Walking School Bus and Its Impact on BMI

Janette Quarles, DrPH,CPH, MPH, MA, CCC/SLP

University of Oklahoma Health Sciences Center

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Mandatory DisclosureStatement

Dr. Janette Quarles and research team had no personal financial relationships with commercial interests relevant to

this presentation during the past 12 months.

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Introduction

• Since 1970, obesity in ages 6-11 more than quadrupled

• As child obesity increased, simultaneous decrease in children walking and biking to school

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1966-69 1972-77 1978-83 1990-91 20010

10

20

30

40

50

Figure 1: Obesity trend and active commute to school, Alliance for

Biking and Walking, 2010.

% children who walk or bike to school% of children who are obese

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Background

• Many families cannot – or will not – sacrifice time or money to purposely pursue exercise

• Normal daily routines can be useful to increase physical activity

• For children, a normal daily routine is the trip to and from school

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Background

Even in walkable areas, perceived safety a significant barrier to children actively commuting to school

(Anderson, et al)(Baslington)(Carver, et al)(Eyler, et al)(Hayne, et al)(Hume, et al)(Lorenc, et al)(Merom, et al)(Ridgewell, et al)(Sallis, et al, 2009)(Zhu, et al)

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Introduction

Many parents’ work schedules – or other life situations – prevent them from walking the child to school

Research indicated parents allow children to walk to school when chaperoned

(Hayne, et al)(Johnston)(Kingham, et al)(National Center for Bicycling and Walking)

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Walking School Bus

• Adult-chaperoned walk-to-school program

• Follows same route each day• Has a specific starting point…

…safe place for children to gather

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Methods

Quasi-experimental in design

Evaluated:1. Community walkability

2. Physical activity levels

3. Pre- & post- body mass index (BMI) in active commuters and controls

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Parent Questionnaire

1. Contributors or barriers to active commute– Neighborhood walkability– Safety– Other factors influencing

transportation choice

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Parent Questionnaire

2. Dose response – Distance and frequency of active commute

3. Confounders– Measures of recreational physical activity

4. Differing beliefs for the active commute vs. other outdoor activities

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Methods and Results

Concurrent control group

Exposed to similar opportunities

1102 total participants ages 5-12–406 active commuters–696 controls – students driven to the

same schools

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Results

In areas with lower walkability, Walking School Bus increased active commuting to school to 39.8%...

…as compared to the national average of 5-14%, p <.0005 (one-tailed)(SPSS Nonparametric Binomial)…

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Results

…and reduced BMI, z = -10.125, p < 0.0005 (two-tailed) (SPSS

Nonparametric Wilcoxon Signed-Rank Test).

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All active commuters Control group

n =267 n =509Pre-test obesity or overweight 65 (24.3%) 171 (33.6%)Post-test obesity or overweight 50 (18.7%) 184 (36.1%)Decrease or increase in obesity and overweight (-) 5.6% (+) 2.5%Absolute Risk Reduction (ARR) (8.1%) 8% naNumber needed to treat (NNT) (12.3) 13 na

Table 1: Change to or from the healthy weight category in walkers versus controls, Oklahoma schools with a Walking

School Bus, 2009-2010.

Weight classification ages 2 to 19 years: Obesity ≥ 95th percentile, Overweight 85th to < 95th percentile, Healthy weight 5th to < 85th

percentile. (CDC, Healthy Weight).

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All active commuters Control group

n =267 n =509Pre-test obesity and overweight 65 (24.3%) 171 (33.6%)Post-test obesity and overweight 28 (10.5%) 187 (36.8%)Decrease or increase in obesity and overweight (-) 13.8% (+) 3.2%Absolute Risk Reduction (ARR) 17% naNumber needed to treat (NNT) (5.9) 6 na

Table 2: Change to a healthier, or less healthy, weight category, Walking School Bus, Oklahoma, 2009-2010.

Weight classification ages 2 to 19 years: Obesity ≥ 95th percentile, Overweight 85th to < 95th percentile, Healthy weight 5th to < 85th

percentile. (CDC, Healthy Weight).

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Dose Response

• Both distance and frequency of active commute demonstrated statistically significant association and correlation with BMI…

• Distance demonstrated a stronger correlation than frequency

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Results - Distance

• Walking School Bus allowed children to walk farther…overcoming distance, a significant barrier to the active commute.

• Participants in the Walking School Bus walked an average of 65% farther than students that walked without an adult chaperone.

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Mean MedianWalked without adult chaperone 0.66 0.44Walking School Bus participants 1.09 0.61

Distance in miles

Table 3: Distance in miles active commuters travelled to Oklahoma schools with a Walking

School Bus, 2009-2010.

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Physical Activity

• Measures of recreational physical activity also demonstrated a statistically significant association with BMI…

• After controlling for confounders, active commute continued to demonstrate statistically significant association with BMI.

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Results – Physical Activity

• No statistically significant association between the active commute and measures of recreational physical activity

• Measures were independent of one another

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Results – Physical Activity

In other words…• Participation in the Walking School

Bus was not limited to more physically active students.

• Walking School Bus increased opportunities for inactive students to actively commute to school.

23My child enjoys itIt's good for him

Live close to schoolNo family car

Required-parent worksAdult chaperone

Travels with peersCrossing guard/light

Sidewalks

21%

50%

Figure 2: Primary contributor to active commute to Oklahoma schools with a

Walking School Bus, 2009-2010.

24Safety

Bridge-no safe sidewalk

Live too far from school

Daycare drives child

No traffic light

No crossing guard

Curbs need ramps

Not enough sidewalks

32%

55%

Figure 3: Primary barrier to active commute to Oklahoma schools with a

Walking School Bus, 2009-2010.

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Practical Applications

By measuring existing programs…

…real world application should contribute to generalization and replication of the results with the knowledge gained regarding the simplicity, feasibility, sustainability and effectiveness of an adult-chaperoned walk-to-school program

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Practical Applications

• Walking School Bus potential “big bang” for virtually no “bucks”!

• Uses existing school personnel or volunteers

• Simple strategy• Does not interfere with instruction

time

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Summary

1. Walking School Bus sufficient to overcome many barriers to active commute to school– Age, Disability, Gender,– Physically inactive lifestyle, – Distance, Other environmental

factors,– Parental safety concerns

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Summary

2. …therefore significantly increasing percentage of children actively commuting to school and significantly decreasing BMI

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Summary

3. Schools should recruit adult chaperones for routes…

…in areas with high populations of students (apartment complexes)

…overcoming environmental barriers

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Questions?

www.safekidsreflectors.com

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http://library.ouhsc.edu/epub/dissertations/quarles-janette.pdf

http://gradworks.umi.com/34/67/3467259.html

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ReferencesAction for Healthy Kids. (2004). The learning connection: The value of improving nutrition and

physical activity in our schools. Retrieved October 26, 2010 from www.actionforhealthykids.org/resources/files/learning-connection.pdf

Anderson, P., Butcher, K. (2006). Childhood obesity: Trends and potential causes. The Future of Children, 16(1), 19-45.

Bain, M. Walk Score. Retrieved August 17, 2009 from www.walkscore.com

Baslington, H. (2008). School travel plans: Overcoming barriers to implementation. Transport Reviews, 28(2), 239-258.

Carver, A., Timperio, A., Crawford, D. (2008). Playing it safe: The influence of neighborhood safety on children’s physical safety – a review. Health & Place, 14(2), 217-227.

Eyler, A., Brownson, R., Doescher, M., Evenson, K., Fesperman, C., Litt, J., et al. (2008). Policies related to active transport to and from school: A multisite case study. Health Education Research, 23(6), 963-975.

Google Maps. Obtained March 10, 2010 from www.google.com

Hayne, C., Moran, P., Ford, M. (2004). Regulating environments to reduce obesity. Journal of Public Health Policy, 25(3/4), 391-407.

Hume, C., Timperio, A., Salmon, J., Carver, A., Giles-Corti, B., Crawford, D. (2009). Walking and cycling to school: Predictors of increases among children and adolescents. Am J Prev Med, 36(3), 195-200.

Johnston, B. (2008). Planning for child pedestrians: Issues of health, safety and social justice. Journal of Urban Design, 13(1), 141-145.

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ReferencesKingham, S., Ussher, S. (2007). An assessment of the benefits of the walking school bus in

Christchurch, New Zealand. Transportation Research, 4(6), 502-510.

Lorenc, T., Brunton, G., Oliver, S., Oliver, K., Oakley, A. (2008). Attitudes to walking and cycling among children, young people and parents: A systematic review. Journal of Epidemiology and Community Health, 62(10), 852-857.

Merom, D., Tudor-Locke, C., Bauman, A., Rissel, C. (2006). Active commuting to school among NSW primary school children: Implications for public health. Health & Place, 12(4), 678-687.

National Center for Bicycling and Walking. (2002). Increasing physical activity through community design: A guide for public health practitioners. Retrieved June 11, 2009 from www.bikewalk.org

Ridgewell, C., Sipe, N., Buchanan, N. (2009). School travel modes: Factors influencing parental choice in four Brisbane schools. Urban Policy & Research, 27(1), 43-57.

Robert Wood Johnson Foundation (RWJF), Trust for America’s Health. (2009). F as in fat: How obesity threatens America’s future. Retrieved July 2, 2010 from www.rwjf.org/childhoodobesity

Sallis, J., Story, M., Lou, D. (2009). Study designs and analytic strategies for environmental and policy research on obesity, physical activity and diet. Am J Prev Med, 36(S), S72-S77.

U.S. Department of Health and Human Services (USHHS), Centers for Disease Control and Prevention (CDC). (2010). The association between school-based physical activity, including physical education, and academic performance. Atlanta, Georgia: U.S. Department of Health and Human Services.

White House Task Force on Childhood Obesity. (2010). Solving the problem of childhood obesity within a generation. Retrieved October 26, 2010 from www.letsmove.gov

Zhu, X., Arch, B., Lee, C. (2008). Personal, social, and environmental correlates of walking to school behaviors: Case study in Austin, Texas. The Scientific World Journal, 8, 859-872.