Physical Activity After-School Services Program (PAASS)
Dr. Kimberly Brodie CHES, ACSM-HFS
Principles of Health Behavior
MPH 515
Rachel A. Franklin
August 2013

Adolescent Obesity and Physical Inactivity
It is no secret that obesity is a currently growing problem and has been for a few decades, particularly among youth. According to the Centers for Disease Control and Prevention, “Childhood obesity has more than doubled in children and tripled in adolescents in the past 30 years (2013).”
Research shows that children who are obese are at a greater risk of being obese in adults. Therefore, it is critical to target these children and adolescents and improve their health in the hopes that the changes in health behavior will be sustained as they grow into adulthood. Adolescents, in particular, are an important population to target as they are at a greater chance of developing prediabetes and because at the time children become adolescents is when the health behaviors start to change either for the good or for the bad (CDC, 2013). “At approximately 14 years of age, engaging in physical activity has been shown to substantially decline for both males and females (Hamilton & White, 2008).” One of the biggest factors in regards to adolescent obesity is their lack of physical activity. Making it easier and more socially acceptable for adolescents to be physically active could lower the obesity rate among these individuals, therefore improving their chances of developing chronic conditions such as diabetes and heart disease as adults.
How important is physical activity among adolescents?
Increasing physical activity among adolescents is crucial to changing the obesity epidemic. The
Centers for Disease Control and Prevention states that, “Regular physical activity in childhood and adolescents improves strength and endurance, helps build healthy bones and muscles, helps control weight, reduces anxiety and stress, increases self-esteem, and may improve blood pressure and cholesterol levels (2013).” Many studies have shown that there are many factors involved with health behaviors among adolescents, particularly social norms and attitudes. “Social environments are especially critical during the early adolescent years when standards for behavior are often set by parents

and peers. Even if individual attitudes and skills support safe behavior, social norms can influence the onset and progression of risky behaviors (Romer, Black, Ricardo, Feigelman, Kaljee, Galbraith, Nesbit,
Hornik, & Stanton, 1994).” Therefore, it makes sense to target programs to take place among those social influences: peers at school. The CDC states that “schools can promote physical activity through comprehensive school physical activity programs, including recess, classroom-based physical activity, intramural physical activity clubs, interscholastic sports, and physical education. Schools can also work with community organizations to provide out-of-school-time physical activity programs and share physical activity facilities (2013).”
Theory of Planned Behavior
The Theory of Planned Behavior suggests that there are different beliefs that lead to one’s behaviors. The beliefs are behavioral, normative, and control beliefs. This means that one’s attitude toward the behavior, their perceived subjective norms, and their perceived control over the behavior will lead to one’s decision to either enact or not enact the behavior. Along with these beliefs there are factors that affect these perceptions. These include both facilitating: those which increase the likelihood of the occurrence of the behavior, and inhibiting factors: those which may inhibit the adoption of the behavior (DiClemente, Salazar, & Crosby, 2013). Using the Theory of Planned Behavior, a health educator could understand what adolescents’ beliefs are towards engaging in physical activity.
This can be done by performing an assessment talking to them about their behavioral, normative, and beliefs about their control over the behavior.
Knowing how adolescents view physical and activity and understanding why they choose not to engage in physical activity could inspire the right program that could change these beliefs and therefore increase physical activity among adolescents. Along with the beliefs, knowing what the inhibiting and facilitating factors involved are as well. For example, an inhibiting factor could be that an obese

adolescent is ashamed to engage in physical activity among peers as they may be made fun of for their size. Their beliefs may be that they want to be more physically active and may know that they if they are more active than then they can lose the weight, however, the inhibiting factor may be just enough that they still choose not to be more physically active.
Current/Past Physical Activity Programs
In Poway, California, a program was created to increase physical activity both in-school and outof-school. Known as Sports, Play and Active Recreation for Kids (SPARK), the program assigned elementary students into 3 separate conditions: specialist-led program in which certified physical activity specialists educated the students on physical activity, the teacher-led program in which teachers taught physical education classes, and usual physical education classes. They were to assess physical activity among the students in and out of school. The results were that physical activity was increased among students in school, but there was no change out of school (Sallis, McKenzie, Alcaraz, Kolody
Faucette, & Hovell, 1997).
In 2002, a campaign was launched to increase physical activity among youth aged 9 to 13.
Known as VERB, it was a multi-ethnic campaign that combined paid ads with community and school promotions as well as internet activities to encourage youth to participate in more physical activities.
Among those who were aware of the campaign, an increase in engaging in free-time physical activity was found. There was a substantial difference among those who were not and those who were aware of the campaign. “The average 9-to 10-year-old youth engaged in 34% more free-time physical activity sessions per week than did 9- to 10-year-old youths who were unaware of the campaign (Huhman,
Potter, Wong, Banspach, Duke, & Heitzler, 2002).”
In another program, female students in 6 th through 8 th grades were assigned to two groups: the control and intervention group. In the intervention group, youth participated in a multi-disciplinary

program that educated them on nutrition, decreasing television youth, engaging in more physical activity, and increasing fruits and vegetable intake. Within the intervention group, there was a decline in obesity rates when compared to the control group (Gortmaker, Peterson, Wiecha, Sobol, Dixit, Fox, &
Laird, 1999).
These past interventions show the need for more multi-disciplinary approaches as well as the need for more than just classroom intervention. Also that media campaigns are a great way to make adolescents aware of what is available to them and to educate as well.
The Physical Activity After-School Services Program (PAASS or “pass”)
The Physical Activity After-School Services Program (PAASS) will be not just an after-school exercise class. It will be a free service for adolescents as a place they can go to be more active, to learn from peers as well as professionals and teachers, so that they have more confidence to engage in healthier behaviors when it comes to reducing obesity and increasing physical activity. The objectives will be to increase knowledge about health, nutrition, and physical activity as well as increasing physical activity both in-school and out-of-school. It will start out being a student-founded idea. First, the public health professional will meet with a focus group of middle-schoolers (in grades 6 through 8) to determine what kinds of programs they would be willing to attend or invite friends to attend as well as what about them would make the more attractive to the students.
PAASS will be peer and professional-run. PASS will hire high school students to participate in helping to educate the adolescents (either by leading some activities or being trained to educate in some of the program’s services). This will be incentivized for the high school students as “extra credit” for classes, a substitute for physical activity or health/nutrition classes they would need to take (only for those who wish to serve as educators in the program), and as a voluntary service they could add to their
“resume” to use when applying for colleges. A few health education professionals will be hired to run

the program and ensure staffing is available and they will be paid through the school district. They will also participate in fundraising efforts in the community to ensure the program has consistent funding year to year, as it is hoped that a grant will fund the initial year(s).
This program will be communicated to the middle-schoolers through mass media. There will be print material that is published throughout the schools as well as on the internet. There will be a focus group that allows fellow peers to join as the group who will not only continue to perform process evaluations by ensuring that the information and activities available to the students is relevant to the students and remain relevant, as over the years students will come in and out of this focus group. They will also be charged will helping to put together the communication channels. They will utilize the internet through social media like Facebook and Twitter, advertisements through the local TV or radio stations, and print material that will be posted around the schools and around the neighborhood. These students will be the “face” of PAASS and will be responsible for spreading the word to their peers and inviting all to attend.
The program will be developed after a needs assessment is ran and the inhibiting and facilitating factors are identified. The inhibiting factors all or at least mostly will be addressed through different channels and interventions within PAASS. For example, an attempt to address the example made previously about an obese student being made fun of by other students, there will be some one-on-one activities that students can sign up for where they will work with either a peer or professional
(depending on staffing) to engage in physical activity and/or learn about health, nutrition, or physical activity.
The evaluation of this program will be done through the initial needs assessment a pre-test that evaluates adolescents’ attitudes toward physical activity and nutrition as well as an evaluation of the self-efficacy. It will also take a quantitative assessment that evaluates the adolescents’ current

engagement in physical activity and eating healthy (eating high-fat foods and eating f/v on a daily basis).
There will also be a biometric screening that will assess their current BMI through height, weight, body measurements, fasting glucose, and blood pressure measurements. With the objectives stated above, the goal would be to see positive improvements in all areas including body measurements, positive beliefs about physical activity and nutrition, and an improved engagement in physical activity and healthy eating.
During the initial implementation process, there will be a process evaluation, and after one year of implementation and every year thereafter of implementation, there will be a post-test done that evaluates all the same variables as the pre-test. This will be a part of the impact evaluation. With these evaluations, changes will be made as appropriate based off of the needs of the current students to ensure that the program is relevant and addressing the current needs of the youth.

References
Centers for Disease Control and Prevention (2013). Adolescent and School Health: Childhood Obesity
Facts. Retrieved August 18, 2013 from http://www.cdc.gov/healthyyouth/obesity/facts.htm
Centers for Disease Control and Prevention (2013). Adolescent and School Health: Physical Activity
Facts. Retrieved August 18, 2013 from http://www.cdc.gov/healthyyouth/physicalactivity/facts.htm
DiClemente, R.J., Salazar, L.F., & Crosby, R.A. (2013). Health Behavior Theory for Public Health.
Burlington, MA: Jones and Bartlett Publishing.
Gortmaker, S.L., Peterson, K., Wiecha, J., Sobol, A.M., Dixit, S., Fox, M.K., & Laird, N. (1999). Reducing obesity via a school-based interdisciplinary intervention among youth. Journal of the American
Medical Association: Pediatrics. Vol. 153, No. 4. Retrieved August 18, 2013 from http://archpedi.jamanetwork.com/article.aspx?articleid=346206
Hamilton, K. & White, K.M. (2008). Extending the Theory of Planned Behavior: The role of self and social influences in predicting adolescent regular moderate-to-vigorous physical activity. Journal
of Sport and Exercise Psychology. 30, 56-74. Retrieved August 18, 2013 from http://eprints.qut.edu.au/13032/1/13032a.pdf
Huhman, H., Potter, L.D., Wong, F.L., Banspach, S.W., Duke, J.C., & Heitzler, C.D. (2002). Effects of a mass media campaign to increase physical activity among children: Year-1 results of the VERB campaign. Pediatrics. Retrieved August 18, 2013 from http://pediatrics.aappublications.org/content/116/2/e277.full
Romer, D., Black, M. Ricardo, I., Feigelman, S., Kaljee, L., Galbraith, J., Nesbit, R., Hornik, R.C., & Stanton,
B. (1994). Social influences on the sexual behavior of youth at risk of HIV exposure. American
Journal of Public Health: Vol. 84, No. 6. Retrieved August 18, 2013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1614950/pdf/amjph00457-0099.pdf
Sallis, J.F., McKenzie, T.L., Alcaraz. J.E., Kolody, B., Faucette, N., & Hovell, M.F. (1997). The effects of a 2year physical education program (SPARK) on physical activity and fitness in elementary school students. American Journal of Public Health: Vol. 87, No. 8. Retrieved August 18, 2013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1381094/pdf/amjph00507-0074.pdf