East Tennessee State University College of Public Health Department of Community Health

1. School-Based Efforts at Health Promotion & Obesity PreventionDeborah Slawson, PhD, RD, LDN &Kasie Richards, MS, CSCS East Tennessee State University College of Public Health Department of Community Health November 2011

2. Topics Coordinated School Health (CSH) as a concept for improving children’s health and wellness Statewide Evaluation of CSH in Tennessee Youth Risk Behavior Survey Team Up for Healthy Living Research Project

3. 20 year prevalence of obesity

4. CDC 2009 Obesity rates (CDC Behavioral Risk Factor Surveillance System “BRFSS” data 2009)

8. Every day, children come to school not ready to learn Reducing the Barriers to Learning No AYP Bullying Community and Parental Involvement is one component of CSH ADHD Diabetic ASTHMA Absenteeism

9. Tennessee Coordinated School Health In Action

10. Tennessee CSH Mission • To improve students’ health and their capacity to learn through the support of families, communities and schools.

11. Tennessee CSH Emphasis Provide prevention education and interventions that encourage: Healthy eating habits Increased physical activity to counteract sedentary lifestyles Skills-based Comprehensive Health Education

12. Physical Education/Physical Activity

13. Healthy Food Choices & Nutrition Education Improving Nutrition Quality Tennessee now ranks 2nd in the nation in the number of schools which do not sell soda or high-calorie fruit juices. The overall percentage rank increased from 26.7% in 2006 to 74% in 2008. (Source: CDC’s School Health Profiles Report 2006 &2008) During the 2008 school year, 64.7% of Tennessee secondary schools did not sell unhealthy food items in vending machines, school stores or snack bars. Tennessee ranks 6th in the nation in this category. (Source: CDC’s School Health Profiles Report 2006 &2008)

14. Improved Ratios of School Nurses Since CSH Inception: Pilot Sites

15. Positive trends in nurse visits and returns to class: Pilot sites

16. Students Return to Class

17. Screenings and Referrals

18. Lower Rates of Obesity

19. Quantifying “Coordination” in Coordinated School Health ProgramsHimmelman’s Strategies for Working Together as a Theoretical Model

20. Himmelman’s Theory of Collaboration • Community Empowerment: the ultimate goal • Effective collaboration is essential

21. Towards Community Empowerment • Essential elements for success • Engage multiple elements of the community • Work together for a common purpose • Overcome barriers to working together: • Time • Trust • Turf Source: Himmelman, 2001

22. Working Together Relationships Collaborating Exchanging information , altering activities, sharingresources and enhancing others’ capacity for mutualbenefit to achieve a common purpose Cooperating Exchanging information, altering activities, sharing resources for mutual benefit to achieve a common purpose Coordinating Exchanging information and altering activities for mutual benefit to achieve a common purpose Networking Exchanging information for mutual benefit Himmelman, 2001

23. Organizational Collaboration “A process in which organizations exchange information, alter activities, share resources, and enhance each other’s capacity for mutual benefit and a common purpose by sharing risks, responsibilities, and rewards.” Himmelman, 2001

24. Addressing Barriers to Working Together • Common vision and purpose • Power shared among partners • Mutual learning • Mutual accountability for results Himmelman, 2001

25. Methods: TN CSH Data • CSH 2009-2010 Continuation Requests for Proposal (RFP) • 131 Tennessee School Systems • Narratives of CSH implementation across all eight CSH components from the 2008-2009 academic year

26. Methods: Thematic Analysis • Identify prominent themes • Categorize prominent details and main ideas based on Himmelman’s framework • Apply the Working Together Strategies on a continuum: • From Networking to Collaboration

27. Methods: Coding of Data • All data were analyzed and coded independently by three doctoral-level graduate students. • Ratings were compared and discrepancies discussed. • Consensus decisions were made.

28. Collaboration & Nutrition • High levels of stakeholder investment: extensive time commitments to provide healthy nutrition resources to students and to the community. • Full sharing of resources between the school system and community organizations/groups to provide mutual benefit to all stakeholders. • Use of local and national resources to provide healthy foods and a healthy food environment for students. • Through partnerships they were able to access and provide resources to students.

29. Collaboration & Physical Activity • School System Highlights: • Encourage student empowerment by providing opportunities for student input on physical activity program development. • Parent and community involvement made real by utilizing volunteers to supervise supplemental recess program. • Work with statewide health plan to provide speakers and physical activity opportunities throughout the school year (jump rope program, track program).

30. Guiding Program Implementation • Collaboration: • Helps the school system be a force for change in the community • Ensures effective use of limited resources • Facilitates mutually beneficial, sustainable partnerships • Helps with Community Asset Mapping – knowing what resources are available locally and elsewhere.

31. TN CSH: Cycle of Community Empowerment Within each school district across Tennessee, the CSH coordinator can ensure that high levels of engagement occur among stakeholders. Trust is fostered and groups represented enhance others’ capacity to work toward a common purpose: improving students’ health and their capacity to learn.

32. YRBS The Youth Risk Behavior Survey: A Tool for Evidence-Based Practice

33. What is the YRBS? • Surveillance system that monitors health risk behaviors that contribute to the leading causes of heath and disability among youth and adults. • High school-based survey for ages 15-18 conducted by the CDC nationwide as well as state, territorial, tribal and local surveys. • Middle School survey: in some areas, for ages 12-14

34. Key Concepts • The YRBS can assesses 6 categories of priority health risk behaviors • Behaviors that contribute to unintentional injuries and violence • Tobacco use • Alcohol and other drug use • Sexual risk behaviors • Unhealthy dietary behaviors • Physical inactivity

35. Contributing Behaviors Include: • unintentional injuries and violence • suicidal ideation • tobacco use • alcohol and other drug use • sexual behaviors that contribute to unintended pregnancy and STDs, including HIV infection • unhealthy dietary behaviors • and physical inactivity—plus overweight and asthma

36. Evidence-Based Strategies • YRBS data can be used to support intervention efforts, develop intervention strategies and decision making processes through evidence-based practices.

37. YRBS Data • Provides local, regional, state and national demographics. • Allows for the ranking of key behaviors and risks. • Allows for the identification of at risk regions and populations. • Used for comparisons of state and school district using Ns and CI’s • Allows for comparisons of middle school YRBS results with high school YRBS (cross-sectional and longitudinal analysis)

38. How are the YRBS results used? • YRBS data are used to: • Set goals and track progress toward goals • Support modification of school health curricula or other programs • Support new legislation and policies that promote health • Seek funding and other support for new initiatives.

39. How are the YRBS results used? • YRBS data are used to: • Provide guidance for intervention strategies through: • Identification of at-risk populations. • Identification of common risky behaviors in youth. • Identification trends in behaviors and populations across geographic designations

40. Who uses YRBS data? • Federal, State and Local Government Agencies • State and Local School Systems • Nongovernmental Organizations

41. Important Concepts • Using the data for facilitating evidence-based improvements in student health is the crucial component. • Personalized components for use with multiple stakeholders • Use your data to effectively focus community engagement and action. • Brochures and resources geared towards optimal use of your community’s outcomes

42. TeamUp For Healthy Living Obesity Prevention among high school students through a cross-peer intervention, based on the work of Dr. Tiejian Wu

43. Project Goal • Establish an ETSU – Community partnership to prevent obesity in our region’s high school students • Specific aims: 1.) Conduct a peer (ETSU student) led education program in regional high schools 2.) Determine if this program is effective for improving student’s health outcomes 3.) Determine which factors contribute to the program’s success

44. Project Overview • The project will be implemented in regional public high schools. • Schools will be randomized to treatment or usual care. • ETSU college students will be trained by key personnel to conduct wellness education at participating schools.

45. Intervention • Key Elements: • Team-Up for Healthy Living Curriculum • Team Action Activities • The curriculum consists of 8 group sessions lasting 40 minutes each. • Undergraduate college students will lead the sessions as peer facilitators. • Each wellness class will be divided into teams. Students will participate in team activities in order to foster trust and promote collaboration.

46. Team-Up Curriculum • Effective Communication • Caring and Sharing • Leadership • Team-up for Change • Introduction of the Program • Eating Styles/Nutrition Consciousness • Portion Distortion • Small Steps Count • Active Living • Fun Sports

47. Project Assessment • Assessments will be performed at baseline and at three and twelve months post intervention. • The following items will be assessed: • Body mass index (height and weight) • Dietary behaviors and physical activity • Social norms • Social support for eating and activity habits • Level of program involvement • Peer facilitators‘ effectiveness • Demographics • Sex, Age, Grade, Race, Socioeconomic Status

48. Team-Up for Healthy Living • Designed to meet critical community needs for adolescent obesity prevention • Engaging higher education institutes and students and fostering within them an ethic of civic responsibility.