Transcript Document

A Statewide Strategy to Battle
Child Obesity in Delaware
Health Affairs, 2010
Debbie I. Chang, MPH
Vice President, Policy & Prevention
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Nemours Integrated Child Health System
 Nemours is a non-profit organization dedicated to children's health &
health care
 Nemours operates Alfred I. duPont Hospital for Children and outpatient
facilities in the Delaware Valley and specialty care services in
Northern/Central Florida. Building new state-of-the-art Children’s
Hospital in Orlando area
 Nemours offers a continuum of care as health and prevention services
are coupled with research, education, advocacy, and clinical treatment
 Nemours focuses on child health promotion and disease prevention to
address root causes of health
– First initiative is preventing childhood obesity
– Complements and expands reach of clinicians using broader, communitybased approach
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Promoting Health and Prevention
Traditional Medical Model
Expanded Approach
Rigid adherence to biomedical
view of health
Incorporate a multifaceted
view of health
Chronic disease prevention
and management
Focused primarily on acute
episodic illness
Focus on Individuals
Focus on communities/
populations
Cure as uncompromised goal
Prevention as a primary goal
Focus on disease
Focus on health
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Delaware Children

Nemours developed its child health promotion model in Delaware –
expanding its mission from the 55,100 patients it serves, to serve the state’s
entire population of 207,000 children

Childhood obesity affects every county in Delaware

In 2006, approximately 37% of Delaware children
age 2-17 were overweight or obese

In 2008:
– Overweight and obesity rates ranged from 40% to
46% across Delaware counties and the City of
Wilmington
– Overweight and obesity rates highest among nonwhite children at 49% (compared to 37% of white
children)

Nemours’ goal is to statistically reduce the
prevalence of childhood overweight and obesity in
Delaware by 2015
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Strategy
 A prevention-oriented child health system
builds upon, and extends beyond, traditional
prevention in primary care to look at the population
level
 Strategy makes use of socio-ecological model,
looks beyond the individual to examine a range
of other factors that affect health outcomes at multiple levels
 Spreading policy and practice changes:
– Population health-focused model: Defined program goals around reducing prevalence
of overweight and obesity
– Strategies in multiple sectors: Exposure to consistent healthy choices/environments
for behavior change, all around 5-2-1-Almost None prescription
– Strategic partnerships: Greatest potential impact, authority to make policy and
practice changes, ability to leverage resources
– Knowledge mobilization: Providing evidence-based materials and tools
– Social marketing: Creating and accelerating social policy and behavior changes
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The NHPS Model: Working with Over
200 Community Partners
Changing the health
status and well-being of
the most children
possible through the
deployment of evidence
based policies and
practices. Seeking the
highest sustainable
impact with the most
efficient use of
resources.
Policy and Practice
Change Agenda
that evidence the
usefulness of
to build and
sustain the
Healthy
Children
Community
Infrastructure
Capacity
that support
supports
that leads to
Behavior
Change
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Going to Where the Children Are With
5-2-1-Almost None
 Together We Can Make Delaware’s
Kids the Healthiest in the Nation
– Kids Can’t Do It Alone
– 5-2-1-Almost None
 Integrated into all 4 sectors
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Community
School
Child Care
Primary Care
– Helping accelerate policy
and practice changes
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More than 140,000 Delaware Children
Growing Up Healthy Due to Nemours
 Changes in regulations and policies, supported by
targeted and strategic activities, are making an impact
on the lives of Delaware’s children – reaching more
than 140,000 children
– 90,180 impacted through statewide
school legislation
– 54,000 impacted through child care
regulation changes
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360o of Child Health Promotion
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Progress Results at the Population Level

Results from the 2008 DSCH, compared to the 2006 DSCH, suggest
that the prevalence of overweight and obesity has leveled off for
children ages 2 -17 years in Delaware
– Overweight remained unchanged at 17%

Evidence indicates the prevalence of obesity and overweight has
leveled off in all Delaware counties and within subpopulations

Disparities still remain among racial groups

Nemours’ initiative is on track to achieve its 2015 goal for some
populations
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Progress Results at the Population Level
Differences between years is not statistically significant in any category.
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Progress Results at the Population Level

Household awareness between 2006-2008 of the 5-2-1-Almost None
campaign increased fourfold (5% to 19%)

When parents were aware of the 5-2-1-Almost None message,
significantly more children engaged in:
–
1 hour of physical activity per day
(26% in 2008 versus 10% in 2006)
–
Moderate to vigorous physical activity for more than 20 minutes
(33% in 2008 versus 21% in 2006)
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School Sector Interventions
 Strengthened and implemented wellness policies
– Impact: 90,180 children per year (2006-present)
 Learning Collaborative
– Impact: 90,180 children per year (2007-present)
– Provide assistance with the implementation of
wellness policies (goals, action plans) and HB 471
– Tools, training, technical assistance
 Implemented HB 372: FITNESSGRAM®
– Impact: 30,000 children (2006-present)
– Assessment of fitness measured in grades 4, 7,9
– BMI data optional by school
 Implemented HB 471: 150 minutes of physical education/activity
– Impact: 26,112 children
– Pilot from 2007-2009
 Implementation of CATCH in elementary/middle/charter
– Impact: 43,213 children (2005-present)
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School Sector Results
 District Wellness Policies
– Schools were 4 times as likely to report wellness policy
implementation if district policy included specific
Nemours-recommended content
– Changes include healthy vending, evidence-based
physical activity programs, fitness equipment, and activity
breaks
– Principles and staff identified the following facilitated
implementation:
 Technical assistance
 Networking with other districts/schools
 Support from other school administrators
 Fitness Measurements & Physical Activity Pilots
– Fitness pilot of 150 minutes of physical activity:
 Increased fitness level as measured by FITNESSGRAM® tests, 1.5 times more
likely to achieve Healthy Fit Zone, an indicator of fitness
 Higher levels of fitness for students in structured activity programs such as CATCH
or Take 10!
– Success sparked expansion of physical activity programs to:
 86 schools; 62% of all elementary and middle schools
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Child Care Interventions

Statewide regulatory change
– Impact 54,000 children (2007-present)
– Reduce sedentary behavior, promote health eating/physical
activity
– Child and Adult Care Food Program (CACFP)
– Office of Child Care Licensing (OCCL)
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Learning collaborative
– Impact 2,750 children (2008-2009)
– Translate policy into practice and support implementation
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Training around Healthy Habits for Life (HHFL), CACFP
– Impact 20,000 HHFL children/ 24,000 CACFP children (2007-present)
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Child care technical assistance pilot program
– Impact 775 children (2006-2008)
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University of Delaware’s Institute for Excellence in Early Childhood
– Impact to be determined; up to 54,000 children (2010-future)
– Continue learning collaborative
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Child Care Results
 81% of centers participating in the collaborative made significant changes in
healthy eating and physical activity practices:
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Increased provider knowledge of childhood obesity as a problem
Family style meals, modeling positive behavior
Policies for parent provided food
Consuming whole grains,1% or nonfat milk, water
Consuming only 1 serving of 100% juice per day
Consuming limited sugary/fried foods
More structured physical activity indoors and outdoors
Participating in 20 minutes of vigorous activity, every 3 hours in care
Watching only 0 -1 hour of TV per day
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Primary Care Interventions
 Implementation of Expert Committee Recommendations on
assessment, prevention, and treatment of childhood overweight
– Impact 207,000 children (2007-present)
– Used by primary care providers, DE AAP, Medical Society of Delaware, Delaware
Academy of Family Physicians
 Learning collaborative
– Impact to be determined; up to 33,000 children (2010-future)
– Provide tools, training, technical assistance for the implementation of Expert
Committee Recommendations
 Nemours primary care strategy
– Impact 50,000 children (2008-present)
– Measuring BMI, identification of
childhood overweight,
counseling on healthy lifestyles
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Primary Care Results
 Commitments from medical community to promote the Expert Committee
Recommendations
 Prevention and health promotion built into Nemours Electronic Medical
Record (EMR)
– Nemours’ provider classification of BMI during well child visits doubled,
49% (2007) to 94% (2008)
– Nemours’ providers offer lifestyle counseling to 95% of all patients
(almost double the national reported rate of 54.5%)
 Delaware Primary Care Quality Improvement Initiative
19 multidisciplinary primary care teams achieved high results:
– 98.2% of providers classified BMI or weight-for-length in 2009 (83% in 2007)
– 88.6% of providers provided counseling on healthy lifestyles in 2009 (72.7% in 2007)
– 88.1% of providers developed a care plan and family-management goals with
obese/overweight patients who were ready to change in 2009 (74.2% in 2007)
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Lessons Learned
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Sustaining policy and practice changes
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Create strong partnerships
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Develop strong relationships with influential organizations
Clearly define roles among partners, understand partners’ reasons for involvement
Provide partners with data, tools and training to make recommended changes
Focus on maintaining strategy
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Policy and practice change, together, in multiple sectors is critical
Policy can drive practice and practice can drive policy
Community capacity is critical to sustainability and to promoting, supporting and
implementing change
Clearly defined program goals are critical to success
Focus on a limited set of priority areas and sectors to avoid dilution of effort and impact
Design an evaluation that works
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Acknowledge the strengths and limitations of the evaluation
Outcome measures (BMI) should remain a focal point
Align evaluation efforts with strategy
Achieving outcomes takes time - establish intermediate milestones to help track progress
Focus on demonstrating broad association and linkages where possible
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Conclusion
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Changes are being implemented in systems – schools, child care,
primary care
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Changes in healthy eating, physical activity, and health outcomes are
taking place
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Results provide evidence for the efficacy of a comprehensive preventionoriented model
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Investments have proven valuable
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Established community collaboration and capacity to address child issues
Resources leveraged from multiple sources to affect child health
Public and private partnerships need to be further developed and
replicated
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Debbie I. Chang, MPH
Vice President of Policy and Prevention
Nemours
252 Chapman Road, Christiana Building, Suite 200, Newark, DE 19702
(p) 302.444.9127 (e) [email protected]
www.nemours.org
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