Urban-Rural Disparities in Secondary School Physical Activity Policies: Statewide trends in Minnesota 2002-2010

Introduction: School policy promoting physical activity (PA) may influence student energy expenditure and risk of obesity. Active surveillance can support policy evaluation and identify sources of health disparities. Methods: We examined survey data from principals and health educators at more than 500 Minnesota secondary schools collected biennially from 2002-2010 as part of the Centers for Disease Control School Health Profiles. Policies requiring physical education (PE) in grade 12, intramural programs, and PA topics addressed in health education using a 12-item index (alpha=0.91) were assessed. We examined patterns in PA policy by school type, location, % minority and % free/reduced lunch and change over time using the generalized estimating equation and mixed effects regression. Results: PE was required in grade 12 at 4.6% of schools in 2002 and 18.1% by 2010, a statistically significant increase (p=0.0003). Required PE in grade 12 was more common in urban (p=0.0111) and suburban (p=0.0651) schools than rural schools. Overall, three in five schools offered intramural programs and this proportion was stable over time, but intramural programs were more common in urban (p<0.0001) and suburban (p=0.0062) locations compared with rural locations. On average, schools covered nine of twelve PA topics in health class, with no changes over time. Fewer PA topics were covered in urban (p=0.0001) compared with rural schools. Discussion: Significant urban/rural disparities in school PA policy exist. Future research should examine whether patterns and change in PA policy are associated with PA and obesity among students and contribute to disparities in health.