Let's Be Healthy!

1. Let's Be Healthy! Healthy messages for young learners 5-7 and families Joan Temmerman, MD

2. Background:Community Needs Assessment • Nutritional problem: pediatric obesity is a public health crisis with lifelong ramifications • Marion County, IN ranked low for health behaviors, health outcomes, SES • Children in Marion County at high risk for overweight & obesity: -22% obese; 18% overweight in Marion County -20% obese; 17% overweight outside

3. Marion County pediatric weight status N = 90,147

4. Background:Pediatric intervention tools • Lifestyle interventions should involve both school and home environment • Include dietary education, physical activity, healthy lifestyle habits and family • Most effective in younger children • Simple messages with pictures/cartoons improve attention & recall (Houts et al, 2006)

5. Simple prevention messages • Eating ≥ 5 servings fruit & vegetables daily • Decreasing sugar-sweetened drinks • Decreasing TV & screen time to ≤ 2 hrs/d • Increasing activity ≥ 1 hour daily • Preparing more meals at home • Eating at the table as a family • Eating a healthy breakfast • Being active as a family • Involving whole family in lifestyle changes • Getting enough sleep Barlow and the Expert Committee, 2007

6. Assessment: conclusions • Marion County children would benefit from school-based & family centered lifestyle intervention tool • Focusing on early school age might positively impact high middle school obesity rates Plan of Action: develop a family-centered wellness lesson & brochure, focusing on healthy lifestyle habits to improve health of young school age children and their families

7. Timetable for Nutrition Education Program and Marketing Plan

8. Marketing Plan and Costs Expenses:Direct: Graphic Designer (Brochure)$250 brochure printing: $207 Pre- and post-tests $50_ Total direct expenses $507 Indirect expenses $0

9. Methods: Lesson Plan Let's Be Healthy! • Target audience: kindergarten and 1st graders • Duration: 45 minutes • General Objectives: to promote healthy lifestyle habits for early school age children & their families • Specific Objectives: at the end of the lesson, students will be able to: -identify that active play is healthier than watching TV -differentiate between fast food & healthier food choices -identify what 5 a Day refers to -identify that eating at the table as a family is healthier than eating out -identify that family activity is healthier than watching TV

10. Lesson concepts • Children understand the concept of wellness • Clear, positive, simple messages help promote specific health or nutritional objectives • Using pictures to support key points improves attention to and recall of health education information

11. Lesson concepts • Wellness lesson emphasizing healthy lifestyle habits for young school age children and their families • Simple captions and colorful multicultural cartoon pictures used to promote health messages: • increasing activity • improving nutrition and eating patterns • decreasing sedentary behaviors • getting enough sleep • These healthy habits are recommended for obesity prevention (Barlow and the Expert Committee, 2007)

12. (Example: simple health messages) Walk or ride to school

13. Implementation • Difficulty accessing local public schools • Curriculum fixed • Not happy to take away any instruction time • Would have to go through a review of IPS grants Private schools approached -nutrition month January -Montessori schools do not test at all

14. Pilot studySt. Monica Elementary School • White 64% • Black 22% • Hispanic 8% • Asian 5% • ~450 students • 14:1 student:teacher ratio • kindergarten ~40 students; 2 classes

15. Results • 38 students participated in wellness lesson • Took test before & after lesson; asked to circle healthier picture • Comparison of pre- and post-tests • Final number = 35 (2 sick for post-test; 1 unclear answers)

16. Results • 35 students completed pre- and post-tests • 12/35 students perfect scores on both • 23/35 remaining students: • 17/23 (74%) had improvement on post test • 6/23 (26%) no change 2-tailed t-test: 0.00007; p<.001

17. 17/23 scored higher on post-test:increase in correct answers Number of Students Post-test improvement (increase in correct answers)

18. What can I improve? • I would have liked to observe lesson (lesson very interactive; affected by leader) • Reading ability may have affected test • Some pictures may have been misleading • 1st graders weren’t tested

19. Circle the healthiest breakfast What can I improve? • correct answer on right, but is portion size misleading?

20. Conclusions • Intervention shows highly significant effect • Participation increased through Indiana Action for Healthy Kids (INAFHK) website: http://take.actionforhealthykids.org/site/Clubs?club_id=1122&sid=2980&pg=newsand Indiana Afterschool Network

21. Conclusions • Preventative health messages follow recommended guidelines • Brochure alone may be useful as family wellness intervention outside of school • Future goals:provide brochure to medical sites and educators

22. Thank You! • Dr. Patsy • My Networking Team: • Stella • Denise • Nicole • Katherine • Stacey • & all my classmates! A happy dance!

23. References • 2010 Indiana County Health Rankings. Mobilizing Action Toward Community Health. Retrieved August 3, 2010 from http://www.countyhealthrankings.org/ • Marion County, Indiana. Stats Indiana. Retrieved Sept. 27, 2010 from www.stats.indiana.edu/profiles/pr18097.html • Barlow S and the Expert Committee. Recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007;120:S164-S192. • Child Health and Wellness Initiative Results, Marion County. Retrieved Sept. 27, 2010 from www.mchd.com/CHWI_results_report.htm • Healthy People. Office of Disease Prevention and Health Promotion. U.S. Department of Health and Human Services. Retrieved November 1, 2010 from http://www.healthypeople.gov/ • Indiana Healthy Eating Patterns; Physical Activity and Body Weight Indicators. USDA ARS Products and Services; Community Nutrition Mapping Project, CNMap. Retrieved Sept. 7, 2010 from www.ars.usda.gov/Research/docs.htm?docid=12396 • The Obesity Epidemic and Indiana Statistics. U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. Division of Adolescent and School Health. Retrieved Sept. 27, 2010 from www.cdc.gov/HealthYouth/yrbs/index.htm

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