Walking School Bus
and Its Impact on BMI
Janette Quarles, DrPH,
CPH, MPH, MA, CCC/SLP
University of Oklahoma Health Sciences Center
Mandatory Disclosure
Statement
Dr. Janette Quarles and research team
had no personal financial relationships
with commercial interests relevant to
this presentation
during the past 12 months.
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Introduction
• Since 1970, obesity in ages 6-11
more than quadrupled
• As child obesity increased,
simultaneous decrease in children
walking and biking to school
3
4
Background
• Many families cannot – or will not –
sacrifice time or money to purposely
pursue exercise
• Normal daily routines can be useful to
increase physical activity
• For children, a normal daily routine is
the trip to and from school
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Background
Even in walkable areas, perceived
safety a significant barrier to children
actively commuting to school
(Anderson, et al)(Baslington)(Carver, et al)(Eyler, et
al)(Hayne, et al)(Hume, et al)(Lorenc, et al)(Merom, et
al)(Ridgewell, et al)(Sallis, et al, 2009)(Zhu, et al)
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Introduction
Many parents’ work schedules – or
other life situations – prevent them
from walking the child to school
Research indicated parents allow
children to walk to school when
chaperoned
(Hayne, et al)(Johnston)(Kingham, et al)(National Center for Bicycling
and Walking)
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Walking School Bus
• Adult-chaperoned walk-to-school
program
• Follows same route each day
• Has a specific starting point…
…safe place for children to gather
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Methods
Quasi-experimental in design
Evaluated:
1. Community walkability
2. Physical activity levels
3. Pre- & post- body mass index (BMI)
in active commuters and controls
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Parent Questionnaire
1. Contributors or barriers to active
commute
– Neighborhood walkability
– Safety
– Other factors influencing
transportation choice
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Parent Questionnaire
2. Dose response
–
Distance and frequency of active commute
3. Confounders
–
Measures of recreational physical activity
4. Differing beliefs for the active
commute vs. other outdoor activities
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Methods and Results
Concurrent control group
Exposed to similar opportunities
1102 total participants ages 5-12
–406 active commuters
–696 controls – students driven to the
same schools
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Results
In areas with lower walkability, Walking
School Bus increased active
commuting to school to 39.8%...
…as compared to the national average
of 5-14%, p <.0005 (one-tailed)(SPSS
Nonparametric Binomial)…
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Results
…and reduced BMI, z = -10.125,
p < 0.0005 (two-tailed) (SPSS
Nonparametric Wilcoxon SignedRank Test).
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Table 1: Change to or from the healthy weight category in
walkers versus controls, Oklahoma schools with a Walking
School Bus, 2009-2010.
All active
commuters Control group
n =267
n =509
Pre-test obesity or overweight
65 (24.3%) 171 (33.6%)
Post-test obesity or overweight 50 (18.7%) 184 (36.1%)
Decrease or increase in obesity
and overweight
(-) 5.6%
(+) 2.5%
Absolute Risk Reduction (ARR) (8.1%) 8%
na
Number needed to treat (NNT)
(12.3) 13
na
Weight classification ages 2 to 19 years: Obesity ≥ 95th percentile,
Overweight 85th to < 95th percentile, Healthy weight 5th to < 85th
percentile. (CDC, Healthy Weight).
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Table 2: Change to a healthier, or less healthy, weight
category, Walking School Bus, Oklahoma, 2009-2010.
All active
commuters Control group
n =267
n =509
Pre-test obesity and overweight 65 (24.3%) 171 (33.6%)
Post-test obesity and overweight 28 (10.5%) 187 (36.8%)
Decrease or increase in obesity
and overweight
(-) 13.8%
(+) 3.2%
Absolute Risk Reduction (ARR)
17%
na
Number needed to treat (NNT)
(5.9) 6
na
Weight classification ages 2 to 19 years: Obesity ≥ 95th percentile,
Overweight 85th to < 95th percentile, Healthy weight 5th to < 85th
percentile. (CDC, Healthy Weight).
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Dose Response
• Both distance and frequency of active
commute demonstrated statistically
significant association and correlation
with BMI…
• Distance demonstrated a stronger
correlation than frequency
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Results - Distance
• Walking School Bus allowed children
to walk farther…overcoming distance,
a significant barrier to the active
commute.
• Participants in the Walking School
Bus walked an average of 65%
farther than students that walked
without an adult chaperone.
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Table 3: Distance in miles active commuters
travelled to Oklahoma schools with a Walking
School Bus, 2009-2010.
Distance in
miles
Mean Median
Walked without adult chaperone 0.66
0.44
Walking School Bus participants 1.09
0.61
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Physical Activity
• Measures of recreational physical
activity also demonstrated a
statistically significant association
with BMI…
• After controlling for confounders,
active commute continued to
demonstrate statistically significant
association with BMI.
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Results – Physical Activity
• No statistically significant association
between the active commute and
measures of recreational physical
activity
• Measures were independent of one
another
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Results – Physical Activity
In other words…
• Participation in the Walking School
Bus was not limited to more
physically active students.
• Walking School Bus increased
opportunities for inactive students to
actively commute to school.
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Figure 2: Primary contributor to active
commute to Oklahoma schools with a
Walking School Bus, 2009-2010.
Sidewalks
Crossing guard/light
Travels with peers
Adult chaperone
Required-parent works
No family car
Live close to school
It's good for him
My child enjoys it
50%
21%
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Figure 3: Primary barrier to active
commute to Oklahoma schools with a
Walking School Bus, 2009-2010.
Not enough sidewalks
Curbs need ramps
No crossing guard
No traffic light
Daycare drives child
55%
Live too far from school
Bridge-no safe sidewalk
Safety
32%
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Practical Applications
By measuring existing programs…
…real world application should
contribute to generalization and
replication of the results with the
knowledge gained regarding the
simplicity, feasibility, sustainability and
effectiveness of an adult-chaperoned
walk-to-school program
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Practical Applications
• Walking School Bus potential “big
bang” for virtually no “bucks”!
• Uses existing school personnel or
volunteers
• Simple strategy
• Does not interfere with instruction
time
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Summary
1. Walking School Bus sufficient to
overcome many barriers to active
commute to school
– Age, Disability, Gender,
– Physically inactive lifestyle,
– Distance, Other environmental
factors,
– Parental safety concerns
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Summary
2. …therefore significantly increasing
percentage of children actively
commuting to school and
significantly decreasing BMI
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Summary
3. Schools should recruit adult
chaperones for routes…
…in
areas with high populations of
students (apartment complexes)
…overcoming environmental barriers
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Questions?
www.safekidsreflectors.com
30
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http://gradworks.umi.com/34/67/3467259.
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References
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References
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