Using Policy to Promote Student Health

1. Using Policy to Promote Student Health Punam Ohri-Vachaspati, PhD, RD Associate Professor, Nutrition College of Nursing and Health Innovation Arizona State University

2. Outline • Prevalence of the problem • Role of policy in improving behaviors • Current practices in schools • Tools available to school health professional to change policy • Future partnerships

3. Map 1: Percentage of Children who are Obese Aged 10–17 Years by State 2003 2007 Data for these maps were retrieved from the Child and Adolescent Health Measurement Initiative, 2003 and 2007 National Surveys of Children's Health, Data Resource Center for Child and Adolescent Health website (accessed 10/03/08 and 5/26/09, www.nschdata.org).

4. Obesity Prevalence Among Children and Adolescents Aged 10-17 years Singh et al. ARCH PEDIATR ADOLESC MED/VOL 164 (NO. 7), JULY 2010

5. Percentage of U.S. youth grades 9-12 who consumed fruit two or more times per day and vegetables three or more times per day, by state – Youth Risk Behavior Surveillance System, 2007 Source: CDC, State Indicator Report on Fruits and Vegetables, 2009

6. Physical Activity http://www.cdc.gov/physicalactivity/downloads/PA_State_Indicator_Report_2010.pdf

7. Why are these behaviors so important?

8. Energy Balance – or Imbalance Food and Beverage Intake Physical Activity Growth and Maintenance Energy Expenditure Energy Intake Energy Imbalance Obese Children & Youth Adapted from Preventing Childhood Obesity: Health in a Balance, Institute of Medicine, 2005

9. Layers of influence on a child’s nutritional wellbeing?

10. Making Healthy Choices - an uphill task Environment Individual and Family • Skills • Knowledge • Use of Time • Policy • Legislation • Economics • Access • Advertising • Affordability Healthy eating & physical activity Culture Social norms and values Source: CDC, Nutrition and Physical Activity Program

11. Making Healthy Choices Default, Convenient, and Easy Environment Individual and Family • Skills • Knowledge • Use of Time • Policy • Legislation • Economics • Access • Advertising • Affordability Healthy eating & physical activity Culture Social norms and values Source: CDC, Nutrition and Physical Activity Program

12. School Food and PA Environment and Policies

13. Wide Availability of High-Calorie Beverages in US Elementary Schools • 61% of the elementary school students had access to beverages for sale in competitive venues (eg. store, vending machines) • 68% of the schools offered higher fat milk in 2008-09 • 92% of the schools offered flavored milk on a regular basis *Turner and Chaloupka, ARCH PEDIATR ADOLESC MED 2010

14. Energy Dense Foods Readily Available to Elementary School Children • 44% of the elementary school children are offered unhealthy energy dense competitive foods • 40% of the students can have french fries as part of NSLP • Almost all students can have pizza as part of NSLP • 20% of the elementary school children are offered whole grain regularly • 21% of the students have salad bar available Turner et al. Bridging the Gap, UIC, 2010

15. Availability and Consumption of Competitive foods in US Public Schools • 40% of children consumed one or more competitive foods / day • Leading choice of competitive foods were low-nutrient energy dense foods • Over 65% of the calories from competitive foods were “junk” calories Fox et al. SNDA III, 2009

16. PA / PE in Elementary Schools (2007-08) • Daily PE offered to only 20% of elementary students • Only 18% get 150 min per week of PE • 32% of the students do not get daily recess in elementary schools • 34% of elementary students have regular physical fitness assessments Turner et al. Bridging the Gap, UIC, 2010

17. Tools available to health professionals to helpchange policy

18. Local Wellness Policy Child Nutrition and WIC Reauthorization Act of 2004 required that school districts participating in the National School Lunch Program or other child nutrition programs must adopt and implement wellness policies by the first day of 2006-2007 school year.

19. Local Wellness Policies Evaluation Nutrition Education: + included in wellness policies - NE not incorporated into health education or other core subjects School Meals: +policies require nutrition guidelines to meet minimum USDA standards - need stronger standards that meet current dietary guidelines Competitive Foods and Beverages: + Policies addressed the sale of competitive foods - Provisions are weak for middle and high schools - Outdated standards - Weak provisions for restrict marketing and advertising Physical Activity and PE + policy requires PA outside of PE - only 18% elementary students enrolled in schools that offer regular recess - PE classes do not devote recommended time to MVPA - NASPE standards not consistently followed. Implementation and Evaluation -- no funding sources were identified to support implementation - vast majority did not make provisions for evaluation Chiriqui et al. (2009), based on a representative sample of school districts across US.

20. Schools that have wellness policies in place are more likely to implement other health related policies Ohri-Vachaspati et al. under preparation

21. Local data can help movepolicy changes

22. Children’s BMI Tool for Schools http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/tool_for_schools.html

24. What school level policy changes are taking place in AZ? • School meals • Competitive foods • Physical activity and PE • Farm to school programs • School gardens • What else?

25. Looking for Research Partners • School interested in bringing about environmental and policy changes • Schools interested in providing nutrition education Please contact: Punam Ohri-Vachaspati pohrivac@asu.edu or 602-496-1279