Latent class analysis identifies a promising combination of Supplemental Nutrition Assistance Program-Education interventions for improving student cardiorespiratory fitness

Sridharshi C Hewawitharana; Gail Woodward-Lopez; Punam Ohri-Vachaspati; Francesco Acciai; Hannah R Thompson; John Pugliese; Wendi Gosliner

doi:10.1016/j.ypmed.2023.107687

Latent class analysis identifies a promising combination of Supplemental Nutrition Assistance Program-Education interventions for improving student cardiorespiratory fitness

Prev Med. 2023 Oct:175:107687. doi: 10.1016/j.ypmed.2023.107687. Epub 2023 Aug 28.

Authors

Sridharshi C Hewawitharana¹, Gail Woodward-Lopez², Punam Ohri-Vachaspati³, Francesco Acciai³, Hannah R Thompson⁴, John Pugliese⁵, Wendi Gosliner²

Affiliations

¹ University of California, Division of Agriculture and Natural Resources, Nutrition Policy Institute, Oakland, CA, United States of America. Electronic address: shewawitharana@ucanr.edu.
² University of California, Division of Agriculture and Natural Resources, Nutrition Policy Institute, Oakland, CA, United States of America.
³ College of Health Solutions, Arizona State University, Phoenix, AZ, United States of America.
⁴ University of California, Division of Agriculture and Natural Resources, Nutrition Policy Institute, Oakland, CA, United States of America; University of California, Berkeley, School of Public Health Berkeley, CA, United States of America.
⁵ California Department of Public Health, Sacramento, CA, United States of America.

PMID: 37648085
DOI: 10.1016/j.ypmed.2023.107687

Abstract

Objective: To inform Supplemental Nutrition Assistance Program Education (SNAP-Ed) and other school-based interventions aiming to improve youth cardiorespiratory fitness, this study aimed to identify which SNAP-Ed school-based physical activity intervention combinations were associated with better student cardiorespiratory fitness.

Methods: This study, utilizing cross-sectional secondary data, included 5th and 7th grade students who attended SNAP-Ed-eligible public schools in California (n = 442,743 students; 4271 schools) and had complete 2016-17 state-mandated fitness test results. Latent class analysis was used to identify underlying school-based intervention combinations. Propensity score methods were used to ensure comparability of intervention and comparison schools, by calculating inverse probability weights. Multilevel models, using those inverse probability weights, assessed the associations between the identified intervention combinations and student cardiorespiratory fitness, as measured by VO₂max. The models were adjusted for school-level variables (urbanicity, percent of students eligible for free- or reduced-price meals, total enrollment, and school type), child-level variables (age, gender, and race/ethnicity), and for clustering of students within schools.

Results: We found that students attending schools with interventions focusing on comprehensive policy changes along with improving opportunities for physical activity had, on average, 1.17 mL/kg/min (95% CI: 0.72, 1.62) greater VO₂max than students attending schools without any intervention. They also had statistically significantly greater VO₂max compared to students attending schools with any other type of intervention combination.

Conclusion: Our results suggest that comprehensive school-based physical activity interventions that include policy changes along with improving physical activity opportunities may be the most effective approach for improving fitness and may warrant prioritization in SNAP-Ed efforts.

Keywords: CFHL; Fitness; Intervention combinations; Physical activity; SNAP-Ed; School wellness; VO(2)max.