摘要：Objectives. We examined whether public schools in states with specific and stringent physical education (PE) laws, as assessed by the Physical Education–Related State Policy Classification System (PERSPCS), available on the Classification of Laws Associated with School Students (C.L.A.S.S.) Web site, reported more weekly PE time in the most recent School Health Policies and Programs Survey (SHPPS). Methods. Schools (n = 410) were grouped by their state’s PERSPCS time requirement scores (none, nonspecific requirement, or specific requirement). Average weekly school-level PE was calculated using the SHPPS-reported PE minutes. Weighted analyses determined if PE minutes/week differed by PERSPCS group. Results. Schools in states with specific requirement laws averaged over 27 and 60 more PE minutes/week at the elementary and middle school levels, respectively, compared with schools within states with nonspecific laws and over 40 and 60 more PE minutes per week, respectively, compared with elementary and middle schools in states with no laws. High school results were nonsignificant. Conclusions. Public health guidelines recommend at least 60 minutes of daily physical activity for children, and PE may further this goal. Strong codified law with specific time requirements for PE may be an important tool contributing toward adequate PE time and daily physical activity recommendations. It is estimated that over a third of school-aged children are overweight or obese, and rates of childhood obesity do not appear to be declining. 1 Children who are overweight are much more likely to become obese as adults, whereas only 9% of children who maintain a normal weight during childhood become obese as adults. 2 In addition, overweight and obesity in childhood confers increased risk for the leading causes of morbidity and premature death later in life, 3 and increased health care costs attributable to obesity appear as early as adolescence and multiply in adulthood. 4 Maintaining an adequate level of physical activity has been associated with healthy weight, weight loss maintenance, 5 and greater likelihood of physical activity in adulthood. 6 For these reasons, the national Physical Activity Guidelines for Americans recommend that children receive a minimum of 60 minutes of daily physical activity. 7 Recognizing that children spend most of their day in school, physical education (PE) provides a natural opportunity for children to obtain a significant portion of the recommended physical activity, and, therefore, PE has been identified as a prime target to improve public health. 8,9 However, not all PE programs are alike. Quality PE programs that meet school health guidelines and the National Association for Sport and Physical Education (NASPE) standards for PE participation, which provide standards for time allotment, curriculum, and staffing, are important because some evidence indicates that meeting these standards has been associated with increased overall physical activity, particularly when at least half of a PE class is spent being physically active. 8,10,11 Yet, although school health guidelines support recommendations for school-based physical activity 8,12 and national standards specifying amount of time for school PE exist, 11 there is great variation in PE practices across schools because states and school districts vary in their policies and schools vary in their degree of implementation of these policies, which may affect both quantity and quality of PE. 13–17 When considering PE time, both quantity and quality are necessary to advance public health goals. Quantity is reflected in minutes allotted to PE, and quality is indicated by the amount of physical activity that actually occurs in PE classes that may result from policies across multiple areas (e.g., teacher qualification or curriculum standards). At the state level, the 2 primary official public policy levers, hereafter referred to as “codified law,” utilized for developing school-based PE policy are: (1) statutory laws (laws enacted by the given state legislature) and (2) administrative laws (rule and regulations developed by state executive branch agencies, such as the Department of Education). 18 On the surface, a “plain-letter” review of the codified law in 2 states may indicate that the provisions of the laws governing PE requirements are fairly comparable. However, differences in interpretation and implementation may vary greatly both from state to state as well as across schools within a given state. For example, a state may have no PE-related codified law or have law that recommends rather than requires schools to meet the NASPE guidelines. 11 In addition, a number of states have codified law with nonspecific requirements (e.g., requires PE but does not specify frequency or duration requirements), which may result in further variation in PE practices in individual schools within the same state. 15 Policy implementation research is only beginning to investigate the association between state laws with school-level PE-related practices. 19–21 Few studies to date have focused on the impact of an individual state’s law on changes in physical activity and PE-related practices in schools within the given state. These studies have found that state physical activity and PE-related mandates have led to increased physical activity awareness and participation 20 and increased physical activity and PE duration and frequency, although the impact of the laws varies within states by demographic and other characteristics. 19,21 However, to our knowledge no study has examined the relationship between codified PE-related laws and school-level practices across grade levels and states. Related research at a national level using data from the Centers for Disease Control and Prevention (CDC) School Health Policies and Programs Survey (SHPPS) indicated that the majority of states (76%, or 38 states) report requiring or encouraging districts and schools to implement a standardized set of PE guidelines (i.e., the NASPE standards). 14 However, despite the appearance of consistency in the SHPPS results regarding PE policy across states, there was great variability in practices at the school level with a relatively small percentage of schools (i.e., 3.8%, 7.9%, and 2.1% of elementary, middle, and high schools, respectively) fully meeting recommended standards for PE (e.g., NASPE standards). 14 Also, analyses did not specifically assess the relationship between state-level policy and school practices to determine if relatively stronger policy was associated with more time allotment for PE. The method of policy assessment (i.e., questionnaire) is one possible reason for the variability in PE practices observed in SHPPS schools, despite the appearance of similar state policy incorporating NASPE standards. The SHPPS relies on self-report of state-level policies rather than independent document review and does not differentiate policies that have been codified into law from informal policy or noncodified state-level practices that may result in different practices at the school level. 22 Because obesity has been consistently associated with many cancers and policy tracking of health relevant practices has been an important activity for cancer control, the National Cancer Institute’s Physical Education–Related State Policy Classification System (PERSPCS) was created to evaluate the extent and stringency of the codified PE laws for each of the 50 states and the District of Columbia in relation to NASPE standards. 15 The PERSPCS uses independent document review to empirically score codified law in relation to NASPE standards and can be used to assess the association between state-level codified law and school practices across states. The purpose of our study was to determine if schools within states with specific and relatively more stringent PE time-related codified law report more PE time allocation compared to schools within states with nonspecific and relatively weaker codified law. We hypothesized that at each school level, schools would report allocating more PE time if the state in which they resided had specific and more stringent PE time-related laws (i.e., high PERSPCS score) compared with schools in states with either no PE time-related codified law or nonspecific and relatively weaker codified laws (i.e. low PERSPCS score).
