Nutrition Friendly Schools and CommunitiesSM Environmental Model to Prevent Overweight in Children

1. Nutrition Friendly Schools and CommunitiesSM Environmental Model to Prevent Overweight in Children Mike Prelip, DPA, MPH University of California, Los Angeles School of Public Health Nutrition Friendly Schools and Communities Group

2. Scope of the Overweight Problem in the United States Rapid rate of increase of overweight over the last three decades1,2 Risk of overweight children carrying over to adulthood3 Rise in co-morbidities4,5 Economic Burden4 1. Ogden, C. L., Flegal, K. M., Caroll, M. D., & Johnson, C. L. (2002). Prevalence and trends in overweight among U.S. children and adolescents, 1999 - 2000. Journal of the American Medical Association, 288(14), 1728-1732. 2. Flegal, K. M., Caroll, M. D., Ogden, C. L., & Johnson, C. L. (2002). Prevalence and Trends in Obesity Among US Adults, 1999-2000. Journal of the American Medical Association, 288(14), 1723-1727. 3. Guo, S. S., Wu, W., Chumlea, W. C., & Roche, A. F. (2002). Predicting overweight and obesity in adulthood from body mass index values in childhood and adolescence. American Journal of Clinical Nutrition, 76(3), 653-658. 4. Dietz, W. H. (1998). Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics, 101(3 Pt 2), 518-525. 5. Colditz, G. A. (1999). Economic costs of obesity and inactivity. Med Sci Sports Exerc, 31(11 Suppl), S663-667.

3. Los Angeles Unified School District (LAUSD) and UCLA History of two groups working together to improve nutrition and physical activity in schools 1998 Hunger Study 2000 Salad Bar Study 2001 Nutrition Network Process Evaluation 2002 Nutrition Friendly Schools and Communities 2003 Nutrition Network Outcome Evaluation

4. LAUSD 2nd largest school district in the country Covers 704 square miles 746,800 students in grades K – 12 713 K – 12 schools 72% students Hispanic, 12% Black, 9% White, 4% Asian, 3% Other

5. Barriers to Improving School Nutrition and Physical Activity Environment Staff overwhelmed – too many mandates Funding Lack of time Not a priority Lack of collaboration among school community Use of “junk food” as fundraiser Lack of training in PE

6. Facilitators to Improving School Nutrition and Physical Activity Environment Funding Dedicated and committed school community UCLA Staff – part of community, flexibility, respectful Clustering Resources Building on existing teacher work

7. Nutrition Friendly Schools and Communities Adapted steps and concepts from Coordinated School Health Model (CSHM) Baby Friendly Hospital Initiative (BFHI) Community Participatory Research (CPR)

8. Coordinated School Health Nutrition Education Physical Education School Health Services School Food Services Family and Community School Environment-Administration & Policy Staff Wellness School Psychosocial Services

9. Coordinated School Health Model (CSHM)

10. Baby Friendly Hospital Initiative UN Children’s Fund and WHO collaborative launched 1991. Aims: Increase breastfeeding rates Encourage international standard for maternity services through compliance with a set of research and evidence based 10 steps.

11. Baby Friendly Hospital Initiative Process of Certification includes: Self-appraisal Changes made to address gaps/deficiencies in meeting the criteria Assessment of hospital from outside assessors.

12. Community Based Participatory Research (CBPR) Definition: The systematic inquiry, with the collaboration of those affected, for the purpose of education and taking action or social change. Also referred to as: Participatory action research Participatory research Action research Mutual inquiry Feminist participatory research

13. NFSC Process Meeting/work groups Identify stakeholders Delphi survey 15 Steps Evidence-based verification review Self-assessment tool development Pilot Study

15. Explanatory letter and questionnaire sent to participating school community stakeholders. Questionnaire included potential criteria developed in meetings and work groups which were corroborated with Healthy People 2010 objectives and the US Department of Health and Human Services recommendations. Participants ranked the criteria in each of the eight areas (nutrition education, physical education, health services, food services, school environment, staff wellness, psychosocial services, and family/community involvement). The top choices from each area were then selected as the final Nutrition FriendlySM Schools minimum criteria.

16. Nutrition Friendly Schools and Communities Goals 1. Create and sustain healthy school environment 2. Improve healthy eating and physical activity with long-term goal to decrease/prevent childhood overweight 3. Capacity Building/Participatory Research

17. 15 StepsSM 1. School has written physical activity and nutrition policies. 2. School administration supports efforts to promote healthy eating and physical activity among all school community stakeholders. 3. There is collaboration throughout the school community regarding nutrition and physical education. 4. School has a standardized nutrition education curriculum integrated into other school subjects. 5. School Food Service provides healthy foods adhering to the USDA recommendations.   6. School staff and students have input into school meal planning. 7. School has a physical education curriculum/program that is adhered to by a minimum of 80% of eligible staff. 8. A minimum of 85% of classroom participate in a minimum of 20 minutes of moderate to vigorous daily physical activity. 9. The school has one nurse for every 750 students. 10. School Health Services identifies and refers students with nutrition and physical activity issues. 11. School has a staff wellness program. 12. School staff is committed to serve as role models for healthy behavior. 13. School includes family and community members in nutrition education and physical education. 14. Family and community members actively promote healthy eating and physical activity.   15. School Psychosocial Services supports healthy eating and physical activity.      

18. NFSC Pilot Study Funded for 3 years through CDC Community Based Participatory Prevention Research Investigators Dr. Charlotte Neumann, Principal Investigator Dr. Mike Prelip, Co – Principal Investigator Dr. Wendy Slusser, Co – Investigator Stephanie Vecchiarelli, Project Director

19. NFSC Pilot Study Goal Goal: actively engage school community to prevent overweight in elementary school aged children through multi-level participative intervention facilitating coordinated changes in the school environment in: nutrition education physical education health services food services school policy staff wellness psychosocial services family/community involvement.

20. NFSC Pilot Study Aims Aims Using a participatory action research model, school community stakeholders (teachers, administrators, students, and parents) will define the Nutrition Friendly School model environmental intervention to prevent overweight in children. School community stakeholders, will define the minimum criteria necessary for schools to be Nutrition Friendly certified. Each school will create a Nutrition Friendly School committee to implement the Nutrition Friendly School model including: conducting a self-evaluation, designing and implementing an action plan to address areas in need of improvement found through the self-evaluation.

21. NFSC Pilot Study Aims Aims, continued School community stakeholders will develop measures of effectiveness to determine if the Nutrition Friendly School model is feasible, sustainable, and reproducible. Affect the knowledge, attitudes, and behaviors related to nutrition, physical activity, and overweight prevention among members of the school community including students, staff, and families.

22. Study Schools East Los Angeles (4 schools) 3,946 students 2 year round, 2 traditional 87 – 100% students on free/reduced meals Majority (98%, est.) Latino students Spanish language spoken

23. Study Schools West Hollywood (4 schools) 1,630 students All traditional calendar Some students bussed from East Los Angeles Korean, Spanish, Chinese, and Russian languages spoken 64 – 91% students on free/reduced meals

24. NFSC Data Collection Student and adult dietary and physical activity behaviors. Student level academic measures including test scores, attendance School measures including attendance, test scores, discipline records, nurse records School environment measures Process measures Baseline and post - intervention

25. Preliminary Results 47.2% of students are overweight or “at – risk” for overweight Students spend 311.3 minutes/day in sedentary activity including watching television, playing video games, and playing on the computer 55.6% of adults are overweight or obese

26. NFSC Committee Includes parent, student, staff, administrators, nurse/health professional, food service staff, community representative, and NFSC liaison Meeting frequency determined by committee Conduct self – evaluation including collecting evidence Develop plan to meet NF criteria Implement plan Evaluate progress

27. NFSC Next Steps Implement NFSC plan (1/04-6/05) Monitor progress towards plan (1/04-6/05) Continuation of data collection (process:1/04-6/05, outcome: 2/05) Capacity building (1/04-6/05) Sustainability (1/04-6/05)