Kathy Cunningham, MEd, RD, LDN ASTPHND Annual Meeting June 11, 2007

1. Boston Steps:A Community Wide Initiative to Increase Physical Activity and Nutrition Education for Adults and Children Kathy Cunningham, MEd, RD, LDN ASTPHND Annual Meeting June 11, 2007

2. Boston Public Health Commission • City Health Department for Boston, MA. • Mission statement: To protect, promote and preserve the health and well-being of all Boston residents, particularly the most vulnerable. • In 2003, received 5-year federal CDC Steps to A Healthier US funding to implement multi-faceted chronic disease prevention and control program as part of broad community collaboration.

3. Boston Steps: Mission • Five year community mobilization effort to reduce the burden of: • Overweight/obesity • Diabetes • Asthma • …By addressing key risk factors: • Lack of physical activity • Poor nutrition (caloric intake and types of foods) • Tobacco use • Environmental triggers for asthma • …And providing disease management supports

4. Boston Steps Project Area • Eight Boston neighborhoods with highest disparities in obesity/overweight, diabetes and asthma • About half (~300,000) of Boston’s residents and 70% of children and youth • 37% are Black, 35% White, 15% Hispanic, 7% Asian and 6% other races/ethnicities. • 20% are immigrants • About 25 square miles

5. Boston Steps Overall messages5-2-1-0 • ( 5) Increase intake of fruits and vegetables. • Increase intake of whole grains • Decrease intake of sweetened beverages • 2 or less of TV and screen time. • 1 hour of physical activity per day. • 0 tolerance for tobacco.

6. Community Initiatives Neighborhood and Workplace

7. Physical Activity: Steps to Wellness Programs • 2005 • 14 CBOs provided neighborhood-based weekly physical activity programs and health education during 10 week sessions. • 755 adults and youth participated in 122 class sessions, including salsa dance, swimming, tai-chi and “Cardio Caliente” aerobics. • Additional health education was provided in various nutrition and chronic disease control focus areas • 2006 • 12 CBOs continued physical activity programs • 796 adults and youth participated in 566 class sessions • Average of 19 participants per class • Average 75 minutes of exercise per class • Beginning to address issues of sustainability going forward

8. NeighborWalk Milestones 2005 • 55 walking groups did 2,325 walks, averaging 2.4 miles • 1,800 individuals participated • All groups also offered at least one health education session. • About 20 groups walked in Boston parks • Kick-off in Franklin Park had 300 participants 2006 • 48 groups did 1921 walks, averaging 2.1 miles • 1300 individuals participated • Celebration at Jamaica Pond at 400 participants

9. NeighborWalk Celebration Jamaica Plain, MA June 17, 2006 402 Walkers!

10. Participant Self-Reported Change in Walking since joining Walk Group

11. Offering mini-grants to community organizations to promote walking more generally Distributing walking kits with pedometers, walking logs and tip sheets Promoting Walking in Daily Life and Improving Walkability

12. Working with BPS to promote walking programs within schools Safe Routes to School Hurley School

13. Walkable Main Streets Main Streets Programs • Not-for-profit organizations to support vibrant neighborhood commercial districts • Supported in part through Boston Office of Neighborhood Development • Steps support for Main Streets programs to promote and support walking to, from, and in neighborhood retail districts

14. Workplace Wellness • Focus on city employees • More likely to live in the project area, due to residency requirements • High burden of chronic disease • The 1010 Mass. Ave Workplace Wellness Team • 4 city agencies with offices in one building (500 employees): • Public Health Commission • Parks Department • Fire Department • Inspectional Services Department

15. Workplace Wellness • Boston City Hall Campaign • 90 walking group participants • Promoting stairwell use • Lunch Time Nutrition education classes • Partnering with American Cancer Society • Great American Smoke Out in November • Cancer screening

16. Take The Stairs:Stairwell Campaign

17. Healthy Eating Initiatives

18. Partnership with the MA Fruit & Vegetable Nutrition Council New message replaces the 5-A- Day. Goals are to increase consumption from current level to more. Includes fresh, frozen, canned and dried. Partnership with State-wide Efforts

19. Beyond the Burger Partnerships • BPHC Men’s Health Program staff responsible for outreach to neighborhood barber shops and residents • Barbers and men’s sports coordinators are key community leaders to reach to attend the workshops

20. Trainings in Promoting Physical Activity and Nutrition • Child Care Provider Training. • 156 licensed family childcare providers attended all-day training sessions (103 in English, 53 in Spanish) using the HEALTHY Kids curriculum that promotes physical activity and better nutrition in childcare settings. • BPHC Behavior Change for Health Care Providers Training. • Two training for BPHC health care providers regarding development of lifestyle behavioral change incorporating 5-2-1-0- messages.

21. To promote healthy beverage consumption in school age children. Interactive book for parents and first graders. Distributed through schools, health centers and primary care practices Healthy Beverage promotion within schools and community

22. We Can!Parent Program: The Basics • A 4-lesson course… • Focusing on “energy balance”… • Through three topics: • Improved nutrition • Increased activity • Reduced screen time • A great start! • Not a weight loss program • A national education program targeting youth ages 8–13 and their • parents /caregivers in home and community settings to meet the • overall goal of preventing • overweight and obesity

23. Goal: Educate parents about strategies to help themselves & their kids maintain a healthy weight. Workshop series format: 4 class series - weekly for 4 weeks Both didactic and group activities Group support: parents enjoyed opportunity to share with others facing similar challenges on how to make healthier choices Child care, light dinner, and incentives We Can!Parent Program:

24. WeCan! Parent Workshops:Community Partnerships • Community partner collaborations • Boston Organization of Nutritionists and Dietitians of Color (BOND) members lead workshops • Community agencies host series and recruit parents • YMCA - Central Boston Branch • Boston Public Schools • Community health center • 2007 Expanded community nutritionists partnership

25. School Initiatives

26. School Environment Policy • September 2004 – Healthy Beverages and Snack Policy. • Includes ban on sale of sweetened beverages in vending machines and supports healthy snack foods sales in all 144 Boston Public Schools. • September 2006 - Wellness Policy. • Overall policy to improve nutrition and physical activity. All school must complete an assessment similar to the School Health Index.

27. School Environment Tools To support Wellness policy implementation “Food Is not the only Fun” • This booklet was distributed to all Elementary Principals

28. Training with nutrition components within schools • Healthy habits in elementary grades 4-5. n= 37 teachers • Reached 1,568 students in Year 3, 2006 • Focus on middle school nutrition and physical activity. N =194 teachers • Reached 5,701 students in year 3, 2006

29. School Initiatives • School-based BMI Surveillance: Baseline BMI surveillance was completed on 8,200 public school and 2,000 parochial school students in grades 1, 4 7, and 10. • These data show that BPS students are • 19 % at risk for overweight (>85% BMI) • or 27% overweight (>95% BMI) at approximately double the national rate. • Explanatory letters and education materials were sent home to parents/guardians of more than 4000 students with BMIs >85%.

30. School Initiatives • School Environmental Health assessments: 100% of Boston Public Schools were inspected for environmental problems that may contribute to asthma, including leaks, mold, pest droppings, and dust. • Collaboration with BPS about remediation efforts is ongoing. • Additional, more intensive assessments and follow-ups were offered to the ten participating Demonstration or Next Steps schools.

31. School Initiatives • School Health Assessment: Through the Boston Steps partnership, BCBSMA extended its Healthy Choices grant program to 15 Boston Public middle schools. • Schools began implementation of $5,000 mini-grants received in spring 2004 as part of a comprehensive program that requires completion of a modified School Health Index. • A Demonstration Schools mini-grant program, modeled on BCBSMA’s Healthy Choices, began implementation with 10 participating schools.

32. New Hires to support School Wellness • School Wellness Coordinator- will assist schools by compliance with new BPS Wellness policy and support to implement activities. • Professional Chef to provide technical support to offer creative school meals which will stimulate new approaches to food preparation.

33. Social Marketing Campaigns

34. Get Healthy Now! Marketing Campaign • Community wide messages for: • Elders • Families with Children • People with Diabetes • English and Spanish versions • Print ads • Red and Orange Line stations • Community Newspapers • Collateral materials • Public Relations • Website: www.bphc.org/gethealthy • Community newspaper articles

36. Changing the Food Environment:Healthy Restaurants Campaign • Free nutritional analysis of selected menu items that might qualify as healthy appetizers, entrees, or desserts. • Free marketing materials to use within restaurants and advertising of the Boston Best Bites sites to neighborhood residents.

37. Increasing Access to Healthy Foods: Boston Best Bites Design

38. Changing the Food Environment

39. FOOD RESOURCE ASSESSMENT OF BOSTON NEIGHBORHOODS: Mapping Food Accessibility in Four Communities Prepared by the Nutrition & Fitness for Life Program of Boston Medical Center Department of Pediatrics Supported by the Boston STEPS Consortium of the Boston Public Health Commission October, 2005 Changing the Food Environment:Promoting Healthy Food Availability • Supported the Food Resource Assessment of Boston Neighborhoods completed by Boston Medical Center. • Assessment result sparked strategies to develop a healthy beverage messages for middle school youth in conjunction with corner stores. • Early phase of working with 4 middle schools and 4 corner stores regarding beverage sales

40. Changing the Food Environment:Improving access • Provided funding support, technical assistance to support community education regarding healthy eating habits. • Supported the new Farmers Market in summer 2005 in Dudley Square, and now working toward other sites in Mattapan with youth as one of the leaders

41. Changing the Food Environment:Access to healthy, affordable, & local foods • Boston Collaborative for Food and Fitness • 52 partner organizations citywide • Awarded a two year $500,000 Kellogg Foundation planning grant on April 1: • Develop sustainable food resources • Improve access to healthy affordable foods • Improve play space and, physical activity • All developments will have a strong family and youth focus. • After development of community action plan, will be able to apply for 8 years of additional funding.

42. For more information: Boston Steps Boston Public Health Commission 1010 Massachusetts Ave. Boston, MA 02118 617-534-5690 bostonsteps@bphc.org