pediatrics, Faculty of Medicine
University of ManitobaManitoba Institute of Child Health
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On Behalf of…• Steve Manske, PhD Propel – U of Waterloo• Erin Hobin, PhD Propel – U of Waterloo• Donna Murnaghan, PhD - UPEI• Catherine Casey, PhD - U of Manitoba• Jane Griffith, PhD - CancerCare MB• Paul Veugelers, PhD - U of Alberta
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Presentation Overview1) Purpose and History of PE Policy
2) Epidemiology 101 and Policy Evaluation
3) Research Design and Methods
4) Results and Future Directions
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Presentation Overview
1) Purpose and History of PE Policy
2) Epidemiology 101 and Policy Evaluation
3) Research Design and Methods
4) Results and Future Directions
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Physical Activity Status: Manitoba
• Only 22% of Manitoba youth aged 5-19 achieve the equivalent of 120 – 150 min/day of MVPA (CLFRI, 2009)
•>30% of Manitoba youth are overweight or obese (CHMS 2007)
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Physical Activity Status: Manitoba
8000
9000
10000
11000
12000
13000
5-10 11-14 15-19
Average steps, by child age, Manitoba
2005-07 2007-09
(CLFRI, 2009)
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Physical Activity Levels
F
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Manitoba Context
Healthy Kids, Healthy Futures Task Force Report:
The task force recommends that the The task force recommends that the government mandate PE/HE from government mandate PE/HE from
kindergarten to Grade 12 in Sept. ‘08.kindergarten to Grade 12 in Sept. ‘08.http://www.gov.mb.ca/healthykids/http://www.gov.mb.ca/healthykids/
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Manitoba PE policy
25%Core Component
25% Minimum
IN-Class Time
25% Flexibility Component
0% 25% 50% 75% 100%
75% Maximum
OUT-of-Class Time
50% PA Practicum
Impacts ~65,000 students in 270 schools in MB
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Manitoba PE Policy
Requirements• Minimum of 110 credit hours of PE/HE• Minimum 55 hours of MVPA (30 mins MVPA
Daily)
Support:• $3.8 Million to support policy implementation• Secondment of PE/Health Consultant for 2
years to oversee implementation
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Manitoba PE PolicyOptions for Policy Implementation:
1) 100% IN – All PE and Health Ed In School
2) 50/50% - Some in, some out (Health On-line)
3) 25%/75% - eg. All PE in health ed on-line
4) 100% out of school on-line
NOTE: Out of class time is logged on an excel
sheet and reviewed by PE teacher frequently
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Manitoba PE policy
• Student fitness portfolio• Student-teacher conferences• Pre- and post-sign off sheets
for teachers and parents• Graded as Complete or
Incompletewww.edu.gov.mb.ca/k12/docs/policy/
imp_pehe/document.pdf
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Presentation Overview1) Purpose and History of PE Policy
2) Epidemiology 101 and Policy Evaluation
3) Research Design and Methods
4) Results and Future Directions
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Asking a Research Question
Target Population
Target Population
Exposure to risk factors
Exposure to risk factors
OutcomesOutcomes
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Asking a Research Question
Men > 50yrsMen > 50yrs
ReducingCholesterolReducing
Cholesterol
Risk of a Heart Attack
Risk of a Heart Attack
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Men > 50Men > 50
Lowering CholesterolLowering
Cholesterol
Reduces Heart
Attacks
Reduces Heart
Attacks
How do you know that this
Causes This
Epidemiology 101
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Gold Standard Design
Target PopulationStudy Sample
Random Assignment
Intervention Control
Outcome Change Outcome ChangeAre they Different?
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Example Problem
Finland
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Proposed Solution
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Entire Population
Entire Population
North Karelia Project
North Karelia Project
Reduces Heart
Attacks
Reduces Heart
Attacks
How do you know that this
Causes This
Gold Standard for Policy Eval?
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Policy Evaluation
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How did it Happen?
0
50
100
150
200
250
300
350
Boys Girls
% C
ha
ng
e f
rom
19
77
-19
99
OWOB
Change in Obesity rates over the same time frame
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Policy Evaluation
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All Grade 11 and 12 Students
in MB
All Grade 11 and 12 Students
in MB
Grade 11/12 PE Policy
Grade 11/12 PE Policy
Increasing PA /
Reducing Obesity
Increasing PA /
Reducing Obesity
How do you know that this
Causes This
Manitoba PE Evaluation
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Gold Standard DesignAll Grade 11 and
12 Students
Small Sample
Random Assignment
Policy Yes Policy No
Increased MVPA Reduced MVPA
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Centre for Physical Activity and Cardiometabolic Health in Youth
The Challenge
Nader, P. R. et al. JAMA 2008;300:295-305
- PE levels decline over time in adolescence
-Parallel intervention at provincial/national level
-Child tax credit, Participaction Olympic Games, gas prices
-School-based initiatives
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Presentation Overview1) Purpose and History of PE Policy
2) Epidemiology 101 and Policy Evaluation
3) Research Design and Methods
4) Results and Future Directions
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RESEARCH QUESTIONS1. Will the policy reduce the number of inactive
youth in Manitoba?2. Will the policy prevent the major decline in
PA levels between grade 9 and 12?3. Does the school environment determine the
effectiveness of the policy? 4. What factors identified by stakeholders
facilitate effective policy implementation?
Centre for Physical Activity and Cardiometabolic Health in Youth
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Question 1 DesignYOUTH HEALTH SURVEY4 pages, 51 questions• Multiple choice, machine
scannable• 20 30 minutes to ‐
complete (short)• Includes questions on
tobacco, nutrition, physical activity, self‐esteem and school connectedness
CENSUS of PA in MB• 46,919 students
participated in the survey • ~33,000 in grades 9-12• 265 of these schools
included grade 9 12‐• All 11 Manitoba Regional
Health Authorities participated
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Research Design 1
Rates of inactivity 2008 n = 33,000
Rates of inactivity 2012 n = 33,000
How do you know it’s the
policy?
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Research Design 1
Policy
No Policy
20122008
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Research Design #21) Cohort study of ~700
adolescents between grades 9 and 12 in Manitoba
2) 32 schools - 20-30/ school beginning in 2008. Followed to 2012
3) Randomly Selected with 40% rural
4) Parallel cohort of 800 youth in Alberta
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Assessment of Physical Activity
• Actical (minimeter)• 7 day data collection• Data collected every 15
seconds• Youth asked to wear it for a
minimum of 10 hrs daily• Provided with a minimal
incentive to wear the unit• Same research assistant for
all 4 years
Eslinger Tremblay APNM 2008
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Research Design #2
0
10
20
30
40
50
60
70
80
90
100
2008 2009 2010 2011 2012
MV
PA
(m
ins/
day
)
ABMB
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SHAPES Environment Survey
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Research Design #3
Follow the cohort until grade 12
Test for Differences in PA levels or change in PA according to School environment and/or polciy type
Original Cohort in Grade 9
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Research Question #4
MethodMethod
• 12 schools 12 schools
– 60% urban60% urban
– 6 schools 50/506 schools 50/50
– 3 schools 75/253 schools 75/25
– 2 schools 25/752 schools 25/75
• 12 PE teachers12 PE teachers
• Concerns-based Concerns-based modelmodel
• 1 interview 1 interview (~60min) with (~60min) with each of the 12 PE each of the 12 PE teachersteachers
• 1 yr post-policy 1 yr post-policy (May/Jun 2009)(May/Jun 2009)
• Interviews Interviews transcribed transcribed verbatimverbatim
• Thematic analysis Thematic analysis to identify key to identify key conceptsconcepts
• Identify themes that fall into each SWOT category
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Presentation Overview1) Purpose and History of PE Policy
2) Epidemiology 101 and Policy Evaluation
3) Research Design and Methods
4) Results and Future Directions
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Policy Implementation
0
5
10
15
20
25
30
35
40
25/75 50/50 75/25 100
Fall 2008
% O
f Tot
al
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Results Question #1
30
35
40
45
50
55
60
65
Grade 9 Grade 10 Grade 11 Grade 12
% o
f to
tal
<30 mins>30 mins
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Results Research Question #1
• Data were very similar for PEI in 2008 (n=~8000)
• 2012 being collected this year in MB• Plan to collect data in PEI• Data will be available mid 2013 for
comparison between the two provinces
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N = 966 Youth(44 Schools)
N = 377
N = 309
N = 274
N = 442 Youth(2008+2009 3 days/8 hours
including 1 weekend day)
N = 253(including 1 weekend day)
Manitoba
N = 588
N = 413
N = 352
N = 242(including 1 weekend day)
Alberta
N = 229(including 1 weekend day)
N = 213(including 1 weekend day)
N=175 (invalid 4 days/8hours) in 2008
N=35 (No weekend) in 2008
N=22 (invalid 4 days/8hours)in 2009
N = 24 (No Weekend Day) in 2009
N=175 (invalid 4 days/8hours) in 2008
N=61(No weekend) in 2008
N=110 (invalid 4 days/8hours)in 2009
N = 29 (No Weekend Day) in 2009
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Weekday Weekend
Per
cen
tag
e o
f T
ime
0
20
40
60
80
100
70 66
22 28
SedentaryLight MVPA
2008
Weekday Weekend
0
20
40
60
80
100
72 72
21 23
SedentaryLight MVPA
2009
Results Question #2
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Figure 3
mean ± SE*=p<0.05 vs. weekday; † vs urban
BOYS GIRLS
MV
PA
TIM
E (
min
s/d
ay)
0
40
60
80WeekdayWeekend
A
*
*
MV
PA
TIM
E (
min
s)
B
URBAN RURAL
040
60
80WeekdayWeekend
* *
†
†
Results Question #2
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Results Question #2Weekday MVPA Weekend MVPA
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Figure 5
2008 2009
Lig
ht
PA
Tim
e (
min
s)
* = p < 0.01, change in Light PA over time
0150
160
170
180
190
200
210
220
Week day Weekend
*
*
Boys
Girls
Results Question #2
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Results Question #2
4042
444648
505254
5658
2008 2009 2010
Min
s/D
ay
AB-MVPA
MB-MVPA
Average MVPA Daily
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Results Question #2
40
45
50
55
60
65
2008 2009 2010
AB Weekday
MB Weekday
Min
s/D
ay
Weekday MVPA
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Results Question #2M
ins
/Da
y
Weekend MVPA
33
34
35
36
37
38
39
40
41
2008 2009 2010
AB Weekend
MB Weekend
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Research Question #2
30
35
40
45
50
55
60
65
Weekday Weekend Weekday Weekend
2008
2009
2010
Min
s/D
ay
Manitoba Alberta
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Research Question #2
0
10
20
30
40
50
60
70
80
90
100
Weekday Weekend
% o
f Y
ou
th
200820092010
% > 30 mins Daily
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Research Question #3• Still analyzing data.• No insight into what policy model works best
to date.
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Research Question #4
‘As far as what it has done to our school environment, as a physical educator I was thrilled.’
Commitment and support of PE teachers
‘…improvement will come from the school level, just talking to each other and seeing how we can deliver the policy more effectively.‘
‘Most PE teachers felt it was long overdue.’
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‘…one of our teachers had a student trying to get his PE hours because he’s a drummer. So we gave him a heart rate monitor…and he spent quite a bit of time in the target heart rate zone drumming.’
‘A lot of students pick skateboarding and they’re very talented and it is a lot of work…so you have students pick different things like that….’
Offering students choice in activities
Research Question #4
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Weaknesses
‘The bookkeeping part of it is kind of overwhelming…the amount of paperwork we took in was tremendous.’
Tracking and Reporting
‘Finding time to track those kids and keep them up to date is very difficult, a huge challenge.’
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Weaknesses
‘…my administrative colleagues weren’t thrilled when they had to timetable and make some hard decisions…we had to make decisions on actually cutting some other courses.’
Scheduling courses
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Weaknesses
‘… I’d like to have more with the parents…I had them sign the declaration and their logs and then a sign-off on policy but then I don’t really know how much they’re actually sort of keeping up with if their child is actually doing it.’
Communication with parents
‘We do have a lot of ESL kids in our schools so we can’t communicate because their parents don’t understand…having the declaration in different languages.’
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Opportunities
‘…we went through some orientation of the new curriculum. I went to some sessions, professional development sessions…’
‘…there’s also good things on the [government’s] website and all the PowerPoint presentations.’
Access to resources and professional development
‘The materials that we are provided are fabulous.’
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Opportunities
‘…we are able to look at what is available and what our kids want and try and meet their needs within the curriculum.’
‘You try something, you throw it out, or you modify it. As long as you are willing to try then it will get better.’
Flexible delivery model
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Threats
Increased Workload
‘…we were told it shouldn’t be putting more work on the teachers…it produced more work, bigger classes and less time…’
‘…it is difficult to have enough time for conferences with each student so it would be helpful to have a supply teacher help fill the time away from class.’
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Threats
Access to facilities
‘Facilities are a bit of a challenge…no question it’s a juggling act to get 4 classes going at the same time. It works, but it is a juggling act.’
‘The #1 problem is our location. We can’t just walk to community recreation facilities. We have to get on a bus or we need rides. When you look at other urban schools, they can just walk across their parking lot to great facilities.’
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Teacher Survey 2012
0
10
20
30
40
50
60
70
80
90
100
% Honesty Effective? Recommend? Mandate?
% R
esp
on
din
g Y
es
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Does the Policy Impact PA outside of class
• They are … feeling good, developing better lifestyles, buying gym memberships. Students in the past have come back and said they are continuing to be active, and understand it is important for their health.
• Students are now more aware of what is out there, that you can do for free. For example some rec centers have discounts, and a lot of games, you do not need equipment for
• they do not want to be physically active. The students that want to be active are going to do it even without the policy
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0
10
20
30
40
50
60
2004 2005 2006 2008 2009 2010
Year
Pre
vale
nce
%unfit
%OW/OB
Pre-Policy Post-Policy
23.2 22.1 23.424.3 24.6
26.7
50.8 51.1 50.4 52.352.6
51.1
Is the Alberta DPA Working?
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Frequency of DPA in Year 1 Simcoe Muskoka SB 2007, n=258 teachers
Centre for Physical Activity and Cardiometabolic Health in Youth
Modeski and O’Connor, 2007
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Challenges with DPA in Year 1Simcoe Muskoka SB 2007, n=260 teachers
Centre for Physical Activity and Cardiometabolic Health in Youth
Modeski and O’Connor, 2007
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Specific barriers to DPE or DPACalgary School Board, n=55 schools
Centre for Physical Activity and Cardiometabolic Health in Youth
Kennedy et al., 2010
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Arkansas' BMI Report Cards
Centre for Physical Activity and Cardiometabolic Health in Youth
Arkansas Center for Health Improvement, 2010
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Centre for Physical Activity and Cardiometabolic Health in Youth
Acknowledgements• Melisa Comte• Pinar Esciogolu• Andrea MacIntosh• Paul MacArthur• Dr. Rob Santos• Heather Willoughby• Jackie Nylen
• Dr. Steve Manske• Dr. Jane Griffith• Dr. Donna
Murnaghan• Dr. Catherine Casey
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Centre for Physical Activity and Cardiometabolic Health in Youth
Questions?
www.mich.ca/dr_mcgavockE-mail: [email protected]