This week’s Blog entry features Dr. Sallis’ comments on the proposed changes to the Carol M. White PEP grant in response to:
Carol M. White Physical Education Program (PEP) Program Summary of Notice of proposed priorities, requirements, and definitions.
Published in the Federal Register, Vol. 75, No. 50; March 16, 2010
Thank you for the opportunity to comment on these proposed new directions for PEP grants. Physical education, physical activity, and public health professionals are grateful for the PEP grant program, as are parents and education officials. Physical education is the primary institution for preparing youth for a lifetime of physical activity, and PEP is the only federal funding for PE. PE also plays a role as a partial solution for childhood obesity, because it is the only the policy/program that can provide physical activity for potentially all students. Thus, there are many reasons for wanting the PEP grant program to be as effective as possible.
But there is not general consensus about the goals of PEP grants or how to achieve the goals. I am providing input as a psychologist and public health researcher who has been working to improve PE and youth PA for over 25 years. My priority is that PE should contribute to improving public health, and the surest way to accomplish this is to ensure students are active during PE. Certainly PE is more than physical activity, but almost everyone would agree that inactive PE is bad PE. PE has always been about “teaching through the physical,” but several studies show that students are inactive most of the time during PE. This is why PEP grants and other efforts to improve the quality of PE are needed. Most of the educational goals targeted in PEP grants can be accomplished better through activity, such as motor skills and social and emotional development.
The Public Health View of PE:
Let’s be clear that public health and PE professionals often have differing opinions about the goals of PE. As reflected in the PEP goals, PE professionals focus on preparing youth for a lifetime of activity, not on providing physical activity during PE. Public health professionals emphasize ensuring PE classes are active, because (a) PA provides well-document physical and mental health benefits during youth and (b) there is little or no evidence that PE has long-term effects on physical activity or health. Especially in the midst of the childhood obesity epidemic, it is a public health imperative to use every resource and opportunity to get children active, and PE is a high priority because it reaches more children than any other program or policy. Yet, students are mostly inactive during PE. Further, the PE profession has not embraced the goal of ensuring PE provides physical activity. My vision of the public health value of PE was written in this highly-cited paper 20 years ago.
Sallis, J.F., and McKenzie, T.L. (1991). Physical education’s role in public health. Research Quarterly for Exercise and Sport, 62, 124-137.
In short, there is little or no evidence linking proposed PEP goals/requirements with lifelong physical activity. There is much more certainty that getting children active NOW in PE classes leads to health and academic benefits. In fact, there is enough evidence to recommend active physical education as a strategy to improve academic achievement.
Thus, from the public health perspective, a critical missing emphasis in PEP is to increase moderate-to-vigorous physical activity (MVPA) in PE classes. Most studies show that students in PE are active less than 50% of the classes. Healthy People Objectives for the Nation (USDHHS) has included an objective since at least 1990 that PE should have at least 50% MVPA. http://www.healthypeople.gov/ However, such a goal is not endorsed by PEP or other Department of Education documents. I strongly recommend that the over-riding goal of PEP be changed. My recommendation is to require grants to improve MVPA in PE (all grants) and to undertake one or more of the other activities that may or may not promote physical activity. Inclusion of the other activities should be justified by the expected impact of the activity on child physical activity.
PEP Needs More Emphasis on Evidence-Based Approaches:
Despite the refreshing call for data and evaluation in this notice, there is a disturbing lack of focus on evidence-based approaches. We do have evidence-based approaches for improving PE and for other school-based PA programs and policies. http://www.calendow.org/uploadedFiles/Publications/By_Topic/Disparities/Obesity_and_Diabetes/PE%20Matters%20Long%20VersionFINAL.pdf
My recommendation is to explicitly encourage the use of evidence-based approaches and provide extra points for doing so. CDC’s Community Guide recommends enhanced (activity-oriented) PE as an evidence-based intervention. Thus, the current requirements are ignoring the health goals and evidence-based strategies for achieving them. Getting children active in PE provides immediate health and academic benefits and helps meet other goals of PE.
Broadening the Scope of PEP to Nutrition Education is Misguided:
The broadening of PEP’s focus to require nutrition education would harm efforts to improve PA, PE, and fitness in youth. PEP funding has declined over the years and is currently very low. Thus, most of the schools applying are not funded. Of course, it is essential to improve children’s eating habits to improve health and prevent obesity. However, this is the wrong mechanism. These are reasons why broadening PEP to require instruction in nutrition is not a good idea:
- By itself, nutrition education has modest to no effects on children’s eating. If the goal is to improve eating, then policy and environmental changes in schools are more promising. Targeting funding for nutrition education at the expense of evidence-based physical activity programs would have a net negative effect on children’s health.
- Requiring every team to have expertise in both physical activity and nutrition would make it more difficult to put teams together.
- Obesity control is generally dominated by nutrition interests and professionals. PEP is a unique source of federal funding for improving PE and physical activity programs in schools. There are already existing sources of funds for improving children’s eating habits.
- The infrastructure (personnel, organizational structure, funding) for physical activity promotion is minimal in the US and is dwarfed by the nutrition infrastructure. See the references. Adding nutrition requirements to PEP would weaken the weak component (physical activity promotion) and strengthen the strong component (nutrition promotion).
Yancey, A.K., Fielding, J.E., Flores, G.R., Sallis, J.F., McCarty, W.J., & Breslow, L. (2007). Creating a robust public health infrastructure for physical activity promotion. American Journal of Preventive Medicine, 32, 68-78.
Yancey, A.K., & Sallis, J.F. (2009). Physical activity: Cinderella or Rodney Dangerfield? Preventive Medicine, 49, 277-279.
Comment on Competitive Preference Priorities:
The proposed priorities are fine, but a more important priority is to give points to schools with high need (such as high obesity rates or low fitness levels). These schools are likely to be under-resourced and lack capacity to compete well in grant writing. A California study showed PE is much worse in low-resource schools, so it is essential to target improvements in these schools. http://www.calendow.org/uploadedFiles/Publications/By_Topic/Disparities/Obesity_and_Diabetes/ASAP12.pdf
Other Evidence-Based Strategies:
Though I would be satisfied with restricting PEP funding to only improving the PE programs, there is also a rationale for allowing grants to support improved PE and other evidence-based physical activity strategies. There are other evidence-based approaches for promoting youth physical activity that could be included in multi-component programs, though they do not have as much evidence as enhanced PE. Numerous studies show that walking or biking to school contributes to higher overall physical activity, and Safe Routes to Schools programs have evidence of effectiveness.
Simple interventions to increase physical activity in recess, such as painting game designs on playgrounds and providing equipment have substantial effects on youth activity.
After school time is the main opportunity for children to be active, yet low-income children have few physical activity resources like parks and programs in their neighborhoods. Thus, joint use agreements that allow schools to the community can provide nearby opportunities for daily physical activity targeted to children who need them most.
After school programs typically emphasize academics, but it is critical to provide physical activity during these programs. Physical activity guidelines for after school programs were developed using a rigorous evidence-based approach in California and could be a national model.
Comments on Proposed Competitive Preference Priorities and Proposed Requirements:
Proposed Competitive Preference Priority 1—Collection of Body Mass Index.
This is fine, but it would not be my highest priority, because there is little or no evidence that measuring BMI and providing feedback will lead to more physical activity.
Proposed Competitive Preference Priority 2—Partnerships Between Applicants and Supporting Community Entities
Proposed Requirement 1—Align Project Goals With Identified Needs Using the School Health Index
This is a reasonable requirement, and SHI is an excellent tool, but more flexibility in the choice of a needs assessment instrument could be helpful. For example, validated instruments like the YMCA’s Community Healthy Living Index, or a PE-specific evaluation could be justified. The PECAT has limited value since it only assesses the content of a curriculum, not the quality or quantity of its implementation.
Another option would be for the applicant to use the SOFIT method of systematic observation of PE classes to identify strengths and weaknesses of actual PE classes.
McKenzie, T.L., Sallis, J.F., & Nader, P.R. (1991). SOFIT: System for observing fitness instruction time. Journal of Teaching in Physical Education, 11, 195-205.
Proposed Requirement 2—Nutrition and Physical Activity-Related Policies.
Proposed Requirement 3—Linkage With Local Wellness Policies.
Proposed Requirement 4—Linkages With Federal, State, and Local Initiatives.
Requirements 2, 3, and 4 are redundant and would create an unnecessary burden on applicants. Many of the policies will be the same or overlapping, so it could be confusing to address all these different types of policies. One requirement that identifies the relevant policies and plans to improve policies and their implementation would be sufficient. The applicant should focus on (a) improving implementation of policies that cannot be changed or are sufficient and (b) improving policies that need change and are modifiable at the local level.
Proposed Requirement 5—Updates to Physical Education and Nutrition Instruction Curricula.
The PECAT is only an assessment of the PE curriculum. It does not deal with the implementation of a quality curriculum, which is also critical. This requirement should also provide encouragement for the adoption of curricula with evidence of effectiveness from research or evaluation.
Proposed Requirement 6—Equipment Purchases.
This approach to ensuring that equipment complements other program elements, including curriculum and training, is an important one.
Proposed Requirement 7—Increasing Transparency and Accountability.
Reporting requirements should be meaningful (directly related to program goals of getting students active) but minimal. There is a trade-off between extent of evaluation and program implementation, because time and resources are limited. The main goal is to use PEP resources to increase children’s physical activity. Though evaluating is critical, the goal is not to document every conceivable program outcome.
Proposed Requirement 8—Participation in a National Evaluation.
I strongly support a national evaluation of PEP.
Proposed Requirement 9—Required Performance Measures and Data Collection Methodology.
Pedometers: This is a useful and feasible tool for assessing PA. However, using them for overall daily PA should be the responsibility of the national evaluation team. PEP grantees should be responsible for evaluating the outcomes of their projects. If it is PE only, then using pedometers only in PE class would be the main goal. If the project targets PA throughout the school day, then using pedometers throughout the school day would be sufficient. Few school-based studies have documented physical activity changes outside of school.
3DPAR: I am co-author of a study showing that 3-day recalls are not valid in middle school students. Thus, there is little justification for the time that needs to be devoted to a 3-day recall. A 1-day recall is sufficient for an aggregate measure. I am also concerned this measure would not be sensitive to small changes since the reports are in 30-minute blocks. It would be better to pilot test this measure with a few grantees to determine feasibility and sensitivity to change.
McMurray, R.G., Ring, K.B., Treuth, M.S., Welk, G.J., Pate, R.R., Schmitz, K.H., Pickrel, J.L., Gonzalez, M., Almeida, M.J.C.A., Young, D.R., & Sallis, J.F. (2004). Comparison of two approaches to structured physical activity surveys for adolescents. Medicine and Science in Sports and Exercise, 36, 2135-2143.
Fitness tests: These would be fine at the beginning and end of each year.
Here is another approach to evaluating the impact of the PEP activities on student MVPA. This method could be used with any set of programs and could support cross-school comparisons.
1. Number of “opportunity minutes for physical activity” provided per enrolled child. These could be estimated over an entire school year and for by school and by specific programs, such as PE, recess, after school.
2. Estimated “physical activity minutes per child.” This value is based on multiplying the opportunity minutes with MVPA minutes per session of a sample of students engaged in the different programs using direct observation or pedometry.
Using these calculations would provide a simple metric that would allow all schools/PEP grants to be compared (i.e., on physical activity opportunity minutes per student per year AND observed/calculated physical activity minutes per year).
Because I am opposed to broadening PEP grants to include nutrition, I am opposed to requiring reports of fruit and vegetable consumption. If you decide to move ahead with measuring these outcomes, then consider this validated measure.
Prochaska, J.J., and Sallis, J.F. (2004). Reliability and validity of a fruit and vegetable screening measure for adolescents. Journal of Adolescent Health, 34, 163-165.
Proposed Criteria for Evaluation:
The evaluation criteria should be based on using the funds to maximize the impact on youth physical activity, sustainability of programs, and evaluation. Here are my recommendations for evaluation criteria for grants, and they should be communicated to applicants:
- Based on a systematic needs assessment
- Evidence basis for effects of proposed activities, programs, policies on youth physical activity
- Likelihood of, or plan for, sustainability of programs, policies, implementation, impact
- Evaluation plan
- Targeting high-need schools and students
James F. Sallis, PhD
Active Living Research
Department of Psychology
San Diego State University
3900 Fifth Avenue, Suite 310
San Diego, CA 92103 USA