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Participation in School Physical Education and Selected Dietary Patterns Among High School Students -- United States, 1991

Inadequate physical activity and unhealthy dietary patterns (particularly diets high in fat and low in fruits, vegetables, and grains) established during youth may extend into adulthood and may increase risk for chronic diseases, such as coronary heart disease and cancer (1-5). This report examines the prevalence of self-reported enrollment, attendance, and participation in school physical education (PE) and examines selected dietary patterns among students in grades 9-12 from two school-based components of CDC's Youth Risk Behavior Surveillance System (6): 1) the national Youth Risk Behavior Survey (conducted during April-May 1991) and 2) individual state and local Youth Risk Behavior Surveys (conducted by departments of education in 23 states and 10 cities during the same time).

The national survey used a three-stage sample design to obtain a sample of 12,272 students representative of students in grades 9-12 in the 50 states and the District of Columbia. The 33 state and local sites drew probability samples from well-defined sampling frames of schools and students. Seventeen sites had adequate school- and student-response rates, which allowed computation of weighted results of known precision; 16 sites had overall response rates below 60% or unavailable documentation, which precluded making estimates of known precision.

The school-response rate for the national survey was 75%, and the student-response rate was 90% (Table 1). For the state and local surveys, school-response rates ranged from 48% to 100%; student-response rates ranged from 44% to 96%. State and local sample sizes ranged from 369 to 5834 students. Students in most samples were distributed evenly across grades and between sexes. The racial/ethnic characteristics of the samples varied.

Students were asked "In an average week when you are in school, on how many days do you go to physical education (PE) classes?" and "During an average physical education (PE) class, how many minutes do you spend actually exercising or playing sports?" Enrollment in PE class was defined as attending PE class at least one day in an average week. Students also were asked about foods they had consumed the day preceding the survey, including fruit; fruit juice; green salad; cooked vegetables; hamburger, hot dogs, or sausage; french fries or potato chips; and cookies, doughnuts, pie, or cake. These foods were selected as typical of the diets of adolescents and were not intended to represent complete dietary histories. The total number of servings* of fruit, fruit juice, green salad, and cooked vegetables was estimated by adding the number of servings of fruits and vegetables consumed during the day preceding the survey. Similarly, the total number of servings of foods typically high in fat was estimated by adding the number of servings of hamburger, hot dogs, or sausage; french fries or potato chips; and cookies, doughnuts, pie, or cake eaten during the day preceding the survey.

Among the state and local surveys, the percentage of students in grades 9-12 who participated in PE classes varied considerably (Table 2): 24%-96% of students (median: 52%) reported being enrolled in PE classes; 2%-74% (median: 35%) reported attending PE classes daily; and among students enrolled in PE class, 52%-90% (median: 75%) reported spending more than 20 minutes exercising or playing sports during an average class. In most sites, more male than female students were enrolled in PE class, attended such classes daily, and spent more than 20 minutes exercising or playing sports during the average class. The national prevalence estimates were similar to the median prevalence estimates from the state and local surveys.

Students' dietary patterns (Table 3) varied less among the state and local surveys than did participation in PE classes: 8%-18% of students (median: 13%) reported consuming five or more (range: 0-8) servings of fruits and vegetables during the day preceding the survey; and 57%-83% (median: 69%) reported eating two or fewer (range: 0-6) servings of foods typically high in fat. In all sites, male students were more likely than female students to consume five or more servings of fruits and vegetables, but female students were more likely than male students to eat two or fewer servings of foods typically high in fat. The national prevalence estimates were similar to the median prevalence estimates from the state and local surveys.

Reported by: J Moore, Alabama State Dept of Education. J Campana, San Diego Unified School District; M Lam, San Francisco Unified School District. D Sandau-Christopher, State of Colorado Dept of Education. J Sadler, District of Columbia Public Schools. D Scalise, School Board of Broward County; N Gay, School Board of Dade County, Florida. R Stalvey, Georgia Dept of Education. J Schroeder, Hawaii Dept of Education. J Pelton, Idaho Dept of Education. B Johnson Biehr, Chicago Public Schools. J Harris, Iowa Dept of Education. N Strunk, Boston Public Schools. R Chiotti, Montana Office of Public Instruction. J Owens-Nausler, Nebraska Dept of Education. B Grenert, New Hampshire State Dept of Education. D Chioda, Jersey City Board of Education; D Cole, New Jersey State Dept of Education. K Meurer, New Mexico State Dept of Education. G Abelson, New York City Board of Education; A Sheffield, New York State Education Dept. P Ruzicka, Oregon Dept of Education. C Balsley, School District of Philadelphia; M Sutter, Pennsylvania Dept of Education. M del Pilar Cherneco, Puerto Rico Dept of Education. J Fraser, South Carolina State Dept of Education. M Carr, South Dakota Dept of Education and Cultural Affairs. E Word, Tennessee State Dept of Education. P Simpson, Dallas Independent School District. L Lacy, Utah State Office of Education. S Tye, Government of the Virgin Islands Dept of Education. B Nehls-Lowe, Wisconsin Dept of Public Instruction. B Anderson, Wyoming Dept of Education. American Cancer Society, Atlanta. Div of Chronic Disease Control and Community Intervention, Div of Nutrition, and Div of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in this report are consistent with results from other recent national surveys that measured participation in school PE and selected dietary patterns among youth (7,8). Because the quality of the samples varied among the state and local surveys, data across sites may not be comparable. Nonetheless, these results can be useful in planning and evaluating broad national, state, and local interventions and in monitoring progress toward achieving the national health objectives for the year 2000 (5).

National health objectives 1.8 and 1.9 are to increase to at least 50% the proportion of children and adolescents in grades 1-12 who participate in daily school PE and to increase to at least 50% the proportion of school PE class time that students spend being physically active (5). At every site, among students enrolled in PE class, at least half reported exercising or playing sports for more than 20 minutes during an average PE class. However, at only six of the 33 sites did at least 50% of the students report daily attendance in PE class.

National health objectives 2.5 and 2.6 are to reduce dietary fat intake among persons aged greater than or equal to 2 years and to increase complex carbohydrate and fiber-containing foods in the diets of adults (5). The American Cancer Society (ACS) has developed two similar goals specifically for high school students: to increase to 35% the proportion who daily consume five or more servings of fruits and vegetables and to increase to 80% the proportion who daily eat no more than two servings of selected foods typically high in fat (9). None of the sites in this report have achieved the first ACS goal; only one site has achieved the second goal.

Specific strategies to meet the national health objectives and ACS goals include implementing state and school district policies requiring comprehensive school health education programs that include nutrition education and daily attendance in PE classes (5). To carry out these and other important strategies, coordinated efforts are needed from federal, state, and local education and health agencies; voluntary health organizations; families; media; community organizations; and youth themselves.

References

  1. Powell KE, Caspersen CJ, Koplan JP, Ford ES. Physical activity and chronic diseases. Am J Clin Nutr 1989;49:999-1006.

  2. Paffenbarger RS Jr, Hyde RT, Wing AL, Hsieh CC. Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med 1986;314:605-13.

  3. Public Health Service. The Surgeon General's report on nutrition and health. Washington, DC: US Department of Health and Human Services, Public Health Service, 1988; DHHS publication no. (PHS)88-50210.

  4. National Research Council. Diet and health: implications for reducing chronic disease risk. Washington, DC: National Academy Press, 1989.

  5. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

  6. Kolbe LJ. An epidemiological surveillance system to monitor the prevalence of youth behaviors that most affect health. Health Education 1990;21:44-8.

  7. CDC. Participation of high school students in school physical education -- United States, 1990. MMWR 1991;40:607,613-5.

  8. American School Health Association, Association for the Advancement of Health Education, Society for Public Health Education. The National Adolescent Student Health Survey. Oakland, California: Third Party Publishing, 1989.

  9. American Cancer Society. Report of the Planning Advisory Council. Atlanta: American Cancer Society, 1990.

    • Students who replied that they had not consumed a particular type of food were assigned a frequency of 0; students who replied that they had consumed a particular type of food ``once only'' were assigned a frequency of 1; and students who replied that they had consumed a particular type of food ``twice or more'' were assigned a frequency of 2.



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