Presenters:

1. What’s in the Home is What’s on the Plate: Evidence-based strategies for counseling families about the home food environmentOctober 20, 2010 Presenters: Paul Estabrooks, PhD, Associate Professor, Human Nutrition, Foods & Exercise, Virginia Tech Moderator: James M. Rippe, MD – Leading cardiologist, Founder and Director, Rippe Lifestyle Institute Recording of the October 20, 2010 webinar and PDF download of PowerPoint available at: www.ConAgraFoodsScienceInstitute.com Approved for 1 CPE (Level 2) by the American Dietetic Association Commission on Dietetic Registration Orlando Health is an approved provider of continuing nursing education by the Florida Board of Nursing (Provider No. FBN 2459). Orlando Health is an approved provider of continuing nursing education by the North Carolina Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation (AP085).

2. Nutri-Bitessm Summary What’s In the Home is What’s on the Plate: This webinar covered: • Physical Environment and Social Environment that children encounter at home and school exert an influence on the development of children’s healthy eating and physically active lifestyles. • Simple modifications in the home environment can positively support child food and activity options. • A systems approach that integrates research, cooperative extension and local health clinics shows promise in making meaningful changes. • Incorporating an assessment of the home food and activity environment can provide additional insights for targeted nutrition counseling strategies. • Kaiser Permanente Colorado Family Connections background available: http://www.innovations.ahrq.gov/content.aspx?id=2516 From the Oct 20, 2010 webinar presentation by Paul Estabrooks

3. From the Oct 20, 2010 CFSI webinar presentation by Paul Estabrooks

4. The Evidence • The Home Social Environment • Parents serve as role models for both physical activity and diet behaviors . • Active role modeling is most effective—doing things with their children. • Unfortunately it also works to role model sedentary behavior--parents who play computer/electronic games with kids have more sedentary children. • Older children may be less influenced by parental role modeling compared to younger children From the Oct 20, 2010 CFSI webinar presentation by Paul Estabrooks

5. The Evidence • The Home Social Environment • Families with more rules about TV watching had children who watch less TV • Encouragement and monitoring of eating and activity is related to improved family eating and physical activity • Enhancing communication skills and providing opportunities for children to contribute to decision making is related to improved eating and activity • Household rules or policies are effective* • The way parents parent is important. From the Oct 20, 2010 CFSI webinar presentation by Paul Estabrooks

6. The Evidence: Examples Authoritative Restrictive Child Age is Important Kremers, Brug, de Vries, & Engels, 2003; Bowne, 2009; Rhee, Lumeng, Appugliese, Kaciroti, & Bradley, 2006 From the Oct 20, 2010 CFSI webinar presentation by Paul Estabrooks

7. The Evidence • The Home Physical Environment • The availability and accessibility of foods has been consistently related to consumption. • Having healthy foods prepared and with easy access for children improves eating habits • Variety and quantity of foods is a better predictor of healthful eating rather than presence or absence alone • Plate, bowl, and cup size influence the amount of food consumed From the Oct 20, 2010 CFSI webinar presentation by Paul Estabrooks

8. The Evidence • The Home Physical Environment • Activity equipment is inversely associated with TV time and positively correlated with physical activity • Pay TV and electronic games at home predicted increased sedentary behavior • Fewer TVs in the home is related to lower weight status of family members • Location matters—TV/electronic equipment in bedrooms is strong predictor of sedentary behavior • More outdoor play equipment is associated with more outdoor play time From the Oct 20, 2010 CFSI webinar presentation by Paul Estabrooks

9. Evidence-informed Intervention Framework, Strategies, and Activities for Health Promotion From the Oct 20, 2010 CFSI webinar presentation by Paul Estabrooks

10. Family Connections • To determine the relative effectiveness an additive process that included: • a) a self-help workbook for parents (mailed), • b) two small group sessions with a registered dietitian, • c) ten tailored counseling sessions over 6 months • To determine if > 50% dose of telephone intervention heightened effectiveness Kaiser Permanente Colorado Family Connections background available: http://www.innovations.ahrq.gov/content.aspx?id=2516 From the Oct 20, 2010 webinar presentation by Paul Estabrooks

11. How can you apply these findings within your practice? • Customize educational materials:Family Connections workbook is available as an open-source resource as a potential starting point. Customize the material to the target population; consider ethnicity and the community's recreational resources. • Consider telephone follow-up over a longer period of time (i.e., 6 or more times over 6 months): Determine whether the program can be integrated into the organization’s existing phone system or an independent system must be created. • Create partnerships that can help with participant identification/motivation or follow-up: Introduce the program to local physicians, highlighting any evidence to support its effectiveness. Solicit physician input on the appropriate process for screening patients and identifying those who may not be good candidates.  • Create a monitoring and evaluation system: Identify who will conduct periodic assessments of participants' progress; establish frequency for assessments. Create a system to document parent involvement, including how many phone calls they complete.  From the Oct 20, 2010 webinar presentation by Paul Estabrooks

12. Home Food Environment Webinar: Reference List 1. Koehly LM, Loscalzo A. Adolescent obesity and social networks. Prev Chronic Dis 2009;6(3):A99. 2.  Estabrooks PA, Shoup JA, Gattshall M, Dandamudi P, Shetterly S, Xu S. Automated telephone counseling for parents of overweight children: a randomized controlled trial. Am J Prev Med 2009;36(1):35-42. 3.  Gattshall ML, Shoup JA, Marshall JA, Crane LA, Estabrooks PA. Validation of a survey instrument to assess home environments for physical activity and healthy eating in overweight children. Int J Behav Nutr Phys Act 2008;5:3. 4.  Shoup JA, Gattshall M, Dandamudi P, Estabrooks P. Physical activity, quality of life, and weight status in overweight children. Qual Life Res 2008;17(3):407-12. 5. Golan M. Parents as agents of change in childhood obesity--from research to practice. Int J Pediatr Obes 2006;1(2):66-76. 6.  Golan M, Crow S. Parents are key players in the prevention and treatment of weight-related problems. Nutr Rev 2004;62(1):39-50. 7.  Golan M, Weizman A. Familial approach to the treatment of childhood obesity: conceptual mode. J Nutr Educ 2001;33(2):102-7. 8.  Kremers SP, Brug J, de Vries H, Engels RC. Parenting style and adolescent fruit consumption. Appetite 2003;41(1):43-50. 9.  Rhee KE, Lumeng JC, Appugliese DP, Kaciroti N, Bradley RH. Parenting styles and overweight status in first grade. Pediatrics 2006;117(6):2047-54. 10.  Estabrooks PA, Glasgow RE. Translating effective clinic-based physical activity interventions into practice. Am J Prev Med 2006;31(4 Suppl):S45-56. 11.  Estabrooks PA, Shetterly S. The prevalence and health care use of overweight children in an integrated health care system. Arch Pediatr Adolesc Med 2007;161(3):222-7. 12.  Estabrooks PA, Fisher EB, Hayman LL. What is needed to reverse the trends in childhood obesity? A call to action. Ann Behav Med 2008;36(3):209-16. From the Oct 20, 2010 webinar presentation by Paul Estabrooks