Transcript Let ` s Go! - New York State Public Health Association
Tory Rogers, MD
Barbara Bush Children’s Hospital at Maine Medical Center (207) 662-4982 [email protected]
October 7 th , 2013
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What I want to talk about today?
What is Let’s Go! – The First 5 years 2006 2011
– Birth to the awkward tween years Let’s Go! 2011-2016 – The Teen years
Evaluation Data – What is working
What we could have done better
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Now…… What do you want me to talk about???
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Let’s Go!
Core Principles
Environmental and policy change influences behavior change Interconnectivity across settings is essential Strategies are evidence based and continuously evaluated
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Tools, Resources, and Trainings
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Why Environmental/Policy Change?
Activities Policies www.letsgo.org
Environments
Let’s Go! Key Strategies for Success –
Priority Strategies
1. Provide healthy choices for snacks and celebrations; limit unhealthy choices.
2. Provide water and low fat-milk; limit or eliminate sugary beverages.
3. Provide non-food rewards.
4. Provide opportunities for children to get physical activity every day. 5. Limit screen time.
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Let’s Go! Key Strategies for Success –
Supporting Strategies
6. Participate in local, state and national initiatives that promote HEAL.
7. Engage community partners to help support and promote HEAL at your site.
8. Partner and educate families in adopting and maintaining a lifestyle that supports HEAL. 9. Implement a staff wellness program that includes HEAL.
10. Collaborate with food and nutrition programs to offer healthy food and beverage options.
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StoryWalks
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Marketing Campaign
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It Worked!
Environments are Changing Policies are being Implemented Healthy Behaviors are increasing Obesity appears to be leveling off
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Greater Portland Reach
As of June 2011, Let’s Go! had engaged the following in the 12 Greater Portland communities: • 56 schools educating more than 23,000 students; • 8 district-wide school nutrition programs serving over 20,000 students; • 34 child care programs caring for over 1,400 children; • 28 after school recreation programs serving over 1,800 students; • 29 healthcare sites; and • 7 of Greater Portland’s largest employers.
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60 Let’s Go! Sites (in Greater Portland) Reported Implementing Let’s Go! Strategies in 2010-11 Strategies
Healthy choices for snacks/celebrations Participate in initiatives that promote HEAL Include community organizations Involve and educate families Encourage water and low fat milk Discourage the use of food as a reward Incorporate physical activity into the day Develop 5-2-1-0 staff wellness program Collaborate with nutrition program Implement or strengthen wellness policy
Elementary Schools Child Care Programs After School Programs
Number (%) that Implemented Strategy* 24/29 (83%) 25/29 (86%) 12/28 (43%) 27/29 (93%) 24/29 (83%) 26/29 (90%) 21/28 (75%) 16/29 (55%) 19/21 (90%) 16/28 (57%) 16/16 (100%) 11/16 (69%) 6/16 (38%) 16/16 (100%) 16/16 (100%) 16/16 (100%) 15/16 (94%) 15/15 (100%) 8/15 (53%) 11/15 (73%) 5/15 (33%) 13/15 (87%) 12/15 (80%) 7/15 (47%) 4/16 (25%) Not measured 6/15 (40%) 15/15 (100%) 4/15 (27%) Not measured *Strategy was implemented in year five or sustained from a previous year, in most classrooms or school- or program-wide.
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Let’s Go! School Nutrition Initiative
Let’s Go! led 35 schools in reaching the USDA’s Healthier US School Challenge. • Healthier US School Challenge Criteria A different fruit and vegetable every day • At least three dark green or orange vegetables per week • Offer legumes at least once per week • Offer whole grains three times per week • Offer only low fat or fat free milk • Offer nutrition education • Provide at least 45 minutes of physical education per week Technical assistance, tools, and resources were provided by Let’s Go! during workgroup meetings, phone calls and emails as they improved the nutritional quality of school meals. Only 2% of schools in the nation have achieved this award.
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There are 14 Let’s Go! Practices in Greater Portland
A recognized Let’s Go! Healthcare site must meet basic criteria for the following three components:
1. Connect to their community and the Let’s Go! community efforts
Hang a Let’s Go! poster in waiting room and exam rooms
2. Accurately weigh and measure patients
Determine Body Mass Index (BMI), BMI percentile, and weight classification in patients > 2 yrs.
3. Have a respectful conversation around weight
Use the 5210 Healthy Habits Questionnaire
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Parents’ Awareness Increased Significantly from 2007 to 2011 10% % Who Heard of Campaign and Message 2007 2009 2011 45% 47% 422% Increase 422% 422% Increase 14% 55% 43% 293% Increase 293% 293% Increase Let's Go! Campaign 5-2-1-0 Message
Note: In 2007 n=802; in 2009 n=800; in 2011 n=801
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Exposure to Let’s Go! in Multiple Settings Increased Parents’ Awareness of 5-2-1-0 % Who Heard of 5-2-1-0 Health Message, by Exposure (2011) 85% 64% 34% 153% Increase No Exposure 1 to 2 3 or more Number of Settings Exposed to Let's Go!
Note: In 2011 n=801
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Exposure to Let’s Go! in Multiple Settings Increased Parents’ Knowledge of 5-2-1-0 % Who Provided Correct Numbers for All Four 5-2-1-0 Recommendations, by Exposure (2011) 58% 51% 39% 51% Increase No Exposure 1 to 2 3 or more Number of Settings Exposed to Let's Go!
Note: In 2011 n=801
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Child’s Adherence with “5” and “0” Behaviors Increased Significantly from 2007 to 2011 % Reported Child (<18 yrs.) Adheres to "5" and "0" Recommendations 2007 2009 2011 63% 66% 69% 18% 22% 26% 63% Increase 18% 18% Increase "5" or More Fruits & Vegetables Daily "0" Sugar Sweetened Beverages
Note: In 2007 n=802; in 2009 n=800; in 2011 n=801
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Overweight and Obesity Prevalence for Ages 3-18 in Greater Portland Trended Down, While U.S. Rate Remained the Same
35% 30% 25% 20% 15% 10% 5% 0%
% Overweight and Obese (Age 3-18) 33% 32% 32% 31% Greater Portland U.S. (NHANES) 2006 2009
NOTE: NHANES data reflect 2006 and 2008 rates, and include ages 2-19. Greater Portland: In 2006 n=3,051; in 2009 n=3,132.
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Overweight and Obesity Prevalence Decreased for Females Age 3-5 in Greater Portland % Overweight and Obese Females 3-5 yrs in Greater Portland 31% 25% 63% Increase 18% Increase 2006
Note: In 2006 n=157; in 2009 n=133
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Let’s Go! 2011-2016
Our teen years growing up and out
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Growth of Let's Go! Engaged Sites (2006-2013)
Schools Child Care After School Healthcare School Nutrition 350 300 250 200 150 100 50 0 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013
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Let’s Go! Dissemination Statewide www.letsgo.org
Survey Response Rates
Registered Sites Completed Survey
787
654
324
261 81% Child Care
194
166 86% School
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92 79% After School www.letsgo.org
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135 89% Healthcare 83% Total
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Let’s Go! Reach Across Four Sectors
(Survey Participants) Area of Reach Counties Towns Sites Students/Patients Child Care
16 132 261
7,388 School
15 106 166
53,626 After School Healthcare
15 59 21 86 92
7,016
135
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Implementing Five Priority Strategies
Strategy Implemented*
1. Provide healthy choices for snacks and celebrations; limit unhealthy choices.** 2. Provide water and low fat milk; limit or eliminate sugary beverages.*** 3. Provide non-food rewards. 4. Provide opportunities for children to get physical activity every day. 5. Limit recreational screen time.
Child Care (n =261) School (n =166)
72% 65%
After School (n =92)
83% 68% 95% 72% 82% 75% 55% 80% 72% 92% 80% 95% 96% *Implementation in schools and after school programs is in most or all classrooms; child care is program wide.
**This year, the survey included questions about limiting unhealthy choices for snacks and celebrations, but those responses are not included in the analysis for this strategy; they will be included next year.
***The school and after school surveys did not include a question about milk; it’s a requirement for all schools participating in the national school meals program.
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Implementing Five Supporting Strategies
Strategy Implemented*
6. Participate in local, state, or national initiatives that support healthy eating and active living. 7. Engage community partners to help support healthy eating and active living at your site. 8. Partner with and educate families in adopting and maintaining a lifestyle that supports healthy eating and active living. 9. Implement a staff wellness program that includes healthy eating and active living. 10. Collaborate with Food Nutrition Programs to offer healthy food and beverage options.
Child Care (n =261) School (n =166)
51% 61% 43% 70% 56% 63% 63% 66% 55% 64%
After School (n =92)
61% 55% 54% 32% 65% *Implementation in schools and after school programs is in most or all classrooms; child care is program wide.
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Policies are Changing
(Schools & After School Programs)* Due to their involvement with Let’s Go! in the past year:
56% of schools did more to implement the district wellness policy
and its recommendations around physical activity and healthy eating (
n
=166).
49% of schools reported their district strengthened their wellness policy
to support the 5-2-1-0 messages or strategies (
n
=166).
61% of after school programs either created, implemented or strengthened an existing wellness policy
and its recommendations around physical activity and healthy eating (
n
=92).
*This policy question was not included in the child care survey this year.
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Healthcare Practices Meeting Basic Criteria Meet BASIC Criteria for Three Components 1. Connect to your community & the Let's Go! Community Efforts
Let's Go!
poster is displayed in practice waiting area.
Let's Go!
poster is displayed in all exam rooms.
2. Accurately weigh & measure patients
At well child visits, all providers routinely have BMI determined for patients age two years and older.
3. Have a respectful conversation around weight
At well child visits, all providers routinely counsel on HEAL using the 5-2-1-0 Healthy Habits Questionnaire.
Healthcare (n =135) 2012-2013 Healthcare (n =99) 2011-2012 96% 76% 96% 71%
86% 43% 86% 55%
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Reach of School Nutrition Workgroups
Let's Go! School Nutrition Workgroup
Greater Portland Southern Maine Somerset Lincoln/Knox Oxford/Androscoggin
Total Startup Year Districts Schools Students
2007-2008 2010-2011 2010-2011 2012-2013 2012-2013 12 12 7 6 9
46
76 64 27 32 53
252
31,557 27,307 7,168 7,818 20,303
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Nudging Kids Toward Healthy Choices
Changes made as a result of school nutrition initiative:
Decreased the portion size
of a la carte items.
Increased number of locations that fruit is available.
Moved healthier items
to high traffic areas.
Offered cut up fruit such as apples and oranges.
Put healthy options at eye level
.
Added new entrees or sides.
Offered free samples
of new menu items.
Encouraged staff to
use verbal reminders to encourage fruit and vegetable consumption
.
Required cash for a la carte or less healthy items.
Note: Members of the Let’s Go! Somerset Workgroup completed a smarter lunchroom survey in May 2013 for 25 schools; response rate was 100%. Questions were grouped around six categories of best practices: manage portion size, increase convenience of healthier items, improve visibility, enhance taste expectations, utilize suggestive selling, and set smart pricing strategies.
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Impact of School Nutrition Program Changes
% of Schools Reporting Change (n=25) Purchase of whole grains increased 72% Purchase of produce increased Students are making healthier choices 88% 100% Students liked at least some of the changes 100%
Note: Members of the Let’s Go! Somerset Workgroup completed a smarter lunchroom survey in May 2013 for 25 schools; response rate was 100%.
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Let’s Go! Recognition Program
Sites of Distinction Eligibility for Schools, Child Care and After School Programs:
Implement all 5 priority strategies: BRONZE 1-4 enforced written policies: SILVER All 5 enforced written policies: GOLD Note: Written policies will be reviewed by Let’s Go! staff.
Eligibility for Healthcare Practices:
Display a Let’s Go! poster in the waiting room and all exam rooms where pediatric patients are seen.
All providers determine BMI for patients age two years and older.
All providers use the 5-2-1-0 Healthy Habits Questionnaire at well child visits.
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Let’s Go! Sites of Distinction
787
Registered Sites Recognized Sites
324
92 28% Child Care
194
57 29% School
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61 52% After School www.letsgo.org
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77 51% Healthcare 287 36% Total
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Let’s Go! Is Changing Environments
About 7 in 10
child care
sites are providing healthy choices for snacks and celebrations and opportunities for recommended levels of physical activity.
Nearly all
child care
sites rarely or never use food to encourage positive behavior.
The vast majority of
child care
sites are limiting screen time.
More than two thirds of
schools
limiting unhealthy choices.
are providing healthy choices for snacks and celebrations and are More than 7 in 10
schools
have implemented strategies around physical activity, water and sugar sweetened beverages, and screen time.
In the past two years, purchase of whole grains and produce has increased in over 100 schools that have been part of the Let’s Go!
school nutrition
program. About three-quarters of
school nutrition
programs are certified in the new federal meal pattern. The vast majority of
after school
programs have implemented all five priority strategies.
Nearly all
healthcare
practices display the Let’s Go! poster in their waiting areas and routinely determine BMI for their pediatric patients.
Over three quarters of
healthcare
children are seen.
practices display the Let’s Go! poster in all exam rooms where In 7 in 10
healthcare
practices, all providers routinely use the 5-2-1-0 Healthy Habits survey.
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Our Work is Not Done
More trainings are needed around wellness policies.
– Schools located within the same school district in as many as 23 of 55 districts reported different policy information.
Increase the reach of School Nutrition Workgroups.
– – Establish workgroups across all regions of the state.
Continue trainings for Dissemination Partners to facilitate workgroups in their regions.
More trainings are needed in the healthcare sector.
– Especially with larger practices (>5 clinicians).
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Key Learnings…….
Consistency in message
and approach is critical
Working across a community
wherever kids live, learn, work and play is essential
It’s the environment
, not the activities that matter most
Partnerships and Collaboration
are paramount
Innovation and risk taking
have been key to our success
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Some of our challenges (mistakes)
Not fully understanding and acknowledging the current efforts on the ground Moving too fast and getting ahead of people Trying to please everybody Making things too complicated Not publishing sooner
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Local and State Partners
Let’s Go! Dissemination Partners, including participating Healthy Maine Partnerships and health care systems Participating Schools, Child Care Programs, Healthcare Practices, After School Programs, Employers and Communities Maine Center for Disease Control and Prevention Maine Department of Education Maine Bureau of Parks and Lands Maine Department of Health and Human Services, including Maine Head Star University of Maine Cooperative Extension Maine Dairy and Nutrition Council Community based programs working to increase physical activity and healthy eating in Maine,) for ex. WinterKids Maine After School Network
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National Partners
National Initiative for Children’s Healthcare Quality (NICHQ) Let’s Move American Academy of Pediatrics (AAP) American Medical Association (AMA) National Convergence Partnership Innovators and Risk Takers all over the country And You!
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Let’s Go! Is Generously Funded by Our:
Founding Partners Platinum Sponsors Gold Sponsors Silver Sponsors
Walmart Jane’s Trust The Bingham Program, Convergence Partnership, The Mattina R. Proctor Foundation, Sam L. Cohen Foundation
Bronze Sponsors Additional Funders
Francis Hollis Brain Foundation, Poland Spring, Rite Aid Foundation, Visiting Board of BBCH, Estate of Mary R. Hodes American Academy of Pediatrics/Healthy Active Living, Fairchild Semiconductor, Leonard C. & Mildred F. Ferguson Foundation, Maine Department of Health & Human Services/ARRA, The Rite Aid Foundation
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Comments Thoughts Questions
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