Using Policy to Promote
Student Health Punam Ohri-Vachaspati, PhD, RD
Associate Professor, NutritionCollege of Nursing and Health Innovation
Arizona State University
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
Outline
Map 1: Percentage of Children who are Obese Aged 10–17 Years by State
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).
2003 2007
2003 2007 Change in Prevalence 2003-2007
Total Male Female
Total Male Female Total Male Female
US 14.8 18.1 11.5 16.4 19.2 13.5 10.4 6.1 17.6
Arizona 16.4 22.2 10.8 20.4 27.2 13.2 24.3 22.1 21.6
Obesity Prevalence Among Children and Adolescents
Aged 10-17 years
Singh et al. ARCH PEDIATR ADOLESC MED/VOL 164 (NO. 7), JULY 2010
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
% Adults active
% adult no leisure time activity
% 9th -12th graders active
% 9th -12th graders in daily PE
US National 64.5 25.4 17.1 30.3
Arizona 66.5 22.9 16.2 26.9
California 66.7 23.5 NA NA
New Mexico 67.9 23.8 22.1 29.8
Utah 71.8 20.7 19.9 29.9
Physical Activity
http://www.cdc.gov/physicalactivity/downloads/PA_State_Indicator_Report_2010.pdf
Why are these behaviors so important?
Energy Intake
Energy Expenditure
Energy Imbalance
Obese Children & Youth
Food and Beverage
Intake
PhysicalActivity
8
Energy Balance – or Imbalance
Growth and
Maintenance
Adapted from Preventing Childhood Obesity: Health in a Balance, Institute of Medicine, 2005
Layers of influence on a child’s nutritional wellbeing?
Making Healthy Choices - an uphill task
Healthy eating & physical activity
• Skills
• Knowledge
• Use of Time
Individual and Family
• Policy
• Legislation
• Economics
CultureSocial norms and values
• Access
• Advertising
• Affordability
Environment
Source: CDC, Nutrition and Physical Activity Program
Making Healthy Choices Default, Convenient, and Easy
Healthy eating & physical activity
• Skills
• Knowledge
• Use of Time
Individual and Family
• Policy
• Legislation
• Economics
CultureSocial norms and values
• Access
• Advertising
• Affordability
Environment
Source: CDC, Nutrition and Physical Activity Program
School Food and PA Environment and
Policies
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
Wide Availability of High-Calorie Beverages in US
Elementary Schools
*Turner and Chaloupka, ARCH PEDIATR ADOLESC MED 2010
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
Energy Dense Foods Readily Available to Elementary School
Children
Turner et al. Bridging the Gap, UIC, 2010
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
Availability and Consumption of Competitive foods in US Public Schools
Fox et al. SNDA III, 2009
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
PA / PE in Elementary Schools (2007-08)
Turner et al. Bridging the Gap, UIC, 2010
Tools available to health professionals to help
change 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.
Local Wellness Policy
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
Local Wellness Policies Evaluation
Chiriqui et al. (2009), based on a representative sample of school districts across US.
Schools that have wellness policies in place are more likely to
implement other health related policies
Ohri-Vachaspati et al. under preparation
Local data can help movepolicy changes
ID(optional)
Name
(optional) SexDate of
birth
Date of measureme
nt
Height Weight
BMI BMI %ileFeet Inches Pounds
Children’s BMI Tool for Schools
http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/tool_for_schools.html
School meals Competitive foods Physical activity and PE Farm to school programs School gardens What else?
What school level policy changes are taking place in AZ?
School interested in bringing about environmental and policy changes
Schools interested in providing nutrition education
Please contact: Punam [email protected] or 602-496-1279
Looking for Research Partners