The Impact of Playworks on Students' Physical Activity by Race/Ethnicity: Findings from a Randomized Controlled Trial.

BACKGROUND: The Playworks program places coaches in low-income urban schools to engage students in physical activity during recess. The purpose of this study was to estimate the impact of Playworks on students' physical activity separately for Hispanic, non-Hispanic black, and non-Hispanic white students. METHODS: Twenty-seven schools from 6 cities were randomly assigned to treatment and control groups. Accelerometers were used to measure the intensity of students' physical activity, the number of steps taken, and the percentage of time in moderate-to-vigorous physical activity (MVPA) during recess. The impact of Playworks was estimated by comparing average physical activity outcomes in treatment and control groups. RESULTS: Compared with non-Hispanic black students in control schools, non-Hispanic black students in Playworks schools recorded 338 more intensity counts per minute, 4.9 more steps per minute, and 6.3 percentage points more time in MVPA during recess. Playworks also had an impact on the number of steps per minute during recess for Hispanic students but no significant impact on the physical activity of non-Hispanic white students. CONCLUSIONS: The impact of Playworks was larger among minority students than among non-Hispanic white students. One possible explanation is that minority students in non-Playworks schools typically engaged in less physical activity, suggesting that there is more room for improvement.

The impact of playworks on boys' and girls' physical activity during recess.

BACKGROUND: School-based programs, such as Playworks, that guide students in organized activities during recess and make improvements to the recess play yard may lead to significant increases in physical activity-especially for girls. This study builds on past research by investigating the impact of Playworks separately for girls and boys. METHODS: Twenty-nine schools were randomly assigned to receive Playworks for 1 school year or serve as a control group. Postintervention physical activity data were collected via accelerometers and recess observations. Impacts were estimated separately for girls and boys using regression models. RESULTS: Girls in Playworks schools had significantly higher accelerometer intensity counts and spent more time in vigorous physical activity than girls in control schools. No significant differences based on accelerometer data were found for boys. A significant impact was also found on the types of activities in which girls engaged during recess; girls in the treatment group were less likely than those in the control group to be sedentary and more likely to engage in jumping, tag, and playground games. CONCLUSIONS: The current findings suggest that Playworks had a significant impact on some measures of girls' physical activity, but no significant impact on measures of boys' physical activity.

Estimated Distributions of Usual Physical Activity during Recess.

PURPOSE: This study aimed to estimate distributions of usual physical activity during recess in schools in low-income areas using measurement error models and to compare model-adjusted distributions to unadjusted distributions based on a single day of measurement. METHODS: A randomized study of the Playworks program was conducted in 29 schools from six U.S. cities. A sample of 365 fourth- and fifth-grade students in 26 of the study schools wore accelerometers during their recess periods on two school days. Estimates for the percentage of time spent in moderate to vigorous physical activity (MVPA) during recess were constructed from the accelerometer data for each school day. Using measurement error models, distributions for the usual amount of time spent in MVPA during recess were estimated for intervention and control groups of males and females. Unadjusted distributions for these same groups were also constructed using data from a single school day. RESULTS: There is considerable intraindividual variability in the students' physical activity, which accounts for 67%-83% of the overall variability, depending on the study group. Unadjusted single-day distributions are much wider and have more weight in the tails than model-adjusted distributions owing to this large intraindividual variability in the data. CONCLUSIONS: Using measurement error models to analyze physical activity data collected from recess periods will allow for more accurate and reliable inferences on students' physical activity.

The impact of Playworks on students' physical activity during recess: findings from a randomized controlled trial.

OBJECTIVE: To evaluate the impact of Playworks on students' physical activity during recess. METHOD: Twenty-seven elementary schools from six U.S. cities were grouped into blocks and randomly assigned to implement Playworks (treatment) or not (control) during an entire school year (either 2010-2011 or 2011-2012). Study data were collected at the end of the school year only. Fourth- and 5th-grade students (n=2278) reported on their physical activity during recess, and a subset (n=1537) wore accelerometers during recess. Teachers (n=111) also reported on their students' physical activity during recess. RESULTS: A significantly higher percentage of teachers in treatment schools reported that their students engaged in an intense physical activity during recess (p=0.01). Marginally significant differences between treatment and control groups were found for the mean number of accelerometer intensity counts recorded per minute during recess (p=0.10) and the mean percentage of time spent in vigorous physical activity during recess (p=0.07). No significant differences were found for student reports about their physical activity during recess (p=0.92). CONCLUSION: Teachers in Playworks schools reported that students were more active during recess, but accelerometer and student survey measures showed either no impacts or marginally significant impacts.

The effectiveness of mandatory-random student drug testing: a cluster randomized trial.

PURPOSE: This article presents findings from the largest experimental evaluation to date of school-based mandatory-random student drug testing (MRSDT). The study tested the effectiveness of MRSDT in reducing substance use among high school students. METHODS: Cluster randomized trial included 36 high schools and more than 4,700 9th through 12th grade students. After baseline data collection in spring 2007, about half the schools were randomly assigned to a treatment group that was permitted to implement MRSDT immediately, and the remaining half were assigned to a control group that delayed MRSDT until after follow-up data collection was completed 1 year later, in spring 2008. Data from self-administered student questionnaires were used to compare rates of substance use in treatment and control schools at follow-up. RESULTS: Students subject to MRSDT by their districts reported less substances use in past 30 days compared with students in schools without MRSDT. The program had no detectable spillover effects on the substance use of students not subject to testing. We found no evidence of unintentional negative effects on students' future intentions to use substances, the proportion of students who participated in activities subject to drug testing, or on students' attitudes toward school and perceived consequences of substance use. CONCLUSIONS: MRSDT shows promise in reducing illicit substance use among high school students. The impacts of this study were measured for a 1-year period and may not represent longer term effects.

Community case management for former jail inmates: its impacts on rearrest, drug use, and HIV risk.

Dramatically increasing incarceration rates in the United States have led to large concentrations of formerly imprisoned people in poverty-stricken urban areas. Therefore, identifying ways to help inmates who exhibit multiple, serious problems and who are at great risk of experiencing poor postrelease outcomes is especially important to urban communities, as well as to service providers and policymakers concerned about these communities. Our research provides evidence about the effectiveness of one strategy, called Health Link, which recruited adult women and adolescent men while they were incarcerated in a New York City jail and offered case management services during the especially challenging first year after release. About 1,400 participants who enrolled during a 3-year period were randomly assigned either to a group that was eligible for intensive discharge planning services and community-based case management services or to a group eligible for less-intensive discharge planning and no community-based services. We investigated whether the availability of these services reduced rates of drug use, HIV risk, and rearrest. Using data from interviews and hair analysis to measure impacts during a 1-year follow-up period after clients' release from jail, we detected increased participation in drug treatment programs and weak evidence for reduced drug use. However, we did not observe reductions in rearrest rates or in activities with high risk of HIV infection. We conclude that a well-executed case management program can make modest differences in a few short-term outcomes of former inmates. However, the intervention did not lead to the hoped-for changes across a range of outcomes that would clearly indicate greater success in community reintegration or improved health.