October 10 & 11, 2013
Physical Health & Well-Beingfor Youth
YOUTH-NEX CONFERENCETHE 3rd ANNUAL
A Discussion to Promote Physical Activity, Nutrition, Health, and Well-Being in Children and Adolescents.
Prepared by Ellen Daniels, Patrick Tolan, and Art Weltman with the assistance of the conference presenters.
Table of ContentsIntroductionp. 2-3
Keynote p. 4-7
Panel 1 Overview of Physical Activity and Healthy Eatingp. 8-11
Lunch SymposiumHow Do Our Built EnvironmentsImpact Youth?p. 12-13
Panel 2Strategies to IncreasePhysical Activityp. 14-21
Panel 3Nutrition and Healthy Eatingp. 22-27
Panel 4The Mind-Body Connectionp. 28-37
Panel 5Injury Prevention and Treatmentp. 38-49
Wrap-Upp. 50-57
List of Conference Presenters p. 58-59
Resources p. 60-61
Image Creditsp. 62-63
The Setting:The University of VirginiaPrepared by Ellen Daniels, Patrick Tolan, and Art Weltman with the assistance of the conference presenters.
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Behavior undertaken in adolescence shapes a lifetime of habits and health long into adulthood. What can we do now to ensure our children’s well-being at this important time of development?
Arthur Weltman, Ph.D. Conference Chair
Arthur Weltman, Ph.D. is professor and chair of Kinesiology at the University of Virginia’s Curry School of Education; professor of Medicine, School of Medicine; and program director at Youth-Nex for Promoting Healthy Eating and Activity for Youth.
L eaders from across the country convened to focus on the physical and mental health of youth in the context of Positive Youth Development.
We listened to the latest and best research, exemplary practices, and key policy considerations to inspire each other’s work and spark new ideas to improve the well-being of youth in Virginia and throughout the nation.Resource
Curry School of Education - www.curry.virginia.edu
INTRODUCTION
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?WHAT CAN WE DO TO INCREASE PHYSICAL ACTIVITY FOR YOUTH
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> Seventeen percent of children and adolescents in the United States are still obese.
> Obesity trends in girls are flat-lining but increasing in boys.
> Being active at each life-stage increases the likelihood of being active for the next phase of life.
KEYNOTE
4
Taking the Pulse
Physical Activity Guidelines
> is moderate to vigorous
> is vigorous for three days a week
> includes muscle-strengthening at least three days per week > includes bone-strengthening at least three days per week
> is age-appropriate, enjoyable and offers variety
Children should get one or more hours a day of physical aerobic activity that:
Parents need to understand
William Dietz is the former director of the Centers for Disease Control and Prevention’s Division of Nutrition, Physical Activity, and Obesity.Resource
Centers for Disease Control and Prevention (CDC) - www.cdc.gov
academically.will help kids
that PE in schools
WILLIAM H. DIETZ, M.D., PH.D.
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YN
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E
Inequities Schools that don’t provide recess to first-graders, have higher levels of minority, poor, or urban youth.
Strategies to Increase Activity> Provide portable play equipment on playgrounds and play spaces> Increase outdoor time> Integrate PA into teaching and learning activities> Train all staff in delivery of structured PA and increase PA session time
Conditions for Collective Success> Common agenda
> Mutually reinforcing activities
> Continuous communication
School-based PA Interventions > Implement Physical Activity Guidelines
> Mobilize Parents
> Convene relevant groups to develop and implement a strategic plan
Opportunities for School-Wide Physical Activity
DESERVES TO BE A MAJOR FOCUS FOR PHYSICAL ACTIVITY
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˜6-7 hrs/day
BeforeSchool School Day
PERecess & Breaks
Class- room
ActiveCommute From
˜60 minutes/day
Only about 30% of 16-19 year olds are meeting the requirement of 60 minutes of exercise per day. Most get around 20-30 minutes per day.
Afterschool Programs
IntramuralSports
Extramural Sports
Afterschool Time
˜2-3 hours/day
ActiveCommute To
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THE SCHOOL DAY
Resources
8Pictured at right: Deanna Hoelscher, Russell Pate, Charles Hillman.
RUSSELL PATE, PH.D. - CHARLES HILLMAN, PH.D. - DEANNA HOELSCHER, PH.D., R.D., L.D.
Panel 1: OVERVIEW OF PHYSICAL ACTIVITY AND HEALTHY EATING
We know there are physical health benef ts to physical activity, but there are huge gaps that limit the ability to develop policies, practices, and
recommendations that will ultimately benef t children.
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Did you know?We’ve had federally mandated dietary guidelines for 25 years, but no physical activity guidelines. Physical activity guidelines were fnally mandated in 2008.
Russell Pate, Ph.D.
Can a single bout of physical activity impact cognition?
» brain health | CHARLES HILLMAN, PH.D.
Institute of Medicine - www.iom.edu/Reports/2011/Early-Childhood-Obesity-Prevention-Policies/Recommendations.aspxThe effect of acute treadmill walking on cognitive control and academic achievement in preadolescent children. CH Hillman, MB Pontifex, LB Raine, DM Castelli, EE Hall, AF Kramer Neuroscience 159 (3), 1044-1054.
It appears so. A study by Hillman’s group had kids come in to their lab for 2 conditions: a 20 minute bout of walking and 20 minutes of sitting quietly. Each condition was followed by a test of inhibition and an academic achievement test. (Citation in Resources section) Scores on the inhibitory task were significantly better after exercise than in the sitting condition. After exercise, kids improved in reading and math by a whole grade level compared to the sitting condition.
Cardiovascular fitness is associated with improvements in cognitive control, which is inherent in academic achievement.
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THE STATE OF LUNCH BAGSHigh income families have an abundance of fruits, vegetables and whole grains available, Y E T
77% of the bread products were refined.
These youth’s lunches contained few fruits and vegetables and
Nutrition education at school is not mandated.What should we focus on?
Abandoning the concept of “kid” food, which sets up a culture of non-nutritious foods.
Learning more specifcally about pre-school nutrition—there has been limited research in this area.
Studying more about nutrition only, versus activity and nutrition.
Structuring interventions knowing that appetite increases throughout the day.
Decreasing food availability - many of us eat too often. Let’s take more breaks from food!
panel 1 » healthy eating | DEANNA HOELSCHER, PH.D.
Kids see:153 ads per year promoting healthy eating and
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Under the Influence:
7600 ads per year promoting unhealthy snacks.
Matthew Trowbridge, M.D., M.P.H.
HOW DO OUR BUILT ENVIRONMENTS IMPACT YOUTH?
Researchers worked with local architects to create a cutting edge school environment in order to improve student well-being. The team’s approach yielded many innovations including a teaching kitchen, composting garden, and nutrition resource library to impact the health behaviors of school children at Buckingham Elementary in Dillwyn, Virginia.
More about the project
Impact of School Architecture on School Habits - http://bit.ly/_archProject Video - http://bit.ly/archvideo
“A pediatrician’s recommendation that a patient get regular physical activity loses its salience if this patient’s everyday world lacks opportunities to walk, play, or run.” - Matt Trowbridge
The dining commons was transformed into a classroom with a teaching kitchen and food labs.
The lounge area —complete with
activity-promoting stools and chairs. Students and teachers help maintain
a community-developed garden on school premises.
Schoolyard garden
Lunch Symposium
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Panel 2: STRATEGIES TO INCREASE PHYSICAL ACTIVITY
Preschool and at Home
DIANNE WARD, Ed.D. - JOSEPH DONNELLY, Ed.D. - PHIL WENDEL, CHRISTINA ECONOMOS, PH.D.
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Infants:
• Should engage in at least 60 minutes – up to several hours per day – of unstructured activity.
• Toddlers should accumulate 30 minutes of structured physical activity each day.
• Preschoolers should get 60 minutes of structured physical activity each day.
• Should interact with parents or caregivers in daily physical activities and in settings that encourage, not restrict, activity.
Toddlers and Preschoolers:
* Institute of Medicine, Washington, 2011.
Childcare settings should engage kids in 120 minutes of physical activity per day. Often this is the only activity children get.
-engaging kids in active play, and modeling physical activity -educating and encouraging kids about being active-involving kids in family activities- it works less well with controlling practices such as monitoring rules for indoor and outdoor play and setting limits for screen time.
A more authoritarian or demanding parenting style works well with more controlling practices, such as:
-monitoring rules for inside & outdoor play-monitoring screen time Although the long-term effects of this style practice are unknown.
Inconsistent parenting where activity was encouraged didn’t produce more active kids.
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How Does Parenting Style Affect Physical Activity?
» early childhood obesity prevention
| DIANNE WARD, Ed.D.
With regard to physical activity, a warmer and responsive parenting style works well with supportive practices, such as:
Delivers Academic Instruction Through Movement • For a spelling lesson, playing a hopscotch-like game, hopping from letter to letter to spell different words.
Does Not Decrease Academic Instruction
Is Low Cost, Has Low Teacher Burden
INTERVENTIONPhysical Activity Across the Curriculum - (PAAC):A classroom-based approach to reduce sedentary behavior while maintaining the focus on academics. The curriculum:
– Joseph Donnelly, Ed.D.
BEHAVE BE QUIET STOP MOV-ING AROUND BEHAVE BE QUIET STOP BEHAVE QUIET STOP MOVING AROUND BEHAVE BE QUIET AND STOP MOVING AROUND BEHAVE BE QUIET STOP MOVING BE SILENCE
BEHAVE BE QUIET STOP SILENCE BEHAVE STOP QUIET
“Before kids are in school, they are always running around and engaged in activity. Once they go to kindergarten, they are basically told to sit down and be quiet for the next 12 years.”
Sch
ools
are
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ry
There is no evidence that removal of physical activity programs results in greater academic achievement. Physical education by itself is
not adequate to provide fitness.
Panel 2 » physical and academic achievement in elementary school | JOSEPH DONNELLY, Ed.D., FACSM
Schools are S
edentary
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Resources
Book: The Most Expensive Game in Town, Mark Hyman - www.themostexpensivegameintown.com
The for-profit youth sports industry is providing physical activity opportunities for children due to the vacuum created by the absence of physical activity in the public schools. Fitness clubs can help bridge the gap between the growing number of competitive, pay-to-play sports teams and fewer school-based programs.
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Because of a lack of activity for children in the past 15 years, the
club began offering robust programs for youth as well
as adults.
In the summer, ACAC serves about 1000 5 – 11-year-olds per week in
summer camps where they are very physically active.
ACAC picks up children whose parents can’t be home when school is
out. ACAC buses transport them to the club,
where they participate in supervised study halls and
physical activities.
Some Richmond area schools have outsourced their physical
education classes to ACAC clubs – students get credit for
participating in activities there.
Phil Wendel opened ACAC in 1984 in Charlottesville, Virginia.
—Phil Wendel, Owner ACAC (Atlantic Coast Athletic Club)
Panel 2 » fitness club programs for children and adolescents| PHIL WENDEL
Resource: childobesity180.org
Scaling up Nationally
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Panel 2 » catalyzing communities | CHRISTINA ECONOMOS, PH.D.
Summertime inactivity undoes much of what is accomplished during the school year.Kids gained up to 10 pounds over the summer (Summer school helps minimize this effect).
CAUTIONARY TALE
Needed to Shift the Way we View Health?CHANGE How Do you Spark the SOCIAL
SOMERVILLE, MAInspirational Change in One Community
To increase youth activity levels In Somerville, Massachusetts, researchers engaged a wide range of community members including.....> families > teachers> every pediatrician> all 14 after-school programs > restaurants> local government
They applied multiple proven interventions: BEFORE SCHOOL: Walking programs and healthy breakfasts. DURING SCHOOL: Micro units of activity, nutrition education, professional development for PE teachers.AFTER SCHOOL: Cooking and nutrition programs, improvements in environment - walkability and bikeability.
RESULTS: Body Mass Index z-score (BMI z-score) went down during the school year; sugary beverage consumption and screen time decreased; participation in sports and activities increased.
“Ultimately, relationships made it work.”Learn from Other Movements
[recycling, seat belts, tobacco, etc.]
Build on a Sound Scientific Base
Know Economics are Important
Develop Advocacy
Use Media
Develop a Clear Plan
Call for a Crisis
Nurture Change-maker “spark plugs” Leaders: teachers, researchers, etc. Use Government Strategically
Create Environmental& Policy Changes
CHALLENGE:Reaching Families
STRATEGY:Maintain contact with families over time
Partner with organizations that reach families
CHALLENGE:Passive Refusals (consent but don’t show up)
STRATEGY:Build the intervention into the programs they are involved with
CHALLENGE:Parents not interested if don’t see immediate need
STRATEGY:Design program around the needs & interests of families
CHALLENGE:Priorities for interventions don’t match priorities for families
STRATEGY:Ask family members what they hope to gain by participating
Even before intervention implementation, we often encounter challenges...
See the study Published in International Journal of Behavioral Nutrition and Physical Activity IJBNPA - www.ijbnpa.org/content/10/1/3
Researchers developed interventions that empowered parents and caregivers to foster healthy family lifestyles and establish systems-level change that reinforces family change. They used family development theory; formed an advisory board including parents; and used a mixed approach to determine needs of families.
Family Action-Based Model of Intervention Layout and ImplementationFAMILI}
2-year study
Intervention: Health communication campaign delivering health facts versus myths
Letters sent home about children’s BMI that were easy to interpret
Family coffee hour with nutrition counseling
Parent-led sessions to increase knowledge about available resources
RESULTSChildren: Declines in % of obesityIncreases in light physical activity Families: Improvement in dietary proflesParents: Improvements in all aspects of resource empowermentImprovements in diet and physical activity
The greater the amount of exposure to components of the program, the greater the improvement in diet and physical activity in families.
> > >
> >
Panel 3: NUTRITION AND HEALTHY EATING
» creating sustainable family-based obesity interventions | KIRSTEN DAVISON, PH.D.
KIRSTEN DAVISON, PH.D. - RANDY BIRD - NOAH CARPENTER & BET HOWRIGAN
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Specifically... • Eat breakfast daily• Eat every few hours (5 – 6 times)• Try to choose the least processed foods• Eat a variety of colors - aim for a wide range of colors in one week
• Include a lean protein source at every meal• Consume a combination of carbs and protein before and after workouts• Stay hydrated• Get adequate sleep
Nutri-Nugget: Which food has the most vitamin C? a. A Glass of Orange Juice b. An Orange c. Beans d. Red Bell PepperAnswer on right-hand page.
Panel 3 » game-breaking nutrition for the young athlete | RANDY BIRD
Drink early and oftenEat a variety of different foodsEat early and often
Nutrition Foundations>
>
>
FAT
> > > >
No! Carbohydrates are the athlete’s fuel. Lack of carbohydrates leads to:
Fatigue Irritability Nutrient defciencies Poor athletic performance Bad breath
Quality Matters Choose high fber, and slower-to-digest carbs, such as: Fresh Fruit, Whole Grains, and Oatmeal.
ARE CARBS FATTENING?
Active Bodies Want to Know:NO! We do need some fat in our diets. > They are needed for proper hormone functioning> They help control satiety (makes you feel full)> They store fat-soluble vitamins (A, D, E, K)> They deliver our essential fatty acids
...and as with carbohydrates; quality of fats matter.
Healthy fats include: avocado, organic butter, almonds, olive oil.
SHOULD WE AVOID FATS?
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Answer: Red Bell Pepper
• Builds & repairs muscles• Enhances the immune system• Produces hormones• Replaces red blood cells> Most people do get enough protein in their daily diet.
PROTEIN
> > > > > > > > > > > > > > > > > > > > > > > >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >
Eat the rainbow: cherries,strawberries, carrots,bananas,squash,peaches,broccoli,lettuce,raisins,blueberries,plums, nuts,olive oil,whole grains
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Panel 3 » ‘Fuel Up To Play 60’ students inspire school health | NOAH CARPENTER & BET HOWRIGAN
Learn MoreFuel Up to Play 60 - FuelUptoPlay60.com
Fuel Up to Play 60 is an in-school nutrition and physical activity program launched by National Dairy Council (NDC) and National Football League (NFL), with additional partnership support from U.S. Department of Agriculture (USDA). The program encourages youth to consume nutrient-rich foods and achieve at least 60 minutes of physical activity every day. It is designed to engage and empower youth to take action for their own health by implementing long-term positive changes for themselves and their schools.
Noah Carpenter - TAKING ACTION
There are 73,000 schools, 11 million students, and 8,000 student ambassadors, like Noah,involved in Fuel Up To Play 60.
Student Ambassador
As ambassador at Fairfield Center School in Vermont, Noah helped initiate:Taste Tests To introduce classmates to new, healthy foods such as smoothie pops.
Activity Breaks During Class Brief, focused, in-class breaks for physical activity that won’t disrupt the classroom.Before school, students run or walk a lap around the school. They can also participate in other activities like Wii bowling before school.
Shelter Soup DriveThe week before the Super Bowl, classmates organized a soup drive for the local food shelter. There were coloring contests and activities at every grade level, such as “Tailgate Party” with dancing and tasty and healthy food.
Farm to ClassroomStudents learn plant and grow their own vegetables. They also learn how to prepare and cook them as part of nutritious meals.
‘Fuel Up to Play 60’ can be customized to fit a school’s unique needs. Students are encouraged to be leaders.
The program works to complement, not compete with, an academics-focused environment.
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Panel 4:
PATRICIA JENNINGS, M.ED., PH.D. - SHERI RAND, M.ED. - ALI SMITH
promoting learning through mindfulness | PATRICIA JENNINGS, M.ED., PH.D.
The Mind-Body Connection M I N D F U L N E S S
Mindfulness is paying attention, in a particular way, on purpose, in the present moment, non-judgmentally. It’s an awareness of one’s conduct and the quality of one’s relationships, inward-ly and outwardly....(Kabat-Zinn, 2009/2011).
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There’s a growing body of research showing positive effects of mindfulness practices (e.g. mindful breathing, meditation, etc.) with adults.
These include: > Enhanced memory > Increased concentration> Increased capacity for empathy and compassion> Brain changes that support emotion regulation
What are the implications for school children and classrooms?
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Panel 4 - promoting learning through mindfulness (cont’d) | PATRICIA JENNINGS, M.ED., PH.D.
InnerKids Foundation (citation in Resources Section)
Evidence-Based Programs for Children
Results:> Improved Executive Function
(Executive Function includes decision- making, organizational skills, planning)
Randomized Controlled Trial(8 weeks, 64 children, around 8 y.o.)
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MindUPTM
Informed by research in cognitive neuroscience,
social-emotional learning, mindfulness training and positive psychology.
Curriculum:
- Getting Focused
- Sharpening Your Senses
- Attitude
- Mindfully Taking Action
Learning to Breathe
Results Included:> Increased calmness, self-acceptance, emotional regulation> Reductions in negative mood, tiredness, aches/pains> 64.6% of participants reported practicing mindfulness techniques outside of class time> The most important skill reported by almost 50% of participants: Learning to let go of distressing thoughts and feelings in order to control their stress level
Pilot Trial(120 high school seniors)
A strengths-based mindfulness curriculum for adolescents that aims to enhance emotion regulation in order to strengthen attention and performance, support pro-social behavior, build stress management skills, and improve health and well-being.
Randomized Controlled Trial(12 weeks, 99 children, 4th & 5th graders)
Results:> 24% increase in positive social behaviors
> 15% increase in math achievement
> 20% increase in self-reported social-emotional competencies and skills
> 24% decrease in aggressive behavior
PANAS (Positive and Negative Affect Schedule) - Watson, Clark & Tellegen, 1988 www.gse.uci.edu/childcare/pdf/instrumental_docs/PANAS%20ID.pdf
DERS (Diffculties in Emotion Regulation Scale) - Gratz, & Roemer, 2004 www.nctsnet.org/content/diffculties-emotion-regulation-scale
Somatization Index (Achenbach, 1991)
Qualitative Process Assessment (Broderick, 2007)
Additional Resources for Learning to Breathe
Book Learning to Breathe: A Mindfulness Curriculumfor Adolescents to Cultivate Emotion Regulation, Attention, and Performance by Patricia C. Broderick, Ph.D., New Harbinger Publications, Inc.
Based on mindfulness stress-reduction for younger children. Taught through games, activities, instruction and sharing.
Composed of 3 units: - Attention & Five Senses- Balance & Movement- Clarity & Compassion
Resources InnerKids - www.susankaisergreenland.com/inner-kids.htmlMindUpTM - www.thehawnfoundation.org/mindupGarrison Institute - www.garrisoninstitute.orgLearning to Breathe - www.learning2breathe.org/
Panel 4 - what does it mean to educate the whole child? | SHERI RAND, M.ED.
A Vermont school district promotes mindfulness in the classroom.
South Burlington Wellness & Resilience Program - bit.ly/sthburl_mindfulUCSD Center for Mindfulness - https://ucsdcfm.wordpress.com/tag/sheri-rand/
Resources
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Adults are offered a professional development course to learn self-care, calming practices, evidence-based emotional self-regulation skills, empathy and compassion. Teachers then implement and imbed mindfulness strategies into their classroom through discrete curriculum, literature, and/or a variety of mindfulness based activities.
Vermont Educators in the South Burlington School District (SBSD) found that stressors, including socio-economics, overstimulation, and academic pressure, were translating into more anxiety, anger and difficulty regulating emotions and focus. What was often missing in the classroom was a true presence on the part of the child and sometimes on the part of the teacher.
At SBSD, mindfulness practices are an intentional part of a Wellness and Resilience Program (WRP) aimed at giving children tools, beginning in Pre-K, for self-control, reflection, and relaxation. Among these techniques are breathing exercises, body scan, sensory perception and social connection exercises, mindful eating, and journaling.
When children are able to calm their bodies and minds, they are more available for learning.
Searching for ways to help children grow strong and resilient.
It’s important for the adults to experience the benefts of the practice and to be able to model what they are learning and teaching. — Sheri Rand, M.Ed.
Panel 4 » the holistic life foundation - from inner health to outer health | ALI SMITH
The Holistic Life Foundation is a Baltimore-based organization committed to nurturing the wellness of children and adults in under-served communi- ties. Using a com-prehensive ap- proach, they help children develop their inner lives through yoga, mindfulness, and self-care, while f o s t e r i n g c o m m u n i t y well-being.
Learn MoreHolistic Life Foundation - www.hlfinc.org
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2010 Crime Rate Indexes Baltimore County, MD
Murder Risk
Rape Risk
Robbery Risk
Assault Risk
Burglary Risk
Larceny Risk
0 100 200 300 400 500 600 700
Motor Vehicle Theft Risk
Baltimore County, MD Maryland United States
T h i n g s w e n o t i c e dLack of connection | Lack of compassion | Extreme hypervigilance | High Stress
Lack of Healthy Foods | High Trauma | Lack of Physical Activity | Lack of Peace |
Hopelessness
In the community:
Panel 4 » the holistic life foundation - from inner health to outer health | ALI SMITH
Learn MoreHolistic Life Foundation - www.hlfinc.org
Self Regulation
Concentration & Focus
Conflict Resolution
Thought & Emotional Awareness
Anger Management
Stress Reduction
Compassion
Interconnectedness
Empowerment
Social & Emotional Wellness
Physical Health
Youth who practiced
Mindfulness ShowedIMPROVEMENTS in
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HLF partnered with Johns Hopkins University Bloomberg School of Public
Health and Penn State University to conduct the only randomized
controlled trial with urban youth and yoga. Students showed increased
concentration, ability to control emotions and decreased rumination.
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(cont’d)
youth sports » encouraging life-long physical activity | MICHAEL BERGERON, PH.D., FACSM
of Americans feel sports participation is important for children and adolescents as a part of an active, healthy lifestyle.
91%
94% feel more needs to be done to ensure the health and safety of youth athletes. 2011 Survey
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National Youth Sports Health & Safety Institute - www.nyshsi.org Datalys Center for Sport Injury Research - www.datalyscenter.org National Collegiate Athletic Association (NCAA) - www.ncaa.org/health-and-safety/ncaa-sport-science-institute National Federation of State High School Associations (NFHS) - www.nfhs.org
Resources
The NYSHSI advocates for advancing and disseminating the latest research and
evidence-based education, recommendations and policy to enhance the experience,
development, health and safety of youth in sports.
The NYSHSI views these areas of focus as urgent:
1. SPORTS TRAUMA: Sport Concussion, etc.
2. ENVIRONMENTAL CHALLENGES: Exertional Heat Illness/Stroke, etc.
3. TRAINING and COMPETITION OVERLOAD: Overuse Injuries, Over-scheduling, etc.
4. PLAYING with CHRONIC DISEASE & DISABILITY: Athletes with Type 1 diabetes, sickle cell trait, physical disabilities, etc.
National Youth Sports Health & Safety Institute
Comprehensive vision for safety & youth sports: To increase awareness, advance research, educate, inform policy.
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Panel 5: Injury Prevention and Treatment
Panel 5 » youth sports - encouraging life-long physical activity | MICHAEL BERGERON, PH.D., FACSM
(cont’d)
Sports Participation Rates Drop by the Late Teens.
Why?Overuse injuries20 years ago, 10-15% of injuries seen by pediatricians were from overuse. Now it’s 60-80%.
• A child typically gets overloaded with excessive training when s/he exhibits the most potential— around 12-13 years old. With such rapid growth at this age, it is the worst time for this kind of training because of greater vulnerability to injuries.
• Early specialization in one sport, versus diversity, lends itself to injury.
• There is often not enough rest and recovery between matches, games, bouts of training. This is one of the biggest competition/training errors and contributors to poor performance and injury risk.
• Prior injury is the largest predictor of future injury risk. Athletes must fully recover, rehabilitate, and correct any contributing deficiencies or other factors before re-engaging in sport.
The responsibility to enforce rest and recovery is on the adults — parents, organizations, event directors, sports associations....
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American College of Sports Medicine - www.acsm.org Nike “Designed To Move” - www.nikeinc.com/designed-to-move
Resources
.1% Less than
Young athletes should participate in sports for reasons other than playing in college or professionally.
>>> Done the right way, youth sports can set a foundation for life-long physical activity, fitness, and health!
5%
The Chances A High School Youth Athlete Will Become a Pro Athlete. Young athletes shouldn’t be driven to train so strenuously and with such pressure. They should get
progressive and diversified exposure through childhood and adolescence.
>>> Injury will be reduced; and athletic capacity and sustained performance will be enhanced.
>>>
The Chances A High School Youth Athlete Will Get a College Sports Scholarship.>>>
Success takes time.
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Partly because the workload and other demands are unsustainable.
Panel 5 » sports concussions | DONNA BROSHEK, PH.D.
Con • cus• sionA complex physiological process affecting the brain, induced by traumatic force.
>>> May be from a blow to head or body that transmits force to the brain
Athlete may or may not lose consciousness
Symptoms usually resolve spontaneously but symptoms may evolve over minutes or hours.
Changes are typically functional but not structural (so won’t show up on CT scans, etc.)
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AAN Guidelines - Sports Concussion Toolkit - www.aan.com/concussion
Resource
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Persisting SymptomsHeadaches Nausea Dizziness / Poor BalanceLight / Sound SensitivityFogginessCognitive FatigueInattentionMemory DeficitsSleep DisturbancesIrritabilityDecrease in Frustration ToleranceSadnessAnxiety
Acute Symptoms {Observable within minutes or hours}
ConfusionNausea and/or Vomiting AmnesiaDizzinessVertigo
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Panel 5 » sports concussions | DONNA BROSHEK, PH.D.(cont’d)
Recovery• At college level, it takes 5-10 days to recover. Youth can take 30 days to recover—younger children need to be managed more conservatively.
• The first 10 days are the most critical for preventing occurrence of a second concussion.
• Youth recover at widely varying rates, so there’s no “cookie-cutter” answer in terms of how long recovery should take. Concussion management should be individualized.
• Baselines need to be taken into account for what is back to “normal” for each child.
• Once beyond the acute phase of recovery, light exercise (e.g., walking) enhances cognitive recovery.
Brain Changes Occurring with Concussion• There is an abrupt change to the normal cellular function of brain cells. The cellular pump mechanism goes into overdrive in an attempt to restore energy. There’s an increase in the demand for glucose that the body cannot deliver.
• This causes a metabolic crisis which the brain needs to recover from in order to heal.
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HOW TO RETURN TO ACTIVITY [Zurich Consensus Statement] After a concussion, athletes should complete each phase symptom-free before advancing to the next phase. Minimum of 48 hours at each stage.
From the 4th International Conference on Concussion in Sport, Zurich, November 2012. McCrory et al. British J Sport Med. 2013
Rehabilitation Stage
Functional Exercise at each Stage of Rehabilitation Objective at each Stage
No activity
Light aerobic exercise
Sport-specific exercise
Non-contact training drills
Full contact practice
Return to play
Complete physical and cognitive rest
Walking, swimming, or stationary cycling, < 70% MHR. No resistance training.
Skating drills - ice hockey, running drills - soccer. No head impact activities.
Progression to more complex training drills (passing). May start progressive
resistance training.
Following medical clearance, participate in normal
training activities.
Normal game play.
Recovery
Increase heart rate
Add movement
Exercise, coordination, cognitive load
Restore confidence, assessment of functional
skills by coaching staff
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ResourcesAthletic Training Practice-Based Research Network (AT-PBRN) - www.atpbrn.org Agency for Healthcare Research and Quality (AHRQ) - www.ahrq.govA.T. Still University Sport-Related Concussion Research - www.atsuconcussion.com
Panel 5 » the psychological and social impact of sports concussions and injury on youth | TAMARA VALOVICH MCLEOD, PH.D.
20 million
3 million $1.3 billion
35%12 million
• There are more than injuries annually that cause time lost from organized sports.
• Estimated cost (1996) of these visits was over annually.
• Sports injuries account for more than of all medical visits in 5-17 year-olds.
• student athletes between the ages of 5-22 will suffer a sports-related injury this year.
• Resulting in lost days of school
The Cost of Injury
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If we want to rehabilitate the injury, we have to look at the whole person
(cont’d)
Male athletes report higher well-being than females for psychological, physical,
emotional and school functioning, but not social functioning.
Panel 5 » the psychological and social impact of sports concussions and injury on youth | TAMARA VALOVICH MCLEOD, PH.D.
Quality of Life
gender difference should be considered during injury evaluation and management.
OVERALL
Youth who have suffered concussions report:> Increased depression, mood disturbance, and fatigue.
Time away from the sport due to injury was most strongly related to school functioning.
AFTER INJURYAthletes report lower social functioning and quality of life in general. They lose the identity they had as a player; their sense of self is affected. They also miss out on the social interaction they had pre-injury. They are likely to mask symptoms, saying they are more well than they really are. This can also affect the child-parent relationship.
ATHLETES
48 49
suffers with injury“Anger, sadness, I can’t, it’s you know, I’ve cried a lot, it’s hard to deal with....” —Injured Youth
Report higher health-related quality of life (HRQOL) than non-athletes and higher HRQOL than healthy adolescent peers - particularly in emotional functioning.
»»» »»»
Virginia Public Access Project - www.vpap.orgSenator John Miller - www.senatorjohnmiller.com
Resources
Panel 6: WRAP-UPSENATOR JOHN MILLER, ALETA MEYER, PH.D., KARIN ADDISON, PATRICK TOLAN, PH.D.
>
» becoming an advocate for change | VIRGINIA SENATOR JOHN MILLER
Senator Miller’s Tips to promote changeRequest a meeting with your legislators (when legislature is not in session)
As an advocate, be on a first-name basis with your legislator or bring someone to the meeting who is.
When legislators don’t hear feedback on a bill, they assume the bill has no opposition. So let them know how you feel about it.
Phone calls are least effective, email is best.
Ask to be a resource for your legislator.
Advocacy is about relationships. Legislators want to hear constituents’ opinions and from those who are knowledgeable about the issues.
>
>
>STRESSEarly adversity negatively impacts health & well-being in childhood and throughout life (e.g. poverty, natural disaster, etc.).
Adult health and employment status were negatively impacted if they suffered more than 2 traumatic life events.
How might interventions help children exposed to frequent and prolonged stress?
» impact of adversity & chronic stress on youth well-being | ALETA MEYER, PH.D.
Might physically ACTIVE interventions be a better match between developmental theory, and desired change?
>
>
51
The Virginia Youth Survey - www.vdh.state.va.us/ofhs/youthsurveyVirginia Obesity Survey - www.vfhy.org/obesity/resources/virginia-childhood-obesity-survey
Resources
Wrap-Up » Obesity in the Commonwealth | KARIN TALBERT ADDISON
83% of VA high school students did not eat the
recommended amount of fruits and vegetables each day
Only 24% of VA high school students met the recommended 60 minutes of physical activity per day.
77% of VA students report more than 2 hours of screen time per day
One-thirdof all
childrenborn after
2000 will
suffer from
diabetes
at some point
in their lives.
Prediction:
53
Over the past 3 decades, child obesity rates have tripled.(Higher in African American and Hispanic communities where almost 40% of children are obese or overweight.)
Wrap-Up » positive youth development and physical health & well-being | PATRICK TOLAN, PH.D.
What We Learned>> 70% of schools don’t have recess
>> We need to apply knowledge to practice early and often in order to form good habits
>> There are multiple ways to influence health and well-being
>> It’s best to build-in opportunities, rather than lecture; it’s best to emphasize adding in positive actions rather than have people stop what they are doing
>> These positive actions can take place in arenas of health care, education, community, after-school programs
>> Positive messaging about health and nutrition can inform habits and lifestyles of our youth
“COOPETITION”— How can we best cooperate to achieve our goals?54 55
Our Challenges>> We need clear goals that are integrated into society.
>> How do we “get it right” versus “get it done”?
>> An agency’s needs sometimes drive the agenda, versus prioritizing collaboration.
>> What is the role of evaluation?
>> Usability - Can what we’ve developed really work?
>> Type of evidence
Challenges
Youth-Nex - www.curry.virginia.edu/youth-nex
Resource
Wrap-Up » positive youth development and physical health & well-being | PATRICK TOLAN, PH.D.
(cont’d)
Types of Scientific Evidence - What is the Quality of the Information you Have?
>> We have inferences from studies showing correlations, but this is not the same thing as proving that a certain intervention will work in ways we intend.
>> We need to develop a roster of programs that demonstrate practices that work.
>> Summarize best practices, benchmarks for practices, methods of managing and evaluating; adaptability and usability.
>> Models are not the same as action. We need to do more than say we need health and well-being.....we need to figure out how to do it.
56 57
“We need to
continually think about bringing
facts to the discussion and test
beliefs we have, whether they’re
scientifc, political, religious,
social, and see which things
really make a difference so when
we do meet with legislators, we
have facts to give them and it
becomes harder to be ignored.”
– Patrick Tolan
Conference Presenters
William H. Dietz, M.D., Ph.D. Former Director, Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention
Arthur Weltman, Ph.D. Professor and Chair of Kinesiology, University of Virginia; Professor of Medicine, School of Medicine, University of Virginia; Program Director, Youth-Nex
Megan A. Witherspoon Manager, Corporate Contributions and Community Relations, Altria Client Services
Robert C. Pianta, Ph.D. Dean, Novartis Professor of Education, Curry School of Education, University of Virginia
Keynote & Plenary Remarks
Speakers
Noah Carpenter Vermont State Student Ambassador for Fuel Up to Play 60
Kirsten Davison, Ph.D. Associate Professor of Nutrition, Harvard School of Public Health
Joseph E. Donnelly, Ed.D., FACSM Professor, Internal Medicine; Director, Energy Balance Laboratory and Center for Physical Activity and Weight Management, Cardiovascular Research Institute, The University of Kansas Medical Center and The University of Kansas-Lawrence
Christina Economos, Ph.D. Vice-Chair and Director, ChildObesity180; Associate Professor, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University
David Germano, Ph.D. - ModeratorDirector, Contemplative Sciences Center; Director, Tibet Center; Professor, University of Virginia
Jay Hertel, Ph.D., A.T.C.- ModeratorJoe H. Gieck Professor of Sports Medicine; Professor, Kinesiology and Physical Medicine and Rehabilitation, Curry School of Education, University of Virginia
Charles Hillman, Ph.D. Professor, Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign
Deanna Hoelscher, Ph.D., R.D., L.D. John P. McGovern Professor in Health Promotion and Behavioral Sciences; Director, Michael & Susan Dell Center for Healthy Living at The University of Texas School of Public Health, Austin Regional Campus
Karin Talbert Addison Former Policy Advisor to the Secretary of Education and Secretary of Health and Human Services, Early Childhood Education and Children’s Health.
Michael F. Bergeron, Ph.D., FACSM Executive Director, National Youth Sports Health & Safety Institute; Professor, Department of Pediatrics, Sanford School of Medicine, University of South Dakota’s Sanford USD Medical Center
Randy Bird Director of Sports Nutrition, University of Virginia
Donna K. Broshek, Ph.D. Associate Professor; Co-Director, Neurocognitive Assessment Lab, University of Virginia Medical School
58
Bet Howrigan Educator, Fairfield Center School, Vermont; Program Advisor, Fuel Up to Play 60
Patricia Jennings, Ph.D., M.Ed. Associate Professor, Curry School of Education, University of Virginia
Tamara Valovich McLeod, Ph.D. John P. Wood, D.O., Endowed Chair for Sports Medicine; Professor, Athletic Training Program, A.T. Still University
Aleta L. Meyer, Ph.D. Senior Social Science Research Analyst, Administration for Children and Families (ACF), Offce of Planning, Research, and Evaluation, Division of Family Strengthening
Senator John Miller Virginia State Senator
Russell R. Pate, Ph.D. Professor and Director, Children’s Physical Activity Research Group, University of South Carolina Arnold School of Public Health
Sheri Rand, M.Ed. Program Administrator, South Burlington Vermont School District Wellness and Resilience Program; Assistant Principal, Frederick H. Tuttle Middle School
Susan Saliba, Ph.D., A.T.C, P.T., F.N.A.T.A - ModeratorAssociate Professor; Director of Kinesiology undergraduate program, Curry School of Education, University of Virginia
Ali Smith Founder, Holistic Life Foundation, Baltimore, Maryland
Patrick H. Tolan, Ph.D. Director, Youth-Nex; Professor, Curry School of Education, and Department of Psychiatry and Neurobehavioral Sciences, School of Medicine, University of Virginia
Matthew Trowbridge, M.D., M.P.H. Physician and Assistant Professor, University of Virginia School of Medicine
Dianne Ward, Ed.D. Professor of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
Phil Wendel Founder ACAC
59
Panel 5 National Youth Sports Health & Safety Institute www.nyshsi.org
Datalys Center for Sport Injury Researchwww.datalyscenter.org
National Collegiate Athletic Association (NCAA)www.ncaa.org/health-and-safety/ncaa-sport-science-institute
National Federation of State High School Associations (NFHS) www.nfhs.org
American College of Sports Medicine - www.acsm.org
Nike “Designed To Move” www.nikeinc.com/designed-to-move
AAN Guidelines - Sports Concussion Toolkit www.aan.com/concussion
Athletic Training Practice-Based Research Network (AT-PBRN) www.atpbrn.org
Agency for Healthcare Research and Quality (AHRQ) www.ahrq.gov
A.T. Still University Sport-Related Concussion Research www.atsuconcussion.com
Wrap-up PanelVirginia Public Access Project www.vpap.org
Senator John Miller www.senatorjohnmiller.com
The Virginia Youth Survey www.vdh.state.va.us/ofhs/youthsurvey
Virginia Obesity Survey www.vfhy.org/obesity/resources/virginia-childhood-obesity-survey
Youth-Nexwww.curry.virginia.edu/youth-nex
Video of All Presentationshttp://bit.ly/YNCONF13
Resources
Keynote & Plenary PresentationsCurry School of Education - www.curry.virginia.edu
Centers for Disease Control and Prevention (CDC) www.cdc.gov
Panel 1Institute of Medicine www.iom.edu/Reports/2011/Early-Childhood-Obesity- Prevention-Policies/Recommendations.aspx Research: “The Effect of Acute Treadmill Walking on Cognitive Control and Academic Achievement in Preadolescent Children.” CH Hillman, MB Pontifex, LB Raine, DM Castelli, EE Hall, AF Kramer. Neuroscience 159 (3), 1044-1054.
Panel 2Book: The Most Expensive Game in Town, by Mark Hyman www.themostexpensivegameintown.com
Child Obesity Program childobesity180.org
Lunch SymposiumImpact of School Architecture on School Habitshttp://bit.ly/_arch
Buckingham School Project Videohttp://bit.ly/archvideo
Panel 3 International Journal of Behavioral Nutrition and Physical Activity (IJBNPA) Study - www.ijbnpa.org/content/10/1/3
Fuel Up to Play 60 FuelUptoPlay60.com
Panel 4InnerKids - www.susankaisergreenland.com/inner-kids.htmlResearch: Flook, Lisa, Smalley, Susan, L., Kitil, M. Jennifer, Galla, Brian M., Kaiser-Greenland, Susan, Locke, Jill, Ishijima, Eric and Kasari, Connie (2010)“Effects of Mindful Awareness Practices on Executive Functions in Elementary School Children” Journal of Applied School Psychology, 26: 1, 70-95
Panel 4 (cont’d)
MindUpTM - www.thehawnfoundation.org/mindup Research: Schonert-Reichl, K. A., Oberle, E., Stewart Lawlor, M., Abbot, D., Thompson, K., Oberlander, T. F., Diamond, A. (under review). “Enhancing cognitive and social-emotional development through a simple-to-ad-minister school program.”
LearningToBreathe - www.learning2breathe.org
Book: Learning to Breathe: A Mindfulness Curriculumfor Adolescents to Cultivate Emotion Regulation, Attention, and Performance, by Patricia C. Broderick, Ph.D., New Harbinger Publications, Inc. Research: Broderick, P. C. & Metz, S. (2009). “Learning to BREATHE: A pilot trial of a mindfulness curriculum for adolescents.” Advances in School Mental Health Promotion, 2, 35-46.
Garrison Institute www.garrisoninstitute.org
PANAS (Positive and Negative Affect Schedule) Watson, Clark & Tellegen, 1988 www.gse.uci.edu/childcare/pdf/instrumental_docs/PANAS%20ID.pdf
DERS (Diffculties in Emotion Regulation Scale) Gratz, & Roemer, 2004 www.nctsnet.org/content/diffculties-emotion- regulation-scale
Somatization Index (Achenbach, 1991)
Qualitative Process Assessment (Broderick, 2007)
Research: Holistic Life FoundationMendelson, T., Greenberg, M.T., Dariotis, J.K., Feagans Gould, L., Rhoades, B.L. & Leaf, P.J. (2010). Feasibility and preliminary outcomes of a school-based mindfulness intervention for urban youth, Journal of Abnormal Child Psychology, 38, 985-994.
South Burlington Wellness & Resilience Program bit.ly/sthburl_mindful
UCSD Center for Mindfulnesshttps://ucsdcfm.wordpress.com/tag/sheri-rand/
Holistic Life Foundation www.hlfnc.org
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PAGES:Front Cover - (Two Girls Standing) Larry Jackson; (Girls with Apple) Jane Haley/U.Va. University Communications; (Soccer) By Deutsche Sport Privatschule (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons Inside Cover - Dan Addison/U.Va. University Communications1 - (Conference Logo) Ellen Daniels2, 3 - Stacey Evans4 - Curry School of Education Image Library5 - Stacey Evans6 - (Bus) By Echtner (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons7 - By Luis Miguel Bugallo Sánchez (Lmbuga Commons)(Lmbuga Galipedia) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY- SA-3.0-2.5-2.0-1.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons8 - By BohPhoto (originally posted to Flickr as soccer_0081) [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], viaWikimedia Commons9 - (Brain Scans) By H.M. Dixon (Flickr: Brain page 368) [Public domain], via Wikimedia Commons; (Panelists) - Stacey Evans11 - (Twinkies) Image by Larry D. Moore, used under a Creative Commons ShareAlike License; (Red Chard) By Sanjay Acharya (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/)], via Wikimedia Commons12, 13 - VMDO Architects/Alan Karchmer Photography14 - Author Unknown, CC-zero, Public Domain via Wikimedia Commons 15 - (Illustration) Ellen Daniels16, 17 - Larry D. Moore [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons19 - By Thomas Ricker (Flickr: Sebastiaan floaties) [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons20 - Courtesy of ChildObesity18021 - (School) By Daderot (Own work) [CC0], via Wikimedia Commons; (Classroom) Courtesy of ChildObesity18022 - (Collage, Top Left: Child) Courtesy UNC Children’s Healthy Weight Research Group; (Collage, Top Right: Donut) Cole Geddy/U.Va. University Communications; (Collage Bottom Left: Children); Curry School of Education Image Library (Collage Bottom Right: Apple) Jane Haley/ U.Va. University Communications 23 - Courtesy UNC Children’s Healthy Weight Research Group24 - (Tomato) By ©2005 User: FoeNyx (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (http://creativecommons.org/ licenses/by-sa/3.0/) or CC-BY-SA-1.0 (http://creativecommons.org/licenses/by-sa/1.0)], via Wikimedia Commons25 - Left to Right: (Tennis) Jane Haley/U.Va. University Communications; (Lettuce) Selena von Eichendorf at the Polish language Wikipedia[GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], from WikimediaCommons; (Bread) By Zantastik (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0-2.5-2.0-1.0(http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons; (Baby) By MasterFinally (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons; (Fruit) By Christopher Hind, http://www.flickr.com/photos/94556645@N00/ via Wikimedia Commons; (Hockey) By Battle Creek CVB (Flickr: Hockey in Battle Creek) [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons; (Nuts) By H. Zell (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia CommonBottom of page: (Hazelnut Plant) By H. Zell (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
Image Credits
62 63
26 - Stacey Evans27 - Courtesy of ChildObesity180
28, 29 - By Jdontfight (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0-2.5-2.0-1.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons30, 31 - (Line Drawings) Ellen Daniels based on By Nobody60 (Own work) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons; (Child Painting) By Bureau of Land Management [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons33 - By lululemon athletica (SSC Yoga with Eoin Finn) [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons34, 36, 37 - Larry Jackson38 - By Knightgal at en.wikipedia [Public domain], from Wikimedia Commons40 - By U.S. Navy photo by Mass Communication Specialist 2nd Class Ricardo J. Reyes [Public domain], via Wikimedia Commons42 - Images are generated by Life Science Databases(LSDB). [CC-BY-SA-2.1-jp (http://creativecommons.org/licenses/by-sa/2.1/jp/deed.en)], via Wikimedia Commons44 - Jim Daves47 - By David Shapinsky from Washington, D.C., United States [CC-BY-SA-2.0 (http://creativecommons.org/licenses/by-sa/2.0)], via Wikimedia Commons49 - By Hank Eber, for So Salem (“Josh Adkins”) [CC-BY-SA-2.0 (http://creativecommons.org/licenses/by-sa/2.0)], via Wikimedia Commons50 - Stacey Evans51 - Jane Haley/U.Va. University Communications52 - (Fries) By Evan-Amos (Own work) [CC0], via Wikimedia Commons53 - Cole Geddy/U.Va. University Communications54 - Stacey Evans55 - Curry School of Education Image Library57 - Courtesy of ChildObesity180
This Youth-Nex conference was supported by a grant from Philip Morris USA, an Altria Company. We gratefully acknowledge this important support. The work of Youth-Nex is solely determined by itself and Youth-Nex does not represent the official views of the sponsor. of EDUCATION
CURRY SCHOOL
