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Children, Youth, and Families at Risk-Sustainable Community Grant Project: Just Be It! Healthy and Fit

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Plan Goal

Reduce the risk factors for childhood obesity for fifth grade students in Santa Fe, Rio Arriba, and Los Alamos Counties by providing nutrition education, increasing exercise time, and affecting change in the home and school environment.

Situation Statement

The Need for Childhood Obesity Prevention Education
Childhood obesity has been identified as a major health concern throughout the United States. Three times as many children are overweight today as compared with 20 years ago. The State of New Mexico is not exempt from this childhood obesity epidemic. Mirroring the national epidemic, the New Mexico Department of Health reports a 57% increase in obesity/overweight prevalence among adults and that 24% of high school students are overweight or at-risk for becoming overweight. Presbyterian Health Service, a major health care provider in the state, completed a long term study in 2005 of body mass index (BMI) measures for elementary school children in Rio Arriba County. BMI measurements were compared for students in the 2nd grade and again for the same student in the 5th grade. Preliminary data showed that 23% were overweight in the 2nd grade, and this rate did not change in the 5th grade. 48% were identified as being at risk for obesity. Rates of overweight youth vary by ethnicity, from 16.4% for American Indian youth to 12.4% for Hispanics and 8% for Non-Hispanic Whites (Centers for Disease Control and Prevention, 2004; New Mexico Department of Education and New Mexico Department of Health, 2001).

Obesity is a significant risk factor for a variety of chronic diseases including high blood pressure, heart disease, stroke, gallbladder disease, arthritis, sleep disturbances, problems breathing, and certain types of cancers. Additionally, overweight and obesity are closely linked to diabetes. There was an estimated 37% increase in diabetes prevalence in New Mexico from 1990 to 2000 (Mokdad, Ford, Bowman, Dietz, Vinicor, Bales, and Marks, 2003). As diabetes prevalence increases, so do diabetes-related complications such as cardiovascular disease, stroke, amputation, end-stage renal disease, and blindness. Two ethnic groups in New Mexico are disproportionately affected by diabetes. Hispanics, 45% of the NM population, are two times more likely and American Indians, 9.5% of the population, are three times more likely to develop diabetes than Non-Hispanic Whites. Furthermore, Type 2 diabetes, previously considered an adult disease, has increased dramatically in children and adolescents in New Mexico (NM State Department of Education & NM Department of Health, 2001).

Risk factors for childhood obesity include lack of nutritious foods, lack of physical activity, lack of support from the school and home environment to choose appropriate foods and make time to exercise, and too much screen time. Poor nutrition and limited physical activity are risk factors for chronic diseases and also play a role in a student's ability to learn, thus affecting scholastic success. There is a significant economic impact of childhood obesity on health care costs and the ability to produce a well educated, prepared work force.

In an effort to combat childhood obesity and teach children about healthy lifestyles, County Extension Agents from Santa Fe, Rio Arriba, and Los Alamos Counties revised and implemented a pilot program, Just Be It! Healthy and Fit, for fifth grade students in their counties in 2004-2005. Evaluation results from a pre/ post test of the 817 students showed that the workshops on My Pyramid, Power Up with Exercise, Making Healthy Snack Choices, and Goal Setting increased student knowledge scores 11%. Teachers were also surveyed and 93% felt the program was a good use of student time. The current need for childhood obesity prevention education, the success of the pilot program, and the literature reviewís evidence that this program addresses the risk factors for obesity, all combined to make this project a program of excellence for Extension. It was chosen as a program to submit for USDA/CSREES funding as a Children, Youth, and Families at Risk-Sustainable Community Project for 2006-2011.

Research Support for the Just Be It! Healthy and Fit Program
USDA/CSREES funded the development of a review of literature on childhood obesity prevention by Brown and Nelson in 2006 because the issue is such a hotbed of concern for educators, health care professionals and families nationwide. The literature review indicates that there is no conclusive evidence that one specific prevention or intervention program works to prevent childhood obesity. The World Health Organization (2003) developed a table which shows the factors which decrease or increase the risk for obesity and the level of evidence from research studies for each factor:

Convincing Evidence:
Decreases risk- Regular physical activity;High dietary fiber intake
Increases risk- High intake of energy-dense foods; Sedentary lifestyle

Probable Evidence:
Decreases risk- Home and school environment that supports healthy food choice for children; Promoting linear growth [Linear growth is normally increasing height with age.]
Increases risk- Heavy marketing of energy-dense foods and fast foods outlets; Adverse social and economic conditions
in developed countries (particularly for women); Sugar-sweetened soft drinks and juice

Possible Evidence:
Decreases risk- Low glycemic index foods;Breast-feeding
Increases risk- Large portion sizes;High proportion of food prepared outside of homes; Rigid restraint and/or periodic disinhibition eating patterns

Insufficient Evidence:
Decreases risk- Increased eating frequency
Increases risk- Alcohol

The educational program, Just Be It! Healthy and Fit, decreases the risk factors for childhood obesity by implementing the concepts listed as convincing and probable evidence in the World Health Organization chart (2003). The program promotes regular physical activity, provides nutrition education to students, teachers, and parents, and affects change in the home and school environment to support healthy food choices for children.

The Just Be It! Healthy and Fit Program contains the basic elements that research has shown to be useful in reducing the risks of obesity for children. According to a literature review by Haskins, Paxson, and Donahue (2006), childhood obesity and overweight can be prevented by providing nutrition education in which students learn to make nutritious food choices and choose appropriate serving sizes of food as well as increasing the time spent in physical exercise. Students need to be physically active at least 30 minutes a day; some sources recommend 60 minutes of physical activity every day. Changing the home and school environment has also been shown to be effective in risk reduction. Parents can purchase and serve nutritious foods in appropriate quantities and can promote physical activity by limiting TV viewing and encouraging exercise. Teachers can provide times for children to exercise, as well as reinforce nutrition education concepts, and influence the number of nutritious food options in school menus and vending machines.

Story, Kaphingst, and French (2006) reviewed literature specifically on the role of schools in obesity prevention. They state that school based prevention program results are not comparable to one another, and have been less effective in reducing body weight than was hoped. Some components of school based programs have been effective and they include requiring physical education classes, providing more interesting and fun physical education choices, and enforcing school wide guidelines about appropriate food and beverage availability and sales. Other effective strategies have been growing school gardens, walking or biking to school, and providing physical activity in after school programs, as well as during the school day. Programs that teach both parents and teachers to create environments which are active, to provide nutritious foods, and model appropriate eating and physical activity, have been effective pieces of an overall program. Changing the home environment in conjunction with school based prevention activities has also been effective in reducing the risks of childhood obesity. Changes in the home include decreasing TV viewing, increasing the availability of healthy food and limiting low nutrition foods

Although much research has been done on how parents shape their childrenís eating and physical habits, few high quality data exist on the effectiveness of such programs (Lindsay, Sussner, Kim, and Gortmaker, 2006) Current evidence suggests that parenting interventions work best when combined with a variety of other settings such as schools, health services, or WIC. School based programs that incorporate parenting and at home components into the curricula are more effective than stand alone school based programs.

Lindsay, Sussner, Kim, and Gortmaker (2006) reviewed the literature on the role of parents in preventing childhood obesity. They concluded that families can reduce the risks of childhood obesity by eating meals together, making fruits and vegetables available and model eating them, not allowing children to drink sugar sweetened beverages, reducing TV and other screen time, and promoting and modeling physical activity. Effective programs included families in prevention efforts by using strategies such as making the school gym and swimming pool available after school and on the weekends, providing a specific curriculum with a parent component, sending home a weekly newsletter to reinforce concepts, providing skill building activity packets, organizing family fun nights, and delivering wellness programs. Programs that included families and had high retention rates used incentives such as food, child care, transportation, rewards for homework completion, and attendance.

References
Brown, Margaret, and Pat Tanner Nelson (2006) Childhood Obesity Prevention: Review of Research Literature. Newark, Delaware: University of Delaware Cooperative Extension. http://ag.udel.edu/extension/fam/obesity/ChildhoodObesity.htm

Centers for Disease Control and Prevention. (2004) Behavioral Risk Factor Surveillance System. http://apps.nccd.cdc.gov/brfss/trends/trenddata.asp

Haskins, Ron, Christina Paxson, Elisabeth Donahue (2006) Fighting Obesity in the Public Schools- Policy Brief. The Future of Children, vol. 16, no. 1. The Woodrow Wilson School of Public and International Affairs at Princeton University and The Brookings Institution. www.futureofchildren.org

Lindsay, Ana C., Katarina M. Sussner, Juhee Kim, and Steven Gortmaker (2006) The Role of Parents in Preventing Childhood Obesity. The Future of Children, vol.16, no1, pp 169-186. www.futureofchildren.org

Mokdad, A.H., Ford, E.S., Bowman, B.A., Dietz, W.H., Vinicor, F., Bales, V.S., Marks, J.S. (2003) Prevalence of Obesity, Diabetes and Obesity-related Health Risk Factors, 2001. Journal of the American Medical Association, 289, 1, pp. 7-9.

New Mexico State Department of Education and New Mexico Department of Health (2001) Youth Risk and Resiliency Survey from Healthier Schools New Mexico. http://www.healthierschools.org/NM01YRRSfinalreport.pdf

Story, Mary, Karen M. Kaphingst, and Simone French (2006) The Role of Schools in Obesity Prevention. The Future of Children, vol.16, no1, pp 109-142. www.futureofchildren.org

World Health Organization (2003) Diet, Nutrition, and the Prevention of Chronic Diseases: Report of the Joint WHO/FAO Expert Consultation, p. 63.
http://www.who.int/dietphysicalactivity/publications/trs916/download/en/index.html

Target Audience and Actions

The target audience for the funded grant project is composed of fifth grade students in one or more schools per county of Santa Fe, Rio Arriba, and Los Alamos. Students will attend educational workshops on nutrition guidelines, how to exercise, healthy snacks, and goal setting, annually from 2006-2011.

A secondary target audience is parents and teachers of the fifth grade students. Activities, which are designed to affect change in the family and school environments will be planned and implemented with parents and teachers in 2006-2011. Activities will teach parents and teachers how important their role is in student food choices and making time to exercise.

Resources used to meet eduactional objectives are online at www.nmcyfar.org.

Short-Term Objectives

Fifth grade students will show an increase in their knowledge level on nutrition guidelines, making healthy snacks, physical activity, and goal setting as a result of attending a one-day educational field trip.

Medium-Term Objectives

Fifth grade students will show a statistically significant increase in their knowledge level on nutrition guidelines, making healthy snacks, physical activity, and goal setting during the school year.

Fifth grade students will show a statistically significant improvement in their nutritional intake during the school year.

Fifth grade students will show a statisticaly significant increase in their level of physical activity during the school year.

Teachers and parents of fifth grade students will increase their knowledge level on nutrition, their role in student food choices, and the need to promote physical activity for children during the school year.

Long-Term Objectives

The New Mexico Cooperative Extension system will integrate the Just Be It! Healthy and Fit program into educational programs which are offered statewide.

Evaluation Plan

Pre/ post knowledge tests will be used to determine level of knowledge gained or lost by students annually from 2006 to 2011. Knowledge level at the beginning of the year will be compared to knowledge level at the end of the year.

A post/pre retrospective survey will be used to determine level of knowledge gained or lost by parents and teachers of fifth grade students and will be collected annually from 2006 to 2011.

To determine change in food intake behavior, nutritional intake data will be acquired from students through a food frequency and food recall instrument annually from 2006-2011. Baseline food intake will be compared to food intake at the end of the school year.

To determine behavior change in physical activity, the amount of physical activity completed by students will be documented by a physical activity questionnaire completed by students with the teachersí and parentsí assistance annually from 2006 to 2011. Baseline level of physical activity at the beginning of the year will be compared to the level of physical activity at the end of the school year.

The long term objective will be evaluated using Extensionís online impact reports and/or interviewing county agents.

Plan of Work Signature Page

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I, Department Head for faculty member  , have reviewed this Plan of Work and agree that it includes:

  • Goal Statement
  • Situation Statement
  • Target Audience and Actions
  • Measurable Short, Medium, and Long-Term Objectives
  • Evaluation Plan


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