research proposal how can student health literacy inform ... · literacy inform key stakeholders...

RESEARCHPROPOSAL

Howcanstudenthealthliteracyinformkeystakeholdersregardingschoolwellnesspolicyimplementation?

L‐8‐Canposequestionsandusemethodsofformalinquirytoanswerquestionsandsolveproblems.

L‐9‐Cananalyzetheeffectivenessofwellnesspolicies

inpublicschools.

AdeniaLinker

DePaulUniversity

10July2012

AdeniaLinker ResearchSeminar EllenBenjamin

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I. THEPROBLEMANDIT’SSETTING

A. STATEMENTOFTOPIC:

PubliceducationinAmericahascomeunderincreasedcriticismfollowingtheNoChildLeft

Behind(NCLB)legislationenactedin2002.Thispolicyattemptedtoincreasetheaccountabilityofschool

districtsregardingspecificacademicmeasurements,andrequiredschoolstoadoptstandards‐based

educationaswellasmaintainaggressiveachievementstandards.Impactingbothfailingandsuccessful

schoolsandnearly1000pagesinlength,NCLBrepresentsthefirstsignificantreformsincethe

ElementaryandSecondaryEducationActof1965(Noddings15).Today’sreformmovementrequires

thatallstudentsbeproficientinmathandreadingby2014(Noddings14)andrequiresschoolstooffer

annualtestsinthirdtoeighthgradeandonceinhighschool(Noddings14).

NCLBlegislationdidnotmandateachievementgoalsforphysicaleducationandmanyschool

districtsfocusedtheirattentionandresourcesonacademics.Thishasresultedinasignificantreduction

oreliminationofrecessandphysicaleducation.Consideringthepopulationwidedeclineinphysical

activity,andepidemicratesofjuvenilediabetesandobesity(Benham‐Dealetal81)publichealth

advocatesfoundsomesolacewhenTheReauthorizationActof2004requiredthedevelopmentof

schoolwellnesspoliciesforschoolsreceivingmealassistance(Lambert,MonroeandWolff271;Longley

andSneed95).

Topicscoveredinhealtheducationvarybystateanddistrictandinclude:physicalfitness,safety,

nutrition,asthmaawareness,mentalhealth,aswellaspreventionofalcohol/druguse,foodborne

illness,HIV,STD,pregnancy,suicide,tobacco‐useandviolence.OneCenterforDiseaseControland

Prevention(CDC)studyfoundthat6.4%ofelementaryschoolsrequiredinstructiononall13topics.The


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samestudyfoundcomprehensivehealtheducationat20.6%ofmiddleschoolsand35.8%ofhigh

schools(Facts:LearningforLife1).A2002InstituteofMedicine(IOM)releasedreportidentifiedhealth

literacyasan“important,cross‐cuttingthemetoaddressinanyeffortstoreduceethnicandracial

healthdisparities”(SandersetalS312).TheCDCdevelopedschoolwellnessguidelines(Youngetal42)

andrecommended:

• Establishingpoliciesthatpromotephysicalactivity.

• Providingenvironmentsthatencouragesafeandenjoyablephysicalactivity.

• Implementingquality,dailyphysicalactivityinstructionandcurricula.

• Implementinghealtheducationthatprovidesstudentswithknowledgeandneeded

behavioralskills.

• Providingsufficienttrainingforpersonnelinvolvedinphysicalactivityinstructionor

promotion.

• Providinginclusiveextracurricularapproachesthatmeettheneedsandinterestsofall

students.

B. STATEMENTOFPROBLEM:

Duringthe2011‐2012schoolyear,404,151childrenattendChicagoPublicSchools.Eighty‐seven

percentofthesestudentscomefromlow‐incomefamilies(ChicagoPublicSchools:StatsandFacts1).

TheConsortiumtoLowerObesityinChicagoChildrenfoundthat22%ofChicagochildrenareoverweight

beforeenteringschool,morethandoublethenationalaverage(Vevea1).AccordingtotheCDC,if

obesityratesremainunchanged,30%ofboysand40%ofgirlsbornin2000willbediagnosedwith

diabetes(HealthEducationinSchools2),astatisticthatclearlyarguestheimportanceofhealthliteracy


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forCPSstudentsbeyondjust“threemostimportantpreventativemeasures:notsmoking,maintaininga

healthyweight,andexercisingregularly”(HealthEducationinSchools1).

ExpertsnowrefertotheAmericanlifestyleasan“obesogenic”environment,onethatpromotes

weightgainthroughfactorssuchasthedecreaseinhomecookingandbreakfastconsumption,portion

distortion,advertisingandgreaterfoodavailability(StrideInstitute4).Nearlytwo‐thirdsoftheU.S.

adultpopulationisoverweightorobese(HealthEducationinSchools1)andthenumberofAmericans

withdiabeteshasdoubledinthelast15yearsto14.6millionin2005(Colemanetal23).Additional

researchfindsoneinthreeAmericanadultshaslimitedhealthliteracy(SandersetalS307).Obesogenic

behaviorsaresogreatthattheDepartmentofPublicHealthnowrequirespreschoolanddaycare

centerstolimitscreentime(televisionandcomputer)tolessthan60minutesaday,andreiteratesthe

needforaminimumof60minutesofphysicalactivity(Vevea1).TheHealthLiteracyreportpublishedby

the(IOM)highlightsthesignificantroleanddirectinfluencethatschoolshaveinroutineliteracyandthe

importanceofenhancinghealthliteracyasagoalwithinliteracyskills(Manganello842).

WritingintheJournalofSchoolHealth,Kolbestates“today,themajorcausesofdeath,

disability,injury,andillnessamongyoungpeople…resultfromafewpatternsofbehaviorthatbecome

establishedduringschool‐ageyears”(226).Althoughhealthliteracymayseemofconcernonlyforthose

inpublichealth,thesepreventablebehaviors(e.g.alcoholanddrugabuse,sexualbehaviors,tobacco

use,unhealthydiets,andphysicalinactivity)areasKolbecontinues“taxingourhealthcare,health

insurance,andunderlyingeconomicsystemstothebreakingpoint”(226)andwarrantearlyintervention

andpreventionmeasures(Manganello840).AccordingtotheCDC’sHealthyYouthinitiative,theschool

dayprovides54millionAmericanstudentstheopportunitytolearntheskillsthatsupporthealthy


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lifestylesandbehaviors(HealthEducationinSchools1),however,asNoddingsimplores“thecurrencyof

accountabilityineducationisstandardizedtesting“(41).

Publicschoolwellnesseducationappearstobeinadequatelyandunequallyprovidednationally.

Thefocusonacademictestingishavinganegativeimpactonwellnesseducationinpublicschools.One

studyfoundthatonly5.9%ofthirdgradersattendphysicaleducationclassesdaily,andthosestudents

onlyaveraged4.8minutesofvigorousactivity(Barrosoetal313)whileanextensivestudyofseventh

andeighthgradersfoundolderstudentsdonotmoveduringrecess(StrideInstitute8).Anotherconcern

accordingtotheStrideInstitute,“inlargePEclasses,60%oftimeisspentdoingnoactivityatall”(8).

Whilestatestandardsvary,it’shighlylikelythatCPSstudentsareexperiencingsimilarlimitedPE

programs.

In2010theU.S.DepartmentofHealthandHumanServicesadded“improvedconsumerhealth

literacy”toitsobjectives.Healthliteracyisdefinedas:"thedegreetowhichindividualshavethe

capacitytoobtain,process,andunderstandbasichealthinformationandservicesneededtomake

appropriatehealthdecisions"(Brown,TeufelandBirch8);essentialskillsforthegrowingpopulationof

youthsufferingfromchronicasthma,diabetes,cysticfibrosisandmentalillness(Manganello841).

Consideringnootherinstitutionhasasmuchcontactwithchildren(Haire‐Joshuetal2)schoolsmust

fosterhealthliteracyintheclassroomforchildrenwhodependonpublicschoolstobuildtheseskills

(Brey,ClarkandWantz640).

Thepublicschool,asNoddingspointsout,“shouldbeaplacewherechildrenlearntomake

intelligent,well‐informedchoices”(75);however,thecaseofa15‐yearoldHispanicintheBronxwho

compareddiabetestoacold,showshowstudent’shealthliteracyneedsmightbemetthrougha

“popularscience”classtolearnaboutdisease,diet,exercise,calculatingcalories,interpretingblood


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pressure/sugar(Noddings36).TheInstituteofMedicinerecommendshealthprogramsbedesignedto

improvehealthliteracy,healthbehaviorsandhealthoutcomes,academicachievement,andsocial

outcome(Kolbe227).Onesuchexample,developedbyBrey,ClarkandWantz,recognizedthestrength

ofthemedia’sinfluenceonadolescent’sasahealthresourceandutilizedthatdevelopmentalinterestto

motivatethelearningexperience(641).Anotherstudyfoundthatpeereducatormodelswere“oneof

themosteffectivestrategiesfordisseminatingpreventioninformation”(Colemanetal23).Theseare

bothexamplesof“well‐designed,well‐deliveredschool‐basedhealthinterventions”designedtoinform

andenablestudentstopreventdiseaseandinjury”(HealthEducationinSchools3).

While“someschoolsystemsarebeginningtorecommendorrequirehealthliteracyasa

componentforgraduation,”(SandersetalS310)mostofferonlyonesemesterinhealth(Noddings48),

andIamunawareofanyrequirementforCPSstudents.Giventhecurrenteconomicclimateandschool

budgetcuts,whatisneededaresignificantsystemswhere“theeasierordefaultchoiceisthehealthy

choice”atnocosttotheschool(StrideInstitute4).Dr.StephanieWhyte,therecentlyannouncedChief

HealthOfficerforChicagoPublicSchools,willcertainlybeconsideringsuchchallenges.Her

appointment,whichreportstoboththeChicagoPublicSchoolsandtheChicagoDepartmentofPublic

Health,representsacriticalpartnershipnecessaryforcommunitywidehealthliteracy(“NewChief

HealthOfficer”).

STATEMENTOFQUESTION:

Inthisstudy,Irecommendresearchingthequestion:HowcanCPSstudents’healthliteracydata

informkeystakeholdersregardingtheeffectivenessoftheirschoolwellnesspolicyimplementation?

STATEMENTOFHYPOTHESIS:


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Iproposetotestthefollowinghypothesis:CPSstudents’healthliteracydatacaninformkey

stakeholdersregardingtheeffectivenessoftheirschoolwellnesspolicy(SWP).

Delimitations

ThisstudywillnotincludetheChicagosuburbsnoranyotherareasthatarenotservedby

ChicagoPublicSchools.Nostudentswhohavetransferredfromanotherschoolsystemduringtheschool

yearwillbeincluded.Thisstudywillexcludegrades1‐2,4‐7,and9‐11.

Definitions

Forthepurposeofthisstudy,keytermswillbedefinedasfollows:

Healthliteracy:thedegreetowhichindividualshavethecapacitytoobtain,process,and

understandbasichealthinformationandservicesneededtomakeappropriatehealthdecisions;

healthknowledge,attitudes,andskills(Brown,TeufelandBirch8;Manganello1).

Keystakeholder:atermborrowedfrombusinessacumenindicatingapartywhocanaffectorbe

affectedbytheoutcomeofaneventorinthiscase,byaschoolwellnesspolicy(e.g.school

boardofeducationmembers,physicaleducationdepartmentspecialists,statepublichealth

nutritiondirectors,healtheducationteachers,schoolfoodservicedirectors,schoolnurses,

socialworkers,andcounselors,schoolwellnessadvocates;andteacher,parentandstudent

representatives).

Effectiveness:PhysicalEducationandHealthstandardsexistwithgoalsformovementskills,

physicalfitness,teambuilding,healthpromotion,preventionandtreatment,humanbody

systems,andcommunicationanddecision‐making(“ILSGoals”).Thesegoalsaredocumentedin

20assessmentrubricscoveringallgradelevels(“ILSAssessments”).


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Schoolwellnesspolicy(SWP)includes:

o Nutrition:healthyeating,whichisassociatedwithreducedriskofmanydiseases,

includingthethreeleadingcausesofdeath–heartdisease,cancerandstroke–andis

importantinchildhoodandadolescenceforpropergrowthanddevelopmentandcan

preventobesity,dentalcaries,irondeficiencyanemia,andotherhealthproblems

(ChicagoPublicSchoolWellnessPolicy1).

o NutritionEducation:planned,sequential,K‐12curriculumorsupplementaleducation

programthataddressesthephysical,mental,emotional,andsocialdimensionsofhealth

relatedtonutrition.(ChicagoPublicSchoolWellnessPolicy1)andisalignedwithNHES

andIllinoisLearningStandards(ChicagoPublicSchoolWellnessPolicy2).

o PhysicalEducation:(PE):plannedsequentialK‐12curriculumthatprovidescognitive

contentandlearningexperienceinavarietyofactivityareas(ChicagoPublicSchool

WellnessPolicy2).

o PhysicalActivity:(PA):movementthatreducestheriskofprematuremortalityin

generalandofcoronaryheartdisease,hypertension,coloncanceranddiabetesin

particular(ChicagoPublicSchoolWellnessPolicy1);enablesstudentstoremainactive

andmaintainhighlevelofpersonalfitness,emphasizesself‐managementandis

consistentwithIllinoisLearningStandards(ChicagoPublicSchoolWellnessPolicy4).

Assumptions

Forthepurposeofthisresearch,Iassumethat:


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Publicschoolswillcontinuetoberequiredtoprovidemealandfoodservices,andwellness

educationtotheirstudents.Schoolswillneedtosupplementwhatmightbeconsideredthefamily’s

responsibilitiesinsomearease.g.healthyeating.

HealthliteracyneedswillcontinuetoincreaseasmoreAmericanchildrenarediagnosedwith

chronicillnesses.

II. REVIEWOFTHERELATEDLITERATURE

A. MAJORISSUESEXPLOREDBYSCHOLARSWHOHAVERESEARCHEDTHISTOPICAND

PROBLEM

Significantresearchexistsidentifyingthebarriersthatpreventtheproperadministrationof

high‐qualityschoolwellnesspolicies.Mostscholarsidentifythetopissuesfacingschooldistrictsand

systemstodayas:lackoftimeandfunding,competingpriorities,andlackofkeystakeholdersupport

(Agronetal533;Barrosoetal316;Hammerschmidtetal63;Lambert,MonroeandWolff271;Longley

andSneed100;Noddings2;andYoungetal45).ThesebarrierscanbecorrelatedtotheNCLBmandates

thatplacedacademicachievementaboveallotherlearning;it’smostdamagingimpactthroughits

corruptinginfluencetomanipulatedata,seekloopholes,triggercheatinganddrainfinancialresources

(Noddings7).

Lackoftimeisobviouswhenyouconsideronly5.9%ofTexan3rdgradershadPEfivetimesa

week(Barrosoetal313),and84%ofelementaryschoolscomplainofinsufficienttimeforPE

(Hammerschmidtetal66).Assuringdailyphysicaleducationisimportantbecause“children[are]more

activeafterschoolondaysthatthey[have]PEthanondaystheydidnot(Benham‐Dealetal84)and

researchfindsthatbothhealthyandunhealthybehaviorsestablishedbysixthgradewillremainintact


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throughouthighschool(Bauer,YangandAustin36).Adolescents,asManganellodeclares,“areata

crucialstageofdevelopment,learningskillsthatwillcarrywiththemintoadulthood”(840),andphysical

educationclassescanbeoptimalinestablishinghealthylifelonghabits(Barrosoetal313).

Allocationoffinancialresourcestoacademicsubjectsleaveslittlefundingforwellness

programming.Adequatefundingwasthenumberonebarriertoeffectiveschoolwellnesspolicy

development,implementation,andmonitoringcitedina2010nationalsurvey(Agronetal533).Lackof

fundinginterfereswithnutritioneducationat67%ofelementaryand45%ofhighschools

(Hammerschmidtetal66)while39%ofelementaryschoolsand41%ofhighschoolslackthefundingto

facilitatephysicalactivity(Hammerschmidtetal67).Somearguethatphysicaleducationprograms

wouldreceivemorefundingandattentioniftheywereconsidered“essential”informaleducation

(Barrosoetal316),anopinionvoicedbymanybeyondjustphysicaleducationspecialists(Youngetal

45).

ObtainingsufficientfacilitiesandPEequipmentisobviouslycriticalandamajorbarrierfor53%

ofmiddleschools(Youngetal45).Student’sperceptionofproperfacilitiesandadequateresources

shouldalsobeconsideredandsuchinvestmentsshouldbe,asNoddingsinsists,“providedasamatterof

decency”(2).Environmentalfactorssuchaslargeclasssizepreventhigh‐qualityphysicaleducation

experiences(Barrosoetal315),andcompetitionforthelimitedslotsonorganizedteamsisnegatively

impactedbyalackofsufficientcoaches,playingspaceandequipment(Bauer,YangandAustin39).Dr.

JohnRatey,authorofSPARK:TheRevolutionaryNewScienceofExerciseandtheBrain,findsthatless

than3%ofAmericansparticipateinteamsportsbeyondage24(17),remindingusthatcompetitive

sportsinterestdonotresultinlifelongphysicalactivity.Studentsreportedstaffmakingnegative

commentsregardingathleticabilityofsomestudents,whileotherobservationssuggestedopengym


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programmingfavoredboyssportsandactivities.Anothercriticalreflectioninvolvedthelimitednumber

ofcoaches,equipmentandspotsonsportsteamsresultinginagreatdealofcompetitionforthe

covetedteampositions(Bauer38‐39).Whensurveyingmiddleandhighschoolsstudentsregardingtheir

motivationwhether,ornot,toparticipate,studentsdemonstratedahighawarenessthatphysical

activitypromoteshealthwithover70%ofresponsesnoting“Itmakesmehealthier”(Couturier,Chepko

andCoughlin3).Whenaskedabouttheirexperiencewiththevarietyofactivitiesoffered,amajority,

over75%wantedtochoosetheiractivities,while45%“donotlikedoingthesameactivitieseveryyear”

(Couturier,ChepkoandCoughlin3).Additionally64%ofrespondentsdisliked“goingtomynextclassall

sweaty”while53%disliked“nothavingenoughtimetochangeandshower”(Couturier,Chepkoand

Coughlin3).

Anotherdominantbarrierisconflictingpriorities(Agronetal533,Benham‐Dealetal89,

Hammerschmidtetal63,LongleyandSneed100,Youngetal45).Whenschoolsdiverttheirresources

andfocustoacademicsinpreparationforstandardizedtesting,itpreventsimplementationofhigh

qualitydailyphysicaleducation(Agronetal533,Benham‐Dealetal90;Hammerschmidtetal66).

Thirty‐twopercentofhighschoolsalsoreport“toomuchfocusonstate‐mandatedtestingtohavetime

tofocusonnutritioneducation”(Hammerschmidtetal66).AccordingtotheCenterforUrban

Education,studentsinCPSaretakingstandardizedtestseveryfiveweeks(Vevea2).

Severalschoolsreportedthatotheractivities“preventqualityprogrammingandsuggestthat

physicaleducationissimplynothighlyvaluedwithintheschool,”afeelingconfirmedby20of36

PhysicalEducationdepartmentheads(Youngetal45).Asmanyas25%ofPEclassesareshortenedor

cancelledinfavorofotheractivities(Youngetal46)suchaspicturedaysandsciencefairs.A2005study

suggestedthatphysicaleducationbeintegratedmorefully“intoschoolpoliciesandevaluation,suchas


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acomponentoftheacademicassessmentscoresofschools”(Barroso316).Unfortunately,astudyof

low‐incomeschoolsalsofoundnutritionhadnopriorityat54%ofhighschoolsand33%ofelementary

schoolssurveyed(Hammerschmidtetal66).WhenGrevesandRivarareviewedthelargestschool

districtsinthenation,responsibleforacollectiveof5.9millionchildrenor11%ofstudents(3),they

foundnodistrictthatmettheIOM’srecommendationsforpreventingobesity(9).

Researchfindsthatnationalenrollmentinphysicaleducationbeginstodeclineinhighschool,

howeveronestudyfoundthisdeclinewasstartinginjuniorhighinWyoming(Benham‐Dealetal84).In

1995,91%ofelementaryand93%ofsecondaryschoolsinWyomingreportedhavingawrittenschool

physicaleducationcurriculum.However,whenthoseschoolswererevisitedadecadelater,only78%of

elementaryand73%ofsecondaryschoolshadawrittencurriculuminplacerepresentingaconsiderate

decline.ThisisparticularlyinterestingconsideringWyominghasalwaysseenphysicaleducationasa

corecurriculumsubject,andschoolshavebeenrequiredtoprovidestandardsbasedphysicaleducation

aswellmeasuretheirachievements(Benham‐Dealetal81).Exposingthedeclininguseofcurriculum,

illuminatesthevulnerabilitynearlyeveryschooldistrictinthenationfeelswhenbalancingtheirstudents

healthneedswithacademicsdemands.

Dependenceonfundraisingwithnon‐nutritiousfoodsconflictswithupholdingnutrition

guidelinessupportingBolesandcolleaguesfindingsthat“eveninthepresenceofnutritioneducation

policies,foodofminimalnutritionalvalueremainsavailable”(5).Inadequatefundingoffieldtripsfor

example,oftenpromptsschoolstoresortonsalesofsnacksandsodasthatdismissthemessages

encouragedbynutritioneducation(Bauer,YangandAustin41).Today’sschoolsoftenutilizenon‐

nutritionalfoodforfundraisingandcontractwithjunkfoodvendorstosponsortheirsportsteams.

Thesebrandedfastfoodandbeveragecontracts,coupledwithsodavendingin61%ofmiddleschools


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and75%ofhighschools(GrevesandRivara7)sendconflictingmessagesthatundermineindividual

studenthealthbehaviors.TheuseoffastfoodsuchasPizzaHut™andMcDonalds™isalsoemployed

evenwhilethosefoodsdonotmeetnutritionrequirements(GrevesandRivara4)whileanother

challengingbarrierwasthepresenceofunhealthyfoodoncampuseitherbroughtfromhomeorusedas

aclassroomreward(StrideInstitute13).Inanationalstudy,63%offoodservicedirectorsfoundthatthe

foodinfundraisingisabarrier(LongleyandSneed100).Accordingtoassessmentofthenation’s51

largestschooldistricts,noschooldistricts“includedafter‐schoolfundraisingorconcessionsalesaspart

oftheirpolicies(GrevesandRivara4).Anotherstudyfound31‐45%ofSWPomittedfoodsusedas

fundraising,partiesandclassroomrewards(Probartetal1499).

A2004studyofstudentsandstafffoundthepoorqualityandpalatabilityoffoodservedinthe

cafeteriatobeasignificantbarriertohealthynutrition.Staffatthesemiddleschoolsalsofeltthat

eliminatingthejunkfoodaroundcampuswouldbedifficultbecausethefundswerenecessaryto

supportacademicactivitiesforlow‐incomefamilies.(Bauer,YangandAustin41).ACPSteachersecretly

bloggedaphotogalleryanddetailsofherexperiencewithschoollunchesservedatherschoolwhere

90%ofthestudentsqualifiedforfreeandreducedmeals.Mealsofmysterymeat,heavilyprocessed

chicken,andhotdogscoveredinsoggydougharesomeofthefoodsdocumentsduringher162meal

blog‐basedjournal,thesamemealherstudentsdependedon.Almost32millionkidsareservedlunchat

schooldaily,andmostschoolsarestrugglingtofindmealsthatkidswillenjoythatincludeenoughfruit

andvegetables(Hellmich2).

Today’syoutharevulnerabletobothtraditionalmorbidityissueslikecommunicablediseases

and“newmorbidities”suchaseatingdisorders,sedentarylifestyleandobesity,thesoontobenumber

onepreventablekillerintheUS(StrideInstitute36).Someteachingstaffvoicestheconcern“wecannot


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havecupcakesorcookiesonholidays”(Lambert,MonroeandWolff274)and“whenIwasinschoolwe

didn’thavea[schoolwellnessplan],andIstillmadeit,”(StrideInstitute36)highlightingthattoday’s

teachersmaynotfullyappreciatehowthesenewmorbiditiesimpacttheirclassroomandstudents.

Teachersmaynotrecognizethevalueandneedforclassroomnutritioncompetenciesthatsupportthe

SWP(Lambert,MonroeandWolff275).

TheNationalHealthEducationStandards(NHES)recommendthatalleducationaldisciplines

(math,readingandsocialstudiescurricula)incorporatehealthliteracycompetencies(Sandersetal

S310),however,onestudyofelementaryschoolteachersfoundonly30%includenutritioncompetences

intotheirlessons,andanalarming75%ofteacherswerenotconfidentthattheywouldhavetimeto

attendprofessiondevelopmentwereitavailable(Lambert,MonroeandWolff274).Thisspeakstothe

currentlowprioritySWPhavewithkeystakeholders,asonly10%ofthoseinterviewedfeltadequately

recognizedfortheirefforts(Lambert,MonroeandWolff274).AccountabilitytoNCLBtieskey

stakeholderstostudentacademicsuccessdiscouragingallocationofresourcesandtimetonon‐

academicmaterial.FoodservicedirectorsalsonotedlackofsupportandfeltNCLBwasabarrierfor

teachersandprincipals(LongleyandSneed100).

Interviewsfromkeyinformantsemphasizethatawellnesscoordinatorordedicatedpersonto

guidewellnessinitiatives,alongwithlong‐termtop‐levelcommitmentformadministratorsandschool

boardswouldsignificantlyimprovecurrentefforts(Agronetal533).Agron’steamfoundthat

administratorsarelimitedintheircapacitytotrainfororimplementwellnesswithintheirschool

environment(533)andoften,differingopinionsregardingwhichwellnesspolicytoolstoutilizehinders

decision‐making(533).Schoolboardmembersaremoreoptimisticregardingeffectivelyimplementing

andmonitoringthepolicywhencomparedtothoseactuallyexpectedtocarryoutthoseactivities,


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suggestingalackofunderstandingaboutwhatisactuallyinvolvedincarryingoutwellnessgoals(Agron

etal534).

Supportandresourcesnecessarytoreducethefinancialandtimebarrierseducatorsfacewill

likelybeslowandinadequate,thereforekeystakeholdersmustconsideradditionalmeanstoimprove

theirstudent’shealthliteracy.Student’sindividualandcollectiveperceptionandawarenessofphysical

educationandnutritiongoalscanprovidekeystakeholderswithcriticalinformationthatmaynot

previouslyhavebeenconsideredwhenplanningandimplementingacomprehensiveSWP.

B. METHODOLOGIESUTILIZEDBYSCHOLARSTORESEARCHTHISTOPICANDPROBLEM

Thescholarlyresearchstudiesandotherarticlesidentifiedusedavarietyofresearch

methodologies,includingfocusgroupsandinterviews;however,themajoritydependedonweb‐based

surveysanddata.Severalofthesestudieswereannounced,administeredandfollowedupon

exclusivelyviawebinteraction.Administratorsandeducationstakeholdersweremorelikelytobe

surveyed,withfewstudiesseekinginputfromstudents,confirmingtheneedforadditionalresearchon

earlyadolescenthealthliteracy(Brown,TeufelandBirch8;Manganello840).

Youngandherteam,forexample,selected36schoolsfromapre‐establishedfieldtrialgroup,

andconductedagroupofphenomenologicalinterviews.Interviewswithschoolprincipals,physical

educationandhealtheducationdepartmentheads,andschool‐basedphysicalactivityprogramleaders

involvedquestionsrangedfrompolicytocurriculumandincludedfrequencyandparticipant’sgender.

Thisstudyfocusedonthebarriersforadolescentgirls,however,didnotinterviewthemwhich

significantlylimitstheresultingdata.Anotherextensivestudythatdidnotincludestudentsdirectlywas

anwide‐rangingtwo‐yearstudyconductedbytheStrideInstituteevaluatingthewellnesspolicesofa


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largecounty.Itincludedfiveinterviewswithkeyinformants,directobservationofphysicalactivity,a

platewastestudyandphotodocumentary,andmodifiedschoolhealthindexscorecardsanalysis.While

anextensivecollectionofdata,itdidnotincludeanystudents’perspective,andthequalitativedatawas

limitedtoasingleschool.

Severalstudiesthatincludedfocusgroups,alsoutilizedonlinesurveysaswell.Hammerschmidt

andhercolleaguessurveyed69keystakeholdersincludingclassroom,healthandPEteachers,school

nurses,foodservicesandparentsviaonlinesurveys,andsupplementedtheirresearchwith56

contributionsviasevenfocusgroupsmadeofteachers,administrators,foodservice,andhealth

coordinators.Amuchlargerqualitativestudy,byAgronandhercolleagueswasconductedbasedonan

onlinesurveyrepresentingall50statesbywayof2350respondents(1296schooldistricts)with37

schoolboardmembersparticipatedinfocusgroups,representing17statesaswell.Fourseparateonline

surveysweredesignedforeachfocusgroup:stateschoolboardmembers,stateschoolboard

associationleaders,statepublichealthnutritiondirectors,andschoolwellnessadvocates,however

therewerenoteachersorstudentsincludedinthisstudy.Onevaluablefindingofthisstudy,the

recommendationforschoolstohavededicatedwellnesscoordinatorspromptsseveralquestionsformy

proposedstudy.

Anothergroupofkeystakeholderswhohavehadlimitedvoicesintheresearcharethephysical

educationteachers.Benham‐Dealandhercolleaguesdesignedastudy,basedonquestionnaires

distributedin1995and2005viamailandemailexclusivelytophysicaleducationteachersineach

elementaryandsecondaryschoolinallofWyoming’s48schooldistricts.Resultsoftheself‐reporting45

open‐endedandclosedquestionsdemonstratethevalueoflongitudinaldata,however,islimitedto

quantitativeanalysiscomparedtolargerstudies.Anothercrosssectionalstudybasedonphysical


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educationspecialists’surveyswasconductedbyBarrosoetal.Approximately150respondentsself

reportedbarriersallowingfortrendanalysisoverthelastfouryears.Thisdatawasinvaluablein

developingquestionsformystudy,especiallywhenconsideringastudyofweb‐basedSWPresearchthat

foundpoliciesretrievedviathewebweresubstantivelydifferentthanon‐site.Supplementaldatafrom

sitevisitsremainsignificantwhencollectingSWPdata(Chriquietal8‐9).

Finallycollectingthevoiceofstudentstakeholders,Bauer,YangandAustinconducteda

phenomenologicalstudyusingtwosuburbanpublicmiddleschoolswithethnicandsocioeconomic

factorsrepresentativeofthesurroundingcommunity.Thestudyparticipantswerederivedfroman80%

whitestudentbodywherelessthan10%ofstudentswereeligibleforfreeorreducedmeals.Forty‐nine

focusgroupsincluded26studentsand23facultywereconductedincludingseventhandeighthgrade

students.Individualinterviewswereconductedwithkeyinformantsincludingcafeteriamanagers,PE

directors,schoolnursesandguidancecounselors.ThediscussiontopicsarerelevantasIdesignmy

study,however,ethnicandeconomicfactorsofthesubjectsarenotconsistentwiththeurban

populationthatintereststhisresearcher.Couturier,ChepkoandCoughlinconductedanotherstudyof

studentstakeholdersbysurveyingmiddleandhighschools.Over5,300urbanschoolstudents

completedthesurvey,offeredinbothSpanishandEnglish,intheirphysicaleducationclass.The

questionspertainedtoreasonsforparticipatingornotparticipatinginphysicaleducation,andwhilenot

includinghabits,establishedthevalueofstudent’svoices.Brownandcolleaguesattest“adolescentsin

theUSandelsewherecanvalidlyandreliablyself‐reporttheirownemotional,behavioral,psychological,

andsomatichealth“(9).Student’sanswerscanpredictinterestinlearningandmotivationtofollow

whatislearned(Brown,TeufelandBirch13),andthereforeinformcurriculadevelopersandprogram

providers.


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III. PROPOSEDRESEARCHMETHODOLOGY

A. DATAOREVIDENCETOBECOLLECTED

Recognizingthat“studentsthemselvescouldberesourcesforaddressingsomeoftheobstacles”

(Couturierp6),IplantoconductfieldresearchonthehealthliteracyofKindergarten,third,eighthand

twelfthgradestudents.Iwillcollectdataregardingindividualnutrition,andphysicalactivityand

educationtodeterminehowschoolwellnesspoliciesareimpactinghealthliteracy.Iwillalsocollectdata

regardingcurrentSWPimplementationandthestudent’sperceptionsofSWPimplementation.

1. DESCRIPTIONOFTHEDATA

Thestudentquestionnairewillexplorehealthtermsandconcepts,snackandbeverage

frequency,andphysicalactivity.Responseswilldemonstratehealthknowledge,attitudeandskillsas

wellascriticalthinking.SurveyingearlyadolescentsusingquestionsbasedonNHESprovidesdatathat

canbeusedtoimprovethedeliveryofhealtheducationandultimatelytoincreasehealthliteracy

(Brown,TeufelandBirch8).Focusgroupsinvolvingstudentsandwellnesscommitteemembersaswell

ason‐sitedatacollectionregardingtoSWPimplementationwillalsobesought.

2. WHERETHEDATAARELOCATED

AllofCPS’s474elementaryschools,106highschools,87chartercampusesandeightcontract

schools(“ChicagoPublicSchools:StatsandFacts”1)willbeconsidered.StudentsingradesKindergarten,

third,eighthandtwelfthgradeswillbesurveyedandincludedintherandomizedfocusgroups.


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B. TECHNIQUESFORCOLLECTIONOFDATA

Myresearchwillemploybothquantitativeandqualitativemethodsofdatacollection.Iwill

conductasurveyusingfourstandardizedquestionnaires,oneforeachgradelevelbeingsurveyed.

QuestionnaireswillbedistributedandcollectedduringasinglePEclass,whichwillensureahigh

completionrateresultinginasignificantclustersamplingfromeachschool.

Similarly,Iwillconductastratifiedsampleschoolcampuses(e.g.neighborhood,selective

enrollment,charterandcontract),conductingface‐to‐facequalitativeinterviewswithstudentsin

preferredgradelevelsandthewellnesscommitteemembers.Iwilluseacombinationofopen‐ended

andmultiple‐choicequestionsduringtheseinterviews.Casefilesforallrespondentswillbedeveloped,

consistingofdatesofcontactandinformationcollectedduringthatvisit.Allsessionswillberecorded

andtranscribed.

Finally,anauditofSWPimplementationwillbedoneatthesameschoolswherethefocus

groupsareconducted.Dataforthepreferredgradelevelswillinclude:contacthoursofnutrition

educationandactivities;minutesofphysicaleducation;andmeasuringmoderatevs.vigorousactivityin

recess.Datafortheschoolwillinclude:verificationofplanned,sequential,curriculumforK‐12physical

education;numberofattendeestocommunityprograms,afterschoolprogramsandrecess

participation;useoflossofrecessasapunishmentoroffoodasclassroomreward;andmeasuring

wellnesscommitteeconductsuchasincludingstudents,andparentsinmembership,andannual

evaluationsasperpolicy.

C. METHODSOFANALYSIS


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Thequestionnairewillcontainbothclosedandopen‐endedquestions,requiringtwodifferent

formsofanalysis.Numericaldatawillbecalculatedbasedonquantitativeresponses,whilequalitative

responseswillbecategorizedaccordingtoemergingthemes.Schoolwellnesspolicyimplementation

andhealthdemographics,willbetriangulatedwiththestudentquestionnaireandfocusgroup

qualitativethemes.

1. HOWTHEDATAWILLBEEXAMINEDFORITSMEANING

Datawillbeexaminedforinteractionandindirecteffects,andthefinalanalysiswilldetermine:

o Abaselineofhealthliteracyatstudiesgradelevels.

o RelationshipbetweenstudenthealthandenvironmentduetoSWPimplementation.

o Whatfactorscankeystakeholdersutilizetoimprovewellnessprogramming.

2. HOWDATAWILLBEPRESENTED

Thisobservationalresearchwillgeneratealargecross‐sectionaldatacollectiononhealth

literacyandschoolwellness.Anareamapwillidentifyparticipatingschools,whilepiechartsandgraphs

willpresentboththeschoolwellnesspolicyimplementationdataandtheordinaldatafromthe

questionnaire.Aqualitativecontentanalysiswillprovideanarrativereportofthedominantthemes

identifiedinthefocusgroups.Additionally,transcriptionoffocusgroupinterviewsandfieldnoteswill

beincluded.

IV. OUTLINEOFTHEFINALREPORT

Afinalreportwillbedesignedtoincludethefollowing:


22

Titlepage

Acknowledgements

TableofContents

ListofTables

ListofFigures

Chapters

TheProblemanditsSetting

ReviewofRelatedLiterature

ResearchMethodology

TheResults

Appendixes

V. EXPECTEDOUTCOMES

Educationalstakeholdersareresponsibleforthewholechild:intellectual,social,emotionaland

physical.ResearchregardingthehealthofAmericanpublicschoolstudentsisextremelyimportantfor

theeducation,publichealthandgovernmentpartnerswhosemissionincludesimprovinghealth

outcomesinouryouth.Suchpartnersincludenot‐for‐profitsliketheAmericanDiabetesAssociation,

publichealthsystemssuchastheChicagoPublicHealthDepartment,professionalorganizations

includingtheNationalSchoolBoardsAssociation,andphilanthropistsliketheRobertWoodJohnson

Foundation.

ThisresearchwillservepublichealthprofessionalsinthebothChicagoandthenationby

providingarichassessmentofpublicschoolwellnessandtheimpactsofwellnesspoliciesontheir

healthliteracy.Individualschoolsandthedistrictasawholecanbuildlongitudinallybyrepeatingthis


23

studyinthefuture.Thisresearchandadditionalstudiesthatwillfollowilluminatethestudent’sworld

forthosekeystakeholderswhoimpactschoolwellnesspolicesandfunding.

Lastly,thisresearchcanbeusedbyeducationkeystakeholdersandreformadvocatestotarget

improvementeffortsregardingpolicyimplementation,andreactwithevidence‐basedpracticesand

programming.


24

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