Communities Putting
Prevention to Work…
IN SCHOOLS
Division of Adolescent and School Health
Communities Putting Prevention to Work
Washington, DC Action Institute
June 2, 2010
DASH Mission
■ To promote the health and well being of children
and adolescents so they become healthy and
well-functioning adults.
2
www.cdc.gov/healthyyouth
Key Messages
■ Young people and schools are central to
prevention
■ Health is academic
■ We know what needs to be done: MAPPS
strategies for schools
■ Despite immense challenges, we have many
reasons to be optimistic
Key Messages
■ Young people and schools are central to
prevention
■ Health is academic
■ We know what needs to be done: MAPPS
strategies for schools
■ Despite immense challenges, we have many
reasons to be optimistic
Why Youth?
■ Health risk behaviors are established in
childhood and adolescence
■ Physiological processes leading to chronic
diseases begin in childhood and adolescence
■ It’s easier to prevent the adoption of health risk
behaviors than to change established behaviors
■ Chronic disease health risks are already common
among young people
Consequences of Obesity in Children
% of children, aged 5-17,
with 1 or more risk
factors for heart disease:
% of children, aged 5-17,
with 2 or more risk
factors for heart
disease:
26%
Freedman DS et al. JPediatr 2007;150(1):12-17
13%
Consequences of Obesity in Children
% of children, aged 5-17,
with 1 or more risk
factors for heart disease:
% of children, aged 5-17,
with 2 or more risk
factors for heart
disease:
26%
70%
Freedman DS et al. JPediatr 2007;150(1):12-17
13%
39%
Percentage of U.S. Children and
Adolescents Who Were Obese, 1963-2008*
19.6
20
18.7
15
10
4.6
5
4.2
Ages 6-11
Ages 12-19
0
1963-70** 1971-74
1976-80
1988-94 1999-2000 2001-02
2003-06
2007-08
*>95th percentile for BMI by age and sex based on 2000 CDC BMI-for-age growth charts.
**1963-1970 data are from 1963-1965 for children 6-11 years of age and from 1966-1970 for adolescents 12-17 years of age.
CDC, National Center for Health Statistics
Percentage of High School Students Who:
■ Currently smoke cigarettes: 20%
■ Do not eat fruits and vegetables 5 or more times
per day: 79%
■ Do not meet recommended levels of physical
activity: 83%
■ Do not participate in 60 or more minutes of
physical activity on any day: 25%
Source: CDC, National Youth Risk Behavior Survey, 2007
Government Agencies
Family
Key Messages
■ Young people and schools are central to
prevention
■ Health is academic
■ We know what needs to be done: MAPPS
strategies for schools
■ Despite immense challenges, we have many
reasons to be optimistic
Health is Academic Because…
■ School health
programs can help
improve students’
educational outcomes
■ Helping young people
stay healthy is a
fundamental part of the
mission of our schools
Percentage of U.S. High School Students Getting
Mostly A’s, Mostly B’s, Mostly C’s and Mostly D’s
and F’s* Who Engage in Selected Health Risk
Behaviors
100
80
60
40
29
32
37
41
28
39
45
47
20
0
Insufficient amount of phy sical activ ity
Mostly As
Mostly Bs
Watched telev ision ≥ 3 hours/day
Mostly Cs
*As reported by students
Source: Unpublished analyses of CDC, National Youth Risk Behavior Survey, 2003
Mostly Ds & Fs
Critical Educationally Relevant
Health Factors
1) vision
2) asthma
3) teen pregnancy
4) aggression & violence
5) ADHD
6) physical activity
7) breakfast
www.equitycampaign.org/i/a/document/125
57_EquityMattersVol6_Web03082010.pdf


• Physical
activity
• Breakfast
Causal Pathways
• Improved cognition
• Connectedness
• Attendance
Educational Outcomes
• Academic grades
• Test scores
• Graduation
■ # studies analyzed: 50
■ # associations between schoolbased physical activity
programs and academic
achievement: 251
■ % associations positive: 50.5%
■ % associations negative: 1.5%
■ % with no association: 48.0%
http://www.cdc.gov/HealthyYouth/health_and
_academics/pdf/pa-pe_paper.pdf
■ Increasing or maintaining time
for PE may help, and does not
appear to adversely impact,
academic performance
■ Substantial evidence that
school-based physical activity
can
• help improve academic
http://www.cdc.gov/HealthyYouth/health_and
_academics/pdf/pa-pe_paper.pdf
achievement (including grades
and standardized test scores)
• have a positive impact on
cognitive skills, attitudes toward
school, and academic behavior
Health is Academic Because…
■ School health programs
can help improve
students’ educational
outcomes
■ Helping young people
stay healthy is a
fundamental part of
the mission of our
schools
Pennsylvania should
establish a public school
that places as much
emphasis on physical as
on intellectual fitness
because “exercise
invigorates the soul as
well as the body.”
- Benjamin Franklin, 1749
“In the great work of
education, our physical
condition, if not the first step
in point of importance, is the
first in order of time. On the
broad and firm foundation of
health alone can the loftiest
and most enduring
structures of the intellect be
reared.”
Horace Mann
“We know what the
Greeks knew: that
intelligence and skill can
only function at the peak
of their capacity when the
body is healthy and
strong, and that hardy
spirits and tough minds
usually inhabit sound
bodies.”
John F. Kennedy
“The more we instill in our children early in life these
[physical activity] habits that will last them a lifetime, the
better they're going to do. And so we'll try to do what we
can to expand those opportunities before school, during
the school day, after school.…this is
going to help a lot academically…
This doesn't take away from our
core mission. This is central to
that core mission.”
Arne Duncan
U.S. Secretary of Education
Opinions of U.S. Adults About
School Health Programs
■ 65% of U.S. adults believe schools should play a
major role in fighting the obesity problem1
■ 81% of parents of children in K—12 want their kids
to receive daily physical education2
■ 74% of parents of adolescents said schools should
spend more time or the same amount of time
teaching health education as they do teaching other
subjects3
1. Survey by Lake Snell Perry and Associates for Harvard Univ., based on interviews with a nationally representative sample of 1,002 adults, May-June 2003
2. Survey by Opinion Research Corp. based on interviews with a nationally representative sample of 1,017 adults, February 2000 (margin of error = +6%)
3. Gallup Organization for the American Cancer Society, national telephone survey of 1,003 parents of adolescents enrolled in U.S. public schools, 1993
Key Messages
■ Young people and schools are central to
prevention
■ Health is academic
■ We know what needs to be done: MAPPS
strategies for schools
■ Despite immense challenges, we have many
reasons to be optimistic
MAPPS Strategies for Schools
NUTRITION
PHYSICAL ACTIVITY
■ Limit unhealthy food/drink
availability
■ High quality PE
■ Increase access to
healthier choices
■ Safe routes to school
■ Farm to schools
■ Afterschool settings
■ Community-centered schools
TOBACCO
■ Tobacco-free schools
MAPPS Strategies for Schools
NUTRITION
PHYSICAL ACTIVITY
■ Limit unhealthy
food/drink availability
■ High quality PE
■ Increase access to
healthier choices
■ Safe routes to school
■ Farm to school
■ Afterschool settings
■ Community-centered schools
TOBACCO
■ Tobacco-free schools
Greater Access to Low-Nutrient,
Energy Dense Competitive Foods
at School is Associated With:
intake of total fat and saturated fat
Cullen K et al. JADA 100(12): 1482-1486; Cullen K & Thompson D. JADA 105(12): 1952-1954
intake of fruits and vegetables
Cullen K & Zakeri I. AJPH 94(3): 463-467; Kubik M et al. AJPH 93(7): 1168-1173
Junk Food and Sugar Sweetened Beverages
Bought at School Account for, on Average,
Among Students Who Consume Them at School
■ 177 calories / day (8% of total daily energy intake)
■ 31,860 calories / school year (9 lbs.)
■ 382,230 calories / 12 years of school (109 lbs.)
Source: Fox MK et al. JADA 2009;109:S57-S66
Percentage of Schools in Which Students Could Not
Purchase Soda Pop or Juice Drinks*— Median Among 34
States and Percentage in Selected States, 2006 and 2008
93
100
% Obese by Poverty
90
75
80
63
70
60
60
50
38
40
30
22
20
10
0
Median, 34 States
*Not 100% Juice
CDC, School Health Profiles
MS
2006
CT
2008
■ Federally reimbursable school
nutrition programs should be
the main source of nutrition in
schools.
■ Opportunities for competitive
foods should be limited.
■ If competitive foods are
available, they should consist
primarily of fruits, vegetables,
whole grains, and fat-free or
low-fat milk and milk products.
IOM Nutrition Standards for Foods in
Schools: FACT SHEETS
www.cdc.gov/HealthyYouth/nutrition/standards.htm
Financial Implications of Nutrition Standards
■ Schools can have strong nutrition standards and maintain financial
stability
• WV – 80% of principals reported little or no change in revenue
• CT–Pilot study in 5 schools, overall increase in NSLP, no
significant changes in school finances
• Making It Happen – 15/16 schools and districts reported an
increase or no change in revenue
■ Careful selection and clever marketing of the healthier food and
beverage choices can minimize financial risk
■ School beverage vending contracts are not a significant source of
revenue to most schools
MAPPS Strategies for Schools
NUTRITION
PHYSICAL ACTIVITY
■ Limit unhealthy food/drink
availability
■ High quality PE
■ Increase access to
healthier choices
■ Safe routes to school
■ Farm to school
■ Afterschool settings
■ Community-centered schools
TOBACCO
■ Tobacco-free schools
Access to Healthier Choices in Schools
■ Nutrition standards for competitive foods
■ Work with vendors to purchase healthier options
■ Safe and palatable drinking water easily accessible
■ Taste testing to select healthier options
■ Pricing and promotion strategies
■ Healthy foods and beverages in classroom parties
■ Healthy fundraising activities and student rewards
MAPPS Strategies for Schools
NUTRITION
PHYSICAL ACTIVITY
■ Limit unhealthy food/drink
availability
■ High quality PE
■ Increase access to
healthier choices
■ Safe routes to school
■ Farm to school
■ Afterschool settings
■ Community-centered schools
TOBACCO
■ Tobacco-free schools
Farm to School
■ Improved procurement practices (e.g., geographic
preference in food purchasing contracts)
■ Funding to support activities
■ Training , technical assistance ,and equipment for
procuring, storing, handling, and preparing fresh
produce
■ Opportunities for hands-on learning opportunities
MAPPS Strategies for Schools
NUTRITION
PHYSICAL ACTIVITY
■ Limit unhealthy food/drink
availability
■ High quality PE
■ Increase access to
healthier choices
■ Safe routes to school
■ Farm to school
■ Afterschool settings
■ Community-centered schools
TOBACCO
■ Tobacco-free schools
High Quality Physical Education
■ Emphasizes knowledge
and skills for a lifetime of
regular physical activity
■ Is based on national
standards that define what
students should know and
be able to do
■ Provides many different
physical activity choices
High Quality Physical Education
■ Meets the needs of all
students, especially those
who are not
athletically gifted
■ Keeps students active for
most of class time
■ Is an enjoyable experience
for students
High Quality Physical Education
Requires
■ Adequate time (150
min/week for elementary;
225 min/week for
secondary)
■ Appropriately trained
teachers
■ Adequate facilities and
supplies
■ Reasonable class sizes
Policies to Support High Quality PE
■ Increase time for PE
■ Support use of PE standards and standardsbased curricula
■ Have all classes taught by certified PE teachers
■ Implement student assessment for PE
■ Limits on PE class size
■ Prohibit use of physical activity to punish
Waterville Junior High School (ME)
■ PE minutes increased from 84 to 112 per week
■ Extra minutes provided by adjusting schedule and
reducing class time for a course that met as a double
block course.
■ Junior High PE teachers led the charge, with support
from principal, parents, students, superintendent
■ New fitness facility at HS raised awareness
Self Assessment and Planning
Physical Education Curriculum
Selection or Development
MAPPS Strategies for Schools
NUTRITION
PHYSICAL ACTIVITY
■ Limit unhealthy food/drink
availability
■ High quality PE
■ Increase access to
healthier choices
■ Safe routes to school
■ Farm to school
■ Afterschool settings
■ Community-centered schools
TOBACCO
■ Tobacco-free schools
Physical Activity in After School Settings
■ Effective after school PA programs feature:1-5
• Coordinated approach between schools and community
organizations
• Involvement of youth in each program planning step
• Parent buy-in and involvement
• Safe and accessible places for physical activity participation
■ Afterschool physical activity guidelines and standards:
• NC: www.eatsmartmovemorenc.com/AfterSchoolStandards/
• CA: www.cde.ca.gov/ls/ba/as/documents/paguidelines.pdf
1. Romero AJ (2005). J Adolsc Health 36(3): 253-9. 2. Sallis, et al. (2001). Am J Public Health 91(4): 618-20.
3. Kelder et al. (2005). Pub HealthGomez, et al. (2004) Prev Med 39(5): 876-81. 4. Hellison D (2000). J Sci Med Sport 3(3): 238-242
5. Nutr Apr;8(2):133-40.
Physical Activity in After School Settings
■ Examples of
programs:
• Functional Fitness 4
Kids (www.ff4k.org) in
metro D.C.
• Bicycle Club in Karnes
City, TX
• Maybury Elementary in
Detroit, MI
• Lauderhill Middle
School, FL
MAPPS Strategies for Schools
NUTRITION
PHYSICAL ACTIVITY
■ Limit unhealthy food/drink
availability
■ High quality PE
■ Increase access to
healthier choices
■ Safe routes to school
■ Farm to school
■ Afterschool settings
■ Community-centered schools
TOBACCO
■ Tobacco-free schools
Safe Routes to Schools
Strategy
Education
Encouragement
Enforcement
Engineering
Where
Description
Duluth, GA
• Developed a 5-session bicycle safety program
•Trained 450 children in grades 3-5 in bicycle safety
during PE class time
Winston-Salem, N.C.
• Committee of parents organized monthly walk-to
school events for students
• Succeeded in attracting 200 students
Phoenix, AZ
• School crossing safety audit was developed
• Equipped schools with radar-controlled cameras
mounted to vans to enforce speed limit
Boulder, CO; Arlington, • Speed sensitive signals built near schools: if
VA; Washington D.C
motorist is speeding, traffic light ahead turns RED
Phoenix, AZ
• Installed “SCHOOL” pavement stencils on roads
approaching schools
MAPPS Strategies for Schools
NUTRITION
PHYSICAL ACTIVITY
■ Limit unhealthy food/drink ■ High quality PE
availability
■ Afterschool settings
■ Increase access to
■ Safe routes to school
healthier choices
■ Community-centered schools
■ Farm to school
TOBACCO
■ Tobacco-free schools
Community-Centered Schools
■ Evaluate state-level barriers to building or renovating
neighborhood schools
■ Consider full cost to community for new construction
■ Collaborate with community planners in local government
and school district to reduce sprawl and encourage joint
use (e.g., shared ball fields, libraries)
■ Involve public stakeholders throughout school siting
decision to ensure stakeholder buy-in and build trust
■ Develop or review school siting criteria
Resources for
Community-Centered Schools
■ Helping Johnny Walk to School: Policy
Recommendations for Removing Barriers to
Community-Centered Schools
• www.preservationnation.org
■ Coming Soon! EPA School Siting Guidelines
• December 2010
MAPPS Strategies for Schools
NUTRITION
PHYSICAL ACTIVITY
■ Limit unhealthy food/drink ■ High quality PE
availability
■ Afterschool settings
■ Increase access to
■ Safe routes to school
healthier choices
■ Community-centered schools
■ Farm to school
TOBACCO
■ Tobacco-free schools
A Tobacco-Free School Policy
Prohibits:
■ Tobacco use on school property, in school
vehicles, and at school- sponsored events (on
and off school property) for students, staff, and
visitors
■ Any form of tobacco advertising on school
property (publications, clothing, student or staff
gear, etc.) and at events off campus
Benefits of a Tobacco-Free
School Policy
■ Protects students and staff from exposure to
secondhand smoke
■ Reduces opportunities in which students
witness use of tobacco
■ Reduces students’ opportunities for personal
use of tobacco
■ Sends powerful message that tobacco-use
prevention is a priority
■ Provides consistent tobacco-free message
between education and practice
A Tobacco-Free School Policy
Provides:
• Signs and posting of tobacco
policies on campus and at events
off campus
■ Strong and consistent enforcement
with appropriate penalties for
violations
■ Faculty, staff, student , and
community orientation on tobaccofree policies
Percentage of Middle and High Schools That Prohibited All
Tobacco Use in All Locations* — Selected States and Median
Among 47 States, 2008
* Prohibited the use of all tobacco, including cigarettes, smokeless tobacco, cigars, and pipes; by students, faculty and school staff, and visitors; in school buildings, outside on
school grounds, on school buses or other vehicles used to transport students, and at off-campus, school-sponsored events; during school hours and non-school hours
School Health Profiles, 2008
Key Messages
■ Young people and schools are central to
prevention
■ Health is academic
■ We know what needs to be done: MAPPS
strategies for schools
■ Despite immense challenges, we have many
reasons to be optimistic
Some Reasons for Pessimism
■ Resistance to change
■ Ongoing pressures for accountability based on
standardized test scores
■ Budget crises
■ Aging population
Some Reasons for Optimism
■ Agenda for action and data systems in place
■ Growing evidence of effectiveness
■ Support from parents
■ Federal funding and national leadership
■ Support from other key sectors of society
“So the only way that we can
initiate true health care reform
is if we control costs. And one
of the most important ways for
us to control costs is to deal
with the issue of prevention.
Which means making sure that
we have proper nutrition
programs in our schools,
making sure that we've got
effective physical education
programs for our children.”
Barack Obama
A Survey of >400 Employers
■ # 1 factor that will have the largest
impact on the workplace over the next
five years:
Rising Health Care Costs
■ #1 emerging content area in terms of
its importance for future graduates
entering the U.S. workforce in the next
five years:
Making Appropriate
Choices Concerning Health
and Wellness (76% of
employer respondents
rated it as “most critical”)
Assoc. for Supervision and Curriculum Development
A New Compact to Educate the Whole Child
Each student:
■ Enters school healthy and learns
about and practices a healthy
lifestyle.
■ Learns in an intellectually challenging
environment that is physically and
emotionally safe for students and adults.
■ Is actively engaged in learning and is
connected to the school and broader
community.
■ Has access to personalized learning and to
qualified, caring adults.
■ Is prepared for success in college or further
study and for employment in a global
environment.
Weight Issues
Plague the Military
■ The Department of Defense estimates as many as 1/3 of
military-age youth are ineligible for service because of
their weight.2
■ In 2007, approximately 15,000 military recruits failed the
entrance physical exam because of weight/body fat limits;
this was the most common reason for medical
disqualification among applicants for active duty enlisted
service.3-4
1. Mission Readiness press release , Feb 9, 2010 2.Hsu et al. J Adolesc Health. 2007 3. AMSARA Annual Report 2008.
4. Reading, Willing , and Unable to Serve, 2010.
Obesity:
A National Security Threat
“Obesity rates threaten the overall health of
America and the future strength of our military. We
must act, as we did after World War II, to ensure
that our children can one day defend our country, if
need be.”
-Retired U.S. Army Gens. John M. Shalikashvili and Hugh Shelton
Source: The Washington Post, April 30, 2010
Communities Putting
Prevention to Work…
IN SCHOOLS
Division of Adolescent and School Health
Communities Putting Prevention to Work
Washington, DC Action Institute
June 2, 2010