1. Texas Childhood Obesity Prevention Policy
Evaluation (T-COPPE Project): Baseline data
from Safe Routes to School Policy evaluation
Co-Leads:
Deanna Hoelscher, PhD, RD, LD
Marcia G. Ory, PhD, MPH

2. Presentation Overview
¨ Why are we doing TCOPPE?
¨ Background and rationale
¨ What are we doing?
¨ Methods
¨ What did we find?
¨ Results
¨ What does it all mean?
¨ Discussion

3. The Rule of 2s
¨ Two policies to evaluate
¤ Both aspects of the energy equation: activity and
nutrition
• Safe Routes to Schools (SRTS)
• WIC
¤ Two environments
• School/home environment
• Grocery stores/home
¤ Two functional timelines
• School year
• Year round

4. Slide 2 of 2s
¨ Two state universities in a unique and effective
working relationship…
¤ The University of Texas School of Public Health
¤ Texas A&M (Health Science Center School of Rural
Public Health)
¨ Two rivalries……

5. Why Evaluating Childhood Obesity &
Prevention Policies?
National
¨ Robert Wood Johnson Foundation is
impact… committed to reducing childhood obesity
starts with by 2015
evidence of
¨ There are a number of national policies
local impact
identified as aimed at reducing
childhood obesity (i.e., SRTS)
¨ Which of these national policies are
actually shown to be effective in reducing
childhood obesity?
¨ What is the impact of implementing these
national policies locally?

6. How did we select our policies?
¨ Potential for evidence of effectiveness
¨ Political feasibility
¤ Potential for leadership engagement
¤ Champions identified in Texas
Legislature and State Government
¨ Public Acceptability
¤ Readinessand feasibility in implementation
¤ Documented history of obesity efforts during last decade

7. How did we select our policies? (cont.)
¨ Partnership support
¤ LiveSmart Texas coalition development/support
¤ Partnership for a Healthy Texas
¨ Policy sustainability

8. Standardized Mode of Transportation
Trips to School, 1965-2005
Source: McDonald, N.C. 2007. American Journal
of Preventive Medicine

9. Walking/Biking by Distance to School,
1965-2005
Source: McDonald, N.C. 2007. American Journal
of Preventive Medicine

10. Active Commuting to School
¨ Current childhood obesity epidemic
¨ Children are not meeting current recommendations for
physical activity
¨ One strategy to increase physical activity among children:
¤ Walking or biking to and from school (Active Commuting to
School or ACS)
¨ Currently, approximately less than 16% of children use
ACS

12. Survey
¨ And now…..let us hear from you!

13. Safe Routes to School Policy
¨ SAFETEA-LU
¤ 2005 Federal Transportation Bill
¤ % of nation s total children K-8 to offer increased physical activity
through health alternatives to bus and car school transportation
¤ Texas received about $40 million in Safe Routes to School (SRTS) funding
between 2005 and 2009
¨ State support for SRTS
¤ In September 2007, The Texas Transportation Commission approved
$24.7 million for 244 projects in 66 communities throughout the state
¤ Supplemented by revenue from the God Bless Texas and God Bless
America specialty license plates
¤ Funds administered through grant process
Source: Tx DOT, 2008

14. Texas SRTS Policy
SRTS
¨ For Texas, two major types of grants
were awarded:
Education
¤ Construction
(Infrastructure) grants, which
Enforcement include brick and mortar type projects,
Encouragement such as construction of crosswalks,
sidewalks, etc.
Evaluation
n Schools need to have a SRTS plan in place
Engineering first
¤ Planning
grants, which include a SRTS
plan, which may or may not include
potential infrastructure changes or
implementation of the plan.

15. Methods
¨ Purpose
Measures: ¤ Todetermine the effects of differing
• Student (4th allocation methods of funding
grade) survey (construction versus planning grants)
• Parent survey
from the Texas Transportation
Commission on parent attitudes &
• ACS
behaviors.
• School Checklist
¨ Natural experiment
• Campus Policy
¤ Quasi-experimental
• School Audit
¨ Initial study assumptions
¤ Foractive commuting to schools (ACS),
construction (infrastructure) schools >
planning schools > comparison schools

16. Methods
Baseline ¨ Funded schools were selected for
measurement based on funding type,
data location (urban/rural), race/ethnicity, and
collected socioeconomic status (SES); comparison
in 2009 schools had similar characteristics but
received no funding.
¨ Data were analyzed using mixed linear
regression and controlled for random and
fixed effects, and other independent
variables.

17. School Sample –
Where We are in Texas

18. SRTS Baseline Data
School Survey Status Infrastructure Planning Control Total
Schools Schools Schools
Measured Spring 2009 11 13 13 37
Measured Fall 2009 14 9 21 44
Total 25 22 34 81
Survey Activity Total (to date)
Student Survey 3315
Parent Survey 2057
Parent/Student Survey 1653
Combination
Active Transport Count 12,167
Environmental Audit 79 *
* Two school environmental audits were not done due to safety concerns for the auditors

19. Demographic Variables by School
Condition (n = 81)
Variable Construction Schools Planning Schools (n Comparison Schools
(n = 25) = 22) (n = 34)
Student Male (%) 49.9 51.9 47.5
Parent race/ethnicity
White (%) 19.8 30.3 24.3
Other (%) 80.2 69.7 75.7
Economically 75.5 65.8 68.3
disadvantaged (%)
All family members 64.1 55.3 57.7
born in USA (%)
Mean time to school
<5 m (%) 27.0 28.5 20.6
5-10 m (%) 38.5 39.3 36.2
11-20 m (%) 20.9 20.3 25.5
>20 min (%) 13.6 11.9 17.6

20. Baseline Rates of Active Commuting to
School (ACS), n = 79
ACS in
1969 (48%)
Mean % ACS
*Means
are
significantly
different
from
comparison
schools
(p<0.05)
Ac>ve
Commu>ng
is
2-­‐day
self-­‐reported
walking
or
biking
to
or
from
school
Analyses
are
controlled
for
%
economically
disadvantaged,
%
white,
mean
precipita>on,
mean
heat,
mean
wind
speed.

21. Mean Active Commuting to School
Before School After School Mean ACS
n=79 n=79 n=79
10.4% 17.1% 13.8%
Analyses were conducted using Mixed Effects Linear Regression

22. School Environment
(Rural)
¨ School in rural area.
¨ Only 2 segments
indicated on audit tool.
¤ One was a one-lane
gravel road that
separated school
property from a corn
field.

23. School Environment
(Urban)
Planning school Planning school

24. Environment Comparisons
¨ Construction school with
gate
¨ Planning School with
crosswalk, sidewalks,
signage

25. Environmental Comparisons
¨ Comparison School
¨ Planning School

26. Differences in Parent Attitudes &
Behaviors by School Types at Baseline
Variable
Construc0on
Schools
Planning
Schools
Comparison
Schools
Mean
(SD)*
Mean
(SD)
Mean
(SD)
n
=
25
n
=
22
n
=
34
Asking
Behavior
Scale
1.11
(.09)
1.29
(.10)a
.98
(.08)a
Parent
Self-­‐Efficacy
Scale
18.6
(.4)a
20.4
(.5)ab
18.7
(.4)b
Parent
Outcome
13.9
(.2)
a
14.7
(.2)
ab
13.7
(.2)
b
Expecta>ons
Student
Self-­‐Efficacy
Scale
27.2
(.5)
a
27.2
(.6)
b
24.7
(.5)
ab
Arrived
Walking
(%)
10.5
(1.5)
a
9.1
(1.7)
b
4.6
(1.3)
ab
Arrived
Biking
(%)
0.5
(0.6)
a
2.5
(0.6)
ab
0.5
(0.5)
b
Arrived
by
School
Bus
(%)
16.4
(4.1)
a
14.0
(4.5)
b
26.9
(0
ab
3.5)
TV
on
during
evening
meal
3.51
(.11)
a
3.14
(.12)
ab
3.58
(.09)
b
TV
>me
on
weekends
4.49
(.07)
4.32
(.08)
a
4.59
(.06)
a
School level analyses using weighted UNIANOVA

27. What Factors are Associated with
Walking or Biking to School (Child)?
Factors NOT ¨ Students who walked or biked to school
Associated
with ACS: were more likely to:
¤ Have a friend who walked or biked to
• Screen time
school
• Days PA
¤ Have self-confidence that they could walk
• Safety
to school
• Social
¤ Feel that they could ask their parents to
support
walk or bike to school
• Attitude

28. What Factors are Associated with
Walking or Biking to School (Parent)?
¨ Parents more likely to let their children commute to
school:
¤ Had higher self-efficacy (self-confidence) in letting their
child walk to school
¤ Perceived better walkability around their house and their
child s school
¤ Were more likely to let their children walk to other places
from school
¤ Reported better outcomes associated
with walking to school (e.g., children
would be healthier)
¤ Reported fewer barriers to commuting

29. Does weather influence ACS?
¨ Students decrease ACS in the morning due to
precipitation (marginally significant, p-
value=0.099)
¨ When the morning temperature was warmer, ACS
was higher (p-value=0.019)
¤ Morning
temperature range = 10.4-89.6 degrees
Fahrenheit
¨ Analysis
¤ Covariates
in the Mixed Effects Linear Regression
Modeling of ACS

30. Implications
¨ Number of children
walking or riding a
bike to school was low
¨ We need policies that
promote environments
that are conducive to
walking and biking
¨ We need safety and
perception of safety

31. Policy Implications
¨ Many parent-related variables were consistent with
ACS
¤ Parents are highly motivated to participate and be
engaged
¤ Parents made a point to contact both PI and Project
Director to express interest and ask how else to be
involved
¨ Need programs that focus on parent education
¨ Need programs that make neighborhoods safer (e.g.,
benefits of complete streets)

32. Conclusions
¨ Significant differences were seen in ACS between
planning/construction and comparison schools
¤ Outcome expectations, self-efficacy, TV
¤ Grant application process encouraged schools to collect
pilot data
n Smaller
grants (planning grants) may be as effective in getting
ACS as larger grants (construction grants) initially
n Grant processèAwarenessèMore likely to engage in ACS?
n More likely to have a program champion?
n Planning schools had greater percentage of children who biked
¨ Allocation of resources may be given to schools who are
already working on SRTS
¤ How do we reach other schools?

33. Conclusions
¨ Child behaviors associated with walking & biking to
school included asking behaviors & having friends
commute
¨ Programs like SRTS increase walking and bike
riding

34. T-COPPE: Environmental Audit

35. Why School Audits?
¨ Important role of the built environment in promoting
WTS.
¨ Recognition of the many micro-scale and modifiable
barriers at/around schools.
¨ Importance of the context-specific and detailed
environmental features in changing school travel
behaviors
à Lack/shortage of instruments designed to capture
school environments systematically and
comprehensively

36. School Audit
Components
z

37. Audit Components and Items
FORMAT:
Letter-size sheets with checklist, rating, closed-end choices, a
nd mapping items
COMPONENTS:
A. STREET AUDIT
B. SCHOOL SITE AUDIT
C. MAP AUDIT – sidewalk, bike lane, drainage ditch, buffer, tr
ail, crosswalk, and bus stop
§ Land Uses
§ Street/traffic/parking conditions
§ Lighting , other amenities, and sigs
§ Unattractive items
§ Perceptual rating items (surveillance, maintenance, cleanliness, vis
ual quality, safety and attractiveness)

38. Street Segment Audit
• Audit info. • Segment Image
- Auditor info. - Indicating each
- Date, weather segment
- Start/end time - North up
- Street name
• Perceptions
• Audit Items
- For objective
observations
• Map Audit Indic
ators
- If related items
present, go to
Map Audit(s)

39. School Site Audit
• School Site Ima
ge
- Indicating
School site and
• Frontage property line
- Maine entry
- Street facing
- Vehicular and
pedestrian entries
• On-site facilities
- Physical features
• Main entry
- Amenities, etc.
- Amenities around
main entry
• D/P Area
- Location, types,
and capacity

40. Map Audit Example
Map audit A : sidewalk &
informal path
• Exact locations
• Detailed conditions
slope, shade, width, holes & cracks
, bumps & uneven surface , weed
s , litter , drainage problems, etc.
• Obstructions
poles , parked cars, mail boxes,
etc.
• Connections

41. Analyzing
School Audit Data
z
Preliminary Results

42. Descriptive Findings from 79
TCOPPE Schools audited across Texas
Street & Map Audit Elements
Requiring Improvements:
¤ Bike lanes (98% lacked)
¤ Benches and trash cans (96%)
¤ Traffic calming devices (85%)
¤ Unattractive items/social disorder
(75% with 1+)
¤ Street lights (25% lacking)
¤ Sidewalk obstructions (many with
poles, parked cars, mail boxes, etc.)

43. Descriptive Findings from 79
TCOPPE Schools audited across Texas
School Site Audit Elements Requiring Improvements:
¤ Designated drop-off/pick-up area (21 lacked)
¤ Adjacency to vacant/abandoned/undeveloped areas (19
schools)
¤ Lack of walkway connections to school buildings (14 lacked)
¤ Trails/paths within campus (73 lacked)

44. Frontage Street Audit Items
Correlated with % Walkers
Variables B Sig.
Presence of sidewalks 10.996 0.001
Presence of street parking 7.143 0.012
Presence of vacant areas -6.999 0.022
Presence of unattended/stray -8.358 0.050
dogs
Presence of drainage ditches -6.853 0.047
Surveillance* 2.030 0.058
Safety in walking* 3.033 0.013
Safety in bicycling* 3.453 0.008
Attractiveness in walking* 2.459 0.048
Attractiveness in bicycling* 2.451 0.047
*likert-type scale item (1 being poor to 5 being excellent)

45. Other Street Audit Items
Correlated with % Walkers
Variable B Sig.
Number of 4 – 10 7.090 0.055
intersections* 11+ 6.194 0.064
Number of street 1-3 6.854 0.037
lights** 4+ 4.202 0.247
Presence of street parking 4.628 0.094
Presence of street calming -7.178 0.019
devices
Presence of safety/child 7.943 0.006
crossing sign
Presence of landscaped buffer 7.642 0.008
Presence of drainage ditch -5.094 0.096
Presence of crosswalk 6.308 0.081
* The reference category is 0-3 driveways.
** The reference category is 0 street light.

46. School Site Audit Items
Correlated with % Walkers
Variable B Photograph by Yang Mi Kim
Sig.
Number of school bus only entry & exit -2.717 0.051
Number of pedestrian only entries & exits 1.562 0.028
Presence of vacant area -7.179 0.029
Presence of sidewalk/walkway connection 9.234 0.016
Presence of private car area -7.163 0.050
Presence of basketball/tennis/volleyball court 7.147 0.006
Presence of baseball/football/soccer field -6.616 0.016
Presence of outdoor swimming pool 5.427 0.056
Presence of bench / seating 6.411 0.019
Presence of picnic table 7.604 0.015
* The reference category is none of evergreen tree.

47. Conclusion
¨ This School Audit Instrument is a tool that can provide
effective and efficient assessments of street and school
site environments, focusing on those attributes related to
children s active transportation to school.
¨ The instrument s three components help objectively
identify many easily modifiable elements, facilitating
policy development toward creating safe and walkable
communities.
¨ With proper training, this audit can be used for education,
research, intervention, and policy-support purposes.
¨ The instrument can be shortened and customized, once
more data are collected from diverse communities.

48. T-COPPE: Policy Implications

49. Multi-pronged Support and
Dissemination System…
¨ Partnership with Texas Health Institute part of initial funding proposal with
expectation of
¤ Legislative policy forums in years 1, 2, 3 and 5 of the grant
¤ Sharing activities and findings in real time
¨ Support and advisement from Texas Obesity Policy Research Advisory
Council (TOPRAC) whose mission is
¤ To provide health policy research, translation, evaluation, and dissemination
support to TCOPPE and Live Smart Texas
¨ Regular feedback to Live Smart Texas (LST) collaboration
¤ Texas coalition working collaboratively on obesity prevention efforts and the
development of resources to fund it
¤ TCOPPE is LST s first major research project
¨ Respond to opportunities as they arise and are appropriate

50. Additional opportunities…
¨ Testimony to the Institute of Medicine on Childhood
Obesity Prevention workshop in Texas, February 2009
¨ Annual participation in the Texas Obesity Awareness
Week events at the Texas Capital
¨ Invited testimony to Texas legislative committees on the
state of obesity in Texas
¨ Development of a Strategic Communications Plan
¤ Intensive communications workshop provided by RWJF to
selected individuals
¤ To provide focus and benchmarks for monitoring success and
outlining timely policy forum opportunities

51. Conclusions
¨ Close collaboration and communication with
stakeholders at multiple levels
¨ Dissemination throughout the project
¨ Establish team of credible experts who can inform
and educate legislators—the go to team
¨ Policy makers knowledgeable about
issue before research conclusions
are made/available

52. It takes more than a Village to
do this Texas-sized project…
It takes a TEXAS-sized team…
¤ Roy Allen ¤ Jingang Miao
¤ Heather Atteberry ¤ Lisako McKyer
¤ Chester Bryant ¤ Hyung Jin Kim
¤ Arthur Castro ¤ Deb Kellstedt
¤ Yichen Cheng ¤ Tiffni Menendez
¤ Diane Dowdy ¤ Marcia Ory
¤ Sandra Evans ¤ Courtney Peterson
¤ Kyna Farmer ¤ Mike Pomeroy
¤ Selina Guerra ¤ Donna Nichols
¤ Emily Hines ¤ John Reilly
¤ Deanna Hoelscher ¤ Tina Simms
¤ Leah Kolar ¤ Carolyn Smith
¤ Pat Koym ¤ Christine Tisone
¤ Chanam Lee ¤ Suojin Wang
¤ Kris Lykins ¤ Pete Walton
¤ Jay Mendoza ¤ Jerri Ward
¤ Ann Mesaros ¤ Cheryl Brien-Warren

53. Contact Information
Live Smart Texas
¤ Tiffni Menendez, MPH
512-391-2512
Tiffni.Menendez@uth.tmc.edu
T-COPPE
¤ Diane Dowdy, PhD
979-458-4249
Dowdy@srph.tamhsc.edu

54. Acknowledgements
This work was partially supported by three Robert Wood
Johnson Foundation grants (64634, 63755, 65539).
We would like to thank:
n Arthur Casto for his help with the audits.
n Jun Hyun Kim, Carolyn Smith, Ashley Wilson, and Chelsea
Mounce for the valuable inputs during the instrument
development phases.
n Dr. Woosung Lee for his help with the data analyses.
To request a copy of the instrument & manual, please
contact Diane Dowdy, PhD, TCOPPE Project Director:
Dowdy@srph.tamhsc.edu

55. Current Stats: The Walking School Bus and Children's
Physical Activity Study
¨ Objective: Evaluated a walking school bus program on active commute and moderate to
vigorous physical activity (MVPA)
¨ Intervention: Walking school bus (a group of children led by an adult to and from school )
¤ Intervention group: n=4 schools; 70 4th graders
¤ Control group: n=4 schools; 79 4th graders
¤ 76% of total students from low-income families (<= $30,000)
¤ 91% of students Hispanic; 47% of students Black
¨ Measures: self-questionnaire and accelerometry at Time 1 and Time 2
¨ Results:
¤ Intervention group increased daily minutes of MVPA from 46.6 +/- 4.5 at Time 1 to 48.8
+/- 4.5 at Time 2
¤ Control group decreased daily minutes of MVPA from 46.1 +/- 4.3 at Time 1 to 41.3 +/-
4.3 at Time 2
Source: Mendoza JA, et al. Pediatrics, 2011.

56. The Walking School Bus and Children's Physical
Activity Study: continued
¨ Objectives:
¤ Evaluate the feasibility of a protocol to measure changes to children s
pedestrian safety behaviors
¤ Evaluate the potential influence of the WSB program, neighborhood safety, and
intersection characteristics on children s pedestrian safety behaviors at the
school-level
¨ Intervention group: Taught and modeled safe pedestrian behaviors during walks
from trained staff members
¨ Control group: Received usual information from school district about school
transportation
¨ Results: impact on pedestrian behaviors is unknown
¤ Child pedestrians at the intervention schools had a five- fold higher odds of
crossing at the corner or crosswalk compared to pedestrians at control schools
¤ Child pedestrians at the intervention school also had five-fold lower odds of
stopping at the curb versus control schools
Source: Mendoza JA, et al. Health Place, 2012.

57. Methods
¨ Baseline data collected for T-COPPE Study
th
¨ 4 grade students and parents were recruited
through 81 schools
¨ Active Transport Survey/Counts
¤ Collected in classrooms
¤ 2-day self-report
¤ Validated instrument