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Jonathan McGavock, PhD Department of Pediatrics, Faculty of Medicine University of Manitoba

Manitoba Increasing Physical Activity among Secondary Students: MIPASS An natural experiment evaluating the Manitoba Grade 11 and 12 PE Policy. Jonathan McGavock, PhD Department of Pediatrics, Faculty of Medicine University of Manitoba Manitoba Institute of Child Health. On Behalf of….

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Jonathan McGavock, PhD Department of Pediatrics, Faculty of Medicine University of Manitoba

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  1. Manitoba Increasing Physical Activity among Secondary Students: MIPASSAn natural experiment evaluating the Manitoba Grade 11 and 12 PE Policy Jonathan McGavock, PhD Department of Pediatrics, Faculty of Medicine University of Manitoba Manitoba Institute of Child Health Centre for Physical Activity and Cardiometabolic Health in Youth

  2. On Behalf of… • Steve Manske, PhD Propel – U of Waterloo • Erin Hobin, PhD Propel – U of Waterloo • Donna Murnaghan, PhD - UPEI • Catherine Casey, PhD - U of Manitoba • Jane Griffith, PhD - CancerCare MB • Paul Veugelers, PhD - U of Alberta

  3. Presentation Overview • Purpose and History of PE Policy • Epidemiology 101 and Policy Evaluation • Research Design and Methods • Results and Future Directions

  4. Presentation Overview • Purpose and History of PE Policy • Epidemiology 101 and Policy Evaluation • Research Design and Methods • Results and Future Directions

  5. Physical Activity Status: Manitoba • Only 22% of Manitoba youth aged 5-19 achieve the equivalent of 120 – 150 min/day of MVPA (CLFRI, 2009) • >30% of Manitoba youth are overweight or obese (CHMS 2007)

  6. Physical Activity Status: Manitoba (CLFRI, 2009)

  7. Physical Activity Levels F

  8. Manitoba Context Healthy Kids, Healthy Futures Task Force Report: The task force recommends that the government mandate PE/HE from kindergarten to Grade 12 in Sept. ‘08. http://www.gov.mb.ca/healthykids/

  9. Manitoba PE policy 75% Maximum OUT-of-Class Time 25% Minimum IN-Class Time Impacts ~65,000 students in 270 schools in MB 0% 25% 50% 75% 100% 50% PA Practicum 25% Core Component 25% Flexibility Component

  10. Manitoba PE Policy Requirements • Minimum of 110 credit hours of PE/HE • Minimum 55 hours of MVPA (30 mins MVPA Daily) Support: • $3.8 Million to support policy implementation • Secondment of PE/Health Consultant for 2 years to oversee implementation

  11. Manitoba PE Policy Options for Policy Implementation: • 100% IN – All PE and Health Ed In School • 50/50% - Some in, some out (Health On-line) • 25%/75% - eg. All PE in health ed on-line • 100% out of school on-line NOTE: Out of class time is logged on an excel sheet and reviewed by PE teacher frequently

  12. Manitoba PE policy • Student fitness portfolio • Student-teacher conferences • Pre- and post-sign off sheets for teachers and parents • Graded as Complete or Incomplete www.edu.gov.mb.ca/k12/docs/policy/imp_pehe/document.pdf

  13. Presentation Overview • Purpose and History of PE Policy • Epidemiology 101 and Policy Evaluation • Research Design and Methods • Results and Future Directions

  14. Asking a Research Question Target Population Exposure to risk factors Outcomes

  15. Asking a Research Question Men > 50yrs Reducing Cholesterol Risk of a Heart Attack

  16. How do you know that this Causes This Epidemiology 101 Men > 50 Lowering Cholesterol Reduces Heart Attacks

  17. Gold Standard Design Study Sample Intervention Control Outcome Change Outcome Change Are they Different? Target Population Random Assignment

  18. Finland Example Problem

  19. Proposed Solution

  20. How do you know that this Causes This Gold Standard for Policy Eval? Entire Population North Karelia Project Reduces Heart Attacks

  21. Policy Evaluation

  22. How did it Happen? Change in Obesity rates over the same time frame

  23. Policy Evaluation

  24. How do you know that this Causes This Manitoba PE Evaluation All Grade 11 and 12 Students in MB Grade 11/12 PE Policy Increasing PA / Reducing Obesity

  25. Gold Standard Design Small Sample Policy Yes Policy No Increased MVPA Reduced MVPA All Grade 11 and 12 Students Random Assignment

  26. The Challenge • - PE levels decline over time in adolescence • Parallel intervention at provincial/national level • Child tax credit, Participaction Olympic Games, gas prices • School-based initiatives Nader, P. R. et al. JAMA 2008;300:295-305 Centre for Physical Activity and Cardiometabolic Health in Youth

  27. Presentation Overview • Purpose and History of PE Policy • Epidemiology 101 and Policy Evaluation • Research Design and Methods • Results and Future Directions

  28. RESEARCH QUESTIONS • Will the policy reduce the number of inactive youth in Manitoba? • Will the policy prevent the major decline in PA levels between grade 9 and 12? • Does the school environment determine the effectiveness of the policy? • What factors identified by stakeholders facilitate effective policy implementation? Centre for Physical Activity and Cardiometabolic Health in Youth

  29. YOUTH HEALTH SURVEY 4 pages, 51 questions • Multiple choice, machine scannable • 20‐30 minutes to complete (short) • Includes questions on tobacco, nutrition, physical activity, self‐esteem and school connectedness CENSUS of PA in MB 46,919 students participated in the survey ~33,000 in grades 9-12 265 of these schools included grade 9‐12 All 11 Manitoba Regional Health Authorities participated Question 1 Design

  30. Rates of inactivity 2012 n = 33,000 Research Design 1 How do you know it’s the policy? Rates of inactivity 2008 n = 33,000

  31. No Policy Research Design 1 Policy 2012 2008

  32. Research Design #2 • Cohort study of ~700 adolescents between grades 9 and 12 in Manitoba • 32 schools - 20-30/ school beginning in 2008. Followed to 2012 • Randomly Selected with 40% rural • Parallel cohort of 800 youth in Alberta

  33. Assessment of Physical Activity Actical (minimeter) 7 day data collection Data collected every 15 seconds Youth asked to wear it for a minimum of 10 hrs daily Provided with a minimal incentive to wear the unit Same research assistant for all 4 years Eslinger Tremblay APNM 2008

  34. Research Design #2 100 90 80 70 60 AB MVPA (mins/day) 50 MB 40 30 20 10 0 2008 2009 2010 2011 2012

  35. SHAPES Environment Survey

  36. Research Design #3 Original Cohort in Grade 9 Test for Differences in PA levels or change in PA according to School environment and/or polciy type Follow the cohort until grade 12

  37. Participants Analysis Research Question #4 Method • 12 schools • 60% urban • 6 schools 50/50 • 3 schools 75/25 • 2 schools 25/75 • 12 PE teachers • Interviews transcribed verbatim • Thematic analysis to identify key concepts • Identify themes that fall into each SWOT category • Concerns-based model • 1 interview (~60min) with each of the 12 PE teachers • 1 yr post-policy (May/Jun 2009)

  38. Presentation Overview • Purpose and History of PE Policy • Epidemiology 101 and Policy Evaluation • Research Design and Methods • Results and Future Directions

  39. Policy Implementation Fall 2008 % Of Total

  40. Results Question #1

  41. Results Research Question #1 • Data were very similar for PEI in 2008 (n=~8000) • 2012 being collected this year in MB • Plan to collect data in PEI • Data will be available mid 2013 for comparison between the two provinces

  42. Manitoba Alberta N = 966 Youth (44 Schools) N = 377 N = 588 N=175 (invalid 4 days/8hours) in 2008 N=175 (invalid 4 days/8hours) in 2008 N = 309 N = 413 N=35 (No weekend) in 2008 N=61(No weekend) in 2008 N = 274 N = 352 N=22 (invalid 4 days/8hours)in 2009 N=110 (invalid 4 days/8hours)in 2009 N = 253 (including 1 weekend day) N = 242 (including 1 weekend day) N = 24 (No Weekend Day) in 2009 N = 29 (No Weekend Day) in 2009 N = 229 (including 1 weekend day) N = 213 (including 1 weekend day) N = 442 Youth (2008+2009 3 days/8 hours including 1 weekend day)

  43. 2009 Sedentary Light 100 MVPA 21 23 80 72 72 60 40 20 0 Weekday Weekend Results Question #2 2008 Sedentary Light MVPA 100 28 22 80 70 Percentage of Time 66 60 40 20 0 Weekday Weekend

  44. B 80 Weekday Weekend MVPA TIME (mins) † 60 * * † * * 40 0 URBAN RURAL Results Question #2 Figure 3 A 80 Weekday Weekend 60 MVPA TIME (mins/day) 40 0 BOYS GIRLS mean ± SE *=p<0.05 vs. weekday; † vs urban

  45. Weekend MVPA Results Question #2 Weekday MVPA

  46. Results Question #2 Figure 5 220 Week day 210 Weekend 200 * 190 Light PA Time (mins) Boys 180 170 * 160 Girls 150 0 2008 2009 * = p < 0.01, change in Light PA over time

  47. Results Question #2 Average MVPA Daily 58 56 AB-MVPA 54 MB-MVPA 52 Mins/Day 50 48 46 44 42 40 2008 2009 2010

  48. Results Question #2 Weekday MVPA 65 AB Weekday 60 MB Weekday 55 Mins/Day 50 45 40 2008 2009 2010

  49. Results Question #2 Weekend MVPA 41 AB Weekend 40 MB Weekend 39 38 Mins/Day 37 36 35 34 33 2008 2009 2010

  50. Research Question #2 65 60 55 2008 50 Mins/Day 2009 45 2010 40 35 30 Weekday Weekend Weekday Weekend Manitoba Alberta

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