Physical Activity Among Children
with Special Health Care Needs
F I N D I N G S F R O M T H E N AT I O N A L S U R V E Y
O F C H I L D R E N ’ S H E A LT H
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
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
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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
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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
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• Questions?
Thank you!
Amelia Phillips, B.S.
aphilli6@health.usf.edu
(863) 286-2067
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