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Batter Up For Bone Health: Education intervention to improve bone health knowledge in school-age children Sarah Allaben, BS Erica Auriemme, BS Alexis Blandine, BS Kiah Ehrke, BS Ellen Hashiguchi, MPH Maggie Tignanelli, BS Thesis advisor: Karen Plawecki PhD, RD

Batter Up For Bone Health

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Page 1: Batter Up For Bone Health

Batter Up For Bone Health: Education intervention to improve bone health knowledge in school-

age children

Sarah Allaben, BSErica Auriemme, BSAlexis Blandine, BS

Kiah Ehrke, BSEllen Hashiguchi, MPHMaggie Tignanelli, BS

Thesis advisor: Karen Plawecki PhD, RD

numbers are too small-Benedictine University
Good pics!-Benedictine University
use for script vs. on slideExpand the table. -Benedictine University
use for script vs. on slideAny more recent data-Benedictine University
use as your "script". Expand the graphic-Benedictine University
this was mentioned earlierUse the text as your verbal presentation. Focus on the bar graph.Any more recent bar graph? What We Eat in America has several?-Benedictine University
Remove as not trends.-Benedictine University
can remove and use for comment as the chart is highlighted with this information.Good chart! Use this for the slide with the content from NHANES being shared as verbal-Benedictine University
Page 2: Batter Up For Bone Health

On Deck● Background ● Methods● Demographics● Results and discussion● Strengths and limitations● Future implications for research

Page 3: Batter Up For Bone Health

Batter Up for Bone HealthAn interactive, behavioral theory-based education game mimicking a game of baseball.

Objectives: 1. Improve bone health knowledge

and behaviors for 7-10 year olds. 2. Educate children on foods rich in

vitamin D and calcium.  3. Promote physical activities that

support healthy bone development.

Tested in both school and camp settings.

Page 4: Batter Up For Bone Health

Bone OverviewCortical Bone and Trabecular bone1

● Crystalline hydroxyapatiteCa5(PO4)2

Osteogenesis = the formation of bones2

● Osteoblasts: bone building● Osteoclasts: bone resorption

Leading Players● Calcium & Vitamin D● Physical Activity

(Lian, 2004; Gilbert, 2000)

Page 5: Batter Up For Bone Health

Mechanism of BonesOsteogenesis

● Osteoblasts + Bone Matrix play pivotal roles1

○ Basic steps:■ Synthesis of matrix■ Matrix mineralization■ Bone remodeling

Osteoblasts● Parathyroid Hormone (PTH) and Estrogen

Bone matrix ● Inorganic compounds● Organic compounds

(Kini, 2012)

Page 6: Batter Up For Bone Health

Bone Remodeling

●Constantly undergoing modeling

●Osteoblasts have a dual function

●Average lifespan of each remodeled unit in humans is 2-8 months1

(Kini, 2012)

Page 7: Batter Up For Bone Health

Bone Remodeling● Peak bone

height velocity slows at puberty

(Fortes, 2012)

Page 8: Batter Up For Bone Health

Bone Remodeling•Highest plasma bone biomarkers in 10-12

year olds1

• Osteocalcin• Bone Alkaline Phosphatase• C-Terminal telopeptide

•Decreased with bone age + breast development1

•At puberty, girls are in Tanner Stage 4 [physical maturation]2

(Fortes, 2014; WHO, 2014)

Page 9: Batter Up For Bone Health

Bone Lifespan● Trabecular bone grows faster than cortical bone● Maximize peak bone mass in adolescence ● Remodeling increases in peri- and early postmenopausal women.● 5-10% of total bone is renewed annually

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Bone Health DiseasesRickets/Osteomalacia

●Softening and weakening of bone

●Osteoid accumulates in the bone tissue below the growth plate

○Bone eventually forms bowing shape1

●Not only Vitamin D deficiency

○Poor calcium and phosphorous intake2

(Nield, 2006; Thacher, 2013)

Page 11: Batter Up For Bone Health
Page 12: Batter Up For Bone Health

Incidence of Rickets/Osteomalacia

● Incidence has increased since 20001

○ Most incidences occur in African Americans

(Thacher, 2013)

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Bone Health DiseasesOsteoporosis • Translates to porous bone • Resorption happens more quickly than

osteoid formation

• 1 in 3 women and 1 in 5 men are at risk 1

• Common fractures in hip, spine and wrist

• Why prevention is important • 10% increase in peak bone mass,

reduces  risk of fracture by 50%1

(IOF, 2015)

Page 14: Batter Up For Bone Health

Calcium Overview

● Positive effect on bone mass in children and adolescents 1

● Nutrient of Concern

(Webb, 2014)

Page 15: Batter Up For Bone Health

Calcium Overview

● Serum calcium is kept constant at bone’s expense

● Increasing calcium consumption has greater bone benefits

(Houillier, 2006)

Page 16: Batter Up For Bone Health

(WWEIA, 2014; Rehm, 2015)

Page 17: Batter Up For Bone Health

Calcium

(Van Stuijvenberg, 2015)

Cross-sectional study - South Africa• 2-5 year olds• 62.6% did not consume milk

Calcium • 21% EAR

Vitamin D• 15% EAR

Results• Significant stunting

Page 18: Batter Up For Bone Health

(Hever, 2015)

Page 19: Batter Up For Bone Health

(Weishaar, 2013)

Distribution of serum 25-hydroxyvitamin D levels by racial/ethnic group in the US population

Page 20: Batter Up For Bone Health

Vitamin DRDA - 15 μg or 600 IU/day¹

• 97.5% of children aged 1–18 years

Dietary Intake¹

• 77% of total vitamin D

• 5.8 μg/day

Serum 25-hydroxyvitamin D: >20 ng/mL²

• Children 6-11 years vs. ages 1-5 years

• Non-Hispanic black children

• Hispanic children

(Moore, 2014; Mansbach, 2009)

Page 21: Batter Up For Bone Health

Vitamin D12-week randomized, double-blind, controlled study

• 6-10 year olds

• 3 Beverage Groups: Ca, CaD, CaDEA

Results

• CaD & CaDEA groups

Improved 25(OH)D status

(Economos , 2014)

Page 22: Batter Up For Bone Health

Joint Force Ground Force

Types of Exercise

(Behnke, 2012)

Page 23: Batter Up For Bone Health

Ground Force Research● Short-term bone biochemical response1

○ Sample: 15 male students○ Age 20-35○ Bilateral jumping

■ ranged from 520 - 2278 jumps (mean=1270)○ Venous blood sample taken pre and post exercise

■ CTx■ P1NP

● Positive % increase○ No significant correlation between number of jumps and

P1NP

(Rantalainen, 2009)

Page 24: Batter Up For Bone Health

Ground Force Research

Page 25: Batter Up For Bone Health

Physical Activity Trends in the Pediatric Population

• Recommended 60 minutes daily activity between ages 6 - 17

1

• Physical Education within the School through a Comprehensive School Physical Activity Program

• Physical Education Classes • Movement within the

Classroom • Recess 2

(USDHHS, 2011; CDC, 2015)

Page 26: Batter Up For Bone Health

Example of Comprehensive School Physical Activity Program Design

(Orlowski, 2013)

Page 27: Batter Up For Bone Health

Research Shows● A decrease in physical

education classes in high school○ 13% decrease from 1991 to

20131

● Physical education classes offered 3 days/week in elementary school2

○ Early Childhood Longitudinal Study

○ 20,000 8th grade students

○ Physical Education offered 3 days a week

(CDC, 2015; Vericker, 2014)

Page 28: Batter Up For Bone Health

Triple Play!

Page 29: Batter Up For Bone Health

Social Cognitive Theory

• Learning occurs within a social context

Page 30: Batter Up For Bone Health

Social Cognitive Theory

Self efficacy is positively associated with healthy eating habits1

• Significant model pathway (B=+0.46) from self-efficacy to percentage energy intake, p=.001

(Lubans, 2012; Larsen, 2015)

Self efficacy predicts outcome expectations2

• Self efficacy increased .728 from pretest to posttest

• Outcome expectations increased 2.52 from pretest to posttest

Page 31: Batter Up For Bone Health

Social Cognitive Theory

Children ate more F & V when exposed to peers eating F & V1

• N=749• Increased F & V

consumption post-intervention (p<.001), increased F & V consumption at home (p<.05)

(Horne, 2004)

Page 32: Batter Up For Bone Health

Batter Up! For Bone Health

The Rules [Methods]

Page 33: Batter Up For Bone Health

Purpose of Batter Up! for Bone Health

Improve bone health knowledge and behaviors for school children ages 7-10 years:

• Identifying bone healthy foods

• Participating in physical activities associated with bone health

Page 35: Batter Up For Bone Health

Survey Tools• Recruitment Flyer• Consent to participate• Demographics• Three Measurable Tests

Page 36: Batter Up For Bone Health

Survey Timeline

Page 37: Batter Up For Bone Health

Tips For the School

Page 38: Batter Up For Bone Health

Location

Location Participants with

Consent Forms

School 59% (n=99)

Camp 41% (n=69)

Page 39: Batter Up For Bone Health

Gender

Page 40: Batter Up For Bone Health

EthnicityChart: Ethnicity of Participants

with Consent Forms

n = 165

Page 41: Batter Up For Bone Health

Ethnicity by Location

N=67 N=98

Page 42: Batter Up For Bone Health

Calcium Sources Consumed

Page 43: Batter Up For Bone Health

Multivitamin Sources Reported

Page 44: Batter Up For Bone Health

7th Inning Stretch

(Results)

Page 45: Batter Up For Bone Health

H01 There is no difference in overall bone health knowledge gained.

Pre-to Post-test

Sample size Mean Difference

standard deviation

test value

p-value confidence interval/effect

size

Overalla 119 Pre-test: 12.55 Post-test: 13.17

Pre-test: 1.85 Post-test: 2.46

-3.03 0.003 0.1239

Between Gendersb

Total N= 129 F= 61M=58

F: 0.61

M: 0.64

Females:2.02Males: 2.46

-0.08 0.940 Inside

Between Agesc

Total N=118(7)=1(8)=32(9)=49(10)=36

Total: 13.167yr: 13.00 8yr: 12.339yr: 13.25 10yr: 13.79

Total: 2.237yr: --8yr: 2.899yr: 1.91 10yr: 1.82

F=2.43 0.069 Outside

Between Locationsb

Total N= 129 S= 93C= 26

S: 0.74

C: 0.19

School: 1.93

Camp: 3.11

1.11 0.27 Inside

aPaired T-Test; bIndependent Samples T-Test; c One-Way ANOVA; F = Female, M = Male, S = School, C = Camp

Page 46: Batter Up For Bone Health

H02 There is no difference in overall bone health knowledge retained.

Post- to 21-day post test

Sample size Mean Standard deviation

Test value

p-value Confidence interval/effect size

Overalla 118 Post-test: 13.4121-day posttest: 13.48

Post-test: 1.9921-day posttest:2.07

-0.49 0.627 outside

Between Gendersb

Total N= 128 F= 60M= 58

F: -0.02M: 0.17

F: 1.14M: 2.13

-0.60 0.548 outside

Between Agesc

Total N= 117(8) N= 29(9) N=52(10) N=36

Total: 13.45 8yr: 13.25 9yr: 13.52 10yr: 13.54

Total: 0.098yr: 0.529yr: 0.19 10yr: -0.42

2.67 0.074 outside

Between Locationsa

Total: 128(S) N=97(C) N=21

S: 0.01 C: 0.38

S: 1.72C: 1.63

-0.91 0.306 inside

aPaired T-Test; bIndependent Samples T-Test; c One-Way ANOVA; F = Female, M = Male, S = School, C = Camp

Page 47: Batter Up For Bone Health

H03 There is no difference in overall bone health knowledge gained in the schools.

In the School

Sample size Mean Standard deviation

test value

p-value Confidence interval/effect size

Overall Knowledgea

93 Pre-test: 12.80 Post-test: 13.54

Pre-test: 1.64 Post-test: 1.91

-3.71 0.0001 0.20

Knowledge Between Gendersb

Total N= 93 F= 49M= 44

F: 0.88 M: 0.59

F: 1.86M: 2.02

0.71 0.478 inside

Knowledge Between Agesc

Total N= 93(8) N= 21(9) N=39(10) N=33

0.74 1.93 0.90 0.412 outside

aPaired T-Test; bIndependent Samples T-Test; c One-Way ANOVA; F = Female, M = Male

Page 48: Batter Up For Bone Health

H04 There is no difference in overall bone health knowledge retained in the schools.

In the School

Sample size Mean Standard Deviation

test value

p-value Confidence interval/effe

ct size

Overall Retentiona

97 Post-test: 13.65 21-day: 13.66

Post-test: 1.76 21-day: 1.75

-0.06 0.953 outside

Retention Between Genders b

Total N= 97 F= 50M= 47

F: -0.08M: 0.11

F: 1.01 M: 2.25

-0.52 0.604 outside

Retention between Ages c

Total N= 97(8) N= 22(9) N=42(10) N=33

0.01 1.72 2.60 0.080 outside

aPaired T-Test; bIndependent Samples T-Test; c One-Way ANOVA; F = Female, M = Male

Page 49: Batter Up For Bone Health

Table: Bone health knowledge gained and retained in both locations; isolated in a school setting.Target Group

Sample Size

Mean Standard Deviation

Test value (F)

p-value Confidence interval/effect size

Overall Knowledge and Retention d

112 Pre-test: 12.53Post-test: 13.3821-day post-test: 13.52

Pre-test: 1.88 Post-test: 2.0221-day post-test: 2.05

18.94 0.0001 0.26

Overall Knowledge and Retention in Schools d

92 Pre-test: 12.80Post-test: 13.6121-day post-test: 13.65

Pre-test: 1.65Post-test:1.80 21-day post-test: 1.79

14.89 0.0001 0.25

dRepeated Measures ANOVA

Page 50: Batter Up For Bone Health

Knowledge gained and knowledge retained at both locations; camp isolation.

p-value, camp <0.0001

p-value, school <0.0001

Overall scores

Page 51: Batter Up For Bone Health

H05 There is no change in knowledge increase of calcium-containing foods among the participants.

Target Group

Sample Size (N)

Mean Difference

Standard Deviation

Test Value

P - Value

Confidence Interval/Effect Size

Overalla 113 Pretest: 4.73Posttest: 5.24Mean Diff: 0.51

Pretest: 0.87Posttest: 0.96

6.89 0.0001 0.28 (M)

Between Gendersb

Total N = 113 (F) N = 58(M) N = 55

F: 0.43M: 0.60

F: 0.70M: 0.87 -1.14 0.26

Outside

Between Agesc

Total N = 112(8) N = 30(9) N =46(10) N =35

Total: 0.528 yr: 0.37 9 yr: 0.5010 yr: 0.63

Total: 0.52 8 yr: 0.379 yr: 0.5010 yr: 0.63

1.04 0.38

Outside

Between Locationsb

Total N = 113 (S) N = 89(C) N = 24

S: 0.53C: 0.46

S: 0.72C: 1.02

0.31 0.76

Outside

aPaired T-Test; bIndependent Samples T-Test; c One-Way ANOVA; F = Female, M = Male, S = School, C = Camp

Page 52: Batter Up For Bone Health

H06 There is no change in knowledge retention of calcium-containing foods among the participants. Target Group

Sample Size (N)

Mean Difference

Standard Deviation

Test Value

P-Value Confidence Interval/Effect Size

Overalla 115 Posttest: 5.5721DayPost: 5.21 Mean Diff: -0.36

Posttest: 0.9521DayPost: 1.01

0.79 0.43 Outside

Between Gendersb

Total N = 115(F) N = 60(M) N = 55

F: -0.08M: -0.04

F: 0.70M: 0.96

-0.30 0.76

Outside

Between Agesc

Total N = 114(8) N = 29(9) N =49(10) N =36

Total: -0.08 8 yr: 0.039 yr: -0.0610 yr: -0.19

Total: 0.81 8 yr: 0.639 yr: 0.9410 yr: 0.75

0.66 0.52 Outside

Between Locationsb

Total N = 115(S) N = 94(C) N = 21

S: -0.07C: 0.00

S: 0.82C: 0.89

-0.37 0.71 Outside

aPaired T-Test; bIndependent Samples T-Test; c One-Way ANOVA; F = Female, M = Male, S = School, C = Camp

Page 53: Batter Up For Bone Health

H07 There is no change in knowledge increase of calcium-containing foods among the participants (school isolated).

Target Group

SampleSize (N)

Mean Difference

Standard Deviation

Test Value

P-Value Confidence Interval/Effect Size

Overalla 89Pretest: 4.84Posttest: 5.37Mean Diff: 0.53

Pretest: 0.80Posttest: 0.82

-6.88 0.0001 0.31 (M)

Between Gendersb

Total N = 89(F) N = 47(M) N = 42

F: 0.53M: 0.52

F: 0.58M: 0.86

0.52 0.96 Outside

Between Agesc

Total N = 89(8) N = 21(9) N = 36(10) N = 32

Total: 0.538 yr: 0.389 yr: 0.5010 yr: 0.66

Total: 0.728 yr: 0.599 yr: 0.8810 yr: 0.60

0.96 0.39 Within

aPaired T-Test; bIndependent Samples T-Test; c One-Way ANOVA; F = Female, M = Male

Page 54: Batter Up For Bone Health

H08 There is no change in knowledge retention of calcium-containing foods among the participants (school isolated).

Target Group

Sample Size (N)

Mean Difference

Standard Deviation

Test Value

P-Value Confidence Interval/ Effect Size

Overalla 94 Posttest: 5.3921DayPost: 5.31Mean Diff: -0.08

Posttest: 0.8121DayPost: 0.89

0.88 0.38 Outside

Between Gendersb

Total N = 94(F) N = 50(M) N = 44

F: -0.10M: -0.46

F: 0.58M: 1.03

-0.32 0.75 Outside

Between Agesc

Total N = 95(8) N = 22(9) N = 39(10) N = 33

Total: -0.078 yr: 0.099 yr: -0.0310 yr: -0.24

Total: 0.898 yr: 0.619 yr: 0.9610 yr: 0.75

1.22 0.30 Outside

aPaired T-Test; bIndependent Samples T-Test; c One-Way ANOVA; F = Female, M = Male,

Page 55: Batter Up For Bone Health

H09 There is no difference between knowledge of Vitamin D sources among participants.

Target Group

Sample Size (N)

Mean Difference

Standard Deviation

Test Value

P Value

Confidence Interval/Effect Size

Overalla 107 Pretest: 4.20Posttest:4.59Difference: 0.39

Pretest: 0.84Posttest: 0.64

-5.61 0.0001

0.23

Between Locationb

Total N = 107(S) N = 85(C) N = 22

S: 0.39C: 0.41

S: 0.73C: 0.73

-0.12 0.905 Outside

Between Genderb

Total N =107(F) N = 57(M) N = 50

F: 0.37 M: 0.42

F: 0.72M: 0.73

-0.37 0.715 Outside

Between Agesc

Total N = 106(8) N = 28(9) N = 43(10) N = 34

Total: 0.388 yr: 0.36 9 yr: 0.3510 yr: 0.44

Total: 0.718 yr: 0.739 yr: 0.6910 yr: 0.75

0.21 0.888 Outside

Between Ethnicitiesc

Total N = 106(H) N = 18(W) N = 74

Total:0.40H: 0.39 W: 0.35

Total: 0.73H: 0.78W:0.71

0.70 0.622 Outside

aPaired T-Test; bIndependent Samples T-Test; c One-Way ANOVA; F = Female, M = Male, S = School, C = Camp, W = White, H = Hispanic

Page 56: Batter Up For Bone Health

Target Group

Sample Size (N)

Mean Difference

Standard Deviation Test Value

P Value

Confidence Interval/ Effect Size

Overalla 111 Posttest: 4.6021DayPost: 4.55Difference: -0.15

Pretest: 0.65Posttest: 0.89

0.70 0.486 Outside

Between Locationb

Total N = 111(S) N = 90(C) N = 21

S: -0.02 C: -0.14

S: 0.58C: 1.01

0.53 0.604 Outside

Between Genderb

Total N = 111(F) N = 58(M) N = 53

F: -0.07M: -0.02

F: 0.67M: 0.69

-0.39 0.700 Outside

Between Agesc

Total N =110(8) N =28(9) N =47(10) N =35

Total:-0.02 8 yr: 0.25 9 yr: -0.04 10 yr: -0.20

Total: 0.62 8 yr: 0.659 yr: 0.5910 yr: 0.58

4.42 (F)

0.014 0.08

Between Ethnicitiesc

Total N = 111(H) N = 19(W) N = 77

Total: -0.05H: -0.21W: -0.01

Total: 0.68H: 1.03W: 0.62

0.77 0.573 Outside

H010 There is no significant difference between retention of Vitamin D sources among participants.

aPaired T-Test; bIndependent Samples T-Test; c One-Way ANOVA; F = Female, M = Male, S = School, C = Camp, W = White, H = Hispanic

Page 57: Batter Up For Bone Health

p<0.012

*Repeated Measures ANOVA

H010a There is no significant difference between retention of Vitamin D sources between the Hispanic and White population.

Page 58: Batter Up For Bone Health

H011 There is no significant difference between knowledge of Vitamin D sources among school participants.

Target Group

Sample Size (N)

Mean Difference

Standard Deviation

TestValue

P Value

Confidence Interval/ Effect

Size

Overalla 85 Pretest:4.26Posttest:4.65Difference:0.39

Pretest: 0.79Posttest: 0.55

-4.94 0.0001

0.22

Between Gendersb

Total N = 85(F) N = 46(M) N = 39

F: 0.41 M: 0.36

F: 0.72M: 0.74

0.34 0.734 Outside

Between Agesc

Total N = 85(8) N = 20(9) N = 34(10) N = 31

Total: 0.39 8 yr: 0.40 9 yr: 0.32 10 yr: 0.45

Total: 0.738 yr: 0.759 yr: 0.6810 yr: 0.77

0.25 0.778 Outside

Between Ethnicitiesc

Total N = 85(H) = 2(W) = 71

Total: 0.39H: 0.00 W: 0.34

Total:0.73H: 0.00W: 0.72

1.08 0.371 Inside

aPaired T-Test; bIndependent Samples T-Test; c One-Way ANOVA; F = Female, M = Male, W = White, H = Hispanic

Page 59: Batter Up For Bone Health

H012 There is no significant difference between retention of Vitamin D sources among school participants.

Target Group

Sample Size (N)

Mean Difference Standard Deviation

Test Value

P Value

Confidence Interval/ Effect

Size

Overalla 90 Pretest: 4.68Posttest:4.66Total Mean Diff: - 0.02

Pretest: 0.54Posttest: 0.74

0.36 0.717 Outside

Between Genderb

Total N = 90(F) N = 48(M) N = 42

F: 0.00 M: -0.05

F: 0.41M: 0.73

0.37 0.710 Outside

Between Agesc

T0tal N = 90(8) N = 21(9) N = 37(10) N = 32

Total: -0.02 8 yr: 0.14 9 yr: 0.54 10 yr: -0.22

Total: 0.588 yr: 0.579 yr: 0.5210 yr: 0.61

3.15 (F)

0.048 0.07

Between Ethnicitiesc

Total N = 90(H) N = 2(W) N = 75

Total: -0.02H: 0.00 W: -0.01

Total: 0.58H: 0.00W: 0.63

0.12 (F)

0.975 Outsideapaired t-test; bindependent samples t-test; c One-way ANOVA; F = Female, M = Male, W = White, H = Hispanic

Page 60: Batter Up For Bone Health

Pre to Posttest Sample Size

Mean Standard deviation

Test Value P-value Confidence interval

Overalla 113 Pretest: 4.00Posttest: 3.88

0.85 1.53 0.127 Inside

Between Gendersb Total N= 113(F) N = 57(M) N = 56

F: -0.05M: -0.19

F: 0.91M: 0.79

0.89 0.375 Inside

Between Agesc Total N = 112(7) N =1(8) N =31(9) N =45(10) N =35

Total: -0.147 yr: ---8 yr: -0.229 yr: -0.0210 yr: -0.22

Total: 0.837 yr: 0.998 yr: 0.839 yr: 0.6810 yr: 0.82

0.53 0.657 Outside

Between Locationsb Total N = 113(S) N =89(C) N =24

S: -0.08C: -0.25

School: 0.79Camp: 1.07

0.81 0.09 Inside

H013 There is no difference in overall physical activity knowledge gained.

aPaired T-Test; bIndependent Samples T-Test; c One-Way ANOVA; F = Female, M = Male, S = School, C = Camp

Page 61: Batter Up For Bone Health

Post to 21-Day Post

Sample size

Mean Standard deviation

Test Value

P-value Confidence interval/effect size

Overalla 114 Posttest: 3.8521-day Posttest: 3.90

Post-test: 0.7521-day Posttest: 0.83

-0.61 0.537 Outside

Between Gendersb

Total N= 114(F) N = 59(M) N = 55

F: 0.01M: 0.07

F: 0.68M: 0.83

-0.39 0.69 Outside

Between Agesc Total N = 113(8) N = 28(9) N = 50(10) N = 35

Total: 0.058 yr: -0.039 yr: 0.1610 yr: -0.02

Total: 0.758 yr: 0.699 yr: 0.8410 yr: 0.66

0.90 0.409 Outside

Between Locationsb

N=114(S)=93(C)= 21

School: -0.01Camp: 0.28

School : 0.69Camp: 0.95

-1.34 0.192 Outside

H014 There is no difference in physical activity knowledge retained.

aPaired T-Test; bIndependent Samples T-Test; c One-Way ANOVA; F = Female, M = Male, S = School, C = Camp

Page 62: Batter Up For Bone Health

In the School

Sample Size Mean Standard Deviation

Test Value P-Value Confidence Interval/ Effect Size

Overalla 89 Pretest: 3.98Posttest: 3.89

Pretest: 0.71Posttest: 0.70

1.07 0.288 Outside

Between Gendersb

Total N = 89(F) N = 42(M) N = 47

F: -0.04M: -0.14

F: 0.88M: 0.68

0.59 0.554 Outside

Between Agesc

Total N = 89(8) N = 20(9) N = 37(10) N = 32

Total: -0.088 yr: -0.059 yr: 0.0010 yr: -0.21

Total: 0.798 yr: 0.829 yr: 0.8410 yr: 0.70

0.68 0.509 Outside

H015 There is no difference in overall physical activity knowledge within the school.

aPaired T-Test; bIndependent Samples T-Test; c One-Way ANOVA; F = Female, M = Male

Page 63: Batter Up For Bone Health

H016 There is no difference in overall physical activity knowledge retained within the school.

In the School

Sample Size

Mean Standard Deviation

Test value

P-value Confidence Interval/

Effect Size

Overalla 93 Posttest: 3.9021DayPost: 3.89

Posttest: 0.7021DayPost: 0.81

1.48 0.882 Outside

Between Gendersb

Total N = 93(F) = 44(M) = 49

F: -0.04M: 0.02

F: 0.57M: 0.82

-0.42 0.67 Inside

Between Agesc

Total N = 93(8) N = 21(9) N = 40(10) N = 32

Total: -0.018 yr: -0.149 yr: 0.1010 yr: -0.06

Total: 0.698 yr: 0.659 yr: 0.7410 yr: 0.66

F=0.96 0.386 Outside

aPaired T-Test; bIndependent Samples T-Test; c One-Way ANOVA; F = Female, M = Male

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21-Day Posttest

Sample Size

Mean Standard Deviation

Frequencies Correct

Frequencies Incorrect

Chi-Square P-Value

Video vs. Vacuum

128 1.0234 .1518 125 3 1116.281 .000

Basketball vs. Swimming

127 1.5276 .5012 60 67 .386 .535

Computer vs. Playing outside

128 1.0078 .0883 127 1 124.031 .000

Listening to music vs. dancing

128 1.1328 .3407 111 17 69.031 .000

Be active for at least ___ minutes/day

126 1.3968 .4911 76 50 5.365 .021

H017 There is no difference in physical activity knowledge retained.

*Chi square test

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Principal Components

Analysis (PCA)

Pre-Test

Question New variable

Cronbach Alpha

When I see my (friends, adults at home, brothers, sisters, teachers) drinking milk, I’m more likely to drink milk

Drinking milk

.863

Like to eat what my teachers eat or when I see my teacher eat something, I like to eat that food tooMy friends and I eat the same foods

School environme

nt

.666

*Principal Components Analysis, Cronbach alpha

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Principal Components

Analysis (PCA)

21-day Post Test

Question New variable Cronbach alpha

When I see my (friends, adults at home, brothers, sisters, teachers) drinking milk, I’m more likely to drink milk

Drinking milk

.885

Like to eat what my friends/teachers eatWhen I see my friends/teachers eat something, I like to eat that food too

School environment

.295

*Principal Components Analysis, Cronbach alpha

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Pre-Test (n=119) 21-Day Post-Test (n=120)Response

valueYes Chi-

Square Statistic

P-Value Effect Size

Yes Chi-square Statistic

P-value Effect size

8 19

128.44

< .0001

.952 (L)

22

49.92 <.0001 .946 (L)

10 10 14

12 15 11

14 18 19

16 57 54

H018 School-age children are not influenced by others drinking milk.

*Chi square test

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p<.0001

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Pre-Test (n=121)

Response value

Yes Chi-Square Statistic

P-Value Effect Size

6 79

119.23

< .0001

.956 (L)

8 31

10 7

12 4

H019 The school environment does not have an effect on participants’ bone healthy nutrition behaviors.

*Chi square test

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p<.0001

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Pre-Test (n=123) 21-Day Post-Test (n=122)Response value

Yes Chi-Square Statistic

P-Value Effect Size Yes Chi-square Statistic

P-value Effect size

6 39

13.55

.004

.956 (L)

13

17.74 <.0001 .956 (L)

8 39 40

10 31 27

12 14 42

H020 The home environment does not have an effect on participants’ bone healthy nutrition behaviors.

*Chi square test

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p=.004, <.0001

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H021 There is no difference between genders with regards to influences in participants’ bone healthy nutrition behaviors.

Pre-Test 21-Day Post TestInfluences Girls Boys P-

ValueConfidence Interval

Girls Boys P-Value Confidence Interval

Drinking milk influences

61 58 .333 Inside 61 59 .136 Inside

Mean 13.15 13.69 13.57 12.71

School environment 61 60 .762 OutsideN/A

Mean 6.98 6.90

Home environment 62 61 .465 Outside 60 62 .402 Inside

Mean 8.19 8.46 9.77 9.45

*Independent t-test

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Table: “It is Important for Kids my Age to Have Healthy Bones”: Pre-test*

*Chi-Square

H022 School-age children do not believe bone health is important.

Response (n=119)

Yes Chi-Square Statistic

198.17

P-Value

.0001

Effect Size

0.94 Very Important 112

Kind of Important

6

Somewhat Important

1

Page 75: Batter Up For Bone Health

Table: “It is Important for Kids my Age to Have Healthy Bones”: Girls vs Boys (Pre-test)*

*Independent T-Test

H022a There is no difference in belief over bone health importance between genders.

Response Girls(n= 63)

Boys (n=56)

P-Value

0.62

Confidence Interval

Outside

Very Important

59 53

Kind of Important

3 3

Somewhat Important

1 0

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H023 There is no difference between posttest and 21-day post-test and participant’s plan to eat foods that are healthy for their bones.

Category Sample Size

Post-Test

Mean

21-Post Test

Mean

t-value p-value Confidence Interval

Overall 79 1.29 + 0.56

1.44 + 0.61

-1.84 0.07 Inside

Female 44 1.20 + 0.55

1.36 + 0.57

-1.42 0.16 Outside

Male 35 1.40 + 0.55

1.54 + 0.66

-1.15 0.23 Outside

Table: “I plan to eat foods that are healthy for my bones*”

*Paired T-Test

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H024There is no difference between post-test and 21-day post-test in ease to incorporate foods that are healthy for their bones.

*Paired T-Test

Category Sample Size

Post-Test

Mean

21-Post Test

Mean

t-value p-value Effect size/Confidence Interval

Overall 80 1.76 + 0.88

1.96 + 0.85

-2.43 0.01 0.13

Female 45 1.82 + 0.91

1.96 + 0.85

-1.43 0.16 Outside

Male 35 1.69 + 0.83

1.97 + 0.86

-1.97 0.06 Inside

Table: “It is easy to choose a snack that is good for your bones*”

*Paired T-Test

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H025 There is no difference between post-test to 21-day post-test for ease to choose activities that are good for their bones.

Category Sample Size

Post-Test

Mean

21-Post Test

Mean

t-value p-value Effect size/Confidence

Interval

Overall 60 1.63 + 0.76

1.77 + 0.83

-1.16 0.25 Outside

Female 38 1.55 + 0.76

1.79 + 0.87

-1.71 0.09 Outside

Male 22 1.77 + 0.75

1.72 + 0.77

0.22 0.83 Outside

Table: “It is easy to choose an activity that is good for your bones*”

*Paired T-Test

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Category Sample Size

Post-Test Mean

21-Post Test

Mean

t-value p-value Effect size/Confiden

ce Interval

Overall 113 1.77 + 0.87

1.65 + 0.75

1.53 0.13 Inside

Female 56 1.75 + 0.86

1.69 + 0.78

0.44 0.66 Outside

Male 57 1.79 + 0.88

1.59 + 0.73

1.80 0.08 Inside

H026 There was no change between post-test and 21-day post-test among school aged children’s belief that exercise is fun.

Table: “I enjoy exercise”

*Paired T-Test

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H027 School-age children do not plan to engage in specific activities that are beneficial to their bones.

Activity Sample Size Yes Chi-Square Statistic

P-Value Effect Size/Confidence

Interval

Chores 92 62 11.13 .001 0.89 (L)

Stairs 91 60 9.24 .002 0.89 (L)

Dancing 91 73 33.24 .0001 0.90 (L)

Tag 91 74 35.70 .0001 0.90 (L)

Karate 91 52 1.86 0.17 Outside

Tennis 91 66 18.47 .0001 0.89 (L)

Table: Plan to Engage in Physical Activities for Bone Health: Post-Test*

*Chi-Square

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Bottom of the Ninth

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● Constraints for time allotted to run the game

● Language barriers during the camp session

● Decrease in sample size due to consent forms

● Further validate test

Limitations

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Strengths● Appropriate for a wide range of ages

● Assessment tool incorporated social cognitive theory

● Covers wide variety of material

● Incorporated into PE classes

● Intervention can take place inside or outside

● Participants enjoyed the interactive and educational game

Page 84: Batter Up For Bone Health

Implications for our study

• Causes changes in bone health knowledge and retention • Applicable in both settings

• Positive bone health behaviors will be modeled

• Influencers and understanding bone health importance can motivate

• Self-efficacy plays a role in behavior changes and motivation

Page 85: Batter Up For Bone Health

Future Research● Implementing the program in

schools with different demographics

● Application of influences and modeling in children

● Female’s dietary behaviors during pubescence

Page 86: Batter Up For Bone Health

Special Thanks!• Thesis Advisor Dr. Karen Plawecki• Students and faculty at St. Walter’s School• Campers and staff at West Chicago Summer Camp• Stan’s Donuts in the city

Page 87: Batter Up For Bone Health

Post-Game Press Conference

Page 88: Batter Up For Bone Health

References- Au L, Rogers G, Harris S, Dwyer J, Jacques P, Sacheck J. Associations of vitamin D intake with 25-

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https://depts.washington.edu/bonebio/ASBMRed/structure.html Updated January 16, 2004. Accessed November 15, 2015.

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References• Larsen, Andrew, McArdle, John, Robertson, Trina and Dunton, Genevieve. Nutrition self-efficacy is

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