Physical Activity Among Children with Special Health Care

Physical Activity Among Children with Special Health Care Needs FINDINGS FROM THE NATIONAL SURVEY OF CHILDREN’S HEALTH Amelia Phillips, BS, CPH (Provisional) | MCH Leadership Training Program Scholar University of South Florida 2015 Making Lifelong Connections Meeting 4/24/2015

Outline • Public Health Significance o Physical inactivity among children with special health care needs (CSHCN) • Methods • Results • Discussion

Public Health Significance • Essential component of a healthy lifestyle • Important for healthy growth and development • May result in benefits across the life span 3

Physical Inactivity • Physical inactivity major risk factor for chronic disease and disability • Higher prevalence of obesity among CSHCN • 20% of CSHCN vs. 15% non-CSHCN • Greatest risk among children with mobility limitations and intellectual disabilities 4

Life Course Implications of Physical Inactivity • Limited involvement during school increases risk for sedentary lifestyles after graduation • ASD, Intellectual disabilities and multiples disabilities most likely to spend leisure time watching TV. • Early exposure is crucial 5

Systems Barriers among CSHCN • • Perceptions, attitudes and beliefs held by parents Poor communication between parents and teachers Attitudes of program leaders and participants Lack of opportunities o Limited physical accessibility • Lack of transportation • Limited awareness of how to adapt services/ activities 6

Inclusive Opportunities • Recent movements toward inclusion in recreation activities have changed programmatic focus o ADA discrimination laws ensure access • Need to ensure supports and resources are available to equip CSHCN with the necessary skills 7

Importance of Parent Involvement • Parental involvement positively associated with child’s education achievement levels o o o Special education, gifted All types of involvement All ages of children • Despite shift towards inclusion in all areas of the community, effect of parental involvement on physical activity remains unknown 8

Study Purpose • To investigate physical activity levels among children ages 6 -17 by severity level of special health care need • To explore relationship between physical activity participation among CSHCN and levels of parent involvement 9

Research Questions 1. Is there an association between the severity of a child’s condition (mild, moderate or severe) and physical activity levels? 2. Is there an association between physical activity levels among CSHCN and levels of parent involvement? 10

Methods • Secondary Data Analysis • National Survey of Children’s Health (NSCH) o o Cross-sectional telephone survey U. S. households with one or more children aged 0 -17 English and Spanish Nationally representative sample of children ages 0 -17 11

Analytic Sample • Children classified as CSHCN o CSHCN Screener Comprehensive, robust screening tool o Considers a wide range of conditions and needs o Reflects MCHB’s definition of CSHCN o • Ages 6 -17 12

Main Outcome Variable Physical Activity (PA) “During the past week, on how many days did [CHILD’S NAME] exercise, play a sport, or participate in physical activity for at least 20 minutes that made [him/her] sweat and breathe hard? “ • The number of days during the previous week that the child engaged in vigorous PA 13

Independent Variables Condition Severity “Does [CHILD’S NAME] currently have condition? ” “Would you describe (his/her) condition as mild, moderate, or severe? ” • Parent-rated severity of child’s condition • Autism Spectrum Disorder (ASD), Attention Deficit Disorder (ADD), Developmental Delay 14

Independent Variables Parent Involvement “During the past 12 months, how often did you attend events or activities that [CHILD’S NAME] participated in? “ • Frequency of parent’s attendance at child’s activities in the past 12 months • Children who participated in one or more extracurricular activities 15

Control Variables • • • Age Sex Race/ethnicity Family structure Poverty level 16

Analysis • Weighted chi-square bivariate analysis o Descriptive characteristics • Weighted logistic regression o Crude (unadjusted) OR o Adjusted OR 17

Results Table 1. Risk of Outcome (Being Physically Inactive) Independent Variables Crude OR (95 % CI) Adjusted OR (95% CI) Condition Severity Mild 1. 831 (0. 58, 9 5. 694) 1. 850 (0. 356, 9. 616) Moderate/Severe 0. 838 (0. 411, 1. 709) 0. 577 (0. 188, 1. 773) Does not currently have condition 1 1 0. 436 (0. 344, 0. 553)** 0. 408 (0. 296, 0. 564)** 1 1 Parent Involvement Never/Sometimes Usually/Always **significant p<0. 05 18

Results Table 2. Risk of Outcome (Being Physically Inactive) Crude OR (95 % CI) Adjusted OR (95% CI) 2. 083 (1. 765, 2. 457)** 2. 079 (1. 579, 2. 738)** 1 1 Age 6 -9 yrs. 10 -17 yrs. Race/Ethnicity Hispanic White (non-Hispanic) African American (non- Hispanic) Multi/Other (non- Hispanic) 0. 607 (0. 474, 0. 778) ** 1 0. 591 (0. 415, 0. 841)** 1 0. 7 (0. 571, 0. 859)** 0. 885 (0. 633, 1. 237) 1. 0 (0. 785, 1. 273) 0. 961 (0. 661, 1. 398) Sex Female Male 0. 645 (0. 557, 0. 747)** 0. 552 (0. 443, 0. 688) ** 1 1 **significant p<0. 05 Data Not Shown: Household income and family structure lost significance after controlling for confounding 19

Discussion • Parents who were less involved had more physically active children • Younger children (6 -9 years) were more likely to be inactive • Hispanics and females were less likely to be inactive 20

Discussion • Conflicting findings with existing literature o Parental involvement; demographics of children at most risk for inactivity • Future research o o Modeling physical activity behaviors (parents and peers) Social learning/cognitive theory • Access is necessary but not sufficient o o Critical need for supportive environments Systems perspective may shed light on barriers and future strategies 21

Acknowledgements • USF MCH Training Grant • SHARP Award, USF College of Public Health • 2015 Making Lifelong Connections Planning Committee • Dr. Russell Kirby and Dr. Cheryl Vamos, USF College of Public Health 22

• Questions? Thank you! Amelia Phillips, B. S. aphilli 6@health. usf. edu (863) 286 -2067 23