Nutrition and Physical Activity as Protective Factors in Eliminating the Achievement Gap
By Alicia Fedewa & Jennifer Hoffman
There is much attention placed on closing the achievement gap among socioeconomically disadvantaged or ethnic/racial minority (herein referred to as disadvantaged to avoid redundancy) students. However, what some may fail to take into account is the impact of poor quality, low-nutrition foods and limited access to physical activity on children's academic outcomes. Disadvantaged youth are at risk for poor nutrition and limited access to physical activity, which may negatively impact their educational outcomes. School psychologists can play a critical role in this area with respect to the implementation of universal interventions, advocacy, and policy changes that will improve the outcomes of these students. This paper will explore the discrepancies that affect disadvantaged youth in the areas of achievement and will highlight the potential of quality nutrition and enhanced physical activity as protective factors in eliminating the achievement gap. Moreover, the implementation of universal interventions, advocacy, and policy will be discussed to demonstrate the feasibility and necessity for targeting these issues for our nation's disadvantaged youth to improve the academic outcomes for those children who need it most.
The Achievement Gap
The achievement gap is the discrepancy in educational achievement—often measured by grades, graduation rates, and high-stakes testing—that occurs between high-achieving students (predominately White, middle class, suburban youth) and low achieving students (typically ethnic minority, socioeconomically disadvantaged, urban youth; Cross, 2007) . Although the achievement gap narrowed in the 1970s and early 1980s (Lee, 2002), it has since increased and remains evident in our nation's schools. Significant achievement gaps in reading and mathematics remain among different racial and ethnic group s and between socioeconomically disadvantaged students and schools with low numbers of socioeconomically disadvantaged students (NAEP, 2011a, b). The complexity of identifying the cause of this gap is evident, as myriad factors have been identified in the research. Some of these factors include poverty or socioeconomic status of the family (Myers, Kim, & Mandala, 2004), attending a school with high numbers of minority students (Caldas & Bankston, 1997), and the disconnect between cultural and linguistic practices across home and school (Bailey & Pranksky, 2005). Since ethnic and racial minority individuals are at an increased risk for living in poverty (Elmelech & Lu, 2004), this places them at risk for lower academic achievement.
Although prior research has emphasized the variables that negatively impact student achievement, it is also critical to investigate those factors that build resilience among youth—namely, protective factors. Several protective factors have been show to enhance children's achievement despite disadvantaged backgrounds. Von Secker (2004) identified several protective factors that promote academic resilience among disadvantaged youth in regard to science education, including: students’ positive attitudes and beliefs toward education and their ability to do well, enriched home learning environments (e.g., literacy experiences), educational opportunities at school, and parental education level. Students' relationships with their teachers, parental monitoring, student mental health, ethnic identity, and peer values have also been shown to play a moderating role in disadvantaged youth's academic achievement (Becker & Luthar, 2002; Shin Daly, & Vera, 2007; Spencer, 2005). Thus, although much attention has been given to student risk factors, it is clear that closing this gap without targeting other, more positive, moderating factors may prove unsuccessful. Although the moderating relationship of two other protective factors—access to healthy foods and physical activity—have not been explicitly examined in the literature with respect to student achievement, these variables may in fact serve as important areas to target in closing the achievement gap.
Access to Healthy Foods: The National School Lunch Program
The National School Lunch Program (NSLP) was developed to promote the health and well-being of school-age children. One of NSLP's proposed initiatives was to serve a protective function in buffering against nutritional deficits. Thus, federal mandates ensured that participating schools must provide free or reduced-price meals to children who are unable to afford full-price meals (U.S. Department of Agriculture, 2011a). Thus, in the public school system, a common estimate for those living in poverty or low socioeconomic status are those who participate or are eligible for free and reduced-price lunch. For the 2011–2012 school year, eligibility for the NSLP was $29,055 for a family of four (for free lunch) and $41,348 for a family of four (for reduced-price lunch, 2011a). Yet it has been noted that qualifying for a reduced or free lunch does not inevitably result in the student's participation in the program (see Bhatia, Jones, & Reicker, 2011). In other words, although approximately 21 million students qualify for free and reduced-price lunch, rates of actual participation in the NSLP vary drastically among schools and students' age (Bhatia et al., 2011; USDA, 2011b). Among a number of factors contributing to students' lack of participation in the NSLP is the stigma attached to being eligible for the program.
The stigma of participating in the NSLP varies among schools and neighborhoods. For instance, significant differences exist across age groups, as low-income high school students are more influenced by peers than are elementary youth (Marples & Spillman, 1995; Mirtcheva & Powell, 2009). Thus, high school students who are eligible for the NSLP are significantly less likely to use it if their peers do not. Moreover, the stigma associated with being eligible for the program was rated as one of the main reasons for not participating by parents of younger children (Glantz, Berg, Porcari, Sackoff, & Pazer, 1994). Finally, the presence of fast-food options and restaurants within the neighborhood has been associated with significantly less use of the NSLP among high school students given open-campus options during lunch time (Mirtcheva & Powell, 2009). Fast-food options in a neighborhood context have been shown to have less effect on elementary-age children's participation in the NSLP (Mirtcheva & Powell, 2009), but the presence of unhealthy foods (including sugar-sweetened beverages and high-fat, processed foods) is significantly associated with increased caloric intake and body mass index among elementary-age children (see Turner & Chaloupha, 2012). Thus, despite the good intentions of the NSLP, a number of contextual and school-level factors have hindered the success of the program, with significantly more low-income students receiving less than adequate nutrition at school.
Access to Physical Activity
In addition to the limited opportunities for nutrition-dense food, children from low-income backgrounds have also also been shown to receive significantly less physical activity than children from middle-class or high socioeconomic backgrounds (Gordon-Larsen, Nelson, & Popkin, 2004; Kumanyika, 2008). Among African American and urban youth, in particular, it is clear from the research that these children receive disproportionately lower levels of physical activity relative to more affluent peers (Odoms-Young & Fitzgibbon, 2008). A 2007 national survey of parents showed that—compared to only 7% of Caucasian youth—approximately 31% of Hispanic and African American youth received 0 days of physical activity in the past week (National Survey of Children's Health, 2007). In a review of the literature regarding the higher prevalence of inactivity among racial/ethnic minorities, Burton and VanHeest (2007) identified a number of factors that have contributed to the increased rates of overweight and obesity in children from low-income backgrounds. The authors highlighted the limited physical activity opportunities that children from low-income and minority communities have compared to children from higher income neighborhoods as well as the increased screen and sedentary time due to limited access to parks and recreational facilities (Burton & Van Heest, 2007).
Researchers have consistently documented the impact of the built environment (e.g., playgrounds, sidewalks, parks) on children's physical activity, as children without access to an environment that promotes physical activity are significantly more sedentary (Ebbeling, Pawlak, & Ludwig, 2002; Kumanyika & Grier, 2006). Specific characteristics of the built environment that promote physical activity in children include the presence of nearby parks and playgrounds, accessibility of local transportation stops (e.g., bus, shuttle, and subway stops), and parental perception of neighborhood safety (see Lovasi et al., 2011). Given that disadvantaged youth do not generally have access to such features of the built environment, their opportunities for physical activity may be limited. This discrepancy in the amount of physical activity children from low-income backgrounds receive relative to their affluent peers inevitably impacts their health and well-being, as physical activity contributes to the overweight and obesity epidemic among youth (Gordon- Larsen et al., 2004; Ogden, Carroll, & Flegal, 2008).
The Health Gap
Childhood obesity is a major health concern and is increasing at a disturbingly high rate in the United States. Specifically, the National Health and Nutrition Examination Surveys (1976–1980; 2003– 2006) estimate that for children ages 2–19 years of age, the prevalence of obesity has nearly tripled (CDC, 2009). In addition, children and adolescents have a greater risk for developing obesity-related diseases, resulting in diminished life expectancy and quality of life; for the first time in history, children are expected to have a shorter life expectancy than their parents (Wang & Veugelers, 2008; WHO, 2009). Some of the health consequences that stem from obesity are immediate while others develop in adulthood. One of the most common health consequences that children and adolescents face is an increased risk for cardiovascular disease, which includes high blood pressure, increased cholesterol levels, and irregular glucose tolerance—all of which can result in heart disease or stroke (CDC, 2009; Ogden, Yanovski, Carroll, & Flegal, 2007). One research study reported that approximately 70% of children ages 5–17 years had one cardiovascular risk factor, and approximately 39% had two or more risk factors (see Freedman, Mei, Srinivasan, Berenson, & Dietz, 2007).
Although childhood obesity affects all racial/ethnic groups, there are significant disparities among rates of overweight and obese status, thus increasing the risk of cardiovascular disease, diabetes, and other mostly lifestyle-preventable disorders (see Magnusson, Sjoberg, Kjellgren, & Lissner, 2011) in these groups. Rates of cardiovascular disease risk and diabetes have been shown to be five times as high in children from low-income or racial/ethnic minority backgrounds (Kumanyika & Grier, 2006). There is clearly a significant disparity between the health statuses of children from disadvantaged backgrounds as compared to their affluent peers.
The disparity between levels of physical activity among disadvantaged youth and children from higher income backgrounds may not solely affect their physical health. A growing body of research is demonstrating a link between physical activity and children's academic achievement and related cognitive outcomes (Fedewa & Ahn, 2011; Singh, Uijtdewilligen, Twisk, VanMechelen, & Chinapaw, 2012). In fact, studies have demonstrated a longitudinal effect between children's physical health (i.e., measured by physical fitness and body mass index [BMI]) and subsequent achievement. An increase in children's BMI from normal to overweight or obese status results in decreased test scores (Datar & Sturm, 2006) while children who are more physically fit have higher academic achievement (London & Castrechini, 2011). Moreover, given the link between healthy nutrition and children's enhanced physical and emotional well-being, improving children's physical activity and access to good nutrition may prove to be a holistic approach to decreasing the achievement gap (Basch, 2011). The following section presents a possible means for eliminating the achievement disparity using evidence-based universal interventions designed for all students, but shown to be effective in working with low-income or racially/ethnically diverse populations.
Eliminating the Disparity: Universal Interventions for all Students
School psychologists are in a unique position to initiate and perpetuate change in our nation's schools. It is evident that disadvantaged youth are in need of Tier 1 intervention programs to address healthier eating and physical activity levels in their schools. This in turn may positively impact students' achievement in schools (Ahn & Fedewa, 2011; Fedewa & Ahn, 2011). This area of research is growing, and there are several studies that offer preliminary findings that might aid with designing effective Tier 1 interventions for underserved populations in the future. Three such studies are briefly described below.
Study 1. Wilson et al. (2005) conducted a 4-week physical activity intervention with underserved 6th graders. The intervention group included 85% African American students, and 89% of the group received free or reduced-price lunches. The adolescents were expected to increase moderate to vigorous physical activity (MVPA) to 60 minutes per day by making various activity choices, while the comparison group received general health education during regular school hours (with no emphasis on physical activity). The intervention was 3 days per week for a 2-hour period after school. After school, the students completed homework and had a snack (30 minutes), selected and participated in MVPA for 60 minutes, and then spent 30 minutes learning behavioral skills and motivational strategies to increase their physical activity at home (Wilson et al., 2005). The intervention also included other activities that aimed to increase the students' intrinsic motivation, self-efficacy, and self-concept. The researchers found significant results in increasing children's MVPA and self-concept in regard to physical activity.
Study 2. In another study, the Medical College of Georgia FitKid Project aimed to increase MVPA in elementary-age disadvantaged youth (Yin et al., 2005). This program was specifically designed for a 2-hour period immediately after school and lasted 3 years. The study involved elementary school students diverse in racial composition (61% African American, 31% Caucasian, 3% Asian and Hispanic). The intervention included a 40-minute academic enrichment period with a healthy snack followed by an 80-minute period of physical activity (half of which consisted of MVPA). The results of the study showed statistically significant effects in the intervention group on percent body fat, bone mineral density, and cardiovascular fitness. Researchers noted that because the intervention utilized the existing infrastructure of the school—including its facilities, staff, and transportation—the program was likely more successful and likely to sustain its effects.
Study 3. In the third study, Hollar et al. (2010) conducted the Healthier Options for Public Schoolchildren (HOPS) program, which provided preliminary evidence for increasing physical activity as a means of increasing academic performance in low-income elementary school children. HOPS occurred over a 2-year period and its main goals were to improve the overall health status and academic achievement of the students. This pilot study included 4,588 elementary school children of low-income families (48% Hispanic). The intervention had multiple components, including a dietary intervention, which altered school-provided meals to include more high-fiber items, fewer high-glycemic items, and lower amounts of total, saturated, and transsaturated fats. The curricular component involved students, parents, and school staff and addressed physical activity and nutritious eating through HOPS program materials. Finally, HOPS included a physical activity component, which increased physical activity in schools, although the amount and intensity of physical activity varied among the intervention schools. Results showed that intervention schools had a significant increase in standardized math scores.
Described above are three selected studies with promising findings for Tier 1 interventions that target both quality nutrition and physical activity to promote academic achievement for disadvantaged students. For successful implementation, it is important to identify and utilize the shared characteristics of these interventions. Overall, these interventions lasted over the course of the academic school year or for multiple years and were conducted 3 or more days per week, often for approximately 2-hour periods after school. Effective intervention characteristics include a physical activity component, a healthy after-school snack, and behavioral or educational components. Educational components targeted behavioral strategies to generalize to the home environment or even periods of time to work on homework after school. The utilization of school facilities is likely an important factor to consider as well for cost-effectiveness of the intervention. Overall, a universal intervention can provide a safe, healthy, and proactive after-school program for disadvantaged youth.
School psychologists can be key personnel in the planning and successful implementation of a Tier 1 intervention like those described above. Not only are the use of research-based practice and data-driven interventions necessary for responsible practice, but school psychologists are also responsible for promoting healthy school, family, and community environments. As mental health professionals highly trained in data-based decision making, consultation and collaboration, and systems-level services, school psychologists have the skills necessary to educate school stakeholders on the importance of a Tier 1 intervention targeting quality nutrition, physical activity, and academic achievement, as well as the skills necessary to design, implement, and measure change.
Policy and Advocacy for Change
While it is imperative that schools implement change, without home and community involvement, interventions may not generalize beyond the school or create lasting effects into adulthood. It is, therefore, essential that school psychologists provide school administrators with research regarding the relationship between physical activity, nutrition, and children's academic and mental health outcomes. In addition, it is important to educate other school personnel as well as parents to form a support group that can advocate for better nutrition and physical activity standards in our schools. Disadvantaged youth in particular require the support of schools, parents, and communities to create positive changes in their achievement, physical, and mental health outcomes (London & Castrechni, 2011).
It is evident that strong leadership, policies, and programs are needed to increase physical activity opportunities and provide healthier foods in schools. While this is important for all students, those who belong to an underprivileged group are at a significant disadvantage in accessing healthy foods and opportunities to be physically active. While schools can initiate significant change efforts in the foods they provide and in their allotment of daily physical activity opportunities, collaborating with other school stakeholders is critical in this process of change. Homes and communities must also be involved for sustainable effects. This also includes being knowledgeable of policies that might impact physical activity and healthier eating so that advocacy can occur at district, state, and federal levels.
While it is unknown how No Child Left Behind (NCLB) will impact schools a decade from now, several revisions are needed to address and promote physical activity and nutrition education. NCLB has been criticized for not including physical education as a core academic subject, which in turn may make physical education more vulnerable to being eliminated from schools as resources are allocated to other subject areas (Story, Nanney, & Schwartz, 2009). This often places a burden at the state level to decide whether to offer physical education. Thus, although NCLB has sought to close the achievement gap, it fails to take into account how physical and mental health impact students' learning. Researchers have noted the particularly adverse impact that NCLB has had on children living in poverty and those from minority backgrounds (Fiscella & Kitzman, 2009). Since NCLB requires high-stakes testing and imposes punitive sanctions on those schools that are underachieving, this disproportionately impacts schools with higher numbers of minority students and students living in poverty. Consequently, this may narrow the curriculum at these schools in favor of abiding by NCLB standards, thus perhaps eliminating time for recess or subjects such as physical or health education. With outside pressures for high achievement from district, state, and federal mandates, health is often seen as inconsequential. Yet many have argued that students cannot achieve academic success without being healthy (Basch, 2011; Story et al., 2009).
One attempt at improving physical activity and nutrition in rural schools specifically was brought about through local wellness policies, which are a requirement under the Child Nutrition and WIC Reauthorization Act of 2004. The Local Wellness Policy requires (a) goals for nutrition education and physical activity, (b) nutrition guidelines for foods served through the NSLP, (c) that NSLP guidelines are being met for reimbursement, and (d) that an evaluation plan is in place for the implementation of the program. It also requires an ecological approach by involving parents, school staff, and the community. However, while some have championed federally mandated local wellness policies to increase physical activity in schools, it is evident that several limitations may exist that would prevent such policies from being implemented with efficacy. Researchers concluded that effective implementation of Local Wellness Policies would likely depend on accountability for implementation, community involvement, and explicit wording in policy language; otherwise, efforts focusing on academic achievement and NCLB may leave little time and attention for other school policies, such as the Local Wellness Policy (Belansky et al., 2009).
As a part of Healthy People 2020, a major overarching goal is to achieve health equity, eliminate disparities, and improve the health of all groups of people. Healthy People 2020 offers a multitude of topics and objectives, including early and middle childhood objectives and physical activity objectives. Community interventions listed for early and middle childhood include reducing screen time (e.g., time spent in front of the television or computer) and increasing school-based interventions aimed at enhancing quality nutrition and physical activity. There is current evidence that including nutrition and physical activity in combination, allotting additional time to physical activity during the school day, including noncompetitive sports such as dance, and reducing sedentary activities positively impacts students' health (CDC, 2005). Thus, it is important to advocate for physical education standards that are in accordance with the National Association for Sport and Physical Education's (NASPE) National Physical Education Standards. NASPE maintains that educating the whole child includes physical education and recommends that all elementary school students participate in at least 150 minutes per week of physical education and that middle and high school students participate in at least 225 minutes per week of physical education for the entire school year. Only 3.8% of elementary schools, 7.9% of middle schools, and 2.1% of high schools provide the recommended dose of daily physical activity for children (CDC, 2006). This highlights the critical need to increase the amount of physical activity and education within our schools. School psychologists may champion these efforts by increasing awareness within their schools as to what the national recommendations are for physical activity and how their school compares. This information, along with evidence of the relationship between physical health and academic outcomes, may serve as an important platform for positive change among school stakeholders.
Policies specifically targeting healthy school food options are also essential. Because children from disadvantaged backgrounds have less access to healthy foods (Zenk et al., 2005), adding alternative healthy food options to Ã la carte snacks, drinks, and fast food meals should be considered a priority for schools with high percentages of free and reduced-price lunch participants. Local policies could support the elimination of low-nutrition foods in vending machines, concession stands, and food fundraisers. Efforts could focus on stricter policies and nutritional standards for types of drinks and foods sold outside of the cafeteria (i.e., NSLP) as well as educating parents on lower cost, healthier food alternatives at home. School personnel and administration can serve as advocates in encouraging the USDA to establish and enforce regulations for healthier foods in schools that participate in the NSLP (Story et al., 2009).
Summary and Further Research
Discrepancies are evident in the areas of academic achievement, access to quality foods, and physical activity between privileged and disadvantaged students. With pressure on schools from NCLB to reduce the achievement gap—in particular among disadvantaged populations—it is imperative to consider what factors could aid in eliminating this discrepancy. Disadvantaged youth are at risk for poor nutrition and a lack of access to physical activity throughout the school day, which negatively impacts their educational and mental health outcomes. As discussed, healthy food choices and physical activity promote academic achievement and positive mental health outcomes, which could enhance outcomes for underserved youth. Continued advocacy in the area of policy change, as well as the implementation of universal interventions, may allow disadvantaged youth to be more successful in school.
While the research in this area is promising, it is not yet conclusive. Future research must continue to target children who are at an increased risk for lack of access to healthy foods and physical activity opportunities, as well as for lower academic performance. Future research should also target the effects of policy changes in schools that address healthier food options or increases in physical activity throughout the school day. Most importantly, instead of focusing solely on the physical health benefits of interventions that target physical activity and healthier eating behaviors, research should continue to investigate the relationship between physical activity, healthy eating, and academic outcomes.
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Alicia Fedewa, PhD, NCSP is an assistant professor in the school psychology program at the University of Kentucky. She is a licensed psychologist and nationally certified school psychologist. Jennifer Hoffman is a doctoral student in the school psychology program at the University of Kentucky.