SNAP-Ed physical activity interventions in low-income schools are associated with greater cardiovascular fitness among 5th and 7th grade students in California
Hannah R. Thompson, Sridharshi C. Hewawitharana, Janice Kao, Carolyn Rider, Evan Talmage, Wendi Gosliner, Lauren Whetstone, Gail Woodward‐Lopez
Abstract
California’s Department of Public Health (CDPH) distributes Supplemental Nutrition Assistance Program-Education (SNAP-Ed) funding, known as CalFresh Healthy Living (CFHL) in California, to local health departments to implement school-based physical activity/nutrition interventions. We determined the association between intervention presence/dose and student cardiorespiratory fitness and BMI. This cross-sectional, observational study included 5th and 7th grade students with 2016–17 FitnessGram® results who attended SNAP-Ed eligible California schools. Intervention group students attended schools with CDPH-CFHL interventions during October 2015-September 2016 (n = 904 schools; 97,504 students, 49% female); comparison group students attended schools without CDPH-CFHL interventions (n = 3,506 schools; 372,298 students, 49% female). Adjusted multilevel models determined the association between school-level intervention presence/dose and students’ cardiorespiratory fitness (estimated VO2max) and BMI z-score, and tested for effect modification by student grade and sex. Students attending intervention schools demonstrated greater VO2max (males: 0.18 mL/kg per min, 95% CI: 0.03, 0.34; females = 0.26 mL/kg per min, 95% CI: 0.13, 0.39) and lower BMI z-scores (males: −0.03, 95% CI: −0.05, −0.02; females = -0.02, 95% CI: −0.04, −0.01) than students in comparison schools. Students in schools with the highest intervention levels demonstrated higher VO2max (0.37 (95% CI: 0.06, 0.16) and 0.22 (95% CI: 0.02, 0.42), respectively), than comparison students, with the strongest associations seen for females and 7th graders. On average, students in schools with CDPH-CFHL physical activity interventions demonstrated better cardiorespiratory fitness and slightly lower BMI z-scores than students in comparable schools without such programing. Investment in these interventions may positively impact students’ cardiorespiratory health, though further causal investigation is warranted.