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 Ohri-Vachaspatipohrivac@asu.edu or 602-496-1279

Looking for Research Partners