Nutrition and physical activity behaviors and perceptions among Georgia high school students, youth risk behavior study, 2013

The Georgia Department of Public Health
Nutrition and Physical Activity Behaviors and Perceptions among
Georgia High School Students Youth Risk Behavior Survey, 2013
Pea
2 Peachtree Street, Atlanta, Ga 30303 | health.state.ga.us

chtree Street, Atlnta, Ga3ate.ga.us

For more information about nutrition and physical activity behaviors among youth in Georgia, please contact: Chronic Disease Epidemiologist Chronic Disease, Healthy Behaviors, and Injury Epidemiology Section Georgia Department of Public Health 2 Peachtree Street, 14th Floor Atlanta, GA 30303-3142 Phone: 404-657-2577 http://dph.georgia.gov/YRBS
This publication is supported by the Cooperative Agreements CDC-RFA-DP13-1305 (State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health) and CDC-RFA-PS13-130803CONT15 (Promoting Adolescent Health through School-Based HIV/STD Prevention and School-Based Surveillance) from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the CDC.
Suggested citation: Kumar GS, Bayakly AR., Bryan M., Drenzek C., DeCaille D., O'Connor J. Nutrition and Physical Activity Perceptions Among Georgia High School Students in 2013. Georgia Department of Public Health, Health Protection, Epidemiology, Chronic Disease, Healthy Behaviors and Injury Epidemiology Section, January 2015. 2014.
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ACKNOWLEDGEMENTS Georgia Department of Public Health Division of Health Protection Epidemiology Program Chronic Disease, Healthy Behaviors and Injury Youth Behavior Surveillance Chronic Disease Prevention Section 1305 Program 1305 Program Georgia SHAPE Program

Brenda Fitzgerald, MD Commissioner, State Health Officer
J. Patrick O'Neal, MD Director
Cherie L. Drenzek, DVM, MS State Epidemiologist
Rana Bayakly, MPH Chief Epidemiologist
Michael Bryan Youth Coordinator
Jean O'Connor, JD, DrPH, MPH Director
Donna DeCaille, MS, RDN, LD Domain 2 Lead
Shana Scott, JD, MPH 1305 Program Manager
Emily Anne Vall, PhD SHAPE Initiative Director

Georgia Department of Education for their collaboration and allowing GA DPH to conduct the survey in the selected high schools.

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TABLE OF CONTENTS A. Key Findings ...................................................................................................................................6 B. Background: Obesity, Nutrition, Physical Activity.....................................................................9 C. Methods .......................................................................................................................................12 D. Obesity...........................................................................................................................................13
2013 Update Trends, 2003-2013 E. Physical Activity............................................................................................................................17 2013 Update Trends, 2003-2013 F. Dietary and Physical Activity Behaviors.....................................................................................25 G. Perceptions about Healthy Eating and Physical Activity..........................................................31 H. Potential Actionable Steps...........................................................................................................50 I. Georgia Program Highlight Georgia SHAPE Initiative ...........................................................52 J. Limitations......................................................................................................................................53 K. References......................................................................................................................................54 L. Appendices Tables........................................................................................................................................57
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A. KEY FINDINGS
1. Almost 1 in 3 Georgia high school students were overweight or obese in 2013.
Among all Georgia high school students in 2013, 17% were overweight and 13% were obese. Male students were more likely to be obese compared to female students, and nonHispanic (NH) black students were more likely to be overweight and obese than NH white students.
2. Only a quarter of Georgia high school students met the recommendation of participating in physical activity (PA) 60 min/day in 2013.
Students in lower grades and male students were more likely to participate in PA 60 min/day than 12th grade students and female students, respectively. 3. About one-third of Georgia high school students attended physical education (PE) 5 days of the week in 2013.
Ninth-grade students and male students were more likely to attend PE class 5 days per week than 11th and 12th grade students and females, respectively. The Georgia Department of Education requires that high school students take a minimum of one semester of physical education during high school. Many Georgia schools recommend that students take this course in their 9th grade year, thereby increasing the likelihood that 9th grade students would be more likely to take physical education.
4. Obese students were more likely to fast and take diet pills to lose weight compared to students who were not overweight or obese.
Obese students were 2 times more likely to fast and 3 times more likely to take diet pills compared to students who were not overweight or obese.
5. The daily fruit and vegetable intake among Georgia high school students is low. Approximately 19% of high school students drank 100% fruit juice and ate fruit at least 3 times a day, 11% ate vegetables at least 3 times a day, and 8% ate fruit or drank 100% juice at least 2 times a day and ate vegetables at least 3 times a day. There were no differences in fruit and vegetable intake by weight status.
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6. A high percentage of Georgia high school students eat out at fast food restaurants during the week.
Almost one in three Georgia high school students ate out at fast food restaurants at least three times during the week. There were no differences in fast food intake by weight status.
7. A high percentage of Georgia high school students skip breakfast every week.
Greater than one-third of Georgia high school students skipped breakfast at least 5 days of the week and 15% of students skip breakfast every day. There were no differences in skipping breakfast by weight status.
8. Obese students were less likely to participate in a school sports team than students who were not overweight or obese.
Obese students were 30% less likely to participate in a school sports team than students who were not overweight or obese.
9. The desire to be healthy, the taste of healthy foods, and the desire to look good were most commonly cited reasons for why Georgia high school students are most likely to eat healthy foods.
Friends, family, and physicians appeared to be less important factors that influence Georgia high school students to eat healthy foods.
10. The majority of Georgia high school students were most likely to eat healthy foods at home.
Georgia high school students were most likely to eat healthy foods at home followed by at their school, at restaurants, and at some other place.
11. The desire to look good, the desire to be healthy, and enjoying exercise were the mostcommonly cited reasons why Georgia high school students exercised.
While the majority of students, regardless of weight status, stated that they exercise because they want to look good, a higher percentage of obese students said that they want to be healthy as a reason to exercise than normal weight students. A higher percentage of normal weight students identified that they enjoyed exercise compared to obese students. Friends, family, and physicians appeared to be less important factors that influence Georgia high school students to exercise.
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12. The majority of Georgia high school students were most likely to exercise at home. The next most likely locations to exercise for students were at their school, at a fitness center, and some other place. However, for students who met the recommendations for physical activity (PA 60 min/day) and strengthening exercises (strengthening exercises 3 days/week), they were most likely to exercise at their school, followed by their home, at a fitness center, and some other place.
13. Georgia high school students who met the recommendations of PA ( 60 min/day) and strengthening exercises ( 3 days/week) were most likely to exercise with friends. A higher percentage of normal weight students stated that they exercised by themselves than overweight or obese students, while more overweight and obese students state that they exercised with family members than normal weight students.
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B. BACKGROUND
Overweight and Obesity
Nationally, adolescent obesity has more than quadrupled in the past 30 years (1, 2). The percentage of adolescents aged 12-19 years who were obese increased from 5% to nearly 21% from 1980 to 2012 in the U.S. The etiology of overweight and obesity among youth is likely multifactorial and could be explained by the social-ecological framework which describes the complex interplay of individual, behavioral, community, and societal or policy-related factors. Factors ranging from individual factors such as taste preferences for healthy foods such as fruits and vegetables to community level factors such as access to foods high in fats and added sugars to societal factors such society support for physical activity and recreational opportunities are potential predictors of adolescent health behaviors that can contribute to their overweight and obesity (3-5).
Overweight is defined as having excess body weight for a particular height from fat, muscle, bone, water, or a combination of these factors (6). Obesity is defined as having excess body fat (7). The Body Mass Index (BMI) provides a reliable indicator of body fat for most people and is used to screen for weight categories that may lead to health problems. The BMI is calculated from a person's weight and height. Adolescents who are overweight are between the 85th and 95th percentiles for BMI, based on their sex and age. Adolescents who are obese have a BMI that is are greater than or equal to the 95th percentile, by age and sex.
Obese adolescents are at higher risk for obesity in adulthood, social and psychological problems, sleep apnea, high blood pressure, pre-diabetes and diabetes, and bone and joint problems (8-10). Engaging adolescents in healthy eating and regular physical activity can lower their risk for overweight and obesity and related chronic diseases (9, 11).
Benefits of Healthy Eating
Healthy eating throughout childhood and adolescence has many benefits. Healthy eating is important for proper growth and development and can prevent health problems such as obesity, cavities, low bone strength, low total body iron, heart disease, stroke, and diabetes (12).
Recommendations for Healthy Eating for Adolescents
The 2010 Dietary Guidelines for Americans provides dietary recommendations for children and adults (12). The guidelines generally recommend a diet rich in fruits and vegetables, whole grains, and fat-free and low-fat dairy products and limiting intake of solid fats, cholesterol, sodium, added sugars, and refined grains for persons 2 years of age (12). The recommended
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servings of 100% fruit juice and fruit for adolescents aged 14-18 years are between 1.5 to 2.5 cups of fruit daily (including 100% fruit juice). The recommended servings of vegetables for this age group are between 2.5 to 4 cups of vegetables daily.

Fast food restaurants are a significant source of energy-dense, high caloric foods and contribute to weight gain in adolescents (13). Adolescents who report eating fast foods and sugarsweetened beverages tend to consume more total energy and fat and consume less fruits and non-starchy vegetables (12-14). Hence, limiting sugar-sweetened beverages and eating out at fast food restaurants could decrease overweight and obesity among adolescents.

Additionally, eating a healthy breakfast is associated with improved cognitive function (especially memory), reduced absenteeism, and improved mood (15-17). Adolescents who eat a healthy breakfast on a daily basis will more likely experience these benefits (15-17).

Benefits of Physical Activity

Regular physical activity builds healthy bones and muscles, reduces risk of being obese, improves academic performance and grades, reduces depression and anxiety, improves concentration in the classroom, and reduces risk of chronic diseases like diabetes (18,19).

Recommendations for Physical Activity for Adolescents

Adolescents should have 60 minutes or more of physical activity daily (20). These activities should include:

Aerobic
Most of the 60 or more minutes a day should include activities of either moderateor vigorous intensity. Aerobic physical activity should be of vigorous intensity at least 3 days a week

Muscle-strengthening
Part of the 60 or more minutes of daily physical activity should include muscle-strengthening. Muscle-strengthening activities should be included on at least 3 days of the week.

Bone-strengthening
Part of the 60 or more minutes of daily physical activity should include bone-strengthening. Bonestrengthening activities should be included on at least 3 days of the week.

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Types of Physical Activity (20)

Moderate physical activities
Rollerblading Brisk walking Biking (stationary bike) Dancing Yard work (mowing lawn, raking leaves) Baseball & softball Washing and waxing car

Vigorous physical activities
Running Biking Jumping rope Karate Vigorous dancing like zumba Sports like soccer, tennis and football

Muscle-strengthening activities
Push-ups Pull-ups Weight-lifting exercises Working with resistance bands Wall Climbing Sit-ups Games like tug-of-war

Bone-strengthening activities
Hopping Skipping Jumping Running Sports like gymnastics, basketball, and tennis

Focusing on Schools to Improve Nutrition and Physical activity in Students
Schools can play a critical role in influencing the dietary and physical activity behaviors of students. The majority of adolescents enrolled in high school spend a large percentage of their time outside the home in school setting typically 6-7 hours a day for approximately 180 days per year. The school's food environment influences youth eating behaviors and provides them with opportunities to consume an array of foods and beverages throughout the school day (21). Schools are also in a unique position to help adolescents attain their daily recommended 60 minutes of physical activity. Including physical activity during the school day reduces students' sedentary behavior, increases overall physical activity participation, and enhances student academic performance (22-24).

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C. METHODS Youth Risk Behavior Survey The YRBS is a nationwide paper-and-pencil survey, conducted by the Georgia Department of Public Health in collaboration with the Centers for Disease Control and Prevention (CDC) and monitors priority health risk behaviors that contribute to the leading causes of death, disability, and social problems among youth in the United States (25). The Georgia high school YRBS survey is administered to students between grades 9 through 12 in a representative sample of schools across the state of Georgia. The surveys are conducted biennially in every odd-numbered year, with data for Georgia beginning in 2003. The results presented in this report are from the 2013 Georgia YRBS survey. Reliability and Validity of YRBS The national YRBS questionnaire has been shown to be reliable after having undergone two test-retest reliability studies (25). No study has been conducted to assess the validity of all self-reported behaviors that are included on the YRBSS questionnaire. However, in 2003, CDC reviewed the existing literature to assess cognitive and situational factors that might affect the validity of self-reporting behaviors of adolescents (25). Following this review, CDC determined that these factors do not threaten the validity of self-reports of each type of behavior equally. Further, not all self-reported behaviors can be measured objectively (25).
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D. OBESITY Throughout the report, phrases such as `more likely', `less likely', and `no differences' when describing the results signify whether the result was statistically significant at a p value of < 0.05.

1. What is the status of overweight and obesity among Georgia's high school students?

Among all Georgia high school students in 2013, 17% were overweight and 13% were obese. There were no differences in the percentage of Georgia high school students who were overweight or obese by grade. The percentage of high school students who were overweight did not differ by sex. Male high school students (14%) were more likely to be obese than female high school students (11%). There were no differences in overweight and obesity between non-Hispanic (NH) black students and Hispanic students or NH
white students and Hispanic students. NH black students (20%) were more likely to be overweight than NH white students (15%). NH black students (15%) were more likely to be obese than NH white students (11%).

Percentage (%)

Figure 1
30 20 10
0

Georgia ranks number 17 out of 43 states for obesity among high school students in the U.S.

Overweight and obesity among high school students, by grade, sex, and Overweight

race/ethnicity, Georgia, 2013

Obesity

16 10

16 15

21 12

17 13

17 14

17 11

15 11

20 15

21 17

9th

10th

11th

12th

Grade

Male Female
Sex 13

White, non- Black, non- Hispanic Hispanic Hispanic
Race/Ethnicity

2. How has obesity among Georgia high school students changed over time?

Figure 2

Obesity among high school students, by grade, Georgia, 2003-2013

9th

30

10th

11th

12th
20

Percenage (%)

10

0

2003

2005

2007

2009

2011

2013

Year

While obesity among 9th, 11th, and 12th graders remained stable over the years, 10th graders were more likely to be obese in 2013 compared to 2003.
In all the years, there were no differences in obesity by grade.

14

Figure 3 30

Obesity among high school students, by gender, Georgia, 2003-2013
Male Female

20

Percentage (%)

10

0

2003

2005

2007

2009

2011

2013

Year

From 2003 to 2013, male students were more likely to be obese than female students. Female students were more likely to be obese in 2013 compared to 2003. The average annual percentage increase for males was 0.003%; the average annual percentage increase for females was -
0.12%.

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Figure 4 30 20

Obesity among high school students, by race/ethnicity, Georgia, 2003-2013
NH Black Hispanic NH White

Percentage (%)

10

0

2003

2005

2007

2009

2011

2013

Year

NH black students have a greater prevalence of obesity than NH white students (p value <0.05). In 2011 and 2013, obesity among NH black students was higher than NH white students (p value <0.05).

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E. PHYSICAL ACTIVITY 1. What is the status of physical activity among Georgia high school students?
Met the recommendations in 2013: o Physical Activity (PA) 60 min/day: 25% of high school students o Muscle-strengthening Exercises 3 days/week: 50% of high school students o Physical Education (PE) Attendance 5 days/week: 34% of high school students 9th (29%), 10th (27%) and 11th (25%) grade students were more likely to have PA 60 min/day than 12th (17%) grade students. 9th (57%) and 10th (52%) grade students were more likely to do strengthening exercises 3 days/week than 12th (43%) grade students. 9th (52%) and 10th (32%) grade students were more likely to attend PE class 5 days/week than 12th grade (20%) students. Male students were more likely to have PA 60 min/day (35% for males vs. 15% for females), do strengthening exercises 3 days/week (60% vs. 40%), and attend PE class 5 days/week (39% vs. 29%) than female students. There were no differences in PA 60 min/day, strengthening exercises 3 days/week or attending PE class 5 days/week by race/ethnicity.
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Percentage (%)

Figure 5

Physical activity and physical education attendance

among high school students, by grade, sex, and race/ethnicity,

70

60 57 52 52

50

45

43

40 29
30
20

32 27

25 23

20 17

Georgia, 2013
60
39 40 35
29
15

Physical Activity 60 min/day Muscle-strengthening exercises 3 days/wk Physical Education Attendance 5 days/wk

53

51

46

37

37

27

29

23 23

10

0 9th 10th 11th 12th
Grade

Males Females
Sex

NH NH Black Hispanic White
Race/ethnicity

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2. How has physical activity among high school students changed over the last decade in Georgia? Figure 6

Percentage (%)

Physical Activity 60 minutes/day among high school students, by gender, Georgia, 2005-2013

40 35 30 25 20 15 10
5 0
2005

2007

2009
Year

2011

Male Female Total
2013

From 2005 to 2013, male students were more likely to be physically active 60 min/day than female students. 19

Figure 7
Physical Activity 60 minutes/day among male high school students, by grade, Georgia, 2005-
2013

Percentage (%)

45 40 35 30 25 20 15 10
5 0
2005

2007

2009
Year

2011

9th 10th 11th 12th
2013

In 2013, 9th, 10th, and 11th grade males were more likely to be physically active 60 min/day than 12th grade males. From 2007 to 2013, physical activity for 60 min/day remained stable for all grades.

20

Figure 8

Percentage (%)

Physical Activity 60 minutes/day among female

high school students, by grade, Georgia, 2005-

2013

40

9th

35

10th

30
11th
25
12th
20

15

10

5

0
2005

2007

2009
Year

2011

2013

In 2013, 9th grade females were more likely to be physically active 60 min/day than 12th grade females. Physical activity 60 min/day remained stable over the years for 9th, 10th, and 11th grade females.
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14. How has PE attendance among Georgia high school students changed over the last decade?

Figure 9

PE attendance among high school students, by grade, Georgia, 2003-2013

9th

100

10th

11th 80
12th

60

Percent (%)

40

20

0

2003

2005

2007

2009

2011

2013

Year

From 2003 and 2013, 9th grade students were more likely to attend PE class daily than 11th and 12th grade students.

22

Figure 10
100 80

PE attendance among high school students, by sex, Georgia, 2003-2013
Male Female

Percent (%)

60

40

20

0
2003

2005

2007

2009

2011

Year

Male students were more likely than females to attend PE class daily across all years.

2013

23

Figure 11

PE attendance among high school students, by race/ethnicity, Georgia, 2003-2013

100 NH Black

80

Hispanic

NH White 60

Percent (%)

40

20

0
2003

2005

2007

2009

2011

2013

Year
The percentage of NH white students and NH black students who attended PE class daily did not significantly change over the years.
The percentage of Hispanic students who attended PE class daily fluctuated across the years (24%-38%).

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F. NEGATIVE DIETARY AND PHYSICAL ACTIVITY BEHAVIORS 1. How were Georgia high school students trying to lose weight in unhealthy ways? (Table 3,
Figure 12) The behaviors that were assessed were fasting, taking diet pills, and vomiting/taking laxatives. Fasting Fourteen percent (14%) of students who were normal weight fasted in order to lose weight compared to 19% of overweight students and 21% of obese students. In the adjusted analyses1, obese students were 2 times more likely to fast compared to to students who were of normal weight. Taking diet pills Six percent (6%) of students who were normal weight took diet pills in order to lose weight compared to 10% of overweight students and 14% of obese students. In the adjusted analyses, obese students were 3 times more likely to take diet pills compared to students who were normal weight. Vomiting/Taking laxatives There was no difference in using vomiting/laxatives as an approach to lose weight by weight status. Six percent (6%) of students who were normal weight vomited/took laxatives in order to lose weight compared to 8% of overweight students and 8% of obese students.
1 Adjusted analyses: Throughout this report, the multivariable logistic regression analyses were adjusted for grade, sex, and race/ethnicity.
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Figure 12

Percentage (%)

Weight loss method by weight status among high school students, Georgia, 2013

25 20 15 10
5 0
Fasting

Normal Overweight Obese

Taking diet pills Behaviors

Vomiting/taking laxatives

2. How often did Georgia high school students consume fruits and vegetables? (Table 4, Figure 13) **Measured in number of times per day orweek.
100% Fruit Juice and Fruit Intake
There was no difference in either 100% fruit juice or fruit consumption by weight status. Nine percent (9%) of students who were normal weight, 10% of overweight students, and 7% of obese students drank 100% fruit juice at least 3 times a day. Similarly, 10% of students who were normal weight, 10% of overweight students, and 11% of obese students ate fruit at least 3 times a day.
There was no difference in consuming 100% fruit juice and/or fruit intake at least 3 times a day by weight status. Nineteen percent (19%) of students who were normal weight, 20% of overweight students, and 19% of obese students drank either 100% fruit juice or ate fruit at least 3 times a day.

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Figure 13

Percentage (%)

Intake of 100% fruit juice, fruit, or both 3 times/day among high school students, Georgia,
2013

Normal 25
Overweight

20

Obese

19 20 19

15

10

9 10 7

5

10

11

8

0 100% fruit juice

Fruit

Both 100% fruit juice

and fruit

Vegetable Intake
There was no difference in vegetable intake by weight status. Eleven percent (11%) of students who were normal weight, 10% of overweight students, and 13% of obese students ate vegetables at least 3 times a day.
Fruit and Vegetable Intake
There was no difference in both fruit and vegetable intake by weight status. Eight percent (8%) of students who were normal weight, 8% of overweight students, and 8% of obese students ate fruit or drank 100% juice at least 2 times a day and ate vegetables at least 3 times a day.

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3. How often did Georgia high school students consume sugar-sweetened beverages, eat out at fast food restaurants, or skip breakfast? (Table 4)
Sugar-sweetened Beverage Intake
There was no difference in sugar-sweetened beverage intake by weight status. Twenty percent (20%) of students who were normal weight, 17% of overweight students, and 20% of obese students consumed sugar-sweetened beverages at least once a day.
Fast Food Restaurant Use
While there was a difference in fast food restaurant use by weight status in the unadjusted analyses, there was no difference in fast food restaurant use by weight status in the adjusted analyses (i.e., after controlling for grade, sex, and race/ethnicity). Thirty-six percent (36%) of students who were normal weight, 32% of overweight students, and 26% of obese students ate out at fast food restaurants at least three times per week. Forty-three percent (43%) of students who were normal weight, 40% of overweight students, and 54% of obese students ate out at fast food restaurants one to two times per week.
Skipping Breakfast
There was no difference in skipping breakfast by weight status. Between 33% to 39% of students skipped breakfast most days of the week (greater than or equal to 5 days of the week), with 15% of students who were normal weight, 15% of overweight students, and 16% of obese students skipping breakfast every day.
4. What were the physical activity behaviors of Georgia high school students? (Table 5, Figure 14-16)
Physical Activity 60 minutes a Day
There was no difference in physical activity level by weight status (Figure 14). Only twentyfive percent (25%) of students who were normal weight, 27% of overweight students, and 22% of obese students participated in the recommended level of physical activity of 60 minutes a day.
Strengthening Exercises 3 times per Week
There was no difference in participating in the recommended amount of strengthening exercises by weight status (Figure 14). Fifty-one percent (51%) of students who were normal weight, 49% of overweight students, and 49% of obese students participated in the recommended amount of strengthening exercises of 3 times per week.
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Stretching Exercises
There was no difference in participating in stretching exercises by weight status (Figure 14). Seventy-one percent (71%) of students who were normal weight, 67% of overweight students, and 64% of obese students participated in stretching exercises at least once per week.
Figure 14

Percentage (%)

Physical activity behaviors among high school students, Georgia, 2013

80

Normal

70

Overweight

71 67 64

60

Obese

51 49 49

50

40

30

25 27 22

20

10

0

Physical activity 60 Strengthening exercises Stretching exercises 1

min/day

3 times/week

time/week

29

Figure 15

Percentage (%)

Physical activity behaviors among male high school students by weight status, Georgia, 2013

Normal

Overweight

80 70

Obese

60

62 66 56

70 72 64

50 40

35 40 29

30

20

10

0

Physical activity 60 Strengthening exercises Stretching exercises 1

min/day

3 times/week

time/week

Figure 16
Physical activity behaviors among female high school students by weight status, Georgia, 2013

Percentage (%)

Normal

80

70

Overweight

60

Obese

72 61 66

50

40

30

20

16 14 14

42

39

31

10

0

Physical activity 60 Strengthening exercises Stretching exercises 1

min/day

3 times/week

time/week

30

Participation in School Sports Teams
Approximately 58% of Georgia high school students who were normal weight, 53% of overweight students, and 49% of obese students participated in at least one school sports team. Obese students were 30% less likely to participate in a school sports team than students who were of normal weight
5. How often did Georgia high school students attend physical education class during the school week? (Table 5)
There was no difference in the frequency of physical education class attendance by weight status. Thirty-three percent (33%) of students who were normal weight, 35% of overweight students, and 39% of obese students met the recommendations to attend physical education class on all 5 days of the school week.
G. PERCEPTIONS ABOUT HEALTHY EATING AND PHYSICAL ACTIVITY
1. What were Georgia high school students' perceptions about eating healthy?
Which of these statements best describes healthy eating to you?
Georgia high school students were asked, "Which of these statements best describes healthy eating to you?" Selected answer choices included: "Eating fruits and vegetables", "Avoiding junk food", "Limiting sugary foods and drinks" and "Not eating very much." Students were only able to choose one answer choice.
Approximately 44% chose "eating fruits and vegetables", 26% chose "avoiding junk food", 24% chose "limiting sugary foods and drinks" and 6% chose "not eating very much."
By weight status (Table 6, Figure 17) There were differences in how Georgia high school students best described healthy eating by weight status. The plurality of normal weight (45%), overweight (42%) and obese (36%) students believe that "eating fruits and vegetables" best describes healthy eating to them. The second most selected statement representing healthy eating to overweight (26%) and obese (32%) students was "limiting sugary foods and drinks" while normal weight students (26%) selected "avoiding junk food". Overall, 5-8% of students believe "not eating very much" best describes healthy eating to them.
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Figure 17: Descriptions of Healthy Eating among Normal Weight, Overweight, and Obese High School Students, Georgia , 2013

Limiting sugary foods and drinks
23%

Not eating very much
6%
Eating fruits and
vegetables 45%

Normal Weight Students

Avoiding junk food 26%

Limiting sugary foods and drinks
26%
Overweight students

Not eating very much
8%
Eating fruits and vegetables
42%
Avoiding junk food
25%

Limiting sugary foods and drinks
32%
Obese students

Not eating very much
5%

Eating fruits and
vegetables 36%
Avoiding junk food 27%

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By daily fruit and vegetable consumption (Table 7, Figure 18) There were no differences in how Georgia high school students best described healthy eating by whether they met the recommendations for weekly fruit or vegetable consumption. The plurality of students who consume fruits 3 times/day (50%) or vegetables 3 times/day (52%) believe that "eating fruits and vegetables" best describes healthy eating to them. Students who consume fruits 3 times/day or vegetables 3 times/day next identified "avoiding junk food" and "limiting sugary foods and drinks" as best describing healthy eating to them. Five to seven percent (5-7%) of students who consume fruits 3 times/day or vegetables 3 times/day believe that "not eating very much" best describes healthy eating to them.
Figure 18: Descriptions of Healthy Eating by Students' Daily Fruit and Vegetable Consumption Status, Georgia, 2013

Limiting sugary foods and drinks
17%

Not eating very much
7%

Fruit consumption 3 times/day

Eating fruits

Avoiding

and

junk food vegetables

27%

50%

Not eating Limiting very much sugary foods 5% and drinks
17%

Vegetable consumption 3 times/day

Avoiding junk food
25%

Eating fruits and
vegetables 52%

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Why are you most likely to eat healthy foods?
Georgia high school students were also asked, "Why are you most likely to eat healthy foods?" Selected answer choices included: "I do not eat healthy foods", "My friends are watching", "I like how healthy foods taste", "My family eats healthy foods", "My doctor told me to", "I want to look good", "I want to be healthy" and "Some other reason". Students were only able to choose one answer choice.
Approximately 10% chose "I do not eat healthy foods", 3% chose "my friends are watching", 16% chose "I like how healthy foods taste", 10% chose "my family eats healthy foods", 2% chose "my doctor told me to", 13% chose "I want to look good", 39% chose "I want to be healthy" and 7% chose "Some other reason".
By weight status (Table 6) There were no differences in the stated reasons why Georgia high school students would eat healthy foods by students' weight status. The plurality of normal weight (39%), overweight (39%), and obese (39%) students chose "I want to be healthy" as a reason for why they are most likely to eat healthy foods. Normal weight (16%), overweight (15%) and obese (17%) students chose "I like how healthy foods taste" as the next most common reason they eat healthy foods, followed by "I want to look good." Friends ("My friends are watching"), family ("My family eats healthy foods"), and physician influence ("My doctor told me to") were chosen less often. About 10% of students said that they do not eat healthy foods.
By daily fruit and vegetable consumption (Table 7) There were differences in the reasons why Georgia high school students would eat healthy foods by their daily fruit and vegetable consumption status.
A higher percentage of students who consume fruits 3 times/day chose "I want to be healthy" (50% vs. 23% of students who did not eat any fruits in the past week), "I like how healthy foods taste" (17% vs. 10%), and "My family eats healthy foods" (10% vs. 6%) as reasons for why they eat healthy foods. A higher percentage of students who did not eat any fruits in the past week (33%) reported that they do not eat healthy foods compared to students who consume fruits 3 times/day (3%).
A higher percentage of students who consume vegetables 3 times/day chose "I want to be healthy" (55% vs. 37% of students who ate vegetables < 3 times/day) compared to students who ate vegetables < 3 times/day. A higher percentage of students who ate vegetables < 3
34

times/day state that "I want to look good" (13% vs. 2% of students who ate vegetables 3 times/day) and that they do not eat healthy foods (10% vs. 5%) in comparison to students who consume vegetables 3 times/day.
Where are you most likely to eat healthy foods?
Georgia high school students were also asked, "Where are you most likely to eat healthy foods?" Selected answer choices included: "I do not eat healthy foods", "At home", "At school", "At a restaurant", and "Some other place". Students were only able to choose one answer choice.
Approximately 8% chose "I do not eat healthy foods", 74% chose "at home", 11% chose "at school", 5% chose "at a restaurant", and 2% chose "some other place".
By weight status (Table 6, Figure 19) There were no differences in where Georgia high school students were most likely to eat healthy foods by students' weight status. The majority of normal weight (74%), overweight (77%) and obese (71%) students stated that they are most likely to eat healthy foods at home, followed by at school, in restaurants, and at some other place. Between 7-9% of students responded that they do not eat healthy foods.
By daily fruit and vegetable consumption (Table 7, Figure 20) There were differences in where Georgia high school students would most likely eat healthy foods by students' daily fruit and vegetable consumption status.
A greater percentage of students who consume fruits 3 times/day (85%) chose that they were most likely to eat healthy foods at home compared to students who did not eat any fruits in the last week (59%). A higher percentage of students who did not eat any fruits in the past week chose that they do not eat healthy foods (21% vs. 2% of students who consume fruits 3 times/day) or that they are most likely to eat healthy foods at a restaurant (8% vs. 1%).
A higher percentage of students who consumed vegetables 3 times/day (83%) chose that they were most likely to eat healthy foods at home than students who ate vegetables < 3 times/day in the past week (73%). Further, a higher percentage of students who ate vegetables < 3 times/day in the past week chose that they do not eat healthy foods (8% vs. 2% of students who consume fruits 3 times/day) compared to students who consume vegetables 3 times/day.
35

Figure 19: Most Likely Locations of Eating Healthy Foods among Georgia Normal Weight, Overweight, and Obese Students, 2013

Some other

At a restaurant place I do not eat

5%

3% healthy foods

At school

8%

11%

Normal Weight Students

At home 74%

At a restaurant 4%
At school 12%

Some other I do not eat

place healthy foods

1%

7%

Overweight Students

At home 77%

At a restaurant 5%
At school 15%

Some other I do not eat

place healthy foods

0.4%

9%

Obese Students

At home 71%
36

Figure 20: Most Likely Locations of Eating Healthy Foods by Daily Fruit and Vegetable Consumption of 3 times/day

At a restaurant 1%
At school 10%

Some other place 3%

I do not eat healthy foods
2%

Fruit consumption 3 times/day

At home 85%

Some other

At a restaurant 8%

place 3%

At school 9%

I do not eat healthy foods
21%

No fruit consumption in past week

At home 59%

37

Some other place
At a restaurant 4% At school 4%
7%

I do not eat healthy foods
2%

Vegetable consumption 3 times/day

At home 83%

Some other place
At a restaurant 2% 5%
At school 12%

I do not eat healthy foods
8%

Vegetable consumption < 3 times/day

At home 73%

38

2. What are Georgia high school students' perceptions about physical activity?
Why are you most likely to exercise?
Georgia high school students were also asked, "Why are you most likely to exercise?" Selected answer choices included: "I do not exercise", "My friends exercise", "I enjoy exercise", "My family exercises", "My doctor told me to", "I want to look good", "I want to be healthy" and "Some other reason".
Approximately 8% chose "I do not exercise", 4% chose "my friends exercise", 18% chose "I enjoy exercise", 3% chose "my family exercises", 1% chose "my doctor told me to", 34% chose "I want to look good", 19% chose "I want to be healthy" and 12% chose "some other reason".
By weight status (Table 6) There were differences in reasons to exercise by weight status among Georgia high school students. The plurality of normal weight (36%), overweight (30%), and obese (29%) students chose that they exercise because they want to look good. A higher percentage of obese students (27%) identified that they want to be healthy as a reason to exercise than normal weight students (18%). A higher percentage of normal weight students (20%) and overweight students (16%) identified that they enjoyed exercise compared to obese students (9%). Similar to reasons to eat healthy, friends ("My friends exercise"), family ("My family exercises"), and physician influence ("My doctor told me to") were chosen less often. Lastly, 7% of normal weight students, 8% of overweight students, and 13% of obese students chose that they do not exercise.
By physical activity status (Table 8) There were differences in the reasons why Georgia high school students would exercise by their physical activity status. A higher percentage of students who participate in PA 60 min/day chose "I enjoy exercise" (26% vs. 9% of students who did not participate in PA 60 min/day) and "I want to be healthy" (24% vs. 14%) as reasons for why they are most likely to exercise. A higher percentage of students who did not participate in PA 60 min/day (34%) chose that they do not exercise in comparison to students who participate in PA 60 min/day (2%).
By participation in strengthening exercises (Table 8) There were differences in the reasons why Georgia high school students would exercise by their status of participation in strengthening exercises. A higher percentage of students who
39

participated in strengthening exercises 3 days/week chose "I want to look good" (37% vs. 28% of students who did not participate in strengthening exercises 3 days/week), "I enjoy exercise" (23% vs. 10%), and "I want to be healthy" (22% vs. 16%) as reasons for why they are most likely to exercise.
Where are you most likely to exercise?
Georgia high school students were also asked, "Where are you most likely to exercise?" Selected answer choices included: "I do not exercise", "At home", "At school", "At a fitness center", and "Some other place".
Approximately 7% chose "I do not exercise", 39% chose "at home", 28% chose "at school", 17% chose "at a fitness center", and 9% chose "some other place".
By weight status (Table 6, Figure 21) The plurality of normal weight (40%), overweight (39%), and obese (34%) students chose that they are most likely to exercise at home, followed by at their school, at a fitness center, and at some other place. Six to nine percent of students chose that they do not exercise. There were no differences in where Georgia high school students were most likely to exercise by their weight status.
By physical activity status (Table 8, Figure 22) There were differences in where Georgia high school students were most likely to exercise by their physical activity status. The plurality of students who participated in PA 60 min/day chose that they were most likely to exercise at school (42%), followed by at their home (33%), at a fitness center (16%), and at some other place (9%). The plurality of students who did not participate in PA in the last week chose that they were most likely to exercise at home (38%), followed by their school (18%), at a fitness center (10%), and at some other place (7%). Twenty-eight percent (28%) of students who did not participate in exercise in the last week chose that they do not exercise at all.
By participation in strengthening exercises (Table 8, Figure 22) There were differences in where Georgia high school students were most likely to exercise by their status of participation in strengthening exercises. The plurality of students who participated in strengthening exercises 3 days/week chose that they were most likely to exercise at school (37%), followed by at their home (35%), at a fitness center (20%), and at some other place (9%). The plurality of students who did not participate in strengthening exercises 3 days/week in the last week chose that they were most likely to exercise at
40

home (42%) followed by their school (16%), at a fitness center (14%), and some other place (7%). Twenty-two percent (22%) of students who did not participate in strengthening exercises in the last week chose that they do not exercise at all.
41

Figure 21: Likely Locations of Exercise among Georgia Normal Weight, Overweight, and Obese Students, 2013

Some other place 10%

I do not exercise
6%

At a fitness center 16%

Normal Weight Students

At school 27%

At home 40%

At a fitness center 19%

Some other place 6%

I do not exercise
6%

Overweight Students

At school 30%

At home 39%

At a fitness center 18%

Some other place 7%

I do not exercise
9%

Obese students

At school 32%

At home 34%

42

Figure 22: Likely Locations of Exercise among Georgia High School Students by Physical Activity Level and Participation in Strengthening Exercises, 2013

Some other place 9%

I do not exercise
1%

At a fitness center 16%

At home 33%

Physical activity of
60 min/day

At school 42%

At a fitness center 10%

Some other place 7%

At school 18%

I do not exercise
28%

No physical activity
in past week

At home 38%

43

At a fitness center 20%

Some other place 9%
At home 35%

Strengthening exercises of
3 days/week

At school 37%

Some other place 7%

At a fitness center 14%

At school 16%
No strengthening exercises in past week

At home 42%

I do not exercise
22%

44

Who are you most likely to exercise with? Georgia high school students were also asked, "Who are you most likely to exercise with?" Selected answer choices included: "I do not exercise", "My friends", "At school", "Myself", "Someone in my family" and "Someone else". Approximately 6% chose "I do not exercise", 40% chose "my friends", 37% chose "at school", 12% chose "myself", 12% chose "someone in my family" and 5% chose "someone else". By weight status (Table 6, Figure 23) There were differences in who high school students were most likely to exercise with by their weight status. The plurality of normal weight (39%), overweight (40%), and obese (43%) students chose that they are most likely to exercise with friends. A higher percentage of normal weight students exercise by themselves (39%) than overweight (33%) or obese (30%) students, while more overweight (18%) and obese (14%) students exercise with family members than normal weight students (10%). Between 5-9% of students chose that they do not exercise at all.
45

Figure 23: Likely Exercise Companions Among Georgia Normal Weight, Overweight, and Obese Students, 2013

Someone else
Someone 6% in my family 10%

I do not exercise
6%

Someone

Someone else in my 3%

I do not exercise
5%

family

18%

Myself 39%
Normal weight students

My friends
39%

Myself 33%
Overweight students

My friends
40%

Someone Someone I do not

in my else exercise

family 4%

9%

14%

Myself 30%

My friends
43%

Obese students

By physical activity status (Table 8, Figure 24) There were differences in who Georgia high school students were most likely to exercise by the students' physical activity status. The majority of students who participated in PA 60 min/day chose that they were most likely to exercise with their friends (50%), followed by themselves (31%), with someone in their family (12%), and someone else (7%). The plurality of students who did not participate in PA in the last week chose that they were most likely to exercise by themselves (34%), followed by with their friends (24%), with someone in their family (13%), and with someone else (4%). Twenty-five percent (25%) of students who did not participate in exercise in the last week chose that they do not exercise at all.
By participation in strengthening exercises (Table 8, Figure 24) There were differences in who Georgia high school students were most likely to exercise by their status of participation in strengthening exercises. The plurality of students who
46

participate in strengthening exercises 3 days/week chose that they were most likely to exercise with their friends (46%), followed by themselves (37%), with someone in their family (11%), and someone else (5%). The plurality of students who did not participate in strengthening exercises 3 days/week in the last week chose that they were most likely to exercise by themselves (35%) followed by with their friends (29%), with someone in their family (12%), and with someone else (5%). Nineteen percent (19%) of students who did not participate in strengthening exercises chose that they do not exercise at all.
47

Figure 24: Likely Exercise Companions among Georgia High School Students by Physical Activity Level and Participation in Strengthening Exercises

Someone else 7%
Someone in my family 12%

I do not exercise
1%

Myself 31%
Physical Activity of 60 min/day

My friends 50%

Someone in my family 13%

Someone else 4% I do not exercise 25%

No physical activity
in past week

Myself 34%

My friends 24%

48

Someone in my family 11%

Someone else 5%

Strengthening Exercises of
3 days/week

Myself 37%

My friends 46%

Someone in my family 12%

No strengthening exercises
in past week

Myself 35%

Someone else 5%
I do not exercise
19%
My friends 29%

49

H. POTENTIAL ACTION STEPS
The dietary and physical activity behaviors of adolescents are influenced by many sectors of society including families, communities, healthcare providers, faith-based institutions, government agencies, the media, and the food and beverage industries and entertainment industry. Schools play a critical role in improving dietary and physical activity behaviors of adolescents. To improve obesity, fruit and vegetable consumption and physical activities levels among Georgia high school students, the following potential action steps could be undertaken:
1. Work with school nutrition directors, other administrative staff, parents, and community members to implement school-based nutrition policies/interventions. (26, 27) Examples include: Ensure that school meals meet federally-defined nutrition standards based on the Dietary Guidelines for Americans (9). The USDA's A Menu Planner for Healthy School Meals provides information on how to plan, prepare, serve, and market healthy school meals (28). Encourage student participation in school meal programs, such as the School Breakfast Program. For meals served outside of the schooI meal programs, implement school nutrition standards that are consistent with the Institute of Medicine's Nutrition Standards for Foods in Schools to increase access to healthy foods/beverages (e.g., snacks, vending) (29, 30). Implement school community gardens/greenhouses, school salad bars, and farm-toschool programs which can promote fruit and vegetable consumption. Adopt marketing techniques to promote healthy dietary choices (e.g., placing nutritious products such as fresh produce in prominent places in cafeteria lines, point-of-purchase promotions) (31). Modify food prices in schools to improve sale and consumption of healthy foods/beverages such as fresh produce and reduce sale and consumption of less healthy foods/beverages. Implement health education that improves knowledge and skills on healthy eating. Develop school wellness policies to address healthy eating (could include policies/practices mentioned above).
2. Work with school physical education directors, other administrative staff, parents and community members implement school-based physical activity policies/interventions. (26, 27)
50

Implement physical activity standards to increase time spent in structured or unstructured play, sports or recreation in the school setting (e.g., physical education, physical activity breaks, after-school and lunchtime intramural and physical activity clubs, interscholastic sports).
Increase access to school facilities and equipment (e.g., playgrounds, fields, courts) to support physical activity (e.g., access during out-of-school hours).
Offer students opportunities to participate in intramural physical activity programs and/or interscholastic sports during after-school hours.
Develop and place point-of-decision prompts for physical activity such as signage for information/navigation/motivation in schools or communities to encourage active choices.
Implement health education that improves knowledge of and skills for physical activity. Increase access to safe, convenient, and fun opportunities to bicycle or walk to and from
school (e.g., traffic safety, sidewalks or bike lanes, walking school bus) through Safe Routes to School programs (32). Improve traffic (e.g., reduced speed limits, increased street crossing aids) and neighborhood safety (e.g., reduced crime rates, reduced physical/social disorder, increased perceptions of safety) around schools. Decrease access to sedentary activities (e.g., reduced television/computer/video game time, television turn-off devices, increased active video games) in schools. Develop school wellness policies to address physical activity and/or BMI assessment (could include policies/practices mentioned above).
3. Work with schools and physical education program directors to provide quality physical education to students of all grade levels for all 5 days of the school week. Students should engage in moderate to vigorous physical activity for at least 50% of the time they spend in PE class.
4. Engage with parents and other community members to promote healthy eating (e.g., reduce eating out at fast food restaurants and eating more fresh fruits and vegetables, encourage eating breakfast every day) and physical activity (e.g., encouraging exercising with friends and family members) among students at home and at school (27).
5. Work with school health, mental health, and social services staff to discourage obese students from using fasting and diet pills as a way to try and lose weight and encourage safer and more healthful behaviors such as healthy eating and physical activity (27).
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I. Georgia Program Highlight Georgia Shape Initiative
Georgia Shape Initiative Georgia Shape is the Governor's statewide, multi-agency and multi-dimensional initiative that brings together governmental, philanthropic, academic and business communities to address childhood (0-18) obesity in Georgia with efforts focused in a variety of settings in including schools and communities. Over the next ten years Georgia Shape will work towards increasing the number of students in the Healthy Fitness Zone for Body Mass Index by ten percent. Other objectives set forth by the Governor and Georgia Shape include reaching disparate populations and increasing the aerobic capacity measure of Georgia's youth.
Georgia Shape grew from the mandate passed in 2009 requiring all students in grades 1st12th enrolled in physical education to participate in a fitness assessment (Georgia chose the Fitnessgram fitness test, which was recently named the national standardized fitness assessment). Georgia Shape, the Georgia Department of Education, Children's Healthcare of Atlanta, and HealthMPowers worked together to effectively train physical educators across the state on how to successfully implement Fitnessgram in their school setting. Other components of the program include fitness test report generation and dissemination of results confidentially to individual students and families as well as aggregate data to schools and the community to provide overview of overall growth and highlight areas for improvement, technical assistance to schools and school districts from partners, and more. Together, these components encourage important conversations about physical health and fitness and endorse a long-term view of health that promotes lifelong habits of physical activity among youth in Georgia (33).
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J. LIMITATIONS There are several limitations when interpreting the results of this report. First, estimates of self-reported behaviors such as fruit and vegetable consumption were based on self-report, and respondents might not have accurately reported their consumption; therefore, estimates might be either underestimated or overestimated. Second, although it was possible to estimate the frequency of self-reported behaviors such as fruit intake, vegetable intake and sugar-sweetened beverage intake, it was not possible to determine the actual amount of these items consumed (e.g., the servings of fruits and vegetables consumed per day). Therefore, we are unable to determine if students are actually meeting the DGA recommendations. Third, socioeconomic variables such as household income and parent education level were not captured in this survey; therefore, an assessment of the relationship between these socioeconomic variables and overweight/obesity, dietary behaviors and physical activity could not be done for high school students in Georgia (previous studies elsewhere have established the important link between socioeconomic status and obesity and dietary and physical activity patterns). Fourth, there are several other potential influential reasons to choose to eat healthy or exercise that were not assessed in this survey, such as the availability of healthy foods at home or nearby recreational facilities. However, these other factors may have been captured in the response `Some other reason'. Lastly, given that this is a cross-sectional study, causality or the directionality of any associations could not be determined.
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K. REFERENCES
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2. National Center for Health Statistics. Health, United States, 2011: With Special Features on Socioeconomic Status and Health. Hyattsville, MD; U.S. Department of Health and Human Services; 2012.
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4. Taveras EM, Berkey CS, Rifas-Shiman SL, Ludwig DS, Rockett HR, Field AE Colditz GA, Gillman MW. Association of consumption of fried food away from home with body mass index and diet quality in older children and adolescents. Pediatrics. 2005; 116(4): e518-24.
5. Graham DJ, Wall MM, Larson N, and Neumark-Sztainer D. Multicontextual correlates of adolescent leisure-time physical activity. American Journal of Preventive Medicine. 2014; 46(6): 605-616.
6. National Institutes of Health, National Heart, Lung, and Blood Institute. Disease and Conditions Index: What Are Overweight and Obesity? Bethesda, MD: National Institutes of Health; 2010.
7. Krebs NF, Himes JH, Jacobson D, Nicklas TA, Guilday P, Styne D. Assessment of child and adolescent overweight and obesity. Pediatrics 2007;120:S193S228.
8. Li C, Ford ES, Zhao G, Mokdad AH. Prevalence of pre-diabetes and its association with clustering of cardiometabolic risk factors and hyperinsulinemia among US adolescents: NHANES 20052006. Diabetes Care 2009; 32:342347.
9. Daniels SR, Arnett DK, Eckel RH, et al. Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation 2005; 111;1999 2002.
10. Freedman DS, Zuguo M, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. Journal of Pediatrics 2007; 50(1):1217.
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12. Dietary Guidelines for Americans. Available at: http://www.health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf.
13. Bowman SA, Gortmaker SL, Ebbeling CB, Pereira MA, Ludwig DS. Effects of fast-food consumption on energy intake and diet quality among children in a national household survey. Pediatrics 2004; 113: 1128.
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14. Park S, Blanck H, Sherry B, Brener N, O'Toole T. Factors associated with sugar-sweetened beverage intake among United States high school students. J Nutr. 2012; 142: 306 312.
15. Taras HL. Nutrition and student performance at school. Journal of School Health 2005; 75: 199213.
16. Rampersaud GC, Pereira MA, Girard BL, Adams J, Metzl JD. Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents. Journal of the American Dietetic Association 2005;105:743760.
17. Hoyland A, Dye L, Lawton CL. A systematic review of the effect of breakfast on the cognitive performance of children and adolescents. Nutrition Research Reviews 2009; 22: 220243.
18. U.S. Department of Health and Human Services. Physical Activity Guidelines Advisory Committee report. Washington, DC: U.S. Department of Health and Human Services, 2008.
19. CDC. The Association Between School-Based Physical Activity, Including Physical Education, and Academic Performance. Atlanta, GA: U.S. Department of Health and Human Services; 2010.
20. U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans. Washington, DC: U.S. Department of Health and Human Services; 2008.
21. Centers for Disease Control and Prevention. School health guidelines to promote healthy eating and physical activity. MMWR Morb Mortal Wkly Rep. 2011;60(RR-5).
22. Centers for Disease Control and Prevention. The Association Between School-Based Physical Activity, Including Physical Education, and Academic Performance. Atlanta, GA: Centers for Disease Control and Prevention. US Dept of Health and Human Services; 2010.
23. Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Report, 2008. Washington, DC: US Dept of Health and Human Services; 2008.
24. Story M, Neumark-Sztainer D, French S. Individual and environmental influences on adolescent eating behaviors. J Am Diet Assoc 2002;102:S4051.
25. Centers for Disease Control and Prevention. Methodology of the Youth Risk Behavior Survey 2013. MMWR 2013;62(1):1-20.
26. Robert Wood Johnson Foundation. Which Environmental and Policy Interventions Prevent Obesity? Available at: http://www.rwjf.org/content/dam/farm/reports/program_results_reports/2013/rwjf4076 04
27. Centers for Disease Control and Prevention. School Health Guidelines to Promote Healthy Eating and Physical Activity. Available at: http://www.cdc.gov/mmwr/PDF/rr/rr6005.pdf
28. US Department of Agriculture, Food and Nutrition Service. A menu planner for healthy school meals. Washington, DC: US Department of Agriculture; 1998.
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30. Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/Healthyyouth/nutrition/standards.htm).
31. Food and Nutrition Service. Fruits and vegetables galore: helping kids eat more. Washington, DC: US Department of Agriculture; 2004.
32. Georgia Department of Transportation. Safe Routes to School. Available at: http://www.saferoutesga.org/
33. Georgia Department of Public Health. Georgia SHAPE Program. Available at: http://www.georgiashape.org/home
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Table 1: Demographics of Georgia High School Students by Physical Activity Status Youth Risk Behavior Survey, 2013

Characteristic

Physical Activity for 60 min/daya

Total sample
Grade 9th 10th 11th 12th
Sex
Male
Female Race/ethnicity
White, nonHispanic Black, nonHispanic Hispanic
Other, Multiracial

None % (CI) 18.7 (16.4, 21.0)
15.6 (9.7, 21.6)
15.5 (11.1, 19.9)
19.4 (16.3, 22.4)
25.4 (18.8, 32.0)
15.7 (12.5, 18.8)
21.5 (17.9, 25.2)
14.0 (11.1, 16.9)
23.3 (19.6, 27.0)
18.5 (12.8, 24.2)
17.1 (9.1, 25.1)

1-6 days/week
% (CI)
56.6 (54.6, 58.6)
N = 1903
55.6 (52.0, 59.3)
57.7 (53.8, 61.7)
55.7 (51.8, 59.5)
57.8 (51.4, 64.1)
N = 1917
49.9 (45.8, 53.9)
63.4 (59.6, 67.2)
N = 1878
59.3 (55.9, 62.7)
54.1 (49.3, 58.9)
58.3 (51.5, 65.1)
54.2 (44.4, 63.9)

Daily % (CI) 24.7 (22.6, 26.8)
28.8 (24.2, 33.3)
26.8 (22.7, 30.9)
25.0 (20.8, 29.1)
16.8 (13.1, 20.5)
34.5 (30.6, 38.3)
15.1 (12.7, 17.4)
26.7 (22.5, 30.9)
22.6 (19.0, 26.2)
23.2 (17.9, 28.6)
28.7 (21.2, 36.3)

Strengthening Exercisesb

None % (CI) 31.4 (27.9, 34.8)
24.0 (17.3, 30.8)
30.4 (26.6, 34.2)
34.8 (25.4, 44.2)
39.7 (32.9, 46.5)

1-2 days/week % (CI)
18.5 (16.7, 20.2)

3 days/week % (CI)
50.1 (46.4, 53.9)

N = 1453

19.0 (14.9, 23.1)
17.4 (14.4, 20.3)
20.5 (16.3, 24.7)
17.4 (15.5, 19.3)

57.0 (50.2, 63.7)
52.2 (47.7, 56.7)
44.7 (37.6, 51.8)
42.9 (35.6, 50.2)

23.1 (18.9, 27.3)
39.4 (35.4, 43.5)

N = 1465
16.0 (13.0, 19.0)
20.9 (17.3, 24.6)

60.9 (55.4, 66.5)
39.6 (35.7, 43.6)

30.4 (25.8, 35.0)
32.8 (26.9, 38.7)
32.0 (24.4, 39.6)
31.5 (24.6, 38.4)

N = 1442
16.9 (13.7, 20.0)
21.5 (19.3, 23.6)
16.5 (10.1, 22.9)
19.1 (13.8, 24.5)

52.7 (47.4, 58.0)
45.7 (39.4, 52.0)
51.5 (42.1, 60.8)
49.4 (41.6, 57.2)

57

Physical Education Attendance During School Weekc

None % (CI) 50.3 (42.9, 57.7)
33.5 (20.3, 46.7)
52.2 (41.4, 63.1)
60.5 (53.0, 68.0)
61.7 (54.2, 69.2)

1-4 days/week
% (CI)
16.1 (10.0, 22.1)
N = 1882
14.3 (6.2, 22.3)
15.8 (7.6, 24.0)
16.1 (9.1, 23.1)
18.5 (11.8, 25.1)

Daily % (CI) 33.6 (26.7, 40.5)
52.2 (37.7, 66.7)
32.0 (22.5, 41.5)
23.4 (16.7, 30.1)
19.9 (13.0, 26.7)

40.9 (34.0, 47.7)
60.0 (51.4, 68.5)
53.5 (44.6, 62.5)
47.9 (38.6, 57.3)
46.1 (34.6, 58.6)
48.7 (39.0, 58.4)

N = 1896
20.4 (13.2, 27.7)
11.3 (6.1, 16.4)
N = 1858
9.7 (5.9, 13.5)
22.7 (11.6, 33.8)
16.9 (8.8, 25.0)
18.3 (9.0, 27.7)

38.7 (31.6, 45.8)
28.8 (20.6, 37.0)
36.8 (27.9, 45.6)
29.3 (22.5, 36.2)
37.0 (24.1, 50.0)
32.9 (25.6, 40.3)

a During the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day? b On how many of the past 7 days did you do exercises to strengthen or tone your muscles, such as push-ups, sit-ups, or weight lifting? c In an average week when you are in school, on how many days do you go to physical education (PE) classes?
58

Table 2: Demographic characteristics of Georgia High School Students by Weight Status Youth Risk Behavior Survey, 2013

Characteristic
Total sample Grade (N = 1880) 9th 10th 11th 12th Sex (N = 1898) Male Female Race/ethnicity (N = 1857) White, non-Hispanic Black, non-Hispanic Hispanic Other, Multiracial

All
% (CI)
29.9 26.4 22.1 21.5
50.5 49.5
46.1 37.6 9.8 6.4

Normal % (CI) 70.2
73.5 68.6 67.4 70.2
68.5 72.0
74.5 65.4 62.6 77.0

Weight Status
Overweight % (CI) 17.1
16.2 15.9 20.5 16.5
17.4 16.9
14.6 20.1 20.7 12.1

Obese % (CI) 12.8
10.3 15.4 12.1 13.3
14.1 11.1
10.9 14.5 16.7 10.8

59

Table 3: Behaviors to Try and Lose Weight among High School Students in Georgia by Weight Status Youth Risk Behavior Survey, 2013

Dietary behaviors
Behaviors to try and lose weight (n = 1727)
Fastingc

Normal % (CI)
13.5 (11.3, 15.8)

Bivariate Analysis Weight Status Overweight % (CI)
19.3 (14.1, 24.6)

Obese % (CI)
21.3 (14.8, 27.7)

P valuea

Multivariable Logistic Regression Analysisb

Obese

Odds ratio

95% CI

0.0013

1.83

(1.3, 2.6)

Took diet pillsd

5.6 (3.8, 7.4)

10.1 (5.4, 14.8)

13.7 (10.8, 16.6)

<0.0001

2.66

(1.8, 4.0)

Vomiting/Laxativese

6.4 (4.5, 8.3)

7.7 (4.4, 11.1)

8.3 (1.5, 15.1)

0.70

1.29

(0.5, 3.2)

a Chi-square tests used to test for statistical significance using a p-value of < 0.05 as cut-off point for significance. b Multi-variable logistic regression model included grade, sex, and race-ethnicity in one model. Reference category included students
who were not obese. c During the past 30 days, did you go without eating for 24 hours or more (also called fasting) to lose weight or to keep from gaining
weight? d During the past 30 days, did you take any diet pills, powders, or liquids without a doctor's advice to lose weight or to keep from
gaining weight? e During the past 30 days, did you vomit or take laxatives to lose weight or to keep from gaining weight?

60

Table 4: Dietary behaviors among High School Students in Georgia by Weight Status Youth Risk Behavior Survey, 2013

Dietary behaviors 100% Fruit juice intakec (n = 1792) None
1-6 times/week
1-2 times/day
3 times/day Fruit intaked (n = 1792) None
1-6 times/week
1-2 times/day
3 times/day

Normal
% (CI)
N = 1255
23.1 (20.4, 25.9)
54.1 (50.7, 57.5)
14.3 (12.2, 16.4)
8.5 (5.9, 11.1)
N = 1255
14.3 (12.3, 16.4)
55.8 (52.6, 59.0)
19.7 (17.6, 21.8)
10.1 (8.4, 11.8)

Bivariate Analysis
Weight Status Overweight
% (CI)
N = 313
22.0 (16.5, 27.6)
51.3 (44.0, 58.6)
17.2 (12.5, 21.8)
9.5 (6.0, 13.1)
N = 313
9.8 (6.2, 13.4)
61.7 (54.3, 69.1)
18.8 (13.7, 23.9)
9.7 (7.3, 12.1)

Obese
% (CI)
N = 224
27.6 (18.9, 36.3)
53.9 (46.8, 61.0)
11.6 (7.6, 15.7)
6.9 (2.8, 10.9)
N = 224
11.3 (6.6, 16.0)
60.2 (54.1, 66.4)
17.8 (12.5, 23.1)
10.7 (4.6, 16.7)

P value

Multivariable Logistic

Regression Analysis

Obese

Odds ratio

95% CI

0.48 Reference

0.85

(0.5, 1.3)

0.69

(0.4, 1.2)

0.64

(0.3, 1.4)

0.34

Reference

1.4

(1.0, 2.1)

1.2

(0.7, 1.9)

1.3

(0.7, 2.7)

61

100% Juice and fruit intake

N = 1289

N = 322

N = 230

0.83

< 3 times/day

81.5 (78.2, 84.7)

80.0 (75.0, 85.1)

81.0 (74.4, 87.6)

3 times/day

18.5 (15.3, 21.8)

20.0 (14.9, 25.0)

19.0 (12.4, 25.6)

Vegetable intakee (n = 1806)

N = 1266

N = 313

N = 227

0.44

< 3 times/day

88.9 (87.3, 90.5)

89.9 (86.0, 93.9)

87.0 (83.6, 90.4)

3 times/day

11.1 (9.5, 12.7)

10.1 (6.1, 14.0)

13.0 (9.6, 16.4)

Fruit and vegetable

intake

1275

319

229

0.95

(n = 1823)

Eat fruit or drink

100% juice 2 times/day and eat vegetables 3

7.9 (6.2, 9.5)

7.44 (3.6, 11.1)

8.0 (4.3, 11.7)

times/day

Sugar-sweetened beverage intakef
(n = 1471)

N = 1031

N = 249

N = 191

0.17

None

27.3 (23.3, 31.2)

25.0 (18.8, 31.2)

31.0 (23.8, 38.3)

1-6 times/week

52.5 (49.0, 56.0)

58.5 (53.6, 63.3)

48.9 (43.9, 53.8)

1 time/day

20.2 (16.7, 23.7)

16.5 (10.9, 22.1)

20.1 (12.8, 27.4)

62

Reference

1.0

(0.7, 1.5)

Reference

1.2

(0.9, 1.6)

1.0

(0.6, 1.8)

Reference

0.83

(0.7, 1.1)

0.87

(0.6, 1.3)

Fast food intakeg (n = 1490)

N = 1041

N = 257

N = 193

0.005

None

21.5 (18.6, 24.3)

28.3 (19.9, 36.7)

21.0 (15.1, 26.8)

1-2 days/week

43.0 (39.7, 46.3)

40.1 (34.4, 45.8)

53.5 (47.4, 59.5)

3 days/week

35.5 (30.7, 40.3)

31.5 (26.1, 37.0)

25.6 (16.7, 34.5)

Skipping breakfasth (n = 1806)

N = 1268

N = 312

N = 226

0.39

Reference

1.3

(1.0, 1.8)

0.74

(0.5, 1.2)

Every day

15.4 (13.2, 17.5)

15.2 (11.0, 19.3)

16.2 (10.9, 21.4)

Reference

5-6 days/week

18.0 (15.1, 20.9)

21.9 (15.9, 27.8)

22.9 (16.5, 29.3)

1.24

(0.7, 2.1)

4 days/week

66.6 (62.8, 70.5)

63.0 (56.8, 69.2)

61.0 (55.0, 66.9)

0.89

(0.6, 1.4)

a Chi-square tests used to test for statistical significance using a p-value of < 0.05 as cut-off point for significance. b Multi-variable logistic regression model included grade, sex, and race-ethnicity in one model. Reference category included students

who were not obese. c During the past 7 days, how many times did you drink 100% fruit juices such as orange juice, apple juice, or grape juice? d During the past 7 days, how many times did you eat fruit? e During the past 7 days, how many times did you eat [green salad + carrots + potatoes + other vegetables]? f During the past 7 days, how many times did you drink a can, bottle, or glass of a sugar-sweetened beverage such as lemonade,

sweetened tea or coffee drinks, flavored milk, Snapple, or Sunny Delight? g During the past 7 days, on how many days did you eat at least one meal or snack from a fast food restaurant such as McDonald's,

Taco Bell, or KFC? hDuring the past 7 days, on how many days did you eat breakfast?

63

Table 5: Physical Activity behaviors among High School Students in Georgia by Weight Status Youth Risk Behavior Survey, 2013

Physical Activity behaviors (n = Physical activity for 60 min/dayc (n = 1794) None
1-6 days/week
Daily Strengthening exercisesd (n = 1390) None
1-2 days/week
3 days/week Stretching exercisese (n = 1408)
None

Normal
% SE
N = 1260
18.0 (15.3, 20.7)
56.8 (54.2, 59.3)
25.2 (23.4, 27.1)
N = 979
30.3 (27.6, 33.1)
18.5 (16.5, 20.5)
51.1 (48.0, 54.2)
N = 986
28.7 (26.7, 30.7)

Bivariate Analysis
Weight Status Overweight
% SE
N = 309
16.0 (11.3, 20.7)
56.6 (50.0, 63.2)
27.4 (19.2, 35.6)
N = 229
32.2 (25.6, 38.9)
19.0 (15.2, 22.7)
48.8 (41.9, 55.6)
N = 241
32.9 (25.7, 40.0)

Obese
% SE
N = 225
19.4 (12.0, 26.7)
58.4 (53.1, 63.7)
22.3 (16.6, 27.9)
N = 182
37.2 (28.4, 46.0)
14.2 (8.6, 19.8)
48.6 (39.5, 57.5)
N = 181
35.8 (24.8, 46.9)

P valuea

Multivariable Logistic Regression Analysisb

Obese

Odds ratio

95% CI

0.75

Reference

1.0

(0.7, 1.5)

0.8

(0.4, 1.3)

0.17

Reference

0.60 (0.4, 0.9)

0.69 (0.5, 0.9)

0.19

Reference

64

Stretch for 1 day/wk
Physical Education Attendance During School Weekf (n = 1776)

71.3 (69.3, 73.3)
N = 1250

67.1 (60.0, 74.3)
N = 306

64.2 (53.1, 75.2)
N = 220

0.73 (0.5, 1.1) 0.45

None 1-4 days/week

51.6 (44.4, 58.7)
15.6 (9.2, 21.9)

47.3 (34.7, 59.9)
18.1 (6.7, 29.6)

49.5 (41.3, 57.8)
12.0 (5.5, 18.4)

Reference 0.73 (0.4, 1.2)

Daily

32.9 (25.4, 40.3)

34.6 (23.7, 45.5)

38.5 (21.5, 44.5)

1.22 (0.9, 1.6)

Participate in Sports teamsg (n = 1812)

1281

310

221

0.008

None

42.1 (38.6, 45.5)

47.3 (42.45, 52.2)

50.4 (43.2, 57.6)

Reference

On 1 sports team

57.9 (54.5, 61.4)

52.7 (47.8, 57.6)

49.6 (42.4, 56.8)

0.69 (0.5, 0.9)

a Chi-square tests used to test for statistical significance using a p-value of < 0.05 as cut-off point for significance. b Multi-variable logistic regression model included grade, sex, and race-ethnicity in one model. Reference category included students

who were not obese. c During the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day?
d On how many of the past 7 days did you do exercises to strengthen or tone your muscles, such as push-ups, sit-ups, or weight

lifting? e On how many of the past 7 days did you do stretching exercises, such as toe touching, knee bending, or leg stretching? f In an average week when you are in school, on how many days do you go to physical education (PE) classes? g During the past 12 months, on how many sports teams did you play?

65

Table 6: Perceptions about Healthy Eating among High School Students in Georgia by Weight Status Youth Risk Behavior Survey, 2013

Perceptions about Healthy Eating and Physical Activity Healthy Eating (n = 1457) Which of these statements best describes healthy eating to you? Eating fruits and vegetables
Avoiding `junk food'
Limiting sugary foods and drinks
Not eating very much
Why are you most likely to eat hI deoalnthoyt feoaotdhse?althy foods
My friends are watching
I like how healthy foods taste My family eats healthy foods
My doctor told me to

Overall
% (CI)
43.4 (40.9, 45.8)
26.1 (23.2, 29.1)
24.4 (21.5, 27.3)
6.1 (4.8, 7.4)
9.8 (8.0, 11.6)
2.5 (1.6, 3.5)
16.2 (13.8, 18.5)
10.3 (7.7, 12.8)
2.4 (1.3, 3.5)

Normal
% (CI)
N = 1023
45.2 (43.0, 47.3)
26.4 (23.5, 29.2)
22.6 (19.7, 25.5)
5.8 (4.6, 7.0)
N = 1023
9.7 (8.0, 11.5)
2.5 (1.4, 3.6)
16.3 (13.8, 18.7)
10.3 (7.0, 13.6)
2.3 (1.1, 3.6)

Weight Status

Overweight

Obese

% (CI)

% (CI)

N = 244
41.8 (34.2, 49.4)
24.5 (17.5, 31.5)
25.9 (20.4, 31.5)
7.8 (3.6, 12.0)
N = 244
10.0 (5.8, 14.2)
2.2 (0.1, 4.3)
15.0 (10.2, 19.8)
11.9 (6.7, 17.1)
2.4 (0.9, 4.0)

N = 190
35.7 (28.7, 42.6)
26.9 (21.3, 32.4)
32.1 (25.2, 39.0)
5.4 (1.5, 9.3)
N = 190
9.7 (4.0, 15.4)
3.2 (1.0, 5.4)
17.1 (12.0, 22.2)
7.9 (3.9, 11.9)
21.8 (0.9, 4.6)

P valuea 0.04
1.0

66

I want to look good
I want to be healthy
Some other reason Where are you most likely to eat healthy foods? I do not eat healthy foods
At home
At school
At a restaurant
Some other place Physical Activity (n = 1337) Why are you most likely to exercise? I do not exercise
My friends exercise
I enjoy exercise
My family exercises
My doctor told me to

12.9 (11.7, 14.2)
39.2 (36.5, 42.0)
6.7 (5.1, 8.2)
7.8 (6.2, 9.4)
74.2 (72.0, 76.5)
11.4 (9.8, 13.0)
4.5 (3.7, 5.3)
2.0 (1.6, 2.5)
8.1 (6.8, 9.5)
3.9 (2.6, 5.1)
18.0 (16.3, 19.6)
2.8 (1.7, 3.9)
1.0 (0.4, 1.7)

12.9 (11.7, 14.0)
39.3 (36.2, 42.4)
6.7 (5.0, 8.4)
N = 1023
7.9 (5.7, 10.1)
74.3 (71.6, 77.1)
10.7 (8.8, 12.6)
4.5 (3.7, 5.3)
2.6 (1.9, 3.2)

13.0 (9.5, 16.6)
39.0 (33.4, 44.7)
6.4 (2.7, 10.0)
N = 244
6.6 (3.4, 9.9)
76.6 (71.7, 81.6)
11.8 (8.2, 15.3)
3.9 (2.2, 5.7)
1.0 (0.0, 2.2)

N = 939
7.2 (5.9, 8.6)
3.3 (1.7, 4.9)
20.0 (17.6, 22.5)
2.7 (1.4, 3.9)
0.9 (0.1, 1.6)

N = 224
8.4 (5.9, 10.9)
6.5 (4.4, 8.6)
15.9 (10.5, 21.3)
3.6 (1.0, 6.1)
1.9 (0.0, 3.7)

67

13.3 (9.2, 17.4)
39.2 (32.2, 46.2)
6.9 (2.9, 10.9)
N = 190
8.9 (4.6, 13.3)
70.6 (62.6, 78.6)
14.7 (9.6, 19.8)
5.4 (2.3, 8.4)
0.4 (0.0, 1.4)
N = 174
12.7 (8.1, 17.4)
3.9 (1.0, 6.8)
9.3 (2.8, 15. 7)
2.6 (0.8, 4.4)
0.8 (0.0, 2.0)

0.18 0.0002

I want to look good
I want to be healthy
Some other reason Where are you most likely to exercise? I do not exercise
At home
At school

34.4 (31.9, 36.9)
19.4 (17.0, 21.8)
12.4 (10.8, 14.0)
6.6 (5.3, 7.9)
38.8 (35.3, 42.3)
28.4 (24.0, 32.9)

36.4 (33.5, 39.4)
17.8 (14.8, 20.7)
11.8 (10.3, 13.2)
N = 939
6.4 (5.0, 7.9)
39.5 (36.3, 42.7)
27.4 (22.3, 32.5)

29.8 (23.4, 36.2)
20.4 (13.9, 26.8)
13.6 (9.7, 17.5)
N = 224
5.6 (3.3, 8.0)
39.3 (31.9, 46.7)
29.9 (22.0, 37.8)

29.0 (21.7, 35.4)
27.4 (22.2, 35.9)
14.5 (9.1, 19.8)
N = 174
8.9 (5.3, 12.4)
34.4 (26.9, 41.9)
32.4 (22.2, 42.6)

At a fitness center

16.9 (13.5, 20.4)

16.3 (12.9, 19.7)

18.8 (14.2, 23.5)

17.8 (10.9, 24.7)

Some other place

9.2 (6.7, 11.7)

10.4 (7.4, 13.3)

6.3 (3.2, 9.4)

6.5 (1.9, 11.1)

Who are you most likely to exercise with?

N = 939

N = 224

N = 174

I do not exercise

5.8 (4.4, 7.1)

5.5 (4.1, 6.8)

4.6 (2.1, 7.2)

9.0 (1.9, 16.1)

My friends

40.0 (36.9, 43.0)

39.3 (36.4, 42.3)

40.4 (31.8, 48.9)

42.9 (35.1, 50.8)

Myself

36.7 (34.4, 39.0)

38.7 (36.0, 41.4)

33.3 (27.8, 38.8)

30.3 (25.0, 35.5)

Someone in my family

12.2 (9.8, 14.5)

10.3 (8.4, 12.3)

18.4 (12.8, 24.0)

14.1 (7.4, 20.7)

Someone else

5.4 (4.1, 6.7)

6.2 (4.5, 7.8)

3.4 (1.1, 5.6)

3.7 (1.2, 6.2)

a Chi-square tests used to test for statistical significance using a p-value of < 0.05 as cut-off point for significance.

0.16 0.002

68

Table 7: Perceptions about Healthy Eating among High School Students in Georgia by Fruit and Vegetable Consumption Status Youth Risk Behavior Survey, 2013

Perceptions about Healthy Eating
Which of these statements best describes healthy eating to you? Eating fruits and vegetables Avoiding `junk food' Limiting sugary foods and drinks Not eating very much Why are you most likely to eat healthy foods? I do not eat healthy foods My friends are watching I like how healthy foods taste My family eats healthy foods

None
% (CI)
N = 187
37.9 (32.2, 43.6)
25.7 (20.3, 31.0)
26.9 (19.2, 34.5)
9.6 (5.9, 13.3)
N = 187
32.9 (22.6, 43.1)
4.7 (2.0, 7.4)
9.8 (5.3, 14.2)
6.3 (2.8, 9.8)

Weekly Fruit Consumption (n = 1455)

1-6 times/week
% (CI)
N = 846
42.6 (38.4, 46.9)
26.3 (23.3, 29.2)
25.2 (20.6, 29.8)
5.9 (4.3, 7.5)
N = 846
7.5 (5.1, 9.9)
1.9 (0.9, 2.9)
16.3 (13.1, 19.5)
11.1 (8.3, 13.9)

1-2 times/day
% (CI)
N = 283
45.8 (40.7, 50.8)
25.0 (20.2, 29.7)
25.6 (21.4, 29.9)
3.6 (1.3, 5.9)
N = 283
3.3 (0.8, 5.8)
1.9 (0.3, 3.4)
18.5 (14.5, 22.5)
12.8 (7.7, 18.0)

3 times/day
% (CI)
N = 139
50.0 (43.8, 56.2)
27.0 (19.8, 34.3)
16.5 (12.7, 20.3)
6.5 (0, 13.2)
N = 139
2.9 (0.0, 6.1)
3.1 (0.5, 5.7)
16.6 (9.9, 23.2)
9.9 (3.4, 16.4)

Weekly Vegetable

Consumption

(n = 1458)

< 3

3

times/day times/day

% (CI)
N = 1306
42.2 (39.6, 44.9)
26.3 (23.6, 29.0)
25.5 (21.9, 29.0)
6.0 (4.9, 7.0)
N = 1306
10.3 (8.3, 12.2)
2.2 (1.4, 2.9)
16.1 (13.6, 18.6)
11.0 (8.4, 13.6)

% (CI)
N = 152
52.3 (44.7, 59.8)
25.1 (17.0, 33.2)
17.2 (12.8, 21.7)
5.4 (0.0, 10.8)
N = 152
5.0 (3.0, 7.0)
3.2 (0.7, 5.7)
15.6 (9.2, 22.1)
6.3 (2.2, 10.4)

69

My doctor told me to I want to look good I want to be healthy Some other reason Where are you most likely to eat healthy foods? I do not eat healthy foods At home At school At a restaurant Some other place

5.5 (1.6, 9.4)
9.6 (6.8, 12.5)
23.2 (14.4, 32.0)
8.1 (4.1, 12.1)
N = 187
21.4 (14.1, 28.6)
59.2 (52.4, 66.0)
8.8 (4.2, 13.4)
8.0 (3.2, 12.7)
2.6 (0.4, 4.9)

2.1 (0.8, 3.4)
13.7 (12.0, 15.5)
39.7 (37.1, 42.4)
7.6 (5.9, 9.3)
N = 846
7.0 (5.1, 8.9)
75.7 (72.4, 78.9)
10.8 (8.2, 13.4)
4.5 (3.5, 5.4)
2.0 (1.0, 3.0)

1.2 (0.0, 3.0)
13.9 (10.0, 17.9)
43.3 (39.1, 47.5)
5.0 (2.9, 7.2)
N = 283
3.4 (0.7, 6.1)
76.1 (72.1, 80.1)
14.9 (11.7, 18.1)
4.1 (1.7, 6.5)
1.5 (0.4, 2.6)

3.0 (0.6, 5.4)
10.3 (6.1, 14.6)
49.8 (40.2, 59.4)
4.3 (0.0, 8.7)
N = 139
2.0 (0.0, 4.0)
84.7 (79.1, 90.3)
10.1 (4.8, 15.4)
0.7 (0.0, 2.2)
2.5 (0.3, 4.7)

2.6 (1.4, 3.8)
13.4 (11.9, 15.0)
37.3 (34.4, 40.1)
7.1 (5.6, 8.7)
N = 1306
8.3 (6.3, 10.3)
73.4 (70.7, 76.2)
11.8 (10.0, 13.6)
4.6 (3.8, 5.4)
1.9 (1.2, 2.6)

0.9 (0.0, 2.3)
2.1 (5.1, 14.0)
55.0 (46.7, 63.4)
4.4 (1.6, 7.2)
N = 152
2.4 (0.7, 4.1)
83.0 (78.9, 87.0)
7.1 (4.3, 10.0)
3.8 (1.4, 6.2)
3.7 (1.0, 6.5)

70

Table 8: Perceptions about Physical Activity among High School Students in Georgia by Physical Activity Status Youth Risk Behavior Survey, 2013

Perceptions about Physical Activity Why are you most likely to exercise? I do not exercise
My friends exercise
I enjoy exercise
My family exercises
My doctor told me to
I want to look good
I want to be healthy
Some other reason Where are you most likely to exercise?

Physical Activity for 60 min/day

None % (CI)

1-6 days/week
% (CI)

Daily % (CI)

N = 212

N = 755

N = 370

33.7 (29.1, 38.2)
4.2 (1.2, 7.3)
8.6 (6.7, 10.5)
2.8 (0.6, 5.0)
1.1 (0.0, 3.2)
28.3 (20.8, 35.9)
13.9 (7.3, 20.5)
7.3 (4.0, 10.7)

4.2 (2.6, 5.8)
4.4 (3.2, 5.7)
17.2 (14.1, 20.4)
2.8 (1.6, 4.1)
1.4 (0.4, 2.3)
38.0 (35.3, 40.6)
19.3 (15.8, 22.7)
12.7 (10.7, 14.7)

1.5 (0.4, 2.6)
1.8 (0.0, 3.5)
26.3 (22.4, 30.2)
2.8 (1.1, 4.4)
0.6 (0.0, 1.4)
28.5 (23.2, 33.8)
23.5 (20.6, 26.4)
15.1 (10.1, 20.0)

N = 212

N = 755

N = 370

Strengthening Exercise

None % (CI)

1-2 days/week
% (CI)

3 days/week % (CI)

N = 412

N = 256

N = 674

26.8 (22.7, 30.9)
4.3 (2.6, 6.0)
10.1 (7.2, 13.0)
1.5 (0.2, 2.9)
1.7 (0.4, 3.1)
27.5 (21.7, 33.4)
15.8 (10.7, 20.9)
12.3 (10.7, 13.9)

--
7.0 (4.8, 9.3)
17.5 (13.0, 21.9)
4.9 (2.8, 7.1)
2.0 (1.2, 2.9)
35.0 (28.2, 41.9)
19.4 (16.0, 22.8)
14.1 (10.6, 17.6)

--
2.5 (1.0, 4.0)
23.3 (19.9, 26.7)
2.6 (0.9, 4.3)
0.4 (0.0, 0.9)
37.2 (33.3, 41.2)
22.0 (18.9, 25.0)
12.0 (9.2, 14.7)

N = 412

N = 256

N = 674

71

I do not exercise At home At school At a fitness center Some other place Who are you most likely to exercise with? I do not exercise My friends Myself Someone in my family Someone else

27.6 (22.8, 32.5)
37.6 (30.4, 44.8)
17.6 (12.7, 22.6)
10.4 (4.6, 16.3)
6.7 (3.7, 9.7)
N = 212
25.4 (18.1, 32.6)
24.2 (18.8, 29.7)
33.5 (27.1, 39.9)
12.9 (8.0, 17.8)
4.0 (1.1, 6.8)

3.2 (1.9, 4.6)
42.5 (37.7, 47.3)
24.9 (19.8, 30.0)
19.1 (14.8, 23.5)
10.3 (7.5, 13.0)
N = 755
2.8 (1.8, 3.8)
39.1 (36.5, 41.8)
40.0 (37.2, 42.8)
12.7 (10.2, 15.1)
5.4 (3.4, 7.5)

0.9 (0.3, 1.4)
32.6 (28.2, 36.9)
41.8 (36.5, 47.1)
16.2 (11.8, 20.6)
8.5 (5.4, 11.6)
N = 370
1.0 (0.3, 1.7)
49.7 (44.1, 55.3)
30.7 (26.2, 35.2)
11.6 (8.1, 15.1)
7.0 (4.6, 9.5)

21.5 (18.0, 25.1)
41.5 (36.7, 46.3)
15.8 (12.9, 18.6)
13.9 (10.8, 17.0)
7.3 (4.0, 10.7)
N = 412
19.2 (15.2, 23.2)
28.7 (24.4, 33.0)
35.2 (28.8, 41.6)
11.7 (8.2, 15.3)
5.1 (2.6, 7.6)

--
45.2 (39.4, 51.2)
25.0 (18.4, 31.6)
15.5 (11.9, 19.0)
14.3 (9.1, 19.5)
N = 256
--
40.6 (35.4, 45.8)
36.1 (31.4, 40.8)
15.8 (11.2, 20.4)
7.5 (4.1, 11.0)

--
34.9 (29.9, 39.9)
36.8 (30.0, 43.5)
19.7 (14.6, 24.9)
8.6 (5.9, 11.2)
N = 674
--
46.2 (42.7, 49.7)
37.2 (34.8, 39.6)
11.4 (8.6, 14.3)
5.2 (4.2, 6.1)

72