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Progress in Preventing Childhood Obesity: How Do We Measure Up? 7 Schools Childhood obesity prevention efforts have primarily focused on the school environment because nearly all children, ages 5 years and older, spend a large part of their days in school for 9 to 10 months out of the year. Schools are an important setting to enhance students’ dietary intake and physical activity opportunities and to provide relevant education and behavioral change programs. Policies and programs have the potential to influence the behaviors of all the students in a classroom, school, or school district. However, because the nation’s estimated 66,000 public elementary schools, 12,000 middle schools, and 14,000 high schools are often governed at the local school board, town, or district level, it is difficult to systematically evaluate prevention strategies or to disseminate promising strategies, policies, and programs (NCES, 2005). Further, more attention needs to be paid to the provision of low-calorie and high-nutrient foods and beverages that contribute to a healthful diet and opportunities for physical activity in the child-care, after-school, and preschool environments regarding the. The Health in the Balance report provided a range of recommendations for schools (Box 7-1) with the goals of creating and maintaining a consistent environment that supports healthful eating behaviors and regular physical activity. The report also emphasized the need to help students understand the benefits of healthy lifestyles and the relationship between calorie intake and energy expenditure to achieve energy balance at a healthy weight (IOM, 2005).
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Progress in Preventing Childhood Obesity: How Do We Measure Up? BOX 7-1 Recommendations for Schools from the 2005 IOM report Preventing Childhood Obesity: Health in the Balance Schools should provide a consistent environment that is conducive to healthful eating behaviors and regular physical activity. To implement this recommendation: USDA, state and local authorities, and schools should Develop and implement nutritional standards for all competitive foods and beverages sold or served in schools. Ensure that all school meals meet the Dietary Guidelines for Americans. Develop, implement, and evaluate pilot programs to extend school meal funding in schools with a large percentage of children at high risk of obesity. State and local education authorities and schools should Ensure that all children and youth participate in a minimum of 30 minutes of moderate to vigorous physical activity during the school day. Expand opportunities for physical activity through: physical education classes; intramural and interscholastic sports programs and other physical activity clubs, programs, and lessons; after-school use of school facilities; use of schools as community centers; and walking- and biking-to-school programs. Enhance health curricula to devote adequate attention to nutrition, physical activity, reducing sedentary behaviors, and energy balance, and to include a behavioral skills focus. Develop, implement, and enforce school policies to create schools that are advertising-free to the greatest possible extent. Involve school health services in obesity prevention efforts. Conduct annual assessments of each student’s weight, height, and gender-and age-specific BMI percentile and make this information available to parents. Perform periodic assessments of each school’s policies and practices related to nutrition, physical activity, and obesity prevention. Federal and state departments of education and health and professional organizations should Develop, implement, and evaluate pilot programs to explore innovative approaches to both staffing and teaching about wellness, healthful choices, nutrition, physical activity, and reducing sedentary behaviors. Innovative approaches to recruiting and training appropriate teachers are also needed. SOURCE: IOM (2005). In June 2005, the committee sponsored the symposium Progress in Preventing Childhood Obesity: Focus on Schools in collaboration with the Kansas Health Foundation and sponsored by the Robert Wood Johnson Foundation (Appendix F). The symposium was held in Wichita, Kansas and provided the committee with the opportunity to interact with a range of
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Progress in Preventing Childhood Obesity: How Do We Measure Up? stakeholders—teachers, students, principals, health educators, dietitians, after-school personnel, food service providers, industry representatives, state government and community leaders, and researchers—and learn about innovative interventions, challenges in implementing and evaluating school-based and after-school programs, and opportunities for evaluating policies and initiatives. In addition to the symposium, the committee draws from reports, scientific literature, and the media to provide examples of obesity prevention activities in schools for this chapter. The obesity prevention effort in schools is an active area for change, and the committee recognizes that it can capture only a small proportion of the obesity prevention-, physical activity-, and nutrition-related policies and programs being implemented. This chapter focuses on assessing progress and ensuring that evaluations are conducted so that the most promising approaches can be identified and disseminated. As noted in the Health in the Balance report (IOM, 2005), there is a relative paucity of scientific data on obesity prevention efforts in schools. Teachers, schools, school districts, states, and the nation are in the midst of many exploratory efforts and new interventions, which provide opportunities to build the evidence base in order for promising efforts to be replicated and scaled up. Additionally, it is important that efforts found to be ineffective are either revised or discontinued, so they do not use resources that can be more effectively used for other efforts. The multitude of actions revolving around nutrition and physical education in schools is a positive step forward. However, as detailed in a recent report examining state and regional obesity prevention-related policies, much remains to be done to provide a consistent healthy school environment that promotes energy balance for children and youth (TFAH, 2005). Although many states are addressing nutrition-related issues, these efforts are not being implemented in all states, and limited attention is focused on concurrently increasing physical activity levels and reducing sedentary behaviors. Highlights from the 2005 Trust for America’s Health (TFAH) report indicate that, as of the time of publication of the report: Six states (Arkansas, Kentucky, South Carolina, South Dakota, Tennessee, and Texas) have mandated nutritional standards for school meals and snacks that are stricter than current USDA requirements. Eleven states (Arizona, California, Hawaii, Kentucky, Maryland, New Mexico, Oklahoma, South Carolina, Tennessee, Texas, and West Virginia) have established nutritional standards for competitive foods sold in schools. Many of these changes had occurred recently with six states setting requirements for competitive foods since 2004. All states except South Dakota have physical education require-
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Progress in Preventing Childhood Obesity: How Do We Measure Up? ments for students; however Illinois is the only state that requires physical education for every grade in schools on a daily basis. Four states (Arkansas, Illinois, Tennessee, and West Virginia) have passed legislation that allows schools to measure students’ body mass index (BMI) levels as part of health examinations or physical education activities. OPPORTUNITIES AND CHALLENGES One of the greatest challenges for school-based obesity prevention efforts may also be an opportunity to rapidly advance progress. As noted above, because schools are primarily controlled and administered at the local level, there are challenges in disseminating effective prevention interventions and for schools to learn about what has been effective or ineffective in other schools or school districts. However, this same lack of coordination between educational institutions may also provide the opportunity for a broad array of highly innovative approaches to emerge or for similar approaches to be implemented within many different settings. If evaluation efforts can be applied to these various approaches, there is an opportunity to rapidly expand the evidence base. In the absence of evaluation, this multiplication of efforts and approaches has less opportunity to support effective policies, programs, and initiatives or ensure the efficient use of resources. Time and financial resources were two key barriers to the implementation of obesity prevention interventions identified by teachers and school administrators at the committee’s regional symposium (Appendix F). The school year and school day are finite, and teachers report competing demands on their time. In particular, the school day is filled with nationally and state-mandated academic subjects, and there has been an increased emphasis in recent years on teaching to meet academic testing requirements. Teachers and school officials also reported that the effort to comply with the academic requirements set forth in the No Child Left Behind Act that was signed into law in 2002 (DoEd, 2006a) and similar state or local mandates often results in a de-emphasis on physical education and nutrition education programs. Financial resources are also limited and are spread across many different competing priorities. Unless an individual school or school district has established health promotion as a high priority, financial resources will be insufficient to hire and train highly qualified physical education teachers, after-school program personnel, health educators, and school health professionals (e.g., school nutritionists and school nurses) and equip them with the space, equipment and supplies, and curricula that they require for creating a healthy school environment. Even when health promotion and obesity
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Progress in Preventing Childhood Obesity: How Do We Measure Up? prevention have been identified as high priorities, school funding may still be insufficient to effectively implement and evaluate relevant policies, programs, and initiatives. As with other sectors that affect the health and wellness of children and youth, schools are only one setting where young people spend part of their day and their year. Therefore, an important challenge is to promote and achieve collaborations between many stakeholders that provide healthful messages and opportunities. These collaboration should involve parents; after-school and child-care programs; media; sports organizations; nonprofit organizations that sponsor after-school, evening, and summer activities (e.g., Girl Scouts, Boy Scouts, and Boys and Girls Clubs); and industry. Nevertheless, although schools are attractive partners and settings for collaborative initiatives, they are also asked to address many other health and social issues (e.g., violence prevention, sexual health education, and substance abuse prevention). Extra demands may create more competition for the time that children and adolescents spend in school and the human and financial resources needed to implement nutrition and physical activity programs. Assessing progress in childhood obesity prevention in the school setting is assisted by many surveillance systems, surveys, and self-assessment tools—some of which have been actively used for 10 to 15 years. The discussions in this chapter frequently refer to the major surveillance systems or tools that are being used to assess progress in obesity prevention in the school setting (Table 7-1; Chapter 4; Appendixes C and D). However, as noted later in the chapter, most surveys do not comprehensively cover all school grades and local-level data are limited. EXAMPLES OF PROGRESS IN PREVENTING CHILDHOOD OBESITY With the myriad of obesity prevention initiatives occurring across the nation, the committee can provide only selected examples of innovative practices. This section examines the progress toward meeting the recommendations presented in the Health in the Balance report (IOM, 2005), provides examples of relevant efforts to fulfill the recommendations, and, where available, discusses the tools and strategies being used to evaluate and assess that progress. Creating an Environment Conducive to Healthy Lifestyles School wellness plans and councils are the focus of current efforts to address the comprehensive issues of creating and sustaining schools throughout the nation that promote healthy lifestyles. The Child Nutrition and
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Progress in Preventing Childhood Obesity: How Do We Measure Up? TABLE 7-1 Overview of Surveillance and Monitoring Systems Surveillance System Description School Health Policies and Programs Study (SHPPS) SHPPS has been conducted every six years by the Centers for Disease Control and Prevention (CDC) since 1994. SHPPS provides state, school district, school, and classroom information that is aggregated at the national and state levels. Of greatest relevance to childhood obesity prevention are the sets of questions about health education, physical education and activity, food service, and school policy and the school environment. School Health Profiles (SHP) SHP is a biennial survey, which CDC has conducted since 1994, of a representative sample of middle and senior high schools in a state or school district. Principals and health education teachers are asked to respond to surveys that encompass a range of school health issues. Youth Risk Behavior Surveillance System (YRBSS) YRBSS collects self-reported data on the risk behaviors primarily of 9th- to 12th-grade students, and has been conducted every two years since 1991. CDC provides technical assistance to states and municipalities that conduct the Youth Risk Behavior Survey (YRBS) at state or local levels concurrent to CDC conducting the YRBS at the national level. In 2005, weighted results (requiring a 60 percent or higher response rate) were collected for 40 states and 21 school districts (Eaton et al., 2006). School Nutrition Dietary Assessment Study (SNDA) SNDA has been conducted by the U.S. Department of Agriculture (USDA) in the 1991–1992 and 1998–1999 school years and data for SNDAS III were collected in the 2005 school year. The study examines calorie content, fat content, pricing, student participation, and other elements of school food sales for a nationally representative sample of elementary, middle, and high schools. School Health Index (SHI) The School Health Index (SHI), developed and promoted by CDC, is an eight-module assessment tool aimed at assisting individual schools examine and evaluate their comprehensive school health and safety policies. Two sets of SHI modules—one for elementary schools and the other for middle and high schools—have been developed. WIC Reauthorization Act (Public Law 108-265) was initiated and passed by Congress in 2004 and requires school districts participating in the National School Lunch Program (NSLP) or School Breakfast Program (SBP) to establish local school wellness policies by the beginning of the 2006–2007 school year (CNWICRA, 2004). Local school wellness policies address a
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Progress in Preventing Childhood Obesity: How Do We Measure Up? range of health-related issues, including nutrition and physical activity. The Act includes a plan for assessing the implementation of local school wellness policies supported by $4 million in appropriated funds (Chapter 4). A number of organizations have developed model wellness policies and components of those policies. For example, the National Alliance for Nutrition and Activity has developed model nutrition and physical education policies that states and school districts can use and customize to local situations (NANA, 2006). The National Association of State Boards of Education in collaboration with the National School Boards Association has developed the resource Fit, Healthy, and Ready to Learn, which provides sample policies that reflect promising practices (NASBE, 2006). USDA has assembled reference materials in its online Team Nutrition: Local Wellness Policy database (USDA, 2006b). Action for Healthy Kids, in partnership with the Centers for Disease Control and Prevention (CDC) has developed the Wellness Policy Tool, which complements the Team Nutrition website and which assists school districts in identifying appropriate policy options (Action for Healthy Kids, 2006). Both websites also include evaluation resources. Additional resources include the wellness policy evaluation checklists developed by state agencies in Pennsylvania and Texas (Pennsylvania School Boards Association, 2006; Texas Department of Agriculture, 2006). Most evaluations conducted to date have focused on outcome measures related to developing and implementing policy changes at the school or school district level (e.g., structural, institutional, and systemic outcomes). Future evaluations should examine the effect of these changes on students’ cognitive, dietary, and physical activity behaviors, as well as health outcomes. It is unclear at this point whether most schools will have the resources required to conduct further evaluations that focus on behavioral and health outcomes. A presentation at the committee’s symposium in Wichita, Kansas highlighted the joint efforts of the Kansas Department of Education and the Kansas Department of Health and Environment. The two departments are collaborating to develop model wellness policies for school districts throughout the state (Appendix F). Additionally, tools are being developed that individual school districts can use to evaluate the implementation of their wellness policy and a state-level database will be used to track the implementation of these policies in each district. Technical assistance will be provided to the school districts, and efforts are under way to sustain local changes through school health advisory councils. In the next few years, as school wellness policies are adopted and promoted, it will be important to systematically evaluate the implementation of the wellness policies and to focus on sustainability issues. The development and implementation of coordinated school health
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Progress in Preventing Childhood Obesity: How Do We Measure Up? programs are the emphases of the funding and technical assistance available through CDC’s Division of Adolescent and School Health (Kolbe et al., 2004). Currently 23 states receive funding focused on the coordinated school health program model, which has eight components, including nutrition, physical education, creating a healthy school environment, and health promotion for staff. Many states and cities are currently enacting legislation that focuses on multiple aspects of enhancing a healthy school environment. For example, in June 2005 South Carolina’s legislature and governor approved legislation that focused on school nutrition, physical activity, and health education particularly in elementary schools (Box 7-2). Arkansas took an early lead in this effort with a focus on assessing BMI levels, implementing changes in school foods, and promoting physical activity (Ryan et al., 2006). Additionally, a number of organizations, foundations, government agencies, corporations, and others are partnering with schools on efforts that affect multiple aspects of the school environment. Examples of these BOX 7-2 South Carolina’s Students’ Health and Fitness Act of 2005 Beginning in the 2006–2007 school year: Students in kindergarten through fifth grade must be provided 150 minutes a week of physical education and physical activity. A minimum of 60 minutes per week must be for physical education, with plans to increase it to 90 minutes per week. The fitness status of individual students, as determined during fifth and eighth grades and during high school physical education classes, must be reported to the student’s parent(s) or guardian. All schools must administer the South Carolina Physical Education Assessment. The assessment of students in the second, fifth, eighth grade, and in high school are used to evaluate the effectiveness of the school’s physical education program and its adherence to the South Carolina Education Curriculum Standards. Effectiveness scores will be developed and reported through the school district and school report cards. The State Board of Education will establish requirements for elementary school food service meals and competitive foods. The State Department of Education will make available to each school district a coordinated school health model. An assessment of district and school health education programs will be conducted. Each school district will establish a coordinated school health advisory council. SOURCE: South Carolina General Assembly (2006).
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Progress in Preventing Childhood Obesity: How Do We Measure Up? broad-based initiatives include Action for Healthy Kids (a public-private partnership with state-based coalitions) and the Healthy Schools Program sponsored by the Alliance for a Healthier Generation (a joint effort of the American Heart Association and the William J. Clinton Foundation with support from the Robert Wood Johnson Foundation) (Chapters 2 and 5). Improving School Food and Beverage Nutrition The food and beverages sold or available in schools through the federal meal programs, as competitive (à la carte) items in the school cafeteria, in vending machines, in school stores, or in the classroom have been the focus of obesity prevention efforts in many localities (CSPI, 2006; Story et al., 2006). Policies related to the types of foods and beverages available in elementary, middle, and high schools generally differ, with more restrictive policies implemented for the lower grades. Many states are developing and implementing state nutrition standards for the foods and beverages served and sold in schools (see for example, Andersen et al., 2004; Connecticut State Department of Education, 2006). Certain cities and localities, such as Chicago and Philadelphia (Box 7-3) are enacting requirements stricter than those mandated by state law. In 2004, the School Health Profiles (SHP) survey found that carbonated soft drinks, sports drinks, or fruit drinks were offered for sale in vending machines in 95.4 percent of the schools in the 27 states for which weighted data were available. Similarly, bottled water was offered by 94.3 BOX 7-3 Overview of Nutrition Standards of the School District of Philadelphia Soft drinks will not be sold or served in school. Juice beverages must contain at least 25 percent real fruit juice. The total fat content of snack foods must be less than or equal to 7 grams per serving. The saturated fat content of snack foods must be less than or equal to 2 grams per serving. The sodium content of snack foods must be less than or equal to 360 milligrams per serving. The sugar content of snack foods must be less than or equal to 15 grams per serving. Candy will not be served or sold during the school day. SOURCE: Philadelphia Comprehensive School Nutrition Policy Task Force (2002).
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Progress in Preventing Childhood Obesity: How Do We Measure Up? percent of the schools (Kann et al., 2005). In future SHP surveys, it will be important to track trends in the type of foods and beverages available for purchase by students. Despite all the attention being paid to improving the nutritional quality of the foods and beverages provided in schools, however, the committee heard at the Wichita symposium that food service managers face ongoing challenges in improving school nutrition. These include insufficient funding, the use of sole-source contracts, open campuses where students can choose to leave schools to eat, a lack of nutrition education, short meal periods, and competition with vending machine options (Appendix F). Other barriers that food service managers face include preferences for fast foods, carbonated soft drinks, and salty snacks; the mixed messages sent by school personnel; and school food preparation and serving space limitations (Gross and Cinelli, 2004). At the more local level, individual schools and school districts have made innovative changes to their menus, food sales, and beverage choices (Box 7-4) (Kojima et al., 2002). One of the challenges, however, has been in disseminating that information. The Produce for Better Health Foundation, in conjunction with 5 a Day and Fresh from Florida, has compiled promo- BOX 7-4 Key Considerations in Improving School Foods and Beverages from the Minneapolis Public Schools Food Service Presentation at the IOM Symposium on Schools Ensure that Minneapolis Public School students have access to nutritious meals and ensure that nutritional and cultural needs of the diverse community are met. Meet or exceed USDA standards for nutrition requirements, food safety, and food security (offering more fresh fruits and vegetables, more whole grains). For example, a free “fixin’s bar” that provides fresh vegetables and salsa can be added outside the serving area so students can help themselves. Broaden community involvement by establishing and maintaining Nutrition Advisory Councils, conducting student and parent annual surveys, and providing school meal and nutrition information on the school’s website. Establish nutrition standards for à la carte items, considering portion size, and sugar and fat content. Form partnerships with local universities and technical colleges, local extension agencies, and state and county health departments. Evaluations can include tracking what students are selecting and consuming; conducting annual student/parents/staff surveys; and using input from partnerships. SOURCE: Dederichs (2005).
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Progress in Preventing Childhood Obesity: How Do We Measure Up? tional ideas and implementation models to help food service managers increase students’ fruit and vegetable consumption (PBH, 2005a,b). A recent CDC and USDA publication, Making It Happen: School Nutrition Success Stories, documents some of those changes. Examples include efforts made in Ennis, Montana, where students were involved from the initial planning in 2002–2003 in restocking vending machines and removing brand logos from vending machine signage. The vending services for the Oceanside, California school district were placed under the auspices of the food services program; and the results included healthier options and increased revenue from vending sales for the high school. In McComb, Mississippi, school policies were changed so that fundraising through the sale of candy or other less nutritious food items is not permitted in kindergarten through the eighth grade (USDA, DHHS, and DoE, 2005). Federal, state, and community programs are increasingly focused on improving the nutritional quality of school foods and beverages—those offered as part of the NSLP and SBP, as well as those sold competitively. As discussed in Chapter 4, USDA’s Team Nutrition program provides technical assistance to school food service personnel and child-care professionals, including Fruit and Vegetables Galore, a tool to assist schools in promoting fruit and vegetable consumption (USDA, 2006c). Additionally, innovative approaches to increase fruit and vegetable availability and consumption are being implemented by students, teachers, food service personnel, and the community through farm-to-school programs and school gardens (Graham and Zidenberg-Cherr, 2005; USDA, 2005). The U.S. Department of Defense (DoD), in partnership with USDA, conducts the DoD Fresh program, which in the 2005–2006 school year distributed produce to school foodservice programs in 46 states and more than 100 American Indian reservations (Chapter 4) (David Leggett, USDA, personal communication, July 13, 2006; USDA, 2006a). Fresh fruits, dried fruits, and fresh vegetables are also being made available to students outside the regular school meal periods through USDA’s Fresh Fruit and Vegetable Program (FFVP). Established as a pilot program in the 2002–2003 school year, the program aims to increase student consumption of fruits and vegetables by increasing the availability of these foods in the school environment (Chapter 4). In 2004, the Child Nutrition and WIC Reauthorization Act (Public Law 108-265) established FFVP as a permanent program and expanded the program from four to eight states and added additional American Indian reservations (UFFVA, 2006); subsequent appropriations legislation in 2006 expanded the program to 14 states, and additional funding for a nationwide program is being sought. FFVP has undergone a preliminary evaluation, and further evaluation efforts are under way (Buzby et al., 2003) (Appendix D). For example, an evaluation of 25 schools in Mississippi that participated in the
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Progress in Preventing Childhood Obesity: How Do We Measure Up? mechanisms, such as through presentations at professional meetings and the publication of findings in professional journals. They also, however, need to be disseminated through innovative mechanisms that can provide teachers, principals, school administrators, and food service personnel with examples of specific interventions that can be implemented. Sharing the innovative changes through publications with concrete examples and details, such as the recent compilation by CDC and USDA of innovations in school food and beverages, Making It Happen: School Nutrition Success Stories, should be continued. Such publications should provide as much detail on the intervention and on the results of its evaluation as possible. Mechanisms to incentivize evaluation and disseminate promising practices include the provision of awards or recognition for schools or school districts that implement and evaluate relevant programs and policies and that are able to demonstrate positive changes on the path to obesity prevention. For example, the Keystone Healthy Zone Schools program in Pennsylvania provides schools with technical assistance in improving the school wellness environment and offers competitive minigrant funding to make improvements. The program also assists schools with collecting benchmark measures of progress and actively disseminates school success stories through its website (Keystone Healthy Zone, 2006). Another example is the Utah Gold Medal Schools program, which was begun just before the 2002 Olympic Games. With the support of the Utah Department of Health, Intermountain Healthcare and other organizations, the program offers incentives for schools that implement policies and programs focused on increasing physical activity, improving nutrition, and reducing tobacco use (Utah Department of Health, 2006). In addition to bronze, silver, and gold awards, schools can work toward the platinum award, which in addition to other nutrition- and physical activity-related stipulations, requires the involvement of families and the community in health-related efforts; a policy of selling only food and beverage choices that contribute to healthful diets at school events, in vending machines, and at school stores; policies that ensure that meal periods are of the appropriate length or policies that schedule recess before lunch; and the implementation of a faculty wellness program (Utah Department of Health, 2006). SUMMARY AND RECOMMENDATIONS Current childhood obesity prevention efforts are largely focused on changes in the school environment, with much of the attention on improving the nutritional quality and the portion sizes of the foods and beverages made available in schools. Momentum related to promoting increased opportunities for physical activity seems to be growing; however, the limited
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Progress in Preventing Childhood Obesity: How Do We Measure Up? time available in the school day and the many competing demands on school time are presenting obstacles to these efforts. Similar to community obesity prevention efforts, wide variations in the extent of resources and the amount of effort devoted to increasing physical activity and making changes in the school nutrition environment are seen across states, school districts, and individual schools. Wide variations in other areas, such as improving the school curriculum on energy balance, discouraging branded marketing in schools, and assessing and communicating student BMI and fitness levels, as well as the collaborative efforts between schools and communities to use schools as community centers, are also found. Less attention appears to be being paid to improving nutrition and increasing the levels of physical activity in the preschool, child-care, and after-school environments, although again, some locations are quite focused on this issue, whereas others are not yet engaged. Throughout the nation there appears to be only limited efforts to evaluate the many policies and programs being implemented in states, local school districts, individual schools, and classrooms. Each of the report’s four recommendations (Chapter 2) is directly relevant to promoting leadership and collaboration and improving the evaluation of school-based childhood obesity prevention efforts. The following provides the report’s recommendations and summarizes the specific implementation actions (detailed in the preceding sections) that are needed to improve childhood obesity prevention efforts in schools. Recommendation 1: Government, industry, communities, schools, and families should demonstrate leadership and commitment by mobilizing the resources required to identify, implement, evaluate, and disseminate effective policies and interventions that support childhood obesity prevention goals. Implementation Actions for Schools School boards, administrators, and staff should elevate the priority that is placed on creating and sustaining a healthy school environment and advance school policies and programs that support this priority. To accomplish this: Relevant federal and state agencies and departments, local school districts, individual schools and preschools, and child-care and after-school programs should prioritize opportunities for physical activity and expand the availability and access in schools to fruits, vegetables, and other low-calorie and high nutrient foods and beverages that contribute to healthful diets.
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Progress in Preventing Childhood Obesity: How Do We Measure Up? Increased resources are needed to develop, implement, and evaluate policies and programs. State and local school-based nutrition and physical activity standards need to be implemented, and the relevant educational entities should be held accountable for promoting and adhering to these standards. Recommendation 2: Policy makers, program planners, program implementers, and other interested stakeholders—within and across relevant sectors—should evaluate all childhood obesity prevention efforts, strengthen the evaluation capacity, and develop quality interventions that take into account diverse perspectives, that use culturally relevant approaches, and that meet the needs of diverse populations and contexts. Implementation Actions for Schools Schools and school districts should strengthen evaluation efforts by partnering with state and federal agencies, foundations, and academic institutions to develop, implement, and support evaluations of all relevant school-based programs. To accomplish this: Federal agencies (e.g., CDC, USDA, Department of Education), state departments of education and health, foundations, academic institutions, school districts, and local schools should Increase the resources devoted to technical assistance for evaluating school-based childhood obesity prevention policies, programs, and interventions and Develop partnerships to fund, develop, and implement childhood obesity prevention evaluations. Recommendation 3: Government, industry, communities, and schools should expand or develop relevant surveillance and monitoring systems and, as applicable, should engage in research to examine the impact of childhood obesity prevention policies, interventions, and actions on relevant outcomes, paying particular attention to the unique needs of diverse groups and high-risk populations. Additionally, parents and caregivers should monitor changes in their family’s food, beverage, and physical activity choices and their progress toward healthier lifestyles. Implementation Actions for Schools Schools and school districts should conduct self-assessments to enhance and sustain a healthy school environment, and mechanisms
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Progress in Preventing Childhood Obesity: How Do We Measure Up? for examining links between changes in the school environment and behavioral and health outcomes should be explored. To accomplish this: Relevant federal agencies (e.g., CDC, NIH, USDA, and the Department of Education), state education departments, school districts, and local schools should Expand and fully use current surveillance systems related to children’s dietary and physical activities, obesity-related health indicators, and relevant school policies and programs; Implement a national survey focused on the physical activity behaviors of all children and youth; Support research on means to improve the monitoring of diet and physical activity; Establish mechanisms to link health, educational, economic, and sociological data sources across a variety of areas related to childhood obesity prevention; and Expand and adapt self-assessment tools for schools, preschools, child-care, and after-school programs and evaluate their validity for predicting changes in children’s levels of physical activity, dietary intakes, and weight. Recommendation 4: Government, industry, communities, schools, and families should foster information-sharing activities and disseminate evaluation and research findings through diverse communication channels and media to actively promote the use and scaling up of effective childhood obesity prevention policies and interventions. Implementation Actions for Schools Schools should partner with government, professional associations, academic institutions, parent-teacher organizations, foundations, communities, and the media to publish and widely disseminate the evaluation results of school-based childhood obesity prevention efforts and related materials and methods. To accomplish this: Schools, preschools, child-care and after-school programs, and relevant stakeholders should broadly disseminate the evaluation results using diverse communication channels and media and develop incentives to encourage the use of promising practices.
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Progress in Preventing Childhood Obesity: How Do We Measure Up? REFERENCES Action for Healthy Kids. 2006. Wellness Policy Development Tool. [Online]. Available: http://actionforhealthykids.org/wellnesstool/index.html [accessed July 6, 2006]. Afterschool Alliance. 2006. After School and Children’s Health. [Online]. Available: http://www.afterschoolalliance.org/active_hours_ob_kit.cfm [accessed May 16, 2006]. Alliance for a Healthier Generation. 2006. Alliance for a Healthier Generation and Industry Leaders Set Healthy School Beverage Guidelines for U.S. Schools. [Online]. Available: http://www.healthiergeneration.org/docs/ afhg_nr_school_beverage_5-3-06.pdf [accessed July 7, 2006]. Andersen K, Caldwell D, Dunn C, Hoggard L, Thaxton S, Thomas C. 2004. Eat Smart: NC’s Recommended Standards for All Foods Available in School. Raleigh, NC: North Carolina Division of Public Health. Austin SB, Fung T, Bearak AC, Wardle K, Cheung LWY. 2006. Facilitating change in school health: A qualitative study of schools’ experiences using the School Health Index. Prev Chronic Dis [Online]. Available: http://www.cdc.gov/Pcd/issues/2006/apr/05_0116.htm [accessed July 23, 2006]. Bachman CM, Baranowski T, Nicklas T. 2006. Is there an association between sweetened beverages and adiposity? Nutr Rev 64(4):153–174. Barroso CS, McCullum-Gomez C, Hoelscher DM, Kelder SH, Murray NG. 2005. Self-reported barriers to quality physical education by physical education specialists in Texas. J School Health 75(8):313–319. Bauer KW, Patel A, Prokop LA, Austin SB. 2006. Swimming upstream: Faculty and staff members from urban middle schools in low-income communities describe their experience implementing nutrition and physical activity initiatives. Prev Chronic Dis [Online]. Available: http://www.cdc.gov/Pcd/issues/2006/apr/05_0113.htm [accessed July 23, 2006]. Boarnet MG, Anderson CL, Day K, McMillan T, Alfonzo M. 2005. Evaluation of the California Safe Routes to School legislation: Urban form changes and children’s active transportation to school. Am J Prev Med 28(2 Suppl 2):134–140. Boyle M, Purciel M, Craypo L, Stone-Francisco S, Samuels S. 2004. National Evaluation & Measurement Meeting on School Nutrition and Physical Activity Policies. Conducted by Samuels & Associates. Commissioned by The Robert Wood Johnson Foundation and The California Endowment. Brandt EN Jr, McGinnis JM.1985. National Children and Youth Fitness Study: Its contribution to our national objectives. Public Health Rep 100(1):1–3. Brener ND, Pejavara A, Barrios LC, Crossett L, Lee SM, McKenna M, Michael S, Wechsler H. 2006. Applying the school health index to a nationally representative sample of schools. J School Health 76(2):57–66. Buzby JC, Guthrie JF, Kantor LS. 2003. Evaluation of the USDA Fruit and Vegetable Pilot Program: Report to Congress. E-FAN-03-006. Washington, DC: USDA. [Online]. Available: http://www.fns.usda.gov/cnd/Research/FV030063.pdf [accessed May 8, 2006]. California Endowment. 2006. Beverage Vending Machines in California High Schools. [Online]. Available: http://www.calendow.org/reference/publications/pdf/disparities/Beverage%20Vending%20Brief.pdf [accessed July 14, 2006]. Cardon G, De Clercq D, De Bourdeaudhuij I, Breithecker D. 2004. Sitting habits in elementary schoolchildren: A traditional versus a “moving school.” Patient Educ Couns 54(2): 133–142. Carver A, Salmon J, Campbell K, Baur L, Garnett S, Crawford D. 2005. How do perceptions of local neighborhood relate to adolescents’ walking and cycling? Am J Health Promot 20(2):139–147.
OCR for page 320
Progress in Preventing Childhood Obesity: How Do We Measure Up? CDC (Centers for Disease Control and Prevention). 2005. School Health Index: A Self-Assessment and Planning Guide, Middle School, High School. [Online]. Available: http://apps.nccd.cdc.gov/shi [accessed August 1, 2006]. CDC. 2006a. School Health Index (SHI): Mini-Grants for Physical Activity and Nutrition Improvements. [Online]. Available: http://www.cdc.gov/HealthyYouth/SHI/grants.htm [accessed February 14, 2006]. CDC. 2006b. SHPPS 2006 Questionnaires. [Online]. Available: http://www.cdc.gov/healthyyouth/shpps/2006/questionnaires.htm [accessed May 17, 2006]. CDC. 2006c. Physical Education Curriculum Analysis Tool. [Online]. Available: http://www.cdc.gov/healthyyouth/PECAT/index.htm [accessed May 24, 2006]. CDC. 2006d. SHPPS 2000, State Health Report Cards. [Online]. Available: http://www.cdc.gov/HealthyYouth/shpps/report_cards/index.htm [accessed May 25, 2006]. CDC. 2006e. School Health Profiles, State and District Fact Sheets. [Online]. Available: http://www.cdc.gov/healthyyouth/profiles/facts.htm [accessed May 25, 2006]. CDC. 2006f. 2005 State and Local Youth Risk Behavior Survey. [Online]. Available: http://www.cdc.gov/HealthyYouth/yrbs/pdfs/2005highschoolquestionnaire.pdf [accessed May 25, 2006]. CDC. 2006g. 2006 School Health Profile School Principal Questionnaire. [Online]. Available: http://www.cdc.gov/Healthyyouth/profiles/2006/QuestionnaireP.pdf [accessed July 12, 2006]. CDC. 2006h. SHPPS 2006, Physical Education District Questionnaire. [Online]. Available: http://www.cdc.gov/HealthyYouth/SHPPS/2006/pdf/pe-district.txt [accessed May 26, 2006]. CNWICRA (Child Nutrition and WIC Reauthorization Act). 2004. Child Nutrition and WIC Reauthorization Act of 2004. PL 108-265. 108th Congress. June 30, 2004. [Online]. Available: http://www.fns.usda.gov/cnd/Governance/Legislation/PL_108-265.pdf [accessed March 22, 2006]. Connecticut State Department of Education. 2006. Action Guide for School Nutrition and Physical Activity Policies. Hartford: Connecticut State Department of Education. Craypo L, Francisco SS, Boyle M, Samuels S. 2006. Food and Beverage Marketing on California High School Campuses Study. Conducted by Samuels & Associates. Commissioned by the Public Health Institute. CSPI (Center for Science in the Public Interest). 2006. School Foods Report Card. [Online]. Available: http://www.cspinet.org/nutritionpolicy/sf_reportcard.pdf [accessed July 17, 2006]. CTSA (Citizenship Through Sports Alliance). 2006. 2005 Youth Sports National Report Card. [Online]. Available: http://www.sportsmanship.org/News/1105%20Report%20Card-Fgrade.pdf [accessed May 26, 2006]. Dederichs R. 2005 (June 27). School District Food Service Policies. Presentation at the IOM Symposium on Progress in Preventing Childhood Obesity: Focus on Schools, Wichita, Kansas. Institute of Medicine Committee on Progress in Preventing Childhood Obesity. [Online]. Available: http://www.iom.edu/Object.File/Master/28/217/RDederichs.2005.pdf [accessed July 9, 2006]. DHHS (U.S. Department of Health and Human Services). 2006. President’s Challenge. [Online]. Available: http://www.fitness.gov/home_pres_chall.htm [accessed May 16, 2006]. DoEd (U.S. Department of Education). 2006a. No Child Left Behind. [Online]. Available: http://www.ed.gov/nclb/landing.jhtml [accessed July 30, 2006]. DoEd. 2006b. Carol M. White Physical Education Program. [Online]. Available: http://www.ed.gov/programs/whitephysed/index.html [accessed March 6, 2006].
OCR for page 321
Progress in Preventing Childhood Obesity: How Do We Measure Up? Donnelly JE. 2005 (June 27). Physical Activity Across the Curriculum/Take 10! Presentation at the Institute of Medicine Symposium Progress in Preventing Childhood Obesity: Focus on Schools, Wichita, Kansas. Institute of Medicine Committee on Progress in Preventing Childhood Obesity. Eaton DK, Kann L, Kinchen S, Ross J, Hawkins J, Harris WA, Lowry R, McManus T, Chyen D, Shanklin S, Lim C, Grunbaum JA, Wechsler H. 2006. Youth risk behavior surveillance—United States, 2005. MMWR 55(5):1–108. Engels HJ, Gretebeck RJ, Gretebeck KA, Jimenez L. 2005. Promoting healthful diets and exercise: Efficacy of a 12-week after-school program in urban African-Americans. J Am Diet Assoc 105(3):455–459. Evenson KR, McGinn AP. 2004. Availability of school physical activity facilities to the public in four U.S. communities. Am J Health Promot 18(3):243–250. Feenstra G, Ohmart J. 2004. “Plate Tectonics”: Do Farm-to-School Programs Shift Students’ Diets? University of California Sustainable Agriculture Research and Education Program. [Online]. Available: http://www.sarep.ucdavis.edu/newsltr/v16n3/sa-1.htm [accessed August 1, 2006]. Feenstra G, Ohmart J. 2005. Yolo County Farm-to-School Project Evaluation. Year Two Annual Report, 2004–2005. Kellogg Foundation Project. University of California Sustainable Agriculture Research and Education Program. Feenstra G, Ohmart J. 2006. Yolo County Farm-to-School Project Evaluation. Year Four Annual Report, Fall/Winter 2005–2006. Kellogg Foundation Project. University of California Sustainable Agriculture Research and Education Program. FHWA/DoT (Federal Highway Administration/Department of Transportation). 2006. Safe Routes to Schools. [Online]. Available: http://safety.fhwa.dot.gov/saferoutes/ [accessed June 10, 2006]. Forshee RA, Storey ML, Ginevan ME. 2005. A risk analysis model of the relationship between beverage consumption from school vending machines and risk of adolescent overweight. Risk Analysis 25(5):1121–1135. Gemmill E, Cotugna N. 2005. Vending machine policies and practices in Delaware. J School Nurs 21(2):94–99. Gittelsohn J, Steckler A, Johnson CC, Pratt C, Grieser M, Pickrel J, Stone EJ, Conway T, Coombs D, Staten LK. 2006. Formative research in school and community-based health programs and studies: “State of the art” and the TAAG approach. Health Educ Behav 33(1):25–39. Gortmaker SL, Peterson K, Wiecha J, Sobol AM, Dixit S, Fox MK, Laird N. 1999. Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Arch Pediatr Adolesc Med 153(4):409–418. Graham, H, Zidenberg-Cherr, S. 2005. California teachers perceive school gardens as an effective nutritional tool to promote healthful eating habits. J Am Diet Assoc 105(11): 1797–1800. Greves HM, Rivara FP. 2006. Report card on school snack food policies among the United States’ largest school districts in 2004–2005: Room for improvement. Int J Behav Nutr Phys Act 3:1. Gross SM, Cinelli B. 2004. Coordinated school health program and dietetics professionals: Partners in promoting healthful eating. J Am Diet Assoc 106(5):793–798 Grunbaum JA, Di Pietra J, McManus T. Hawkins J, Kann L. 2005. School Health Profiles: Characteristics of Health Programs Among Secondary Schools (Profiles 2004). Atlanta, GA: CDC. [Online]. Available: http://www.cdc.gov/HealthyYouth/profiles/2004/report.pdf [accessed July 20, 2006].
OCR for page 322
Progress in Preventing Childhood Obesity: How Do We Measure Up? Indiana Governor’s Council for Physical Activity and Sports. 2006. Governor’s Fitness Award. [Online]. Available: http://www.in.gov/isdh/programs/GovernorsCouncil/award.htm [accessed May 26, 2006]. IOM (Institute of Medicine). 2005. Preventing Childhood Obesity: Health in the Balance. Washington, DC: The National Academies Press. IOM. 2006a. Nutrition Standards for Foods in Schools. [Online]. Available: http://www.iom.edu/project.asp?id=30181 [accessed May 15, 2006]. IOM. 2006b. Food Marketing to Children and Youth: Threat or Opportunity Washington, DC: The National Academies Press. Kann L, Grunbaum J, McKenna ML, Wechsler H, Galuska DA. 2005. Competitive foods and beverages available for purchase in secondary schools—Selected sites, United States, 2004. J School Health 75(10):370–374. Katz DL, O’Connell M, Yeh M-C, Nawaz H, Njike V, Anderson LM, Cory S, Dietz W. 2005. Public health strategies for preventing and controlling overweight and obesity in school and worksite settings: A report on recommendations of the Task Force on Community Preventive Services. MMWR 54(RR10):1–12. Kelder S, Hoelscher DM, Barroso CS, Walker JL, Cribb P, Hu S. 2005. The CATCH Kids Club: A pilot after-school study for improving elementary students’ nutrition and physical activity. Public Health Nutr 8(2):133–140. Keystone Healthy Zone. 2006. Keystone Healthy Zone Schools. [Online]. Available: http://www.panaonline.org/programs/khz/ [accessed June 3, 2006]. Klesges LM, Baranowski T, Beech B, Cullen K, Murray DM, Rochon J, Pratt C. 2004. Social desirability bias in self-reported dietary, physical activity and weight concerns measures in 8- to 10-year-old African-American girls: Results from the Girls Health Enrichment Multisite Studies (GEMS). Prev Med 38(Suppl):S78–S87. Kojima D, Teare C, Dill L, Boyle M. 2002. Improving Meal Quality in California’s Schools: A Best Practices Guide for Health School Food Service. California Food Policy Advocates. [Online]. Available: http://www.cfpa.net/obesity/MealQualityReport_May2003.pdf [accessed August 6, 2006]. Kolbe L, Kann L, Patterson B, Wechsler H, Osorio J, Collins J. 2004. Enabling the nation’s schools to help prevent heart disease, stroke, cancer, COPD, diabetes, and other serious health problems. Public Health Rep 119(3):286–302. Konami Digital Entertainment. 2006. Konami Digital Entertainment and West Virginia Schools Develop Ground-Breaking Partnership. [Online]. Available: http://www.konami.com/gs/newsarticle.php?id=726 [accessed May 26, 2006]. Lloyd LK, Cook CL, Kohl HW III. 2005. A pilot study of teachers’ acceptance of a classroom-based physical activity curriculum too: TAKE 10! TAHPERD Journal Spring: 8–11. Martin S, Carlson S. 2005. Barriers to children walking to or from school—United States, 2004. J Am Med Assoc 294(17):2160–2162. Mathematica Policy Research. 2005. National School Meals Study. [Online]. Available: http://www.mathematica-mpr.com/nutrition/schoolmeals study.asp [accessed July 13, 2006]. Michigan Governor’s Council on Physical Fitness, Health, and Sports. 2006. Governor’s Council on Physical Fitness, Health and Sports Exemplary Physical Education Awards. [Online]. Available: http://www.michiganfitness.org/awardsprogram/exemplarypeawards.htm [accessed May 26, 2006]. Murimi M, Colvin J, Liner K, Guin J. 2006. Methodology to Evaluate the Outcomes of the Team Nutrition Initiative in Schools. USDA Contractor and Cooperator Report No. 20, Economic Research Service. [Online]. Available: http://www.ers.usda.gov/publications/ccr20/ccr20.pdf [accessed July 14, 2006].
OCR for page 323
Progress in Preventing Childhood Obesity: How Do We Measure Up? NANA (National Alliance for Nutrition and Activity). 2006. Model School Wellness Policies. [Online]. Available: http://www.schoolwellnesspolicies.org [accessed May 12, 2006]. NASBE (National Association of State Boards of Education). 2006. Fit, Healthy, and Ready to Learn: A School Health Policy Guide. [Online]. Available: http://www.nasbe.org/HealthySchools/fithealthy.html [accessed May 12, 2006]. NASPE (National Association for Sport and Physical Education) and AHA (American Heart Association). 2006. 2006 Shape of the Nation Report. [Online]. Available: http://www.aahperd.org/naspe/ShapeOfTheNation/ [accessed June 7, 2006]. NASSP (National Association of Secondary School Principals). 2006. NASSP Guidelines for Beverage-Provider Business Agreements. [Online]. Available: http://www.principals.org/s_nasspsec.asp?TrackID=&SID=1&DID=47375&CID=63&VID=2&RTID=0&CIDQS=&Taxonomy=False&specialSearch=False [accessed July 31, 2006]. NCES (National Center for Education Statistics). 2005. Digest of Education Statistics, 2004 (NCES 2006-2005), Chapter 2. NCSL (National Conference of State Legislatures). 2006. Physical Education and Physical Activity for Children. [Online]. Available: http://www.ncsl.org/programs/health/perequirement.htm [accessed July 13, 2006]. NetScan. 2006. State Actions to Promote Nutrition, Increase Physical Activity, and Prevent Obesity: A 2006 First Quarter Legislative Overview. [Online]. Available: http://www.rwjf.org/files/research/NCSL%20FinalApril%202006%20Report.pdf [accessed June 3, 2006]. Neumark-Sztainer D, French SA, Hannan PJ, Story M, Fulkerson JA. 2005. School lunch and snacking patterns among high school students: Associations with school food environment and policies. Int J Behav Nutr Phys Act 2(1):14. NSBN (New Schools, Better Neighborhoods). 2002. A New Strategy for Building Better Neighborhoods. [Online]. Available: http://www.nsbn.org/publications/cra/cra-newstrategy.pdf [accessed July 13, 2006]. O’Hara Tompkins N, Zizzi S, Zedosky L, Wright J, Vitullo E. 2004. School-based opportunities for physical activity in West Virginia public schools. Prev Med 39(4):834–840. PANA (Pennsylvania Advocates for Nutrition and Activity). 2006. Growth Screening. [Online]. Available: http://www.panaonline.org/programs/ khz/screening/index.php [accessed May 26, 2006]. Parsad B, Lewis L. 2006. Calories In, Calories Out: Food and Exercise in Public Elementary Schools, 2005. Washington, DC: National Center for Education Statistics. NCES 2006– 057. Pate RR, Ross JG. 1987. Factors associated with health-related fitness. J Phys Educ Rec Dance November–December:93–95. Pate RR, Davis MG, Robinson TN, Stone EJ, McKenzie TL, Young JC. 2006. Promoting physical activity in children and youth. A leadership role for schools. Circulation 114(11): 1214–1224. PBH (Produce for Better Health Foundation). 2005a. School Foodservice Guide: Successful Implementation Models for Increased Fruit and Vegetable Consumption. Wilmington, DE: PBH. PBH. 2005b. School Foodservice Guide: Promotions, Activities, and Resources to Increase Fruit and Vegetable Consumption. Wilmington, DE: PBH. Pearlman DN, Dowling E, Bayuk C, Cullinen K, Thacher AK. 2005. From concept to practice: Using the School Health Index to create healthy school environments in Rhode Island elementary schools. Prev Chronic Dis [Online]. Available: http://www.cdc.gov/PCD/issues/2005/nov/05_0070.htm [accessed July 23, 2006].
OCR for page 324
Progress in Preventing Childhood Obesity: How Do We Measure Up? Pennsylvania School Boards Association. 2006. Local Wellness Policy Checklist [Online]. Available: http://www.psba.org/policy/localwellnesspolicychecklist.pdf [accessed June 16, 2006]. Philadelphia Comprehensive School Nutrition Policy Task Force. 2002. Comprehensive School Nutrition Policy [Online]. Available: http://www.thefoodtrust.org/pdf/snpolicy.pdf [accessed May 16, 2006]. President’s Challenge. 2006. President’s Challenge, Educators. [Online]. Available: http://www.presidentschallenge.org/educators/program_details.aspx [accessed May 26, 2006]. Probart C, McDonnell E, Weirich JE, Hartman T, Bailey-Davis L, Prabhakher V. 2005. Competitive foods available in Pennsylvania public high schools. J Am Diet Assoc 105(8):1243–1249. Probart C, McDonnell E, Hartman T, Weirich JE, Bailey-Davis L. 2006. Factors associated with the offering and sale of competitive foods and school lunch participation. J Am Diet Assoc 106(2):242–247. Robinson TN. 1999. Reducing children’s television viewing to prevent obesity: A randomized controlled trial. J Am Med Assoc 282(16):1561–1567. Robinson TN, Killen JD, Kraemer HC, Wilson DM, Matheson DM, Haskell WL, Pruitt LA, Powell TM, Owens AS, Thompson NS, Flint-Moore NM, Davis GJ, Emig KA, Brown RT, Rochon J, Green S, Varady A. 2003. Dance and reducing television viewing to prevent weight gain in African-American girls: The Stanford GEMS pilot study. Ethn Dis 13(1 Suppl 1):S65–S77. Ryan KW, Card-Higginson P, McCarthy SG, Justus MB, Thompson JW. 2006. Arkansas fights fat: Translating research into policy to combat childhood and adolescent obesity. Health Aff 25(4):992–1004. Scheier LM. 2004. School health report cards attempt to address the obesity epidemic. J Am Diet Assoc 104(3):341–344. Schneider DJ, Carithers T, Coyle K, Endahl J, Robin L, McKenna M, Debrot K, Seymour J. 2006. Evaluation of a fruit and vegetable distribution program—Mississippi, 2004–05 school year. MMWR 55(35):957–961. Sisson SB, Lee SM, Burns EK, Tudor-Locke C. 2006. Suitability of commuting by bicycle to Arizona elementary schools. Am J Health Promot 20(3):210–213. South Carolina General Assembly. 2006. Students Health and Fitness Act of 2005. Act No. 102. [Online]. Available: http://www.scstatehouse.net/sess116_2005-2006/bills/3499.htm [accessed June 9, 2006]. SPARK (Sports, Play, and Active Recreation for Kids Program). 2006. The SPARK After School Program. [Online]. Available: www.sparkpe.org/programAfterSchool.jsp [accessed May 24, 2006]. SRTS (Safe Routes to School). 2006. National Safe Routes to School Clearinghouse. [Online]. Available: http://www.saferoutesinfo.org/ [accessed June 9, 2006]. Stanford SMART (Student Media Awareness to Reduce Television). 2006. Examining the Negative Effects of Excessive Television. [Online]. Available: http://notv.stanford.edu/ [accessed June 9, 2006]. Staten LK, Teufel-Shone NI, Steinfelt VE, Ortega N, Halverson K, Flores C, Lebowitz MD. 2005. The School Health Index as an impetus for change. Prev Chronic Dis [Online]. Available: http://www.cdc.gov/PCD/issues/2005/jan/04_0076.htm [accessed July 23, 1976]. Staunton CE, Hubsmith D, Kallins W. 2003. Promoting safe walking and biking to school: The Marin County success story. Am J Public Health 93(9):1431–1434. Stewart JA, Dennison DA, Kohl HW III, Doyle JA. 2004. Exercise level and energy expenditure in the TAKE 10! in-class physical activity program. J School Health 74(10):397– 400.
OCR for page 325
Progress in Preventing Childhood Obesity: How Do We Measure Up? Story M, Sherwood NE, Himes JH, Davis M, Jacobs DR Jr, Cartwright Y, Smyth M, Rochon J. 2003. An after-school obesity prevention program for African-American girls: The Minnesota GEMS pilot study. Ethn Dis 13(1 Suppl 1):S54–S64. Story M, Kaphingst KM, French S. 2006. The role of schools in obesity prevention. In: Paxon C, ed. The Future of Children 16(1):109–142. Texas Department of Agriculture. 2006. Local Wellness Policy Checklist. [Online]. Available: http://www.psba.org/policy/localwellnesspolicy checklist.pdf [accessed June 16, 2006]. TFAH (Trust for America’s Health). 2005. F As in Fat: How Obesity Policies Are Failing in America 2005. Washington, DC: Trust for America’s Health. [Online]. Available: http://healthyamericans.org/reports/obesity2005/Obesity2005Report.pdf [accessed December 22, 2005]. Timperio A, Ball K, Salmon J, Roberts R, Giles-Corti B, Simmons D, Baur LA, Crawford D. 2006. Personal, family, social, and environmental correlates of active commuting to school. Am J Prev Med 30(1):45–51. UFFVA (United Fresh Fruit and Vegetable Association). 2006. Fruit and Vegetable Snack Program Resource Center. [Online]. Available: http://www.uffva.org/fvpilotprogram.htm [accessed May 10, 2006]. University of Arkansas for Medical Sciences. 2006. Year Two Evaluation: Arkansas Act 1220 of 2003 to Combat Childhood Obesity. Little Rock, AR: University of Arkansas. [Online]. Available: http://www.uams.edu/coph/ reports/Act1220Eval.pdf [accessed May 16, 2006]. USDA (U.S. Department of Agriculture), Food and Nutrition Service. 2005. Eat Smart— Farm Fresh: A Guide to Buying and Serving Locally-Grown Produce in School Meals. [Online]. Available: http://www.fns.usda.gov/cnd/Guidance/Farm-to-School-Guidance_12-19-2005.pdf [accessed June 16, 2006]. USDA. 2006a. Department of Defense Fresh Fruit and Vegetable Program. [Online]. Available: http://www.fns.usda.gov/FDD/programs/dod/default.htm [accessed July 13, 2006]. USDA. 2006b. Local Wellness Policy. [Online]. Available: http://www.fns.usda.gov/tn/ Healthy/wellnesspolicy.html [accessed June 8, 2006]. USDA. 2006c. Team Nutrition. [Online]. Available: http://www.fns.usda.gov/tn/ [accessed May 17, 2006]. USDA, DHHS, and DoEd. 2005. Making It Happen! School Nutrition Success Stories. [Online]. Available: http://www.cdc.gov/healthyyouth/nutrition/Making-It-Happen/index.htm [accessed June 13, 2006]. Utah Department of Health. 2006. Gold Medal Schools. [Online]. Available: http://www.hearthighway.org/gms.html [accessed July 18, 2006]. Virginia Department of Education. 2006. Health Education, Physical Education, and Driver Education. [Online]. Available: http://www.pen.k12.va.us/VDOE/Instruction/PE/ [accessed May 26, 2006]. Westcott RF. 2005. Measuring the Purchases of Soft Drinks by Students in U.S. Schools: An Analysis for the American Beverage Association. Washington, DC: American Beverage Association. [Online]. Available: http://www.ameribev.org/pressroom/measuring%20the%20purchases%20of%20soft%20drinks%20by%20students%20in%20u.s.%20schools.pdf [accessed July 17, 2006]. Wynns J, Chin EY. 1999. Healthy Food and Physical Activity in the San Francisco Unified School District. Resolution No. 95-25A6. Yin Z, Hanes J Jr, Moore JB, Humbles P, Barbeau P, Gutin B. 2005a. An after-school physical activity program for obesity prevention in children. Eval Health Prof 28(1): 67–89.
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