Nutrition Friendly Schools and CommunitiesSM Environmental

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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

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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.

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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

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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

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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

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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

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Nutrition Friendly Schools and Communities

• Adapted steps and concepts from
• Coordinated School Health Model (CSHM)
• Baby Friendly Hospital Initiative (BFHI)
• Community Participatory Research (CPR)

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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

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Coordinated School Health Model (CSHM)
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Baby Friendly Hospital Initiative

• UN Childrens 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.

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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.

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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

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NFSC Process

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

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Meetings/Work Groups

• 3 large group meetings with school stakeholders
  to identify potential criteria. 220 invited with
  over 100 participating.
• 2 groups of school personnel including
• Teachers
• School administrators
• Nurses
• Cafeteria staff
• Parents
• 1 group of district level personnel
• Several small work groups based on 8 components
  of CSHM to narrow criteria.
• Resulting in list of potential NFSC criteria.

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Delphi Survey

• 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.

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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

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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.
•  
•  
•  

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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

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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.

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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.

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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.

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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

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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

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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

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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

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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

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NFSC Next Steps

• Implement NFSC plan (1/04-6/05)
• Monitor progress towards plan (1/04-6/05)
• Continuation of data collection
  (process1/04-6/05, outcome 2/05)
• Capacity building (1/04-6/05)
• Sustainability (1/04-6/05)