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Background: Few studies have examined school physical activity policies to assess dose–response on student outcomes. The purpose of this study was to evaluate the association between health-promoting physical activity policies in elementary schools and physical activity behavior. Methods: In this cross-sectional study, physical activity was assessed using self-report measures in fourth-grade students in Texas (N = 1958, x = 9.66 y) from the School Physical Activity and Nutrition (SPAN) survey. School policies were assessed using the number of health-promoting policies in place taken from the SPAN School Health Survey with principals and their proxies. Multiple linear regressions adjusted for student- and school-level confounders and school clustering were performed. Results: School physical activity policies were significantly associated with student-level physical activity behavior (P < .05), even after controlling for the student- and school-level confounding variables. The interactions between physical activity policy-by-economic disadvantage (P < .01) and between physical activity policy-by-geographic strata (P < .01) were both significant, with stronger direct effects of policies on student physical activity for economically disadvantaged schools and major urban schools. Conclusion: Results from this study provide evidence for the importance of school-based health policies and practices in potentially reducing health disparities, especially in low-income and urban schools.
Ganzar, Ranjit, and Hoelscher are with the Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston, School of Public Health in Austin, Austin, TX. Saxton is with the Texas Department of State Health Services, Austin, TX.