Results of this study, unexpectedly, indicated that the prevalence of overweight and obesity in the sample was greater than the statewide prevalence for Florida high school students (40% compared with 26.4%, respectively) (17
). However, our study included a majority (87%) of students from ethnic/racial minority groups. Strauss and Pollock (18
) documented that during 1986-1998, overweight increased fastest among Southerners and minorities, specifically African American and Latino populations. Our data support this trend and suggest that students who are minorities, economically disadvantaged, and reside in a Southern state face health disparities.
Overall, approximately 28% of ninth-grade students met the 2005 VPA guidelines, and approximately 23% met the MPA guidelines. These numbers fall short of the Healthy People 2010
goal of 85% of high school-age students engaging in 5 or more days per week of MPA or VPA for 30 minutes per session (7
). Although the sixth-grade students in this sample did not meet recommendations for high school-age students, they reported higher levels of physical activity than ninth-grade students did. Consistent with previous research (19
), results demonstrated that physical activity levels decline among youth over time. Girls consistently reported lower levels of physical activity than did boys, and minority girls reported the largest reduction in physical activity between grades 6 and 9. This downward trend of physical activity over time in girls is a health concern that warrants further investigation. Physical activity is important for developing bone density and for prevention of osteoporosis (1
), and reducing anxiety and depression (2
), which are more common among women than men. Consequently, girls should be taught healthy behaviors that protect them against the development of disease.
Future studies should explore factors that prevent youth from participating in physical activity. Not having time to engage in physical activity was reported as the greatest barrier to exercise and may indicate the limited opportunities to engage in physical activity during school hours. All sixth-grade students in this sample attended PE daily throughout the school year; however, the ninth-grade students were required to take only 1 semester of PE and 1 semester of health, which reduced their opportunity for physical activity during the school day. In addition, given the sociodemographic characteristics of this sample, we hypothesize that a lack of time to engage in physical activity may be associated with competing responsibilities such as after-school employment, care of younger siblings, or assistance with other domestic duties. Furthermore, a relatively large portion of sixth- (14.0%) and ninth-grade (16.5%) students reported that they did not like physical activity. Options such as dance, yoga, or virtual exercise video games should be explored to motivate these students and enhance their enjoyment of physical activity.
This study has implications for local education agencies and can be conceptualized within the public health model of primary, secondary, and tertiary prevention. In this approach, intervention and prevention are not mutually exclusive; instead, different approaches are used at each level to achieve specific outcomes (20
). At the district level, supervisors of PE and health and student support services (eg, nursing, psychology, social work) could revisit policies regarding PE requirements and opportunities for recess. At the primary prevention level, districts could increase all students' opportunities to engage in physical activity.
On the basis of the results of the present study and the literature on early intervention, sixth-grade students could be targeted for school-wide prevention programs to increase health-supporting activity behaviors. Health professionals could assist in prevention efforts by serving on a school-wide staff committee to develop a healthy behaviors campaign for students to learn about and engage in health-promoting behaviors in the educational setting.
Secondary prevention efforts aim to provide at-risk students with skill development, support, and mentoring (21
). Examples of secondary prevention strategies include small-group exercise lessons, behavioral contracting (setting exercise goals and monitoring progress), specialized counseling from a school nurse, and special exercise groups for students at highest risk. Because some youth (eg, girls, minorities) are at higher risk for overweight and insufficient physical activity, secondary prevention strategies should target these subgroups. In addition, because students tend to become less active over time, secondary prevention programs should target younger adolescents who are at risk for decreased activity.
Finally, tertiary prevention is appropriate for students already identified as overweight. Linking these children to community resources that serve youth who are overweight and providing them with mental health counseling to promote their social and emotional well-being also is important.
This study has several strengths. First, trained nursing staff assessed students' BMIs, and the research protocol was carried out exclusively by school staff. Also, the survey was written at an appropriate reading level for most ninth-grade students. Therefore, the participants interacted with people with whom they were familiar and were able to understand the survey. The study took place in schools largely serving minority and economically disadvantaged students and documented the disparity in health factors at young ages.
This study had limitations. For 1 school district, we used a convenience sample of students in grades 6 and 9 in which the majority of students were eligible for free and reduced lunch, and the student body consisted mostly of ethnic and racial minorities. Although these results may not be generalized to all schools, they are important because they provide information relevant to student populations that have been identified as most at-risk for obesity and inadequate physical activity. Future studies should investigate these variables in more representative samples. Second, the readability of the questions may have been challenging for some of the sixth-grade students. Third, data were collected via self-report, a process that has known limitations. Finally, test-retest reliability was not assessed and would be useful in evaluating the reliability of this survey with students in different grades.
In summary, this article describes a collaborative effort between a local university and school district that provided data on a public health issue. Further, it documents the importance of prevention and intervention efforts for sixth- and ninth-grade students to promote better health through increased physical activity.