Original Article

School-Based Adolescent Obesity Prevention Programming: Perceptions of School Personnel in Southern Appalachia

Authors: Jodi L. Southerland, DrPH, Christian L. Williams, MPH, Taylor McKeehan Dula, BS, Deborah Leachman Slawson, PhD, RD

Abstract

Objectives: Coordinated School Health (CSH) is a systematic approach to improving the health and well-being of school-age children. It is recommended for its potential to promote healthy weight in adolescents through strategic programming. Resources and programming for adolescent obesity prevention varies among schools, thereby limiting the intended benefits of CSH. The purpose of this study was to understand gaps in schools’ approaches to healthy weight promotion and support for overweight/obese students. We evaluated perceptions of adolescent obesity and environmental factors and programs facilitating healthy weight in high schools in Appalachian Tennessee.

Methods: In 2012, 17 key school personnel from 5 randomly selected high schools were interviewed. Questions addressed their perceptions of adolescent obesity, school-based physical activity and nutrition programming, and support available to overweight/obese students. Thematic analysis was conducted to identify emerging themes.

Results: Participants consistently identified adolescent obesity and/ or associated risk factors as major health problems within their schools. Barriers to physical activity and healthful eating were identified at multiple levels. Because of the sensitivity surrounding
overweight/obesity, no particular programs or curricula targeted overweight/obese adolescents specifically, but they were available to all students. Support is not explicitly available; therefore, overweight/obese students must seek out these resources.

Conclusions: Findings suggest that although school personnel are concerned about the impact of adolescent obesity on health outcomes,there is wide variation across schools on the types and quality of programming available to address the issue. Results can be used to encourage school-based strengths and identify gaps in the CSH infrastructure in school systems.

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References

1. Ogden CL, Carroll MD, Kit BK, et al. Prevalence of obesity in the United States. NCHS Data Brief 2009-2010;2012:1-8.
 
2. Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance System--United States, 2011. http://www.cdc.gov/mmwr/pdf/ss/ss6104.pdf. Accessed January 13, 2015.
 
3. Centers for Disease Control and Prevention. Estimated county-level prevalence of diabetes and obesity--United States, 2007. MMWR Morb Mortal Wkly Rep 2009;58:1259-1263.
 
4. Khambalia AZ, Dickinson S, Hardy LL, et al. A synthesis of existing systematic reviews and meta-analyses of school-based behavioural interventions for controlling and preventing obesity. Obes Rev 2012;13:214-233.
 
5. Waters E, de Silva-Sanigorski A, Hall BJ, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2011;12. CD001871.
 
6. Whittemore R, Chao A, Popick R, et al. School-based internet obesity prevention programs for adolescents: a systematic literature review. Yale J Biol Med 2013;86:49-62.
 
7. Centers for Disease Control and Prevention (CDC). Adolescent and school health: Coordinated School Health. www.cdc.gov/healthyyouth/cshp. Accessed January 31, 2014.
 
8. Wright K, Giger JN, Norris K, et al. 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. Int J Nurs Stud 2013;50:727-737.
 
9. Lohrmann DK. A complementary ecological model of the coordinated school health program. J Sch Health 2010;80:1-9.
 
10. Tennessee Department of Education. Tennessee Coordinated School Health. www.state.tn.us/education/schoolhealth. Accessed January 31, 2014.
 
11. Centers for Disease Control and Prevention. SHPPS fact sheets& studies. SHPPS 2012 school health policies and practices studies, physical education. http://www.cdc.gov/healthyyouth/shpps/2012/factsheets/pdf/FS_PhysicalEducation_SHPPS2012.pdf. Accessed August 24, 2014.
 
12. Southerland J, Behringer B, Slawson DL. Using the give-get grid to understand potential expectations of engagement in a community-academic partnership. Health Promot Pract 2013;14:909-917.
 
13. Patton MQ. Qualitative Evaluation and Research Methods. Newbury Park, CA: Sage Publications, 1990.
 
14. Dixon-Woods M, Agarwal S, Jones D, et al. Synthesising qualitative and quantitative evidence: a review of possible methods. J Health Serv Res Policy 2005;10:45-53.
 
15. Rice P, Ezzy D. Qualitative Research Methods: A Health Focus. New York: Oxford University Press, 1999.
 
16. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3:93.
 
17. Gundersen C, Waxman E, Del Vecchio T, et al. Map the meal gap: exploring food insecurity at the local level. In: Agricultural and Applied Economics Association/European Association of Agricultural Economists Food Environment Symposium; May 30Y31, 2012; Boston, MA.
 
18. Moore JB, Jilcott SB, Shores KA, et al. A qualitative examination of perceived barriers and facilitators of physical activity for urban and rural youth. Health Educ Res 2010;25:355-367.
 
19. Lawman HG, Wilson DK, Van Horn ML, et al. The role of motivation in understanding social contextual influences on physical activity in underserved adolescents in the ACT trial: a cross-sectional study. Child Obes 2012;8:542-550.
 
20. Fulkerson JA, Farbakhsh K, Lytle L, et al. Away-from-home family dinner sources and associations with weight status, body composition, and related biomarkers of chronic disease among adolescents and their parents. J Am Diet Assoc 2011;111:1892-1897.
 
21. Ding D, Sallis JF, Norman GJ, et al. Community food environment, home food environment, and fruit and vegetable intake of children and adolescents. J Nutr Educ Behav 2012;44:634-638.
 
22. MacLean LM, Meyer M, Walsh A, et al. Stigma and BMI screening in schools or ‘‘Mom, I hate it when they weigh me.’’. In: O’Dea JA, Eriksen MP, eds. Childhood Obesity Prevention: International Research, Controversies, and Interventions. New York: Oxford University Press, 2010:17-31.
 
23. Schafer M, Ferraro K. The stigma of obesity: does perceived weight discrimination affect identity and physical health? Social Psychol Q 2011;74:76-97.
 
24. Williams KJ, Taylor CA, Wolf KN, et al. Cultural perceptions of healthy weight in rural Appalachian youth. Rural Remote Health 2008;8:932.
 
25. Thomas RE, McLellan J, Perera R. School-based programmes for preventing smoking. Cochrane Database Syst Rev 2013;4. CD001293.
 
26. Bauer KW, Neumark-Sztainer D, Hannan PJ, et al. Relationships between the family environment and school-based obesity prevention efforts: can school programs help adolescents who are most in need? Health Educ Res 2011;26:675-688.
 
27. Shi L. The association between the availability of sugar-sweetened beverage in school vending machines and its consumption among adolescents in California: a propensity score matching approach. J Environ Public Health 2010;2010:735613.
 
28. Terry-McElrath YM, O’Malley PM, Johnston LD. Factors affecting sugar-sweetened beverage availability in competitive venues of US secondary schools. J Sch Health 2012;82:44-55.
 
29. Nanney MS, Nelson T, Wall M, et al. State school nutrition and physical activity policy environments and youth obesity. Am J Prev Med 2010;38:9-16.
 
30. Tennessee Department of Education, Office of Coordinated School Health. Physical activity/physical education annual report 2012-13 school year. http://www.tn.gov/education/health_safety/reports.shtml. Accessed August 24, 2014.
 
31. Grigal M, Hart D. The power of expectations. J Policy Pract Intellect Disabil 2012;9:221-222.
 
32. Mendelson M. Differences in teachers’ occupational and high-stakes testing stress related to school socioeconomic status. https://login.ezproxy.etsu.edu:3443/login?url=http://search.proquest.com/docview/881105736?accountid=10771. Accessed August 24, 2014.
 
33. Tennessee Department of Education. First to the top. http://www.tn.gov/education/about/fttt.shtml. Accessed January 31, 2014.
 
34. Florin TA, Shults J, Stettler N. Perception of overweight is associated with poor academic performance in US adolescents. J Sch Health 2011;81:663-670.
 
35. Hollar D, Lombardo M, Lopez-Mitnik G, et al. Effective multi-level, multi-sector, school-based obesity prevention programming improves weight, blood pressure, and academic performance, especially among low-income, minority children. J Health Care Poor Underserved 2010;21(2 Suppl):93-108.
 
36. Marshall J, Friedman HL. Human versus computer-aided qualitative data analysis ratings: spiritual content in dream reports and diary entries. Humanist Psychol 2012;40:4.