The Effects of Health-Related Fitness on School Attendance in New

City University of New York (CUNY) CUNY Academic Works Dissertations, Theses, and Capstone Projects CUNY Graduate Center 9-2016 The Effects of Health-Related Fitness on School Attendance in New York City 6th-8th Grade Youth Emily M D'Agostino The Graduate Center, City University of New York How does access to this work benefit you? Let us know! More information about this work at: https://academicworks.cuny.edu/gc_etds/1561 Discover additional works at: https://academicworks.cuny.edu This work is made publicly available by the City University of New York (CUNY) Contact: AcademicWorks@cuny.edu The effects of health-related fitness on school attendance in New York City 6th-8th grade youth by Emily M D’Agostino A dissertation submitted to the Graduate Faculty in Public Health in partial fulfillment of the requirements for the degree of Doctor of Public Health, The City University of New York 2016 © 2016 Emily D’Agostino All Rights Reserved ii This manuscript has been read and accepted for the Graduate Faculty in Public Health in satisfaction of the dissertation requirement for the degree of Doctor of Public Health Denis Nash Date _ Chair of Examining Committee Denis Nash Date _ Executive Officer Katarzyna Wyka Lorna Thorpe Joseph Egger Supervisory Committee THE CITY UNIVERSITY OF NEW YORK iii Abstract The effects of health-related fitness on school attendance in New York City 6th-8th grade youth By Emily M D’Agostino Advisor: Katarzyna Wyka Background: Only 42% of youth ages 6-11 in the United States meet the World Health Organization’s recommendation for ≥60 minutes of daily moderate to vigorous physical activity Estimates for adolescents ages 12-19 are even lower, ranging from 8-17% Literature suggests low levels of youth health-related fitness (fitness) may negatively impact attendance, potentially due to reduced physical and psychosocial wellness Nationally, 10-15% of (5-7.5 million) students are chronically absent, meaning that they miss ≥10% of the school year (or ≥20 days of school per year) Moreover, 20-30% of students in high-poverty, urban school districts not attend school regularly (≥6 days absent per year) To the author’s knowledge, this is the first multi-year study on the longitudinal fitness-attendance relationship, taking into account multilevel student and school factors Objectives: To describe differences in student- and school-level attendance, examine the longitudinal causal effects of change in fitness on attendance (days absent and chronic absenteeism), and assess gender effect measure modification in the fitness-attendance relationship in a large and diverse sample of New York City (NYC) middle school students iv Methods: Data were drawn from the NYC Fitnessgram Six cohorts of NYC public middle school students were followed over years during a seven-year study period (2006/7-2012/13; n=349,381) A 2-level cross-sectional Generalized Linear Mixed Model (GLMM) was used to assess the extent of school-level clustering in attendance, and determine the variation in student attendance accounted for by school-area poverty A 3-level longitudinal adjusted GLMM, overall and stratified by gender, was used to test the effects of change in fitness (cardiorespiratory, muscular strength and endurance composite score) on attendance (1-year lagged student-specific days absent) Lastly, a 3level logistic GLMM was used to test the effects of change in fitness on chronic absenteeism (1-year lagged student-specific chronic absenteeism, defined as ≥20 days absent per year) Results: The Intraclass Correlation Coefficient (ICC) estimate demonstrated a large degree of variance in student attendance explained by schools (11%; p20% decrease in fitness composite percentile scores (p20% increase in fitness had 1.12 times the incidence rate for attendance compared with having a >20% decrease in fitness (IRR=1.12) More specifically, a child with consistent improvements in fitness each year at the >20% increase (vs >20% decrease) level with mean days absent (10) would be expected to have >1 day fewer absences per year; almost 3.5 fewer days absent across the middle-school period and almost fewer days absent per year across the high school period (1.12*7 years=7.84 days) 110 Appendix H Model Specifications Paper 1: UNCONDITIONAL 2-LEVEL GENERALIZED LINEAR MIXED MODEL: Attendanceij = β00 + μ0j + εij,, where εij ~ N(0, σ2) and μ0j ~ N(0, τ2) In this model, i and j correspond to individuals and schools, respectively β0j (β0j = β00 + μ0j) is the mean days absent across individuals in school j Also, β00 represents the overall mean days absent across all schools, τ2 is the estimated between-school variance (level 2), and σ2 corresponds to the student-level variance Lastly, εij and u0j (individual-level and school-level effects, respectively) are normally distributed and assumed to be independent of each other 2-LEVEL AREA POVERTY-ADDED GENERALIZED LINEAR MIXED MODEL: Attendanceij = β00 + β01(SAP) j + μ0j + εij In this model, β01 is the effect of school-level characteristic (school-area poverty) on mean days absent Paper Two: FINAL 3-LEVEL GENERALIZED LINEAR MIXED MODEL WITH REPEATED MEASURES: Absenttij= β000 + β100 (GRADE)tij + β200 (FITNESS)tij + β300 (CHANGE IN OBESITY STATUS)tij + β400(YEAR)tij + β010(RACE/ETHNICITY)ij + β020(GENDER)ij + β030(PLACE of BIRTH)ij + β040(STARTING FITNESS)ij +β001(SCHOOL AREA POVERTY)j+ β110(GRADE)tij*(RACE/ETHNICITY)ij + β120 (GRADE)tij* (GENDER) ij + β130(GRADE)tij* (PLACE of BIRTH)ij +β140(GRADE)tij*(STARTING FITNESS)ij + β011(SCHOOL AREA POVERTY)j*(RACE/ETHNICITY)ij + εtij + r0ij+μ00j Paper Three: FINAL 3-LEVEL LOGISTIC MIXED MODEL WITH REPEATED MEASURES: Logit(chronic absenteeism)tij= β000 + β100(GRADE)tij + β200(FITNESS)tij+ β300(CHANGE IN OBESITY STATUS)tij+β400(YEAR)tij + β010(RACE/ETHNICITY)ij + β020(GENDER)ij + β030(PLACE OF BIRTH)ij + β 110(GRADE)tij*(RACE/ETHNICITY)ij + β120(GRADE)tij*(GENDER)ij + β130(GRADE)tij* (PLACE OF BIRTH)ij + β011(SCHOOLAREA POVERTY)j * (RACE/ETHNICITY)ij+ β001(SCHOOL-AREA POVERTY)j 111 References Andersen LB, Riddoch C, Kriemler S, Hills AP Physical activity and cardiovascular risk factors in children Br J Sports Med 2011;45(11):871-876 Koplan JP, Liverman CT, Kraak VI Preventing childhood obesity: Health in the balance Washington, DC: The National Academies Press; 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139 Baranowski T, Bouchard C, Bar-Or O, et al Assessment, prevalence, and cardiovascular benefits of physical activity and fitness in youth Med Sci Sports Exerc 1992;24(6):S237-47 122 ... modifier in the fitness- attendance association, or the longitudinal, causal effects of fitness on chronic absenteeism, taking contextual factors into account 1.5 Overview of the dissertation 1.5.1... identified on the association of fitness and attendance considering contextual factors as potential antecedents or confounders In this sense, research is warranted on the effects of school contextual... examined the relationship between fitness and attendance among youth, and their findings are consistent in demonstrating a positive association.19,22,32-34 Mohar, in a cross-sectional study of