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School Policies and Healthy Kids

Moynihan Professor Amy Ellen Schwartz is exploring whether public intervention on the nutrition and fitness of students is well-applied and effective.

By Renée K. Gadoua

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Culture of Health
With more than 1.1 million schoolchildren in 1,500-plus schools, New York City is home to the nation’s largest public school district. It includes about a third each black, Hispanic, and a mix of white and Asian students. Students are native and foreign-born, and they speak a multitude of languages. It’s also, generally, a poor population. More than 80 percent of students are eligible for subsidized lunch. Further, the district’s schools and programs vary in size, quality, and student outcomes.

Its diversity and size make the district a great laboratory because it “lets you understand disparities,” says Amy Ellen Schwartz, Maxwell’s Daniel Patrick Moynihan Professor of Public Affairs. Schwartz is an economist who has researched New York City school data for 20 years. In addition to test scores, she’s reviewed longitudinal data on housing, neighborhoods, graduation rates, attendance, health outcomes, bullying, and free-meal programs. She’s looking at how factors outside school relate to student performance.

“There’s a growing sense we’re not going to solve problems with schools just by pouring money into them,” Schwartz says. “There’s a real hunger for new ideas.” Central to her work is a conviction that education happens in many places other than the classroom — neighborhoods, homes, libraries, museums, gymnasiums, cafeterias, and playgrounds.

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Moynihan Professor Amy Ellen Schwartz

Because so many factors affect student achievement, teachers are not solely responsible for student success. “We’ve done everything we can to incentivize teachers to do better,” Schwartz says. “Now it’s time to ask, who else? How can we leverage others to help students succeed?”

Lately, her focus has been student health and, in particular, obesity. More than a third of New York City public school students are either overweight or obese; the 2012 obesity rate for children in kindergarten through eighth grade was 20.7 percent. That’s worrisome because childhood obesity predicts obesity in adulthood. It increases the risk for high cholesterol, high blood pressure, pre-diabetes, bone and joint problems, sleep apnea, and social and psychological problems. Obese adults risk heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis.

But obesity is important for another reason: It is strongly associated with success in school.

“Kids spend a lot of time in school, and schools have lunch programs,” she says. “Lunch programs are important parts of kids’ lives and are really understudied.”

Schwartz, who holds Maxwell appointments in both Economics and Public Administration and International Affairs, is working with New York University researchers to look at the relationship between school policies and student obesity. It’s a research project funded by a $1.3-million, multi-year National Institute of Health grant.

Schwartz also serves as director of the NYU Institute for Education and Social Policy and she is a highly regarded expert in applied econometrics; her research focuses on issues in urban policy, education policy, and public finance. She’s authored or co-authored more than 40 chapters and articles about New York City schoolchildren and factors that affect their academic success.

Most recently, three of the NIH-funded studies have been published (and are described on the following pages). Each offers fresh approaches and innovative school policies aimed at reversing the overwhelming obesity crisis

“We’ve done everything we can to incentivize teachers to do better. Now it’s time to ask, who else?”
— Amy Ellen Schwartz

Perhaps the simplest way to fight obesity and promote health is to decrease consumption of high-calorie beverages and increase consumption of water. Schwartz and her colleagues wondered: Does easy access to fresh, cold water make a difference?

The team analyzed more than 1 million students in more than 1,200 elementary and middle schools and compared students in schools with and without self-serve water dispensers. About 40 percent of the district’s schools had received large water jets since 2008 through a program of the city’s Departments of Health and Mental Hygiene and Education. Each large, electronically powered water dispenser costs about $1,000.

The study, published in JAMA Pediatrics, found that the water jets resulted in small but statistically significant declines in students’ weight. The body mass index (BMI) of students who were at schools that had the dispensers for at least three months decreased, compared to kids at schools without the jets. Researchers also cited a decrease in the amount of milk students bought.

Her recent articles:

“Effect of a School-Based Water Intervention on Child Body Mass Index and Obesity,” JAMA Pediatrics, March 2016, Vol 170, No. 3:220-226.

“Impacts of classifying New York City students as overweight,” Proceedings of the National Academy of Sciences, 2016.

“The Effect of Breakfast in the Classroom on Obesity and Academic Performance: Evidence from New York City,” Journal of Policy Analysis and Management, March 30, 2016.
“Suddenly, kids can get cold water quickly and easily,” Schwartz says. “It’s cheap. It’s effective. It’s not coercive. And it works.”

Schwartz is also studying how access to salad bars might affect obesity levels. “Let’s start thinking about the possibilities,” she says. “There might be simple things we can try, like the water jets. We can’t complain obesity is a problem and not question our role in it.”

New

York is among 21 states that require BMI screenings or other weight-related assessments at schools. New York City schools have given students fitness report cards since 2007. Called Fitnessgrams, they report each student’s BMI and, based on age and sex, whether it’s classified as “underweight,” “healthy,” “overweight,” or “obese.” Reports for students whose BMI is classified “overweight” say, “Your BMI falls outside of a healthy weight; please review your BMI with a health care provider.” Schools give students hard copy Fitnessgrams in May.

Schools distribute BMI information in the hope that parents of students classified “overweight” or “obese” will take action to lose weight and improve health. Schwartz and her team wanted to find out if, in fact, that was happening.

Researchers reviewed more than 3.5 million BMI student reports from 2007 to 2012. They compared female students who were classified as overweight, but just over the BMI cutoff that would put them in a healthy weight category, with those students who narrowly missed being designated as overweight. Although the schools provided health report cards with the students’ weight, researchers found those labeled “overweight” or “obese” showed no weight loss in the next academic year. The study was published in theProceedings of the National Academy of Sciences.

“Maybe you’re telling people what they already know,” Schwartz says. “It’s not like we’re telling you your kid has a problem with a well-known, easy solution.”

As a follow-up, researchers will investigate if there was no change in the students’ weight because parents never saw the report cards. They’ll also study if e-mail or U.S. mail are more effective in getting the reports to parents. “You have to get information to people in a timely matter and provide it in a way that’s actionable,” Schwartz says.

“We can’t complain obesity is a problem and not question our role in it.”
— Amy Ellen Schwartz

Even as officials worry about childhood obesity, hunger remains an entrenched problem, with about 25 percent of households with children not having sufficient food. Hungry students also risk health problems and poor academic performance. The federal School Breakfast Program has subsidized breakfast since 1966, and New York City has offered free breakfast to all students since 2003. But participation in the breakfast program is lower than the lunch program, with less than a third of students taking breakfast each day.

“A lot of kids just don’t go to the cafeteria,” Schwartz says. “There may be some stigma. And kids want to hang out.” Many students don’t get to school early because of transportation or family commitments, and some may not be aware that breakfast is served in the cafeteria before school.

To encourage participation, the district in 2003 began offering Breakfast in the Classroom (BIC). The meal is offered in the first 10 to 20 minutes of the school day and typically includes cold, packaged items, such as cereal, bagels, yogurt, and fresh fruit. The city serves more than 30,000 classroom breakfasts each day and plans to extend BIC to all schools in the district.

The program reduces hunger and food insecurity; increases participation; and improves academic performance, attendance, and engagement, advocates say. It may even allow educators to integrate nutrition and healthy eating into the curriculum. But critics say BIC leads to weight gain, because some students may eat two morning meals.

To test those claims, Schwartz and her colleagues examined the early effects of New York City’s BIC program on participation, BMI and obesity, and academic outcomes. They compared data on weight and academic achievement of students in schools that had not yet adopted the program. The results were published in the Journal of Policy Analysis and Management.

The study included students in more than 1,100 NYC public elementary and middle schools between the 2006-07 and 2011-12 school years; about 300 schools offered BIC at the time. Researchers found that serving breakfast in classrooms substantially increased participation. They found no evidence that BIC led to student weight gain or reduced academic performance.

“The breakfast program seems to work,” Schwartz says. “It makes sense to expand it.”

Linking the three studies is a concern for creating “public schools that serve our kids well,” Schwartz says. “We should be looking for ways to make better environments to serve our kids. That’s what our tax money is for.”

Additional studies are in the works, including analyses of universal free lunch and academic success and weight. Schwartz is also curious about how obesity varies across schools and who goes to the school nurse’s office and how often. Does feeding kids more often lead to fewer visits to the nurse?

Policymakers must look at how things outside the classroom can improve kids’ health and wellness as well as academic success, Schwartz says. “Kids are about more than test scores and schools are about more than pedagogy,” she says. Parents and families certainly play a role, but so do public schools. “I’m a fan of designing schools so it’s easier for kids to succeed. We have to collaborate to make that happen,” she says

This article appeared in the spring 2016 print edition of Maxwell Perspective; © 2016 Maxwell School of Syracuse University. To request a copy, e-mail dlcooke@maxwell.syr.edu.